Antimicrob Agents Chemother, 1987 Mar, 31(3), 467 - 9 Effect of Haemophilus influenzae infection and moxalactam on platelet function in children; Kaplan SL et al.; In a prospective randomized study, children with Haemophilus influenzae type b meningitis received moxalactam or ampicillin or chloramphenicol . Of 41 children, 6 had prolonged bleeding times (greater than 6 min), and 7 of 9 tested had abnormal platelet aggregation at hospital admission . At the end of therapy, no children in the ampicillin-chloramphenicol group, compared with 5 of 22 moxalactam-treated children (23%) (P = 0.08), had prolonged bleeding times (6.5 to 7.5 min) . Our data suggest that H . influenzae meningitis and treatment with moxalactam may each have an effect on platelet function in children. Vet Pathol, 1987 Mar, 24(2), 129 - 34 Experimental Haemophilus somnus pneumonia in calves; Jackson JA et al.; Purulent bronchopneumonia was induced in 12 young calves inoculated endotracheally with a total of 2 to 8 X 10(10) viable Haemophilus somnus organisms . Calves treated before inoculation of bacteria with dexamethasone had more extensive lung changes than nontreated calves . Two of six dexamethasone-pretreated calves died while none of the non-pretreated calves died in the 12-day experimental period . Cranial-ventral gray to red lung consolidations with multifocal abscesses were present in all calves . Histologic examination revealed purulent to fibrinopurulent bronchiolitis accompanied by alveolar filling with fibrin, neutrophils, and macrophages . In addition, peribronchiolar fibrosis and bronchiolitis obliterans were common as were interlobular fibrosis and thrombosis of interlobular and pleural lymphatics . Focal to diffuse ulceration of bronchiolar epithelium was present in five of 12 lungs . Abscessation and severe alveolar filling with fibrin, red blood cells, and streaming inflammatory cells were present in dexamethasone-treated calves . H . somnus was isolated from lungs of all 12 calves . Complement fixation and microagglutination antibody titers to H . somnus antigens increased in most calves following infection with H . somnus . This model of H . somnus pneumonia closely resembles the naturally occurring disease. Pediatr Infect Dis J, 1987 Mar, 6(3), 243 - 6 Evaluation of routine lumbar punctures in newborn infants with respiratory distress syndrome; Eldadah M et al.; Infants with respiratory distress syndrome are routinely evaluated for infection which commonly includes a lumbar puncture . In this study cerebrospinal fluid (CSF) examination failed to elicit evidence for meningitis in 238 consecutively admitted infants with respiratory distress syndrome evaluated during the first 24 hours of life . Blood cultures were obtained in all; suprapubic or catheterized urine was obtained in 163 infants; CSF was collected successfully in 203 infants . Seventeen infants demonstrated positive blood cultures: 7 Streptococcus, 5 Staphylococcus, 3 Haemophilus influenzae, 1 Bacillus subtilis and 1 diphtheroid infection . CSF obtained from 14 of those infants had normal examinations and sterile cultures . Factors associated with bacteremia were birth weight (P less than 0.01), gestational age (P less than 0.01), prolonged rupture of membranes (P less than 0.05) and leukopenia below 10 000/mm3 (P less than 0.05) . In view of the negative CSF examinations in infants with positive blood cultures and the potential complications of lumbar puncture (hypoxia, trauma, infection, epidermoid tumor), the potential risks of CSF evaluation may exceed the assessed benefit for the infant with respiratory distress syndrome. Am J Vet Res, 1987 Mar, 48(3), 366 - 9 Development of a defined medium for Haemophilus somnus isolated from cattle; Inzana TJ et al.; Nutritional factors that influence the growth of Haemophilus somnus were examined, and a defined medium was developed . Optimal growth of H somnus in broth occurred under conditions of maximum aeration . Nutritional components required for or enhanced growth of most H somnus isolates in the defined medium included uracil, D-glucose, isotonic NaCl, Na2HPO4, nicotinamide, flavin mononucleotide, pantothenic acid, pyridoxine, and a variety of salts and amino acids . The defined medium supported optimum growth of 18 of 21 isolates of H somnus from cattle. J Hand Surg {Am}, 1987 Mar, 12(2), 299 - 301 Aerobic mouth flora of the rhesus monkey; Rayan GM et al.; The aerobic and facultative anaerobic mouth flora of 17 rhesus monkeys was studied qualitatively, including antibiotic susceptibilities . The organisms most often encountered were Neisseria species (19.8%), alpha haemolytic streptococci (19.8%), and Haemophilus parainfluenzae (17.2%) . All Haemophilus parainfluenzae isolates were susceptible to cefoperazone . The combination of penicillin and cefoperazone may be the most appropriate initial antibiotic treatment for monkey bite injuries. Vet Clin North Am Food Anim Pract, 1987 Mar, 3(1), 61 - 73 Neurologic disease caused by Haemophilus somnus; Ames TR; Haemophilus somnus is an important cause of neurologic disease in young cattle . Controversy exists over the taxonomic classification of this organism, but the name has persisted . Although the clinical signs and postmortem findings have been well described, the epidemiology and pathogenesis are poorly understood . With early detection, the disease can be successfully treated with antimicrobial therapy . Prevention of the disease may be possible with commercial bacterins. Pediatr Med Chir, 1987 Mar-Apr, 9(2), 235 - 6 {Arthritis caused by type B Haemophilus influenzae . Description of 2 cases}; Bonora G et al.; Haemophilus Influenzae type B is perhaps the most important pathogen in childhood . H.I . is the most common cause of bacterial septic arthritis in children under 2 years of age in the U.S.A . We describe two cases of H.I . septic arthritis and we discuss the the treatment . The antibiotic therapy is invasive H.I . type B disease is in a period of transition . New drugs are available that offer the same therapeutic efficacy as Ampicillin and Chloramphenicol but with decreased toxicity. Antimicrob Agents Chemother, 1987 Mar, 31(3), 417 - 20 Comparative evaluation of enoxacin, ofloxacin, ampicillin, and chloramphenicol for treatment of experimental Haemophilus influenzae pneumonia; Kemmerich B et al.; A murine model of bacteremic Haemophilus influenzae type b pneumonia was used to evaluate the therapeutic efficacies of the quinolone antimicrobial agents enoxacin and ofloxacin compared with those of ampicillin and chloramphenicol . Ampicillin-susceptible (AS) and ampicillin-resistant (AR) challenge strains were employed . Treatment with enoxacin or ofloxacin produced intrapulmonary killing of H . influenzae that was superior to that achieved with ampicillin (P less than 0.01 to P less than 0.001 for both AS and AR strains) . Ofloxacin and enoxacin also provided killing greater than that with chloramphenicol for the AS strain (P less than 0.01 to P less than 0.001) . For the AR strain, ofloxacin provided killing greater than that obtained with chloramphenicol (P less than 0.001) . Survival from AS strain pneumonia was 60% in enoxacin-treated and 78% in ofloxacin-treated animals compared with 41% for chloramphenicol-treated and 23% for ampicillin-treated groups . We conclude that enoxacin and ofloxacin may be effective antimicrobial agents in treating either AS or AR strains causing H . influenzae pneumonia. Acta Otolaryngol, 1987 Mar-Apr, 103(3-4), 307 - 11 Effect of lipopolysaccharide of Haemophilus influenzae on ciliary activity of the human nasal mucosa and bullfrog palate clearance; Harada T et al.; The influence of lipopolysaccharide (LPS) of Haemophilus influenzae on the ciliary activity of human nasal mucosa was first studied using both a photo-oscillographic apparatus and by bullfrog palate clearance . Neither modification of ciliary activity nor change in bullfrog palate clearance was observed in the early phase after the administration of LPS. J Antimicrob Chemother, 1987 Mar, 19(3), 373 - 83 Amoxycillin/clavulanate in acute purulent exacerbations of chronic bronchitis; Maesen FP et al.; Twenty patients, all admitted to hospital with acute purulent exacerbations of chronic bronchitis associated with Haemophilus influenzae, Streptococcus pneumoniae or beta-lactamase producing Branhamella catarrhalis were treated twice daily for ten days with amoxycillin/clavulanate . Ten patients were first given 1000 mg amoxycillin with 200 mg potassium clavulanate intravenously bd for three days, before crossing to the standard oral regimen of 1000 mg amoxycillin + 250 mg potassium clavulanate bd . Clinical results on day 10 were excellent in 16/20 patients, but 14 patients developed recurrences or reinfections within a week of the end-of-treatment, five of them with beta-lactamase producing B . catarrhalis . Bacteriological and kinetic studies showed that the branhamella beta-lactamases were inhibited by 0.25 mg/l clavulanic acid and that the mean sputum concentration of clavulanic acid was 0.16 mg/l, that of amoxycillin being 0.92 mg/l . The importance of the follow-up of such infections is stressed. J Antimicrob Chemother, 1987 Mar, 19(3), 297 - 301 Comparative susceptibilities of ampicillin and chloramphenicol resistant Haemophilus influenzae to fifteen antibiotics; Campos J et al.; Eighty-three isolates of ampicillin and chloramphenicol resistant Haemophilus influenzae were tested for susceptibility to fifteen antibiotics by the agar dilution method . Fifty-four were from paediatric patients with H . influenzae disease and 29 from nasopharyngeal carriers (pre-school children) . Twenty-five strains belonged to serotype b, one to serotype a, one to serotype c and the rest were non-typable . All strains produced beta-lactamase and inactivated chloramphenicol in a rapid bioassay, suggesting the production of chloramphenicol-acetyltransferase . The most active drugs were ceftriaxone, cefotaxime, latamoxef, aztreonam and desacetyl-cefotaxime (MIC90: 0.03, 0.06, 0.12, 0.25 and 0.25 mg/l, respectively) . Cefuroxime, rifampicin and imipenem (MIC90 1 mg/l), and the combination of amoxycillin and clavulanic acid (MIC90 2:1 mg/l), also showed good activity . Cefaclor, erythromycin, tetracycline, trimethoprim, sulfamethoxazole and cotrimoxazole were the least active of the drugs studied . The excellent in-vitro activity of the new beta-lactam agents against H . influenzae resistant to ampicillin and chloramphenicol offers a therapeutic alternative in the treatment of serious infections caused by these micro-organisms. Pediatr Emerg Care, 1987 Mar, 3(1), 28 - 9 Unusual case of Haemophilus influenzae type b: Haemophilus influenzae type b meningitis cellulitis and subcutaneous abscess; Medina FA; An unusual case of beta-lactamase positive Haemophilus influenzae type b infection is reported . Clinical manifestations included meningitis, a left ankle subcutaneous abscess, and bilateral hand cellulitis . Discussion and review of literature are presented for the previously unreported association of this common childhood pathogen. J Med Microbiol, 1987 Mar, 23(2), 155 - 62 Relationship between lipopolysaccharide composition and virulence of Haemophilus ducreyi; Odumeru JA et al.; The relationship between lipopolysaccharide (LPS) composition and virulence of Haemophilus ducreyi strains was investigated . Glycoses identified in LPS by gas-liquid chromatography were glucose, galactose, and their amino derivatives glucosamine and galactosamine . Fucose was found in trace amounts but mannose and rhamnose, characteristic of the O-side chain of LPS in many species, were not detected . Qualitatively, the LPS composition of the eight strains examined was similar and differences were mainly quantitative . The total glycose:KDO ratio of the LPS of virulent strains exceeded that of avirulent strains . All strains had similar fatty-acid composition but lacked lauric acid . SDS-polyacrylamide gel electrophoresis of the LPS of virulent and avirulent strains also revealed differences in their electrophoretic mobilities . The LPS profiles of avirulent strains were similar, but differed from those of virulent strains . These profiles lacked high mol . wt bands representing O-side chain repeating units . Thus, differences in the electrophoretic mobilities of the LPS of virulent and avirulent strains may reflect differences in the amount of carbohydrates associated with the core polysaccharide. South Med J, 1987 Mar, 80(3), 405 - 6 Endocarditis caused by beta-lactamase-producing Haemophilus influenzae; Dall L et al.; We have described a case of tricuspid valve endocarditis caused by beta-lactamase-producing H influenzae that responded well to four weeks of cefamandole therapy. Diagn Microbiol Infect Dis, 1987 Mar, 6(3), 185 - 92 CI-934, a new difluoroquinolone: in vitro antibacterial activity and proposed disk diffusion test interpretive criteria; Fuchs PC et al.; The susceptibility of 7,763 clinical isolates at four medical centers to CI-934 and three comparative quinolones was tested . CI-934 was the most active compound against Gram-positive isolates, such as staphylococci (MIC 90 = 0.25 microgram/ml), and enterococci (MIC 90 = 0.5 microgram/ml) . CI-934 was the least active of these drugs against Pseudomonas spp . (MIC 90 = greater than 8.0 micrograms/ml) . Against all other organisms CI-934 was very effective, being most comparable with enoxacin . With a selected group of isolates, CI-934 demonstrated high activity against Haemophilus influenzae (MIC 90 = 0.06 microgram/ml), Neisseria meningitidis and N . gonorrhoeae (MIC 90 = 0.13 microgram/ml), Listeria monocytogenes (MIC 90 = 1.0 microgram/ml), methicillin-resistant staphylococci (MIC 90 = 0.13 microgram/ml), and modest activity against anaerobes . Disk diffusion susceptibility testing of CI-934 was evaluated using 3-, 5-, and 10-micrograms disks . Because of its lower interpretive error rate, the 3-micrograms disk is tentatively recommended . With less than or equal to 2 micrograms/ml and greater than 4 micrograms/ml as the susceptible and resistant MIC breakpoints, the corresponding 3-micrograms disk zone diameters breakpoints are greater than or equal to 15 mm and less than or equal to 11 mm . Because most isolates of Pseudomonas spp . are not susceptible to CI-934 and the zone size interpretive error rate is particularly high (33%) with Pseudomonas spp., we suggest that isolates of this genus not be tested for clinical purposes. Infect Dis Clin North Am, 1987 Mar, 1(1), 217 - 33 Sexually transmitted diseases . Genital ulceration with regional adenopathy; Krockta WP et al.; The specific agent causing genital ulceration is difficult to identify without laboratory confirmatory testing including darkfield microscopy, syphilis and lymphogranuloma venereum serology, and culture for Haemophilus ducreyi and herpes simplex virus . Empiric antimicrobial therapy risks masking clinical or serologic diagnosis of syphilis. Vet Microbiol, 1987 Mar, 13(3), 249 - 57 Serotyping of Haemophilus pleuropneumoniae in the Netherlands: with emphasis on heterogeneity within serotype 1 and (proposed) serotype 9; Kamp EM et al.; Four hundred and forty-three Dutch field isolates of Haemophilus pleuropneumoniae were serotyped by rapid slide agglutination (RSA) using specific antisera against serotypes 1 to 5 and against the recently proposed types 6 to 9 . The predominant serotypes were 9 (49%) and 2 (32%) . Serotypes 1, 3, 5, 7 and 8 were isolated in small numbers: together they accounted for 3% of the total . Five percent of the isolates were not typable either due to autoagglutination or because they were not agglutinated by any of the available antisera . The remaining 49 strains (11%) agglutinated in more than one antiserum and could therefore not be properly classified . Forty-four of these 49 strains agglutinated in both anti type 1 and anti type 9 serum . Antigenic relationships between serotype 1, serotype 9 and isolates reacting with both antisera were studied using immunodiffusion and RSA with adsorbed sera . Serotype 9 strains appeared not to be a homogenous group . Isolates agglutinating exclusively in anti type 9 serum can be divided into two groups: one closely related and another hardly related to serotype 1 . Serotype 9 reference strain 13261 belongs to the latter . Type 1 + 9 strains have antigens in common with serotypes 1 and 9, but they also have their own specific antigenic material . Such strains are proposed as a new serotype 10. Acta Paediatr Scand, 1987 Mar, 76(2), 221 - 7 Etiology and diagnosis of neonatal conjunctivitis; Sandstrom I; Chlamydia trachomatis was isolated from the most inflamed eye of 13 of 107 (12%) infants with neonatal purulent conjunctivitis and from none of 100 healthy infants (p less than 0.01) . Staphylococcus aureus was recovered from 49 (46%) inflamed eyes and from 8 (8%) healthy eyes (p less than 0.01) . Streptococcus pneumoniae, Haemophilus influenzae, Branhamella catarrhalis, Escherichia coli and Klebsiella pneumoniae were isolated from very few infants with conjunctivitis but not from controls . No organisms could be recovered from 23 (22%) infants with conjunctivitis and from 60 (60%) healthy infants (p less than 0.01) . The incidence of neonatal purulent conjunctivitis was 107 (2%), of 5,924 births . Eyes infected with C . trachomatis were significantly more inflamed than eyes from which S . aureus or no organisms could be isolated . Furthermore, conjunctival "pseudomembranes" were associated with C . trachomatis . The age at onset of the chlamydial conjunctivitis was higher compared to the age at onset of conjunctivitis in which S . aureus or no organisms were isolated. Vaccine, 1987 Mar, 5(1), 3 - 4 Prospects for the prevention of meningococcal disease: special reference to group B; Frasch CE; Safe and effective polysaccharide (PS) vaccines for prevention of bacteraemia and meningitis due to meningococcal serogroups A, C, Y, and W135 have been licensed for a number of years in the United States and in some European countries . The bivalent AC and the tetravalent ACYW135 PS vaccines have generally been used in the civilian population only for the control of outbreaks . A major meningococcal disease problem persists in parts of Africa, especially in the so-called 'meningitis belt' . Studies by Greenwood and Wali have shown that a cost effective way to control the disease in Africa is to vaccinate the entire population of a village at the start of an outbreak . When this was done they found that further cases of group A disease ceased within ten days . There are, however, some problems with the existing PS vaccines . The group C PS is less immunogenic in young children than the three other PS, and does not protect children below 18 to 24 months of age . This problem will probably be solved by conjugation of the group C PS to a protein carrier, analogous to that which has been done with the Haemophilus influenzae type b PS. Immunology, 1987 Mar, 60(3), 415 - 8 Interleukin-1-like activity in capsular material from Haemophilus actinomycetemcomitans; Harvey W et al.; This paper describes the activity of a bacterial surface component (capsular material, CM) in biological assays for interleukin-1 (IL-1) . CM from the periodontal pathogen Haemophilus actinomycetemcomitans was tested in the following in vitro assays: mouse thymocyte proliferation (LAF assay), stimulation of collagenase and prostaglandin (PG) E2 synthesis by articular chondrocytes, and stimulation of PGE2 synthesis by fibroblasts . In all these assays, CM gave a response similar to an IL-1 preparation . This ability to mimic IL-1 suggests an important role for CM in both cell-mediated immunity and connective tissue destruction in localized juvenile periodontitis (LJP). J Bacteriol, 1987 Mar, 169(3), 990 - 4 Constitutive expression of tetracycline resistance mediated by a Tn10-like element in Haemophilus parainfluenzae results from a mutation in the repressor gene; Heuer C et al.; The Tn10-like constitutively expressed tetracycline resistance determinant from a Haemophilus parainfluenzae strain was cloned in Escherichia coli . Toxicity resulting from expression on multicopy plasmids necessitated its being cloned on a low-copy plasmid vector or in cells containing the Tn10-encoded repressor . Constitutive expression of tetracycline resistance was found to result from the synthesis of a truncated inactive repressor molecule . Instead of the 23-kilodalton repressor found in other Tn10-containing strains, this determinant encoded a 14.5-kilodalton molecule . The DNA sequence of the 700-base-pair region spanning the repressor gene and promoter-operator regions of the Haemophilus determinant was identical to that of the same region of Tn10, except for the absence of a single T X A base pair in the repressor gene . This deletion leads to premature termination of the protein . Antisera to the repressor suggested that the repressor was also absent in a second independently isolated H . parainfluenzae strain bearing a Tn10-like constitutive tetracycline resistance determinant. J Med Microbiol, 1987 Mar, 23(2), 163 - 70 A monoclonal antibody directed against a serotype-specific, outer-membrane protein of Haemophilus influenzae type b; Hamel J et al.; Monoclonal antibodies (Mabs) were produced against outer-membrane proteins (OMPs) of Haemophilus influenzae type b . The clones were screened by ELISA with outer-membrane preparations of H . influenzae type b and untypable strains as coating antigens . Antibodies directed against the proteins of mol . wt (10(3)) 43, 37 and 13 were identified by immunoblotting of SDS-PAGE patterns of OMPs . Proteolytic enzyme treatments of the OMPs resulted in reduction of Mab reactivity as measured by ELISA . Furthermore, the absence of reactivity of Mab Hb-2 with a preparation of lipopolysaccharide confirmed the protein nature of its corresponding epitope . Binding assays with live bacteria showed that Hb-2 reacted with a cell surface-exposed antigenic determinant . Mab Hb-2 was bactericidal in vitro in the presence of complement . The characterisation of Hb-2 (IgG2a) by Western immunoblotting analysis revealed that it was directed against the 37 X 10(3)-mol . wt OMP . In a dot-enzyme immunoassay, Hb-2 reacted specifically with 326 strains of H . influenzae type b . It did not cross-react with the other serotypes or untypable strains of H . influenzae or with other bacterial species . This is the first report of a monoclonal antibody identifying a serotype-specific surface-exposed OMP of H . influenzae type b. Infect Immun, 1987 Mar, 55(3), 513 - 20 Conservation of epitopes in the oligosaccharide portion of the lipooligosaccharide of Haemophilus influenzae type b; Gulig PA et al.; The antigenic characteristics of the lipooligosaccharide (LOS) of Haemophilus influenzae type b (Hib) were examined in strains obtained over an extended period of time . These Hib strains were isolated from patients with systemic Hib disease in Dallas, Tex., over a 20-year period and in New York City between 1941 and 1956 . The antigenic characteristics of the LOS of these Hib strains were examined by using a set of four murine monoclonal antibodies directed against epitopes present in the oligosaccharide portion of the LOS molecule . The same basic set of LOS antigenic determinants that is expressed by recent Hib isolates was also found to be present in this collection of Hib strains spanning a 40-year period . Some variation with time was detected in the distribution of the systemic disease isolates among four Hib LOS antigenic groups; however, only 2 of 188 Hib isolates failed to react with a set of two LOS-specific monoclonal antibodies . Therefore, little variation has occurred among Hib strains with regard to the LOS epitopes defined by these monoclonal antibodies over a considerable period of time. Nature, 1987 Feb 5-11, 325(6104), 536 - 7 Role of Staphylococcus protease in the development of influenza pneumonia; Tashiro M et al.; In influenza the combined virus-bacterial pneumonia is approximately three times more common than primary viral pneumonia . The bacteria most commonly involved are Staphylococcus aureus, Streptococcus pneumoniae and Haemophilus influenzae . S . aureus co-infection is reported to have a fatality rate of up to 42% (ref . 2) . It is thought that virus infection in the respiratory tract favours growth conditions for bacteria . In this letter data are presented which show that some S . aureus strains secrete a protease which exerts a decisive influence on the outcome of influenza virus infection in mice by cleavage activation of the virus haemagglutinin. Arch Dis Child, 1987 Feb, 62(2), 191 - 3 Meningitis presenting as hypertension; Waters K et al.; A 21 month old girl who presented with what seemed to be hypertensive encephalopathy is described . Although her encephalopathy resolved with antihypertensive treatment, subsequent investigations revealed haemophilus meningitis. Am J Vet Res, 1987 Feb, 48(2), 219 - 26 An evaluation of agglutination and coagglutination techniques for serotyping of Haemophilus pleuropneumoniae isolates; Mittal KR et al.; A comparative evaluation of rapid slide agglutination, tube agglutination, 2-mercaptoethanol tube agglutination, and coagglutination tests was made for serotyping isolates of Haemophilus pleuropneumoniae . The results indicated that a majority of the isolates could be serotyped by any of these tests . But, it was not uncommon to find isolates which were inagglutinable or poorly agglutinable in homologous sera . Heat treatment of whole-cell suspensions of such isolates was essential to unmask the serotype-specific antigenic determinants; however, in the process of heat treatment, cross-reactive common antigens of minor nature were also exposed . The antibodies involved in such cross-reactions were mainly of immunoglobulin M type, because the cross-reactivities were completely abolished in coagglutination and 2-mercaptoethanol agglutination tests . Thus, both these tests were satisfactory for serotyping inagglutinable mucoid strains . For serotyping strains which were either polyagglutinating or autoagglutinating, agglutination tests could not be used, but the coagglutination test proved to be satisfactory . The coagglutination test was serotype-specific, sensitive, simple, rapid, reproducible, and easier to read and interpret than rapid slide or tube agglutination tests . This test could be used to serotype mucoid, smooth, or rough isolates. J Clin Microbiol, 1987 Feb, 25(2), 226 - 9 Diagnosis of pneumococcal pneumonia by enzyme-linked immunosorbent assay of antibodies to pneumococcal hemolysin (pneumolysin); Kalin M et al.; An enzyme-linked immunosorbent assay (ELISA) with a highly purified pneumolysin as the antigen was evaluated for serological diagnosis of pneumococcal pneumonia . One hundred four healthy controls were tested, and the specificity of the test was set to 95% . In samples from patients with bacteremic pneumococcal pneumonia, 82% (18 of 22) were positive, i.e., at least one serum sample had a titer above the upper normal limit or at least a twofold rise in antibody titers was noted . In nonbacteremic pneumococcal pneumonia, 45% (21 of 47) of samples were positive . All sera were negative for patients with pneumonia caused by Haemophilus influenzae, Legionella pneumophila, Chlamydia psittaci, and influenza A virus . However, in patients with a diagnosis of Mycoplasma pneumoniae infection, 8 of 25 (32%) samples were positive for antibodies to pneumolysin . All sera, including those from patients with mycoplasma infection, were negative to a protein control antigen by ELISA . Serum immunoglobulin G response to pneumolysin as measured by ELISA might thus be an aid in the laboratory diagnosis of pneumococcal pneumonia . This assay may also help to further elucidate the occurrence of dual infections with pneumococci. Am J Dis Child, 1987 Feb, 141(2), 202 - 4 Microbiology of retropharyngeal abscesses in children; Brook I; Aspiration of retropharyngeal abscesses was performed in 14 children . Cultures were taken from aspirates for aerobic and anaerobic bacteria, and all yielded bacterial growth . Anaerobes were isolated in all patients; they were the only organisms isolated in two patients (14%) and were mixed with aerobes in 12 patients (86%) . There were 78 anaerobic isolates (5.6 per specimen) . The predominant anaerobes were Bacteroides species, Peptostreptococcus species, and Fusobacterium species . There were 26 aerobic isolates (1.9 per specimen) . The predominant aerobes were alpha- and gamma-hemolytic streptococci, Staphylococcus aureus, Haemophilus species, and group A beta-hemolytic streptococci . beta-Lactamase production was noted in 16 isolates recovered from ten patients (71%) . These included all isolates of S aureus, six of 18 Bacteroides melaninogenicus group (33%), and two of three Bacteroides oralis (67%) . These findings demonstrate the major role of anaerobic organisms in retropharyngeal abscesses and the presence of beta-lactamase-producing organisms in two thirds of the patients. Jpn J Antibiot, 1987 Feb, 40(2), 439 - 47 {Clinical evaluation of cefuzonam in pediatrics}; Haruta T et al.; Cefuzonam (L-105, CZON), a new injectable cephalosporin, was used in 12 pediatric patients with infections . The following is a summary of the results: The 12 cases included 3 cases of tonsillitis (pathogen: Haemophilus parainfluenzae in 1 case, Haemophilus influenzae in 2 cases), 4 cases of pneumonia (Staphylococcus aureus in 1 case, pathogen unknown in 3 cases), 2 cases of nephropyelitis (Escherichia coli in 2 cases), 1 case of purulent lymphadenitis (pathogen unknown), 1 case of purulent thyroiditis (mixed infection of Streptococcus milleri, Haemophilus aphrophilus and anaerobes), and 1 case of vulvar abscess (E . coli) . Dose levels of CZON were 42.9 approximately 93.3 mg/kg/day divided into 3 or 4 times and the drug was intravenously injected for 6 to 12 days . Clinical efficacies were excellent in 4 cases, good in 5 cases, and poor in 3 cases, with the efficacy rate of 75.0% . The 3 cases with poor efficacy consisted of 1 case each of pneumonia complicated with chronic granulomatosis, purulent thyroiditis associated with piriform recess fistula, and purulent lymphadenitis of armpit developed after surgical operation of congenital heart disease . In the first 2 cases satisfactory efficacy was not obtained by chemotherapy alone, and complete cure was seen after surgical operation . Side effects were not observed clinically . One case each of slight prolongation of prothrombin time and transient elevations of GOT and GPT values were noted but no severe abnormalities were found in laboratory tests.(ABSTRACT TRUNCATED AT 250 WORDS) Jpn J Antibiot, 1987 Feb, 40(2), 405 - 18 {Fundamental and clinical studies on cefuzonam in the field of pediatrics}; Kuno K et al.; Fundamental and clinical studies on cefuzonam (L-105, CZON), a newly semisynthesized cephem antibiotic, were carried out in the field of pediatrics and the following results were obtained . Antibacterial activities of CZON against clinically isolated strains of Staphylococcus aureus, S . epidermidis, Streptococcus pneumoniae, S . pyogenes, Escherichia coli, Klebsiella pneumoniae, Haemophilus parainfluenzae and H . influenzae were compared with those of cefmenoxime (CMX), latamoxef (LMOX), cefoperazone (CPZ), cefmetazole (CMZ), cefotiam (CTM) and cefazolin (CEZ) . CZON was nearly as active as CEZ against S . aureus and S . epidermidis and superior to other antibiotics against other Gram-positive cocci . Against Gram-negative rods, CZON was as active as CMX and superior to other 5 antibiotics compared . Serum concentrations and urinary excretion rates after intravenous bolus injection of CZON at doses of 10 mg/kg, 20 mg/kg and 40 mg/kg for 5 minutes in 1, 5 and 4 cases, respectively, were determined . Mean serum concentrations of CZON at these dose levels were 11.0, 43.8 and 111.5 micrograms/ml at 15 minutes, 2.4, 10.3 and 30.3 micrograms/ml at 1 hour and 0.17, 0.72 and 1.28 micrograms/ml at 4 hours, with serum half-lives of 1.79, 0.88 and 1.19 hours, respectively . Mean cumulative urinary excretion rates within 6 hours after administration were 47.9, 56.3 and 40.3%, respectively . Thirty-four pediatric patients with various bacterial infections (tonsillitis 2, acute bronchitis 1, pneumonia 14, pyothorax 1, sepsis 1, suppurative lymphadenitis 1, UTI 13 and enteritis 1) were treated with CZON at a daily dose of 40-94 mg/kg t.i.d . or q.i.d. . The overall clinical efficacy rate was 94.1% . No adverse reactions were observed except 2 cases with mild diarrhea . Abnormal laboratory findings were also mild; slight elevation of GOT and GPT in 2, eosinophilia in 1 and thrombocytosis in 1 . These results clearly indicate the usefulness of CZON in the treatment of bacterial infections in children. Pediatr Infect Dis J, 1987 Feb, 6(2), 197 - 8 Bacteremia in children afebrile at presentation to an emergency room; Kline MW et al.; Charts of 182 outpatient children with bacteremia caused by Streptococcus pneumoniae, Haemophilus influenza type b or Neisseria meningitidis were reviewed . Twenty-four patients (13%) were afebrile (temperature less than 37.8 degrees C) at presentation . Five afebrile patients had no history of fever . Four of the five had localizing signs of infection and one appeared toxic . Afebrile patients were not strikingly different from febrile bacteremic patients by any assessments . Bacteremia in children cannot be excluded on the basis of absence of fever by history and examination . Blood cultures should be performed on afebrile children who either have localizing signs of serious bacterial infection or appear toxic. Acta Pathol Microbiol Immunol Scand {C}, 1987 Feb, 95(1), 27 - 34 Monoclonal antibodies reacting selectively with core and O-polysaccharide of Yersinia enterocolitica O:3 lipopolysaccharide; Pekkola-Heino K et al.; In order to obtain specific tools for studying the alterations of the immunochemical structure of Yersinia enterocolitica lipopolysaccharide in various conditions, we have produced monoclonal antibodies reacting with core and O-polysaccharide chains of Yersinia enterocolitica O:3 LPS . Immunizations were made with whole bacterial cells and outer membrane preparation, respectively . Monoclonal antibody 2B5 reacted in enzyme immunoassay with purified core-lipid A complex, and its binding was not inhibited by Polymyxin B, suggesting that the target determinant is in the outer core . 2B5 recognized 100% of all tested Y . enterocolitica O:3 strains (n = 152) and reacted to some extent also with many other gram-negative bacteria . In immunoblotting with 2B5, a band corresponding to core-lipid A complex was visualized both with Y . enterocolitica, Brucella abortus and Haemophilus influenzae . In immunofluorescence assay, the only positive reaction was seen with Y . enterocolitica . Monoclonal antibody A6 reacted in enzyme immunoassay with purified O-polysaccharide chains, recognized 100% of tested Y . enterocolitica O:3 strains, and showed no cross-reactions with other bacteria . A typical ladder pattern was not seen in the immunoblotting analysis with A6 . This suggests that the O-chain of Y . enterocolitica O:3 may be different from those in other gram-negative bacteria . These two antibodies will make it possible to study the structural variations of Yersinia enterocolitica LPS more precisely than described before, because of their fine specificity against important immunogenic components of LPS . They will also be useful in serology measuring the immune response against the target determinants of these antibodies. Antimicrob Agents Chemother, 1987 Feb, 31(2), 286 - 91 Cloning and expression of genes responsible for altered penicillin-binding proteins 3a and 3b in Haemophilus influenzae; Malouin F et al.; A Haemophilus influenzae strain (T-1,3) possessing clinical beta-lactam resistance due to altered penicillin-binding protein 3 was used to construct a recombinant cosmid gene bank in Escherichia coli . Three of the recombinant cosmids were capable of transforming a susceptible H . influenzae strain (Rdnov) simultaneously to moxalactam resistance and altered the binding of penicillin-binding proteins 3a and 3b to {35S}penicillin G . Restriction endonuclease mapping of one of the recombinant cosmids, pLB100, was performed to facilitate subsequent subcloning of the gene(s) responsible for the altered penicillin-binding protein 3 (a and b) binding phenotype . Subcloning of individual fragments derived from pLB100 indicated that two adjacent fragments of DNA were both capable of transforming a susceptible Haemophilus strain to moxalactam resistance and altered penicillin-binding protein 3 binding . Expression of plasmid-coded proteins in minicells indicated that one fragment coded for a major 55,000-molecular-weight polypeptide and that the second contained a C-terminal coding region that expressed a 28,000-molecular-weight polypeptide when fused to the N-terminal region of the tetracycline resistance gene . Initial attempts at labeling the plasmid-coded proteins expressed in minicells with {35S}penicillin G were unsuccessful. Proc Soc Exp Biol Med, 1987 Feb, 184(2), 154 - 61 Haemophilus influenzae type b polysaccharide-protein conjugate vaccine; Tai JY et al.; An Haemophilus influenzae type b capsular polysaccharide-protein conjugate has been prepared . The polysaccharide was coupled to the serotype II protein of group B meningococcus through the spacer 6-aminocaproic acid using cyanogen bromide and water soluble carbodiimide . The conjugate can be shown to be reproducible and is stable and highly immunogenic in mice and African green monkeys . Clinical evaluation of this conjugate in children 3 months to 4 years of age showed that it elicited an antibody titer to the polysaccharide moiety greater than 1000 ng/ml in children 8 months of age or older. Microb Pathog, 1987 Feb, 2(2), 139 - 45 Limited genetic diversity of Haemophilus influenzae (type b); Allan I et al.; 170 strains of Haemophilus influenzae (serotype b), isolated largely from patients with invasive disease from differing temporal and geographic origins were characterized using the combined approaches of DNA hybridization and outer membrane protein classification . Hybridization of a DNA probe to a region of the chromosome involved in the expression of type b capsular polysaccharide revealed that 163 (96%) isolates had one of three distinct, but closely related, chromosomal restriction fragment length polymorphisms (RFLPs) . Each polymorphism was associated with its own distinctive set of outer membrane protein subtypes, indicating that the majority of H . influenzae (type b) isolates have evolved from common ancestors, giving rise to globally distributed organisms that have clonal characteristics. J Antimicrob Chemother, 1987 Feb, 19(2), 187 - 91 Comparison of antimicrobial susceptibility patterns of fifty-seven strains of Haemophilus ducreyi isolated in Amsterdam from 1978 to 1985; Sturm AW; The in-vitro activities of 16 antimicrobial agents were tested against 57 strains of Haemophilus ducreyi isolated in Amsterdam during an eight year period . The susceptibility patterns of the isolates from different years were compared . In the first four years more than 30% were beta-lactamase negative and showed MICs for tetracycline of 2 mg/l or less . From 1982 to 1985 all strains, except one, produced beta-lactamase and were tetracycline resistant . Furthermore, MICs for cefotaxime, sulphamethoxazole and trimethoprim increased . No changes were seen with cephradine, erythromycin, kanamycin, gentamicin, chloramphenicol, nalidixic acid, pipemidic acid, norfloxacin, pefloxacin or ciprofloxacin. Eur J Clin Microbiol, 1987 Feb, 6(1), 76 - 7 Liver abscess due to Haemophilus influenzae type b; Bradley J et al.; A case of liver abscess due to Haemophilus influenzae type b in a 70 year old man is described . The patient responded to cefotaxime . This represents the first such case reported. Eur J Clin Microbiol, 1987 Feb, 6(1), 111 - 3 In vitro activity of BMY 28100, a new oral cephalosporin; Steele J et al.; BMY 28100, a new oral cephalosporin, demonstrated good in vitro activity against common gram-positive and gram-negative respiratory and urinary tract pathogens . Its activity was shown by microdilution techniques to be generally higher than those of ampicillin, cephalothin and cephalexin, but comparable to those of cefaclor and, except for Haemophilus spp . and Branhamella spp., to amoxicillin/clavulanate. Am J Obstet Gynecol, 1987 Feb, 156(2), 458 - 9 Acute Haemophilus influenzae chorioamnionitis associated with intact amniotic membranes; Winn HN et al.; While Haemophilus influenzae infection commonly occurs in the age group 6 to 48 months, it uncommonly affects adults . A case of acute chorioamnionitis due to Haemophilus influenzae in the presence of intact fetal membranes is presented . The low incidence of maternal urogenital carriage, the high attack rate, and the virulence are discussed. J Clin Microbiol, 1987 Feb, 25(2), 248 - 50 Detection of Streptococcus pneumoniae and Haemophilus influenzae type b antigens in acute nonbacteremic pneumonia; Martin SJ et al.; Commercially available latex agglutination and coagglutination reagents were evaluated for their ability to detect bacterial antigens in the sera of 165 patients to determine their suitability for rapid diagnosis of pneumonia . These reagents were used to detect the polysaccharide capsular antigens of Haemophilus influenzae type b and Streptococcus pneumoniae in nonbacteremic patients known to be respiratory culture positive for these organisms . The reagents were unable to detect the polysaccharide antigens in sera from nonbacteremic patients . Patients with a clinical diagnosis of pneumonia who had respiratory or extrarespiratory infections with a variety of organisms were also tested . No evidence of cross-reactivity or of false-positive reactions was observed with either reagent . Because a negative agglutination test may occur during the course of a nonbacteremic infection, these reagents should not be used alone, and if used, they should be used only in conjunction with standard bacteriological tests. Diagn Microbiol Infect Dis, 1987 Feb, 6(2), 93 - 100 Rapid determination of X/V growth requirements of Haemophilus species in broth; Inzana TJ et al.; A broth system was developed for rapid identification of the requirement for X factor (hemin), or V factor (NAD), or both for growth of Haemophilus species . This system was compared to growth around paper discs/strips impregnated with factors X and/or V . The broth system consisted of three tubes, each containing brain-heart infusion broth supplemented with V factor, X factor, or both . Each tube was inoculated with a saline suspension of an Haemophilus isolate, and the broths were shaken for aeration at 37 degrees C . Under these conditions turbidity or clumping was usually evident after 4-5 hr only in the broth(s) containing the required supplement(s) . A few strains requiring only V factor required overnight incubation . One hundred fifty-six Haemophilus isolates were tested for growth around supplemented discs/strips or in supplemented broths: 129 were H . influenzae/aegypticus, 25 were of various species that required only V factor, and 2 were H . aphrophilus . Ten of 89 H . influenzae isolates from the respiratory tract were misidentified by satellitism . All isolates were correctly identified by growth in supplemented broths . The cost of the broth assay was about 60 cents/test, whereas the satellite assay cost about 120 cents/test . Serotyping and antibiotic sensitivity testing could be performed directly from the broth culture . Determination of X and/or V requirement by Haemophilus species with supplemented broths was sensitive, rapid, and inexpensive. Arch Intern Med, 1987 Feb, 147(2), 241 - 4 Invasive Haemophilus influenzae disease in adults; Crowe HM et al.; In a five-year period, 29 cases of bacteremia and/or meningitis in adults caused by Haemophilus influenzae were seen in our large community hospital . There were 17 cases of bacteremic pneumonia and 12 cases of serious extrapulmonary infections . The extrapulmonary infections included cases of endocarditis, meningitis, cholecystitis, epiglottitis, tubo-ovarian abscess, and cellulitis . In contrast with the pediatric experience, H influenzae type B was the causative pathogen in only 45% of patients and only one isolate was ampicillin resistant. South Med J, 1987 Feb, 80(2), 182 - 4 Haemophilus ducreyi infection in south Florida: a rare disease on the rise? Becker TM, DeWitt W, Van Dusen G. Increased numbers of patients with genital ulcers sought medical attention in the Palm Beach County, Florida, Sexually Transmitted Disease clinics from Aug 1, 1982 to Aug 31, 1983 . We established that a small proportion of subsequent cases of genital ulcers were caused by Haemophilus ducreyi, the etiologic agent associated with chancroid . We also set up a surveillance system to monitor this sexually transmitted infection, and have illuminated several recent cases of chancroid occurring in that area . This outbreak of chancroid suggest that clinicians practicing in south Florida consider chancroid (generally a rare disease in the United States) in their differential diagnoses of genital ulcers. Pediatrics, 1987 Feb, 79(2), 173 - 80 Prospective surveillance of Haemophilus influenzae type b disease in Dallas County, Texas, and in Minnesota; Murphy TV et al.; Among children less than 12 years of age residing in Dallas County, Texas, and in the state of Minnesota we conducted prospective, active surveillance of invasive Haemophilus influenzae disease . During 18 months, 616 cases were identified, of which 600 were caused by type b organisms . The annual incidence of disease was significantly greater in Dallas than in Minnesota (109 v 68/100,000 children younger than 5 years of age, P less than .001) and was greater in Dallas, even when rates for white children in the two regions were compared (P less than .001) . Other regional differences were observed . In Dallas, a larger proportion of cases were in children attending day-care centers (27% compared with 12% in Minnesota, P less than .001) and more patients attended day care for greater than 40 h/wk (56% compared with 30% in Minnesota, P less than .001) . Outer membrane protein subtyping of isolates revealed that in Dallas 6U isolates were associated significantly with cases in black children who attended day care . In Minnesota, but not in Dallas, isolates with subtype 1H were associated significantly with cases in children in day care . These data indicate that there are regional differences in the epidemiology of type b Haemophilus disease that may relate to differences in strains, day-care practices, or other unknown cultural or environmental factors . Finally, because only 15% of systemic Haemophilus disease in these regions occurred in children in the age groups recommended for vaccination (24 to 59 months), the new Haemophilus type b polysaccharide vaccine is expected to have a limited impact on the overall incidence of disease. J Pediatr, 1987 Feb, 110(2), 228 - 33 Genetic factors in Haemophilus influenzae type b disease susceptibility and antibody acquisition; Petersen GM et al.; Because Alaskan Eskimos have the greatest known endemic risk of Haemophilus influenzae type b (Hib) disease and represent a comparatively homogeneous population, we selected this population to evaluate the presence or absence of an association of 35 genetic markers (alleles or allotypes) at 12 chromosomal loci with susceptibility to both invasive Hib disease risk and level of Hib anticapsular antibody . We studied nearly all Alaskan Eskimo children who had had invasive Hib disease between 1971 and 1982 in southwestern Alaska (n = 103) and an equivalent number of controls matched for age, race, and village of residence, and verified not to have had proved or suspected Hib disease . We found no significant associations with Hib disease for the single alleles of HLA-A, -B, -C, -DR, Gm, Km, Am, Kidd, MNSs, ABO, esterase D, or glutamate pyruvate transaminase loci . However, we observed a significant interaction of two loci, Gm(a;..;g,s,t) allotype and HLA-DR8 (P = 0.002), with increased Hib disease susceptibility, and an interaction of the same Gm allotype and HLA-DR5 with decreased disease susceptibility (P = 0.01) . We also compared the level of anticapsular antibody to Hib with each genetic marker and two-locus interactions, but no genetic association with antibody level was found . We conclude that some genetic factors contribute to the susceptibility to invasive Hib disease in this population. J Infect Dis, 1987 Feb, 155(2), 283 - 91 Lack of comparability between commonly used serological assays of immune response to Haemophilus influenzae vaccine; Edwards KM et al.; Reliable measures of the serum level of antibody to the capsular polysaccharide (PRP) of Haemophilus influenzae type b (Hib) are essential for evaluating current and future vaccines intended to protect against invasive disease . It was recently noted, however, that certain commonly used assays of antibody to PRP produced incompatible results . To investigate this observation, we analyzed banked sera from four PRP vaccine studies in parallel by several assays . Significant differences were noted, both in absolute titers and in the ratios of post- to prevaccination titers, between the various assays . These differences seemed to be due to the different antigen preparations used in the assays . Unless workers standardize on a single assay, protective levels of antibody to PRP will have to be defined separately for each assay . Serological results of Hib vaccine trials cannot be compared without considering the assay methods used. J Infect Dis, 1987 Feb, 155(2), 213 - 9 Dexamethasone in the treatment of experimental Haemophilus influenzae type b meningitis; Syrogiannopoulos GA et al.; A model of experimental lapin meningitis was used to assess the effect of meningeal inflammation caused by Haemophilus influenzae type b on development of brain edema, increase in intracranial pressure, and production of brain lactate . Four treatments were assessed: dexamethasone alone, dexamethasone plus ceftriaxone, ceftriaxone alone, and no treatment . The brain water content in untreated rabbits with meningitis was 419 +/- 10 g of H2O/100g of dry weight after 29 hr of infection (vs . 405 +/- 14 in uninfected rabbits; P less than .05) . In rabbits treated with dexamethasone, dexamethasone plus ceftriaxone, or ceftriaxone alone, these values were 404 +/- 12, 406 +/- 12, and 411 +/- 14 g, respectively (P greater than .05) . The cerebrospinal fluid (CSF) pressure and lactate levels were significantly increased in all animals during the 24 hr of meningeal inflammation (P less than .005), and these levels were comparably reduced after 9 hr of treatment . Although the values for brain water content, CSF pressure, and lactate concentrations in infected animals treated with ceftriaxone plus dexamethasone were not significantly different from those in animals treated with ceftriaxone alone, the values were consistently lower in the former group. J Bacteriol, 1987 Feb, 169(2), 565 - 71 Electron microscopy of single-stranded structures in the DNA of competent Haemophilus influenzae cells; McCarthy D et al.; Chromosomal DNAs from exponential-phase and competent cells of Haemophilus influenzae were examined by electron microscopy to determine whether the chromosome undergoes structural changes during competence development . Single-stranded gaps and single-stranded tails formed in chromosomal DNA during competence development . The generation of gaps was dependent on the rec-2 function . Since the rec-2 mutant is defective in the translocation of donor DNA, it was inferred that the gaps were involved in the translocation step of transformation . The generation of single-stranded tails was independent of the rec-1 and rec-2 genes . Therefore, these structures were assumed to play no direct role in the interaction of donor and recipient DNAs during transformation . Gaps were preferentially associated with a readily denaturable, possibly A + T-rich fraction of the genome . This finding raised the possibility that hot spots for transformation might be associated with A + T-rich DNA. Arch Otolaryngol Head Neck Surg, 1987 Feb, 113(2), 138 - 44 Phagocytosis and killing of bacteria by middle ear macrophages; Bakaletz LO et al.; Because macrophage dysfunction has been suggested as one of the underlying pathogenic mechanisms for otitis media with effusion, we have examined macrophage-bacterial interactions using keyhole limpet hemocyanin-induced middle ear macrophages from chinchillas . Our data indicate that macrophages recruited to the middle ear were functional phagocytes capable of discriminate phagocytosis and intracellular killing of eight species of bacteria associated with otitis media, as determined by a fluorochrome microassay . Streptococcus pneumoniae types 14 and 19F, which are associated with the highest relapse frequency in cases of acute otitis media, were the most resistant to phagocytosis . The two organisms most often involved in chronic otitis media (Staphylococcus epidermidis and nontypable Haemophilus influenzae), however, were among the most readily phagocytized isolates . The relative importance of macrophage function in defense of the middle ear, therefore, may be dependent on the causative agent. Clin Pharm, 1987 Feb, 6(2), 105 - 17 Ciprofloxacin and norfloxacin, two fluoroquinolone antimicrobials; Nix DE et al.; The chemistry, mechanism of action, antimicrobial spectrum, pharmacokinetics, clinical efficacy, adverse effects, and dosage and administration of ciprofloxacin and norfloxacin are reviewed, and mechanisms of antimicrobial resistance and drug and laboratory interactions are described . Norfloxacin is the first antimicrobial in the fluoroquinolone class to be marketed in the United States; ciprofloxacin is under investigation in clinical trials . The fluoroquinolones are structurally related to nalidixic acid . The activity and spectrum are enhanced by the addition of 6-fluoro and 7-piperazino substituents . Quinolone antimicrobials appear to inhibit DNA gyrase, an enzyme specific and essential for all bacteria, as their primary mechanism of action . As a result, DNA synthesis is inhibited . Ciprofloxacin and norfloxacin are active against gram-negative enteric bacteria, Pseudomonas aeruginosa, Haemophilus influenzae, and Neisseria gonorrhoeae . Ciprofloxacin has good activity against Staphylcoccus spp., including methicillin-resistant Staph . aureus . Norfloxacin generally is less potent than ciprofloxacin, particularly against Ps . aeruginosa and Staph . aureus . Peak concentrations occur about one to two hours after an oral administration of either drug . Both drugs are widely distributed in body fluids and tissues and are eliminated by renal excretion, metabolism, and biliary excretion . Dosage reductions are required in severe renal dysfunction . Ciprofloxacin and norfloxacin are effective agents for treating urinary-tract infections, including infections caused by Ps . aeruginosa . The recommended dosage of norfloxacin for urinary-tract infections in adults is 400 mg orally every 12 hours; the drug should be given for 7 to 10 days in uncomplicated infections and for 10 to 21 days in complicated ones . The fluoroquinolones may be useful for treating chronic bacterial prostatitis . Ciprofloxacin is potentially useful for treating sexually transmitted diseases . Ciprofloxacin is active against N . gonorrhoeae, including beta-lactamase-producing strains and strains that are resistant to tetracycline, and Chlamydia spp . Use of ciprofloxacin for treating gastrointestinal infections and for selective decontamination of the gastrointestinal tract is promising . In open studies, ciprofloxacin has been effective against a variety of infections caused by susceptible organisms . Resistance to ciprofloxacin has developed during treatment of infections caused by Ps . aeruginosa, Staph . aureus, and Serratia marcescens . The most frequently reported adverse effects of either drug are gastrointestinal complaints, headache, and dizziness.(ABSTRACT TRUNCATED AT 400 WORDS) Chemioterapia, 1987 Feb, 6(1), 41 - 4 Roxithromycin (RU 28965) in the treatment of respiratory tract infections; Grassi C et al.; The clinical efficacy of roxithromycin, administered at the daily dosage of 300 mg (150 mg every 12 hours), was evaluated in 25 patients with respiratory tract infections, mostly infectious exacerbations of chronic bronchitis . Pathogens isolated before treatment were Staphylococcus aureus, Streptococcus pneumoniae, Streptococcus beta-haemoliticus, Haemophilus influenzae . Clinical cure or improvement was achieved in 21 out of 22 evaluable patients . The eradication rate was 91% . Tolerability was good: two patients reported gastrointestinal side effects which caused treatment discontinuation . These preliminary data suggest that roxithromycin may have a place in the treatment of respiratory infections. Eur J Clin Microbiol, 1987 Feb, 6(1), 40 - 3 Enzyme profile of Haemophilus ducreyi strains isolated on different continents; Van Dyck E et al.; Two hundred strains of Haemophilus ducreyi, isolated in different parts of the world, were investigated using the API-ZYM system, which included 95 different substrates . All strains produced aminopeptidase against beta-naphthylamide derivatives of L-lysine, glycine, L-arginine, L-alanine, D-L-methionine, glycyl-glycine, glycyl-L-alanine and L-leucine . All strains also produced alkaline and acid phosphatase and phosphohydrolase . Nearly all strains showed esterase activity against butyrate, valerate, caproate and caprylate, but the reactions were very weak . No glycosidase activity could be detected . Of the 47 aminopeptidase tests showing variable reactions, only the results for S-benzyl-L-cystine, L-ornithine, L-alanyl-L-phenyl-alanyl-L-proline, L-hystidyl-L-leucyl-L-histidine and L-histidyl-L-serine arylamidase obtained on strains from Asia, Africa and Europe were significantly different (p less than 0.05) . On the basis of test results for L-ornithine arylamidase and L-alanyl-L-phenyl-alanyl-L-proline arylamidase, the distribution of three biovars found among the isolates of the different continents was significantly different (p less than 0.0001), whereas African strains isolated in Kenya and South Africa yielded the same enzymatic pattern . Thus, these enzymes may constitute a marker system for the epidemiological study of Haemophilus ducreyi. Infect Immun, 1987 Feb, 55(2), 381 - 7 "Haemophilus somnus," a facultative intracellular pathogen of bovine mononuclear phagocytes; Lederer JA et al.; We have reported previously that bovine neutrophils are unable to kill the bovine respiratory pathogen "Haemophilus somnus." In the present study we expanded our efforts and examined the interaction of bovine mononuclear phagocytes with this important veterinary pathogen . Bovine alveolar macrophages and blood monocytes ingested but did not kill opsonized "Haemophilus somnus" in vitro, whereas these same cells ingested and killed opsonized Escherichia coli . Because this suggested that "H . somnus" was a facultative intracellular pathogen, we developed an assay to monitor the intracellular fate of ingested "H . somnus" within bovine monocytes . Our results indicated that ingested "H . somnus" multiplied within bovine monocytes (1- to 2-log10 increase in 4 h); equivalent intracellular growth was noted for both a laboratory strain and a recent field isolate of "H . somnus." Bovine monocytes killed ingested E . coli (1- to 2-log10 decrease in 4 h) under the same assay conditions that were used to follow intracellular growth of "H . somnus," thus indicating that the assay conditions did not induce a generalized defect in monocyte antibacterial activity . Light and electron microscopic examination of "H . somnus"-infected monocytes confirmed that intracellular growth had occurred . We did not observe an obvious correlation between the release of superoxide anion from bovine mononuclear phagocytes that had ingested opsonized "H . somnus" and E . coli and the subsequent intracellular survival of the bacteria . The results of this study suggest that infected mononuclear phagocytes sustain "H . somnus" infections in cattle and thus contribute to the subacute to chronic clinical course that has been reported. Eur J Clin Microbiol, 1987 Feb, 6(1), 103 - 8 Comparative in vitro activity of A-56268 (TE-031), a new macrolide antibiotic; Hodinka RL et al.; The in vitro activity of A-56268 (TE-031) was determined by either standard agar dilution or macrobroth tube dilution and compared with erythromycin and other antimicrobial agents against 329 clinical aerobic and anaerobic bacterial isolates . A-56268 showed good to excellent in vitro activity against methicillin-sensitive Staphylococcus aureus, Neisseria meningitidis, and most anaerobes tested with the exception of Bacteroides fragilis isolates . A-56268 had relatively poor activity against coagulase-negative staphylococci and methicillin-resistant Staphylococcus aureus . Except for Haemophilus spp., the activity of A-56268 was similar to or more potent than erythromycin against all other isolates tested . A-56268 did not have significant bactericidal activity against any of the isolates examined. Anal Biochem, 1987 Feb 1, 160(2), 281 - 9 A method for purification of bacterial R-type lipopolysaccharides (lipooligosaccharides); Wu LH et al.; A new gel filtration method was developed for purification of R-type lipopolysaccharides (lipooligosaccharides) from some nonenteric gram-negative bacteria, including Neisseria meningitidis, Haemophilus influenzae, and Bordetella pertussis . These wild-type lipooligosaccharides are poorly extractable by the phenol-chloroform-ether extraction method of C . Galanos, O . Luderitz, and O . Westphal {1969) Eur . J . Biochem . 9, 245-249) and therefore a new procedure was developed for their isolation . The lipooligosaccharides (LOS) were first extracted by hot phenol-water, treated with RNase, then disaggregated in deoxycholic acid, and purified by gel filtration on Sephadex G-75 . By comparison the conventional hot phenol-water purification method using repeated ultracentrifugations yielded less LOS . The yield of LOS by gel filtration was 30 to 108% higher and the purity was better. Vet Rec, 1987 Jan 17, 120(3), 62 - 5 Effect of heat treatment on the surface antigens of Haemophilus pleuropneumoniae; Mittal KR et al.; Coagglutination and ring precipitation tests were used to study the effect of heat on the surface antigens of Haemophilus pleuropneumoniae strains employing the reference strains belonging to serotypes 1 to 7 and field isolates belonging to serotypes 1, 2, 3, 5, 6 and 7 . By immunising rabbits with formalin-fixed whole-cell suspension, antibodies were obtained which sensitised Cowan I Staphylococcus aureus to coagglutinate antigen preparations which had not been heated, or heated at 56 degrees C, or boiled or autoclaved . Similar positive reactions were obtained with the ring precipitation test . Heating the cultures at 56 degrees C for one hour was best for exposing the most potent serotype-specific antigens in all the strains studied . All the reference strains and most of the field isolates possessed the thermostable type specific antigens which could withstand autoclaving for one hour . However, many field isolates belonging to serotype 1 did not possess this antigen . The apparent antigenic heterogeneity of serotype 1 strains based on the presence or absence of these thermostable antigens could be valuable in epidemiological investigations . It was shown that most potent serotype-specific antigens are present as freely diffusible material on the surface layer of the bacterial cells, which could easily be removed by washing in saline solution . Well washed bacterial cells devoid of surface materials are poor antigens . It is recommended that test strains should not be heated above 56 degrees C for serotyping because higher temperatures are liable to destroy the capsular antigen of some strains and render the culture untypeable. J Immunol, 1987 Jan 15, 138(2), 587 - 92 Subclass distribution of human antibodies to Haemophilus influenzae type b capsular polysaccharide; Shackelford PG et al.; The polysaccharide (PS) capsule of Haemophilus influenzae type b (Hib) is a "simple" antigen, polyribosylribitolphosphate . Although similar carbohydrate antigens have been reported to elicit IgG antibodies relatively restricted to the IgG2 subclass in man, we report here that Hib PS elicits substantial quantities of both IgG1 and IgG2 serum antibodies in most individuals . Because the determination of IgG subclass distribution can be technically difficult, we used four different approaches to establish our finding . First, we used an IgG subclass-specific, antigen-specific "sandwich assay." Second, we measured IgG subclasses of purified antibodies to Hib PS . Third, we showed that significant amounts of IgG anti-PS can be absorbed with a monoclonal anti-IgG1 affinity column . Fourth, we showed that IgG1 and IgG2 fractions of immune sera have clonally restricted anti-Hib PS antibodies that are easily distinguishable by their isoelectric points . The data indicate that both IgG1 and IgG2 contribute substantially to the IgG antibody response of most adults to immunization with Hib PS. S Afr Med J, 1987 Jan 10, 71(1), 15 - 6 A microbiological study of acute otitis media in Bloemfontein; Claassen AJ et al.; Tympanocentesis was done on 36 patients (57 ears) with acute otitis media . Positive cultures were obtained in 65% of cases . Streptococcus pneumoniae was the most commonly isolated organism (25% of ears) . There was a high incidence of Staphylococcus epidermidis infection (14% of ears); these organisms are considered to be true pathogens . Haemophilus influenzae seemed to be less common than in other series and in all our cases were non-producers of beta-lactamase . Penicillin and amoxycillin appeared to be equally effective and there seemed to be little difference between responses to cefaclor, erythromycin and co-trimoxazole. J Infect, 1987 Jan, 14(1), 21 - 30 The aetiology of pneumonia . Application of bacterial serology and basic laboratory methods; Kerttula Y et al.; The aetiology of community-acquired pneumonia was studied by use of new bacterial and established viral serological methods besides blood culture in 162 patients . Evidence for a specific aetiology was obtained in 79 patients (49.4%) . The pneumococcus was the most common aetiological agent, identified in 25.6% of cases . Other bacteria, Haemophilus influenzae, Branhamella catarrhalis, Neisseria meningitidis and Chlamydia spp . were demonstrated in 23.5%, Mycoplasma pneumonia in 1.2% and viruses in 7.4% patients . In 58% those with viral pneumonia there was evidence of mixed infection with bacteria . The predictive value of rapid laboratory tests, erythrocyte sedimentation rate, white blood cell count and C-reactive protein (CRP), was evaluated in relation to the aetiological diagnosis . They all differentiated viral from bacterial pneumonia, with CRP having the best predictive value . On the basis of these tests, most cases in which our serological tests remained negative would appear to have a bacterial aetiology also. Med Care, 1987 Jan, 25(1), 20 - 4 Pneumonia--the quality of medical records data; Marrie TJ et al.; The quality of medical records data for patients who were hospitalized with community-acquired pneumonia was assessed by comparing medical records data with data obtained in a prospective study of pneumonia for the period April 1, 1984, to December 31, 1984 . One hundred five patients fulfilled the case definition of pneumonia for entry into the prospective study . One hundred twenty-seven patients were identified by medical records data . Seventy-three of the patients appeared in both studies . The positive predictive accuracy of the medical records data was 57% . When the etiologic diagnoses for the 73 patients identified by both studies were compared, there was agreement only 52.6% of the time . Streptococcus pneumoniae was overdiagnosed, and Mycoplasma, specific viral causes, and Haemophilus influenzae were not recorded by the medical records data . The quality of medical records data regarding pneumonia can be improved by changing the current ICD-9-CM coding system for pneumonia and by providing instruction and an algorithm for abstractors to follow in assigning a diagnosis of pneumonia. Rev Mal Respir, 1987, 4(4), 159 - 65 {Bacteriological aspects of 64 cases of severe pneumonia seen in a respiratory intensive care unit}; Chollet S et al.; We report on the bacterial aspects of 64 cases of severe pneumonia in an intensive care over a two year period, excluding cases occurring during artificial ventilation . In all the cases, the grave respiratory and haemodynamic signs, the blood gas and radiological findings justified admission of these patients to an intensive care unit . Specimens for bacteriology, virology and parasitology enabled a precise microbiological diagnosis 43 times (63%); in 44% of these diagnosis the possibility of the protected specimens (trans-tracheal, protected brushing) were confirmed by another specimen (pleural or blood) . The germs identified were: Streptococcus pneumoniae (13), Staphylococcus aureus (9), Haemophilus influenzae (6), other gram negatives (12), Mycoplasma pneumoniae (1), Koch's bacillus (1), Aspergillus fumigatus, Cytomegalovirus, Myxovirus, Pneumocystis carinii (5) . Twenty eight patients died of whom eight had marrow failure following chemotherapy; amongst the non-leukopenic patients an analysis of the records allowed certain presumptions as to the causative organism according to the patients mode of referral and immune state . The prognosis of these pneumonias remains serious in spite of improved bacteriological diagnosis, above all in the elderly, poorly nourished or with marrow aplasia. Pediatrie, 1987, 42(3), 199 - 204 {A single daily injection of ceftriaxone for treating suppurated meningitis in infants and children . Apropos of 31 cases}; Floret D et al.; Thirty-one infants and children aged 1 month to 15 years 3 months were treated with ceftriaxone once a day for the treatment of a meningitis related to Neisseria meningitidis (19 cases), haemophilus influenzae (7 cases), streptococcus pneumoniae (1 case), not identified bacteria (4 cases) . All identified bacteria were sensitive to ceftriaxone . Twenty children were treated with 100 mg/kg/day, 11 with 50 mg/kg/day . CSF was sterile at the first control-generally performed 30 h after the onset of treatment-in all cases . Despite a great number of severe forms (fulminans purpura and septic shock; 11 cases; severe neurologic disturbances: 6 cases), all patients survived and recovered after a treatment of 9 to 22 days . Two infants exhibited neurologic sequelae: deafness, delayed development and hydrocephalus . Tolerance to ceftriaxone appeared to be good . With a 100 mg/kg/day dosage, mean CSF level at 6 h was 3.3 mg/l (0.8-7.7), on the first day of treatment . At the end of treatment, mean CSF level at 24h was 0.47 (0.15-2.5) . With a 50 mg/kg/day dosage, mean CSF level at 6 h was 2,1 mg/l (1.1-3.9) in the first day of treatment . At the end of the treatment, mean CSF level at 24h was 0.22 mg/l (0.08-0.5) . Once a day administration of ceftriaxone is adequate for the treatment of meningitis in infants and children . Though a 50 mg/kg/day dosage is probably sufficient in most cases, it seems to be more secure to use a 100 mg/kg/day dosage. Drugs Exp Clin Res, 1987, 13(4), 201 - 3 The in vitro activity of roxithromycin (RU 28965) compared with four oral antibiotics; Drabu YJ et al.; The in vitro activity of roxithromycin (RU 28965), a new semisynthetic macrolide, was compared with that of amoxycillin, cephradine, doxycycline and erythromycin against 160 respiratory and skin isolates including 10 methicillin-resistant Staph . aureus, 10 beta-lactamase-producing Haemophilus influenzae and 30 anaerobes . The MIC determinations were performed by an agar dilution method using a final inoculum of 10(4)-10(5) c.f.u./ml and results were recorded as the lowest concentration of the drug that inhibited visible growth (MIC) . All organisms were incubated aerobically at 37 degrees C for 18 h, except anaerobes which were incubated in an anaerobic chamber at 37 degrees C for 48 h . The MICs of roxithromycin against staphylococci (30 strains, 10 of which were erythromycin-resistant, MIC greater than or equal to 2 mg/l) ranged from 0.03 to greater than or equal to 16 mg/l . The MIC90 against erythromycin-sensitive staphylococci was 1.0 mg/l . The MICs of roxithromycin ranged from 0.03-4 mg/l (MIC90 0.25 mg/l) against streptococci (50 strains), from 1 to 32 mg/l (MIC90 8 mg/l) against Haemophilus spp . (40), and from 0.06 to 0.25 mg/l (MIC90 0.125 mg/l) against B . catarrhalis (10) . Roxithromycin was less active than erythromycin against fusobacteria (MIC 0.05 to greater than or equal to 128 mg/l) and against Veillonella spp . (MIC greater than 128 mg/l) . Roxithromycin was more active than cephradine, doxycycline and amoxycillin against the aerobic organisms (except for amoxycillin against streptococci, where the activity was similar) but less active against the anaerobes examined . Taken together with reported kinetic advantages, these results suggest that roxithromycin may be a useful antibiotic in selected circumstances and studies to determine its efficacy seem indicated. Scand J Infect Dis, 1987, 19(3), 315 - 23 Relapse of acute purulent otitis media: antibiotic sensitivities of nasopharyngeal pathogens; Thore M et al.; The present investigation was conducted to find out if a relapse of acute purulent otitis media is associated with a decreased sensitivity of nasopharyngeal pathogens to commonly used antimicrobial agents . All but one of 63 children with relapse included in this study yielded one or more of the classical middle ear pathogens (Streptococcus pneumoniae, Haemophilus influenzae, Branhamella catarrhalis, S . pyogenes) in their nasopharynx (NPH) secretions . S . pneumoniae was the predominating isolate from NPH (71% of the patients) as well as from middle ear effusion (53%) . At a control visit 4 weeks after the start of antibiotic therapy, 91% were NPH carriers of potential pathogens and S . pneumoniae was still the most common isolate (53%) . Beta-lactamase was produced by 55% of B . catarrhalis isolates from the NPH specimens on the first visit, but only by 33% of B . catarrhalis isolates on the control visit . Two NPH isolates of H . influenzae produced beta-lactamase . One isolate of S . pneumoniae (serotype 18) was intermediately sensitive to phenoxymethylpenicillin . Generally low MICs were found for erythromycin and cefaclor . H . influenzae isolates were generally sensitive to ampicillin in vitro, but only 1 isolate was fully sensitive to erythromycin . B . catarrhalis isolates were uniformly sensitive to doxycycline and trimethoprim/sulphamethoxazole . No tolerance to penicillin was demonstrated in S . pneumoniae and H . influenzae . The present data indicate that the relapse of acute otitis media is not associated with development of tolerance or resistance to therapeutic antimicrobials commonly used. Microbiol Immunol, 1987, 31(4), 313 - 25 Leukotoxic activity in Actinobacillus (Haemophilus) actinomycetemcomitans isolated from periodontal disease patients; Ohta H et al.; Leukotoxic activity in Actinobacillus (Haemophilus) actinomycetemcomitans isolated from patients with rapidly progressive periodontitis (RP), gingivitis (G), and juvenile periodontitis (JP), and several oral bacteria, was determined by observation of morphological changes in polymorphonuclear leukocytes (PMNs) . Many A . actinomycetemcomitans isolates yielded both rough-surfaced and umbonate-shaped colonies (A-type), and smooth-surfaced and convex-shaped colonies (B-type), when stock cultures were streaked on agar medium . Both types of cells were identical in terms of Gram stain, cell morphology, sugar fermentation profile, nitrate reduction and cellular fatty acid composition . Sonic extracts were prepared from 32 A . actinomycetemcomitans strains isolated from patients and from 3 American Type Culture Collection (ATCC) strains . Sonic extracts from 8 isolates and 2 ATCC strains induced sphering of PMNs during a 45-50 min period of incubation at 37 C . Extracts from the other oral bacteria had no effects on PMN morphology . The sphered PMNs were found by their fluorochromatic-negative reactions to be damaged cells . The leukotoxic substance was heat-sensitive (56 C, 30 min), trypsin-sensitive and did not induce sphering of PMNs at 4 C . There was no clear correlation between colony type and leukotoxicity . Among 8 leukotoxic strains, 5 were isolates from an RP patient. Infection, 1987, 15 Suppl 3, S123 - 8 {Smoking and lower respiratory tract infection}; Brown RB; Cigarette smoking exerts deleterious effects not only on the respiratory tract, but also on the lung's parenchyma . The FEV is reduced in heavy chronic smokers . Persistent smoking has an unfavourable influence on mucociliary activity . According to the results of recent research almost 8 million people in the U.S . were suffering from chronic bronchitis in 1981 . There is a direct correlation between the number of cigarettes smoked, over what period of time, and the incidence of chronic bronchitis . In studies with patients suffering from exacerbations of chronic bronchitis the most common bacterial pathogens found were Haemophilus influenzae, Streptococcus pneumoniae and Branhamella catarrhalis . Mycoplasma pneumoniae and certain viruses are counted amongst the non-bacterial pathogens . Antibiotics should be effective against such possible pathogens . The resistance of H . influenzae to ampicillin/amoxicillin is currently observed in at least 12% of cases, whilst H . influenzae is regularly observed to be resistant to erythromycin . Cefaclor, trimethoprim/sulphamethoxazole and amoxicillin/clavulanic acid offer satisfactory forms of treatment . Pneumonia caused by S . pneumoniae, H . influenzae, B . catarrhalis and Legionella pneumophila is often seen in smokers and patients with COLD . Haemocultures should be prepared for all hospitalized patients . Penicillin G and/or V is the agent of choice . Cefaclor or trimethoprim/sulphamethoxazole can be given to counter beta-lactamase producing H . influenzae whilst cefaclor, erythromycin, tetracycline or trimethoprim/sulphamethoxazole are used for the treatment of B . catarrhalis infections . In Legionella infections erythromycin is the preferred treatment . A combination of erythromycin and cefamandole or ceftriaxone is indicated for empirical management . Patients with COLD should be immunised with pneumococcus and influenza vaccines. Ann Otolaryngol Chir Cervicofac, 1987, 104(2), 137 - 41 {Tonsillitis today . Epidemiologic review . Clinical correlates . Therapeutic impact}; Gehanno P et al.; A prospective study was conducted in 216 patients with ulceration of throat and 100 controls . Bacteriology showed, in the low percentage of case with positive results, the classical distribution of germs generally identified from throat swabs, with predominance of haemolytic streptococci AB and associated fusospirilla . Haemophilus influenzae was very rarely isolated (1%) and immunofluorescence tests for Chlamydia trachomatis in the pharyngeal exudate were always negative, in both patients and controls . These findings confirm utility of Penicillin V as single therapeutic agent in ulcerated throat . Correlations between clinical findings and between these and bacteriology results demonstrated that clinical examination failed to provide data contributive to the establishment of an aetiological diagnosis and therefore to treatment, which, in the absence of complementary examinations, must remain empirical. Avian Dis, 1987 Jan-Mar, 31(1), 59 - 63 Comparison of adjuvants for an inactivated infectious coryza vaccine; Reid GG et al.; Differently formulated inactivated infectious coryza vaccines were administered to 6-week-old chickens as a single dose of 10(8) colony-forming units of Haemophilus paragallinarum HP31 . After 3 weeks, all chickens were challenged by intrasinus inoculation of HP31 . Two vaccines, one containing an aluminum-hydroxide adjuvant and the other a combined aluminum-hydroxide + mineral-oil adjuvant, gave the best protection (means of 80% and 90%, respectively) . Two vaccines that contained mineral oil as the sole adjuvant gave less protection (50% and 35%) . The Quil A vaccine gave no significant protection . Granulomatous swellings developed at the site of injection in birds given mineral-oil adjuvant but not in those that received other adjuvants. Infection, 1987 Jan-Feb, 15(1), 60 - 8 {Prevention of gram-negative and gram-positive infections using 3 intravenous immunoglobulin preparations and therapy of experimental polymicrobial burn infection using intravenous Pseudomonas immunoglobulin G and ciprofloxacin in an animal model}; Collins MS et al.; Three immunoglobulin preparations for intravenous infusion were compared in vivo to determine their relative protective capacity against several gram-negative and gram-positive pathogens . Polyglobin N is a conventional IgG concentrate . Psomaglobin N is identical in formulation to Polyglobin N but is prepared from the plasma of donors who have naturally high levels of antibody to lipopolysaccharide antigens of Pseudomonas aeruginosa . IgGMA is a conventional IgG concentrate containing 12% IgG and 16% IgA . In a murine model of burn wound sepsis the three IgG preparations were similarly protective against three or ten strains of P . aeruginosa . Psomaglobin N and Polyglobin N were significantly (p less than or equal to 0.015) more protective than IgG-MA against six of ten and three of ten strains of P . aeruginosa, respectively . In a murine model of Streptococcus pneumoniae type 3 pneumonia, the three Ig preparations were similarly protective . IgG-MA was significantly more protective (p less than or equal to 0.025) than Psomaglobin N and Polyglobin N against Salmonella typhimurium in murine peritonitis . However, the mean protective dose (PD50) of the two later preparations was less than or equal to 20 mg/kg body weight . In models of peritonitis both Psomaglobin N and Polyglobin N were more protective than IgGMA (p less than or equal to 0.004) against Haemophilus influenzae b, Klebsiella pneumoniae, Serratia marcescens 06:H3 and group B Streptococcus types 1b and 1c . Psomaglobin N and ciprofloxacin were employed to treat established polymicrobial murine burn wound sepsis resulting from contamination of the burn site with mixtures of P . aeruginosa and Staphylococcus aureus . Psomaglobin N or albumin was given once 16 h after challenge.(ABSTRACT TRUNCATED AT 250 WORDS) Infection, 1987 Jan-Feb, 15(1), 16 - 9 Fusidic acid in infections of the external eye; van Bijsterveld OP et al.; A newly developed 1% eye preparation of the potent antistaphylococcal antibiotic fusidic acid, showed an excellent clinical effect in 206 Egyptian children with external eye infections . The 248 patients included in the study were randomized, in the ratio 5:1, to either fusidic acid or chloramphenicol 0.5% eye drops . Both preparations were given four to six times daily for one week . Bacterial conjunctivitis was diagnosed in 56% of the children . Offending eye pathogens were mainly Staphylococcus aureus (60%), Haemophilus aegyptius (10%), Streptococcus pneumoniae (13%) and Neisseria gonorrhoeae (6%) . The overall clinical success rate in children with bacterial conjunctivitis was 85% with fusidic acid, compared to 48% with chloramphenicol (p less than 0.001) . The better effect of fusidic acid could be ascribed to a lower frequency of in vitro resistance (16%) in comparison to chloramphenicol (55%) . Both drugs were apparently well tolerated and no side-effects were observed. Antimicrob Agents Chemother, 1987 Jan, 31(1), 67 - 9 Single-dose ceftriaxone for chancroid; Bowmer MI et al.; Men with genital ulcers that were culture positive for Haemophilus ducreyi were treated with intramuscular ceftriaxone and randomized to three different dose regimens . All but 1 of 50 men treated with 1 g of intramuscular ceftriaxone were cured . Similarly, 0.5 and 0.25 g cured 43 of 44 men and 37 of 38 men, respectively . A single dose of 250 mg of intramuscular ceftriaxone is an effective treatment for chancroid. Scand J Infect Dis, 1987, 19(1), 19 - 27 Invasive haemophilus influenzae and meningococcal infections in Finland . A climatic, epidemiologic and clinical approach; Valmari P et al.; A nationwide epidemiological survey on invasive (blood and/or CSF culture positive) Haemophilus influenzae (HI) and meningococcal infections was performed in Finland in 1976-1980 . The mean annual incidence of HI infection was 3.4/100,000 inhabitants (813 cases) vs . 2.0/100,000 (469 cases) of meningococcal infection . HI infections showed no geographical predilection, but meningococcal disease, mainly of group B, was more common in northern than in southern Finland (p less than 0.005) . Meningitis accounted for 61% of the HI and 91% of the meningococcal infections . The overall fatality rates were 3.1% and 7.9%, respectively . Children accounted for 94% of the HI and 59% of the meningococcal cases . The overall annual incidence of bacterial meningitis in children (less than 15 years) was 19/100,000; in children less than 5 years it was 52/100,000 . HI was the most common (62%) causative agent, followed by meningococci (18%) and pneumococci (5%) . The fatality rate was 4% . Major neurological sequelae were found in 5%, minor ones in 16% . It was calculated that 42% of the cases of meningitis could have been prevented by vaccines now available on the market . Vaccines now under field investigation may increase the preventability to about 65%. Scand J Infect Dis, 1987, 19(1), 1 - 11 Increased incidence of childhood bacterial meningitis . A 25-year study in a defined population in Sweden; Salwen KM et al.; In a retrospective study in Orebro, Sweden 1956-1980, 201 cases of bacterial meningitis in children over the age of 1 month were analysed . The aetiology was Haemophilus influenzae in 123 cases, Neisseria meningitidis in 55 cases and Streptococcus pneumoniae in 19 cases . We registered a significant increase in incidence of H . influenzae meningitis from 5.6 (1956-1965) to 13.0 (1971-1980) per 100,000 children and year (p less than 0.01) . The mortality decreased from 19% to 4% during the period studied . This decrease was primarily due to a reduced mortality in hospital later than 12 h after admission . Hearing impairment was the most frequent sequel (10%) and no change in frequency was observed during the 25 years studied . Hearing impairment was registered significantly more often in cases with a late admission to hospital (greater than 48 h) as compared to cases with an earlier admission (p less than 0.001). Rev Infect Dis, 1987 Jan-Feb, 9(1), 176 - 88 Vaccines against encapsulated bacteria: a global agenda; Griffiss JM et al.; The World Health Organization (WHO) asked the authors to create a comprehensive program for the development of vaccines against encapsulated bacteria as a guide for the WHO Programme on Vaccine Development . The goal is a new generation of safe, inexpensive, and easily administered vaccines that are immunogenic in infancy and provide prolonged immunity in the vaccinate, secondary immunization to community members not reached in the initial application, and/or herd immunity . The approach is to capitalize on advances in molecular biology, biochemistry, and immunology, and the agenda developed addresses the five genera that cause most morbidity in less-developed areas of the world: Neisseria, Streptococcus, Staphylococcus, Haemophilus, and Pseudomonas . Three strategic areas for study are emphasized: existing polysaccharide vaccines, natural immunity and pathogenesis, and evaluation of new or speculative alternative approaches . It is hoped that this agenda will stimulate the widest possible participation in this global initiative. Rev Infect Dis, 1987 Jan-Feb, 9(1), 1 - 15 Nontypable Haemophilus influenzae: a review of clinical aspects, surface antigens, and the human immune response to infection; Murphy TF et al.; Nontypable Haemophilus influenzae has now become well established as an important pathogen in both adults and children . Recent work has identified clear distinctions between nontypable and type b strains of H . influenzae . These organisms affect different patient populations, cause different infections, present different surface antigens to the host, and are genetically different . The commonest clinical manifestation of infection due to nontypable H . influenzae in adults is lower respiratory tract infection, particularly in the elderly and in those with chronic bronchitis . The bacterium is a frequent cause of acute otitis media in children . The surface of nontypable H . influenzae is composed of outer-membrane proteins and lipooligosaccharide, and both of these demonstrate substantial antigenic heterogeneity, which can be used to serotype isolates . Some respiratory tract isolates are fimbriated, but the role of fimbriae in pathogenesis is unclear . Antibodies to outer-membrane proteins and lipooligosaccharide are present in human serum . Investigation of human immunity to infection is focusing on identification of those antigens to which protective antibody is directed. J Pediatr, 1987 Jan, 110(1), 20 - 5 Early recurrences of otitis media: reinfection or relapse? Carlin SA, Marchant CD, Shurin PA, Johnson CE, Murdell-Panek D, Barenkamp SJ. In a prospective study, 36 (35%) of 103 patients had early recurrence of acute otitis media . We wished to identify risk factors for early recurrences (those recurring within 1 month of initial diagnosis) and to determine if the second episode was caused by the same pathogen (relapse) or a new organism (reinfection) . When the same bacterial species was recovered in both episodes, Streptococcus pneumoniae were serotyped and Haemophilus influenzae were classified by biotypes and by electrophoretic pattern of the outer membrane proteins . Twenty-nine patients underwent tympanocentesis at the time of the recurrent episode . In 13, no pathogen was recovered either initially or at the time of recurrence . Twelve (75%) of the remaining 16 patients had reinfection; only four (25%) had relapse . Thus, early recurrences of acute otitis media were more often caused by a new organism . This finding suggests that underlying susceptibility to middle ear infection is important in the development of recurrent otitis media . Pediatricians should not assume that early recurrences are necessarily the result of failure of initial treatment . Tympanocentesis may be helpful in this setting to aid in choosing appropriate antibiotic therapy. Dig Dis Sci, 1987 Jan, 32(1), 97 - 101 Phlegmonous gastritis and Hemophilus influenzae peritonitis in a patient with alcoholic liver disease; Tierney LM Jr et al.; A patient with alcoholic liver disease and ascites had Haemophilus influenzae peritonitis and died in spite of vigorous antibiotic therapy . At autopsy, a phlegmonous gastritis was found as a likely cause of the peritonitis . Phlegmonous gastritis is an uncommon cause of unexplained gastrointestinal symptoms in alcoholics and in the elderly, and it may be pathogenetic in rare patients with bacterial peritonitis of unclear source. Pediatrie, 1987, 42(7), 527 - 9 {Ecchymotic cellulitis in infants: consider Haemophilus influenzae}; Loras-Duclaux I et al.; Three cases of ecchymotic cellulitis in 7 to 11 month old infants are reported . Haemophilus influenzae was isolated from blood in two cases . Ecchymotic cellulitis in infants should, in the first place, evoke an Haemophilus influenzae infection . Bacteremia being frequent in this condition, blood cultures should be performed. Scand J Infect Dis, 1987, 19(6), 641 - 6 In situ hybridization for the detection of Haemophilus in sputum of patients with cystic fibrosis; Terpstra WJ et al.; In this study we performed in situ hybridization using biotin-labelled total genomic DNA of Haemophilus influenzae type b as a probe on: (1) smears containing bacteria cultured in vitro: all haemophilus species that can be found in the human respiratory tract appeared to be positive and a large number of other bacterial species appeared to be negative in this in situ hybridization test; (2) sputum smears from 287 patients with bronchitis: the hybridization test was positive on all but 2 of the 44 smears derived from patients whose culture yielded haemophilus and additionally on 12 smears derived from patients, whose culture was negative; and (3) sputum smears from 7 patients suffering from cystic fibrosis (CF): the hybridization test was positive in all these 7 sputum smears, while the culture only yielded haemophilus in 3 cases . The higher sensitivity of the hybridization test compared to culturing could mainly be explained by the failure to detect haemophilus in culture caused by masking due to overgrowth by other bacteria . In conclusion the in situ hybridization test, which can be performed in only 4 h, is a sensitive and specific method for the detection of haemophilus in sputum and is particularly useful in CF patients, where overgrowth by pseudomonas often interferes with diagnosis by culturing. Arch Otorhinolaryngol, 1987, 244(4), 253 - 7 Experimentally induced otitis media with effusion following inoculation with the outer cell wall of nontypable Haemophilus influenzae; Nonomura N et al.; Previously, we extracted lipopolysaccaride endotoxin (LPS) from an axenic culture of Haemophilus influenzae and inoculated it into the middle ears of guinea pigs, inducing temporary serous effusions . In the present study, we tried to clarify whether the immunological mechanism responsible for producing the otitis media following outer cell wall inoculation was persistent . We extracted the outer cell wall from nontypable H . influenzae, using Zollinger's method, and inoculated extracts into the middle ears of guinea pigs that had previously received three injections of nonviable H . influenzae in Freund's complete adjuvant . Histological evaluations were performed from day 2 to day 24 . Effusions and mucosal changes persisted for a longer time than in the LPS-inoculated model . Hypertrophied mucosae and increased numbers of goblet cells with hypersecretion were visible in the specimens on days 23-24 . The condition seemed to show a greater similarity to chronic otitis media with effusion in children than did the LPS-inoculated model . We concluded that both the biological activity of the outer cell wall and immunological mechanisms might induce prolonged otitis media . We speculate that not only single middle ear infection but also general infections and repetitive middle ear infections may contribute to prolonged otitis media. Scand J Infect Dis, 1987, 19(2), 247 - 56 Increased use of erythromycin causes resistance in Haemophilus influenzae; Ringertz S et al.; The use of erythromycin in Sweden has increased since 1975 . An increasing prevalence of Haemophilus influenzae (H.i.) with reduced susceptibility to erythromycin has been noted in our laboratory during the years 1980 to 1985 . The largest consumers of erythromycin were found to be children less than 4 years of age . Variations in resistance level of H.i . isolated from patients within this age group and variations in consumption of erythromycin were analysed for each year . The highest prevalence of resistant strains was found during spring and summer . The consumption of the antibiotic was highest during the first quarter of the year, gradually decreasing, and increasing sharply again during the fourth quarter of the year . Judging also from deviations from this pattern there seems to be an association between consumption and resistance . The different levels of resistance reported in the literature may reflect different populations of patients with different consumption of erythromycin, and different levels at different time of the year . Considering the present high level of H.i . with decreased susceptibility to erythromycin the drug is not likely to have clinical effect in H.i . infections. Infection, 1987, 15 Suppl 3, S99 - 102 {Significance of Haemophilus influenzae and other microorganisms for the pathogenesis and therapy of chronic respiratory infection}; Cole PJ; The host's respiratory defence mechanisms are transformed to chronic inflammatory reactions by the persistence of microorganisms and hence inflict damage on the host's own tissues . This change primarily reduces the capability of the mucociliary defence mechanisms . Such impairment can result from modifications to the mucus's physical chemical properties after an infection, or from damage to the ciliary epithelium . Haemophilus influenzae, Pseudomonas aeruginosa and Streptococcus pneumoniae cause ciliary dyskinesia and eventually lead to the destruction of the ciliary epithelium . Encapsulated type b H . influenzae strains appear to slow down the cilia most markedly . There is a fundamental difference between acute and chronic infections . In the case of acute infections the patient's normal defence mechanisms are usually intact . In chronic infections the chronic inflammatory response to the microorganisms causes the disease to progress . In such cases treatment must be considerably more aggressive since the host's "cleansing" capability is diminished . Thus, antibiotics must be applied which can effectively penetrate the bronchial tree and which also remain stable and bioactive in the presence of beta-lactamase producing microorganisms such as H . influenzae . It is conceivable that, in the future, antibiotic therapy will have to be combined with antiphlogistic agents. Infection, 1987, 15 Suppl 3, S120 - 2 {Acute sinusitis in adults}; Ekedahl C; An average of 1.4% of the more than 30,000 participants in a treatment study were diagnosed as having acute sinusitis . 62% of all cases of sinusitis arose in patients aged between 15 and 44 years . Treatment with antibiotics is indicated in purulent sinusitis whilst non-purulent sinusitis is treated either with local or systemic antiphlogistic agents . The secondary bacterial infection is usually caused by Haemophilus influenzae, Streptococcus pneumoniae and anaerobic bacteria . In Scandinavia these probably account for 90% of the purulent sinusitis cases whilst Branhamella catarrhalis is responsible for the remaining 10% . Penicillin V is the agent of choice in acute sinusitis . Cefaclor is preferable in combatting H . influenzae . In a double blind study comparing doxycycline to cefaclor in the management of acute sinusitis (108 patients with cefaclor, 105 patients with doxycycline, no difference emerged between the two groups in the subjective assessment of the treatment results . Objective evaluation recorded excellent results for 88% and 83% of the patients in the cefaclor and doxycycline groups, respectively . Side-effects were noted by 7% of the cefaclor and by 13% of the doxycycline patients . The difference between the incidence of side-effects was not statistically significant . Taking into account the treatment results, the side-effects and ecological aspects, cefaclor is second only to penicillin as the agent of choice in suspected or confirmed purulent sinusitis (e . g . in presence of penicillin allergies or failure of the infection to respond to penicillin V). Infection, 1987, 15 Suppl 3, S113 - 9 {Infections of the lower respiratory tract in general practice}; Cazzola M; Haemophilus influenzae and Streptococcus pneumoniae are found in 87% of all cases of exacerbated chronic obstructive bronchopulmonary disease . Complications of viral respiratory tract disease are most frequently caused by H . influenzae . Not only encapsulated forms of H . influenzae, but also non-encapsulated strains may be responsible for the onset of pneumonia and acute exacerbations of chronic bronchitis in adults . The most common symptoms of infections with H . influenzae are cough, dyspnoea, increase in purulent sputum and wheezing . A quantitative sputum culture is recommended for diagnosing chronic obstructive bronchopulmonary disease . Acute exacerbations of chronic bronchitis are always treated with antibiotics effective against H . influenzae and pneumococci . As a rule, empirical treatment should suffice in general practice . In the comparison between ampicillin, co-trimoxazole and cefaclor included in the study protocol appended to this report, the latter produced the most favourable results both in the empirical and specific forms of treatment . We would recommend cefaclor as the antibiotic of choice for this disease. Infection, 1987, 15 Suppl 3, S109 - 12 {Respiratory tract infections caused by Haemophilus influenzae in adults}; Weinstein AJ; Pneumonia counts as one of the most frequent severe Haemophilus influenzae infections to afflict adults . 60% of patients with pneumonia caused by type b H . influenzae are more than 50 years old, 30% to 40% are alcoholics, and 30% to 40% have chronic pulmonary disease or other concurrent illness . In the majority of cases there is multilobular, maculate, diffuse and usually bilateral involvement of the pulmonary tissue . The mortality rate due to type b H . influenzae pneumonia ranges between 30% and 40% . In patients with non-bacteriaemic pneumonia caused by non-encapsulated strains of H . influenzae it is rare for several lobes to be involved, there is little exudation and the mortality rate is low . H . influenzae is a significant pathogen in acute epiglottitis in adults and it also appears to play an important role in acute exacerbations of chronic obstructive lung disease (COLD) and acute sinusitis . beta-lactamase production mediated by R-factors or plasmids of gram-negative bacteria is responsible for ampicillin resistance . In 1978 the overall rate of resistance of H . influenzae to ampicillin in American hospitals amounted to 18% . H . influenzae are found in the nasopharynx of people exposed to others infected with H . influenzae . The risk of secondary infection in children who come into contact with patients infected with type b H . influenzae amounts to approximately 2.1% . Adults in close contact with children suffering from severe H . influenzae infections must be warned of the possible risks of secondary infection. Infection, 1987, 15 Suppl 3, S103 - 8 {Haemophilus influenzae: epidemiologic problems of antibiotic resistance to ampicillin, tetracycline, chloramphenicol, kanamycin}; Dabernat H; Haemophilus species usually occur on mucous membranes of both the upper respiratory tract and oral cavity, in children mostly in the pharynx . In children and adults, Haemophilus influenzae has pathogenic properties . In 1973, the first ampicillin-resistant and beta-lactamase-producing strain was isolated . Since then, an increase in ampicillin resistance has been observed worldwide in different countries due, mostly, to beta-lactamase production . Thus, the latter should be examined on a systematic basis in all pathogenic strains . Prior to 1980, the incidence of ampicillin resistance was still below 100% . In the course of a joint French study, in which both the "Centre d'Etude des Haemofiles" and municipal hospitals and university clinics participated in 1985, 705 strains occurring in clinical infections have been isolated . 613 strains (86.9%) were susceptible to the antibiotics tested, in 92 strains (13%) resistance to one or several antibiotics was seen . Biotype I and serotype b constituted the major proportion of residual strains . Resistance to ampicillin, tetracycline, kanamycin, and chloramphenicol was observed in 11.2%, 9%, 6.8%, and 3.4% of the strains respectively . 11 different phenotypes of resistance have been considered feasible for the resistant strains . With one exception, resistance to ampicillin was invariably due to beta-lactamase production . On account of the level of incidence of ampicillin-resistant strains it is recommended that ampicillin no longer be used in the treatment of systemic infections due to H . influenzae. Sex Transm Dis, 1987 Jan-Mar, 14(1), 33 - 6 Etiology of nonvesicular genital ulcers in Winnipeg; Diaz-Mitoma F et al.; Twenty-eight patients with recent onset of nonvesicular ulcerative genital lesions were studied prospectively to define the microbial etiology . Causative agents identified included herpes simplex virus (HSV), Chlamydia trachomatis, Haemophilus ducreyi, and Treponema pallidum . Three women and 25 men (seven of whom were homosexual) were studied . Ten patients did not have an etiology identified . Nine patients had syphilis, six had genital herpes, one had chancroid, one had granuloma inguinale, and one had a human bite injury . Six of seven homosexual men had syphilis, as compared with one of eight heterosexual men (P less than .002) . Among heterosexual men, five had atypical HSV infections, three with extensive balanoposthitis and two with chancroidal ulcers . Of the clinical characteristics examined, induration of the ulcer base and tenderness on palpation were predictive of etiology, whereas numbers of ulcers and regional lymphadenopathy were not . H . ducreyi was not a common cause of genital ulcers in Winnipeg, and it was not found as a commensal or superinfecting organism in ulcers caused by other agents. J Antimicrob Chemother, 1987 Jan, 19(1), 49 - 58 Antibiotic interaction of amoxycillin and clavulanic acid against 132 beta-lactamase positive Haemophilus isolates: a comparison with some other oral agents; Lapointe JR et al.; We studied the specific beta-lactamase inhibitory activity of clavulanic acid in association with amoxycillin against 132 beta-lactamase producing Haemophilus isolates . Inhibitory synergy between amoxycillin and clavulanic acid (ratio 2:1) was found in 131/132, partial synergy or antagonism in none; bactericidal synergy was found in 124/131, partial synergy in 4 and antagonism in 1 . In comparison, inhibitory synergy between trimethoprim and sulphamethoxazole (ratio 1:19) was found in only 39/104 beta-lactamase positive strains, partial synergy in 42 and antagonism in 3 and bactericidal synergy in 18/104, partial synergy in 8 and antagonism in 3 . The amoxycillin-clavulanic acid combination expressed significantly (P less than 0.001) more frequent synergy, at both inhibitory and bactericidal levels, than the trimethoprim-sulphamethoxazole combination . The synergy of amoxycillin-clavulanic acid resulted in a significant decrease of MIC90 (greater than or equal to 32.0-2.0 mg/l) and MBC90 (greater than or equal to 32.0-4.0 mg/l) of amoxycillin; the synergy of trimethoprim-sulphamethoxazole resulted in a significant decrease of MIC90 (8.0-2.0 mg/l) of trimethoprim but did not change MBC90 . The amoxycillin-clavulanic acid combination was also more active than cefaclor or erythromycin alone against the 132 beta-lactamase producing strains. J Antimicrob Chemother, 1987 Jan, 19(1), 109 - 12 Clinical trial of cefuroxime axetil in children; Carson JW et al.; Cefuroxime axetil tablets were given to 12 children (aged 19 months to 13.5 years) for a total of 14 episodes of lower respiratory tract infection . Doses ranged from 15 to 32 mg/kg/day . Six infections were regarded as cured and seven improved . In four cases, Haemophilus influenzae was present at the end of treatment . Serum levels of cefuroxime showed great variability . Absorption and penetration of the drug into the lower respiratory mucosa may not be sufficient to kill organisms which are sensitive in vitro . Cefuroxime axetil tablets were acceptable to most children. Pediatr Infect Dis J, 1987 Jan, 6(1), 41 - 5 Lack of correlation of in vitro adherence of Haemophilus influenzae to epithelial cells with frequent occurrence of otitis media; Porras O et al.; The adherence to human epithelial cells, biotype and capsular type of 175 Haemophilus influenzae cultured from the upper respiratory tract were studied in a prospective study of children with recurrent otitis media . Forty-three children who had greater than 2 episodes of acute otitis media (AOM) during the first year of life were followed for at least 1 year . Cultures of the oropharynx were done periodically, and the middle ear fluid (MEF) was cultured at the time of AOM . H . influenzae was recovered from MEF in 44% of the 136 AOM episodes recorded . Thirty-one children had at least one episode of AOM caused by H . influenzae; the remaining 12 children, designated as "controls," had no otitis or had AOM caused by other organisms . The possible differences between carriage and infection strains were evaluated by comparison of MEF and oropharyngeal isolates, by pairwise comparison of MEF and oropharyngeal isolates and by pairwise comparison of multiple isolates from each host recovered at the time of AOM and during infection-free intervals . No significant differences in patterns of adherence, capsular type or biotype were found . The lack of correlation between these characteristics and infection suggests either that H . influenzae organisms have determinants of virulence yet to be defined or that variations in host susceptibility permit infection by the strain colonizing the upper respiratory tract . Adherence per se may be less important in the development of infection than in establishing and maintaining colonization within the host. Pediatr Infect Dis J, 1987 Jan, 6(1), 20 - 3 Capsular polysaccharide Haemophilus influenzae type b vaccine: clinical and immunologic responses to two vaccines; Barkin RM et al.; The clinical reactions and immunologic responses to two Haemophilus influenzae type b capsular polysaccharide vaccines were studied in 24- to 36-month-old children . A candidate vaccine (Connaught) induced greater than or equal to 1.0 microgram/ml of antipolysaccharide