Gene, 1990 Jan 31, 86(1), 99 - 102 Improved plasmid shuttle vectors for Haemophilus influenzae and Escherichia coli; Trieu VN et al.; In vitro deletion and transposon mutagenesis experiments were performed to localize the region essential for plasmid RSF0885 replication to a 1.7-kb sequence downstream from the beta-lactamase gene . This locus was named rep, for replication . Plasmid RSF0885 can replicate in both Haemophilus influenzae and Escherichia coli . Replication in E . coli depended on transcription run-off from the beta-lactamase promoter into the rep locus . Insufficient transcription into the rep locus could account for the instability of this plasmid in an E . coli background, a property which reduced its usefulness as a shuttle vector . Therefore, four improved shuttle vectors for H . influenzae and E . coli were constructed . They possess the Co1E1 replication origin for maintenance in E . coli and the plasmid RSF0885 rep locus for maintenance in H . influenzae . Together, they provide twelve unique restriction sites for cloning by insertional inactivation of drug-resistance genes. Lancet, 1990 Jan 27, 335(8683), 214 - 6 Outbreak of multiresistant non-encapsulated Haemophilus influenzae infections in a pulmonary rehabilitation centre; Sturm AW et al.; 15 out of 21 patients admitted to a pulmonary rehabilitation centre were infected with a non-encapsulated strain of Haemophilus influenzae . All isolates showed identical outer membrane protein patterns, harboured a 40 MD plasmid, produced beta-lactamase, and were resistant to amoxycillin, co-trimoxazole, chloramphenicol, and tetracycline . The strain was first isolated from sputum of another 3 patients in the same hospital ward . 2 of them later introduced it into the rehabilitation centre . The strain spread among the other patients over the next 2 months . The absence of a common iatrogenic source of the organism and its slow spread indicate that the most likely means of transmission was person to person. Ugeskr Laeger . 1990 Jan 15;152(3):168. {Prosthetic valve endocarditis caused by Haemophilus parainfluenzae}; Christensen I et al.; A case of endocarditis preceded by dental treatment without prophylactic antibiotics and caused by Haemophilus parainfluenzae in a patient with a biological heart valve prosthesis is described . This bacteria grows slowly in the usual blood culture media and, because of this, the etiological diagnosis was not established until after incubation for 11 days . Blood cultures from patients suspected of having endocarditis should be incubated for longer than the usual five to seven days . Close cooperation between the clinical microbiologist and clinicians is necessary so that important findings are not overlooked . Dental treatment of patients with heart valve prostheses should always take place under antibiotic prophylaxis. J Am Vet Med Assoc, 1990 Jan 15, 196(2), 301 - 6 Seroprevalence of Actinobacillus (Haemophilus) pleuropneumoniae serotype-1 infection in swine herds in Quebec; Vaillancourt JP et al.; Seroprevalence of Actinobacillus (Haemophilus) pleuropneumoniae serotype-1 infection was evaluated in pigs on 7 farms in Quebec . Commercial cross-bred herds A to G, ranging from 110 to 235 sows and infected with A pleuropneumoniae serotype-1 were selected . Five pigs/litter were selected at random and were identified (group 1) . Blood samples were obtained from group-1 pigs at 2 to 4, 14, 28, 42, and 56 days of age . Blood also was obtained from group-1 pigs remaining in the postweaning unit at 70 days of age, and from 20 to 40 sows 1 to 3 times . To determine prevalence of seropositive pigs in all age groups for the entire study period in herds C to G, blood samples were obtained from 20 pigs/age group (group 2) selected at random at 28, 42, and 56 days of age at each visit . Group-1 pigs were included when they reached 28, 42, and 56 days of age . Pigs were serologically monitored in herds A and B for 3 months and in herds C to G for 5 to 6 months . Serologic status of pigs at 2 to 4 days of age was not statistically associated with status at 42 days (P = 0.6293) and at 56 days (P = 0.3098) of age for the same pigs . Therefore, seronegative pigs 2 to 4 days old did not seroconvert earlier than did those with detectable maternal antibodies at 2 to 4 days old . Only about 50% of the 70-day-old pigs were seropositive at 56 days . Seemingly, pigs seroconverted late in the postweaning period.(ABSTRACT TRUNCATED AT 250 WORDS) Ugeskr Laeger . 1990 Jan 8;152(2):110. {Familial infection caused by Haemophilus influenzae}; Jensen A et al.; A three-year-old girl developed purulent arthritis and her nine-month-old younger brother meningitis with Haemophilus influenzae type b, after an interval of 43 days . Attention should be drawn to the spread of Haemophilus disease other than meningitis. Clin Pharm, 1990 Jan, 9(1), 15 - 34 Therapy of otitis media; Lisby-Sutch SM et al.; The epidemiology, pathogenesis, diagnosis, complications and sequelae, and therapy of otitis media are reviewed . Otitis media is one of the most common infections in infants and children . Epidemiologic studies have identified season of the year, bottle versus breast feeding, socioeconomic status, race, sex, and daycare attendance as factors associated with the occurrence of otitis media . The condition is believed to arise secondary to eustachian tube dysfunction in the presence of viral or bacterial invasion of the nasopharynx . Diagnosis is often made by direct observation of the tympanic membrane with an otoscope . If untreated, the infection can spread to other structures in the aural cavity or even to the brain and meninges . The most frequent complication of otitis media is hearing loss, which may result in speech and learning difficulties . Oral antimicrobial agents--notably ampicillin, amoxicillin, amoxicillin-clavulanate, cefaclor, cefuroxime axetil, bacampicillin, cyclacillin, erythromycin ethylsuccinate-sulfisoxazole, cefixime, and trimethoprim-sulfamethoxazole--are the mainstay of treatment . Selection of the agent should be based primarily on its spectrum of activity against Streptococcus pneumoniae and Haemophilus influenzae . Other considerations include the presence of beta-lactamase-producing strains of H . influenzae and Branhamella catarrhalis, adverse effects, cost, and compliance . In cases of recurrent otitis media, antimicrobial prophylaxis or surgery may be indicated . Chronic otitis media with effusion may be treated with oral antimicrobials, but surgery may also be necessary . Chronic suppurative otitis media often requires hospitalization and intravenous antimicrobial therapy with agents effective against Pseudomonas aeruginosa . Oral antimicrobial agents represent the treatment of choice for otitis media, but such therapy addresses only one of the several etiologic factors identified. DICP, 1990 Jan, 24(1), 45 - 51 Oral cephalosporins in perspective; Smith GH; Oral cephalosporins, after 25 years of use, continue to present the clinician with a therapeutic challenge . The older agents have been extensively prescribed for ambulatory adult and pediatric patients with a wide variety of infections caused by gram-positive and some gram-negative organisms . The newer agents, cefaclor, cefuroxime axetil, and cefixime, have increased in vitro activity against beta-lactamase-secreting strains of Haemophilus influenzae and Branhamella catarrhalis which has made them more popular for the treatment of otitis media and respiratory tract infections in children . The new agents are also more active against most gram-negative organisms . However, clinical trials have failed to show a clear-cut superiority over older, proven therapy when used to treat infections of the respiratory tract, middle ear, skin and soft tissue, urinary tract, and bone and joints when caused by sensitive organisms . Published reports of clinical trials continue to support the recommendation that oral cephalosporins, especially the newer and more expensive agents, be reserved for second- or third-line therapy when amoxicillin, penicillin V, or trimethoprim/sulfamethoxazole have either failed or produced patient intolerance . Erythromycin/sulfisoxazole and amoxicillin/clavulanate potassium are equally efficacious and also less expensive than cefaclor, cefuroxime axetil, and cefixime and could be considered second-line therapy prior to the use of the newer cephalosporins for infections in the ambulatory patient. Bull World Health Organ, 1990, 68(2), 179 - 84 Antimicrobial susceptibility patterns of Haemophilus isolates from children in eleven developing nations . BOSTID Haemophilus Susceptibility Study Group; Weinberg GA et al.; The antimicrobial susceptibilities of 426 isolates of Haemophilus species, which were collected as part of a worldwide study of the etiology of acute respiratory disease in children in selected developing countries, were determined . Eleven antibiotics were tested using the recently described Haemophilus Test Medium . There was a low prevalence of antibiotic resistance; 6% of strains were resistant to ampicillin, and 1.6% were resistant to chloramphenicol . Strains resistant to both ampicillin and chloramphenicol were recovered only from Thailand . Susceptibility to penicillin G was also determined; the minimum inhibitory concentrations for penicillin and ampicillin were concordant within one 2-fold dilution in 97% of the isolates . Thus, Haemophilus isolates were as susceptible to penicillin G as they were to ampicillin, and penicillin resistance was infrequent overall . These data provide support for the current protocols for the management of acute respiratory infections in children in developing countries, in which penicillin G is a first-line agent. Aust Vet J, 1990 Jan, 67(1), 9 - 12 The comparative pathogenicity of four serovars of Actinobacillus (Haemophilus) pleuropneumoniae; Rogers RJ et al.; The pathogenicity of 2 isolates of each of serovars 7, 3, 1 and 2 of Actinobacillus pleuropneumoniae was tested by intranasal inoculation into 60, 6-week-old large white pigs . Four dose rates varying from 0.27 to 560 x 10(6) organisms per pig with 10-fold serial dilutions were used . Surviving pigs were necropsied 7 days after inoculation . The proportion of pigs dying and developing gross lesions following infection was significantly greater for pigs given serotype 1 than for each of the other 3 serotypes, which did not differ significantly from each other . Twelve of 16 pigs given either of the 2 isolates of serovar 1 died after acute illness and 1 of 44 pigs given either of the 2 isolates each of serovars 7, 3 and 2 died . Pigs given serovar 1 showed high temperatures, severe respiratory distress, frothy haemorrhagic nasal discharge and weight loss . Lung lesions were produced in all 16 pigs given serovar 1, in 7 of 14 pigs given serovar 7, 7 of 14 pigs receiving serovar 3 and in 5 of 16 pigs given serovar 2 . The lethal infections were characterised by a severe acute fibrinohaemorrhagic necrotising pleuropneumonia, whereas non-lethal cases had lung lesions ranging from necrotising purulent pleuropneumonia to abscessation . Significant differences between isolates in proportions of tissues culture positive for A . pleuropneumoniae for serovars 7 and 2, but not for serovars 3 and 1 suggested that isolates may vary in virulence within serovars, but more detailed studies are needed to clarify this point. Zh Mikrobiol Epidemiol Immunobiol, 1990 Jan, (1), 45 - 9 {The characteristics of suppurative meningitis morbidity caused by Streptococcus pneumoniae and Haemophilus influenza type B}; Deviatkina NP et al.; Of the 1,018 patients with purulent bacterial meningitis, hospitalized at the 2nd Clinical Infectious Hospital in Moscow during the period of 1980-1987, the diagnosis was confirmed in 54.7%; of these, meningitis of pneumococcal etiology was established in 44.8% and meningitis caused by H . influenzae, type b, in 23.8% of the patients . In meningitis of pneumococcal etiology high risk groups included mainly adults, especially those over 50 years, and children under 3 years of age . In meningitis of H . influenzae etiology high risk groups included mainly young children under 2 years of age . Meningitis of pneumococcal etiology was characterized by considerable death rate (on the average, 20%), while in meningitis of H . influenzae etiology death rate was 3 times lower . Pneumococci of serotypes 1, 3, 6, and 19 were found to be of the highest etiological importance for adults and pneumococci of serotypes 19, 6, 12, and 1, for children . In recent years greater etiological role of serotype 42 in adults was noted . The study of the spread of meningitides of different etiology is a high-priority task for this country. Zentralbl Allg Pathol, 1990, 136(1-2), 3 - 13 {The pathologic anatomy of important forms of bacterial pneumonia}; Zinserling AV; Postmortem examinations were conducted on 7,952 cases with acute inflammatory processes of respiratory organs, among them 452 adults, between 1949 and 1988 . Bacteria had been responsible for 87.5%, of these pneumonia cases, including Klebsiella for 15.3%, Pseudomonas for 13.5%, staphylococci for 9.9%, pneumococci for 4%, streptococci for 3.9% and Haemophilus for 0.7% . Other bacterial species of lower pathogenicity were recorded from 24.4% of all individuals who had died with pneumonia and mixed bacterial flora from another 29.3% . Pneumococcal and streptococcal forms of pneumonia were predominant in untreated patients . Staphylococci and gram-negative bacteria were primarily recorded from inflammatory foci, following penicillin treatment . Macroscopic and microscopic peculiarities are discussed in greater detail, together with aspects relating to the pathogenesis of forms of pneumonia caused by different pathogens. Scand J Infect Dis, 1990, 22(1), 105 - 8 Interleukin-1 production in bacterial meningitis; Helminen M et al.; Interleukin-1 (IL-1) is the key initiator of host responses to infection . We describe here the lipopolysaccharide-(LPS) (20 micrograms/ml) stimulated IL-1 production of peripheral blood monocytes in 2 children with Haemophilus influenzae meningitis . We found a depressed IL-1 production at the acute stage of the infection when the meningitis was most active with return to normal coinciding with clinical recovery . These results show an inverse correlation with acute phase reactants and IL-1 production . Normalization of IL-1 production seems to be a good prognostic sign in bacterial meningitis. Eur Arch Otorhinolaryngol, 1990, 247(2), 122 - 4 Adherence of Haemophilus influenzae to nasal, nasopharyngeal and buccal epithelial cells from patients with otitis media; Harada T et al.; Since mucosal colonization may be an important determinant in the pathogenesis of otitis media with effusion (OME), we studied the adherence of Haemophilus influenzae (HI) to human nasal, nasopharyngeal, and buccal mucosal cells obtained from patients with OME . Non-typeable HI adhered in significantly greater numbers than type b HI . HI bacteria adhered to both nasal and nasopharyngeal mucosal cells in significantly greater numbers than to buccal ones . Non-typeable HI adhered to the epithelial cells from children with chronic sinusitis in more significant numbers than did those from children without chronic sinusitis . These results indicate that non-typeable HI adhere more readily to epithelial cells and that the nasal and nasopharyngeal mucosa may be an important route for HI infection in OME. Br Vet J, 1990 Jan-Feb, 146(1), 57 - 67 Experimental Haemophilus somnus infection in pregnant cattle; Stuart FA et al.; Of five pregnant cows inoculated intravenously with 5 X 10(8) viable 'Haemophilus somnus', one aborted within 5 days and excreted 'H . somnus' from the vagina for a further 7 weeks . A second cow proceeded to full term parturition but both it and its apparently healthy calf persistently excreted 'H . somnus' . The other animals underwent normal full term calvings and 'H . somnus' was not isolated from them or their calves . Lesions attributable to 'H . somnus' were detected only in the aborted fetus which showed an acute generalized inflammatory cell response consistent with a systemic Gram-negative bacterial infection . 'H . somnus' was isolated from all fetal tissues, including the placenta . The fetus and placenta also showed evidence of damage prior to inoculation . The placental damage may have predisposed the fetus and placenta to infection with 'H . somnus' . The placental epithelial cells contained intracytoplasmic organisms with the morphological and antigenic properties of 'H . somnus'. Anaesthesist, 1990 Jan, 39(1), 53 - 9 {Bacterial pneumonia in ventilated patients . The role of bronchoalveolar lavage in diagnosis and therapy}; Konrad F et al.; In the diagnosis and treatment of bacterial pneumonia, the isolation and resistance pattern of the causative organisms are very relevant . Bronchoalveolar lavage (BAL) with quantitative culture is the best technique to obtain material for bacteriological investigations in nonintubated medical patients and in a baboon model . The present study was designed to clarify the following questions: What is the value of BAL compared to tracheal secretion (TS) in ventilated patients with regard to antibiotic therapy? Is it possible to distinguish colonization and infection by investigation of BAL? MATERIAL AND METHODS . In 34 ventilated patients, we studied the diagnostic and therapeutic value of BAL in comparison to TS . Thirteen patients suffered from pneumonia, 9 patients were colonized, and in 12 pneumonia was uncertain . These terms are defined as follows: 1 . Pneumonia: temperature over 38.5 degrees C, leukocyte count over 12,000/mm3, infiltrate in the x-ray compatible with pneumonia, purulent tracheal secretion, positive bacteriological findings . All criteria must be fulfilled . 2 . Colonized patients: mechanical ventilation more than 7 days, no signs of infection, isolation of the same bacteria species in two previously obtained tracheal secretions . 3 . Uncertain pneumonia: not all criteria mentioned above were fulfilled . BAL was performed in the usual manner . The bronchoscope was wedged into a distal airway and 6 x 20 ml of sterile, nonbacteriostatic saline (0.9% NaCl) was instilled through the suction channel and subsequently aspirated . All investigation materials were immediately processed in the bacteriological laboratory . From the BAL specimen Giemsa and Gram preparations were performed to look for contamination from the throat and intracellular bacteria . RESULTS . Patients with pneumonia: In all patients the TS and BAL were positive . Cultures from BAL and TS were in agreement in 77% of the cases . In 10 patients intracellular bacteria (BAL) were present, in two patients the Gram preparation was nonapplicable because of destroyed cells . In one patient Haemophilus spp . could be isolated in the BAL (10(5)/ml BAL), but not in TS, which definitely influenced therapy . Colonized patients: In all patients TS and BAL were positive, with exact agreement in 33% of the cases . The concentration of isolated bacteria (BAL) was not as high in these patients as in the patients with pneumonia (median: 8 X 10(3) vs 6 X 10(4} . However BAL allowed no differentiation between colonization and infection in individual cases . Uncertain pneumonia: TS was positive in 8 patients, no TS could be obtained in 4 . BAL was sterile in 4 . Only in 2 bacteria greater than or equal to 10(4)/ml were isolated and both patients had intracellular bacteria . The results (BAL) influenced therapy in 5 cases (4 patients received no antibiotics; in 1 patient the antibiotics were modified) . CONCLUSION . BAL is very helpful in patients suspected of having pneumonia and in sepsis of unknown origin when pneumonia should be excluded... Eur J Clin Microbiol Infect Dis, 1990 Jan, 9(1), 24 - 9 Spread of non-typable multiply resistant Haemophilus influenzae in a South African hospital; Heney C et al.; In July 1987 non-typable Haemophilus influenzae strains resistant to both ampicillin and chloramphenicol were isolated from the endotracheal aspirate of two children with pneumonia at Baragwanath Hospital, Johannesburg, South Africa . A study was therefore undertaken to determine the carriage rates of Haemophilus influenzae strains in the nasopharynx of children and staff in the index ward and in three control wards . Using a disc diffusion and an agar dilution method the susceptibility was determined of 100 isolates to ampicillin, chloramphenicol, erythromycin, rifampicin, amoxicillin/clavulanic acid, gentamicin, cefaclor, cefotaxime, tetracycline, sulphamethoxazole, trimethoprim and trimethoprim/sulphamethoxazole (1:19) . The overall carriage rate of Haemophilus influenzae on admission was 76% . In the index ward, children carrying multiply resistant strains differed from the other children in that there was a longer mean duration of hospitalization, a lower proportion of males, and a higher proportion who had previously received antibiotics . All ampicillin resistant strains were shown to produce beta-lactamase . Only four isolates belonged to serotype b, of which three were ampicillin resistant and chloramphenicol sensitive while one was resistant to both drugs . Nasopharyngeal spread of resistant non-typable strains of Haemophilus influenzae was demonstrated to affect the management of paediatric patients in the hospital. APMIS, 1990 Jan, 98(1), 50 - 2 Carriage and antibiotic susceptibility of Haemophilus influenzae type b and non b in Danish day-care attendees; Kristensen K; A study of carriage of Haemophilus influenzae type b (Hib) and non b in Danish day-care facilities, employing a highly selective medium supplemented with three antibiotics and direct detection of the type b capsular antigen by latex-agglutination and coagglutination, was carried out . Of 329 children, 217 (66%) were found to be carriers of Haemophilus influenzae . Among 64 children from day-care centers in which a case of invasive Hib infection had occurred, four carriers of type b were found, whereas no type b carriers were identified among 265 children from unexposed day-care centers (p less than 0.003) . Of 217 isolated strains, seven (3.2%) were found to have lowered susceptibility to ampicillin, two (0.9%) to chloramphenicol, two (0.9%) to cefuroxim, and one (0.5%) to cefotaxim. Ann Emerg Med, 1990 Jan, 19(1), 55 - 8 Epiglottitis: comparison of signs and symptoms in children less than 2 years old and older; Losek JD et al.; A 20-year retrospective review of 236 children with epiglottitis was performed to determine the frequency of occurrence of 21 presenting signs and symptoms . To determine the association of age with clinical presentation and diagnosis of epiglottitis, the signs and symptoms of children less than 2 years old were compared with those of children 2 years of age and older . Fifty-eight children (25%) were less than 2 years old . Sore throat was the only factor significantly different in the two age groups (P less than .01), occurring more commonly in the older children . There were 128 children (54%) with blood cultures positive for Haemophilus influenzae . Analyses of patients with positive blood cultures gave similar results . The signs and symptoms that clinically support epiglottitis in children less than 2 years old are similar in older children. Pediatr Res, 1990 Jan, 27(1), 16 - 21 Clinical and immunologic characteristics of healthy children with subnormal serum concentrations of IgG2; Shackelford PG et al.; To understand the relevance of subnormal serum concentrations of IgG2, we measured IgG2 in serum of 575 healthy children and identified 11 with concentrations greater than 2 SD less than the mean for age . The levels of IgG2 present were similar to those found in symptomatic children with IgG2 subclass deficiency associated with antibody deficiency . The 11 children ranged in age from 1 to 14 y (mean = 5.7) . Detailed clinical information was available on 10 of the 11 children and each was matched for age with two controls . The median number of visits/y to the doctor for infectious illnesses was identical for the two groups (1.0) . Nine of the children with subnormal IgG2 were followed for 1 to 5 y (mean = 2.3) . All nine children had normal serum concentrations of IgA, IgG1, IgG3, and IgG4 but seven had persistently subnormal or low-normal serum IgG2 concentrations . One of these seven children also had a subnormal serum concentration of IgG, and one had subnormal IgM . Antibody responses to Haemophilus b polysaccharide vaccine were normal in five of six who were immunized . In vitro secretion of Ig by mitogen-stimulated peripheral blood mononuclear cells was measured in six of seven children with persistently subnormal or low-normal IgG2; five showed decreased secretion of IgG2, and two of the five also had subnormal secretion of IgG1 and IgG3 . An important implication of this study is that the subnormal concentrations of serum IgG2 found in infection-prone children are not a sufficient explanation for their increased susceptibility to infection.(ABSTRACT TRUNCATED AT 250 WORDS) J Infect Dis, 1990 Jan, 161(1), 130 - 3 Brazilian purpuric fever: evolutionary genetic relationships of the case clone of Haemophilus influenzae biogroup aegyptius to encapsulated strains of Haemophilus influenzae; Musser JM et al.; As a first step toward identifying the evolutionary origin of a pathogenic clone of Haemophilus influenzae biogroup aegyptius causing Brazilian purpuric fever, chromosomal variation and genetic relationships were indexed among 17 isolates of biogroup aegyptius and 2209 previously characterized encapsulated H . influenzae strains recovered from 30 countries on six continents . Biogroup aegyptius isolates form three distinct evolutionary lineages of the species H . influenzae and isolates of the case clone are genetically not closely related to other isolates classified as biogroup aegyptius . The Brazilian purpuric fever case clone was found to be genetically allied with H . influenzae isolates producing serotype c polysaccharide capsule . The population genetic evidence suggests that biogroup aegyptius isolates may represent cell lineages occasionally transmitted from nonhuman hosts or spawned from a much larger base population consisting of genetically diverse nonpathogenic precursor clones. J Clin Invest, 1990 Jan, 85(1), 208 - 18 Role of complement in mouse macrophage binding of Haemophilus influenzae type b; Noel GJ et al.; Previous in vivo studies demonstrated that clearance of encapsulated Haemophilus influenzae from blood is associated with the deposition of C3 on these bacteria and is independent of the later complement components (C5-C9) . Since clearance of encapsulated bacteria is determined by phagocytosis of bacteria by fixed tissue macrophages, we studied the interaction of H . influenzae type b with macrophages in vitro . Organisms bound to macrophages in the presence of nonimmune serum . Binding was not evident in heat-treated serum or in serum from complement depleted animals and was inhibited by F(ab')2 fragments of antibody to C3 and by blockade of the macrophage complement receptor type 3 . The majority of organisms bound in the presence of complement alone remained extracellular . Antibody in the form of convalescent serum or an IgG1 monoclonal to type b capsule did not increase the total number of organisms associated with macrophages, but did increase the number of organisms ingested . Furthermore, complement enhanced antibody-mediated ingestion . This in vitro study demonstrates that complement largely mediates binding of H . influenzae to macrophages . This binding may be critical in determining the early clearance of these bacteria from blood and may be an important mechanism of defense in the nonimmune, as well as the immune host. Infect Immun, 1990 Jan, 58(1), 237 - 44 Characterization of a 78-kilodalton outer membrane protein of Haemophilus somnus; Kania SA et al.; A 78-kilodalton (kDa) outer membrane protein (OMP) of Haemophilus somnus was one of the two antigens most consistently and most intensely immunoreactive in Western immunoblots of whole cells of H . somnus reacted with convalescent-phase serum obtained from cattle with experimental H . somnus pneumonia . This antigen was isolated by gel filtration chromatography of sodium dodecyl sulfate-solubilized OMP . Reactions of Western blots with bovine monospecific antiserum prepared against the 78-kDa antigen indicated that this 78-kDa OMP was present in each of 22 isolates of H . somnus obtained from cattle with pneumonia, thromboembolic meningoencephalitis, and abortion as well as from vaginal or preputial carriers . The 78-kDa OMP was also present in each isolate obtained weekly throughout the course of experimental H . somnus pneumonia in a calf . Monospecific antiserum to the 78-kDa OMP also reacted with proteins from closely related bacterial species in the family Pasteurellaceae but not with bacteria of 13 other genera . The 78-kDa OMP of H . somnus is of interest because it is surface accessible, highly conserved, immunogenic, cross-reactive with other members of the family Pasteurellaceae, and reactive with convalescent-phase serum which is passively protective against H . somnus pneumonia. Chemotherapy, 1990, 36(6), 441 - 7 Ceftriaxone monotherapy for bacterial meningitis in children; Grubbauer HM et al.; A total of 33 patients with bacterial meningitis were treated with single daily doses of ceftriaxone (CTR 100 mg/kg/day i.v.) for a median duration of 13 days . Pathogens isolated by culture and/or determined by latex agglutination were 15 Haemophilus influenzae b, 7 Neisseria meningitidis, 2 Streptococcus pneumoniae, 1 group B streptococcus, 2 Streptococcus viridans and 2 Staphylococcus epidermidis . In 4 cases a diagnosis of purulent meningitis could only be made by means of the inflammatory liquor parameters . All cerebrospinal fluid (CSF) drug levels even at the end of the dosing interval were at least 10-fold higher than the MICs of the respective bacterial isolates . The average penetration of CTR into the CSF was 6.6% . Within 12-46 h after the first dose, control spinal taps were performed . Cultures were sterile in all cases . Side effects encountered were diarrhea, exanthema, neutropenia and transient elevation of glutamic oxaloacetic transaminase, but none caused a change of therapy . One patient developed a biliary concrement . No patient died; 5 patients had prolonged fever (greater than 5 days), and 2 were left with persistent hearing deficiencies . CTR can be recommended as a safe and effective antibiotic agent for once daily treatment of bacterial meningitis in children. Scand J Infect Dis, 1990, 22(6), 691 - 7 Effect of amoxycillin/clavulanic acid on the aerobic and anaerobic tonsillar microflora in the treatment of recurrent tonsillitis; Agren K et al.; 30 patients with recurrent tonsillitis were treated with amoxycillin/clavulanic acid (500 mg/125 mg) t.i.d . for 10 days . The most often isolated potential aerobic pathogenic bacteria were Staphylococcus aureus, Streptococcus milleri and Haemophilus parainfluenzae . Group A streptococci were isolated from 7 patients . Anaerobic cocci and Bacteroides species were the dominating anaerobic bacteria isolated from the tonsils . Tonsillar cultures were taken before antibiotic treatment started, on days 11-12, day 30, and day 90 . Beta-lactamase producing aerobic and anaerobic bacteria were present in 13 patients prior to treatment, on days 11-12 in 18 patients, on day 30 in 15 patients, and on day 90 in 13 patients . Group A streptococci were eradicated in 6/7 patients . In the aerobic tonsillar microflora, the numbers of viridans streptococci decreased during treatment but were normalized after 30 days . Only minor changes in the numbers of other aerobic microorganisms occurred during the investigation . The effect on the anaerobic microflora was minor and no new colonizing microorganisms were isolated during or after antibiotic treatment . All patients except one were cured on days 11-12 . Five patients had another episode of tonsillitis during the observation period of 3 months . The antibiotic treatment was well tolerated in most patients and mild adverse events such as nausea, vomiting and diarrhoea were observed in 3 patients. J Int Med Res, 1990, 18 Suppl 4, 78D - 84D Sultamicillin (sulbactam/ampicillin) versus amoxycillin in the treatment of acute otitis media in children; Rodriguez WJ et al.; A comparative study of sultamicillin (an orally active dimer of sulbactam and ampicillin) and amoxycillin for the treatment of acute otitis media was carried out in 86 children with acute otitis media . After 10 days' treatment, of those with traditional middle ear pathogens, 35/36 (97%) 50 mg/kg.day or 500 mg/day sultamicillin-treated children were cured with eight relapses after a further 18 days without treatment compared with 12/13 (92%) 40 mg/kg.day or 250 mg/day amoxycillin-treated children and three subsequent relapses . All six beta-lactamase-producing pathogens were in the sultamicillin treatment group: four were Haemophilus influenzae/H . parainfluenzae that were resistant to amoxycillin, and all were cured although two then relapsed . No significant clinical or laboratory side-effects were noted in either amoxycillin- or sultamicillin-treated patients . It is concluded that sultamicillin was comparable to amoxycillin in the treatment of acute otitis media. Int Immunol, 1990, 2(4), 317 - 22 Effect of Gm allotypes on IgG2 antibody responses and IgG2 concentrations in children and adults; Sarvas H et al.; Earlier studies have suggested that in adults the n-positive allele of the human IgG2 gene is more productive than the n-negative allele . This superiority was seen to be manifested in IgG2 antibody responses to polysaccharides, in the higher serum concentration of total IgG2 in the n/n than in -/- individuals, and in the higher concentration of n-positive than n-negative IgG2 in heterozygotes . The present study shows that in 1- or 2-year-old children, the concentration of IgG2 was independent of allotype G2m(n), and both alleles of a heterozygote contributed an average of one-half of the total IgG2 . On the other hand, the superiority of the n-positive allele was also seen in young children in IgG2 antibody responses induced by the Haemophilus influenzae type b polysaccharide (Hib) . The effect of allotype n on antibody responses was evident only when the immunogen was the Hib polysaccharide . When the immunogen was a conjugate of Hib and diphtheria toxoid, the IgG2 antibody responses of n-positive and n-negative vaccinated individuals were almost equal, both in adults and in children. Scand J Infect Dis, 1990, 22(5), 563 - 8 Increase of acute frontal sinusitis in southwestern Finland; Suonpaa J et al.; The number of patients hospitalized for acute infection in the frontal sinuses at the Department of Oto-Rhino-Laryngology of Turku University Hospital has increased markedly during the last decade . Causes for this increase were evaluated by comparing the backgrounds and medical findings of the 134 patients treated in the years 1977-81 and those of the 421 patients treated in the years 1982-86 . Nasal polyps and history of allergic rhinitis were considerably more common in the latter patient group . The disease also seems to recur increasingly in the same patients . Of the aerobic bacteria Streptococcus pneumoniae and Haemophilus influenzae were the most common pathogens and the share of H . influenzae increased slightly, becoming the commonest pathogen in the latter 5-year period . Increasing air pollution in the city area of Turku is worth consideration and should be investigated further. Scand J Infect Dis, 1990, 22(5), 537 - 45 Rapid aetiological diagnosis of pneumonia based on routine laboratory features; Holmberg H et al.; The values of some basic laboratory features on admission to hospital were recorded and compared in 418 adult patients with community-acquired pneumonia, namely erythrocyte sedimentation rate, C-reactive protein, white blood cell (WBC) count, serum lactate dehydrogenase (S-LD), serum alanine-aminotransferase, and serum sodium . Discriminant analysis was performed to obtain an aetiological diagnosis . WBC value of greater than 15 x 10(9)/l strongly indicated a bacterial and, especially a pneumococcal aetiology, whereas increased S-LD could imply a mycoplasmal infection . For patients less than 50 years of age the equation C2 = -1.788 + 0.204 x WBC-0.0909 X S-LD was constructed, in which C2 greater than 0 indicated a pneumococcal aetiology . This function correctly classified 31/33 (93.9%) patients with a mycoplasmal and 20/31 (64.5%) patients with a pneumococcal infection . Patients with viral, Haemophilus influenzae or chlamydial infection could not be discriminated from each other . The age of the patient, WBC and possibly S-LD on admission are easily accessible parameters and these results could therefore be of value in daily clinical practice in hospitals. Rev Cubana Med Trop, 1990 Jan-Apr, 42(1), 37 - 45 {Microbiologic aspects of bacteremia in patients hospitalized in the intensive care unit}; Perez Monras MP et al.; The microbiologic aspects of the bacteriemia were prospectively studied in patients hospitalized in a pediatric Intensive Care Unit . Thirty six episodes of bacteriemia were detected in 29 patients . Secondary bacteriemia prevailed on the primary ones . The most frequent infectious foci associated with bacteriemia were the infections of respiratory tract, followed by intravascular catheterism . The microorganisms more frequently associated with bacteriemia were: Haemophilus influenzae, Staphylococcus epidermidis, Eacherichia coli and Pseudomonas seruginosa. Arch Exp Veterinarmed, 1990, 44(4), 549 - 55 {Haemophilus somnus--properties and isolation}; Molenda J; An account is given in this paper of characteristic parameters of Haemophilus somnus, the aetiological factor of various cattle diseases . Morphological properties of the pathogen are described together with techniques for isolation and identification . Also discussed are its physiological, biochemical, and antigenic properties as well as its present position in taxonomy and the structure of the outer membrane. Am J Pediatr Hematol Oncol, 1990 Fall, 12(3), 306 - 9 Splenectomy in compound heterozygous hemoglobinopathies in Saudi Arabia; Sumer T et al.; Hemoglobinopathies are a major public health problem in Saudi Arabia . We studied the effect of splenectomy in 16 Saudi Arabian children with compound hemoglobinopathies . Seven patients no longer require regular blood transfusions, and transfusion requirements were decreased by 30 to 60% in the other eight patients . Three patients whose heights and weights were below the 5th percentile before splenectomy reached the 25th percentile 1 year after the surgery . In spite of preoperative pneumococcal vaccination and the penicillin prophylaxis after the surgery, one patient died of Haemophilus influenzae Group B bacteremia, and three others had six episodes of pneumonia. Nord Med, 1990, 105(10), 257 - 9 {Bacterial meningitis in Iceland}; Jonsdottir KE et al.; The article reports on the number of patients in Iceland who in the last 30 years have been diagnosed as having bacterial meningitis, and on changes in the choice of medication during this period . The vaccination of Icelandic children against Haemophilus Influenzae B began in 1989. Nephron, 1990, 56(1), 35 - 9 Serum immunoglobulin levels and natural antibodies to Haemophilus influenzae in hemodialysis patients: evidence for IgG subclass imbalances; Borradori L et al.; Humoral immune parameters were studied in 13 patients with end-stage renal failure on maintenance hemodialysis . Serum IgA, IgM and IgG concentrations were comparable to control values from 14 healthy blood donors . IgG subclass analysis revealed significantly increased IgG1 levels in the patients when compared to controls (p less than 0.01) . In 3 patients, IgG2 deficiency was found, in one case associated with low IgG3 level . Concentrations and subclass composition of naturally occurring antibodies to Haemophilus influenzae type b (Hib) polysaccharide (PS) were measured using an indirect ELISA . In patients IgM and IgG, including IgG1 and IgG2 antibodies to Hib, presented no difference from controls . Subclass analysis of Hib specific IgG antibodies revealed that IgG2 accounted for a substantial amount of the anti-Hib PS antibody response in controls as well as in patients . We conclude that patients on maintenance hemodialysis present imbalances of immunoglobulin levels . However, the antibody response to certain PS antigens could remain unaffected by renal failure. Scand J Infect Dis Suppl, 1990, 68, 56 - 63 Overview of experience with ofloxacin in respiratory tract infection; Ball P; Ofloxacin is highly active against common respiratory pathogens including Haemophilus influenzae and Branhamella catarrhalis and has clinically applicable activity against Streptococcus pneumoniae, Staphylococcus aureus and Pseudomonas aeruginosa . Sputum, lung tissue and bronchial mucosal concentrations of ofloxacin equal or, in most cases significantly exceed the MICs of such pathogens . These in vitro attributes are reflected in the results of the worldwide ofloxacin clinical trial program which achieved overall response rates of 98% in lower respiratory tract infections, 83% in pneumonias and 87% to 95%, in open and comparative studies respectively, in patients with acute exacerbations of chronic bronchitis (CB) . Overall bacterial eradication rates ranged from 70% for pneumococci and 84.5% for B . catarrhalis to 88.5% for H . influenzae . In lower respiratory infection ofloxacin gave equal or superior clinical results to amoxycillin or erythromycin therapy together with an overall bacterial eradication rate of 100% . Clinical results comparable with standard agents were also obtained in pneumonia, cure rates ranging from 77-89% at various dosages . Eradication rates proved greatest for H . influenzae (92%) and were satisfactory for Klebsiella spp . (80%), although less so for pneumococci (73%) . Bacteriological eradication rates in acute exacerbations of chronic bronchitis ranged from 68% for pneumococcal infections, to 85% in B . catarrhalis and 94% in H . influenzae infections . Ofloxacin compared favourably with pivampicillin, co-trimoxazole and doxycycline clinically . A daily oral ofloxacin dose of 400 mg produced a good clinical response in 92% of patients or more . The available clinical data therefore substantially confirm the claim of ofloxacin to offer an effective alternative in many forms of acute bacterial respiratory infection, especially where H . influenzae and B . catarrhalis are involved. Scand J Infect Dis, 1990, 22(4), 437 - 44 Haemophilus isolated from unusual anatomical sites; Christensen JJ et al.; During a 15-year period Haemophilus species were isolated from unusual anatomical sites in 80 patients, mostly adults . The origin of specimens was pus and swabs from suppurative lesions, fluids from serosal cavities and gall bladder, gut content, and blood in cases with a supposed tissue focus . In 17 patients Haemophilus species were isolated in pure culture, in 63 patients in conjunction with other bacteria . 17 patients had gynaecological complaints: bartholinitis, salpingitis, and vaginal discharge . 22 patients had gastrointestinal complaints, comprising 17 with appendicitis, peritonitis following perforation of gastric ulcer, gall-duct infections, and an abscess in the stomach wall, and 5 patients with colonization of the gut . 41 patients had soft tissue and bone infections. Scand J Infect Dis, 1990, 22(4), 431 - 5 Reappearance of group A streptococci in acute otitis media; Jensen IP et al.; Specimens from acute otitis media (AOM) examined in the first quarter of the years 1986, 1987, 1988, and 1989 were reviewed in order to point out any changes in the bacteriological etiology . A total of 1,722 specimens were taken in the community and in the hospitals of a county of 500,000 inhabitants in the 4-year-period: 447 (1986), 420 (1987), 388 (1988), 467 (1988) . The majority of the specimens came from children less than 10 years of age . The specimen sampling technique differed between the various otologists, but their sampling techniques were constant through the years . Haemophilus influenzae was the most frequent isolate and held a constant incidence of 29.9% with little variation . In 1986-88 Streptococcus pneumoniae was the second (19.8%) and group A streptococci (GAS) the third (9.8%) most common agent in frequency . In 1989 a change in the etiologic agents was seen as GAS increased in frequency to 18.8% (p less than 0.001), while no significant changes occurred in the frequency of H . influenzae and S . pneumoniae . 33% of the specimens were negative in the whole period . It is too early to decide whether a transient epidemic has occurred or whether the findings announce a more constant change in etiology. Biomed Pharmacother, 1990, 44(3), 153 - 8 Neutrophil dysfunctions in sickle cell disease; Humbert JR et al.; The abnormal susceptibility towards certain infections in SCD patients has a partial explanation in the well described functional defects of the spleen and of the alternative complement pathway; such defects probably account for the etiology of fulminant, often fatal, childhood infections with encapsulated organisms (Streptococcus pneumoniae, Haemophilus influenzae) . On the other hand, the frequent systemic infections with enteric organisms in SCD patients, particularly of the salmonella species, and also with Staphylococcus aureus, are more difficult to explain . We therefore reviewed the potential contribution of neutrophil (PMN) dysfunctions to the increased infective tendency of SCD patients and included some previously unpublished data from our laboratory . While notable discrepancies still exist--and need further clarification--a tentative working hypothesis can be extracted from the available data: dysfunctions of neutrophils affect their locomotion (as reflected by decreased chemotaxis and in vivo migration), their phagocytic processes and their bactericidal performance . The latter concerns the ineffective killing of Staphylococcus aureus, Candida albicans, and Streptococcus pneumoniae . Dysfunctional bactericidal activity, in turn, apparently relates to a poor or at times non-existent PMN oxidative activity, which prevents the prompt disposal of microorganisms . Under certain circumstances salmonella species seem to further paralyze the oxidative machinery of PMNs in SCD . Serum from some patients contains a poorly defined inhibitor, or lacks an enhancing factor, and such serum abnormalities aggravate the existing defects just described . Interestingly recent findings suggest that dysfunctional PMNs may originate from the mandatory demargination of leukocytes secondary to the functional asplenia of SCD; a predominance of non-rosetting (EA-) PMNs among such leukocytes could produce the operational explanation for an exaggerated representation of dysfunctional PMNs in SCD patients with leukocytis. J Antimicrob Chemother, 1990 Jan, 25(1), 83 - 90 Model simulation of a single oral dose of cefuroxime axetil and the related in-vitro kill kinetics against four bacterial species; Silley P et al.; An in-vitro model was shown to be capable of simulating a cefuroxime serum profile equivalent to that observed in human volunteer studies, following a single dose of 250 mg cefuroxime axetil . The model was used to carry out kill kinetic studies and showed cefuroxime to lyse the four bacterial test strains, time of onset of lysis being related to the sensitivity of the respective organisms . The more sensitive Staphylococcus aureus and Haemophilus influenzae strains were subject to a higher absolute kill and showed no regrowth over the duration of the simulated serum profile . In contrast, Proteus mirabilis and Escherichia coli showed regrowth after 4 and 5 h respectively . The kill kinetic profiles of the respective organisms are discussed in relation to the pharmacokinetic analysis of the cefuroxime serum profile. Scand J Infect Dis, 1990, 22(3), 307 - 12 Bacterial involvement in parainfluenza virus infection in children; Korppi M et al.; 37 children with serologically confirmed parainfluenza virus (PV) infection were studied by new serological methods for evidence of concomitant bacterial infection . 24 of the children were hospitalized because of croup and 13 because of lower respiratory tract infection . Serological evidence of bacterial involvement was found in 4 (11%) of the 37 children, in none of the 24 children with croup but in 31% of the 13 children with PV infection of the lower airways (p less than 0.05) . Streptococcus pneumoniae was implicated in 3 cases and Haemophilus influenzae in 1 . Serological evidence of staphylococcal involvement was not seen in any case . The 3 patients with pneumococcal involvement had pneumococcal antigen in the acute serum . In all of them pneumonia was associated with PV type 1 or 3, and in 2 serum C-reactive protein was elevated . The data presented support the view, that secondary bacterial infection is rare in children with croup, but common in lower respiratory tract infection caused by PV. Zh Nevropatol Psikhiatr Im S S Korsakova, 1990, 90(2), 94 - 8 {Lesions of the nervous system in Haemophilus influenzae infection in adults}; Kononenko VV et al.; The authors depict 13 cases of CNS injuries in the form of meningities, meningoencephalitis and encephalitis in adults, provoked by Haemophilus influenzae . Provide the clinical, laboratory and instrumental data obtained during examination of the patients in the acute disease stage and during follow-up studies lasting up to 5 years . Rare strains of Haemophilus influenzae, serotypes "c" and "d", were detected in the CSF . Concomitant virus infection was confirmed in seven patients . It is desirable that chloramphenicol, erythromycin or ampicillin be used in such cases . Patients who suffered influenzal meningitis should undergo follow-up studies. Pathol Biol (Paris), 1990 Jan, 38(1), 19 - 21 {First results of bacteriologic study of strains of Haemophilus influenzae isolated from meningitis in the Abidjan University Hospital Center (Ivory Coast)}; Edoh V et al.; Biovars and serovars of 132 Haemophilus influenzae isolated from cerebro-spinal fluid (CSF) in Treichville hospital during a period of October 1986 to July 1988 were studied . Usual distribution was not found: biovar IV was first met (49.2%) followed by biovars I (28.8%), III (14.4%), II (6.1%) and V (1.5%) . Strains belong to serovar b in 88% of cases. J Antimicrob Chemother, 1990 Jan, 25 Suppl A, 83 - 9 Relationship of high tissue concentrations of azithromycin to bactericidal activity and efficacy in vivo; Retsema JA et al.; Measurement of killing kinetics of azithromycin against strains of Streptococcus pneumoniae and Klebsiella pneumoniae in vitro showed that it had a limited bactericidal activity (greater than 90% kill) for the first eight hours of incubation, but developed complete bactericidal activity (greater than 99.9% kill) by 24 h incubation . Since high and sustained tissue levels of azithromycin occur in animals and humans, it was proposed that it might produce a bactericidal effect in vivo . This was demonstrated in a lung infection model in mice, designed to mimic the in-vitro killing studies . A 25 mg/kg dose of azithromycin given 24 h before intranasal challenge reduced the recoverable Str . pneumoniae population by greater than 99.9%, in comparison with untreated controls . Erythromycin did not produce a bactericidal effect at 100 mg/kg, and roxithromycin only reduced the viable count by 96%, at a dose of 50 mg/kg . Against a K . pneumoniae lung infection, a 50 mg/kg dose of azithromycin reduced the bacterial count by 99% . The bactericidal effect was correlated with lung tissue concentrations of azithromycin . In a proliferating Escherichia coli paper disc infection model, extravascular fluid concentrations of azithromycin were correlated with a 99.9% reduction in bacterial count, while corresponding serum concentrations were always less than the MIC . Dosing with azithromycin eradicated Haemophilus influenzae from the bulla (middle ear) of gerbils, as was not the case with erythromycin and roxithromycin . This effect was correlated with the antibiotic concentration in bulla lavage. J Antimicrob Chemother, 1990 Jan, 25 Suppl A, 25 - 8 Bacteriostatic and bactericidal activity of azithromycin against Haemophilus influenzae; Goldstein FW et al.; Macrolide antibiotics, commonly used in upper and lower respiratory tract infections, are inconsistently active against Haemophilus influenzae . The new azalide, azithromycin, was compared with erythromycin and roxithromycin against this pathogen . Azithromycin (MIC range 0.06-1 mg/l) was four to eight times more potent than erythromycin (MIC range 0.5-8 mg/l) and roxithromycin (MIC range 0.5-16 mg/l) . At 1 mg/l, 100% of the strains of H . influenzae were inhibited by azithromycin compared with 16% with erythromycin and 5% with roxithromycin . Azithromycin exhibited a rapid bactericidal effect, with a 99.9% kill at 4 h . The MBC was equal to or up to four-times greater than the MIC. J Antimicrob Chemother, 1990 Jan, 25 Suppl A, 19 - 24 Comparative in-vitro activity of azithromycin and erythromycin against Gram-positive cocci, Haemophilus influenzae and anaerobes; Maskell JP et al.; The in-vitro activities of azithromycin and erythromycin were compared against 689 clinical isolates, including Gram-positive cocci, Haemophilus influenzae, and anaerobes . Of the 100 methicillin-susceptible isolates of Staphylococcus aureus tested, 77% were susceptible to 1 mg/l azithromycin and 0.5 mg/l erythromycin, whereas 22% were resistant to 32 mg/l of both compounds . All methicillin-resistant S . aureus isolates were highly resistant to both macrolides (MIC greater than 64 mg/l) . Coagulase-negative staphylococci showed a wide range of susceptibilities to both compounds; MIC50 values for azithromycin and erythromycin for all isolates were 0.5 and 0.25 mg/l, respectively . With the exception of enterococci, both macrolides showed similar activity against streptococci; MIC90 values for both group A and group B streptococci were 0.03 and 0.06 mg/l for erythromycin and azithromycin, respectively . Azithromycin was less active than erythromycin against enterococci, with mode MICs of 4.0 and 1.0 mg/l, respectively; about 20% of isolates were highly resistant to both compounds . Azithromycin was substantially more active than erythromycin against H . influenzae; 41% of isolates were inhibited by 0.5 mg/l azithromycin and all isolates were inhibited by 2 mg/l . The MIC90 for erythromycin was 8 mg/l; 36% of isolates required concentrations of greater than or equal to 4 mg/l for inhibition . The anaerobic bacteria tested showed similar susceptibility to both azithromycin and erythromycin. J Antimicrob Chemother, 1990 Jan, 25 Suppl A, 1 - 5 In-vitro activity of azithromycin, erythromycin, ciprofloxacin and norfloxacin against Neisseria gonorrhoeae, Haemophilus ducreyi, and Chlamydia trachomatis; Slaney L et al.; The minimum inhibitory concentrations (MICs) of azithromycin, erythromycin, ciprofloxacin and norfloxacin for 300 strains of Neisseria gonorrhoeae, 100 strains of Haemophilus ducreyi and six strains of Chlamydia trachomatis were determined . The two quinolones were more active against gonococcal strains than were the two macrolides . Azithromycin was approximately eight-fold more active against N . gonorrhoeae than was erythromycin (MIC90: 0.25 mg/l azithromycin, 2.0 mg/l erythromycin) . The Mtr phenotype of gonococci increased azithromycin MICs approximately four fold . Azithromycin was less active than erythromycin against C . trachomatis . Azithromycin had considerable activity against H . ducreyi and was ten-fold more active than was erythromycin (MIC90: 0.004 mg/l azithromycin, 0.03 mg/l erythromycin) . Clinical trials of azithromycin in the treatment of chlamydial infection and genital ulcer disease are indicated. J Clin Microbiol, 1990 Jan, 28(1), 108 - 11 Use of the RapID-ANA system and sodium polyanetholesulfonate disk susceptibility testing in identifying Haemophilus ducreyi; Shawar R et al.; Haemophilus ducreyi has traditionally been difficult to identify . We have utilized simple test methods to identify 19 fresh isolates obtained during a recent outbreak of chancroid in Houston and six strains of H . ducreyi from other outbreaks . Tests were performed from growth on chocolate agar after 48 h of incubation at 35 degrees C with increased humidity and CO2 . All isolates exhibited typical colonial morphology and Gram stain . Isolates were catalase negative and oxidase and nitrate positive (in enriched broth) . The RapID NH system failed to identify these strains because of negative reactions with alkaline phosphatase and nitrate reductase . However, by using the RapID-ANA system, all strains were positive for alkaline phosphatase and arginine, glycine, and serine aminopeptidases . Their biochemical profiles were distinct from those obtained with 66 strains representing 13 species similar to H . ducreyi . We also investigated the use of sodium polyanetholesulfonate (SPS) disk susceptibility to identify and differentiate H . ducreyi from other species . All H . ducreyi isolates were susceptible, as evidenced by the presence of a zone of inhibition with an average size of 15 mm around the SPS disk . With the exceptions of Neisseria gonorrhoeae, Gardnerella vaginalis, and Capnocytophaga spp., no other strain showed any evidence of inhibition . The latter three organisms can be easily differentiated from H . ducreyi by various features including reactions in the RapID-ANA . We conclude that, by considering simple growth and biochemical characteristics, SPS susceptibilities, and reactions in RapID-ANA, it is possible for more clinical laboratories to definitively identify this organism. Public Health Rev, 1990-91, 18(4), 307 - 17 Epidemiology of Haemophilus influenzae type b meningitis in Israel, 1981-90; Slater PE et al.; BACKGROUND AND METHODS . In the Western world, Haemophilus influenzae type b is an important cause of morbidity and long-term disability in children . The availability of vaccines capable of preventing H . influenzae type b disease in very young infants stimulated this longitudinal observational review of the epidemiology of H . influenzae type b meningitis in Israel, based on cases reported to the Ministry of Health in the decade 1981-90 . RESULTS . In the last decade, H . influenzae type b accounted for 884 cases of meningitis, making it the main cause of bacterial meningitis in children . Almost all cases were in children under the age of 5 years, the great majority under 18 months . Age-standardized incidence rates were the same in Jews and in non-Jews, and in both sectors incidence was slightly higher in males than in females . The case fatality rate was 3.3% . CONCLUSIONS . The new Haemophilus b conjugate vaccines are reported to be safe, effective at an early age, and compatible with current vaccination schedules . Their availability means that control of invasive disease caused by this organism is within reach . Use of the vaccines in infants should be encouraged and their effect on morbidity patterns should be closely monitored. Avian Dis, 1990 Jan-Mar, 34(1), 52 - 7 Characterization and use of monoclonal antibodies to identify Haemophilus paragallinarum serovars; Yamaguchi T et al.; Two serovar-specific monoclonal antibodies (MAbs) to Haemophilus paragallinarum serovars A/1 and C/2 strains, respectively, were developed and characterized by hemagglutination-inhibition (HI) and dot-blotting tests using representative H . paragallinarum serovars A/1, B, and C/2 strains . In both the HI and dot-blotting tests, one MAb (E5C12D10), raised against strain 221, serovar A/1, reacted only with serovar A/1 strains, while the other MAb (F2E6), raised against strain S1 of serovar C/2, reacted with only serovar C/2 strains examined . In both tests, the two MAbs did not react with two serovar B strains . These results indicated that the two MAbs recognize serovar-specific hemagglutinating (HA) antigens of H . paragallinarum serovars A/1 and C/2 strains, respectively, and that a dot-blotting test using these MAbs is a practical alternative to the HI test for serotyping H . paragallinarum . Strains 0222 and Spross of serovar B, which did not react with these two MAbs, were found to possess serovar-specific HA antigen in cross-HI tests. Pediatr Neurosurg, 1990-91, 16(1), 17 - 20; discussion 20 Posttraumatic meningitis in adolescents and children; Wilson NW et al.; To define the clinical features of posttraumatic meningitis in the pediatric age group, we have reviewed 7 cases presenting to Children's Hospital-San Diego between 1981 and February 1988 . Ages ranged from 3 to 16 years with 4 of the 7 patients being adolescents (greater than 13 years of age) . These 4 adolescents accounted for 25% of the adolescent bacterial meningitis and all cases of nonmeningococcal meningitis in this age group . Six of 7 patients had positive cerebrospinal fluid (CSF) cultures and positive blood cultures . Organisms were Streptococcus pneumoniae (4), group A streptococcus (1), and Haemophilus influenzae (1) . Five of the 7 patients required intensive cardiovascular and respiratory support . Four patients had a good neurologic recovery, 2 patients had neurologic sequelae, and 1 suffered sensorineural hearing loss . These data suggest that direct invasion of the CSF by bacteria may cause sepsis and cardiovascular compromise . Further, in adolescents with nonmeningococcal bacterial meningitis, a history of previous head trauma and CSF leakage should be sought and radiographic evaluation for CSF fistula should be considered. Pol Arch Weter, 1990, 30(3-4), 141 - 54 The influence of Haemophilus somnus on bull sperms examined in vitro; Chelmonska A; The purpose of the paper is to determine the ability of direct influence of Haemophilus somnus on the bull sperms in vitro . The experiment was carried out on fresh semen of bulls of low-land black-and-white breed . During 3-hour exposure to H . somnus, the loss of progressive movement and increase in the number of dead sperms were observed . The adjacency of Haemophilus somnus to head, midpiece and flagellum was found out . H . somnus adjoins the sperms heads most frequently. Scand J Infect Dis Suppl, 1990, 73, 17 - 21 Therapeutic intervention of clinical sepsis with intravenous immunoglobulin, white blood cells and antibiotics; Fischer GW et al.; Antibiotics are the mainstay of therapy for acute bacterial infections . However, recent studies have suggested that adjunctive therapy designed to augment host immunity, might reduce morbidity and mortality . Many bacterial pathogens such as Haemophilus influenzae, Streptococcus pneumoniae and Group B streptococcus are encapsulated and require opsonic antibody to promote efficient phagocytosis and killing by neutrophils . Children with bacterial sepsis may be deficient in both of these components of immunity . This is a particularly serious problem in premature babies who may not receive protective amounts of antibodies from their mothers, since most antibody crosses the placenta in the last 4-6 weeks of pregnancy . Septic infants may also deplete their neutrophil reserves and develop neutropenia during infection . Since efficient clearance of encapsulated bacteria require both neutrophils and antibody, these babies are at high risk for treatment failure even with appropriate antibiotic therapy . Several studies have analyzed the role of neutrophil transfusions and immunoglobulin therapy in septic infants . However, relatively few patients have been prospectively evaluated in controlled studies . In addition, the logistical problems related to rapidly collecting neutrophils for therapy of bacterial sepsis are considerable and have decreased the usefulness of this approach . The availability of intravenous immunoglobulin (IVIG) has made the use of immunoglobulin feasible even in rapidly progressing bacterial sepsis . Animal studies have demonstrated the potential usefulness of IVIG and studies in septic babies strongly suggest that IVIG as an adjunct to antibiotics might improve mortality in septic neonates . Further research is needed to improve the logistics of obtaining neutrophils and to improve the availability of pathogen-specific immunoglobulin preparations. Scand J Infect Dis Suppl, 1990, 66, 1 - 103 Childhood acute bacterial meningitis in the Sudan: an epidemiological, clinical and laboratory study; Salih MA; The aims of the present study were to document the epidemiology, clinical features and complications of childhood acute bacterial meningitis (ABM) in The Sudan during both an inter-epidemic (endemic) period (1985-1986), and the 1988 serogroup A epidemic; and to examine the phenotypic and genetic similarities and differences of Neisseria meningitidis strains isolated in The Sudan and Sweden . A new enzyme immunoassay test (Pharmacia Meningitis EIA-Test) was evaluated as a potential rapid diagnostic method for the detection of Haemophilus influenzae (HI) type b, Neisseria meningitidis (MC) and Streptococcus pneumoniae (PNC) . The test was found to have good sensitivity (0.86) and specificity (0.95) in the inter-epidemic period; and to be adaptable to the field work in The Sudan during the 1988 MC epidemic . During inter-epidemic (endemic) situations in The Sudan, greater than 90% of childhood ABM was caused by one of the three organisms, HI type b, MC and PNC . HI accounted for 57% of the cases . The peak incidence (76%) of HI cases was in infants (less than 12 months) similar to the situation in other African countries . The overall case fatality ratio was 18.6% . Prospective follow-up of survivors for 3-4 years revealed that an additional 43% either died or had permanent neurological complications, the most prevalent and persistent of which was sensorineural hearing loss recorded in 22% of long term survivors . Post-meningitic children were found to have significantly lower intelligence quotients (92.3 +/- 13.9) than their sibling controls (100.7 +/- 10.2, P = 0.029) . Features of the large serogroup A sulphonamide resistant MC epidemic (February-August 1988) in Khartoum are described . An estimated annual incidence of 1,679/100,000 was recorded at the peak of the epidemic . The highest attack rate was in young children less than 5 years, as in many other African countries; nevertheless, a high morbidity was observed in adults (31% of the cases greater than or equal to 20 years) . The clinical features, mortality (6.3%) and short term sequelae in Sudanese children were generally within the framework described for MC disease elsewhere . Detailed analysis of MC isolates from Sudan and Sweden by characterizing their electrophoretic enzyme types, DNA restriction endonuclease pattern and outer membrane proteins, revealed that serogroup A MC clone III-1 was responsible of The Sudan epidemic in 1988 and has been the dominant serogroup A organism in Sweden since 1973 . The Sudanese strains isolated prior to the epidemic (1985) were clone IV-1.(ABSTRACT TRUNCATED AT 250 WORDS) Scand J Infect Dis, 1990, 22(3), 333 - 7 Quantification of nasopharyngeal bacteria for diagnosis of respiratory tract infection in children; Soderstrom M et al.; Agreement between clinical signs of bacterial respiratory tract infections and quantities of respiratory tract pathogens in nasopharynx was studied in 77 children, aged 6-13 years . Specimens were obtained from 27 clinically bacterial and 51 clinically non-bacterial respiratory tract infections, and in 124 instances from healthy children . Viable counts of Streptococcus pneumoniae, Haemophilus influenzae, Branhamella catarrhalis, and beta-haemolytic streptococci were made from swab specimens suspended in saline before being plated on agar media . The frequency of these species in children with clinically bacterial, non-bacterial and no signs of respiratory tract infections were 85%, 47% and 26%, respectively . Bacterial counts greater than 10(4) colony-forming units (CFU)/ml of the pathogens occurred in 59% of clinically bacterial infections, as compared with 18% in clinically non-bacterial infections (p less than 0.001), the corresponding figures for counts greater than 10(3) CFU/ml being 85% and 41% (p less than 0.01), respectively . At neither level of bacterial count (i.e . greater than 10(4) or greater than 10(3}, was there a significant difference between the healthy and those with a clinically non-bacterial infection . The quantification of bacteria in nasopharyngeal samples may thus be of clinical diagnostic value. Jpn J Antibiot, 1990 Jan, 43(1), 147 - 80 {Susceptibility of bacteria isolated from patients with lower respiratory tract infections to antibiotics (1987)}; Ikemoto H et al.; Since 1981, in cooperation with research institutions across the nation, Ikemoto, et al . have been collecting clinical isolates from patients with respiratory tract infections and conducting an annual retrospective survey of patients' background factors and of isolated strains and their sensitivities to various antibacterial agents and antibiotics . In the period from October, 1987 to September, 1988, 17 institutions participated in the survey and a total of 706 strains which were demonstrated to be causative organisms were isolated from 562 patients with respiratory tract infections . Strains were mostly isolated from the sputum . The taxonomic breakdown of these strains was: Staphylococcus aureus (69 strains), Streptococcus pneumoniae (120), Haemophilus influenzae (170), Mucoid-producing Pseudomonas aeruginosa (42), Non-mucoid-producing P . aeruginosa (87), Escherichia coli (11), Klebsiella pneumoniae (35), Brahamella catarrharis (72), etc . Of these strains, 629 were used to determine MICs of various antibacterial agents and antibiotics for susceptibility analyses . Relationships between patient backgrounds and diagnoses and between infections diseases and causative organisms were also investigated . Most of the major causative organisms, such as H . influenzae and P . aeruginosa, showed no substantial changes from previous years, with regard to their sensitivities to antibiotic agent, but S . aureus, particularly methicillin/cephem-resistant strains of S . aureus (MCRSA) showed somewhat lower sensitivity to beta-lactams, and as in recent years, to ofloxacin, a new quinolone drug, as well . Regarding background factors of patients, the age distribution was heavily concentrated in age brackets of 50 years and older, thus patients in these age group accounted for 75.2% of all the patients, which was comparable to 73.5% in 1985 and 77.9% in 1986 . Among infections encountered, bacterial pneumonia was most frequent at 28.3%, followed by chronic bronchitis (27.2%) and bronchiectasis (16.0%) . Bacterial pneumonia was actually the most frequent, throughout the entire age groups accounting for 34.3% of patients up to 29 years, 26.6% in the group of 30-69 years and 30.7% in patients aged 70 years and older . Chronic bronchitis was next most frequent and accounted for 20.0%, 26.4% and 30.7% among the three age groups, respectively . Breaking down clinical isolates by diagnosis, H . influenzae, S . pneumoniae and P . aeruginosa were isolated frequently from most of the infectious diseases.(ABSTRACT TRUNCATED AT 400 WORDS) Infection, 1990 Jan-Feb, 18(1), 61 - 4 The role of bacterial adhesion in cystic fibrosis including the staphylococcal aspect; Ramphal R; The bacteriology of cystic fibrosis shows a unique and predictable progression of colonizing micro-organisms . The reason for this sequence is still not known, but thought must be given to the idea that it may be related to the genetic disorder in some way . If this were to be true, an understanding of the colonization mechanisms at all stages in this progression could provide valuable insights for the development of novel therapies . As far as can be ascertained from published studies, mucus is the site of colonization in cystic fibrosis . While there is no doubt that the major pathogen, Pseudomonas aeruginosa, adheres to injured cells more avidly than to intact cells, the overwhelming evidence indicates that it also attaches more avidly to mucus than to intact airway cells by means of specific adhesin-receptor mechanisms . Studies with Staphylococcus aureus, the other major pathogen, are also in progress . These indicate that this organism also has an affinity for mucus . At this time the studies suggest a lesser affinity than P . aeruginosa, at least with adult mucins . These two organisms do not however appear to share the same receptor . In addition to these two major pathogens, Haemophilus influenzae and Streptococcus pneumoniae, pathogens of lesser importance also adhere to mucus . Therefore adhesion to mucus or mucins may be a recurring theme in all airway colonization . A knowledge of the factors which control these tropisms ought to provide insights into the bacterial specificity seen in cystic fibrosis and other diseases. Acta Otolaryngol, 1990 Jan-Feb, 109(1-2), 111 - 8 Antibodies against Streptococcus pneumoniae, Haemophilus influenzae and Branhamella catarrhalis in middle ear effusion during early phase of acute otitis media; Karjalainen H et al.; Serum type (IgG, IgM and IgA-class) and secretory type antibodies specific to Streptococcus pneumoniae (Pn), Haemophilus influenzae (Hi) and Branhamella catarrhalis (Br) were measured by enzyme-linked immunosorbent assay (ELISA) in 46 serum and 114 middle ear effusion (MEE) samples from 85 children with acute otitis media (AOM) . The samples were obtained within 12 h from the onset of the ear symptoms . Serum (but not secretory) type antibodies to the infecting Pn serotype were found in 24% of the MEE samples of the patients with Pn AOM and, correspondingly, serum and/or secretory type antibodies to Hi and Br were seen in 54% and 63% of the MEE samples of the patients with Hi or Br AOM, respectively . Moreover, antibodies against bacteria other than the causative one could also be found in the MEE . The occurrence of the serum type antibodies against these bacteria in the MEE was closely correlated with their serum levels . The findings of this study indicate that during the very early phase of AOM, the MEE contains both serum type antibodies originating from the serum, and secretory antibodies of middle ear origin . Among them there are antibodies specific to the three most common bacteria causing AOM (Pn, Hi, and Br) regardless of the bacterial etiology of the AOM attack in question. Mil Med, 1990 Jan, 155(1), 1 - 3 Incidence and etiology of conjunctivitis in Navy recruits; Heggie AD; Recruit sick call at the Naval Training Center, Great Lakes, Illinois was monitored for cases of conjunctivitis during two 2-week periods in March in 1981 and 1982 . Twenty-three cases were detected . The incidence of conjunctivitis was 1.1 cases per 1000 recruits per week . Peak incidence occurred during the third and fourth weeks of training and two recruit companies had multiple cases . Conjunctival cultures for viruses and Chlamydia trachomatis were negative in all cases . Concurrent cultures of conjunctival exudate were obtained from 12 cases . Haemophilus influenzae was isolated from three of these cases and Streptococcus pneumoniae from one . Despite the high percentage of negative cultures, the clinical characteristics and pattern of occurrence of conjunctivitis in Navy recruits suggest that it is caused by an infectious agent or agents. AJR Am J Roentgenol, 1990 Jan, 154(1), 135 - 8 Treatment of suppurative arthritis by percutaneous catheter drainage; Renner JB et al.; Percutaneous catheter drainage to treat suppurative arthritis was performed in five joints in five patients . Joints drained included the hip in two cases and one case each of a hip joint prosthesis, an ankle joint, and a glenohumeral joint . Organisms isolated from the joints included Staphylococcus aureus in one hip joint and the hip prosthesis, and Haemophilus influenzae in the ankle joint . Specific organisms were not isolated in the other hip joint or in the shoulder joint . Systemic antibiotic therapy was used in all five patients, and in two patients gentamicin was instilled through the catheters . Joint infection was managed successfully with catheter drainage and antibiotics in three patients . In all three cases, the range of motion was restored and the patients became free of pain after catheter drainage . These three patients remained asymptomatic at follow-up ranging from 3 weeks to 9 months . In two patients, percutaneous drainage failed . In one patient, the catheter positions could not be maintained and the catheters repeatedly became dislodged . In the other, superimposed osteomyelitis necessitated surgical debridement . No complications occurred . Our experience suggests that suppurative arthritis can be successfully treated with drainage of the joint via a percutaneous catheter in combination with antibiotic therapy. Arch Roum Pathol Exp Microbiol, 1990 Jan-Mar, 49(1), 43 - 50 Bacterial agents associated with bronchopulmonary disorders in eastern Nigeria; Iroegbu CU et al.; Altogether 16,539 sputum specimens were examined microbiologically from 1980 to 1984 . Out of these 12,588 were screened by Ziehl-Neelsen's staining technique and 782 were (6.3%) found AFB-positive . Age and sex distributions of the AFB-positive individuals were statistically significant (at 0.05), incidence being most prevalent among those 20 years and above (90.2%) and among males (61.2%) . From other specimens cultured, non-AFB organisms were isolated at the following frequencies: coliform-like organisms (15.1%), Streptococcus pneumoniae (55.5%) . Klebsiella pneumoniae (5.3%), Streptococcus pyogenes (3.9%), Pseudomonas aeruginosa (3.4%), Haemophilus influenzae (3.0%) . Proteus Spp . (0.7%) and Escherichia coli (0.5%) . The antibiogram of these isolates revealed a high incidence of multiple antibiotic resistance, a situation that has most probably arisen from the high degree of antibiotic misuse in Nigeria. Scand J Infect Dis Suppl, 1990, 73, 7 - 15 The immunology of sepsis and meningitis--cytokine biology; Jacobs RF et al.; Although antibiotics have reduced mortality, the most recent clinical trials in sepsis and meningitis have been directed at the host inflammatory response in an attempt to improve outcome . Endotoxin, cell wall constituents and toxins are potent inducers of small molecular weight proteins (cytokines) from a variety of host cells . Several lines of investigation have implicated tumor necrosis factor-alpha (TNF-alpha) as a cytokine mediator of sepsis and septic shock . A recent study has been able to measure plasma TNF-alpha concentrations in patients with meningococcemia and demonstrated a correlation with prognostic groups related to mortality . Therefore, TNF-alpha, probably through its effects on other mediators, has an effect in sepsis . New speculation regarding morbidity in bacterial meningitis focuses on cytokine activity in the central nervous system . Cerebrospinal fluid (CSF) from experimental animals with meningitis contains increased amounts of interleukin-1 beta (IL-1 beta) and TNF alpha . These IL-1 beta levels correlated directly with duration of fever and neurological sequelae . Children with Haemophilus influenzae, type b meningitis treated with dexamethasone had significantly reduced levels of CSF IL-1 beta compared to placebo-treated controls. Scand J Infect Dis Suppl, 1990, 73, 43 - 54 Corticosteroids and bacterial meningitis; Kaplan SL; Despite timely and appropriate antimicrobial therapy of bacterial meningitis, neurologic sequelae still occur in some children . This also remains true for the third generation cephalosporins such as ceftriaxone and cefotaxime despite their extraordinary high bactericidal titers in the cerebrospinal fluid of children with bacterial meningitis . The most effective way to prevent neurologic damage in these patients is to prevent the infection from developing in the first place . This may be achievable in the very near future for meningitis due to Haemophilus influenzae type b, the most common organism causing meningitis in children in many parts of the world . Unfortunately, even though such means of prevention may be available or under development, ensuring that all children receive these immunizations is very difficult to accomplish . Furthermore, some forms of bacterial meningitis are not likely to be preventable by immunization or other methods and thus efforts to develop new means to minimize the neurologic damage due to meningitis remain important . One such effort involves the use of antiinflammatory agents in addition to antimicrobial therapy for the treatment of this infection . This review will focus on the role of one such antiinflammatory agent, corticosteroids, as adjunctive therapy for bacterial meningitis. Arch Oral Biol, 1990, 35 Suppl, 181S - 183S Humoral immune responses in experimental gingivitis in rats; Konakajima Y et al.; Serum IgG, IgM, and IgA antibody levels to extracts of rat dental plaque and five oral bacteria (Haemophilus actinomycetemcomitans Y-4, Bacteroides gingivalis 381, Bact . intermedius ATCC 25261, Capnocytophaga sp . M-12, Eikenella corrodens ODU) were determined by ELISA . In addition, the presence of rat dental plaque and oral bacterial components in the inflamed gingival tissue was studied using immunofluorescence techniques . Serum and gingival tissue samples were obtained from ODU plaque-susceptible and plaque-resistant rats . In several susceptible rats, IgG, IgM, and IgA antibodies against dental plaque and oral bacteria were detected . There was a correlation between the levels of IgG antibody to dental plaque and pocket probing depth, but not between pocket probing depth and the levels of IgM and IgA . Furthermore, components of rat dental plaque and oral bacteria were detected in the inflamed gingival tissue. Acta Derm Venereol, 1990, 70(4), 359 - 60 Haemophilus influenzae type b cellulitis of the lower extremity in a non-immunocompromised elderly patient; Bernard P et al.; An 83-year-old non-immunocompromised man who developed Haemophilus influenzae cellulitis on his lower left leg is described . H . influenzae type b was isolated by conventional bacteriological cultures from one blood culture and from a cutaneous blister fluid aspirate, and identified within the dermis by immunofluorescence on a punch biopsy of lesional skin . Evolution was characterized by a slow healing during appropriate systemic antibiotherapy, and absence of any significant increase in antibodies to the capsular polysaccharide of H . influenzae type b. Rev Infect Dis, 1990 Jan-Feb, 12(1), 75 - 111 Global genetic structure and molecular epidemiology of encapsulated Haemophilus influenzae; Musser JM et al.; A collection of 2,209 isolates of six polysaccharide capsule types of Haemophilus influenzae, including 1,975 serotype b isolates recovered in 30 countries was characterized for electrophoretically demonstrable allele profiles at 17 metabolic enzyme loci . Two hundred eighty distinct multilocus genotypes were distinguished, and cluster analysis revealed two primary phylogenetic divisions . The population structure of encapsulated H . influenzae is clonal . Currently, most of the invasive disease worldwide is caused by serotype b strains of nine clones . Strains producing serotype c, e, and f capsules belong to single divisions and have no close genetic relationships to strains of other serotypes . Serotype a and b strains occur in both primary phylogenetic divisions, probably as a result of transfer and recombination of serotype-specific sequences of the cap region between clonal lineages . A close genetic relatedness between serotype d isolates and some strains of serotypes a and b was identified . There are strong patterns of geographic variation, on an intercontinental scale, in both the extent of genetic diversity and the clonal composition of populations of encapsulated strains . The analysis suggests that the present distribution of clones is, in part, related to patterns of racial or ethnic differentiation and historical demographic movements of the human host populations. Pediatrie, 1990, 45(12), 895 - 900 {Broncho-alveolar lavage in HIV-1 seropositive children}; Albertini M et al.; Sixteen bronchoalveolar lavages (BAL) were performed in 15 children with HIV1 seropositivity, 12 of them being infected by HIV1 . BAL was performed during episodes of acute pneumonitis with respiratory distress (group I: three cases) or without severity (group II: five cases), or in the presence of asymptomatic radiological pulmonary abnormalities (group III: seven cases) . A specific diagnosis of infection was obtained in five cases of acute pneumonitis and 12 micro-organisms were identified by BAL: three cytomegaloviruses, three respiratory syncytial viruses, two Pneumocytis carinii, one Haemophilus influenzae, one Herpes simplex virus type 1, one Escherichia coli and one group A streptococcus . In three cases two micro-organisms were simultaneously identified . Cytological examination showed a high proportion of polymorphonuclear leukocytes in cases of acute pneumonitis (group II) and alveolar lymphocytosis in clinically asymptomatic children with radiological pulmonary abnormalities (group III) . BAL appears to be a reliable tool for the investigation of pulmonary infections in children with HIV1 seropositivity . In addition it has the advantage of revealing latent cytological abnormalities in these patients. Ann Trop Paediatr, 1990, 10(3), 285 - 91 Initial treatment of bacterial meningitis in Yaounde, Cameroon: theoretical benefits of the ampicillin-chloramphenicol combination versus chloramphenicol alone; Tetanye E et al.; A prospective 6-month study in Yaounde evaluated 49 children aged from 2 months to 8 years, hospitalized with bacterial meningitis . They were randomly assigned to one of two initial treatment groups, either an ampicillin-chloramphenicol combination (group A) or chloramphenicol alone (group B) . The majority of patients were infected with Haemophilus influenzae, and the majority of deaths were caused by Streptococcus pneumoniae . Altogether, 17.9% of Haemophilus influenzae isolates were ampicillin-resistant and 3.6% chloramphenicol-resistant . We found no isolate resistant to both antibiotics . Response to both treatments was similar in both groups . The theoretical risk of treatment failure with ampicillin was higher than with the ampicillin-chloramphenicol combination (p less than 0.05) . There was no statistically significant difference between the risk of treatment failure with the ampicillin-chloramphenicol combination and the risk with chloramphenicol alone (p less than 0.05), but the latter was increased by the occurrence of chloramphenicol-resistant isolates of Streptococcus pneumoniae (11.1%) . Although treatment with an ampicillin-chloramphenicol combination is four times more expensive than treatment with chloramphenicol alone, costwise it is also one-quarter the price of a third-generation cephalosporin (moxalactam) . At present, the ampicillin-chloramphenicol combination can be suggested as the first choice for initial treatment considering both the epidemiological data and the cost/efficiency ratio in the area of Yaounde. Ann Trop Paediatr, 1990, 10(2), 221 - 2 Fulminant Branhamella catarrhalis tracheitis; Singh RP et al.; Branhamella catarrhalis, a well known commensal of the normal respiratory flora, is being increasingly implicated as an aetiological agent in various acute respiratory and non-respiratory infections . B . catarrhalis has demonstrated a particular predilection for turning pathogenic in the immunocompromised host . Bacterial tracheitis, presenting as an acute airway obstruction, is commonly caused by Staphylococcus aureus and Haemophilus influenzae . The unusual occurrence of a fulminant B . catarrhalis bacterial tracheitis in a previously normal and healthy Indian child is the subject of this communication. Allergy, 1990 Jan, 45(1), 10 - 7 Endotoxin from Haemophilus influenzae enhances IgE-mediated and non-immunological histamine release; Clementsen P et al.; Haemophilus influenza and its extracellular products (EP) did not release histamine from basophil leukocytes in cell suspensions from normal individuals, patients with chronic bronchitis or patients allergic to either house dust mite, grass pollen, cat dander or to their own bacteria . However, the EP was found to enhance their basophil histamine release . IgE-mediated histamine release was examined by stimulation of the cells with anti-IgE or the specific allergens, and non-immunological histamine release by stimulating the cells with the calcium ionophore A23187 or Staphylococcus aureus . In all the experiments EP caused a significant increase in the histamine release . When H . influenzae endotoxins were removed from the EP, the potentiating effect of EP was completely abolished, whereas heating (80 degrees C, 30 min) or treatment of EP with proteinase did not influence the potentiating effect . These results indicate that H . influenzae endotoxin potentiates histamine release caused by IgE-mediated reactions or by non-immunological mechanisms. Am J Med, 1989 Dec 29, 87(6C), 52S - 56S Ofloxacin in community-acquired lower respiratory infections . A comparison with amoxicillin or erythromycin; Stocks JM et al.; Ninety-one patients with community-acquired lower respiratory infections were treated orally in a comparative 10-day trial of ofloxacin versus amoxicillin or erythromycin . Approximately one-half of the patients had no major underlying disease and the other half had some form of chronic lung disease . Pneumonia was present in 31 percent of the patients and the remainder had purulent bronchitis . Bacterial pathogens were recovered from 60 percent of the patients, with Haemophilus influenzae (33 isolates) and Streptococcus pneumoniae (16 isolates) being the most common . Ofloxacin was found to be a safe, well-tolerated therapeutic agent, which was as effective clinically as amoxicillin or erythromycin and with an advantage of less frequent administration . Ofloxacin was more effective than amoxicillin (90 percent versus 75 percent; p = 0.05) in elimination of pathogenic bacteria from lower airway cultures . Caution should be exercised in the use of ofloxacin, at least in short-term treatment regimens, with anaerobic pulmonary infections; additional information is needed for S . pneumoniae given the relatively high minimal inhibitory concentrations for this species. Am J Med, 1989 Dec 29, 87(6C), 14S - 16S In vitro activity of ofloxacin against Chlamydia trachomatis; Schachter J et al.; The activity of ofloxacin against Chlamydia trachomatis isolates obtained from eight metropolitan areas in the United States has been evaluated . Growth of C . trachomatis in first passage was completely inhibited by less than 1 microgram/ml of ofloxacin (all 27 isolates tested) . The bactericidal effect (inability to pass in the absence of antibiotics) was less than or equal to 1 microgram for 26 of the 27 isolates . Other studies have shown that less than 0.1 microgram/ml of ofloxacin is the minimal inhibitory concentration for 90 percent of strains tested (MIC90) for Neisseria gonorrhoeae and less than 2 micrograms/ml is the MIC90 for Haemophilus ducreyi . Ofloxacin is less active (MIC90, 8 to 25 micrograms/ml) against Ureaplasma urealyticum . These in vitro results suggest that ofloxacin may be useful in the treatment of bacterial sexually transmitted diseases . Because there is a need for a single antibiotic active against both chlamydiae and gonococci, this quinolone could play an important role in the management of these infections. J Immunol, 1989 Dec 15, 143(12), 4110 - 6 Clonal characterization of the human IgG antibody repertoire to Haemophilus influenzae type b polysaccharide . III . A single VKII gene and one of several JK genes are joined by an invariant arginine to form the most common L chain V region; Scott MG et al.; To characterize the L chain V region repertoire of IgG anti-Haemophilus influenzae type b capsular polysaccharide (Hib-PS) antibodies, clonal antibodies were purified from immune serum and internal amino acid sequences of VKII anti-Hib-PS L chains obtained . We examined VKII L chains because it is the most common VL family expressed in the anti-Hib-PS response . Comparison of VKII amino acid sequences, including the entire CDR2 and CDR3 regions, of five anti-Hib-PS clonal antibodies from four unrelated individuals revealed complete identity with the exception of a single CDR3 residue from one antibody . When the sequence of these antibodies was compared with known VKII genes and myeloma proteins, it was found to be identical to the human VKII gene, A2, whose genomic sequence is presented here . In addition, all five of the VKII anti-Hib-PS antibodies examined contain an arginine inserted at the V-J junction . Finally, in contrast to the extraordinary homology of the VKII-encoded residues, there is variability in the JK gene utilization by these antibodies . These results demonstrate that the most common L chain V region in IgG anti-Hib-PS antibodies is the product of a single germ-line gene . The invariant arginine insertion suggests that this residue has an important role in Ag binding. An Esp Pediatr, 1989 Dec, 31(6), 549 - 53 {Pertussis syndrome: study of 74 cases}; Galles Pacareu C et al.; Pertussis syndrome controversy induced us to study 74 hospitalized patients, with pertussis cough and Bordetella sp isolation in 29, other bacteria in 24 and viruses in 21 . The most frequently isolated bacteria in the patients with negative culture for bordetella were Haemophilus influenzae, Streptococcus pneumoniae and Branhamella catarrhalis . The viruses with highest incidence were respiratory syncitial viruses . The negative culture for bordetella, the lack of antibiotherapy previous to obtention of the sample (29/45 cases), the clinical differences and their different seasonal distribution in relation to the patients with positive culture for bordetella, permit us to suppose that the bacteria/viruses isolated could be the etiologic agents of pertussis syndrome . Although Bordetella sp occupies an important place in the pertussis cough etiology, it is advisable to investigate the presence of viruses and other bacteria in these patients . However the difficulties to isolate bordetella implies the necessity of performing adequate isolation techniques and to study larger numbers of patients including control groups. Semin Respir Infect, 1989 Dec, 4(4), 261 - 5 The prevention of severe lower respiratory infections in chronic bronchitis; Ruben FL; Chronic bronchitis remains as a serious medical problem for many adults and a smaller proportion of children in the United States . The frequency of severe lower respiratory infections in patients with chronic bronchitis is quite variable . The infectious agents most likely responsible for severe lower respiratory disease include pneumococci, nontypable Haemophilus influenza, Mycoplasma pneumoniae, and Branhamella catarrhalis among the bacteria, and influenza A and B viruses, with parainfluenza and adenoviruses less common . Prophylactic antibiotics, particularly tetracycline and derivatives, were the only drugs suggesting efficacy in controlled trials for decreasing exacerbation, but many studies failed to show efficacy . Killed influenza vaccines should be used annually in any patient with chronic bronchitis . Pneumococcal vaccine has had questionable benefit for bronchitics but should nevertheless be considered for use because of its low cost and proven safety . The antiviral drug amantadine may be useful in bronchitics unable to take influenza vaccines. Jpn J Antibiot, 1989 Dec, 42(12), 2527 - 39 {Clinical studies on cefixime in pediatrics}; Mikawa H et al.; Clinical usefulness of cefixime (CFIX), a new oral cephalosporin antibiotic, in pediatric field was investigated . The results obtained were summarized as follows . 1 . The clinical efficacy of CFIX was investigated in a total of 138 children including 49 with upper respiratory tract infections (RTI), 22 with acute bronchitis, 18 with pneumonia, 19 with scarlet fever and 21 with urinary tract infections (UTI) . 2 . Clinical effectiveness was excellent in 58, good in 60, fair in 14 and poor in 3, with an overall efficacy rate of 87.4% . The efficacy rate classified according to types of infection were 85.7% in upper RTI, 89.5% in acute bronchitis, 94.4% in pneumonia, 78.9% in scarlet fever, and 90.5% in UTI . 3 . Out of the suspected causative organisms, 43 strains of a total of 50 strains isolated were eradicated . The bacteriological eradication rate was 86.0% . (Haemophilus influenzae 100%, Haemophilus parainfluenzae 100%, Streptococcus pyogenes 88.5%, Escherichia coli 85.7%) . 4 . One hundred forty four children were analyzed for side effect . Side effects were observed in 2 children (1.4%) with diarrhea in 1 and anorexia in another . Abnormal laboratory test results were recorded in 4 children (3.3%) . The above results suggest that CFIX is a very useful new oral cephalosporin for the treatment of bacterial infections in children. J Biol Buccale, 1989 Dec, 17(4), 255 - 61 A comparison of fibronectinolytic activities from several oral bacteria; Pellat B et al.; Fibronectinolytic activity from two Gram-positive microorganisms (Streptococcus mutans and Bacterionema matruchotii), and from three Gram-negative oral bacteria (Bacteroides intermedius, Bacteroides gingivalis and Haemophilus actinomycetemcomitans) were compared . 125I-labelled human plasma fibronectin (FN) was incubated either either with bacterial extracts or with concentrated culture medium samples and the patterns of FN-degradation products were determined by SDS-PAGE . Results to date have shown that Streptococcus mutans, Bacterionema matruchotii and Haemophilus actinomycetemcomitans were unable to degrade FN . On the other hand the Gram-negative Bacteroides intermedius and Bacteroides gingivalis were shown to contain Fn-degrading activity . The highest activity was found in the bacterial extracts of Bacteroides gingivalis . Inhibition assays demonstrated that fibronectinolytic activity of Bacteroides gingivalis occurred predominantly by cysteine proteinase(s) while that of Bacteroides intermedius by a common action of serine and cysteine proteinases. Genitourin Med, 1989 Dec, 65(6), 361 - 5 Rapid detection of Haemophilus ducreyi in clinical and experimental infections using monoclonal antibody: a preliminary evaluation; Karim QN et al.; A monoclonal antibody raised against Haemophilus ducreyi was tested for its sensitivity and specificity as an immunofluorescence (IF) reagent using simulated vaginal smears containing H . ducreyi, smears taken from skin lesions of mice infected with H . ducreyi and patients from South Africa, Thailand and Malaysia with clinically diagnosed chancroid . The IF test was more sensitive than culture or Gram staining in the simulated smears, theoretically detecting less than 4 organisms/sample . It detected H . ducreyi in 95% of the animal lesions compared with 14% detected by culture . Immunofluorescence testing identified over 90% of culture-positive cases of chancroid but also detected organisms in some culture-negative cases where clinical evidence for the diagnosis was strong . These results suggest that this antibody may provide a simple, rapid and sensitive means of detecting H . ducreyi in cases of chancroid. Microbiol Rev, 1989 Dec, 53(4), 377 - 89 Biology of Haemophilus ducreyi; Albritton WL; The etiological agent of the sexually transmitted genital ulcer disease chancroid was first described in 1889 by Auguste Ducrey following repeated autoinoculation of purulent ulcer material from a series of patients . The organism was isolated on artificial media a decade later but has remained difficult to isolate consistently, resulting in controversy over its characteristics and role as the causative agent of chancroid . Because of its fastidious growth requirements, including unknown components in blood, the organism was included in the original description of the genus Haemophilus . Requirement for exogenous hemin and limited phenotypic characteristics, including structural and antigenic properties, suggested that Haemophilus ducreyi was a valid member of the genus Haemophilus . Recent studies of respiratory quinones, deoxyribonucleic acid hybridization, and competition for homologous transformation of the type species, H . influenzae, suggest that H . ducreyi is unrelated to any of the present species of the family Pasteurellaceae, which includes members of the genera Haemophilus, Actinobacillus, and Pasteurella . This review summarizes the early studies with H . ducreyi and our current knowledge of the microbiology of this important human pathogen. Southeast Asian J Trop Med Public Health, 1989 Dec, 20(4), 501 - 9 Multiple colonization of the upper respiratory tract of Papua New Guinea children with Haemophilus influenzae and Streptococcus pneumoniae; Gratten M et al.; Nasal secretions from Papua New Guinea children were cultured using selective agents, to determine the prevalence of multiple colonization for both S . pneumoniae and H . influenzae . 29.5% of 156 and 53% of 93 carriage positive subjects harbored more than one type of S . pneumoniae and H . influenzae respectively . Of 95 strains of pneumococci isolated from multiply colonized children, 40% were relatively resistant to benzylpenicillin . In more than one half of the children in this group both penicillin sensitive and resistant serotypes coexisted . Significantly more penicillin resistant pneumococci were isolated from children with ready access to primary and regional health care services . Among H . influenzae the prevalence of multiple isolations due to nonencapsulated variants only, and encapsulated plus nonencapsulated organisms was similar . The commonest biotypes were types I, II, III and V, and each was similarly associated with multiple carriage. Arq Neuropsiquiatr, 1989 Dec, 47(4), 468 - 70 {Meningoencephalitis due to Pasteurella multocida: clinico-laboratory study of a case in an infant}; Levy CE et al.; The authors report a case of Pasteurella multocida meningoencephalitis in a 5 week-old female infant, with special attention to clinical, laboratory and evolutive features . A moderate neurological sequel was observed at follow-up examinations . A brief review of the importance of P . multocida in human pathology is presented on the basis of the international literature, since the authors did not find any Brazilian reports . The most important feature on P . multocida is the prevalence of bacterial meningitis at the extremes of age . Otherwise, significant mistaken was found between Gram stained smears of body fluids for P . multocida and Haemophilus influenzae or Neisseria meningitidis . Because its role in infections following animal bite or scratch and its opportunistic feature, P . multocida must be included among the possible etiologic agent of bacteremia or sepsis in patients with liver cirrhosis or immunosuppression. Microb Pathog, 1989 Dec, 7(6), 449 - 57 Genetic and phenotypic variation in the capsulation and virulence of culture collection strains of Haemophilus influenzae type b; Kroll JS et al.; Haemophilus influenzae type b strains deposited in the National Reference Collections of the United States, United Kingdom and Sweden are derived from strains isolated in the United States during the 1940s . With respect to both the genetic locus for capsulation and to virulence, assessed in the infant rat bacteremia model, these strains are no longer representative of clinical isolates which currently cause meningitis and other serious infections in children all over the world . Alternative well-characterized strains resembling current common clinical isolates may often be more suitable for the study of Haemophilus influenzae pathogenicity. J Antimicrob Chemother, 1989 Dec, 24(6), 963 - 71 The prevalence of antibiotic resistance in Haemophilus influenzae in Ireland; Howard AJ et al.; From January to April 1988, 36 clinical microbiology laboratories in Northern Ireland and Eire took part in a survey to determine the prevalence of antibiotic resistance in Haemophilus influenzae . All isolates were collected and despatched to a coordinating laboratory where identification was confirmed and antibiotic sensitivity tests repeated . One thousand seven hundred and ninety strains were available for analysis . Of these, 10.9% were resistant to ampicillin (10.2% being beta-lactamase producers), 0.4% to amoxycillin-clavulanate, 2.1% to cefaclor, 3.7% to chloramphenicol, 2.6% to erythromycin, 4.1% to tetracycline, 2.6% to sulphonamide and 5.1% to trimethoprim . One hundred and nine strains (6.3%) were resistant to two or more of the antibiotics tested and 31 (1.7%) exhibited combined resistance to ampicillin, chloramphenicol and tetracycline . The prevalence of resistance to ampicillin and chloramphenicol was higher than had been previously recorded in largescale studies conducted on the British mainland. J Antibiot (Tokyo), 1989 Dec, 42(12), 1844 - 53 In vitro and in vivo antibacterial activity of KT3777, a new orally active carbacephem; Sato K et al.; KT3777 is a novel carbacephem antibiotic structurally identical to cefaclor (CCL), except that the sulfur atom of position 1 of the cephem nucleus has been replaced by carbon . KT3777 was investigated for in vitro and in vivo antibacterial activities in comparison with CCL, cephalexin (CEX) and amoxicillin . The MIC50 of KT3777 ranged from 0.2 to 3.13 micrograms/ml for clinical isolates of Staphylococcus aureus, Streptococci, Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis, Haemophilus influenzae, and Neisseria gonorrhoeae . KT3777 possessed an antibacterial spectrum and potency similar to that of CCL . However, against E . coli and K . pneumoniae, KT3777 was about twice as active as CCL . KT3777 was more active than CEX against all strains tested . Killing-curve studies demonstrated bactericidal activity of KT3777 at concentrations above the MIC . KT3777 showed good affinity for penicillin-binding proteins 1A, 1Bs, 3 and 4 of E . coli NIHJ JC-2 . The protective effect of KT3777 against systemic infections in mice was comparable to that of CCL with a few exceptions and about 3 to 7 times greater than that of CEX . KT3777 also proved effective against localized infections such as acute pneumonia and ascending urinary tract infections in mice. Eur J Pediatr, 1989 Dec, 149(3), 168 - 9 IgG2/IgG4 subclass deficiency in a patient with chronic mucocutaneous candidiasis and bronchiectases; Bragger C et al.; A 22-year-old man with chronic mucocutaneous candidiasis (CMC) and hypothyroidism developed severe bronchiectases following recurrent bronchopneumonia . Immunological investigations revealed IgG2/IgG4 subclass deficiency and absence of antibodies against pneumococcal and Haemophilus polysaccharides . Under regular immunoglobulin substitution every 3 weeks pulmonary symptoms improved markedly. J Trop Med Hyg, 1989 Dec, 92(6), 402 - 6 Morbidity and mortality of bacterial meningitis in Arab children; Shaltout AA et al.; Between September 1981 and March 1987, 92 episodes of bacterial meningitis in 90 children were treated in three major hospitals in Kuwait . The diagnosis was bacteriologically confirmed in 80 (87%) . Haemophilus influenzae was the most common aetiological organism and accounted for 42 episodes (45.6%) followed by Streptococcus pneumoniae in 21 (22.8%) and Neisseria meningitidis in only three (3.3%) . Bacterial meningitis occurred in 53 children (57.6%) below the age of 1 year and in 81 (88%) below 5 years . The overall case fatality rate was 5.4% and ten children (9%) had severe neurological sequelae of their disease . Sequelae were more common following pneumococcal meningitis (28%) than after Haemophilus (7%) . All 12 children with unknown pathogen recovered completely. Eur J Immunol, 1989 Dec, 19(12), 2243 - 9 Anti-inflammatory activity of human IgA antibodies and their Fab alpha fragments: inhibition of IgG-mediated complement activation; Russell MW et al.; The interaction of human IgA antibodies with the classical pathway of complement activation was investigated in a homologous human system, by means of two IgA1 and three IgG1 myeloma proteins having antibody activity against a defined antigen, staphylococcal alpha-toxin . In a solid-phase antigen-dependent C3b-binding ELISA system, the monoclonal IgG antibodies were previously shown to activate the classical complement pathway synergistically, resembling polyclonal IgG antibodies, whereas IgA antibodies were unable to activate complement by either pathway . In the present study, IgA antibodies were found to inhibit significantly the activation of complement initiated by antigen-bound polyclonal or mixed monoclonal IgG antibodies, in relation to the amount of IgA antibodies applied and bound to antigen . IgA1 myeloma proteins devoid of antigen-binding activity were without effect . Inhibition was independent of the ability of the IgA antibodies to compete against the IgG antibodies in binding to antigen, and was demonstrable with physiological concentrations of antibodies . Similar results were obtained with polyclonal serum IgA having antigen-binding activity . However, the binding of C1q to antigen-complexed IgG was inhibited only by a monoclonal IgA antibody that could compete against one of the three monoclonal IgG antibodies that bound C1q synergistically . This observation implied that at least two mechanisms were involved in the inhibition of C3b fixation . Fab alpha fragments of monoclonal IgA antibodies, obtained by cleavage with IgA1 protease from Haemophilus influenzae type b, were found to have a similar inhibitory effect on C3b fixation to the intact IgA1 antibodies . This observation supports the hypothesis that IgA1 proteases contribute to the invasive pathogenicity of certain mucosal bacteria, by cleaving secretory IgA1 antibodies to antigen-binding Fab alpha fragments, which are not only defective in mucosal defense properties, but which also protect the organisms from other immune effector systems, such as complement activation. South Med J, 1989 Dec, 82(12), 1571 - 3 Waterhouse-Friderichsen syndrome caused by Haemophilus influenzae type b in an immunocompetent young adult; McKinney WP et al.; A previously healthy 19-year-old woman had a febrile illness with hypotension, progressive cyanosis, and an evolving petechial rash . Despite aggressive therapy in the face of shock and disseminated intravascular coagulation, the patient suffered a cardiac