Pediatr Infect Dis, 1985 Sep-Oct, 4(5), 472 - 5 Bacterial infection in the acquired immunodeficiency syndrome of children; Bernstein LJ et al.; We have followed 46 children with acquired immunodeficiency syndrome and acquired immunodeficiency syndrome-related complex . Twenty-six patients had at least one episode of serious bacterial infection . Twenty-seven episodes of sepsis were documented in 21 patients . Soft tissue infection was common in both the presence and the absence of documented bacteremia . Urinary tract infection commonly presented as worsening diarrhea in the absence of sepsis . Organisms commonly isolated included Streptococcus pneumoniae, Haemophilus influenzae and Salmonella sp . Staphylococcal infection accompanied episodes of cellulitis/abscess . Escherichia coli commonly caused urinary tract infection in the absence of sepsis . Enteric and nosocomial sepsis was limited to hospitalized, instrumented patients or to individuals who had received prior antibiotic therapy as outpatients . We conclude that bacterial infection causes serious morbidity in acquired immunodeficiency syndrome and acquired immunodeficiency syndrome-related complex and may be further evidence for altered humoral immunity in the disorder. Pediatrie, 1985 Sep, 40(6), 451 - 9 {Neonatal Haemophilus influenzae infection . Apropos of 4 cases}; Garcia P et al.; Four cases of neonatal haemophilus influenzae have been reported in Intensive Care Unite of Timone's Hospital (Marseille) during a 2 year period . Three of the cases were due to non typable organism, one was a type III . Hemoculture was positive twice . None of the patients had meningitis . Clinically it was a neonatal septicemia without particularity . Prognosis is bad (50% mortality) . Several hypothesis have been proposed to explain the increase of the frequency of this neonatal infection . One of the major problem is the choice and the moment of prescription of antibiotherapy. Antimicrob Agents Chemother, 1985 Sep, 28(3), 404 - 12 Influence of four modes of administration on penetration of aztreonam, cefuroxime, and ampicillin into interstitial fluid and fibrin clots and on in vivo efficacy against Haemophilus influenzae; Lavoie GY et al.; The extravascular penetration and bactericidal activity of aztreonam, cefuroxime, and ampicillin against beta-lactamase-positive and -negative Haemophilus influenzae strains were compared in a rabbit model . All groups of animals received an identical total dose of 100 mg of either antibiotic per kg given by four different intravenous modes of administration including a single large injection, four intermittent injections, a continuous infusion, and an injection followed by an infusion . Aztreonam had a higher degree of penetration in interstitial fluid and fibrin clots and was the most effective agent against beta-lactamase-positive and -negative H . influenzae . A single large injection of either drug resulted in significantly higher peak levels and higher initial area under the curves of concentrations of drugs in serum, the interstitial fluid, and fibrin clots than those by other modes of administration . Continuous infusions of antibiotics resulted in poor in vivo bactericidal activity . Other modes of administration exhibited good antibacterial activity within the first 6 h of the study . Thereafter, a single large injection of aztreonam resulted in a much more rapid killing of H . influenzae than that by injection of the other drugs . Aztreonam and cefuroxime showed good in vivo stability to beta-lactamase produced by H . influenzae while ampicillin was rapidly hydrolyzed in vivo. J Infect, 1985 Sep, 11(2), 109 - 17 Haemophilus influenzae meningitis: a 5-year study in Ibadan, Nigeria; Nottidge VA; A total of 131 children with Haemophilus influenzae meningitis was studied over a period of 5 years . Of these, 92% and of those who died from this disease, 94% were 2 years old or less . Mortality was 26% and morbidity among the survivors was 36% . Most of the children studied were marasmic . The seasonal incidence is discussed since incidence peaked mainly in the dry season with a secondary peak in the rainy season . Haemoglobin (H6) electrophoresis, done in respect of a few children, showed a significantly higher incidence of Hb SS among patients than in the general population . This relationship is being studied further . The prognosis did not appear to be significantly affected by the choice between a combination of penicillin and chloramphenicol on the one hand and ampicillin alone on the other . A combination of penicillin and chloramphenicol is preferred to chloramphenicol alone in initiating therapy because 100% of strains of H . influenzae isolated in our laboratory are susceptible to chloramphenicol but only 75% of strains of Streptococcus pneumoniae are susceptible to this drug. Eur J Pediatr, 1985 Sep, 144(3), 259 - 60 Fatal meningitis due to multi-resistant Haemophilus influenzae type b; Moulin D et al.; We report the case of a 3-month-old boy suffering from an acute bacterial meningitis due to a multi-resistant strain of Haemophilus influenzae type b . Also presented is our current strategy of treatment and chemoprophylaxis of Haemophilus influenzae meningitis in children. J Pediatr, 1985 Sep, 107(3), 346 - 51 Immunization of 2-month-old infants with protein-coupled oligosaccharides derived from the capsule of Haemophilus influenzae type b; Anderson P et al.; We studied an immunogen consisting of oligosaccharides derived from Haemophilus influenzae type b capsular polysaccharide (PRP) coupled to CRM197, a nontoxic relative of diphtheria toxin . Subcutaneous injections were given to eight subjects at ages 2, 4, and 6 months, simultaneously with conventional diphtheria-tetanus-pertussis (DTP) vaccine . After the first immunization, total serum anti-PRP antibodies declined in all subjects, but increased in most after the second immunization and after the third in seven of seven subjects analyzed . In these seven infants, the geometric mean level at age 9 months (0.73 micrograms/ml) exceeded by at least 40 times the means of historical control groups given DTP only or DTP plus (uncoupled) PRP vaccine . An isotype-specific assay showed that IgM antibodies increased after the first immunization with the coupled vaccine in all eight infants . Against the background of declining maternal IgG antibody, elevations in IgG antibody were detected after the second or third immunization in six of the eight . These six at age 9 to 11 months were immunized with (uncoupled) PRP vaccine, and a "boost" in anti-PRP antibody, including an IgG component, was found. J Infect Dis, 1985 Sep, 152(3), 485 - 92 Alteration of the cell wall of Haemophilus influenzae type b by transformation with cloned DNA: association with attenuated virulence; Zwahlen A et al.; A virulent strain of Haemophilus influenzae type b was used to construct a lambda library of chromosomal DNA in Charon 4, amplified in Escherichia coli . From this library a recombinant (I-69) phage was isolated that contained a 10.2-kilobase-pair fragment of DNA eliciting H . influenzae transformants whose colonies had a distinctive opaque phenotype . Compared with their H . influenzae parent strains the opaque I-69 transformants had two defined cell wall alterations: one in the lipopolysaccharide (greater mobility on sodium dodecyl sulfate-polyacrylamide gel electrophoresis) and one in the outer membrane proteins . The I-69 transformant of virulent type b strain Rd-/b+ had stable expression of type b capsule . In contrast to strain Rd-/b+, the Rd-/b+/I-69 transformant was serum sensitive in vitro and avirulent in vivo in rats . Thus the potential of H . influenzae type b organisms to cause invasive infection can be substantially attenuated by altering the expression of one or more genes that affect the cell wall composition. Infect Immun, 1985 Sep, 49(3), 819 - 27 Coprecipitation of lipopolysaccharide and the 39,000-molecular-weight major outer membrane protein of Haemophilus influenzae type b by lipopolysaccharide-directed monoclonal antibody; Gulig PA et al.; The major outer membrane protein of Haemophilus influenzae type b (Hib) with an apparent molecular weight of 39,000 (39K) was purified from three different Hib strains and was shown to be free from detectable contamination with other proteins . However, these purified 39K protein preparations were found to contain Hib lipopolysaccharide (LPS) . Immunization of rats with these 39K protein preparations resulted in the production of antisera containing both 39K protein-directed and LPS-directed antibodies, as determined by Western blot analysis . The reactivity pattern of the LPS-directed serum antibodies with different Hib strains was identical to the reactivity of these Hib strains with a set of monoclonal antibodies (mabs) previously shown to immunoprecipitate the 39K protein in a radioimmunoprecipitation (RIP) system . Examination of the antigenic specificities of the 39K protein-immunoprecipitating mabs by using Western blot analysis showed that these mabs were actually directed against Hib LPS . RIP analysis of 125I-labeled Hib cells and 32P-labeled Hib cells revealed that the 39K protein and LPS existed as a complex in a RIP system, which resulted in the coprecipitation of both antigens by LPS-directed mabs . The interaction between LPS and the 39K protein was highly selective for this protein and did not involve other outer membrane proteins . The LPS/39K protein complex could be reconstituted by mixing purified LPS and purified 39K protein; it could also be reconstituted with 39K protein from one Hib strain and LPS from another Hib strain . These findings have necessitated the reinterpretation of previous studies involving the 39K protein-immunoprecipitating mabs . Of primary importance is the fact that the demonstrated immunoprotective ability of a 39K protein-immunoprecipitating mab (E . J . Hansen, S . M . Robertson, P . A . Gulig, C . F . Frisch, and E . J . Haanes, Lancet i:366-368, 1982) must now be regarded as evidence that antibody directed against Hib LPS can be protective against experimental Hib disease. J Antimicrob Chemother, 1985 Sep, 16(3), 379 - 88 Pefloxacin in acute exacerbations of chronic bronchitis; Maesen FP et al.; Forty-three patients admitted to hospital with acute purulent exacerbations of chronic bronchitis were treated with 400 mg pefloxacin twice daily for ten days . The first 20 patients were given the first dose of the drug as a 60 min intravenous infusion . Serum and sputum concentrations of pefloxacin were measured microbiologically at intervals on the first treatment day and the sputum was cultured before, during, and after the course of pefloxacin . Two patients died from unrelated causes during the follow-up and one refused to continue treatment . All strains of Haemophilus influenzae and Branhamella catarrhalis were eradicated at end-of-treatment but eight strains of Streptococcus pneumoniae and three of Pseudomonas aeruginosa were cultured and the sputum remained purulent despite the pefloxacin . Peak serum concentrations averaged approximately 4.5 mg/l after the infusion and 5 mg/l on oral administration, the corresponding sputum concentrations being 3.8 and 4.6 mg/l, respectively . MICs for H . influenzae were 0.06 mg/l, or less . Mode MICs for the pre- and post-treatment strains of Str . pneumoniae were 4 and 16 mg/l, and the corresponding values for Ps . aeruginosa were 2 and 16 mg/l . The poor results in pseudomonas and pneumococcal infections could largely be explained by the degree of resistance among these organisms. Pediatr Med Chir, 1985 Sep-Oct, 7(5), 693 - 700 {Antibiotic therapy in bronchopulmonary diseases in children}; Battistini A; With a wide-spectrum antibiotic the results obtained are not as satisfactory as those obtained with an aimed antibiotic therapy . It is for this reason that a physician must always keep up to date on all the antibiotics and their field of action . Apart the antituberculosis drugs we can currently count on three large families, the penicillins, the cephalosporins, the aminoglycosides, and on a polymorph group made up of erythromycin, chloramphenicol, vancomycin and trimethoprim-sulfamethoxazole (TMP-SMZ) . Of all the lung diseases, pneumoniae is without doubt the disease in which the choice of the antibiotic is most difficult and also most determinant . Using a scheme made up of three successive stages could be useful . In the first stage we exploit our knowledge of the prevalence of certain infectious agents in single age group . In the first two months of life gram negative rods, B and D Streptococci and Pneumococcus are the most probable agents, therefore an association of ampicillin and aminoglycoside is recommended . In the pre-school age we find a predominance of Haemophilus influenzae and Pneumococcus and therefore the antibiotic of choice is amoxicillin . In the school age there remains only the Pneumococcus so that the first choice antibiotic is now penicillin . All of this is true for those clinical situations that do not present peculiar characteristics . When this is not the case, we pass on to the second stage which consists of suspecting, on the basis of clinical and instrumental data, of a certain etiologic agent and in choosing an appropriate antibiotic.(ABSTRACT TRUNCATED AT 250 WORDS) Tohoku J Exp Med, 1985 Sep, 147(1), 1 - 13 Clinical significance of respiratory infection caused by Branhamella catarrhalis with special reference to beta-lactamase producing strains; Nagatake T; I found the recent increase during the past eight years of the incidence of respiratory infections caused by Branhamella catarrhalis . Namely, I experienced 74 cases (93 episodes) of the respiratory infections; 5 pneumonia, 14 acute bronchitis, 1 lung abscess, 36 chronic bronchitis, 7 chronic bronchiolitis, 21 bronchiectasis and 9 chronic pulmonary emphysema with infection . In 65 of 93 infectious episodes, Branhamella catarrhalis was isolated as a pure culture and in 28 episodes it was associated with other organisms, 13 Haemophilus influenzae etc . In all the cases, a positive correlation was found between beneficial clinical results and disappearance of the organism from the sputum . Minimum inhibitory concentrations of the representative beta-lactam and other antibiotics against 104 strains were determined . All of these strains were obtained during last four years from 1980 to 1983 from the purulent sputa as the main pathogen . Annually, this organism has significantly acquired resistance to beta-lactams . By 1983, 74% of Branhamella catarrhalis isolated from the purulent sputa became a beta-lactamase producers . And the failure cases of Branhamella catarrhalis infections treated with beta-lactams have increased during the last two years . These results have clearly showed also the importance of Branhamella catarrhalis as the common pathogen for respiratory organ. J Hosp Infect, 1985 Sep, 6(3), 281 - 4 Prophylaxis in bacterial meningitis; Davies AJ et al.; A questionnaire about the use of prophylactic antibiotics in bacterial meningitis was sent to medical officers of environmental health and microbiologists in England . There was broad agreement that prophylaxis should be offered to close contacts of acute meningitis due to Neisseria meningitidis but not to contacts of meningitis caused by Streptococcus pneumoniae . Overall 28% of those who replied said they could consider giving prophylaxis to contacts of meningitis due to Haemophilus influenzae . Rifampicin was the most common choice of drug . The indications for prophylaxis in bacterial meningitis are discussed. Infect Immun, 1985 Sep, 49(3), 544 - 9 Purification and partial characterization of outer membrane proteins P5 and P6 from Haemophilus influenzae type b; Munson RS Jr et al.; The major outer membrane proteins of Haemophilus influenzae type b (Hib), designated P5 and P6 (R.S . Munson, Jr., J.L . Shenep, S.J . Barenkamp, and D.M . Granoff, J . Clin . Invest . 72:677-684, 1983), were purified to homogeneity and partially characterized . P5 was insoluble in octylglucoside-NaCl and could be extracted with 1% sodium dodecyl sulfate (SDS) in 20 mM phosphate (pH 7.5) . Solubilized P5 was further purified on hydroxylapatite in 0.1% SDS . The purified protein had an apparent molecular weight of 27,000 as determined by SDS-polyacrylamide gel electrophoresis after sample preparation at room temperature . The protein migrated with an apparent molecular weight of 35,000 after heating for 30 min at 100 degrees C in the presence of 10% beta-mercaptoethanol (beta ME) . Rabbit antisera prepared against the purified preparation immunoprecipitated solubilized protein P5 but had no protective activity in the infant rat bacteremic model . The SDS-insoluble residue was further extracted with 1% SDS-0.5 M NaCl-0.1% beta ME at 37 degrees C . A single outer membrane protein, designated P6, with an apparent molecular weight of 16,000, remained insoluble under these conditions . Antiserum prepared against this insoluble fraction contained antibodies which, after removal of anti-lipopolysaccharide antibody, immunoprecipitated P6 and protected infant rats challenged with Hib . Protein P6 could be released from the insoluble cell wall in the presence of SDS-NaCl-beta ME at 60 degrees C . Thus, proteins P5 and P6 could be purified from the cell envelope of Hib . Based on the results from infant rat passive protection experiments, antigens in the P6-cell wall fraction merit further investigation as possible vaccine components . In contrast, epitopes on protein P5 did not appear to elicit protective antibody. Lancet, 1985 Aug 31, 2(8453), 468 - 71 Immunological paralysis to pneumococcal polysaccharide in man; Pichichero ME; A 9-month-old infant had severe pneumococcal meningitis and for the next two years showed immunological paralysis to the causal serotype . He remained normally responsive to a protein antigen (tetanus toxoid) and to polysaccharide antigens (Haemophilus influenzae type b capsule and pneumococcal capsule antigens other than the infecting/paralysing serotype) . By the fourth year of life the child was spontaneously producing antibody to the infecting/paralysing pneumococcal serotype, at which time rechallenge with the previously tolerising antigen resulted in a secondary response . The occurrence of pneumococcal immunological paralysis in man is therefore validated. Lancet, 1985 Aug 24, 2(8452), 417 - 9 Uridine monophosphate kinase 3: a genetic marker for susceptibility to Haemophilus influenzae type B disease; Petersen GM et al.; Alaskan Eskimos have the highest known prevalence of invasive Haemophilus influenzae type b (Hib) disease, primarily meningitis, affecting 1-5% of all children in the first two years of life . In this population a polymorphic genetic variant of the pyrimidine pathway enzyme, uridine monophosphate kinase-3 (UMPK-3), was found to be positively associated with invasive Hib disease (relative risk 3.3) and a tendency towards a younger age at onset of illness . There was no difference in levels of naturally acquired Hib anticapsular antibody between persons with Hib disease and healthy controls in this population . This suggests that UMPK-3 may have a role in mediating non-humoral immunity to Hib . However, unlike other enzyme variants in the nucleoside synthesis pathways which result in syndromes of severe immunodeficiency, this gene appears to confer a more subtle disease susceptibility. Vet Rec, 1985 Aug 17, 117(7), 143 - 7 Prevalence of pig herds affected by pleuropneumonia associated with Haemophilus pleuropneumoniae in eastern England; Brandreth SR et al.; A survey for the macroscopic lesions indicative of pneumonic infection in the pig with Haemophilus pleuropneumoniae was made in an abattoir in eastern England . A total of 78 herds located in 11 counties of eastern or central England were seen between December 1982 and August 1983 . Lesions were noted in the batches submitted by 44 (56 per cent) of the 78 herds . A further 16 herds (21 per cent) submitted batches containing pigs affected by pleurisy principally of the caudal lobes but without the pneumonic lesions . Lesions suggestive of enzootic pneumonia were also seen in 61 herds (78 per cent) . Circumstances restricted corroborative bacteriological examinations to 53 and serological examinations to 33 herds . Strains of H pleuropneumoniae (predominantly serotype 3 but also serotype 2) were isolated from 26 herds . These comprised 22 out of 42 (51 per cent) of those where typically affected plucks, or plucks with caudal lobe pleurisy, were encountered, and four out of 11 (36 per cent) in which there was either no observable thoracic disease or enzootic pneumonia only . Complement fixing antibodies to serotype 3 or 2 antigens occurred in 26 out of 33 herds (79 per cent) . These comprised 25 (83 per cent) of 30 herds with batches exhibiting either typical pulmonary lesions and, or, caudal lobe pleurisy and one of three herds without such lesions . Collectively these data indicate that herds containing pigs with pleuropneumonia are common at least in the more easterly parts of England and that H pleuropneumoniae, usually but not always associated with disease, is also widespread. Int J Pediatr Otorhinolaryngol, 1985 Aug, 9(3), 249 - 56 Progressive hearing loss following Haemophilus influenzae meningitis; Silkes ED et al.; Loss of hearing is a sequelae of meningitis . This hearing loss has been known to fluctuate for as long as one year following the acute infection . This paper presents a case of an 11-year documented downward fluctuating hearing loss following Haemophilus influenzae meningitis . The case indicates that patients should be followed audiologically for years following meningitis . A review of the literature of hearing loss in meningitis is presented with special emphasis on cases in which the hearing loss fluctuated . The cases in the literature were usually not followed for more than one year . In this case of acquired hearing loss secondary to Haemophilus influenzae meningitis, the patient's hearing fluctuated over 11 years, in a downward progression . It is not clear what type of mechanism is involved in the ongoing damage to the cochlea that could account for this gradual fluctuation . It is suggested that as the possibility of long-term fluctuation exists, patients with meningitis should be monitored audiologically for many years. Eur J Clin Microbiol, 1985 Aug, 4(4), 419 - 21 Meningitis and brain abscess due to Haemophilus paraphrophilus; Jensen KT et al.; A case of meningitis and brain abscess due to Haemophilus paraphrophilus in a patient with congenital heart disease is reported . The abscess communicated with the cerebral ventricular system . Although the infecting strain was found to be highly sensitive to ampicillin, the patient died despite appropriate antimicrobial therapy . Characteristics distinguishing Haemophilus paraphrophilus and related species are discussed. J Clin Microbiol, 1985 Aug, 22(2), 192 - 8 Serum susceptibility of Haemophilus somnus from bovine clinical cases and carriers; Corbeil LB et al.; The serum susceptibility of 64 isolates of Haemophilus somnus from cattle was determined in a bactericidal assay with undiluted fresh or inactivated bovine serum with serial dilutions of bacterial suspension in RPMI 1640 medium . A total of 27 strains isolated from cattle with clinical disease (4 with thromboembolic meningoencephalitis, 13 with pneumonia, and 10 with reproductive failure) were compared with 35 strains from asymptomatic carriers (11 from the vagina and 24 from the prepuce) . Essentially, all clinical isolates were serum resistant, whereas approximately 25% of preputial isolates were serum susceptible, as judged after 1 h of incubation in serum; a majority of vaginal isolates showed delayed serum susceptibility . Lysozyme played no role in serum killing, and the alternative complement pathway played only a minor role . Iron saturation, however, appeared to impart greater serum resistance to serum-susceptible strains from the vagina and prepuce . Perhaps the serum-susceptible strains from carriers would be useful vaccine candidates, but resistant strains from carriers may be pathogenic. J Bacteriol, 1985 Aug, 163(2), 769 - 73 Evidence for covalent attachment of phospholipid to the capsular polysaccharide of Haemophilus influenzae type b; Kuo JS et al.; Cells of Haemophilus influenzae type b were grown in a liquid medium containing {3H}palmitate or {14C}ribose or both for two generations of exponential growth . Radiolabeled type-specific capsular polysaccharide, polyribosyl ribitol phosphate (PRP), was purified from the culture supernatant by Cetavlon precipitation, ethanol fractionation, and hydroxylapatite and Sepharose 4B chromatography . The doubly labeled ( {3H}palmitate and {14C}ribose) PRP preparation was found to coelute in a single peak from a Sepharose 4B column, suggesting that both precursors were incorporated into the purified PRP . A singly labeled ( {3H}palmitate) purified PRP preparation was found to be quantitatively immune precipitated by human serum containing antibody against PRP . The radioactivity of this preparation could not be dissociated from PRP by treatment with chloroform-methanol, 6 M urea, sodium dodecyl sulfate, or Zwittergent . Only after acid, alkaline, or phospholipase A2 treatment of PRP labeled with {3H}palmitate or {3H}palmitate and {14C}ribose followed by chloroform-methanol extraction could most of the 3H-radioactivity be recovered in the organic phase . The chloroform-soluble acid-hydrolyzed or phospholipase A2-treated product was identified as palmitic acid after thin-layer chromatography . These results strongly suggest that a phospholipid moiety is covalently associated with the H . influenzae type b polysaccharide PRP. J Clin Microbiol, 1985 Aug, 22(2), 225 - 8 Comparison of radiometric and conventional culture systems in detecting Haemophilus influenzae type b bacteremia in rats; Mitchell MJ et al.; To compare the efficiency of detecting Haemophilus influenzae type b bacteremia by the BACTEC radiometric system (RS; Johnston Laboratories, Inc., Towson, Md.) and a conventional Trypticase soy broth (BBL Microbiology Systems, Cockeysville, Md.) blood culture system (TSB), we developed an in vivo model of bacteremia in rats . After intravenous injection of 50 to 200 CFU into adult rats, there was a linear logarithmic increase in CFU per milliliter of rat blood during the first 10 h (r = 0.98), allowing accurate prediction of the level of bacteremia with time . Culture bottles were inoculated with 0.5 ml of blood obtained by cardiac puncture and processed as clinical samples in the microbiology laboratory with our RS and conventional protocols . We found the following . (i) The first detection of bacteremia by RS was similar to that by TSB if a Gram stain of the TSB was done on day 1 and was superior if that smear was omitted (P less than 0.01) . (ii) The detection times in both systems were comparable at different magnitudes of bacteremia (10(1) to 10(4) CFU/ml) . (iii) Supplementation of inoculated bottles with 2 ml of sterile rat blood interfered with Gram stain detection in TSB but resulted in increased 14CO2 production in RS . (iv) No difference in detection time was found between RS and TSB for four different clinical isolates . These studies show that, in a biologically relevant model, the detection of positive blood cultures for H . influenzae type b by RS was comparable to or better than detection by TSB when blood was processed analogously to clinical specimens. Am J Dis Child, 1985 Aug, 139(8), 766 - 70 Erythromycin-sulfisoxazole vs amoxicillin in the treatment of acute otitis media in children . A double-blind, multiple-dose comparative study; Rodriguez WJ et al.; A fixed combination of erythromycin ethylsuccinate and sulfisoxazole acetyl (erythromycin-sulfa) was compared with amoxicillin for the treatment of acute otitis media (AOM) in children . Of 145 patients studied, 76 boys and 69 girls were compliant and were evaluated for drug efficacy (72 amoxicillin, 73 erythromycin-sulfa) . Based on otoscopic and tympanometric results, cure rates at ten to 14 days for AOM due to all organisms were 83% (63/72) for amoxicillin and 89% (65/73) for erythromycin-sulfa; for Haemophilus species (including mixed infections), they were 84% for amoxicillin (26/31) and 83% for erythromycin-sulfa (20/14) . Cure rates for ampicillin-resistant Haemophilus were 1/1 for amoxicillin and 7/8 (88%) for erythromycin-sulfa; one patient (12%) had persistent AOM at day 10 . Of the patients with AOM due to Streptococcus pneumoniae, 82% (29/35) in the amoxicillin-treated group and 98% (39/40) in the erythromycin-sulfa-treated group were cured . Patients with S pneumoniae as the initial infecting organism who were treated with amoxicillin had significantly more clinical recurrences then their erythromycin-sulfa-treated counterparts, 66% (8/12) vs 33% (3/9) . There was no difference between treatment groups in recurrence rates for patients with Haemophilus as the initial infecting organism . On the treatment day indicated, the following number of patients had middle ear effusion: by days 10 to 14, 38% (27/72) amoxicillin-treated patients and 48% (35/73) erythromycin-sulfa-treated patients; by day 28, 10% (7/71) amoxicillin-treated patients and 16% (11/70) erythromycin-sulfa-treated patients . There were no significant differences in adverse reactions . The erythromycin-sulfa combination is safe and effective treatment for AOM, including ampicillin-resistant Haemophilus. Antimicrob Agents Chemother, 1985 Aug, 28(2), 343 - 6 In vitro antibacterial activity of SK&F 88070 against aerobic gram-positive and gram-negative cocci and Haemophilus influenzae; Gooch WM 3rd et al.; The inhibitory activity of SK&F 88070, a cephalosporin whose kinetic characteristics in animals suggest the possibility of once-daily doses, was determined against 345 clinical isolates, and results were compared with the activities of ceftizoxime, ceftriaxone, moxalactam, methicillin, and ampicillin . The spectrum of SK&F 88070 is similar to that of ceftizoxime. Antimicrob Agents Chemother, 1985 Aug, 28(2), 320 - 5 Tolerance of Haemophilus influenzae to beta-lactam antibiotics; Bergeron MG et al.; Two hundred clinical isolates of Haemophilus influenzae were tested for tolerance (MBC/MIC greater than or equal to 32) to ampicillin and cefotaxime by broth dilution tests . Of 200 strains, 9 were tolerant to ampicillin, and 10 were tolerant to cefotaxime . Tolerant organisms were identified in both systemic and nonsystemic infections and among different biotypes and serotypes of H . influenzae . These tolerant isolates were compared with nontolerant isolates by broth dilution and killing curves with log-phase and stationary-phase inocula . Both tolerant and nontolerant bacteria in log phase were killed more rapidly by antibiotics than bacteria in stationary-phase growth . When tested against 11 different beta-lactams, several patterns of tolerance were observed . Six of the ten strains were tolerant to aztreonam, four were tolerant to cefuroxime, three were tolerant to cefamandole, and two were tolerant to cefoxitin . Strain H130 was tolerant to all beta-lactam antibiotics studied . None of the 10 tolerant H . influenzae isolates were tolerant to chloramphenicol, rifampin, tobramycin, ciprofloxacin, enoxacin, and trimethoprim-sulfamethoxazole . Although the clinical significance of tolerance is not determined, this study suggests that the bactericidal activity (MBC) of beta-lactam antibiotics against H . influenzae should be determined in cases of severe infections in which clinical response is slow or unsatisfactory. Antimicrob Agents Chemother, 1985 Aug, 28(2), 176 - 80 Molecular characterization of chloramphenicol-resistant Haemophilus parainfluenzae and Haemophilus ducreyi; Roberts MC et al.; We examined chloramphenicol-resistant Haemophilus parainfluenzae and Haemophilus ducreyi strains isolated in various parts of the world . The antibiotic resistance determinants were located on conjugative plasmids in H . ducreyi, but were chromosomally located in H . parainfluenzae . Both species produced chloramphenicol acetyltransferases (CATs) that were sensitive to 5,5'-dithiobis(2-nitrobenzoic acid) like the enteric type II and Haemophilus influenzae CAT enzymes, but differed from these enzymes in elution patterns and subunit molecular weight . Southern blot analysis showed the H . parainfluenzae and H . ducreyi CAT genes were molecularly related to the enteric type II class as well as the H . influenzae CAT . Heterogeneity of the physiochemical properties of the CATs was observed; however, the data suggested that all three Haemophilus spp . have a common ancestral source for the CATs. J Antimicrob Chemother, 1985 Aug, 16(2), 165 - 8 The comparative in-vitro activity of twelve 4-quinolone antimicrobials against Haemophilus ducreyi; Wall RA et al.; We have compared the in-vitro activity of 12 quinolone antibiotics against 50 recent isolates of Haemophilus ducreyi from The Gambia . While these isolates were relatively resistant to the parent compounds, the newly synthesized quinolones exerted significant activity against H . ducreyi . Ciprofloxacin and ofloxacin were the most active compounds (MIC90 0.03 mg/l). Zhonghua Min Guo Wei Sheng Wu Ji Mian Yi Xue Za Zhi, 1985 Aug, 18(3), 184 - 9 Viability and growth of clinical isolates of Haemophilus influenzae; Flournoy DJ et al.; Studies were done on clinical isolates of Haemophilus influenzae to investigate viability and determine the effects of disc-agar diffusion (DAD) medium modification on antimicrobial susceptibility results . Most isolates were viable for two days in distilled water, up to a week on chocolate agar and months when frozen in skim milk at -70 degrees C . Differences in viability were not related to biotype, serotype, beta-lactamase production or site of isolation of isolates . Several medium modifications resulted in better growth of isolates for antimicrobial susceptibility testing by DAD, but the zone sizes of inhibition differed from those of the recommended medium. J Infect Dis, 1985 Aug, 152(2), 307 - 14 Role of intravascular replication in the pathogenesis of experimental bacteremia due to Haemophilus influenzae type b; Rubin LG et al.; The potential role of extravascular and intravascular replication was studied in initiation of sustained bacteremia in experimental infection due to Haemophilus influenzae type b . When organs and fluid from rats were cultured after intranasal inoculation of the rats with H . influenzae type b, the organism was not recovered from any putative extravascular focus before development of bacteremia . To evaluate the potential contribution of intravascular replication in initiation of bacteremia due to H . influenzae type b, we obtained serial blood cultures after intravenous or intranasal inoculation . Bacterial counts increased exponentially immediately after intravenous and 12-18 hr after intranasal inoculation . Using the same model system, we observed bacteremia due to Streptococcus pneumoniae after intraperitoneal but not intravenous inoculation . After intraperitoneal inoculation, the magnitude of bacteremia in individual rats did not regularly increase exponentially over time . These findings are consistent with extravascular replication leading to bacteremia due to S . pneumoniae and efficient intravascular replication leading to sustained bacteremia due to H . influenzae type b. Proc Natl Acad Sci U S A, 1985 Aug, 82(15), 5078 - 82 A population genetic framework for the study of invasive diseases caused by serotype b strains of Haemophilus influenzae; Musser JM et al.; One hundred seventy-seven isolates of serotype b Haemophilus influenzae recovered largely from children with invasive disease in the United States were characterized by the electrophoretic mobilities of 16 metabolic enzymes, the NaDodSO4/PAGE pattern of outer-membrane proteins (OMP), and biotype . Thirty-two distinctive multilocus genotypes (electrophoretic types, ETs) were distinguished on the basis of allele profiles at the enzyme loci . Twenty-eight OMP types and five biotypes were identified, but only 55 distinctive combinations of ET, OMP type, and biotype were represented . The strong nonrandom associations of characters and the recovery of isolates with identical properties in widely separated geographic regions and over a 40-year period suggest that the population structure of H . influenzae is basically clonal . Examination of nonserotype b isolates indicated that clones of serotype b are a restricted subset of the genotypes in the species as a whole . Currently, most of the invasive H . influenzae disease in the United States is caused by serotype b strains of two related ETs, and, more specifically, much of it is attributable to two subclones marked by OMP type . There is evidence that the frequency of the ET-1/OMP 1H/biotype I subclone has increased dramatically in the United States since the 1939-1954 period . The hypothesis that populations of H . influenzae are subject to marked temporal variation in clonal composition is supported by evidence of major differences in the genetic structure of populations in the United States and the Netherlands. J Bacteriol, 1985 Aug, 163(2), 629 - 34 Reexamination of phenotypic defects in rec-1 and rec-2 mutants of Haemophilus influenzae Rd; Barouki R et al.; Radiolabeled donor DNA is efficiently taken up into competent H . influenzae Rd rec-2 mutant cells but does not undergo the rapid degradation observed in wild-type cells . Furthermore, donor label is not recovered in the chromosome even after 1 h . The donor DNA appears to remain in a protected state in a compartment that can be separated from the rest of the cell . We interpret this as a failure of the donor DNA to be translocated out of the transformasome . In contrast, rec-1 cells translocate labeled donor DNA normally . The donor label accumulates in the recipient chromosome, but, as expected for cells with a recombination defect, there is no preferential localization of the label in sites homologous to the donor DNA . In addition, we have observed two enzymatic activities that act on transformasome-associated DNA of rec-2 cells, an endonuclease which may play a role in the translocation of closed circular DNA and a phosphatase. Antimicrob Agents Chemother, 1985 Aug, 28(2), 315 - 9 Plasmid-mediated aminoglycoside phosphotransferases in Haemophilus ducreyi; Sanson-le Pors MJ et al.; Three clinical isolates of Haemophilus ducreyi, representing at least two subtypes, were shown to be resistant to streptomycin and kanamycin . They also produced a beta-lactamase and chloramphenicol acetyltransferase and were resistant to tetracycline . In the three strains the resistance to both aminoglycoside antibiotics was encoded by a plasmid of ca . 4.7 kilobases which apparently did not carry ampicillin, chloramphenicol, or tetracycline resistance genes, as determined after transfer to Escherichia coli by transformation . Resistance to streptomycin and kanamycin was due to the presence of two aminoglycoside phosphotransferases (APH) . The enzyme modifying kanamycin was a 3',5"-APH of type I {APH(3',5")-I}, as inferred from its substrate profile and immunological cross-reactivity with the APH(3',5")-I encoded by the transposable element Tn903 . However, the APH(3',5")-I gene in H . ducreyi did not appear to be carried by Tn903. J Gen Microbiol, 1985 Aug, 131 ( Pt 8), 2041 - 5 Studies of the 2':3'-cyclic nucleotide phosphodiesterase of Haemophilus influenzae; Anderson BM et al.; The 2':3'-cyclic nucleotide phosphodiesterase:3'-nucleotidase of Haemophilus influenzae was purified from a periplasmic preparation by affinity chromatographic techniques . The enzyme-catalysed hydrolysis of 2':3'-cyclic AMP to adenosine without accumulation of the intermediate substrate 3'-AMP was demonstrated by high performance liquid chromatography . Competitive inhibition of the enzyme by a variety of nucleosides and mononucleotides indicated the presence of either purine or pyrimidine bases to be essential for selective interactions with the enzyme, and confirmed the need for a 3'-position phosphate for the functioning of mononucleotides as substrates for the enzyme . The enzyme had a molecular weight of 79 000, was stable at low temperatures and was thermally denatured at temperatures above 50 degrees C. Infect Immun, 1985 Aug, 49(2), 389 - 95 Genetics of spontaneous, high-frequency loss of b capsule expression in Haemophilus influenzae; Hoiseth SK et al.; We determined that the frequency of spontaneous capsule loss in Haemophilus influenzae type b is 0.1 to 0.3% . All of 10 independent capsule-deficient variants (derived from four different type b strains) were found to be missing an identical 9-kilobase EcoRI restriction fragment when probed with a cloned piece of DNA containing sequences known to be necessary for type b capsule expression . These results suggest the existence of a specific mechanism for shutting off type b capsule synthesis at a high frequency . Intranasal infection of infant rats showed that capsule loss occurred in vivo at frequencies comparable to those observed in vitro. Genitourin Med, 1985 Aug, 61(4), 266 - 9 The microbial aetiology of genital ulcers in black men in Durban, South Africa; Coovadia YM et al.; The microbial aetiology of genital ulcers was assessed in 100 black men attending a sexually transmitted disease (STD) clinic in Durban, South Africa . Forty patients harboured Haemophilus ducreyi, one hepes simplex virus, and one Neisseria gonorrhoeae . Syphilis was diagnosed in 44 patients on the basis of dark field microscopy or positive syphilis serology test results, or both . Of these 44 patients, eight also harboured N ducreyi, one herpes simplex virus . Lymphogranuloma venereum was diagnosed in one patient . No cause of ulceration could be found in the remaining 16 patients. J Med Microbiol, 1985 Aug, 20(1), 33 - 8 Serum factors for opsonisation of non-typable Haemophilus influenzae; Lever AM et al.; Neutrophil chemiluminescence was used to assess the opsonins required for phagocytosis of non-typable Haemophilus influenzae isolated from sputum samples of patients with hypogammaglobulinaemia . Immunoglobulin was the major opsonin, whereas complement was relatively unimportant . Evidence was found for a heat-labile opsonin other than complement that enhanced phagocytosis of these organisms . Tuftsin was shown to aid phagocytosis of H . influenzae without triggering chemiluminesence. JAMA, 1985 Jul 26, 254(4), 509 - 14 Secondary Haemophilus influenzae type b in day-care facilities . Risk factors and prevention; Fleming DW et al.; The risk factors for acquisition of secondary day-care-associated Haemophilus influenzae type b disease were evaluated in a cohort of children in Seattle-King County, Washington; Atlanta; and the state of Oklahoma . During the study period, 129 primary cases were identified in children less than 5 years old who attended day-care facilities . In ten instances (8%), a secondary case occurred between one and 60 days after a primary case in the same classroom . Risk of secondary disease in classroom contacts was strongly age related: 2.4% in children 0 to 11 months old, 1.2% in children 12 to 23 months old, and 0.0% in children 24 to 59 months old . Controlling for age, children attending day-care more hours per week were more likely to transmit or acquire secondary disease . Risk of secondary disease for children in other classrooms at a center where a case had occurred was not significantly greater than risk of primary disease . Administration of rifampin to classroom contacts of a child with invasive H influenzae was effective in preventing secondary cases (95% confidence interval for rifampin efficacy, 47% to 100%) . For children 0 to 23 months old not treated with rifampin, risk of secondary disease was 2.7% (95% confidence interval, 1.1% to 4.3%), a risk approaching that reported in household contacts. J Chromatogr, 1985 Jul 12, 342(1), 13 - 23 Differentiation between major species of the Actinobacillus--Haemophilus--Pasteurella group by gas chromatography of trifluoroacetic acid anhydride derivatives from whole-cell methanolysates; Brondz I et al.; A method based on whole-cell methanolysis and trifluoroacetic acid anhydride derivatization was developed for routine laboratory differentiation between isolates from the Actinobacillus--Haemophilus--Pasteurella group . All species, except Haemophilus aphrophilus, contained D-glycero-D-mannoheptose, although in varying concentrations . The distribution of this sugar could be used to distinguish H . aphrophilus from Actinobacillus actinomycetemcomitans, H . paraphrophilus, H . influenzae type b, Pasteurella haemolytica, P . multocida and P . ureae, and also H . influenzae type b from Pasteurellae . The pattern of major sugars in P . ureae and P . haemolytica resembled that of A . actinomycetemcomitans . Major fatty acids of the whole-cell methanolysates provided no basis of interspecies differentiation. Avian Dis, 1985 Jul-Sep, 29(3), 601 - 12 Genetic and phenotypic comparison of three new avian Haemophilus-like taxa and of Haemophilus paragallinarum Biberstein and White 1969 with other members of the family Pasteurellaceae Pohl 1981; Piechulla K et al.; In the course of post-mortem bacteriological examinations, several previously unreported bacterial strains were isolated from budgerigars, pigeons, kestrels, and a goose . They have been separated into three distinct collectives according to their cultural, morphological, and biochemical characteristics . Since they require V factors, they were tentatively assigned to the genus Haemophilus Winslow et al . 1917 . This preliminary classification was checked by determination of guanine + cytosine contents and genome sizes and by DNA:DNA hybridization tests among reference strains of the three new avian taxa and recognized species of the family Pasteurellaceae Pohl 1981 . With the same methods, the genetic relationships of Haemophilus paragallinarum Biberstein and White 1969 within the family were determined . It could be shown that the three avian Haemophilus-like taxa have to be regarded as new species within the family Pasteurellaceae not affiliated with the recognized genera Actinobacillus, Haemophilus and Pasteurella . H . paragallinarum must be excluded from the genus Haemophilus because of its closer relationship to the actinobacilli . All strains investigated can be differentiated from each other and from recognized species of Pasteurellaceae using an appropriate set of biochemical tests. Nord Vet Med, 1985 Jul-Aug, 37(4), 217 - 27 Haemophilus pleuropneumoniae (Actinobacillus pleuropneumoniae) . Serotypes 8, 3 and 6 . Serological response and cross immunity in pigs; Nielsen R; Immunity obtained by vaccination with Haemophilus pleuropneumoniae is type specific and protection will only be obtained against the serotype contained in the vaccine . Serotype 8 is closely related to serotypes 3 and 6 and the objective of the present study was therefore to examine if cross immunity between the three serotypes could be obtained at vaccination. J Laryngol Otol, 1985 Jul, 99(7), 629 - 35 Bacteriological features and chemotherapy of adult acute purulent otitis media; Sugita R et al.; Eighty-eight patients from 16 to 79 years old, with acute purulent otitis media, were bacteriologically examined at the Otorhinolaryngology Department of a primary care hospital in Tokyo from July 1979 to May 1983 . Fifty-six patients underwent paracentesis, and 32 patients exhibited otorrhea due to previous spontaneous perforation of the tympanic membrane . Bacteriologic cultures revealed the presence of Streptococcus pneumoniae (62.5 per cent), including S . pneumoniae Type III (28.1 per cent), Haemophilus influenzae (10.5 per cent), Staphylococcus aureus (11.5 per cent), and Streptococcus pyogenes (7.3 per cent) . S . pneumoniae Type III had a notably high detection rate in patients from 50 to 79 years old (50-75 per cent) . Because Haemophilus influenzae was detected at a relatively high rate in patients of all ages, if can be considered as a major causative pathogen of AOM . In 44 patients, selected mainly from those who underwent paracentesis, a comparative study of bacteria found in middle ear fluid and naso-pharyngeal mucus revealed the same bacteria in 43 out of 44 cases (97.7 per cent), indicating the presence of bacterial infection through the auditory canal . Antibiotics were selected according to an Expected Efficacy Index (EEI), the antibiotic of first choice being Ampicillin or Cefaclor. J Antimicrob Chemother, 1985 Jul, 16 Suppl A, 221 - 3 The in-vitro activity of pristinamycin against Haemophilus influenzae and Neisseria meningitidis; Lafaix C et al.; The in-vitro activity of erythromycin, oleandomycin, spiramycin, josamycin and pristinamycin was tested by a plate-dilution method against strains of Haemophilus influenzae and Neisseria meningitidis . Pristinamycin was the most active product tested with minimal inhibitory concentrations (MIC) ranging between 0.5 and 4 mg/l for H . influenzae (modal value 1 mg/l) and between 0.03 and 0.12 mg/l for N . meningitidis (modal value 0.06 mg/l). Rev Infect Dis, 1985 Jul-Aug, 7 Suppl 3, S513 - 7 Therapy for lower respiratory tract infections with imipenem/cilastatin: a review of worldwide experience; Acar JF; The worldwide experience with imipenem/cilastatin as of November 7, 1983, in the intravenous therapy for severe and moderately severe infections of the lower respiratory tract is reviewed . Of 204 assessable patients treated in 77 studies conducted by 70 investigative groups (43 in the United States, 27 in other countries), 173 (85%) were cured of their infections or showed improvement . Imipenem was tested against 289 of 303 bacterial pathogens isolated before therapy, and 284 (98%) were found to be susceptible . Principal pathogens were Pseudomonas aeruginosa, Streptococcus pneumoniae, Klebsiella species, Haemophilus influenzae, Escherichia coli, and Staphylococcus aureus . A total of 76% of infecting pathogens were eradicated during therapy . Of 54 imipenem-susceptible infecting strains of P . aeruginosa, however, 57% were eradicated, 19% acquired resistance to imipenem, and 17% were replaced by new resistant strains of P . aeruginosa . Higher doses of imipenem/cilastatin and/or combined therapy with an aminoglycoside may improve these results . Imipenem/cilastatin compares well with the most active agents available for therapy for lower respiratory tract infections. Clin Exp Immunol, 1985 Jul, 61(1), 183 - 8 Assessment of biological activity of immunoglobulin preparations by using opsonized micro-organisms to stimulate neutrophil chemiluminescence; Munro CS et al.; We have used the ability of opsonised bacteria to stimulate luminol enhanced chemiluminescence of human neutrophils to examine the opsonic capabilities of normal and hypogammaglobulinaemic sera for four common bacterial pathogens . Preparations of human immunoglobulin modified for i.v . use have then been compared with unmodified Cohn Fraction II for their effectiveness in improving opsonization when added to antibody deficient sera in vitro . Hypogammaglobulinaemic sera exhibited impaired opsonisation of Haemophilus influenzae, and severely antibody deficient sera also opsonized Streptococcus pneumoniae and Pseudomonas aeruginosa poorly . The opsonization of these organisms was improved by Cohn Fraction II, and by pH 4 and beta-propionolactone treated immunoglobulins, in descending order of effectiveness . Pepsin digested immunoglobulin was inactive, and in some cases impaired opsonic capacity . The opsonisation of Staphylococcus aureus by hypogammaglobulinaemic sera was near normal, and was not improved by any immunoglobulin . This technique, which assesses biological activity of immunoglobulin, is useful in comparing preparations, and may help to establish appropriate dosage and frequency for intravenous immunoglobulin replacement therapy. Antimicrob Agents Chemother, 1985 Jul, 28(1), 146 - 8 Comparison of ceftazidime with cefamandole for therapy of community-acquired pneumonia; Engle JC et al.; Ceftazidime and cefamandole were compared in the treatment of pneumonia . The median MIC of ceftazidime for all Streptococcus pneumoniae (n = 17) and Haemophilus influenzae (n = 10) isolates was 0.125 microgram/ml . All other isolates were inhibited by less than 0.5 microgram of ceftazidime per ml, with the exception of a group B streptococcus (MIC = 4 micrograms/ml) . Satisfactory clinical responses were observed in 91% (20 of 22) of cefamandole-treated patients and 85% (17 of 20) of ceftazidime-treated patients. J Infect, 1985 Jul, 11(1), 19 - 24 Recovery of blood-borne bacteria from human urine; Eng RH et al.; Recovery from the urine of organisms causing bacteraemia may depend on the bacterial species involved . The survival of the more common species of bacteria which cause bacteraemia was examined in human urine, serum and normal saline . All species survived well or grew in serum . Haemophilus influenzae, Streptococcus pneumoniae, Streptococcus sanguis and group A streptococci were killed in all urine samples . The number of colony-forming units of Staphylococcus aureus, Staphylococcus epidermidis, Staphylococcus saprophyticus and group B streptococci either remained the same or increased in the urine, while the numbers of Escherichia coli and Klebsiella pneumoniae increased rapidly . These data suggest that the observed differences in recovery from urine of these bacterial species that cause bacteraemia are related to the viability of the species in human urine. Acta Paediatr Scand, 1985 Jul, 74(4), 560 - 3 Cerebrospinal fluid C-reactive protein in the laboratory diagnosis of bacterial meningitis; Macfarlane DE et al.; Samples of cerebrospinal fluid from 112 cases of suspected meningitis were tested for the presence of C-reactive protein (CRP), using a qualitative and quantitative slide test . Bacterial meningitis was confirmed in 34 patients, based on CSF and blood culture results, and/or elevated CSF white blood cell (WBC) count and typical biochemical profile . There were 8 patients with early onset, and 3 who had received prior antimicrobial therapy among the 5 neonates, 23 children, and 6 adults with bacterial meningitis . Organisms recovered from CSF, and/or blood, included Haemophilus influenzae 14, Streptococcus pneumoniae 9, Streptococcus group B-5, Staphylococcus aureus 2, E . coli 2 and Klebsiella pneumoniae 1 . Slide test was positive for CRP in 33 cases, giving a sensitivity of 97% which compared favourably with elevated CSF protein 33%, decreased CFS glucose 64.7% CSF glucose/blood glucose less than 1/2, 85%, raised CSF WBC 38.2%, raised CSF PMN 61.7%, CSF culture positive 88.2%, and CSF gram-positive 82.5% . Slide test was positive for CRP in 1 of 78 CSF samples negative for bacterial meningitis, giving a specificity of 98% . It was concluded that testing of CSF for CRP is a simple, rapid and accurate method for the laboratory diagnosis of bacterial meningitis, which is particularly appropriate for areas lacking adequate laboratory facilities. Pediatr Infect Dis, 1985 Jul-Aug, 4(4), 362 - 8 Prospective comparative trial of ceftriaxone vs . conventional therapy for treatment of bacterial meningitis in children; Barson WJ et al.; Fifty children with bacterial meningitis were prospectively evaluated in a randomized comparative trial of twice daily ceftriaxone with conventional ampicillin and chloramphenicol therapy . The groups were comparable in age, sex, days of illness before admission, severity of illness at admission, etiology and admission cerebrospinal fluid (CSF) parameters and bacterial colony counts . The pathogens were Haemophilus influenzae type b (34 beta-lactamase-negative, 8 beta-lactamase-positive); Streptococcus pneumoniae (4); Neisseria meningitidis (3); and Streptococcus agalactiae (1) . Initial CSF colony counts ranged from 2.5 X 10(2) to 1 X 10(10) colony-forming units/ml . In 44 children a lumbar puncture was repeated 10.5 to 18 hours after starting treatment; 16 of 24 (67%) ceftriaxone patients and 12 of 20 (60%) conventional therapy patients had sterile cultures . The reduction in the CSF bacterial colony counts (6.3 log10 colony-forming units/ml) was similar in both groups . Ceftriaxone CSF levels ranged from 1.0 to 8.0 micrograms/ml, representing a mean CSF penetration of 11.3% (range, 3.0 to 24.5%) of the simultaneous serum concentration . The median ceftriaxone bactericidal titer in CSF was 1:1024 compared with 1:4 achieved with conventional therapy . There were no significant differences in clinical responses or in frequency of complications, except for diarrhea which occurred in 59% of the ceftriaxone group and in 22% of the other (P less than 0.01) . Despite one H . influenzae type b relapse occurring in the ceftriaxone group, ceftriaxone appears to be safe and as effective as conventional therapy for bacterial meningitis in children older than 2 months of age. Br J Dis Chest, 1985 Jul, 79(3), 258 - 61 A single dose of sulfametopyrazine versus 7 days of ampicillin in acute on chronic bronchitis; Anderson G et al.; Forty-two patients with acute on chronic bronchitis received in double-blind fashion either a single dose of 2 g of sulfametopyrazine or ampicillin 250 mg thrice daily for 7 days . There were no significant differences between treatments in the number of patients achieving white sputum, the time to do so, or the incidence of pathogens at the end of treatment . Blood levels of sulfametopyrazine between 8 and 24 hours and on the seventh day were likely to result in sputum concentration adequate to kill Haemophilus influenzae. Laryngoscope, 1985 Jul, 95(7 Pt 1), 802 - 5 Meningitis and sensorineural hearing loss; Baldwin RL et al.; A 12 month retrospective study was conducted on 54 children discharged from the Children's Hospital, Birmingham, Alabama, with a diagnosis of generalized meningitis, a major cause of post-natal sensorineural hearing loss (SNHL) . Of these high risk patients, 38 or 70% had Haemophilus influenza meningitis and fully 40% of those children tested audiometrically were determined to have SNHL . Because there would appear to be an increase in SNHL in the post meningeal population, all children with a diagnosis of Haemophilus influenza, pneumococcal, or meningococcal meningitis should have an audiological workup, preferably prior to discharge from the hospital. J Antimicrob Chemother, 1985 Jul, 16(1), 103 - 9 Trimethoprim sulphamoxole in the treatment of chancroid . Comparison of two single dose treatment regimens with a five day regimen; Dylewski J et al.; In a prospective blinded study, 135 men with genital ulcers culture positive for Haemophilus ducreyi, were randomized to one of three regimens . Two single dose regimens, either the combination of sulphamoxole 3200 mg/trimethoprim 640 mg or trimethoprim 700 mg alone were compared to a five day regimen of sulphamoxole 800 mg/trimethoprim 160 mg twice daily . All 31 treated with a five day regimen of trimethoprim sulphamoxole healed without further treatment . Of 27 patients treated with the single dose sulphamoxole/trimethoprim regimen, only 21 were cured and of 34 treated with trimethoprim alone, 25 responded . Antibacterial susceptibilities were performed on 31 H . ducreyi isolates . The laboratory susceptibility of these strains to trimethoprim correlated with the clinical response to the single agent . Trimethoprim alone in a dose of 700 mg or the combination of sulphamoxole (3200 mg) and trimethoprim (640 mg) is not satisfactory for the single dose treatment of genital ulcer disease . However, when prescribed for five days, sulphamoxole/trimethoprim is effective and compares favourably with other treatment regimens. Int J Pediatr Otorhinolaryngol, 1985 Jul, 9(2), 101 - 14 Longitudinal studies of experimental otitis media with Haemophilus influenzae in the gerbil; Fulghum RS et al.; Haemophilus influenzae non-typable strain 119 was found to cause severe otitis media with sequellae when inoculated into the middle ear cavities of the Mongolian gerbil, Meriones unguiculatus . Acute inflammation was followed by the development of highly vascular granulation tissue and formation of new bone within the middle ear bulla . These changes persisted throughout the 14-week study in the untreated animals . The gerbil was variably susceptible to otitis media caused by inoculating 30-3000 bacterial cells and 100% susceptible to greater than 3000 cells . The susceptibility of the gerbil to common etiological agents of otitis media allows its use as an appropriate model of the disease. J Clin Pathol, 1985 Jul, 38(7), 750 - 3 Distribution of biotypes of Haemophilus influenzae and H parainfluenzae in patients with cystic fibrosis; Watson KC et al.; One hundred and eighty eight isolates of Haemophilus influenzae and 187 isolates of H parainfluenzae from patients with cystic fibrosis, patients with respiratory infections but without cystic fibrosis, and patients with neither cystic fibrosis nor respiratory infections were biotyped . Biotype I of H influenzae were found significantly more often in patients with cystic fibrosis compared with those with normal respiratory tracts . On the other hand, biotype II strains of H influenzae were found less often in the cystic fibrosis group . Half of the biotype V strains produced beta-lactamase. J Clin Invest, 1985 Jul, 76(1), 52 - 9 Immunogens consisting of oligosaccharides from the capsule of Haemophilus influenzae type b coupled to diphtheria toxoid or the toxin protein CRM197; Anderson P et al.; Haemophilus influenzae type b (Hib) capsular polysaccharide (PRP) was selectively hydrolyzed to reducing oligosaccharides, and the fraction containing 3-10 ribosylribitolphosphate repeating units (VS) was conjugated by reductive amination to diphtheria toxin (DTx), its nontoxic derivative CRM197 (Dcr), or diphtheria toxoid (DTd) . Conjugate DTx-VS retained approximately 1% of native toxicity, which was eliminated by treatment with formalin . Immunization of rabbits with the conjugates elicited antibody (Ab) to PRP and to DTx but not to a model for the linkage determinant . Human adults given single subcutaneous injections had rises in serum Ab to PRP and in bactericidal activity in vitro; the Ab protected infant rats challenged with Hib . Adults had rises also in Ab to DTd, and these Ab protected rabbits against DTx . A series of two injections of the conjugates Dcr-VS and DTd-VS was tested in infants beginning at 19-23 mo of age . Rises in anti-PRP Ab after the primary resembled the rises after PRP vaccine . In contrast to PRP, the conjugates elicited large rises after the secondary vaccinations and a substantial IgG component . Development of bactericidal activity paralleled the rises in anti-PRP Ab . Secondary rises after Dcr-VS were higher than after DTd-VS . In infants 12-16 mo of age, Dcr-VS (but not DTd-VS) elicited strong primary and secondary Ab responses that included IgG and bactericidal activity . Both conjugates produced consistent rises in Ab to DTd. Pediatrics, 1985 Jul, 76(1), 26 - 8 Bacterial etiology of conjunctivitis-otitis media syndrome; Bodor FF et al.; Simultaneous cultures of conjunctivae and middle ear exudates were obtained from 20 episodes of the syndrome of purulent conjunctivitis and otitis media . Paired cultures from 18 episodes yielded Haemophilus influenzae at both sites . In two cases with prior topical antibacterial therapy of the conjunctivitis, H influenzae was isolated from the middle ear exudate only . Biotyping and outer membrane protein analysis of H influenzae isolates from five patients demonstrated that: conjunctival and middle ear strains were concordant in all cases, and all five patients had different strains . The conjunctivitis-otitis media syndrome is most often caused by strains of nontypable H influenzae of diverse clonotype. J Infect Dis, 1985 Jul, 152(1), 4 - 13 Phagocytosis and killing of common bacterial pathogens of the lung by human alveolar macrophages; Jonsson S et al.; To investigate factors that determine susceptibility of the lungs to infection with common respiratory pathogens, we studied phagocytosis and killing of nontypable Haemophilus influenzae, H . influenzae type b, Streptococcus pneumoniae types III, VI, and XIV, an unencapsulated variant of S . pneumoniae type III, and Staphylococcus aureus Cowan I, by using human alveolar macrophages obtained by bronchoalveolar lavage of healthy nonsmokers . After opsonization with 10% pooled human serum, mean uptake (+/- standard deviation) of nontypable H . influenzae (67.5% +/- 15.0%), unencapsulated S . pneumoniae type III (71.2% +/- 4.8%) and S . aureus (79.1% +/- 10.2%) was significantly greater (P less than .01) than that of H . influenzae type b (40.1% +/- 15.0%), and S . pneumoniae types III (4.4% +/- 3.1%), VI (11.8% +/- 9.6%), or XIV (8.7% +/- 7.0%) . Nontypable H . influenzae was ingested after opsonization with much less pooled human serum than was H . influenzae type b, and uptake of encapsulated S . pneumoniae was not enhanced by as much as 80% pooled human serum . Intracellular killing of unencapsulated S . pneumoniae type III and nontypable H . influenzae was rapid and complete and corresponded to the degree of phagocytosis, but despite a high uptake, S . aureus were killed slowly and incompletely . The virulence of S . pneumoniae and H . influenzae as lung pathogens is thus determined jointly by encapsulation and the inadequate opsonizing effect of normal human serum, whereas that of S . aureus may be related to the organism's relative resistance to intracellular killing by alveolar macrophages. J Pediatr, 1985 Jul, 107(1), 129 - 33 A prospective randomized comparison of cefotaxime vs ampicillin and chloramphenicol for bacterial meningitis in children; Jacobs RF et al.; Fifty children with bacterial meningitis were prospectively randomized to receive cefotaxime (50 mg/kg/dose every 6 hours) or ampicillin and chloramphenicol in standard doses . Twenty-three patients received cefotaxime and 27 received standard therapy . Bacterial isolates included: Haemophilus influenzae (29), Streptococcus pneumoniae (eight), Neisseria meningitidis (eight), group B streptococci (three), and Salmonella enteritidis (two) . Ten (34%) of the H . influenzae isolates were resistant to ampicillin, nine on the basis of beta-lactamase production . All strains were susceptible to cefotaxime . Clinical cure rates for the cefotaxime (100%) and standard therapy (96%) groups were similar; survival without detectable sequelae was similar, at 78% and 77%, respectively . The duration of therapy, 11.1 +/- 2.4 days (range 10 to 21 days) vs 11.9 +/- 3.9 days (range 10 to 21 days), and days to defervescence, 4.7 +/- 2.6 days (range 1 to 14 days) vs 5.6 +/- 2.9 days (range 2 to 17 days), were similar in the cefotaxime and standard therapy groups, respectively . No adverse drug reactions or side effects were noted in either group . Cefotaxime was found to be as safe and effective as standard therapy for the treatment of bacterial meningitis in children. Pediatr Infect Dis, 1985 Jul-Aug, 4(4), 379 - 82 Increased susceptibility to infection in hypothermic children: possible role of acquired neutrophil dysfunction; Clardy CW et al.; The addition of hypothermia to regimens to control cerebral edema in children at our institution has been associated with a substantial incidence of infectious complications . Of the 13 children maintained at 30 degrees C to prevent cerebral edema, 3 developed Haemophilus influenzae pneumonia and 2 developed Streptococcus pneumoniae sepsis (one with pneumonia) . The importance of neutrophil (PMN) function for elimination of bacterial pathogens prompted in vitro studies of PMN function at clinically attainable hypothermic temperatures . Neutrophils at 30 degrees C had significantly less ability to migrate towards a chemotactic stimulus (45 +/- 10% inhibition; P less than 0.02), to ingest staphylococci (22 +/- 5% inhibition; P less than 0.01) and to be metabolically activated as measured by superoxide production (35 +/- 10% inhibition; P less than 0.01) or by chemiluminescence (18 +/- 8% inhibition; P less than 0.05) . These in vitro findings support the clinical observation that persons with decreased body temperature may be at an increased risk for bacterial infections secondary to PMN dysfunction. Zh Mikrobiol Epidemiol Immunobiol, 1985 Jul, (7), 10 - 3 {IgA protease activity of microbes in the genus Bordetella}; Shakirova RG et al.; Monoclonal IgA paraproteins of subclasses 1 and 2, isolated from the sera of myeloma patients, were incubated for 4, 24, 48 and 72 hours with B . pertussis, B . parapertussis, B . bronchiseptica cultures, as well as Haemophilus influenzae strain . The fragmentation of IgA was studied by immunielectrophoresis with antisera to alpha-chain, to Fab alpha + Fc alpha, to Fab alpha and with antisera to light chains corresponding to the type of paraprotein . B . pertussis and B . parapertussis were found to have subclass-unspecific IgA protease which splitted off a cathode fragment, similar to Fab-fragment and, probably, corresponding to the variable domain of alpha-chain (Fv), after 48-hour incubation . Similar IgA protease was detected in H . influenzae, found to have classical IgA1 protease as well . All Bordetella species under study splitted off anode components from IgA paraproteins of both subclasses . These components, containing the determinants of heavy and light IgA chains, were either IgA - alpha I-antitrypsin complexes or some IgA fragments with high electrophoretic motility . None of the strains under study splitted monoclonal IgG. Infect Immun, 1985 Jul, 49(1), 98 - 103 Frequency and properties of naturally occurring adherent piliated strains of Haemophilus influenzae type b; Mason EO Jr et al.; We found that 41 of 75 (55%) children with Haemophilus influenzae type b disease (70 cases of meningitis, 2 of cellulitis, 2 of septic arthritis, and 1 of epiglottitis) and 2 of 120 (1.7%) children with upper respiratory infection were colonized with H . influenzae type b in the nasopharynx (NP) . Of these 43 NP strains from children with systemic H . influenzae type b disease, 7 (16%) adhered to human buccal epithelial cells . The strains isolated from the systemic site of all children, including children from whose NP adherent bacteria were isolated, did not adhere to buccal epithelial cells in vitro . Each adherent NP strain had biotype (I), serotype (b), and antibiotic susceptibility (sensitive) similar to that of the corresponding nonadherent systemic isolate . With one exception, all NP-systemic pairs had similar major outer membrane proteins . Six of the seven NP strains had a protein band in the whole cell lysate preparation with a molecular weight between 22,000 and 23,000, which could not be seen in the nonadherent cerebrospinal fluid strains . Electron micrographs of all adherent strains showed that more than 95% of the organisms examined were highly piliated, whereas the nonadherent strains were not piliated . All piliated strains agglutinated human erythrocytes . Adherence to buccal epithelial cells and agglutination of erythrocytes could not be blocked by mannose or alpha-methyl-D-mannoside . We speculate that piliation is not important for NP colonization by H . influenzae type b and that the loss of pili may be required for host invasion. JAMA, 1985 Jun 28, 253(24), 3559 - 63 Seven days of ceftriaxone therapy is as effective as ten days' treatment for bacterial meningitis; Lin TY et al.; Seventy-nine children were enrolled in a study to compare seven vs ten days of ceftriaxone therapy for bacterial meningitis . On the basis of a computer-generated list of therapy assignments, 35 children with Haemophilus, pneumococcal, or group B streptococcal meningitis each were assigned to seven- or ten-day treatment regimens; nine children with meningococcal meningitis received seven days of therapy . The population characteristics and etiologic agents were similar for the two treatment groups, as were also the findings on examination and culture of cerebrospinal fluid at completion of therapy . There were no significant differences in the frequency and types of neurological complications between the two treatment groups; four patients in each group had two or more neurological abnormalities . The rates of nosocomial infections and prolonged and secondary fever were similar in those who received seven days of therapy compared with patients treated for the conventional ten days . Diarrhea occurred in 44% of those receiving the drug . Patients treated with the seven-day regimen were discharged from the hospital approximately two days earlier than those with the ten-day regimen. N Z Med J, 1985 Jun 26, 98(781), 494 - 7 Treatment of pneumonia with imipenem/cilastatin; Beasley CR et al.; This pilot study assessed the efficacy, safety and tolerance of intravenously administered imipenem/cilastatin in the treatment of adults hospitalised with community acquired pneumonia . Thirteen patients were treated with 500 mg imipenem and 500 mg cilastatin eight hourly for a minimum of five days . Eleven patients (85%) had a clinical cure; (Legionella pneumophila was the pathogen in four, Streptococcus pneumoniae in one, Branhamella catarrhalis in one, no pathogen identified in five) . One patient had a partial response (Staphylococcus aureus); and one patient was a treatment failure (Haemophilus influenzae and Klebsiella ozaenae) . Clinical and laboratory side effects were mild, reversible and did not require treatment to be stopped . We conclude that the combination of imipenem and cilastatin was effective as a single agent in the treatment of the majority of these patients with hospital referred community acquired pneumonia. J S Afr Vet Assoc, 1985 Jun, 56(2), 97 - 8 Thromboembolic meningoencephalitis diagnosed in Natal; Kitching JP et al.; Nine feedlot cattle showed clinical signs consistent with those expected in thromboembolic meningoencephalitis . These signs included pyrexia, ataxia, posterior paresis, paralysis and coma . Brown necrotic foci with haemorrhagic borders were observed in the brains of three animals that had died . In these foci vasculitis, thrombosis, infarction and neutrophil infiltration were observed during microscopical examination . Haemophilus somnus was isolated in pure culture from the brains. Eur J Clin Microbiol, 1985 Jun, 4(3), 268 - 72 Etiology of community-acquired pneumonia in patients requiring hospitalization; Berntsson E et al.; The etiology of community-acquired pneumonia was studied in 127 patients with roentgenologically verified pneumonia who needed hospitalization . Etiology was determined on the basis of a positive blood culture and/or a significant antibody titer increase . Streptococcus pneumoniae was the probable etiological agent in 69 patients, nontypeable Haemophilus influenzae in five patients, Streptococcus pyogenes in two patients, and Legionella pneumophila and Staphylococcus aureus in one patient each . Evidence of Mycoplasma pneumoniae infection was found in 18 patients and of Chlamydia psittaci infection in three patients . Influenza virus type A was the cause of infection in 15 patients . One patient had infection with influenza virus type B, one patient with parainfluenza virus type 1, and three patients with respiratory syncytial virus . In 20 patients there was evidence of infection with more than one microorganism . No etiological agent was found in 27 patients . Since Streptococcus pneumoniae was the predominant etiological agent penicillin should be drug of first choice in patients with pneumonia who need treatment in hospital . In young adults, however, the high frequency of Mycoplasma pneumoniae infection would justify the use of erythromycin or doxycycline as drug of first choice. J Pediatr, 1985 Jun, 106(6), 907 - 12 Spontaneous bacterial peritonitis in children with chronic liver disease: clinical features and etiologic factors; Larcher VF et al.; We analyzed the clinical and bacteriologic features of 12 episodes of spontaneous bacterial peritonitis (SBP) in 11 children (four boys, median age 5.5 years) with chronic liver disease . All patients had cirrhosis and ascites; four had hypersplenism, and one was asplenic . Symptoms included increasing abdominal distention, pyrexia, abdominal pain, gastrointestinal disturbance, and encephalopathy . Nine had rebound tenderness on abdominal palpation, and 12 had reduced bowel sounds . The most frequent organisms isolated from culture of ascitic fluid were Streptococcus pneumoniae (nine) . Klebsiella (two), and Haemophilus influenzae (one); blood cultures grew identical organisms in nine . Seven patients died despite intensive antibiotic therapy . In the 3 months prior to onset of SBP, defective yeast opsonization and reduced serum concentration of C4 were found in all nine children tested; eight had reduced concentration of C3 . Functional deficiency of all complement components was present in four tested within 1 to 5 months of the onset . In contrast, only eight of 59 cirrhotic children without SBP had low C3, and eight had defective yeast opsonization, although 35 had low C4 values . Four of the patients with SBP and low C3 and C4 concentrations had normal concentrations at the time of diagnosis of liver disease 2 to 5 years previously . Opsonization of type III pneumococci was reduced in sera from three patients who subsequently developed pneumococcal peritonitis . The incidence of SBP in children with chronic liver disease is similar to that in adults, as are the clinical features . Our observations suggest that complement deficiency induced by chronic liver disease may be important in the pathogenesis of SBP. Vet Microbiol, 1985 Jun, 10(4), 393 - 7 Biochemical and serological identification of strains of Haemophilus pleuropneumoniae; Lombin LH et al.; Eighteen field isolates of Haemophilus pleuropneumoniae were studied biochemically and serotyped using the complement fixation test (CFT), agglutination test and the immunodiffusion test . Three biochemical tests (V-dependency, CAMP-reaction and urease activity) were found to be very useful for the biochemical characterization of the H . pleuropneumoniae . Haemolysis on blood agar plates, although present, was not sufficiently pronounced in all cases to warrant absolute dependence on this characteristic . Serological typing revealed the isolates belong to Serotypes 1 and 5 . The immunodiffusion test proved to be the most serotype specific, while a marked cross-reaction was observed with the CFT. J Clin Invest, 1985 Jun, 75(6), 1935 - 42 Correlation between G2m(n) immunoglobulin allotype and human antibody response and susceptibility to polysaccharide encapsulated bacteria; Ambrosino DM et al.; To determine whether genetic factors influence the human antibody response to polysaccharides, we correlated Ig allotypes with the concentrations of antibody to 14 bacterial capsular antigens in 130 actively immunized Caucasian adults . The 88 individuals possessing G2m(n), an allotype antigen of IgG2 subclass heavy chains, had significantly higher postimmunization antibody levels to Haemophilus influenzae type b (Hib) and 8 of 11 pneumococcal types (P less than 0.05) than the 42 lacking this antigen . For Hib, pneumococcus type 14, and meningococcus group C, an increased response was observed in IgG class but not in IgM or IgA classes of antibody . The G2m(n) positive individuals also had higher preimmunization antibody levels to most polysaccharide antigens . Total IgG2 concentrations were correlated with the mean postimmunization antibody concentrations to pneumococci (P = 0.005), but this correlation was independent of G2m(n) by multiple regression analysis . To determine if the lack of G2m(n) was associated with increased susceptibility to infection, we compared the frequencies of various Ig allotypes in 98 children infected with Hib and 98 matched controls . Caucasian children with Hib infections other than epiglottitis were significantly more likely to lack the G2m(n) allotype than controls (P less than 0.05) . G2m(n) negative Caucasian children less than or equal to 18 mo old have a 5.1-fold higher risk of nonepiglottitic Hib infections than G2m(n) positive children (P less than 0.01) . We conclude that allotypic variants of the gamma-2 heavy chain genes, or genes in linkage equilibrium with them, exert a regulatory influence on the caucasian antibody response to a variety of immunologically distinct bacterial polysaccharide antigens . Young Caucasian children of the low responder phenotype, i.e., those lacking the G2m(n) allotype, are genetically predisposed to Hib and perhaps other bacterial infections. Pathol Biol (Paris), 1985 Jun, 33(5 Pt 2), 557 - 63 {Evaluation of the sensitivity of Haemophilus to antibiotics by the modified API-ATB system}; Bourlioux P et al.; A simple micromethod in a liquid medium using the API-ATB system was developed for testing the susceptibility of Haemophilus to antibiotics . To evaluate this method, 50 strains, including 12 beta-lactamase producers, were studied . Results were compared to those obtained using MIC determination in a liquid medium (reference) and an agar diffusion method (routine) . For all three techniques, a Mueller-Hinton medium enriched in hemoglobin and NAD was used, and cultures were incubated at 37 degrees C for 24 hours in normal atmosphere . Influence of the inoculum on results was evaluated using the API-ATB method for all antibiotics and MIC determination for ampicillin; the optimal inoculum was found to be 8.10(5) CFU/ml . Beta-lactamase was looked for using the chromogen cephalosporin test associated with the API-ATB system . Values of MICs for the various antibiotics were consistent with previous reports . Paired comparison of techniques showed a 5.3% disagreement rate between API-ATB and MIC, with only 0.5% major discrepancies; in contrast, the disagreement rate exceeded 10% when disk diffusion was compared with the two other techniques . We conclude to the reliability and reproducibility of the API-ATB method which seems capable of improving current routine evaluations of the susceptibility of Haemophilus to antibiotics. Drug Intell Clin Pharm, 1985 Jun, 19(6), 415 - 20 Amoxicillin-potassium clavulanate: a novel beta-lactamase inhibitor; Smith BR et al.; Potassium clavulanate is a novel beta-lactamase inhibitor, which, in combination, expands the spectrum of amoxicillin to include many amoxicillin-resistant organisms . Potassium clavulanate is excreted 30-50 percent unchanged renally and its plasma time-course parallels that of amoxicillin . Several studies suggest that an increased incidence of gastrointestinal side effects may occur with this combination . In the current oral formulation, its greatest utility may be in pediatric infections due to beta-lactamase-producing Haemophilus influenzae and B . cattarhalis . In adults, the combination has not been adequately studied against other effective antibiotics. Jpn J Antibiot, 1985 Jun, 38(6), 1685 - 92 {In vitro antimicrobial activity of various antibiotics against Haemophilus influenzae isolated from clinical specimens in 1983}; Matsuo K et al.; In vitro susceptibilities of 73 strains of Haemophilus influenzae isolated from clinical specimens in 1983 to various antibiotics were studied . The following antibiotics were evaluated; ampicillin (ABPC), piperacillin (PIPC), cefotaxime (CTX), cefoperazone (CPZ), ceftizoxime (CZX), cefmenoxime (CMX), latamoxef (LMOX), tetracycline (TC), doxycycline (DOXY), minocycline (MINO), chloramphenicol (CP) and erythromycin (EM) . Susceptible strains to ABPC and PIPC with MICs less than 3 micrograms/ml were 80.3 and 84.1%, respectively . With this break point of MIC, all strains showed susceptibility to CPZ, CZX, and CMX, but resistant strains were observed in 1.5% against CTX and LMOX . Susceptible strains to TC, DOXY and MINO at MICs less than 2 micrograms/ml were 86.3, 80, and 87.7%, respectively . Those to CP at MICs less than or equal to 4 micrograms/ml and to EM at MICs less than or equal to 1 microgram/ml were 86.2 and 71.9%. Acta Pathol Microbiol Immunol Scand {B}, 1985 Jun, 93(3), 175 - 9 Subtyping of Danish Haemophilus influenzae type B by their 45000 and 46000 molecular weight proteins; Honberg PZ; In order to obtain a way of subtyping Haemophilus influenzae type b strains, outer-membrane protein patterns were investigated . Outer-membrane proteins from 45 different Haemophilus influenzae type b strains were examined by sodium dodecyl sulfate polyacrylamide gel electrophoresis . The non-heated sarkosyl insoluble outer-membrane preparations all contained four major proteins with molecular weights (Mr) of 39,000, 33,000, 30,000, and 28,000, except for one strain which possessed a protein weighing approximately 32,000 . After heating the samples a 45,000 Mr protein appeared in 43 of the strains, and a 46,000 Mr in two . The 39,000 Mr protein remained unchanged, whereas the 33,000 Mr protein disappeared . The 30,000 and the 28,000 Mr proteins became more clearly separated . A faint 16,000 Mr band was observed in both heated and non-heated samples . 42 strains with the light heat-modified protein band had identical protein patterns and could not be subdivided by the methods used and may therefore constitute a clone . The remaining strains had individual patterns. Vaccine, 1985 Jun, 3(2), 103 - 8 Enhancement of immunogenic activity of ribosomal preparations from Haemophilus influenzae by various adjuvants; Cabrera-Contreras R et al.; Ribosomes from Haemophilus influenzae type b have been reported to have immunoprotective activity in animals that can be enhanced by adjuvants . In this report we evaluated the adjuvant activity of several compounds in conjunction with ribosomes from the b and c serotypes of H . influenzae . Alhydrogel, saponin, and DPT were found to significantly enhance the immunoprotective response in mice, equalling or exceeding the activity of Freund's incomplete adjuvant . All of these adjuvants also enhanced significantly the IgM response of mice to sheep red blood cells . Ribosomes were also found to enhance this response . Among the compounds failing to provide adjuvant activity for ribosomes were poly(A:U), muramyl dipeptide, mycobacterial extract, dimethylglycine, methylated bovine serum albumin, sodium diethylthiocarbamate, and cetyltrimethylammonium bromide. Antimicrob Agents Chemother, 1985 Jun, 27(6), 912 - 5 Amoxicillin-clavulanic acid in the treatment of lower respiratory tract infections caused by beta-lactamase-positive Haemophilus influenzae and Branhamella catarrhalis; Wallace RJ Jr et al.; Twenty-one adult patients hospitalized with lower respiratory tract infections due to Branhamella catarrhalis or Haemophilus influenzae or both were treated with the combination of oral amoxicillin and potassium clavulanate (Augmentin) in an open, noncomparative clinical trial . Diseases included pneumonia, empyema, and exacerbations of bronchiectasis and chronic lung disease . Thirteen of 16 B . catarrhalis and six of nine H . influenzae isolates were beta-lactamase positive . The patients with B . catarrhalis were treated for a mean of 5.3 days, and those with H . influenzae were treated for a mean of 7.0 days . The overall response to therapy was excellent, with 18 of 19 beta-lactamase-producing strains eradicated on therapy . One patient secondarily infected with Pseudomonas aeruginosa was a clinical failure, and two patients with H . influenzae who became culture positive again after therapy were considered microbiologic failures . Gastrointestinal side effects (especially nausea) were common, although all patients completed a course of therapy . Sputum levels of amoxicillin were surprisingly low (less than 0.05 to 0.54 micrograms/ml), a finding which may explain the high relapse rate (22%) seen with H . influenzae, as these are below the usual MICs of amoxicillin for this organism . The combination of amoxicillin plus potassium clavulanate appears to be an excellent drug for treatment of beta-lactamase-producing strains of these two species, although mild gastrointestinal side effects are common. Eur J Clin Microbiol, 1985 Jun, 4(3), 310 - 5 Method for testing adherence of Haemophilus influenzae to human buccal epithelial cells; Porras O et al.; A method for testing adherence of Haemophilus influenzae strains to buccal mucosal cells is described . Bacteria grown in broth for 4 h were mixed with buccal mucosal cells . After elimination of unattached bacteria by repeated cycles of centrifugation and resuspension in PBS, the number of attached bacteria was counted microscopically . Optimal results were obtained with an early log-phase bacterial culture at a concentration of 10(9) bacteria/ml mixed with 2 X 10(4) cells/ml and incubated at 37 degrees C for 60 min . This assay showed an at least ten times higher rate of adherence for Haemophilus influenzae than previous studies . Nontypeable strains attached in higher numbers than strains with the type b capsule . Adherence was related to the frequency of nontypeable strains rather than to the site of isolation or type of infection . Thus all the isolates from middle ear fluid were nontypeable, and all but one adhered . The results suggest a difference in virulence mechanisms between type b and nontypeable Haemophilus influenzae strains. J Clin Microbiol, 1985 Jun, 21(6), 899 - 901 Preparation of urine samples for use in commercial latex agglutination tests for bacterial antigens; Weinberg GA et al.; The use of latex agglutination (LA) tests for bacterial antigen detection in urine specimens is hindered by troublesome reactions such as nonspecific agglutination . Therefore, procedures such as boiling or membrane filtration of urine specimens are often used before LA testing . We discovered that the composition of the membrane filter used in filtration has a marked effect on the performance of an LA test used for detection of Haemophilus influenzae type b antigen . False-positive LA reactivity was common in urine specimens from pediatric patients that were processed by membrane filtration through certain filters; furthermore, such reactivity also occurred in LA tests for antigens other than those of H . influenzae . A protein present in urine at low concentrations appeared to be responsible for these phenomena. South Med J, 1985 Jun, 78(6), 759 - 60 Haemophilus influenzae endocarditis; Blair TP et al.; Haemophilus influenzae endocarditis on a prosthetic valve has previously been reported only once . Routine physical and laboratory evaluation does not distinguish endocarditis from this organism from other causes of endocarditis . Our patient with prosthetic mitral valve endocarditis was successfully treated with antibiotics, but surgery was subsequently required for congestive heart failure from valve dehiscence. South Med J, 1985 Jun, 78(6), 643 - 6 Beta-lactamase-positive strains of Haemophilus influenzae: susceptibility to and inactivation of beta-lactam antibiotics; Anderson EL et al.; Susceptibility and time-kill studies were done with low and high inocula of both beta-lactamase-positive and -negative strains of Haemophilus influenzae with cefamandole, ampicillin, cefoperazone, mezlocillin, moxalactam, and ceftriaxone . Bioassay was done to test for antibiotic inactivation by beta-lactamase-positive strains . All six antibiotics were highly active against the low inoculum (10(4) to 10(5) colony-forming units/ml) of beta-lactamase-negative strains; ceftriaxone, moxalactam, and cefoperazone were equally active against the same inoculum concentration of beta-lactamase-positive strains . In contrast, cefamandole, mezlocillin, and ampicillin were less active against the low inoculum of beta-lactamase-positive H influenzae . A marked inoculum effect occurred with the high inoculum (10(7) to 10(8) CFU/ml) with all six antibiotics, regardless of beta-lactamase production . In time-kill studies, marked differences in bacterial killing resulted after low and high inocula . Ampicillin, cefamandole, cefoperazone, and mezlocillin were rapidly inactivated by the high inoculum of beta-lactamase-positive H influenzae. Jpn J Antibiot, 1985 Jun, 38(6), 1638 - 42 {Serum levels and sputum levels of cefmenoxime in respiratory tract infections}; Matsumoto Y et al.; In 11 patients with respiratory tract infections, the concentrations of cefmenoxime (CMX) in serum and sputum after 1 hour intravenous administration of 2 g of CMX were investigated . The peak serum level of CMX was 102.2 +/- 11.4 micrograms/ml after 1 hour drip infusion, then declined and was 3.51 +/- 0.55 micrograms/ml after 5 hours . Sputum level of CMX was lower than serum level but it was able to cover enough for MIC of Haemophilus influenzae, Klebsiella pneumoniae, Escherichia coli, Streptococcus pneumoniae and the peak sputum level of CMX was 0.77 +/- 0.17 micrograms/g after from 2 hours to 4 hours . Among the 11 patients with respiratory tract infections, 2 patients showed excellent, 6 patients good, 3 patients poor results (isolated organisms of sputum were normal flora) and no side effects observed. Proc Natl Acad Sci U S A, 1985 Jun, 82(11), 3731 - 5 Processing of donor DNA during Haemophilus influenzae transformation: analysis using a model plasmid system; Pifer ML et al.; A plasmid system was used to investigate the processing of donor DNA during transformation of competent Haemophilus influenzae . Using biochemical and genetic methods, we have determined that portion of a donor plasmid molecule that, on average, can become integrated into a homologous recipient plasmid during transformation . Our results show that (i) transformation efficiency decreases linearly with donor DNA length over the range of 11 to 3.5 kilobase pairs, (ii) transformation efficiency decreases exponentially with size for donor molecules less than 3.5 kilobase pairs in length, and (iii) 5'-end label, but not 3'-end label, can be specifically incorporated into the resident homologous region . We present a model for donor processing during entry that encompasses and explains these observations. J Infect Dis, 1985 Jun, 151(6), 1061 - 72 Molecular epidemiology of plasmid-mediated ampicillin resistance in Haemophilus influenzae type b isolates from Alaska; Mendelman PM et al.; Native Alaskans have a high incidence of disease caused by invasive Haemophilus influenzae type b and represent an isolated population for epidemiological study . We used plasmid DNA analysis and subtyping of outer membrane proteins as markers to characterize 29 ampicillin-resistant, invasive strains and seven ampicillin-resistant, noninvasive strains of this organism from distinct geographic regions . All 36 strains produced beta-lactamase; 34 strains transferred resistance by conjugation . Seven of the 36 strains harbored detectable plasmid DNA: four had a molecular mass of 40 MDa, and three had a molecular mass of 3 MDa . Furthermore, 20 transconjugants had a similar large plasmid, and four had a similar small plasmid . Ten of 12 transconjugants with either the large, small, or undetectable plasmid DNA were able to retransfer resistance . Transformation of resistance was successful with two large plasmids . DNA-DNA hybridization studies revealed that 33 of 36 strains had DNA homology . Restriction endonuclease digestion of 10 large plasmids revealed five patterns; identity was evident within a geographic region, and similarity existed between regions . Seven restricted plasmids demonstrated an identical pattern with a small beta-lactamase probe . Ampicillin resistance in these isolates from Alaska is primarily due to a common, 40-MDa conjugative plasmid that mediates beta-lactamase production, a finding which differs from that for ampicillin-resistant plasmids isolated elsewhere in the United States . Despite variable outer membrane protein profiles of the distinct strains of H . influenzae type b, the plasmids shared significant DNA homology . It appears that a common genetic element was responsible for the dissemination of this phenotype for resistance in Alaska. J Bacteriol, 1985 Jun, 162(3), 918 - 24 Transmembrane permeability channels across the outer membrane of Haemophilus influenzae type b; Vachon V et al.; Outer membranes of Haemophilus influenzae type b were fractionated to yield Triton X-100-insoluble material and lipopolysaccharide and phospholipids . Liposomes reconstituted from lipopolysaccharide and phospholipids were impermeable to sucrose (Mr, 342) and to a high-molecular-weight dextran (average Mr, 6,600) . When the Triton X-100-insoluble material was introduced into the reconstituted liposomes, the vesicles became permeable to sucrose, raffinose (Mr, 504), and stachyose (Mr, 666) and fully retained dextrans of Mr greater than 1,500 . Inulin (average Mr, 1,400) was tested for its efflux from the reconstituted outer membrane vesicles; 62% of the added inulin was trapped . The molecular weight exclusion limit for the outer membrane of H . influenzae type b was therefore estimated at approximately 1,400 . A protein responsible for the transmembrane diffusion of solutes was purified from H . influenzae type b by extraction of whole cells with cetyl trimethyl ammonium bromide . When this extract was passed over DEAE-Sepharose, three protein-containing peaks (I, II, and III) were eluted . Peaks I and II contained mixtures of proteins as determined by sodium dodecyl sulfate-polyacrylamide gel electrophoresis; when tested for their pore-forming properties, these proteins were unable to render liposomes of lipopolysaccharide and phospholipid permeable to sucrose . Peak III contained only one molecular species of protein of molecular weight 40,000; this protein acted as a porin in reconstituted vesicles . The molecular weight exclusion limit for 40,000-molecular-weight protein matched the estimate of approximately 1,400 which was determined for outer membranes . A series of homologous saccharides of increasing degree of polymerization was prepared from agarose by hydrolysis with beta-agarase and fractionation on gel filtration chromatography . These oligosaccharides of Mr, 936, 1,242, 1,548, and 1,854 were assayed for retention by the complete vesicles containing 40-kilodalton protein and lipopolysaccharide and phospholipids . All of these oligosaccharides were lost by efflux through the porin . Since the molecular conformation of the largest oligosaccharide is an elongated semirigid helix, it is suggested that the pore formed by the 40-kilodalton protein does not act as a barrier to the diffusion of this compound. Lancet, 1985 May 25, 1(8439), 1184 - 6 Antibody levels achieved in infants by course of Haemophilus influenzae type B polysaccharide/diphtheria toxoid conjugate vaccine; Eskola J et al.; A Haemophilus influenzae type b (Hib) capsular polysaccharide (polyribosylribitol phosphate, PRP)/diphtheria toxoid (D) conjugate vaccine was given to 71 infants . The level of anti-PRP antibody believed to predict long-term protection, 1.0 microgram/ml, was reached in 50% of the infants who were vaccinated at 3, 5, and 7 months, and in 57% of the infants who received PRP-D at 7 and 9 months of age . A lower level of antibody, 0.15 micrograms/ml, which has been associated with protection at the time of assay, was reached in 92% and 87% of the two groups . Thus, the seroresponse was dependent upon both the frequency of immunisation and age of the infant . Comparison of these results with previous experience with PRP immunisation in Finland showed that PRP-D induced substantial antibody rises at an earlier age than did PRP. J Clin Lab Immunol, 1985 May, 17(1), 45 - 8 NBT-reduction for detection of specific, opsonizing antibodies against haemophilus parainfluenzae; Julander I et al.; Specific, opsonizing antibodies against Haemophilus parainfluenzae were demonstrated in serum by measuring their enhancing effect on the nitroblue tetrazolium (NBT)-reduction of normal human granulocytes, phagocytizing the homologous bacteria . Patients with septicemia and/or endocarditis and carriers of H . parainfluenzae were studied . In late phase sera of the first group such antibodies were detected in 6 of 9 cases . Opsonizing antibodies against H . parainfluenzae were not detected in any of the carrier sera . A dose-response effect was observed when a positive late phase serum was tested in serial 2-fold dilutions . The enhancement of the NBT-reduction was eliminated by absorption of serum with homologous antigen . The detection of opsonizing antibodies, essential for the immune defense against H . parainfluenzae might be helpful for evaluation of the pathogenicity of this organism, which so far is considered as a rare causative agent. Pediatrics, 1985 May, 75(5), 819 - 26 Comparative treatment trial of augmentin versus cefaclor for acute otitis media with effusion; Odio CM et al.; A total of 150 children with acute otitis media were randomly allocated to treatment with amoxicillin-potassium clavulanate (Augmentin) or with cefaclor . Each drug was given in a daily dosage of approximately 40 mg/kg in three divided doses for ten days . Tympanocentesis done before treatment yielded specimens that contained pneumococcus or Haemophilus sp or both in 67% of specimens . Viridans group streptococci were isolated from 10% of specimens and Branhamella catarrhalis from 6% . Patients were scheduled for follow-up examinations at midtreatment, end of therapy, and at 30, 60, and 90 days . Of the 150 children, 130 were evaluable . Five of 60 patients (8%) treated with cefaclor were considered therapeutic failures because of persistent purulent drainage and isolation of the original pathogen or suprainfection . There were no failures among patients treated with Augmentin (P = .019) . Rates of relapse, recurrent acute otitis media with effusion, and persistent middle ear effusion were comparable in the two groups of patients . Diaper rash, or loose stools, or both were significantly more common in children treated with Augmentin (34%) than in those taking cefaclor (12%), but in no case was it necessary to discontinue medication because of these mild side effects (P = .002) . Cefaclor therapy was discontinued in one patient because of severe abdominal pain and vomiting . In this study, treatment with Augmentin was superior to treatment with cefaclor in the acute phase of acute otitis media with effusion, but Augmentin produced more adverse effects . The rates of persistent middle ear effusion and recurrent acute otitis media with effusion were comparable with the two regimens. Am J Vet Res, 1985 May, 46(5), 1185 - 91 Lesions induced in the respiratory tract of chickens by encapsulated or nonencapsulated variants of Haemophilus paragallinarum; Sawata A et al.; Lesions induced in chickens by an encapsulated or nonencapsulated strain of Haemophilus paragallinarum were investigated . In terms of lesion severity, major differences in pathogenicity were observed between the encapsulated and nonencapsulated variants . The principal lesion manifested by the encapsulated variant was an acute catarrhal inflammation of the upper respiratory tract, mainly of the nasal cavity and paranasal sinus . Infiltration of a large number of mast cells into the lamina propria of the mucous membrane of the nasal cavity was also characteristic . Numerous organisms were found on the cilia or on the surface of the epithelial cells of the nasal mucosa . Chickens with these histologic lesions had severe clinical signs of coryza, and organisms were recovered in high numbers from the nasal cavity and paranasal sinus . In contrast, chickens that were given the nonencapsulated variant did not have clinical signs of coryza, and the organisms were recovered in low numbers from the inoculated sites; slight histopathologic lesions were observed in the nasal mucosa at postinoculation day 1 . Mast cell infiltration in the chickens inoculated with the encapsulated variant indicated that mast cells may be responsible for producing clinical signs of coryza via the activation of pharmacologic mediators . Adherence to and colonization of the encapsulated variant on the nasal mucosa seems to be a first step of the infection. Pediatr Infect Dis, 1985 May-Jun, 4(3), 336 - 41 Skin and soft tissue infections: pharmacologic approaches; Blumer JL et al.; Skin and soft tissue infections are common infectious problems in pediatric practice . Recent clinical and pharmacologic evaluations of several new antimicrobial agents have shed new light on the pathogenesis and management of these infections . Staphylococcus aureus now appears to be the most common bacterial isolate in children with impetigo . In patients hospitalized because of skin and soft tissue infections, S . aureus and Haemophilus influenzae type b remain the predominant pathogens . Rational therapeutic approaches to these infections require a recognition of the interplay among the pharmacodynamic, pharmaceutic and pharmacokinetic determinants of effective antimicrobial therapy . Using this approach the therapeutic questions regarding "what drug," "what dose" and "how long to treat" can be approached . Drugs such as the aminopenicillin-beta-lactamase inhibitor combinations may offer rational outpatient therapeutic alternatives, while parenteral cefuroxime and ceftriaxone are more probably the drugs of choice for parenteral therapy . In an age when cost effectiveness must prevail, strategies using ceftriaxone for both inpatient and outpatient management may provide the safest and most cost-effective therapy. Pediatrics, 1985 May, 75(5), 827 - 31 Early detection of bacteremia in an outpatient clinic; Liu CH et al.; A total of 570 patients, aged less than 24 months, who were seen in the emergency room at Texas Children's Hospital for evaluation of acute febrile illness had a WBC count, differential count, and a blood culture obtained . Bacteremia occurred in 7.7% (n = 44) (22 Haemophilus influenzae; 17 Streptococcus pneumoniae; three Escherichia coli; one group B Streptococcus; one Staphylococcus aureus) . The sensitivity, specificity, and positive predictive value of morphologic changes (vacuolization and toxic granulation) of polymorphonuclear neutrophils (segmented neutrophils plus band cells), WBC count greater than or equal to 15,000/microL and band cells greater than or equal to 500/microL were examined . Additionally, abnormalities in three of four tests (WBC count greater than or equal to 15,000/microL, band cells greater than or equal to 500/microL, segmented neutrophils greater than or equal to 10,000/microL, and/or total polymorphonuclear neutrophils greater than or equal to 10,500/microL) were evaluated . Morphologic changes of polymorphonuclear neutrophils were noted frequently in patients with culture-proven bacteremia (63% and 51% positive predictive value for vacuolization and toxic granulation, respectively) and were more predictive of bacterial infection than traditional tests . If both vacuolization and toxic granulation were present, the positive predictive value increased to 76% . Examination of the peripheral blood smear may provide important adjunctive information for the presence of bacteremia prior to bacteriologic confirmation. Pathol Biol (Paris), 1985 May, 33(5), 435 - 9 {Antibiotic therapy of pneumopathies in intensive care and protected distal bronchial samples}; Laudat P et al.; Bacteriology was performed on 57 specimens collected by the Wimberley protected catheter bronchoscopy technique (PCB) from 42 ventilated patients with severe head trauma hospitalized in the neurosurgical intensive care unit to determine the etiology of their pneumopathy . All patients had a nasotracheal tube upon arrival at the intensive care unit . For each sample, smears were examined and cultures under aerobic and anaerobic conditions as well as with CO2 were performed . In 34 (59%) of the 57 cases, examination of smears allowed rapid diagnosis and appropriate chemotherapy . In 47 (82%) cases, culture was positive, with a single pathogen being recovered in half of cases . The most prevalent organisms among the 75 species isolated were S . aureus (38%), P . aeruginosa (15%), Klebsiella (12%), Haemophilus (8%), and Pneumococcus (9%) . Consistency with positive cultures of blood or pleural effusion samples was recorded in 92% of cases . Narrow spectrum antibiotic therapy can be chosen according to the results of PCB bacteriology and rapid automated antibiotic sensitivity testing obtained within 24 hours . PCB is therefore recommended in pulmonary infections in intensive care units. Tohoku J Exp Med, 1985 May, 146(1), 105 - 17 Invasion of Haemophilus influenzae and Pseudomonas aeruginosa in humans; Suzuki H et al.; Levels of serum IgG antibodies to somatic antigens of Haemophilus influenzae and Pseudomonas aeruginosa were determined in 127 healthy people, 37 patients with chronic bronchitis and 20 patients with bronchiectasis by enzyme-linked immunosorbent assay . The logarithmic mean titers of antibodies to Haemophilus influenzae and Pseudomonas aeruginosa were significantly higher in the patients with chronic bronchitis and bronchiectasis than in healthy people . The invasion rate of Haemophilus influenzae was identical in healthy people, chronic bronchitis and bronchiectasis, while that of Pseudomonas aeruginosa was significantly lower in healthy people than in chronic bronchitis and bronchiectasis patients . These results indicate that patients with chronic bronchitis and bronchiectasis may often have recurrence and are easily infected because of lowered defense mechanisms in the respiratory tract. J Clin Pathol, 1985 May, 38(5), 561 - 4 Evaluation of Bactigen latex agglutination and Phadebact coagglutination for detection of bacterial antigens in cerebrospinal fluid; Coovadia YM et al.; The Bactigen latex agglutination and Phadebact coagglutination tests were evaluated for their ability to detect bacterial antigens of Haemophilus influenzae type b, Streptococcus pneumoniae (83 serotypes) and Neisseria meningitidis groups A, B, C, and Y in 214 samples of cerebrospinal fluid (CSF) . Bactigen latex agglutination was more sensitive than Phadebact coagglutination: it detected 87% (59/68) of culture positive CSF specimens, whereas Phadebact detected 72% (52/72) . Bactigen detected all cases of meningitis caused by S pneumoniae