Haemophilus

South Med J, 1984 Oct, 77(10), 1240 - 2
Occurrence of bacteremia in febrile children seen in a hospital outpatient department and private practice; Brook I et al.; Blood cultures were obtained during a one-year period from 147 febrile children seen in the hospital outpatient clinic (group 1), and 42 seen in a private practice office (group 2) . Although the two clinics were located in the same geographic area, they served different socioeconomic groups . Bacteremia was detected in 12 (8.2%) of the children in group 1; the organisms recovered were Streptococcus pneumoniae in nine and Haemophilus influenzae in three . Bacteremia was observed in two (4.8%) of the children seen in group 2, and both cases were due to S pneumoniae . The difference in prevalence rates for bacteremia between groups was not significant by chi-square testing (P = .46) . The age of all the 13 patients with bacteremia was less than 24 months, their temperature was above 104 F (40 C), their polymorphonuclear leukocyte count was above 15,000/cu mm, and a localized site of infection was present in ten of them . These data suggest that the presence of bacteremia in febrile children depends more on the patients' clinical and laboratory findings than on the medical facility in which they are seen.

J Pediatr, 1984 Oct, 105(4), 533 - 7
Do children with recurrent Haemophilus influenzae otitis media become infected with a new organism or reacquire the original strain?
Barenkamp SJ, Shurin PA, Marchant CD, Karasic RB, Pelton SI, Howie VM, Granoff DM.
Using the techniques of outer membrane protein gel analysis and biotyping, we characterized nontypable Haemophilus influenzae isolates from middle ear aspirates of 30 children with recurrent nontypable H, influenzae (NTHI) otitis media . Nine of the 13 children with early recurrence of NTHI otitis (less than 30-day intervals) had respective first and second isolates that were identical . In contrast, 14 of 18 children with late recurrences of NTHI otitis (greater than 30-day intervals) had respective first and second isolates that were different, whereas four children had late recurrences with organisms that appeared to be identical with their respective initial infecting strains . These results suggest that early recurrent NTHI otitis usually is a result of relapse with the initial infecting NTHI strain . In contrast, late recurrent disease is usually the result of infection with a new organism . However, the observation that four children had late recurrences with the original strains suggests that strain-specific protective immunity may not uniformly develop after recovery from NTHI otitis.

Clin Pediatr (Phila), 1984 Oct, 23(10), 535 - 41
Haemophilus influenzae infections . The impact of resistance on the use of aminopenicillins and other antimicrobials in outpatient therapy; Marks MI; The clinical manifestations of Haemophilus influenzae infections and the growing problem of ampicillin-resistant strains are reviewed . Despite the fact that approximately 25 percent of H . influenzae are resistant to penicillin and ampicillin, oral aminopenicillins (ampicillin, amoxicillin, bacampicillin, and cyclacillin) are commonly used for the outpatient management of these infections . The characteristics of these drugs and the rationale for their use are discussed and compared with alternative approaches to therapy . This subject requires periodic review in consideration of the increasing prevalence of ampicillin and multiple antibiotic resistance among H . influenzae isolates.

J Clin Microbiol, 1984 Oct, 20(4), 711 - 7
Sensitivity and specificity of monoclonal antibodies directed against antigenic determinants of Treponema pallidum Nichols in the diagnosis of syphilis; Norgard MV et al.; Murine anti-Treponema pallidum monoclonal antibodies were employed in studies on sensitivity and specificity of binding to examine their potential for use in the detection of low numbers of pathogenic treponemes present in various body fluids . Monoclonal antibodies were used as a primary antibody source in a solid-phase immunoblot assay system . All monoclonal antibodies assayed were capable of detecting ca . 1.0 X 10(3) to 2.5 X 10(3) treponemes . Of 13 monoclonal antibodies examined, 3 were able to detect 10(3) virulent treponemes, and 1 of these antibodies was able to reveal the presence of as few as 500 organisms . Western blot analyses showed that all anti-T . pallidum monoclonal antibodies exhibiting high sensitivities for the detection of T . pallidum cells were directed against an abundant, 47,000-dalton surface-exposed antigen of the organism (S . A . Jones, K . S . Marchitto, J . N . Miller, and M . V . Norgard, Abstr . Annu . Meet . Am . Soc . Microbiol . 1984, B173, p . 46; K . S . Marchitto, S . A . Jones, and M . V . Norgard, Abstr . Annu . Meet . Am . Soc . Microbiol . 1984, B182, p . 48) . Differences in binding properties of the various monoclonal antibodies were most likely a reflection of differential binding affinities or their specificities for different epitopes on the 47,000-dalton surface antigen . With two possible exceptions, the monoclonal antibodies tested reacted specifically with T . pallidum, either purified or found within a high-contaminating tissue background, and not with Treponema phagedenis biotype Reiter, Haemophilus ducreyi, Neisseria gonorrhoeae, herpes simplex virus type 2, or normal rabbit testicular tissue . The high sensitivity and specificity exhibited by these anti-T . pallidum monoclonal antibodies make them excellent candidates for employment in new syphilis or other treponemal diagnostic tests designed to detect very low numbers of pathogenic treponemes in lesion exudates or other body fluids.

Sex Transm Dis, 1984 Oct-Dec, 11(4), 304 - 7
Cefotaxime treatment of Haemophilus ducreyi infection in Kenya; Plummer FA et al.; The authors conducted a double-blind randomized clinical trial comparing single-dose cefotaxime (1 g im) plus daily placebo injections with cefotaxime (1 g im on each of three days) . Each regimen was given with probenicid (1 g orally) for the treatment of chancroid . Twenty Haemophilus ducreyi culture-positive men received the single-dose cefotaxime regimen; in eight patients ulcers or buboes failed to respond to therapy . Nineteen H . ducreyi culture-positive men received cefotaxime on each of three days; H . ducreyi was eradicated from all patients, but one had a continuing ulcer and another had a bubo that failed to respond . Thus cefotaxime (1 g im daily for three days) plus probenicid (1 g orally) is effective therapy for chancroid . The lack of efficacy for chancroid of the single-dose cefotaxime regimen is surprising, given the remarkable susceptibility of H . ducreyi to cefotaxime; presumably the half-life of cefotaxime is too short for predictable eradication of H . ducreyi from the ulcer with a single-dose regimen.

Jpn J Antibiot, 1984 Oct, 37(10), 1801 - 11
{Clinical study on sulbactam/cefoperazone in the field of pediatrics}; Minamitani M et al.; Sulbactam/cefoperazone (SBT/CPZ) was used in pediatric patients with acute infections, and the following results were obtained . SBT/CPZ was administered to 18 pediatric patients with acute infections . Out of them, 14 patients, i.e., 3 with acute tonsillitis, 1 with acute laryngitis, 1 with acute bronchitis, 4 with acute pneumonia, 4 with bronchopneumonia, 1 with pyothorax, were adopted for the evaluation, and the other 4 were excluded because they were judged inadequate for clinical efficacy evaluation . The clinical efficacy of SBT/CPZ was assessed as excellent in 4, good in 9 and fair in 1 . The effective rate was 92.9% . In 6 cases causative organisms were detected, i.e., Haemophilus influenzae in 3, Klebsiella in 1 and Staphylococcus aureus in 2 cases . Eradication of these organisms was confirmed in all cases except for 1 patient with pyothorax caused by S . aureus . The doses used in 12 out of the evaluated 14 cases ranged from 58.4 to 80 mg/kg/day, 84.1 mg/kg/day was used in 1 case and 101.4 mg/kg/day was used in 1 case with pyothorax . Patients with severe infections were generally given large doses . The frequency of administration was 3 times per day except 1 case, and intravenous drip infusion was used in all cases . The duration of treatment was 2- less than 3 days for 7 cases, 3-5 days for 6 cases and 9 days for 1 case (pyothorax) . No clinical side effects were observed in any case . In laboratory examinations, a slight elevation of GOT was observed in 1 case, but no abnormal findings in the other cases . From the above results, SBT/CPZ was considered to be a highly useful drug in the treatment of pediatric infections.

J Bacteriol, 1984 Oct, 160(1), 87 - 94
Transposon Tn10-like tetracycline resistance determinants in Haemophilus parainfluenzae; Levy SB et al.; Tetracycline resistance (Tcr) determinants from three different strains of Haemophilus parainfluenzae expressed 10-fold higher levels of resistance when mated into Escherichia coli . No plasmid was found in any of the E . coli recipients, even in matings in which a plasmid was identified in the donor Haemophilus sp . The Tcr determinant from Haemophilus sp . caused instability of resident plasmids in the recipient E . coli: all plasmids were lost within 30 generations in antibiotic-free media . However, by serial subculture in antibiotics, stable resident plasmids were obtained which carried the Tcr determinant from Haemophilus sp . and were transferable by conjugation and transformation among E . coli strains . All Haemophilus determinants hybridized with a probe for the Tcr determinant on Tn10, which bears inducible Tcr . However, Haemophilus determinants were constitutively resistant to tetracycline in the Haemophilus donors and in the E . coli recipients . This constitutive expression was recessive to wild-type Tn10 in the same cell, indicating that the constitutive phenotype resulted from the absence of an active repressor . Restrictive enzyme analysis of various E . coli plasmid derivatives bearing a Tcr determinant from Haemophilus sp . demonstrated that the inserted DNA was of similar size (8.95 to 9.35 kilobases), close to that of Tn10 . Heteroduplex analysis and DNA:DNA hybridization confirmed that the Tcr determinant from Haemophilus sp . had greater than 90% homology with the Tn10 determinant, including the DNA sequence for the repressor.

Lancet, 1984 Sep 8, 2(8402), 537 - 41
Aetiology of pneumonia in children in Goroka Hospital, Papua New Guinea; Shann F et al.; To determine the aetiology of pneumonia in 83 children admitted to Goroka Hospital, Papua New Guinea, lung aspirates and blood were cultured for bacteria . Haemophilus infuenzae, Streptococcus pneumoniae, or both, were isolated from 43 (52%) of the children, other bacteria from 8 (10%), and no bacteria from 32 (39%) . Of the 32 strains of H influenzae tested, 18 (56%) were non-serotypable, 8 (25%) were serotypes other than type b, and only 6 (19%) were type b . Viruses were isolated from lung or nasopharyngeal aspirates from 18 (29%) of the 62 children for whom viral cultures were done . It seems that, although viruses may initiate infection, death from pneumonia in children in developing countries is often due to H influenzae, S pneumoniae, or both . Antibiotic therapy would prevent many of these deaths . There is an urgent need for vaccines, effective in children less than 6 months old, that protect against all strains of H influenzae, and S pneumoniae.

J Antimicrob Chemother, 1984 Sep, 14 Suppl C, 57 - 62
Diffusion of enoxacin into the cerebrospinal fluid in dogs with healthy meninges and with experimental meningitis; Tran Van Tho et al.; After a 1 h intravenous injection of 12.5 and 25 mg/kg enoxacin in dogs with healthy meninges, the concentrations in cerebrospinal fluid observed between 90 and 240 min averaged 2.6 (1.8-3.3) mg/l and 6.5 (4.7-8.4) mg/l respectively . In dogs with meningitis, a dosage of 12.5 mg/kg yielded a mean concentration of 4.9 (3.1-6.4) mg/l . The concentrations obtained in dogs with healthy meninges greatly exceeded the MICs for meningococci and Haemophilus influenzae . In the infected dogs, the concentrations obtained exceeded the MICs of the most common causative agents of meningitis . In the dogs with healthy meninges the ratio CSF/plasma AUCs was 47% after 25 mg/kg and 33% after 12.5 mg/kg . In the infected dogs, the ratio was 67.3% after 12.5 mg/kg.

Infection, 1984 Sep-Oct, 12(5), 328 - 30
White blood cell count, erythrocyte sedimentation rate and serum C-reactive protein in meningitis: magnitude of the response related to bacterial species; Valmari P; White blood cell count (WBC), erythrocyte sedimentation rate (ESR) and serum C-reactive protein (CRP) were determined upon diagnosis of 61 children with bacterial meningitis in order to compare the responses evoked by different bacteria . The age of the patients and the duration of their symptoms were similar in all groups . WBC and ESR corresponded significantly with the bacterial species . The mean WBC in Haemophilus influenzae (n = 44), meningococcal (n = 11) and pneumococcal (n = 6) infection were 14,605/microliters 19,391/microliters and 23,833/microliters, respectively (for H . influenzae and pneumococci p less than 0.001) . The mean ESR varied from 58 mm/h (meningococci) to 100 mm/h (pneumococci) (p less than 0.025) . CRP was the test least influenced by the nature of the bacteria . The characteristics of CRP suggest its superiority over WBC and ESR as a detector of bacteremic infections . WBC is unsuitable for screening of systemic H . influenzae disease.

Equine Vet J, 1984 Sep, 16(5), 430 - 4
Contagious equine metritis--use of gas liquid chromatography in identifying the causal agent; Neill SD et al.; Cellular fatty acid compositions of contagious equine metritis isolates and three reference Haemophilus equigenitalis cultures were determined by gas chromatography . The chromatographic data were standardised and normalised fatty acid methyl ester (FAME) profiles were produced . The profiles were compared visually and similarity indices were determined using a computer peak matching method . There was little difference between the profiles of the three reference strains, each strain being characterised by three major fatty acids; C 18:1, C 16:0 and 30H-C 14:0 . Variations in cultural conditions had no significant effect on the FAME profiles . The identification of laboratory isolates using the technique was in agreement with the presumptive identification based on the currently recommended tests and an improvement on the confirmatory serological identification . The FAME profiles provided confirmation of identity where it was not possible to use the presently recommended serological procedures . The authors recommend the gas chromatography technique for use in the diagnostic laboratory as an adjunct to the presently accepted identification methods.

Surgery, 1984 Sep, 96(3), 471 - 8
Complications related to 234 staging laparotomies performed in the Intergroup Hodgkin's Disease in Childhood study; Hays DM et al.; This is a study of 234 children and young adult patients entered in the Intergroup Hodgkin's Disease in Childhood (stage I-II) Study from November 1975 to June 1981 and followed for a mean of 3.8 years after laparotomy . All patients had a staging laparotomy with total splenectomy, liver biopsy, and sampling of abdominal lymph node groups . Four patients (1.7%) have had documented sepsis, and three have had possible sepsis . There has been no sepsis-related death . Intestinal obstruction requiring operation was noted in four patients (no intestinal resection required) . Urgent operation was necessary in two patients, one with ureteral obstruction and one with ovarian torsion, following a repositioning procedure, neither of these patients died . Organisms in the four patients with positive blood cultures were Streptococcus pneumoniae (two) and Haemophilus influenzae (two) . Of the 234 patients in the study, 194 (83%) had received polyvalent pneumococcal vaccine, and 174 (74%) were taking prophylactic antibiotics . One of the two patients with pneumococcal sepsis had not been vaccinated, and the second was vaccinated only during radiotherapy . Only one of the four patients with positive blood cultures was on a prophylactic antibiotic treatment regimen at the time of the septic episode . The liabilities in employing laparotomy-splenectomy for the evaluation of pediatric patients with Hodgkin's disease include both general surgical complications and an increase in the risk of hyperacute infection, specifically related to encapsulated species . The latter appears to be modified to a major degree by current prophylactic measures or therapy.

Zh Mikrobiol Epidemiol Immunobiol, 1984 Sep, (9), 28 - 32
{Immunoenzyme method in the diagnosis of meningococcal infections}; Zhuravleva GV et al.; The materials on the development and use of the test system, based on the enzyme-linked immunosorbent assay (ELISA) and intended for the detection of specific group A and C meningococcal polysaccharides and type b Haemophilus influenzae polysaccharide in the spinal fluid of patients, are presented . In this work commercial preparations manufactured in the USSR were used, and all parameters of the assay were developed on the basis of these preparations . The study was made on the samples of spinal fluid from 410 patients; of these, 203 had meningococcal infection, 57 had purulent bacterial meningitides and 150 had other diseases (acute respiratory diseases, influenza, etc.) . As demonstrated by the results of this study, ELISA proved to be a highly specific and sensitive technique . In the investigation of the spinal fluid samples from the patients with meningococcal infection the use of ELISA with bacteriological techniques increased the number of positive results to 67%; with countercurrent electrophoresis, to 78%; and with bacterioscopy, to 83.8% . ELISA is recommended for practical use as an auxiliary laboratory technique and as a rapid method for the diagnosis of meningococcal infection.

Pediatr Infect Dis, 1984 Sep-Oct, 3(5), 410 - 6
An extended experience with cefuroxime therapy of childhood bacterial meningitis; Schaad UB et al.; Eighty-four pediatric patients with bacterial meningitis were prospectively evaluated while receiving cefuroxime (200 mg/kg/day in four equal intravenous doses) as single-drug therapy for 9 to 13 days . Six cases were admitted in extremis and died within a few hours because of irreversible central nervous system damage or shock . The remaining 78 patients were cured, and prompt bacteriological and clinical responses were noted . The pathogens were Haemophilus influenzae b (43 cases), Neisseria meningitidis (20 cases), Streptococcus pneumoniae (10 cases) and unknown (five cases) . All pathogens were susceptible in vitro to cefuroxime including two strains of beta-lactamase producing H . influenzae . Time to defervescence, incidence and cause of both prolonged and secondary fever, as well as type and frequency of complications and sequelae compared favorably to other series . It is concluded that cefuroxime is effective and safe single-drug therapy for childhood bacterial meningitis beyond the neonatal age group.

Am J Clin Pathol, 1984 Sep, 82(3), 311 - 8
Antimicrobial resistance in Haemophilus isolates: a Minnesota experience and literature review; Woolfrey BF et al.; Annual ampicillin susceptibility rates for Haemophilus influenzae isolates at the St . Paul-Ramsey Medical Center gradually decreased from 100% in 1974 to 83.3% in 1980 and then remained stable at 88.90% . Penicillin susceptibility rates were similar to those for ampicillin . Ampicillin rates were source dependent: eye 95%, respiratory 90%, miscellaneous sources 82%, and blood and CSF 80% . Rates for Haemophilus parainfluenzae varied and showed no trend . H . parainfluenzae isolates were distinctly less susceptible to penicillin (70%) than to ampicillin (96%) . H . influenzae isolates were highly susceptible to chloramphenicol (99.6%) and tetracycline (97.5%), with the latter also showing source dependency . Characterization of isolates for colony morphology and hemolysis showed no clinical relevancy . Ampicillin and penicillin MICs were determined for 128 clinical isolates saved in stock culture during 1978-1983 . All 19 resistant isolates (MIC greater than or equal to 4 micrograms/mL) were resistant to both penicillin and ampicillin and produced beta-lactamase . Eight had penicillin MICs of 1 or 2 micrograms/mL and three had ampicillin MICs of 1 or 2 micrograms/mL . The significance of isolates with MICs of 1-2 micrograms/mL is discussed in relation to our findings and a review of the literature.

Can J Microbiol, 1984 Sep, 30(9), 1184 - 7
Lipopolysaccharide composition of three strains of Haemophilus influenzae; Parr TR Jr et al.; The lipopolysaccharides of three strains of Haemophilus influenzae with varying beta-lactam susceptibility were examined . All three strains contained galactose, glucose, galactosamine, glucosamine, heptose, phosphate, and a trace of mannose . None contained fucose, rhamnose, or mannosamine . Levels of 2-keto-3-deoxy-octulosonic acid were consistently detected in all three strains at levels similar to that of Salmonella typhimurium LT2, but only following hydrolysis with 4 N hydrochloric acid.

Acta Otolaryngol, 1984 Sep-Oct, 98(3-4), 343 - 50
Nasopharyngeal carriage of bacteria in otitis-prone and non-otitis-prone children in day-care centres; Prellner K et al.; During a 2-year period nasopharyngeal specimens were taken monthly on scheduled occasions as well as at episodes of acute otitis media (AOM) from a population of children attending day-care centres . The carriage rates of pneumococci, Haemophilus influenzae and Branhamella catarrhalis in 26 otitis-prone (OP) children when asymptomatic and at episodes of AOM were compared with the carriage rates in 36 non-otitis-prone (NOP) children . Pneumococci, H . influenzae and B . catarrhalis were found as frequently in NOP as in asymptomatic OP children . At AOM episodes only B . catarrhalis was found significantly more often than in the scheduled cultures . The frequencies of the six most commonly isolated pneumococcal types/groups (6, 23, 19, 14, 11, 18) were similar in the cultures taken from NOP and OP children on scheduled occasions as well as in cultures taken at AOM episodes . In contrast to the NOP children H . influenzae and B . catarrhalis were isolated less frequently in the 3-4-year-old than in the 2-3-year-old asymptomatic OP children . Our data indicated that the presence of pneumococci, H . influenzae or B . catarrhalis in the nasopharynx does not per se increase the risk for the development of AOM.

J Clin Microbiol, 1984 Sep, 20(3), 599 - 601
Laboratory identification of Haemophilus influenzae: effects of basal media on the results of the satellitism test and evaluation of the RapID NH system; Doern GV et al.; The effects of four different basal media, tryptic soy agar, brain heart infusion agar, nutrient agar, and Mueller-Hinton agar, were investigated with respect to the identification of Haemophilus influenzae with a satellitism test in which X and V growth factors were supplied by factor-impregnated filter paper strips . A total of 187 recent clinical isolates of H . influenzae were examined . Of these, 179 strains (95.7%) were correctly identified with tryptic soy agar, 173 (92.5%) with brain heart infusion agar, 105 (56.1%) with nutrient agar, and 133 (71.1%) with Mueller-Hinton agar . Failure to obtain a correct identification was usually the result of satelliting growth around V factor-containing strips, possibly due to the presence of trace amounts of hemin in the basal media, or was because of an absence of growth due to nutritional deficiencies in the basal media . All 187 H . influenzae strains were also examined with a new biochemical and chromogenic substrate micromethod, the RapID NH system (Innovative Diagnostics Systems, Inc., Decatur, Ga.) . A total of 168 (89.8%) strains were correctly identified with this system.

J Clin Microbiol, 1984 Sep, 20(3), 587 - 8
Use of Directigen and acridine orange for rapid identification of human blood culture isolates; Flejzor B et al.; Of 7,871 blood cultures from hospital patients, 22 yielded growth of Streptococcus pneumoniae or Haemophilus influenzae type b . The identities of 19 (86%) of these 22 strains could be verified after 18 to 24 h of incubation by application of the Directigen meningitis test kit to the unheated, uncentrifuged supernatant from the cultures; thus, the turnaround time for these cultures was halved . Growth in 16 (72%) of the Directigen-positive cultures was detected by visual inspection, and that in 3 (14%) of the cultures was detected by acridine orange staining . Growth in the three remaining bottles (14%) was detected by blind subculturing after 18 to 24 h or incubation and, therefore, was delayed by 24 h . The systematic application the acridine orange stain was helpful in 40 (44%) of 91 cases for which macroscopic inspection failed to reveal growth after 24 h of incubation.

Diagn Microbiol Infect Dis, 1984 Sep, 2(4), 333 - 7
Activities of newer beta-lactam antibiotics against ampicillin, chloramphenicol, or multiply-resistant Haemophilus influenzae; Strandberg DA et al.; The susceptibilities of singly or multiply-resistant clinical isolates of Haemophilus influenzae were determined by agar dilution to aztreonam, imipenem, and six third-generation cephalosporins . These included selected isolates that were resistant to ampicillin only, chloramphenicol only, and four isolates that were resistant to ampicillin, chloramphenicol, and trimethoprim-sulfamethoxazole . All of the isolates were highly susceptible to these newer beta-lactam antibiotics . Isolates resistant to trimethoprim-sulfamethoxazole and/or chloramphenicol had susceptibilities similar to those of strains resistant only to ampicillin . Ceftriaxone, ceftizoxime, and cefotaxime were the most active of the study antibiotics (MIC90 = 0.004-0.016 micrograms/ml), and were also bactericidal at concentrations no more than twice the minimum inhibitory concentration (MIC) . Minimum inhibitory concentrations of cefoperazone increased dramatically with only a 10-fold increase in inoculum size of beta-lactamase producing strains, while MICs of the other new agents were not significantly affected by elevation of the inoculum . These new antibiotics appear to be promising candidates for therapy of infections due to resistant H . influenzae.

J Infect Dis, 1984 Sep, 150(3), 402 - 6
Safety and immunogenicity of Haemophilus influenzae type B polysaccharide-diphtheria toxoid conjugate vaccine in adults; Lepow ML et al.; Sixty-one adults received either Haemophilus influenzae type b capsular polyribosephosphate (PRP) vaccine or H . influenzae type b polysaccharide-diphtheria toxoid conjugate (PRP-D) vaccine in two doses, one month apart . Both vaccines were well tolerated with no fever or systemic reactions . There were no significant local reactions . Mild local tenderness was reported by about half of the subjects in both groups . There was no observed effect of the vaccines on hematologic parameters, including reticulocyte and platelet counts, evaluated before immunization, one month after the first dose, and seven to 10 days after the second dose . A single dose of PRP-D induced levels of IgG antibody to PRP three times that observed with PRP alone one month after the first inoculation.

Infect Immun, 1984 Sep, 45(3), 582 - 91
Serum antibody responses of juvenile and infant rhesus monkeys injected with Haemophilus influenzae type b and pneumococcus type 6A capsular polysaccharide-protein conjugates; Schneerson R et al.; Juvenile and infant rhesus monkeys were injected subcutaneously with saline solutions of Haemophilus influenzae type b (Hib) and pneumococcus type 6A (Pn6A) capsular polysaccharides conjugated to either tetanus toxoid (TT), horseshoe crab hemocyanin, or cholera toxin (CT), and the antibody responses of the monkeys to both bacterial components were measured . All three Hib conjugates were immunogenic and elicited booster responses; their comparative immunogenicity was Hib-CT greater than Hib-TT greater than Hib-horseshoe crab hemocyanin . Hib alone did not elicit antibodies in the juveniles . Juveniles responded earlier and with higher levels of antibodies than did infants . TT, as well as diphtheria-tetanus toxoids-pertussis vaccine adsorbed injected concurrently at a separate site, increased both Hib and TT antibody responses in juveniles (P less than 0.05) . Concurrent injection of 5 Lf of fluid TT with a nonimmunogenic 5-micrograms dose in infants elicited levels of Hib antibodies comparable to those elicited by 50 micrograms of Hib-TT . Hib antibodies elicited by the conjugates remained at protective levels in both juveniles and infants 2 months after the last injection, were bactericidal, and conferred passive immunity against bacteremia in infant rats . Passive immunization of juveniles with tetanus immune globulin before each injection of Hib-TT did not suppress Hib antibodies . Hib-TT and Hib-CT elicited increases of Hib antibodies of the immunoglobulin M and G isotypes in the infants . The Pn6A-TT conjugate was considerably less immunogenic than the Hib-TT conjugate; only a few of the juveniles or infants responded with protective levels of Pn6A antibodies . Pn6A antibodies from responders conferred protection in mice against intraperitoneal challenge with Pn6A organisms . TT antibodies were elicited in both juvenile and infant animals after one injection of 50 micrograms of Hib-TT and in the infants injected with 5 micrograms of Hib-TT plus 5 Lf of TT; 5 micrograms of Hib-TT and Pn6A-TT in combination alone did not elicit TT antibodies . Hib-CT elicited CT antibodies in both juveniles and infants.

J Antimicrob Chemother, 1984 Sep, 14 Suppl B, 181 - 9
Cefotaxime therapy of bacterial meningitis in children; Wells TG et al.; Thirty children with bacterial meningitis were randomized to receive either ampicillin and chloramphenicol in standard doses or cefotaxime (50 mg/kg/dose every 6 h) for 10 to 14 days . Eighteen patients received ampicillin and chloramphenicol and 12 patients received cefotaxime . Cerebrospinal fluid isolated included: Haemophilus influenzae (20), Streptococcus pneumoniae (4), Neisseria meningitidis (3), Group B streptococcus (2), and Salmonella enteritidis (1) . Five of the H . influenzae isolates were ampicillin resistant but no isolates were resistant to cefotaxime . The minimum inhibitory concentrations of cefotaxime for 30 isolates ranged from 0.0004 to 0.06 mg/l, while the minimum bactericidal concentrations ranged from 0.007 to 0.12 mg/l . The cerebrospinal fluid bactericidal titres for the cefotaxime-treated group ranged from 1:64 to 1:1024 . On the second day of therapy the mean cefotaxime serum concentrations were 56.9 +/- 28.7 mg/l at 1 h and 3.66 +/- 5.65 mg/l at 6 h after administration of the drug whilst mean desacetyl-cefotaxime serum concentrations were 12.31 +/- 7.56 mg/l at one hour and 7.96 +/- 8.26 mg/l at 6 h respectively . Cerebrospinal fluid concentrations of cefotaxime and desacetylcefotaxime measured one hour after drug administration were 3.72 +/- 5.57 mg/l and 4.35 +/- 7.12 mg/l, respectively . No adverse drug reactions were noted in either treatment group . Cefotaxime proved to be both as safe and as efficacious as standard therapy for the treatment of bacterial meningitis in children.

J Antimicrob Chemother, 1984 Sep, 14 Suppl B, 167 - 80
A comparison of ampicillin-cefotaxime and ampicillin-chloramphenicol in childhood bacterial meningitis: an experience in 55 patients; Lapointe JR et al.; Ampicillin-cefotaxime was tested as initial therapy of presumptive bacterial meningitis in 55 children greater than or equal to 2 months of age at our hospital . During the first year of this ongoing trial, 11 patients, 10 whose CSF yielded ampicillin-resistant Haemophilus influenzae type b (MIC greater than 16 mg/l, beta-lactamase +) and one, indole-negative proteus (MIC 4 mg/l), were begun on ampicillin-cefotaxime and then continued on cefotaxime alone . All did well clinically except one who convulsed briefly but recovered without sequelae . The cefotaxime MICs/MBCs of the beta-lactamase-positive H . influenzae isolates (less than or equal to 0.007 to 0.03/less than or equal to 0.007 to 0.12) and the proteus isolate (0.03/0.12) were significantly lower than chloramphenicol MICs/MBCs (0.25 to 1.0/0.5 to 1.0 and 8/greater than 16) . We followed 44 other children with meningitis due to ampicillin-sensitive organisms who were treated with ampicillin or penicillin after 1 or 2 days of ampicillin-cefotaxime . Aetiological agents included ampicillin-sensitive H . influenzae (25), pneumococci (9), meningococci (8), Strept . MG (1) and Listeria monocytogenes (1) . 40/44 recovered uneventfully . There were 4 neurological complications: the streptococcal meningitis sustained a brain abscess and the three others were motor incoordination (sensitive haemophilus), hearing loss and subdural effusion (2 pneumococci) . There were no deaths . 18/48 children managed initially with ampicillin-chloramphenicol during the same 12-month period one year earlier had significant neurological complications and/or sequelae and there was one death; aetiological agents included sensitive H . influenzae (30), pneumococci (9), ampicillin-resistant haemophilus (5), meningococci (3) and pneumococci plus strept . MG (1) . The two groups were comparable except for the number of resistant haemophilus and meningococcal strains and underlying disease more frequent in the ampicillin-cefotaxime group . A significant reduction of neurological morbidity (5/55 or 9.1% vs . 18/48 or 37.5%:P less than 0.001) was therefore associated with the ampicillin-cefotaxime schedule in the initial treatment of proven bacterial meningitis . A prolonged hospitalization (greater than 15 days) was less frequent (P less than 0.01) in the ampicillin-cefotaxime group (3/55 or 5.5% vs . 13/48 or 27.1%) . The results of the trial to date are considered to be very promising.

J Antimicrob Chemother, 1984 Sep, 14 Suppl B, 161 - 5
Pharmacokinetics and clinical evaluation of cefotaxime in children suffering with purulent meningitis; Begue P et al.; Seventy-five children with bacterial meningitis were included in a multicentre trial for evaluation of cerebrospinal fluid (CSF) pharmacokinetics and clinical efficacy of cefotaxime . Mean age of patients was 4 years . Causative pathogens were Haemophilus influenzae in 28 patients (37%), Neisseria meningitidis in 27 patients (36%), Streptococcus pneumoniae in 10 patients (13%), group B streptococcus in 2 patients (2%) and unknown in 8 patients . All isolated pathogens were susceptible to cefotaxime . Seven ampicillin-resistant H . influenzae (9.4%) were found . Cefotaxime was 50 mg/kg intravenously, 4 times daily . The duration of treatment ranged from 5 to 22 days (mean: 13.8) . Blood and CSF concentrations of cefotaxime were performed in 50 patients 3 h after infusion at day one and seven cefotaxime levels were determinated both by microbiological assay procedure and high pressure liquid chromatography . On day 1, CSF levels ranged from 0.39 to 2.0 mg/l by microbiological assay procedure (median 3.6) and from 0.0 to 17.4 mg/l (median 2.2) for cefotaxime and from 0.0 to 11.5 mg/l (median 2.2) for desacetyl-cefotaxime by HPLC . We observed a decrease in CSF levels of cefotaxime on day 7 . They ranged from 0.3 to 7.0 mg/l (median 1.1) by microbiological assay and from 0.0 to 3.3 mg/l (median 0.8) for cefotaxime and from 0.0 to 6.0 mg/l (median 1.0) for desacetyl-cefotaxime by HPLC . On day 1 and day 7, CSF levels determined by microbiological assay and HPLC were correlated as follows: day 1:r = 0.59 (P less than 0.001) . All children (100%) were cured and efficacy of cefotaxime was excellent in 72 cases (96%).(ABSTRACT TRUNCATED AT 250 WORDS)

J Biol Chem, 1984 Aug 10, 259(15), 9711 - 6
Inhibition of DNA methyltransferases in vitro by benzo{a}pyrene diol epoxide-modified substrates; Wojciechowski MF et al.; Covalent adducts formed from the ultimate carcinogen 7 beta,8 alpha-dihydroxy-9 alpha, 10 alpha-epoxy-7,8,9,10-tetrahydrobenzo{ a}pyrene inhibit the enzyme-catalyzed transfer of methyl groups from S-adenosylmethionine to cytosine residues in DNA . Two DNA methyltransferase enzymes, isolated from the bacterium Haemophilus and mouse spleen nuclei, were tested for their ability to methylate carcinogen-modified substrates in vitro . These model enzymes possess the known methylation activities found in mammalian cells, de novo, and maintenance methylation of CpG-containing nucleotide sequences . The in vitro alkylation of DNA substrates by the carcinogen effectively decreases the methyltransferase reaction of both enzymes in a manner that is directly dependent upon the level of covalent modification of the DNA . Inhibition of de novo methylation activity can be detected at very low levels of carcinogen modification, 1 hydrocarbon residue per 20,000-40,000 nucleotides . Adduct levels in this range are capable of initiating transformation . Both enzymes are inactivated by direct reaction with the carcinogen in the absence of DNA . We also find that carcinogen adducts are capable of inhibiting DNA methylation at CpG sites removed from the primary lesion . These results support the proposal that carcinogen-induced DNA damage can cause alterations in methylation patterns that may eventually lead to heritable changes in gene expression.

Pediatrics, 1984 Aug, 74(2), 198 - 205
Intellectual, neuropsychological, and achievement outcomes in children six to eight years after recovery from Haemophilus influenzae meningitis; Taylor HG et al.; Twenty-four grade school children who had sustained an earlier episode of Haemophilus influenzae type b meningitis were tested, along with a group of 24 school-aged siblings . Evaluations consisted of tests of IQ, academic achievement, and neuropsychological skills . Parents completed forms rating each child's behavioral adjustment and temperament . Available school-administered standardized achievement tests were also obtained . Information relating to the episode of meningitis was extracted from the medical charts of each child who had had meningitis in order to investigate the relationship of these parameters to developmental outcome . Results showed that, compared with nearest-age siblings, children who had had meningitis scored lower on performance IQ and full-scale IQ . The group that had had meningitis also performed more poorly on several neuropsychological tasks . However, the groups did not differ in verbal IQ, and they performed comparably on all academic measures . Significant behavioral adjustment problems were absent from both groups, and there were no notable differences in temperament . Although findings support the existence of postmeningitis sequelae, the selective nature of the deficiencies observed indicate that prognosis for children in the age range examined may be better than that suggested by earlier studies.

Infect Immun, 1984 Aug, 45(2), 437 - 42
Pulmonary clearance of encapsulated and unencapsulated Haemophilus influenzae strains; Toews GB et al.; A mouse model system was employed to investigate the temporal pattern of pulmonary clearance of Haemophilus influenzae and to evaluate the effect of the type b polysaccharide capsule on this clearance pattern . The lungs of BALB/c mice were inoculated with boluses of several different H . influenzae strains via an endobronchial catheter . A fully encapsulated H . influenzae type b strain multiplied readily in the lungs for at least 6 h and then was eventually cleared from the lungs over the next 18 h . The pulmonary clearance pattern obtained with an unencapsulated variant of this H . influenzae type b strain was identical to that obtained with the fully encapsulated parent strain . Two nontypable H . influenzae strains isolated by transtracheal aspiration of patients with acute H . influenzae pneumonia also multiplied in the lung and resisted significant clearance for at least 6 h after inoculation . Bolus deposition of either H . influenzae type b or nontypable H . influenzae in the lungs resulted in an eventual influx of polymorphonuclear leukocytes into the alveoli . The observed delay in clearance of all these strains suggests that resident host defense mechanisms must be augmented for clearance to occur . Furthermore, these data indicate that one or more factors other than the Haemophilus capsule are important bacterial determinants of pulmonary clearance of H . influenzae.

J Laryngol Otol, 1984 Aug, 98(8), 767 - 9
Erythromycin in the treatment of otitis media with effusion (OME); Ernstson S et al.; Previous studies have shown erythromycin to penetrate into both the middle-ear effusion and the adenoid tissue in children with Otitis Media with Effusion (OME) . The levels obtained were similar to the plasma levels . Cultures in long-standing cases of OME have yielded respiratory pathogens--Haemophilus influenzae, Streptococcus pneumoniae and Branhamella catarrhalis--in the nasopharynx in 79 per cent and in the middle-ear effusion in 18 per cent . In the present investigation a group of children with OME of more than three months' duration were given erythromycin (Abboticin) in standard dosage for the last 10 days prior to scheduled operation (paracentesis or tympanostomy) . Resolution was determined as normalization of the middle ear status, and this led to cancellation of surgery . The rate of resolution--12/26 (45 per cent)--was significantly higher than in a similar group of children not treated with erythromycin--11/72 (15 per cent) . There are thus rational reasons for using erythromycin in OME, in many cases as an alternative to tympanostomy.

J Clin Microbiol, 1984 Aug, 20(2), 259 - 65
Detection of Neisseria meningitidis group A, Haemophilus influenzae type b, and Streptococcus pneumoniae antigens in cerebrospinal fluid specimens by antigen capture enzyme-linked immunosorbent assays; Sippel JE et al.; Antigen capture enzyme-linked immunosorbent assay was compared to coagglutination and counterimmunoelectrophoresis for the detection of meningococcal, Haemophilus, and pneumococcal antigens . Enzyme-linked immunosorbent assay detected 1 ng of purified meningococcal and Haemophilus polysaccharides per ml and 5 ng of pneumococcal polysaccharide per ml; coagglutination detected 20, 25, and 30 ng/ml, respectively, of these polysaccharides; and counterimmunoelectrophoresis detected 10, 50, and 60 ng/ml . Double-antibody sandwich-antiglobulin enzyme-linked immunosorbent assays, which employed antibodies produced in two animal species, differentiated 100% of the cerebrospinal fluid (CSF) specimens from meningococcal meningitis patients and 95% of the CSFs from Haemophilus patients from heterologous control CSFs . Double-antibody sandwich procedures, which use the same antiserum preparation for coating the wells of microtiter plates and for alkaline phosphatase-conjugated immunoglobulin, differentiated meningococcal CSFs from control specimens but were unable to effectively differentiate the Haemophilus or pneumococcal specimens from control CSFs . Coagglutination detected specific antigen in 92% of the meningococcal CSFs, 80% of the Haemophilus CSFs, and 92% of the pneumococcal specimens . The comparable percentages for counterimmunoelectrophoresis were 76, 95, and 71%.

J Clin Microbiol, 1984 Aug, 20(2), 231 - 4
Comparative evaluation of three commercial products and counterimmunoelectrophoresis for the detection of antigens in cerebrospinal fluid; Tilton RC et al.; Three commercial products and counterimmunoelectrophoresis were evaluated for their ability to detect microbial antigens of Neisseria meningitidis, Haemophilus influenzae, and Streptococcus pneumoniae in cerebrospinal fluid from 157 patients suspected of having meningitis . Thirty-four patients were diagnosed as having bacterial meningitis by culture, microscopy, or antigen detection . The overall results showed the following detection percentages; counterimmunoelectrophoresis, 76%; Phadebact CSF, 76%; Directigen, 82%, and Bactigen, 93% . The results with purified antigen revealed that latex agglutination was more sensitive than coagglutination, which in turn was more sensitive than counterimmunoelectrophoresis.

An Esp Pediatr, 1984 Aug, 21(2), 153 - 6
{Meningitis caused by Haemophilus influenzae type B, resistant to ampicillin and chloramphenicol}; de Juan Martin F et al.; Authors present three cases of ampicillin and chloramphenicol resistant Haemophilus influenzae type b meningitis, and one case with resistance to ampicillin and allergy to chloramphenicol . These multiresistant Haemophilus influenzae strains create very important therapeutic problems . They have used first (cefacetrile), second (cefamandole) and third (cefotaxime an moxalactam) generation cephalosporins, in order to their disponibility . There was an excellent evolution in every case . They conclude that third generation cephalosporins are useful in cases of ampicillin and chloramphenicol resistant Haemophilus influenzae type b meningitis.

J Clin Microbiol, 1984 Aug, 20(2), 145 - 50
Lipopolysaccharide subtypes of Haemophilus influenzae type b from an outbreak of invasive disease; Inzana TJ et al.; Thirty isolates of Haemophilus influenzae type b were obtained during an outbreak of invasive H . influenzae type b disease and were classified by the electrophoretic profile of their lipopolysaccharide (LPS) . The LPS was extracted by a rapid micromethod and analyzed by sodium dodecyl sulfate-polyacrylamide gel electrophoresis and silver staining . The isolates could be divided into 1 of 14 subtypes based on the profile of two to four bands . No subtype was predominant . However, all isolates obtained from duplicate sites of the same individual were of the same subtype . Isolates obtained from two patients (6 weeks apart) who attended the same day-care center differed in LPS subtype but were identical in their major outer membrane protein electrophoretic profile . Nasopharyngeal cultures were obtained from healthy children, their immediate families, and employees of the day-care center . Of 13 H . influenzae isolates examined from these contacts, only 1 was type b, which was obtained from a day-care worker and had the same LPS subtype and major outer membrane protein electrophoretic profile as one of the disease isolates . The remaining nasopharyngeal isolates were untypable, and most, but not all, were different in LPS pattern . Thus, LPS subtyping of H . influenzae type b may be useful in examining the predominance or transmission of a strain during an outbreak and may distinguish some strains not differentiated by outer membrane protein pattern.

Antimicrob Agents Chemother, 1984 Aug, 26(2), 235 - 44
Characterization of non-beta-lactamase-mediated ampicillin resistance in Haemophilus influenzae; Mendelman PM et al.; Ampicillin resistance in Haemophilus influenzae is most often due to the plasmid-mediated production of TEM beta-lactamase . We studied four strains with high-level ampicillin resistance (MIC of 32 micrograms/ml with an inoculum of 10(5) CFU on solid media) which did not produce detectable beta-lactamase activity with two different detection methods . Two of the four strains contained extrachromosomal DNA by agarose gel electrophoresis . Conjugation failed to transfer ampicillin resistance; in contrast, transformation yielded ampicillin-resistant transformants in three of the four strains . These transformants did not contain detectable extrachromosomal DNA . In addition, mobilization of the resistance determinant by transformation to, or conjugation with, recombination-deficient strains was unsuccessful . DNA-DNA hybridization experiments revealed no homology of the DNA of these strains with two R plasmids (one coding for ampicillin resistance, the other for chloramphenicol and tetracycline resistance) . We conclude that the genetic basis of the non-beta-lactamase ampicillin resistance in these strains appears to be chromosomally mediated . We investigated the mechanism of resistance in these strains . Enzymatic modification of penicillin was not detected by autoradiography of a thin-layer chromatogram of cell sonic extracts of three ampicillin-resistant transformant strains incubated with {14C}penicillin . To assess changes in permeability of the cell envelope, a plasmid coding for beta-lactamase was conjugated into these strains, and the hydrolysis of penicillin by intact cells and cell sonic extracts was compared . Only one of three transformant strains had significantly diminished permeability . Outer membrane proteins of these strains analyzed by sodium dodecyl sulfate-polyacrylamide gel electrophoresis revealed apparent differences in comparison with the isogenic ampicillin-susceptible recipient strain . Autofluorography of a sodium dodecyl sulfate-polyacrylamide gel electrophoresis of Sarkosyl-solubilized crude membrane (the putative inner membranes) from these ampicillin-resistant transformant strains incubated with {3H}penicillin compared with the isogenic ampicillin-susceptible recipient strain revealed reduced binding to PBP 3 and 6, 3 and 4, or 4 . In addition, affinity binding studies revealed decreased affinity of PBP 4 for ampicillin of all four transformants tested . We conclude that the major mechanism of resistance in these strains is altered penicillin-binding proteins; however, other mechanisms, including permeability, may also play a role.

Ann Intern Med, 1984 Aug, 101(2), 180 - 6
Delayed onset of infectious mononucleosis associated with acquired agammaglobulinemia and red cell aplasia; Purtilo DT et al.; In 1974, an 11-year-old white boy with the X-linked lymphoproliferative syndrome developed hyper-IgM after becoming infected with Epstein-Barr virus . However, he failed to develop normal immune responses against the virus . In December 1981, when red cell aplasia occurred, he was given packed erythrocytes and gammaglobulin . Nine weeks later, acute infectious mononucleosis developed . Concurrently, his T4/T8 helper/suppressor ratio decreased from 2.7 to 0.2, and IgM antibodies to Epstein-Barr virus appeared . Subsequently, circulating B cells became undetectable in his blood, and agammaglobulinemia appeared . Red cell aplasia abated transiently . This patient's course was complicated by Haemophilus influenzae and Mycobacterium tuberculosis pneumonias, and red cell aplasia and agammaglobulinemia have persisted . Epstein-Barr virus acting as a slow virus probably induced the red cell aplasia and agammaglobulinemia because of the aberrant immune responses to Epstein-Barr virus . Immunodeficient responses to Epstein-Barr virus should be sought in other patients with the diseases documented in our patient.

Aust Vet J, 1984 Aug, 61(8), 251 - 3
Serological classification of Australian isolates of Haemophilus paragallinarum; Thornton AM et al.; Thirty-nine Australian isolates of Haemophilus paragallinarum were compared serologically with 3 reference serotype strains of H . paragallinarum using a plate agglutination test . Twenty-eight of the isolates were serotype C, 5 were serotype A, while the remaining 6 isolates could not be assigned to a serotype.

J Med Microbiol, 1984 Aug, 18(1), 107 - 16
Adherence of Haemophilus influenzae to human buccal and pharyngeal epithelial cells: relationship to pilation; Pichichero ME; An improved understanding of the role of pili in adherence of Haemophilus influenzae type b to human epithelial cells (EC) would enhance knowledge of the pathogenesis of H . influenzae b infections . In this study a highly sensitive in-vitro assay allowed the quantitative assessment of H . influenzae b adherence to EC . The degree of adherence was influenced by incubation time, temperature, bacteria/EC ratio, EC type and the growth phase of the bacteria . Most serially subcultured (SC) capsular type-b strains originally isolated from cerebrospinal fluid, blood, nasopharynx or throat gave similar low degrees of adherence, as did representative single strains of capsular types a, c, d, e and f . SC non-capsulated H . influenzae strains adhered in significantly greater numbers than most SC capsulated strains (p less than 0.001) . One SC type-b strain isolated from a throat, with stable piliation, adhered in very high numbers despite capsulation . Piliated subpopulations selected from type-b capsulated strains adhered in greater numbers than did their parent strains . These data suggest that capsulation of H . influenzae is a deterrent to adherence of the bacteria to EC . However, the presence of pili may allow type-b organisms to overcome the effects of capsulation.

J Chromatogr, 1984 Jul 27, 296, 257 - 62
A rapid method for the detection and quantitation of IgA protease activity by macrobore gel-permeation chromatography; Mortensen SB et al.; A rapid assay to detect and quantitate immunoglobulin A1 (IgA1) protease activity was developed by the use of a high-performance gel-permeation chromatography column . The assay measured the disappearance of intact substrate and the emergence of cleavage fragments and the results could be expressed in absolute units . The utility of the assay was demonstrated in the partial purification of an IgA1 protease from a strain of Haemophilus influenzae.

J Clin Microbiol, 1984 Jul, 20(1), 15 - 7
Endotoxin in middle-ear effusions from patients with chronic otitis media with effusion; DeMaria TF et al.; Endotoxin concentrations were determined in middle-ear effusions (MEEs) from 89 children with chronic otitis media by using the Limulu's amoebocyte lysate assay . Mean concentrations of endotoxin in Haemophilus influenzae-positive and Streptococcus pneumoniae-positive MEEs were 157 and 21.8 ng/ml, respectively, and were significantly different (P less than 0.01) . Endotoxin was also found in Gram stain-positive, culture-negative and Gram stain-negative, culture-negative MEEs, but the levels were not significantly different (P greater than 0.05) . However, the endotoxin concentrations in both groups of culture-negative MEEs significantly lower than those found in MEEs that grew either H . influenzae or S . pneumoniae (P less than 0.05) . These results show that endotoxin is present in a high percentage of human MEEs, including those that are culture negative, and may contribute to the pathogenesis of otitis media with effusion.

J Pediatr, 1984 Jul, 105(1), 22 - 7
Immunogenicity of Haemophilus influenzae type b polysaccharide--diphtheria toxoid conjugate vaccine in adults; Granoff DM et al.; The capsular polysaccharide of Haemophilus influenzae type b is a poor immunogen in human infants . In an attempt to enhance immunogenicity, this polysaccharide was covalently coupled to diphtheria toxoid and the conjugate tested as a vaccine in adult volunteers . Two injections of PRP-D vaccine were given, separated by one month . The anti-PRP antibody responses in this group were compared with those in a group receiving a comparable dose (20 micrograms) of conventional PRP vaccine . Both vaccines were well tolerated . A single injection of PRP-D was significantly more immunogenic than PRP, eliciting higher serum concentrations of total anti-PRP antibody 1 month later (geo means of 248 and 62 micrograms/ml, respectively; P less than 0.001) . In addition, higher concentrations of IgG anti-PRP antibody were observed in the PRP-D group (P less than 0.001) . One month after reinjection of vaccine, subjects receiving PRP-D showed a small but significant decline in total antibody (P = 0.03), whereas the serum antibody concentrations in the group that received PRP remained unchanged . At 12 months, the antibody concentrations of the two groups were not significantly different . Bactericidal activity and passive protection activity (infant rat model) were tested in pooled sera from the three highest and three lowest responders in each vaccine group; both PRP and PRP-D vaccines induced biologically active anti-PRP antibody . Thus PRP-D was found to elicit biologically active serum antibody and to be more immunogenic in adults than PRP vaccine; however, the duration of higher concentrations of antibody was transient.

Infect Immun, 1984 Jul, 45(1), 36 - 40
Immunoglobulin A from bronchopulmonary secretions blocks bactericidal and opsonizing effects of antibody to nontypable Haemophilus influenzae; Musher DM et al.; Patients with chronic bronchitis are colonized by and may develop acute bronchopulmonary infection due to nontypable Haemophilus influenzae (NTHI) despite the presence of bactericidal and opsonizing antibody to the infecting organism . To test the hypothesis that secretory immunoglobulin A (IgA) interferes with host defense mechanisms, we extracted secretory IgA from bronchopulmonary secretions of five patients with NTHI pneumonia . NTHI was incubated with IgA before or during incubation with each patient's own serum or normal human serum . IgA from four of these individuals blocked the bactericidal and opsonizing effects of normal human serum and/or their own serum against their own and/or other NTHI . IgA from bronchopulmonary secretions of patients not infected with NTHI or from the serum of a patient with an IgA myeloma had no such effect . Blocking appeared to result from a direct interaction between IgA and the bacteria . The presumed mechanism is an interaction with bacterial surface antigens, although it is not known whether this occurs at antigenic sites responsible for bactericidal and opsonizing activity or whether interaction with adjacent antigenic sites and subsequent steric interference is responsible . This blocking effect of IgA may be one mechanism that allows for the development of NTHI colonization or pneumonia in an individual who already has seemingly adequate antibody against the infecting organism.

Pediatr Infect Dis, 1984 Jul-Aug, 3(4), 383 - 6
Antimicrobial therapy for acute otitis media; McCracken GH Jr; The management of acute otitis media is made more rational by consideration of the in vitro susceptibilities of the common pathogens, penetration of drug into middle ear fluid and results of comparative clinical efficacy trials . The emergence of beta-lactamase-producing Haemophilus strains and the finding that B . catarrhalis is a frequently encountered beta-lactamase-producing organism in some areas of the country emphasize the importance of delineating the cause of disease in children with acute otitis media . Because of the many variables that confound the response to therapy, each patient must be carefully followed and the regimen altered if the clinical response is unsatisfactory.

Nord Vet Med, 1984 Jul-Aug, 36(7-8), 221 - 34
Haemophilus pleuropneumoniae serotypes--cross protection experiments; Nielsen R; Pigs vaccinated with a killed 6-hour culture of Haemophilus pleuropneumoniae serotype 2 with Freund's incomplete adjuvant were not protected against challenge with serotypes 1, 5, 6 or 8 . Equivalent results were obtained when pigs were vaccinated with serotypes 4 or 5 and challenged with serotype 2 . In earlier studies of immunity induced by intranasal immunization with live H . pleuropneumoniae organisms, it was clearly shown that intranasal inoculation with one serotype of H . pleuropneumoniae would induce a strong immunity to both homologous and heterologous serotypes (Nielsen 1979) . The present study has shown that cross immunity is not obtained with parenteral immunization . The results strongly suggest that the immune response of the pig to parenteral vaccination is different from the response seen after natural infection, and indicate that an important part of the defence mechanism against H . pleuropneumoniae infection is a local immune-barrier which is effective in preventing the bacterium from penetrating the mucosa . In earlier vaccination experiments 90 per cent of vaccinates were protected against homologous challenge (Nielsen 1976) . In the present work a vaccine containing serotypes 1 through 6 was fully protective against serotypes 2 and 3 and also against serotype 8, which shares antigenic determinants with serotypes 3 and 6 . These results indicate that the protection obtained by parenteral immunization is serotype-specific . Vaccines must therefore contain the serotypes existing in the swine population.

Pediatr Infect Dis, 1984 Jul-Aug, 3(4), 319 - 22
Fever during treatment for bacterial meningitis; Lin TY et al.; The records of 476 infants and children with bacterial meningitis treated between 1979 and 1982 were reviewed . By the sixth hospital day 90% or more of children with pneumococcal or meningococcal infection compared with 72% of children with Haemophilus infection (P less than 0.001) were afebrile . The rates of prolonged fever for 10 days or more, persistent fever for 5 to 9 days and secondary fever were 13, 13 and 16%, respectively . The conditions associated with prolonged fever for 10 days or more were subdural effusion (27%), drug fever (23%) and concomitant arthritis or pneumonia (20%); 15% were of indeterminable cause . The principal conditions associated with persistent fever for 5 to 9 days were other foci of disease (17%), nosocomial infections (16%) and subdural effusion (14%); in 42% the cause was unknown . The conditions associated with secondary fever were nosocomial infections (27%) and subdural effusion (23%); 39% were of indeterminable cause . Neither the duration nor the patterns of fever correlated with neurologic abnormalities at discharge, including hearing deficit.

Public Health Rep, 1984 Jul-Aug, 99(4), 404 - 9
Epidemiology of Haemophilus influenzae type B disease among Navajo Indians; Coulehan JL et al.; During a 7-year period ending June 30, 1980, the annual incidence of all Haemophilus influenzae type b disease among Navajo children less than 5 years old was 214 per 100,000, and that of H . influenzae meningitis was 152 per 100,000 . Eighty-one percent of H . influenzae meningitis occurred in children 12 months of age or younger, and 64 percent clustered in children ages 4 through 8 months . Meningitis accounted for 70 percent of all invasive disease . No epiglottitis was observed . The epidemiology is similar to that in Yupik Eskimos, who have an even higher rate of H . influenzae type b disease than Navajos but are a much smaller population . Mortality from H . influenzae meningitis was low (4 percent) among Navajo children, but neurological sequelae were observed in at least 16 percent of the survivors . This high rate of sequelae may be due in part to clustering of cases in infancy . Among normal Navajo neonates, 79 percent had maternal capsular type b antibody titers greater than or equal to 0.15 micrograms per deciliter (microgram per dl), and the whole group had a geometric mean titer of 0.51 micrograms per dl . By age 4 months, when meningitis cases became frequent, only 14 percent of Navajo infants had antibody titers greater than or equal to 0.15 micrograms per dl . Twelve of 67 asymptomatic infants (18 percent), each monitored every 2 months, had H . influenzae type b or a cross-reacting organism isolated from the pharynx on at least one occasion before they were 9 months old.(ABSTRACT TRUNCATED AT 250 WORDS)

J Clin Microbiol, 1984 Jul, 20(1), 55 - 8
Trans-isolate medium: a new medium for primary culturing and transport of Neisseria meningitidis, Streptococcus pneumoniae, and Haemophilus influenzae; Ajello GW et al.; A diphasic medium, Trans-Isolate medium, was developed for the transport of primary cultures of cerebrospinal fluids from patients with bacterial meningitis . It consists of a charcoal-starch agar slant and soybean-casein digest-gelatin broth buffered at pH 7.2 with 0.1 M 3-(N-morpholino)propanesulfonic acid buffer . In the laboratory, this medium supported the growth and survival of stock cultures of Neisseria meningitidis, Streptococcus pneumoniae, and Haemophilus influenzae for at least 3 months . Under field conditions in Africa, cerebrospinal fluids from patients suspected of having bacterial meningitis were inoculated directly onto plates of chocolate agar medium and into bottles of Trans-Isolate medium . An etiological agent was isolated from 52 spinal fluids by direct plating . After shipment to Atlanta, Ga., 2 to 4 weeks later, the same etiological agents were recovered from 38 bottles of Trans-Isolate medium.

Pediatrics, 1984 Jul, 74(1), 77 - 80
Incidence of invasive bacterial disease in children with fever and petechiae; Van Nguyen Q et al.; The records of 129 patients admitted to the hospital with the findings of fever and petechiae were reviewed to determine the incidence of invasive bacterial disease in patients with this symptom complex . Twenty-six patients (20.2%) had culture-proven bacterial infections; 13 (11.1%) of the group had Neisseria meningitidis, eight had Haemophilus influenzae type B . No single laboratory test was sufficiently sensitive to detect all patients with life-threatening bacterial infections, but a combination of normal laboratory findings was highly specific for those without significant disease.

Infect Immun, 1984 Jul, 45(1), 248 - 54
Preparation of human hyperimmune globulin to Haemophilus influenzae b, Streptococcus pneumoniae, and Neisseria meningitidis; Siber GR et al.; As a first step in exploring the feasibility of passive antibody prophylaxis and therapy of serious infections caused by common encapsulated bacteria, we have immunized healthy adults with Haemophilus influenzae type b vaccine, 14-valent pneumococcal vaccine, and meningococcal group A and C vaccine; collected plasma by repeated pheresis; and purified a hyperimmune globulin termed bacterial polysaccharide immune globulin by the cold-ethanol fractionation method of Cohn and Oncley . Specific antibacterial antibody concentrations were measured in individual donors before and after immunization . In addition, antibody concentrations were measured in plasma pools prepared from immunized donors and from unimmunized controls and in the immunoglobulin-containing Cohn-Oncley fractions II and III derived from the respective plasma pools . A comparison of Cohn-Oncley fractions II, which contain primarily immunoglobulin G and which are used therapeutically as immune globulin, revealed that antibody to H . influenzae type b was enriched 15.3-fold and that antibody to meningococcal serogroups and pneumococcal types was enriched a mean of 4.4-fold (range, 1.2- to 9.9-fold) . Enrichment of antibacterial antibody in Cohn fraction III, which contains substantial amounts of immunoglobulin M and immunoglobulin A in addition to immunoglobulin G, closely paralleled that in fraction II . Only antibodies to pneumococcal types 1 and 7 were increased disproportionately in fraction III . Based on the clinical experience that conventional immune serum globulin at a dose of 100 mg/kg protects agammaglobulinemic patients for ca . 1 month, we estimate that bacterial polysaccharide immune globulin, in similar dosage, will provide protection from systemic H . influenzae type b infection for 4 to 6 months and from pneumococcal and meningococcal infections for 3 to 4 months.

Pediatr Infect Dis, 1984 Jul-Aug, 3(4), 317 - 8
The effect of dilution during culture on detection of low concentrations of bacteria in blood; Kennaugh JK et al.; The standard procedure for culturing blood is to inoculate 5 ml of blood into 50 ml of broth, resulting in a blood-broth ratio of 1:10 . In infants, where only 0.5 to 1.0 ml of blood is available for culture, blood:broth ratios may be as dilute as 1:100 . The purpose of this study was to determine whether a blood-broth ratio of 1:100 was as sensitive as a ratio of 1:10 for detecting low concentrations of bacteria in blood . Blood (0.5 ml) seeded with 2 to 30 organisms/ml of one of four common pediatric pathogens (Escherichia coli, Streptococcus pneumoniae, Group B Streptococcus or Haemophilus influenzae type b) was inoculated into culture broth so as to provide blood-broth ratios of 1:10, 1:30 or 1:100 . There were no differences in the ability to recover organisms or in the time-to-positivity of cultures with different blood-broth ratios . Cultures were positive in 24 of 40 (60%) bottles at a ratio of 1:10, 28 of 40 (70%) at 1:30 and 30 of 40 (75%) at 1:100 . Common pediatric pathogens can be recovered without delay from volumes of blood as small as 0.5 ml cultured at blood-broth ratios up to 1:100.

J Infect Dis, 1984 Jul, 150(1), 30 - 9
Plasmid-mediated resistance in multiply resistant Haemophilus influenzae type b causing meningitis: molecular characterization of one strain and review of the literature; Mendelman PM et al.; The increasing prevalence of infections due to ampicillin-resistant strains of Haemophilus influenzae type b requires that suspected H . influenzae meningitis in children be initially treated with both ampicillin and chloramphenicol . Previously, the recognition of strains resistant to chloramphenicol but susceptible to ampicillin supported combination chemotherapy . In this study one case of meningitis due to a strain of H . influenzae resistant to ampicillin, chloramphenicol, and tetracycline was analyzed . The patient involved received intravenous trimethoprim-sulfamethoxazole, but putative resistance to this combination prompted the additional administration of intravenous moxalactam . The resistance of this organism was mediated by a conjugative 43-megadalton R plasmid; the determinants of ampicillin and chloramphenicol resistance were transferred as a single unit . However, not all of the multiply resistant transconjugants contained a detectable plasmid; DNA homology studies with R plasmids of H . influenzae confirmed that these extrachromosomal DNA sequences were associated with chromosomal DNA and that an extrachromosomal location was rare.

J Clin Microbiol, 1984 Jul, 20(1), 131 - 2
Simple screening method for beta-lactamase-positive and -negative ampicillin-resistant Haemophilus influenzae isolates; Parr TR Jr et al.; A simple, inexpensive method for screening for beta-lactamase-positive and beta-lactamase-negative ampicillin-resistant Haemophilus influenzae isolates was developed . Disks containing 10 micrograms of cloxacillin yielded no zone of inhibition when placed on chocolate agar plates inoculated with beta-lactamase-positive (16 strains) or ampicillin-resistant (greater than or equal to 1 microgram/ml) beta-lactamase-negative (10 strains) H . influenzae, whereas ampicillin-susceptible (less than or equal to 0.5 microgram/ml; 36 strains) H . influenzae almost always (92%) showed a zone of inhibition.

J Infect, 1984 Jul, 9(1), 30 - 42
A review of Haemophilus influenzae infections in Cambridge 1975-1981; Broughton SJ et al.; Invasive Haemophilus influenzae infections diagnosed in Cambridge between January 1975 and December 1981 are reviewed . Altogether, 81 sites in 77 patients were infected . Of these patients, 41 had meningitis, 20 epiglottitis, 8 bone or joint infections (2 with concurrent meningitis), 4 cellulitis, 5 pneumonia (2 with concurrent epiglottitis) and 3 septicaemia in the absence of documented localised infection . Most patients (88%) were children less than 5 years of age . Only 8 adults with such infections were identified . Of these, 6 had an identifiable predisposing condition . The incidence of meningitis was 18 cases per 100 000 children less than 5 years of age . There were 3 deaths . Of the strains of H . influenzae isolated, 16% were ampicillin-resistant . The unusual age-specific incidence of epiglottitis and the incidence of deafness after meningitis are emphasised.

Jpn J Antibiot, 1984 Jul, 37(7), 1241 - 62
{Susceptibility of bacteria isolated from lower respiratory tract infections to antibiotics (1982)}; Ikemoto H et al.; Two hundred seventy-six bacterial strains were isolated as possible causative pathogens mainly from sputum in 248 patients with lower respiratory tract infections at 12 medical institutions in various parts of Japan during the period from September 1982 to March 1983 . Of these, 272 isolates including 28 Staphylococcus aureus strains, 38 Streptococcus pneumoniae strains, 107 Haemophilus influenzae strains, 68 Pseudomonas aeruginosa strains, 17 Klebsiella pneumoniae strains, 9 Escherichia coli strains and 5 strains of other species were tested in vitro for MICs of various antibiotics, and their drug sensitivity distributions determined . Data were also analyzed for distribution of cases by clinical entities, age and sex, interrelations between the types of infections and the species and frequency of isolation of organisms, and relations of the antimicrobial regimens at collection of clinical specimens to the species and frequency of isolation of the organisms . It engenders great interest that there was a significant increase in frequency of S . aureus isolation within 7 days after antibiotic therapy, compared to pretreatment isolation frequency, in the 1982 series . This seems to deserve further investigation in detail . The H . influenzae strains isolated with the highest frequency in 1981 and those in 1982 were examined as to susceptibility to several representative antibiotics, with interdrug comparisons: ABPC vs . SBPC, CTM vs . CMZ, and CMX vs . LMOX . The isolates demonstrated high degrees of susceptibility to these drugs and there was no conspicuous change in bacterial sensitivity to the drugs.

Antimicrob Agents Chemother, 1984 Jul, 26(1), 91 - 3
In vitro interactions between rifampin and ampicillin or chloramphenicol against Haemophilus influenzae; Jadavji T et al.; Twenty clinical isolates of Haemophilus influenzae type b were used to determine the in vitro interactions of rifampin with ampicillin or chloramphenicol . Potential interactions of the drugs were evaluated by calculating the fractional inhibitory concentration index and fractional bactericidal concentration index for each strain after treatments with the drugs alone and in combination . There was no evidence of synergy or antagonisms between ampicillin and rifampin or between chloramphenicol and rifampin . With ampicillin-susceptible H . influenzae type b strains, an additive effect was observed with seven strains, and an indifferent effect was observed with three strains . Similarly, with chloramphenicol-susceptible H . influenzae type b strains, an additive effect was observed with eight strains, and an indifferent effect was observed with two strains.

J Gen Microbiol, 1984 Jul, 130 ( Pt 7), 1787 - 93
The acid end-products of glucose metabolism of oral and other haemophili; Tuyau JE et al.; The acids produced in broth culture by various species of oral haemophili and by stock strains of capsulated and other haemophili were identified and measured by gas-liquid chromatography . Succinic acid was the major acid end-product of all strains, with acetic acid also being regularly produced but in smaller amounts . A stock strain, Haemophilus parainfluenzae NCTC 4101, produced less succinic acid than other strains of haemophili . Strain NCTC 4101 possessed all the enzymes of the tricarboxylic acid cycle, as previously reported, but in the other haemophili examined only succinic dehydrogenase, fumarase and malate dehydrogenase could be detected . No other enzymes of the tricarboxylic acid cycle were detected and isocitrate lyase, malate synthase and pyruvate carboxylase were also absent . Phosphoenolpyruvate-carboxylase was present in all strains . A partial tricarboxylic acid cycle and marked malate dehydrogenase activity appear to be characteristic of haemophili . The pathway to succinate in haemophili appears to be via carboxylation of phosphoenolpyruvate to oxalacetate and thence via malate and fumarate . The results of tracer studies on a single oral strain of H . parainfluenzae using various labelled substrates were in keeping with this proposed metabolic pathway.

Acta Paediatr Scand, 1984 Jul, 73(4), 541 - 7
Antibiotic treatment of Haemophilus influenzae and Haemophilus parainfluenzae infections in patients with cystic fibrosis; Pressler T et al.; During the period 1977-81, 188 Cystic fibrosis patients have been treated with 1 254 anti-haemophilus treatments in the Danish Cystic Fibrosis Center . On an average, each patient received 1.7 courses of chemotherapy per year . Haemophilus infections were more prevalent in the youngest age group of patients . The average number of H . influenzae precipitins increased with age, and this pattern was consistent throughout the whole study . The standard treatment was orally administered pivampicillin or amoxicillin given for 14 days . 1 case of allergy or ampicillin-resistant strains, erythromycin was given, in most cases alone, in some cases in combination with rifampicin . The overall results showed, that H . influenzae was eradicated from sputum by a single course of chemotherapy in 73% of the courses and H . parainfluenzae in 100% of the courses . Six per cent of the patients suffered from chronic H . influenzae infection in spite of repeated treatments . No decrease of treatment efficiency was found even after many repeated chemotherapy courses . The prevalence of patients harbouring ampicillin-resistant H . influenzae increased in the beginning of the period (6%-20%), but a slight fall was subsequently observed.

Infect Immun, 1984 Jul, 45(1), 276 - 7
Examination of Haemophilus pleuropneumoniae for immunoglobulin A protease activity; Mulks MH et al.; Haemophilus pleuropneumoniae, the etiological agent of porcine contagious pneumonia, was examined for the ability to produce an immunoglobulin A (IgA) protease specific for porcine IgA . No IgA protease activity against either porcine or human IgA was detected . Furthermore, no sequence homology was found between H . pleuropneumoniae chromosomal DNA and the gene which specifies IgA protease in Haemophilus influenzae.

J Infect Dis, 1984 Jul, 150(1), 40 - 3
Fimbriation of Haemophilus species isolated from the respiratory tract of adults; Apicella MA et al.; Twenty-two clinical isolates of Haemophilus species were studied within two passages of their original isolation for the presence of fimbriae by negative-staining electron microscopy . Six isolates were identified as fimbriated, including three strains of nontypable Haemophilus influenzae, one strain of Haemophilus parainfluenzae, and two strains of Haemophilus haemolyticus . In fresh isolates of fimbriated strains of nontypable H . influenzae, approximately 40%-50% of cells had fimbriae; after five passages in vitro, less than 1% of the cells had fimbriae . Thus, a variety of Haemophilus species that colonize the human respiratory tract can be fimbriated, and this fimbriation is rapidly lost on passage in vitro.

Sex Transm Dis, 1984 Jul-Sep, 11(3), 148 - 51
The role of Haemophilus ducreyi in penile ulcers in Bangkok, Thailand; Taylor DN et al.; In October 1982, penile ulcers were identified in 248 (19%) of 1282 men at Bangrak Hospital, Bangkok, Thailand . The etiology of the ulcers was determined for 120 (48%) of these patients . Haemophilus ducreyi was isolated from 45 (38%), herpes simplex virus from 14 (12%), and Neisseria gonorrhoeae from two (2%) of 120 patients . Syphilis was detected in one patient . Two patients had both H . ducreyi and herpes simplex virus isolated from the same ulcer . Thirty-five per cent of patients had a single ulcer, 56% had two to four ulcers, and 9% had more than four . Ulcers were located on the prepuce or coronal sulcus (69%), frenulum (18%), shaft (9%), and glans (4%) . Inguinal adenopathy was present in only 11% of patients . H . ducreyi infection was diagnosed by gram stain in 28 (62%) of 45 patients from whom H . ducreyi was isolated and in only one of 75 patients from whom H . ducreyi was not isolated . Of the 45 isolates of H . ducreyi, 42 (93%) were isolated with use of media containing horse blood and 34 (76%) with use of media containing rabbit blood.

Jpn J Antibiot, 1984 Jul, 37(7), 1294 - 305
In vitro antibacterial activity and beta-lactamase stability of cefodizime, a new cephalosporin antibiotic; Kasai K et al.; The in vitro activity and beta-lactamase stability of cefodizime (HR 221), a new cephalosporin, were compared with those of other cephem antibiotics . HR 221 was highly active against Gram-negative bacteria . The compound inhibited growth of all tested Haemophilus influenzae strains at 0.10 microgram/ml and showed strong activity even against penicillin-resistant Neisseria gonorrhoeae strains, but it was less effective against Pseudomonas aeruginosa than the other antibiotics tested . Against Gram-positive bacteria, HR 221 showed 100% inhibition of growth of Streptococcus pneumoniae at 0.39 microgram/ml, and it was slightly less active against Staphylococcus aureus (MIC90:12.5 micrograms/ml) than other antibiotics such as cefotaxime (CTX) . The bactericidal activity of HR 221 against E . coli was dose-related and comparable to that of CTX, cefoperazone and latamoxef . The bactericidal activity of the compound at medium concentrations simulating human serum levels was higher than that of CTX and cefmetazole, and no cell regrowth was noted after beta-lactamase-induced inactivation of the compound . HR 221 was stable to most drug-inactivating enzyme preparations from various bacterial species.

J Chromatogr, 1984 Jun 8, 308, 19 - 29
Determination of acids in whole lipopolysaccharide and in free lipid A from Actinobacillus actinomycetemcomitans and Haemophilus aphrophilus; Brondz I et al.; Acids from whole lipopolysaccharide and free lipid A of the closely related bacteria Actinobacillus actinomycetemcomitans and Haemophilus aphrophilus were determined by gas chromatography and gas chromatography-mass spectrometry . In whole lipopolysaccharide, 3-hydroxymyristic acid was most abundant, followed by myristic and 3-deoxy-D-manno-2-octulosonic acid . In the lipid A moiety, myristic acid dominated, followed by 3-hydroxymyristic acid . The acid composition of whole lipopolysaccharide and free lipid A from A . actinomycetemcomitans and H . aphrophilus was not so specific as to allow taxonomic differentiation between these bacteria . If fatty acids of lipopolysaccharide are essential for expression of endotoxicity, the present results suggested no marked difference in the endotoxic activities of A . actinomycetemcomitans and H . aphrophilus.

Mayo Clin Proc, 1984 Jun, 59(6), 415 - 22
Clinical and therapeutic aspects of Haemophilus influenzae pericarditis in pediatric patients; Fyfe DA et al.; Two cases of Haemophilus influenzae type B pericarditis are presented which demonstrate the major clinical features and sequelae of this serious illness . These cases are analyzed together with 77 others from the literature to characterize the clinical features, natural history, and optimal therapy . H . influenzae pericarditis is an increasingly frequent disease of young children . A mild prodromal illness is often followed by rapid progression of cardiac compromise until death ensues, unless pericarditis is diagnosed and treated appropriately . The development of cardiomegaly in a febrile patient with a Haemophilus infection is an indication for echocardiography, which is diagnostic of the pericardial effusion . Initial cultures of pericardial aspirates will be positive in 75% of cases even when antibiotic therapy has been initiated . Use of appropriate parenterally administered antibiotics, in combination with early surgical pericardial drainage or partial pericardiectomy, should minimize morbidity and mortality and prevent acute constrictive sequelae.

Pathol Biol (Paris), 1984 Jun, 32(6), 689 - 92
{Comparative activity of sulfamethoxazole-trimethoprim (SMZ-TMP) on bacteria responsible for ORL infections}; Joly B et al.; The bacteriostatic activity in vitro of co-trimoxazole (SMZ-TMP); ampicillin, tetracycline and oleandomycin was evaluated against 225 bacterial strains . All the strains (49 Pneumococci, 49 Haemophilus, 41 Streptococci and 86 Staphylococcus aureus) were isolated from sinusitis (63 strains) and otitis (162 strains) in monomicrobial samples . The minimal inhibitory concentrations (MICs) of the 4 antibiotics were determined by the agar diffusion method on all strains . Moreover MICs of SMZ-TMP were determined by the broth dilution method on Haemophilus strains . Seventy seven p . cent of the strains were found sensitive to SMZ-TMP, 70.7% to ampicillin, 85.4% to tetracycline and 73% to oleandomycin . SMZ-TMP was the most effective on Staphylococcus aureus (80% of the isolates were sensitive), whereas ampicillin was effective on all Streptococcus, and Pneumococcus strains and tetracycline was the most active on Haemophilus strains (88% of the isolates were sensitive).

Antimicrob Agents Chemother, 1984 Jun, 25(6), 747 - 53
Mechanism of resistance of an ampicillin-resistant, beta-lactamase-negative clinical isolate of Haemophilus influenzae type b to beta-lactam antibiotics; Parr TR Jr et al.; The mechanism of non-beta-lactamase-mediated beta-lactam resistance in a clinical isolate of Haemophilus influenzae type b was studied . This clinical isolate showed up to a 32-fold increase in MICs of a wide variety of beta-lactams, including moxalactam and cefotaxime, although no beta-lactamase activity was detected, even after attempted induction . Transformation of broad-spectrum beta-lactam resistance into ampicillin-susceptible H . influenzae RDnov was accomplished . Examination of the outer membrane protein profile of the resistant parent by sodium dodecyl sulfate-polyacrylamide gel electrophoresis of Triton X-100-extracted membranes revealed an unusual major outer membrane protein band at a molecular weight of 45,000 . This outer membrane protein profile did not transform with beta-lactam resistance . Permeability differences were noted between the resistant strain and the nonisogenic susceptible strain of H . influenzae, although these penetration differences were not transformed . Comparison of the penicillin-binding protein profile of a resistant transformant with that of a susceptible parent with both whole-membrane preparations and whole-cell labeling, revealed a major reduction in binding affinity to penicillin-binding proteins 3a and 3b (molecular weights, 68,000 and 65,000, respectively) . Thus, alteration in penicillin-binding proteins 3a and 3b correlated with the beta-lactam resistance.

Antimicrob Agents Chemother, 1984 Jun, 25(6), 706 - 9
Susceptibility studies of multiply resistant Haemophilus influenzae isolated from pediatric patients and contacts; Campos J et al.; From February 1981 to December 1983, 225 strains were isolated from pediatric patients infected with Haemophilus influenzae . Forty-one strains were found to be resistant to ampicillin, chloramphenicol, and other antibiotics . They were isolated from 20 patients with invasive diseases (meningitis, 16; bacteremia, 4) and 21 with noninvasive diseases (otitis media, 19; conjunctivitis, 2) . During this period, 44 patients with invasive diseases were seen (meningitis, 28; bacteremia, 16) . Strains resistant to both ampicillin and chloramphenicol occurred in 45.4% of cerebrospinal fluid and blood isolates and in 51% of cerebrospinal fluid isolates only . In this group, individual resistance to ampicillin was 50%; chloramphenicol, 52.2%; tetracycline, 54.5%; and sulfamethoxazole-trimethoprim, 63.6% . No epidemiological relationship could be found among the patients . The presence of asymptomatic carriers was investigated in two nurseries and in eight family groups . From a total of 125 individuals studied, 80 were found to be colonized by H . influenzae, and 36 carried multiply resistant strains . From patients and carriers, 77 strains were found to be resistant to ampicillin, chloramphenicol, and other drugs; 39 belonged to type b (cerebrospinal fluid, 16; blood, 4; ear, 7; and nasopharynx, 12), and 38 were non-type b . The most frequent pattern of resistance was ampicillin-chloramphenicol-tetracycline-sulfamethoxazole-trimethoprim (94.8%), followed by ampicillin-chloramphenicol-tetracycline (3.9%) . The disk diffusion method correctly predicted multiple resistance . The mean inhibition zone diameters were: ampicillin, 12.8 mm; chloramphenicol, 15.2 mm; tetracycline, 9.9 mm; and sulfamethoxazole-trimethoprim, 10.8 mm . These resistant strains were susceptible to cefotaxime, moxalactam, cefoperazone, cefuroxime, rifampin, and gentamicin . Our data suggest that in Spain the resistance of H . influenzae to ampicillin and chloramphenicol is endemic and that other effective therapeutic modalities are needed.

Br J Vener Dis, 1984 Jun, 60(3), 196 - 8
Sheffield medium for cultivation of Haemophilus ducreyi; Hafiz S et al.; Our interest in the role of Haemophilus ducreyi in genital ulceration led us to examine the various media commonly used for the cultivation of the organism . We describe an improved medium for the routine isolation of H ducreyi . In comparative studies using 50 test strains originally isolated in the United Kingdom, Canada, the United States of America, and Kenya, the new medium proved superior to three standard media in requiring a shorter incubation period to first visible growth, giving larger colonies in the same period, and making possible a starch aggregation test which we have found helpful in the presumptive identification of H ducreyi from clinical material.

J Med Microbiol, 1984 Jun, 17(3), 335 - 45
A chemotyping scheme for clinical isolates of Haemophilus influenzae; Tebbutt GM; A total of 464 Haemophilus influenzae strains, most of them fresh clinical isolates, have been classified by chemotyping --a combination of auxotyping and biotyping . Seven auxotests and four other biochemical tests allowed recognition of 56 types . These were to a degree site-specific . H . influenzae of capsular type b proved almost without exception to belong to one chemotype, and 24 of 33 strains assigned to this chemotype were capsulated . When surgical-ward isolates of H . influenzae were typed, the results suggested that some cross-infection had occurred.

Infect Immun, 1984 Jun, 44(3), 614 - 6
Effect of bacterial secondary infection in an animal model of trachoma; Taylor HR et al.; In trachoma the interaction between chronic chlamydial and acute bacterial conjuntivitis has been suggested as important in determining the severity of disease and, therefore, blindness . We investigated the effect of acute conjunctival infection with each of three common human pathogens, Haemophilus influenzae, Haemophilus aegyptius , and Streptococcus pneumoniae, in a model of trachoma established in cynomolgus monkeys . Although acute conjunctivitis developed, animals with trachoma were not more susceptible to infection than other monkeys, nor did they develop more severe disease as a result of the bacterial conjunctivitis . The failure of bacterial conjunctivitis to exacerbate the experimental trachoma indicates that, in this model at least, chronically maintained chlamydial infection alone is sufficient to produce the changes characteristic of trachoma.

J Reprod Med, 1984 Jun, 29(6), 411 - 5
Sexually transmittable diseases and other genital infections during adolescence; Weinstein AJ; PIP: Sexually transmitted (STD), diseases in which sexual contact is epidemiologically important but not the only mode of acquisition, will continueto increase in incidence unless effective control strategies can be applied . The recent increase in incidence has been due, in part, to increased levels of sexual activity among young people . Focus in this discussion is on the epidemiology of STD, the importance of an accurate sexual history in the diagnosis of STD, gonorrhea, syphilis, nongonococcal urethritis, vaginitis, herpes genitalis, pelvic inflammatory disease, and adolescent attitudes and knowledge . The sexual partners of infected patients are at particulary high risk of acquiring STD . The prevelence of inection among partners of patients with STD is so high that antibiotic therapy can be initiated as soon as a patient is identified as a sexual partner of an index case . Such epidemiolofgic treatment probably is appropriate in gonorrhea, syphilis, and infections produced by Haemophilus ducreyi, Gardnerella vaginalis, Calymmatobacterium granulomatis, Ureaplasma urealyticm, Chlamydia, trachomatis, and parasites . An important result of the sexual role of transmission is the high incidence of coinfection . The incidence of syphilis has remained relatively constant during the past 20 years, but gonorrhea has markedly increased in incidence, as have nonspecific urethritis in men, nonspecific genital infection in women, and herpes genitalis . The diagnosis of gonorrhea must be based on bacteriologic techniques; smears and cultures must be obtained from the urethra in the male and from the urethra and cervix in the female . The failure of prevention of gonorrhea has been due, in part, to a change in contraceptive methods, with greater use of oral contraceptives (OCs) and IUDs . The diagnosis of syphilis is established most accurately by examination of the exudate utilizing darkfield microscopy . The presence of nonspecific antibodies is most helpful as a diagnostic tool in the late primary phase of syphilitivc infection . Nongonococcal urethritis may be distinguished from gonococcal urethritis by the presence of a more mucoid, less copious, less purulent discharge . Nonspecific genital infection is a considerable problem in both sexes . Patients with nonspecific vaginitis experience itching and burning of the vulva, often accompanied by a slightly gray to white, frothy discharge that has an odor described as "fishy." Herpes genitalis is produced by herpes simplex virus type II and occasionally by herpes simplex virus type I . Clinical disease develops after an incubation period of 3-6 days . Approximately 500,000 cases of pelvic inflammatory disease occur annually in the US . An investigation designed to assess knowledge of, attitudes toward, and behavior regarding prophylaxis amoung a group of 200 single US female adolescents demonstrated much ignorance about veneral disease prophylaxis .

Am J Vet Res, 1984 Jun, 45(6), 1109 - 13
Comparison of uterine protein content and distribution of bacteria in the reproductive tract of mares after intrauterine inoculation of Haemophilus equigenitalis or Pseudomonas aeruginosa; Strzemienski PJ et al.; Two groups of 3 mares were inoculated with Haemophilus equigenitalis or Pseudomonas aeruginosa on the 1st day of estrus . Uterine flushing samples were recovered on day 3 of estrus and day 8 after ovulation for each cycle . Mares were killed 22, 25, and 30 days after inoculation with P aeruginosa and 45, 46, and 49 days after inoculation with H equigenitalis . Pseudomonas aeruginosa was recovered from the uterus of 2 mares 48 hours after inoculation . Although the initial flushing sample of 1 of these 2 mares had an increased total protein concentration, there appeared to be little difference between protein concentrations of other uterine flushing samples . Haemophilus equigenitalis was recovered from the uterus of each of the 3 mares at postmortem . One mare had a slight, purulent discharge from the vulva . Total protein values were not increased in flushing samples from this mare after inoculation with H equigenitalis . Total protein values decreased in the last flushing sample of each of the 2 remaining mares . Swabbing the uterus was more effective than was homogenizing the uterine mucosa in isolating H equigenitalis.

J Immunogenet, 1984 Jun-Aug, 11(3-4), 181 - 8
Interactive effect of genes associated with immunoglobulin allotypes and HLA specificities on susceptibility to Haemophilus influenzae disease; Granoff DM et al.; Genes associated with immunoglobulin (Ig) allotype determinants are important in regulation of immune responses to bacterial polysaccharides . Furthermore, loci associated with Ig allotypes have been reported to interact with those associated with the major histocompatibility complex and affect susceptibility to certain diseases . In the present study we determined the frequencies of certain Gm phenotypes in patients with Haemophilus meningitis or epiglottitis and in controls . HLA-A, -B and -DR specificities had previously been determined in the majority of these subjects . Although no Ig phenotype was associated with increased or decreased relative risk of disease, the frequencies of several combinations of HLA specificities and Ig phenotypes were significantly different from those of controls . Thus, for subjects with the Gm phenotype (1, 3, 17; 23; 5, 13, 21), the risk of Haemophilus meningitis or epiglottitis was lower in individuals with HLA-B5 than in those without this specificity (odds ratio less than 0.1, P less than 0.004) . In contrast, for subjects with the closely related Gm phenotype differing only by the absence of Gm(23), (1, 3, 17; ; 5, 13, 21), the risk of disease was higher in those with HLA-DR3 than in individuals who lacked DR3 (odds ratio = 11.0, P = 0.02) . Although the present data require confirmation in an independent sample, they suggest that complex interactions between genes at two independent loci controlling HLA and Ig allotypes, respectively, may affect susceptibility to Haemophilus disease.

Can J Microbiol, 1984 Jun, 30(6), 763 - 73
The cytochrome complement of Haemophilus parasuis; Niven DF; Spectral analyses with subcellular fractions derived from Haemophilus parasuis demonstrated that this organism could synthesize membrane-bound and soluble CO- and NO-binding c-type cytochromes in addition to the membrane-bound cytochromes d, a1, b, and c; cytochromes d, a1, and o were identified as potential oxidases . The membrane-bound and soluble CO- and NO-binding cytochromes c were not spectrally variant cytochromes c, and the redox properties of the soluble cytochrome (reducible by NADH but not by succinate or ascorbate plus N,N,N',N'-tetramethyl-p-phenylenediamine) suggested that it, at least, was a low-potential cytochrome; up to 68% of the soluble cytochrome c could be released from the organisms by osmotic-shock treatment, demonstrating its extracytoplasmic location . The cytochrome content of H . parasuis was influenced by both the composition of the growth medium and the phase of growth; it is suggested that the bacterial concentration and growth rate, and therefore the availability of oxygen, regulated cytochrome synthesis.

Eur J Clin Microbiol, 1984 Jun, 3(3), 244 - 8
Increased frequency of isolation of Pasteurella and Actinobacillus species and related organisms; Sakazaki R et al.; Ninety-six clinical isolates of Pasteurella, Actinobacillus and related organisms were submitted to our reference laboratory for identification . The procedures for detecting the 11 identified species, Pasteurella multocida, Pasteurella haemolytica, Pasteurella ureae, Pasteurella pneumotropica, Actinobacillus lignieresii, Actinobacillus equuli, Actinobacillus actinomycetemcomitans, Haemophilus aphrophilus, Cardiobacterium hominis, and two unnamed species of CDC groups, HB-5 and EF-4, are described and their clinical importance is discussed . These organisms have been increasingly isolated in Japan and are most often associated with respiratory infections and endocarditis.

Eur J Clin Microbiol, 1984 Jun, 3(3), 236 - 40
Rapid identification of Capnocytophaga isolated from septicemic patients; Kristiansen JE et al.; Four Capnocytophaga strains from blood cultures of immunocompromised patients with malignant disease and the type strains of three Capnocytophaga species were examined and compared to strains representing five other genera that are hard to differentiate from Capnocytophaga . With three rapid identification methods, negative catalase and oxidase reactions and positive ONPG assay, Capnocytophaga was easily separated from Eikenella corrodens, Actinobacillus actinomycetemcomitans, Cardiobacterium hominis, and CDC group DF-2 . Haemophilus aphrophilus was excluded by leucine, valine and cystine arylamidase and alpha-glucosidase reactions (API ZYM) . Further confirmatory reactions constituted gelatin hydrolysis, haemin requirement, and carbohydrate and esculin breakdown . Although rapid identification of Capnocytophaga to the genus level was feasible, differentiation on a species level proved impossible.

J Gen Microbiol, 1984 Jun, 130 ( Pt 6), 1437 - 47
Adherence of Haemophilus influenzae to monkey respiratory tissue in organ culture; Roberts M et al.; We studied the adherence of Haemophilus influenzae to monkey respiratory mucosa using nasal turbinates maintained in organ culture . Adherence of capsulated and rough strains was not inhibited by monosaccharides, sucrose, human albumin, foetal calf serum or polyribophosphate . However, antisera directed against surface components decreased bacterial adherence . Although variation in adherence capacity in individual strains was observed there was no correlation with capsulation, anatomical site of strain isolation or biotype . Bacterial surface structures other than capsular material appear important in effecting upper respiratory tract colonization.

J Clin Microbiol, 1984 Jun, 19(6), 777 - 82
Interpretive criteria and tentative quality control limits for apalcillin disk susceptibility tests; Barry AL et al.; In vitro studies with 661 bacterial isolates were performed to establish interpretive criteria . In addition, a nine-laboratory study was performed to establish quality control limits for tests with 100-micrograms apalcillin disks and to confirm testing criteria for tests with 100-micrograms piperacillin disks . The two drugs were very similar, and nearly identical criteria were recommended for interpretation and for control of the two types of disks . Neither disk is recommended for testing Staphylococcus spp . or Haemophilus spp.; with other microorganisms, zone size limits of less than or equal to 13 mm (resistant) and greater than or equal to 18 mm (susceptible) are proposed for tests with 100-micrograms apalcillin disks.

Diagn Microbiol Infect Dis, 1984 Jun, 2(3), 251 - 3
Haemophilus organisms: urinary tract pathogens in children?
Burns TR, Hinds DB, Hawkins E.
The incidence and significance of isolation of Haemophilus species from urine specimens was determined at a pediatric referral center . The incidence was 0.27%, and half the isolates were pathogens . Evaluation of incidence and a cost analysis led to the conclusion that routine efforts to isolate Haemophilus from urine are not cost-effective.

Quad Sclavo Diagn, 1984 Jun, 20(2), 131 - 40
{Quantitative determination in the culture examination of the sputum}; Bovelacci A et al.; 1448 sputa specimens were examined by a quantitative research: they were fluidified with dithiothreitol and subsequently serially diluted; was also performed a microscopic examination in order to notice the presence of leukocytes . If we consider as significant a microbic concentration greater than or equal to 10(7)/ml, the 61.5% for specimens presented a saprophytic flora, the 15.1% was included from 10(5) to 10(6)/ml and the 23.3% had a concentration greater than 10(7)/ml . The sputa with a concentration greater than or equal to 10(7)/ml had a prevalence of Pneumococcus, Haemophilus and Pseudomonas, often in pure culture . The authors emphasize the importance of quantitative assay in sputum's culture and at the same time of cytologic examination.

Acta Ophthalmol (Copenh), 1984 Jun, 62(3), 461 - 71
A study of the incidence of neonatal conjunctivitis and of its bacterial causes including Chlamydia trachomatis . Clinical examination, culture and cytology of tear fluid; Molgaard IL et al.; Out of 300 newborn infants who had conjunctival swabs inoculated for detection of Chlamydia trachomatis and other bacteria, 72% had bacteria isolated 4 to 6 days after birth . Of these, Staph . albus constituted 51% and Staph . aureus 19% . None of the infants were Chlamydia positive . Five out of 112 mothers (4.5%) were Chlamydia positive from the cervix just before delivery . Nineteen of the neonates were treated for conjunctivitis within the first month of life . Chlamydia trachomatis was isolated from 2, and Staph . aureus, alpha-Streptococci, Pneumococci and Haemophilus influenzae from some of the other infants . A likely diagnosis could be made in 46% of these cases, while the remaining cultures showed only apathogenic bacteria or no growth . There was a fairly good accordance with observation of inflammatory cells in the tear fluid and the clinical picture, 17/19 = 90% showing neutrophilia . Despite failing aetiological diagnosis in several cases, the infants responded satisfactorily to local antibiotic treatment . 75% of the parents replied to questionnaires 2 months after birth concerning conjunctivitis within the first month of life . The replies showed that 58 = 25% had had conjunctivitis, of whom 17% had been treated with antibiotics.

J Infect Dis, 1984 Jun, 149(6), 950 - 5
Response of infants to Haemophilus influenzae type b polysaccharide and diphtheria-tetanus-pertussis vaccines in combination; Lepow ML et al.; In a multicenter study, responses to a combined vaccine containing standard diphtheria-tetanus-pertussis (DTP) and polyribosylribitol phosphate (PRP), the capsular polysaccharide of Haemophilus influenzae type b, were evaluated in 107 infants who received single doses at two, four, and six months of age and compared with those in 61 infants given single doses of DTP alone on the same schedule . Reaction rates were comparable in the two treatment groups . At seven months of age 61% of the subjects given the combined DTP-PRP vaccine and 8% and of those given DTP alone showed an antibody response to PRP, as defined as a twofold increase in titer over the lowest previous level . Among those given the DTP-PRP combined vaccine, 92% of the positive antibody responses occurred after the third dose . There was a variation in antibody response, possibly due to a difference in the vaccine lots administered.

P N G Med J, 1984 Jun, 27(2), 95 - 102
Acute lower respiratory tract infections in children admitted to Port Moresby General Hospital; Watt P; The clinical pattern of acute lower respiratory tract infection (ALRTI) in children admitted to Port Moresby General Hospital (PMGH) was studied . Most patients (60%) were less than twelve months of age . Common symptoms were cough, fever and shortness of breath . Common signs were crepitations, chest recession, elevated temperature and tachypnoea . Concurrent illness was common, with evidence of malnutrition in 62% patients . Most patients were anaemic (haemoglobin less than 10g per dl) . Blood cultures isolated pathogens in 13% of patients in which it was done, the most common isolate being Haemophilus influenzae . Chest radiograph showed most patients had multisegmental changes, with the lower lobes commonly involved . Of the 129 patients, discharges accounted for 106 (82%), while 15 (12%) absconded and eight (6%) died . Of those 121 discharged or absconding, 15 (12%) were readmitted within three months of departure . Sixty-six (51%) patients stayed in hospital for four days or less . Of the eight patients who died, six (75%) were malnourished, six (75%) were less than eighteen months of age, seven (87.5%) were sick for one week or less before admission, five (62.5%) had received antibiotics before admission and chest radiograph showed more lung zones affected than in those not dying . Of the eight patients who died, six had white cell counts (WCC) performed and none of these was more than 30,000.

Acta Pathol Microbiol Immunol Scand {B}, 1984 Jun, 92(3), 135 - 8
Bacteremia caused by a beta-lactamase producing Haemophilus parainfluenzae strain of a new biotype . A case report; Bruun B et al.; A case of Haemophilus parainfluenzae bacteremia without known infectious focus is reported . Phenotypically, the isolated strain is a typical H . parainfluenzae except for its ability to produce indole and beta-lactamase . Beta-lactamase producing H . parainfluenzae organisms are encountered occasionally, but to the best of our knowledge this is the first reported blood culture isolate with this ability . We propose a new biotype (IV) of H . parainfluenzae to accommodate strains that are indole, urease and ornithine decarboxylase positive.

Eur J Clin Microbiol, 1984 Jun, 3(3), 261 - 2
Adult vertebral osteomyelitis caused by Haemophilus influenzae; Holzgang J et al.; Two cases of adult vertebral osteomyelitis with typical symptoms are reported . Haemophilus influenzae serotypes b and c, respectively, were isolated from needle biopsies of the vertebrae . Both patients recovered with antimicrobial treatment, immobilization, and subsequent physiotherapy . No source or predisposing factor for the infection could be found . Only one similar case has been reported in the literature.

Eur J Clin Microbiol, 1984 Jun, 3(3), 249 - 52
Relative proportions of Haemophilus species in the throat of healthy children and adults; Kuklinska D et al.; To determine normal proportions of pharyngeal Haemophilus species, qualitative and quantitative mapping of the species in the pharynx of ten healthy children and ten healthy adults was carried out using a selective and a non-selective medium . Haemophilus organisms were present in all samples, comprising approximately 10% of the total cultivable flora (range 0.6-36.9%) . Haemophilus parainfluenzae was a member of the normal flora throughout life, constituting 74% of pharyngeal Haemophilus organisms . Haemophilus segnis and Haemophilus paraphrophilus occurred more frequently in samples from adults, whereas Haemophilus haemolyticus was present in only one sample . Non-encapsulated Haemophilus influenzae strains, usually of multiple biotypes, were present in 80% of the children but accounted for a mean of only 1.8% of the total flora . Their number decreased with increasing age; 40% of the adults harbored Haemophilus influenzae but only of a single biotype which constituted a minor proportion of the total flora (mean 0.15%) . These findings suggest that host mechanisms can influence changes in the proportions of Haemophilus influenzae strains colonizing the host.

Eur J Clin Microbiol, 1984 Jun, 3(3), 180 - 4
Incidence, predisposing factors and manifestations of invasive Haemophilus influenzae infections in adults; Trollfors B et al.; A retrospective study was conducted on invasive Haemophilus influenzae infections in adults (greater than or equal to 16 years) for the period 1971-1983 in two regions in Sweden . The annual incidence was determined to be 1.1 per 100,000 . Predisposing factors included advanced age, bronchopulmonary diseases, alcoholism, traumatic head injury, malignant diseases and pregnancy . Pleuropulmonary infections were the most common manifestations followed by epiglottitis, meningitis and septicaemia of unknown origin . A death rate of 8% was established . Both encapsulated and non-typable strains were found to be potentially pathogenic, but the non-typable strains had a lower virulence.

J Bacteriol, 1984 Jun, 158(3), 872 - 7
Loss of plasmids containing cloned inserts coding for novobiocin resistance or novobiocin sensitivity in Haemophilus influenzae; Setlow JK et al.; Plasmids pNov1 and pNov1s , coding for resistance and sensitivity to novobiocin, respectively, were readily lost from wild-type Haemophilus influenzae but retained in a strain lacking an inducible defective prophage . The plasmid loss could be partly or wholly eliminated by a low-copy-number mutation in the plasmid or by the presence of certain antibiotic resistance markers in the host chromosome . Release of both phage HP1c1 , measured by plaque assay, and defective phage, measured by electron microscopy, was increased when the plasmids were present . The frequency of recombination between pNov1 and the chromosome, causing the plasmid to be converted to pNov1s , could under some circumstances be decreased from the normal 60 to 70% to below 10% by the presence of a kanamycin resistance marker in the chromosome . This suggested that a gene product coded for by the plasmid, the expression of which was affected by the kanamycin resistance marker, was responsible for the high recombination frequency . Evidence was obtained from in vitro experiments that the gene product was a gyrase.

Am J Med, 1984 May 15, 76(5A), 215 - 23
Management of bacterial meningitis in infants and children . Current status and future prospects; McCracken GH Jr; Outcome from bacterial meningitis in infants and children has not appreciably changed in a 14-year period from 1969 to 1982 at Children's Medical Center and Parkland Memorial Hospital, Dallas, Texas . Overall, the case-fatality rate was 6.4 percent; it was 4.6 percent for 414 patients managed in 1969 to 1972 and 3.9% for 376 patients in 1981 and 1982 . In neonatal meningitis due to group B streptococci or coliform bacilli, the fatality rates were comparable in 1969 to 1972 and 1981 and 1982; ampicillin and an aminoglycoside were the mainstays of therapy during these periods . Because of changing susceptibilities of gram-negative enteric bacilli to the aminoglycosidic agents, Haemophilus influenzae to ampicillin and possibly chloramphenicol and of Streptococcus pneumoniae to penicillin, alternatives to conventional therapy must be developed and thoroughly tested . Assessment of new antimicrobial agents in the rabbit model of experimental meningitis provides valuable information on penetration of drug into cerebrospinal fluid, on achievable bactericidal activity in spinal fluid and on the bacteriologic effect of single dose or nine hour infusion therapy . These data are directly applicable to therapy in infants and children with meningitis . Although newer antimicrobial agents such as moxalactam, cefotaxime, or ceftriaxone have greatly enhanced bactericidal activity against the commonly encountered pathogens, outcome from meningitis will not be substantially improved with therapy using these agents . Improved outcome will more likely occur with the advent of therapeutic modalities that prevent or rapidly decrease cerebral edema and cerebritis, thereby preserving cerebral perfusion pressure and cellular integrity.

Pediatrics, 1984 May, 73(5), 587 - 93
Empyema in children: clinical course and long-term follow-up; McLaughlin FJ et al.; Sixteen patients, aged 1 month to 15 years, were studied to determine the clinical course and long-term outcome of empyema in previously healthy children . The pathogens responsible were Haemophilus influenzae type b (seven patients), Staphylococcus aureus (five patients), Streptococcus pneumoniae (three patients), and viridans group Streptococcus (one patient) . All patients had loculated fluid showing on chest roentgenographs . Chest tube drainage yielded 20 to 1,495 mL (mean 293 mL) during the first three days, accounting for 83% of total drainage . Chest tubes were removed after three to 17 days (mean ten days) . Only slight roentgenographic improvement showed during chest tube drainage . Three patients required an open thoracotomy because of an unsatisfactory clinical response . Hospitalization ranged from eight to 77 days (mean 25 days) . All patients had residual pleural thickening shown on chest roentgenographs taken at discharge . Thirteen patients were seen 5 to 140 months (mean 66 months) after discharge . Findings from physical examination were normal in 12 of the 13 patients . Pulmonary function tests in ten of the 13 patients revealed (mean percent predicted +/- 1 SD): vital capacity 92 +/- 12, residual volume 85 +/- 31, total lung capacity 92 +/- 13, peak flow rate 96 +/- 17, forced expiratory volume in 1 second 90 +/- 13, and maximal mid-expiratory flow rate 93 +/- 25 . In all but one patient, findings on chest roentgenograms were normal or showed slight pleural thickening . Children with loculated empyema can be treated successfully with antibiotics and chest tube drainage . Few patients require open drainage, and further surgery is rarely required . The long-term outcome is excellent.

Pediatrics, 1984 May, 73(5), 575 - 8
Onset of hearing loss in children with bacterial meningitis; Kaplan SL et al.; Auditory brainstem responses were evaluated in 37 children with bacterial meningitis within 48 hours of admission . Four children (two with Haemophilus influenzae type b, and two with Streptococcus pneumoniae) had definite abnormalities of hearing detected at admission . Two of these children had severe-to-profound hearing losses which have persisted . Hearing losses were greatly reduced in the other two children (one child also was ataxic) when repeat testing was performed . Auditory brainstem responses in two additional children suggested brainstem dysfunction at admission (one child died and the other has had severe sequelae) . Hearing losses occur early in the course of bacterial meningitis in some children . Further studies are required to confirm the use of auditory brainstem responses in detecting hearing losses early in high-risk children with bacterial meningitis.

Clin Pediatr (Phila), 1984 May, 23(5), 275 - 80
Systemic Haemophilus influenzae infection in Finland; Peltola H et al.; A total of 813 patients from the years 1976 to 1980 who had a bacteremic Haemophilus influenzae infection were analyzed . Special attention was paid to disease entities (16.5% of the total) other than meningitis (60.5%) or epiglottitis (23.0%) . Ninety-six cases in the nonmeningitis, nonepiglottitis (NMNE) group showed the following distribution: 25 patients with septicemia without specific focus, 21 arthritis, 19 cellulitis, 17 pneumonia, six otitis, four local abscess, two laryngotracheobronchitis, and two with an eye infection . Eighty-eight percent of the cases were children who were less than 5 years old; in the septicemia and pneumonia groups, however, 33 percent were 15 years of age and older, and 10 percent were over 60 years of age . All diseases in the NMNE group were acute; 51 percent of the patients sought medical advice within two days . C-reactive protein (CRP) was elevated constantly at presentation, erythrocyte sedimentation rate (ESR) was increased (greater than 20 mm/hr) in 87 percent, high fever greater than 38.5 degrees C (101.3 degrees F) was measured in 85 percent, and leukocytosis (greater than 15 X 10(9)/l) was present in 71 percent . Various antimicrobial agents were given for an average of 17 days . The mean period of hospitalization was 13 days . Case fatality rate was 4 percent; all deaths occurred among patients with an underlying disease . No permanent damage was observed.

Zh Mikrobiol Epidemiol Immunobiol, 1984 May, (5), 36 - 40
{Etiology of the infectious process in chronic pneumonia in children}; Vishniakova LA et al.; During the phase of exacerbation in chronic pneumonia in children Streptococcus pneumoniae and/or Haemophilus influenzae were isolated practically from all patients under examination . In the mild form of chronic pneumonia in children the high occurrence of H . influenzae (65.5-69%) was observed . During the whole acute phase of the disease, irrespective of the activity of the infectious process and the character of therapeutic measures, the degree of contamination of bronchial washings from the patients with these microorganisms was 5.95-6.6 lg/ml . In the bronchiectatic variant of chronic pneumonia the high activity and stability of the infectious processes induced by S . pneumoniae and H . influenzae were found to be linked with the considerable spread of these processes or with deeper morphological and functional changes in the bronchial stem and branches . During the phase of clinical remission in chronic pneumonia in 36.8-58.8% of children the release of S . pneumoniae and H . influenzae was observed . The geometric mean of their concentration varied within 3-5.3 lg/ml.

J Clin Microbiol, 1984 May, 19(5), 672 - 4
Characteristics of Haemophilus ducreyi in culture; Sturm AW et al.; Growth on different media and the influence of culture conditions were studied on 19 recently isolated strains of Haemophilus ducreyi, none of which had more than four passages on artificial media . The results were compared with 10 laboratory strains, which had an unknown number of passages in vitro . For all strains, growth was best on 30% rabbit blood agar and on Bieling agar . The laboratory strains showed a tendency to grow better on chocolate agar than did the fresh isolates . Of 19 fresh clinical isolates, 12 were CO2 dependent, and 2 needed extra moisture for growth . From the 10 laboratory strains, only one needed CO2 and none needed extra moisture . All 29 strains grew under anaerobic conditions . Of the 19 fresh clinical isolates, 12 grew at 22 degrees C, but only 2 of the 10 laboratory strains grew at this temperature . The laboratory strains grew better than the fresh isolates at 37 degrees C, and the optimal pH for all strains was pH 6.5 to 7.0 . All strains showed starch aggregation.

J Infect Dis, 1984 May, 149(5), 728 - 34
Experimental pneumonia due to Haemophilus influenzae: observations on pathogenesis and treatment; Esposito AL et al.; A model of pneumonia due to Haemophilus influenzae type b was developed in mice and used for exploration of the pathophysiology of the infection and evaluation of the efficacy of five antimicrobial agents . Adult C57BL/6 mice were challenged with 3 X 10(9) cfu of H influenzae by intratracheal inoculation . Mice given placebo or no treatment experienced a uniformly bacteremic and fatal infection . Animals given ampicillin, cefamandole, chloramphenicol, erythromycin plus sulfisoxazole, or fludalanine plus pentizidone (MK 0641/MK 0642, an investigational combination drug) survived at a higher rate than did controls (P less than .001 at 72 hr for each antibiotic) . However, survival rates for the various antibiotic-treated groups were similar . Viable organisms were eradicated from the lungs of antibiotic-treated mice more quickly than from the lungs of controls (P less than .001 at 24 hr for each drug) . Studies of pulmonary clearance revealed significant differences among regimens; the order of efficacy (from most to least) was ampicillin, chloramphenicol, erythromycin/sulfisoxazole, cefamandole, and fludalanine / pentizidone . This model represents an appropriate system for evaluation of invasive pulmonary infection caused by H influenzae type b . Of the antibiotics assessed, ampicillin was most active in vivo.

Infect Immun, 1984 May, 44(2), 452 - 8
Antibody-dependent alternative pathway killing of Haemophilus influenzae type b; Steele NP et al.; The bactericidal activities of human complement and human antibody directed against specific Haemophilus influenzae type b cell surface determinants were investigated . Strain Eagan, a laboratory isolate, and strain Kn, a clinical isolate, were used as the test organisms and gave qualitatively similar results . In the absence of antibody, both isolates were resistant to killing by 60% agammaglobulinemic serum (AGS) containing normal complement levels . The addition of affinity-purified immunoglobulin G anticapsular antibody was bactericidal with 15% AGS as the complement source . Bactericidal activity was also demonstrated with this antibody when the complement source was AGS-Mg-EGTA {ethylene glycol-bis(beta-aminoethyl ether)-N,N-tetraacetic acid}, C2-deficient human serum (alternative complement pathway), or AGS in which factor D and properdin had been selectively inactivated (classical pathway) . Immunoglobulin G fractions from a human serum pool or from serum from an adult who had recovered from H . influenzae type b (Kn) sepsis were absorbed to remove anticapsular antibody . The absorbed fractions containing noncapsular antibodies also activated complement-dependent bactericidal activity . But, in contrast to the results with anticapsular antibody, noncapsular antibodies did not elicit alternative pathway bactericidal activity . Incubation of cells of H . influenzae type b in C2-deficient serum or AGS-Mg-EGTA did not cause complement consumption (total hemolytic complement and C3) . The addition of immunoglobulin G anticapsular antibody (but not noncapsular antibody) increased consumption of total complement and C3, paralleling the results of the bactericidal assays . These studies demonstrated an absolute requirement for anticapsular antibody in alternative pathway activation and killing of H . influenzae type b.(ABSTRACT TRUNCATED AT 250 WORDS)

Acta Otolaryngol, 1984 May-Jun, 97(5-6), 443 - 9
Aspiration cytology in acute otitis media; Qvarnberg Y et al.; One hundred and ninety-three middle ear effusion samples from patients with acute otitis media were studied for cellular content and bacteria . Findings were compared with clinical and radiological data . In samples positive for pathogenic bacteria (Haemophilus, pneumococci) neutrophils predominated, whereas monocytes or phagocytes were more numerous in samples with nonpathogens . Inflammatory cells were more frequent in large than in small mastoid air cell systems . Destruction of cell walls was associated with increase of neutrophils and sclerosis with preponderance of lymphocytes, monocytes and phagocytes.

Ann Immunol (Paris), 1984 May-Jun, 135C(3), 345 - 52
Effect of oral administration of a variety of bacteria on depressed macrophage functions in tumour-bearing rats; Iannello D et al.; In consideration of the well documented influence of normal microbial flora on the level of activation of macrophages, we evaluated the effects of oral administration of bacteria on rats with depressed macrophage functions . An oral, killed polyvalent vaccine (Diplococcus pneumoniae types I, II and III, Streptococcus haemolyticus, Staphylococcus aureus and Haemophilus influenzae), the live lyophilized Streptococcus faecium and spores of Bacillus subtilis, respectively, were administered orally to immuno-depressed rats . Results demonstrate the restoration of phagocytosis, intracellular killing and the chemotactic activity of macrophages . These experimental observations suggest that bacterial flora associated with mucosae can influence the level of activation of peritoneal macrophages.

Rev Infect Dis, 1984 May-Jun, 6(3), 374 - 89
Selective primary health care: strategies for control of disease in the developing world . XIII . Acute bacterial meningitis; Greenwood BM; Three species of bacteria (Haemophilus influenzae type b, Neisseria meningitidis, and Streptococcus pneumoniae) cause approximately three-quarters of all cases of acute bacterial meningitis in industrialized and developing countries . Infections due to N . meningitidis, S . pneumoniae, and H . influenzae type b are endemic in most countries; major epidemics of meningococcal disease still occur regularly, especially in sub- Saharan Africa . Such epidemics may be large, involving many thousands of patients, with a mortality that can exceed 10% . Both chemoprophylaxis and immunization are used to prevent meningococcal, pneumococcal, and H . influenzae type b meningitis . Chemoprophylaxis may involve the use of expensive antibiotics, and it can encourage the emergence of drug resistance . Mass immunization with meningococcal polysaccharide vaccine can effectively halt an epidemic of group A or group C meningococcal disease, and immunization protects close contacts . However, polysaccharide vaccines are ineffective in infants, who are very susceptible to bacterial meningitis . New protein-polysaccharide conjugated vaccines may be more effective in this young population.

Pediatr Infect Dis, 1984 May-Jun, 3(3), 226 - 32
Bacteriology and treatment of purulent nasopharyngitis: a double blind, placebo-controlled evaluation; Todd JK et al.; One hundred forty-two children with purulent nasopharyngitis were randomized to four treatment groups with an antibiotic (cephalexin) alone or combined with a decongestant/antihistamine (pseudoephedrine/triprolidine) or their corresponding placebo equivalents . Follow-up evaluations by parents and physicians and bacteriologic evaluations were performed after 5 to 6 days of therapy . Groups were comparable with regard to age, sex, race, number of patients withdrawn from the study, fever greater than 38.0 degrees C, appearance of nasal discharge, nasal crusting and number of days until follow-up . Initial cultures from patients grew: Streptococcus pneumoniae, 46%; Haemophilus influenzae type b, 21%; and Streptococcus pyogenes, 8% . Nasal crusting was significantly associated with the growth of S . pneumoniae or H . influenzae type b . There were no significant differences between active drug and placebo treatment groups for change in nasal discharge, complications or apparent drug benefit . Cephalexin therapy did not result in a decrease in cultivation of pathogenic organisms from the nasopharynx . Significantly more side effects were attributed to pseudoephedrine/triprolidine treatment than to placebo . Routine culture or treatment of purulent nasopharyngitis should not be considered unless future controlled clinical trials demonstrate some therapeutic benefit.

J Clin Microbiol, 1984 May, 19(5), 634 - 8
Clinical comparison of the Isolator 1.5 microbial tube and the BACTEC radiometric system for detection of bacteremia in children; Carey RB; The Isolator 1.5 microbial tube (E . I . du Pont de Nemours & Co., Inc., Wilmington , Del.) was compared with the BACTEC radiometric detection system (Johnston Laboratories, Inc., Cockeysville, Md.) for the detection of bacteremia in children . The Isolator 1.5 is a blood culture system designed for small volumes of blood (0.5 to 1.5 ml) . The method involves lysis of the cells of the patient and the direct plating of the entire blood lysate on agar media appropriate for the growth of fastidious microorganisms . Of 1,500 paired samples inoculated into the two systems, 68 were positive for 73 clinically significant organisms . The Isolator 1.5 recovered 81% of the positive cultures compared with 84% recovered by the BACTEC system . When paired blood samples with disproportionate volumes were excluded, the Isolator 1.5 detected 3% more positive cultures . More isolates of Streptococcus pneumoniae and Neisseria meningitidis were recovered by the Isolator 1.5, whereas Haemophilus influenzae was recovered most often in the BACTEC bottles (P greater than 0.1) . The contamination rates were 8.7 and 3.1% for the Isolator 1.5 and the BACTEC system, respectively . In cultures positive by both systems, the mean time to detection was 4.1 h faster with the Isolator 1.5 . The mean time to obtain isolated colonies was 26.6 h faster with the Isolator 1.5 . These data indicate the potential value of the Isolator 1.5 microbial tube as a simple, rapid, and sensitive method for the detection of bacteremia in children.

J Antimicrob Chemother, 1984 May, 13(5), 517 - 20
Therapeutic activity of ceftazidime and eleven other beta-lactam antibiotics against experimental Haemophilus influenzae, type b meningitis; McColm AA et al.; Twelve beta-lactams (11 cephalosporins and aztreonam) were compared in an infant rat model of Haemophilus influenzae, type b meningitis . Ceftazidime was the most effective compound tested and showed greater activity than cefuroxime, latamoxef (moxalactam) and cefotaxime--all of which have been used successfully in clinical haemophilus meningitis in children.

J Antimicrob Chemother, 1984 May, 13(5), 437 - 45
Evaluation of ceftazidime, ampicillin and chloramphenicol in experimental Haemophilus influenzae type b meningitis; McColm AA et al.; In an infant rat model of Haemophilus influenzae, type b meningitis, where treatment was given 24 and 48 h after infection, the dose of ceftazidime required to eradicate the infection from the CSF of half the animals (CD50) ranged from less than 0.15-1.5 mg/kg/dose . The accompanying blood infections were marginally less responsive to therapy with CD50 values ranging from 0.5-3.9 mg/kg/dose . Comparable data for ampicillin were 12.5-40 mg/kg/dose and 20- greater than 200 mg/kg/dose for the CSF and blood infections while those for chloramphenicol were 18- greater than 100 mg/kg/dose and 22- greater than 100 mg/kg/dose for the CSF and blood infections respectively . Investigation of the relative rates of kill in vivo showed that all three drugs rapidly reduced the bacterial numbers to minimal levels . However, whereas ceftazidime completely eradicated the infection, chloramphenicol, and to a lesser extent, ampicillin-treated rats experienced substantial relapsing . Ceftazidime penetrated into the CSF of infected and uninfected rats slightly better than ampicillin--7.3% compared to 4.0% of the corresponding blood levels respectively . These results indicate that ceftazidime is significantly more active in the infant rat model of H . influenzae, type b meningitis than ampicillin or chloramphenicol.

Clin Pharmacokinet, 1984 May-Jun, 9(3), 222 - 38
Clinical pharmacokinetics of chloramphenicol and chloramphenicol succinate; Ambrose PJ; In recent years there has been a renewal of interest in chloramphenicol, predominantly because of the emergence of ampicillin-resistant Haemophilus influenzae, the leading cause of bacterial meningitis in infants and children . Three preparations of chloramphenicol are most commonly used in clinical practice: a crystalline powder for oral administration, a palmitate ester for oral administration as a suspension, and a succinate ester for parenteral administration . Both esters are inactive, requiring hydrolysis to chloramphenicol for anti-bacterial activity . The palmitate ester is hydrolysed in the small intestine to active chloramphenicol prior to absorption . Chloramphenicol succinate acts as a prodrug, being converted to active chloramphenicol while it is circulating in the body . Various assays have been developed to determine the concentration of chloramphenicol in biological fluids . Of these, high-performance liquid chromatographic and radioenzymatic assays are accurate, precise, specific, and have excellent sensitivities for chloramphenicol . They are rapid and have made therapeutic drug monitoring practical for chloramphenicol . The bioavailability of oral crystalline chloramphenicol and chloramphenicol palmitate is approximately 80% . The time for peak plasma concentrations is dependent on particle size and correlates with in vitro dissolution and deaggregation rates . The bioavailability of chloramphenicol after intravenous administration of the succinate ester averages approximately 70%, but the range is quite variable . Incomplete bioavailability is the result of renal excretion of unchanged chloramphenicol succinate prior to it being hydrolysed to active chloramphenicol . Plasma protein binding of chloramphenicol is approximately 60% in healthy adults . The drug is extensively distributed to many tissues and body fluids, including cerebrospinal fluid and breast milk, and it crosses the placenta . Reported mean values for the apparent volume of distribution range from 0.6 to 1.0 L/kg . Most of a chloramphenicol dose is metabolised by the liver to inactive products, the chief metabolite being a glucuronide conjugate; only 5 to 15% of chloramphenicol is excreted unchanged in the urine . The elimination half-life is approximately 4 hours . Inaccurate determinations of the pharmacokinetic parameters may result by incorrectly assuming rapid and complete hydrolysis of chloramphenicol succinate . The pharmacokinetics of chloramphenicol succinate have been described by a 2-compartment model . The reported values for the apparent volume of distribution range from 0.2 to 3.1 L/kg.(ABSTRACT TRUNCATED AT 400 WORDS)

J Bacteriol, 1984 May, 158(2), 730 - 2
Plasmid containing a DNA ligase gene from Haemophilus influenzae; McCarthy D et al.; A ligase gene from Haemophilus influenzae was cloned into the shuttle vector pDM2 . Although the plasmid did not affect X-ray sensitivity, it caused an increase in UV sensitivity of the wild-type but not excision-defective H . influenzae and a decrease in UV sensitivity of the rec-1 mutant.

Pathol Biol (Paris), 1984 May, 32(5), 378 - 80
{Inhibitory activity of ampicillin and mecillinam on Haemophilus influenzae}; Dabernat H et al.; Mecillinam, an antibiotic of the beta-lactam group, is active against Gram negative bacilli, with the exception of a few species such as Haemophilus influenzae . The activities of ampicillin, mecillinam, and ampicillin-mecillinam combinations at ratios of 1/1, 2/1, 4/1, 1/2 and 1/4, on 21 Haemophilus influenzae strains, were studied by agar dilution and determination of minimal inhibitory concentrations (MIC) . Ampicillin at concentrations of 0.12 to 0.25 mg/l was active on susceptible strains . Beta-lactamase-producing strains were inhibited by 4 and 8 mg/l ampicillin . MICs of mecillinam were above 128 mg/l for 19 strains; two strains were susceptible to 2 mg/l . In every case, antibacterial activity was greater with the ampicillin-mecillinam combination than with either one of the antibiotics alone . The maximum antibacterial effect was obtained at ratios of 1/1 and 1/2; in this case, susceptible strains were inhibited by 0.06 mg/l ampicillin . Kinetic evaluation (killing curves) showed that ampicillin has a bactericidal effect at concentrations under the MIC when it is combined with mecillinam at a 1/1 ratio.

J Antimicrob Chemother, 1984 May, 13(5), 511 - 6
Twice daily ceftriaxone therapy for serious bacterial infections in children; Chonmaitree T et al.; The clinical efficacy and safety of ceftriaxone, a long half-life cephalosporin were evaluated in 48 children with a variety of serious bacterial infections . Clinical cure was achieved in 92% (44 of 48) of patients . Peak serum bactericidal titres for Haemophilus influenzae type b, Streptococcus pneumoniae, Str . pyogenes and Escherichia coli were greater than or equal to 1:1024 . Mean peak and trough ceftriaxone levels were 173 and 42 mg/l, respectively . Mild and transient diarrhoea was observed in 10% of patients . Laboratory side effects encountered were eosinophilia, thrombocytosis and neutropenia in another 8% . Ceftriaxone is a useful antibiotic for common childhood infections . Its prolonged half-life allows twice daily administration which reduces problems related to intravenous therapy as well as the cost and personnel time.

Br Med J (Clin Res Ed), 1984 Apr 21, 288(6425), 1199 - 201
Policies on antibiotics of south east London general practitioners for managing acute otitis media in children; Mills RP; Questionnaires on antibiotic treatment of acute otitis media in children were sent to the general practitioners who make regular referrals to clinics in the King's College Hospital group . The most popular first choice of drug was amoxycillin (44%), but 37% of general practitioners said that they often used oral phenoxymethylpenicillin . This drug has relatively low activity against Haemophilus influenzae and many strains of Staphylococcus aureus . It is poorly absorbed from the stomach, does not penetrate the middle ear well, and its use may be one factor in the development of chronic middle ear effusions after acute otitis media . Sixty two per cent of the doctors who replied never treated acute otitis media with intramuscular antibiotics, but 57% used oral loading doses . Ninety seven per cent never treated their patients without antibiotics.

Am J Vet Res, 1984 Apr, 45(4), 715 - 9
A 2-mercaptoethanol tube agglutination test for diagnosis of Haemophilus pleuropneumoniae infection in pigs; Mittal KR et al.; A 2-mercaptoethanol (2-ME) tube agglutination (TA) test has been developed as an alternative to the complement fixation (CF) test for the detection of antibodies to Haemophilus pleuropneumoniae, a causative agent of pleuropneumonia in pigs . Using sera from experimentally infected pigs, herds with confirmed H pleuropneumoniae infection, and from disease-free pigs, the specificity and the sensitivity of the 2-ME-TA test were investigated and results were compared with those obtained using the CF test . The TA test without 2-ME gave 100% nonspecific reaction . The 2-ME-TA test was highly specific and more sensitive than was the CF test . Seemingly, the 2-ME-TA test can be used to monitor herds for H pleuropneumoniae antibodies instead of the CF test because it was easier to perform . Test procedures for a presumptive herd diagnosis of H pleuropneumoniae have been proposed.

Zh Mikrobiol Epidemiol Immunobiol, 1984 Apr, (4), 67 - 70
{Role of Streptococcus pneumoniae and Haemophilus influenzae in the etiology of acute pneumonias in the elderly}; Zubkov MN et al.; The quantitative study of microflora in the sputa of 158 patients and the serological analysis of the blood sera of 37 patients with diagnosed acute pneumonia were carried out . The occurrence of S . pneumoniae and H . influenzae in diagnostic titers was, respectively, 55.1% and 5.7% in bacteriological study and 89.2% and 43.2% in serological analysis . The sensitivity of clinical strains to antibacterial preparations varied within a wide range: 99.8% to 58.8% for S . pneumoniae and 90.6% to 56.2% for H . influenzae.

Zentralbl Bakteriol Mikrobiol Hyg {A}, 1984 Apr, 256(4), 531 - 3
Rapid detection of beta-lactamase by PADAC test strip; Qadri SM et al.; A total of 967 isolates of Gram-positive and Gram-negative bacteria were tested for the production of beta-lactamase by the PADAC test strip, and the results were compared with acidometric, disk diffusion and antibiotic dilution procedures . All the penicillinase producting strains of gonococci (23) and Haemophilus influenzae (36) gave positive results with PADAC, but the 361 isolates of Staphylococcus aureus and S . epidermidis remained negative . All of the 547 strains of penicillin sensitive strains of gonococci, Haemophilus and staphylococci were negative with PADAC test.

Ann Ophthalmol, 1984 Apr, 16(4), 334 - 40
Bacterial corneal ulcer, endophthalmitis, and embolic phenomena; Brenner M; A 66 year-old-white woman had a central bacterial corneal ulcer and acute endophthalmitis due to Gram-positive cocci and, Haemophilus parainfluenzae.

J Clin Microbiol, 1984 Apr, 19(4), 526 - 8
Distribution and relationship to serotype of Haemophilus influenzae biotypes isolated from upper respiratory tracts of children and adults in Papua New Guinea; Gratten M et al.; The relationship between serotypes and biotypes of 505 carriage strains of Haemophilus influenzae isolated from the upper respiratory tracts of well children, children with pneumonia, and healthy adults was studied . All except serotype c were significantly associated with one or two specific biotypes (P less than 0.001) . No encapsulated organisms belonging to biotypes V, VI, or VII were encountered . No significant difference in the interaction of biotypes and serotypes isolated from well and sick children was present . Both encapsulated and nonserotypable biotype I H . influenzae strains were commonly carried in the upper respiratory tracts of healthy Melanesian children . The distribution of nonserotypable H . influenzae strains occurred throughout all biotypes, and the frequency of nonencapsulated biotype III and IV strains differed significantly from serotypable organisms with the same biotype (P less than 0.001).

Clin Pediatr (Phila), 1984 Apr, 23(4), 215 - 9
Pathogenesis and prevention of recurrent infection after Haemophilus influenzae bacteremia; Liston TE; Recurrence of disease after Haemophilus influenzae bacteremia is relatively uncommon and may often be preventable . Three previously unreported and 11 reported occurrences in ten patients were evaluated in regard to pathogenesis . Recrudescence can be prevented by adequate culturing prior to therapy, proper treatment based on complete sensitivity testing and pharmacologic principles, and careful evaluation of clinical and microbiologic response . Relapse may be prevented in some instances by administering prophylactic rifampin to patients and close contacts who may be carriers of an infecting strain . Reinfections may be prevented through public health measures and the development of effective vaccines.

Pathology, 1984 Apr, 16(2), 192 - 5
An evaluation of latex particle agglutination to detect antigenemia in children; Richardson CJ et al.; Latex particle agglutination (LPA) was used to detect specific bacterial capsular antigen in sera collected at the time blood samples were taken from children with suspected bacteremia . Capsular polysaccharide antigens tested for were Haemophilus influenzae type b (Hi b), Streptococcus pneumoniae (Sp), Streptococcus agalactiae (Sa) and Neisseria meningitidis (Nm) groups A and C . An adequate volume of serum was available for 1085 of the blood culture sets received . Antigenemia was detected in 47 children; 36 children from whom the homologous microorganism was isolated from the associated blood culture and 11 children who had prior antibiotic therapy and whose blood culture grew no microorganism . Antigenemia was not detected in 46 children whose blood culture yielded a bacterium for which a homologous LPA reagent was available . Fifty children had positive blood cultures with microorganisms considered significant to which no LPA reagent was available . LPA was of value as a rapid diagnostic test in the identification of the etiological agent in severe infectious disease in children.

J Med Microbiol, 1984 Apr, 17(2), 113 - 9
Selective media for the quantitation of bacteria in cystic fibrosis sputum; Wong K et al.; We used selective media together with aerobic and anaerobic incubation for the quantitation of common pathogens in liquefied sputum from children with cystic fibrosis . The accuracy of the technique was verified by reconstruction studies in which laboratory strains with antibiotic-resistance markers were added to sputum from cystic fibrosis patients . Comparison of the numbers of bacteria found on quantitative culture of clinical specimens with the "predominant" organism found on routine culture yielded a poor correlation . When Pseudomonas aeruginosa was the most prevalent on routine culture, it was present in the highest numbers on quantitative culture (mean count = 10(8) cfu/g) . However, large numbers of Haemophilus influenzae (mean count = 10(7) cfu/g), Staphylococcus aureus (mean count = 2 X 10(6) cfu/g), and streptococci (mean count = 2 X 10(6) cfu/g) were also present in these cultures . When S . aureus was the predominant organism, H . influenzae and P . aeruginosa were also present in similar numbers (c . 10(7) cfu/g) . When H . influenzae was the predominant species on routine culture, the mean count was 7 X 10(6) cfu/g and P . aeruginosa was often completely absent . We conclude that the selective technique permits reliable enumeration of sputum bacteria, and offers a more accurate assessment of the microbial flora of sputum in cystic fibrosis than does simple plating of unhomogenised sputum.

Eur J Clin Microbiol, 1984 Apr, 3(2), 122 - 5
Presence of alveolar macrophages as a criterion for determining the suitability of sputum specimens for bacterial culture; Courcol RJ et al.; The microscopic and bacteriological findings in paired saliva and sputum specimens from 66 patients with chronic bronchitis were compared in order to determine whether the presence of alveolar macrophages is a valid criterion for determining the suitability of a sputum specimen for bacterial culture . Alveolar macrophages were mainly present in sputum specimens, the culture results of which differed from the culture results of the matching saliva specimen (p less than 0.001) . Sputum specimens containing alveolar macrophages appeared to be contaminated less with oropharyngeal flora than specimens which did not contain alveolar macrophages . Potential pathogens such as Streptococcus pneumoniae and Haemophilus influenzae were isolated only from sputum specimens containing alveolar macrophages . It is concluded that the presence of alveolar macrophages indicates that sputum originates from the lower respiratory tract . The results also showed that the presence of leukocytes in sputum may be considered significant if alveolar macrophages are also present.

Infect Immun, 1984 Apr, 44(1), 41 - 8
Immunogenic proteins in cell-free culture supernatants of Haemophilus influenzae type b; Gulig PA et al.; Cell-free culture supernatant (CFCS) prepared from Haemophilus influenzae type b (Hib) was examined for the presence of soluble Hib proteins . Two proteins with apparent molecular weights of 100,000 (100K) and 116K were predominant in the CFCS, and antibodies directed against these proteins could be detected by radioimmunoprecipitation or Western blot analyses of serum from adult rats immunized with Hib . Radioimmunoprecipitation analyses and sodium dodecyl sulfate-polyacrylamide gel electrophoresis of these two proteins demonstrated that the 100K CFCS protein was also present on the cell surface of Hib, whereas the 116K CFCS protein was only detectable in culture supernatants . Both the 100K and 116K CFCS proteins were immunogenic in human infants with Hib meningitis and in infant rats systemically infected with Hib . In addition, the first detectable antibodies produced in these Hib-infected rats against Hib proteins were specific for the 100K protein in both its CFCS and cell-associated forms . These two CFCS proteins were also immunogenic in rats immunized with CFCS in the absence of Hib infection . Monoclonal antibody directed against the 100K protein reacted with 34 of 55 Hib strains examined by using a colony blot radioimmunoassay . The immunogenicity of the 100K and 116K CFCS proteins suggests that one or both of these proteins may have potential for vaccine development, either by themselves or covalently coupled to Hib capsular polysaccharide.

Avian Dis, 1984 Apr-Jun, 28(2), 397 - 405
The effect of oil-emulsion vaccines on the occurrence of nonspecific plate agglutination reactions for Mycoplasma gallisepticum and M . synoviae; Glisson JR et al.; Six groups of ten 18-week-old mycoplasma-free white leghorn pullets were vaccinated with one of the following: Mycoplasma gallisepticum (MG) bacterin . Haemophilus gallinarum bacterin, Pasteurella multocida bacterin, combined infectious bursal disease (IBD)-Newcastle (NDV) chicken-embryo-origin (CEO) vaccine . IBD-NDV tissue-culture-origin (TC) vaccine, or saline emulsified in oil; one group received no vaccine . Plate agglutination tests for M . synoviae (MS) and MG were done for 10 weeks after vaccination using three different test antigens . Pullets vaccinated with H . gallinarum bacterin and IBD-NDV TC vaccine showed the greatest incidence of nonspecific plate agglutination reactions . The incidence of positive plate agglutination reactions varied with test antigens . Five groups of fifty 18-week-old mycoplasma-free heavy-breed pullets were vaccinated with one of the following: saline emulsified in oil, chicken embryo fibroblasts emulsified in oil, allantoic fluid emulsified in oil, chicken embryos emulsified in oil, or MS-contaminated chicken embryos emulsified in oil . Plate agglutination tests for MS and MG were done for 8 weeks after vaccination . Chickens vaccinated with chicken embryo fibroblasts emulsified in oil had the greatest incidence of nonspecific plate agglutination reactions . Pullets vaccinated with MS-contaminated chicken embryo vaccine had only a small increase in MS-positive plate agglutination reactions compared with pullets vaccinated with uncontaminated chicken embryo vaccine.

J Bacteriol, 1984 Apr, 158(1), 393 - 5
Origin and direction of in vitro replication of Haemophilus ducreyi and Neisseria gonorrhoeae ampicillin resistance plasmids; McNicol PJ et al.; The origin of replication of Haemophilus ducreyi and Neisseria gonorrhoeae ampicillin resistance plasmids was located by cloning BamHI restriction fragments into vector plasmid pAT153 and a derivative plasmid, pAT2 . Selection was made for plasmid maintenance in a polA mutant . Direction of replication was determined by in vitro replication of plasmid DNA in the presence of radiolabeled deoxynucleotide.

J Pediatr, 1984 Apr, 104(4), 623 - 6
Efficacy of topical antibiotic therapy in acute conjunctivitis in children; Gigliotti F et al.; We studied 102 children aged 1 month to 18 years in a randomized, double-blind trial designed to determine both the natural history of bacterial conjunctivitis and whether topical antibiotic therapy is beneficial . Affected eyes were treated four times a day for 7 days with drug (polymyxin-bacitracin ophthalmic ointment) or placebo . Eighty-four patients had proved bacterial conjunctivitis (Haemophilus influenzae 61, Streptococcus pneumoniae 22, both one); 66 of these received only topical therapy . By 3 to 5 days, 21 of 34 (62%) patients receiving topical antibiotic were clinically cured, whereas only nine of 32 (28%) patients given placebo were cured (P less than 0.02) . By 8 to 10 days, 31 (91%) of the patients given antibiotic and 23 (72%) of the placebo group were cured (P = NS) . The bacterial pathogen was eradicated by day 3 to 5 in 71% and by day 8 to 10 in 79% of patients given antibiotic, compared to 19% and 31% of the placebo group (P less than 0.001) . Acute bacterial conjunctivitis is a self-limited disease, but topical antibiotic therapy with polymyxin-bacitracin shortens the duration of clinical disease and enhances eradication of the causative organism from the conjunctiva.

Clin Pediatr (Phila), 1984 Apr, 23(4), 220 - 2
Evaluation of cefotaxime in bacterial infections; Varghese M et al.; Cefotaxime, a third generation cephalosporin antibiotic, was evaluated in 26 infants and children for the treatment of documented or suspected bacterial infections, including pneumonia (10 cases), soft tissue skin infection (13 cases), and urinary tract infection (3 cases) . An average daily dose of 60 mg/kg in 3 to 4 divided doses was administered parenterally for an average of 7 days . In 14 of the cases, primary pathogens, including Haemophilus influenzae b (resistant to ampicillin), Staphylococcus aureus, Staphylococcus pyogenes, Streptococcus pneumoniae and Escherichia coli, were eradicated . Clinical recovery occurred in each case . Blood levels at different time intervals and biological half-life were similar to those reported for adults . Mild and transient side effects observed were elevation of SGOT in two cases, alkaline phosphatase in one, and eosinophilia in one case.

J Infect Dis, 1984 Apr, 149(4), 518 - 22
Nontypable Haemophilus influenzae are unencapsulated both in vivo and in vitro; Gyorkey F et al.; Some investigators have suggested that nontypable Haemophilus influenzae isolated from sputum of adults with pneumonia are variant forms of typable H influenzae that have lost their capsule during passage in vitro . We examined colonies of both typable and nontypable H influenzae after they had been grown in vitro, as well as bronchopulmonary secretions from patients with pneumonia or acute, purulent tracheobronchitis due to H influenzae; electron microscopy combined with ruthenium-red staining was used to detect the presence of capsular glycocalyx . H influenzae types a, b, and e', whether grown in vitro or observed directly in bronchopulmonary secretions, had readily detectable capsular glycocalyx external to the cell membrane . In contrast, non-typable H influenzae appeared to be unencapsulated after cultivation in vitro or when directly visualized in bronchopulmonary secretions of infected patients.

Infect Immun, 1984 Apr, 44(1), 196 - 8
Monoclonal antibodies reactive with all strains of Haemophilus ducreyi; Hansen EJ et al.; We have isolated plasma cell hybridomas which secrete monoclonal antibodies directed against Haemophilus ducreyi . Two of these monoclonal antibodies recognize all strains of H . ducreyi tested to date and are capable of detecting the presence of H . ducreyi in skin lesions produced by this pathogen in experimental animals . These monoclonal antibodies which react with apparently all strains of H . ducreyi have the potential to be developed into a rapid immunodiagnostic test for chancroid.

Infect Immun, 1984 Apr, 44(1), 12 - 5
Significance of encapsulated Bacteroides melaninogenicus and Bacteroides fragilis groups in mixed infections; Brook I et al.; Organisms of the Bacteroides melaninogenicus and Bacteroides fragilis groups are often found mixed with facultatively anaerobic organisms in infections . The relative importance of these Bacteroides groups and facultative anaerobic pathogens in mixed infections was investigated in a subcutaneous abscess model in mice . This was determined by observing the effect of antimicrobial therapy directed against one or both organisms present in the abscess . Clindamycin or metronidazole was used for treatment of infections caused by Bacteroides species, and either gentamicin, penicillin, ampicillin, or oxacillin was used for treatment of infections caused by facultative flora . In almost all instances the aerobic counterparts in the infection were more important than the unencapsulated Bacteroides species . On the other hand, encapsulated B . melaninogenicus group organisms were found to be more important in abscess formation than were group A streptococci, Streptococcus pneumoniae, Klebsiella pneumoniae, Haemophilus influenzae, and Staphylococcus aureus . Encapsulated B . fragilis group organisms were found to be more important than or as important as Escherichia coli and group D streptococci and less important than S . aureus, group A streptococci, and K . pneumoniae in induction of subcutaneous abscesses . This study demonstrates that encapsulated Bacteroides species are a factor that should be considered in the treatment of mixed infections with antibiotics.

J Am Vet Med Assoc, 1984 Mar 15, 184(6), 716 - 9
Porcine Haemophilus pleuropneumonia: microbiologic and pathologic findings; Didier PJ et al.; Haemophilus pleuropneumoniae was isolated from 11% of porcine lung specimens submitted to the University of Illinois Diagnostic Laboratory during 1979-1982 . Acute necrotizing fibrinous bronchopneumonia was the most common diagnosis; 65% of lungs had severe involvement of the caudal lobes; 10% of lungs had unilateral involvement only . In 46% of lungs, a second pathogen was isolated . Isolates of H pleuropneumoniae tested by the Kirby-Bauer disk method were most sensitive to nitrofurazone (100%), polymyxin B (97%), chloramphenicol (95%), gentamicin (94%), sulfachloropyridazine (87%), ampicillin (83%), and penicillin (77%) . Isolates were less sensitive to 9 other antimicrobials tested . Over 4 years in 1 herd, succeeding isolates of H pleuropneumoniae developed resistance to ampicillin, streptomycin, bacitracin, lincomycin, penicillin, and tetracycline.

Southeast Asian J Trop Med Public Health, 1984 Mar, 15(1), 59 - 62
Counterimmunoelectrophoresis in the rapid diagnosis of bacterial meningitis; Sivakumaran S et al.; Cerebrospinal fluid from patients with clinically diagnosed meningitis was tested for meningococcal, pneumococcal, streptococcal Group B and Haemophilus influenzae antigens by counterimmunoelectrophoresis . Antigens were rapidly identified and the results compared favourably with that of bacteriological culture . In the case of pneumococcal meningitis counterimmunoelectrophoresis proved to be more sensitive than culture . The procedure was shown to be sensitive, specific, rapid and easily performed.

Infection, 1984 Mar-Apr, 12(2), 64 - 7
In vitro comparison of fluid blood culture media; Simon C et al.; Eight fluid blood culture media from different manufacturers were compared with regard to their ability to culture fastidious microorganisms . In turbidity measurements following inoculation with different bacteria, the media differed with respect to the duration of the lag phase and the log phase of bacterial growth . Similar differences were observed with small inocula in original blood culture bottles (commercially available) . Fastidious microorganisms grew better in Supplemented Peptone Broth II (Becton-Dickinson), BHI Roche and BHI bioMerieux . Meningococci could only be cultured in four of the eight media tested, and pneumococci in seven of the eight media (with different velocities of growth) . Haemophilus influenzae showed the best results after adding blood or IsoVitalex BBL.

Thorax, 1984 Mar, 39(3), 185 - 91
Cutaneous vasculitis and immune complexes in severe bronchiectasis; Hilton AM et al.; Four patients with severe bronchiectasis (chronic bronchial suppuration) are described who developed cutaneous lesions associated with exacerbations of their respiratory disease . The skin abnormalities consisted of purpuric lesions in three patients and an erythematous vasculitis in one . Circulating immune complexes were present in all patients and in three skin biopsy specimens showed deposition of C3, IgG, and IgA in dermal blood vessels . Haemophilus influenzae had been isolated from the sputum of all four patients and in two patients was present at the time the cutaneous lesions appeared . It is suggested that local immune complex deposition was responsible for the skin lesions which occurred during acute exacerbations of bronchiectasis.

Infection, 1984 Mar-Apr, 12(2), 75 - 9
A comparative study of osteomyelitis and purulent arthritis with special reference to aetiology and recovery; Peltola H et al.; We analysed the records of 44 paediatric cases of acute haematogenous osteomyelitis (age 0-14 years) and 25 cases of purulent arthritis (age 0-13 years) . The annual incidences were 4.5 and less than two per 100,000 children, respectively . Bacteriologic diagnosis was achieved in 82% of the acute haematogenous osteomyelitis cases and in 40% of the acute purulent arthritis cases . Staphylococcus aureus was responsible for 70% of the proven acute haematogenous osteomyelitis and acute purulent arthritis cases combined, followed by streptococci (20%) and Haemophilus influenzae (7%), which caused only acute purulent arthritis . Acute haematogenous osteomyelitis was localized in the femur in 41% of the cases and acute purulent arthritis in the knee joint in 76% . Surgery (in most cases drilling, fenestration or arthrotomy) was performed on 82% of the acute haematogenous osteomyelitis and on 32% of the acute purulent arthritis patients . Although six of the acute haematogenous osteomyelitis patients (but none of the acute purulent arthritis patients) underwent surgery for a second time, permanent damage, which was functionally non-significant, developed in only 14% . No sequelae were found in the acute purulent arthritis group . The average duration of antimicrobial therapy was 44 days in the acute haematogenous osteomyelitis group and 29 days in the acute purulent arthritis group . The prognosis for the children was similar, irrespective of whether the drugs used were staphylococcal penicillins, ampicillin, lincomycin or clindamycin.

Acta Otolaryngol, 1984 Mar-Apr, 97(3-4), 379 - 83
The effect of erythromycin on the nasopharyngeal pathogens in children with secretory otitis media; Sundberg L et al.; Seventy-five children not older than 11 years, with secretory otitis media of more than 3 months' duration were randomly divided into two groups prior to myringotomy . One group remained untreated, whereas the other received erythromycin ethylsuccinate (Abboticin) in standard dosage for the last 10 days before surgery . Nasopharyngeal cultures were taken under general anaesthesia, which ensured an uniform mode of sampling . In the erythromycin-treated group the occurrence of Streptococcus pneumoniae (3%) and Branhamella catarrhalis (0%) was significantly lower than in the control group (35% and 32%, respectively); and the frequency of cultures with no pathogen was significantly higher in the treated group . The occurrence of Haemophilus influenzae remained essentially unchanged.

J Clin Microbiol, 1984 Mar, 19(3), 333 - 7
Comparative laboratory evaluation of three antigen detection methods for diagnosis of Haemophilus influenzae type b disease; Marcon MJ et al.; Cerebrospinal fluid, urine, serum, and other body fluid specimens from pediatric patients with systemic disease were tested with Bactigen latex agglutination (555 specimens), Phadebact coagglutination (319 specimens), and counterimmunoelectrophoresis (335 specimens) for the presence of Haemophilus influenzae type b antigen . All three methods showed good sensitivity for detecting antigen in the cerebrospinal fluid of patients with culture-positive meningitis (greater than or equal to 86% sensitivity) . However, coagglutination and counterimmunoelectrophoresis were much less sensitive (less than or equal to 40%) than latex agglutination (96%) for detecting antigen in other body fluid specimens in culture-positive, nonmeningeal H . influenzae disease . Bactigen latex agglutination was also more sensitive than the other procedures for detecting antigen in specimens from patients with culture-negative, presumed H . influenzae disease . Comparative testing of fluids spiked with known quantities of purified H . influenzae b polyribosephosphate capsular polysaccharide revealed an apparent 100-fold greater sensitivity with Bactigen as compared with the other two methods . Although all three methods showed good specificity (greater than 98%), both agglutination methods gave a few false-positive results . In a clinical setting where both meningeal and nonmeningeal H . influenzae b disease are encountered frequently, Bactigen latex agglutination appears to be superior to coagglutination and counterimmunoelectrophoresis for detecting antigen in body fluids.

South Med J, 1984 Mar, 77(3), 386 - 7
Epiglottitis due to ampicillin-tolerant Haemophilus influenzae type b; Westerman EL et al.; Tolerance to beta-lactam antibiotics has been described with staphylococci and enterococci, but this phenomenon and its clinical significance in Haemophilus influenzae has not been reported . We have reported a case of bacteremic epiglottitis due to an ampicillin-tolerant, beta-lactamase-negative strain of Haemophilus influenzae type b which was cured with ampicillin therapy alone . The organism was not tolerant to moxalactam, cefotaxime, or rifampin . Rifampin therapy eliminated pharyngeal carriage.

Br J Ophthalmol, 1984 Mar, 68(3), 188 - 91
Haemophilus influenzae corneal ulcer in a therapeutic contact lens wearer; Armstrong JR et al.; Haemophilus influenzae is an unusual corneal pathogen and an unusual cause of corneal ulcers in Western society . In previous reports corneal complications from H . influenzae have been secondary to a conjunctivitis . The first case of a primary H . influenzae corneal ulcer as a complication of therapeutic contact lens wear is presented . Since other uncommon bacteria have been reported as causes of contact lens related corneal ulcers, the bacteriology of contact lens related corneal ulcers is reviewed . Ophthalmologists need to be aware that H . influenzae infections in adults are becoming more frequent.

J Immunol, 1984 Mar, 132(3), 1517 - 21
Development of respiratory mucosal tolerance during Haemophilus influenzae type B infection in infancy; Rosales SV et al.; Groups of patients with different forms of infection with Haemophilus influenzae type B (Hib), namely meningitis, epiglottitis, arthritis, and periorbital cellulitis, were evaluated for the appearance of serum IgG, IgA, IgM, and nasopharyngeal secretory (NPS) IgA (SIgA) antibody response to Hib capsular antigen at various intervals after the onset of clinical illness, by using an indirect enzyme-linked immunosorbent assay . The serum immune response was characterized by its predictable absence in infants under 23 mo of age, and in those with meningitis who, regardless of age, had high levels of circulating antigen . On the other hand, antibody response was frequently detected in the serum of older infants . Significantly, however, the appearance of SIgA antibody was demonstrated in virtually all patients with Hib infections under 23 mo of age . In addition, a positive correlation was observed between the concentration of antigen NPS, the level of SIgA activity in the NPS, and the absence of antibody response in the serum . These observations are strikingly similar to the development of systemic hyporesponsiveness (oral tolerance) observed after oral administration of certain infectious or nonreplicating antigens in experimental animals . It is suggested that similar mechanisms may underlie the immunologic abnormalities observed in the serum antibody response in infants with Hib meningitis.

J Gen Microbiol, 1984 Mar, 130 ( Pt 3), 665 - 72
Human serum bactericidal activity against Haemophilus influenzae type b; Stull TL et al.; We examined bactericidal and opsonizing activity of pooled adult 'immune' serum against Haemophilus influenzae type b with and without the addition of phagocytes . Four type b strains from cerebrospinal fluid (CSF) and three such strains from the nasopharynx (NP) of healthy children were examined . Duplicate reaction mixtures contained organisms in exponential (E) or stationary phase (S) of growth, serum, a complement source (human agammaglobulinaemic serum), and culture medium (bactericidal assay); separate assays contained the above components and polymorphonuclear leucocytes (opsonization system) . A decrease in bacterial density of greater than or equal to 1 log10 unit was considered significant . All four S-CSF strains, three of four E-CSF strains and one of three S-NP strains were sensitive to the bactericidal activity of pooled serum . The other E-CSF strain, two S-NP strains and all three E-NP strains were resistant to the bactericidal activity of pooled serum . Two of three E-NP strains were opsonized by pooled serum; the other strains resistant to the bactericidal activity of pooled serum were also resistant to opsonization . Bactericidal and opsonizing activity of serum from an immunized adult was greater than or equal to that of pooled serum against each strain . Assuming normal adults are immune to invasive H . influenzae type b infection, an experimental test reflecting this immunity is the bactericidal activity against CSF isolates tested in stationary phase . We conclude that protection against invasive disease due to H . influenzae type b appears more complex than the presence of bactericidal and opsonizing activity in serum.

Pharmacotherapy, 1984 Mar-Apr, 4(2), 81 - 8
Community-acquired bacterial pneumonia in the elderly; Gleckman RA et al.; Pneumonia remains the leading infectious disease-related cause of death among the elderly . Streptococcus pneumoniae is the most frequent pathogen isolated from aged individuals with community-acquired pneumonia . Other common bacteria that cause this disease include Haemophilus influenzae and Legionella pneumophila . Manifestations of pneumonia in the elderly can be subtle and result in delayed recognition and treatment . Gram stain evaluation and culture of non-contaminated expectorated sputum remain the conventional techniques to guide initial antibiotic selection . While the presence of a new infiltrate on chest X-ray confirms the clinical diagnosis of pneumonia, the radiographic appearance of the infiltrate cannot accurately define the etiologic agent . Specific therapeutic measures include administration of appropriate antibiotics, correction of fluid and electrolyte imbalances, nutritional support and treatment of concomitant disorders . Preventive measures include use of influenza vaccine, amantadine and pneumococcal vaccine.

J Pediatr, 1984 Mar, 104(3), 447 - 53
Prospective comparative trial of moxalactam versus ampicillin or chloramphenicol for treatment of Haemophilus influenzae type b meningitis in children; Kaplan SL et al.; In a prospective, randomized study, moxalactam in 44 children was compared with ampicillin or chloramphenicol in 47 children for the treatment of Haemophilus influenzae type b meningitis . Both groups were comparable in terms of clinical and laboratory findings at admission . The hospital course, neurologic sequelae including deafness, and number of deaths were the same for both groups . The incidence of adverse reactions also was the same except that diarrhea and thrombocytosis occurred significantly (P less than or equal to 0.04) more frequently in children given moxalactam . Moxalactam was equivalent to ampicillin or chloramphenicol in the treatment of H . influenzae type b meningitis in children.

J Bacteriol, 1984 Mar, 157(3), 785 - 8
Uptake of heterologous DNA by Haemophilus influenzae; Goodgal SH et al.; With the use of highly competent Haemophilus influenzae cells, it was possible to demonstrate the uptake of heterologous DNAs . However, these DNAs, as expected, were only 1% or less as effective when competing for uptake with Haemophilus DNA . Escherichia coli DNA was removed from solution by competent cells to the extent expected if all the E . coli DNA particles contained at least one uptake recognition signal . The data were consistent with a model in which there was one uptake signal per 20 X 10(6) to 30 X 10(6) daltons of E . coli DNA . Since H . influenzae DNA has many more recognition signals, approximately one per 2 X 10(6) daltons (Danner et al., Gene 77:311-318, 1980; K . Vogt and S . H . Goodgal, submitted for publication), it has been suggested that the slower rate of E . coli DNA binding and the so-called specificity of Haemophilus DNA binding are due to the number of recognition signals per molecule of DNA as well as the nature of the DNA receptor (Vogt and Goodgal, submitted for publication) . The specificity of native H . influenzae DNA binding does not apply to the uptake of denatured DNA in the transforming system (low pH) for denatured DNA.

J Clin Microbiol, 1984 Mar, 19(3), 356 - 60
Enzyme immunoassays in which biotinillated beta-lactamase is used for the detection of microbial antigens; Yolken RH et al.; The performance characteristics of enzyme immunoassays are determined to a great extent by the enzyme-substrate system utilized for the immunoassay . Beta-lactamases (penicillin amido-beta-lactamhydrolase EC 3.5.2.6) offer a number of advantages which might make them useful in immunoassay systems . We linked beta-lactamase from Bacillus cereus with biotin and used the biotinillated enzyme to devise immunoassay systems for the detection of a number of microbial antigens . An assay system in which antibodies to the polyribitol phosphate antigen of Haemophilus influenzae type b were used was capable of detecting between 0.4 and 1.6 ng of that antigen . Similarly, an assay in which antibodies to the common antigens of adenoviruses and biotin-linked beta-lactamase were used was capable of detecting between 1 and 10 50% tissue culture infective doses of a strain of enteric-type adenovirus . When applied to the detection of rotavirus, a similar system in which biotinillated beta-lactamase was used was capable of detecting small amounts of antigen in a standard rotavirus preparation . This assay could also detect virus in 36 of 37 stool specimens from children with rotavirus gastroenteritis . The positive specimens could easily be distinguished from negative ones by the naked eye, and a permanent record of the qualitative results could be obtained by the use of a standard office photocopying machine . Beta-lactamases have promise for use in practical enzyme immunoassay systems, especially in situations in which expensive colorimetric instrumentation is not available.

J Bacteriol, 1984 Mar, 157(3), 868 - 73
Role of the electrochemical proton gradient in genetic transformation of Haemophilus influenzae; Bremer W et al.; The uptake of homologous DNA by Haemophilus influenzae was studied as a function of the proton motive force in completely competent cultures in the pH range of 6 to 8 . The composition and magnitude of the proton motive force were varied by using the ionophores valinomycin and nigericin (in the presence of various potassium ion concentrations) and by using protonophores . No interaction of the ionophores with the DNA transformation system itself was observed . Either component of the proton motive force, the electrical potential or the pH gradient, can drive the uptake of DNA, and the extent of the uptake of DNA is ultimately determined by the total proton motive force . The transformation frequency increases with the proton motive force, which reaches a maximum value at around -130 mV . These results are consistent with an electrogenic proton-DNA symport mechanism, but direct evidence for such a system is not available . The proton motive force was followed during competence development of H . influenzae at pH 8 . In the initial phase (up to 50 min), the proton motive force remained constant at about -90 mV, whereas the transformation frequency rose steeply . In the second phase, the proton motive force increased . The transformation frequency in this phase increased with the proton motive force, as in completely competent cultures . These observations and the observed inhibition by NAD of both the proton motive force and the transformation frequency indicate that structural components of the competent state are formed in the initial phase of competence development, whereas the second phase is characterized by an increase of the proton motive force.

J Infect Dis, 1984 Mar, 149(3), 373 - 7
Histocompatibility leukocyte antigen and erythrocyte MNSs specificities in patients with meningitis or epiglottitis due to Haemophilus influenzae type b; Granoff DM et al.; The frequencies of erythrocyte MNSs antigens and certain histocompatibility leukocyte antigen (HLA) specificities (HLA-A, HLA-B, and HLA-DR) were determined in white patients with meningitis or epiglottitis due to Haemophilus influenzae type b and in controls . The frequency of the erythrocyte MNSs genotype was significantly lower among patients with meningitis than among those with epiglottitis (P = 0.03); this observation confirms a trend observed previously . However, the frequencies of the HLA specificities did not differ significantly in the three groups studied; this result fails to confirm previous reports of disease associations with several HLA-A and HLA-B specificities . Although susceptibility to different clinical manifestations of haemophilus disease may be influenced by genetic factors, our studies indicate that the major loci conferring susceptibility are not in linkage disequilibrium with specificities in the major histocompatibility complex.

Am J Vet Res, 1984 Feb, 45(2), 336 - 8
Morphologic features, structure, and adherence to bovine turbinate cells of three haemophilus somnus variants; Ward GE et al.; Three colony variants (translucent, small opaque, and large opaque) of Haemophilus somnus recovered during infection studies of chicken embryos were examined using electron microscopy . Ruthenium red-strained H somnus preparations revealed no capsule in any variants . Pili were not seen on phosphotungstate-negative stained preparations . The translucent variant was thin-walled and had an irregular, pleomorphic rod shape . The small opaque variant had a thicker cell wall and an even rod shape . The large opaque variant had the thickest, most rigid wall of the 3, with uniform rod morphologic features . When each of the 3 variants was allowed to contact bovine epithelial turbinate cells, the translucent and small opaque were significantly (P less than 0.01) more adherent than was the large opaque variant.

Am J Vet Res, 1984 Feb, 45(2), 234 - 9
Isolation of Haemophilus somnus antigens and their use as vaccines for prevention of bovine thromboembolic meningoencephalitis; Stephens LR et al.; Antigens extracted from Haemophilus somnus were examined for their suitability as vaccines for prevention of thromboembolic meningoencephalitis and as antigens in immunologic tests for detection of susceptible cattle . Saline extraction of whole H somnus cells produced an outer membrane complex (OMC) that contained 2 major antigens when tested against antiserum to intact cells by immunoelectrophoresis . Anion exchange chromatography was used to separate an anionic antigen (AA) from the more cationic antigen (CA) . According to chemical analysis and polyacrylamide gel electrophoresis, both AA and CA were complex mixtures--probably, outer membrane fragments . Enzyme-linked immunosorbent assays were used to measure serum levels of immunoglobulin (Ig) G and IgM against AA and CA in cattle vaccinated with whole cells, OMC, CA, or AA . Protection of vaccinated cattle was assessed after IV challenge exposure to H somnus . Moderate IgG and IgM responses occurred when cattle were given 2 vaccinal doses of 0.1 mg or 1.0 mg of whole cells, OMC, or AA . Two of 10 cattle given 2 vaccinal doses (1.0 mg) of OMC died after IV challenge exposure, whereas 8 of the 10 controls died, indicating significant protection (P less than 0.05) . All of the 10 cattle given 2 vaccinal doses (1.0 mg) of AA were protected from IV challenge exposure, whereas 5 controls died (P less than 0.05) . Two vaccinal doses of either 0.1 mg or 1.0 mg of CA produced high IgG and IgM responses . However, 3 of 10 cattle given 2 vaccinal doses (1.0 mg) of CA died after IV challenge exposure, as did 3 of the 10 controls, indicating that CA was not protective.(ABSTRACT TRUNCATED AT 250 WORDS)

Can J Neurol Sci, 1984 Feb, 11(1), 78 - 81
Fulminating haemophilus influenzae b meningitis; MacDonald NE et al.; Haemophilus influenzae type b (HIb) is the most common cause of bacterial meningitis in children with a mortality rate ranging from 1.6% to 14% . Most patients have a 2-3 day history of symptoms prior to admission . A few have fulminating disease with rapid neurological deterioration . Review of 191 cases of HIb meningitis revealed a mortality rate of 2.1% but all who died had fulminating meningitis (FM) . Four of six patients with FM died . FM patients had symptoms for less than 24 hours before rapid neurological deterioration with increased ICP, seizures, coma and/or respiratory arrest . Review of 10 FM cases revealed that on admission, 5 had hypotension, 3 had thrombocytopenia, and 8 had coma . Typical CSF changes were seen in only 7 . All fatal cases died within 24 hours . Brain swelling and tonsillar herniation were found at autopsy . SDS-PAGE outer membrane protein subtyping did not show one "killer strain" . Animal and autopsy data suggest that diminished CSF outflow and cerebral edema contribute to increased ICP . To improve survival of FM patients, initial treatment must (1) decrease ICP below levels impairing cerebral perfusion, (2) maintain adequate ventilation and blood pressure, and include (3) LP when stable, (4) antibiotics, and (5) close monitoring . Utilizing these principles, two FM patients survived without major sequelae.

J Clin Microbiol, 1984 Feb, 19(2), 144 - 6
Analysis of bacterial isolates from cerebrospinal fluid; Olson DA et al.; We set out to determine the frequency of occurrence of contamination of cerebrospinal fluid with bacteria, seeking also to identify aids to differentiating contaminants from etiologically significant isolates . From 2,091 specimens, 182 bacterial isolates were obtained from 129 patients . Meningitis was the source of 81 isolates (32 patients); contamination yielded 101 isolates (97 patients) . The cell counts and protein and glucose concentrations in the cerebrospinal fluid were significantly more often abnormal in specimens from patients with meningitis . Haemophilus influenzae and enteric gram-negative bacilli were usually cause for meningitis, whereas Staphylococcus epidermidis was the most common contaminant . In view of the reported high rate of procedural error in carrying out lumbar puncture, a program aimed at teaching proper technique is recommended to decrease the frequency of false-positive cultures of cerebrospinal fluid.

Antimicrob Agents Chemother, 1984 Feb, 25(2), 273 - 5
Cefuroxime treatment of bacterial meningitis in infants and children; Sirinavin S et al.; Recently, ampicillin- and chloramphenicol-resistant strains of Haemophilus influenzae type b and multiply-resistant Salmonella strains have appeared in some areas of the world . Therefore, alternative drug therapy for infections caused by these organisms is being sought . We used cefuroxime to successfully treat five children with H . influenzae type b meningitis and two children with Salmonella meningitis . Four H . influenzae type b isolates and one Salmonella isolate were resistant to ampicillin, chloramphenicol, and cotrimoxazole . Each of the patients received 200 to 250 mg of cefuroxime per kg per day in four divided doses for 14 to 21 days . The concentrations of cefuroxime in cerebrospinal fluid at 2 h after intravenous 50-mg/kg doses were 6.4 +/- 1.7 (mean +/- standard deviation) and 3.6 +/- 2.2 micrograms/ml on days 2 and 14 of treatment, respectively . The level of drug in cerebrospinal fluid was 1.34 +/- 1.3 micrograms/ml in children without meningitis . The mean cefuroxime concentration in subdural fluid samples from each of three patients was 12.6, 15, and 25.2 micrograms/ml . Cefuroxime is recommended as an alternative drug for the treatment of H . influenzae type b meningitis, but additional information is necessary before cefuroxime can be recommended for therapy of Salmonella meningitis.

J Clin Invest, 1984 Feb, 73(2), 298 - 306
Cloning of chromosomal DNA from Haemophilus influenzae . Its use for studying the expression of type b capsule and virulence; Moxon ER et al.; Haemophilus influenzae may make any one of six chemically distinct capsular polysaccharides, but only strains of capsular serotype b commonly cause systemic infection (e.g., meningitis) in humans . Molecular cloning of DNA was used to investigate the expression of type b capsule and its association with H . influenzae virulence . A virulent H . influenzae type b strain was used to construct a lambda library of chromosomal DNA in Charon 4 . Two independently isolated recombinant phage were isolated from the library and were found to possess DNA necessary for expression of type b capsule . Using a well-characterized rat model of H . influenzae systemic infection, we showed that type b transformants elicited by the cloned DNA were pathogenic, causing bacteremia and meningitis, whereas the untransformed capsule-deficient H . influenzae organisms were not . A 4.4-kb EcoRI fragment, common to both DNA clones, was used to characterize clinical isolates representing all six encapsulated serotypes as well as several capsule-deficient H . influenzae by Southern hybridization analysis . The probe hybridized to an identical sized (4.4 kb) fragment of EcoRI-digested chromosomal DNA from eight independently isolated type b strains . Single bands of homology to the probe were also found in EcoRI fragments of chromosomal DNA obtained from 33 encapsulated, nontype b H . influenzae . However, the size of these EcoRI fragments proved to be characteristic for each of the different capsular serotypes . These studies provide a basis for pursuing the molecular analysis of the epidemiology and virulence of pathogenic H . influenzae.

Infect Immun, 1984 Feb, 43(2), 607 - 11
Virulence factors of Haemophilus ducreyi; Odumeru JA et al.; We investigated the susceptibility of virulent and avirulent strains of Haemophilus ducreyi to the bactericidal activity of normal human serum and to phagocytosis and killing by human polymorphonuclear leukocytes (PMNL) . Strains were defined as virulent if intradermal inoculation into a rabbit produced a typical necrotic lesion . Nonvirulent strains produced no cutaneous lesions in rabbits . Virulent strains were resistant to the complement-mediated lethal action of normal human and rabbit sera, whereas avirulent strains were susceptible (greater than 95% kill, 60 min) . Virulent strains were relatively resistant to phagocytosis and killing by human PMNL, in contrast to the avirulent strains . In past studies polymyxin resistance has been correlated with virulence in H . ducreyi . In our studies, polymyxin resistance could not be correlated with virulence, since polymyxin-sensitive mutants obtained from polymyxin-resistant parent strains remained virulent for rabbits and resistant to bactericidal action of normal serum and phagocytosis and killing by human PMNL . Similarly, polymyxin-resistant mutants obtained from polymyxin-sensitive parent strains remained avirulent for rabbits and susceptible to bactericidal action of normal serum and PMNL . The acquisition of polymyxin resistance was accompanied by the loss of a 47,000-molecular-weight protein . The association of serum resistance and resistance to phagocytosis and killing by human PMNL with virulent strains, as defined by the rabbit intradermal test, suggests that these factors may mediate the pathogenicity of H . ducreyi.

Infect Immun, 1984 Feb, 43(2), 593 - 9
Generation of chemotactic activity in serum by Haemophilus influenzae type b; Tosi MF et al.; Studies were performed to characterize chemotactic activity generated by Haemophilus influenzae type b (HiTb) in serum or elaborated independent of serum . Neutrophil aggregometry, Sephadex G-75 gel chromatography, and anti-C5 neutralization studies were used to demonstrate that the complement fragment C5a represented the major chemotactic moiety derived from HiTb-serum interactions . HiTb elaborated minimal chemotactic activity independently . Maximal C5a generation by HiTb as measured by neutrophil response in chemotaxis, shape change, and aggregation assays required specific antibody to the capsular polysaccharide, polyribosyl ribitol phosphate (PRP) . Significantly more C5a was generated in pooled normal human serum containing high titers of anti-PRP (determined by an enzyme-linked immunosorbent assay) than in hypogammaglobulinemic serum . Furthermore, C5a generated in hypogammaglobulinemic serum reconstituted with purified high-titer immunoglobulin G, hyperimmune rabbit serum or heat-inactivated normal human serum was comparable to that generated in normal human serum . Absorption of antibody with PRP versus whole HiTb showed a contribution by non-PRP-directed antibody . As shown with the use of C4-deficient guinea pig serum, C5a generation occurred via the alternative complement pathway in nonimmune serum, and activation of the alternative complement pathway was facilitated by specific anti-PRP . C5a generation in test sera was proportional to its opsonic activity for HiTb as assessed by a luminol-chemiluminescence assay . Overall low levels of C5a activity were observed in 13 pediatric patient serum samples obtained during the acute phase of HiTb meningitis, and no pulmonary symptoms or radiographic abnormalities consistent with a leukocyte aggregation syndrome were observed in these patients.

Antimicrob Agents Chemother, 1984 Feb, 25(2), 296 - 7
Common beta-lactamase-specifying plasmid in Haemophilus ducreyi and Neisseria gonorrhoeae; Anderson B et al.; Eighty-nine strains of Haemophilus ducreyi from a chancroid epidemic in Orange County, California, were examined for plasmid content . Seventy-eight (88%) of these isolates were found to contain a plasmid of 3.2 megadaltons which conferred beta-lactamase production . Restriction endonuclease digests indicated that this was the same plasmid that was found in some strains of beta-lactamase-producing Neisseria gonorrhoeae.

South Med J, 1984 Feb, 77(2), 164 - 7
Should sputum isolates of Haemophilus influenzae be serotyped?
Liston TE.
In a patient with pneumonia, sputum culture revealed ampicillin-resistant Haemophilus influenzae, type b . Although nontypable H influenzae is a normal inhabitant of the upper respiratory tract and should be considered normal flora, typable H influenzae is found in less than 5% of healthy persons . Although only 1.8% of sputum cultures reveal typable H influenzae, these strains account for 98.3% of isolates from blood cultures of patients with pneumonia due to H influenzae . Serotyping of sputum isolates is recommended in patients with pneumonia to separate pathogenic typable strains from nonpathogenic nontypable strains.

J Clin Microbiol, 1984 Feb, 19(2), 187 - 90
Quantitation of bacteria in cerebrospinal fluid and blood of children with meningitis and its diagnostic significance; La Scolea LJ Jr et al.; Cerebrospinal fluid (CSF) specimens from pediatric patients with meningitis were examined for their concentration of microbes and the relationship of this count to the bacteremia levels, microscopy results, and polymorphonuclear leukocyte concentration . A total of 2,031 consecutive CSF specimens were analyzed, of which 63 (3.1%) were positive by culture from the same number of patients . We observed that 85% of the total CSF specimens positive for Haemophilus influenzae type b, Streptococcus agalactiae, Streptococcus pneumoniae, and Neisseria meningitidis had counts in excess of 10(3) CFU/ml, with 56% of the specimens exceeding 10(5) CFU/ml . A correlation existed between the number of organisms present in the CSF and blood . For example, from a total of 22 patients who had counts of H . influenzae greater than 10(3) CFU/ml in the CSF, 16 or 73% had levels of bacteremia greater than 10(3) CFU/ml . It was also noted that the bacterial concentration had a profound effect on the sensitivity of microscopy . The percentage of positive results increased from 25% with less than or equal to 10(3) CFU/ml to 60% in the range of greater than 10(3) to 10(5) CFU/ml and to 97% at concentrations of greater than 10(5) CFU/ml . Furthermore, a significant correlation (P less than 0.01) was noted between the concentration of bacteria in the CSF and the number of polymorphonuclear leukocytes observed on microscopy.

J Pediatr, 1984 Feb, 104(2), 297 - 302
Treatment of acute maxillary sinusitis in childhood: a comparative study of amoxicillin and cefaclor; Wald ER et al.; Maxillary sinus aspiration and quantitative culture of the aspirate were performed in 50 patients, ranging in age from 1 to 16 years, with clinical and radiographic evidence of acute sinusitis . Of 79 sinuses aspirated, at least one was found to be infected in 35 (70%) children . Streptococcus pneumoniae, Branhamella catarrhalis, and Haemophilus influenzae were the most common organisms recovered . All H . influenzae were nontypeable . Twenty percent of the H . influenzae and 27% of the B . catarrhalis organisms were beta-lactamase positive and amoxicillin resistant . The subjects received either amoxicillin or cefaclor at a dose of 40 mg/kg/day in three doses for 10 days . The clinical cure rate with amoxicillin was 81%, compared to 78% with cefaclor . Radiographic improvement was similar in both treatment groups . Antibiotic therapy failed in four patients; three had been given amoxicillin, and one cefaclor . In three of these, a beta-lactamase-positive antibiotic-resistant bacterial species was recovered from the maxillary sinus aspirate; the fourth aspirate was sterile.

Ann Urol (Paris), 1984 Feb, 18(1), 40 - 1
{Haemophilus influenzae orchitis in an adult}; Pinon G et al.; This article reports the case of an adult suffering from orchitis due to Haemophilus influenzae . The difficulties encountered in isolating this bacteria when the correct techniques are not used may explain the apparent rarity of Haemophilus influenzae infections of the genital tract . The physiopathological mechanisms of this infection are discussed in relation to the characteristics of the strain isolated.

Antimicrob Agents Chemother, 1984 Feb, 25(2), 258 - 62
Treatment of bacterial meningitis with ceftizoxime; Overturf GD et al.; Ceftizoxime was evaluated in the treatment of 18 patients (6 adults and 12 children) with bacterial meningitis . In seven patients Haemophilus influenzae was the causative agent, in three Neisseria meningitidis, in five Streptococcus pneumoniae, and in one each alpha-streptococcus and Escherichia coli; one case was culture negative . Ceftizoxime was administered intravenously in doses of 200 mg/kg per day . Clinical response was appropriate in all patients with a mean time of defervescence of 3.7 days, and sterile cerebrospinal fluid was obtained from all patients at 24 to 36 h after initiation of therapy . The mean concentration of ceftizoxime in 46 cerebrospinal fluid samples obtained during therapy was 8.53 micrograms/ml (range, less than 0.5 to 29.0 micrograms/ml) . Ceftizoxime concentrations in cerebrospinal fluid samples were ten- to several hundredfold the bactericidal concentrations of the pathogens isolated from the cerebrospinal fluid . Ceftizoxime penetrates the meninges well during acute infection and appears to be an excellent candidate antibiotic in the treatment of bacterial meningitis.

Antimicrob Agents Chemother, 1984 Feb, 25(2), 187 - 90
Plasmid-mediated tetracycline resistance in Haemophilus ducreyi; Albritton WL et al.; Clinical isolates of Haemophilus ducreyi were shown to be resistant to tetracycline . Resistance was associated in some strains with a 30-megadalton plasmid capable of transferring resistance in conjugative matings with other strains of H . ducreyi and other species of Haemophilus . Restriction endonuclease digestion patterns suggest a relationship between H . ducreyi plasmids and other tetracycline resistance plasmids in Haemophilus . The presence of plasmid-mediated resistance to the tetracyclines limits the use of these agents for the treatment of chancroid.

J Antimicrob Chemother, 1984 Feb, 13(2), 143 - 51
Comparison of the efficacy and safety of ceftriaxone to ampicillin/chloramphenicol in the treatment of childhood meningitis; Aronoff SC et al.; Ceftriaxone is a new cephalosporin with a broad spectrum of antibacterial activity and unique serum and CSF pharmacokinetics . The drug was compared in a randomized fashion with ampicillin and chloramphenicol in the treatment of 19 children with Haemophilus influenzae type b meningitis . Ceftriaxone was also administered non-randomly to six other patients including three children with Gram-negative meningitis . Among the children with H . influenzae meningitis, no deaths were noted and the outcomes of the study and the control groups were similar . Ninety per cent of the isolates of H . influenzae were inhibited by 0.0625, 1 and 1 mg/l of ceftriaxone, ampicillin and chloramphenicol respectively . One child with pneumococcal meningitis and two children with meningococcal meningitis recovered rapidly and without incident during ceftriaxone therapy . Three children with Gram-negative meningitis caused by multiply-drug resistant organisms were bacteriologically cured within five days of the onset of therapy . Persistent pleocytosis and neurological disabilities were noted in two at the conclusion of therapy . Ceftriaxone, as a single agent, was comparable in efficacy with traditional antimicrobial therapy usually employed in childhood meningitis.

Vet Microbiol, 1984 Feb, 9(1), 77 - 82
Pathogenicity of Australian isolates of Haemophilus paragallinarum and Haemophilus avium in chickens; Reid GG et al.; Twenty-seven Australian avian Haemophilus isolates were tested for their ability to cause infectious coryza in specific pathogen-free chickens . All 15 isolates, identified as H . paragallinarum, produced infectious coryza, whereas all 12 H . avium isolates were nonpathogenic, but spread to in-contact chickens.

Vet Res Commun, 1984 Feb, 8(1), 1 - 14
Haemophilus influenzae and the beta-adrenergic system: a review; Schreurs AJ et al.; Haemophilus influenzae is a bacterium that often can be isolated from the deeper respiratory airways of patients with chronic asthmatic bronchitis . In the present study the effects of H . influenzae vaccination on guinea pig pulmonary beta-adrenoceptor number and function (in vitro and in vivo) have been evaluated . Functioning of beta-adrenoceptors is determined by measuring the beta-mimetic effect of isoprenaline on the inhibition of anaphylactic mediator release and isolated tracheal strip relaxation . The number of beta-adrenoceptor binding sites was measured by means of a 3H-dihydroalprenolol binding assay . Also the mechanism of action underlying the changes in beta-adrenoceptor functioning was evaluated . Furthermore, it was established that the effect on the beta-adrenoceptor system was not specific for H . influenzae and that other respiratory pathogens were also biologically active in this respect.

J Clin Microbiol, 1984 Feb, 19(2), 230 - 4
Enzyme-linked immunosorbent assay with a monoclonal antibody for detecting group A meningococcal antigens in cerebrospinal fluid; Sugasawara RJ et al.; Hybridomas were produced from spleen cells of BALB/c mice immunized with a membrane preparation from Neisseria meningitidis group A strain 4402 and S194/5.XXOBU.14 myeloma cells . The hybridomas were screened for secretion of antibodies suitable for an enzyme-linked immunosorbent assay (ELISA) diagnostic for group A meningococcal meningitis . One hybridoma antibody, 3G7, was directed against the pilus protein . This antibody bound to all six lipopolysaccharide and protein group A meningococcal serotyping strains, as well as to meningococcal strains from serogroups C, W135, and Y, but not to a strain of Escherichia coli, Haemophilus influenzae type b, or to two or more strains of Streptococcus pneumoniae, Neisseria gonorrhoeae, and Salmonella typhi . The ELISA used on antibody, antigen, antibody-conjugate sandwich . Rabbit anti-meningococcal serum was the coating antibody for the antibody sandwich, cerebrospinal fluids contained the bacterial antigens, and 3G7-alkaline phosphatase conjugate was the detecting antibody . The monoclonal antibody conjugate ELISA system was able to detect group A meningococcal antigens in 21 of 25 cerebrospinal fluid specimens that were positive in an immune rabbit serum conjugate ELISA; cerebrospinal fluid samples from patients with Haemophilus meningitis served as the controls . Counterimmunoelectrophoresis detected meningococcal antigens in 16 of the same 25 cerebrospinal fluid samples.

S Afr Med J, 1984 Jan 28, 65(4), 117 - 20
Acute osteomyelitis and septic arthritis in children . A simple approach to treatment; Learmonth ID et al.; A 12-month prospective study of 45 patients with bacteriologically proven acute osteitis and septic arthritis is presented . Sodium fusidate and erythromycin at the recommended dosage of 30 mg/kg/d for 3 weeks was found to be an effective first-line antibiotic regimen . The hazards of Haemophilus infection are emphasized . Immediate Gram staining is therefore strongly recommended . It was found that adequate drainage of a subperiosteal abscess without drilling of the bone always resulted in complete cure, while cases of septic arthritis consequent upon decompression of a contiguous metaphysitis were adequately treated by arthrotomy and irrigation alone . The authors believe that early limited surgery with adequate administration of antibiotics aided by early circumspect mobilization will provide a good functional and cosmetically acceptable result in most cases.

Vet Rec, 1984 Jan 7, 114(1), 6 - 8
Does the use of chloramphenicol in animals jeopardise the treatment of human infections?
Lacey RW.
It has been suggested that the therapeutic use of oral chloramphenicol in animals is liable to select resistance to antibiotics and that the resistance may jeopardise the treatment of infections in man . At present this risk appears minimal; resistance to chloramphenicol in animal bacteria may well be selected by the increasing use of semi-synthetic penicillins because of linkage between genes coding for production of beta-lactamase and resistance to chloramphenicol . Among salmonellae, the strains causing enteric fever have no animal reservoir and the few food poisoning incidents in man that require therapy can be treated with antibacterial agents such as trimethoprim . Chloramphenicol is not now the antibiotic of choice for any human infection except perhaps a few caused by Haemophilus influenzae . Resistance to antibiotics in 'human' cultures has largely been selected by the use of antibiotics in human medicine . Control of salmonellosis is essentially a public health, not a therapeutic problem.

Can J Comp Med, 1984 Jan, 48(1), 47 - 50
Antimicrobial susceptibility of 51 strains of Haemophilus pleuropneumoniae; Gilbride KA et al.; Fifty-one strains of Haemophilus pleuropneumoniae were tested for susceptibility to 27 antimicrobial agents using agar disc diffusion, broth-tube dilution and microdilution methods . There was generally good agreement between the interpretation of the disc diffusion inhibition zones and the actual minimal inhibitory concentrations obtained with the dilution methods . The agreement between the results obtained with the broth-tube dilution method and the microdilution method was very good . Three strains were resistant to penicillin, ampicillin, carbenicillin, methicillin and tetracycline . One of those was also resistant to chloramphenicol . Forty strains were resistant to streptomycin, 23 strains were resistant to novobiocin and seven were resistant to triple sulfa . It is thus necessary to consider resistance development against antimicrobial agents chosen for the treatment of pleuro-pneumonia in pigs caused by Haemophilus pleuropneumoniae.

Can J Comp Med, 1984 Jan, 48(1), 27 - 9
The pathogenicity of Haemophilus somnus in various laboratory animal species; Dewey KJ et al.; As a test of susceptibility of laboratory animals to the causative organism of thrombotic meningoencephalitis of cattle, young mice, rats, rabbits, piglets, chicks and hamsters were exposed to the virulent strain 43826 of Haemophilus somnus by the intravenous and intraperitoneal routes . Only the hamsters developed lesions attributable to the organism . Two of ten hamsters developed an acute orchitis and epididymitis characterized by necrosis and arteritis . The fact that Histophilus ovis, a cause of epididymitis in Australian and New Zealand rams, is apparently very closely related to Haemophilus somnus suggests that the hamster may be a useful laboratory model to study this disease.

Can J Comp Med, 1984 Jan, 48(1), 23 - 6
Environmental survival of Haemophilus somnus and influence of secretions and excretions; Dewey KJ et al.; Environmental survival of the Haemophilus somnus virulent strain 43826 was examined by mixing it with bovine secretions and excretions and observing viability after storage at -70 degrees C, 3 degrees C, 23.5 degrees C and 37 degrees C at one day, five days, 12 days, 19 days and intermittently up to 75 days . Survival of the organism beyond 70 days occurred when it was mixed with cerebrospinal fluid, whole blood, blood plasma, vaginal mucus and milk and frozen at -70 degrees C . At 3 degrees C the organism in these fluids survived for five days or less . At 23.5 degrees C the organism survived beyond 70 days when mixed with whole blood and nasal mucus . The viability of H . somnus in urine at all temperatures was less than 24 hours and less than 15 minutes at 20 degrees C and 37 degrees C . Infective cerebrospinal fluid frozen alone in liquid nitrogen and with the addition of various cryopreservatives allowed the organism to survive and maintain virulence for at least 56 days . The implications of these studies to disease transmission and experimental studies is discussed.

Aust Vet J, 1984 Jan, 61(1), 17 - 9
Serological and bacteriological survey of three horse studs for contagious equine metritis; Dolan M et al.; A bacteriological and serological survey for evidence of contagious equine metritis (CEM) was made during the 1980 breeding season on 3 horse studs in South Australia with a history of previous infection . Swabs from the clitoral sinus and the cervix were cultured for Haemophilus equigenitalis and serum was screened for antibody using the complement fixation test (CFT) and the enzyme-linked immunosorbent assay (ELISA) . The specificity of both tests was greater than 0.99 but the ELISA was more sensitive in detecting antibody in infected mares . On the evidence presented it was concluded that H . equigenitalis is no longer present in the horse studs investigated.

Antimicrob Agents Chemother, 1984 Jan, 25(1), 118 - 22
Evaluation of three 4"-deoxy-4"-sulfonamido-oleandomycin derivatives with erythromycin-like antibacterial potency; English AR et al.; Three derivatives of oleandomycin in which the C"-4 hydroxyl moiety was replaced for the first time with a nitrogen functionality have been compared with erythromycin base and oleandomycin base . The minimum inhibitory concentrations of these derivatives for 90% of a group of clinical isolates of Staphylococcus aureus were one-half to one-fourth those of erythromycin . The minimum inhibitory concentrations of the experimental macrolides for 50% of a group of S . aureus isolates resistant to greater than 12.5 micrograms of erythromycin per ml ranged from 0.2 to 0.39 micrograms/ml . The activities of these experimental compounds were equivalent to the activities of erythromycin against Staphylococcus epidermidis, Bacteroides fragilis, and Haemophilus influenzae isolates . In general, erythromycin was more active against Streptococcus species . Each experimental macrolide was superior to erythromycin in inhibiting RNA-directed, cell-free polypeptide synthesis . The three experimental compounds were markedly more active than erythromycin base after oral administration to mice infected with S . aureus . The 50% protective doses of the experimental compounds ranged from 27.4 to 45.7 mg/kg; that of erythromycin was approximately 100 mg/kg.

Pediatr Infect Dis, 1984 Jan-Feb, 3(1), 14 - 9
Pathogens associated with acute lower respiratory tract infection in young children; Paisley JW et al.; To determine the agents associated with acute lower respiratory infection in young children, we studied 102 hospitalized children less than 5 years old using culture and serology for viruses and Chlamydia trachomatis, fluorescent antibody testing for pertussis and respiratory syncytial virus, blood cultures and counterimmunoelectrophoresis of nasopharyngeal secretions and urine for pneumococcal and Haemophilus influenzae type b antigens . At least one agent was detected in 87 children and multiple agents were found in 33 . Viruses were detected 80 times; respiratory syncytial virus was most common (61 cases) and was detected as often by fluorescent antibody testing as by culture . C . trachomatis was detected in 10 children; all were less than 4 months old and 9 had mixed infections . Bacteria were detected 32 times, were usually pneumococcus (23) or H . influenzae (5) and were detected more often by counterimmunoelectrophoresis than by blood culture . Compared with children yielding only C . trachomatis or viruses, those with bacteria were significantly more likely to have fever, a band count over 2000/mm3 and radiographic consolidation . In this study acute lower respiratory infection was associated commonly with viruses, often with multiple pathogens but not with C . trachomatis after 4 months of age.

J Pediatr, 1984 Jan, 104(1), 23 - 8
Value of antigen quantitation in Haemophilus influenzae type b meningitis; Russell R et al.; We studied Haemophilus influenzae type b meningitis in 68 patients to evaluate whether quantitative determination of PRP in body fluids obtained at admission or measurement of the duration of its presence helped identify patients at risk for complications . Geometric mean admission PRP concentrations in CSF, blood, and urine increased with severity of disease, but individual values varied greatly . Measurements of the duration of antigenemia and antigenuria also varied widely and were best predicted by the admission or peak PRP concentration . The mean duration of both antigenemia and antigenuria increased with severity of disease . In contrast, the elimination half-life of PRP did not differ significantly with severity of hospital course, peak PRP concentration in blood or urine, or patient age . Clearance from CSF could not be accurately assessed, but PRP was detectable in only six of 41 patients in whom spinal fluid was obtained after the eighth day of hospitalization; all had complicated courses . Although latex particle agglutination assay is a valuable aid in rapid diagnosis of invasive Hib infections, the predictive value of antigen quantitation at admission and the determination of its duration in body fluids is limited by the wide range of observed values.

J Pediatr, 1984 Jan, 104(1), 18 - 22
Effect of penicillin prophylaxis on nasopharyngeal colonization with Streptococcus pneumoniae in children with sickle cell anemia; Anglin DL et al.; Polyvalent pneumococcal vaccine and oral penicillin prophylaxis are frequently used in patients with functional or anatomic asplenia to protect them from fulminant Streptococcus pneumoniae sepsis . We studied nasopharyngeal colonization with pneumococci in 34 patients with sickle cell anemia (aged 6 months to 5 years) receiving penicillin prophylaxis and in 63 age- and race-matched comparison patients . Patients with sickle cell anemia had fewer positive initial pneumococcal nasopharyngeal cultures than did the comparison group (14.5% vs 34.4%, P = 0.03) and significantly lower carriage rates during the respiratory illness season of November to March (8.7% vs 40.5%, P = 0.005) . Penicillin prophylaxis did not result in emergence of penicillin-resistant pneumococci or in an increased carriage rate of Haemophilus influenzae type b . Our data suggest a mechanism of action for penicillin prophylaxis and provide some evidence for the relative safety of this regimen.

Arch Otorhinolaryngol, 1984, 240(1), 79 - 83
Serum bactericidal effect on capsulated and non-capsulated Haemophilus influenzae in chronic sinusitis; Harada T et al.; Study on the incidence of bactericidal (BC) antibodies to a Haemophilus influenzae type b and a non-capsulated H . influenzae was carried out on sera from 50 healthy subjects, and from 30 patients with chronic sinusitis . Of the 50 sera from normal subjects, only one (2.0%) lacked BC antibodies to the H . influenzae type b, whereas 13 (26.0%) lacked BC antibodies to the non-capsulated H . influenzae . All of the 30 sera from patients with chronic sinusitis were bactericidal for the H . influenzae type b, whereas only three (10.0%) lacked BC antibodies to the non-capsulated H . influenzae . Specific IgG, IgM and IgA antibodies to the non-capsulated H . influenzae in serum were determined by the indirect fluorescent antibody assay . Of the 22 sera tested in this study, 15 (68.0%) had antibodies of at least the IgG, IgM, or IgA classes; with IgG occurring most often . These data suggest that a lack of circulating BC antibodies to both H . influenzae isolates is not associated with the chronic carriage of these organisms by patients with chronic sinusitis.

Sex Transm Dis, 1984 Jan-Mar, 11(1), 6 - 9
Comparison of media for the primary isolation of Haemophilus ducreyi; Nsanze H et al.; The rates of isolation of Haemophilus ducreyi from patients with presumed chancroid has been low, and improved cultural techniques are required . We determined the isolation rates of H . ducreyi from 38 patients with clinical chancroid and compared gonococcal agar supplemented with bovine hemoglobin to Mueller-Hinton agar supplemented with chocolated horse blood, each with and without 5% fetal calf serum . The rate of isolation and the qualitative and quantitative growth of strains was best on gonococcal agar with added fetal calf serum (GC-HgS) . However, three strains were isolated only on Mueller-Hinton base (MH-base) . GC-HgS was compared with MH-HB for the isolation of H . ducreyi from 201 patients with clinical chancroid . Seventy-one percent of cultures were positive on GC-HgS, and 61% were positive on MH-HB (P less than .005); however, 10% of cultures were positive only on MH-HB . The use of the two media together increased the yield of positive cultures to 81% . Thus maximal rates of isolation of H . ducreyi from clinical specimens requires the use of two media, GC-HgS and MH-HB.

Pediatr Infect Dis, 1984 Jan-Feb, 3(1), 35 - 9
Incidence and prognosis of Haemophilus influenzae meningitis in children in a Swedish region; Claesson B et al.; Haemophilus influenzae meningitis in children 0 to 15 years old was studied retrospectively in a defined region of southwest Sweden from 1971 through 1980; 147 patients with culture-verified H . influenzae meningitis were found . Sixty-seven of them were younger than 18 months and would not have been protected by a purified H . influenzae b polysaccharide vaccine . The age-specific yearly incidence was 27 per 100,000 in the 0- to 4-year age group, 4 per 100,000 in the 5- to 9-year age group and 1 per 100,000 in the 10- to 15-year age group . Predisposing factors were found in only three patients . Two patients died, 3 developed severe neurological sequelae and 19 developed irreversible auditory impairment.

Mol Gen Genet, 1984, 193(2), 358 - 63
Heterospecific transformation in the genus Haemophilus; Albritton WL et al.; The relationship between nine Haemophilus species and Haemophilus influenzae was studied by DNA-DNA hybridization, by transformation of H . influenzae to streptomycin resistance with heterospecific DNA, by competition of heterospecific DNA for transformation by homospecific DNA and by the lethal effect of heterospecific DNA on competent H . influenzae . H . parainfluenzae, H . parasuis, and H . aegyptius DNA transformed at more than 10% efficiency when compared to homologous transformation, but only H . aegyptius demonstrated, by hybridization, a relative binding ratio of more than 80% . H . aphrophilus and H . paraphrophilus DNA demonstrated a relative binding ratio of less than 30% and transformed H . influenzae at only 10(-5) the efficiency of homologous DNA, but they competed for H . influenzae transformation as well as or better than homospecific DNA . The data indicated that in some of the species sharing the common ecological habitat of the mammalian respiratory tract, sequences necessary for competition and efficient uptake into H . influenzae are present in large numbers in their DNAs, which nevertheless have little overall homology with H . influenzae DNA.

J Infect Dis, 1984 Jan, 149(1), 43 - 7
Reproducible production of protective human monoclonal antibodies by fusion of peripheral blood lymphocytes with a mouse myeloma cell line; Gigliotti F et al.; The production of monoclonal antibodies of human origin may represent a significant advance in immunotherapy for disease in humans . Although human monoclonal antibody has been produced from human lymphocytes by fusion with human myeloma cell lines or by Epstein-Barr viral transformation, fusion of postimmunization human lymphocytes with a mouse myeloma cell line is a relatively simple and reproducible alternative . Mouse-human hybrid cell lines were obtained in 205 (53%) of the microtiter wells initially seeded . Thirty-one (15%) of these hybrid cell lines secreted antibody of predefined specificity . Cloning was attempted with eight of the hybrid cell lines, and long-term antibody production was established in four of the lines: two hybridomas secreted antibody to the capsule of Haemophilus influenzae type b, one secreted antibody to tetanus toxoid, and one secreted antibody to diphtheria toxin . The production of mouse-human hybridomas appears to be a reliable method for obtaining human monoclonal antibody of predefined specificity.

Scand J Infect Dis Suppl, 1984, 42, 7 - 16
Trends in the development of beta-lactam antibiotics; Neu HC; In many ways it is ironic that the first description of a beta-lactamase occurred in 1940 with an enzyme isolated from Escherichia coli since in recent years there has been a major interest in Gram-negative species and the development of agents to overcome the hydrolytic action of beta-lactamases of Gram-negative species . There have been four distinctly different approaches to the development of new beta-lactam antibiotics . These have been the search for inhibitors of beta-lactamases and agents such as clavulanic acid and sulbactam are examples of compounds which by virtue of Kcat function act as suicide inhibitors and make old antibiotics new . There has been the modification of the penicillin and cephem nucleus to increase beta-lactamase stability or failing that to improve the ability of the compounds to pass through the cell wall and increase affinity for critical beta-lactam receptors, i.e . penicillin-binding proteins . There has been the development of carbapenem type of agents such as imipenem which would have broad activity including aerobic, anaerobic, Gram-positive and Gram-negative species . There has been the discovery of the monobactam agents of which aztreonam is an example of a compound with great beta-lactamase stability but with activity limited to Gram-negative aerobic species . Bacterial resistance has indeed been the major factor that has modified use of beta-lactams and influenced the development of the aforementioned types of drugs . The widespread presence of beta-lactamases in common pathogens such as Haemophilus influenzae, Neisseria gonorrhoeae, Escherichia coli, Klebsiella sp., Pseudomonas aeruginosa, and Bacteroides fragilis has made it necessary to have beta-lactamase stable compounds for initial therapy of infection . It is possible to analyze structure-activity relations of beta-lactam compounds to determine changes which will be most advantageous in light of known and expected resistance patterns . But the increased realization in recent years of the importance of the pharmacokinetics of beta-lactam drugs has made it essential that the development of new compounds be based on an integration of microbiological and pharmacokinetic parameters . Interest in the prevention of resistant flora has also affected the development of new drugs since it is increasingly appreciated that alteration of intestinal flora contributes to selection of drug resistant microorganisms . Finally, new toxicities or adverse effects associated with the use of certain new agents has modified the development of certain compounds.

Scand J Infect Dis Suppl, 1984, 42, 117 - 21
Treatment of acute bacterial meningitis with special emphasis on beta-lactam antibiotics; Solberg CO et al.; Acute bacterial meningitis still represents a therapeutic problem . Successful management depends on early administration of large doses of bactericidal antibiotics and adequate treatment of complications, i.e . shock, acute cerebral edema, consumption coagulopathy, convulsions and electrolyte disturbances . Meningitis caused by Neisseria meningitidis or Streptococcus pneumoniae should be treated with benzylpenicillin . If benzylpenicillin cannot be given, chloramphenicol has remained the best substitute . However, cefuroxime or ceftriaxone now seems to offer an alternative to chloramphenicol . The prevalence of beta-lactamase-producing Haemophilus influenzae strains is increasing and chloramphenicol has replaced ampicillin in the treatment of H . influenzae meningitis . Recent studies indicate that cefuroxime, ceftriaxone or moxalactam may be as effective as chloramphenicol in this type of meningitis . In neonatal meningitis, cefotaxime or moxalactam may constitute alternatives to the present regimens with ampicillin-gentamicin, gentamicin-chloramphenicol, cotrimoxazole or gentamicin . Promising results have also been obtained with cefotaxime or moxalactam in elderly patients with meningitis due to Gram-negative enteric bacilli . However, more extensive studies are needed to determine the role of the newer cephalosporins in the treatment of acute bacterial meningitis.

Microbios, 1984, 41(165-166), 149 - 57
Bacteraemia in hospitalized children; Brook I et al.; The results of 3,037 blood cultures taken from hospitalized children during 1977 are reviewed, and 171 patients were considered to have bacteraemia whilst 67 were considered to have contaminants . Streptococcus pneumoniae, Haemophilus influenzae, Staphylococcus aureus and Streptococcus spp were found to be the most common organisms associated with 80% of the observed bacteraemias . H . influenzae and groups B and D streptococci were more often isolated in young children (less than 3 years) . Group D streptococcal bacteria occurred more in newborns and patients with congenital anomalies . H . influenzae and S . pneumoniae bacteraemias were frequently associated with the presence of a foci of infection . Elevated temperature and an absolute differential cell count, were present in 75% of the patients with bacteraemia.

Infection, 1984, 12 Suppl 1, S65 - 71
Chemoprophylaxis for the prevention of bacterial meningitis; Schaad UB; Close contacts of index patients with Neisseria meningitidis or Haemophilus influenzae type b meningitis show higher nasopharyngeal carriage rates and are at an increased risk of contracting the disease . The key issue in the management of such contacts remains close and careful surveillance, because prophylaxis will never result in the absolute prevention of secondary cases . Adequate chemoprophylaxis with rifampin eradicates nasopharyngeal colonization in more than 90% and may prevent both co-primary and secondary diseases . Routine chemoprophylaxis for close contacts of systemic meningococcal diseases is recommended . However, there are several factors inherent in rifampin prophylaxis for the prevention of H . influenzae type b meningitis which exclude its use as a routine measure.

Chemotherapy, 1984, 30(6), 358 - 65
Penetration of parenterally administered rifampicin into bone tissue; Roth B; This study in 32 patients was undertaken to determine the penetration of rifampicin into bone tissue using the recently developed intravenous formulation of this antibiotic . 300 mg rifampicin given as an intravenous injection over 5 min followed by 300 mg slow intravenous drip infusion over 1 h give a plasma level of rifampicin of more than 2 micrograms/ml for 6 h . In patients with osteomyelitis, bone rifampicin concentrations ranged from 1.4 to 8.8 micrograms/g at 2.5-3.5 h after the start of treatment . Osteomyelitis due to gram-positive organisms and to Haemophilus can be treated with rifampicin in combination with a second antibiotic, depending on the minimum inhibitory concentration of the infecting organism(s).

Acta Otorhinolaryngol Belg, 1984, 38(3), 331 - 6
Study of lymphoid tissue in paediatric ENT practice; Deggouj N et al.; This study comprises 2 groups of children; allergic (18) and non-allergic (36), having undergone tonsillectomy, adenoidectomy or both . The humoral immunity profile' bacteriology and neutrophile and eosinophile cell populations of the lymphoid tissues removed were compared . No significant difference was brought into evidence . The bacteriology of the two groups did however show a preponderance of Haemophilus influenzae . This would appear to be in contradiction to the generally accepted theories.

Vet Med Nauki, 1984, 21(7-8), 22 - 30
{Clinical cases of infectious coryza and the properties of isolated Haemophilus strains}; Giurov B; Studied were a total of sixteen cases with the clinical picture of coryza . Leading role in eleven of them had Haemophilus, in one the signs of chronical cholera and pox were seen, and in three there was a Pseudomonas aeruginosa infection . All cases were serologically positive for CRD . By their needs of nutrient growth factors the isolated Haemophilus strains belonged to H . paragallinarum, and they proved pathogenic for 8-week-old birds and poults that were about to lay their first eggs, killing 4-7-day-old chick embryos up to the 48 h hour . Tests for resistance to therapeutic means with the use of the disk-diffusion method revealed sensitivity to streptomycin, tetracycline, chloramphenicol, gentamycin, erythromycin, spectinomycin, furazolidon, imekil, cosumix, trimetoprim, and sulfadoxin . Good and very good therapeutic and prophylactic effects were produced with the use of sulfotin, cosumix, linkospectin, and trimedin coupled with aerosol disinfection with rivanol, the birds being present on the premise . It is stated that with regard to differential diagnosis coryza caused by Haemophilus paragallinarum should not be confused with fowl cholera, pox, CRD, and Pseudomonas aeruginosa infection which may run their course in a mixed infection.

Respiration, 1984, 46(2), 187 - 200
{Tracheal stenosis in the cat: anatomopathologic repercussions on the pulmonary parenchyma}; Reichart E et al.; A calibrated stenosis of the trachea was performed in 6 young cats and 1 old one (TS cats); the animals were observed for 8 or 15 weeks thereafter . The percentage of macrophages in bronchoalveolar lavage fluid was greater in the TS cats than in the controls . An irregular distribution of pulmonary lesions was found . 4 TS cats presented with a real emphysema with tracheobronchial inflammation, a parenchymatous infection which was histologically shown or quantified in lavage fluid (Haemophilus (10(8} . They exhibited episodes of hypoventilation which followed in quick succession . The alveolar section of the TS emphysematous lung was equal or greater (up to 88% of the lung surface observed) than that of both the same-aged controls (81.5%) and of an old emphysematous cat (88 months) . The alveoli were more homogeneous (lower deviation) . TS lung was characterized by a higher amount of dry tissue protein but hydroxyproline varied individually . A possible synergy between infection and ventilatory obstruction may be a tentative explanation for the etiogeny of this emphysema which appears to be secondary to tracheal stenosis.

Cardiology, 1984, 71(4), 215 - 9
Haemophilus parainfluenzae endocarditis on tricuspid valve; Graninger W et al.; After an episode of intermittent fever which lasted 45 days, endocarditis of the tricuspid valve was diagnosed using M-mode echocardiography in a 17-year-old female patient who had no history of drug abuse . After unsuccessful therapy with ampicillin, tetracycline and aminoglycosides, clinical improvement was achieved by treatment with temocillin.

Pharmatherapeutica, 1984, 3(10), 692 - 7
Penetration of ampicillin ('Pondocillin') and amoxycillin ('Imacillin') into bronchial secretions; Hagstad H; The penetration of ampicillin and amoxycillin into bronchial secretions was investigated by bronchoscopy in 20 patients suffering from exacerbations of chronic bronchitis . Five patients received 500 mg pivampicillin, 8 received 700 mg pivampicillin and 7 received 500 mg amoxycillin . There were no significant differences between these three treatments in respect of the serum and bronchial secretion concentrations at the time of bronchoscopy, nor were there any significant differences in the peak serum level or total bioavailability of each regimen . The concentrations in bronchial secretions, on average, were 5.7%, 9.0% and 7.6% of the corresponding serum concentrations in patients given 500 mg pivampicillin, 700 mg pivampicillin and 500 mg amoxycillin, respectively . The concentration in bronchial secretions exceeded the MIC for sensitive strains of Haemophilus influenzae in more cases treated with pivampicillin than with amoxycillin.

Infection, 1984, 12 Suppl 1, S72 - 7
Capsular polysaccharide vaccines today; Makela PH; Polysaccharide (PS) vaccines are a relatively new class of antibacterial vaccines that have special advantages but also special problems related to their character . Several of them have proven very effective in preventing bacteremic infections caused by encapsulated bacteria such as meningococci, pneumococci and Haemophilus influenzae type b . Protective activity shows excellent correlation with serum anti-PS . However, young children often respond poorly to PS antigens and this limits the use of these vaccines in childhood . Some PS are poor immunizing agents even in adults . The practical implications of these aspects for the use and development of PS vaccines are discussed.

Scand J Infect Dis Suppl, 1984, 42, 110 - 6
The use of beta-lactam antibiotics in the treatment of septicaemia and endocarditis; Watanakunakorn C; Despite the availability of numerous beta-lactam antibiotics, benzylpenicillin remains the most important beta-lactam antibiotic in the treatment of bacterial endocarditis . Penicillin alone and in combination with an aminoglycoside is effective in the treatment of endocarditis due to all streptococci, Streptococcus pneumoniae, penicillin-susceptible Staphylococcus aureus, Haemophilus aprophilus, Actinobacillus actinomycetemcomitans, Cardiobacterium hominis, Listeria monocytogenes . Oral phenoxymethylpenicillin in combination with streptomycin is effective in treating endocarditis due to viridans streptococci . Ampicillin is effective in endocarditis due to Haemophilus influenzae, H . parainfluenzae, H . paraphrophilus, Listeria monocytogenes and Escherichia coli . Oral amoxicillin with gentamicin has been used to treat enterococcal endocarditis . The penicillinase-resistant penicillins are effective in treating S . aureus endocarditis . Carbenicillin or ticarcillin in combination with tobramycin or gentamicin are used to treat endocarditis due to Serratia marcescens and Pseudomonas aeruginosa . The use of piperacillin in combination with tobramycin against P . aeruginosa endocarditis has been associated with failure and increased resistance . The cephalosporins have been used to treat endocarditis caused by susceptible organisms . There have been few data on the efficacy of the newer cephalosporins in treating endocarditis . They have been used to treat septicaemia due to susceptible organisms with good results.

Acta Otolaryngol Suppl, 1984, 407, 43 - 9
Activity of common antibiotics against Branhamella catarrhalis, Haemophilus influenzae, pneumococci, group A streptococci and Staphylococcus aureus in 1983; Forsgren A et al.; The activity of phenoxymethylpenicillin (PcV), ampicillin, cefaclor, cefuroxime, chloramphenicol, co trimoxazole, doxycycline and erythromycin against clinical isolates of Branhamella catarrhalis, Haemophilus influenzae, pneumococci, group A streptococci and Staphylococcus aureus in 1983 was investigated with the MIC-method (plate-dilution technique) . Forty-six percent of B . catarrhalis, 2% of H . influenzae and 78% of S . aureus were beta-lactamase producing and had high MIC-values for penicillin and ampicillin . Thus MIC for 90% of all strains of B . catarrhalis was 32 mg/l and 8 mg/l for penicillin and ampicillin while MIC for 90% of non beta-lactamase producing Branhamella strains was 2 mg/l and 0.25 mg/l respectively . This indicates a high susceptibility of penicillins to the action of Branhamella beta-lactamase . Almost all strains of B . catarrhalis, pneumococci, group A streptococci and S . aureus were inhibited at low concentrations of erythromycin . However, 4 mg/l was required to inhibit 90% of H . influenzae . Co-trimoxazole and doxycycline had good activity against all B . catarrhalis and H . influenzae strains while a few pneumococci, streptococci and staphylococci had intermediate sensitivity or were resistant . Essentially all strains were sensitive to cefuroxime and chloramphenicol.

Mutat Res, 1984 Jan, 125(1), 15 - 22
Prophage induction in Haemophilus influenzae and its relationship to mutation by chemical and physical agents; Balganesh M et al.; It is known that UV, X-rays, MMC and MMS are not mutagenic for H . influenzae, whereas HZ, EMS and MNNG are potent mutagens for this bacterium . All of these agents, however, are known to be both mutagenic and able to induce prophage in E . coli . We report here that all the agents except HZ induce prophage in H . influenzae, and EMS even induces in the recombination-defective recl mutant, which is non-inducible by UV, MMC, MNNG and MMS . MMS did not cause single-strand breaks or gaps in DNA synthesized after treatment of H . influenzae, but EMS and MNNG produced them . EMS caused more breaks in DNA synthesized before treatment than in that synthesized after treatment . On the other hand we did observe such breaks or gaps induced in E . coli in DNA synthesized posttreatment by EMS as well as by MMS and MNNG, at comparable survival levels.

Infection, 1984, 12 Suppl 1, S52 - 7
Bacterial meningitis in infants and children; Marks MI; Bacterial meningitis of infants and children exact a major toll worldwide . Haemophilus influenzae, Streptococcus pneumoniae and Neisseria meningitidis continue to be the major causes, and efforts to reduce the incidence of this disease have had limited success . Major advances in rapid diagnosis, such as antigen detection, have occurred over the past several decades; however, Gram stain, cytologic examination and culture of the CSF remain the most reliable means of making an etiologic diagnosis . Despite shifts in bacterial susceptibilities to commonly used antibacterial agents, penicillin, ampicillin and chloramphenicol remain effective therapy for the vast majority of cases, although newer cephalosporin derivatives may be required to avoid the toxicities of chloramphenicol and to effectively treat selected bacteria that have developed resistance to these more classical antibiotics . The prognosis for bacterial meningitis in infants and children remains guarded because of late diagnosis and the severity of the disease . Major reductions in the incidence of the disease will depend on definition of high-risk populations and application of appropriate preventions.

Infection, 1984, 12 Suppl 1, S11 - 22
Experimental meningitis in the rat: Haemophilus influenzae; Smith AL et al.; Leptomeningitis due to type b Haemophilus influenzae can be produced in infant rats (up to three weeks of age) by intranasal inoculation, and in animals up to three months of age by intraperitoneal inoculation . In infant animals, the pathogenesis appears to mimic the disease in human infants . Immunologic experiments indicate that antibody directed against the type b capsule (actively or passively acquired) will protect against bacteremia (by any route of inoculation) and the subsequent development of meningitis . However, antibody directed against other surface structures of H . influenzae b (alone or with anticapsular antibody) will protect against sustained bacteremia after any route of inoculation . Evaluation of antibiotic activity against this infection in rats is unreliable due to a marked age-dependent increase in antibiotic clearance . A means of mimicking human pharmacokinetics in rats is proposed . The rat model is useful for the study of H . influenzae meningitis provided certain limitations are recognized.

Scand J Infect Dis Suppl, 1984, 42, 155 - 68
Beta-lactam therapy of osteomyelitis and septic arthritis; Wilber RB; The goal of therapy in osteomyelitis is to eradicate established bone infection and to prevent progression into the chronic form . Beta-lactams generally lack organ toxicity or serious side effects when used in high doses for the prolonged intervals necessary to eradicate osteomyelitis . Also, the spectrum of many beta-lactams covers the usual etiologic agents of bone and joint infections . Penetration of beta-lactams into joint fluid is variable but adequate . The significance of measurable "bone levels" is unclear . Staphylococcus aureus in some series accounts for up to 80% of acute haematogenous osteomyelitis, and anti-staphylococcal penicillins and cephalosporins are the drugs of choice in these cases . Other clinical types of osteomyelitis and septic arthritis are associated with a wider range of etiologies . Factors such as the age of the patient (neonates with Gram-negative infections, infants with Haemophilus influenzae arthritis), host defense status (sickle cell patients with Salmonella osteomyelitis) as well as the site of infection (vertebral osteomyelitis associated with UTI), have an increased frequency of causes other than staphylococci, necessitating broader coverage . If environmental contamination has been introduced into the systemic circulation (drug addicts), or into the joint, bone, or contiguous soft tissue (by trauma), the spectrum of causative agents is diverse, and may necessitate concomitant therapy with aminoglycosides and/or anti-anaerobe drugs . As experience is gained with expanded spectrum cephalosporins and carbapenems, their role in the therapy of bone and joint infections will be better defined . Non-beta-lactam antibiotics have been evaluated, but at least for staphylococcal infections should probably be reserved for use in patients with known hypersensitivity or those infected with methicillin resistant or tolerant strains . The development of a non-toxic agent active against these pathogens is a challenge for the future.

Respiration, 1984, 46(4), 379 - 81
Haemophilus parainfluenzae lung abscess; Israel RH et al.; To our knowledge, Haemophilus parainfluenzae lung abscess has not been described previously . Such a case is presented in the setting of diabetes mellitus . The implications of diagnosis and management are discussed.

Clin Ther, 1984, 6(6), 824 - 38
Asian multicenter trial of cefoperazone in respiratory tract infection; Matsumoto K et al.; The safety and clinical efficacy of cefoperazone were evaluated in a multicenter trial conducted at institutions in Japan, Korea, and Taiwan . Cefoperazone was given as the sole antibiotic for 481 respiratory tract infections in 476 patients . An overall satisfactory clinical response was achieved in 73.7% of patients . Cefoperazone was effective in 78.9% of cases of pneumonia, 81.1% of acute exacerbations of chronic bronchitis, and 69.4% of bronchiectasis with infection . A satisfactory bacteriological effect was obtained in 93.2% of cases in which Haemophilus influenzae was isolated, 70.2% of Klebsiella infections, and 84.6% of infections with Streptococcus pneumoniae . Although the eradication rate was only 38.6% in patients with Pseudomonas aeruginosa, the success rate increases to 59.1% if patients showing a decrease in the number of organisms are included . Cefoperazone was effective in 63.5% of the 148 cases that had failed to respond to treatment with other antibiotics . Adverse reactions occurred in 8.0% of patients and consisted primarily of rash, diarrhea, and fever . Cefoperazone appears to be an extremely useful injectable antibiotic for the treatment of respiratory tract infections in hospitalized patients.

Scand J Infect Dis, 1984, 16(3), 291 - 6
Secretory otitis media: microbiology of the middle ear and the nasopharynx; Kamme C et al.; Specimens for bacterial culture were obtained from 117 children with secretory otitis media (SOM) . From the nasopharynx Streptococcus pneumoniae, Haemophilus influenzae, Branhamella catarrhalis and group A streptococci were isolated in 79% of the patients . Of 168 ear exudates, 30 yielded growth (18%) from 26 of the patients (22%) . Pneumococcal capsular polysaccharides could not be detected in exudates assayed by counterimmunoelectrophoresis . The recovery rate of bacteria from the ear exudates was significantly higher in patients with positive than with negative nasopharyngeal culture (p less than 0.05) . The nasopharyngeal pathogens invading the middle ear in SOM seem to survive there for a period of time and are then replaced by other strains according to the fluctuation of the nasopharyngeal flora where approximately 40% of the strains were eliminated and replaced by other strains over a period of 12 to 13 days.

Biomed Biochim Acta, 1984, 43(3), 381 - 7
Quantitation of Haemophilus influenzae serotype b capsular polysaccharide antigen in body fluids by enzyme immunoassay; Henne G et al.; A heterogeneous enzyme immunoassay (EIA) has been developed to quantify capsular polysaccharide antigen of Haemophilus influenzae serotype b (Hib) polyribosyl - polyribitol -phosphate (PRP) in body fluids . Anti-Hib immunoglobulin G form rabbit adsorbed to the solid phase reacts with PRP existing in free soluble form in cerebrospinal fluid, serum or urine during Hib infection . IgG-anti-Hib labelled with horseradish peroxidase then links to PRP; the enzyme activity is measured by oxidation of the chromogenic substrate o-phenylenediamine . PRP concentrations ranged between 2 micrograms/1 to 21 mg/1 detected in acute Hib disease . The applicability of the EIA as a diagnostic aid is limited by cross-reaction of other bacterial antigens . However, quantitative measurements of PRP by enzyme immunoassay should improve studies on Hib disease.

Pediatr Infect Dis, 1984 Jan-Feb, 3(1), 20 - 4
The bacteriology of recurrent otitis media and the effect of sulfisoxazole chemoprophylaxis; Liston TE et al.; Middle ear effusion specimens were obtained from 31 children with recurrent episodes of acute otitis media . Of 75 total specimens 28 were obtained from children during chemoprophylaxis with sulfisoxazole . A single organism was isolated in 65 of 70 instances . Beta-lactamase was produced from Gram-negative organisms in 11 instances, and penicillin resistance from Streptococcus pneumoniae occurred in one instance . Haemophilus influenzae predominated during prophylaxis; S . pneumoniae predominated without it . Serotyping and biotyping were performed on 28 isolates from 8 children with consecutive episodes . In 17 instances the infecting organism was the same species but seven of these strains differed in serotype or biotype . The average number of weeks between onset of recurrence in children with homologous strains was shorter (2.6 weeks) than in the children from whom heterologous strains were found (5.7 weeks) . Three media were evaluated for efficacy in 32 episodes, and direct plating resulted in the highest rate of recovery.

Scand J Urol Nephrol Suppl, 1984, 86, 135 - 41
Clinical aspects of Gardnerella vaginalis-associated vaginitis . A review of the literature; van der Meijden WI; Almost 30 years ago Gardner & Dukes introduced the term Haemophilus vaginalis vaginitis . Most authors agree that this disease entity is characterized by a malodorous, homogeneous, greyish-white discharge, displaying clue cells in the wet-mount preparation . The diagnosis can be made in the office, the microscope being the most important diagnostic tool . There still seems to be some controversy regarding cause and clinical manifestations of the condition . A lack of uniformity in case definition and laboratory methods is probably responsible . The use of the term non-specific vaginitis should be discouraged, the condition being a specific entity not accompanied by vaginitis . A new term, 'clue cell-positive discharge' (CCPD), is proposed.

Acta Otolaryngol Suppl, 1984, 407, 50 - 4
Penetration of erythromycin in respiratory tract infections; Walstad RA et al.; Successful treatment of respiratory tract infections with erythromycin may depend upon adequate penetration of the drug to the site of infection . The delivery of antibiotics into respiratory tract secretions is a simple passive diffusion process along a concentration gradient according to Fick's principle . A number of other factors including physicochemical characteristics of the drug and host defence mechanisms may further modify the tissue penetration . A common feature of penetration studies in respiratory tract infections is the wide range of results . This is due to the numerous variables involved in this kind of study . However, the studies performed at steady state, and after oral administration of erythromycin, show a rapid increase in drug concentrations in adenoid and tonsillar tissue homogenates and sustained levels equal to or higher than in serum . In secretions of the middle ear, paranasal sinuses and bronchiae the penetration and elimination of erythromycin is much slower . The drug levels were equal to--or in some cases even higher than--steady state serum concentrations . Fluctuations, however, were less pronounced . In lung tissue homogenates erythromycin concentrations higher than the serum levels have generally been found . In respiratory tract secretions and tissues the penetration of erythromycin is good . Sufficient levels are reached to inhibit in vitro the growth of most common pathogens involved in respiratory tract infections with the exception of some strains of Haemophilus influenzae.

Scand J Infect Dis, 1984, 16(3), 271 - 8
Adherence of Haemophilus influenzae to human epithelial cells; Gilsdorf JR et al.; Haemophilus influenzae organisms, both type b and non-typable strains, were tested for their adherence to human buccal epithelial cells . Adherence was determined by visual examination of gram-stained specimens of epithelial cells following incubation with H . influenzae . Among 36 isolates tested, 2 organisms adhered well to buccal cells; a type b nasopharyngeal isolate showed a mean of 19.94 bacteria per cell and a non-typable throat isolate showed a mean of 37.72 bacteria per cell . These isolates readily hemagglutinated human red blood cells . None of the other 12 type b blood or spinal fluid isolates tested adhered well (range 0.04-1.34 bacteria per cell) nor hemagglutinated red cells . There was no difference in the adherence of H . influenzae to buccal mucosal cells from 6 donors, and no difference between epithelial cells obtained from the buccal or nasal mucosa . Although both type b and non-typable H . influenzae strains appear capable of adhering to human epithelial cells, many strains do not . The role of adherence factors in the maintenance of mucosal colonization with these poorly-adherent strains remains unknown.

Gerontology, 1984, 30(5), 290 - 6
Lower respiratory tract infections in an acute geriatric male ward: a one-year prospective surveillance; Andrews J et al.; A prospective study of 340 patients admitted to an acute geriatric male ward for a 12-month period was carried out to determine the aetiology and incidence of lower respiratory tract infection (LRTI) acquired either prior or after admission to the hospital . Over the year, 120 patients (35%) were found to have LRTI; a specific aetiology was found in 44 (37%) patients . The pathogens most frequently isolated were Haemophilus influenzae (11 patients), Streptococcus pneumoniae (9 patients) and influenza A (4 patients) . A further 8 (7%) patients had antibody titres sufficiently raised to indicate a recent infection (influenza A6, Chlamydia psittaci 2) . A marked difference in the aetiology between community- and hospital-acquired infection was demonstrated . Cross-infection was not found, although patients with influenza A infection were admitted to the ward . Mortality showed a high correlation with current and ex-smokers.

Plasmid, 1984 Jan, 11(1), 99 - 101
A molecular characterization of H . influenzae plasmid pVe445: a comparison with N . gonorrhoeae plasmids pNG10 and pNG18; Dickgiesser N; Haemophilus influenzae plasmid pVe445 (4.6 MDa) has been compared with Neisseria gonorrhoeae plasmids pNG18 (3.3 MDa) and pNG10 (4.6 MDa) by heteroduplex and restriction enzyme analysis . This study demonstrates that pVe445 differs from pNG18 only that it carries an additional 1.3-MDa DNA fragment between coordinates 0.9 and 2.2 . Heteroduplex studies demonstrated that pNG10 and pVe445 are indistinguishable whereas restriction endonuclease analysis indicated minor differences in the distribution of AluI sites.

Antimicrob Agents Chemother, 1984 Jan, 25(1), 40 - 4
Comparison of ceftriaxone and traditional therapy of bacterial meningitis; Congeni BL; Forty-five children (aged 1 day to 15 years) with bacterial meningitis were randomized to receive either traditional therapy (ampicillin and chloramphenicol or gentamicin, pending sensitivity) or ceftriaxone (100 mg/kg per day in two doses for a minimum of 10 days) . The etiological agents involved were similar for the two groups and included Haemophilus influenzae type b, Neisseria meningitidis, Streptococcus pneumoniae, and group B streptococcus . Repeat spinal taps were carried out 24 to 48 h after admission . Organisms were seen on the Gram stain of one patient treated with ceftriaxone, but five patients in the traditional therapy group had organisms present on Gram stain of uncentrifuged spinal fluid or positive cultures of the spinal fluid (or both) . Ceftriaxone entered the cerebrospinal fluid well, and the average cerebrospinal fluid bactericidal activity for ceftriaxone 1 h after a dose was at least 60 times greater than for ampicillin or chloramphenicol . In those patients who received treatment for a long enough period of time to permit evaluation, there was one death in each group, both due to S . pneumoniae . The length of fever and complications were similar for the patients in both groups . Ceftriaxone was well tolerated; diarrhea, seen in 5 of the 22 patients who received the drug, was the most commonly encountered adverse effect . It was mild, and in no case was it necessary to discontinue the drug . Ceftriaxone appears in this preliminary study to be a safe and acceptable single agent for the treatment of bacterial meningitis in children.

Antimicrob Agents Chemother, 1984 Jan, 25(1), 29 - 32
Pharmacokinetics and therapeutic efficacy of imipenem, ceftazidime, and ceftriaxone in experimental meningitis due to an ampicillin- and chloramphenicol-resistant strain of Haemophilus influenzae type b; Sakata Y et al.; The pharmacokinetics and therapeutic efficacy of imipenem, ceftazidime, and ceftriaxone were compared with those of ampicillin and chloramphenicol in rabbits with experimental meningitis due to an ampicillin- and chloramphenicol-resistant strain of Haemophilus influenzae type b . The mean bacterial colony counts in cerebrospinal fluid were reduced by 49% (-1.85 log10 CFU/ml), 92% (-3.37 log10 CFU/ml), and 92% (-4.30 log10 CFU/ml) after a single dose of imipenem, ceftazidime, and ceftriaxone, respectively . The median peak cerebrospinal fluid bactericidal titers against this multiply resistant strain of H . influenzae were 1:4 for thienamycin, 1:16 for ceftazidime, and 1:256 for ceftriaxone . By contrast, no bactericidal activity was observed in cerebrospinal fluid and the mean concentrations of H . influenzae were either unchanged or slightly increased in animals treated with ampicillin or chloramphenicol.

Zh Mikrobiol Epidemiol Immunobiol, 1984 Jan, (1), 26 - 31
{Taxonomic significance of the fatty acid composition of bacteria of the genera Bordetella and Haemophilus}; Vasiurenko ZP et al.; Bacteria of the species B . parapertussis and B . bronchiseptica have proved to be identical in their fatty-acid composition with a high level (35.7-39%) of methylene-hexadecanoic acid, found to be absent in B . pertussis in experimental conditions . At the same time the total content of methylene-hexadecanoic acid and its biosynthetic precursor, hexadecenoic acid, in the first two Bordetella species is similar to the content of hexadecenoic acid in B . pertussis, which, along with the presence of common characteristics in the sign under consideration (the low level of C18:1), indicates the close relationship of these three Bordetella species . Bacteria of the species H . influenzae, H . parainfluenzae, H . aegyptius, H . aphrophilus have similar fatty-acid composition with the prevalence of hexadecanoic and hexadecenoic acids and the low level of fatty acids with 18 carbon atoms . The data on fatty-acid composition may suggest the presence of philogenetic links between the genera Bordetella and Haemophilus.

Infect Immun, 1984 Jan, 43(1), 101 - 7
Nucleotide sequence homology between the immunoglobulin A1 protease genes of Neisseria gonorrhoeae, Neisseria meningitidis, and Haemophilus influenzae; Koomey JM et al.; Isolated DNA fragments encoding the immunoglobulin A1 (IgA1) protease of Neisseria gonorrhoeae were used as hybridization probes to search for homologous sequences in whole cell DNA from Neisseria meningitidis and Haemophilus influenzae . Significant homology was detected . That the detected homology represented IgA1 protease-specific sequences was confirmed by the cloning of these sequences in Escherichia coli HB101 and demonstrating the expression of IgA1 protease by these transformed cells . Molecular probing of commensal Neisseria and Haemophilus species, which do not elaborate IgA1 protease activity, revealed that they were devoid of sequence homology with the cloned IgA1 protease gene DNA.

Infection, 1984, 12 Suppl 1, S23 - 8
Pathogenesis of meningitis: experimental studies on the molecular basis of Haemophilus influenzae infection; Moxon ER et al.; The successful development and implementation of rational strategies for the prevention of bacterial meningitis should be facilitated by acquiring a more detailed knowledge of its pathophysiology . We have used a biologically relevant rat model of meningitis in conjunction with classical microbial genetics and recombinant DNA technology to investigate the molecular basis of Haemophilus influenzae pathogenicity . These studies aim to define how specific bacterial genes mediate the potential of H . influenzae to colonize the nasopharynx, disseminate within the blood stream and invade the central nervous system . By identifying the state or stages in the pathogenic sequence for which the determinant is critical, this approach should also provide insight into the relevant host defense mechanisms which determine resistance or susceptibility . An understanding of the genetic basis of H . influenzae pathogenicity may develop basic knowledge relevant to the treatment and prevention of bacterial meningitis.

Clin Ther, 1984, 6(2), 163 - 9
A comparison of cefaclor and tetracycline in the treatment of bacterial bronchitis; Hurst DJ; Cefaclor and tetracycline were compared in a single-blind study designed to treat patients with acute bacterial bronchitis and acute exacerbations of chronic bronchitis . Twenty-five pathogens (including 19 of Haemophilus influenzae and four of Streptococcus pneumoniae) were obtained from sputum samples of 48 patients . No pathogen could be cultured from the sputum of 23 patients . All of these pathogens were susceptible to cefaclor, while 12 (63%) of the 19 H influenzae isolates and three of the four S pneumoniae isolates were resistant to tetracycline . When the susceptibility of the 25 isolates to other commonly used antibacterials was tested, 18 isolates of H influenzae were resistant to erythromycin and one was resistant to ampicillin . (One H influenzae isolate was not tested for erythromycin susceptibility.) The four isolates of S pneumoniae were susceptible to erythromycin and ampicillin . Satisfactory results were achieved in 21 of the 23 patients receiving cefaclor . After four to six days of cefaclor therapy, the other two patients were diagnosed as having bronchopneumonia, and parenteral antibiotic therapy was instituted . Of the 25 patients assigned to the tetracycline regimen, three with resistant H influenzae had unsatisfactory clinical responses and required parenteral antibiotic therapy for recovery . Although patients were randomly assigned to therapy, only three of the 16 patients infected with tetracycline-resistant organisms were assigned to the tetracycline group, and all three failed to respond to treatment . Had the patients been more evenly distributed according to susceptibilities, it is possible that more treatment failures would have occurred in the group receiving tetracycline.

Br Med J (Clin Res Ed), 1983 Dec 3, 287(6406), 1658 - 60
Vertebral osteomyelitis due to coccobacilli of the HB group; Farrington M et al.; Three cases of pyogenic vertebral osteomyelitis occurred in which unusual, fastidious, Gram negative coccobacilli belonging to the "HB" group were isolated . The organisms were Haemophilus aphrophilus in case 1, intermediate between H aphrophilus and Actinobacillus actinomycetemcomitans in case 2, and Eikenella corrodens in case 3 . All HB bacteria are sensitive to a wide range of antibiotics.

Lancet, 1983 Dec 3, 2(8362), 1293 - 5
Epidemiology of chancroid and Haemophilus ducreyi in Nairobi, Kenya; Plummer FA et al.; Of 300 men in Nairobi, Kenya, with culture-proven chancroid, 57% had acquired infection from prostitutes . The majority of infections were acquired in the city of Nairobi . All 10 female source contacts examined had genital ulcers . 13 of 29 female secondary contacts were culture-positive for Haemophilus ducreyi and 10 of these infected women had clinical chancroid . Of 122 prostitutes from the middle and lower social strata, 12 had genital ulcers, 5 of which were culture-positive for H ducreyi, and a further 5 had symptomless genital carriage of H ducreyi . Prostitutes are a major reservoir of H ducreyi in Nairobi . No evidence of transmission of H ducreyi by women without clinical chancroid was detected.

Klin Monatsbl Augenheilkd, 1983 Dec, 183(6), 467 - 70
{Massive blenorrhea in a newborn infant caused by a Chlamydia trachomatis subtype}; Jahn GJ et al.; An 8-day-old baby girl was found to be suffering from massive blennorrhoea caused by a strain of Chlamydia trachomatis . Differential diagnosis included possible bacterial (e.g . Pseudomonas, Staphylococci and Haemophilus sp.) and viral causes of the disease . A 10-day systemic therapy with erythromycin 50 mg/kg/body weight is sufficient to prevent possible complications such as pneumonia . The parents also have to be treated for this disease.

Postgrad Med J, 1983 Dec, 59(698), 788 - 9
Liver abscess caused by Haemophilus parainfluenzae; Chattopadhyay B et al.; A case of liver abscess caused by Haemophilus parainfluenzae in an otherwise healthy adult is described which responded to medical management without surgery . This we believe to be the first reported case of liver abscess caused by this organism in the English medical literature.

J Clin Microbiol, 1983 Dec, 18(6), 1355 - 7
Detection of type-specific antigens in the lungs of Haemophilus pleuropneumoniae-infected pigs by coagglutination test; Mittal KR et al.; Specific diagnosis of Haemophilus pleuropneumoniae infection by the conventional culture and identification method usually requires 3 to 4 days . Since H . pleuropneumoniae may be disseminated from infected individuals during this period, this amount of time required for diagnosis may be too slow to aid in epidemic control . To obtain an earlier diagnosis, a coagglutination test was successfully used to detect serotype-specific antigens in lung extracts of infected pigs . A total of 19 lung tissues from experimentally infected pigs, 240 lung tissues from naturally infected pigs that died of pleuropneumonia, and 571 lung specimens from an apparently healthy pig population were examined for culture isolation as well as for antigen detection . The results showed that detection of antigens in lung tissues by the coagglutination test is an extremely rapid, simple, quite specific, and highly sensitive procedure for the diagnosis of H . pleuropneumoniae infection . Further, detection of antigens in lung tissues was found to be a much simpler and much more rapid method than culture isolation . The coagglutination test seems to be especially useful for detecting H . pleuropneumoniae in pigs exposed to chronic infection as well as those in which multiple serotypes are involved.

J Clin Microbiol, 1983 Dec, 18(6), 1351 - 4
Identification and serotyping of Haemophilus pleuropneumoniae by coagglutination test; Mittal KR et al.; A coagglutination test for the identification and serotyping of Haemophilus pleuropneumoniae is described . A total of 360 H . pleuropneumoniae strains were isolated from pulmonary tissues of feeder pigs which died of acute pleuropneumonia . All of the isolates were serotyped by coagglutination, and the results were confirmed by the ring precipitation test . The most common serotype isolated in Quebec was serotype 1, followed by serotypes 5, 2, and 7 . None of the isolates belonged to serotypes 3, 4, or 6 . Mixed infections due to H . pleuropneumoniae of more than one serotype in the same animal were encountered . Serotype 1 was the only common isolate among the mixed-serotype infections . The coagglutination test was more sensitive than was the ring precipitation test . Serotyping by the coagglutination test is inexpensive, rapid, reliable, and easy to perform.

J Pediatr, 1983 Dec, 103(6), 991 - 5
Cefoperazone pharmacokinetics in acute childhood meningitis; Chartrand SA et al.; We studied the serum pharmacokinetics and cerebrospinal fluid concentrations of cefoperazone in 15 children with acute meningitis . Mean cefoperazone concentrations of 117 micrograms/ml in the serum and 3.8 micrograms/ml in the cerebrospinal fluid were noted 2 hours after a single 100 mg/kg dose . Following multiple 50 or 100 mg/kg doses, the mean peak serum cefoperazone concentrations were 232 and 498 micrograms/ml, respectively, with an overall mean elimination phase half-life of 2.12 hours . The data best fit a linear, two-compartment model . Cerebrospinal fluid concentrations 1.5 to 2.5 hours after the end of cefoperazone infusions ranged from 1.4 to 19.2 micrograms/ml for all doses and states of illness . This represented 1.2% to 6.4% of simultaneous serum values . The cerebrospinal fluid inhibitory titer was greater than or equal to 1:16 in 17 of 18 specimens tested against a strain of Haemophilus influenzae type b resistant to both chloramphenicol and ampicillin . In the doses given, cefoperazone produces adequate cerebrospinal fluid concentrations and bioactivity to treat the common bacterial forms of acute meningitis in infants and children.

Int J Pediatr Otorhinolaryngol, 1983 Dec, 6(3), 279 - 83
Occurrence of Haemophilus influenzae strains in children with respiratory tract infections; Gutkowska J et al.; In the time period from February 1980 to October 1981, 179 children with upper respiratory tract infections and 67 healthy controls were investigated in Warsaw . The clinical condition of the studied children, the types of the obtained H . influenzae strains and their sensitivity to the antibiotics and sulphamides used most frequently in clinical practice were analyzed.

Diagn Microbiol Infect Dis, 1983 Dec, 1(4), 317 - 22
Comparison of coagglutination, latex agglutination, and enzyme-linked immunosorbent assay for detection of Haemophilus influenzae type b infection; Drow DL et al.; Two commercially available kits were compared to an enzyme-linked immunosorbent assay (ELISA) for detection of Haemophilus influenzae type b antigen polyribophosphate in clinical specimens with infections proved by culture . Methods employed by the kits were latex agglutination (LA) and staphylococcal coagglutination (COA) . The COA kit detects H . influenzae type b and types a and c-f with a polyvalent antiserum, whereas the ELISA assay and the LA kit detect only type b . A total of 139 specimens (41 spinal fluid, 35 urine, 25 serum, and 38 sputum) were tested . All spinal fluid samples positive by culture were positive by all three procedures . Of urine specimens from patients with a variety of H . influenzae type b infections, 13 of 15 were positive by ELISA, 8 of 15 by COA, and 8 of 14 by LA . Of serum samples collected from the same patients at various times during their illness, 8 of 15 were positive by ELISA, 6 of 15 by COA, and 10 of 15 by LA . Of sputum samples positive by culture for H . influenzae type b, 14 of 17 were positive by ELISA, 9 of 17 by COA, and 4 of 16 by LA . The ability to detect additional serotypes of H . influenzae was shown by the COA kit, which detected H . influenzae type a in spinal fluid from a patient with type a meningitis proved by culture.

Br J Exp Pathol, 1983 Dec, 64(6), 655 - 9
The effect of influenza virus on the adherence of Haemophilus influenzae to human cells in tissue culture; George RC et al.; The adherence of eleven strains of Haemophilus influenzae to MRC5 cells was studied and compared with adherence of the same eleven strains to MRC5 cells infected with influenza A/NWS/33 virus . Per cent Adhesion (the proportion of cells to which more than two bacteria were adhering) was estimated . Organisms grown on solid media adhered better than those grown in liquid media though the difference was not statistically significant (t test for independent means) . A wide range of % Adhesion values for organisms grown on solid media to control cells was exhibited (1-88%) . Ten of eleven strains grown on solid media or in broth showed increased adherence to influenza virus infected cells; this difference was significant (P less than 0.05, t test for independent means) . The effect of virus infection in increasing % Adhesion was inversely proportional to the adhesiveness of the strain in question to uninfected cells . Strains that adhered most efficiently to control cells showed little increase in % Adhesion following virus infection, while strains that adhered poorly to control cells showed large increases in % Adhesion following virus infection.

J Lab Clin Med, 1983 Dec, 102(6), 939 - 46
Haemophilus influenzae b bacteremia and meningitis in infant rabbits after intranasal inoculation; San Joaquin VH et al.; A suitable model of Haemophilus influenzae meningitis will facilitate better understanding of the pathophysiology, therapy, and prevention of the disease and its sequelae . Bacteremia and meningitis were induced in infant New Zealand white rabbits by intranasal inoculation of H . influenzae type b . Intranasal trypsin prior to challenge significantly increased (p = 0.002) the rate of bacteremia from 64% (7/11) to 100% (45/45) . In the trypsin-treated group, H . influenzae b was isolated from the CSF of 89% (25/28) of 17- to 21-day-old rabbits and from 76% (13/17) of 23- to 30-day-old animals, p = 0.3; fatality rates were 88% and 31%, respectively, p = 0.001 . Bacteremia developed within 24 hr of inoculation and meningitis within 96 hr . Death occurred 1 to 7 days after the development of meningitis . Histologic evidence of nasopharyngitis and meningitis was found at autopsy . The intranasal route of infection, the age-dependent outcome, the size of the animal, and its low cost and availability make the infant rabbit an appropriate model of H . influenzae b meningitis.

J Antimicrob Chemother, 1983 Dec, 12(6), 565 - 70
Antibiotic resistance amongst various types of Haemophilus species; Mehtar S et al.; Antibiotic resistance of haemophili was studied as part of an epidemiological survey on the distribution of biotypes of Haemophilus influenzae and H . parainfluenzae from various clinical isolates . Biotype II H . influenzae was the commonest biotype isolated but biotype III yielded the most frequent antibiotic resistance . Resistance to ampicillin (15.1%) was commonest, followed by sulphonamide, tetracycline, trimethoprim and chloramphenicol . Multi-resistant strains were found including one capsular type b (biotype III) strain . H . parainfluenzae biotype I was the commonest isolate but biotype II was most frequently resistant to antibiotics . The resistance pattern followed that of H . influenzae except for chloramphenicol to which resistance was commoner than for trimethoprim.

Acta Pathol Microbiol Immunol Scand {B}, 1983 Dec, 91(6), 383 - 7
Antibiotic susceptibility pattern and capsular types of Haemophilus influenzae recovered from clinical specimens in northern Norway; Melby K et al.; One hundred and nine strains of Haemophilus influenzae recovered from clinical specimens were examined for antibiotic sensitivity pattern and capsular types . All strains from blood cultures, cerebrospinal fluid and a joint aspirate were type b whereas most of the isolates were acapsular when recovered from other specimens viz . wound secretions (67%), maxillary sinus (75%), lower resp tract (86%), nasal cavity (90%) . Out of the 109 strains 88 (81%) were non-typable, and 3.6% were beta-lactamase-producing, two of which were type e, one was type b and one was acapsular . Three beta-lactamase-producing strains were isolated from specimens from the respiratory tract and one from blood cultures . Beta-lactamase-producing strains including one chloramphenicol-resistant strain harboured similar plasmids, as judged by agarose gel electrophoresis . The strains showed quite a uniform sensitivity to antibacterial agents with the exception of sulphonamides to which the capsular strains, particularly type b strains, were less susceptible.

J Clin Microbiol, 1983 Dec, 18(6), 1358 - 61
Evaluation of the Phadebact CSF test for detection of the four most common causes of bacterial meningitis; Drow DL et al.; A five-center collaborative study was undertaken to determine the suitability of the Phadebact CSF test kit and the Phadebact group B Streptococcus reagent for routine use by clinical laboratories to detect antigens of common organisms causing bacterial meningitis . The kits employ staphylococcal protein A coagglutination to detect the antigens of Haemophilus influenzae types a, b, c, d, e, and f, Neisseria meningitidis groups A, B, C, Y, and W135, Streptococcus pneumoniae (83 serotypes), and group B Streptococcus . A total of 2,817 individual tests were performed on 577 cerebrospinal fluid specimens . The percent positive specimens detected by coagglutination was as follows: overall, 84%; H . influenzae, 97%; group B Streptococcus, 75%; S . pneumoniae, 71%; and N . meningitidis, 58% . Eighty-five of the specimens were also tested by counterimmunoelectrophoresis . Coagglutination was more sensitive than counterimmunoelectrophoresis because it detected 74% of the positive specimens, whereas counterimmunoelectrophoresis detected only 65% . No false-positive results were obtained with coagglutination . The Phadebact CSF test kit is recommended for routine use in screening cerebrospinal fluid samples for antigens of the common organisms causing bacterial meningitis along with the Gram stain and culture for delayed confirmation of the rapid results.

Infect Immun, 1983 Dec, 42(3), 863 - 8
Monoclonal antibodies against Neisseria meningitidis lipopolysaccharide; Sugasawara RJ et al.; A cell line producing monoclonal antibodies directed against a lipopolysaccharide component of Neisseria meningitidis group A has been established . These antibodies reacted with only one of three lipopolysaccharide serotyping strains of group A meningococci by coagglutination, enzyme-linked immunosorbent assay, and Western blotting techniques . A Western blot analysis showed that a NaOH digest of lipopolysaccharide was detectable by the serotype-specific antibody . The monoclonal antibodies cross-reacted with a group B meningococcal strain in an enzyme-linked immunosorbent assay . The immunoblotting analysis also showed that these antibodies reacted with the lipopolysaccharides of a group B meningococcus as well as Haemophilus influenzae type B, but not with the lipopolysaccharides of several strains of Salmonella typhi, Escherichia coli, Streptococcus pneumoniae, and Neisseria gonorrhoeae.

Proc Natl Acad Sci U S A, 1983 Dec, 80(23), 7274 - 8
Directional transport and integration of donor DNA in Haemophilus influenzae transformation; Barany F et al.; DNA transport and integration in Haemophilus influenzae transformation was studied with a plasmid clone of homologous DNA (pCML6) . Our results indicate that: (i) donor DNA enters specialized membranous extensions on the cell surface, which we have termed "transformasomes"; (ii) linear DNA undergoes degradation upon exiting transformasomes; and (iii) DNA without a free end remains within transformasomes and is not degraded . By comparing the fate of label from uniformly labeled versus middle-labeled DNA, it appears that donor DNA undergoes degradation from an end prior to recombining with the chromosome . Using donor DNA with covalently closed termini (hairpin ends) prevents efficient exit from transformasomes . When one hairpin is removed, exit of donor DNA is shown to be directional from the free end, with preferential homologous integration of the 3' strand from that end.

J Bacteriol, 1983 Dec, 156(3), 1263 - 7
Circularized copies of amplifiable resistance genes from Haemophilus influenzae plasmids; Spies T et al.; Tandem repeat amplification of resistance determinants in Haemophilus influenzae plasmids is associated with the occurrence of separate circular DNA molecules . They were demonstrated to represent mono- and multimeric forms of the amplifiable segments of the plasmids which comprise the respective resistance transposons and an additional region designated as an amplification sequence . The latter region mediates the recombinational events involved in amplification . The DNA circles apparently lack the ability to replicate autonomously but most probably provide an effective means for the translocation of resistance genes from one plasmid to another.

Acta Pathol Microbiol Immunol Scand {C}, 1983 Dec, 91(6), 371 - 6
Nature of cross-reactivity between Haemophilus influenzae types a and b and Streptococcus pneumoniae types 6A and 6B; Lagergard T et al.; Cross-reactivity between capsular antigens of Haemophilus influenzae types a and b, and Streptococcus pneumoniae types 6A and 6B was studied by means of comparative double diffusion, quantitative precipitin tests and enzyme-linked immunosorbent assay (ELISA) . Antisera against whole bacteria were employed . When capsular antigens of S . pneumoniae types 6A and 6B were compared by means of the double diffusion technique, three antigenic determinants were distinguished, two of them being common to the two serotypes . When pneumococcal capsular antigens were compared with H . influenzae capsular antigens, cross-reactive antibodies were detectable only in anti-pneumococcal sera . The heterologous pneumococcal polysaccharide preparation precipitated about 80% of the capsular antibodies in pneumococcal antisera, while heterologous H . influenzae polysaccharide precipitated only about 20-30% of the capsular antibodies in anti-H . influenzae sera . S . pneumoniae polysaccharide precipitated 10-20% of the antibodies in antisera against . H . influenzae, and H . influenzae polysaccharide precipitated about 20-25% of the antibodies in antisera against S . pneumoniae type 6A . Approximately the same degree of cross-reactivity was revealed when ELISA was employed . The absorption study of the antisera with D-ribitol-5-phosphate indicates that this structure is responsible for the cross-reactivity between S . pneumoniae and H . influenzae.

Diagn Microbiol Infect Dis, 1983 Dec, 1(4), 277 - 85
Coagglutination for detection and serotyping of bacterial antigens: usefulness in acute pneumonias; Mayer ME et al.; Staphylococcal coagglutination was evaluated for detection of Streptococcus pneumoniae and Haemophilus influenzae antigens in vitro and in the clinical setting of acute pneumonia . Coagglutination testing was performed with Phadebact reagents and with polyvalent and type-specific reagents for pneumococci prepared in the laboratory . Purified capsular antigens of 10 of 14 pneumococcal serotypes (included in the current pneumococcal vaccine formulation) were detected by coagglutination in the range of 0.5-62 ng/ml; serotype 6 was detected at 125 ng/ml, and serotypes 12, 23, and 25 were detected only at 500 ng/ml or more . Haemophilus influenzae type b antigen was detected at 100 ng/ml . Sputum, blood, and urine specimens of 36 consecutive patients admitted with pneumonia were evaluated prospectively by coagglutination . Nonspecific reactions were eliminated by pretreatment with ethylenediaminetetra-acetic acid and heating and with staphylococcal protein A . Eight of nine patients with sputum cultures positive for pneumococci had positive sputum coagglutination (sensitivity of 89%); 24 of 27 patients with cultures negative for pneumococci had negative sputum coagglutination (specificity of 89%) . Serum or urine coagglutination was positive in five patients with pneumococcal pneumonia, including the only bacteremic case, the only fatality, and another patient who had a protracted clinical course . In conclusion, coagglutination is a simple, rapid, sensitive, and specific test for antigen detection in patients with acute pneumonia.

Antimicrob Agents Chemother, 1983 Nov, 24(5), 679 - 81
Amoxicillin combined with clavulanic acid for the treatment of soft tissue infections in children; Fleisher GR et al.; We compared responses to amoxicillin combined with clavulanic acid (ACA) with a cefaclor regimen in children with skin and soft tissue infections (impetigo and cellulitis) due to Staphylococcus aureus, Streptococcus pyogenes, and Haemophilus species . All isolates from the 41 patients we were able to evaluate were susceptible to ACA by disk susceptibility testing at the onset of treatment . The 21 children receiving ACA and 18 (90%) of 20 taking cefaclor responded to therapy . Clinical cure was achieved in 18 (86%) of 21 and 18 (90%) of 20 in the two groups, respectively . Bacteriological failure occurred in 2 (10%) patients in the cefaclor group and none in the group receiving ACA; however, there were 2 (9%) relapses and 1 (5%) reinfection among the 21 children taking ACA . Adverse effects, although mild, occurred more commonly (9 of 21 versus 1 of 20; P = 0.005) with ACA than with cefaclor.

J Med Microbiol, 1983 Nov, 16(4), 467 - 75
Aspects of the pathogenicity of some oral and other haemophili; Tuyau JE et al.; The pathogenicity of the predominantly non-capsulated, V-factor requiring haemophili that are commonly recovered from oral infections has been explored by studies of their endotoxins and infectivity as compared with those of Haemophilus influenzae . Similar yields of endotoxin (2.40-2.59% w/w) were obtained from all the haemophili examined except H . haemolyticus (1.61% w/w) . The lipopolysaccharide (LPS) extracts all contained heptoses but not 2-keto-3-deoxyoctonate (KDO) . The fatty acid compositions of the lipid-A fractions were essentially similar but comprised 76% of the LPS in the H . influenzae type d strain tested and only 20% in the H . influenzae type b strain and some strains of H . parainfluenzae . All extracts contained arachidic acid, which may be unique to haemophili . The endotoxins from all strains produced characteristic pyrogenic and polymorph effects in rabbits . The endotoxins from the pharyngeal X- and V-factor-requiring strains had LD50 values for actinomycin-D-sensitised mice of 2.4-2.7 micrograms/kg, and were about eight times more potent than those from the oral V-factor-requiring strains (LD50 values 17.2-22.4 micrograms/ml) . Approximately ten thousand times more free endotoxin was detected in broth cultures of H . influenzae type b than in those of oral haemophili, and this greater endotoxin release was not associated with a greater degree of autolysis . Endotoxin release from viable cells may be important in the pathogenicity of this organism . H . influenzae type b was much more potent in producing infection in chambers implanted subcutaneously in guinea pigs than were oral strains of haemophili; only 10 type b organisms were required, compared with 9 X 10(5) of H . parainfluenzae . However, in infections maintained for 90 days, the numbers of haemophili--c . 10(7)/ml of chamber fluid--were similar for all the test strains . Thus, although the oral haemophili lack special attributes of invasiveness and resistance to host defences, they are not devoid of pathogenic potential and, if allowed to proliferate, may become an important element in an infection.

J Antimicrob Chemother, 1983 Nov, 12(5), 435 - 49
The permeability barrier of Haemophilus influenzae type b against beta-lactam antibiotics; Coulton JW et al.; An evaluation was made of the role of the outer membrane of Haemophilus influenzae type b as a permeability barrier against beta-lactam antibiotics . Sonic extracts of H . influenzae containing beta-lactamase were assayed for the rates of hydrolysis of benzylpenicillin, ampicillin, cloxacillin, cephacetrile, cefazolin, cefamandole, cephalothin, cephaloridine, cephaloglycin, and cefaclor . Benzylpenicillin was hydrolyzed most rapidly, whereas cephacetrile, cephaloridine, and cephaloglycin were the poorest substrates for the beta-lactamase . The hydrolysis of these ten beta-lactams by intact cells was also determined; it was necessary to stabilize the cells with MgCl2 to prevent lysis and thereby to maintain the beta-lactamase in the periplasm . Calculations were made of the concentration of the antibiotics which had accumulated in the periplasm . The transmembrane permeability coefficient, C, was determined for the ten beta-lactam antibiotics . All of the compounds tested were able to diffuse across the outer membrane of H . influenzae type b very efficiently . The values of the permeability coefficient were compared with the partition coefficients of the antibiotics in a two-phase isobutanol/water mixture . For a ten-fold increase in hydrophobicity, there was a ten-fold decrease in the permeability coefficient . The outer membrane of haemophilus was not an effective barrier against the penetration of penicillins or cephalosporins . The activity of these compounds could be attributed either to their low hydrolysis by beta-lactamase or to the high affinity of binding to their sensitive targets.

Int J Pediatr Otorhinolaryngol, 1983 Nov, 6(2), 135 - 44
Bacteriology of acute otitis media in Japan and chemotherapy, with special reference to Haemophilus influenzae; Sugita R et al.; Middle ear effusions from 574 patients with acute otitis media (AOM) were sampled and cultured in metropolitan Tokyo . Sampling was done by myringectomy and from otorrhea after the occurrence of spontaneous perforation . Streptococcus pneumoniae and Haemophilus influenzae were isolated more widely in 'fresh' (myringotomized) cases than in 'old' cases . The freshness of cases, and the sampling and culture techniques appear to account for the difference in reports concerning causative pathogens of AOM from Japan on one hand and the U.S.A . and Scandanavia on the other . The relatively high detection rate of H . influenzae indicates its importance in all age groups . H . influenzae was isolated from a second group of 50 patients, and MIC values were determined . ABPC proved to be the most effective chemotherapy, except in cases (10%) of beta-lactamase producing H . influenzae . The correlation between the main causative pathogens of AOM and penicillin concentrations found in middle ear effusions was also investigated . The oral administration of 10-12 mg/kg of ABPC surpassed the 85% MIC level against H . influenzae.

Antimicrob Agents Chemother, 1983 Nov, 24(5), 658 - 62
Trimethoprim and rifampin in combination for chemoprophylaxis of household contacts of patients with invasive infections due to Haemophilus influenzae type b; Daum RS et al.; We compared the effectiveness of rifampin-trimethoprim in fixed combination (3.75:1) to rifampin alone in the eradication of Haemophilus influenzae type b carriage among contacts of patients with invasive infection caused by this organism . The study population was composed of 127 index patients and 620 contacts . Twenty-six percent of contacts were colonized . Rifampin-trimethoprim eradicated carriage in 77.6% of contacts (71.1% in contacts less than 5 years, 84.2% in contacts greater than or equal to 5 years) whereas rifampin eradicated carriage in 69.9% of contacts (56.4% in contacts less than 5 years, 81.8% in contacts greater than or equal to 5 years) . A single isolate resistant to rifampin and rifampin-trimethoprim was encountered . The eradication rate achieved with this regimen of rifampin-trimethoprim was too low to recommend its routine use . However, a higher dose or longer course might merit clinical trial.

Zh Mikrobiol Epidemiol Immunobiol, 1983 Nov, (11), 52 - 6
{Etiology of acute and chronic bronchopulmonary diseases in children . I . The results of a bacteriological and immunological study}; Katosova LK et al.; The bacteriological study of tracheal aspirate, sputum and bronchial washings obtained from 130 children with acute pneumonia and pleuritis and from 186 children with chronic pneumonia was carried out . In the samples of pleural exudate, urine and blood serum from the patients with acute pneumonia and pleuritis the presence of Streptococcus pneumoniae and Haemophilus influenzae antigens was determined by the method of countercurrent immunoelectrophoresis (CIE) . S . pneumoniae and H . influenzae were found to be of different importance in the pathogenesis of acute and chronic bronchopulmonary diseases in children . In acute pneumonia and pleuritis in children who had not been treated with antibiotics pneumococci were isolated in 65.9% of cases and H . influenzae, in 20.4% of cases . In children with chronic pneumonia at the period of exacerbation H . influenzae dominated in the microflora (79%), while pneumococci were isolated 31.9% of cases . The use of CIE permitted the detection of pneumococcal antigen in 21.8% of those exudate samples which had shown no bacterial growth after inoculation . H . influenzae antigen was detected in pleural exudate in 5.4% of cases . In concentrated urine obtained from the children with acute pneumonia and pleuritis pneumococcal antigen was detected in samples from 29.6% of patients, and in nonconcentrated urine the occurrence of this antigen was reduced by half.

J Med Microbiol, 1983 Nov, 16(4), 477 - 82
Scanning electron microscopy of the interaction between Haemophilus influenzae and organ cultures of rat trachea; Johnson AP et al.; Organ cultures of rat trachea inoculated with either a type b or a non-capsulated strain of Haemophilus influenzae showed loss of ciliary activity and disruption of the mucosal surface . Examination of tissue pieces by scanning electronmicroscopy showed that mucosal damage was due to the sloughing of epithelial cells . Bacteria associated with the epithelial surface were seen infrequently and this, together with the observation that sloughed cells were usually free of adherent bacteria, indicated that bacterial attachment was not a necessary prerequisite for the production of tissue damage.

J Clin Microbiol, 1983 Nov, 18(5), 1201 - 4
Enzyme-linked immunosorbent assay for detection of capsular antibodies against Haemophilus influenzae type b: comparison with radioimmunoassay; Kaplan SL et al.; An enzyme-linked immunosorbent assay (ELISA) is described for detection of anti-capsular antibodies against Haemophilus influenzae type b . Polyribosephosphate was covalently bonded to poly-L-lysine before adsorption to microtiter plates . ELISA immunoglobulin G and immunoglobulin M anti-polyribosephosphate antibody titers were comparable to total anti-polyribosephosphate antibody concentration determined by radioimmunoassay . The ELISA technique will be useful for further investigations of host response to infections due to H . influenzae type b but is not intended to be used as a serological method for documenting H . influenzae type b infections.

Infect Immun, 1983 Nov, 42(2), 708 - 15
Participation of complement in host defense against capsule-deficient Haemophilus influenzae; Zwahlen A et al.; To investigate the role of complement in immunity to capsule-deficient Haemophilus influenzae, rats were depleted of C3 with cobra venom factor and challenged with three different strains of capsule-deficient H . influenzae . Two of them (Rd and U1) did not elaborate type b capsular antigen, whereas the other (S2) elaborated 0.16% of the amount made by its type b parent strain . Depletion of C3 significantly enhanced early intravascular bacterial survival after intravenous inoculation and strikingly increased the susceptibility of rats to infection with capsule-deficient H . influenzae . After intraperitoneal inoculation with strain Rd or U1, C3-depleted rats developed bacteremia, whereas control rats did not; challenge with strain S2 resulted in transient bacteremia in normal rats and in death in C3-depleted animals . To determine whether the greater virulence of strain S2, as compared with strain Rd or U1, was accounted for by the small amounts of capsular antigen it elaborated, we also compared its relative virulence to that of three genetically closely related capsule-deficient variants elaborating either small amounts of type b capsule or producing no detectable b antigen . No difference in virulence was observed among these four variants; all C3-depleted rats inoculated developed bacteremia of similar magnitude followed by similar mortality rates . These studies demonstrate a significant role for complement in host defense mechanisms against capsule-deficient H . influenzae and suggest that interstrain differences of virulence are not attributable to residual elaboration of small amounts of type b capsule.

Infect Immun, 1983 Nov, 42(2), 516 - 24
A set of two monoclonal antibodies specific for the cell surface-exposed 39K major outer membrane protein of Haemophilus influenzae type b defines all strains of this pathogen; Gulig PA et al.; Six murine plasma cell hybridomas producing monoclonal antibodies (mabs) directed against the 39,000-molecular-weight (39K) major outer membrane protein of Haemophilus influenzae type b were employed in the antigenic analysis of the 39K protein . The initial characterization of the mabs by radioimmunoprecipitation analysis showed that four of these mabs reacted with antigenic determinants of the 39K protein that are exposed on the bacterial cell surface and accessible to antibody . The other two mabs reacted with antigenic determinants of the 39K protein that are either not exposed on the H . influenzae type b cell surface or not accessible to antibody (internal determinants) . A total of 126 clinical isolates of H . influenzae type b obtained from pediatric research centers throughout the United States were examined for reactivity with the six mabs by using a solid-phase radioimmunoassay in which bacterial colony growth from agar plates was placed on filter paper and used as antigen . The reactivities of these strains with two of the mabs recognizing cell surface-exposed antigenic determinants of the 39K protein were used to divide the 126 strains into four different groups . Group 1 strains reacted with mab 12D9, group 2 strains reacted with mab 4C4, group 3 strains reacted with both mabs 12D9 and 4C4, and group 4 strains (only one was found) did not react with either mab . The reactivities of two other mabs recognizing cell surface-exposed antigenic determinants of the 39K protein were used to further divide the four groups into eight subgroups . A single mab recognizing an internal antigenic determinant of the 39K protein reacted with every H . influenzae type b strain examined in this study . These data indicate that only limited antigenic heterogeneity exists among the cell surface-exposed antigenic determinants of the 39K outer membrane proteins among H . influenzae type b strains and that at least one internal antigenic determinant of the 39K protein is universally present in all H . influenzae type b strains . Radioimmunoprecipitation analysis also demonstrated that H . influenzae type b strains which lacked a 39K major outer membrane protein possessed a 38K major outer membrane protein which reacted with the anti-39K mabs, indicating that the 38K and 39K outer membrane proteins of different H . influenzae type b strains are antigenically related.

Am J Clin Pathol, 1983 Nov, 80(5), 703 - 6
Sensitivity of commercial agglutination and counterimmunoelectrophoresis methods for the detection of Haemophilus influenzae Type b capsular polysaccharide; McGraw TP et al.; Comparison testing of commercial latex agglutination, coagglutination, and counterimmunoelectrophoresis (CIE) reagents for the detection of Haemophilus influenzae Type b capsular antigen in cerebral spinal fluid was performed . Latex agglutination was the most sensitive (0.2 ng/mL), followed by coagglutination (10 ng/mL), and CIE (20 ng/mL) . In addition, the commercial antisera for CIE failed to react with high concentrations of capsular antigen, well within the range found during the course of meningitis.

J Allergy Clin Immunol, 1983 Nov, 72(5 Pt 1), 481 - 6
Mucosal antibody response to parenteral vaccination with Haemophilus influenzae type b capsule; Pichichero ME et al.; The simultaneous serum and mucosal antibody response to parenteral vaccination with the Haemophilus influenzae type b (Hib) polysaccharide capsule (PRP) was evaluated in a group of 10 children and nine adults . All subjects responded to parenteral vaccination with an increase in serum anticapsular antibody . The children's preimmunization anti-PRP antibody level (mean = 0.04 microgram/ml) and 3 wk postimmunization level (mean = 19.3 micrograms/ml) were lower than the adults' (preimmunization mean = 1.5 microgram/ml; postimmunization mean = 81.2 micrograms/ml) . Eight of 10 children and seven of nine adults also developed a rise in antibody in nasal secretions . The children's mean nasal preimmunization level was 0.74 microgram/mg IgA and mean postimmunization level was 5.0 micrograms/mg IgA . The adults' mean nasal preimmunization level was 0.98 microgram/mg IgA and mean postimmunization level was 3.0 micrograms/mg IgA . Salivary antibody responses generally followed the pattern of nasal antibody responses . These data suggest that parenteral administration with the Hib capsular polysaccharide can produce a mucosal antibody response . Furthermore, although serum antibody responses to PRP vaccination are greater in adults than in children, mucosal antibody responses are comparable.

Jpn J Antibiot, 1983 Nov, 36(11), 2925 - 50
{Susceptibility of bacteria isolated from lower respiratory tract infections to antibiotics (1981)}; Ikemoto H et al.; During the period from September 1981 to March 1982, 363 bacterial isolates were obtained as possible pathogens from 311 patients with lower respiratory tract infections at 12 medical institutions in Japan . Of these clinical isolates, mostly from the sputum, a total of 231 isolates including 19 strains of Staphylococcus aureus, 33 strains of Streptococcus pneumoniae, 90 strains of Haemophilus influenzae, 65 strains of Pseudomonas aeruginosa, 17 strains of Klebsiella pneumoniae and 7 strains of Escherichia coli were tested in vitro for minimal inhibitory concentrations (MIC) of 17 antimicrobial agents, and their antimicrobial susceptibility distribution and cumulative percentages of inhibited isolates by increasing concentrations of drugs were determined . The data were further analyzed to investigate the interrelation between such parameters as the age-distribution of patients by diseases of the respiratory system, sex and types of infection and the species and frequency of isolation of the organisms, and also the relationship between the antimicrobial chemotherapy prior to collection of clinical specimens and the species and incidence of the bacterial isolates . In respiratory infections, it is frequently that chemotherapy should be instituted with an appropriate drug even before the causative organism can be identified and assessed for its antimicrobial susceptibility . The present data may provide valuable informations in selecting appropriate drugs in practical, clinical use.

Zentralbl Bakteriol Mikrobiol Hyg {A}, 1983 Nov, 255(4), 489 - 93
Detection of beta lactamase producing bacteria by Cefinase: comparison with three other methods; Qadri SM et al.; Nine hundred and sixty-seven strains of gram positive and gram negative bacteria were tested for the production of beta lactamase by Cefinase and the results were compared with acidometric microtiter, disc diffusion and antibiotic dilution procedures . A total of 420 strains of bacteria had a minimal inhibitory concentration (MIC) of more than 2.0 micrograms/ml for penicillins . They consisted of 23 strains of Neisseria gonorrhoeae, 36 of Haemophilus influenzae, 188 of Staphylococcus aureus and 173 strains of S . epidermidis . All the penicillin resistant strains gave positive results for beta-lactamase with Cefinase and acidometric method within 60 min . All the 547 strains of penicillin sensitive bacteria (MIC less than or equal to 2.0 micrograms/ml) were negative for beta-lactamase production by both methods.

J Clin Microbiol, 1983 Nov, 18(5), 1119 - 21
Detection of bacterial antigens in body fluids with the Wellcogen Haemophilus influenzae b, Streptococcus pneumoniae, and Neisseria meningitidis (ACYW135) latex agglutination tests; Ingram DL et al.; The Wellcogen Haemophilus influenzae b, Streptococcus pneumoniae, and Neisseria meningitidis (ACYW135) latex agglutination tests (Wellcome Diagnostics, Dartford, England) were evaluated as methods to detect bacterial antigens in cerebrospinal fluid (CSF), urine, and serum from patients with meningitis or sepsis . Antigen was detected in 92% of CSFs from H . influenzae b, 100% of CSFs from N . meningitidis groups A and Y, 36% of CSFs from N . meningitidis group C, and 69% of CSFs from pneumococcal meningitidis patients . Serum samples presented a problem, with a few false-positive or possible cross-reactions . The Wellcogen latex agglutination tests were more sensitive than the Bactogen (H . influenzae type b) latex agglutination test and the Phadebact (S . pneumoniae) coagglutination test.

J Infect Dis, 1983 Nov, 148(5), 886 - 91
Moxalactam for the treatment of bacterial meningitis in children; Freedman JM et al.; Increasing resistance to antibiotics in meningeal pathogens has stimulated a search for new antimicrobial agents for the treatment of bacterial meningitis . Moxalactam penetrates well into infected cerebrospinal fluid (CSF) and is highly active against most gram-negative bacteria . The clinical efficacy and safety of moxalactam in the treatment of childhood meningitis caused by Haemophilus influenzae (25 patients) or Neisseria meningitidis (five patients) was evaluated in a random, uncontrolled study . The penetration of the antibiotic into CSF was also evaluated in these patients and in another five children with bacterial meningitis . The clinical results were excellent, with 29 of 30 cases cured . The single adverse clinical reaction noted was the development of a wound hematoma in a postoperative patient; this problem may have been related to moxalactam therapy . The levels of moxalactam achieved in CSF greatly exceeded the minimal bactericidal concentrations for the infecting organisms . Moxalactam appears to be safe and effective as primary therapy for meningitis caused by H influenzae or N meningitidis.

J Bacteriol, 1983 Nov, 156(2), 778 - 88
D-(-)-poly-beta-hydroxybutyrate in membranes of genetically competent bacteria; Reusch RN et al.; D-(-)-Poly-beta-hydroxybutyrate is a constituent of the membranes and the cytoplasms of genetically competent Azotobacter vinelandii, Bacillus subtilis, and Haemophilus influenzae cells . Within each species the concentration of D-(-)-poly-beta-hydroxybutyrate in the membranes and cytoplasm correlates with transformability . Fluorescence analysis of the thermotropic lipid phase transitions in A . vinelandii and B . subtilis cells indicates that D-(-)-poly-beta-hydroxybutyrate forms an organized gel structure in the membranes which is very labile . The concentration of organized D-(-)-poly-beta-hydroxybutyrate in the membranes, which can be estimated from the intensity of its phase transition, can be used to assess the competence of a culture.

Antimicrob Agents Chemother, 1983 Nov, 24(5), 682 - 8
Evaluation of aztreonam in experimental bacterial meningitis and cerebritis; Scheld WM et al.; Aztreonam (SQ 26,776), a new monocyclic beta-lactam agent, was compared with ampicillin, ampicillin plus chloramphenicol, and gentamicin in rabbits with experimental meningitis induced by, respectively, ampicillin-susceptible Haemophilus influenzae, ampicillin-resistant H . influenzae, and Escherichia coli . Aztreonam was also compared with gentamicin in experimentally induced E . coli cerebritis in rats . Doses of the various agents were delivered that produced near-peak concentrations in serum comparable to those attained in humans on standard parenteral regimens . The percent penetration {( concentration in cerebrospinal fluid/concentration in serum} X 100) of aztreonam into purulent rabbit cerebrospinal fluid was 23% (versus 12, 27, and 21%, respectively, for ampicillin, chloramphenicol, and gentamicin) . In experimental meningitis in vivo, aztreonam was more rapidly bactericidal than was ampicillin in ampicillin-susceptible H . influenzae meningitis, ampicillin or chloramphenicol in ampicillin-resistant H . influenzae meningitis, or gentamicin in E . coli meningitis . In the therapy of experimental cerebritis, the early stage of brain abscess formation, aztreonam reduced the numbers of E . coli in rat brain as rapidly as did gentamicin . Aztreonam deserves further evaluation in acute gram-negative bacterial infections of the central nervous system in both experimental animals and in humans.

J Clin Microbiol, 1983 Nov, 18(5), 1032 - 9
Development of a test system for rapid differentiation of Neisseria and Haemophilus spp; Eriquez LA et al.; A qualitative micromethod (IDS Rapid NH system) employing conventional and single-substrate enzyme tests was developed for the biochemical characterization of Neisseria spp., Haemophilus spp., and other gram-negative species . A total of over 140 dehydrated, miniaturized biochemical tests were investigated for their ability to distinguish species . Computer-assisted test selection and pair separation analysis of the data allowed the selection of 11 4-h tests that would identify Haemophilus and Neisseria spp . implicated as etiological agents as well as differentiate them from other Neisseria spp., Moraxella spp., Branhamella catarrhalis, Centers for Disease Control M groups, and Kingella spp . The final test configuration included modified glucose, sucrose, galactosidase, nitrate, phosphatase, resazurin reduction, and two arylamidase tests . In addition, indole, urea, and ornithine decarboxylase tests were included to biochemically type strains of Haemophilus influenzae and Haemophilus parainfluenzae.

Pediatrics, 1983 Nov, 72(5), 608 - 12
Treatment of occult bacteremia: a prospective randomized clinical trial; Carroll WL et al.; Antibiotic therapy for children without foci of infection and at risk for bacteremia is controversial . A prospective randomized clinical trial was conducted using expectant antibiotic therapy in children at risk for bacteremia . A total of 96 children (aged 6 to 24 months) with temperature of more than 40 degrees C, no identifiable source of infection, and a leukocyte count greater than or equal to 15,000/microL and/or sedimentation rate greater than or equal to 30 were enrolled . The following tests were performed on all children: blood culture, chest roentgenogram, urinalysis, and urine culture . A lumbar puncture was performed if a child was 12 months or less . Patients were randomized to receive either no antibiotic therapy or Bicillin C-R, 50,000 U/kg intramuscularly, followed by penicillin V, 100 mg/kg/d, orally four times a day for three days . Patients were examined at 24 and 72 hours . Fifty patients were treated expectantly and 46 received no antimicrobial therapy . Ten of the 96 patients were bacteremic (nine had Streptococcus pneumoniae, one had Haemophilus influenzae) . Four of the five children treated for bacteremia showed improvement at the first follow-up visit (afebrile and no obvious focus of infection) . The five untreated patients showed no improvement; four patients developed focal infections (two had meningitis, two had otitis media) (P less than or equal to .05, Fisher exact test) . No complications of expectant therapy were detected . Thus, expectant antibiotic therapy for children who have no obvious source of infection and who meet these criteria associated with occult bacteremia is warranted.

Proc Natl Acad Sci U S A, 1983 Nov, 80(22), 6927 - 31
Transformasomes: specialized membranous structures that protect DNA during Haemophilus transformation; Kahn ME et al.; The mechanism by which Haemophilus protects donor DNA from cellular restriction and degradative enzymes during transformation is unclear . In this report, we demonstrate that donor DNA enters Haemophilus influenzae through specialized membranous extensions, which we have termed "transformasomes." DNA within transformasomes is in a protected state--resistant to external DNase and cellular restriction enzymes, although remaining unmodified and double-stranded . The ability of donor DNA to exit from transformasomes is dependent on its topological conformation . Circular DNA remains intact within transformasomes, while linear DNA rapidly exits and undergoes homologous recombination . Protected donor DNA can be preferentially removed from the surface of competent cells by extraction with organic solvents . Structurally intact transformasomes containing donor DNA could be partitioned into the organic layer and can be further purified by density centrifugation.

J Infect, 1983 Nov, 7(3), 218 - 26
Pathogenicity of encapsulated Bacteroides melaninogenicus group, B . oralis and B . ruminicola subsp . brevis in abscesses in mice; Brook I et al.; The pathogenicity of 27 clinical isolates of the Bacteroides melaninogenicus (BM) group and four clinical isolates of B . oralis and B . ruminicola subsp . brevis were investigated by inoculating them into mice and subsequently determining their ability to cause subcutaneous (SC) or intraperitoneal abscesses . Only 11 isolates of BM group and one B . ruminicola induced abscesses in mice, and all were found to be heavily encapsulated on recovery from the abscesses (more than 50 per cent of the organisms were encapsulated) . When the other 23 isolates, however, were injected SC in combination with either Klebsiella pneumoniae, Haemophilus influenzae, Pseudomonas aeruginosa, Escherichia coli, Staphylococcus aureus or Streptococcus pyogenes, abscesses were formed in 16 of the 23 combinations . The Bacteroides spp . recovered from the mixed infection were heavily encapsulated . Capsules also formed in Bacteroides if the organisms were injected together with capsular material or formalin killed cells of K . pneumoniae or encapsulated Bacteroides sp . Once non-encapsulated or only slightly encapsulated strains acquired a capsule, they could induce abscesses on reinoculation into mice.

Infect Immun, 1983 Nov, 42(2), 612 - 7
Role of adherence in the pathogenesis of Haemophilus influenzae type b infection in infant rats; Kaplan SL et al.; We evaluated the role of pili in the pathogenesis of disease due to Haemophilus influenzae type b (HiTb), using the infant rat model . Piliated and nonpiliated HiTb strains were isolated from the nasopharynx and cerebrospinal fluid, respectively, of three children . Infant rats inoculated intranasally with nonadherent HiTb developed bacteremia and meningitis more frequently (P = 0.005) than animals inoculated with companion adherent HiTb strains . When analyzed separately, only one HiTb pair (884/880) demonstrated significant differences in the incidence of bacteremia and meningitis between the adherent and nonadherent strains . Blood or cerebrospinal isolates recovered from infant rats inoculated with piliated adherent HiTb strains were not piliated and were not adherent in vitro . Adherent and nonadherent HiTb colonized the nasopharynx of infant rats equally . The piliated strains of HiTb were not adherent in vivo or in vitro to rat nasal or buccal epithelial cells, respectively . Piliated strains of HiTb have no apparent advantage over nonpiliated HiTb strains for colonization or invasion of infant rats . Furthermore, the loss of piliation is noted for cerebrospinal fluid, blood, and nasal isolates of HiTb cultured from infant rats inoculated with an adherent piliated HiTb strain . Thus, the loss or suppression of pili may be an important prerequisite for the invasion of the host by HiTb strains that are highly piliated.

J Infect Dis, 1983 Nov, 148(5), 855 - 60
A hemadsorption method for detection of colonies of Haemophilus influenzae type b expressing fimbriae; Connor EM et al.; Although fimbriated variants of Haemophilus influenzae type b have recently been described, cultures of most clinical isolates contain only a small proportion of fimbriated forms . Because colonies of fimbriated and nonfimbriated cells are visually indistinguishable, a rapid, simple method was developed for the identification and quantitation of colonies of fimbriated H influenzae . This procedure, also applicable to other bacteria (for example, Escherichia coli), involves transferring the colonies from agar to nitrocellulose disks and incubating the disks in a suspension of red blood cells . Colonies that contain predominantly fimbriated bacteria bind the red blood cells and appear as red dots on the nitrocellulose . This nitrocellulose hemadsorption method is described, as well as its applicability for determining the proportion of fimbriated cells in a culture, the kinetics of enrichment of fimbriated forms during enrichment procedures, and the transition rate from the nonfimbriated to the fimbriated state.

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