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 Microb