Vet Microbiol, 1988 Oct, 18(2), 155 - 61 Passive hemagglutination test for detection of antibodies against Taylorella (Haemophilus) equigenitalis in sera of mares; Eguchi M et al.; The passive hemagglutination (PHA) test was improved to enable the detection of antibodies to Taylorella (Haemophilus) equigenitalis in the sera of mares . Horse red blood cells (RBC) fixed with glutaraldehyde were compared with similarly treated RBC of a cow, pig and sheep for the PHA test . The horse RBC were superior to those of the other animals tested in detecting mares affected with contagious equine metritis (CEM) . A PHA test using these cells as indicator and an antigen prepared from T . equigenitalis by sonication following treatment with hyaluronidase was the most satisfactory in terms of sensitivity and specificity . None of the 156 serum samples from clinically healthy mares without a history of contact with T . equigenitalis-infected stallions or mares showed PHA titers greater than 1:32 and only a few samples (7.1%) showed PHA titers of 1:32 . Four of the 50 serum samples from mares affected with CEM showed PHA titers of 1:32, while most of the samples (92.0%) showed PHA titers greater than 1:32 . The glutaraldehyde-fixed horse RBC sensitized with the antigen had the advantage of being reproducible for at least 7 months when preserved at 4 degrees C. Eur J Clin Microbiol Infect Dis, 1988 Oct, 7(5), 691 - 4 In vitro activity of florphenicol; Graham R et al.; Florphenicol was active at a lower concentration than chloramphenicol against over half of 234 recent clinical bacterial isolates . The majority (98%) of the isolates were inhibited by florphenicol at a concentration of 8 mg/l or less . Florphenicol was particularly effective against chloramphenicol resistant strains of Haemophilus influenzae . Klebsiella aerogenes and Bacteroides spp . Florphenicol was bacteristatic for salmonellae and Escherichia coli but bactericidal for Haemophilus influenzae . Florphenicol was slightly more active than chloramphenicol against Chlamydia trachomatis, Mycoplasma hominis and Mycoplasma pneumoniae but less active against Ureaplasma urealyticum. Eur J Clin Microbiol Infect Dis, 1988 Oct, 7(5), 678 - 80 Lectin typing of Haemophilus ducreyi; Korting HC et al.; The cell wall carbohydrates of 43 strains of Haemophilus ducreyi isolated in different parts of the world were subjected to lectin analysis using commercial panels containing 14 different plant lectins of known specificity . Preliminary evidence indicated both intrastrain and inter-strain variation in cell wall carbohydrate composition . In addition, it was possible to group strains from different geographical areas by lectin agglutination patterns . Lectin typing might thus become a useful marker system for epidemiological investigation of Haemophilus ducreyi infections. Eur J Clin Microbiol Infect Dis, 1988 Oct, 7(5), 646 - 50 Antibiotic therapy of meningitis caused by ampicillin-resistant Haemophilus influenzae in Denmark and Greenland 1981 to 1987; Cordtz T et al.; A survey was performed in Denmark and Greenland in order to determine whether the current recommendation of ampicillin (400 mg/kg/day) for initial treatment of purulent meningitis is appropriate . Data obtained 1981-1987 in an ongoing nationwide programme for surveillance of ampicillin-resistant Haemophilus species was analysed, and patient records of 21 cases of meningitis caused by ampicillin-resistant Haemophilus influenzae strains (17 in Denmark, 4 in Greenland) reported in the period 1981-1987 were reviewed . In Denmark the overall rate of ampicillin-resistant Haemophilus influenzae was estimated to be approximately 2% for the study period, and the average rate of resistant isolates from spinal fluid was 5.2% (range 0-12.3%) . The incidence of meningitis caused by ampicillin-resistant Haemophilus influenzae strains remained low in the Danish population (around 0.05/100,000/year) except for a peak in 1985 . The overall mortality rate of Haemophilus influenzae meningitis for the study period was 2.4%, which was the same as before 1980 . In Greenland the actual number of cases of meningitis caused by ampicillin-resistant Haemophilus influenzae was small, but the incidence was at least 40 to 80 times higher than in Denmark with a high mortality rate (50%) . These observations prompted revision of the antibiotic regimen in Greenland, whereas the regimen was considered appropriate in Denmark. Eur J Clin Microbiol Infect Dis, 1988 Oct, 7(5), 610 - 5 Mechanisms of beta-lactam resistance in Haemophilus influenzae; Gutmann L et al.; Haemophilus influenzae has become increasingly resistant to beta-lactam antibiotics . Three major mechanisms, both enzymatic and non-enzymatic, are involved . Enzymatic resistance is mainly due to production of a TEM-1 plasmid-mediated beta-lactamase, and in some cases to a new enzyme ROB-1 . Of the non-enzymatic mechanisms, decreased permeability due to alteration of outer membrane proteins seems to be rare in comparison to decreased affinity of penicillin-binding proteins for beta-lactam antibiotics . Enzymatic resistance is present in about 10-20% of clinical isolates, while non-enzymatic resistance is present only in 2-4%. J Antimicrob Chemother, 1988 Oct, 22(4), 445 - 56 Comparative in-vitro activity of a new oral carbacephem, LY163892; Howard AJ et al.; The in-vitro activity of a new oral carbacephem, LY163892, was compared with cefaclor, cephalexin, cephradine, cefadroxil and selected penicillins against 529 bacterial isolates . LY163892 exhibited greater activity in vitro than all four cephalosporins against Haemophilus influenzae, beta-lactamase producing Branhamella catarrhalis, Escherichia coli, Klebsiella spp . and Proteus mirabilis . LY163892 had equivalent potency to cefaclor against non-beta-lactamase producing B . catarrhalis, streptococci and Staphylococcus aureus . Group D beta-haemolytic streptococci, Proteus vulgaris, and methicillin-resistant staphylococci were universally resistant to LY163892 and the four cephalosporins . Broth dilution experiments indicated that LY163892 was bactericidal against a range of Gram-positive and Gram-negative organisms and suggested that the antibiotic had a similar degree of stability to the beta-lactamases of H . influenzae, B . catarrhalis and Staph . aureus as did cefaclor . The susceptibility of 16 strains of H . influenzae to LY163892 and cefaclor were equivalent when estimated using three different commercially available agar media . Addition of carbon dioxide to the incubation atmosphere significantly reduced the potency of both drugs. Vaccine, 1988 Oct, 6(5), 393 - 8 Vaccination strategies in developing countries; Poore P; By 1990 it is hoped that all of the world's infants will have access to immunization services and that these services will then continue indefinitely . The link between people and health services, including immunization, can only be forged and maintained by an effective system of delivery and support to all health workers . A careful choice of strategies for this delivery system and an understanding of local cultural attitudes and behaviour is vital if this link is to be effective . Health workers will have to be trained and then supported in the field by regular contact with their supervisors . They will also need continuous, reliable, predictable and adequate supplies of equipment, drugs, vaccines, fuel and money, including salaries . Immunization is cost effective as a health intervention, but an effective programme of immunization can contribute much more than just vaccines, if it is developed in the context of primary health care (PHC) as originally proposed in 1978 at the conference in Alma AtaPIP: In developing countries, where economic development is lacking and literacy rates are low, priority must be given to primary health care and to the establishmend of sustainable health care delivery systems . The World Health Organization's Expanded Program of Immunization was designed with the goal of immunizing all children against measles, pertussis, tetanus, poliomyelitis, tuberculosis, and diphtheria by 1990 . A second function of the immunization program is to establish a health care delivery system . Today 50% of infants receive 3 doses of diptheria/pertussis/tetanus and polio vaccines, and 70% receive at least 1 dose . Measles kills 2 million children every year . The standard strain of attenuated vaccine is given at 9 months, and 1 dose protects 95% of children for life . Tetanus kills 800,000 infants every year . The vaccine must be refrigerated, and 2 doses are essential . Tuberculosis kills 2 million children under 5 every year . The attenuated BCG vaccine should be given at birth, and a single dose confers some protection . Diphtheria is most common among poor, urban children in termperate climates, and 3 doses of toxoid at monthly intervals are recommended . Poliomyelitis paralyzes 250,000 children a year . 4 doses of live attenuated Sabin vaccine are recommended . The vaccine is very sensitive to heat . Other vaccines in use or being developed include yellow fever, meningococcus, Japanese B encephalitis, rubella, hepatitis B, cholera, rotavirus, pneumonococcus, and Haemophilus influezae . 2 problems that confront the delivery of health services, including immunization, are lack of funds and lack of access to susceptible populations . Approaches to the lack of funds problem include fee for service, taxation, beter management of existing resources, reallocation of health resources, and increased funding from donor nations . Approaches to the problem of access include vaccination whenever children come into contact with a health facility for any reason, channeling by members of the community, involvement of traditional healers and birth attendants, outreach services, mass campaigns, pulse technics, and financial incentives . Arch Otolaryngol Head Neck Surg, 1988 Oct, 114(10), 1131 - 3 Inflammatory mediators in chronic otitis media with effusion; Skoner DP et al.; Otitis media with effusion (OME) is a common middle ear inflammatory disease in the pediatric population . This article determines concentrations of three functionally and metabolically distinct inflammatory mediators in middle ear effusions (MEE) and corresponding plasma of children with OME . One hundred two patients (mean age, 4.9 years) with persistent OME were studied . Middle ear effusions were collected from all subjects and plasma from a subset at the time of tympanostomy tube insertion . Histamine was assayed radioisotopically, 13,14-dihydro-15-keto-prostaglandin F2 alpha (stable PGF2 alpha metabolite) by radioimmunoassay, and neutrophil chemotactic factor of anaphylaxis by modified Boyden chamber . Mean MEE levels of the mediators (39 +/- 13 ng/mL, 462 +/- 179 pg/mL, and 264% +/- 57% positive control, respectively) were markedly higher than those of corresponding plasma (0.5 +/- 0.1 ng/mL, 285 +/- 127 pg/mL, and 47% +/- 5% positive control, respectively) . The mean histamine content of mucoid effusions (43.2 +/- 56.9 ng/mL) was significantly higher than that of purulent (22.5 +/- 10.5 ng/mL) and serous (17.9 +/- 16.8 ng/mL) effusions . Higher histamine levels were observed in effusions positive for Haemophilus influenzae when compared with those with other pathogenic isolates . The high concentrations of these mediators in MEE and their potential for inducing or sustaining the inflammatory process supports a role in the pathogenesis of OME. Eur J Clin Microbiol Infect Dis, 1988 Oct, 7(5), 606 - 9 Unencapsulated Haemophilus influenzae--what kind of pathogen? Makela PH. Haemophilus influenzae are small, gram-negative, rod-shaped bacteria . Because of their special growth requirements, they do not grow on usual blood agar media, but flourish on the mucosal membranes of the human respiratory tract where they adhere to the epithelial cells by fimbriae (a potential vaccine component) . Nasopharyngeal carriage of Haemophilus influenzae is very common, and in healthy carriers the bacteria are usually unencapsulated . The outer membrane of Haemophilus influenzae contains lipopolysaccharide (of so called R form, without O antigen) and major outer membrane proteins . The lipopolysaccharide is a virulence determinant . An extracellular enzyme, IgA protease, is another potential virulence determinant . The outer membrane of Haemophilus influenzae is a rather ineffective barrier towards antibiotics, and thus the major determinants of antibacterial resistance in Haemophilus influenzae are plasmid-coded enzymes that inactivate the antibiotic, and changes in the target molecules. J Clin Microbiol, 1988 Oct, 26(10), 2077 - 82 Monoclonal antibody-based sandwich enzyme-linked immunosorbent assay for detection of Bordetella pertussis filamentous hemagglutinin; Gustafsson B et al.; Hybrid cell lines producing monoclonal antibodies against Bordetella pertussis filamentous hemagglutinin (FHA) were established . The specificity of the antibodies was ascertained by enzyme-linked immunosorbent assay (ELISA), sandwich ELISA, and sodium dodecyl sulfate-polyacrylamide gel electrophoresis followed by electroblotting . The monoclonal antibody-based sandwich ELISA was developed for detection of B . pertussis FHA . The assay had a detection limit of B . pertussis FHA in concentrations ranging from 7 to 15 ng/ml . The assay was also able to detect whole B . pertussis, Bordetella parapertussis, and Bordetella bronchiseptica bacteria . No cross-reactions were observed with strains of Branhamella catarrhalis, Neisseria meningitidis, Haemophilus influenzae, Klebsiella pneumoniae, Legionella pneumophila, Streptococcus miteor, or Streptococcus pneumoniae . The monoclonal antibodies might be useful for the detection of soluble antigens and whole bacteria in clinical samples and for studies of the immunochemical structure of B . pertussis FHA. Proc Natl Acad Sci U S A, 1988 Oct, 85(20), 7758 - 62 Evolutionary genetics of the encapsulated strains of Haemophilus influenzae; Musser JM et al.; Genetic relationships among 2209 isolates of Haemophilus influenzae of polysaccharide capsule serotypes a, b, c, d, e, and f were determined by analyzing electrophoretically demonstrable allelic variation at 17 chromosomal enzyme loci . We distinguished 280 electrophoretic types (ETs), representing distinctive multilocus genotypes . Genetic diversity among ETs of isolates of the same serotype was, on average, only 67% of that in the total sample, and no ETs were shared among isolates of different serotypes . Cluster analysis of the ETs revealed 2 primary phylogenetic divisions at a genetic distance of 0.66 and 12 major lineages diverging from one another at distances greater than 0.42 . In general, strains of different phylogenetic lines or groups of allied lineages have characteristic cap region restriction fragment length polymorphism patterns obtained by digestion of genomic DNA with EcoRI . Strains producing serotype c, e, and f capsules have no close relationships to those of other encapsulated strains . Lineages of both serotype a and b strains occur in each primary phylogenetic division, most probably as a result of the transfer of serotype-specific sequences of the cap region between clonal lineages . Serotype a strains allied in division I with a group of abundant serotype b clones and the serotype d strains apparently are more virulent than the serotype a strains in division II, which are related to serotype b and f strains that rarely cause invasive disease. J Clin Microbiol, 1988 Oct, 26(10), 1934 - 8 Rapid chemiluminescent nucleic acid assays for detection of TEM-1 beta-lactamase-mediated penicillin resistance in Neisseria gonorrhoeae and other bacteria; Sanchez-Pescador R et al.; Two new assays for the detection of TEM-1 beta-lactamase-mediated bacterial penicillin resistance were developed that involve the use of specific nucleic acid hybridization . Both techniques are based on a solution-phase hybridization of oligonucleotide probes to the target DNA sequence, solid-phase capture of the probe-target complex, and an amplified chemiluminescent labeling method . One configuration of hybridization probes detected the presence of TEM-1 in Neisseria gonorrhoeae (45 strains), Haemophilus spp., Escherichia coli, Shigella sonnei and Salmonella typhi . A second configuration (TEM-1NH) detected TEM-1 beta-lactamase-mediated penicillin resistance only in N . gonorrhoeae (97 strains) and Haemophilus (6 strains) isolates in which TEM-1 is inserted in a pFA7-type plasmid . Both methods were 100 times more sensitive than a commercially available colorimetric beta-lactamase activity test and approximately 5 times more sensitive than radioisotopic dot blot screening for the gene . The assays are particularly well suited to the analysis of large numbers of samples, can be performed in a total of 4 h, and are sensitive to 10(4) to 10(5) CFU. Infect Immun, 1988 Oct, 56(10), 2736 - 42 Cloning and expression of genes encoding Haemophilus somnus antigens; Corbeil LB et al.; A genomic library of Haemophilus somnus 2336, a virulent isolate from a calf with pneumonia (later used to reproduce H . somnus experimental pneumonia), was constructed in the cosmid vector pHC79 . The gene bank in Escherichia coli DH1 was screened by filter immunoassay with convalescent-phase serum, which reacted with several outer membrane antigens of H . somnus . On Western blotting (immunoblotting) of immunoreactive colonies, five clones were found to express proteins which comigrated with H . somnus surface antigens . Three clones (DH1 pHS1, pHS3, and pHS4) expressed both a 120-kilodalton (kDa) antigen and a 76-kDa antigen, one clone (DH1 pHS2) expressed only the 76-kDa antigen, and the fifth clone (DH1 pHS5) expressed a 60-kDa antigen . The 120-kDa and 76-kDa antigens were found internally, whereas the 60-kDa protein was detected in the DH1 pHS5 culture supernatant as membrane blebs or insoluble protein . Both the H . somnus 120-kDa antigen and the recombinant 120-kDa antigen had immunoglobulin Fc-binding activity . Restriction endonuclease mapping demonstrated that the genomic DNA inserts of clones expressing the 76-kDa antigen shared a common 28.4-kilobase-pair region, and the three clones also expressing the 120-kDa antigen shared an additional 7.0-kilobase-pair region . The restriction endonuclease map of pHS5, which expressed the 60-kDa antigen, was not similar to the maps of the other four plasmids . Since these three H . somnus antigens reacted with protective convalescent-phase serum, the recombinants which express these proteins should be useful in further studies of protective immunity in bovine H . somnus disease. Infect Immun, 1988 Oct, 56(10), 2673 - 9 Human bactericidal antibody response to outer membrane protein P2 of nontypeable Haemophilus influenzae; Murphy TF et al.; The human bactericidal antibody response to the major outer membrane protein, P2, of nontypeable Haemophilus influenzae was studied . P2 was isolated from two strains of nontypeable H . influenzae and coupled to affinity columns . Pooled normal human serum was subjected to affinity chromatography with the P2 columns and a control column . Reducing the titer of antibody to P2 resulted in reduced bactericidal activity of that serum for the organism . Immunopurified antibody to P2 from human serum was bactericidal for the homologous strain . The extent to which these bactericidal determinants on P2 are conserved among strains was investigated . Immunopurified antibodies to P2 of two epidemiologically unrelated isolates were bactericidal for four of six strains tested . We conclude that P2 is a target for human bactericidal antibody and that some of these determinants that are recognized by human bactericidal antibody are conserved among strains of nontypeable H . influenzae. Am J Med, 1988 Sep 16, 85(3A), 6 - 13 Comparative, multicenter studies of cefixime and amoxicillin in the treatment of respiratory tract infections; Kiani R et al.; A total of 560 patients were treated in two double-blind, randomized multicenter studies to compare the safety and efficacy of cefixime (400 mg administered once daily) and amoxicillin (250 or 500 mg administered three times daily) for the treatment of bacterial respiratory tract infections . Eighty percent of the 244 patients treated in the lower respiratory tract infections (LRTI) study had acute bronchitis . Streptococcus pneumoniae (13 percent), Haemophilus influenzae (28 percent), and Escherichia coli (10 percent) were the pathogens most frequently isolated from sputum in these patients . Among evaluable patients with positive bacterial culture results at baseline, a favorable clinical response (cured or improved) was obtained in 100 percent of the cefixime-treated patients (22 of 22) and in 96 percent of the amoxicillin-treated patients (23 of 24) . Bacteriologic eradication rates were 100 percent and 83 percent for cefixime and amoxicillin, respectively . In the upper respiratory tract infections (URTI) study, 316 patients with pharyngitis (80 percent) or tonsillitis (14 percent) were treated . Group A, beta-hemolytic Streptococcus (69 percent) and H . influenzae (8 percent) were the pathogens most frequently isolated from the throat culture specimens of these patients . Favorable clinical results were obtained in 99 percent of the evaluable cefixime-treated group (n = 73) and in 98 percent of the amoxicillin-treated group (n = 66) . The bacteriologic eradication rates were 93 percent and 100 percent, respectively . The adverse experiences reported during both studies were similar in nature and frequency to those reported for other beta-lactam antibiotics with the exception of a higher incidence of altered bowel movement (diarrhea and stool changes) with both drugs . These episodes usually resolved without remedial medication when the treatment was withdrawn . No significant adverse laboratory findings were observed . Results of these trials demonstrate that cefixime at a dosage of 400 mg once daily is an effective and safe oral antibiotic for the treatment of acute respiratory tract infections. JAMA, 1988 Sep 9, 260(10), 1446 - 9 Cluster of Haemophilus influenzae type b infections in adults; Smith PF et al.; Haemophilus influenzae type b commonly causes illness in young children, among whom transmission is known to occur . Most adults are believed to be immune to H influenzae type b and outbreaks of disease among adults appear to be uncommon . From July 14 to Aug 12, 1985, a cluster of six cases of acute febrile illness with cultures positive for H influenzae, biotype II (five cases) or untyped H influenzae (one case), occurred among adults in a nursing home and an adjoining hospital . All six case-patients had personal contact with at least one other case-patient . Among the 46 nursing home residents, men were more likely than women to become ill (44% vs 0%) . This cluster of disease suggests that elderly adults may be more susceptible to H influenzae infection than is generally recognized and that outbreaks among adults may result from person-to-person transmission. JAMA, 1988 Sep 9, 260(10), 1423 - 8 Lack of efficacy of Haemophilus b polysaccharide vaccine in Minnesota; Osterholm MT et al.; We evaluated the efficacy of Haemophilus b polysaccharide vaccine in children in Minnesota using a case-control study . The vaccine became available in Minnesota in August 1985 . During the subsequent 28 months, 88 cases of invasive H influenzae type b disease were identified in children 24 to 71 months of age, the group targeted for vaccination . Of the 88 cases, 36 (41%) occurred in vaccinated children . Fifty-eight (33%) of 176 controls were vaccinated during a similar period . The vaccine's protective efficacy for children with any history of vaccination was -58% (95% confidence interval = -204% to 18%) . The vaccine's protective efficacy for children who were most likely to be protected by vaccination was -55% (95% confidence interval = -238% to 29%) . Our results indicate that vaccination with Haemophilus b polysaccharide vaccine had no effect in preventing H influenzae type b disease in Minnesota children. JAMA, 1988 Sep 9, 260(10), 1419 - 22 The protective efficacy of Haemophilus b polysaccharide vaccine; Shapiro ED et al.; To assess the protective efficacy of the Haemophilus b polysaccharide vaccine, a case-control study was conducted in Connecticut, Dallas County, and greater Pittsburgh . Seventy-six children 24 to 72 months of age who had H influenzae type b isolated from normally sterile sites from August 1985 through July 1987 were enrolled . For each case two controls, matched by age and place of residence, were randomly selected from the records of all live births in the area . Antecedent receipt of the Haemophilus b polysaccharide vaccine was ascertained from the records of all physicians and clinics at which the subjects received medical care . Overall, 12% of the cases and 39% of the controls had received the vaccine . The estimate of the protective efficacy of the vaccine was 88% overall (95% confidence interval, 74% to 96%) and 91% (95% confidence interval, 71% to 99%), 92% (95% confidence interval, 76% to 99%), and 81% (95% confidence interval, 45% to 96%) in Connecticut, Dallas County, and greater Pittsburgh, respectively . The estimates were not substantially affected by adjusting with logistic regression for differences between the cases and controls in race and the attendance of group day care . We conclude that the Haemophilus b polysaccharide vaccine is highly effective in these areas among children who receive the vaccine when they are 24 months of age or older. JAMA, 1988 Sep 9, 260(10), 1413 - 8 A day care-based study of the efficacy of Haemophilus b polysaccharide vaccine; Harrison LH et al.; To assess the efficacy of the Haemophilus b polysaccharide vaccine following licensure and to evaluate the risk of Haemophilus influenzae type b (Hib) disease in the week following vaccination, we conducted a day care-based case-control efficacy study using cases of invasive Hib disease ascertained through active surveillance in areas with a total population of 34 million . For each patient 18 to 59 months old, up to three 18- to 59-month-old controls were chosen from the same day care classroom . Using conditional logistic regression, the vaccine efficacy was estimated to be 45% (95% confidence interval = -1% to 70%) and did not change significantly after accounting for potential biases . In addition, three (3%) of 104 patients vs five (2%) of 207 controls were vaccinated within seven days before the patients' dates of admission (odds ratio = 1.8, 95% confidence interval = 0.3 to 10.2), which does not suggest an increased risk of Hib disease in the week following immunization . This study suggests that the efficacy of the currently used HBPV is less than expected from previous studies and points out the usefulness of case-control studies for monitoring vaccine efficacy following licensure. Am J Clin Pathol, 1988 Sep, 90(3), 355 - 7 Maximizing the productive interface between the clinical microbiologist and the infectious disease clinician; Rosenblatt JE; Laboratory testing of antimicrobials is probably the single most important area for close communication between the infectious disease clinician and the clinical microbiologist . The two should work together to determine such basic issues as methods to use for antimicrobial susceptibility testing, agents to test, and format to use for reporting results in both cost-efficient and clinically useful ways . Only a limited number of antimicrobials can be selected from the many new agents . Reporting of results should be structured to promote the use of generally active and less expensive agents while restricting the use of more specialized and more expensive drugs and, at the same time, preventing the rapid emergence of resistance to them . A good working relationship will be especially helpful in determining the applications of minimum bactericidal concentrations, serum bactericidal activity, susceptibility testing of anaerobes, and in selection of methods for detecting resistant isolates of pneumococci, gonococci, and Haemophilus influenzae. Infect Immun, 1988 Sep, 56(9), 2307 - 16 Protective ability of antibodies against 78- and 40-kilodalton outer membrane antigens of Haemophilus somnus; Gogolewski RP et al.; The ability of concentrated antibody against the 78- or 40-kilodalton (kDa) outer membrane protein (OMP) of Haemophilus somnus to passively protect calves against H . somnus-induced pneumonia was determined . The 78- and 40-kDa OMPs were evaluated in passive protection experiments, because results of previous studies demonstrated their (i) immunogenicity for cattle, (ii) intense reactivity with convalescent-phase sera which passively protected calves against experimental H . somnus pneumonia, (iii) surface location and accessibility to antibody, and (iv) conservation among a wide range of H . somnus isolates obtained from animals with different diseases and from different geographic locations . The specificity of the two antisera evaluated in this study was verified by (i) immunoblots in which reactivity against the 78- or 40-kDa OMP was present in postimmunization but not preimmunization serum and (ii) immunoblots in which affinity-purified, surface-reactive antibodies in each antisera were used, which demonstrated that essentially only antibody to the 78- or 40-kDa OMP was reactive with the surface of H . somnus . In enzyme-linked immunosorbent assays, the antiserum against the 40-kDa OMP contained immunoglobulin G1 (IgG1), IgG2, and IgM against H . somnus, while the antiserum against the 78-kDa OMP contained IgG1 and IgM but no IgG2 against H . somnus . The antiserum against the 40-kDa OMP contained IgG1 and IgG2 specific for the 40-kDa OMP, as determined by Western blot analysis . Slight reactivity against H . somnus lipopolysaccharide was detected by enzyme-linked immunosorbent assay but not by Western blot analysis . In passive protection experiments, preincubation of bacteria with antibody against the 40-kDa OMP protected calves (P less than 0.025) against H . somnus pneumonia, while antibody against the 78-kDa OMP failed to protect calves against H . somnus pneumonia . Determination of the potential protective capacity of the 78-kDa OMP awaits resolution of the role of anti-78-kDa IgG2 in protection against H . somnus pneumonia . The 40-kDa OMP is, however, a good candidate antigen for evaluation of protective ability against H . somnus pneumonia following active immunization. Pediatrics, 1988 Sep, 82(3 Pt 2), 486 - 91 Once-daily administration of ceftriaxone for the treatment of selected serious bacterial infections in children; Frenkel LD; Ceftriaxone treatment (50 to 80 mg/kg once daily) was given to 201 children between 1 month and 18 years of age . There were 201 serious bacterial infections, including epiglottitis, pneumonia, cellulitis, osteomyelitis, septic arthritis, pyelonephritis, sepsis, and meningitis . The common pathogens responsible for pediatric infections isolated from these patients included Haemophilus influenzae, Staphylococcus aureus, Streptococcus pyogenes, Streptococcus pneumoniae, and Escherichia coli . The overall clinic cure rate was 94% . Ten patients were clinically improved but not cured . There were two clinical failures . Bacteriologic failure occurred in six patients . The overall bacteriologic cure rate was 97% . Twenty patients (10%) experienced adverse effects; none required discontinuation of therapy . The efficacy, safety, spectrum, and convenience of ceftriaxone monotherapy make this antimicrobial agent a candidate for the treatment of choice of selected serious pediatric infections. Pediatrics, 1988 Sep, 82(3), 300 - 8 Day-care center attendance and hospitalization for lower respiratory tract illness; Anderson LJ et al.; To identify risk factors associated with hospitalization for acute lower respiratory tract illness, 102 children less than 2 years of age admitted to four Atlanta metropolitan area hospitals between December 1984 and June 1985 with the diagnosis of lower respiratory tract illness were studied . The most common causative agent associated with illness was respiratory syncytial virus, followed by other respiratory viruses, Haemophilus influenzae, and Streptococcus pneumoniae . The 102 case-patients were compared with 199 age- and sex-matched controls . A parent or guardian for each patient and control was interviewed by telephone regarding demographic data, care outside the home, breast-feeding, previous medical history, allergies, and smoking and illness in household members . Five factors were associated with lower respiratory tract illness in both a univariate analysis and a multiple logistic regression model (P less than .05) . These factors were the number of people sleeping in the same room with the child, a lack of immunization the month before the patient was hospitalized, prematurity, a history of allergy, and regular attendance in a day-care center (more than six children in attendance) . Care received outside of the home in a day-care home (less than or equal to six children in attendance) was not associated with lower respiratory tract illness . The suggestion made by our study and other studies was that for children less than 2 years of age, care outside of the home is an important risk factor for acquiring lower respiratory tract illness, as well as other infectious diseases, and that this risk can be reduced by using a day-care home instead of a day-care center. Jpn J Antibiot, 1988 Sep, 41(9), 1194 - 204 {Antimicrobial activities of sultamicillin against clinical isolates from upper respiratory tract infections}; Deguchi K et al.; Sultamicillin (SBTPC) is a mutual prodrug in which ampicillin (ABPC) and a potent beta-lactamase inhibitor sulbactam (SBT) are ester-bound in an equimolar ratio . SBTPC is hydrolyzed during absorption after oral administration to provide ABPC and SBT for systemic circulation . In the present study, the antimicrobial activities of SBTPC against 50 isolates each of 6 species (Staphylococcus aureus, Klebsiella pneumoniae subsp . pneumoniae, Branhamella catarrhalis, Haemophilus influenzae, Streptococcus pneumoniae and Streptococcus pyogenes) of bacteria freshly obtained from upper respiratory tract infections were examined in relation to their bacterial beta-lactamase producing abilities . beta-Lactamase producing strains were identified using the acidometry disc method with benzylpenicillin (PCG) of cefazolin (CEZ) as a substrate, and their frequencies of appearance were calculated as follows: S . aureus 86%; K . pneumoniae subsp . pneumoniae 100%; B . catarrhalis 68%; H . influenzae 24% . Fourteen per cent of S . aureus strains examined were beta-lactamase positive using both PCG and CEZ acidometry discs . SBTPC, however, demonstrated excellent antimicrobial activities even against these beta-lactamase producing strains . Good activities were observed especially against those bacterial strains producing penicillinase (PCase) . Average MIC80 values of SBTPC were 3.13 micrograms/ml for S . aureus and K . pneumoniae subsp . pneumoniae, 0.39 micrograms/ml for B . catarrhalis and H . influenzae, 0.05 micrograms/ml for S . pneumoniae and 0.025 micrograms/ml for S . pyogenes . As SBTPC was shown to possess excellent antimicrobial activities against PCase producing strains, the enhancement in activities of SBTPC compared to ABPC alone can be attributed to the inhibition of beta-lactamase by SBT which, as noted above, is a component of SBTPC in an equimolar ratio to ABPC. Infection, 1988 Sep-Oct, 16(5), 293 - 6 In vitro activity of second and third generation cephalosporins against ampicillin susceptible and resistant haemophilus influenzae; Burns JL et al.; One hundred seventy-five clinical isolates of Haemophilus influenzae (including 74 beta-lactamase-producing strains) were examined for susceptibility to ampicillin, cefonicid, cefamandole, cefuroxime and cefotaxime . Cefonicid and cefamandole exhibited similar activity against ampicillin-susceptible strains (MIC90 = 0.2 mg/l for both antibiotics); cefuroxime was slightly less active (MIC90 = 0.01 mg/l) . However, cefonicid, cefuroxime and cefotaxime were all more active against beta-lactamase-producing H . influenzae than cefamandole (MIC90 = 1.0 mg/l for cefonicid, MIC90 = 2.0 mg/l for cefuroxime, MIC90 = 0.01 mg/l for cefotaxime, MIC90 = 5.0 mg/l for cefamandole) . One hundred twenty-five of the 175 isolates were also tested for susceptibility to cefonicid and cefamandole by disc diffusion technique and a plot of zone diameter vs . MIC was analyzed for the beta-lactamase-producing strains. Antimicrob Agents Chemother, 1988 Sep, 32(9), 1458 - 60 Antimicrobial susceptibilities of southern African isolates of Haemophilus ducreyi; Dangor Y et al.; We determined the antimicrobial susceptibilities of 122 recent clinical isolates of Haemophilus ducreyi to 24 antimicrobial agents . All isolates produced beta-lactamase and were resistant to penicillins . The majority of strains were also resistant to tetracycline, doxycycline, and sulfamethoxazole . All isolates were susceptible to macrolides, quinolones, extended-spectrum cephalosporins, spectinomycin, rifampin, and amoxycillin-clavulanate . Reduced susceptibility to minocycline, co-trimoxazole, and kanamycin was noted . Chloramphenicol and thiamphenicol resistance was noted for the first time among southern African strains. Antimicrob Agents Chemother, 1988 Sep, 32(9), 1421 - 6 In vitro and in vivo antibacterial activities of ME1207, a new oral cephalosporin; Tamura A et al.; ME1207 (pivaloyloxymethyl ester of ME1206) is a new oral cephalosporin . ME1206 is (6R,7R)-7-{(Z)-2-(2-aminothiazol-4-yl)-2-(methoxyimino)- acetamido}-3-{(Z)-2-(4-methylthiazol-5-yl)-ethyl}-cephem-4-carboxy lic acid . The susceptibilities of about 1,600 clinical isolates to ME1206 were determined by the agar dilution method . ME1206 showed a broad spectrum of activity against gram-positive and gram-negative bacteria . ME1206 was more active than cefaclor, T-2525, and cefixime against Staphylococcus aureus and Staphylococcus epidermidis . Against gram-negative bacteria, the activity of ME1206 was comparable with that of T-2525, but ME1206 was less active than cefixime . Against Streptococcus pneumoniae, Haemophilus influenzae, and Neisseria gonorrhoeae, ME1206 had high activity (MIC, less than or equal to 0.05 microgram/ml) . ME1206 was stable against various beta-lactamases, except beta-lactamases from Providencia rettgeri, Pseudomonas cepacia, and Escherichia coli W3630 (Rms213) . The 50% effective doses of ME1207 after oral administration against systemic infections in mice were comparable with those of T-2588 against gram-negative bacteria and about one-fourth that of T-2588 against Staphylococcus aureus Smith. J Clin Microbiol, 1988 Sep, 26(9), 1887 - 9 Disk diffusion interpretive criteria for extended-spectrum cephalosporins with Haemophilus influenzae; Jorgensen JH et al.; Disk diffusion interpretive zone size criteria for use with Haemophilus test medium are proposed for five extended-spectrum cephalosporins . With cefuroxime, zones greater than or equal to 24 mm in diameter indicated susceptibility, while zones less than or equal to 20 mm implied resistance . With cefotaxime, ceftizoxime, and ceftriaxone, a single susceptible-zone size, greater than or equal to 26 mm, is proposed. J Bacteriol, 1988 Sep, 170(9), 4161 - 4 Lipoproteins of Haemophilus influenzae type b; Weinberg GA et al.; Haemophilus influenzae type b Minn A produced 12 lipoproteins with apparent molecular weights of between 14,000 and 67,000 . The lipoproteins were identified by sodium dodecyl sulfate-polyacrylamide gel electrophoresis and fluorography of delipidated extracts of cells grown in {3H}palmitate . When the delipidated cell extracts were subjected to acid methanolysis, tritium was quantitatively recovered as palmitate and methyl palmitate, indicating that the {3H}palmitate had not been degraded and reincorporated into nonlipid material during cell growth . One of the lipoproteins comigrated with outer membrane protein (OMP) P6 . OMP P6 was purified from {3H}palmitate-labeled cells . The purified protein preparation contained both amide- and ester-linked fatty acids . We conclude that (i) H . influenzae type b produces several lipoproteins, and (ii) one of these lipoproteins is OMP P6, a protein under consideration as a vaccine component. Jpn J Antibiot, 1988 Sep, 41(9), 1304 - 8 {Clinical evaluation of S 6472 granule preparation (sustained-release cefaclor) in chronic bronchitis}; Hiraga Y et al.; S 6472 granule preparation, a sustained-release cefaclor, was orally administered to 20 acutely exacerbated cases of chronic bronchitis at a daily dosage of 750 mg (titer) in 2 divided doses for a duration of 7-15 days and its clinical usefulness was evaluated . Clinical efficacies were good in 17 cases and fair in 3 cases, with a rate of efficacy of 85.0% . Organisms isolated from 13 patients were totalling 14 strains, i.e., 5 strains of Streptococcus pneumoniae, 3 strains of Branhamella catarrhalis, 2 strains of Streptococcus sp., 2 strains of Klebsiella oxytoca, 1 strain of Haemophilus influenzae and 1 strain of Staphylococcus aureus . All these strains, except the strains of Streptococcus sp., disappeared upon the administration of the drug . With regard to the safety, no side effects nor abnormal laboratory test values were encountered. Int J Pediatr Otorhinolaryngol, 1988 Sep, 15(3), 269 - 78 Treatment of chronic maxillary sinusitis in children; Otten FW et al.; In the present study 141 children aged between 3 and 10 years and suffering from chronic maxillary sinusitis were treated non-selectively in one of 4 ways: amoxicillin combined with decongestive nose drops, drainage of the maxillary sinus, a combination of the two, or a placebo . The duration of the follow-up period was 6 months . The therapeutic effects of the 4 forms of treatment did not differ significantly . Haemophilus influenzae and streptococcus pneumoniae were the micro-organisms encountered most often in these children . The results are discussed. Pediatr Infect Dis J, 1988 Sep, 7(9), 630 - 3 Differences in the epidemiology of childhood community-acquired bacterial meningitis between two ethnic populations cohabiting in one geographic area; Rosenthal J et al.; A comparison of the epidemiology of community-acquired bacterial meningitis between Jewish and Bedouin populations cohabiting one geographical area is reported here . During the years 1981 to 1985, 100 children younger than 13 years old with community-acquired bacterial meningitis were hospitalized . Seventy-one patients were younger than 12 months . The principal bacteria isolated were Haemophilus influenzae 42%; Streptococcus pneumoniae 29% and Neisseria meningitidis 20% . The case fatality rate was 12% . The chance of acquiring meningitis during the first 5 years of life was twice as common among Bedouins than among Jews (328/100,000 vs . 173/100,000, respectively; P less than 0.0001) . The most common cause of meningitis during the first year of life was S . pneumoniae among Bedouins and H . influenzae among Jews . Meningitis caused by H . influenzae and S . pneumoniae was usually associated with respiratory morbidity during fall and winter among Jews, but with diarrheal morbidity during summer and fall among Bedouins . Since the most prevalent type of morbidity among Jews results from respiratory infections and among Bedouins from diarrhea, our findings suggest that community-acquired bacterial meningitis is associated with the type of morbidity most prevalent in the community at any given season rather than with a specific type of infection. Jpn J Antibiot, 1988 Sep, 41(9), 1231 - 6 {Clinical experience with ofloxacin in the treatment of chronic respiratory tract disease aggravated by acute infection}; Muraki N et al.; We studied the clinical usefulness of ofloxacin (OFLX) in 13 patients with chronic respiratory tract diseases aggravated by acute infections with identified causative bacteria . 1 . Overall clinical efficacies were: highly effective 5, effective 6, slightly effective 2, and ineffective none, showing an efficacy rate of 84.6% . 2 . In 6 patients with fever of over 37 degrees C, time lengths in days for symptoms to have been alleviated due to OFLX treatment were; 1 day: 4 cases, 3 days: 1 case and 5 days: 1 case (2.0 days on average) . 3 . As to bacterial transitions, in 9 of 10 patients Haemophilus influenzae was eliminated and in 1 patient it was substituted by Pseudomonas aeruginosa . In 3 patients Branhamella catarrhalis was eliminated and in 1 patient, the number of P . aeruginosa was reduced . OFLX is expected to have a potent bacteriological effect on H . influenzae and B . catarrhalis . 4 . As to side effects, 1 of the 13 patients (7.7%) complained of discomfort in the epigastrium . This discomfort disappeared when a gastric mucosa protective agent was administered . There was no abnormality in laboratory test values . Judging from the above results, we consider OFLX a useful drug for the treatment of patients with chronic respiratory tract diseases aggravated by acute infections. Jpn J Antibiot, 1988 Sep, 41(9), 1212 - 22 {Recent trend of incidence of respiratory pathogenic bacteria and its susceptibility to antimicrobial agents: studies in the year 1984-1986}; Nishioka K et al.; Based on a quantitative analysis of sputum cultures, pathogenic bacteria in respiratory ailments isolated in our laboratory during 1984 to 1986 were classified and analyzed . During the study period, the most frequently isolated agent was Haemophilus influenzae followed by Pseudomonas aeruginosa, Branhamella catarrhalis and Streptococcus pneumoniae . They together consisted of 70 approximately 74% of all the respiratory pathogenic bacteria isolated in our study . Susceptibilities of above pathogens to antimicrobial agents were investigated using the agar dilution method . Results are summarized as follows . 1 . Ratio of proportion of beta-lactamase producing strains among non beta-lactamase producing strains of H . influenzae markedly decreased in 1986 (6/70, 8.6%) as compared to previous years (11/73, 15.1% in 1984 and 8/49, 16.3% in 1985) . In consequence, MIC90 values for penicillins reduced considerably in 1986 . Among the antibiotics examined cefmenoxime (CMX) and cefotaxime (CTX) were the most active agents against H . influenzae . A development of resistance to other cephems and new quinolones (norfloxacin, ofloxacin, ciprofloxacin) was not evident during the 3-year survey . 2 . Against S . pneumoniae, benzylpenicillin was still the most active agent despite gradual increase of frequency of isolation . Ampicillin (ABPC), piperacillin (PIPC), CMX and CTX were also potent against S . pneumoniae . S . pneumoniae were frequently isolated from patients treated with new quinolones or minocycline (MINO) . This phenomenon may be explained by higher MIC values of these agents against S . pneumoniae . 3 . Of B . catarrhalis strains isolated, more than 80% were beta-lactamase positive, although MIC90 were not so high (1.56 micrograms/ml for ABPC and 0.20 micrograms/ml for PIPC) . Among the antibiotics tested, latamoxef was the most active agent against B . catarrhalis and inhibited all the strains at a concentration of 0.05 micrograms/ml or less . No resistant strains were observed against cephems, new quinolones, erythromycin or MINO . 4 . P . aeruginosa appeared to be rapidly developing resistance against new quinolones in patients with chronic P . aeruginosa respiratory infections who had been treated with these agents . In treating chronic respiratory infection due to P . aeruginosa, one must be watchful of rapid development of resistance by the organism or its replacement with S . pneumoniae. Monatsschr Kinderheilkd, 1988 Sep, 136(9), 622 - 5 {Postinfectious thrombocytosis as an acute phase reaction: the example of Haemophilus influenzae meningitis}; Heyne K et al.; The postinfectious thrombocytosis occurring in 11 children with Haemophilus influenzae meningitis and/or septicaemia shows regular progress . The rise of thrombocyte concentrations starts around the 5th day after onset of antibiotic therapy, reaches values above 500,000/microliter between the 9th and 12th day, and relapses afterwards to normal values, which are reached around the 20th day . The range of thrombocytosis is influenced by the severity and complications (subdural effusions, secondary infection) of the infection as well as by the age of the patient . An inverse course of serum concentrations of C-reactive protein and thrombocyte concentrations points to the influence of this humoral reaction on the thrombocytic acute phase reaction. Acta Otolaryngol, 1988 Sep-Oct, 106(3-4), 171 - 7 Recurrent and penicillin V-resistant otitis media . A treatment study with amoxycillin/clavulanate and cefaclor; Jacobsson S et al.; Clinical and bacteriological studies were performed in 122 children, aged 1-10 years, with recurrent otitis media or failed therapy with phenoxymethyl penicillin . A specimen for bacteriological culture was taken from the nasopharynx in all patients, and in our material Haemophilus influenzae, Branhamella catarrhalis and Streptococcus pneumoniae were equally distributed, each forming one-third of the total bacterial count . Thus, H . influenzae and B . catarrhalis (as well as their betalactamase-producing strains) were found more frequently than is generally reported for acute otitis media . Treatment with amoxycillin/clavulanate (Spektramox) gave a high and satisfactory effect comparable to the treatment result of cefaclor (Kefolor) . The eradication of the initial pathogens was achieved to a significantly higher extent with Spektramox than with Kefolor . Both drugs were well tolerated. Antimicrob Agents Chemother, 1988 Sep, 32(9), 1341 - 6 Mechanism of action and in vitro and in vivo activities of S-6123, a new oxazolidinone compound; Daly JS et al.; The in vitro activity of S-6123, a synthetic antimicrobial compound of the new oxazolidinone series, was compared with those of other orally administered agents against 328 clinical isolates . The compound was moderately active (MICs, 16 to 64 micrograms/ml) against 90% of staphylococci, nonenterococcal streptococci, and Haemophilus influenzae, including strains resistant to beta-lactam antibiotics . S-6123 was minimally active against enterococci and facultative gram-negative bacilli . Nevertheless, the compound had significant activity in a lethal rat Escherichia coli peritonitis model at serum concentrations of one-tenth the MIC against the infecting organism . The drug demonstrated only bacteriostatic activity against susceptible organisms . Studies to define the mechanism of antibacterial action revealed that S-6123 inhibited ribosomal protein synthesis without inhibiting DNA or RNA synthesis . This compound represents a new series of antibacterial agents not related to any other antibacterial compound of natural or synthetic origin. Pediatr Emerg Care, 1988 Sep, 4(3), 200 - 2 Haemophilus influenzae cellulitis of the extremities; Akin K; A brief case report is described of a 10-month-old male with Haemophilus influenzae cellulitis of the upper extremity . A review of the literature concerning this pathogen in extremity cellulitis follows, with discussion of epidemiology, site of infection, response to therapy, and possible pathogenesis. J Antimicrob Chemother, 1988 Sep, 22(3), 333 - 9 Haemophilus influenzae from four laboratories in one Canadian city; Righter J et al.; Serotype, biotype and antimicrobial susceptibilities of 250 clinical isolates of Haemophilus influenzae from University, affiliated and community hospitals and a private laboratory were compared . For each drug, agar dilution susceptibility testing was compared to at least one other method (modified Kirby-Bauer and/or microdilution) . Most isolates (86%) were non-typable, 10% were type b . Biotype II was most common (58%) . The highest prevalence of serotype b (28%) was seen in the community hospital, which also had only 4% of all biotype III isolates . beta-Lactamase production ranged from 20% (private laboratory) to 5% (affiliated hospital); it was higher among type b (23%), biotype II (17%), and from non-respiratory (26%) than respiratory sites (8%) . 51% of 35 beta-lactamase producers were found in the 24% of patients under age 6 . Microdilution missed seven while agar dilution and disc diffusion detected all . All isolates were susceptible to cefamandole, cefuroxime, cotrimoxazole and chloramphenicol, 86%, 98%, 99% and 27% to ampicillin, cefaclor, tetracycline and erythromycin respectively . Microdilution is unreliable for detection of ampicillin resistance mediated by beta-lactamase production. Pediatr Infect Dis J, 1988 Sep, 7(9), 637 - 45 Mortality and morbidity from invasive bacterial infections during a clinical trial of acellular pertussis vaccines in Sweden; Storsaeter J et al.; A double blind placebo-controlled efficacy trial of two acellular pertussis vaccines was conducted in 3801 6- to 11-month-old children . Four vaccinated children died during 7 to 9 months follow-up as a result of Haemophilus influenzae type b meningitis, heroin intoxication with concomitant pneumonia, suspected septicemia, and Neisseria meningitidis Group B septicemia . From the actual death rate in children belonging to the same birth cohort in Sweden that could have been eligible for the trial, one death was expected among vaccinated children . Several investigations were carried out to examine the possibility that the deaths could be causally related to the vaccination . The relative risk for hospitalization due to systemic or respiratory infections was 1.07 (95% confidence interval, 0.95 to 1.20) and 0.83 (95% confidence interval, 0.64 to 1.08) in the vaccine groups as compared with the placebo group . Subsets of the population were studied for signs of immunosuppression . There was no indication of immunoglobulin deficiency or any sign of clinically significant leukopenia or lymphocytosis in vaccine recipients . The results of this analysis provide no evidence for a causal relation between vaccination with the studied acellular pertussis vaccines and altered resistance to invasive disease caused by encapsulated bacteria . The hypothesis that the two variables are related, however, cannot be refuted from these data. J Bacteriol, 1988 Sep, 170(9), 3876 - 81 Characterization of the rec-1 gene of Haemophilus influenzae and behavior of the gene in Escherichia coli; Setlow JK et al.; The rec-1 gene of Haemophilus influenzae was cloned into a shuttle vector that replicates in Escherichia coli as well as in H . influenzae . The plasmid, called pRec1, complemented the defects of a rec-1 mutant in repair of UV damage, transformation, and ability of prophage to be induced by UV radiation . Although UV resistance and recombination were caused by pRec1 in E . coli recA mutants, UV induction of lambda and UV mutagenesis were not . We suggest that the ability of the H . influenzae Rec-1 protein to cause cleavage of repressors but not the recombinase function differs from that of the E . coli RecA protein. Pediatr Infect Dis J, 1988 Sep, 7(9), 626 - 9 Comparison of three topical antimicrobials for acute bacterial conjunctivitis; Lohr JA et al.; One hundred fifty-eight patients, 21 years of age or less, presenting with culture-positive (Haemophilus influenzae or Streptococcus pneumoniae) conjunctivitis were treated with trimethoprim-polymyxin B (TP), gentamicin sulfate (GS) or sodium sulfacetamide (SS) ophthalmic solution for 10 days . Clinical response at 3 to 6 days after start of therapy was similar for all test agents: 26 of 55 (47%) patients cured, 25 of 55 (45%) improved for TP; 28 of 57 (49%) cured, 26 of 57 (46%) improved for GS; and 19 of 46 (41%) cured, 22 of 46 (48%) improved for SS . Clinical response at 2 to 7 days after completion of therapy was also similar: 46 of 55 (84%) patients cured, 5 of 55 (9%) improved for TP; 50 of 57 (88%) cured, 5 of 57 (9%) improved for GS; and 41 of 46 (89%) cured, 2 of 46 (4%) improved for SS . Bacteriologic response at 2 to 7 days after completion of therapy was similar for all antimicrobials: 44 of 55 (83%) patients for TP; 39 of 57 (68%) for GS; and 33 of 46 (72%) for SS. J Bacteriol, 1988 Sep, 170(9), 4402 - 5 Sizing of the Haemophilus influenzae Rd genome by pulsed-field agarose gel electrophoresis; Lee JJ et al.; The four restriction enzymes ApaI (5'-GGGCCC), EagI (5'-CGGCCG), NaeI (5'-GCCGGC), and SmaI (5'-CCCGGG) were found to produce distributions of DNA fragment sizes useful for mapping of the Haemophilus influenzae Rd genome by pulsed-field agarose gel electrophoresis . ApaI produced 21 fragments (range, 1.6 to 305 kilobases {kb}), EagI yielded 30 fragments (0.6 to 339 kb), NaeI produced 32 fragments (2.3 to 290 kb), and SmaI yielded 16 fragments (6.0 to 377 kb) . Summation of the fragment lengths in each digest yielded estimates for the size of the H . influenzae chromosome ranging from 1,834 kb. Infect Immun, 1988 Sep, 56(9), 2235 - 42 Purification, cloning, and sequence of outer membrane protein P1 of Haemophilus influenzae type b; Munson R Jr et al.; Outer membrane protein P1 from Haemophilus influenzae type b MinnA was purified and partially characterized . Antiserum was generated against the purified protein and was used to immunologically screen a lamba EMBL3 genomic library prepared from strain MinnA DNA . A 4.2-kilobase-pair EcoRI-BamHI fragment containing the P1 gene was subcloned into pBR322 . The recombinant protein was synthesized by Escherichia coli K-12, in which it localized to the outer membrane . The N-terminal sequence of the purified protein was determined and found to correspond to residues 23 through 36 . The 22-amino-acid leader peptide had a typical structure, with two lysine residues near the amino terminus, a stretch of hydrophobic residues, and alanine residues at positions 20 and 22 . The Mr of the processed protein was 47,752, which is in good agreement with the estimate of 50,000 from sodium dodecyl sulfate-polyacrylamide gel electrophoresis . Putative -35 and -10 promoter sequences were identified upstream from the translational start site . Codon usage was examined and determined to be substantially different than the codon preference in E . coli. Carbohydr Res, 1988 Aug 15, 179, 31 - 5 Synthesis of p-trifluoroacetamidophenyl beta-D-glucopyranoside 4-(D-ribit-5-yl phosphate) corresponding to the Haemophilus influenzae type A capsular antigen; Classon B et al.; The synthesis is described of the title glycoside which corresponds to the Haemophilus influenzae type a capsular antigen . The hydrogenphosphonate method was used with 3,3'-(chlorophosphonylidene)bis(2-oxo-1,3-oxazolidene) as the condensing agent. Carbohydr Res, 1988 Aug 15, 179, 245 - 58 Structure of the O-antigen polysaccharide of Haemophilus pleuropneumoniae serotype 3 (ATCC 27090) lipopolysaccharide; Altman E et al.; The structure of the O-antigen polysaccharide of Haemophilus pleuropneumoniae serotype 3 (ATCC 27090) S-type lipopolysaccharide was investigated by methylation analysis, partial hydrolysis, periodate oxidation, and 1H- and 13C-n.m.r . spectroscopy, and concluded to be composed of linear pentasaccharide repeating-units having the structure: {----3)-alpha-D-Glcp-(1----2)-beta-D-Galf-(1----6)-alpha-D-Galp-(1 ----6)- beta-D-Glcp-(1----3)-beta-D-Galf-(1----}n. Proc Natl Acad Sci U S A, 1988 Aug, 85(16), 6157 - 61 Many pulmonary pathogenic bacteria bind specifically to the carbohydrate sequence GalNAc beta 1-4Gal found in some glycolipids; Krivan HC et al.; Pneumonia is one of the most common causes of death from infectious disease in the United States . To examine the possible role of carbohydrates as adhesion receptors for infection, several pulmonary pathogenic bacteria were studied for binding to glycosphingolipids . Radiolabeled bacteria were layered on thin-layer chromatograms of separated glycosphingolipids, and bound bacteria were detected by autoradiography . The classic triad of infectious bacteria found in cystic fibrosis, Pseudomonas aeruginosa, Haemophilus influenzae, and Staphylococcus aureus, along with other bacteria commonly implicated in typical pneumonia, such as Streptococcus pneumoniae, Klebsiella pneumoniae, and certain Escherichia coli, bind specifically to fucosylasialo-GM1 (Fuc alpha 1-2Gal beta 1-3GalNAc beta 1-4Gal beta 1-4Cer), asialo-GM1 (Gal beta 1-3GalNAc beta 1-4Gal beta-1-4Galc beta 1-1Cer), and asialo-GM2 (GalNAc beta 1-4Gal beta 1-4Glc beta 1-1Cer) . Bacteria maintained in nutrient medium bind better than the same cells suspended in buffer . They do not bind to galactosylceramide, glucosylceramide, lactosylceramide, trihexosylceramide, globoside, paragloboside, Forssman glycosphingolipid, or several other glycosphingolipids tested, including the gangliosides GM1, GM2, GM3, GD1a, GD1b, GT1b, and Cad . The finding that these pathogens do not bind to lactosylceramide suggests that beta 1-4-linked GalNAc, which is positioned internally in fucosylasialo-GM1 and asialo-GM1 and terminally in asialo-GM2, is required for binding . beta-N-Acetylgalactosamine itself, however, is not sufficient for binding, as the bacteria did not bind to globoside, which contains the terminal sequence GalNAc beta 1-3Gal . These data suggest that these bacteria require at least terminal or internal GalNAc beta 1-4Gal sequences unsubstituted with sialyl residues for binding . Other bacteria, including Mycoplasma pneumoniae, Streptococcus pyogenes, Salmonella species, and some E . coli, do not bind to the GalNAc beta 1-4Gal sequence . The biological relevance of these data is suggested by our finding that substantial amounts of asialo-GM1 occur in human lung tissue. Br J Urol . 1988 Aug;62(2):185. Epididymo-vasitis associated with previous reversal of sterilisation; Waghorn DJ et al.; PIP: Physicians treated a 37 year old man, who 5 years earlier had a successful vasectomy reversal, with a 24 hour history of intense left testicular pain, rigors, and pain and difficulty in urinating . Prior to these symptoms, he noted a mild, transient urethral discharge . Upon examination, physicians noted a fever of 38.5 degrees Celsius and swelling and tenderness around the left testis extending towards the groin . Pus cells existed in the urine, but no organism was found . While operating on the scrotal sac, physicians observed severe epididymitis which extended to the vasovasostomy site where a firm granuloma existed . The testis itself seemed fine . Blood cultures taken on admission revealed Haemophilus influenzae (non capsulate, biotype II) and ampicillin was administered intravenously . This case's physicians have not heard of any previous reported severe infection of a vasovasostomy site with bacteremia . Generally, granuloma formation after a vasovasostomy is caused by sperm leakage and represents an inflammatory response often resulting in obstruction . This may predispose the site to infection . Haemophilus influenzae rarely causes epididymo-vasitis but perhaps non capsulated strains possess an increased ability to evade host defenses, especially in a vasovasostomy granuloma, a damaged tissue . J Med Microbiol, 1988 Aug, 26(4), 307 - 11 Non-immune immunoglobulin binding by "Haemophilus somnus"; Widders PR et al.; In-vitro culture of Haemophilus somnus in liquid or solid media supplemented with bovine blood or serum resulted in non-immune binding of immunoglobulin (Ig) by the organism . This binding was independent of the antigen-combining site of the Ig molecule, since binding of an IgG preparation specific for the hapten dinitrophenol was unaffected by the presence of the homologous antigen . Quantitative comparison of the binding of Ig fragments Fab and Fc demonstrated that the non-immune binding occurred in the Fc region of bovine IgG . The isotypes of Ig that became bound to H . somnus included both bovine IgG subclasses (IgG1 and IgG2), which were bound equally, and bovine IgM. Infect Immun, 1988 Aug, 56(8), 1880 - 9 Virulence properties and protective efficacy of the capsular polymer of Haemophilus (Actinobacillus) pleuropneumoniae serotype 5; Inzana TJ et al.; The role of the capsule of Haemophilus (Actinobacillus) pleuropneumoniae serotype 5 in bacterial virulence, and the protective efficacy of antibody to serotype 5 capsule was investigated . Encapsulated H . pleuropneumoniae serotype 5 were resistant to killing by complement and antibody to capsule or somatic antigens, whereas a noncapsulated mutant was sensitive to killing by the alternative complement pathway alone . Antiserum to whole H . pleuropneumoniae serotype 5 bacteria or monospecific antiserum to capsule was capable of opsonizing bacteria of the homologous serotype for phagocytosis by swine polymorphonuclear leukocytes but was not opsonic for a heterologous serotype . An immunoglobulin M monoclonal antibody to the serotype 5 capsule was not opsonic for any serotype . Mice were protected against lethal, intranasal challenge with the homologous or heterologous serotype after immunization with live encapsulated or noncapsulated bacteria, but not after immunization with killed bacteria, lipopolysaccharide, or a capsule-protein conjugate vaccine . The protection induced by immunization with live bacteria was transferred to nonimmune, syngeneic mice by serum but not by spleen cells . Nonimmune pigs passively immunized with monospecific swine serum to capsule were protected from lethal infection but not from development of hemorrhagic lung lesions, whereas pigs passively immunized with swine antiserum to live bacteria did not develop severe respiratory lesions . Thus, the capsule of H . pleuropneumoniae serotype 5 was inhibitory to the bactericidal activity of serum and was antiphagocytic . Antibody to the capsule was opsonic but was not fully protective. Am J Dis Child, 1988 Aug, 142(8), 853 - 7 Periorbital cellulitis . Clinical and laboratory findings in 146 episodes, including tear countercurrent immunoelectrophoresis in 89 episodes; Powell KR et al.; Medical records of 144 children hospitalized for 146 episodes of periorbital cellulitis were reviewed . During 44 episodes, systemically administered antibiotics were given before hospitalization . Bacterial pathogens were isolated in only two (5%) of 44 episodes in pretreated patients compared with 33 (32%) of 102 episodes in patients who were not pretreated . Thirty-one children who were not pretreated were bacteremic . Compared with nonbacteremic children who were not pretreated, bacteremic children were younger, more often had a history of upper respiratory tract infection and fever, had a higher white blood cell count and temperature at admission, and more often had a violaceous cellulitis . No difference between groups existed in the frequency of a history of trauma or a local lesion near the affected eye . Tear specimens from 13 of 89 children tested by countercurrent immunoelectrophoresis (CIE) to detect Haemophilus influenzae type b capsular polysaccharide were positive . Compared with positive blood culture results, tear CIE has a sensitivity of 50% and a specificity of 93% . Streptococcus pneumoniae infections were not detected by CIE. Antimicrob Agents Chemother, 1988 Aug, 32(8), 1282 - 4 Genetic determinant of the ROB-1 beta-lactamase in bovine and porcine Pasteurella strains; Livrelli VO et al.; The ROB-1 beta-lactamase, previously described in Haemophilus influenzae, has been found in the genus Pasteurella . In three bovine strains of Pasteurella multocida and Pasteurella haemolytica, ROB-1 production was determined by plasmids of 4.4 kilobases . In one porcine strain of Pasteurella aerogenes, the enzyme seems to be chromosomally encoded. Pediatr Res, 1988 Aug, 24(2), 180 - 5 IgG subclass response to immunization with Haemophilus influenzae type b polysaccharide-outer membrane protein conjugate vaccine; Granoff DM et al.; We immunized 117 children with either Haemophilus influenzae type b polysaccharide vaccine or type b polysaccharide coupled to an outer membrane protein of group B Neisseria meningitidis (conjugate vaccine), and measured the IgG, IgG1, and IgG2 subclass composition of antibody to type b polysaccharide in postimmunization sera by ELISA . The IgG responses of 51 children, 24-83 months of age, immunized for the first time with the conventional type b vaccine consisted of both IgG1 and IgG2 antibody (respective geometric means of 2.24 and 0.77 micrograms/ml) . In contrast, the IgG responses of 28 infants, 2-17 months of age, immunized with conjugate vaccine were predominantly or exclusively IgG1 (genometric mean IgG1 and IgG2 antibody concentrations of 1.92 and 0.19 micrograms/ml) . A total of 38 children was primed with conjugate vaccine between 2 and 17 months of age and boosted approximately 1 yr later . The 28 children boosted with type b polysaccharide vaccine showed memory antibody responses consisting of both IgG1 and IgG2 (respective geometric means of 12.7 and 4.8 micrograms/ml); the 10 children boosted with conjugate vaccine showed a similar pattern of IgG subclass responses (respective geometric means of 20.8 and 5.1 micrograms/ml, p greater than 0.4 compared to the respective geometric mean IgG1 and IgG2 values of the group boosted with polysaccharide) . Thus, in children 24-83 months of age, immunization with conventional type b polysaccharide vaccine generally elicits both IgG1 and IgG2 responses, with a slight predominance of IgG1.(ABSTRACT TRUNCATED AT 250 WORDS) J Clin Microbiol, 1988 Aug, 26(8), 1524 - 34 Biochemical, genetic, and epidemiologic characterization of Haemophilus influenzae biogroup aegyptius (Haemophilus aegyptius) strains associated with Brazilian purpuric fever; Brenner DJ et al.; Brazilian purpuric fever (BPF) is a recently recognized fulminant pediatric disease characterized by fever, with rapid progression to purpura, hypotensive shock, and death . BPF is usually preceded by purulent conjunctivitis that has resolved before the onset of fever . Both the conjunctivitis and BPF are caused by Haemophilus influenzae biogroup aegyptius (formerly called H . aegyptius) . Isolates from 15 BPF cases, mainly from blood or hemorrhagic cerebrospinal fluid, case-associated isolates from 42 persons in towns where BPF cases occurred, and control strains from 32 persons in towns without BPF cases were characterized biochemically, genetically, and epidemiologically . Results indicated that a single clone was responsible for all BPF cases identified in six Brazilian towns from 1984 through 1986 . All of 15 (100%) case strains were the same clone as was 1 of 32 (3%) control strains (P = less than 10(-8) . Isolates of the clone were preferentially intrarelated by DNA hybridization (99% relatedness, hydroxyapatite method at 60 and 75 degrees C) and were separable from other H . influenzae biogroup aegyptius strains (approximately 90% relatedness at 60 degrees C and 82% relatedness at 75 degrees C) . All isolates of the BPF clone and no other strains contained a 24-megadalton plasmid of restriction endonuclease type 3031, were of a single multilocus enzyme mobility type, were of a single sodium dodecyl sulfate-polyacrylamide gel electrophoresis type, and were in one of two ribosomal DNA restriction patterns . All BPF clone isolates reacted with monoclonal antibodies produced from a case strain; only 3 of 62 (5%) other strains reacted with this monoclonal antibody . Ninety percent of BPF clone strains and 27% of other strains were relatively resistant to sulfamethoxazole-trimethoprim. Helv Paediatr Acta, 1988 Aug, 43(1-2), 41 - 51 {Systemic infections due to type b Haemophilus influenzae . A retrospective study of 114 cases}; Gervaix A et al.; The choice of treatment, the importance of chemoprophylaxis in household contacts and the potential impact of immunization with vaccines against Haemophilus influenzae type b (Hib) currently under investigation are discussed on the basis of the patients hospitalized for invasive Hib infections at the University Children's Hospital Geneva from 1976 to 1985 . Among 122 culture-proven infections due to Hib, there were 41% of cases of meningitis, 37.7% of epiglottitis, 9.8% of pneumonia, 5.7% of septicemia, 3.3% of cellulitis and 2.4% of septic arthritis . From 1981 to 1983, one strain of Hib produced beta-lactamase, but between 1984 and 1985, 5 strains (19.2%) produced beta-lactamase . Only one case of possible horizontal transmission of the infection was found in this 10-year period . We conclude that 1 . the appearance of beta-lactamase producing strains of Hib requires that treatment be initiated with an antimicrobial agent resistant to beta-lactamase when a Hib infection is suspected; 2 . in our region, only one case of an invasive Hib infection could theoretically have been prevented by chemoprophylaxis; and 3 . the calculated theoretical impact of vaccination with the new types of vaccines against Hib could have prevented 106 of 122 cases of invasive Hib infections. J Infect Dis, 1988 Aug, 158(2), 343 - 8 Spectrum of disease due to Haemophilus influenzae type b occurring in vaccinated children; Hiner EE et al.; Haemophilus b polysaccharide vaccine was first licensed in the United States in April 1985 . Between May 1985 and September 1987, 228 reports of disease due to Haemophilus influenzae in vaccinated children were submitted to the Food and Drug Administration, of which 216 were accepted for analysis . We compared the relative frequencies of the different disease entities caused by H . influenzae type b reported in vaccinated children with those reported in unvaccinated children (greater than 1000 cases that occurred between 1973 and 1984, as reported in the literature) . Over 90% of the vaccinated children were greater than or equal to 24 mo of age . A higher proportion of cases was reported to have occurred within the first two months after vaccination, with 10 cases occurring within 72 h of vaccination . Vaccination did not alter the expected frequencies of the different clinical entities associated with invasive H . influenzae disease . No estimates of clinical efficacy are possible based on the adverse events submitted to the Food and Drug Administration. J Dent Res, 1988 Aug, 67(8), 1131 - 5 Production of interleukin-1 and tumor necrosis factor by human peripheral monocytes activated by periodontal bacteria and extracted lipopolysaccharides; Lindemann RA et al.; Whole Gram-negative bacteria associated with juvenile and adult periodontitis, and their respective extracted lipopolysaccharides (LPS), were tested for the ability to activate quiescent human peripheral blood monocytes . All pathogenic Gram-negative bacteria and all LPS tested were able to induce the production of significant amounts of IL-1 and TNF, monokines known to induce osteoclastic bone resorption . Haemophilus segnis, which has not been associated with any form of periodontal disease, did not activate monocytes . Purified LPS from Actinobacillus actinomycetemcomitans Y4 was able to elicit IL-1 and TNF release at a threshold concentration of 1-10 ng/mL . To examine the mechanism whereby whole bacteria activated monocytes, we added polymixin B in culture with glutaraldehyde-fixed bacteria to bind LPS . This resulted in the abrogation of IL-1 and TNF production . To compare the effects of Gram-positive oral bacteria on monocytes, we also tested Staphylococcus epidermidis and the Gram-positive amphipathic equivalent of LPS, lipoteichoic acid (LTA) extracted from Staphylococcus aureus bacteria . Whereas whole Gram-positive bacteria had no stimulatory effect on monocytes, LTA induced IL-1 and TNF production at a concentration range equivalent to that of the LPS . These results indicate that monocytes are activated by free LPS or LPS bound to Gram-negative pathogenic periodontal bacteria to produce monokines which may contribute to the destruction of periodontal bone. J Pediatr, 1988 Aug, 113(2), 312 - 7 Adenosine deaminase deficiency with late onset of recurrent infections: response to treatment with polyethylene glycol-modified adenosine deaminase; Levy Y et al.; We report a 5-year-old girl with adenosine deaminase (ADA) deficiency who was asymptomatic during the first years of life . At 3 years of age, she developed chronic and recurrent sinopulmonary infections, and at 4 1/2 years of age she had one major infection with Streptococcus pneumoniae (bacteremia and septic arthritis of the hip) . Immunologic evaluation at 5 years of age revealed persistent lymphopenia, decreased helper-suppressor T cell ratios, and low proliferative responses to mitogens . The IgG, IgM, and IgA levels were normal; the IgG2 level was low normal or below normal . The patient had specific antibodies against toxoids and viral antigens but failed to produce antibodies against Haemophilus influenzae type b and pneumococcal polysaccharides . Although no symptoms of allergy were present, she had persistent eosinophilia and elevated IgE levels . The patient had 0.6% of normal ADA activity in erythrocytes and approximately 1% of normal ADA activity in peripheral blood mononuclear cells . Beginning at 6 years of age, she was treated with weekly injections of polyethylene glycol-modified bovine ADA . This treatment was well tolerated and effectively reversed the biochemical consequence of ADA deficiency . Concomitantly, she improved clinically and her T lymphocyte numbers and blastogenic responses to mitogens in vitro became normal . The late onset of clinical symptoms and relatively benign clinical course in this patient emphasize the need to consider ADA deficiency in a broad spectrum of immunodeficient children. J Pediatr, 1988 Aug, 113(2), 272 - 7 Immunogenicity of the Haemophilus influenzae type b capsular polysaccharide conjugate vaccine in children after systemic Haemophilus influenzae type b infections; Kaplan SL et al.; We immunized 24 patients (mean age 15.2 +/- 9.3 months) with polyribosylribitol phosphate-diphtheria toxoid conjugate vaccine (PRP-D) 2 months after a systemic Haemophilus influenzae type b infection . Children less than 24 months of age were immunized twice . Serum was obtained for antibody to PRP before and 1 or 2 months after immunization . Three of five children greater than 24 months of age and three of six children 18 to 24 months of age developed greater than 1 microgram/ml of antibody after immunization, and geometric mean postimmunization levels were significantly greater than preimmunization levels for both groups . However, two children who failed to respond to conventional PRP vaccine did not respond as expected to one dose of PRP-D . For children 7 to 17 months of age, the geometric mean PRP antibody levels increased as follows: preimmunization, 0.05 micrograms/ml; after the first dose, 0.28 micrograms/ml (p = 0.003); and after the second dose, 3.39 micrograms/ml (p = 0.001) . Of 13 children, 10 developed antibody values greater than 1.0 micrograms/ml . PRP conjugate vaccines are immunogenic in young children who have not developed protective PRP antibody levels after a systemic H . Influenzae type b infection. Arch Fr Pediatr, 1988 Aug-Sep, 45(7), 471 - 6 {Bacteriologic study of acute otitis media in hospitals and private practice}; Francois M et al.; The authors report the results of the study of 435 bacteriological samples taken in children presenting with acute otitis media, in the out-patient department of ENT at the hospital Bretonneau (Paris) and in Valognes (Manche) from October 1981 to September 1987 . Three bacterial organisms prevailed: Haemophilus (37 and 22% respectively), S . pneumoniae (25 and 7%) and Staphylococcus (16 and 17%) . Pseudomonas was fairly frequent in cases with otorrhea, even when recent . Comparison with other studies shows the clear progression of the incidence of Haemophilus in acute otitis media . The percentage of the strains secreting a beta-lactamase was 17% whether the children live in the country or in town . The frequency of S . pneumoniae was independent of age but was clearly lower in cases with prolonged or relapsing otitis . According to these results, the authors discuss the therapeutic strategy for acute otitis media . Amoxicillin still remains the antibiotic of choice . In case of persisting or relapsing otitis, the bacteriological examination will allow choosing the best adapted antibiotic: first generation cephalosporin, clavulanic acid and amoxicillin or trimethoprime and sulfamethoxazole. Diagn Microbiol Infect Dis, 1988 Aug, 10(4), 213 - 9 Characterization of beta-lactam antagonist in Supplement C; Woolfrey BF et al.; In the course of using Mueller-Hinton agar with 1% Supplement C (SC) (Difco, Detroit, MI) as a susceptibility test medium for Haemophilus influenzae, one lot of SC was encountered whose use was associated with markedly increased ampicillin MICs . Acidimetric and chromogenic cephalosporin filter paper disc tests of SC failed to detect beta-lactamase activity . Macrobroth dilution MIC tests to determine substrate specificity showed SC to antagonize benzylpenicillin and ampicillin but not cephalothin, cefazolin, or cefaclor, with the antagonism being prevented by the addition of clavulanic acid . High pressure liquid chromatographic analysis of reference and reaction solutions of benzylpenicillin with SC showed almost complete degradation of benzylpenicillin to benzylpenicilloic acid after 24 hr at 37 degrees C . For two other lots of SC that had passed MIC quality control testing, similar high pressure liquid chromatographic studies demonstrated slow conversion of small amounts of benzylpenicillin to benzylpenicilloic acid . These findings indicate that the beta-lactam antagonism by SC was due to the presence of a contaminating beta-lactamase directed primarily toward the penicillins. Immun Infekt, 1988 Aug, 16(4), 152 - 8 {Comparative antibacterial activity of fleroxacin: selection frequencies and outer membrane proteins of resistant mutants}; Cullmann W et al.; The antibacterial activity of fleroxacin was evaluated in 427 gram-positive and gram-negative strains, all isolated recently from clinical specimens and compared to that of ofloxacin, ciprofloxacin and co-trimoxazole . The activity of fleroxacin resembled to that of ofloxacin; its excellent activity against Haemophilus influenzae on the one hand and its lack of activity against beta-hemolytic streptococci on the other hand have to be mentioned . Selection frequencies for resistant clones were evaluated for clinical E . coli and Serratia marcescens isolates and the quinolones . With respect to clinical E . coli and Serratia marcescens isolates selection frequencies ranged from 10(-7) to 10(-9) in the presence of 2-fold or 8-fold the MIC . The outer membrane proteins of E . coli and Serratia marcescens wild-type strains were compared with those of their quinolone-resistant mutants . No discrepancies could be observed in E . coli, whereas some of the resistant Serratia marcescens mutants exhibited an increased expression of 31 kdal protein linked with a decrease of a 37 kdal major outer membrane protein . As these alterations could not be observed in each of the resistant mutants, it cannot be decided at present whether such alterations may provide an explanation for the resistance observed. Eur J Clin Microbiol Infect Dis, 1988 Aug, 7(4), 551 - 3 In vitro activity of azithromycin and erythromycin against organisms associated with bacterial vaginosis and chancroid; Jones BM et al.; The in vitro activity of the new macrolide azithromycin and erythromycin against Haemophilus ducreyi, Gardnerella vaginalis, Bacteroides spp . and Mobiluncus spp . was compared . Gardnerella vaginalis, Mobiluncus spp . and Haemophilus ducreyi were highly susceptible to both agents but azithromycin was more effective overall against all three groups of organisms . The activity of both antibiotics against Bacteroides spp . varied greatly, but azithromycin was again more active . Collectively, 62% of all Bacteroides strains were susceptible to erythromycin (MIC 1 mg/1) and 74% were susceptible to azithromycin. J Antibiot (Tokyo), 1988 Aug, 41(8), 1029 - 47 Synthesis, in vitro and in vivo activity of novel 9-deoxo-9a-AZA-9a-homoerythromycin A derivatives; a new class of macrolide antibiotics, the azalides; Bright GM et al.; A series of erythromycin A-derived semisynthetic antibiotics, featuring incorporation of a basic nitrogen atom into a ring expanded (15-membered) macrocyclic lactone, have been prepared and biologically evaluated . Semisynthetic modifications focused upon (1) varied substitution at the macrocyclic ring nitrogen and (2) epimerization or amine substitution at the C-4'' hydroxyl site within the cladinose sugar . In general, the new azalides exhibit improved Gram-negative potency, expanding the spectrum of erythromycin A to fully include Haemophilus influenzae and Neisseria gonorrhoeae . When compared to erythromycin A, the azalides exhibit substantially increased half-life and area-under-the-curve values in all species studied . The overall in vitro/in vivo performance of N-methyl, C-4'' epimers 3a and 9; and C-4'' amine 11 identify these compounds as the most interesting erythromycin A-superior agents . Compound 3a has been advanced to clinical study. Pediatr Infect Dis J, 1988 Aug, 7(8), 574 - 7 Immunogenicity and reactogenicity of four Haemophilus influenzae type b capsular polysaccharide vaccines in Finnish 24-month-old children; Kayhty H et al.; Stimulated by questions raised on potential differences between the Haemophilus influenzae type b capsular polysaccharide (PRP) vaccines on the market and the applicability of the efficacy data of a similar PRP vaccine obtained in a large field study in 1974 in Finland, we wished to compare the immunogenicity of all these preparations in 24-month-old Finnish children . In our study 137 children received the now recommended 25-micrograms dose of 1 of 4 H . influenzae type b PRP vaccines currently available, and an additional 86 children received half this dose corresponding to the 12.7 micrograms used in 1974 . Anti-PRP antibodies were measured in blood samples taken before and 4 weeks after vaccination by the same radioimmunoassay and in the same laboratory as in 1974 . The vaccines were equally immunogenic . Furthermore the now recommended dose of 25 micrograms did not give results (geometric mean concentrations, 2.38 to 3.45 micrograms/ml) differing from those after a 12.5-micrograms (2.01- to 3.45-micrograms/ml) dose which was used in 1974 . Antibody concentrations of 0.15 and 1.0 micrograms/ml were achieved in 91 to 95 and 66 to 84% of the children, respectively . The corresponding values after 1974 vaccinations were 3.53 micrograms/ml and 100 and 82% of children, respectively . The percentage of those responding with concentrations greater than or equal to 1 microgram/ml was somewhat higher in these Finnish children than reported for children of the same age receiving the same vaccine lots in the United States . Adverse reactions were mild or moderate and transient. South Med J, 1988 Aug, 81(8), 978 - 80 Treatment of otitis media with cefuroxime axetil; Aronovitz GH; Cefuroxime axetil and cefaclor were compared for efficacy in the treatment of acute otitis media with effusion . Sixty-four pediatric outpatients had tympanocentesis for culture, and then were randomized to a ten-day course of treatment with cefuroxime axetil or cefaclor . Streptococcus pneumoniae and Haemophilus influenzae were isolated from 25 (39%) and 23 (36%) patients, respectively . Treatment was beneficial in 26 (90%) of the patients who received cefuroxime axetil, and in 16 (76%) of the cefaclor-treated patients . Treatment failed in five (24%) of the cefaclor-treated patients, and in only three (10%) patients who received cefuroxime axetil . Haemophilus influenzae was the initial causative pathogen in a disproportionate number of treatment failures . This study demonstrates the efficacy of cefuroxime axetil in the treatment of otitis media. Epidemiol Infect, 1988 Aug, 101(1), 151 - 7 Antigenic analysis of Haemophilus ducreyi by Western blotting; Abeck D et al.; Twenty-one strains of Haemophilus ducreyi were analysed by Western blotting using two antisera produced in mice . Common antigens of molecular weights 58, 46, 41, 28, 22 and 16 kDa were detected in all the strains . The antigens were protein in nature, since they could not be detected in whole-cell lysates which had been treated with proteinase K . The H . ducreyi strains showed antigenic cross-reactivity with strains of H . influenzae and H . parainfluenzae, but showed minimal or no cross-reactivity with seven other species of bacteria. Infect Immun, 1988 Aug, 56(8), 1837 - 45 Clonal population structure of encapsulated Haemophilus influenzae; Musser JM et al.; Chromosomal genotypes of 2,209 isolates of the six polysaccharide capsule types of Haemophilus influenzae recovered from human hosts worldwide were characterized by an analysis of electrophoretically demonstrable allelic profiles at 17 metabolic enzyme loci . For 222 representative isolates, restriction fragment length polymorphism patterns produced by digestion of cap region DNA were also determined . With few exceptions, isolates belonging to individual phylogenetic lines or groups of allied lineages identified by multilocus enzyme electrophoresis had characteristic cap region restriction fragment length polymorphism patterns and characteristic combinations of cap region patterns and outer membrane protein types . The occurrence of strong associations of characters and the recovery of isolates with identical genetic properties in widely separated geographic regions and over a 40-year period indicated that the population structure of encapsulated H . influenzae is clonal . Recombination of chromosomal genes, including those mediating capsule synthesis, apparently is not a major factor in the short-term evolution of these pathogenic organisms and, therefore, may be of minor clinical significance. Pediatr Infect Dis J, 1988 Aug, 7(8), 552 - 6 Simultaneous recovery of bacterial and viral pathogens from cerebrospinal fluid; Sferra TJ et al.; Mixed bacterial infection in meningitis is well-documented, but there have been few previous reports of mixed viral-bacterial meningitis . A retrospective analysis of the bacterial and viral cerebrospinal fluid (CSF) cultures from a 1-year period in a 315-bed children's hospital revealed 5 patients with mixed viral-bacterial meningitis among 276 patients with viral and/or bacterial culture-positive meningitis . These 5 accounted for 2.8% of the patients with positive CSF viral cultures and 4.8% of those with positive CSF bacterial cultures . All of the viruses were identified as enteroviruses, and the bacteria were Group B Streptococcus, Group D Salmonella, Streptococcus pneumoniae, Haemophilus influenzae type b and Staphylococcus aureus . The ages of the patients ranged from 10 days to 22 years . The clinical course of each of the illnesses was typical of bacterial meningitis . This relatively high frequency of mixed viral-bacterial meningitis could affect the utility of rapid viral diagnostic tests for CSF viruses. J Infect Dis, 1988 Aug, 158(2), 360 - 5 Changes in outer membrane proteins of nontypable Haemophilus influenzae in patients with chronic obstructive pulmonary disease; Groeneveld K et al.; Five individual colonies of Haemophilus influenzae were isolated from each of one to three cultures of sputum collected from 18 patients with chronic obstructive pulmonary disease (COPD) . The isolates were studied to investigate whether the major outer membrane proteins (MOMPs) changed during persistence . The relationship between isolates was analyzed by fingerprinting their chromosomal DNA . The fingerprints of eight strains (isolated from eight patients) with various MOMP compositions were different, whereas fingerprints of isolates with identical MOMP compositions were indistinguishable . In 12 patients, two or more strains with different MOMP compositions were found; one strain was isolated from the sputum samples of each of the six remaining patients . In seven of the 12 patients, strains with different MOMPs but with indistinguishable fingerprints were found . The differences were found in proteins b,c (five patients) and d (five patients) . In patients with COPD, the MOMPs of H . influenzae are subject to changes that may enable this bacterium to escape immunological defense mechanisms. J Clin Microbiol, 1988 Aug, 26(8), 1535 - 8 rRNA gene restriction patterns of Haemophilus influenzae biogroup aegyptius strains associated with Brazilian purpuric fever; Irino K et al.; The rRNA gene restriction patterns of 92 isolates of Haemophilus influenzae biogroup aegyptius, associated with conjunctivitis or Brazilian purpuric fever in the State of Sao Paulo, Brazil, were studied with 16 + 23S rRNA from Escherichia coli as a probe . All strains were classified into 15 patterns . Isolates from Brazilian purpuric fever cases were seen only in patterns 3 (most frequently) and 4 (rarely), whereas isolates from conjunctivitis were found in all 15 patterns . The study demonstrated that rRNA from E . coli can serve as a probe for molecular epidemiology. Scand J Immunol, 1988 Aug, 28(2), 129 - 37 Isolation and characterization of Fc receptors from Haemophilus somnus; Yarnall M et al.; Receptors that bind the Fc region of bovine immunoglobulin (Ig) have been isolated from the culture supernatant of Haemophilus somnus by chromatography on a Sepharose 4B column . One receptor with a relative molecular weight of 41,000 weakly binds both bovine IgG subclasses, IgA and IgM, while three high molecular weight receptors (350,000, 270,000, and 120,000) strongly bind bovine IgG2, IgA, and IgM . All four Fc receptors are antigenically related and the 41,000 receptor appears to be a subunit of the high molecular weight receptors . In addition to bovine Ig, the purified 270,000 Fc receptor strongly binds horse IgG, rabbit IgG, pig IgG, cat IgG, dog IgG, and sheep IgG . The receptor also reacts weakly with mouse, rat, chicken, human, and guinea pig IgG and does not bind goat IgG . Fc receptors from 19 H . somnus isolates were compared . Variations in the molecular weight of the 41,000 protein were demonstrated among preputial isolates from asymptomatic carriers, but all other isolates appeared to have identically migrating proteins. Presse Med, 1988 Jul 27, 17(28), 1441 - 4 {Chronic bronchitis . Value of RU 41740}; Piquet J et al.; Chronic bronchitis is responsible for 20,000 deaths per annum in France, i.e . 5 per cent of the overall mortality rate . Infection of the bronchi and lung tissue is a frequent cause of death in these patients . Acute on chronic bronchitis ranks fifth among the causes of disablement and admission to hospital . Pneumococci and Haemophilus influenza are the organisms most frequently isolated . the incidence and potential severity of acute episodes of infection account for the repeated use of antibiotics which carries a risk of promotion bacterial resistance . RU 41740 is a non-specific immunomodulator agent which reinforces the non-specific means of the respiratory tract against infections . Three double-blind, drug versus placebo and therefore reliable therapeutic trials have shown that the drug is effective in preventing airway infection . In patients with moderately advanced chronic bronchitis, RU 41740 reduces the number and duration of acute infectious episodes as well as antibiotic consumption . This positive effect persists in patients with chronic respiratory failure, including those who present with extensive bronchial dystrophy . RU 41740 is particularly effective in patients with numerous previous episodes of infection, but it also acts at all stages of chronic bronchitis. J Biol Chem, 1988 Jul 15, 263(20), 9790 - 4 Purification and characterization of a peptidoglycan-associated lipoprotein from Haemophilus influenzae; Zlotnick GW et al.; We have purified to homogeneity a peptidoglycan-associated protein from Haemophilus influenzae . Our purification process used differential extraction of cell envelopes with nondenaturing detergents . Solubilization of this protein was accomplished by heating a peptidoglycan-enriched subcellular fraction in the presence of one of several nondenaturing detergents at 55-60 degrees C . The purified protein migrated as a single band, with a Mr approximately 15,000, following sodium dodecyl sulfate-polyacrylamide gel electrophoresis . This protein contains covalently linked fatty acids, is rich in tyrosine, but lacks methionine and tryptophan . Amino acid analysis also revealed the presence of glycerylcysteine, which has been shown to be the site of fatty acylation in other bacterial lipoproteins . Over 87% of the primary structure has been determined by sequencing high pressure liquid chromatography purified fragments derived from several endoproteinase digests . This protein belongs to a family of proteins, known as peptidoglycan associated lipoproteins, which appear to be components of the outer membranes of most Gram-negative bacteria. Am J Vet Res, 1988 Jul, 49(7), 1053 - 8 Evaluation of heat-sensitive, neutrophil-toxic, and hemolytic activity of Haemophilus (Actinobacillus) pleuropneumoniae; Rosendal S et al.; Cytotoxic and hemolytic activity of Haemophilus (Actinobacillus) pleuropneumoniae serotype 1 strain CM5 was investigated because of the potential role as a virulence determinant . Viable bacteria were toxic for porcine and bovine neutrophils, whereas bacteria killed by heat treatment at 60 C for 1 hour were not . Similarly, bacteria-free culture supernatant was cytotoxic and hemolytic in assays that used porcine neutrophils and erythrocytes, whereas supernatant treated at 60 C for 1 hour had no activity . Erythrocytes from various species were susceptible to the hemolytic activity of bacteria-free culture supernatant, with ovine and bovine erythrocytes being most sensitive . The neutrophil-toxic and hemolytic activity of bacteria-free culture supernatant was inhibited by cholesterol and oxygen and abolished after trypsin digestion . The neutrophil-toxic and hemolytic activity was preserved during storage at or less than 4 C, but was lost rapidly at 56 C or 80 C . Neutralizing antibodies were demonstrated in serum of pigs and rabbits immunized with 10-fold concentrated culture supernatant of strain CM5 and in field pigs that had recovered from natural infection with H pleuropneumoniae serotype 1 . Bacteria-free culture supernatants of 18 strains, including H pleuropneumoniae serotypes 1 through 10, Actinobacillus suis, and Haemophilus taxon minor group, were tested for heat-sensitive, neutrophil-toxic, and hemolytic activity . Fifteen strains were neutrophil toxic, but only 10 of these were hemolytic . Haemophilus pleuropneumoniae, serotype 1, strain VLS557; serotype 5, strain K17; and Haemophilus taxon minor group strain 33PN were neither cytotoxic nor hemolytic. Thorax, 1988 Jul, 43(7), 582 - 3 Bilateral empyema and purulent pericarditis due to Haemophilus influenzae capsular type b; Iggo R et al.; A previously fit woman developed a sore throat followed by bilateral empyema and pericarditis due to haemophilus influenzae capsular type b . She was treated successfully with antibiotics, bilateral thoracotomies, and pericardotomy. J Antimicrob Chemother, 1988 Jul, 22 Suppl B, 57 - 62 Spiramycin alone and in combination with trimethoprim against Haemophilus influenzae; Arditi M et al.; Following determination of MICs and MBCs of spiramycin and trimethoprim by the broth microdilution method for 16 typable (including 13 type b) and 15 nontypable H . influenzae isolates, bactericidal synergy was tested by the chequerboard method and the time-kill curve methods . Nineteen (13 typable and six nontypable) of 31 strains demonstrated synergy by the chequerboard method . Ten strains showed indifference, and two manifested antagonism . In contrast, 12/13 strains tested by the time-kill method showed synergy and 1/13 demonstrated indifference . Of note was the finding that seven isolates that showed indifference by chequerboard method (three typable, four nontypable) manifested synergism by the kill-curve method . Of the two nontypable strains showing antagonism by chequerboard, one manifested synergy and the other indifference by the time-kill method . Our studies show that in-vitro synergy between spiramycin and trimethoprim against H . influenzae strains is frequently demonstrable . In-vivo studies may be helpful in confirming these in-vitro observations. Jpn J Antibiot, 1988 Jul, 41(7), 859 - 62 {Clinical results of rokitamycin dry syrup on respiratory tract infections in pediatric field}; Saito A et al.; 1 . A total of 15 patients with pediatric respiratory tract infections were mediated with rokitamycin (RKM) dry syrup, and its clinical effects were excellent in 2, good in 10, fair in 1 and poor in 1 . 2 . The efficacy rate in Streptococcus pneumoniae pneumonia and mycoplasmal pneumonia was 100% . 3 . Clinical effects on 7 patients with Haemophilus influenzae were excellent in 1, good in 4, fair in 1 and poor in 1 . 4 . No adverse reaction was observed, and the taste and odor of RKM was well accepted by the children . 5 . RKM is useful and one of the first choice antibiotics on respiratory tract infections in pediatric field. Pediatr Infect Dis J, 1988 Jul, 7(7), 480 - 4 Simultaneous administration of Haemophilus influenzae type b capsular polysaccharide-diphtheria toxoid conjugate vaccine with routine diphtheria-tetanus-pertussis and inactivated poliovirus vaccinations of childhood; Eskola J et al.; A Haemophilus influenzae type b capsular polysaccharide-diphtheria toxoid conjugate vaccine (PRP-D) is capable of protecting infants against invasive H . influenzae diseases . Therefore it is very likely that it will be incorporated in routine vaccination schedules during the next few years . In order to test the suitability of simultaneous administration of PRP-D and other vaccines we administered it to 25 infants mixed with diphtheria-tetanus-pertussis vaccine at 3, 4 and 6 months and simultaneously, but in a separate syringe, with inactivated polio vaccine at 12 months . A comparison group of equal size received only diphtheria-tetanus-pertussis and inactivated poliovirus vaccines . The concentration of postvaccination antibodies to diphtheria toxoid was 0.411 IU/ml in the group that received PRP-D vs . 0.352 IU/ml in the comparison group, to tetanus toxoid 3.666 vs . 3.668 IU/ml and the neutralization titer to poliovirus type 1 was 370 vs . 320 units in the comparison group, to type 2 titer values were 230 vs . 270 units and to type 3, respectively, 210 vs . 290 units . Thus the seroresponse to antigens in routine vaccines was not affected by the presence of PRP-D in the vaccination schedule, and PRP-D can safely and effectively be included in the vaccination schedule of infancy. J Clin Invest, 1988 Jul, 82(1), 102 - 9 Role of cerebrospinal fluid pleocytosis and Haemophilus influenzae type b capsule on blood brain barrier permeability during experimental meningitis in the rat; Lesse AJ et al.; The influence of leukocytes and Haemophilus influenzae type b (Hib) capsule on blood brain barrier permeability (BBBP) to circulating 125I-albumin in normal and leukopenic rats was assessed after intracisternal inoculation of encapsulated (Rd-/b+/02) or unencapsulated (Rd-/b-/02) isogenic strains of Hib . Both normal and leukopenic animals had increased BBBP 18 h after inoculation, with normal rats demonstrating significantly increased BBBP after challenge with the encapsulated strain . Despite cerebrospinal fluid (CSF) pleocytosis in normal rats, CSF bacterial concentrations were not lower . Normal rats cleared unencapsulated Rd-/b-/02 more effectively than leukopenic rats, with BBBP correlating with CSF bacterial density and not leukocyte concentrations . Challenge with heat-killed Rd-/b+/02 resulted in increased BBBP in both normal and leukopenic rats, with greater BBBP at higher bacterial concentrations . The data suggest: (a) significant increases in BBBP occur in the near absence of CSF leukocytes; (b) CSF leukocytes can augment changes in BBBP; (c) type b capsule inhibits host clearance mechanisms within the CSF; and (d) BBBP appears to correlate with bacterial concentrations within the CSF. Q J Med, 1988 Jul, 68(255), 517 - 24 The pattern of infection of the nervous system in Riyadh: a review of 121 cases; Bahemuka M et al.; Analysis of 121 consecutive cases with infection of the nervous system showed that the majority were the granulomatous infections, tuberculosis and brucellosis (53 cases (44 per cent)) . Thirty-nine patients had tuberculosis and 14 had brucellosis . The clinical and microbiological pattern of infection differs from that frequently reported from Western countries . Tuberculosis lesions presented with features of intracranial space occupying lesions (14), spinal cord compression (13) and lumbosacral root compression (1 child) . Ten adults and one child had tuberculous meningitis . Pyogenic meningitis present in 38 cases (31 per cent), was most common in children . The infecting organism was identified in 26 patients; Gram-positive cocci in 17, Haemophilus influenzae in four and other Gram-negative organisms in five . Eleven patients had brain abscesses, caused by bacterial infection in eight, fungal infection in two and Toxoplasma gondii in one . Nineteen patients had clinical and pathological features of viral meningitis . Fourteen patients (12 per cent) died including six children with pyogenic meningitis. J Gen Microbiol, 1988 Jul, 134 ( Pt 7), 1993 - 9 Characterization of two Haemophilus somnus Fc receptors; Yarnall M et al.; Haemophilus somnus expresses two types of receptors that bind to the Fc region of bovine IgG, IgA and IgM . In this study, the relationship between these two types of Fc receptors is characterized . The high molecular mass receptors (350, 270 and 120 kDa) were secreted into the culture medium and were also in the insoluble protein fraction of the culture medium . The 41 kDa Fc receptor, which is a major outer-membrane protein, was only present in the insoluble protein fraction . Peptide mapping of the two types of Fc receptors suggests that the 41 kDa receptor is related to the high molecular mass receptor complex . Disulphide linkage is unlikely to be the mechanism of association of the 41 kDa receptor with the high molecular mass receptors since reducing agents had no effect on separating the individual receptors . Although the 41 kDa receptor is a major protein in the outer membrane of H . somnus, it does not react with convalescent bovine sera in Western blots . In contrast, convalescent bovine sera reacts intensely with the high molecular mass receptors in Western blots. Antimicrob Agents Chemother, 1988 Jul, 32(7), 1034 - 9 Gentamicin penetration into cerebrospinal fluid in experimental Haemophilus influenzae meningitis; Smith AL et al.; We studied the effect of meningitis and the method of parenteral gentamicin administration (intramuscular injection, a 30-min intravenous infusion, or intravenous bolus administration) on achievable concentrations of drug in cerebrospinal fluid (CSF) . In normal animals, only intravenous bolus administration of 2 to 8 mg/kg produced a gentamicin concentration of greater than 0.1 microgram/ml in CSF in some animals . All CSF samples contained less than the limit of detection (0.1 microgram/ml) after the intramuscular administration of 6 mg/kg . In animals with meningitis, gentamicin penetration into cisternal CSF was increased significantly after a bolus administration of 6 mg/kg (mean, 0.197 +/- 0.063 microgram/ml in normal animals versus 1.68 +/- 0.38 micrograms/ml in animals with meningitis; P less than 0.01) . In meningitic animals that received 6 mg/kg as an intravenous bolus, lumbar CSF had the highest maximum concentration (4.25 +/- 1.08 micrograms/ml), in comparison with ventricular CSF (3.10 +/- 0.66 micrograms/ml) . The gentamicin concentration in cisternal CSF decreased more slowly than it did in serum (elimination half-life, 238.70 +/- 64.56 min in cisternal CSF versus 82.73 +/- 2.91 min in serum), yielding a relative increase in the percentage of penetration . We conclude that maximum penetration by gentamicin into CSF occurs after intravenous bolus administration and that the maximum concentration occurs in lumbar CSF. Jpn J Antibiot, 1988 Jul, 41(7), 914 - 9 {Clinical studies of rokitamycin dry syrup in the field of pediatrics}; Haruta T et al.; We studied the absorption and excretion as well as the clinical effect of rokitamycin (RKM, TMS-19-Q) dry syrup . The results we found are summarized as follows: 1 . When 3 pediatric patients were medicated orally with a single dose of 10 mg/kg of the drug, its peak concentrations of 0.75 and 0.51 microgram/ml appeared in the blood in 30 minutes after administration in 2 patients, and of 0.21 microgram/ml in 1 hour in the other patient . At 4 hours after administration, its concentration in the blood was 0.07-0.08 microgram/ml in all of the patient, and at 6 hours, it was undetectable . T1/2 values were 1.05-2.08 hours . First 6-hour urinary recovery rates of the drug in the first 2 patients were 1.52 and 1.11%, respectively . 2 . Twenty-four patients with 25 diseases were medicated with 7.14-12.5 mg/kg of the drug 3-4 times daily for 4-10 days . The patients consisted of 12 with tonsillitis, 7 with bronchitis, 3 with colitis, one each with Haemophilus influenzae pneumonia, mycoplasmal pneumonia, and pertussis . Clinical responses to the treatment were excellent in 7, good in 13, and poor in 5, with an efficacy rate of 80.0% . Bacteriologically, of 17 isolates whose changes were followed, 8 were eradicated, 1 decreased, and 8 remained unchanged, with an eradication rate of 47.1% . 3 . No adverse reactions to the drug were observed in any of these patients, while abnormal laboratory test values observed were slight eosinophilia and also slight elevations of S-GOT and S-GPT in one of the patients.(ABSTRACT TRUNCATED AT 250 WORDS) Rev Infect Dis, 1988 Jul-Aug, 10 Suppl 2, S311 - 6 Parasite-directed endocytosis; McGee ZA et al.; Following the attachment of gonococci to human fallopian tube mucosa in organ culture, the gonococci are endocytosed by specialized low columnar epithelial cells, are transported to the base of the epithelial cells, and are subsequently exocytosed into the subepithelial tissues . This transepithelial transport process by which "invasion" of the host occurs appears to be dependent on microbial factors is designated parasite-directed endocytosis to distinguish it from host-directed endocytosis by cells such as macrophages that eventually degrade the parasites . "Invasion" of the host by a number of human pathogens--bacteria (e.g., Neisseria meningitidis,