Haemophilus

Jpn J Antibiot, 1989 Jun, 42(6), 1381 - 4
{Clinical experience with cefodizime on pediatric infections}; Haruta T et al.; Cefodizime (THR-221, CDZM), a newly developed injectable cephem antibiotic, was injected intravenously to 13 cases of pediatric infections . Patients received the drug at a dose level of approximately 20 mg/kg x 3 times daily . The results obtained are summarized as follows . 1 . Clinical efficacy was excellent in 4 patients, good in 6 and poor in 0 for 10 cases (2 phlegmon, 1 periproctal abscess, 5 pneumonia and 2 bronchitis) except 3 Mycoplasma pneumonia . 2 . Three strains of pathogens were followed for their changes (Streptococcus pyogenes in 1 phlegmon, Klebsiella pneumoniae in periproctal abscess and Haemophilus influenzae in 1 bronchitis) and they were found to have been eliminated . 3 . No adverse reactions occurred . Abnormal changes in laboratory test data found were 2 cases of eosinophilia, 1 cash each of increased GOT and GPT, and thrombocytosis, but none of them was severe.

Jpn J Antibiot, 1989 Jun, 42(6), 1366 - 80
{Clinical and pharmacokinetic evaluation of cefodizime in children}; Hirabayashi Y et al.; Cefodizime (CDZM, THR-221), a new cephem antibiotic, was investigated for its clinical efficacy and pharmacokinetics in children . The results obtained are summarized as follows . 1 . Antimicrobial activities Antimicrobial activities of CDZM against clinically isolated organisms were determined . MICs of CDZM against 1 strain each of Streptococcus pneumoniae, Escherichia coli and Klebsiella pneumoniae were 0.05 micrograms/ml to 0.10 micrograms/ml . Especially, MIC against all 6 strains of Haemophilus influenzae was less than or equal to 0.024 micrograms/ml . This MIC value was lower than those of other antibiotics such as cefotaxime, cefotiam, cefazolin, piperacillin . 2 . Pharmacokinetics CDZM was given to 1 case at a dose of 20 mg/kg by a 60-minute intravenous drip infusion . The peak value of serum concentration of CDZM was 207.80 micrograms/ml at the end of the infusion . The half-life was 2.15 hours . The mean urinary excretion rate was 68.5% in the first 4 hours, 79.2% in 6 hours and 76.5% in 8 hours after the 30-minute drip infusion . 3 . Clinical efficacy CDZM was given to a total of 27 patients, 13 with pneumonia, 1 with bronchitis, 2 with acute pharyngitis, 1 with purulent tonsillitis, 5 with urinary tract infection, 1 each with retrograde cholangitis, acute enteritis, pericementitis, phlegmon and inguinal lymphadenitis . Overall clinical efficacies were excellent in 5 cases, good in 17 and the efficacy rate was 81% . Bacteriological effects were investigated in 13 cases and the eradication rate was 85% . No adverse reactions were observed in any case . As abnormal laboratory findings, elevated GOT, GPT, A1-P, LAP and gamma-GTP, were noted in 1 out of the 28 cases examined.

Jpn J Antibiot, 1989 Jun, 42(6), 1358 - 65
{Clinical evaluation of cefodizime in children}; Mochizuki Y et al.; Cefodizime (THR-221, CDZM), a new parenteral cephalosporin, was evaluated for its efficacy and safety in 20 children with bacterial infections (Table 1), and the following results were obtained . 1 . CDZM was administered in 3 or 4 divided doses at daily dosages ranging from 54.5 to 84.2 mg/kg administered by 30 minutes drip infusion or intravenous injection to 20 patients (7 cases of acute tonsillitis, 6 cases of pneumonia, 2 cases each of bronchitis and suppurative cervical lymphadenitis, and 1 case each of acute pharyngitis, acute enteritis and furunculosis) and the following clinical results were obtained: excellent, 7 cases; good, 11 cases; fair, 2 cases . The overall efficacy rate was 90% (Table 4) . 2 . MICs of CDZM against 15 strains of isolated organisms are shown in Table 2 . MICs against all 7 strains of Haemophilus influenzae were less than 0.025 micrograms/ml . MIC against 1 out of 5 strains of Streptococcus pneumoniae was 0.05 micrograms/ml and those against 2 strains were 0.10 micrograms/ml and against the other 2 were 0.20 micrograms/ml . MICs against 3 strains of Staphylococcus aureus were 1.56, 25 and higher than 100 micrograms/ml, respectively . 3 . No clinical adverse reaction was observed in any of the 20 patients . Eosinophilia was observed in 2 cases . A slight elevation of S-GOT was found in 1 patient (case No . 8) and moderate elevation of S-GOT and S-GPT in another (case No . 18) (Table 4) . In case No . 18, the S-GOT and S-GPT activity improved after the administration of the drug was stopped.(ABSTRACT TRUNCATED AT 250 WORDS)

Antimicrob Agents Chemother, 1989 Jun, 33(6), 983 - 6
Penicillin-binding proteins of Haemophilus ducreyi; Lee BC et al.; The penicillin-binding protein (PBP) profile of Haemophilus ducreyi was determined by a whole-cell-labeling assay . Only two major PBPs, of molecular weights 90,000 (PBP 1) and 38,500 (PBP 2), were detected in six of eight strains studied . Competition binding experiments and the attendant morphological effects suggested that PBP 1 was either a functional amalgamation or a lack of resolution of two proteins equivalent to PBPs 1 and 3 of Escherichia coli.

Pediatr Infect Dis J, 1989 Jun, 8(6), 361 - 3
Bacteriology of middle ear fluid specimens obtained by tympanocentesis from 111 Colombian children with acute otitis media; Trujillo H et al.; We cultured middle ear fluid specimens obtained by tympanocentesis from 111 Colombian infants and children, ages 11 days to 11 years, with acute otitis media . Bacteria were isolated in 82 patients (74%) . Haemophilus influenzae, the most common isolate, was present in 40 cases (36%); 32 were nontypable strains and 8 were type b . Streptococcus pneumoniae, identified in 26 cases (22%), was the second most common pathogen . All H . influenzae and S . pneumoniae strains were susceptible to ampicillin and penicillin, respectively . We conclude that amoxicillin remains the drug of choice for treatment of acute otitis media in our country.

Hybridoma, 1989 Jun, 8(3), 337 - 51
Production of monoclonal antibodies specific for Haemophilus ducreyi: a screening method to discriminate specific and cross-reacting antibodies; Odumeru JA et al.; Haemophilus ducreyi is the etiological agent of chancroid . The organism shares extensive immunological cross-reactivity with other Haemophilus species . This presents substantial difficulties for the production of specific monoclonal antibodies (MAbs) . A competition ELISA was devised for hybridoma screening which allowed the detection of H . ducreyi-specific antibody-producing hybridoma cultures during the initial screening process . With this screening method, seven MAbs specific for H . ducreyi were obtained in a single cell fusion exercise . The specificities of the 7 MAbs were demonstrated by direct ELISA and dot immunobinding assays against several strains each of H . influenzae, H . parainfluenzae and Neisseria gonorrhoeae . Five of the MAbs reacted against all ten strains of H . ducreyi . These MAbs may permit the development of rapid and efficient immunodiagnostics for chancroid . The principle of the competition ELISA for hybridoma screening should be widely applicable to the development of specific MAbs to other organisms in which immunological cross-reactivity is an impediment to hybridoma screening by conventional methods.

Health Visit, 1989 Jun, 62(6), 179 - 80
Meningitis and epiglottitis: a new immunisation against haemophilus influenzae type b infections; Lungmuss J; Since 1985 the number of cases of systemic haemophilus influenzae type b (Hib) disease in children in the Oxford region has been recorded . This study shows that a cumulative incidence of children suffering systematic Hib infections before their fifth birthday is 1:600, 71 per cent of sufferers having meningitis . Because the incidence of haemophilus infections may be increasing in the UK and there is increasing resistance of the organism to antimicrobial therapy, the need for primary prevention through immunisation is becoming increasingly attractive . We have therefore undertaken a safety and immunogenicity study of a haemophilus influenzae type b conjugate vaccine (HbO-C) as a first step towards introducing a routine immunisation programme for the UK.

Pediatrics, 1989 Jun, 83(6), 1016 - 9
Severity of disease correlated with fever reduction in febrile infants; Baker RC et al.; A prospective study of the effects of fever reduction on the clinical appearance of infants at risk for occult bacteremia was undertaken to study the hypothesis that infants with bacteremic illness fail to improve clinically following defervescence compared with infants with benign viral illness . A total of 154 children were enrolled in the study, including 19 with bacteremia: 13 with occult Streptococcus pneumoniae bacteremia, two with occult Haemophilus influenzae, type b bacteremia, and four with Haemophilus meningitis and bacteremia . There were no differences in degree of temperature reduction with acetaminophen between the bacteremic and nonbacteremic groups of infants . Among infants with bacteremia but without meningitis, differences from nonbacteremic children were detected in clinical appearance prior to fever reduction but not following defervescence . All patients with meningitis appeared seriously ill before and after defervescence . It was concluded that clinical improvement with defervescence is not a reliable indicator of the presence of occult bacteremia . Lack of clinical improvement with defervescence may be a reliable indicator for the presence of meningitis . Because there were differences in clinical appearance prior to fever reduction, routine administration of acetaminophen may interfere with the clinical evaluation by the physician.

J Pediatr, 1989 Jun, 114(6), 925 - 33
Immunogenicity of Haemophilus influenzae type b polysaccharide-outer membrane protein conjugate vaccine in patients who acquired Haemophilus disease despite previous vaccination with type b polysaccharide vaccine; Granoff DM et al.; To investigate the basis of the immune defect in children who acquire invasive Haemophilus disease despite previous vaccination with Haemophilus influenzae type b (Hib) polysaccharide vaccine, we determined the ability of vaccine failure patients with low levels of serum anticapsular antibody (less than 1 microgram/ml) to respond to reimmunization . Thirty-four patients, ranging in age from 27 to 61 months, were vaccinated with either Hib polysaccharide (n = 20) or Hib polysaccharide-outer membrane protein conjugate vaccine (n = 14) . All but three of the children had normal serum concentrations of immunoglobulins, including IgG2 . The geometric mean serum anticapsular antibody concentration of the group given polysaccharide vaccine increased from 0.27 microgram/ml before vaccination to 0.65 microgram/ml 1 month later (p less than 0.05), but the magnitude of the response was nearly 10-fold less than that of 31 age-matched control children given polysaccharide vaccine (6.3 micrograms/ml, p less than 0.001) . In contrast, all 14 patients with vaccine failure who were given conjugate vaccine showed increases of fivefold or more in serum anticapsular antibody (geometric means 0.35 and 12.8 micrograms/ml, respectively; p less than 0.001) . All patients with vaccine failure who did not respond to polysaccharide vaccine were subsequently given conjugate vaccine, and all had high antibody responses . Most patients tested showed increases in complement-mediated serum bactericidal activity . These data suggest that immunization with conjugate vaccine confers protection against Hib disease to children who, because of genetic or other reasons, cannot respond to the unconjugated form of the polysaccharide vaccine.

J Infect Dis, 1989 Jun, 159(6), 1083 - 7
Functional affinity of antibody to the Haemophilus influenzae type b polysaccharide; Griswold WR et al.; The functional affinity, or avidity, of antibody to the capsular polysaccharide of Haemophilus influenzae (Hib-PS) was measured in serum samples from 12 adult male subjects before and after immunization with Hib-PS vaccine . Mean avidity increased from 0.74 nM-1 to 1.5 nM-1 after immunization (P less than .05, paired Student's t test) . The Bureau of Biologics reference antiserum had an avidity constant of 12 nM-1, which was the highest of all 25 serum samples studied.

J Bacteriol, 1989 Jun, 171(6), 3343 - 7
Common organization of chromosomal loci for production of different capsular polysaccharides in Haemophilus influenzae; Kroll JS et al.; Cloned Haemophilus influenzae type b capsulation genes were used as hybridization probes to isolate DNA from the capsulation loci (cap) of other serotypes of H . influenzae . Mapping of the resulting clones and Southern hybridization analysis of chromosomal DNAs from type a, b, c, and d strains showed that in each strain cap was organized in the same way: a central DNA segment specific to each serotype flanked by DNA segments of common structure . We infer that enzymes necessary for the synthesis of specific capsular polysaccharide are encoded in the central segment of cap, while proteins involved in a more general way in the process of capsulation are encoded in the flanking segments . Studies of the function of the DNA in one of these non-serotype-specific flanking segments (J . S . Kroll, I . Hopkins, and E . R . Moxon, Cell 53:347-356, 1988) have previously identified a gene encoding a protein necessary for polysaccharide export, an event now deduced to proceed by a mechanism independent of the nature of the disaccharide subunit in the polysaccharide . The near-total duplication of cap that has been found in most type b strains was not found at the analogous locus in the other serotypes . This reinforces our previous hypothesis, based on study of type b strains alone, that while such a duplication is unnecessary for capsulation, it confers some unexplained survival advantage on the widely prevalent strains with this clinically important serotype.

J Bacteriol, 1989 Jun, 171(6), 3016 - 24
Organization of the Haemophilus influenzae Rd genome; Lee JJ et al.; We present the first complete map of the Haemophilus influenzae genome, consisting of a detailed restriction map with a number of genetic loci . All of the ApaI, SmaI, and RsrII restriction sites (total of 45 sites) were mapped by Southern blot hybridization analysis of fragments separated by pulsed-field gel electrophoresis . Cloned genes were placed on the restriction map by Southern hybridization, and antibiotic resistance loci were also located by transformation with purified restriction fragments . The attachment site of the HP1 prophage was mapped . In addition, the number, locations, and orientations of the six rRNA operons in the H . influenzae chromosome were determined . The positions of conserved restriction sites in these rrn operons confirm that the direction of transcription is 16S to 23S, as in most other bacteria . The widely used strain BC200 appears to contain an unexpected 45-kilobase duplication.

Infect Immun, 1989 Jun, 57(6), 1639 - 46
Expression of the heat-modifiable major outer membrane protein of Haemophilus influenzae type b is unrelated to virulence; Hanson MS et al.; The heat-modifiable major outer membrane protein (P1) of Haemophilus influenzae type b (Hib) has been shown to be both exposed on the cell surface and capable of inducing the synthesis of antibodies protective against experimental Hib disease . Chemical mutagenesis of a recombinant plasmid containing the Hib gene encoding P1 resulted in inactivation of P1 expression by this plasmid . The mutated P1 gene was transformed into Hib to obtain an isogenic mutant lacking only the ability to synthesize this surface protein . In addition, the P1 gene was inserted into a plasmid shuttle vector and used to construct a recombinant Hib strain that overexpressed the P1 protein . Lack of P1 expression did not affect the ability of Hib to grow in vitro . Neither the absence nor the overproduction of P1 affected expression of capsular polysaccharide and lipooligosaccharide by Hib . The P1-negative mutant and the P1-overexpressing strain were both as susceptible to the bactericidal activity of pooled normal human serum as was the wild-type parent strain, while the P1-negative mutant was as resistant to the bactericidal activity of normal infant rat serum as was the wild-type parent strain . The P1-negative mutant was no less virulent than was the wild-type parent strain in an animal model system, such that both the numbers of animals infected by this mutant and the mean magnitudes of the resultant bacteremias were essentially identical to those obtained with challenge by the wild-type parent strain . Similarly, overexpression of P1 did not detectably affect the virulence of Hib . These data indicate that this protective protein antigen plays no detectable role in the expression of virulence by Hib, as assessed in an animal model system.

Kinderarztl Prax, 1989 Jun, 57(6), 271 - 5
{Purulent meningitis in childhood caused by Haemophilus influenzae with ampicillin and chloramphenicol resistance}; Rockstroh T et al.; A report is given on two children suffering from meningitis caused by ampicillin- and chloramphenicol-resistent Haemophilus influenzae . Since effective therapy has been started with delay, recovery was affected with complications . The need for the early determination of minimal inhibitory concentrations and detection of beta-lactamase-production is emphasized as well as for repeated measurement of C-reactive protein in serum . Cefotaxime is recommended in case of presence of resistent Haemophilusstrains.

Int J Cardiol, 1989 Jun, 23(3), 343 - 7
Endocarditis from a dental focus . Importance of oral hygiene in valvar heart disease; Verhaaren H et al.; Fastidiously growing bacteria more and more are recognised as a source of infectious endocarditis . Over recent years, three new cases of endocarditis caused by Actinobacillus actinomycetemcomitans were diagnosed in our institution . The rise in frequency is possibly secondary to better laboratory skills . Two patients with Actinobacillus (Haemophilus) actinomycetemcomitans endocarditis presented the classical history of preexisting valvar disease together with poor dental hygiene . The third patient had no congenital or rheumatic preexisting lesion to the valves . The distal part of a ventriculo-atrial drainage device had caused microtrauma to the tricuspid valve . The right-sided endocarditis in this patient was complicated by pulmonary septic emboli . Dental origin of the infection was very likely in this patient too . No dental procedure had been performed in the months preceding the endocarditis of our three patients . They presented endocarditis with an oral microorganism in the absence of any dental manipulation . All three had very poor dental hygiene . Better dental care could possibly have prevented this serious complication.

Arch Intern Med, 1989 Jun, 149(6), 1341 - 5
Haemophilus species bacteremia in patients with cancer . A 13-year experience; Fainstein V et al.; We reviewed the clinical and laboratory presentation of Haemophilus species bacteremia at our institution, with special attention to predisposing and prognostic factors . Of 36 cases, 18 presented with pneumonia, 1 with cellulitis, and another with sinusitis . No cases of meningitis or endocarditis were detected . Most episodes were caused by Haemophilus influenzae, and the overall response rate to treatment was 72% . Factors including chronic obstructive pulmonary disease, alcoholism, prior splenectomy, and neutropenia did not play an important role in these patients' infections . Most of the isolates serotyped were found to be nontypable . The occurrence of ampicillin resistance was 6% throughout the study . Ampicillin, chloramphenicol, and second-generation cephalosporins were all effective therapeutic regimens . Bacteremia due to Haemophilus species remains an uncommon infection in patients with cancer, despite the predominance of traditional predisposing factors.

Arch Otolaryngol Head Neck Surg, 1989 Jun, 115(6), 721 - 4
Microbiology of obstructive tonsillar hypertrophy and recurrent tonsillitis; Kielmovitch IH et al.; A qualitative and quantitative analysis of the tonsillar surface and core of children with recurrent streptococcal tonsillitis and children with obstructive tonsillar hypertrophy was performed . No qualitative difference was found within the two population groups . Haemophilus influenzae and Bacteroides melaninogenicus were the most prevalent beta-lactamase-producing isolates in both groups . Staphylococcus aureus had the highest rate of beta-lactamase production on the tonsillar surface of children with recurrent tonsillitis, while Streptococcus pyogenes was more prevalent in the tonsillar surface cultures of children with obstructive tonsillar hypertrophy . The bacterial density was high but not significantly different in both groups of children . The similar microbial composition and density of both groups and the higher rate of S pyogenes recovery may signify a subclinical disease or normal flora in children with obstructive tonsillar hypertrophy.

Eur J Epidemiol, 1989 Jun, 5(2), 199 - 201
Detection of IgA protease from Haemophilus influenzae by immunoblotting; Tsuji T et al.; IgA protease produced by various strains of Haemophilus influenzae can digest serum IgA and yield its fragments which can react with anti-IgA serum . We assayed IgA protease activity by detecting the digests of IgA by SDS-PAGE and immunoblotting . The digests were separated with SDS-PAGE, transferred to nitrocellulose membranes and detected with anti- (alpha chain of human IgA, its Fab and its Fc) immunoglobulin conjugated peroxidases . Using this method, we can determine which type of IgA protease is produced by various of H . influenzae strains . All the 20 strains isolated from respiratory tracts produced IgA protease.

FEMS Microbiol Immunol, 1989 Jun, 1(6-7), 357 - 62
Relationship between secretion of the Anton blood group antigen in saliva and adherence of Haemophilus influenzae to oropharynx epithelial cells; van Alphen L et al.; Inhibition of adherence of bacteria to epithelial cells contributes to a reduction of infections by these bacteria . We have shown that the Anton blood group antigen, the erythrocyte receptor for Haemophilus influenzae (van Alphen et al . 1986, FEMS Microbiol . Lett . 37, 69-71), occurs in saliva, that the occurrence is not related to the secretor state of the donor of the saliva and that saliva containing Anton antigen could not inhibit the adherence of H . influenzae to oropharynx epithelial cells . Anton antigen was detected in saliva samples of 14 donors by immunoblotting with two different anti-Anton sera . The amount of Anton antigen correlated with the ability of H . influenzae to adhere to the epithelial cells of the donor of the saliva: 4.1 +/- 0.1 Anton antigen units for donors with more than 50 H . influenzae per cell and 1.6 +/- 0.5 units for donors with less adhering epithelial cells . No correlation between the amount of Anton antigen in saliva and secretor status of the donor was observed . Adherence of H . influenzae to epithelial cells was not inhibited by saliva of secretors (N = 11) or non-secretors (N = 3) . The same saliva did not inhibit the interaction of the bacteria with Anton antigen bearing erythrocytes as measured by haemagglutination inhibition . This indicates that the amount of Anton antigen in saliva is probably too low to interfere with the interaction of H . influenzae with oropharynx epithelial cells and erythrocytes.

J Med Microbiol, 1989 Jun, 29(2), 121 - 30
Identification of the transferrin- and lactoferrin-binding proteins in Haemophilus influenzae; Schryvers AB; An affinity procedure with purified, biotinylated human transferrin and streptavidin-agarose was used to identify the transferrin-binding proteins in strains of Haemophilus influenzae . Proteins of 58 and 98 Kda were isolated from total membranes prepared from iron-deficient but not iron-sufficient H . influenzae KC548 cells . The 58-Kda protein was capable of binding human transferrin after sodium dodecyl sulphate (SDS)-polyacrylamide gel electrophoresis (PAGE) and electroblotting . Isolation of transferrin-binding proteins from type-b and non-typable H . influenzae strains demonstrated some variability in the size of the higher mol . wt protein (94-106 Kda) and in ease of elution of the smaller protein from the affinity resin . Use of purified, biotinylated human lactoferrin in the affinity isolation procedure with membranes from a strain expressing lactoferrin-binding activity resulted in isolation of proteins of 105 and 106 Kda distinct from the transferrin-binding proteins.

J Clin Microbiol, 1989 Jun, 27(6), 1187 - 91
Serotype-related differences in production and type of heat-labile hemolysin and heat-labile cytotoxin of Actinobacillus (Haemophilus) pleuropneumoniae; Kamp EM et al.; Reference strains of serotypes 1 to 12 of Actinobacillus (Haemophilus) pleuropneumoniae were cultured in Eagle minimal essential medium with 10% Serum Plus . Culture supernatants were examined for cytotoxicity to alveolar macrophages and for the ability to hemolyze sheep erythrocytes . All strains except the reference strain of serotype 6 produced cytotoxin, whereas only serotypes 1, 5, 9, 10, and 11 produced hemolysin . Both cytotoxin and hemolysin appeared to be heat labile . Antisera were raised against cytotoxin- and hemolysin-containing culture supernatants of serotypes 1 to 11 . Cross-neutralization studies revealed that the hemolysins were serologically homogeneous . In contrast, four serologically different cytotoxins were distinguished . One cytotoxin was produced by serotypes 1, 5, 9, and 11, and a second was produced by serotypes 2, 3, 4, and 8 . A third cytotoxin was produced by serotypes 7 and 12; this cytotoxin was related to the cytotoxins of serotypes 1, 2, 4, 5, 9, and 11 . A fourth cytotoxin, produced by serotype 10, was related to the cytotoxin of serotypes 1, 5, 9, and 11 . Seventy field strains belonging to serotypes 2, 3, 7, 8, 9, and 11 were also tested for production of cytotoxin and hemolysin . All strains belonging to serotypes 9 and 11 produced hemolysin and cytotoxin, whereas all strains of serotypes 2, 3, 7, and 8 produced only cytotoxin . Hemolysins and cytotoxins of both the field strains and the corresponding serotype reference strains were comparably neutralized . These findings strongly suggest that the observed differences in production and type of hemolysin and cytotoxin were related to serotype and not to strain.

Taiwan Yi Xue Hui Za Zhi, 1989 Jun, 88(6), 610 - 6
Branhamella catarrhalis pneumonia: report of 4 cases; Yen MY et al.; This is the first time Branhamella Catarrhalis has been identified as a lower respiratory tract pathogen in Taiwan . All 4 patients with B . catarrhalis pneumonia reported herein had a certain degree of underlying pulmonary dysfunction . Two patients had pure B . catarrhalis infection, whilst the other two had concomitant infections with Haemophilus influenzae or Viridans streptococci . Amongst the 3 strains of B . catarrhalis examined, all were capable of producing beta-lactamase . By using the Kirby-Bauer method, 2 of these strains were observed as penicillin resistant . Therefore, patients with poor clinical response to penicillin, ampicillin, and cephapirin were treated effectively with trimethoprim/sulfamethoxazole or ofloxacin . B . catarrhalis should no longer be regarded as a normal flora of the sputum in patients with lower respiratory tract infections . Beta-lactamase production should be tested for each isolated strain to avoid failure of penicillin therapy due to bacterial resistance.

Microb Pathog, 1989 Jun, 6(6), 425 - 32
Identification of a maltose-inducible major outer membrane protein in Actinobacillus (Haemophilus) pleuropneumoniae; Deneer HG et al.; The addition of maltose to the growth media of Actinobacillus pleuropneumonia (serotype 1) resulted in the induction of an outer membrane protein (OMP) with a molecular mass of 42 kDa . This protein had porin-like properties in that it was peptidoglycan-associated and was resistant to proteolysis by trypsin . A pleuropneumoniae expressing the 42 kDa OMP were unable to bind lambda phage . Similar proteins were also induced in A . pleuropneumoniae isolates representing serotypes 2 to 7 with the exception of serotype 4; however, not all isolates of any given serotype expressed a maltose-inducible OMP . Western immunoblotting using convalescent antiserae against the serotype 1 A . pleuropneumoniae indicated that the 42 kDa OMP was expressed in vivo and was cross-reactive with the maltose-inducible OMPs from other serotypes.

Tijdschr Diergeneeskd, 1989 May 15, 114(10), 551 - 6
{Serologic studies on the presence of antibodies against Haemophilus (Actinobacillus) pleuropneumoniae at swine breeding farms in North Brabant}; Hunneman WA et al.; Serological screening for the presence of antibodies to both H . pleuropneumoniae serotype 2 and serotype 9 using the complement fixation test was carried out on twenty-nine piglets production farms of an integrated group in the province of North Brabant . Antibodies to H . pleuropneumoniae serotype 2 and serotype 9 were not detected on six of the twenty-nine farms when a single screening was performed . The proportions of farms with animals serologically positive in regard to serotypes 2 and 9 were 59 and 34 per cent respectively . Of the specimens on farms with seropositive animals, those positive for serotype 2 averaged 13 per cent, those positive for antibodies to serotype 9 averaging 9 per cent . When a re-examination was made within two months after the first screening, animals showing antibodies to serotype 2 or serotype 9 were present on three of the six pig-breeding farms which were negative for these antibodies at first examination . When a third investigation was carried out within two months after the re-examination, antibodies to serotypes 2 or 9 were also detected on the remaining farms which were negative for antibodies in the two previous investigations.

Tidsskr Nor Laegeforen, 1989 May 10, 109(13), 1408 - 11
{Guidelines for the diagnosis and treatment of meningococcal disease at hospitals}; Autoradiographic localization of changes in pulmonary beta-adrenoceptors in an animal model of atopy; Department of Veterinary Pharmacology, University of Utrecht, The NetherlandsVaccination of guinea pigs with Haemophilus influenzae leads to an impairment of beta-adrenoceptor function in lung . We have used an autoradiographic technique to study the distribution of changes in lung beta-adrenoceptor density . H . influenzae induced a decrease in beta-adrenoceptors in peripheral lung membranes of 22 +/- 5% (mean +/- S.E.M., n = 7), while the affinity of binding was unaffected . Tracheal beta-adrenoceptor binding was not influenced by H . influenzae . Autoradiography revealed a 27% reduction in beta-adrenergic binding sites on alveolar septa . Bronchial epithelial beta-adrenoceptors were decreased for 36%, and vascular smooth muscle and endothelial beta-adrenoceptors were also reduced . beta-Adrenoceptors on airway smooth muscle were unaffected . H . influenzae affected both the beta 1- and beta 2-subtypes of receptors . It is concluded that in this animal model of atopy beta-adrenoceptors may be decreased on several different cell types within the lungs, which may influence overall airway and vascular reactivity.

Diagn Microbiol Infect Dis, 1989 May-Jun, 12(3), 257 - 60
The use of cefepime (BMY 28142) to treat respiratory infections; Clynes N et al.; Cefepime, an aminothiazolyl cephalosporin active against Gram-positive and Gram-negative bacteria, was used at a dose of 1 g every 12 hours to treat respiratory and other infections in 29 patients . All 19 patients from whom an organism was cultured responded clinically and microbiologically . The patients had underlying risk factors of human immune virus positive status, 58%, and chronic lung disease, 19% . Cefepime was well tolerated . Organisms eradicated included Streptococcus pneumoniae and Haemophilus influenzae . Further study will define cefepime's role in hospital-acquired respiratory infection.

Pathol Biol (Paris), 1989 May, 37(5), 390 - 3
{Comparison of the in vitro activity of amoxycillin + clavulanic acid and ampicillin + sulbactam combinations against 50 Haemophilus influenzae strains producing beta lactamase}; Moittie D et al.; We compared the ability of two beta lactamase inhibitors, clavulanic acid and sulbactam, to reduce the minimal inhibitory concentrations (MICs) respectively of amoxycillin and ampicillin against fifty strains of Haemophilus influenzae producing a beta lactamase . The reduction of MICs of aminopenicillins was studied using low concentrations of beta lactamase inhibitors (0.125 to 0.5 mg/l) . Moreover, the synergic effect of each association was evaluated against a heavy bacterial inoculum (10(8) cfu/ml) . The combination of amoxycillin + clavulanic acid was more synergic on these strains than the association of ampicillin + sulbactam.

J Clin Microbiol, 1989 May, 27(5), 1132 - 4
Gardnerella vaginalis bacteremia from pulmonary abscess in a male alcohol abuser; Legrand JC et al.; A case of Gardnerella vaginalis bacteremia is reported . This bacteremia occurred in a male alcohol abuser who developed definite signs of pulmonary abscess and empyema . Streptococcus milleri grew from another blood culture, but Gardnerella vaginalis was also isolated from a bronchoscopic aspirate and pleural drainage sample as part of mixed flora containing anaerobes, Streptococcus species, Neisseria sicca, and a Haemophilus sp . We discuss the possible pathogenic character of G . vaginalis outside the genital tract from a review of the literature.

Immunology, 1989 May, 67(1), 87 - 91
Antibody to the outer membrane proteins is the dominant opsonic antibody in normal human serum against H . influenzae type b; Hetherington SV; We hypothesized that the predominant opsonic antibody of normal serum is directed against outer membrane proteins (OMP) . Sera from 10 normal adults were tested for their opsonic capacity against Haemophilus influenzae b (Eagan strain) by the luminol-enhanced neutrophil chemiluminescence elicited on incubation with serum-opsonized bacteria, and the ability to deposit C3 on the bacterial surface . Peak chemiluminescence correlated with the amount of C3 on the bacterial surface (r = 0.71, P less than 0.025) and this, in turn, correlated with the concentration of IgG directed against outer membrane proteins, (r = 0.75, P less than 0.01), but not with the concentration of anticapsular polysaccharide antibody . Two groups of sera were easily distinguished based on the chemiluminescence experiments: a high opsonic group (greater than 50,000 peak counts per second; c.p.s.) and a low opsonic group (less than 10,000 c.p.s.) . The IgG fraction from the high opsonic sera could augment C3 deposition when added to a low opsonic serum, but could not after absorption of the anti-OMP antibody by affinity chromatography . We conclude that the predominant opsonin of normal serum is antibody to outer membrane proteins, a finding which could be significant for the development of future vaccines against H . influenzae b.

J Pediatr, 1989 May, 114(5), 742 - 7
Decline in serum antibody to the capsule of Haemophilus influenzae type b in the immediate postimmunization period; Daum RS et al.; STUDY OBJECTIVE: To determine what change, if any, occurs in the serum anticapsular antibody concentration immediately after immunization with either Haemophilus influenzae type b capsular polysaccharide vaccine (PRP) or a vaccine consisting of the capsular polysaccharide conjugated to diphtheria toxoid (PRP-D) . SETTING AND PATIENTS: Children: a convenience sample of 32 healthy 2-year-old children from diverse locales . Adults: a convenience sample of 16 healthy adults chosen from employees at the Washington University and Tulane University schools of medicine . INTERVENTIONS: PRP or PRP-D vaccine administered to the adults and serum obtained daily for 5 days . PRP vaccine was administered to the children, and serum was sampled 2 or 3 days or 4 or 5 days after immunization, or both . MEASUREMENTS AND MAIN RESULTS: Decline in serum antibody in all seven (100%) adult recipients of PRP . The nadir occurred on days 1 to 3, and the decrease average 26.0% of the preimmunization concentration . Eight (89%) of nine PRP-D recipients had a similar decline that averaged 25.9% . Of 29 children, 20 (69%) had a decline that averaged 14.7% . The magnitude of anticapsular antibody present before immunization was correlated with the magnitude of the observed decrease . CONCLUSIONS: A decrease in serum anticapsular antibody occurs in most children and adults immunized with PRP (adults and children) or PRP-D (adults) . Such a decrease might transiently increase the risk of invasive disease if it occurred during a period of asymptomatic colonization with H . influenzae type b.

Arch Surg, 1989 May, 124(5), 625 - 8
Splenectomy . The treatment of choice for human immunodeficiency virus-related immune thrombocytopenia?
Ravikumar TS, Allen JD, Bothe A Jr, Steele G Jr.
Immune thrombocytopenia is a well-recognized part of the clinical spectrum of infection with the human immunodeficiency virus . From November 1985 to February 1988, 15 patients who were human immunodeficiency virus-positive underwent splenectomy for refractory immune thrombocytopenia . Eight patients had thrombocytopenia only, and 7 others were pancytopenic prior to splenectomy . Three of the 15 patients fulfilled criteria for acquired immunodeficiency syndrome before splenectomy, and acquired immunodeficiency syndrome developed in 5 patients during the follow-up period . The median duration of thrombocytopenia prior to surgical therapy was 6 months . A bone marrow biopsy specimen showed hypercellularity with increased megakaryocytes . All patients had a therapeutic response to splenectomy . Long-term remission from thrombocytopenia/pancytopenia was achieved in 14 of the 15 patients during a follow-up period of 2 to 21 months . Splenectomy can be accomplished with an acceptable morbidity . Pneumonia developed postoperatively in 2 patients, but they did not manifest the characteristic picture of overwhelming postsplenectomy sepsis . They had received vaccinations against encapsulated organisms preoperatively . We conclude that splenectomy provides a durable and lasting response for HIV-related thrombocytopenia . Vaccination for Streptococcus pneumonia and Haemophilus influenzae should be given prior to splenectomy although its efficacy is not clear in this group.

J Infect Dis, 1989 May, 159(5), 908 - 16
Host and bacterial factors associated with Haemophilus influenzae type b disease in Minnesota children vaccinated with type b polysaccharide vaccine; Granoff DM et al.; Host and bacterial factors were evaluated among 86 Minnesota children with Haemophilus influenzae type b disease detected by active surveillance after introduction of type b polysaccharide vaccine in the state . Children were 2-6 y of age . Thirty-three (38%) had been vaccinated . There was no significant difference between the frequency of low serum concentrations of IgM, IgA, IgG, or IgG2 in the vaccinated and nonvaccinated subjects (13% vs . 8%, P = .5) . The presence of the Gm immunoglobulin allotype phenotype (1,3,17;23;5,13,21), previously associated with a lower relative risk of vaccine failure in children from other states, was associated with a fourfold decrease in the relative risk of vaccine failure in Minnesota (P less than .07) . Haemophilus isolates from 58 of the children were available for clonal characterization by multilocus electrophoresis and outer membrane protein subtyping . There were no significant differences between the clone distribution of the strains causing disease in vaccinated and nonvaccinated patients, and nearly all disease-producing clones in Minnesota also are known to cause disease in other areas of the country . Thus, vaccine failure in Minnesota is infrequently associated with hypogammaglobulinemia or with infection by unusual clones of a H . influenzae type b . Also, the Gm phenotype associated with protection against vaccine failure in other areas of the USA appears to be protective in Minnesota.

J Bacteriol, 1989 May, 171(5), 2474 - 9
Size and physical map of the chromosome of Haemophilus influenzae; Kauc L et al.; A variation of pulse-field electrophoresis, field-inversion gel electrophoresis, was used to determine the size and physical map of the chromosome of Haemophilus influenzae . The DNA of H . influenzae had a low G + C content (39%) and no restriction sites for the enzymes NotI or SfiI . However, a number of restriction enzymes (SmaI, ApaI, NaeI, and SacII) that recognized 6-base-pair sequences containing only G and C nucleotides were found to generate a reasonable number of DNA fragments that were separable in agarose gels by field-inversion gel electrophoresis . The sizes of the DNA fragments were calibrated with a lambda DNA ladder and lambda DNA restriction fragments . The sum of fragment sizes obtained with restriction digests yielded a value for the chromosome of 1,980 kilobase pairs . Hybridization of a labeled fragment with two or more fragments from a digest with a different restriction enzyme provided the information needed to construct a circular map of the H . influenzae chromosome.

J Antimicrob Chemother, 1989 May, 23(5), 737 - 41
Roxithromycin in the treatment of pneumonia; Peterslund NA et al.; An open multicentre study of the efficacy and side effects of roxithromycin, a new macrolide antibiotic, in the treatment of community acquired pneumonia was undertaken . The diagnosis was verified by transtracheal aspiration . Fifty-three patients were studied . In the 49 patients evaluable the clinical efficacy rate was 92% (95% confidence limits 84-100%) . Only by measurement of the fall in serum C-reactive protein was it possible to detect a difference in response between pneumonia due to Streptococcus pneumoniae and Haemophilus influenzae . The drug was well tolerated clinically and laboratory abnormalities included transient eosinophilia and elevated liver enzymes in two patients.

Jpn J Antibiot, 1989 May, 42(5), 1216 - 32
{Antimicrobial activity of cefteram comparison with other oral antibiotics}; Deguchi K et al.; Antimicrobacterial activities of cefteram (CFTM) against clinical isolates collected in 1988 were compared with those of new beta-lactams . 1 . Antibacterial activities of CFTM against Streptococcus pneumoniae, Streptococcus pyogenes, Haemophilus influenzae, Branhamella catarrhalis isolated from acute respiratory tract infections were 8- to 16-fold higher than those of cefaclor (CCL) . 2 . Activities of cefixime (CFIX) were superior to those of CFTM against B . catarrhalis, Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis, but were inferior to CFTM against S . pneumoniae, S . pyogenes, Staphylococcus saprophyticus and Staphylococcus aureus . 3 . Activities of cefuroxime were superior to those of CCL against each of the 4 tested bacterial species from acute respiratory tract infection and S . aureus by 4-fold, but were inferior to CFTM and CFIX against most of Gram-negative rods . 4 . Sultamicillin (SBTPC) is considered to have an activity to inhibit beta-lactamase, but its MICs did not exceed the MICs of ampicillin by itself . SBTPC showed poor antibacterial activities against methicillin-resistant S . aureus (MRSA) . Considering these observations, it is apparent that we are faced with a variety of factors in selecting antibiotics for best results.

Res Vet Sci, 1989 May, 46(3), 424 - 5
Genetic homogeneity of Actinobacillus seminis isolates; McGillivery DJ et al.; Isolates of Actinobacillus seminis from clinical cases and reference sources had markedly similar Bam H1 restriction endonuclease profiles but were readily distinguishable from the Bam H1 profiles of the Histophilus-Haemophilus group as well as from A lignieresii . For epidemiological purposes this lack of interstrain variation in Bam H1 profiles makes restriction endonuclease analysis of isolates of A seminis unsuitable.

Infection, 1989 May-Jun, 17(3), 165 - 7
In-vitro activity of lomefloxacin (SC-47111) and other quinolones; Sun ZM et al.; The in vitro activity of lomefloxacin, a new difluorinated quinolone, was compared to that of ciprofloxacin, ofloxacin, norfloxacin and other relevant antibacterial agents . Lomefloxacin and norfloxacin shared similar activity, whereas ofloxacin and in particular ciprofloxacin showed superior activity . Most gram-negative aerobes were susceptible to all four quinolones, 90% of isolates were inhibited by 1 mg/l . The gram-positive organisms were generally less susceptible, although 90% of Staphylococcus aureus isolates were inhibited by 0.5 mg/l of ciprofloxacin and ofloxacin; values for lomefloxacin and norfloxacin were 1 mg/l and 2 mg/l, respectively; susceptibility was not affected by methicillin resistance . Neisseria gonorrhoeae and Haemophilus influenzae were highly susceptible to the quinolones, especially ciprofloxacin . Penicillin/ampicillin-resistant isolates remained susceptible to the quinolones.

APMIS, 1989 May, 97(5), 395 - 405
Differentiation of some species of Neisseriaceae and other bacterial groups by DNA-DNA hybridization; Tonjum T et al.; DNA-DNA hybridization using total genomic DNA probes may represent a way of differentiating between miscellaneous bacterial species . This was studied with type and reference strains of 20 species in Moraxella, Kingella, and other selected Gram-negative groups . Both radioactive and biotin labelling were employed . Most of the species examined were easily distinguished, such as Moraxella (Branhamella) catarrhalis, M.(B.) ovis, M . atlantae, M . phenylpyruvica, M . osloensis, Neisseria elongata, N . meningitidis, Kingella kingae, K . indologenes, K . dentrificans, Oligella urethralis, Eikenella corrodens, Cardiobacterium hominis, Haemophilus aphrophilus, Actinobacillus actinomycetemcomitans, Gardnerella vaginalis, and DF-2 . This reflected the extent of the genetic distances between them as a basis for identification by hybridization . There was some clustering in the Moraxella group . Especially the closely related Moraxella nonliquefaciens, M . lacunata and M . bovis showed strong hybridization affinities . This leads to potential problems in distinguishing these three species from each other by DNA-DNA hybridization with total genomic probes alone.

Pathol Biol (Paris), 1989 May, 37(5), 358 - 63
{In vitro antibacterial activity of a new macrolide, miokamycin . Results of a multicenter study}; Soussy CJ et al.; Minimal inhibitory concentration (MIC) of miokamycin (M) were evaluated by agar dilution for 1,024 bacterial strains isolated in 6 hospitals and classed as a function of susceptibility and resistance to macrolides, lincosamides, streptogramins group (MLS) . MIC of M ranged from 0.25 to 4 micrograms/ml (mode MIC 1-2) on Staphylococcus susceptible to MLS and on MLSB inducible strains; M was inactive on MLSB constitutive strains . MIC of M ranged from 0.016 to 4 micrograms/ml (mode MIC 0.12 to 0.5) for Streptococci and Pneumococci susceptible to erythromycin (E) and from 0.12 to greater than 128 for strains resistant to E . Enterococci susceptible to E were inhibited by 0.5 to 2 micrograms/ml (mode MIC 1) and strains resistant to E by 4 to greater than 128 . Haemophilus were inhibited by 2 to 64 micrograms/ml (mode MIC 32), Neisseria by 0.12 to 4 (mode MIC 0.5-1) and B . catarrhalis by 0.12 to 8 (mode MIC 1) . L . pneumophila was very susceptible to M: MIC 0.016 to 0.12 (mode MIC 0.06) . MIC of M ranged generally from 0.5 to 2 micrograms/ml (mode MIC 1) for C . perfringens and from 0.03 to 2 (mode MIC 1) for B . fragilis . Thus, M was shown to be among macrolide antibiotics of resistance non-inducing type on MLSB inducible resistance strains . Its activity was similar to that of spiramycin slightly superior on Staphylococci, slightly inferior on Streptococci and Enterococci, similar on Pneumococci, very superior on Neisseria, Legionella and anaerobes . M had a good activity on Branhamella and, as others macrolides, was poorly active on Haemophilus.

Rev Infect Dis, 1989 May-Jun, 11 Suppl 3, S588 - 97
Epidemiology and prospects for prevention of disease due to Haemophilus influenzae in developing countries; Munson RS Jr et al.; Haemophilus influenzae is an important cause of meningitis and severe cases of lower respiratory infection (LRI) in children in developing countries . In children with meningitis, H . influenzae type b organisms are the most frequently encountered serotype, but in some countries type a strains are also implicated . In children with LRI, type b organisms are also important, but the proportion of organisms with other serotypes and non-typable strains is greater than that associated with cases of meningitis . In developing countries, nearly all cases of H . influenzae meningitis and a substantial fraction of cases of LRI occur in children younger than one year of age . This age distribution is younger than that seen in the continental United States, where more than one-half of the cases of invasive H . influenzae disease are in children older than one year of age . New type b polysaccharide-protein conjugate vaccines are immunogenic in infants as young as two months of age and offer the promise of preventing H . influenzae type b disease in infants younger than one year of age . However, for developing countries, more complete data defining the populations at risk, the immunogenicity of candidate vaccines in children in different geographic regions, and the serotypes of the infecting organisms will be needed before successful cost-effective vaccination strategies can be devised and implemented.

J Clin Microbiol, 1989 May, 27(5), 1055 - 61
Activities and sources of beta-lactamase in sputum from patients with bronchiectasis; Dragicevic P et al.; beta-Lactamase activity was measured in secretions from patients with bronchiectasis . Of 28 sputum samples, 23 contained measurable amounts of activity; values were significantly higher (P less than 0.01) in purulent samples than in mucoid or mucopurulent samples . beta-Lactamase activity was usually present in saliva collected before and between sputum expectorations, although values for sputum were higher than for either group of saliva samples (P less than 0.025 and P less than 0.005, respectively) . This difference suggests that at least part of sputum beta-lactamase activity originates in the bronchial tree . Detailed microbiological study of a further eight specimens (seven were beta-lactamase positive) led to the isolation of Haemophilus influenzae from six, although only two of these isolates were beta-lactamase positive . Several other beta-lactamase-producing organisms were also isolated, including Staphylococcus aureus (n = 3), Escherichia coli (n = 1), Proteus spp . (n = 1), and Bacteroides spp . (n = 3) . Size-exclusion high-performance liquid chromatography of the sputum showed several peaks of beta-lactamase activity which usually coeluted in fractions similar to those of their beta-lactamase-positive isolates . Therefore, sources of sputum beta-lactamases are often bacteria not considered truly pathogenic or not isolated during routine bacteriological assessment . These observations should be considered when embarking on antimicrobial therapy in bronchiectatic patients and suggest that increased dosages of penicillins are indicated.

Clin Ther, 1989 May-Jun, 11(3), 304 - 14
Comparison of once-daily cephalosporin regimens for community-acquired lower respiratory tract infections in patients with chronic lung disease; McCabe RE et al.; The efficacy of cefonicid and of ceftriaxone, administered once daily for the treatment of lower respiratory tract bacterial infections (pneumonia or bronchitis), was evaluated and compared in 118 patients with chronic lung disease . The patients were randomly assigned to receive 1 gm of either drug, intravenously or intramuscularly, daily for three to 11 days (mean, seven days) . Pathogenic bacteria were isolated from sputum in 59% of patients; Haemophilus influenzae and Streptococcus pneumoniae predominated . Clinical cure or improvement was noted in 95% and 93% of patients treated with cefonicid and ceftriaxone, respectively, and bacteriologic cure or improvement in 69% and 81% (the differences were not significant) . Side effects were infrequent and similar in the two treatment groups, except that diarrhea was more common in the ceftriaxone group (11%, versus 4.4% in the cefonicid group) . It is concluded that patients with chronic lung disease who experience acute exacerbations associated with infection caused by H influenzae or S pneumoniae, or other susceptible organisms, can be effectively treated with once-daily administration of either cefonicid or ceftriaxone.

Pediatr Infect Dis J, 1989 May, 8(5), 297 - 302
Epidemiology of invasive Haemophilus influenzae type b disease among children in Finland before vaccination with Haemophilus influenzae type b conjugate vaccine; Takala AK et al.; On the basis of intensified surveillance in Finland we report the epidemiology of invasive Haemophilus influenzae type b disease based on 333 consecutive culture-proved cases recorded during 1985 and 1986 . The annual incidence rate among children younger than 5 years of age was 52/100,000; 46% of patients had meningitis, 29% had epiglottitis and 25% had other forms of invasive disease . The median age of patients was 27 months, with 45% younger than 2 years of age . Meningitis and epiglottitis were found more often among boys than among girls, whereas the opposite was found among patients with other types of invasive disease (P = 0.015) . Among the latter 68% of children with pneumonia or septicemia were 2 years or older compared with 32% of patients with arthritis, cellulitis or pyelonephritis (P = 0.009) . These background data are essential for correct interpretation and application of results from trials with H . influenzae type b conjugate vaccines that are currently ongoing in Finland.

Pediatr Infect Dis J, 1989 May, 8(5), 287 - 90
Systemic antibiotics for treatment of the conjunctivitis-otitis media syndrome; Bodor FF; In a private pediatric practice setting 114 episodes of conjunctivitis-otitis syndrome were treated with orally administered antibiotics . In 108 (95%) of these infections Haemophilus influenzae was isolated from the pretreatment cultures of the conjunctivae; 61 were susceptible and 47 (44%) were resistant to ampicillin by a disc diffusion technique . Six cultures grew Streptococcus pneumoniae, all ampicillin-susceptible . Symptoms of conjunctivitis disappeared in 2 to 3 days in all but one patient . Of the 48 follow-up conjunctival cultures 3 to 5 days after start of therapy, 46 grew no pathogens.

J Antimicrob Chemother, 1989 May, 23(5), 743 - 51
Azithromycin (CP-62,993) in acute exacerbations of chronic bronchitis: an open clinical, microbiological and pharmacokinetic study; Davies BI et al.; A group of 21 patients admitted to hospital with acute purulent exacerbations of chronic bronchitis was treated for five days with a new oral macrolide azithromycin . They received one dose of 500 mg on the first day, followed by 250 mg once daily thereafter . Pre-treatment sputum cultures were typical for this district, but the cultures during and after treatment showed many Haemophilus influenzae infections persisting . Geometric mean MICs of azithromycin for these organisms rose from 1.23 mg/l (pre-treatment) to 4.87 mg/l, a week after the end of treatment . The mean MICs for erythromycin also rose four-fold . Streptococcus pneumoniae and Branhamella catarrhalis strains were effectively eradicated . Pharmacokinetic studies on serum and sputum from the first treatment day showed relatively low serum Cmax values, averaging 0.63 mg/l, but with considerable individual variation . However, peak sputum concentrations averaged 3.7 mg/l . Nevertheless, the clinical and microbiological results were not encouraging because of the failure to eradicate H . influenzae with the drug dosage used in this study.

J Infect Dis, 1989 May, 159(5), 923 - 30
Invasion of the inner ear by Haemophilus influenzae type b in experimental meningitis; Kaplan SL et al.; Bacterial interstrain variation for cochlear invasion was studied by intraperitoneal inoculation of infant rats with Haemophilus influenzae type b . Eight pairs of CSF isolates from children with or without deafness due to meningitis were injected into half of each litter in separate experiments . At 48 h, quantitative CSF culture results and CSF white blood cell counts were equivalent for the two groups . Organisms within the cochlea were detected in four of eight animals in each group . There was no difference between the deaf and nondeaf isolates in the degree or frequency of inner ear inflammation in formalin-fixed sections . In separate experiments, animals were inoculated with H . influenzae type b and 24 h later treated with ampicillin, or ampicillin plus dexamethasone . At 48 h, although CSF white blood cell counts were significantly reduced in the steroid group, no difference was noted in the degree of cochlear inflammation between the two groups . The ability of H . influenzae type b to invade the inner ear of infant rats does not correlate with the development of sensorineural deafness in children following H . influenzae type b meningitis . Steroid administration does not appear to diminish the inflammatory reaction within the cochlea more than antibiotics alone in this model, but may delay CSF sterilization by ampicillin.

Diagn Microbiol Infect Dis, 1989 May-Jun, 12(3 Suppl), 83S - 86S
In vitro activity of lomefloxacin against Chlamydia trachomatis, Neisseria gonorrhoeae, Haemophilus ducreyi, Mycoplasma hominis, and Ureaplasma urealyticum; Hoban D et al.; The in vitro activity of lomefloxacin, a new difluorinated quinolone antimicrobial was compared to comparative agents against organisms causing sexually transmitted diseases . Against Chlamydia trachomatis, Mycoplasma hominis, Ureaplasma urealyticum, Neisseria gonorrhoeae, and Haemophilus ducreyi, lomefloxacin exhibited MIC90 of 2.0, 8.0, 8.0, less than or equal to 0.015, and 0.003 micrograms/ml, respectively . Overall, the lomefloxacin activity was very similar to ciprofloxacin.

Rev Clin Esp, 1989 May, 184(8), 399 - 400
{Branhamella catarrhalis in respiratory infections}; Marin Casanova P et al.; Given the increasing interest that Branhamella catarrhalis is acquiring as a possible pathogen of the respiratory tract, we have studied 81 sputum samples of patients with respiratory problems with the aim of evaluating its clinical significance . In 22 of these patients (27.2%) the implication of B . catarrhalis could be established, either as a primary pathogen (40.9%) or in association with other pathogens, especially with Haemophilus influenzae (36.4%) . Chronic bronchitis and bronchopneumonia were the clinical manifestations more frequently associated with B . catarrhalis . 79.0% of the strains were beta-lactamase producers, although only 58.0% of them were resistant to ampicillin.

Kansenshogaku Zasshi, 1989 May, 63(5), 471 - 8
{Fundamental studies on rapid detection of Haemophilus influenzae by enzyme-linked immunosorbent assay (ELISA)}; Hoshino H et al.; To establish a rapid method for detection of Haemophilus influenzae, an antiserum against H . influenzae (Anti-HibOMP) was prepared by immunization of rabbits with crude outer membrane proteins (OMP) of H . influenzae type b . Various isolates of H . influenzae including typable and nontypable strains and other species were tested by ELISA and Western blot assay with Anti-HibOMP . The results are as follows: 1 . Anti-HibOMP reacted to all of the OMPs from 18 H . influenzae isolates which contained typable and nontypable strains by Western blot assay . Molecular weights of these OMPs were about 24, 27, 31, 34, 39 and 45 kilo-dalton . This result suggests that all H . influenzae isolates have identical antigenic proteins on their outer membranes . 2 . It was found that 172 out of 179 (96%) culture suspensions of H . influenzae isolates including 66 typable and 113 nontypable showed positive result by ELISA with Anti-HibOMP . 3 . To define the cross-reactivity of Anti-HibOMP, 20 species (111 isolates) other than H . influenzae were tested by the ELISA . All isolates were negative with exception of a portion of H . parainfluenzae and Staphylococcus aureus producing Protein A . The cross-reactions to H . parainfluenzae and S . aureus were removed by absorption of Anti-HibOMP with formalinized cells of H . parainfluenzae and reduction of the antibody to F(ab)2 with pepsin digestion respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Antimicrob Agents Chemother, 1989 May, 33(5), 612 - 4
Evaluation of fleroxacin (RO 23-6240) as single-oral-dose therapy of culture-proven chancroid in Nairobi, Kenya; MacDonald KS et al.; Chancroid is gaining importance as a sexually transmitted disease because of its association with transmission of human immunodeficiency virus type 1 (HIV-1) . Effective, simply administered therapy for chancroid is necessary . Fleroxacin is effective against Haemophilus ducreyi in vitro . We performed an initial randomized clinical trial to assess the efficacy of fleroxacin for treatment of chancroid in Nairobi, Kenya . Fifty-three men with culture-positive chancroid were randomly assigned to receive either 200 mg (group 1) or 400 mg (group 2) of fleroxacin as a single oral dose . Groups 1 and 2 were similar with regard to severity of disease, bubo formation, and HIV-1 status . A satisfactory clinical response to therapy was noted in 23 of 26 patients (88%) in group 1 and 18 of 23 patients (78%) in group 2 . Bacteriological failure occurred in 1 of 26 evaluable patients (4%) in group 1 and 4 of 23 evaluable patients (17%) in group 2 . Two of 37 HIV-1-seronegative men (5%) and 3 of 11 HIV-1-infected men (27%) were bacteriological failures . Fleroxacin, 200 or 400 mg as a single oral dose, is efficacious therapy for microbiologically proven chancroid in patients who do not have concurrent HIV-1 infection . Among HIV-1-infected men, a single dose of 200 or 400 mg of fleroxacin is inadequate therapy for chancroidPIP: In Kenya, researchers enrolled 53, men aged 18-60 years with chancroid who enrolled at the Nairobi City Council Special Treatment Clinic in a clinical trial to test the efficacy of fleroxacin in clinical Haemophilus ducreyi infections . They randomly allocated the men the group receiving 200 mg of oral fleroxacin or the group receiving 400 mg of oral fleroxacin . 88% of the men receiving 200 mg oral fleroxacin (group 1) experienced either improvement in their clinical status or healing compared to 78% of the men receiving 400 mg oral fleroxacin . 2 of 7 (29%) patients who experienced delayed healing tested positive for HIV-1 . 2 of 22 patients (9%) who healed right away were HIV-1 positive . The size of the genital ulcer had the most significant effect on healing time . The mean widest ulcer diameter was 9.5 mm in men who healed quickly while it was 18.5 mm in men who experienced a delay in healing (p .005) . Microbiological cure occurred in 92% of men from group 1 and in 83% of those in group 2 . The difference in microbiological failure rates of HIV-1 seropositive men and HIV-1 seronegative men approached significance (27% vs . 5%; p = .07) . These results showed that a 200 or 400 mg single dose of oral fleroxacin is an efficacious treatment for men with microbiologically confirmed chancroid who are not HIV-1 infected . On the other hand, a single dose of neither 200 or 400 mg of oral fleroxacin adequately treats chancroid in HIV-1 infected men . Further study of chancroid treatment in HIV infected patients is needed, especially since chancroid may facilitate HIV transmission .

J Clin Microbiol, 1989 May, 27(5), 869 - 73
Identification of Neisseria spp., Haemophilus spp., and other fastidious gram-negative bacteria with the MicroScan Haemophilus-Neisseria identification panel; Janda WM et al.; The Haemophilus-Neisseria identification (HNID) panel (American MicroScan, Sacramento, Calif.) is a 4-h microdilution format system for identification of Haemophilus and Neisseria spp., Branhamella (Moraxella) catarrhalis, and Gardnerella vaginalis . The HNID panel was evaluated by using 423 clinical isolates and stock strains of these organisms, and HNID identifications were compared with those obtained by conventional methods . In addition, 32 isolates representing six genera not included in the HNID data base were tested to determine whether these organisms would produce unique biotype numbers for possible inclusion in the data base . The HNID panel correctly identified 95.3% of 86 Neisseria gonorrhoeae strains, 96% of 25 G . vaginalis strains, and 100% of 28 Neisseria lactamica strains and 48 B . catarrhalis strains . Only 64.7% of 68 Neisseria meningitidis isolates were identified correctly owing to false-negative or equivocal carbohydrate and/or aminopeptidase reactions . Among the Haemophilus spp., 98.8% of 83 H . influenzae strains, 97.1% of 34 H . parainfluenzae strains, and 80% of 15 H . aphrophilus and H . paraphrophilus strains were correctly identified . Eight strains of Neisseria cinerea, a species not included in the data base, produced profiles identical with those for B . catarrhalis and N . gonorrhoeae . Isolates of other species not included in the data base, including Eikenella corrodens, Kingella spp., and Cardiobacterium hominis, produced unique biochemical reaction patterns on the panel . Modification of interpretative criteria for certain tests, expansion of the data base to include other species, and suggestions for additional confirmatory tests will increase the accuracy and utility of the HNID panel.

J Infect Dis, 1989 May, 159(5), 917 - 22
Induction of meningeal inflammation by outer membrane vesicles of Haemophilus influenzae type b; Mustafa MM et al.; Haemophilus influenzae type b (Hib) lipooligosaccharide (LOS) induces meningitis in an established rabbit model of experimental meningitis . To evaluate the inflammatory ability of Hib LOS in its native state as part of outer membrane of Hib, the CSF inflammatory response to Hib outer membrane vesicles (OMV) was compared with that produced by Hib LOS . A significant dose-dependent meningeal inflammatory response, as evidence by increased concentrations of white blood cells and protein and lactate concentration in CSF, was found after intracisternal injection of Hib OMV containing 0.02-200 ng of LOS . On a LOS weight basis, purified LOS and LOS in OMV did not differ significantly with regard to the CSF inflammatory response . Preincubation of Hib OMV with monoclonal antibodies directed against cell surface-exposed epitopes on Hib LOS did not affect the inflammatory ability of OMV, whereas preincubation of OMV with polymyxin B significantly reduced both pleocytosis and lactate concentration . Thus, Hib OMV represents a relevant nonreplicating vehicle in which Hib LOS might interact with CNS tissues to produce meningitis.

Ned Tijdschr Geneeskd, 1989 Apr 22, 133(16), 831 - 4
{Guidelines in bacterial meningitis in children}; Roord JJ; A committee of the Scientific Council of the National Organization for Quality Assurance in Hospitals has published a report on the diagnosis and management of children with meningitis . Agreement was achieved on the diagnostic investigations that should precede antibiotic treatment, and on the prognosis and follow-up of children recovered from meningitis . No agreement was reached on the role of cephalosporins and aminoglycosides in the antibiotic treatment of bacterial meningitis . Furthermore there was no consensus on the prophylactic administration of rifampicin to family members of patients with meningitis caused by Neisseria meningitidis or Haemophilus influenzae . The arguments pro and contra are mentioned and considered.

N Z Med J, 1989 Apr 12, 102(865), 149 - 51
Haemophilus influenzae type b disease in Auckland children 1981-87; Voss L et al.; Haemophilus influenzae type b invasive disease was reviewed in the Auckland paediatric population . A total of 205 episodes were confirmed by sterile cavity culture in 203 patients under 15 years of age over a seven year period . The incidence of invasive disease was 14/100,000/year in those under 15 years and 41/100,000/year in under 5 year olds . The age range was from 1 month to 11 years, with 91% under 5 years and 64% under 2 years . Most cases were due to meningitis (63%) . Other diseases included epiglottitis, pneumonia, cellulitis, arthritis, and occult bacteraemia . There was only one fatality . Beta lactamase production was found in 9% of meningeal isolates . Recently a new conjugated haemophilus vaccine has been licensed in the United States for use in children 18 months and older . Consideration should be given to introducing this vaccine in New Zealand.

JAMA, 1989 Apr 7, 261(13), 1924 - 9
Interannual variation of the incidence of Haemophilus influenzae type b meningitis; Sherry B et al.; We conducted a population-based retrospective cohort study to define the annual age-specific incidence of Haemophilus influenzae type b meningitis for birth to 5-year-old residents of King County, Washington, from January 1977 through December 1986 . We found naturally occurring wide interannual variations in incidence . The standard deviations of the age-specific incidence during the eight years before the introduction of H influenzae vaccine varied from 26% to 115% of the mean . If short-term changes in incidence were used to assess the efficacy of an H influenzae vaccine (which is less than 100% efficacious and not administered to all susceptible children), the conclusions could be erroneous . To avoid this bias, long-term cohort studies, case/control studies using concurrent controls, or large clinical trials are better choices . We found no significant change in overall incidence during the ten-year study period.

Arch Dis Child, 1989 Apr, 64(4), 517 - 9
Haemophilus influenzae type b disease in the Oxford region; Tudor-Williams G et al.; A prospective survey of children in the Oxford region identified 200 cases of systemic Haemophilus influenzae type b disease in the first three and a half years of the study . The annual incidence in children less than 5 years of age was 33.4/100,000 . This represents a cumulative incidence of one systemic infection in 600 children before their 5th birthday . The mortality was 5.0% . The risk of H influenzae type b meningitis was one in 850 with a mortality of 5.6%, and substantial morbidity among survivors . From the total live birth rate, about 1300 cases of systemic H influenzae type b disease, over 900 cases of H influenzae type b meningitis, and 65 deaths would be predicted annually in children in the United Kingdom.

Clin Exp Immunol, 1989 Apr, 76(1), 73 - 5
Defective opsonization of Haemophilus influenzae by sera of elderly patients; Garbett ND et al.; The elderly are prone to respiratory infection but the role of disordered immunity is uncertain . Opsonization of bacteria is an important early host defence mechanism required for optimal phagocytosis . There are conflicting reports in the literature as to the ability of the elderly to perform this function and one reason may be the use of in vitro tests in which the 'target' microorganism is clinically unrealistic . We have tested the hypothesis that use of a more clinically relevant microorganism Haemophilus influenzae, which commonly infects the respiratory tract of such persons, may detect abnormalities of opsonization in the elderly . Using an in vitro luminol-enhanced chemiluminescence (CL) assay we have compared sera from 45 elderly subjects (age greater than 70 years without known immune deficiency or current infection) with sera from 12 young, healthy subjects, for their capacity to opsonize Staphylococcus aureus (Oxford strain) and H . influenzae (non-capsulated) expressed as percentage CL obtained using pooled normal human serum (PNHS) . There was no significant difference (median) between the elderly (95%) and the young (108%) with regard to S . aureus but opsonization of H . influenzae was poor in the elderly (63%) compared with that in the younger group (87%; P = 0.002); the sera of 11 elderly subjects having an opsonic capacity less than 30% that of PNHS . We conclude that use of the more clinically relevant microorganism, H . influenzae, appears to differentiate a subgroup of the elderly with reduced serum opsonic capacity . It remains to be determined prospectively whether these individuals are in fact more prone to infection.

J Clin Microbiol, 1989 Apr, 27(4), 792 - 4
Resistance to serum bactericidal activity distinguishes Brazilian purpuric fever (BPF) case strains of Haemophilus influenzae biogroup aegyptius (H . aegyptius) from non-BPF strains . Brazilian Purpuric Fever Study Group; Porto MH et al.; We studied the ability of normal human serum to lyse H . influenzae biogroup aegyptius (H . aegyptius) isolates recovered from patients with Brazilian purpuric fever (BPF clone) or non-BPF clone strains . BPF clone isolates, although similar to non-BPF clone isolates with regard to the ability to fix C3 to their surfaces, could be distinguished from non-BPF clone strains by their resistance to lysis in vitro following incubation with normal adult human serum.

J Clin Microbiol, 1989 Apr, 27(4), 762 - 7
Comparison of lipopolysaccharides from Brazilian purpuric fever isolates and conjunctivitis isolates of Haemophilus influenzae biogroup aegyptius . Brazilian Purpuric Fever Study Group; Erwin AL et al.; Haemophilus influenzae biogroup aegyptius (H . aegyptius) has been identified as the etiologic agent of the recently described disease Brazilian purpuric fever (BPF) . Although there is heterogeneity among the strains associated with conjunctivitis, isolates from patients with BPF appear to be derived from a single clone . The clinical presentation of BPF suggests that bacterial lipopolysaccharides (LPS) are involved in its pathogenesis . We prepared LPS from H . influenzae biogroup aegyptius and found them to be similar to H . influenzae type b LPS in apparent size (by sodium dodecyl sulfate-polyacrylamide gel electrophoresis), biological activities, and fatty acid composition . We compared LPS from BPF clone isolates with LPS from non-BPF clone isolates in tests of Limulus lysate activation, spleen cell mitogenesis, promotion of neutrophil adherence to LPS-treated endothelial cells, and the dermal Shwartzman reaction . In none of these activities were LPS from the BPF clone isolates more potent . Because LPS shed from growing bacteria may be involved in the pathogenesis of purpura, we also measured the rate at which LPS were released into culture medium during bacterial growth and found no significant difference between BPF clone and non-BPF clone isolates.

J Clin Pathol, 1989 Apr, 42(4), 409 - 13
Outer membrane protein and biotype analysis of non-serotypable strains of Haemophilus influenzae; Coverdale CH et al.; Strains of Haemophilus influenzae (n = 161) were isolated from inpatients with symptoms of pulmonary infection . Conventional tests showed that 144 strains were non-serotypable and all belonged to one of eight biotypes . The common biotypes were 2 (41%), 3 (27.1%), 1 (13.2%) and 5 (10.4%) . The outer membrane protein (OMP) profiles of 59 non-serotypable strains were examined by sodium dodecyl sulphate-polyacrylamide gel electrophoresis (SDS-PAGE) . A comparison of OMP profiles suggested a possible association between several strains belonging to biotype 2 . Although no clear correlation was established between biotype or OMP profile cluster groups and the age or clinical state of the patients from whom the strains were isolated, SDS-PAGE analysis was a useful technique for the epidemiological study of non-serotypable H influenzae.

J Bacteriol, 1989 Apr, 171(4), 1898 - 903
Amplification of DNA at a prophage attachment site in Haemophilus influenzae; Kauc L et al.; The Escherichia coli plasmids pBR322 and pBR327 can be taken up by Haemophilus influenzae but do not replicate in this organism; however, integration of pBR into the H . influenzae chromosome was achieved by ligation to a fragment of the Haemophilus phage S2 that carried a phage attachment site (attP) . Once these sequences were integrated, they could serve as sites of recombination and amplification for homologous (pBR or phage) DNA . Amplification appeared to occur in one of two prophage sites (attB) present in the H . influenzae chromosome . The extent of amplification was different in different cells and reflected the ability of these sequences to undergo rearrangement leading to the formation of a DNA ladder . The ladder was obtained by treatment of DNA with restriction enzymes that cut outside of the inserted DNA, i.e., did not cut in the repeat sequence, and represented different numbers of repeat elements . Reversed-field gel electrophoresis was instrumental in resolving amplified structures . Inasmuch as single-cell isolates gave rise to the same ladder structure, it was assumed that amplification was under regulatory control and that it reproduced the same equilibrium of repeat structures . Transformation of E . coli with the amplified H . influenzae DNA resulted in precise excision and replication of the original monomeric plasmids . This excision was independent of the recA and recBC genes.

J Immunol, 1989 Apr 1, 142(7), 2464 - 8
Effect of oligosaccharide chain length, exposed terminal group, and hapten loading on the antibody response of human adults and infants to vaccines consisting of Haemophilus influenzae type b capsular antigen unterminally coupled to the diphtheria protein CRM197; Anderson PW et al.; Vaccines consisting of oligosaccharide (OS) derived from Haemophilus influenzae type b capsular polysaccharide and conjugated to carrier proteins had been shown capable of eliciting memory-type capsular polysaccharide of H . influenza type b antibody responses in human infants, but the structural variables governing immunogenicity were not defined . Here a series of conjugates were made with the diphtheria protein CRM197 and with uniterminally coupled OS haptens that varied in chain length, exposed terminal residue, or multiplicity of loading as defined by ribose/protein ratio . Adults were given a single injection, 1-yr-old infants were given a two-injection sequence, and capsular polysaccharide of H . influenzae type b antibody responses were assessed by radioantigen binding . Vaccines C-4r, C-6r, and C-12r, in which ribitol-ended OS of mean length 4, 6, or 12 repeat units were coupled at low hapten loading, were about equally immunogenic (geometric means 2 to 5 micrograms/ml in infants, 5 to 9 micrograms/ml in adults) . Vaccine C7p was made with a higher loading of OS having mean length 7 repeat units and having mainly phosphate monoester at the exposed termini Vaccine C-7R was made from a portion of C-7p by enzymatic removal of most of the terminal phosphates . Compared to the C-4r, C-6r, and C-12r series, vaccines C-7p and C-7R induced geometric means about 10-fold higher in adults and 20-fold higher in infants . Thus OS chain length (in the range studied) and exposed terminus are less critical variables in this system than the extent of hapten loading.

Avian Dis, 1989 Apr-Jun, 33(2), 219 - 25
Monoclonal antibody characterization of two field strains of Haemophilus paragallinarum isolated from vaccinated layer hens; Verschoor JA et al.; An oil-based bacterin, containing strains 083 and 0222 of Haemophilus paragallinarum, is commonly used in South Africa to vaccinate laying flocks against infectious coryza . Two strains of H . paragallinarum, designated M85 and SB86, were isolated from infected but vaccinated commercial laying flocks in two incidental outbreaks of coryza in 1985 and 1986 . A panel of five monoclonal antibodies was established which clearly distinguished the vaccine strains from the field isolates . One of these reacted with only vaccine strains A and B, another reacted with only field strains M85 and SB86, and the remaining three cross-reacted to various degrees with all four strains or isolates . Immunoassays were performed by enzyme-linked immunosorbent assay using whole bacteria as solid-phase antigen . These monoclonal antibodies may aid in serotyping new field isolates of H . paragallinarum and in improved standardization of vaccine strains.

Nippon Juigaku Zasshi, 1989 Apr, 51(2), 359 - 63
Antibiotic susceptibility of serotype 2 and 5 strains of Actinobacillus (Haemophilus) pleuropneumoniae isolated from swine from 1974 to 1986; Kawahara K et al.; Antibiotic susceptibility of 129 isolates of Actinobacillus (Haemophilus) pleuropneumoniae was examined . All the strains were isolated in 1974 to 1986 from the nasal cavities of swine housed on 35 farms in 11 prefectures of Japan . All 28 strains of serotype 2 isolated before 1984 were susceptible to 10 antibiotics used . In contrast, more than one-half of 79 strains of serotype 2 isolated in 1985 and 1986 were resistant to aminoglycosides, tetracycline, tylosin and carbadox, and most of them showed multiple drug resistance . All the 22 strains of serotype 5 were isolated only in 1985 and 1986, and almost all the isolates were susceptible to the antibiotics used in this study . Distribution of minimal inhibitory concentration of serotype 2 strains were bimodal to aminoglycosides, tetracycline, or tylosin . The present results showed that the number of antibiotic resistant strains of A . pleuropneumoniae has increased recently in Japan.

Arch Dis Child, 1989 Apr, 64(4), 520 - 4
Haemophilus influenzae type b conjugate vaccine trial in Oxford: implications for the United Kingdom; Tudor-Williams G et al.; The safety and immunogenicity of a Haemophilus influenzae type b conjugate vaccine was investigated in 103 infants immunised at 3, 5, and 9 months of age; the infants also received diphtheria, pertussis, and tetanus and polio vaccines . Side effects were compared with 99 matched infants receiving diphtheria, pertussis, and tetanus and polio vaccines only . No serious side effects were observed and the incidence of minor side effects was no greater in the recipients of H influenzae type b conjugate vaccine . Two doses of the vaccine (standard and low) were compared: geometric mean titres of serum anticapsular antibody rose from 0.11 microgram/ml before immunisation to 26.4 micrograms/ml after three immunisations with the standard dose and 14.6 micrograms/ml with the low dose . The geometric mean titre among 21 unimmunized infants at this age was 0.06 micrograms/ml . Both doses therefore generated antibody concentrations likely to be protective after three immunisations . There were no non-responders . Incorporation of an H influenzae type b conjugate vaccine into the primary immunisation schedule has the potential for preventing over 1000 cases of systemic H influenzae type b disease and 50 deaths each year in the United Kingdom.

Sex Transm Dis, 1989 Apr-Jun, 16(2), 88 - 90
Comparison of Sheffield media with standard media for the isolation of Haemophilus ducreyi; Macdonald K et al.; Isolation of Haemophilus ducreyi is the only method for the definitive diagnosis of chancroid . Culture on supplemented gonococcal base (GCHgs) or on supplemented Muller-Hinton agar (MHHb) has yielded the best isolation rates . Sheffield media is an alternative to standard media . We compared the isolation rate of H . ducreyi on GCHgs and MHHb to that on the Sheffield media with and without 5% horse blood . Vancomycin (3 mg/L) was added to all media . Of the 87 specimens cultured from patients with genital ulcer disease, 57 (66%) were positive on either GCHgs or MHHb or on both . Twenty six (30%) were positive on GCHgs only, 15 (17%) on MHHb only, and 15 (17%) on both . One culture was positive on Sheffield medium with 5% horse blood; none were positive on Sheffield medium without horse blood . Stock strains showed good growth at 48 hr on GCHgs and MHHb, but no growth at 48 hr and only minimally detectable growth at 72 hr on Sheffield media with horse blood . No growth was detected on Sheffield media without horseblood . Thus optimal culture of H . ducreyi in Kenya requires two media, supplemented gonococcal base and Muller-Hinton agar . Sheffield media is not useful for the primary isolation of H . ducreyi.

J Comp Pathol, 1989 Apr, 100(3), 231 - 6
Shwartzman reaction in the brain induced by Haemophilus somnus and Escherichia coli lipopolysaccharide in rabbits; Nakajima Y et al.; Intracerebral inoculation of viable Haemophilus somnus resulted in suppurative or fibrino-suppurative meningitis of the brain and spinal cord in rabbits . Multiple fibrin thrombosis complicated with meningitis in the central nervous system was produced by intracerebral inoculation of H . somnus followed by intravenous inoculation with Escherichia coli lipopolysaccharide . The latter reaction may be attributable to a form of Shwartzman reaction.

Clin Microbiol Rev, 1989 Apr, 2(2), 137 - 57
Chancroid and Haemophilus ducreyi; Morse SA; Haemophilus ducreyi is the causative agent of chancroid, one of the genital ulcerative diseases . H . ducreyi is the major cause of genital ulcer disease in Africa and Southeast Asia and is of increasing concern in the United States . Definitive diagnosis of chancroid requires the isolation and identification of H . ducreyi, but isolation of this organism is difficult and the available medium is not optimal for all strains . Fluorescent antibody and serologic tests are of limited value . In general, our knowledge of this organism is rather limited, and indeed, recent studies have questioned the placement of H . ducreyi in the genus Haemophilus . H . ducreyi has relatively few biochemical activities, and epidemiologic studies are limited because there are limited phenotypic markers available for strain typing . Specific virulence factors of H . ducreyi have yet to be identified . Antimicrobial resistance in H . ducreyi is of special concern, as this organism has acquired both gram-negative and gram-positive resistance determinants . In addition, some of these determinants can be mobilized and transferred to other Haemophilus species or to Neisseria gonorrhoeae.

Ou Daigaku Shigakushi, 1989 Apr, 16(1), 7 - 12
{Pathophysiological analysis of rapidly progressive periodontitis}; Kamagata Y et al.; Pathophysiological features were studied on 7 patients with rapidly progressive periodontitis but without any evidence of systemic disease, to analyse the clinical pathogenesis . The patients consisted of 5 females, 2 males, between the ages of 32 and 42 years . All patients had severe and rapid alveolar bone destruction on the basis of radiographic measurement . Abnormal serum levels of IgG and IgM were detected in some patients . Higher IgG level was found in 4 patients and higher IgM level was found in 2 patients . The proportion of lymphocyte subsets was calculated in mononuclear cells from peripheral blood of patients . Higher OKT4/OKT8 ratio was found in all patients . The percentage of OKT4 positive cells in 2 patients was higher than that in normal subjects while the percentage of OKT8 positive cells in 4 patients was lower than that in the healthy controls . Microorganisms from periodontal pockets were examined in 5 patients . Bacteriodes was isolated in all 5 patients and Haemophilus actinomycetemcomitans in 2 patients.

Infect Immun, 1989 Apr, 57(4), 1100 - 7
Primary structure of the porin protein of Haemophilus influenzae type b determined by nucleotide sequence analysis; Hansen EJ et al.; Sequencing techniques for single- and double-stranded DNA were used to determine the nucleotide sequence of the gene encoding P2, the major outer membrane (porin) protein of Haemophilus influenzae type b (Hib) . The open reading frame encoding the P2 protein comprised 361 amino acid codons . Comparison of the inferred amino acid sequence with data obtained by amino acid sequencing of the N terminus of the mature or fully processed P2 protein revealed that this protein has a signal peptide composed of 20 amino acids . N-terminal amino acid sequencing of tryptic peptides derived from purified P2 allowed direct identification of 158 of the 341 amino acids in the fully processed P2 protein; there was 100% correlation between these amino acid sequences and that inferred from the nucleotide sequence . The amino acid sequence of Hib P2 protein had 23 to 25% homology with the sequence of the OmpF porin of Escherichia coli and with that of the Neisseria gonorrhoeae porin P.IA . Codon usage in the Hib P2 gene was significantly different from that observed for a gene encoding a porin of E . coli . DNA hybridization studies indicated that there is a single copy of the P2 gene in the Hib chromosome . The availability of the nucleotide and amino acid sequences for the Hib P2 protein will facilitate investigation of the antigenic characteristics and structure-function relationship of this porin.

Vet Microbiol, 1989 Apr, 19(4), 337 - 49
Toxicity of Haemophilus pleuropneumoniae to porcine lung macrophages; Van Leengoed LA et al.; Viable Haemophilus pleuropneumoniae bacteria were toxic for porcine alveolar macrophages in vitro . This cytotoxic effect proved to be dose-related . A cell-free extract of H . pleuropneumoniae, heat-killed bacteria, and a Pasteurella multocida field strain were nontoxic . When macrophages were cultured with H . pleuropneumoniae bacteria in a ratio of 100 macrophages to six bacteria, ultrastructural signs of cellular degeneration were observed within 1 h . This degeneration was observed in macrophages with or without phagosomes containing H . pleuropneumoniae . A cytotoxic substance was filtered from a H . pleuropneumoniae culture in Eagle's minimal essential medium supplemented with Earle's salts (EMEM) and 10% foetal calf serum that was incubated for 10 h at 37 degrees C . This substance was destroyed by heating at 65 degrees C for 30 min . Macrophages were less susceptible to the toxic effect of H . pleuropneumoniae when serum of convalescent pigs was added.

Vet Q, 1989 Apr, 11(2), 65 - 72
A method for bronchoalveolar lavage in live pigs; van Leengoed LA et al.; In order to isolate porcine alveolar macrophages and to quantitatively study the components of recovered lung fluid, a bronchoalveolar lavage technique in living pigs was developed . Lung lavage was performed after introducing a catheter through the mouth via the trachea in the diaphragmatical lobe . Thirty ml of phosphate-buffered saline (PBS) was introduced into the lung and the fluid was aspirated after one minute . Following this, another 15 ml of PBS was introduced into the lung and aspirated after one minute . The recovered volume of the second lavage averaged 15 ml (+/- 0.4 S.E.M.) . Cells thus obtained from specific-pathogen-free (SPF) pigs were composed of 98% macrophages . Lavage fluids from conventionally bred pigs contained 67% macrophages, 17% neutrophilic granulocytes and about 16% lymphocytes, demonstrated by their morphology and acid phosphatase activity . The viability of the recovered cells was over 98% in both SPF and conventionally bred pigs . The dilution of the aspirated lung liquid was determined by using methylene blue in the introduced fluid . The calculated dilution factor of the recovered lavage fluid was 0.58 (S.E.M . 0.02) . No influence was noticed on the number or composition of cells nor on the dilution factor when lung lavage was done in SPF pigs twice a week during a four week period . The protein concentration in lavage fluid from SPF pigs was 142 (SD +/- 26) mcg/ml . In conventionally bred pigs, however, a wide variation (276 +/- 229 mcg/ml) in protein content was noted . Lavage fluid supernatant of some animals had a bactericidal effect on Haemophilus pleuropneumoniae strain 13261, whereas no bactericidal effect was noted in other lavage samples.

Kansenshogaku Zasshi, 1989 Apr, 63(4), 363 - 8
{Respiratory tract infections caused by Branhamella catarrhalis in outpatients with pneumoconiosis}; Ide M et al.; To investigate the occurrence of Branhamella catarrhalis respiratory tract infections in 109 outpatients with pneumoconiosis, clinical and bacteriological studies were performed during a 4-year period from April 1984 to March 1988 . B . catarrhalis was isolated in 26 patients; only three of these received continuous corticosteroid treatment . The incidence of B . catarrhalis respiratory tract infections increased gradually during the years 1984-1986, but decreased for the first time in 1987 compared with the previous year . There was a seasonal variation in isolations with a peak incidence during the winter, a pattern in contrast to Haemophilus influenzae . Almost all isolates produced beta-lactamase . B . catarrhalis found in mixed culture was usually in association with H . influenzae or Streptococcus pneumoniae . The isolation rates for B . catarrhalis in sputum of patients with pneumoconiosis followed those of H . influenzae and S . pneumoniae, and almost all strains were positive for beta-lactamase, so B . catarrhalis should be admitted that it is a primary pathogen.

J R Soc Health, 1989 Apr, 109(2), 71 - 3
Subcutaneous versus intramuscular administration of Haemophilus influenzae type b vaccine; Leung AK et al.; Four hundred ninety eight children of 15 months to 5 years of age were immunized with 0.5 ml of b-CAPSATM I Haemophilus influenzae type b polysaccharide vaccine (Hib) . Every other child received the vaccine subcutaneously (S.C.) and the alternates received the vaccine intramuscularly (I.M.) . Two hundred and two (81.1%) children in the S.C . group and 198 (79.5%) children in the I.M . group returned for follow-up visits 48-72 hours after the immunization and had the adverse reactions documented . The rest were contacted by telephone . After matching for sex and age, we had 194 pairs (103 males and 91 females) in each group with a mean age difference between the pairs of 0.4 month . Based on paired comparisons, pain, manifested as crying, at the time of inoculation was more frequent with intramuscular administration (p less than 0.01) . Tenderness at the injection site occurred in 4 children in the I.M . group but none in the S.C . group and was of borderline statistical significance (p = 0.06) . The occurrence of other adverse reactions was not significantly different between the two groups . The findings of this study suggest that subcutaneous injection is the method of choice for Hib vaccine administration.

J Laryngol Otol, 1989 Apr, 103(4), 369 - 71
Bacteriology of chronic otitis media with effusion; Diamond C et al.; Samples of middle ear effusions from 102 children with serous and mucoid otitis media were cultured for mycoplasmas and bacteria . No sample yielded mycoplasmas but bacteria were cultured from 48 (47 per cent) . Organisms commonly regarded as pathogens were present in 25 samples (Haemophilus influenzae 17, Streptococcus pneumoniae four, other streptococci four) . The only sample from which anaerobic bacteria were isolated was from a patient with cholesteatoma.

J Immunol, 1989 Apr 1, 142(7), 2519 - 26
Clonal characterization of the human IgG antibody repertoire to Haemophilus influenzae type B polysaccharide . Demonstration of three types of V regions and their association with H and L chain isotypes; Tarrand JJ et al.; The antibody response to Haemophilus influenzae type b polysaccharide (Hib-PS) is pauciclonal but can vary between different individuals . To estimate the size of this antibody repertoire we examined the constant and V regions of human IgG anti-Hib antibodies from 14 individuals at the clonal level using various serologic and IEF methods . Examination of H chains showed that 11 of 14 individuals produced both IgG1 and IgG2 antibodies, two individuals produced only IgG2 and one individual produced only IgG1 antibody . All 14 individuals produced kappa-containing antibody clones and three persons also produced significant lambda-containing antibody clones . V region heterogeneity was examined by comparing cross-reactivity of anti-Hib-PS antibodies to the capsular polysaccharide of Escherichia coli K100 carbohydrate (K100 CHO) . These studies showed that clones of IgG anti-Hib-PS antibodies cross-reactive with K100 CHO were present in 5 of 14 (36%) individuals and also revealed at least three types of V regions among these antibodies . The first type has no cross-reaction with K100 CHO and was found in 13 of the 14 individuals . The second type, found in three of 14 individuals, cross-reacts with K100 CHO and uses a lambda L chain V region . The third type, found in 2 of 14 individuals, cross-reacts with K100 CHO and uses a kappa L chain V region . Although the lambda type V region was found only in association with IgG2, the other two V region types associate with both IgG1 and IgG2 . Thus, five IgG antibody clones are serologically discernable . An individual generally responds to Hib-PS by expressing several clones selected from these discernable antibody clones . Indeed, we can observe six individual response patterns among these 14 individuals and conclude that considerable variability in individual responses to Hib-PS can be achieved with very few V regions.

Enferm Infecc Microbiol Clin, 1989 Apr, 7(4), 186 - 8
Use of a latex agglutination test in rapid diagnosis of acute meningitis; Aguiar-Nogueira J et al.; Capsular antigens of Neisseria meningitidis groups A, B, C, Y and W135, Streptococcus pneumoniae and Haemophilus influenzae were searched in CSF specimens of 66 patients with acute meningitis, using a latex agglutination test . Simultaneously CSF samples were processed for Gram stain and culture . Blood cultures were also performed in all patients . The test was positive in 43 (82.7%) samples: N . meningitidis-19, S . pneumoniae-18 and H . influenzae-6 . In 32 samples the result of the test was concordant with CSF or blood culture . In 11 cases the test was positive but CSF or blood cultures were negative . Gram stain was diagnostic in 13 (25%) samples in which the latex agglutination test was also positive, and were negative in the remaining cases . There were six false negative tests . In 17 cases the test, culture and Gram stain were simultaneously negative: 14 cases corresponded to viral meningitis, and the three other were unidentified purulent meningitis . Concluding, the test was useful in early aetiologic diagnosis of acute meningitis, but the occurrence of false negative results requires a complete bacteriological study.

Med Clin (Barc), 1989 Mar 11, 92(9), 321 - 2
{Haemophilus influenzae and Haemophilus parainfluenzae: etiologic agents of sexually transmitted diseases?}; Andreu A et al.; In 573 urethral swabs, 3 Haemophilus influenzae (HI) and 7 Haemophilus parainfluenzae (HPI) were isolated; 7 of the patients had clinical features of urethritis and in 3 another genital pathogen was associated . Biotype IV was the predominant one in HI, and II in HPI . In 6.259 endocervical and/or vaginal swabs 15 HI and 5 HPI were isolated . Three out of the 15 females infected by HI, had clinical features of salpingitis and 8 of vaginitis; 5 of them were carriers of an IUD . In four out of the 5 females with HPI another genital pathogen coexisted, and in the fifth there was an additional non analysable isolate . Biotype I predominated in HI and biotype II in HPI.

Infect Immun, 1989 Mar, 57(3), 798 - 804
Effect of iron restriction on the outer membrane proteins of Actinobacillus (Haemophilus) pleuropneumoniae; Deneer HG et al.; The outer membrane protein profile of Actinobacillus (Haemophilus) pleuropneumoniae grown under iron-restricted and iron-replete conditions was studied by polyacrylamide gel electrophoresis and immunoblotting . A virulent serotype 1 isolate synthesized a novel protein with an apparent molecular weight of 105,000 (105K) and increased the synthesis of a 76K protein under iron-restricted conditions . Both proteins were synthesized within 15 min of establishment of iron-restricted conditions . Proteins of equivalent molecular weights could also be induced by iron restriction in serotype 2, 3, 4, 5, and 7 isolates of A . pleuropneumoniae . Convalescent-phase sera from serotype 1-infected pigs contained antibodies which recognized both the 105K and 76K proteins from all six serotypes examined, indicating that these proteins were expressed in vivo and were immunologically conserved . Cells expressing the 105K and 76K proteins also displayed an enhanced ability to bind Congo red and hemin, suggesting that one or both of these proteins functioned to acquire complexed iron during in vivo growth.

Rhinology, 1989 Mar, 27(1), 53 - 61
Differential diagnosis of purulent and non-purulent acute maxillary sinusitis in young adults; Savolainen S et al.; In acute maxillary sinusitis, purulence could best be assessed from sinus washings, but evaluation based on aspirates was also reliable, provided that the amount of secretion was adequate . Injection-aspirates were of negligible diagnostic value in this respect . Sinus washings and aspirates which were clinically defined as purulent were almost invariably indicative of bacterial infection . The bacterial etiology was most accurately obtained by sinus aspiration . Only 14.5% of cultured specimens were negative for pathogenic bacteria . In maxillary sinusitis, judged to be non-purulent, 52.5% of cultures grew a pathogen . The most common pathogen was Haemophilus influenzae, which accounted for 90% of these isolations . There was a clear correlation between occurrence of many PMNs and pathogen positive culture in non-purulent cases . Thus, antimicrobial therapy which is effective against Haemophilus influenzae seems indicated in most cases of non-purulent maxillary sinusitis.

Arch Fr Pediatr, 1989 Mar, 46(3), 191 - 3
{Suspicion of Haemophilus influenzae endocarditis of the bicuspid aortic valve in a 7-month-old infant}; Colin A et al.; The authors report a case of probable Haemophilus influenzae endocarditis in a 7 month-old infant with a bicuspid aortic valve . Precocity of the occurrence of endocarditis in such asymptomatic cardiac abnormality, scarcity of the suspected germ, and the observed mode of evolution are underlined . This case raises the problem of an endocardial involvement in an infant properly treated by adapted intravenous antibiotherapy . It can be concluded that regular clinical and echocardiographic examination is necessary for every case of severe Haemophilus influenzae infection.

Arch Fr Pediatr, 1989 Mar, 46(3), 181 - 5
{Epidemiology of Haemophilus influenzae type b infections (excluding meningitis) in 2 French departments}; Livartowski A et al.; The spectrum of severe Haemophilus influenzae type b disease exclusive of meningitis includes: epiglottitis, pneumonia, arthritis, septicemia, cellulitis and pericarditis . The results of a 7 year-epidemiologic study (Jan 1980 to Dec 1986) performed in 2 French departments are reported . Sixty-nine cases were detected, representing a yearly rate of 9/100,000 children aged 0 to 4 years . The real incidence is probably higher and was estimated as 11/100,000 . In all of France, it corresponds to 382 annual cases and, more specifically to 60 to 70 annual cases of epiglottitis . No deaths were recorded and only 2 cases with minor sequelae were documented in this series . These results, as compared with those of previous studies, show that the incidence is lower than that in other countries, especially with regard to epiglottitis which is more frequent in North America and in Scandinavian countries.

Arch Fr Pediatr, 1989 Mar, 46(3), 175 - 9
{Epidemiology of Haemophilus influenzae type b meningitis in 2 French departments}; Livartowski A et al.; Meningitis represents a frequent and severe expression of Haemophilus influenzae type b disease . The results of a 7 year-epidemiologic study (Jan 1980 to Dec 1986) undertaken in 2 French departments are reported herein . One hundred and twenty-three cases of meningitis were detected, representing a yearly rate of 15 cases for 100,000 children aged 0 to 4 years . The real incidence is probably higher and has been estimated as 17/100,000 which corresponds to 572 annual cases for the entire country . The death rate was 3.3% and severe sequelae were documented in 1.6% . To these should be added less severe neurologic (9%) and hearing (2.4%) deficits . These results show that the incidence of meningitis is comparable to the rate observed in Northern Europe but lower than the one reported in the United States . However, the rates of mortality and of neurologic deficit published in recent studies are comparable to those in the present report . Hearing sequelae are probably underestimated and would need systematic screening during the immediate follow-up period.

Pediatr Infect Dis J, 1989 Mar, 8(3), 148 - 51
Haemophilus influenzae type b in respiratory secretions; Murphy TV et al.; Oral and respiratory secretions of 31 children who were healthy or had mild upper respiratory infection, and who had a positive throat culture for Haemophilus influenzae type b, were cultured to determine which secretions contain this organism and how long it can be recovered from fomites . Rhinorrhea was present in 11 of 31 (34%) children and nasal mucus was positive for H . influenzae type b in 10 (91%) . In 5 of these children the concentration of H . influenzae type b in nasal mucus was 10(4) to 10(7) colony-forming units/ml3 . H . influenzae type b in nasal mucus applied to fomites were recovered for 12 hours . Cultures of saliva and cough secretions compared with nasal mucus were less often positive (3 of 31, P less than 0.001; 3 of 25, P less than 0.001, respectively) and contained fewer H . influenzae type b (5 and 15 colony-forming units, respectively) . H . influenzae type b was recovered from the hand of 2 of 27 (7%) children; both children had positive cultures of saliva . These data indicate that H . influenzae type b can be found in oral and respiratory secretions of pharyngeal carriers and can contaminate children's hands . Nasal mucus was the most consistently positive secretion and contained the largest number of bacteria . Careful management of nasal mucus secretions is warranted in settings where transmission could occur to susceptible children.

Pediatr Infect Dis J, 1989 Mar, 8(3), 143 - 8
Problems in determining the etiology of community-acquired childhood pneumonia; Isaacs D; Fifty-seven children ages 1 month to 12 years hospitalized because of community-acquired pneumonia were compared with age-matched controls who had acute asthma without pneumonia to test the value of rapid bacterial antigen detection and clinical and radiographic criteria for diagnosis of bacterial pneumonia . Bacterial pneumonia, defined on the basis of positive cultures of blood or pleural fluid, was diagnosed in 4 children (7%), 1 of whom also had viral pneumonia . Viral pneumonia, defined as a positive nasopharyngeal sample or positive serology, was diagnosed in 20 children (35%) . Serum and concentrated urine were tested by latex agglutination (Wellcogen) for Haemophilus influenzae type b and pneumococcal antigens and by countercurrent immunoelectrophoresis for pneumococcal antigens . Pneumococcal antigen could not be detected in serum or urine from 3 children with culture-proved pneumococcal pneumonia, indicating poor sensitivity of the tests . In contrast apparent H . influenzae type b antigenuria was detected by latex agglutination in 4 of 40 children with pneumonia but also in 5 of 57 controls, and a sensitive enzyme-linked immunosorbent assay for polyribosyl ribitol (PRP) phosphate antigen showed that all 9 cases were false positives . The specificity of H . influenzae type b antigen detection was thus poor . Children with viral and bacterial pneumonia could not be distinguished by radiographic or clinical criteria (symptoms, fever) or by total or differential white blood cell counts, serum C-reactive protein or nasal or serum interferon levels . It is not possible to distinguish reliably childhood viral from bacterial pneumonia clinically or by rapid diagnostic tests.

Infect Immun, 1989 Mar, 57(3), 1002 - 4
Isolation and characterization of a mutant of Haemophilus influenzae type b deficient in outer membrane protein P1; Munson R Jr et al.; The gene for outer membrane protein P1 of Haemophilus influenzae type b has been previously cloned and expressed in Escherichia coli . To investigate the physiologic role of the P1 protein, the cloned P1 gene was insertionally inactivated with the Tn5 derivative Tn5tac1, and an isogenic P1-deficient Haemophilus mutant was then generated by transformation with linearized plasmid DNA containing the insertionally inactivated gene . The P1-deficient strain grew normally in vitro and induced bacteremia in the infant rat model.

Nippon Kyobu Geka Gakkai Zasshi, 1989 Mar, 37(3), 498 - 503
{Study of postoperative bronchopleural fistulas--analysis of factors related to bronchopleural fistulas}; Sato M et al.; Postoperative bronchopleural fistulas, although reduced in incidence, remain as a grave complication of pulmonary resection . In our department, cases of lung cancer have been rapidly increasing and those of infectious diseases have been decreasing . In light of this trend, the causes of bronchopleural fistulas may have changed, and thus we studied recent cases of postoperative bronchopleural fistulas from 1982 to 1986 . Bronchopleural fistulas were seen in 5 (7.8%) of 64 cases of inflammatory diseases and in 19 (4%) of 481 cases of lung cancer . In lung cancer, bronchopleural fistulas were more frequently seen with advanced cases, especially in cases of residual tumors on the stump and in cases of intrathoracic use of anticancer drugs . The highest incidences of bronchopleural fistulas were seen with right pneumonectomy and right lower lobectomy . Bronchoscopic examination showed bronchopleural fistulas to be mainly located on the stump beside the residual lobe . When Sweet's procedure is employed, this is the point with the most tension on the stump . Clinical and retrospective analysis of preoperative data revealed the following factors to be significantly higher in cases of bronchopleural fistulas than in cases of non-bronchopleural fistulas: fever, use of steroid hormone, Haemophilus influenzae in sputum, elevation of erythrocyte sedimentation ratio and anemia . Such analysis of postoperative data showed the following factors to be significant: fever, use of steroid hormone, leucocytosis, tracheostomy and bronchoscopy for sputum suction.

Jpn J Antibiot, 1989 Mar, 42(3), 743 - 53
{Pharmacokinetic, bacteriological and clinical evaluation of sulbactam/ampicillin in pediatrics}; Hayashi M et al.; The pharmacokinetics, efficacy and safety of sulbactam/ampicillin (SBT/ABPC) were evaluated in 21 children with a variety of infections . The results obtained are summarized as follows . 1 . Pharmacokinetics in 4 children, each receiving a single dose of 60 mg/kg, were evaluated . The average half-life of SBT was 1.03 hours and that of ABPC was 0.83 hour . 2 . In vitro antimicrobiol activity (MIC) of SBT/ABPC in which SBT and ABPC are combined at a ratio of 1:2 was stronger than ABPC alone and was quite effective against Staphylococcus aureus and Haemophilus influenzae, but activity against Escherichia coli was relatively low . Antimicrobial activity of SBT/ABPC against S . aureus was almost equal to those of piperacillin (PIPC), cefazolin (CEZ) and cefmetazole (CMZ), but against H . influenzae was stronger than those of CEZ and CMZ . Activity against E . coli was lower than those of PIPC, CEZ and CMZ . 3 . A total of 21 patients including 3 with pharyngitis, 10 with bronchitis, 5 with pneumonia, 1 each with acute enteritis, pyelonephritis and suspected sepsis were treated with SBT/ABPC . The clinical efficacy rate for these patients was 95.2% (20/21) . The bacteriological eradication rate was 80% (8/10) . 4 . There were 4 instances of side effects, 1 case each of eruption, diarrhea, thrombocytosis and eosinophilia, but all symptoms were transient.

Jpn J Antibiot, 1989 Mar, 42(3), 623 - 38
{Clinical and pharmacokinetic studies on intravenous administration of sulbactam/ampicillin in pediatrics}; Sato H et al.; Intravenous administration of sulbactam/ampicillin (SBT/ABPC) was evaluated in pediatric patients . The serum half-lives of both ABPC and SBT were approximately 1 hour following the intravenous injection or intravenous drip infusion of 20-35 mg/kg, and 30-50% of ABPC and 30-70% of SBT were recovered in the urine 6 hours . Cerebrospinal fluid concentrations of ABPC and SBT were 0.76 and 0.68 micrograms/ml, respectively, at 1 hour after intravenous drip infusion of the 58 mg/kg, and concentration ratios of the drugs in cerebrospinal fluid/serum were 6.39 and 5.71%, respectively . Thirty-four pediatric patients were treated with intravenous drip infusion of SBT/ABPC in doses ranging from 54 to 150 mg/kg divided into 3 times a day . The rate of clinical efficacy was 93.5% and the bacterial elimination rate was 92.3% . The synergistic activity of sulbactam with ampicillin was demonstrated against beta-lactamase-producing Staphylococcus aureus and Haemophilus influenzae isolated from patients in the present study . The side effects of SBT/ABPC were observed in 6 patients (5 diarrheas; 1 diarrhea with vomiting) out of 34 patients administered . Eosinophilia (2 patients) and a slight elevation of GOT (1 patient), GPT and LDH (1 patient) were observed . The tolerance to the therapy, however, was good.

J Antibiot (Tokyo), 1989 Mar, 42(3), 454 - 62
Biological properties of ER 42859, a novel erythromycin derivative; Wilson JM et al.; The antimicrobial activity of a new semi-synthetic oral erythromycin derivative, ER 42859, was evaluated in vitro and in vivo in comparison with erythromycin, spiramycin, josamycin, oleandomycin and the newer semi-synthetic derivatives flurithromycin, roxithromycin and A-56268 . MIC values of ER 42859 were superior to those of roxithromycin, oleandomycin, josamycin and spiramycin but generally 2-fold poorer than those of erythromycin . The activity equalled that of erythromycin against Haemophilus influenzae and was superior to that of roxithromycin and A-56268 against this organism . MIC values of the compound were greatly influenced by pH due to the dibasic nature of the molecule . ER 42859 had markedly superior activity to erythromycin, spiramycin, josamycin, oleandomycin and flurithromycin against experimental infections in mice and similar activity to roxithromycin and A-56268 . Blood and tissue levels were high and prolonged in rodents . In volunteers, blood levels were prolonged but inferior to those of erythromycin.

Res Vet Sci, 1989 Mar, 46(2), 212 - 7
Isotypic antibody responses in cattle infected with Haemophilus somnus; Widders PR et al.; Bovine antibody responses to Haemophilus somnus were compared on the basis of clinical and bacteriological findings . Serum IgG1 and IgM antibody titres were significantly increased in clinically normal cattle that were bacteriologically positive for H somnus from the nasal or vaginal mucosae compared with clinically normal, negative cows . IgG2 titres did not differ significantly between these two groups . However, IgG2 antibody was significantly higher in animals with H somnus disease (pneumonia or abortion) than in clinically normal cattle (whether bacteriologically positive or negative), while IgG1 and IgM titres did not differ between diseased and bacteriologically positive, clinically normal cattle . These antibody trends were duplicated in experimental H somnus abortion or pneumonia, with the greatest response occurring within the IgG2 subclass . Cattle vaccinated systemically with killed whole H somnus produced a predominant IgG2 response with minimal IgG1 and IgM responses . These results demonstrate that IgG2 antibody is consistently elevated in H somnus disease, and suggest that this response may be useful in discriminating diseased from asymptomatic cattle.

Res Vet Sci, 1989 Mar, 46(2), 202 - 11
In vitro evaluation of various quinolone antibacterial agents against veterinary mycoplasmas and porcine respiratory bacterial pathogens; Hannan PC et al.; The in vitro activities of 12 quinolones and four antibiotics were determined against 15 veterinary mycoplasmal species and four species of bacteria commonly involved in respiratory infections in pigs . The newer quinolones were markedly more active in vitro against a wide range of mycoplasmas than nalidixic acid and the earlier quinolones . Against Mycoplasma hyopneumoniae ciprofloxacin was the most active quinolone with a geometric mean minimal inhibitory concentration (MIC) against 16 strains of 0.01 microgram ml-1 compared with 0.04 microgram ml-1 for tiamulin, 0.06 microgram ml-1 for tylosin, 0.17 microgram ml-1 for oxytetracycline and 0.23 microgram ml-1 for gentamicin . M hyosynoviae was less sensitive to the quinolones with mean MICs of 0.6 microgram ml-1 for ofloxacin and 0.7 microgram ml-1 for ciprofloxacin compared with 0.034 microgram ml-1, or less, for tiamulin . Norfloxacin and its 6-chloro analogue were both mycoplasmacidal in vitro at five or 10 times their MICs against M hyopneumoniae UCD4 . Tiamulin was mycoplasmastatic . The quinolones were also active against porcine Bordetella bronchiseptica and Pasteurella multocida strains and Haemophilus species . Ciprofloxacin was the most active quinolone with mean MICs of 0.58 microgram ml-1 against B bronchiseptica (nine strains), 0.026 microgram ml-1 against P multocida (five strains) and 0.01 microgram ml-1, or less, against Haemophilus pleuropneumoniae (nine strains) and H parasuis (two strains) compared with mean MICs of from 0.5 microgram ml-1 to 64 micrograms ml-1, or more, for the antibiotics . This combination of excellent mycoplasmacidal activity against M hyopneumoniae and good antibacterial activity, suggests that the quinolones have great potential for treating respiratory infections in pigs, including enzootic pneumonia.

Jpn J Antibiot, 1989 Mar, 42(3), 675 - 85
{Clinical evaluation of sulbactam/ampicillin in children}; Ito S et al.; Sulbactam/Ampicillin (SBT/ABPC), a combination at a fixed ratio of ABPC and SBT which is an irreversible inhibitor of beta-lactamase in a 2:1 ratio, was clinically evaluated for its efficacy and safety in 24 patients with ages from 5 month-old to 12 years old with bacterial infection . The results obtained are summarized as follows . 1 . A pharmacokinetic study following 30 mg/kg SBT/ABPC administration by 30 minutes drip infusion or intravenous bolus injection showed that mean half-lives of SBT and ABPC were 48.9 minutes and 40.2 minutes, respectively, and mean urinary excretion rates of SBT and ABPC in the first 6 hours were 67.1% and 48.3%, respectively . 2 . SBT/ABPC was administered to 14 patients with bronchopneumonia, 4 patients with tonsillitis, a patient each with acute upper respiratory infection, with submandibular lymphadenitis, with phlegmon, with enterocolitis, with pyelonephritis and with cystitis at a daily dosage of 88.2-133.3 mg/kg, divided into 3 or 4, by intravenous bolus injection or by 30 minutes drip infusion . Clinical responses of the 24 patients were as follows: excellent: 17 patients, good: 7 patients . The efficacy rate was 100% . 3 . Neither clinical adverse reactions nor abnormal laboratory test values, except slight eosinophilia in a patient and an elevation of GOT, GPT in another were observed . 4 . MICs of SBT/ABPC against 7 strong beta-lactamase producing strains isolated from some of the patients were as follows . MIC against a strain of Staphylococcus aureus was 3.13 micrograms/ml, MICs against 2 out of 5 strains of Branhamella catarrhalis were 0.10 microgram/ml and those of the remaining 3 strains were 0.20 microgram/ml . MIC against a strain of Haemophilus parainfluenzae was 3.13 micrograms/ml . 5 . These data described above show that SBT/ABPC has excellent bactericidal capacity against beta-lactamase producing bacteria as well as beta-lactamase non-producing Gram-positive and negative bacteria and suggest that SBT/ABPC is a very useful antibiotic for pediatric patients.

Jpn J Antibiot, 1989 Mar, 42(3), 662 - 74
{Studies on sulbactam/ampicillin in the field of pediatrics}; Nakamura H et al.; Pharmacokinetic and clinical studies on sulbactam/ampicillin (SBT/ABPC) were carried out in the field of pediatrics . 1 . Absorption and excretion Serum levels and urinary excretion of SBT/ABPC were studied in 4 children with ages 6 to 8 years . The mean serum concentration of SBT at 15 minutes following a single intravenous injection of 30 mg/kg of SBT/ABPC was 27.4 +/- 2.2 micrograms/ml and that of ABPC was 42.8 +/- 3.9 micrograms/ml, and their concentrations declined with mean half-lives of 1.06 +/- 0.15 hours and 0.84 +/- 0.05 hour, respectively, and at 6 hours were 0.3 +/- 0.2 microgram/ml and 0.2 +/- 0.1 microgram/ml on the average, respectively . The urinary recovery rates of SBT and ABPC at 6 hours after the injection were 59.0 +/- 22.4% and 58.4 +/- 25.3% on the average, respectively . 2 . Clinical study SBT/ABPC was used for the treatment of a total of 36 pediatric patients with ages ranging 2 months to 11 years and it's clinical effectiveness, bacteriological efficacy and adverse effects were evaluated . Clinical efficacies in 5 patients with acute purulent tonsillitis, 26 with acute pneumonia and 1 with acute pyelonephritis were judged to be excellent in 27 cases and good in 5 cases with an overall efficacy ratio of 100.0% . Clinical efficacies in 6 patients whose infections were caused by beta-lactamase producing strains were judged to be excellent in all cases . Bacteriological efficacies of SBT/ABPC were assessed on 1 strain of Staphylococcus aureus (beta-lactamase producing strain), 2 strains of Streptococcus pneumoniae, 16 strains of Haemophilus influenzae (5 beta-lactamase producing strains and 11 non-beta-lactamase producing strains), 1 non-beta-lactamase strain of Haemophilus parainfluenzae and 2 strains of Escherichia coli (non-beta-lactamase producing strains) . All strains except 1 strain of H . influenzae (beta-lactamase producing strain) which decreased in number were eradicated with a bacteriological eradication rate of 95.5% . Only 1 patient complained of diarrhea which was suspected to be related to the drug . No other side effect was reported . Elevations of GOT and GPT were observed in only 1 patient . The above results suggested that SBT/ABPC was a useful drug with preferable safety profile in the treatment for pediatric patients with infectious disease caused by beta-lactamase producing strains as well as those by non-beta-lactamase producing strains.

J S Afr Vet Assoc, 1989 Mar, 60(1), 56 - 61
Haemophilus pleuropneumoniae in pigs: a review; Veary CM; Haemophilus (Actinobacillus) pleuropneumoniae is a primary and specific pathogen of the respiratory tract and is an economically important pathogen of pigs . The disease is starting to cause peracute deaths in South Africa and the chronic form leads to deteriorating heard performance . This review highlights various aspects of the taxonomic, antigenic, and drug sensitivity characteristics of the bacterium and the epidemiology, clinical signs, pathology, serology and immunology, detection and diagnosis, differential diagnosis, prevention and control of the disease.

Rev Infect Dis, 1989 Mar-Apr, 11(2), 329 - 34
Meningitis due to Haemophilus influenzae type b resistant to ampicillin and chloramphenicol; Givner LB et al.; Invasive disease due to Haemophilus influenzae type b (Hib) resistant to chloramphenicol and ampicillin is rare in the United States . Review of the literature reveals that all previously reported cases occurred in children with meningitis . These children were treated initially with ampicillin and chloramphenicol and had complicated courses characterized by delayed sterilization of the cerebrospinal fluid . The present report describes an infant who developed meningitis due to ampicillin- and chloramphenicol-resistant Hib . The patient received cefotaxime from the onset of therapy and had an uncomplicated course . The presence of Hib strains resistant to chloramphenicol and ampicillin should be considered in patients with meningitis due to Hib who respond poorly to treatment with these two drugs . Furthermore, the in vitro susceptibility of all Hib isolates to chloramphenicol (as well as to other antimicrobial agents) should be evaluated routinely . If the incidence of such resistant organisms increases, a change will be warranted in the commonly recommended combination of ampicillin and chloramphenicol as empiric therapy for bacterial meningitis in pediatric patients.

J Bacteriol, 1989 Mar, 171(3), 1747 - 50
Site-specific recombination between cloned attP and attB sites from the Haemophilus influenzae bacteriophage HP1 propagated in recombination-deficient Escherichia coli; Astumian JH et al.; Plasmids were constructed which contain both attP and attB DNA segments derived from the insertion sites of the lysogenic bacteriophage HP1 and its host, Haemophilus influenzae . Similar plasmids containing the two junction segments (attL and attR regions) between the phage genome and the lysogenic host chromosome were also prepared . The formation of recombinant dimer plasmids was observed when attP-attB plasmids were propagated in Escherichia coli HB101 (recA), while plasmids containing the junction segments did not form recombinant dimers . Deletion of the phage DNA segment adjacent to the attP site from the attP-attB constructions eliminated detectable recombination, suggesting that this sequence contains the gene encoding the HP1 integrase . No plasmid recombination was observed in strains of E . coli defective in integration host factor . This suggests that integration host factor is important in the expression or activity of the system which produces the site-specific recombination of sequences derived from HP1 and H . influenzae . Further, it suggests that a protein functionally analogous to E . coli integration host factor may be present in H . influenzae.

Oral Microbiol Immunol, 1989 Mar, 4(1), 30 - 4
In vivo chemotaxis evoked by Actinobacillus actinomycetemcomitans and Haemophilus aphrophilus; Holm A et al.; The chemotaxis-evoking capacity of 5 Actinobacillus actinomycetemcomitans and 5 Haemophilus aphrophilus strains were studied in a tissue cage model in rabbits . A significant increase of the total number of polymorphonuclear leukocytes was induced in the tissue cage fluid by both viable and killed bacteria, reaching a maximum after 12-24 h . In parallel, the proportion of viable/non viable leukocytes increased . The leukocyte counts declined during the following 24-48 h in all chambers except in those inoculated with viable cells of H . aphrophilus . The H . aphrophilus strains survived the 72 h experiment while A . actinomycetemcomitans decreased to undetectable levels within 24-72 h . Lactate dehydrogenase and lysozyme activities in cage fluid increased in all but the uninoculated chambers . Viable bacteria induced higher activities of the enzymes than killed ones . It is concluded that both species of bacteria exhibit similar chemotaxis evoking properties . A strain dependent ability to induce release of leukocyte-associated enzymes exists.

Nihon Kyobu Shikkan Gakkai Zasshi, 1989 Mar, 27(3), 289 - 92
{Therapy of chronic recurrent respiratory tract infections}; Nagatake T; In 1987, the most frequently identified pathogens in chronic respiratory tract infections in our clinic were Haemophilus influenzae, Pseudomonas aeruginosa, Branhamella catarrhalis, Streptococcus pneumoniae, Staphylococcus aureus and Klebsiella pneumoniae . Recurrent infection is a common phenomenon in patients with chronic respiratory tract infections, including chronic bronchitis, chronic bronchiolitis and bronchiectasis . H . influenzae is the most common pathogen in such patients . Macrolides, tetracyclines and new quinolones were effective to protect against recurrent infection of H . influenzae and these finding suggested that L-forms of H . influenzae may be significant in the recurrence of infection in patients with chronic respiratory tract infection . Bacterial colonization of the oropharynx is the initial event in most lower respiratory tract infections . Gargling protects against bacteria colonization of the oropharynx and occurrence of acute exacerbation.

Zh Mikrobiol Epidemiol Immunobiol, 1989 Mar, (3), 3 - 8
{Design of a nutrient medium for bacteria of the genus Haemophilus--producers of restriction endonucleases}; Poliachenko VM et al.; A culture medium for the cultivation of hemophilic bacteria, containing acidic casein hydrolysate, aminopeptide and fodder yeast extract, has been proposed . The growth-stimulating properties of this medium have been studied on 5 strains producing restrictases differing in their specificity . In growing these producer strains in a model ANKUM-2 fermenter with the supply of carbohydrate substrates (glucose, sucrose, glycerin) the yield of biomass, considered to be high for hemophilic bacteria (10-14 g of humid substance from 1 liter of the medium), has been achieved . As shown on H . influenzae Rc B-2297 used as an example, an increase in the yield of microbial biomass leads to a decrease in restrictase specific activity.

Kansenshogaku Zasshi, 1989 Mar, 63(3), 248 - 55
{Clinical studies on the secondary bacterial infection in respiratory syncytial virus infection of children}; Arimasu O; Secondary bacterial infection was studied on 231 children admitted with Respiratory Syncytial virus (RSV) infection in the 10 years since 1987 . Of the 231 children, 56 (24.2%) had dual bacterial infection possibly due to secondary bacterial invasion . The diagnoses of bacterial disease were sepsis (2), pyothorax (2), pneumonias (41), otitis media (7), nasopharyngitis (2) and urinary tract infection (2) . Dual bacterial infections were more frequent in infants and children over 6 months than in infants younger than 6 months . The main etiologic agents were Staphylococcus aureus and enteric gram-negatives in infants, and Haemophilus influenzae, Streptococcus pneumoniae, beta streptococci and Branhamella catarrhalis in children over 1 year . The incidence of secondary bacterial infection was compared according to the usage of antibiotics just before admission . Patients who had been administered with penicillins or macrolides before admission had a significantly higher percentage of secondary bacterial infection (21/56, 37.5%) than those of no previous antibiotic therapy (11/64, 17.2%, p less than 0.025) . The results indicate that the RSV infection itself sometimes predisposes to secondary bacterial infections, but indiscriminate use of antibiotics further increases the risk of secondary bacterial infections.

Semin Respir Infect, 1989 Mar, 4(1), 40 - 6
Pneumonia due to Moraxella (Branhamella) catarrhalis; Wright PW et al.; Branhamella catarrhalis is a Neisseriae-like organism that is the newest member of the family of pneumonic pathogens . The organism is seasonal, encountered only during the respiratory disease season . The majority of patients with pneumonia (80% to 90%) have underlying chronic pulmonary disease, and their clinical illness may be difficult to distinguish from exacerbations of lung disease by other causes . B catarrhalis is the most common bacterial pathogen in this setting after Haemophilus influenzae and Streptococcus pneumoniae . The organism is easy to identify in the laboratory, with a quality gram stain of sputum being the key to recognition . Most patients show patchy non-cavitary infiltrates on chest roentgenograms . Because 75% of isolates produce beta lactamase, empiric therapy with penicillin or amoxicillin is likely to fail . Recommended drugs include erythromycin, trimethoprim/sulfamethoxazole, amoxicillin/clavulanic acid (Augmentin), or one of the newer broad spectrum cephalosporins.

Otolaryngol Head Neck Surg, 1989 Mar, 100(3), 200 - 6
Restriction fragment mapping of nontypable haemophilus influenzae: a new tool to study this middle ear pathogen; Bernstein JM et al.; Isolates of nontypable haemophilus influenzae (NTHI) recovered from paired nasopharyngeal (NP) and middle ear (ME) fluid cultures performed simultaneously on seven children with otitis media with effusion (OME) were studied by analysis of the restriction fragment patterns produced from total genomic DNA . This method provides a sensitive measure of the genetic similarities between strains . In the seven pairs examined, the NP and ME strains were indistinguishable from one another, whereas each pair was distinct from the other, except for two siblings in whom all four strains were identical . This information provides evidence that the pathogenesis of OME caused by NTHI involves spread of the bacteria from NP to the ME . Analysis of paired NP and ME isolates from three children with recurrent OME caused by NTHI indicated that the second episode was caused by the reinfection with a different strain rather than persistence and reemergence of the first strain . Finally, DNA analysis of strains from two siblings with concurrent OME suggested that person-to-person transmission of NTHI can occur among children . These findings suggest that at any one time the NTHI population in the NP is relatively homogenous, at least at the time of acute upper respiratory disease . Our observation that the strains present at the second episode of otitis media were different than the strains present in the first episode is consistent with strain replacement in the NP . Restriction fragment mapping analysis of genomic DNA of NTHI could provide a powerful tool for investigating the rate of turnover of the NTHI population in the NP.

J Laryngol Otol, 1989 Mar, 103(3), 253 - 6
Bacteriology of otitis media with effusion; Sriwardhana KB et al.; A study was undertaken to evaluate the prevalence and antibiotic susceptibility of bacteria present in the middle ear of patients with otitis media with effusion . Middle ear effusions (MEE), nasopharyngeal and throat swabs were obtained at operation and cultured for aerobic and anaerobic bacteria . Two hundred and fifty-nine effusions were obtained from 152 subjects examined . Haemophilus influenzae was isolated from 32 (12.3 per cent) effusions, Streptococcus pneumoniae from seven (2.7 per cent), Staphylococcus aureus from seven (2.7 per cent), Branhamella catarrhalis from one (0.4 per cent)--Group A beta haemolytic streptococci from one (0.4 per cent) and Staphylococcus epidermidis from three (1.9 per cent) . The occurrence of respiratory pathogens in MEE reflected their prevalence in the upper respiratory tract . Significantly fewer children who had received antibiotics prior to surgery had organisms present in the MEE . Eight and a half per cent of H . influenzae and 64 per cent of B . catarrhalis were resistant to ampicillin . The present study confirms that bacteria are present in the middle ear in a significant number of patients with otitis media with effusion.

Am J Dis Child, 1989 Mar, 143(3), 307 - 11
Clinical identification and comparative prognosis of high-risk patients with Haemophilus influenzae meningitis; Gary N et al.; One hundred ninety-five consecutive children with Haemophilus influenzae meningitis were retrospectively reviewed to identify those patients at high risk of death or severe sequelae using a previously described clinical scoring system . One hundred sixty-nine children (86.7%) had prognostic scores less than or equal to 4.0 and all survived . Twenty-six patients (13.3%) had prognostic scores greater than or equal to 4.5 points . Five of these high-risk patients (2.6% overall) died as a direct result of their acute meningitis . Of the remaining 21 survivors, 15 were available for prospective, observer-blinded, follow-up evaluation, as compared with 15 low-risk control patients matched for age, sex, and year of admission . High-risk patients were significantly more likely to have more serious sequelae (2.0 +/- 2.1) as compared with low-risk controls (0.5 +/- 0.7) . Those high-risk patients who by the choice of their treating physicians had received corticosteroids (and usually osmotic therapy as well) appeared to have outcomes similar to their matched low-risk controls and significantly better than those high-risk patients who did not receive such additional therapy.

Rev Chil Pediatr, 1989 Mar-Apr, 60(2), 76 - 9
{Etiology of acute infections of the lower respiratory tract in hospitalized infants: bacterial antigens}; Martinez F et al.; Demonstration of bacterial antigens in biological fluids has been used for early detection of bacterial infections . Recent evidence suggests that higher detection rates of these antigens can be obtained from concentrated urine than from serum samples of patients . Evidence of bacterial infection by antigen detection was looked for from 50 fold concentrated urine samples by means of an ultrafilter system (Minicom) and latex agglutination for Haemophilus influenzae B (HiB) and Streptococcus pneumoniae (Sp) in three groups of patients . Group A (Positive controls), included 7 patients whose blood culture were positive for HiB (n = 5) and Sp (n = 2) . Group B (Healthy controls) involved 16 children without clinical and laboratory signs of infection, coming from ambulatory well baby clinics and surgical wards, and group C was formed by 77 patients with negative blood cultures but with clinical and X ray evidence of lower respiratory tract infection . The corresponding antigen was demonstrated in urine samples from all group A patients . Three group B subjects gave positive results for HiB antigen . HiB antigen was detected from 10 and Sp antigen from 2 group C patients . These results suggest that the search for bacterial antigens in urine would be useful for etiological diagnosis and management of patients with bacterial pneumoniae . There is no definite explanation for the finding of HiB antigen in urine from apparently healthy children but the possibility of previous or actual asymptomatic infections must be taken into account.

Ann Pediatr (Paris), 1989 Feb, 36(2), 119 - 22
{Acute infectious cellulitis . Apropos of 28 cases}; Sanciaume C et al.; Acute infectious cellulitis is a common condition in pediatric patients . We retrospectively studied 28 cases seen over the last four years . Average age of patients was four years . Fever and a decline in general health were often found . Streptococcus pyogenes and Staphylococcus aureus were the most common organisms in our series . Outcome was favorable under early antimicrobial therapy selected according to age and clinical features . Before three months of age, cellulitis suggests a streptococcus B infection and should be treated by ampicillin or parenteral penicillin, combined with an aminoglycoside if called for . Between 4 months and 2 years of age, Haemophilus influenzae b or a pneumococcus are the most likely organisms; Haemophilus cellulitis should be treated by a third generation cephalosporin for ten days or longer, followed by ampicillin or ampicillin-clavulanic acid per os for ten or 15 days . Beyond 2-3 years of age, all organisms may be the cause of cellulitis, but the most likely are Streptococcus pyogenes and Staphylococcus aureus, treatment consists in administration of either a penicillin M or a macrolide, the route being selected according to the general condition and site of the cellulitis.

Clin Invest Med, 1989 Feb, 12(1), 39 - 43
Role of fluoroquinolones in lower respiratory tract infections; Vellend H; Oral quinolones such as ciprofloxacin are promising agents in the treatment of serious bronchopulmonary infections due to susceptible gram-negative micro-organisms such as Haemophilus influenzae, Branhamella catarrhalis, Klebsiella pneumoniae and even Pseudomonas aeruginosa . Their moderative activity against Streptococcus pneumoniae may limit the use of these agents in the treatment of acute exacerbations of chronic bronchitis and in the empiric management of community-acquired bacterial pneumonia . Further prospectively designed studies are needed to address this issue . The ability of quinolones to effectively penetrate bronchial mucosa and to be concentrated within macrophages may afford additional advantage to these agents . They should not be used as a sole agent in the treatment of aspiration pneumonia nor anaerobic pleuropulmonary disease . Quinolones are very active in experimental models of Legionnaire's disease and deserve further clinical study . Ciprofloxacin is a promising alternative to standard parenteral drugs in the management of Pseudomonas aeruginosa infections in adults with cystic fibrosis . The potential for drug interactions with theophylline must be kept in mind for patients on both of these drugs.

Am J Med, 1989 Feb, 86(2), 169 - 72
Occult polymicrobial endocarditis with Haemophilus parainfluenzae in intravenous drug abusers; Raucher B et al.; PURPOSE AND PATIENTS AND METHODS: Fewer than 8 percent of intravenous drug abusers are found to have polymicrobial endocarditis . We report on cases of occult polymicrobial infective endocarditis with Haemophilus parainfluenzae in 10 intravenous drug abusers . Clinical and laboratory data on all 10 patients were obtained from hospital charts, and information on illicit drug use methods was given by five patients . Blood cultures were performed, as well as susceptibility testing to antibiotics . Subsequent molecular epidemiologic studies were performed on selected Staphylococcus aureus and H . parainfluenzae strains . Phage typing of S . aureus and biotyping of H . parainfluenzae strains were also done . RESULTS: Results of the initial blood cultures were positive on the second to fifth days (mean, 2.6 days), demonstrating a gram-positive pathogen in nine patients and Bacteroides asaccharolyticus in one . Significantly, in each case, H . parainfluenzae alone was subsequently identified from additional blood cultures, with a mean delay of 20.4 days (range, five to 57 days) to the isolation of this organism . Epidemiologic data indicated that our cases did not represent a point-source outbreak . Antibiotic therapy uniformly failed until an agent active against H . parainfluenzae was added . The constellation of clinical, microbiologic, and epidemiologic findings was similar, and permitted prospective diagnosis and therapy in three patients . Despite the absence of S . aureus bacteremia in four, all 10 patients had right-sided endocarditis with septic pulmonary emboli . Five patients had initial blood cultures that were positive for two facultative gram-positive cocci (S . aureus and commensal oral streptococcal species) . CONCLUSION: Our findings suggest that polymicrobial endocarditis with H . parainfluenzae in intravenous drug abusers is a distinct clinical syndrome, and should be considered in all patients if the response to appropriate antibiotics is atypical or if pulmonary emboli continue with therapy.

Infect Immun, 1989 Feb, 57(2), 639 - 42
Immunoglobulin-binding activity among pathogenic and carrier isolates of Haemophilus somnus; Widders PR et al.; Nonimmune binding of immunoglobulin to whole bacteria was quantitated for North American isolates of Haemophilus somnus recovered from cattle with pneumonia, reproductive failure (abortion), or thromboembolic meningoencephalitis or from the vagina or prepuce of carrier cattle . Quantitative binding activity covered a wide range, with most pathogenic and carrier isolates demonstrating significant immunoglobulin-Fc binding . Isolates for which Fc binding was not detectable were recovered only from the prepuces of asymptomatic bulls . Expression of Fc-binding activity correlated with the presence of the 41,000-molecular-weight protein (41K protein) and 270K protein . Isolates that lacked Fc-binding activity did not possess 41K or 270K protein . A 33K protein was detected in isolates that lacked Fc-binding activity but not in isolates that bound Fc.

Epidemiol Infect, 1989 Feb, 102(1), 11 - 9
Subtyping of Haemophilus influenzae type b strains from Europe and North America by SDS-PAGE of whole-cell polypeptides: the geographical distribution of subtypes; Pennington TH et al.; One hundred and nine strains of Haemophilus influenzae type b were subtyped by sodium dodecyl sulphate polyacrylamide gel electrophoresis of whole-cell polypeptides . Twenty-one strains from England, 44 from Scotland, 8 from Sweden, 6 from the Netherlands and 30 from the USA were examined . Some of these strains had been subtyped by outer membrane protein analysis; most of the strains had been isolated from cases of invasive disease . Comparison of polypeptide profiles using the Dice coefficient of similarity showed that the majority of European strains were closely related and formed a single large group . Four smaller groups were identified; three of these included American and European strains, indicating a world-wide distribution of subtypes . However, the common European and American subtypes fell into different groups, indicating the existence of marked geographical variations in subtype frequency.

Zhonghua Min Guo Wei Sheng Wu Ji Mian Yi Xue Za Zhi, 1989 Feb, 22(1), 68 - 74
Serotypes, biotypes, and antimicrobial susceptibility of clinical isolates of Haemophilus influenzae; Teng LJ et al.; Serotypes, biotypes, and antimicrobial susceptibility of Haemophilus influenzae isolated from clinical specimens were investigated . Of 100 strains . only five were encapsulated . Three were type b (two from blood and one from spinal fluid), one was type c (from pus), and one was type e (from sputum) . All strains were biotypable . Of these, 33% were biotype II, 26% biotype I, 26% biotype III, 2% biotype IV, 8% biotype V, and 5% biotype VI . The minimal inhibitory concentration (MIC) of 10 antibiotics was measured by agar dilution method . Among them, cefotaxime was the most effective (the geometric mean of MIC was 0.013 microgram/ml), followed by cefoperazone, cefamandol, doxycycline, chloramphenicol, ampicillin, oxytetracycline, cefaclor, and cefazoline . Erythromycin had the highest geometric mean of MIC (4.86 micrograms/ml) . Twenty-seven isolates (27%) were resistant to ampicillin, and all the ampicillin-resistant isolates were beta-lactamase producer . Biotype III were the most resistant isolates to ampicillin among different biotypes.

J Med Microbiol, 1989 Feb, 28(2), 119 - 23
Comparison of genital and respiratory carriage of Haemophilus parainfluenzae in men; Houang E et al.; In the first study, genital carriage of Haemophilus parainfluenzae was investigated in 103 women and 292 men attending a clinic for genitourinary medicine . In a second study, pairs of urethral and throat swabs were studied in 279 men . The vaginal carriage was 2%, urethral 12.4% and throat 13.3% . Biotype 2 was found to be a genital type and throat carriage of this biotype was significantly associated with its concomitant urethral carriage . Biotypes 1 and 3 were mainly found in the throat . Biotype 2 was significantly more likely to be resistant to ampicillin, tetracycline and sulphonamide but biotype 1 was significantly more likely to be resistant to trimethoprim.

J Gen Microbiol, 1989 Feb, 135 ( Pt 2), 469 - 74
'Haemophilus gallinarum'--a re-examination; Blackall PJ et al.; The growth factor requirements and other properties of two strains of avian haemophili, labelled as 'Haemophilus gallinarum' (an X- and V-factor-dependent organism) and stored since the 1940s and 1950s, were examined . Both strains were X-factor independent and V-factor dependent and possessed the typical biochemical, serological and pathological properties of H . paragallinarum . In experiments repeating the tests used in the 1930s that reported the existence of X- and V-factor-dependent avian haemophili, we found that the methodology used resulted in reference strains of H . paragallinarum (X-factor independent and V-factor dependent) appearing to be X- and V-factor dependent . It is likely that the early descriptions of the aetiological agent of infectious coryza as an X- and V-factor-dependent organism were incorrect.

J Gen Microbiol, 1989 Feb, 135 ( Pt 2), 445 - 51
Characterization of the outer-membrane proteins of Haemophilus parainfluenzae expressed under iron-sufficient and iron-restricted conditions; Morton DJ et al.; SDS-PAGE of the outer-membrane (OM) proteins of Haemophilus parainfluenzae P205 grown under iron-sufficient conditions revealed three major proteins of 40, 37 and 13 kDa . In addition, growth under conditions of iron-restriction resulted in the expression of at least four iron-repressible OM proteins (IROMPs) of 72, 81, 88 and 90 kDa . OM proteins of 40 and 13 kDa were non-covalently associated with peptidoglycan and were resistant to digestion with trypsin . A 38 kDa peptidoglycan-associated protein, which was masked by the abundant 37 kDa protein, was also observed following tryptic digestion of whole cells or OMs . Neither the 37 kDa protein (which was heat-modifiable) nor the IROMPs were peptidoglycan-associated, and both were cleaved following treatment of whole cells with trypsin, indicating that they are exposed at the cell surface . A variety of IROMPs from five other H . parainfluenzae strains was also observed . In each strain, both the IROMPs and a major protein of 37 kDa were exposed at the cell surface.

J Gen Microbiol, 1989 Feb, 135 ( Pt 2), 245 - 50
Site-directed inhibition of Haemophilus influenzae malate dehydrogenase; Yoon H et al.; Previous studies of Haemophilus organisms documented the importance of an NAD+-dependent malate dehydrogenase in the incomplete tricarboxylic acid cycle present in these organisms . Selective interactions occurring at the coenzyme and substrate binding sites of a purified Haemophilus influenzae malate dehydrogenase were investigated . Coenzyme-competitive inhibition by adenosine derivatives demonstrated the presence of regions in the coenzyme binding site that interacted with the adenosine and pyrophosphate moieties of the coenzyme . Positive chainlength effects in the coenzyme-competitive inhibition by aliphatic carboxylic acids indicated the presence of a hydrophobic region at this site that was close to the pyrophosphate region . Seven analogues of NAD+ that were structurally altered in either the pyridine or purine ring were evaluated as selective inhibitors of the enzyme . The three most effective inhibitors of the purified malate dehydrogenase inhibited the growth of H . influenzae when the organism was grown on a limiting concentration of NAD+.

Antimicrob Agents Chemother, 1989 Feb, 33(2), 235 - 8
Characterization of a streptomycin-sulfonamide resistance plasmid from Actinobacillus pleuropneumoniae; Willson PJ et al.; An Actinobacillus pleuropneumoniae strain contained a plasmid (pHD8.1) conferring resistance to streptomycin and sulfonamide . Restriction endonuclease mapping and DNA-DNA hybridization showed that pHD8.1 is related to RSF1010 from Salmonella panama, which also confers resistance to streptomycin and sulfonamide, and to pHD148 from Haemophilus ducreyi, which confers resistance only to sulfonamide.

J Antimicrob Chemother, 1989 Feb, 23(2), 261 - 6
Trimethoprim-polymyxin B sulphate ophthalmic ointment versus chloramphenicol ophthalmic ointment in the treatment of bacterial conjunctivitis--a review of four clinical studies . The Trimethoprim-Polymyxin B Sulphate Ophthalmic Ointment Study Group.
{Basic and clinical studies on use of clarithromycin granules in pediatrics}
Hayashi M, Kida K, Matsuda H, Murase M.

Department of Pediatrics, School of Medicine, Ehime UniversityStudies were conducted on in vivo pharmacokinetics of clarithromycin (TE-031, A-56268) in children and also on the efficacy and the safety of this macrolide antibiotic in the treatment of bacterial infections in children . The results obtained are summarized as follows: 1 . TE-031 granules were orally administered to 5 children in a dosage of 5 mg/kg before meal . Maximum drug concentrations (range: 0.29-2.0 micrograms/ml) in the serum occurred during a period from 30 minutes to 1 hour after administration, but there were clear differences in blood concentrations among the individuals . 2 . TE-031 granules were orally administered in a average dosage of 20 mg/kg/day to a total of 17 patients, consisting of 14 children with respiratory tract infections and 3 children with intestinal infections . The clinical efficacy evaluation resulted in 10 excellent cases, 6 good cases and 1 fair case, for an efficacy rate of 94.1% . 3 . Studies on the bacterial efficacy were carried out for 10 cases . The TE-031 bacteriological efficacy evaluation showed elimination in 7 cases, a decreased bacterial count in 2 cases, and no change in 1 case . The elimination rate was, thus, 70.0% . Elimination rates according to different species of bacteria were 66.7% (2 of 3 strains) for Staphylococcus aureus, 100% for both Streptococcus pneumoniae (3 of 3) and Streptococcus pyogenes (1 of 1), and 42.9% (3 of 7) for Haemophilus influenzae . 4 . There were no symptoms which were attributable to side effects of the TE-031 therapy . The only laboratory test abnormality detected was eosinophilia in 1 patient.

Jpn J Antibiot, 1989 Feb, 42(2), 381 - 7
{A clinical study on clarithromycin especially on its granular form for children in pediatrics}; Tsutsui T et al.; Clarithromycin (TE-031, A-56268), a new macrolide antibiotic, was administered to a total of 25 child patients (age range: 4 months-12 years) to treat infections; the patients consisted of 23 children who received the drug in the form of granules for children and 2 patients who were given tablets . Daily dosages were 14.3 mg/kg (in 2 divided doses) in 1 patient, and 18.3-30.3 mg/kg (in 3 divided doses) in the other 24 patients . Lengths of administration ranged from 4 to 13 days with 6-8 days for 18 of the patients . The results obtained are summarized as follows . 1 . Clinical efficacy evaluations for various infections were as follows: 1 excellent, 4 good and 2 fair cases in 7 cases of pertussis; 3 excellent, 2 good and 1 fair cases in 6 cases of tonsillitis; 1 good case in tonsillitis with bronchitis; 1 excellent and 3 good cases in 4 cases of bronchitis; 1 excellent and 1 good cases in 2 cases of pneumonia; and 4 excellent and 1 good cases in 5 cases of enteritis . Thus, evaluations of a total of 25 patients showed 10 excellent, 12 good and 3 fair cases, with no poor cases . The overall clinical efficacy rate was, therefore, 88.0% . These results were attributed to good antimicrobial activity and absorption of TE-031 . 2 . Causative bacteria were isolated from 12 of the patients . Bacteriological efficacies of TE-031 on those strains were investigated with the following results . Of 5 Haemophilus influenzae strains, 3 were eliminated, 1 was reduced, and no change was observed in the other.(ABSTRACT TRUNCATED AT 250 WORDS)

Jpn J Antibiot, 1989 Feb, 42(2), 371 - 80
{Clinical study of clarithromycin, a new macrolide antibiotic, in children}; Hattori K et al.; 1 . Clarithromycin (TE-031, A-56268) was given orally to 46 children with respiratory infections, skin infections and others . A total of 9 patients were excluded; 8 patients refused to take the drug because of it's taste, and 1 patient was later found to have viral pneumonia . Clinical efficacy was therefore evaluated in remaining 37 cases and was good or excellent in 27 cases . 2 . Bacteriologically, Haemophilus influenzae strains isolated from 4 patients were eradicated in 1 and decreased in 3, respectively . Haemophilus parainfluenzae and Staphylococcus aureus isolated from 1 patient each were both eradicated . 3 . Side effect or abnormal laboratory test values were not observed . 4 . Based on the above findings, it appears that TE-031 is a safe and is useful antibiotic for the treatment of mild and moderate respiratory infections . It is necessary, however, to improve the taste of the current granule preparation in order to make the drug more easily palatable to children.

Jpn J Antibiot, 1989 Feb, 42(2), 343 - 51
{Clinical evaluation of clarithromycin in pediatric patients}; Ito S et al.; A clinical evaluation of clarithromycin (TE-031, A-56268), a newly synthesized macrolide antibiotic, was made for its efficacy and safety in 30 patients with ages ranging from 8 month-old to 12 year- 2 month-old with mycoplasmal and bacterial infections . The obtained results are summarized below . 1 . A pharmacokinetic study following oral administration of TE-031 at 10 mg/kg (granule) or 5.5 mg/kg (tablet) resulted in blood concentrations and urinary recovery rates higher than with other macrolides . 2 . TE-031 was administered orally to 5 patients with Mycoplasma pneumonia, 21 patients with pneumonia or bronchopneumonia, 2 patients with pertussis and 2 patients with enterocolitis at daily dosages ranging 11.1-31.6 mg/kg divided into 3 . Clinical evaluations of these 30 patients were as follows; excellent: 19 patients, good: 11 patients . The efficacy rate was 100% . 3 . Neither clinical adverse reaction nor abnormal laboratory data was found in any of these 30 patients . 4 . MICs of TE-031 against 10 strains of bacteria isolated from 10 patients with pneumonia or bronchopneumonia were as follows . MICs against 3, 2 and 2 out of 7 strains of Streptococcus pneumoniae were less than 0.025 microgram/ml, 0.05 microgram/ml and 0.10 microgram/ml, respectively . MIC against a strain of Haemophilus influenzae was 3.13 micrograms/ml . MICs of 2 strains of Branhamella catarrhalis were 0.20 microgram/ml . 5 . TE-031 is considered to be a new useful and safe antibiotic in pediatric patient with an excellent bactericidal capacity.

Eur J Clin Microbiol Infect Dis, 1989 Feb, 8(2), 123 - 6
Diagnosis of pulmonary infections in patients infected with the human immunodeficiency virus; Chave JP et al.; Over a three-year period, 54 episodes of pneumonia were diagnosed in 45 adults infected with the human immunodeficiency virus (HIV) . These episodes were reviewed in order to assess the distribution of pathogens and their clinical presentation . Thirty-six episodes were due to an opportunistic pathogen (Pneumocystis carinii in 31, Mycobacterium avium complex in 3, Mycobacterium tuberculosis in 2), and 18 were caused by non-opportunistic pathogens (11 Streptococcus pneumoniae, 2 Haemophilus influenzae, 5 unknown pathogens that responded to broad-spectrum antibiotics) . Non-opportunistic pneumonias were characterized by an abrupt onset (18/18 had pulmonary symptoms of less than 7 days duration), high fever (13/18), and focal lung infiltrates (17/18) . In contrast, opportunistic infections infrequently presented with pulmonary symptoms of less than 7 days duration (3/36) or high fever (7/36), and most of the chest radiograms (34/36) disclosed a diffuse lung infiltrate . In HIV-infected patients presenting with pneumonia, simple clinical and radiological data may point to bacterial pathogens . Such data could be used in selected cases to spare invasive procedures and to start empirical antibiotic therapy.

Pediatr Infect Dis J, 1989 Feb, 8(2), 94 - 9
Acute otitis media and respiratory virus infections; Ruuskanen O et al.; We studied the association of acute otitis media with different respiratory virus infections in a pediatric department on the basis of epidemics between 1980 and 1985 . Altogether 4524 cases of acute otitis media were diagnosed . The diagnosis was confirmed by tympanocentesis in 3332 ears . Respiratory virus infection was diagnosed during the same period in 989 patients by detecting viral antigen in nasopharyngeal mucus . There was a significant correlation between acute otitis media and respiratory virus epidemics, especially respiratory syncytial virus epidemics . There was no significant correlation between outbreaks of other respiratory viruses and acute otitis media . Acute otitis media was diagnosed in 57% of respiratory syncytial virus, 35% of influenza A virus, 33% of parainfluenza type 3 virus, 30% of adenovirus, 28% of parainfluenza type 1 virus, 18% of influenza B virus and 10% of parainfluenza type 2 virus infections . These observations show a clear association of respiratory virus infections with acute otitis media . In this study on hospitalized children Haemophilus influenzae strains were the most common bacteriologic pathogens in middle ear fluid, occurring in 19% of cases . Streptococcus pneumoniae was present in 16% and Branhamella catarrhalis in 7% of cases . There was no association between specific viruses and bacteria observed in this study.

Am J Vet Res, 1989 Feb, 50(2), 259 - 62
Actinobacillus (Haemophilus) pleuropneumoniae serotype-8 isolates and their antigenic relationships with other A pleuropneumoniae serotypes; Mittal KR et al.; Antigenic relationship of Actinobacillus (Haemophilus) pleuropneumoniae serotype-8 isolates with other serotypes was studied, using tube agglutination, with and without 2-mercaptoethanol, indirect hemagglutination with and without 2-mercaptoethanol, ring precipitation, coagglutination, and immunodiffusion tests . Serotype-8 isolates possessed serotype-specific, group-specific common antigens cross-reactive with serotypes 3 and 6 and species-specific common antigens cross-reactive with other serotypes . Absorption studies were done to study the antigenic relationship of serotype 8 with serotypes 3 and 6 . Rabbit antisera against whole-cell (WC) suspensions of reference strains of serotypes 3, 6, and 8 were used for absorption studies with WC and boiled WC suspensions of homologous and heterologous serotypes . Unabsorbed and absorbed sera were tested for antibodies against WC and boiled WC antigen preparations of serotype 8, using various serotests . Absorption studies revealed that serotype-8 strains possessed 2 main types of epitopes, one of which was serotype-specific and did not have cross-reactivity with other serotypes . The second type of epitopes was group specific and was cross-reactive with serotypes 3 and 6.

Gene, 1989 Jan 30, 75(1), 135 - 43
Cloning of the rec-2 locus of Haemophilus influenzae; McCarthy D; A collection of transposon mutants of Haemophilus influenzae was constructed by additive transformation with mutagenized chromosomal DNA . A rec-2::miniTn10 km mutation was cloned from a transformation-defective member of the mutant collection, followed by the reconstruction of the wild-type rec-2 locus by recombination to create pDM62 . Southern blots showed that the commonly studied Rec-2 mutant, Rd(DB117)rec-, contained either a large deletion or a substitution that removed part of rec-2 locus . A collection of transposon mutations in pDM62 was used to characterize the rec-2 locus by complementation . A corresponding collection of mutants was also constructed . A single segment was required to complement the transformation defect in Rd(DB117)rec- . All of the transformation-defective transposon mutants failed to translocate donor DNA into then cell, in agreement with previous studies of Rd(DB117)rec-.

Biochim Biophys Acta, 1989 Jan 19, 994(1), 75 - 80
Kinetic studies of Haemophilus influenzae 6-phosphogluconate dehydrogenase; Yoon H et al.; Haemophilus influenzae 6-phosphogluconate dehydrogenase (6-phospho-D-gluconate:NADP+ 2-oxidoreductase (decarboxylating), EC 1.1.1.44) was purified 308-fold to electrophoretic homogeneity with a 16% recovery through a five-step procedure involving salt fractionation and hydrophobic and affinity chromatography . The purified enzyme was demonstrated to be a dimer of Mr 70,000, and to catalyze a sequential reaction process . The enzyme was NADP-specific and kinetic parameters for the oxidation of 6-phosphogluconate were determined for NADP and four structural analogs of NADP . Coenzyme-competitive inhibition by adenosine derivatives was significantly enhanced by the presence of a 2'-phosphoryl group consistent with the observed coenzyme specificity of the enzyme . The purified enzyme was effectively inhibited by 3-aminopyridine adenine dinucleotide phosphate, but at concentrations higher than that observed to inhibit growth of the organism . Rates of inactivation of the enzyme by N-ethylmaleimide were suggestive of sulfhydryl involvement in the reaction catalyzed.

Avian Dis, 1989 Jan-Mar, 33(1), 168 - 73
Whole-cell protein profiles of Haemophilus paragallinarum as detected by polyacrylamide gel electrophoresis; Blackall PJ et al.; The soluble whole-cell protein profiles of 15 isolates of Haemophilus paragallinarum were examined using standardized sodium dodecyl sulfate-polyacrylamide gel electrophoresis . The patterns were reproducible and the isolates were similar overall . Despite this similarity, two protein profile types were recognized.

Aust Vet J, 1989 Jan, 66(1), 1 - 4
Characterisation and antimicrobial sensitivity of haemophili isolated from pigs; Eaves LE et al.; A total of 70 haemophili from Australia pigs was compared with a range of reference strains of porcine haemophili . Forty-eight of the isolates were identified as Actinobacillus pleuropneumoniae biovar 1 and the remaining 22 isolates as Haemophilus parasuis . Forty one of the A . pleuropneumoniae isolates were used in a study to determine to the minimal inhibitory concentration (MIC) of 12 antimicrobial agents, or combinations of agents . Penicillin, neomycin, trimethoprim, trimethoprim-sulphamethoxazole and tetracycline all showed low MIC values, indicating their potential for the treatment of porcine pleuropneumonia, although 2 isolates showed resistance to tetracycline . A wide range of MIC values was encountered with the sulphonamides.

Berl Munch Tierarztl Wochenschr, 1989 Jan 1, 102(1), 6 - 11
{Experiences with vaccination against Haemophilus pleuropneumonia of swine}; Ewald C et al.; In a Haemophilus pleuropneumonia problem herd with piglet production and fattening, sows and weaned pigs were vaccinated with a Danish vaccine (Pleurinord) . Due to consequent vaccination of the sows the health of the piglets could be improved decisively, resulting in an increased number of raised piglets per sow and year from 16.8 to 20.3 . In the vaccinated fattening pigs compared to the unvaccinated ones the following effects were observed: markedly reduced expenses for medication and a markedly reduced frequency of characteristic lesions in the respiratory tract; the improvement of the daily weight gains and the reduction of losses remained behind the expectations . Decisive causes for this were respiratory and enteric diseases unrelated to Haemophilus, which were favoured by serious mismanagement and inadequacies in the feeding regimen and barn climate . On the example of the vaccinated herd it is shown how important the analysis of a multifactorial disease situation is, in order to be able to objectify better or at all the influence of a vaccination program under field conditions . Within a concept of prevention and control of Haemophilus pleuropneumonia the vaccination is a helpful part.

Mutat Res, 1989 Jan, 217(1), 3 - 10
Existence and expression of photoreactivation repair genes in various yeast species; Yasui A et al.; Photoreactivation repair (Phr) activities in cell extracts of 13 different yeast species were measured by the Haemophilus influenzae transformation assay . Five species including Schizosaccharomyces pombe showed no or low enzymatic activity . In contrast to the other species, chromosomal DNAs of these 5 species did not show detectable hybridization using a DNA fragment of the photolyase PHR1 gene of Saccharomyces cervisiae as a probe even at a low stringency condition . When the PHR1 gene was attached to the 5'-flanking sequence of the iso-1-cytochrome c (CYC-1) gene of S . cerevisiae and introduced into S . pombe cells, the transformants acquired a high Phr activity, indicating that the PHR1 gene alone can provide a Phr-negative species with this repair activity and the light-absorbing cofactor(s) must be present in S . pombe . Our results also demonstrated that the 5'-flanking sequence of the S . cerevisiae CYC-1 gene works in S . pombe as a regulatory element.

Am J Dis Child, 1989 Jan, 143(1), 28 - 30
Haemophilus B polysaccharide vaccine . Antibody kinetics in 17- to 71-month-old children; Ramsey KP et al.; The antibody response to polysaccharide vaccines is well known to be age variable, with younger infants or children responding less dependably and with lower antibody levels . The fate of these induced antibodies over time is less well understood . We studied the antibody kinetics of beta-Capsa 1, a Haemophilus B polysaccharide vaccine, in 185 children aged 17 to 71 months . Ninety percent of the children vaccinated at age 2 years or older achieved reportedly immune serum antibody levels three weeks after vaccination; 45% vaccinated at age 18 months achieved such levels . In six months, the antibody levels fell significantly in all children . In those vaccinated at age 18 months, the levels six months after vaccination were not significantly different from those prior to vaccination . Our study raises the possibility that antibody kinetics may be as critical a consideration as immediate antibody response in deciding the proper clinical use of a polysaccharide-based vaccine.

Pediatrie, 1989, 44(1), 45 - 51
{Broncho-alveolar lavage by fibroscopy in immunodepressed children}; Farge A et al.; Thirty broncho-alveolar lavage (BAL) were performed in order to investigate 30 infectious episodes in immunocompromised children . Twenty patients were previously treated by high-dose chemotherapy and autologous bone marrow transplantation and 6 other patients by conventional methods . A specific etiologic diagnosis was obtained in 16 of 30 episodes (56%), 22 microorganisms were identified by BAL . The most frequently involved microorganism was Candida albicans and the other agents were as follows: 3 cytomegalovirus, 2 Pneumococcus, 2 Pneumocystis carinii, 1 Aspergillosis, 1 syncytial respiratory virus, 1 myxovirus, 1 Pseudomonas aeruginosa, 1 Mycoplasma pneumoniae, 1 Haemophilus influenzae and 1 Escherichia coli . In 5 cases, more than 2 agents were involved . This study emphasizes the diagnostic interest of BAL for infectious diseases of the immunocompromised child . BAL appears to be a non invasive, rapid and reproducible method, and a useful therapeutic approach in the treatment of infectious episodes occurring in grafted children where several microorganisms could be involved at the same time.

Padiatr Grenzgeb, 1989, 28(4), 231 - 6
{Pneumococcal infections in children: osteomyelitis and arthritis}; Huhle D et al.; A pneumococci-osteoarthritis in 8 children is reported on . In almost all the cases an adequate therapy (antibiotics, immobilization, physical therapy) resulted in a healing process free of defects with a full maintenance of the articular function . Besides by staphylococci and haemophilus influenzae, pneumococci too use to play a role as pathogenic organisms for osteomyelitis and arthritis.

Chemotherapy, 1989, 35(2), 88 - 94
Antimicrobial activities and susceptibility testing considerations of ampicillin, cephalothin, cefaclor, and cefuroxime against invasive isolates of Haemophilus influenzae; Shelton MM et al.; The activities of ampicillin, cefaclor, cephalothin, and cefuroxime against invasive clinical isolates of Haemophilus infleunzae were studied to determine the correlation between resistance and beta-lactamase production . Approaches to in vitro susceptibility testing of cephalosporins in the clinical laboratory were also assessed . Three hundred and eight isolates of H . influenzae were tested for ampicillin susceptibility, and those which required for inhibition greater than or equal to 1.0 micrograms/ml of ampicillin were tested for beta-lactamase production with a chromogenic cephalosporin . Twenty-two percent of isolates produced beta-lactamase and 85% were serotype b . All isolates considered resistant (MIC greater than or equal to 2.0 micrograms/ml) to ampicillin produced beta-lactamase . A single beta-lactamase-producing isolate was identified, but was inhibited by 1.0 microgram/ml of ampicillin, and a zone diameter of 20 mm was produced by disk diffusion testing . One hundred and ninety-seven isolates were tested for susceptibility to cefaclor, cefuroxime, and cephalothin . Chloramphenicol susceptibility testing by disk diffusion was also performed on these isolates . General agreement and interchangeable results were found among these three cephalosporins by both agar dilution and disk diffusion methods . We conclude that ampicillin-resistant H . influenzae not producing beta-lactamase is rare among these isolates of H . influenzae responsible for invasive disease . Susceptibility testing results of cephalothin, cefaclor, or cefuroxime appear to be interchangeable, although results of cephalothin testing would tend to underestimate the activities of cefaclor or cefuroxime.

Arch Gynecol Obstet, 1989, 244(3), 183 - 4
Intraamniotic Haemophilus influenzae infection; Leiberman JR et al.; Haemophilus influenzae was identified in the amniotic fluid of a patient who had a genetic amniocentesis and later aborted.

ORL J Otorhinolaryngol Relat Spec, 1989, 51(3), 175 - 81
The bacteriology of acute maxillary sinusitis; Ylikoski J et al.; Sinus secretions obtained by antral aspiration from 347 patients with acute maxillary sinusitis were examined bacteriologically . Special attention was paid to the method by which anaerobic bacteria could be recovered . On the total, 485 sinus secretion samples were examined, of these 336 were aspirates, 149 yields of injection-aspirations . Aerobic bacteria were cultured from 263 aspirates and from 100 injection-aspiration samples . Only anaerobes were recovered from 6 sinuses . Bacterial culture was negative in 115 sinuses (24%) . The most common pathogens isolated were Haemophilus influenzae (50.5%), Streptococcus pneumoniae (18.5%), Streptococcus pyogenes (5%) and Branhamella catarrhalis (1.5%) . A true anaerobic infection was considered to be present in only 7 sinuses (1.5%) indicating that anaerobes are not a significant cause of acute maxillary sinusitis . According to this study the most common pathogen in acute maxillary sinusitis in young adults is H . influenzae . From this follows that in such patients aminopenicillins may be a more appropriate choice than conventional penicillin in the antimicrobial treatment of acute maxillary sinusitis.

Pediatr Pulmonol, 1989, 6(3), 153 - 7
Nontypable Haemophilus influenzae nosocomial pulmonary infections in children following intubation; Hicks RA et al.; Twenty-nine intubated pediatric patients were prospectively studied to determine whether nontypable Haemophilus influenzae (NTHI) is associated with the development of nosocomial pneumonia . Throat cultures and tracheal Gram stains, leukocyte counts and cultures were obtained immediately following intubation, then serial studies on tracheal secretions were performed . Median patient age was 13 months . One patient had preexisting lung disease and 14 (48%) had pneumonia when intubated . There were five deaths . NTHI was recovered from the initial throat or tracheal culture in seven patients (24%); none developed a nosocomial lower respiratory tract infection . NTHI was not associated with any of three cases of nosocomial pneumonia . Three of 12 NTHI isolates were beta-lactamase producers . Tracheal leukocyte counts and Gram stains were not predictive of pneumonia, either at the time of intubation or subsequently . We conclude that NTHI in the oropharynx or trachea is not predictive of pneumonia among intubated pediatric patients.

Zh Mikrobiol Epidemiol Immunobiol, 1989 Jan, (1), 27 - 30
{Antibiotic sensitivity of Haemophilus influenzae isolated from patients with inflammatory lung diseases}; Faustova ME et al.; In 1980-1986 the sensitivity of 2,045 H . influenzae strains isolated from the bronchial contents of patients with inflammatory lung diseases were studied . This study revealed that 60-80% of H . influenzae cultures circulating in Leningrad were sensitive to tetracyclin, chloramphenicol and erythromycin . During the period of observation the tendency towards the decrease of the number of highly sensitive H . influenzae cultures and the increase of the number of strains resistant to all antibiotic preparations was followed . Most of H . influenzae strains isolated in Leningrad were sensitive to penicillin, oleandomycin and ampicillin . In 1983 the appearance of H . influenzae strains, multiresistant to antibiotics, was noted . In 1986 these strains constituted 4.5% of all isolated cultures.

Int J Immunopharmacol, 1989, 11(1), 29 - 34
Stimulation of cytotoxic and non-cytotoxic functions of natural killer cells by bacterial membrane proteoglycans and ribosomes; Allavena P et al.; The present study was designed to investigate the effect of membrane proteoglycans (MPG) from Klebsiella pneumoniae on the function of human natural killer (NK) cells . MPG combined with bacterial ribosomes from Klebsiella pneumoniae, Streptococcus pneumoniae, Streptococcus pyogenes and Haemophilus influenzae, constitute a bacterial immunomodulator (MS D 53), currently in clinical use . Human peripheral blood lymphocytes (PBL) exposed in vitro to MPG or MS D 53 for 20 h showed enhanced NK cytotoxicity . Augmentation of NK cytotoxicity depended upon a direct effect on NK cells, inasmuch as these compounds were also effective on highly purified large granular lymphocytes (LGL) . We also studied the effects of MPG on non-cytotoxic functions of NK cells, namely in vitro locomotion and production of IL-1 . MPG (and MS D 53) induced IL-1 release in LGL . Moreover, MPG-treated LGL showed enhanced locomotory activity, as assessed by measuring the penetration into nitrocellulose filters . The capacity of MPG (and MS D 53) to activate cytotoxic and noncytotoxic functions of NK cells may contribute to enhancement of nonspecific resistance in vivo after treatment with this agent.

Ann Pediatr (Paris), 1989 Jan, 36(1), 20 - 5
{Tolerance and immunogenicity of the capsular polyoside vaccine against Haemophilus influenzae type b . A study of 325 children 15 to 71 months of age}; Reinert P et al.; The antigenic properties of the capsule polyoside (PRP) from Haemophilus influenzae type b (Hib) are adequate to form the basis for immunization designed to prevent the severe infections caused by this organism . The tolerance and immunogenicity of a vaccine containing either 12.5 or 25 micrograms PRP were studied in 325 healthy children aged 15 to 71 months after informed consent had been obtained from the parents . Each child was given one subcutaneous injection of 0.5 ml vaccine . Antibodies against Hib were assayed before and one month after the injection . Clinical tolerance was outstanding both locally (moderate and transient pain in 13% of cases) and systematically, with only eight (2.6%) febrile reactions in excess of 38.5 degrees C within 24 hours after the injection . A very significant rise in antibody titers was seen in all age groups, but a mean titer of 1 microgram/ml was achieved only in children aged 24 months or more . No significant difference was found between the two dosages . Individual analysis showed that following immunization antibody titers reached 0.15 micrograms/ml or more in 65% of infants aged 15 to 17 months, 71% of infants aged 18 to 23 months, 80% of infants aged 24 to 30 months and 95% of children older than 30 months . Despite the inadequate immune response evidenced in the younger age groups, our results confirm that Hib infections are preventable from the age of 2 years . Our results are consistent with those recorded with a similar vaccine in Finland.

Pediatr Infect Dis J, 1989 Jan, 8(1), 20 - 3
Haemophilus influenzae b polysaccharide revaccination: a continued role for the unconjugated vaccine; Pichichero ME et al.; In a study of the issue of revaccination with Haemophilus influenzae b polysaccharide vaccine, 36 children who had been vaccinated with polysaccharide vaccine at age 18 to 20 months were stratified according to their 3-week postvaccination anticapsular antibody concentration determined by radioantigen binding assay, then sequentially assigned to one of three groups so as to have comparable distributions of peak antibody concentrations . These children were revaccinated with polysaccharide vaccine at 24 to 27, 30 to 33, or 36 to 39 months of age . The post-reimmunization geometric mean antibody concentrations in these three groups were 3.1, 3.0 and 7.8 micrograms/ml, respectively, and the percentages rising to greater than 1 microgram/ml were 75, 80 and 93% . The geometric means and antibody response rates were nearly identical to age-matched control groups not previously vaccinated . Thus there was no evidence of priming (memory induction) or of tolerance induction by the early (18 months old) primary vaccination.

J Allergy Clin Immunol, 1989 Jan, 83(1), 5 - 10
Burkitt's lymphoma developing in a 7-year-old boy with hyper-IgE syndrome; Gorin LJ et al.; We report a case of Burkitt's lymphoma developing in a 7-year-old boy with hyper-IgE syndrome . This is the third reported case of malignancy in the hyper-IgE syndrome . The other two cases were an 18-year-old man with Hodgkin's disease and a 10-year-old girl with histiocytic lymphoma . The patient developed retroperitoneal Burkitt's lymphoma with probable metastasis to the brain . His short life was characterized by recurrent staphylococcal skin, middle ear, and lung infections associated with extremely elevated serum concentrations of IgE . There was also an associated disturbance of bone metabolism with osteoporosis and pathologic fractures and absence of parathormone, findings that have been observed in other patients with hyper-IgE syndrome and other forms of T cell immunodeficiency . At the age of 5 years, inadequate B cell responses to immunization with antigens derived from diphtheria, tetanus, and Haemophilus influenzae type b organisms and with the OX174 bacteriophage were demonstrated in the patient . In his terminal state his in vitro lymphocyte analysis demonstrated findings of anergy . Although the precise immunologic defect in hyper-IgE syndrome is unknown, these cases of associated malignancy stress the role that a completely normal immune system plays in preventing the premature appearance of cancer.

Am J Med, 1989 Jan, 86(1), 11 - 4
Haemophilus influenzae pneumonia in young adults with AIDS, ARC, or risk of AIDS; Schlamm HT et al.; PURPOSE: Since the acquired immunodeficiency syndrome (AIDS) was first described in 1981, we have observed an increasing number of cases of Haemophilus influenzae pneumonia, particularly in young adult patients . To confirm this observation, we systematically identified and reviewed all cases of H . influenzae pneumonia that occurred in adult patients recently hospitalized at our institution . PATIENTS AND METHODS: Using a strict case definition, we identified all cases of adult H . influenzae pneumonia that were observed during a recent 32-month period at our institution, a large teaching hospital in New York City . We further reviewed each case record for evidence of AIDS, AIDS-related complex (ARC), or risk of AIDS . RESULTS: H . influenzae pneumonia was diagnosed in 51 adults . Thirty-four cases occurred in young adults (mean age = 33.9 years) with AIDS risk factors, including 23 (67 percent) intravenous drug abusers, six (18 percent) homosexual men, and five (15 percent) with both risks . Nine patients (26 percent) had a previous or concurrent diagnosis of AIDS, four (12 percent) developed AIDS later, and 13 (38 percent) others had ARC . The common presenting symptoms in young adult patients with H . influenzae pneumonia were fever (100 percent), productive cough (100 percent), chest pain (53 percent), and dyspnea (47 percent) . Lung consolidation was detected on physical examination in 20 (59 percent), and chest radiograph demonstrated unilateral infiltrates in 18 (53 percent) and bilateral infiltrates in 16 (47 percent), with pleural effusions in three (nine percent) . Most patients had an elevated white blood cell count (mean = 9.6 X 10(9)/liter) with a left shift in 22 (65 percent), and hypoxia on room air (mean partial pressure of oxygen = 69 mm Hg) . Four patients with H . influenzae pneumonia and coexisting Pneumocystis carinii pneumonia had diffuse, bilateral infiltrates on chest radiograph, with significantly more dyspnea and a higher serum lactate dehydrogenase level than the others . All but one patient showed improvement with appropriate therapy . CONCLUSION: We conclude that potentially serious pneumonia caused by H . influenzae occurs in young adult patients with AIDS, ARC, or AIDS risk.

Am J Dis Child, 1989 Jan, 143(1), 31 - 3
Immunization after invasive Haemophilus influenzae type b disease . Serologic response to a conjugate vaccine; Edwards KM et al.; Fifteen children with previous invasive Haemophilus influenzae type b disease were immunized with a Hemophilus-diphtheria toxin mutant protein conjugate vaccine . Serologic responses were compared with those of 31 newly immunized children without previous invasive H influenzae type b disease . Mean levels of antibody to polyribosylribitol phosphate among study children younger than 18 months were 0.086 mg/L before immunization, 0.737 mg/L after first immunization, and 4.453 mg/L after second immunization . In contrast, the comparable mean polyribosylribitol phosphate antibody levels among control children younger than 18 months were 0.107, 3.580, and 63.502 mg/L . A similar pattern of results was found among children aged 18 months or older . Although children with previous invasive H influenzae type b disease do not respond as vigorously to conjugate vaccine as do previously healthy controls, the response is sufficient to justify routine immunization of such children.

Dev Pharmacol Ther, 1989, 12(4), 188 - 99
Anemia during Haemophilus influenzae type b meningitis: lack of an effect of chloramphenicol; Sherry B et al.; We sought to determine whether chloramphenicol would worsen or mitigate the anemia associated with Haemophilus influenzae type b meningitis if administered in doses which produce 'therapeutic' serum concentrations . Seventy-four cases of H . influenzae meningitis were stratified by chloramphenicol cumulative doses (mg/kg body weight) of less than 300 and greater than 300 . There was no significant difference in the decrease in blood hemoglobin concentration or in the increase in the FEP:Heme ratio between the two study groups . Plasma iron and transferrin saturation values indicated iron deficiency at days 1 and 5 of hospitalization; by day 10 mean values were within the normal range . These data suggest that H . influenzae type b meningitis, not chloramphenicol therapy in the presence of monitoring is causing the observed anemia.

Drugs Exp Clin Res, 1989, 15(2), 59 - 62
Comparative in vitro activity of ciprofloxacin and other unrelated antimicrobials against bacterial respiratory tract pathogens; Felmingham D et al.; Ciprofloxacin is a new fluorinated 4-quinolone with a broad spectrum of antimicrobial activity which includes both Gram-negative and Gram-positive bacteria . In this study the in vitro activity of ciprofloxacin has been determined against bacteria associated with respiratory tract infections and compared with that of other antimicrobial agents used in the therapy of such infections . Ciprofloxacin (MIC90 0.008 mg/l) was highly active against Haemophilus influenzae, including isolates producing beta-lactamase which were resistant to amoxycillin . Ciprofloxacin (MIC90 0.06 mg/l) was also highly active against Branhamella catarrhalis, again including those isolates resistant to amoxycillin as a result of beta-lactamase production . Isolates of Streptococcus pneumoniae were less susceptible to ciprofloxacin (MIC90 2 mg/l) but were highly susceptible to amoxycillin (MIC90 less than 0.12 mg/l) and erythromycin (MIC90 0.25 mg/l) . Isolates of Klebsiella aerogenes were highly susceptible to ciprofloxacin (MIC90 0.06 mg/l) but much less so to amoxycillin, sulfamethoxazole, trimethoprim, oxytetracycline and erythromycin . Ciprofloxacin (MIC90 0.5 mg/l) was very active against Staphylococcus aureus, including those isolates resistant to amoxycillin and flucloxacillin, and against Mycoplasma pneumoniae . Together with rifampicin and erythromycin, ciprofloxacin was highly active against Legionella pneumophila (MIC90 0.015 mg/l) . These results suggest that clinical evaluation of ciprofloxacin in the treatment of respiratory tract infections is justified.

Chemotherapy, 1989, 35 Suppl 1, 39 - 44
Aztreonam in the treatment of bacterial meningitis; Ayroza-Galvao PA et al.; The monobactam aztreonam was used to treat 22 young patients with meningitis caused by gram-negative bacilli . Haemophilus influenzae was isolated from the CSF of 21 patients and Salmonella heidelberg from the CSF of 1 . Dosages ranged from 100 to 200 mg/kg/day in 4 doses at 6-hour intervals . Minimal inhibitory concentrations were determined by the broth dilution method for all isolated strains, and values ranged from 0.05 to 2.0 micrograms/ml . Blood and CSF drug levels were determined by a microbiologic plate diffusion method, and mean values for CSF and blood were 1.4 and 14.9 micrograms/ml, respectively . The outcome was good in 21 patients; 1 patient died . Complications were mild; subdural effusion occurred in 6 cases and was managed clinically; asymptomatic hydrocephalus was seen in 4; seizure during the acute phase occurred in 6 cases; hypoacusis was noted in 2, and motor impairment was detected at the follow-up in 1 case . Aztreonam achieved good blood and CSF penetration and performed well in the treatment of 20 cases of H . influenzae meningitis and in the one case of S . heidelberg meningitis.

Chemotherapy, 1989, 35 Suppl 1, 31 - 8
Aztreonam in the treatment of gram-negative meningitis and other gram-negative infections; Feris J et al.; Ninety patients (41 males, 49 females) with a diagnosis of meningitis, urinary tract infection (UTI), gastroenteritis or other miscellaneous gram-negative infections were enrolled . Their ages ranged from 7 days to 10 years, with a mean age of 4 months . 58 (63%) patients had an etiology confirmed by either positive culture (52; 89%) or latex agglutination (6; 10%) . 41 of these patients had meningitis diagnosed by positive CSE culture (38) or by positive CSF latex agglutination (3); 27/41 patients also had positive blood cultures . Aztreonam MIC100 for 27 isolates of Haemophilus influenzae, all ampicillin-sensitive, was 0.19 micrograms/ml; 4 Salmonella sp., 1 Neisseria meningitidis and 1 Serratia marcescens isolates were inhibited by 0.19 micrograms/ml, and the MIC100 for 2 Klebsiella pneumoniae, 1 Proteus vulgaris and 2 Pseudomonas aeruginosa isolates were 0.045 and 0.19, 0.022 and 12.5 micrograms/ml, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Chemotherapy, 1989, 35 Suppl 1, 25 - 30
Aztreonam in the treatment of aerobic, gram-negative bacillary infections in pediatric patients; Trujillo H et al.; Aztreonam was administered to 20 children diagnosed as having any of the following infections: urinary tract infection, pneumonia, meningitis, and abscess of the appendix . Haemophilus influenzae, Escherichia coli, and Klebsiella pneumoniae were isolated . The minimum inhibitory concentrations of aztreonam for these bacteria ranged from 0.03 to 0.5 micrograms/ml . All patients were clinically and bacteriologically cured within 5-16 days of treatment . Six months after completion of therapy, patients who had had meningitis appeared to be free of any neurologic sequelae . The antibiotic was well tolerated by all patients.

Scand J Infect Dis, 1989, 21(1), 53 - 7
Etiology of acute infectious epiglottitis in adults: septic vs . local infection; Carenfelt C; Adult patients with acute epiglottitis hospitalized between 1975 and 1988 were retrospectively analysed . 79 of 138 patients had a valid diagnosis and had delivered at least one blood culture and were considered eligible for further evaluation . Cultures from the upper airways, including epiglottis, were available in 43 of the patients as a consequence of prospective measures . 27% of the patients had bacteremia, which may however be an overestimation . Haemophilus influenzae was the predominating finding, but Streptococcus pneumoniae was isolated from 3 severely ill patients, indicating the existence of pneumococcal epiglottitis at a rate of less than 5% . From the non-bacteremic patients with a localized disease, either H . influenzae or beta-hemolytic streptococci were isolated from the epiglottis in one third of the cases . The distribution of pathogens in upper airways indicates that beta-hemolytic streptococci may have an etiological role in acute infectious epiglottitis . Except for H . influenzae, species with the potential ability of beta-lactamase production have no significance in the disease.

Arch Microbiol, 1989, 151(2), 133 - 6
Selected low-cohesion variants of Actinobacillus actinomycetemcomitans and Haemophilus aphrophilus lack distinct antigens recognized by human antibodies; Wyss C; Actinobacillus actinomycetemcomitans OMZ 346 A and Haemophilus aphrophilus OMZ 384 A, isolated on a synthetic selective and differentiating agar, show the highly cohesive and wall adherent growth in liquid medium which is typical for all primary oral isolates of these species . From each of them a low cohesion variant, OMZ 346 F and OMZ 384 F, respectively, was obtained by selection for cells growing in suspension . Screening of Western blots of these four strains with several human sera revealed the loss of a 4000 Mr antigen in both F strains . Human antibodies bound to the 4000 Mr band material on preparative Western blots of the A strains were eluted with 4 M magnesium chloride . These antibodies showed no cross-reaction between the 4000 Mr material of the two closely related species.

ORL J Otorhinolaryngol Relat Spec, 1989, 51(1), 50 - 5
Bacterial flora in the nasopharynx and nasal cavity of healthy young men; Ylikoski J et al.; The bacterial flora of the nose and nasopharynx was studied in 86 healthy young men . Common pathogens (Haemophilus influenzae and Streptococcus pneumoniae) were isolated from only 6% of all 172 nasal cavities . The same pathogens were isolated from 27% of 86 nasopharyngeal samples . H . influenzae dominated over S . pneumoniae both in the nose and the nasopharynx . No culture either from the nose or nasopharynx grew Streptococcus pyogenes . Potentially pathogenic bacteria, non-group-A hemolytic streptococci and various groups of Neisseria meningitidis were isolated from the nasopharynx in 20% of the subjects . According to the present study healthy adults do not carry group-A hemolytic streptococci in the nose and seldom if ever in the pharynx . Thus, isolation of S . pyogenes by bacterial culture is suggestive of a bacterial infection by this agent at these sites . Isolation of hemolytic streptococci other than group A from the pharynx does not necessarily indicate bacterial infection, and the same holds true for H . influenzae and S . pneumoniae.

Acta Paediatr Scand Suppl, 1989, 363, 31 - 6
Endobronchial infection in cystic fibrosis; Smith AL et al.; In symptomatic patients with cystic fibrosis, the recovery of bacteria in an inflammatory exudate from the lower respiratory tract is strong evidence of endobronchitis . It is not known when this chronic infection begins, the etiologic agents during infancy or the mechanism of evolution from Haemophilus influenzae and Staphylococcus aureus to Pseudomonas aeruginosa . Antibiotic administration to "suppress" the infection in relatively well patients is an unproven benefit . During an exacerbation of bronchitis, administration of appropriate antibiotics decreases sputum bacterial density and is accompanied by decreased amounts of indicators of inflammation in sputum: pulmonary function improves, particularly that reflecting medium to small airway status . In the future aggressive diagnostic procedures will be followed by therapeutic and prophylactic antibiotic administration conducted in a manner to minimize emergence of antibiotic-resistant bacteria . Adjunctive therapy, to minimize those aspects of the host response which inflict lung damage, will become standard.

J Basic Microbiol, 1989, 29(6), 361 - 7
{Loading of polystyrene solid phases with microbial agents and their polysaccharide antigens for the screening of monoclonal antibodies}; Mehl M et al.; Before screening monoclonal antibodies using enzyme immuno assays, it is necessary to prove that the coating of the solid phases occurs efficiently . The adhesion of whole cells of group B streptococci, Escherichia coli K1, Haemophilus influenzae type b and Candida albicans as well as B-Streptococcus group antigen, H . influenzae type b capsular antigen, and C . albicans cell wall antigen to polystyrene solid phases was studied and detected by the following methods: Peroxidase competition procedure, scintillation measurement of 32phosphate-labelled germs, and reactions with monoclonal antibodies.

Br J Clin Pract, 1989 Jan, 43(1), 19 - 23
A randomised, prospective, single-blind comparison of cefadroxil and amoxycillin in the treatment of acute exacerbations of chronic bronchitis; Bint AJ et al.; Cefadroxil 1 g twice daily and amoxycillin 500 mg three times a day were compared in 111 patients suffering from acute exacerbations of chronic bronchitis . Treatment was for seven days . Excellent or good clinical responses were found in 85 per cent of cases receiving cefadroxil and 81 per cent of patients taking amoxycillin . However, residual symptoms of cough and rhonchi were present to a statistically significantly greater extent in the amoxycillin group . Tolerance of both drugs was good with mild to moderate side effects reported in seven of 54 patients in the cefadroxil group and six of 56 patients taking amoxycillin . Severe nausea and vomiting in two cases in the amoxycillin group resulted in discontinuation of therapy . Microbiological examination of sputum samples showed pathogenic bacteria in 16 per cent, principally Haemophilus influenzae . Amoxycillin 500 mg tds and cefadroxil 1 g bd were equally effective in the treatment of acute exacerbations of chronic bronchitis.

Respiration, 1989, 55 Suppl 1, 49 - 52
Attachment of Streptococcus pneumoniae to human pharyngeal epithelial cells; Andersson B et al.; Streptococcus pneumoniae and Haemophilus influenzae are major respiratory pathogens . They attach to the mucosal surfaces of the respiratory tract . This attachment is the first contact with the host tissues and may determine whether the bacteria will colonize the mucosa and cause infection . Conversely, if attachment is inhibited, the infection may be prevented . Our studies have defined the mechanisms of pneumococcal attachment as a specific interaction between bacterial proteins and epithelial cell glycoconjugates . The free oligosaccharide blocks adhesion . So does human milk, which contains the receptor oligosaccharides . The accessibility of receptors is likely to be influenced by secreted substances like mucins, surfactant, etc . The effect of such components has not been evaluated . Ambroxol, bromhexin, as well as secretions from individuals treated with the substances may have such activity.

Srp Arh Celok Lek, 1989 Jan-Feb, 117(1-2), 39 - 46
{A rapid penicillinase paper strip test for the detection of beta-lactamase}; Petreska-Sibinovska D; The penicillinase paper strip beta-lactamase detecting test is an easy and rapid method which gives the information about some organism susceptibility to penicillins, immediately after their primary isolation . This information is important in serious infection treatment . This test is a modification of the standard iodometric test and is performed on paper penicillin and starch impregnated strips . The paper penicillinase strip test has been evaluated in speed, accuracy and value; it was compared with iodometric test, nitrocefin test and penicillin susceptibility test . The following fresh clinical isolates were used: 247 Staphylococcus aureus strains, 20 Staphylococcus epidermidis strains and 36 Haemophilus influenzae strains; total 303 isolates . The high correlation among all three tests mentioned in beta-lactamase detection was found as well as the correlation between penicillin susceptibility and this enzyme production . The sequence of susceptibility of the tests used is obtained as follows: nitrocefin test, paper penicillinase strip test, iodometric test.

Rev Pneumol Clin, 1989, 45(1), 14 - 22
{Fluoroquinolones: pharmacology, antibacterial spectrum and indications in pneumology}; Underner M et al.; Fluoroquinolones are antibiotics that act principally on DNA gyrase . At the moment, resistance to these antibiotics is purely chromosome-mediated . As regards pharmacokinetics, these compounds have a high bioavailability and penetrate extremely well into tissues and cells . Therapeutic concentrations are obtained in bronchial mucosa and lung tissue . In severe lower respiratory tract infections fluoroquinolones must be given in combination with other antibiotics to prevent the emergence of resistant mutants . The indications of fluoroquinolones in lower respiratory tract infections depend on their antibacterial spectrum . They are particularly useful in the treatment of infections caused by methicillin-sensitive or resistant staphylococci, Pseudomonas spp . (notably in cystic fibrosis) and intracellular organisms . They are not indicated for streptococcal infections, notably those due to Streptococcus pneumoniae, and for anaerobic infections . Fluoroquinolones are currently used mainly in hospital-acquired lower respiratory tract infections, in infected cystic fibrosis and in some acute episodes of chronic bronchitis since they are active against Haemophilus influenzae and Branhamella catarrhalis.

APMIS Suppl, 1989, 5, 23 - 34
Worldwide clinical experience with sultamicillin; Pitts NE et al.; Sultamicillin at an adult dose of 375-750 mg twice daily or a pediatric dose of 50 mg/kg/d provides effective outpatient/office therapy for community-acquired infections of the upper and lower respiratory tract, urinary tract, and skin/soft tissue structures . Given the incidence of Haemophilus influenzae and Branhamella catarrhalis in otitis media and the frequent occurrence of beta-lactamase-producing strains, it is particularly appropriate for the therapy of otitis media in infants and children . The increasing prevalence of beta-lactamase-producing pathogens in these infections, coupled with the fact that diagnostic bacteriology is often not available or practical in office practice, suggests that the broad use of sultamicillin might be desirable . Several factors support such usage: 1) the superiority of sultamicillin compared with the ampicillin commercial dosage form as a delivery system for ampicillin; 2) the possible occurrence at the infection site of beta-lactamase-producing organisms, not themselves pathogens, which nevertheless impair the activity of the beta-lactam antibiotic against sensitive pathogens; 3) the complementary binding of penicillin-binding proteins by ampicillin and sulbactam in ampicillin-sensitive organisms; 4) the lack of resistance development following repeated exposure of strains sensitive to sulbactam/ampicillin suggested by in vitro studies; and 5) the inability of sulbactam to induce beta-lactamase production . In addition to broad use in community-acquired infections, oral therapy with sultamicillin should also provide convenient outpatient follow-up for initial parenteral sulbactam/ampicillin therapy . Extensive testing of various laboratory parameters has revealed no evidence of systemic toxicity with sultamicillin . The only significant side effect of sultamicillin is diarrhea/loose stools, which, although a frequent complaint in some studies, is of mild to moderate severity and results in a low discontinuation rate.

J Med Assoc Thai, 1989 Jan, 72(1), 37 - 40
Comparison of culture and latex agglutination in the diagnosis of bacterial meningitis; Komolpis P et al.; This preliminary study compared culture and latex agglutination in the diagnosis of bacterial meningitis . Only 23.08 per cent of meningitis patients were bacterial meningitis by culture . The causative organisms detected by culture and latex agglutination respectively were as follows: Streptococcus pneumoniae 7.69, 5.77 per cent: Haemophilus influenzae 1.92, 1.92 per cent: Neisseria meningitidis 1.92, 5.77 per cent: Salmonella species 5.77 per cent, -: Viridans streptococci 1.92 per cent, - and Nonfermentative gram-negative rod 3.85 per cent - . There was no latex reagent for the latter three organisms.

Padiatr Grenzgeb, 1989, 28(1), 47 - 56
{Clinically relevant pathogens isolated from blood cultures of inpatient treated children (1972 to 1985)}; Spencker FB et al.; Blood cultures are extremely useful in diagnosing various bacteremic diseases in childhood . The results obtained in this study are presented in relation to two periods of equal length (1972-1978, 1979-1985) . At the present time there are about 22 relevant isolates from blood cultures per 1000 admitted children and year in the Department of Pediatrics, and about 3 isolates per 1000 admitted children and year in the Department of Pediatric Surgery, respectively . From newborns we isolated most frequently E . coli, Staph . aureus, B-Streptococci, Pseudomonas aeruginosa, Klebsiella pneumoniae, and yeasts . From children beyond the first month of life Haemophilus influenzae, Streptococcus pneumoniae, other streptococci, Neisseria meningitidis, and Staph . aureus were the most frequent identified etiologic agents . The main factors influencing the spectrum of agents causing bacteremia are: age of patients, status of hospitals, and applicated diagnostic and therapeutic procedures.

Drugs, 1989 Jan, 37(1), 8 - 41
Roxithromycin . A review of its antibacterial activity, pharmacokinetic properties and clinical efficacy; Young RA et al.; Roxithromycin is an acid-stable orally administered antibacterial macrolide structurally related to erythromycin . It has an in vitro antibacterial profile similar to that of erythromycin, with activity against Staphylococcus aureus, S . epidermidis, Streptococcus pneumoniae, S . pyogenes, Branhamella catarrhalis, Mycoplasma pneumoniae, Legionella pneumophila, Chlamydia trachomatis, Gardnerella vaginalis, Haemophilus ducreyi, some anaerobes and other less common pathogens . Roxithromycin has a pharmacokinetic profile that is characterised by excellent enteral absorption achieving high concentrations in most tissues and body fluids . The results of clinical studies with roxithromycin have confirmed the potential for its use in a variety of infections, which was suggested by its antibacterial activity in vitro and pharmacokinetic profile . Clinical efficacy has been confirmed in the treatment of respiratory tract infections, including community-acquired and atypical pneumonias, ear, nose and throat infections, genitourinary tract infections, and skin and soft tissue infections . In a relatively small number of patients roxithromycin has generally been shown to be as effective as erythromycin and other appropriate antibacterial drugs in some of the above indications . Roxithromycin is well tolerated and has less potential than erythromycin to produce clinically significant drug interactions . Thus, roxithromycin is an orally active drug which should prove a useful alternative when selecting antibacterial therapy for indications where macrolides are appropriate.

Ann Pediatr (Paris), 1989 Jan, 36(1), 49 - 54
{Treatment of acute otitis media in infants using an amoxicillin-clavulanic acid formulation (in the form of an oral suspension for pediatric use)}; Cohen R et al.; In a multicenter study, Augmentin pediatric suspension was given to 1,227 young children (3 months - 3 years) with otitis media seen in private practice . Patterns of otitis included first episodes, recurrences, and forms that had failed to respond to previous antimicrobial therapy . The study medication was given as a first-line treatment, on the basis of epidemiologic data, in a daily dose of 40 mg/kg for 7 to 10 days . In the 3 months to 3 years age group, two micro-organisms are prevalent, ie . Haemophilus influenzae, which is the most common agent and may produce beta-lactamases (10 to 18% of strains), and Streptococcus pneumoniae . Among our patients, the otitis-conjunctivitis syndrome caused by Haemophilus influenzae was fairly frequent (8.7% of cases) . Clinical effectiveness as evaluated between D8 and D11 was good or very good in 91.2% of cases . Tolerance was satisfactory in 83% of patients . Side effects were uncommon and consisted primarily in gastrointestinal symptoms . We point out the potentially deleterious effect of concurrent anti-inflammatory treatment . Acceptability of the suspension was judged satisfactory by the parents in 91.6% of cases . Augmentin proved well-suited to epidemiologic data, outstandingly effective, well tolerated, and easy to use because of its presentation as a pediatric suspension; it is therefore an appropriate first-line drug in the common indication addressed in our study.

Crit Rev Microbiol, 1989, 16(3), 161 - 80
Direct and indirect pathogenicity of beta-lactamase-producing bacteria in mixed infections in children; Brook I; The recent emergence of numerous aerobic and anaerobic beta-lactamase-producing bacterial strains has been associated with an increase in the failure rate of penicillins in the therapy of infection caused by these organisms . These include respiratory tract, skin of soft tissue, female genital tract, intra-abdominal, and other miscellaneous infections . The important aerobic beta-lactamase-producing bacteria (BLPB) include Staphylococcus aureus, Branhamella catarrhalis, Haemophilus sp., Neisseria gonorrhoeae, Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, and Legionella sp . The anaerobic BLPB are all Bacteroidiaceae and include Bacteroides fragilis group, B . melaninogenicus group, B . oralis, B . oris-buccae, and Fusobacterium sp . Laboratory, animal, and clinical studies that support the indirect pathogenicity of these organisms and the distribution of these BLPB in various infections are reviewed . BLPB may not only have a direct pathogenic role in causing the infection, but also an indirect pathogenic role . The indirect pathogenicity of these organisms is apparent through their ability not only to survive penicillin therapy, but also to protect penicillin-susceptible pathogens from that drug . These direct and indirect virulence characteristics of aerobic and anaerobic BLPB require the administration of appropriate antimicrobial therapy directed against all pathogens in mixed infections.

J Clin Microbiol, 1989 Jan, 27(1), 111 - 7
Antibody response to Haemophilus somnus Fc receptor; Yarnall M et al.; To characterize the bovine immune response to an Haemophilus somnus antigen known to be recognized by convalescent-phase serum, we studied isotypic antibody titers to the 270-kilodalton protein, which we had previously shown to be an immunoglobulin Fc receptor . With a modified immunodot procedure, an immune response was detected after experimental H . somnus abortion, experimental H . somnus pneumonia, or vaccination with commercial H . somnus vaccine, with the greatest titer found within the immunoglobulin G2 isotype . With protein A peroxidase conjugate, which detects primarily bovine immunoglobulin G2, we showed that cattle with H . Somnus disease could be distinguished from clinically normal carriers, culture-negative cattle, or cattle with disease due to Pasteurella haemolytica or P . multocida . Little cross-reactivity between the 270-kilodalton Fc receptor antigen and antigens from other gram-negative bovine pathogens was seen . Thus, this antigen may be a useful diagnostic antigen.

CMAJ, 1989 Jan 1, 140(1), 46 - 50
Bacterial tracheitis in children; Kasian GF et al.; We examined the records of 14 patients aged 7 months to 10 1/4 years who were treated for bacterial tracheitis from May 1982 to December 1987; the management protocol for 13 of the patients included the use of nasotracheal intubation . The infection was caused by Staphylococcus aureus in seven, Haemophilus influenzae in three, Branhamella catarrhalis in one and Streptococcus pneumoniae in one . Both H . influenzae and B . catarrhalis were isolated in another patient, and no organism was found in the remaining patient . In addition to the bacteria, viruses were cultured from the tracheal secretions of two patients . The mean duration of intubation was 7.6 days and of hospital stay 9.2 days . Twelve of the cases occurred during the cold months of the year (October to March) . Of the three deaths only one occurred in the pediatric intensive care unit and was due to severe bronchospasm and an air leak that caused bilateral pneumothorax and pneumomediastinum . In one patient subglottic stenosis developed that necessitated tracheostomy . Healing began 5 to 9 days after the onset of symptoms, as demonstrated with the use of repeated fibreoptic bronchoscopy . We found that the airway could be safely managed with the use of a nasotracheal tube . Bronchoscopy helped to confirm the diagnosis, to remove adherent secretions and to monitor the course of the disease . The ventilation tube can be removed after the patient's temperature returns to normal, if there is an air leak around the tube, if the quantity and viscosity of the secretions decrease and if healing is observed at bronchoscopy.

Genitourin Med, 1989 Jan, 65(1), 54 - 7
Treating chancroid: summary of studies in southern Africa; Ballard RC et al.; Recent studies undertaken in southern Africa and elsewhere indicate that many short or single dose treatments are available to treat chancroid . Erythromycin 500 mg three times a day for five days, ciprofloxacin 500 mg, sulphamethopyrazine 800 mg and trimethoprim 1000 mg or sulphametrole 3200 mg and trimethoprim 640 mg as single oral doses, or ceftriaxone 250 mg as a single intramuscular injection are all effective in treating the disease . The widespread use of these regimens largely depends on the accuracy of diagnosis, susceptibilities of local Haemophilus ducreyi isolates to antimicrobials, and financial considerations.

Arch Exp Veterinarmed, 1989, 43(5), 685 - 9
On the aetiopathogenesis of Mycoplasma pneumonia in calf; Buchvarova Y et al.; A pure culture of Mycoplasma (M.) bovis was isolated from calves with respiratory disease, exhibiting the picture of lymphohistiocytic proliferative pneumonia with presence of eosinophil plasmatic cells . A mixed infection of M . bovis and Pasteurella (P.) multocida was demonstrated in calves with exudative pneumonia . Both M . bovis and Haemophilus (H.) somnus were recovered from calves with necrotic pneumonia . All 3 organisms--M . bovis, P . multocida, and H . somnus--were present in cases of exudative-necrotic pneumonia . It was also shown that M . bovis played a primary role in the aetiopathogenesis of respiratory diseases caused by mixed infections.

Scand J Infect Dis, 1989, 21(6), 651 - 3
Haemophilus influenzae type b infections in adults; Kristensen K; 31 cases of invasive Haemophilus influenzae type b infections occurred in adults in Denmark during a period of 2 years and 5 months corresponding to an incidence of 0.3/100,000/year . Only 6 patients had no underlying condition . The incidence of H . influenzae type b infections in adults will probably rise in the future, because the increasing use of therapeutic measures affecting the immune system will lead to an increase in the number of susceptible patients.

Chemotherapy, 1989, 35 Suppl 2, 27 - 32
Ceftriaxone monotherapy for severe bacteremic infections . Spanish Ceftriaxone Study Group; Soriano E et al.; We tested the efficacy of a single daily dose of ceftriaxone (active ingredient of Rocephin) for the treatment of severe bacteremic infections in 125 non-neutropenic adult patients . A single daily dose of ceftriaxone ranging from 1 to 4 g was given . Surgical procedures were performed if needed . Seventy-six (60.8%) were males and bacteremia was nosocomially acquired in 45 (36%) . Microbiologically proven bacteremia was demonstrated in all patients . The most common microorganisms isolated were Escherichia coli (46 episodes), Streptococcus pneumoniae (17 episodes), Klebsiella pneumoniae, and Haemophilus influenzae, Serratia marcescens, Salmonella sp., and Staphylococcus aureus (9, 7, 6, 6, respectively) . The urinary tract was the source of the bacteremia in 45 cases (36%), and the lower respiratory tract in 33 (26.4%) . Mean duration of treatment was 10.8 days (range 3-21 days) . One hundred and six patients (84.8%) recovered completely, 11 (8.8%) improved, but needed an alternative antibiotic treatment . An alternative treatment was also given to a patient whose condition had initially deteriorated . Seven patients (5.6%) died . Death was directly related to the infection in 2 cases . Three patients (2.4%) developed a superinfection, and 5 (4%) a severe (1 case) or mild (4 cases) adverse effect . In summary, a single daily dose of ceftriaxone proved to be useful for the treatment of selected severe bacteremic infections.

Bull World Health Organ, 1989, 67(5), 479 - 86
Approaches to prevent acute bacterial meningitis in developing countries; Wright PF; Endemic acute bacterial meningitis of childhood appears to be neglected as a cause of morbidity and mortality in developing countries, probably because it has been overshadowed by the dramatic epidemics of meningococcal disease in sub-Saharan Africa . The available data based on reviews of hospitalized patients suggest that endemic meningitis is mostly a disease of young infants, Streptococcus pneumoniae and Haemophilus influenzae type b being the most important etiologic agents . The epidemiological pattern appears to be different in developing countries, compared with northern Europe or the USA, and closely resembles the early age of onset and high incidence of meningitis observed among the native American populations in Alaska . The mortality from meningitis appears to be much higher in developing countries than in industrialized countries . The availability of vaccines against the pneumococcus and haemophilus, particularly those in which the bacterial polysaccharide is conjugated to a protein, promises protection against systemic bacterial infection from these organisms . The assessment of the efficacy of such vaccines will have to include a close examination of meningitis as an outcome . It is suggested that before such vaccines become available careful clinical and epidemiological studies of meningitis will help both to define the impact of this disease and how to design an intervention strategy.

Arch Oral Biol, 1989, 34(10), 787 - 91
Incidence of selected ureolytic bacteria in human dental plaque from sites with differing salivary access; Salako NO et al.; Saliva is the main source of urea in the human mouth and may be responsible for the predilection of ureolytic bacteria for certain tooth sites . As a test of this hypothesis, the ureolytic bacteria, Haemophilus parainfluenzae, Actinomyces naeslundii, Actinomyces viscosus and coagulase-negative oral staphylococci, were enumerated in supragingival plaque from various sites in each of 10 subjects . The sites sampled included the maxillary and mandibular incisors (chosen because the lower incisors are more exposed to the submandibular-sublingual secretion than the upper) and the maxillary and mandibular molars (the upper molars being closer to the source of parotid saliva) . After dispersion of the plaque samples in saline, subsamples of each suspension were plated on appropriate selective media and other subsamples were taken for nitrogen analysis to measure the amount of plaque sampled . H . parainfluenzae that used urea was present in the largest numbers, A . viscosus was next and A . naeslundii and coagulase-negative staphylococci were least . The staphylococci and H . parainfluenzae were more numerous from mandibular than from maxillary incisors and from maxillary than mandibular molars, a pattern which suggests that salivary access favours their selection . The numbers of A . viscosus and A . naeslundii were not related to salivary access: A . viscosus was most numerous from the maxillary incisors, possibly because this site is normally the most acidic of the four studied and A . viscosus is strongly acidogenic and aciduric; the incidence of A . naeslundii had no relationship with site.(ABSTRACT TRUNCATED AT 250 WORDS)

Acta Microbiol Hung, 1989, 36(1), 13 - 7
Histamine production by Haemophilus; Csukas Z et al.; Eight Haemophilus influenzae and four Haemophilus parainfluenzae strains, all freshly isolated from patients, were examined for histamine production . Histamine was produced by all the H . influenzae (0.06 microgram-2.6 micrograms/100 ml) and by two of the H . parainfluenzae strains (46.5-47.9 micrograms/100 ml) . It is concluded that histamine which plays an important role in the pathogenesis of chronic aspecific respiratory diseases, may derive not only from degranulation of mast cells, but also produced by Haemophilus.

Meikai Daigaku Shigaku Zasshi, 1989, 18(1), 1 - 20
{Inducing effect of periodontopathic bacteria on activation of macrophage functions and production of interleukin-1 by mouse peritoneal macrophages}; Honda K et al.; Periodontal disease is thought to be initiated by a bacterial infection and subsequently developed by immunopathological mechanisms thorough host-parasite interactions . The macrophage and lymphocyte are the major functional cell types in the lesion of the disease and participate in tissue destruction and alteration of the periodontal connective tissue as well as in host defense mechanisms . However, the detailed implications of macrophages in development of the disease is still unclear . The aim of this study was to gain more understanding of the functional role of macrophages in periodontal disease . In this study, we examined the inducing effects of sonicated extracts from some gram-negative and gram-positive bacteria associated with the pathogenesis of periodontal disease, including Bacteroides gingivalis, Fusobacterium nucleatum, Haemophilus actinomycetemcomitans, and Actinomyces viscosus, on activation of macrophage functions and IL-1 production by the macrophages from the mouse peritoneum . At a dose as low as 1 microgram/ml (dry weight) sonicated extracts from B . gingivalis induced an increase in acid phosphatase activity and in glucose consumption of mouse peritoneal macrophages in vitro . A significant increase in the acid phosphatase and in glucose consumption was observed in the cultures at 24 h and 48 h, respectively, after the addition of the sonicate . Sonicated extracts from A . viscosus, a gram-positive bacterium, as well as B . gingivalis, F . nucleatum, and H . actinomycetemcomitans, gram-negative ones, were able to induce the increase in acid phosphatase activity and in glucose consumption of the macrophages . These periodontopathic bacteria were found to strongly induce IL-1 production by the macrophages as early as 24 h after addition of the sonicates . A significant increase in the IL-1 production was observed at a dose of 1 microgram/ml of the sonicates . The inducing ability was equivalent to 1 microgram/ml Escherichia coli lipopolysaccharide . The highest production of IL-1 was observed in the macrophages treated with H . actinomycetemcomitans among these sonicates . Sonicated extracts from both gram-negative and gram-positive bacteria were able to induce the IL-1 production by macrophages from C3H/HeJ mice, which are LPS low-responders . These results suggest that periodontopathic bacteria have potent ability to induce macrophage activation and IL-1 production and that the activated macrophages may play an important role in development of periodontal disease.(ABSTRACT TRUNCATED AT 400 WORDS)

Life Sci, 1989, 45(14), 1227 - 35
Membrane fluidity of guinea pig lymphocytes and the dysfunction of the respiratory airway and lymphocyte beta-adrenergic systems of the guinea pig; Loesberg C et al.; The beta-adrenergic receptor responsiveness of isolated guinea pig tracheal spirals can be negatively affected by intraperitoneal administration of the Gram-negative bacterium Haemophilus influenzae, four days prior to the experiment . The reduction in tracheal relaxation is accompanied by a decrease in beta-adrenergic receptor binding sites in splenic lymphocyte membranes and by a decrease in the fluidity of these membranes . The H . influenzae-induced dysfunction of both the respiratory airway and lymphocyte beta-adrenergic systems can be mimicked by modulating the amount of linoleic acid in the diet . This linoleic acid induced dysfunction of the beta-adrenergic system is also accompanied by a decrease in the plasma membrane fluidity of the splenic lymphocyte membranes of the guinea pigs . The role for plasma membrane fluidity in asthma is discussed in relation to current concepts for atopy.

Infect Immun, 1989 Jan, 57(1), 88 - 94
Molecular cloning, expression, and primary sequence of outer membrane protein P2 of Haemophilus influenzae type b; Munson R Jr et al.; The structural gene for the porin of Haemophilus influenzae type b, designated outer membrane protein P2, was cloned, and the DNA sequence was determined . An oligonucleotide probe generated by reverse translation of N-terminal amino acid sequence data from the purified protein was used to screen genomic DNA . The probe detected a single EcoRI fragment of approximately 1,700 base pairs which was cloned to lambda gt11 and then into M13 and partially sequenced . The derived amino acid sequence indicated that we had cloned the N-terminal portion of the P2 gene . An overlapping approximately 1,600-base-pair PvuII genomic fragment was cloned into M13, and the sequence of the remainder of the P2 gene was determined . The gene for P2 was then reconstructed under the control of the T7 promoter and expressed in Escherichia coli . The N-terminal sequence of the purified protein corresponds to residues 21 through 34 of the derived amino acid sequence . Thus, the protein is synthesized with a 20-amino-acid leader peptide . The Mr of the processed protein is 37,782, in good agreement with the estimate of 37,000 from sodium dodecyl sulfate-polyacrylamide gel electrophoresis.

Glycoconj J, 1989, 6(4), 489 - 98
Chemical evidence for covalent linkages of a semi-synthetic glycoconjugate vaccine for Haemophilus influenzae type B disease; Seid RC Jr et al.; We have defined the nature of the covalent linkages in a Haemophilus influenzae type b oligosaccharide-CRM197 conjugate vaccine, designated HbOC . The conjugate was acid hydrolyzed to release a novel amino-acid derivative, N epsilon-(2-hydroxyethyl)lysine (OHEt-Lys), identifiable with an amino-acid analyzer . This amino-acid derivative was formed by reduction of Schiff bases formed between H . influenzae type b oligosaccharides (HbO) and the lysyl epsilon-amino groups of CRM197 (a non-toxic, cross-reactive variant of diphtheria toxin), followed by acid hydrolysis of HbOC . Quantification of OHEt-Lys per CRM197 molecule allowed the determination of a covalency ratio, a useful parameter for evaluating the stoichiometry and consistency of HbOC preparations . Covalent association between HbO and CRM197 was also demonstrated by the coincidence of immunoreactivity of gel-electrophoresed HbOC on a Western blot probed with anti-CRM197 and anti-saccharide antisera.

J Antimicrob Chemother, 1989 Jan, 23(1), 123 - 9
Doxycycline and minocycline in the treatment of respiratory infections: a double-blind comparative clinical, microbiological and pharmacokinetic study; Maesen FP et al.; A group of 41 patients, all admitted to hospital because of acute purulent exacerbations of chronic respiratory disease, were treated with either doxycycline or minocycline in a double-blind randomized study . Drug dosage was one 100 mg capsule twice daily for seven days . Bacteriological and clinical assessment before and immediately after treatment showed no significant differences between the doxycycline and the minocycline groups, nor did further evaluation after seven days follow-up . Pharmacokinetic studies showed that the Cmax and 0-11 h AUC values in blood were higher for doxycycline, whereas the sputum Cmax was, on average, higher for minocycline because of the greater penetration of the latter . The MIC values for the two antibiotics differed slightly, usually, but not always, in favour of minocycline . Problems were experienced with both agents in the eradication of Haemophilus influenzae . The net clinical results with the two drugs were identical.

Eur J Clin Microbiol Infect Dis, 1989 Jan, 8(1), 11 - 4
Emerging pathogens in nosocomial pneumonia; Berk SL et al.; The organisms responsible for nosocomial pneumonia are continuously evolving . Gram-negative bacilli have become the most common etiologic agents over the past 20 years, and with this evolution has come a better understanding of the pathogenesis of gram-negative bacillary pneumonia . Some gram-positive cocci, such as enterococci, group B beta hemolytic streptococci and methicillin-resistant Staphylococcus aureus, haven taken on new significance in nosocomial respiratory infections . Streptococcus pneumoniae, nontypeable Haemophilus influenzae and Branhamella catarrhalis are increasingly reported in hospitalized patients with chronic lung disease . Etiologic agents will change as new antibiotics are introduced . A better understanding of etiologic agents and their pathogens may be the best tool toward preventing hospital-acquired pneumonia.

Mil Med, 1989 Jan, 154(1), 25 - 9
Side-effects and immunogenicity of Haemophilus influenzae type B polysaccharide vaccine in a multiethnic pediatric population; Popejoy LA et al.; Side-effects and immunogenicity of the Haemophilus influenzae type B polysaccharide vaccine (Hbpv) were reported following introduction in a multi-ethnic border population of 2- to 6-year-old U.S . military dependents . Eighty percent of 659 vaccinees were reported by parents to have no reactions within 48 hours following vaccination; 20% were reported to have local and/or systemic reactions . Each reaction was reported with one-fifth or less the frequency previously reported following DPT vaccination . Serologic data are presented on 114 of the vaccinees . The frequency of pre-vaccination levels reportedly associated with immunity ranged from a lower than expected 54% of 2-year-olds to an expected 86% of 5-year-olds . Post-vaccination levels reportedly associated with immunity ranged from a lower than expected 80% of 2-year-olds to an expected 93% of 5-year-olds . Of the 114 vaccines with serologic data, those with side-effects had serologic changes comparable to those without side-effects . There was no difference in side-effects or immunologic response across ethnic groups . Therefore, side-effects, immunologic responses, and ethnic group appear to be independent variables.

Rev Laryngol Otol Rhinol (Bord), 1989, 110(1), 17 - 20
{Current bacteriologic status and therapeutic results in acute otitis media in children aged over 3 months}; Francois M et al.; 355 children, 3 months to 15 years old, presenting with acute otitis media, underwent a bacteriological study of otitis exsudate . From November 1985 to September 1987, 162 myringotomy and 149 acute otitis media spontaneously discharging were studied in Paris . From October 1981 to September 1987, 62 myringotomy and 46 spontaneously discharging acute otitis were studied in Valognes . There was none pathogenic bacterium in respectively 20 and 14% of the samples . Two or more pathogenic bacterium were isolated in 24 and 7% of the samples . In Paris as in Valognes, 3 pathogens were predominants: Haemophilus (17% were beta-lactamase producers), S . pneumoniae and Staphylococcus . There was only 5 and 3% Streptococcus pyogenes, 2% Branhamella catarrhalis in Paris, none in Valognes . Pseudomonas was present only in case of spontaneous otorrhea, even if recent . For the moment, the combination of amoxicillin with clavulanic acid is not our first treatment in case of acute otitis media in children . Actually we prescribe amoxicillin alone, 50 to 100 mg/kg/day . If the child is allergic to beta lactamin, we give him the combination of trimethoprime and sulfamethoxazole.

Boll Ist Sieroter Milan, 1989, 68(3), 241 - 8
Immunomodulation of polymorphonuclear leukocytes by D53 Immucytal and its constitutive fractions; Minonzio F et al.; D53 (Immucytal) is a compositive vaccine made of immunogenic ribosomes extracted from 4 bacterial species (Klebsiella pneumoniae, Haemophilus influenzae, Streptococcus pyogenes and Streptococcus pneumoniae) associated with a membrane proteoglycan from a non-encapsulated strain of Klebsiella pneumoniae (MPG-Kp) . In this work we have studied the effect of the compound on human polymorphonuclear leukocyte (PMN) function "in vitro" . We have demonstrated that D53 was able to significantly increase Fc- receptor dependent phagocytosis without modify the C3-receptor dependent activity . Furthermore D53 enhanced the oxidative metabolism (evaluated by chemiluminescence) both using cells in resting conditions or after stimulation with phagocytable or soluble stimuli . On the contrary D53 caused a dose-dependent inhibition of PMN migration toward different chemoattractants . Using the two constitutive fractions of the compound (ribosomes and proteoglycans) we have observed that the MPG-Kp component was mainly responsible for the modulating activity of the drug on human PMNs.

G Batteriol Virol Immunol, 1989 Jan-Dec, 82(1-12), 133 - 40
{Bacterial meningitis . Study from 1970 to 1988 at the Regina Margherita Children's Hospital in Turin}; Grandi G et al.; From 1970 to 1988, 330 cases of bacterial meningitis were diagnosed at the Children's Hospital Regina Margherita of Turin . Neisseria meningitidis was the most frequent cause of bacterial meningitis (45%); meningitis caused by Haemophilus influenzae increased from 4% in 1970-1983 to 19% in 1984-1988, and meningitis with pathogen unknown decreased from 28% in 1970-1983 to 7% in 1984-1988 . The neonatal meningitis in 1984-1988 were caused by Streptococcus B in 90% of cases.

Meikai Daigaku Shigaku Zasshi, 1989, 18(3), 420 - 9
{Production of IL-1 like cytokine by cultured bone cells: inducing effect of Haemophilus actinomycetemcomitans lipopolysaccharide on the cytokine production}; Yoshimura K et al.; We have studies the role that interleukin-1 (IL-1) and IL-1-like cytokine play in the mechanism of bone resorption that occurs in periodontal disease . To determine whether the bone cell itself produces IL-1-like cytokine, we examined bone cells migrating from fragments of newborn mouse calvaria . These bone cells were cultured in alpha-MEM with of without fetal calf serum . IL-1-like cytokine activity was measured by incorporation of {3H} thymidine into C3H/HeJ thymocytes treated with lipopolysaccharide (LPS) from Haemophilus actinomycetemcomitans, a bacterium found in juvenile periodontopathy . The bone cells produced a significant amount of IL-1-like cytokine . The maximum production of IL-1-like cytokine was observed at 24 hours with the LPS in serum-free alpha-MEM . IL-1-like cytokine production stimulated by LPS was marked in the bone cells from LPS high-responder C3H/HeN mice, but not in those from low-responder C3H/HeJ mice . Peak of IL-1-like cytokine activity in culture supernatants of the bone cells was detected in fractions with a molecular weight corresponding to 15,000 daltons.

J Vet Diagn Invest, 1989 Jan, 1(1), 16 - 9
Antimicrobial susceptibility and serotypes of Actinobacillus (Haemophilus) pleuropneumoniae recovered from Missouri swine; Fales WH et al.; The antimicrobial susceptibility of 73 Actinobacillus (Haemophilus) pleuropneumoniae isolates from swine in Missouri was determined with a microdilution minimal inhibitory concentration test system . Serotyping was accomplished by means of co-agglutination . Serotype 1 (39/73) and serotype 5 (30/73) were commonly found, whereas serotype 7 (4/73) was infrequently encountered . Most isolates (MIC90) were found susceptible to ampicillin (amoxicillin), cephalothin, penicillin, erythromycin, gentamicin, and kanamycin . Marked resistance was found with oxytetracycline, tylosin, and sulfadimethoxine . The data indicate that use of ampicillin (amoxicillin) or penicillin may correlate well with the favorable outcome of treatment.

J Vet Diagn Invest, 1989 Jan, 1(1), 12 - 5
Actinobacillus (Haemophilus) pleuropneumoniae: use of coagglutination and complement fixation to determine the relationship between presence of organism and antibody titer in slaughterhouse pigs; Hoffman LJ; The conventional culture method was compared to coagglutination for detection of Actinobacillus (Haemophilus) pleuropneumoniae in 425 sets of pig lungs . Sera from the same animals were evaluated for antibodies to A . pleuropneumoniae by the complement fixation (CF) test . All samples were collected at 2 packing plants in Iowa . In 2 nonvaccinated herds with no history of respiratory disease, the difference between standard culture results and coagglutination was highly significant (P less than 0.001) . None of the 57 pigs in this group were positive for A . pleuropneumoniae by conventional culture, but 7 were positive by the coagglutination test . There were 15 animals with CF titers between 1:8 and 1:32 . Animals from 6 herds vaccinated for A . pleuropneumoniae and without recent respiratory problems were evaluated . One out of 118 animals tested was positive for A . pleuropneumoniae by standard culture as compared to 9 positive by coagglutination . The difference in positive results between culture and coagglutination was highly significant (P less than 0.001) . Twenty-eight animals had CF titers to A . pleuropneumoniae (1:4 to greater than or equal to 1:128) . Two hundred fifty lungs and sera samples were collected from 7 herds which had recently experienced varying degrees of respiratory disease . Thirty-nine lungs were positive for A . pleuropneumoniae by culture and 182 were positive by coagglutination . The number of positives detected by coagglutination was significantly different (P less than 0.001) from the number positive by culture . There were 172 animals with antibody titers ranging from suspect to greater than or equal to 1:128 . There were significantly fewer positive animals detected by standard culture than with the CF test (P less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Adv Exp Med Biol, 1989, 251, 175 - 80
Synthetic peptide representing a T-cell epitope of CRM197 substitutes as carrier molecule in a Haemophilus influenzae type B (Hib) conjugate vaccine; Bixler GS Jr et al.; The cross-reactive material (CRM197) of diphtheria toxin is considered to be advantageous as a carrier molecule in the formulation of a Haemophilus influenzae type b conjugate vaccine . In order to more precisely understand the function of the CRM197 in the vaccine, we have begun mapping the T-cell epitopes of the protein . A peptide which represents a segment of the primary sequence of CRM197 has been identified and found to stimulate diphtheria toxoid or CRM197-primed murine T-lymphocytes . In addition, the peptide is capable of priming T-cells in vivo for a subsequent in vitro T-cell response to itself or to the intact CRM197 molecule . The ability of the peptide to replace CRM197 as a carrier molecule was examined by immunizing mice with PRP, PRP-CRM197 conjugate, or PRP covalently coupled to the peptide . Antibodies to PRP were only detected in the PRP-CRM197 or PRP-peptide immunized groups . Both conjugates elicited primary and secondary antibody responses . Thus, a synthetic peptide representing a defined T-cell epitope of CRM197 has been functionally demonstrated based on its ability to act as a carrier molecule in a PRP conjugate vaccine.

Gene, 1988 Dec 25, 74(1), 221 - 4
Cytosine methylation as an effector of right-handed to left-handed DNA structural transitions; Zacharias W et al.; Cytosine methylation has energetic and structural influences on left-handed Z-DNA formation in supercoiled plasmids . The restriction and modification enzymes from Haemophilus haemolyticus (HhaI and M.HhaI) provide a system to locate and analyze small segments of Z-DNA in large supercoiled plasmids . An approach is outlined that uses M.HhaI as an in vivo conformational probe for the detection of unusual DNA structures in a living cell . Also, characteristic features of the M.HhaI gene and protein are discussed.

Gene, 1988 Dec 25, 74(1), 45 - 50
Cloning and analysis of the HaeIII and HaeII methyltransferase genes; Slatko BE et al.; The HaeIII methyltransferase (MTase) gene from Haemophilus aegyptius (recognition sequence: 5'-GGCC-3') was cloned into Escherichia coli in the plasmid vector pBR322 . The gene was isolated on a single EcoRI fragment and on a single HindIII fragment . Clones carrying additional adjacent fragments were found to code also for the HaeII restriction endonuclease and HaeII modification MTase (recognition sequence: 5'-PuGCGCPy-3') . The sequence of the HaeIII modification gene was determined . The inferred amino acid sequence of the protein was found to share extensive similarity with other sequenced m5C-MTases . The central 'non-conserved' region of the M.HaeIII MTase, thought to form the nucleotide sequence-specificity domain, is almost identical to that of the M.BsuRI, M.BspRI and M.NgoPII MTases, which also recognize the sequence 5'-GGCC-3'.

Gene, 1988 Dec 25, 74(1), 15 - 21
Overproduction and purification of the M.HhaII methyltransferase from Haemophilus haemolyticus; Chandrasegaran S et al.; The HhaII methyltransferase gene from Haemophilus haemolyticus was subcloned in an expression vector under control of the hybrid trp-lac promoter . Induction with isopropyl-beta-D-thiogalactopyranoside results in overproduction of the methyltransferase to about 3% of total cellular protein . The methyltransferase was purified to near electrophoretic homogeneity by phosphocellulose, DEAE, and gel chromatography . Its monomer Mr by sodium dodecyl sulfate-polyacrylamide gel electrophoresis is 25 kDa, in good agreement with that predicted from the nucleotide sequence . Crystals of the methyltransferase were obtained in the presence of a two-fold molar excess of the duplex oligodeoxynucleotide substrate 5'd-GGACTCC.CCTGAGG.

Jpn J Antibiot, 1988 Dec, 41(12), 2065 - 74
{Antimicrobial activity of sultamicillin against clinical isolates from upper respiratory tract infections II}; Deguchi K et al.; In an attempt to examine the effect of sulbactam (SBT) on beta-lactamase activity, three hundred clinical isolates from the infected upper respiratory tract were tested for MICs and disk sensitivities of ampicillin (ABPC) and sultamicillin (SBTPC) . beta-lactamase production was tested using the acidometry disk method (beta-Check, Taito Pfizer Co.) . For strains such as Klebsiella spp . which form mucoid type colonies, we used the SS culture medium which, by reducing the influence of huge amounts of capsular material, allows a better reaction to the acidometry disk . Penicillinase, produced by Branhamella catarrhalis, Haemophilus influenzae, Neisseria spp., etc . was detected clearly by direct application of portions of colonies onto acidometry disks . For cephalosporinase, however, a direct application of such fractions resulted in weak reactions . We, therefore, used fractions which had undergone the enzyme induction, and obtained better reactions . Sensitivities of tested bacteria to ABPC and SBTPC were inversely related to MIC values . beta-Lactamase-producing strains showed weaker sensitivity to ABPC than non-producing strains . To SBTPC, however, beta-lactamase-producing strains and non-producing strains showed very similar sensitivity . We thus confirmed that the inhibitory action of SBT to beta-lactamase can well be demonstrated using the disk sensitivity method.

J Antimicrob Chemother, 1988 Dec, 22(6), 905 - 10
The reliability of methods for detecting chloramphenicol resistance in Haemophilus influenzae; Walker CW et al.; Eighty-eight strains of Haemophilus influenzae were examined for resistance to chloramphenicol by various techniques . Methods compared were a rapid chemical assay for chloramphenicol acetyltransferase (CAT), an agar dilution minimum inhibitory concentration (MIC) method, disc diffusion tests with 10, 30, and 50 micrograms discs, and a microbiological technique for detecting CAT . Fifty-eight chloramphenicol-sensitive strains had MICs less than or equal to 0.5 mg/l, while 30 resistant strains had MICs greater than or equal to 4 mg/l . The chemical CAT assay clearly distinguished resistant from sensitive strains, was simple to perform and provided results within 30 min . By disc diffusion, the lower the disc content the clearer the distinction between sensitive and resistant populations . Difficulties were encountered in interpretating the microbiological CAT assays as some sensitive strains appeared resistant . The chemical CAT assay is recommended for use when a rapid result is required . Rare chloramphenicol-resistant, CAT-negative strains have been described in the USA and these strains would only be detected by a disc diffusion or MIC test.

Int J Pediatr Otorhinolaryngol, 1988 Dec, 16(3), 211 - 7
Bactericidal activity of middle ear effusion on a single isolate of non-typable Haemophilus influenzae; Shimizu T et al.; Bactericidal activity of middle ear effusion (MEE) from children with otitis media with effusion (OME) on one strain of non-typable Haemophilus influenzae was measured and was compared with that of normal human serum . H . influenzae culture negative MEEs had a bactericidal activity on one strain of non-typable H . influenzae (P less than 0.01), and the activity of serous effusions was significantly stronger than that of mucoid ones (P less than 0.01) . The bactericidal activity of 20% pooled MEE was almost equal to that of 4% normal human serum . Heat treatment (56 degrees C, 30 min) abolished this activity of both pooled MEE and normal human serum . Addition of fresh guinea pig serum (GPS) as a complement source to the heat-treated pooled MEE restored this activity, while its addition to the heat-treated normal human serum failed to do so . These results suggest that complement factor is important in the bactericidal activity of MEE.

J Clin Microbiol, 1988 Dec, 26(12), 2549 - 53
Development of serum antibodies of the immunoglobulin G class and subclasses against the capsular polysaccharide of Haemophilus influenzae type b in children and adults with invasive infections; Claesson BA et al.; The development of total immunoglobulin G (IgG) antibodies and antibodies of the four IgG subclasses in serum against Haemophilus influenzae type b capsular polysaccharide (CPS) was studied in 24 children and 11 adults with invasive Haemophilus influenzae type b infections, by using an enzyme-linked immunosorbent assay . None of the 8 children aged 10 months or younger had increases in the IgG class or in any of the IgG subclasses . In contrast, 14 of 16 children between 10 months and 6 years of age and 10 of 11 adults had significant increases in total IgG, IgG1, or IgG2 antibodies in various combinations, but none of them had increases in IgG3 or IgG4 antibodies . The increases in IgG1 and IgG2 antibodies in the children were of similar magnitudes . Of 11 adult patients, 9 had significant increases in IgG2 antibodies, while only 4 had increases in IgG1 antibodies . In conclusion, this study shows that children younger than approximately 1 year have no IgG response to H . influenzae type b CPS, while individuals above this age have a mixed IgG1 and IgG2 response.

Eur Respir J, 1988 Dec, 1(10), 929 - 31
Bacteraemic Haemophilus influenzae pneumonia; Allen MB et al.; Bacteraemia with Haemophilus pneumonia is uncommon . To determine its incidence and features case notes of patients in whom Haemophilus spp . were isolated from blood and pleural fluid over a five-year period were reviewed . Eight adult patients with H . influenzae bacteraemia were identified, five of whom had pneumonia on clinical and radiographic criteria . Only one patient had a predisposing factor, chronic obstructive lung disease . Two patients had beta-lactamase producing isolates, one of whom developed an empyema, following treatment with ampicillin, which required surgical drainage . Four patients were elderly, aged 69-80 yrs and were clinically in shock at the time of diagnosis . Seven of the eight patients survived.

Infect Immun, 1988 Dec, 56(12), 3058 - 63
Nearest neighbor analysis of outer membrane proteins of nontypeable Haemophilus influenzae; Klingman KL et al.; The arrangement of outer membrane proteins on the surface of nontypeable Haemophilus influenzae was investigated with cleavable and noncleavable bis-imidate cross-linking agents . Whole organisms were subjected to cross-linking agents, and oligomers of proteins were detected by sodium dodecyl sulfate-polyacrylamide gel electrophoresis, two-dimensional gel electrophoresis, and immunoblot assay, using monoclonal antibodies to outer membrane proteins . The major outer membrane protein (P2) formed dimers and trimers detected by all three methods . Oligomers of other outer membrane proteins were not detected . These data indicate that P2 exists as a trimer on the outer membrane and suggest that other outer membrane proteins exist as monomers on the outer membrane.

Jpn J Antibiot, 1988 Dec, 41(12), 1947 - 53
{Clinical experience with sultamicillin fine granules in pediatric field}; Haruta T et al.; Sultamicillin fine granules were used orally in 18 pediatric patients with infections in doses ranging 7.3-10.0 mg/kg t.i.d . or q.i.d . The following is a summary of the results: 1 . Clinical efficacies in 16 cases with tonsillitis were excellent in 13 cases, good in 2 cases and fair in 1 case . Efficacy in 1 case of bronchitis and 1 case of pneumonia were good . The overall efficacy rate in the 18 cases was 94.4% . 2 . Four out of 5 strains of Staphylococcus aureus were eradicated but 1 strain persisted . Three out of 7 strains of Haemophilus influenzae were rated as eradicated, 1 strain as decreased and 3 strains as persisted . Two strains of Streptococcus pyogenes and 3 strains of Haemophilus parainfluenzae were eradicated . The bacteriological efficacy rate for the 17 strains was 70.6% . Four strains out of the 17 were found to produce beta-lactamase and 3 strains were suspected, to produce the enzyme, but of these 7 strains, 5 strains were eradicated . 3 . Diarrhea and loose stool were observed as side effects in each of 2 cases . It appeared that diarrhea was related to this drug . A slight elevation of GOT was observed in 1 case in laboratory tests . 4 . This drug appears to be easy for children to take in terms of taste and smell.

Jpn J Antibiot, 1988 Dec, 41(12), 1895 - 905
{Pharmacokinetic, bacteriological and clinical studies of sultamicillin fine granule in pediatric field}; Ishikawa H et al.; Pharmacokinetic, bacteriological and clinical studies on sultamicillin (SBTPC) fine granule were carried out in the field of pediatrics . The results obtained are summarized as follows . 1 . Antibacterial activities of SBTPC against clinically isolated strains of Haemophilus influenzae, Haemophilus parainfluenzae, Streptococcus pneumoniae, Streptococcus pyogenes, Streptococcus agalactiae, Staphylococcus aureus, Branhamella catarrhalis, and Escherichia coli were compared with those of ampicillin (ABPC) . SBTPC was superior to ABPC especially against beta-lactamase producing H . influenzae, E . coli, S . aureus, and B . catarrhalis . 2 . Serum concentrations and urinary excretion rates of sulbactam (SBT) and ABPC after administration of SBTPC fine granule at a dose level of 10 mg/kg in 2 cases were determined . Mean half-lives of SBT and ABPC in the serum following oral administration were about 1.33 and 1.61 hours respectively . Mean urinary recovery rates of SBT and ABPC in 6 hours after oral administration at a dose of 10 mg/kg were 58.7% and 49.6% respectively . 3 . SBTPC fine granule was administered to 20 pediatric patients with various bacterial infections (pneumonia 8 cases, bronchitis 2, pharyngitis 2, tonsillitis 4, subcutaneous abscess 1 and urinary tract infection 3) . The overall clinical efficacy rate was 100% and the overall bacteriological eradication rate was 75% . 4 . No adverse reactions were observed except 1 case of loose stool . No abnormal laboratory test values were observed . These results indicate the usefulness of SBTPC fine granule in the treatment of bacterial infections in children.

Vet Microbiol, 1988 Dec, 18(3-4), 335 - 48
Protection of mice against the lethal effect of an intraperitoneal infection with Haemophilus (Actinobacillus) pleuropneumoniae after vaccination with capsular proteins; Lenser DK et al.; Haemophilus (Actinobacillus) pleuropneumoniae Serotypes 5 and 7 capsular antigens (CA-1) were precipitated from culture supernatants with N-cetyl-N,N,N,-trimethylammonium bromide (Cetavlon) . CA-1 contained a carbohydrate to protein ratio of 2:1 for Serotype 5 and 3:1 for Serotype 7 . Glucosamine and uronic acid were detected in CA-1 from both serotypes suggesting that the capsule contained hyaluronic acid . All mice immunized intraperitoneally with CA-1 vaccine were protected from death when challenged with 10X the LD50 of the homologous but not the heterologous serotype . Oil adjuvants and the use of young (6 h) cultures were necessary for CA-1 vaccines to be protective . Deproteinization of CA-1 with chloroform and butanol followed by pronase treatment resulted in failure to protect mice from death . The protective capsular protein antigen in CA-1 vaccine may not originate from the outer membrane (OM) since repeated washing of the OM to elute the capsular protein antigen rendered the OM vaccine completely nonprotective for mice . Vaccines prepared from cell-wall lipopolysaccharide also were nonprotective for mice . Passive immunization of mice with anti-CA-1 antibody produced in rabbits to Serotype 5 was highly protective (P less than 0.01) for mice when challenged with 10X the LD50 of the homologous serotype.

Pediatr Emerg Care, 1988 Dec, 4(4), 241 - 2
Bacteremia in febrile children with lobar pneumonia and leukocytosis; Bonadio WA; A retrospective analysis of 86 consecutive cases of childhood pneumonia with clinical features indicative of bacterial etiology was performed to delineate the prevalence of and characteristics associated with accompanying bacteremia . All patients had temperature greater than or equal to 40 degrees C, a lobar pulmonary infiltrate on chest radiograph, and a peripheral white blood cell concentration greater than 20,000/mm3 or absolute band count greater than 2,000/mm3 . Associated clinical findings included 44% with an "ill" appearance, 37% with respiratory rate greater than or equal to 60/minute, 20% with heart rate greater than or equal to 200/minute, 33% with otitis media . Only one of 86 patients had a bacterial pathogen isolated by blood culture (Haemophilus influenzae, type b) . In children older than four months of age with pneumonia whose characteristics are indicative of bacterial etiology, associated clinical findings and laboratory data are insensitive markers for distinguishing those with concomitant bacteremia . The rate of bacteremia in this group of patients is low; if the clinical situation warrants, most with these features do not require empiric hospitalization with parenterally administered antibiotic therapy pending blood culture results.

J Clin Microbiol, 1988 Dec, 26(12), 2554 - 7
Comparison between radioimmunoassay and direct and indirect enzyme-linked immunosorbent assays for determination of antibodies against Haemophilus influenzae type b capsular polysaccharide; Lagergard T et al.; Levels of antibodies against Haemophilus influenzae type b capsular polysaccharide were determined in acute-phase and convalescent-phase serum samples obtained from 21 children with invasive H . influenzae type b infections and from 44 children vaccinated with two H . influenzae type b vaccines . Amounts of immunoglobulin G (IgG), IgM, and IgA antibodies were measured by direct and indirect enzyme-linked immunosorbent assay (ELISA), and the total amount of antibodies was measured by radioimmunoassay (RIA) . Results obtained by ELISA were calculated by multiple-point parallel-line comparison and by endpoint analysis . A very good correlation was obtained between direct and indirect ELISA values . In the lower range of antibody concentrations, the correlation between ELISA values obtained by endpoint analysis and those obtained by multiple-point parallel-line comparison was poor, since the latter method of calculation yielded values of up to 1 microgram/ml in sera that were negative according to endpoint analysis . These sera with negative endpoint titers also had undetectable or very low antibody concentrations as measured by RIA . Consistent with this finding, in acute-phase and prevaccination sera with undetectable or low antibody concentrations as measured by RIA, ELISA values calculated by multiple-point parallel-line comparison were much higher . In sera with higher antibody concentrations, however, parallel-line comparisons showed good correlation between RIA and ELISA values . Although no reference method for measuring true antibody concentrations is available, ELISA values as calculated by multiple-point parallel-line comparison appear to overestimate antibody concentrations in sera containing low antibody concentrations, whereas ELISA values obtained by endpoint analysis are less well correlated with RIA values at higher concentrations.

South Med J, 1988 Dec, 81(12), 1593 - 4
Haemophilus aphrophilus sternal osteomyelitis; Berenson CS et al.; We have described a unique case of Haemophilus aphrophilus sternal osteomyelitis, with two separate infections seven years apart . Historical data suggest dental abscesses and trauma, with hematogenous seeding, as the cause . The patient responded well to surgical debridement and penicillin therapy after dental extractions.

J Dent Res, 1988 Dec, 67(12), 1455 - 60
Utilization of a continuous streptococcal surface to measure interbacterial adherence in vitro and in vivo; Liljemark WF et al.; Cell-to-cell interactions are essential for the formation of dental plaque . A continuous layer of Streptococcus sanguis SA-1 cells fixed to a solid surface has been used to evaluate interactions among this bacterium, Haemophilus parainfluenzae, and Streptococcus sobrinus . S . sanguis cells were attached to a Falcon 3001 tissue culture plates or bovine enamel chips, coated with a biological adhesive . Scanning electron microscopy of the chips showed the streptococci as a contiguous surface . Radiolabeled bacteria were used to measure a second-species interbacterial adherence to the streptococcal-coated culture plates . Strains of H . parainfluenzae known to coaggregate (strain HP-28) and not to coaggregate (strains HP-42 and HP-80), in suspension with S . sanguis strain SA-1, were studied for adherence . Ten-fold-higher numbers of coaggregating strain HP-28 adhered in vitro to the streptococcal layer than did the non-coaggregating strains . S . sobrinus strain 6715 did not show appreciable adherence to the S . sanguis surface . Saliva did not affect the adherence of coaggregating or non-coaggregating H . parainfluenzae strains to S . sanguis strain SA-1 . Bovine enamel chips, coated with streptococci, mounted on modified orthodontic appliances and placed in the mouths of three volunteers, facilitated the measurement of interbacterial adherence in vivo of streptomycin-resistant strains of H . parainfluenzae (HP-28R or HP-42R) . Suspensions of bacteria were placed into the mouth, distributed throughout, and expectorated . After 15 or 120 minutes, the appliance with the chips was removed, the chips sonified, and colony-forming units (CFU) of streptomycin-resistant haemophili determined per chip.(ABSTRACT TRUNCATED AT 250 WORDS)

J Antimicrob Chemother, 1988 Dec, 22(6), 867 - 72
In-vitro activity of amoxycillin/clavulanic acid and five other oral antibiotics against clinical isolates of Haemophilus influenzae and Branhamella catarrhalis; Fernandez-Roblas R et al.; The in-vitro activity of amoxycillin/clavulanic acid, amoxycillin, erythromycin, doxycycline, chloramphenicol and cephalexin against 183 clinical isolates of Haemophilus influenzae and 61 of Branhamella catarrhalis was determined . Amoxycillin/clavulanic acid showed the greatest activity against H . influenzae . All isolates of B . catarrhalis were susceptible to amoxycillin/clavulanic acid, chloramphenicol, cephalexin and doxycycline.

Eur J Clin Microbiol Infect Dis, 1988 Dec, 7(6), 812 - 4
In vitro activity of new antibiotics against Haemophilus influenzae; Machka K et al.; The activity of sulbactam/ampicillin, aztreonam, cefetamet, cefixime, ciprofloxacin, enoxacin, fleroxacin and ofloxacin was determined against 160 Haemophilus influenzae strains using a standardized microdilution method . The strains were categorized into four groups according to beta-lactamase production and their resistance to ampicillin, chloramphenicol, erythromycin, tetracycline and cotrimoxazole . All isolates tested, regardless of their beta-lactamase production or resistance to the above mentioned drugs, were susceptible to the nine antibiotics . The most active antimicrobial agents were aztreonam, cefixime, and the two quinolone derivatives ciprofloxacin and ofloxacin.

Antimicrob Agents Chemother, 1988 Dec, 32(12), 1820 - 4
Safety and efficacy of topical norfloxacin versus tobramycin in the treatment of external ocular infections; Jacobson JA et al.; Bacterial conjunctivitis appears to resolve more rapidly when treated with appropriate topical antimicrobial agents . In this multicenter, randomized, double-blind study of efficacy and safety, patients with presumed bacterial external eye infections were assigned to topical therapy with 0.3% norfloxacin or 0.3% tobramycin . A total of 120 patients were enrolled . Of the total, 65 had documented bacterial infections and were evaluable; 59 of these patients had bacterial conjunctivitis . All of the patients with documented infections were cured or improved regardless of the drug treatment regimen or in vitro susceptibility testing results . The most common bacteria isolated were Haemophilus influenzae, Streptococcus pneumoniae, alpha-hemolytic streptococci, Staphylococcus aureus, and Staphylococcus sp . No patients had serious adverse reactions attributed to their therapy . Norfloxacin ophthalmic solution seems to be a safe, effective, and appropriate agent for the treatment of bacterial external eye infections.

Ann Trop Paediatr, 1988 Dec, 8(4), 217 - 21
Endotracheal aspiration for the bacteriological diagnosis of nosocomial- and measles-associated pneumonia; Berkowitz FE et al.; Endotracheal aspirates were obtained from 51 young children for the microbiological diagnosis of pneumonia acquired in hospital or associated with measles or severe protein-energy malnutrition . The procedure proved safe and the information obtained assisted in the management of most cases . There was a fairly good correlation between the findings of Gram stain and those of culture of the aspirates, which improved when only Gram stains showing many or moderate numbers of bacteria were used . The bacteria most frequently isolated were Gram-negative enteric bacilli, Staphylococcus aureus, Streptococcus viridans, Streptococcus pneumoniae and Haemophilus influenzae, many strains of which were resistant to conventional antibiotics . The role of endotracheal aspiration in the microbiological diagnosis of pneumonia in the above-mentioned types of patients is compared with that of percutaneous lung puncture, percutaneous transtracheal aspiration and expectorated sputum.

Am J Vet Res, 1988 Dec, 49(12), 2072 - 5
Use of monoclonal antibodies to serotype-specific antigens of Haemophilus pleuropneumoniae serotype 2 in passive immunization; Korvuo A et al.; The prophylactic value of mouse monoclonal antibodies to the pig pathogen Haemophilus pleuropneumoniae was studied . Approximately 250 mg of purified mouse monoclonal antibody specific to capsular antigens of H pleuropneumoniae serotype 2 was given IV to five 9-week-old pigs . Five additional pigs from the same litter served as controls . On the following day, all pigs were given a lethal dose (5 x 10(9)) of H pleuropneumoniae serotype 2 into the trachea . Four controls and 1 pig that was given antibodies died within 24 hours . The surviving 5 pigs developed typical signs of pleuropneumonia . After 6 days, the pigs were euthanatized and their respiratory tracts were examined for pathologic changes . All 5 pigs had pathologic changes, but they were less severe in the 4 pigs that had been given antibodies, compared with those in the control pig.

Eur Respir J, 1988 Dec, 1(10), 923 - 8
Gram stain and culture of morning and 24 h sputum in the diagnosis of bacterial exacerbation of chronic bronchitis: a dogma disputed; Medici TC et al.; Bacteriological results from microscopic and cultural examinations of morning and 24 h sputum were compared in an attempt to optimize the diagnosis of bacterial exacerbations of chronic bronchitis . Twelve patients collected sputum randomly on two consecutive days, either fresh morning sputum (3 h sputum) first, followed by 24 h sputum or vice-versa . Sputa were washed three times in 0.9% NaCl and then examined microscopically before and after homogenization with 2% pancreatin . Cultural examinations were performed on homogenized sputum . Haemophilus influenzae, pneumococci and neisseriae were identified more often in Gram stains than in cultures; staphylococci and Gram-negative rods less frequently so . About 50% of organisms microscopically identified as pneumococci failed to grow in cultures . Microscopic examinations revealed a marked reduction of cells and bacteria after homogenization with pancreatin . Gram stains of 24 h sputum show comparable results to those of morning sputum . No differences were found in cultures . Microscopic examination of the Gram stains was found to be superior to cultural examination . The value of microscopic examination was impaired by the addition of pancreatin.

J Immunol Methods, 1988 Nov 25, 115(1), 111 - 7
Measurement of anti-Haemophilus influenzae type b capsular polysaccharide antibodies by ELISA; Barra A et al.; Measurement of antibodies to the capsular polysaccharide polyribosylribitolphosphate (PRP) of Haemophilus influenzae type b by ELISA is made difficult by the poor binding of this antigen to the solid phase . Six coating conditions were compared using immune and non-immune human sera . Direct coating with PRP was inefficient . Precoating with protamine or poly-L-lysine (PLL) yielded irreproducible results and high background levels . Assays with PRP conjugated with PLL as coat were not sensitive enough . In addition, anti-PRP antibodies, especially those belonging to the IgM class, crossreacted with PLL . Coating with avidin or streptavidin followed by incubation with biotin-coupled PRP was not satisfactory either, due to binding of certain sera in the absence of PRP . Coating with PRP coupled to tyramine resulted in low backgrounds and acceptable specific binding levels . However, the finding that the binding of a few sera was only partially inhibited by soluble PRP led us to include an inhibition step in every experiment . Only optical densities inhibited by the antigen were taken into account . In view of the lack of parallelism of dilution curves from different sera, no attempt was made to express the results in weight units . They were expressed in arbitrary units calculated by comparison with internal standards . Under such conditions, the assay permitted a reproducible (interassay coefficients of variation around 10%) determination of PRP-Ab belonging to the various immunoglobulin classes and IgG subclasses and showed a good correlation with results obtained using the Farr assay.

Eur J Biochem, 1988 Nov 15, 177(3), 483 - 92
Chemical structure of the lipopolysaccharide of Haemophilus influenzae strain I-69 Rd-/b+ . Description of a novel deep-rough chemotype; Helander IM et al.; The chemical structure of the lipopolysaccharide of a deep-rough mutant (strain I-69 Rd-/b+) of Haemophilus influenzae was investigated . The hydrophilic backbone of lipid A was shown to consist of a beta-(1',6)-linked D-glucosamine disaccharide with phosphate groups at C-1 of the reducing D-glucosamine and at C-4' of the non-reducing one . Four molecules of (R)-3-hydroxytetradecanoic acid were found directly linked to the lipid A backbone, two by amide and two by ester linkage (positions 2,2' and 3,3', respectively) . Laser-desorption mass spectrometry showed that both 3-hydroxytetradecanoic acids linked to the non-reducing glucosamine carry tetradecanoic acid at their 3-hydroxyl group, so that altogether six molecules of fatty acid are present in lipid A . The lipopolysaccharide was the first described to contain only one sugar unit linked to lipid A . This, sugar in accordance with a previous report {Zamze et al . (1987) Biochem . J . 245, 583-587}, was shown to be a dOclA phosphate . The phosphate group was found at position 4, but the analytical procedures employed (permethylation and methanolysis followed by gas-liquid chromatography/mass spectrometry) also revealed dOclA 5-phosphate . Since a cyclic 4,5-phosphate could be ruled out by 31P-NMR, we conclude that, in this lipopolysaccharide, a mixture of dOclA 4- and 5-phosphate is present . By methylation analysis of the dephosphorylated, deacylated and reduced lipopolysaccharide the attachment site of the dOclA was assigned to position C-6' of the non-reducing glucosamine of lipid A . The anomeric linkages present in the lipopolysaccharide were assessed by 1H-NMR and 13C-NMR of deacylated lipopolysaccharide . The saccharide backbone of this Haemophilus influenzae lipopolysaccharide possesses the following structure: (Formula; see text)

S Afr Med J, 1988 Nov 5, 74(9), 444 - 5
A microbiological study of acute maxillary sinusitis in Bloemfontein; Snyman J et al.; Microbiological analyses and antibiotic sensitivity tests were done on 26 patients with acute maxillary sinusitis during the first 9 months of 1986 . Positive cultures were obtained in 23 of the patients, with anaerobes cultured in 13 (50%) . Haemophilus influenzae was cultured in all non-producers of beta-lactamase . Therapy with erythromycin and chloromycetin appeared to be equally effective in aerobic cases and metronidazole was effective in all anaerobic cases.

J Clin Microbiol, 1988 Nov, 26(11), 2387 - 90
Relationship between in vitro susceptibility test results for chloramphenicol and production of chloramphenicol acetyltransferase by Haemophilus influenzae, Streptococcus pneumoniae, and Aerococcus species; Matthews HW et al.; Haemophilus influenzae, Streptococcus pneumoniae, and Aerococcus species were tested for susceptibility to chloramphenicol by standard broth microdilution and disk-diffusion methods . MICs and zone diameter breakpoints were correlated with production of chloramphenicol acetyltransferase (CAT) . A comparison of MICs and zone diameters indicated that the interpretative criteria for H . influenzae and S . pneumoniae should be an MIC of less than or equal to 4 micrograms/ml or a zone diameter greater than or equal to 25 mm for susceptible strains and an MIC of greater than or equal to 8 micrograms/ml or a zone diameter of less than or equal to 20 mm for resistant strains; for Aerococcus species, interpretative criteria should be an MIC of less than or equal to 8 micrograms/ml or a zone diameter of greater than or equal to 20 mm for susceptible strains and an MIC of greater than or equal to 32 micrograms/ml or a zone diameter of less than or equal to 12 mm for resistant strains . All but four strains of H . influenzae and one strain of S . pneumoniae that were resistant to chloramphenicol by these criteria produced CAT . For Aerococcus species, however, chloramphenicol-resistant strains were negative for CAT as determined by a commercially available disk test . When comparing susceptibility results with CAT production, thiamphenicol was a better indicator of the presence of the enzyme than chloramphenicol and may be useful in assaying resistance to chloramphenicol.

Pediatr Infect Dis J, 1988 Nov, 7(11), 781 - 5
Counterimmunoelectrophoresis and latex particle agglutination in the etiologic diagnosis of presumed bacterial pneumonia in pediatric patients; Rusconi F et al.; A commercial latex agglutination (LA) kit (Wellcogen, Wellcome Diagnostics) used to detect bacterial polysaccharide antigens (Haemophilus influenzae type b and Streptococcus pneumoniae) was compared with a modified counterimmunoelectrophoresis technique and blood culture for etiologic diagnosis of presumptive bacterial pneumonia requiring hospitalization in 60 infants and children . Serum, urine and either sputum or nasopharyngeal secretions were collected during the first 5 days of therapy for antigen detection . Blood culture was positive in 6 of 52 (11.5%) of cases . Antigens were detected by counterimmunoelectrophoresis and/or LA in 13 of 60 (21.7%) serum samples, 2 of 16 (12.5%) unconcentrated urine samples, 19 of 42 (45.2%) urine samples concentrated 25-fold and 21 of 45 (46.7%) sputum or nasopharyngeal secretions . Antibiotic treatment for 5 days did not affect the antigen detection rate . Counter-immunoelectrophoresis was more sensitive than LA in serum and urine but not in sputum . However, because false positive reactions were frequently obtained with LA on nasopharyngeal secretions of an age-matched control group, this test appears unreliable.

Pediatr Infect Dis J, 1988 Nov, 7(11), 747 - 52
Comparison of active and combined passive/active immunization of Navajo children against Haemophilus influenzae type b; Letson GW et al.; In a high risk Navajo population we compared the immunogenicity of a new Haemophilus influenzae type b mutant-diphtheria toxic conjugate vaccine (HbOC) with simultaneous active (HbOC) and passive immunization with bacterial polysaccharide immunoglobulin prepared from adults immunized with H . influenzae b, pneumococcal and meningococcal vaccines . Only 7 of 26 (27%) 2-month-olds had an increase in H . influenzae b capsular polysaccharide antibody after a single dose of HbOC, a proportion similar to that of saline controls (9 of 25, 36%) . After a second HbOC dose at 4 months 88% had antibody concentrations of 0.15 microgram or more, and after a third dose at 6 months all had antibody levels greater than or equal to 0.15 microgram/ml . The group receiving both HbOC and bacterial polysaccharide immunoglobulin at 2 months uniformly had H . influenzae b CP antibody concentrations of greater than or equal to 0.15 microgram/ml at 4 months (P less than 0.001 relative to "HbOC alone" group) and subsequently responded similarly to second and third doses of HbOC vaccine as did also the "HbOC alone" group . We conclude that combined passive/active immunization with bacterial polysaccharide immunoglobulin and HbOC at 2 months maintains antibody at concentrations thought to be protective (greater than or equal to 0.15 microgram/ml) without interfering with the active antibody response to second and third doses of HbOC at 4 and 6 months of age.

J Antimicrob Chemother, 1988 Nov, 22(5), 697 - 706
Therapeutic efficacy of chloramphenicol, co-trimoxazole (trimethoprim/sulphamethoxazole), cefmenoxime and ceftriaxone in experimental bacteraemia and meningitis caused by ampicillin-resistant Haemophilus influenzae type b; Kim KS; Therapeutic efficacy of two newer cephalosporins, cefmenoxime and ceftriaxone, was evaluated in newborn rats with experimental bacteraemia and meningitis due to an ampicillin-resistant strain of Haemophilus influenzae type b, and the results were compared with those of ampicillin, chloramphenicol and co-trimoxazole (trimethoprim/sulphamethoxazole) . Measured by MICs and MBCs, cefmenoxime and ceftriaxone were at least a hundred-fold more active in vitro than chloramphenicol . Co-trimoxazole was bacteriostatic in vitro . For in-vivo studies, the following daily doses were used: 200 mg/kg for ampicillin; 100 mg/kg and 200 mg/kg for chloramphenicol; 10/50 mg/kg, 20/100 mg/kg and 100/500 mg/kg for trimethoprim/sulphamethoxazole; 10 mg/kg and 50 mg/kg for cefmenoxime; and 10 mg/kg and 25 mg/kg for ceftriaxone . Cefmenoxime and ceftriaxone were highly efficacious, even at a dose of 10 mg/kg/day, in eradicating the organism from blood and CSF, preventing bacteriological relapse and improving the survival rate . In contrast, chloramphenicol was effective in reducing mortality, but failed to eradicate the organism or to prevent relapse, while co-trimoxazole was least effective in that all but one survivors suffered relapse with positive blood and CSF cultures . Ampicillin gave unexpected results in that the organism was eradicated in all survivors and bacteriological relapse was prevented in most animals (73-75%).

J Pediatr, 1988 Nov, 113(5), 814 - 9
Postvaccination susceptibility to invasive Haemophilus influenzae type b disease in infant rats; Sood SK et al.; To evaluate the possibility that immunization with a capsular polysaccharide vaccine decreases immunity in the immediate postvaccination period and renders an animal susceptible to invasive Haemophilus influenzae type b disease, we passively immunized infant rat pups with an immune globulin preparation, vaccinated them with an H . Influenzae type b capsular polysaccharide vaccine at a wide range of doses, and challenged them with H . influenzae type b given intraperitoneally . Bacteremia occurred in 89% of protected, vaccinated pups compared with 17% of protected, unvaccinated pups (p = 0.0001) . In protected, vaccinated pups the rate of bacteremia resembled that in unprotected, unvaccinated control pups and did not vary with the dose of vaccine administered . The magnitude of bacteremia and the incidence of meningitis in protected, vaccinated pups exceeded that occurring in the protected, unvaccinated control animals, but these effects diminished with the dose of vaccine . Diminution of anticapsular antibody occurred in association with the largest doses of vaccine . We conclude (1) that the administration of H . influenzae type b capsular polysaccharide vaccine in infant rats is associated with a diminution of passively acquired anticapsular antibody immediately after vaccination and (2) that experimental challenge with H . influenzae type b at this time produces disease resembling that in animals not passively given protection.

Infect Immun, 1988 Nov, 56(11), 2801 - 7
Production of an interleukin-1 inhibitor by cell line P388D1 murine macrophages stimulated with Haemophilus actinomycetemcomitans lipopolysaccharide; Nishihara T et al.; Murine macrophages of the P388D1 cell line stimulated with lipopolysaccharide (LPS) from Haemophilus actinomycetemcomitans Y4 released an interleukin-1 (IL-1) inhibitor, as well as IL-1 . Maximal IL-1 activity in culture supernatants was detected after 24 h of culture . On the other hand, IL-1 inhibitor activity reached a maximum level after 72 h of culture . An IL-1 inhibitor was partially purified from the culture supernatant of P388D1 cells stimulated with Y4 LPS for 72 h by ammonium sulfate precipitation, followed by Sephacryl S-200 gel chromatography . A 160-kilodalton peak inhibitory to IL-1 and a 14-kilodalton peak showing IL-1 activity were separated by Sephacryl S-200 column chromatography . The partially purified IL-1 inhibitor significantly suppressed the proliferation of C3H/HeJ murine thymocytes that had been induced with murine and human IL-1 in the presence of a submitogenic dose of concanavalin A . The IL-1 inhibitor more strongly suppressed human recombinant IL-1 beta than human recombinant IL-1 alpha . This inhibitory activity of the partially purified preparation was unaffected by the presence of trypsin inhibitor and the protease inhibitor aprotinin . The IL-1 inhibitor did not exhibit either IL-2 or IL-2 inhibitor activity . The inhibitor suppressed C3H/HeJ thymocyte proliferation induced by IL-1 in the presence of a saturated concentration of IL-2 instead of a suboptimal concentration of concanavalin A . These results indicate that prolonged culture of Y4 LPS-stimulated murine macrophages releases a specific inhibitor of IL-1.

Arch Otolaryngol Head Neck Surg, 1988 Nov, 114(11), 1262 - 5
Staphylococcus epidermidis and Staphylococcus aureus in otitis media with effusion; Kurono Y et al.; Bacteriologic investigation of middle ear effusion (MEE), external ear canal, and the nasopharynx was carried out on 458 patients with otitis media with effusion . Staphylococcus epidermidis was the most common bacteria in MEE, even after excluding the contaminants from the external ear canal, which had the same value of minimal inhibitory concentration as the paired MEE . The bacterial agreement of S epidermidis between MEE and the nasopharynx was extremely rare in contrast with Haemophilus influenzae, Streptococcus pneumoniae, and Branhamella catarrhalis, although the organism was also frequently isolated from the nasopharynx . Staphylococcus aureus, having the same minimal inhibitory concentration as that in the nasopharynx, was more frequently found in MEE than S epidermidis . The results suggest that S epidermidis found in MEE is not a pathogen, but rather a contaminant in many instances . Staphylococcus aureus seems to be a causative agent in otitis media with effusion.

Neurosurgery, 1988 Nov, 23(5), 643 - 5
Haemophilus paraphrophilus frontal lobe abscess: case report; Pajeau AK et al.; We report a case of cerebral abscess due to Haemophilus paraphrophilus in a 51-year-old man who was otherwise healthy and had no cardiac abnormality . A source for the infection was not definitively identified; however, the patient had had dental manipulations 2 weeks before the onset of symptoms, and an oral source is probable . The patient was treated successfully with antibiotics after removal of the abscess . Bacteriological studies are discussed.

Am J Dis Child, 1988 Nov, 142(11), 1225 - 8
Safety and efficacy of flexible endoscopy in children with bronchopulmonary dysplasia; Cohn RC et al.; Because concern has been raised about the efficacy and safety of flexible fiberoptic bronchoscopy (FFB) in pediatric patients with chronic cardiopulmonary disorders, we reviewed the results of 129 flexible endoscopies performed on 47 children with a history of bronchopulmonary dysplasia (BPD) at our institution over a 44-month period . Indications for FFB; weight and age of the patient; and procedure format, including medication usage, findings, specimen results, and complications, were analyzed . Evaluation of previously diagnosed subglottic stenosis and airway abnormalities were the two most common indications (33% and 32%, respectively) . Persistent or recurrent infiltrates or atelectasis, need for cultures, stridor, failure to extubate, hoarseness, and persistent wheeze were also cited . Endoscopic diagnoses included adenoidal hypertrophy, laryngomalacia, vocal cord abnormalities, interarytenoid membrane, subglottic stenosis, granulomas, tracheobronchomalacia, stenosis, obstruction, generalized inflammation/edema, polyps, tracheal bronchi, and anomalous bronchial anatomy . Cytomegalovirus, pneumococcus, nontypeable Haemophilus influenzae, Pseudomonas, or mixed gram-negative flora were isolated from some patients without tracheostomy . Minor complications (transient bradycardia, mild nasopharyngeal bleeding, and mild worsening of upper airway obstruction) occurred in 3.1% of procedures, but no severe complications occurred . Management was directly affected by procedure results in 41% of procedures . We concluded that the FFB can be a safe, useful procedure in the management of children with BPD.

Zentralbl Bakteriol Mikrobiol Hyg {A}, 1988 Nov, 270(1-2), 83 - 97
A comparison between methods of identification and serotyping of encapsulated strains of Haemophilus influenzae; Taubitz IS et al.; Seven methods of serotyping of Haemophilus influenzae were evaluated . Comparing slide agglutination, staphylococcal coagglutination, latex agglutination, counterimmunoelectrophoresis, immunofluorescence, capsular swelling, and cultivation on antiserum agar the commercial coagglutination test was most reliable, most rapid, and easiest to perform . To identify all six serotypes this coagglutination test had to be combined with slide agglutination . With most methods best results were achieved by using cultures incubated at 37 degrees C for 6 h . As nonencapsulated strains often agglutinated unspecifically, selection of probably typeable strains was useful . Differentiation with help of colonial morphology and opalescent growth was facilitated by cultivation on Brain Heart Infusion (BHI) Chocolate Agar and testing of growth factor requirements on translucent BHI Agar with strips containing the growth factors V, X, and VX, respectively . In broth turbid growth was a hint for encapsulation . Nigrosin staining, a negative capsule staining, proved to be useful if specific antisera are not available . From 252 clinical isolates of H . influenzae 216 were not typeable . 36 strains could be serotyped . 27 (75%) belonged to serotype b, 6 (16.6%) were serotype e, 3 (8.3%) were serotype f . Serotype e and f were most difficult to identify . Spectrum of patients and diseases were corresponding to the findings of other authors . Less well-known infections like cellulitis (erysipelas of the cheeks) and arthritis were observed, too . Rapid identification of at least H . influenzae type b could render treatment in some cases more effective by early application of a suitable antibiotic.

Pediatr Infect Dis J, 1988 Nov, 7(11 Suppl), S150 - 3
Sinusitis in children; Wald ER; Upper respiratory tract infection and allergic inflammation are recognized as the important risk factors for acute sinusitis, with upper respiratory tract infection being most common . In children with acute or chronic sinusitis, the respiratory symptoms of nasal discharge, nasal congestion and cough are usually prominent . Radiography has traditionally been used to determine the presence or absence of sinus disease . The radiographic findings most diagnostic of bacterial sinusitis are diffuse opacification, mucous membrane thickening or an air-fluid level . The predominant organisms include Streptococcus pneumoniae, Branhamella catarrhalis and nontypable Haemophilus influenzae . Several viruses including adenovirus and parainfluenzae have also been recovered . Clinical improvement is prompt in nearly all children treated with an appropriate antimicrobial agent.

Pediatr Infect Dis J, 1988 Nov, 7(11 Suppl), S129 - 36
Management of otitis media in infants and children: current role of old and new antimicrobial agents; Bluestone CD; Otitis media, the diagnosis most frequently made by the pediatrician, is most effectively treated with antimicrobial therapy . Amoxicillin (or ampicillin) has been the standard for infants and children with acute otitis media because it is safe and effective for most of the causative bacterial pathogens . Amoxicillin has also been shown to be effective for treatment of some children with otitis media with effusion ("secretory" otitis media) and is the recommended prophylactic antimicrobial agent for prevention of frequently recurrent acute otitis media . However, during the past decade there has been an increasing rate of bacteria that are resistant to amoxicillin, primarily beta-lactamase-producing Haemophilus influenzae and Branhamella catarrhalis . Because of the emergence of these bacteria, other antimicrobial agents both old and new have been advocated for treatment and prevention of otitis media; amoxicillin-clavulanate and cefuroxime axetil are the newer agents . These agents are indicated for selected infants and children but for most patients amoxicillin remains a safe and relatively inexpensive effective "old friend".

J Infect Dis, 1988 Nov, 158(5), 973 - 82
Isotype distribution and bactericidal activity of antibodies after immunization with Haemophilus influenzae type b vaccines at 18-24 months of age; Kayhty H et al.; The serum antibody response to Haemophilus influenzae type b capsular polysaccharide or its protein conjugate vaccine (PRP and PRP-D, respectively) was studied in 28 children initially immunized at the age of 24 mo with either vaccine and in 10 children immunized for the third time with PRP-D at the age of 18 mo . The methods used were isotype-resolving enzyme immunoassay, Farr-type radioimmunoassay, and the in vitro bactericidal activity (BCA) test . Immunization with PRP evoked a higher proportion of IgA antibodies than did either the first or third dose of PRP-D, whereas the latter vaccine evoked a somewhat higher IgG response, but the differences were not statistically significant . In all groups the IgG antibody responses were predominantly IgG1, with the mean proportions being 82.2%, 84.2%, and 65.9% in the PRP, first-dose PRP-D, and third-dose PRP-D groups, respectively . Postimmunization antibodies were functionally active in the BCA test.

J Clin Microbiol, 1988 Nov, 26(11), 2415 - 20
Variability of clarithromycin and erythromycin susceptibility tests with Haemophilus influenzae in four different broth media and correlation with the standard disk diffusion test; Barry AL et al.; Four separate laboratories performed antimicrobial susceptibility tests with 40 Haemophilus influenzae isolates, each tested in triplicate . Erythromycin and a new macrolide, clarithromycin (A-56268; TE-031), were tested by the disk diffusion method, by the agar dilution procedure in two different media, and by broth microdilution tests in four different media . Erythromycin MICs for 90% of the strains were 16 micrograms/ml in Mueller-Hinton broth with 3% lysed horse blood and NAD, 4.0 micrograms/ml in hemophilus test medium, and 2.0 micrograms/ml in supplemented Schaedler broth or in the fastidious broth medium from Beckman Instruments, Inc . Clarithromycin MICs were generally 1 doubling dilution greater than erythromycin MICs in each of the media . Erythromycin disk tests corresponded best with MICs determined in the fastidious broth medium . In that same medium, clarithromycin MICs were about 1 doubling dilution greater than what would be expected from the results of disk tests . Because there were fewer growth failures, hemophilus test medium is recommended for microdilution tests with H . influenzae . Incubation of all tests for a full 24 h without an increased CO2 atmosphere was needed to achieve maximal precision of the tests . Interlaboratory and intralaboratory reproducibility of all tests was satisfactory.

Prostaglandins Leukot Essent Fatty Acids, 1988 Nov, 34(2), 127 - 34
Effects of dietary linoleic acid on beta-adrenergic responsiveness of the guinea pig respiratory system; Loesberg C et al.; Respiratory autonomic beta-adrenergic receptor function was investigated in isolated tracheal spirals of guinea pigs receiving different diets . Comparison was made between control and Haemophilus influenzae treated animals; this latter group serving as animal model for atopy . The different semi-synthetic diets (35 energy%) varying in their linoleic acid contents (5.85, 11.25 and 22.05 en%), exerted profound effects on membrane fatty acid composition . No influence of these diets on either food intake or growth could be detected . Isoprenaline induced relaxation of guinea pig tracheal spirals was maximal in the dietary group receiving moderate linoleic acid (11.25 en%) . Both the addition and the withdrawal of linoleic acid to this diet resulted in a significant impairment of beta-adrenergic receptor function, to the same extent as can be induced by Haemophilus influenzae . The results are discussed in view of current concepts for atopy.

Arch Otolaryngol Head Neck Surg, 1988 Nov, 114(11), 1266 - 9
Efficacy of a new macrolide (azithromycin) . For acute otitis media in the chinchilla model; Chan KH et al.; The efficacy of an investigational macrolide, azithromycin, in the treatment of acute otitis media consequent to an infection by a strain of beta-lactamase-producing Haemophilus influenzae, was evaluated using the chinchilla animal model . The results indicate that the azithromycin high-dosage (30 mg/kg/d) group has a significantly higher rate for effusion sterilization and resolution as compared with the other treatment groups . Unique pharmacokinetic properties of this investigational antimicrobial were demonstrated . Clinical trials using azithromycin for the treatment of upper respiratory tract infections, including otitis media, are warranted.

Allergol Immunopathol (Madr), 1988 Nov-Dec, 16(6), 375 - 8
Histamine release from human pulmonary mast cells induced by bacterial antigens; Brzezinska-Blaszczyk E et al.; Antigens of four bacteria (Staphylococcus aureus, Haemophilus influenzae, Streptococcus viridans, Branhamella catarrhalis) were tested for their ability to release histamine from human pulmonary mast cells recovered by means of bronchoalveolar lavages . For the sake of comparison the action of bacterial antigens on human mesenteric and adenoidal mast cells obtained by enzymatic dispersion of the tissues was studied . BAL mast cells released histamine in response to all studied bacterial antigens . Haemophilus influenzae antigens were the most effective histamine releasers . From among three populations of human mast cells pulmonary mast cells were the most sensitive to the challenge with bacterial antigens . Mesenteric mast cells were markedly more reactive than adenoidal cells . Adenoidal cells had low sensitivity to bacterial antigens.

CMAJ, 1988 Oct 15, 139(8), 743 - 7
Haemophilus influenzae meningitis in Manitoba and the Keewatin District, NWT: potential for mass vaccination; Hammond GW et al.; A community-based surveillance study of all central nervous system infections was carried out in Manitoba and the Keewatin District, NWT, between Apr . 1, 1981, and Mar . 31, 1984 . There were 201 cases of bacterial meningitis in Manitoba over the study period, 81 (40%) caused by Haemophilus influenzae; all but one isolate tested were type b (Hib) . There were nine cases of H . influenzae meningitis in the Keewatin District . The overall annual incidence rate of H . influenzae meningitis in Manitoba was 2.5/100,000; for children under 5 years the rate was 32.1/100,000 . For the Keewatin District the corresponding rates were 69.6/100,000 and 530/100,000 . A total of 85% and 100% of the cases of H . influenzae meningitis occurred by 24 months of age in Manitoba and the Keewatin District respectively . The age at onset was earlier in native Indian children (22 cases) and Inuit children (9 cases) than in non-native children (59 cases) (p less than 0.005); thus, vaccine prevention of Hib meningitis will likely be more difficult in native Indian and Metis children . Without evaluating the increased potential of H . influenzae vaccines to prevent nonmeningitic forms of disease, we concluded that mass childhood vaccination with polyribosylribitolphosphate (PRP) vaccine is not warranted in Manitoba or the Keewatin District . Immunogenicity studies suggest that administration of conjugated Hib vaccines such as PRP-D in infancy may prevent approximately one-third to two-thirds of cases of H . influenzae meningitis; these vaccines warrant consideration for use in mass childhood vaccination programs.

J Am Vet Med Assoc, 1988 Oct 15, 193(8), 941 - 2
Reproductive difficulties in cattle with antibody titers to Haemophilus somnus; Ruegg PL et al.; A herd of Holstein cows was examined because of suspected embryonic death . Four cows had embryonic loss, and 2 cows had aborted . Paired serum samples were tested for antibodies to infectious bovine rhinotracheitis virus, bovine viral diarrhea virus, and Haemophilus somnus . Of 16 cows, 8 had antibody titers to H somnus greater than 1:1,024, and 3 had greater than or equal to four-fold changes in antibody titers to H somnus . Haemophilus somnus infection was active in this herd and may have been responsible for the herd's reproductive problems.

J Antimicrob Chemother, 1988 Oct, 22(4), 437 - 44
Antibiotic susceptibilities and plasmid profiles of Haemophilus ducreyi isolates from southern Africa; Abeck D et al.; Thirty-eight strains of Haemophilus ducreyi isolated in southern Africa were tested in vitro against 15 antimicrobial agents including those frequently used for the treatment of chancroid . In addition, newer compounds which possess characteristics consistent with their possible use as single-dose therapy for the disease were tested . All isolates were found to be resistant to penicillin as a result of beta-lactamase production . The majority of strains were also resistant to tetracycline, sulphamethoxazole and trimethoprim, but susceptible to co-trimoxazole, erythromycin, spectinomycin, ceftriaxone, ceftizoxime, cefodizime, ciprofloxacin, fleroxacin, rifampicin, rifabutin and FCE 22250 . beta-Lactamase production appeared to be associated with the presence of low molecular weight plasmids (5.7 or 7 Md) . Sulphonamide resistance appeared to be either chromosomally-mediated or due to the presence of a 4.9 Md plasmid . No evidence of plasmid-mediated tetracycline resistance was observed.

Can J Microbiol, 1988 Oct, 34(10), 1129 - 34
Comparison of whole-cell protein electrophoretic profiles of Haemophilus influenzae: implementation of a microcomputer mainframe linked system and description of a new similarity coefficient; Albritton WL et al.; A microcomputer mainframe linked system is described which allows video camera data capture and storage of one-dimensional whole-cell protein electrophoresis gel images, processing of normalized traces to produce a similarity matrix, and analysis of the matrix using the commercial cluster analysis program CLUSTAN . A new similarity coefficient is introduced which takes into account both band position and intensity . Forty-five strains of Haemophilus influenzae, including the eight biotypes and six serotypes, were analyzed using this system . Results demonstrated groupings which are consistent with known genetic relationships.

Scand J Immunol, 1988 Oct, 28(4), 471 - 9
Human antibody responses to two conjugate vaccines of Haemophilus influenzae type B saccharides and diphtheria toxin; Seppala I et al.; Antigenicity of two Haemophilus influenzae type b (Hib) conjugate vaccines was studied by immunizing adults and 2-year-old children . Both vaccines induced strong anti-Hib responses and strong antibody responses to diphtheria toxin (DT), the protein part of the conjugate . The adults' responses were stronger than the children's . A conjugate of Hib oligosaccharide and mutant diphtheria toxin (HbOC) emerged as slightly superior to a conjugate of Hib polysaccharide and diphtheria toxoid (PRP-D) . HbOC induced somewhat higher total anti-Hib responses and significantly higher IgG1 anti-Hib responses than PRP-D . IgG1 and IgG2 were the main IgG subclasses of the anti-Hib antibodies, whereas IgG1 and IgG4 were the main subclasses of the anti-DT antibodies . Within this main rule, the ratio IgG1/IgG2 of anti-Hib antibodies varied between individuals . The average ratio was higher than five in children but approximately one in adults . It was lower in adult recipients of the polysaccharide conjugate (0.69) than in adult recipients of the oligosaccharide conjugate (1.55) . A large interindividual variation was observed in concentrations of IgG2 of Hib specificity, perhaps reflecting a small number of IgG2-committed B-cell clones participating in the response.

Antimicrob Agents Chemother, 1988 Oct, 32(10), 1484 - 9
Laboratory- and species-specific interpretive breakpoints for disk diffusion tests of chloramphenicol susceptibility of Haemophilus influenzae; Kronvall G et al.; A total of 601 clinical isolates of Haemophilus influenzae isolated in six different regions of Sweden were tested for chloramphenicol susceptibility by using agar dilution MIC determinations and disk diffusion tests . For seven strains MICs were 4 micrograms/ml or higher, and for one strain the MIC was 2 micrograms/ml . All eight strains produced chloramphenicol acetyltransferase . For the remaining 593 strains, MICs were less than or equal to 1 microgram/ml, and the MICs for 50% and 90% of the strains were both 0.5 microgram/ml . Disk diffusion tests carried out by using revised interpretive criteria introduced in 1984 by the Swedish Reference Group for Antibiotics correctly identified the 593 strains as susceptible and the 8 strains as resistant . Quality assessments were performed in 29 clinical microbiology laboratories . The revised criteria for chloramphenicol disk diffusion testing gave rise to false resistance results in some laboratories . The interpretive accuracy improved when the interlaboratory variation was compensated for by using adjusted breakpoints . Such revision was possible through peak correction, single-strain regression analysis, and standard curve regression analysis . Peak-corrected breakpoints improved the accuracy from an overall incidence of false-resistant isolates of 4.4% to 2.3% . Single-strain regression analysis and standard curve regression analysis provided laboratory- and species-specific breakpoints which reduced false resistance rates of 0.14% and 0%, respectively.

J Clin Microbiol, 1988 Oct, 26(10), 2132 - 8
DNA probe technology for rapid detection of Haemophilus influenzae in clinical specimens; Malouin F et al.; In a previous study, we reported that a 5-kilobase Haemophilus influenzae DNA fragment involved in penicillin-binding protein expression could be used as a probe for specific detection of H . influenzae strains (F . Malouin and L . E . Bryan, Mol . Cell . Probes 1:221-232, 1987) . Here, we report the ability of this probe to detect H . influenzae in clinical specimens . In a bacterial dot experiment, there was strong hybridization of the 32P-labeled probe to nonencapsulated and serotype a through f H . influenzae strains . The detection of H . influenzae in body fluids was then evaluated by using pooled human serum, urine, cerebrospinal fluid, and sputum as dilution media for H . influenzae, Haemophilus aegyptius, Haemophilus parainfluenzae, and Escherichia coli cells . At 65 degrees C, the probe hybridized to H . influenzae and H . aegyptius (greater than or equal to 10(5) cells) in all fluids . There was no hybridization with the E . coli negative control, and H . parainfluenzae hybridized when greater than or equal to 10(7) cells were used . Experiments performed at 73 and 80 degrees C permitted elimination of H . parainfluenzae hybridization . The detection of H . influenzae in 232 sputa from patients with respiratory tract infections was very specific (96 to 97%) and sensitive (74 to 100%) when the total time of the procedure was sufficient (6 to 24 h) and when the experiments were performed at 80 degrees C . In addition, the probe detected three of three and four of four H . influenzae-infected cerebrospinal fluids and blood cultures, respectively, and did not react with pneumococcus- or streptococcus-infected cerebrospinal fluids . Finally, by using a small-scale procedure, the probe rapidly detected H . influenzae in cerebrospinal fluid and sputum specimens (4 and 8 h, respectively) . These results imply prompt diagnosis of H . influenzae infections caused by nonencapsulated and serotype a through f strains.

Pediatrics, 1988 Oct, 82(4), 571 - 5
Haemophilus influenzae type b immunization of children with sickle cell diseases; Frank AL et al.; Haemophilus influenzae type B vaccine is recommended for children 1.5 to 6 years of age with sickle cell anemia, but the adequacy of their response is unknown . A total of 69 children with sickle cell syndromes, 1.5 to 5.6 years of age, were immunized with two vaccines alternatively, single blind . PRP vaccine was given to 36 children and a diphtheria toxoid conjugated vaccine, PRP-D, was given to 36 . Coded pre- and postvaccine sera were tested by radioimmunoassay for anti-PRP antibody . The groups did not differ in age distribution or type of sickle hemoglobinopathy . Preexisting antibody levels were low in both vaccine groups; 65% were less than 0.15 microgram/mL . The vaccines were safe but associated with frequent minor reactions . PRP-D gave higher geometric mean titers and mean fold titer increase than PRP in all children (15.58 micrograms/mL {234-fold} v 2.63 micrograms/mL {29-fold}) and in the subgroups 1.5 to 2.5 years of age or with pretiter values less than 0.15 microgram/mL . Titers for 64% of children receiving PRP and 94% receiving PRP-D were greater than or equal to 1.0 microgram/mL . Thus, both vaccines were useful in this population, but PRP-D was more immunogenic . Duration of antibody levels postvaccination, booster responses, and PRP-D immunogenicity in younger children with sickle cell syndromes all require further study.

Laryngoscope, 1988 Oct, 98(10), 1055 - 60
The role of Haemophilus influenzae in the pathogenesis of tonsillar hypertrophy in children; Brodsky L et al.; The role of specific bacteria in the pathogenesis of tonsillar hypertrophy in children in unknown . To determine the effect of specific bacteria on the presence and nature of tonsillar hypertrophy (measured both clinically and by tonsil weight), quantitative aerobic bacteriology was performed on 54 tonsil-core specimens from 54 children undergoing tonsillectomy for chronic tonsillitis and/or tonsillar hypertrophy . Twelve tonsil-core biopsies from 12 children with no history of tonsil disease served as controls . Haemophilus influenzae (HI), Streptococcus pyogenes (SP), Streptococcus pneumoniae (SPn), and Staphylococcus aureus (SA) were the most common microorganisms cultured from diseased tonsils . Few bacteria were cultured from the cores of controls . HI was cultured as the dominant aerobic bacteria in 15 of 54 tonsils (27%) . For HI alone, the number of bacteria/gram tonsil showed a significant positive correlation to tonsil weight (p less than 0.05) . Fourteen of 15 (94%) tonsils with HI were found in patients with clinical tonsillar hypertrophy, while only 6 of 10 patients (60%) with SP and SPn had tonsillar hypertrophy . Of the 38 tonsils removed for obstructive symptoms (clinical hypertrophy), 14 of 38 (37%) cultured HI as the dominant microorganisms, whereas only 6 of 38 (16%) cultured SP . Neither the type of HI (b vs . non-b) nor the presence of beta-lactamase production had a significant correlation to tonsil weight, bacterial load or the number of B- or T-cell subsets . The number of T-helper (Th), T-suppressor (Ts) and B-cells (per gram/tonsil) was markedly greater in all diseased tonsils than in controls . For both HI and SP the total number of bacteria/gram tonsil correlated positively to the number of Ts cells (p less than 0.003 and p less than 0.007, respectively) . In patients with HI type b (HI-b), the tonsil weight correlated to an increase in Ts and B-cells (p less than 0.004 and p less than 0.007, respectively) . An increased presence of the Ts and B-cells in the HI-b tonsils (and not in tonsils with HI non-b) suggests a differential response by the tonsil to these distinct but related bacteria . The above data strongly support an etiological role for HI in the pathogenesis of tonsillar hypertrophy in children . Alterations in the relationship between Th and Ts cells may affect normal B-cell function and be implicated in this phenomenon . Clinical implications for pathogenesis, antimicrobial therapy, and future directions for research are discussed.

J Med Microbiol, 1988 Oct, 27(2), 95 - 8
The penicillin binding proteins of the genus Haemophilus; Mendelman PM et al.; We questioned whether the penicillin binding protein (PBP) profiles of representative strains from the 19 species varied within the genus Haemophilus and whether these profiles would be of taxonomic value . Seventeen of the 19 representative strains studied had distinct PBP profiles; only those of H . avium and H . paragallinarum were identical . The data support the inclusion of H . aegyptius in the genus as a species related to but separate from H . influenzae and could not exclude H . somnus, H . agni, and H . equigenitalis from the genus . Comparative PBP analysis within the genus Haemophilus may therefore be useful taxonomically.

J Infect Dis, 1988 Oct, 158(4), 719 - 23
Haemophilus influenzae type b anticapsular antibody responses to PRP-pertussis and PRP-D vaccines in Alaska native infants; Ward JI et al.; To evaluate immune responses in Alaska Native infants at high risk for invasive Haemophilus influenzae type b (Hib) disease, we studied PRP-pertussis and PRP-D conjugate vaccines in this population relative to responses in white infants in California and New York . Infants were immunized at two, four, and six months of age (both vaccines) . In the PRP-pertussis trial, there were no significant differences in antibody levels at any age between Alaska Native infants and infants from California . Only 50% of the infants had a twofold or greater antibody rise after three doses . In the PRP-D trial, antibody levels at two months of age (presumably maternally acquired) were significantly higher for Alaska Native infants compared with infants from New York (P = .002) . There were no significant differences in antibody levels after any of the three doses . Among Alaska Native infants there was no significant difference in antibody response based upon degree of ethnic purity.

J Clin Invest, 1988 Oct, 82(4), 1339 - 46
Haemophilus influenzae lipopolysaccharide-induced blood brain barrier permeability during experimental meningitis in the rat; Wispelwey B et al.; The factors responsible for blood-brain barrier (BBB) injury during bacterial meningitis are incompletely defined . We evaluated the role of Haemophilus influenzae type b (Hib) lipopolysaccharide (LPS) in the alteration of blood-brain barrier permeability (BBBP) in an adult, normal and leukopenic, rat model of meningitis . Intracisternal inoculation of Hib LPS resulted in (a) dose-dependent increases in BBBP from 2 pg to 20 ng, with significant attenuation in the peak response after challenge with 500 ng and 1 microgram; (b) time-dependent increases in BBBP, with a delayed onset of at least 2 h, maximum alteration at 4 h, and complete reversal at 18 h; (c) greater BBBP than after challenge with the live parent strain; (d) and a close correlation (r = 0.86) between CSF pleocytosis and BBBP at 4 h . The LPS effect was significantly inhibited by preincubation with Polymyxin B and neutrophil acyloxyacyl hydrolase, however two different oligosaccharide-specific monoclonal antibodies did not inhibit activity . No change in BBBP after inoculation with Hib LPS occurred in leukopenic rats . Hib LPS, in the setting of an intact leukocyte response, exerts profound effects on BBBP.

Infect Immun, 1988 Oct, 56(10), 2709 - 16
Cloning of the gene encoding the major outer membrane protein of Haemophilus influenzae type b; Hansen EJ et al.; The major outer membrane protein (P2) of Haemophilus influenzae type b (Hib) with an apparent molecular weight of 37,000 to 40,000 has been previously shown to function as a porin and also as a target for antibodies protective against experimental Hib disease . The gene encoding the Hib P2 protein was cloned by using a shuttle vector capable of replication in both Escherichia coli and H . influenzae . The amino acid sequence of the amino terminus of the Hib P2 protein was determined and used to design an oligonucleotide probe corresponding to the first 20 amino acids of this protein . This oligonucleotide probe was used to identify Hib chromosomal DNA fragments containing the Hib P2 gene . These DNA fragments were ligated into the plasmid vector pGJB103 and then used to transform a rec-1 mutant of H . influenzae Rd . Recombinant clones expressing the Hib P2 protein were identified in a colony blot-radioimmunoassay by using a monoclonal antibody specific for a surface epitope of the Hib P2 protein . The gene encoding this Hib protein was present on a 10-kilobase Hib DNA insert in the recombinant plasmid . Transformation experiments involving the recombinant plasmid suggested that unregulated synthesis of Hib P2 is a lethal event in E . coli . The recombinant Hib P2 protein was exposed on the surface of the recombinant H . influenzae strain . This recombinant strain was used to develop a system for detecting polyclonal serum antibodies directed against surface determinants of the Hib P2 protein . The availability of the gene encoding the Hib P2 protein should facilitate investigation of both the immunogenicity and the structure-function relationship(s) of this major outer membrane protein.

J Gen Microbiol, 1988 Oct, 134 ( Pt 10), 2789 - 99
Utilization and metabolism of NAD by Haemophilus parainfluenzae; Cynamon MH et al.; The utilization of exogenous nicotinamide adenine dinucleotide (NAD) by Haemophilus parainfluenzae was studied in suspensions of whole cells using radiolabelled NAD, nicotinamide mononucleotide (NMN), and nicotinamide ribonucleoside (NR) . The utilization of these compounds by H . parainfluenzae has the following characteristics . (1) NAD is not taken up intact, but rather is degraded to NMN or NR prior to internalization . (2) Uptake is carrier-mediated and energy-dependent with saturation kinetics . (3) There is specificity for the beta-configuration of the glycopyridine linkage . (4) An intact carboxamide groups is required on the pyridine ring . The intracellular metabolism of NAD was studied in crude cell extracts and in whole cells using carbonyl-14C-labelled NR, NMN, NAD, nicotinamide, and nicotinic acid as substrates in separate experiments . A synthetic pathway from NR through NMN to NAD that requires Mg2+ and ATP was demonstrated . Nicotinamide was found as an end-product of NAD degradation . Nicotinic acid mononucleotide and nicotinic acid adenine dinucleotide were not found as intermediates . The NAD synthetic pathway in H . parainfluenzae differs from the Preiss-Handler pathway and the pyridine nucleotide cycles described in other bacteria.

Avian Dis, 1988 Oct-Dec, 32(4), 831 - 5
Further comparison of adjuvants for an inactivated infectious coryza vaccine; Blackall PJ; Inactivated infectious coryza vaccines containing different adjuvants were administered to 6-week-old chickens as a single dose containing 10(8) colony-forming units of Haemophilus paragallinarum HP31 . After 3 weeks, all chickens were challenged by intrasinus inoculation of HP31 . Two vaccines, one containing an aluminum-hydroxide adjuvant and the other a combined aluminum-hydroxide + avridine (a lipoidal amine) adjuvant, were effective . The three remaining vaccines--containing mineral-oil double-emulsion, avridine, or a combination of mineral-oil double-emulsion + avridine--gave much lower levels of protection . No adverse reactions were seen with any vaccine.

Avian Dis, 1988 Oct-Dec, 32(4), 742 - 7
Antimicrobial drug resistance and the occurrence of plasmids in Haemophilus paragallinarum; Blackall PJ; A broth microdilution method was used to examine the sensitivity of 75 Haemophilus paragallinarum isolates to six antimicrobial drugs (ampicillin, erythromycin, neomycin, penicillin, streptomycin, and tetracycline) . A total of 55 of the isolates (73%) were sensitive to all six drugs . The remaining 20 isolates were resistant to streptomycin, with one of these isolates also being resistant to tetracycline and another also resistant to neomycin . No isolate showing antimicrobial drug resistance belonged to agglutinin serovar C, despite this being the single largest serovar (27 out of 75) in the study . No plasmids were detected among the 75 isolates, despite the use of five different plasmid-screening techniques.

Arch Dis Child, 1988 Oct, 63(10), 1266 - 7
Acute pneumonia in Zimbabwe: bacterial isolates by lung aspiration; Ikeogu MO; Forty children, aged 2 months to 11 years, with severe acute pneumonia were investigated by needle aspiration of the lung . Fourteen organisms were isolated in only 13 patients . Streptococcus pneumoniae was isolated in six patients, Staphylococcus aureus in three, and Haemophilus influenzae in two . Two patients had mixed organisms.

J Clin Microbiol, 1988 Oct, 26(10), 1926 - 33
Macroscopic purulence, leukocyte counts, and bacterial morphotypes in relation to culture findings for sinus secretions in acute maxillary sinusitis; Jousimies-Somer HR et al.; Macroscopic purulence, leukocyte counts, and bacterial morphotypes in Gram-stained smears were investigated in 335 sinus secretions (240 aspirates and 95 injection aspirates) obtained by puncture in 234 young patients with acute maxillary sinusitis . Over 90% of the 147 aspirates macroscopically classified as purulent also contained high numbers of leukocytes (greater than 20 per oil immersion field) . A total of 82% of the 147 macroscopically purulent aspirates and 79% of the 156 aspirates containing high numbers of leukocytes yielded presumed sinus pathogens by culture in quantities of greater than 10(3) CFU/ml . Streptococcus pneumoniae or Streptococcus pyogenes was associated relatively more often (92 or 87%, respectively) with high numbers of leukocytes than Haemophilus influenzae, which was not infrequently (29%) recovered from the less purulent aspirates . When a bacterial morphotype was seen in the Gram-stained smear, a corresponding sinus pathogen was isolated in quantities of greater than 10(3) CFU/ml in 92% of aspirates . Other bacterial species (most often staphylococci) were usually isolated in low numbers and were almost never seen in the smear, suggesting nasal contamination . The 95 injection aspirates behaved, to a large extent, like diluted aspirates, with the exception that there was a higher frequency of probable nasal contamination . Macroscopic purulence, high leukocyte counts, and bacterial morphotypes seen in Gram-stained smears each predicted well the isolation of a presumed sinus pathogen and in some cases supported the significance of an otherwise doubtful culture finding . However, the macroscopic appearance of the secretion should not be used to screen samples for culture, because in several cases H . influenzae grew from nonpurulent samples as well.

J Clin Microbiol, 1988 Oct, 26(10), 1919 - 25
Bacteriological findings of acute maxillary sinusitis in young adults; Jousimies-Somer HR et al.; Bacteriological findings in 339 sinus secretions obtained by puncture were investigated in 238 young adult patients with acute maxillary sinusitis . Aerobic and anaerobic cultures were performed immediately . A total of 76% of the secretions were positive . The most common pathogens isolated were Haemophilus influenzae (50%), Streptococcus pneumoniae (19%), Streptococcus pyogenes (5%), and Branhamella catarrhalis (2%) . Coagulase-negative staphylococci and Staphylococcus aureus were isolated in 8 and 1% of the specimens, respectively . The staphylococci were almost invariably present in low numbers and, therefore, probably represented nasal contamination . Other aerobic species were found only occasionally . Anaerobes were isolated in 5% of the secretions . In one-half of these, a low concentration of Propionibacterium acnes was the sole anaerobe that was found, and it was usually mixed with a facultative organism (suggestive of contamination with nasal flora) . Only 2% of the sinuses were considered to have true anaerobic infections (high concentrations of several species typical of anaerobic infection), indicating that anaerobes are not a significant cause of acute maxillary sinusitis in a young adult population . The high recovery of H . influenzae in this study indicates that aminopenicillins may be more appropriate choice than conventional penicillin in the antimicrobial therapy of acute maxillary sinusitis (only 2 of 168 H . influenzae strains produced beta-lactamase).

J Gen Microbiol, 1988 Oct, 134 ( Pt 10), 2801 - 5
Biochemical properties of catalase-positive avian haemophili; Blackall PJ; The biochemical properties of 39 strains of Haemophilus avium from chickens were determined . All the strains produced acid from fructose, galactose, glucose and mannose but not from lactose . Variable reactions were found for arabinose, maltose, mannitol, sorbitol, trehalose and xylose . No strains showed urease activity or produced indole, while beta-galactosidase and/or ornithine decarboxylase activity was present in some strains . This variability allowed the recognition of 15 biochemical biovars including some not previously recognized in H . avium . Only 25 (64%) of the H . avium strains could be assigned to the three species (Pasteurella avium, P . volantium and Pasteurella species A) recently proposed to replace H . avium.

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