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