Can J Comp Med, 1983 Oct, 47(4), 456 - 9 Epidemiology of Haemophilus somnus infection in dairy cattle in Quebec; Sanfacon D et al.; Serological studies on Haemophilus somnus infection were carried out on 1795 cattle from 231 dairy herds in the province of Quebec . An epidemiological investigation was done in each of the dairy operations . Seroreactivity rate and mean log2 titer for all the sera were 55.4% and 4.1620 respectively . Cattle from eastern regions of Quebec demonstrated the lowest prevalence of H . somnus agglutinins . The percentage of seroreactor animals was 60.3 in herds of 100 cattle or more in comparison to 53.2 in herds of smaller size . About 75% of the animals from 16 herds in which one or more cattle showed nervous manifestations of undetermined origin over a one year period had antibodies to H . somnus . Herds in which respiratory diseases occurred had 59.6% seroreactor animals and herds in which weak calf syndrome was diagnosed over a one year period had 61.4% seroreactor animals . In 87 herds located within 20 km of feedlots, 61.8% of the sera had titers and the mean log2 titer was 4.4813. J Hyg (Lond), 1983 Oct, 91(2), 189 - 201 Bacterial meningitis in Nottingham; Ispahani P; Records of 171 cases of bacterial meningitis admitted to Nottingham hospitals from January 1974 to June 1980 were reviewed . The distribution of organisms producing meningitis and the factors influencing mortality in different age groups were assessed . Neisseria meningitidis, Haemophilus influenzae and Streptococcus pneumoniae accounted for 69% of all proven cases . The overall mortality was 26% being lowest in patients with meningococcal meningitis (0%) and highest in those with pneumococcal meningitis (53%) . The following factors were associated with a poor prognosis: age more than 40 years, or less than 2 months; state of consciousness on admission; high CSF protein concentration; and a positive blood culture . There was no evidence that antibiotic therapy prior to admission affected prognosis . Although many laboratory findings were altered by prior treatment with antibiotics, this did not prevent the establishment of a diagnosis in the individual patient. Am J Vet Res, 1983 Oct, 44(10), 1946 - 8 Prevalence of antibodies to Mycoplasma hyopneumoniae in Iowa swine; Young TF et al.; The prevalence of complement-fixing antibodies to Mycoplasma hyopneumoniae was determined in 7,321 sera collected from breeding swine of various ages . Samples were selected randomly in approximate proportion to the number of hogs marketed annually from each of 9 crop-reporting areas in Iowa . Testing was accomplished by means of a Microtiter complement-fixation test . Of the 7,321 sera, 22% had antibody titers of 1:4 or greater to M hyopneumoniae . Of the 597 herds sampled, 60% or 357 had at least 1 animal with a titer of 1:4 or greater . Use of the chi-square association test indicated that animals which were M hyopneumoniae-positive were more often Haemophilus pleuropneumoniae-positive than those that were M hyopneumoniae-negative. Antimicrob Agents Chemother, 1983 Oct, 24(4), 564 - 7 Susceptibility of 40 Haemophilus ducreyi strains to 34 antimicrobial products; Slootmans L et al.; A study was performed to examine compounds that might improve the selectivity of the primary isolation medium for Haemophilus ducreyi . The susceptibility of 40 H . ducreyi strains to 34 antimicrobial agents, including 10 antibiotics, 3 quaternary ammonium compounds, 3 phenolic derivatives, 3 acridines, and 15 heavy metal compounds, was investigated by using an agar plate dilution technique . Results were compared with the susceptibilities of other gram-negative rods which may be contaminants on isolation media . The minimal inhibitory concentration range for colistin (16 to 128 micrograms/ml) indicated that this antibiotic might be of use as a selective agent . H . ducreyi was susceptible to spectinomycin (minimal inhibitory concentration range, 16 to 64 micrograms/ml), thiamphenicol (0.12 to 1 microgram/ml), chloramphenicol (0.12 to 0.5 micrograms/ml), and streptomycin (4 to 32 micrograms/ml) and moderately susceptible to kanamycin (2 to 8 micrograms/ml) . For the heavy metal compounds, a high susceptibility was seen with copper(II) chloride (2 to 8 micrograms/ml, corresponding to a concentration of 0.75 to 3 micrograms of Cu2+ ions per ml), sodium selenite (1 to 4 micrograms/ml, or 0.45 to 1.83 micrograms of Se- ions per ml), and phenylmercury acetate (0.12 to 0.5 micrograms/ml) . The minimal inhibitory concentrations of quaternary ammonium compounds, acridines, and phenolic derivatives were between 1 and 32 micrograms/ml, 8 and 32 micrograms/ml, and 8 and 250 micrograms/ml, respectively. J Antimicrob Chemother, 1983 Oct, 12 Suppl C, 13 - 20 Intracellular penetration and antimicrobial activity of antibiotics; Jacobs RF et al.; Delayed response or recurrence of clinical infections may, in part, be due to the inability of certain antibiotics to penetrate human polymorphonuclear leukocytes (PMN) and exert intracellular antibacterial activity . We determined the penetration of PMN by certain hydrophilic and certain lipophilic antibiotics, and assessed their activity against intracellular Haemophilus influenzae, type b or Staphylococcus aureus . We found that penicillin G was excluded from human PMN while chloramphenicol was concentrated within these cells; chloramphenicol killed significantly more intracellular H . influenzae than did penicillin or ampicillin . Clindamycin and trimethoprim penetrated into normal and chronic granulomatous disease (CGD) PMN equally and were at least transiently concentrated in the cells . Clindamycin and the combinations trimethoprim/sulphamethoxazole and trimethoprim/rifampicin were most effective in killing intracellular Staph . aureus in vitro; these antibiotics reduced the bacterial density in CGD PMN to values comparable to those in normal PMN . The mechanism by which clindamycin and rifampicin killed intracellular Staph . aureus appeared to be due to direct antimicrobial activity . Antibiotics that penetrate into phagocytes may be more effective in infections due to pathogens capable of intracellular survival. J Antibiot (Tokyo), 1983 Oct, 36(10), 1345 - 56 In vitro and in vivo evaluation of MDL 19,592, an oral cephalosporin; Erickson RC et al.; MDL 19,592 is a new semisynthetic cephalosporin with a good therapeutic potential against Gram-positive bacterial infections when administered orally or parenterally . In the oral treatment of benzylpenicillin-resistant Staphylococcus aureus infections in mice, MDL 19,592 was superior to cephalexin, cephradine, cefaclor, cefadroxil and cefroxadine . These in vivo results reflect the in vitro superiority expressed by MDL 19,592 over the other oral cephalosporins against staphylococci . Additionally, MDL 19,592 orally was superior to cefazolin and cephalothin administered subcutaneously and to a number of penicillinase-resistant penicillins given orally or subcutaneously in the treatment of S . aureus mouse infections . MDL 19,592 killed S . aureus cells at the same or faster rate than did cephalexin or cephradine . As compared to cephalexin, MDL 19,592 was marginally superior in vitro against Streptococcus pyogenes and Streptococcus pneumoniae . In vivo, MDL 19,592 was significantly the more effective of the two against S . pyogenes and marginally more effective against S . pneumoniae . Against Gram-negative organisms, with the exception of Haemophilus influenzae, cephalexin was the more potent of the two antibiotics both in vitro and in vivo . Administered orally to mice, MDL 19,592 was absorbed as rapidly as cephalexin with both drugs attaining similar concentrations in the blood . MDL 19,592, like cephalexin, was minimally bound by mouse serum. Eur J Clin Microbiol, 1983 Oct, 2(5), 469 - 72 Biliary tract infections caused by Haemophilus influenzae type b; Pallares R et al.; Four cases of women with biliary infection caused by Haemophilus influenzae type b are reported . The patients had underlying benign or malignant disease of the biliary tract . Haemophilus influenzae was isolated in pure culture from bile in all cases and also from blood cultures in three cases . The clinical condition of three patients was not severe, two of them recovering after surgery without antibiotic therapy . The fourth patient died of septic shock which occurred after liver biopsy . The frequency of biliary infections caused by Haemophilus influenzae has probably been underestimated because of the special nutritional requirements of this microorganism . The route by which Haemophilus influenzae reaches the biliary tract is not fully understood. J Infect Dis . 1983 Oct;148(4):767. Class-specific antibody response to Haemophilus influenzae type b capsular polysaccharide vaccine; Kayhty H et al.; Bacteremic infections caused by H influenzae type b have their peak incidence in children around one year of age, at a time when the serum antibody response to the capsular polysaccharide is very low {1, 3} . The capsular polysaccharide vaccine has in fact been shown to be efficacious in preventing the disease above but not below the age of 18 months {1} . Preliminary observations supported the notion that slow maturation of cells that synthesize antibody to H influenzae type b altered immunoglobulin class distribution of the response and resulted specifically in a defective IgG antibody response {1} . We have used a solid-phase ELISA to measure the class-specific antibody responses in 14 infants and children vaccinated with the capsular polysaccharide vaccine . We found that, among the infants who were less than 18 months old and whose antibody response was generally low, the response was only IgG-specific in two children and only IgM-specific in two others . In one child an IgG and IgM response was detected, and in two no response was detected . Among the older children, all children showed an increase in IgG antibody; only two also had an increase of IgM antibody . IgA antibodies were not detectable in any preimmune sera . The first IgA antibody responses were seen at the age of 15 months but were common thereafter . These data do not indicate a specific defect of IgG-class antibodies in the antibody response to the capsular polysaccharide vaccine. J Infect Dis, 1983 Oct, 148(4), 710 - 4 Characterization of cell proteins of Haemophilus ducreyi by polyacrylamide gel electrophoresis; Odumeru JA et al.; The whole-cell proteins of 105 clinical isolates of Haemophilus ducreyi from several geographic sources (North America, Africa, Asia, and Europe) were examined by sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) . The protein profiles were reproducible and unaffected by repeated subculturing or age of culture . At least seven different subtypes were determined by proteins in the molecular weight range of 24,000-50,000 . These proteins are located in the outer membrane of the cell, as determined by SDS-PAGE of the sarcosinate-insoluble membrane preparations of these strains . Thirteen isolates from a Winnipeg, Manitoba, Canada, outbreak of chancroid had identical patterns, suggesting a common origin . Although H ducreyi shares a number of proteins in common with other Haemophilus species, the protein profiles appear to be species specific . Heterogeneity in the protein composition of H ducreyi has provided a basis for subtyping, which could be of value in future epidemiologic studies. J Clin Microbiol, 1983 Oct, 18(4), 1015 - 6 Haemophilus influenzae biotype VII; Gratten M; A hitherto unreported biotype of Haemophilus influenzae is described . The isolate is noncapsulate and fails to decarboxylate ornithine or hydrolyze urea but is a strong indole producer . Its frequency is low . It is suggested that this newly recognized biotype of H . influenzae be designated biotype VII. Ann Intern Med, 1983 Oct, 99(4), 444 - 50 Pneumonia and acute febrile tracheobronchitis due to haemophilus influenzae; Musher DM et al.; Of 30 patients with pneumonia due to Haemophilus influenzae, 26 had infection due to nontypable and 4 due to typable organisms . Biotype I isolates were implicated with surprising frequency . Blood cultures were positive in six patients . An additional 14 patients, all with nontypable H . influenzae infection, had febrile purulent tracheobronchitis that was clinically indistinguishable from pneumonia except for the absence of a radiographic infiltrate; none were bacteremic . Penicillin susceptibility was shown for 95% of isolates, and response to ampicillin was prompt . Patients had high serum levels of bactericidal antibody on admission but had lower levels of serum opsonizing activity against their own organism than did uninfected carriers with chronic bronchitis; 2 to 3 weeks later, levels of opsonizing antibody had risen to equal those of carriers . Deficient opsonizing activity may have contributed to susceptibility to infection . These findings identify both host and bacterial factors that may cause susceptibility to pulmonary infection from H . influenzae. Am J Clin Pathol, 1983 Oct, 80(4 Suppl), 609 - 14 Special topics in antimicrobial susceptibility testing: test accuracy against methicillin-resistant Staphylococcus aureus, pneumococci, and the sensitivity of beta-lactamase methods; Jones RN et al.; Three contemporary problems in antimicrobial susceptibility testing were assessed by the CAP-Microbiology Surveys Program in 1982 . A penicillin-resistant Streptococcus pneumoniae was categorized correctly as resistant by nearly 78% of Infectious Disease Survey subscribers . This rate compares with a 15% accuracy in the 1981 Surveys challenge, and all results reported from the NCCLS recommended 1 microgram oxacillin screening test correctly found penicillin resistance . Further improvement in the microbiology laboratories' ability to recognize pneumococcal penicillin resistance is critical to good patient care . A methicillin-resistant Staphylococcus aureus (MRSA) strain was assessed accurately by 96.8% of NCCLS disk diffusion test users (methicillin, nafcillin, and oxacillin disks) . The microdilution broth method using methicillin as the representative of the penicillinase-stable penicillins performed well . Only nafcillin and oxacillin broth microdilution tests and the automated MIC methods had reduced accuracy . Automated systems also failed to recognize an associated erythromycin resistance in the MRSA strain . Suggestions for improved microdilution test accuracy are made . Three survey challenges have evaluated the sensitivity and specificity of commercial and other beta-lactamase test methods . The false-positive rates for staphylococci range from 3.9 to 4.5% . The false-negative results on a Haemophilus paraphrophilus (beta-lactamase producer) were highest for the iodometric technic (8.7%) and lowest for the chromogenic cephalosporins (1.9%) such as nitrocefin and PADAC . Recommendations for their more limited use in generally emergent clinical settings are offered. J Clin Pathol, 1983 Oct, 36(10), 1105 - 10 Accuracy of methods used for susceptibility testing of Haemophilus influenzae in United Kingdom laboratories; Philpott-Howard J et al.; Antibiotic susceptibility test reports on 1841 strains of Haemophilus influenzae from 25 microbiology laboratories were compared with results obtained with the same strains at The London Hospital Medical College . Of strains found to be sensitive to the antibiotics tested, 0.5% were reported as tetracycline-resistant, 1.6% as ampicillin-resistant, and 6.2% as trimethoprim-resistant . Of strains found to be resistant to these antibiotics, 37% were reported as tetracycline-sensitive, 27% as ampicillin-sensitive, and 66.7% as trimethoprim-sensitive . Factors found to be of significance in improving accuracy of sensitivity reporting included use of chromogenic cephalosporin and low-content antibiotic discs for detection of ampicillin resistance, and use of lysed blood agar rather than chocolated blood agar to detect trimethoprim sensitivity. Infect Immun, 1983 Oct, 42(1), 257 - 63 Further studies of the role of noncapsular antibody in protection against experimental Haemophilus influenzae type b bacteremia; Shenep JL et al.; Serum antibody against polyribosylribitol phosphate, the capsular antigen of Haemophilus influenzae type b, confers protection against experimental Haemophilus infection . Antibodies against noncapsular antigens are also protective, but the antigenic specificity of the protective antibodies remains unknown . Antilipopolysaccharide antibody was prepared by immunization of rabbits with boiled H . influenzae type b cells . Antilipopolysaccharide antibodies present in these sera did not protect against experimental Haemophilus bacteremia in infant rats . Antisera were also prepared by immunization of rabbits with live H . influenzae type b bacteria . After absorption of anticapsular and antilipopolysaccharide antibodies, these sera contained antibody to several outer membrane proteins which were accessible on the intact bacterial surface as detected by radioimmune precipitation . These absorbed sera prevented experimental Haemophilus bacteremia in infant rats . Thus, antibodies against noncapsular, non-lipopolysaccharide determinants, possibly against one or more outer membrane proteins, confer protection against experimental H . influenzae type b disease . In contrast, antibodies against lipopolysaccharide are ineffective. Pediatrics, 1983 Oct, 72(4), 473 - 5 Haemophilus influenzae type b brain abscess complicating meningitis: case report; Feldman WE et al.; A 7-month-old child developed beta-lactamase negative Haemophilus influenzae type b meningitis which was treated with parenteral ampicillin and chloramphenicol for two days and ampicillin for eight additional days . She was readmitted two days after discharge on the 14th day after the initial hospitalization because of a suspected relapse of meningitis . Cultures of CSF and blood yielded no growth, and therapy with ampicillin and chloramphenicol was discontinued after three days . After discharge, her fontanel became full and a large, right, frontoparietal brain abscess was found on her third admission on day 25 . Pus from the abscess yielded beta-lactamase negative H influenzae type b but CSF and blood yielded no growth . The abscess resolved after needle aspiration of pus and 4 weeks of therapy with ampicillin and chloramphenicol . It is speculated that this rare complication of H influenzae meningitis arose from a focal infection in an area of brain necrosis that resulted from the initial meningitis. Pediatrics, 1983 Oct, 72(4), 464 - 8 Ampicillin-resistant Haemophilus in the oropharynx: prevalence in three groups of young, middle-class children; Schwartz RH et al.; Infections caused by ampicillin-resistant Haemophilus influenzae type b are prevalent in Fairfax County, VA . In order to gain information on pharyngeal carriage of ampicillin-resistant H influenzae, oropharyngeal cultures were obtained from 249 young children . The study population comprised three groups: 90 healthy children (group A), 79 children who had finished a ten-day course of amoxicillin treatment for acute otitis media (group B), and 80 children who were brought to our office for treatment of purulent nasopharyngitis (group C) . Approximately 60% of the children in each group carried Haemophilus in the oropharynx . H parainfluenzae was the predominant oropharyngeal species in group 1 . H influenzae was predominant in the other two groups . Ampicillin-resistant Haemophilus sp organisms were recovered from 16% of children in group A, 25% of those in group B, and 17% of patients in group C . Recent exposure to ampicillin was associated with an increase in the recovery of ampicillin-resistant strains of Haemophilus. Infect Immun, 1983 Oct, 42(1), 10 - 4 Antibacterial activity of microbicidal cationic proteins 1 and 2, natural peptide antibiotics of rabbit lung macrophages; Lehrer RI et al.; Microbicidal cationic proteins 1 and 2, peptides derived from rabbit lung macrophages, were tested for bactericidal activity against various bacterial species . Both were highly active against diverse gram-positive and gram-negative organisms under conditions of near-neutral pH (between 7 and 8) and relatively low ionic strength . Susceptible species included Staphylococcus aureus, Staphylococcus epidermidis, Streptococcus pneumoniae, Listeria monocytogenes, Pseudomonas aeruginosa, Klebsiella pneumoniae, Haemophilus influenzae, Escherichia coli, and Serratia marcescens . Streptococcus agalactiae, type 1A, was less susceptible than the aforementioned organisms or S . agalactiae, type 3 . Bordetella bronchiseptica, a common commensal and pathogen of the rabbit respiratory tract, was completely resistant to both peptides. Pediatrics, 1983 Oct, 72(4), 469 - 72 Apparent meningococcemia: clinical features of disease due to Haemophilus influenzae and Neisseria meningitidis; Jacobs RF et al.; To determine the etiology of apparent meningococcemia, all cases of sepsis with coagulopathy, purpura, and/or adrenal hemorrhage (Waterhouse-Friderichsen syndrome) with and without shock occurring over a 12-year period were reviewed . A total of 42 cases were identified; 30 cases were caused by Neisseria meningitidis and 12 cases were caused by Haemophilus influenzae . Compared with patients with disease caused by H influenzae, patients with meningococcal disease were older, more often male, more often contracted the disease in winter-spring, and had a longer duration of antecedent symptoms; however, none of these differences was statistically significant . All patients were febrile (greater than 38 degrees C) and appeared toxic . Similar proportions in each group had shock and disseminated intravascular coagulopathy at the time of admission . Ten of 12 patients with H influenzae infection compared with 15/30 (P less than .05) with meningococcal infection were lethargic or comatose at the time of admission . Nine of 12 patients with H influenzae infection died compared with 5/30 with meningococcal disease (P less than .005); the mean time from onset of symptoms to death with H influenzae infection (20.7 +/- 11.4 {SE} hours) was significantly shorter (P less than .05) than with meningococcal infection (120 +/- 74.4 hours) . Children with clinical signs of sepsis and with purpura, petechiae, or coagulopathy may have N meningitidis or H influenzae as etiologic agents . Initial antibiotic therapy should be directed against these pathogens. Jpn J Antibiot, 1983 Oct, 36(10), 2769 - 812 {Double-blind comparative clinical evaluation of cefamandole and cefmetazole in the treatment of respiratory tract infections}; Oshima S et al.; Cefamandole sodium (CMD), a new cephalosporin-derivative, was synthesized in the Laboratory of Eli-Lilly Co . Ltd . U.S.A . in 1972 . CMD, which is several times more active than cefmetazole (CMZ, a cephamycin antibiotic) against Gram-positive cocci, is only as active as the latter antibiotic against Gram-negative bacilli . Against Haemophilus influenzae, CMD exhibits an antimicrobial activity which is as strong as that of ampicillin sodium . Our previous comparative tests on efficacy and safety of CMD versus cefazolin (CEZ) demonstrated that CMD was as effective and safe as CEZ in the treatment of respiratory tract infections . In the present clinical trial, the efficacy and safety of CMD are evaluated by a comparative double blind method using CMZ, a more recently synthesized cephamycin antibiotic, as a reference drug . For this purpose, a comparative double blind study was carried out in 50 institutions and clinics in Tohoku and Hokkaido districts in Japan . A total of 272 inpatients, who was aged over 16 years and was diagnosed as having pneumonia, lung abscess or acute infectious exacerbation of chronic obstructive pulmonary diseases, was included in this trial . They received 2 g of CMD or CMZ twice a day by intravenous drip infusions, as a rule, for 14 days . Of these patients, 264 (133 received CMD and 131 CMZ) were available for the evaluation of safety and usefulness . Two hundred and thirty-eight patients (122 received CMD and 116 CMZ) were adopted for the evaluation of efficacy . Prior to the treatment, there was no significant difference with respect to age, sex, severity of infection and underlying diseases between subjects in 2 treatment groups . An excellent or good clinical response was obtained in 82% of the patients treated with CMD, and in 81% of those treated with CMZ . Thus, there was no significant difference in cure rate between 2 treatment groups . However, an excellent clinical response was found in 12.3% of the patients treated with CMD, whereas only in 4.3% of those treated with CMZ . This difference in percentage of excellent clinical response between 2 treatment groups was statistically significant (P less than 0.05) . Of the 87 patients with moderate to severe infection who were treated with CMD, 13 showed an excellent response . Only 4 of 90 patients treated with CMZ showed an excellent response . Statistically the difference in the rate of excellent response between these 2 groups was significant (P less than 0.05).(ABSTRACT TRUNCATED AT 400 WORDS) J Infect Dis, 1983 Oct, 148(4), 726 - 31 Antimicrobial therapy of chancroid: effectiveness of erythromycin; Plummer FA et al.; The emergence of Haemophilus ducreyi resistant to multiple antibiotics has limited the effectiveness of sulfonamides and tetracycline for the therapy of chancroid . A randomized, double-blind study compared 10-day courses of erythromycin base (500 mg) and rosaramicin (250 mg) each given four times daily for the treatment of men with chancroid in Nairobi, Kenya . Of 99 evaluable patients, 84 were positive for H ducreyi . H ducreyi-positive genital ulcers in men treated with either drug resolved with mean +/- SD healing times of 10.8 +/- 5.1 days for erythromycin and 10.7 +/- 5.5 for rosaramicin . There were no clinical or bacteriologic failures with either agent . Fifteen men with H ducreyi-negative genital ulcers for whom no other etiology could be determined also responded rapidly to treatment with either agent . Both erythromycin and rosaramicin are highly effective in the treatment of chancroid. Br J Vener Dis, 1983 Oct, 59(5), 320 - 4 Treatment of chancroid . A comparison of sulphamethoxazole and trimethoprim-sulphamethoxazole; Fast MV et al.; Since sulphonamides are no longer predictably effective in the treatment of chancroid the combination of trimethoprim-sulphamethoxazole (TMP-SMX) was evaluated to identify other effective regimens . One hundred and nine patients with genital ulcers (75 men and 34 women) seen at the Special Treatment Clinic in Nairobi, Kenya, were randomly assigned to treatment with a seven day course of either sulphamethoxazole 1000 mg twice daily or trimethoprim (160 mg)-sulphamethoxazole (800 mg) (TMP-SMX) twice daily . Haemophilus ducreyi was isolated from the ulcer in 57 patients (33 men and 24 women) . 16 patients were subsequently diagnosed serologically as having syphilis . No aetiological diagnosis was made in 40 patients . Treatment with sulphamethoxazole failed in five of 21 (24%) culture positive patients who were available for evaluation after seven days, whereas all 19 of such patients who were treated with TMP-SMX responded to treatment . Of the 21 isolates available for susceptibility testing, all were susceptible to trimethoprim alone (MIC less than 0.5 mg/l) and three were resistant to sulphonamides, all three containing a 4.9 megadalton (Mdal) plasmid . Two of the three patients from whom these isolates had been obtained were treated with sulphamethoxazole and both were clinical and bacteriological failures . Five of six patients with sulphonamide-susceptible H ducreyi responded to treatment with sulphamethoxazole . Failure of sulphonamides to eradicate H ducreyi in some patients with chancroid is associated with the presence of a sulphonamide resistant plasmid . In regions where this plasmid is present in H ducreyi TMP-SMX is the preferred treatment for chancroid. Gene, 1983 Oct, 24(2-3), 227 - 36 The nucleotide sequence of the HhaII restriction and modification genes from Haemophilus haemolyticus; Schoner B et al.; We have determined the nucleotide sequence of a cloned 1710-bp segment of Haemophilus haemolyticus DNA which contains the HhaII restriction (r) and modification (m) genes . The m gene is 513 bp in length and the rgene is 681 bp in length . Both are in the same reading frame, being separated by a 21-bp region . A ribosome-binding site is identified in front of each gene, but no Haemophilus promoter is apparent on the cloned fragment . Transcription originates from a plasmid promotor and proceeds in the direction m to r. J Bacteriol, 1983 Oct, 156(1), 437 - 40 Characterization of ampicillin resistance plasmids of Haemophilus ducreyi and Neisseria gonorrhoeae with regard to location of origin of transfer and mobilization by a conjugative plasmid of Haemophilus ducreyi; McNicol PJ et al.; Restriction endonuclease maps of the ampicillin resistance plasmids of Haemophilus ducreyi and Neisseria gonorrhoeae show marked structural similarities . Transfer frequencies obtained by mobilization correlated with physical structure and were enhanced by increased homology with the conjugative plasmid . The origin of transfer of each plasmid was located within a specific restriction fragment. Infect Immun, 1983 Oct, 42(1), 126 - 32 Antigenic heterogeneity of immunoglobulin A1 proteases from encapsulated and non-encapsulated Haemophilus influenzae; Kilian M et al.; Indirect evidence suggests that immunoglobulin A1 (IgA1) proteases may be factors in the pathogenesis of certain infectious diseases, including meningitis, gonorrhoea, and destructive periodontitis . Bacterial IgA1 proteases are therefore potential candidates as vaccines . In this study, IgA1 proteases from 166 clinical isolates and reference strains of Haemophilus influenzae and Haemophilus aegyptius were compared with regard to specific activity and pattern of enzyme inhibition by antisera raised against IgA1 protease from nine selected strains of H . influenzae . A total of 93% of H . influenzae strains and all H . aegyptius strains had detectable IgA1 protease activity . The majority of strains cleaved a prolyl-seryl or a prolyl-threonyl peptide bond in the alpha 1 hinge region, whereas occasional H . influenzae strains possessed two separate IgA1 proteases with these two specific activities . Of the 155 IgA1 protease-producing strains, all except 12 could be assigned to one of 14 IgA1 protease "inhibition types," each defined by a characteristic pattern of inhibition by the nine antisera . There was no correlation between IgA1 protease type and biotype of the strains . However, among 92 encapsulated H . influenzae strains, a close correlation between capsular serotype and IgA1 protease type was observed . With the exception of serotype f, strains of all capsular serotypes produced an exclusive antigenic type of IgA1 protease . All 38 strains of serotype b produced IgA1 protease of inhibition type 1, which was never demonstrated in non-encapsulated H . influenzae strains . These results facilitate the detection of an antibody response against specific IgA1 proteases and are of practical value for a possible future vaccine against H . influenzae serotype b infections. S Afr Med J, 1983 Sep 17, 64(12), 443 - 6 Acute community-acquired pneumonias; Prout S et al.; Of 81 adult patients with community-acquired pneumonia, bacterial infections were found in 37%, mycoplasma and viral infections in 21%, and tuberculosis in 6%; no pathogen could be identified in 46% of cases . More than one agent was identified in 12% of patients . Streptococcus pneumoniae, the most common pathogen, was found in 63%, Haemophilus influenzae in 26,7%, Staphylococcus aureus in 6,7%, and other Gram-negative organisms in 10% of patients with proven bacterial pneumonia . Most clinical and radiographic features were of little value in differentiating between different aetiological agents, but Gram-stained sputum gave a valuable early guide to therapy in 60% of cases of proven bacterial pneumonia . Blood culture was positive in 13,6% of cases . All the organisms conformed to their usual sensitivity patterns . Since Strept . pneumoniae is the predominant pathogen, penicillin should be the drug of choice in the immediate 'blind' treatment of community-acquired pneumonia. Int J Pediatr Otorhinolaryngol, 1983 Sep, 6(1), 89 - 94 Penetration of trimethoprim--sulfadiazine into middle ear fluid in secretory otitis media; Kohonen A et al.; Thirty-nine middle ear fluid samples from 23 patients with chronic secretory otitis media were studied . The patients received 3 doses of 3 mg of trimethoprim and 5 mg of sulfadiazine per kg body weight before tympanostomy, the last dose being given 80-270 min (mean 142 min) prior to operation . Mean trimethoprim concentrations were 1.62 micrograms/ml (range 0.8-3.5) and mean sulfadiazine concentrations 10.54 micrograms/ml (range 0-25.0) . For most patients the levels exceeded the usual MIC-values for the two commonest pathogens; pneumococci and Haemophilus influenzae . Otitis media caused by beta-lactamase producing Haemophilus is an important indication for trimethoprim-sulfonamide therapy. Antimicrob Agents Chemother, 1983 Sep, 24(3), 443 - 4 In vitro activity of midecamycin, a new macrolide antibiotic; Neu HC; Midecamycin, an acetoxy-substituted macrolide antibiotic, was tested against gram-positive and gram-negative bacteria . It inhibited the majority of streptococci, staphylococci, and strains of Haemophilus and Listeria at concentrations of less than 3.1 micrograms/ml . It was less active than erythromycin, and it failed to inhibit erythromycin-resistant isolates. Pediatr Infect Dis, 1983 Sep-Oct, 2(5), 377 - 80 Efficacy and safety of ceforanide in the treatment of childhood infections; Thirumoorthi MC et al.; Fifty-seven children, ages 1 month to 17 years, were treated with parenteral ceforanide . Most patients received 20 mg/kg of the drug intramuscularly every 12 hours . The mean duration of ceforanide therapy was 6.3 days (range, 3 to 14 days) . Because ceforanide has a relatively long half-life of 1.94 +/- 0.43 hours (range, 1.1 to 3.3 hours), suprainhibitory plasma concentrations against most pathogens recovered from the study patients were maintained for 8 to 12 hours after a dose . Ceforanide diffused well into abscess cavities and joint fluid . Initial clinical response was satisfactory in all patients; however, one patient with Haemophilus influenzae type b bacteremia had relapse of bacteremia one week after ceforanide therapy . Ceforanide was well-tolerated with minimal pain at the site of intramuscular injections . Other side effects were minor and transient. Am J Vet Res, 1983 Sep, 44(9), 1793 - 5 Genetic relatedness of Haemophilus somnus to select genera of bacteria; Gonzales HF et al.; The degree of DNA homology from Haemophilus somnus and DNA from select members of the genera Haemophilus, Actinobacillus, Pasteurella, Escherichia, and Micrococcus was determined . Hybridization tests indicated that H somnus DNA has a 46%, 58%, and 43% homology with the DNA from H influenzae, H parainfluenzae, and A lignieresii, respectively . These percentages of homology values indicate that H somnus was moderately related to 2 members of the genus Haemophilus and 1 member of the genus Actinobacillus . Haemophilus somnus DNA did not show any hybridization with DNA from the genera of Escherichia, Micrococcus, or Pasteurella. J Clin Microbiol, 1983 Sep, 18(3), 730 - 2 Pneumonia and bacteremia associated with Haemophilus influenzae serotype d; Holmes RL et al.; Haemophilus influenzae serotype d was isolated from three women with pneumonia and underlying cardiopulmonary disease . Two of the strains were isolated from blood, and the third strain was isolated from sputum . The biotypes of the isolates were I, IV, and VI. J Clin Microbiol, 1983 Sep, 18(3), 725 - 6 Primary peritonitis due to Haemophilus influenzae type b in a previously healthy child; Chang MJ et al.; A case of primary peritonitis caused by Haemophilus influenzae type b biotype 2 in a 3-year-old child is described . The organism was isolated from peritoneal fluid . This is the first case of documented peritoneal infection due to this species in a patient who showed no evidence of being immunocompromised. J Clin Microbiol, 1983 Sep, 18(3), 596 - 600 Comparison of outer membrane protein subtypes of Haemophilus influenzae type b isolates from healthy children in the general population and from diseased patients; Hampton CM et al.; Over a 12-month period we obtained throat cultures from 1,448 children less than 5 years of age attending well-child clinics and identified 24 carriers of Haemophilus influenzae type b (1.7%) . The outer membrane protein subtypes of the strains from the carriers were compared to the subtypes of isolates from 50 patients with Haemophilus type b disease hospitalized in St . Louis, Mo., during the same period (1981 to 1982), and the latter were compared to the subtypes of isolates from 51 patients hospitalized between 1977 and 1980 . There were no significant differences in the frequencies of the five most common subtypes (1L, 1H, 2L, 2H, and 3L), comparing isolates from the carriers to those from the patients . However, 5 of the 24 throat isolates had the unusual 13L subtype compared with only 1 of the 50 invasive isolates (P = 0.02) . The lower frequency of 13L strains among the invasive isolates suggests that type b isolates with this subtype may be less pathogenic than type b isolates with other subtypes . Subtype 2L strains accounted for only 2% of recent cerebrospinal fluid or blood isolates, compared with 22% of those from 1977 to 1980 (P = 0.02) . Subtype 1H and 3L strains together accounted for 73%, compared with 47% of the earlier ones (P = 0.02) . Thus, temporal shifts may also occur in the subtype distribution of Haemophilus type b strains causing invasive disease in a community. J Antimicrob Chemother, 1983 Sep, 12(3), 269 - 71 Influence of beta-lactamase-producing strains of Branhamella catarrhalis and Haemophilus influenzae on certain beta-lactam antibiotics; Johnsson J et al.; Ampicillin, benzylpenicillin, cefaclor and cefuroxime were exposed to strains of Branhamella catarrhalis and Haemophilus influenzae with and without ability to produce beta-lactamase . The antibiotics were dissolved in phosphate buffer at pH 6, 7 and 8 and the mean enzyme activity was calculated from decrease in peak heights by the HPLC technique . Cefuroxime was the most stable drug regardless of pH . For the other antibiotics, changes in pH influenced the results . In infectious processes factors like pH and pCO2 show some variation . This fact may influence the interaction between beta-lactams and beta-lactamases. J Infect Dis, 1983 Sep, 148(3), 492 - 9 Electrophoretic heterogeneity and interstrain variation of the lipopolysaccharide of Haemophilus influenzae; Inzana TJ; Lipopolysaccharide (LPS) was extracted from 50 isolates of Haemophilus influenzae by a rapid micromethod and was analyzed by sodium dodecyl sulfate-polyacrylamide gel electrophoresis and silver staining . LPS isolated by this method was electrophoretically indistinguishable from conventionally purified LPS but lacked the large degree of heterogeneity indicative of variable polymerization of O-side-chain repeating units; one to four bands appeared in gels . Electrophoretic profiles of LPS from H influenzae type b varied among strains and were useful for subtyping . Thirty-three isolates of type b were classified into 11 subtypes on the basis of stable band mobilities . Certain isolates of identical outer-membrane-protein subtype differed in LPS subtype . The LPS profiles of non-b, typable strains of H influenzae were generally similar in microheterogeneity to those of type b strains, while those of untypable isolates usually displayed less electrophoretic variation. J Infect Dis, 1983 Sep, 148(3), 385 - 94 Surface determinants of Haemophilus influenzae pathogenicity: comparative virulence of capsular transformants in normal and complement-depleted rats; Zwahlen A et al.; In an assessment of the contribution of different capsular polysaccharides to the pathogenicity of Haemophilus influenzae, the virulence of H influenzae strain Rd and of a series of capsular transformants (types b, c, d, and f) of strain Rd was compared and in normal and complement-depleted rats . After intraperitoneal inoculation, the encapsulated transformants were strikingly more virulent than strain Rd, although their pathogenicity varied; type b was the most virulent, type c the next most virulent, type f less virulent, and type d the least virulent . C3 depletion enhanced the susceptibility of rats to systemic infection but did not influence the relative virulence of the transformants . Comparative studies of clearance showed efficient intravascular survival of type b, c, and f transformants but not of the type d transformant or strain Rd; C3 depletion enhanced the intravascular survival of type d . Further analysis of the capsular transformants revealed differences in the electrophoretic characteristics of their lipopolysaccharides . These studies indicate that elaboration of a unique capsular polysaccharide may not be a sufficient explanation for the greater virulence of H influenzae type b and that lipopolysaccharide may contribute to the mediation of the differential pathogenicity of the various serotypes. Am J Hematol, 1983 Sep, 15(2), 117 - 21 Effect of splenic congestion associated with hemolytic anemia on mortality of rats challenged with Haemophilus influenzae b; Chen LT et al.; The effect of splenic congestion associated with acute hemolytic anemia on susceptibility to bacterial infection was investigated in rats inoculated with Haemophilus influenzae b by intranasal (in) or intravenous (iv) challenge . The rats were made anemic by phenylhydrazine treatment and were challenged with 10(6) (in) or 5 X 10(7) (iv) H influenzae b . Forty-eight hours after in inoculation of bacteria, the number of bacteria in the blood was 10 times greater in the anemic rats with extensive splenic congestion than in controls . After iv inoculation of bacteria, a significantly (P less than 0.001) higher mortality rate was found in the anemic rats with extensive splenic congestion and fewer bacteria were present in the spleens but not the livers, as compared to normal rats . Since phenylhydrazine-induced hemolytic anemia exhibited an extensive congestion in the spleen, higher mortality rate observed in the anemic rats challenged with H influenzae b may result, in part, from decreased intravascular clearance of bacteria by the spleen. Infect Immun, 1983 Sep, 41(3), 987 - 91 Nasopharyngeal flora and acute otitis media; Long SS et al.; A semiquantitative nasopharyngeal culture was found to be sensitive and specific in predicting middle ear pathogens in children with acute bacterial otitis media . In nasopharyngeal specimens with growth of at least 1,000 colonies, the tympanocentesis isolate was present and was either the predominant isolate or accounted for 50% of growth in 16 of 16 children . Data suggest that virulence of nasopharyngeal organisms plays a role in the pathogenesis of acute otitis media . Qualitative differences were found in the nasopharyngeal flora of children with bacterial otitis media as compared with children with clinical otitis media and sterile tympanocentesis cultures, children with uncomplicated upper respiratory illness, and healthy children . Abundant growth of Haemophilus influenzae (greater than or equal to 50% total colony count) was associated with children with bacterial otitis media, and abundant Branhamella catarrhalis was associated with the others (P less than or equal to 0.01) . Abundant growth of Streptococcus pneumoniae occurred frequently and regardless of clinical category . Antibiotic treatment of children with otitis media resulted in rapid quantitative and qualitative changes in nasopharyngeal flora. Acta Otolaryngol, 1983 Sep-Oct, 96(3-4), 247 - 53 Acute otitis media in older children and adults treated with phenoxymethyl penicillin or erythromycin stearate . Bacteriological and immunological aspects; Rosen C et al.; Seventy-eight patients, all over 10 years of age, with clinical signs of acute otitis media, received either phenoxymethyl penicillin or erythromycin stearate, in a randomized manner, and the clinical, bacteriological and immunological effects were studied . Haemophilus influenzae and Streptococcus pneumoniae were the major pathogens isolated from the nasopharynx in 30 and 28 patients, respectively . Increased levels of C-reactive protein (CRP) were detected in 53 (68%) of the patients . There was no statistical difference in the CRP-levels depending on species of bacteria isolated . The highest incidence was observed in cases with Branhamella catarrhalis and H . influenzae . Persistence of H . influenzae during antibiotic therapy was demonstrated in 70% and after therapy in 63% compared to 4% and 11% persistence of S . pneumoniae . The type of antibiotic treatment did not influence persistence . An immune response to H . influenzae and S . pneumoniae was detected significantly more often in patients treated with erythromycin stearate than with phenoxymethyl penicillin. J Clin Pathol, 1983 Sep, 36(9), 991 - 5 Evaluation of some methods for the laboratory identification of Haemophilus influenzae; Tebbutt GM; Five tests--satellitism, synthesis of porphyrins, acid production from sucrose, beta-galactosidase activity (ONPG), and indole production--to differentiate between strains of Haemophilus influenzae and strains of V-dependent Haemophilus species were evaluated . Six per cent of strains of H influenzae were misidentified as H parainfluenzae by a test for satellitism using filter paper discs impregnated with X factor, V factor, or both, applied to Columbia Agar . None of seven nutrient agars tested grew Haemophilus species, and determined accurately the X factor requirement . Synthesis of porphyrins from delta-aminolaevulinic acid provided a reliable means of demonstrating that X factor was required . A test for the production of acid from sucrose discriminated successfully between strains of V-dependent Haemophilus species (positive) and H influenzae (negative) . Most isolates were identified correctly by the ONPG test, but occasional V-dependent strains were negative and could be misidentified as H influenzae . The discriminative value of the indole test was unsatisfactorily low . The results of the tests are discussed in relation to the identification of H influenzae in the diagnostic laboratory. Mol Immunol, 1983 Sep, 20(9), 1051 - 8 Molecular biology of Haemophilus influenzae IgA1 proteases; Kilian M et al.; IgA1 proteases of two distinct specificities were demonstrated among 95 isolates of Haemophilus influenzae and nine isolates of H . aegyptius . The two enzymes cleaved two different peptide bonds in the hinge region of the alpha chain of IgA1: a prolyl-seryl bond located at position 231-232 (type A cleavage) and a prolyl-threonyl peptide bond between residues 235 and 236 (type B cleavage) . Each strain of H . influenzae produced either one or both of these types of enzymes, whereas all H . aegyptius strains produced type A enzyme only . The application of enzyme-neutralizing antibodies to the study of IgA1 proteases produced by the 104 strains of H . influenzae and H . aegyptius revealed at least 15 different types of protease activities based on inhibition patterns in nine selected antibody preparations . The types of IgA1 proteases closely correlated with the serotype of encapsulated strains of H . influenzae . The study suggests that H . influenzae strains produce at least two serologically different IgA1 proteases with distinct or identical enzymatic activities. Gene, 1983 Sep, 24(1), 29 - 35 Restriction map and location of mutations on the genome of bacteriophage Hp1c1 of Haemophilus influenzae Rd; Fitzmaurice WP et al.; A physical map of the 32.4-kb chromosome of the Haemophilus influenzae bacteriophage Hp1c1 has been constructed, using the cleavage sites of eight restriction endonucleases . Two temperature-sensitive mutations have also been localized on the phage chromosome . The phage DNA exhibited an affinity for the specific DNA receptor of Haemophilus transformation approx . 1.5-fold higher than that obtained with bulk chromosomal DNA of H . influenzae. J Infect Dis, 1983 Sep, 148(3), 530 - 4 Immunogenicity of a Haemophilus influenzae type b vaccine in combination with diphtheria-pertussis-tetanus vaccine in infants; Coulehan JL et al.; Seventy-eight Navajo infants (one to two months of age) were randomly assigned to one of two vaccination groups: one group (40 infants) was scheduled to receive three doses of diphtheria-pertussis-tetanus (DPT) vaccine and the other (38 infants) to receive DPT combined with Haemophilus influenzae type b polyribosyl-ribitol phosphate (DPT + PRP vaccine) . In the latter vaccine, pertussis antigen served as an adjuvant for PRP . Sixty-seven infants (37 who received DPT vaccine and 30 who received DPT + PRP vaccine) completed the protocol . Local and systemic reactions were equally frequent in the two groups . Fifty percent of the infants who received DPT + PRP vaccine had definite antibody responses to PRP after three doses, and 13% had possible responses . Of the infants who received DPT vaccine, 14% and 8% had definite and possible responses, respectively; three of five infants with definite responses were infected with H influenzae type b or cross-reacting organisms, as determined by pharyngeal cultures . The immune response did not appear to be suppressed by the presence of maternal antibody. Am J Med, 1983 Aug 29, 75(2A), 125 - 9 Randomized trial of cefamandole plus amdinocillin versus cefamandole in serious pediatric infections; Nelson JD et al.; In a randomized, prospective clinical trial cefamandole therapy was compared with cefamandole plus amdinocillin in infants and children with suspected bacterial infections . Fifty-two infections in 50 patients with bone and joint (19 infections), pulmonary (19 infections), soft tissue (eight infections), and urinary tract (6 infections) diseases were treated . Bacterial infection was documented in 31 patients . All isolates were susceptible to cefamandole except one strain of Serratia marcescens, which was susceptible to the combination . In vitro synergy was demonstrated in all coliform bacilli, in three of seven Haemophilus strains, and in six of 16 gram-positive cocci . No correlation between degree of serum bactericidal activity and presence or absence of synergy could be demonstrated . One patient treated with cefamandole died; all other patients responded promptly to therapy without serious adverse drug effects. J Am Vet Med Assoc, 1983 Aug 15, 183(4), 445 - 7 Long-acting oxytetracycline for control of induced Pasteurella multocida rhinitis in swine; Gois M et al.; A long-acting oxytetracycline formulation was evaluated for control of rhinitis induced experimentally in pigs with a capsular type A, toxin-negative, low-passage strain of Pasteurella multocida . The pigs were 6 to 7 weeks old and were naturally infected with Haemophilus parasuis . The H parasuis infection was thought to predispose to establishment of P multocida in the nasal cavity . A long-acting oxytetracycline formulation was given IM at the rate of 20 mg/kg, 4 times at 5-day intervals . Medication reduced (P less than 0.05) the severity of turbinate atrophy and the proportion of pigs with P multocida and H parasuis in their nasal cavities . Numbers of colonies of P multocida and H parasuis isolated were also less in medicated pigs. Br J Rheumatol, 1983 Aug, 22(3), 176 - 8 Hyposplenism in systemic lupus erythematosus; Pines A et al.; Hyposplenism, which is suggested by a typical peripheral blood smear and by the absence of splenic activity in a 99m Tc sulphur colloid scan, has been recently found to be associated with various diseases . This condition increases the susceptibility of patients to certain bacterial infections principally by pneumococci, meningococci and Haemophilus influenzae . The association of SLE and hyposplenism has not often been reported before; thus we see fit to report another such case . The administration of polyvalent pneumococcal vaccine is recommended in this condition. Jpn J Antibiot, 1983 Aug, 36(8), 2129 - 34 {Susceptibility of clinical isolates in pediatrics to cefpiramide}; Deguchi K; Cefpiramide (CPM, SM-1652) had broad-spectrum antibacterial activities against most of clinically isolated organisms to which are paid attention as pathogenic organism in the field of pediatrics . Antibacterial activities of CPM against Staphylococcus aureus, Streptococcus pyogenes, Haemophilus influenzae, Bordetella pertussis and Proteus mirabilis were almost the same as those of cefoperazone (CPZ) . Antibacterial activities of CPM against Escherichia coli and Klebsiella pneumoniae were somewhat weaker than those of CPZ, but antibacterial activity of CPM against Pseudomonas aeruginosa was rather stronger than that of CPZ and almost the same as that of cefsulodin . Antibacterial activity of CPM has a tendency to decrease in beta-lactamase (PCase type) producing S . aureus, E . coli, K . pneumoniae, H . Influenzae, etc . It is suggestive that the determination of not only the antibacterial activity of CPM against pathogenic organisms but also the beta-lactamase producing activity of them is important on the occasion of clinical use of CPM. Antimicrob Agents Chemother, 1983 Aug, 24(2), 287 - 9 Effect of inoculum size on Haemophilus influenzae type b susceptibility to new and conventional antibiotics; Laferriere C et al.; Thirty-three Haemophilus influenzae type b isolates, including beta-lactamase acetyltransferase-positive strains, were tested by microtiter broth dilution for susceptibility to eight beta-lactam compounds and chloramphenicol . All antibiotics except ampicillin and chloramphenicol were highly bactericidal against all isolates at an inoculum of 10(5) CFU/ml . However, at an inoculum of 10(5) CFU/ml, the minimal bactericidal concentrations of all drugs except ceftriaxone were above levels usually achievable in cerebrospinal fluid . Results of time-kill studies confirmed this inoculum effect . In vivo studies are needed to test the clinical impact of these observations. J Clin Microbiol, 1983 Aug, 18(2), 376 - 9 Growth of Haemophilus influenzae in simulated blood cultures supplemented with hemin and NAD; Artman M et al.; The mean generation time of Haemophilus influenzae in simulated blood cultures is 103 to 107 min . With 0.56 to 0.58 doublings per h, even large inocula of 256 cells per ml reach only 2 X 10(6) cells per ml and produce no visible evidence of growth after 24 h of incubation . Hemin and NAD added to simulated blood cultures triple the rate of growth of H . influenzae, so that even small inocula produce visible turbidity after overnight incubation . With a mean generation time of 36 min, a single cell of H . influenzae in simulated blood culture supplemented with hemin and NAD undergoes 30 doublings in 18 h, producing 2(30) (1.07 X 10(9} cells and visible turbidity. J Pediatr, 1983 Aug, 103(2), 185 - 91 Siblings of patients with Haemophilus meningitis have impaired anticapsular antibody responses to Haemophilus vaccine; Granoff DM et al.; Siblings of patients with type b Haemophilus influenzae meningitis are at increased risk of developing Haemophilus disease . We immunized 26 healthy siblings and 25 control subjects using a vaccine containing the type b polysaccharide capsule (10 micrograms PRP) and pertussis vaccine (4 opacity units) (Lederle Laboratories) to determine whether siblings of patients with Haemophilus meningitis had an impaired antibody response to PRP . Using two intramuscular injections one month apart, we found that the siblings had a lower response to PRP . One month after the second injection, 12 of 24 of the siblings had serum concentrations of anticapsular (PRP) antibody thought to be sufficient to confer protection against Haemophilus disease (greater than or equal to 300 ng/ml), compared with 19 of 24 of the control children tested (50% vs 79%, P = 0.035 by chi-square analysis) . In comparison with the normal controls, the siblings produced significantly less IgG anti-PRP antibody but similar amounts of IgM . The impaired responsiveness to PRP was most evident among the 16 children born after their sibling had meningitis and who were not known to have been exposed to type b Haemophilus infection previously . These data indicate that siblings of some patients with type b Haemophilus meningitis have reduced ability to form IgG anti-PRP antibody, which may be associated with increased susceptibility to Haemophilus disease. J Clin Invest, 1983 Aug, 72(2), 677 - 84 Purification and comparison of outer membrane protein P2 from Haemophilus influenzae type b isolates; Munson RS Jr et al.; Haemophilus influenzae type b isolates have been subdivided based on differences in major outer membrane protein (OMP) profiles resolved on gradient and modified Laemmli sodium dodecyl sulfate-polyacrylamide gel electrophoresis systems . Although 21 subtypes have been observed, 86% of invasive isolates have one of five common subtypes and 71% of isolates have one of three subtypes . In isolates with two of the most common outer membrane subtypes, one major OMP has an apparent molecular weight of 37,000 . In isolates with another common OMP subtype, a cross-reactive protein with an apparent molecular weight of 36,500 is observed . All three proteins have been designated P2 . Protein P2 from these prototype isolates was solubilized with Zwittergent 3-14 and purified to homogeneity . Based on amino acid compositions, cyanogen bromide cleavage products, staphylococcal V8 protease, and chymotryptic peptide maps, the P2 protein from the three isolates has been highly conserved . Rabbit antibody prepared against P2 from one strain was cross-reactive with P2 isolated from the other two heterologous strains by Western blot . This antibody passively protected infant rats against type b Haemophilus infection caused by the homologous organism, but not against challenge by a strain with the heterologous 36,500 mol wt P2 protein . Thus, although the P2 protein from isolates with different OMP subtypes are closely related, the protection experiments suggest that determinants on the cell surface interacting with protective antibody may be strain or subtype specific. J Bacteriol, 1983 Aug, 155(2), 878 - 85 Characteristics of major outer membrane proteins of Haemophilus influenzae; van Alphen L et al.; Several properties of Haemophilus influenzae outer membrane proteins were analyzed to define related proteins in various isolates . H . influenzae type b 760705 had six major outer membrane proteins with the following characteristics . Protein a (Mr, 47,000) demonstrated heat modifiability in sodium dodecyl sulfate; its apparent molecular weight was 34,000 at temperatures below 60 degrees C . This protein was extracted from cell envelopes by using Triton X-100-10 mM MgCl2; in cell envelope preparations, the protein was degraded by trypsin . Proteins b (Mr, 41,000) and c (Mr, 40,000) were insensitive to trypsin degradation, were not heat modifiable in sodium dodecyl sulfate, and were peptidoglycan associated in 0.5% Triton X-100-0.2% sodium dodecyl sulfate . The amount of protein b was reduced in ultrasonically obtained cell envelopes . Protein d (Mr, 37,000) was heat modifiable in sodium dodecyl sulfate with an Mr of 28,000 at temperatures below 100 degrees C and was degraded by trypsin, leaving a membrane-bound fragment of Mr, 27,000 . Both the intact and degraded proteins were immunologically cross-reactive with the heat-modifiable OmpA protein of Escherichia coli K-12 . Protein d was absent in LiCl-EDTA extracts of cells . Protein e (Mr, 30,000), invariably present in all H . influenzae strains tested, was insensitive to trypsin and absent in LiCl-EDTA extracts of cells . Protein k (Mr, 58,000) was extracted from cell envelopes with 2% Triton X-100-10 mM MgCl2 and, in cell envelopes, appeared to be sensitive to trypsin degradation . Proteins with similar properties to those of proteins a to k were found in 10 other H . influenzae b strains, reference strains with serotype a, c, d, e, and f capsules, and 18 of 20 nonencapsulated strains . Their relative molecular weights, however, varied. Clin Immunol Immunopathol, 1983 Aug, 28(2), 218 - 28 Abnormalities in cell-mediated immune functions to Haemophilus influenzae chronic purulent infections of the upper respiratory tract; Drexhage HA et al.; Delayed hypersensitivity (dh) skin test reactivity to a somatic antigen of Haemophilus influenzae was studied in 21 patients with unexplained, chronically relapsing, purulent upper respiratory tract infections . Only 2 showed a dh reactivity comparable to that of healthy controls . A majority--15 patients--had a defective dh response, whereas 4 showed exaggerated reactivity leading to necrosis of the test site and general feelings of malaise . Not only was the dh reactivity to somatic H . influenzae antigen affected, but also that to streptokinase/streptodornase and candidal antigen in most cases, though to a lesser extent . Skin test reactivity to the mitogen PHA was normal as were the dh skin test reactivities in 4 out of 5 control patients with mucous atopic rhinitis/sinusitis and 2 cases of nasal suppuration due to disturbed mucociliary transport . Delayed hypersensitivity skin test disorders were associated with elevated ratios of OKT4 + /OKT8 + peripheral lymphoid cells . In addition a high incidence of atopy and thyroid autoimmunity was evident in patients as well as in their first-degree relatives . A negative lymphocyte proliferative response to somatic H . influenzae antigen was found in 3 of our patients . These results suggest that unexplained, chronically relapsing upper respiratory tract infections might be based on restricted T-cell defects to H . influenzae, streptococcal, and candidal antigens . Such defects are reminiscent of the T-cell immune disorders to fungi playing a role in some cases of chronic mucocutaneous candidiasis. Br J Vener Dis, 1983 Aug, 59(4), 265 - 8 Treatment of chancroid with erythromycin . A clinical and microbiological appraisal; Duncan MO et al.; One hundred and thirty seven patients presenting with genital ulcerations from which Haemophilus ducreyi was isolated were treated with erythromycin stearate 500 mg every six hours for seven days . Of these, 91 (66%) had associated inguinal lymphadenopathy . Only two of the 100 patients who returned after one week showed no clinical improvement . Despite decrease in size H ducreyi was reisolated from the ulcers of three patients, two of whom had not complied with treatment . The patients were treated for a further week either with erythromycin or with a placebo preparation and on day 14 no discernible difference in clinical response was evident . H ducreyi was not reisolated from any lesion . In contrast, the natural course of development of associated lymphadenopathy was not modified by treatment . H ducreyi was not, however, isolated from any gland after the start of treatment . Side effects attributable to erythromycin were minimal and treatment had to be discontinued in only two patients . This study clearly indicates that treatment with erythromycin for one week results in rapid healing of lesions and the elimination of H ducreyi from both ulcers and associated lymph glands. Hosp Pract (Off Ed), 1983 Aug, 18(8), 158 - 61, 166, 169-70 Haemophilus influenzae infections; Musher DM; Of the six typeable strains of this organism, type b is the most virulent, accounting for 95% of serious infections in children . Unexpectedly, in adults, nearly two thirds of isolates from blood and CSF were found to be nontypeable . The spectrum of clinical disease associated with type b and nontypeable strains is discussed . Effective immunization of infants is now in the planning stages. J Clin Microbiol, 1983 Aug, 18(2), 365 - 71 Quantitative screening of clinical isolates for immunoglobulin A protease production; Lindler LE et al.; The production of immunoglobulin A (IgA) protease is a potentially useful marker in differentiating pathogenic from nonpathogenic species of clinical isolates; however, current quantitative assay methods are too tedious for routine application . A simple quantitative method was developed to screen clinical isolates for IgA protease production . This method is based on the specificity of reaction between IgA and alpha chain-specific antiserum in an immunochemistry analyzer (Beckman Instruments, Inc., Brea, Calif.) . Colonies of IgA protease producers (Streptococcus sanguis, Streptococcus pneumoniae, Neisseria gonorrhoeae, Neisseria meningitidis, and Haemophilus influenzae) were picked from solid media, transferred to brain heart infusion containing IgA1, and incubated at 37 degrees C for at least 2 h to provide a detectable decrease in IgA concentration . The standard deviation for randomly picked colonies within a species was about +/- 15% . Several IgA protease-negative species caused no detectable reduction in the IgA content of the system . The specificity of the IgA measurement eliminates the requirements for extensive purification and radiolabeling of substrate and provides the basis for a well-defined IgA protease activity unit (micrograms of IgA1 cleaved per minute per milliliter of culture). Jpn J Antibiot, 1983 Aug, 36(8), 2053 - 7 {Antibacterial potency of cefotiam based on the clinical effect, MIC and decrement of organisms in the sputum}; Kawagoe M et al.; To evaluate the antibacterial potency of cefotiam (CTM) clinical and laboratory studies were carried out and the results were as follows . Clinical evaluation and adverse reaction CTM was given to total of 23 patients, 10 with bronchopneumonia, 10 with bronchitis and one each with cystitis, enteritis and suspected sepsis . Overall efficacy rate was 78.3% (18/23) (excellent 9, good 9, fair 3, poor 2) . Only 1 case showed a side effect of slightly elevated GOT and GPT . Antibacterial activities MIC of CTM against isolates from sputum was investigated on those patients mentioned above and was compared with MIC of CEZ and CMZ . CTM showed superior antibacterial activity against almost all strains . Especially on Haemophilus and Klebsiella antibacterial activity of CTM was impressive . Organisms in sputum Four out of 8 causative bacteria disappeared and 1 out of 8 decreased after administration of CTM . Thus CTM is considered to be the useful drug for the treatment of respiratory infection. J Bacteriol, 1983 Aug, 155(2), 839 - 46 Amplification of resistance genes in Haemophilus influenzae plasmids; Spies T et al.; Intramolecular amplification produces tandem repeats of tetracycline and combined tetracycline-chloramphenicol resistance determinants in conjugative plasmids of Haemophilus influenzae . This process depends on host recombination pathways . Physical mapping revealed the tetracycline transposon involved in amplification to be almost identical with Tn10, including two IS10 insertion elements . The chloramphenicol resistance determinant of the combined transposon is 1.9 kilobases (kb) in size and is bound by two 1.3-kb inverted repeats . Insertion in the close vicinity of the inside end of the left-hand IS10 generates a deletion of a 1.6-kb Tn10 region . The amplifiable units were resolved to comprise not only the respective resistance transposons, but also an additional 1.6-kb sequence (designated AS) which was demonstrated to be identically present in the different amplification systems studied . AS separates amplified transposons from each other, thereby maintaining the same orientation . Moreover, AS is present at the left flank of the transposons, but is missing at the right one . It was shown that AS represents a general constituent of the H . influenzae plasmids of the 45-kb class . Evaluation of the results suggests that AS is responsible for the recombinational events involved in the gene amplification process. Am J Med, 1983 Jul 28, 75(1B), 98 - 101 Bacterial meningitis--1982; Gold R; The etiologic agents in bacterial meningitis vary with time, geography, and patient age . Predominant pathogens are Escherichia coli, group B streptococci, Listeria monocytogenes, Haemophilus influenzae, Neisseria meningitidis, and Streptococcus pneumoniae . Approximately 70 percent of all cases occur in children under the age of five . The case-fatality rate in the United States in 1978 was 13.6 percent, but it is known that underreporting of cases, and therefore of case-fatalities, occurs . Prevention by vaccine appears to be the ultimate solution, but until a vaccine is developed emphasis should be on rapid diagnosis, improved management, and proper choice of antibiotic. Am J Med, 1983 Jul 28, 75(1B), 119 - 23 Rapid and reliable techniques for the laboratory detection of bacterial meningitis; Martin WJ; Microorganisms encountered in cerebrospinal fluid require rapid and accurate means of detection and identification in the laboratory . Although restricted to morphologic study and Gram reaction, the Gram stain of cerebrospinal fluid has been the primary diagnostic tool for preliminary diagnosis of purulent meningitis, with identification of the etiologic agent often made within one to two hours by direct microscopic examination . Gram stain and appropriate culture procedures still provide the basis for comparing other diagnostic methods . Nonimmunologic methods that show promise in being both rapid and reliable include gas-liquid chromatography and the Limulus amebocyte lysate test . Fatty acid and carbohydrate profiles characteristic of Haemophilus influenzae, Streptococcus pneumoniae, Neisseria meningitidis, and Staphylococcus aureus in the cerebrospinal fluid of human subjects and animals have been obtained by gas-liquid chromatography . Also, a unique compound has been detected by gas-liquid chromatography in cerebrospinal fluid from patients with tuberculous meningitis . The Limulus test has been reliable in spinal fluid and almost always gives positive results in H . influenzae and other Gram-negative meningitides . Nonspecific test procedures of varying degrees of accuracy and promise include lactic acid, C-reactive protein, and lactate dehydrogenase determination . Direct microscopic examination of cerebrospinal fluid remains the most practical and accurate method for identifying the etiologic basis of bacterial (and fungal) meningitis. Am J Med, 1983 Jul 28, 75(1B), 85 - 92 Urine as an antigen reservoir for diagnosis of infectious diseases; Coonrod JD; Soluble or particulate microbial antigens are excreted in the urine in many systemic infectious processes . The ease with which urine antigens can be concentrated has facilitated their detection by immunologic methods . The group and type-specific bacterial polysaccharides are among the best studied examples of urinary excretion of microbial antigens . These polysaccharides are often present in the urine as low molecular weight fragments (70,000 daltons or less) and in some instances may represent degradation products of the native polysaccharides . Urine polysaccharides are sufficiently immunoreactive to be detectable by simple precipitin and agglutination techniques in a large percentage of patients with infections due to certain pyogenic bacteria including Haemophilus influenzae and group B streptococci . Both polysaccharide and protein antigens have been detected in the urine by immunologic methods in numerous other infections including parasitic, viral, and spirochetal diseases . Detection of a thermostable antigen in the urine of patients with Legionnaires' disease by radio- and enzyme-linked immunoassays represents an important recent advance . The exact role of immunologic tests for etiologic diagnosis in infectious diseases is not established, but will undoubtedly be influenced by developments such as monoclonal antibody technology and better availability of standardized immunologic reagents. J Clin Microbiol, 1983 Jul, 18(1), 49 - 55 Relationships between virulence and morphological or serological properties of variants dissociated from serotype 1 Haemophilus paragallinarum strains; Sawata A et al.; Relationships between morphological or serological properties and virulence were investigated in seven Haemophilus paragallinarum variants . The variants, originated from five serotype 1 strains, were classified into seven types on the basis of colony morphology and iridescence and the presence of variant-specific antigens . Smooth (S) and encapsulated organisms having variant-specific antigens and forming highly iridescent (ir+) colonies were highly virulent in vivo; slightly encapsulated organisms having variant-specific antigens and forming slightly iridescent (ir +/-) colonies were moderately virulent; and nonencapsulated or slightly encapsulated organisms with or without variant-specific antigens and forming noniridescent (ir-) or ir +/- colonies were avirulent . Virulence was well correlated with the amount of capsule substance containing hyaluronic acid . The evidence suggests that the presence of variant-specific agglutinogen L and hemagglutinin HA-L seem to be responsible for adherence or colonization, but not for virulence, of the organisms in chickens. Can J Comp Med, 1983 Jul, 47(3), 304 - 8 Haemophilus somnus: a comparison among three serological tests and a serological survey in beef and dairy cattle; Sanfacon D et al.; Serological tests for the detection of antibodies against Haemophilus somnus were carried out in herds of beef and dairy cattle using three different techniques: agglutination, complement fixation and counterimmunoelectrophoresis . The agglutination test appeared to detect more seroreactors than the complement fixation and counterimmunoelectrophoresis tests . Results of the three tests indicated that there were more positive reactors in beef cattle and dairy cattle from infected herds than in dairy cattle from clinically normal herds. Rev Infect Dis, 1983 Jul-Aug, 5 Suppl 3, S565 - 72 Short-course and single-dose antimicrobial therapy for chancroid in Kenya: studies with rifampin alone and in combination with trimethoprim; Plummer FA et al.; Tetracyclines and sulfonamides are no longer effective for the treatment of chancroid in many parts of the world . Rifampin and trimethoprim both possess in vitro activity against Haemophilus ducreyi, the causative agent of chancroid . In a randomized, controlled study, 22 patients with H . ducreyi-positive genital ulcers received 600 mg of rifampin once daily for three days, and 32 patients received 600 mg of rifampin plus 160 mg of trimethoprim once daily for three days . Both regimens rapidly eradicated H . ducreyi from ulcers, with subsequent healing of ulcers and buboes . Two relapses of ulcers and one therapeutic failure were observed in the rifampin-trimethoprim group, whereas no relapses or failures were noted in the rifampin group . In addition, all of 16 H . ducreyi-negative ulcers responded rapidly to treatment with either regimen . In an uncontrolled, open study, 22 H . ducreyi-positive ulcers were treated with a single dose of rifampin (600 mg) plus trimethoprim (160 mg) . Ulcers and buboes resolved by day 14 in all but one patient . Thus, these short-course and single-dose regimens are effective against chancroid. J Infect, 1983 Jul, 7(1), 21 - 30 Eight hundred and seventy-five cases of bacterial meningitis . Part I of a three-part series: clinical data, prognosis, and the role of specialised hospital departments; Bohr V et al.; Between 1966 and 1976, 875 patients with bacterial meningitis were treated at the Department of Infectious Diseases, Rigshospitalet . Among 495 patients admitted directly to the department, fatality rates were 0.4 per cent for meningococcal infections (including septicaemia), 3.7 per cent for haemophilus meningitis and 8.7 per cent for pneumococcal meningitis . The total fatality rate for directly admitted patients was 3.8 per cent, and 4.0 per cent had sequelae on discharge . Patients transferred from other hospitals often had complications, and their fatality rate (20.1 per cent) was markedly higher than that for directly admitted patients, but not significantly higher than that for patients treated elsewhere in Denmark (17.6 per cent) . The low fatality at a specialised unit may reflect an open and swift admission procedure and the preparedness of staff familiar with the management of meningitis . During the first five years after discharge, the relative death risk was increased among meningitis patients but later declined to that found in the general population. Rev Infect Dis, 1983 Jul-Aug, 5(4), 680 - 91 Cardiobacterium hominis: review of microbiologic and clinical features; Wormser GP et al.; Cardiobacterium hominis, like other fastidious, opportunistic gram-negative bacilli, including Actinobacillus actinomycetemcomitans, Haemophilus aphrophilus, and Eikenella corrodens, is increasingly recognized as a cause of human disease . In this review the microbiologic and clinical features of C . hominis are discussed . The findings are based on observations of two infected patients (the case history of one was reported previously) and on reports in the literature of 32 others . Microbiologically, the chief distinguishing features of C . hominis are its characteristic colonial morphotype and its production of indole . Infection with C . hominis is clinically distinctive because of its chronic course (averaging 169 days among patients with endocarditis), the absence of documented infection outside of the bloodstream, and the high degree of responsiveness to treatment with penicillin. Rev Infect Dis, 1983 Jul-Aug, 5 Suppl 3, S549 - 55 Rifampin alone and in combination with trimethoprim in chemoprophylaxis for infections due to Haemophilus influenzae type b; Glode MP et al.; The efficacy of rifampin in eradicating Haemophilus influenzae type b from the pharynx of colonized individuals was assessed for 1,467 close contacts of 291 children hospitalized with invasive infections due to H . influenzae type b . Twenty-six percent of all contacts were carrying H . influenzae type b in the pharynx, and 52% of contacts younger than age five had throat cultures positive for this organism . Four different regimens of rifampin were studied and compared with placebo for efficacy in eradication of carriage of H . influenzae type b . The most effective dosage was 20 mg of rifampin/kg given once daily for four days . This schedule was associated with eradication of carriage in 96.2% of 52 colonized, compliant contacts . Carriage of H . influenzae type b was eradicated in 90.9% of the 22 colonized contacts who were younger than age five . Significantly lower rates of carriage eradication were seen with other regimens of rifampin . Potential problems associated with widespread rifampin usage are reviewed. Microbiologica, 1983 Jul, 6(3), 251 - 4 Incidence and antibiotic susceptibility of Haemophilus influenzae in clinical specimens; Speciale AM et al.; Recent data report increasing Haemophilus influenzae ampicillin- and chloramphenicol-resistant strains . Authors report the results of one year investigation in Sicily . In 281 clinical specimens tested, Haemophilus influenzae has been isolated in 60 cases . From antibiotic susceptibility tests it can be observed that 58 strains show ampicillin-resistance. Pediatrics, 1983 Jul, 72(1), 93 - 8 Bacterial infection and splenic reticuloendothelial function in children with hemoglobin SC disease; Buchanan GR et al.; Although the epidemiology and pathophysiology of serious bacterial infection in homozygous sickle cell anemia (SS disease) have become increasingly well understood, information about infection risk and splenic reticuloendothelial function in hemoglobin SC disease is quite limited . Therefore, the type and frequency of invasive bacterial disease were examined in 51 children with SC disease followed for 370 person-years and splenic function was assessed in 31 patients by quantitation of pitted erythrocytes . Seven serious bacterial infections occurred in four of the patients, five due to Streptococcus pneumoniae and two to Haemophilus influenzae . A primary focus of infection was present in all episodes, none of which proved fatal . Although 30 episodes of pneumonia or chest syndrome occurred in 20 of the patients, a bacterial etiology was proven in only three instances . Splenic function was usually impaired, with a mean pit count of 7.1% +/- 8.2% (range 0% to 22.9%) . This is significantly greater than normal, but less than pit counts in patients with SS disease or asplenic subjects . Children with SC disease may have a greater risk of bacterial infection than normal children, but their infection rate is not nearly as high as that in patients with SS disease. Infect Immun, 1983 Jul, 41(1), 285 - 93 Induction of active immunity with membrane fractions from Haemophilus influenzae type b; Burans JP et al.; Using Escherichia coli strain E-1 as a model, we developed procedures for the preparation of outer- and inner-membrane-enriched fractions as structural units . These procedures could be used to prepare relatively pure inner and outer membrane fractions as determined by succinate dehydrogenase activity, ketodeoxyoctonate levels, and polyacrylamide gradient gel electrophoresis . The use of these procedures to fractionate membrane components from Haemophilus influenzae type b strains H-2 and H-E led to good separation of outer- and inner-membrane-enriched fractions as determined by succinate dehydrogenase and ketodeoxyoctonate levels but incomplete separation as determined by polyacrylamide gradient gel electrophoresis . Although there were differences between the electrophoresis profiles of outer membrane fractions of strains H-2 and H-E, immunization with outer membrane of either strain led to the induction of a high degree of immunoprotection against challenge with the H-2 strain . Protection could also be elicited with inner membrane preparations, but such protection may be due to contamination with outer membrane . Extracted membrane protein induced levels of protection that were comparable to those induced by whole membrane fractions. Infect Immun, 1983 Jul, 41(1), 280 - 4 Pathogenesis of bloodstream invasion with Haemophilus influenzae type b; Rubin LG et al.; Possible route(s) by which encapsulated bacteria invade the blood from the nasopharynx include (i) the direct invasion of submucosal blood vessels and (ii) clearance via lymphatics to regional nodes followed by bloodstream invasion . These possibilities were investigated in rats after intranasal inoculation with 10(5) Haemophilus influenzae type b . Within 24 h of inoculation, 10 of 42 rats with sterile blood cultures had similar numbers of H . influenzae b recovered from both cervical (local) and periiliac (distant) lymph nodes, which suggested early bacteremic spread . When virtually continuous blood cultures were obtained for 30 min after inoculation with 10(8) H . influenzae b, early transient bacteremia was documented in four of eight rats . Also, we found no significant difference in bacteremia among rats whose cervical lymph nodes had been removed surgically compared with sham-operated rats . These findings favor the hypothesis of a rapid, perhaps direct invasion of pharyngeal blood vessels as an initial determinant of the systemic spread of H . influenzae b. J Infect Dis, 1983 Jul, 148(1), 75 - 81 Homogeneity of cell envelope protein subtypes, lipopolysaccharide serotypes, and biotypes among Haemophilus influenzae type b from patients with meningitis in The Netherlands; van Alphen L et al.; Eighty strains of Haemophilus influenzae type b were randomly selected from 531 strains collected between 1975 and 1982 from patients with meningitis in The Netherlands . Subtyping by sodium dodecyl sulfate-polyacrylamide gel electrophoresis revealed that 67 of 80 isolates had identical major outer membrane protein patterns (subtype 1) . Among the 13 other isolates four different polyacrylamide gel electrophoresis patterns were observed, two of which closely resembled subtype 1 . Lipopolysaccharides were characterized immunologically by immunoprecipitation (Ouchterlony technique) and the gel-immuno-radio-assay . Four serotypes were found among the 80 selected strains, leaving one strain not typable . Seventy-four strains (93%) belonged to the same lipopolysaccharide serotype; 77 (97%) of 80 of the strains belonged to biotype I . Sixty strains (75%) had identical major outer membrane protein patterns (subtype 1), lipopolysaccharide serotypes (serotype 1), and biotypes (I). J Clin Pathol, 1983 Jul, 36(7), 819 - 22 Comparison of Phadebact coagglutination tests with counterimmunoelectrophoresis for the detection of bacterial antigens in cerebrospinal fluid; Tompkins DS; One hundred and seventeen specimens of cerebrospinal fluid from 94 patients were examined for the presence of pneumococcal and Haemophilus influenzae type b antigens using counterimmunoelectrophoresis and coagglutination tests . The coagglutination method using Phadebact reagents was as sensitive as counterimmunoelectrophoresis, but culture was a more sensitive diagnostic procedure than either test . A meningococcus coagglutination reagent, included in a prototype meningitis diagnostic kit, was also found to be as sensitive as counterimmunoelectrophoresis when tested on culture-positive cerebrospinal fluid specimens . Coagglutination tests for the detection of bacterial antigen are useful supportive tests when used in conjunction with direct microscopy and culture for bacterial pathogens. Infect Immun, 1983 Jul, 41(1), 19 - 27 Serology of oral Actinobacillus actinomycetemcomitans and serotype distribution in human periodontal disease; Zambon JJ et al.; Actinobacillus actinomycetemcomitans from the human oral cavity was serologically characterized with rabbit antisera to the type strain NCTC 9710; a number of reference strains, including Y4, ATCC 29522, ATCC 29523, ATCC 29524, NCTC 9709; and our own isolates representative of each of 10 biotypes . Using immunoabsorbed antisera, we identified three distinct serotypes by immunodiffusion and indirect immunofluorescence . Serotype a was represented by ATCC 29523 and SUNYaB 75; serotype b was represented by ATCC 29522 and Y4; and serotype c was represented by NCTC 9710 and SUNYaB 67 . Indirect immunofluorescence revealed no reaction between the three A . actinomycetemcomitans serotype-specific antisera and 62 strains representing 23 major oral bacterial species . Distinct from the serotype antigens were at least one A . actinomycetemcomitans species common antigen and an antigen shared with other Actinobacillus species, Haemophilus aphrophilus, and Haemophilus paraphrophilus . All serotype a A . actinomycetemcomitans strains failed to ferment xylose, whereas all serotype b organisms fermented xylose . Serotype c included xylose-positive as well as xylose-negative strains . A total of 301 isolates of A . actinomycetemcomitans from the oral cavity of 74 subjects were serologically categorized by indirect immunofluorescence with serotype-specific rabbit antisera . Each patient harbored only one serotype of A . actinomycetemcomitans . Fourteen healthy subjects, five diabetics, and seventeen adult periodontitis patients exhibited serotypes a and b in approximately equal frequency, whereas serotype c was found less frequently . In contrast, in 29 localized juvenile periodontitis patients, the incidence of serotype b was approximately two times higher than that of serotypes a or c, suggesting a particularly high periodontopathic potential of A . actinomycetemcomitans serotype b strains . In subjects infected with A . actinomycetemcomitans, serum antibodies were detected to the serotype antigens, indicating that these antigens may play a role in the pathogenesis of periodontal disease. Jpn J Antibiot, 1983 Jul, 36(7), 1785 - 805 {Pharmacological evaluation of an ampicillin suppository (KS-R1) in acute pneumonia in children--a comparison with a parenteral preparation of ampicillin}; Motohiro T et al.; A comparative well-controlled study was performed to evaluate the efficacy and tolerability of KS-R1 (ampicillin (ABPC) rectal suppository) compared with those of intravenous injection of ABPC against acute bacterial pneumonia caused by ABPC-sensitive bacteria, such as Streptococcus pyogenes, Streptococcus pneumoniae and Haemophilus influenzae in pediatric field . KS-R1 at the dose of 250 mg X 4/day of ABPC in potency, or the intravenous injection at the dose of 125 mg X 4/day of ABPC in potency, was given to 68 cases of patients with bacterial pneumonia, aged between 10 months and 8 years and 2 months, for 7 days, as a rule . The clinical efficacy rates evaluated in 61 cases (KS-R1 group in 31 cases, intravenous group in 30 cases) on standard criteria of committee members were 93.5% for the KS-R1 group and 83.3% for the intravenous group, respectively . There was no significant difference between 2 groups . Evaluation by stratification according to the age showed that KS-R1 was significantly superior, the rate being 90.5% among the children from 1 year to 3 years in the KS-R1 group and 61.5% in the intravenous group . The bacteriological effect was evaluated in 16 cases (KS-R1 group in 7 cases, intravenous group in 9 cases), the disappearance rate was 100% for the KS-R1 group and 88.9% for the intravenous group, without significant difference . With regard to side effects, 66 cases (KS-R1 group in 35 cases, intravenous group in 31 cases) were strictly evaluated in relation to subjective and objective symptoms . As a result, no significant difference was noted between 2 groups in the incidence rate which was 17.1% for the KS-R1 group and 9.7% for the intravenous group . The above results indicate that against acute bacterial pneumonia in pediatric field, the KS-R1 at the dose of 250 mg X 4/day of ABPC in potency possesses clinical efficacy and safety similar to the intravenous injection at the dose of 125 mg X 4/day of ABPC in potency, and that it is a useful suppository. Jpn J Antibiot, 1983 Jul, 36(7), 1769 - 84 {Pharmacological evaluation of an ampicillin suppository (KS-R1) in acute respiratory tract infection in children: a comparison with an oral form of ampicillin}; Nishimura T et al.; A comparative well-controlled study was performed to evaluate the efficacy and tolerability of ampicillin rectal suppository (KS-R1) compared with those of oral form of ampicillin (ABPC) against acute respiratory tract infections in pediatric field . KS-R1 at the dose of 125 mg X 4/day of ABPC in potency, or the oral form at the same dosage, was given to 166 cases of patients with acute respiratory tract infection due to Streptococcus pyogenes, Streptococcus pneumoniae or Haemophilus influenzae for 7 days, as a rule . The clinical efficacy rates evaluated in 151 cases (KS-R1 group in 77 cases, oral group in 74 cases) on standard criteria of committee members were 88.3% for the KS-R1 group and 86.5% for the oral group, respectively . There was no significant difference between 2 groups . Evaluation by stratification according to the diagnosis showed that the efficacy rates for the KS-R1 group and for the oral group were 87.5% and 85.0% against pharyngitis, 90.5% and 90.0% against tonsillitis and 84.2% and 78.6% against bronchitis, respectively . None of them showed significant difference between 2 groups . The bacteriological effect was evaluated in 55 cases (KS-R1 group in 33 cases, oral group in 22 cases), and disappearance rate was 93.9% for the KS-R1 group and 95.5% for the oral group, showing no significant difference . Side effect including subjective and objective symptoms were strictly evaluated in 163 cases (KS-R1 group in 83 cases, oral group in 80 cases), but the incidence rate which was 22.9% for the KS-R1 group and 23.8% for the oral group showed no significant difference . The above results indicate that against acute respiratory tract infections in pediatric field, KS-R1 possesses clinical efficacy and safety similar to the oral form of ABPC, and that it is a useful suppository. J Antimicrob Chemother, 1983 Jul, 12 Suppl A, 325 - 9 Experience with ceftazidime in cystic fibrosis; Dodge J et al.; Twelve adults and children with cystic fibrosis received a total of 17 courses of ceftazidime for the treatment of an acute exacerbation of respiratory tract infection . In 6 cases ceftazidime was given as the sole antibiotic . All patients who were clinically assessable were considered to be cured of the acute infection, or improved . Bacteriologically all initial sputum specimens contained Pseudomonas aeruginosa . In 13 instances the organism disappeared during treatment, while in the other 4 the organism remained although the patients improved clinically . Additional organisms, usually Staphylococcus aureus or Haemophilus influenzae, were present in 7 instances . One patient suffered from nausea, palpitations and local skin inflammation on injection whilst being treated with ceftazidime, but the relationship between these adverse effects and ceftazidime was uncertain . The patient tolerated these effects without discontinuation of the drug. J Clin Microbiol, 1983 Jul, 18(1), 143 - 5 Dilution technique for isolation of Haemophilus from swine lungs collected at slaughter; Pijoan C et al.; A total of 307 lungs obtained from a slaughterhouse were cultured by a dilution technique for the isolation of Haemophilus spp . The technique consisted of performing serial (10-fold) dilutions of the tissue samples to a dilution of 10(-5) . Two selective media were used . L broth consisted of a basal brain heart infusion broth containing 5% horse serum, 5% yeast extract, and 100 micrograms of NAD and 0.5 microgram of lincomycin per ml . L-B broth was identical to L broth, except 1.5 microgram of bacitracin per ml was included . The broths were incubated overnight and then plated onto blood agar . A total of 83 (27%) isolates were obtained, and both media proved to be necessary, as a proportion of isolates grew in one of the media employed but not in the other . Of the isolates, 66.3% were urease positive and most of these (98%) were classified as "minor group" strains . Urease-negative strains (27.7%) were classified as Haemophilus parasuis. Medicine (Baltimore), 1983 Jul, 62(4), 195 - 208 The hyperimmunoglobulin E recurrent-infection (Job's) syndrome . A review of the NIH experience and the literature; Donabedian H et al.; The hyperimmunoglobulin E recurrent-infection syndrome (HIE) entails a disorder of recurrent bacterial infections of the skin and sinopulmonary tract commencing in infancy or early childhood in the presence of serum levels of IgE which are at least 10 times normal (greater than 2,000 IU/ml) . Variable concomitants of HIE are coarse facies, chronic eczematoid rashes, cold cutaneous abscesses, mild eosinophilia, mucocutaneous candidiasis, and a neutrophil chemotactic defect . The bacteria which commonly infect these patients are Staphylococcus aureus and Haemophilus influenzae although Streptococcus pneumoniae and enteric gram-negative rods are seen in some cases . Other than pneumonias, deep-seated infections are unusual, although osteomyelitis, arthritis, and visceral abscesses are seen . Bacteremia and sepsis are rare . Therapy should involve prolonged intravenous antibiotics and early surgery to treat infections which usually seem deceptively benign . HIE patients' neutrophils display a variable chemotactic defect, and their mononuclear cells variably produce an inhibitor of neutrophil chemotaxis . The production of the inhibitor correlates with the in vitro chemotactic defect . The basis of the propensity for recurrent infections is still speculative, and the further study of this syndrome should add new dimensions to our understanding of host defenses against bacterial invaders. J Bacteriol, 1983 Jul, 155(1), 443 - 6 Lactoperoxidase and Iodo-Gen-catalyzed iodination labels inner and outer membrane proteins of Haemophilus influenzae; Loeb MR et al.; Both inner and outer membrane proteins of Haemophilus influenzae type b were labeled by iodination procedures believed to be specific for exposed surface proteins only . It is suggested that this is due to specific properties of the outer membrane of H . influenzae and that use of these procedures with other gram-negative bacteria be evaluated carefully. J Antimicrob Chemother, 1983 Jul, 12 Suppl A, 297 - 311 Alternative antibiotics for the treatment of Pseudomonas infections in cystic fibrosis; Mastella G et al.; We have investigated the effectiveness of seven new beta-lactam antibiotics, azlocillin, piperacillin, ceftazidime, cefsulodin, cefoperazone, latamoxef (moxalactam), and cefotaxime, against acute pulmonary exacerbations caused by Pseudomonas aeruginosa in cystic fibrosis . Three hundred and fifty-five strains of Ps aeruginosa isolated from 310 sputum cultures (190 cystic fibrosis patients) were tested for susceptibility to the drugs by determination of minimal inhibitory concentrations (MIC) . The highest activity was shown by ceftazidime (6% resistant strains) followed by cefsulodin and piperacillin (15 and 16% resistant strains); very low activity was found for cefotaxime and latamoxef (moxalactam) . Ceftazidime was the most active drug against 32 pseudomonas isolates that were resistant to both carbenicillin and aminoglycosides (78% susceptible) . A randomized, double-blind trial of azlocillin, piperacillin, ceftazidime, cefsulodin or cefoperazone was performed in 111 cystic fibrosis patients with predominant and susceptible pseudomonas in their sputum . Results were evaluated by a clinical, radiological and bacteriological scoring system: the best results were obtained with ceftazidime, followed by cefsulodin and piperacillin . However, pseudomonas was eradicated in only 22 (23%) of the cases with the most active drugs and persisted or reappeared in all the cases 1 to 3 months later . Ceftazidime always eradicated Staph . aureus and Haemophilus influenzae associated with pseudomonas . Similar eradication occurred nearly always with cefsulodin but rarely with the other drugs . No serious drug reaction occurred but a later fever and rash with piperacillin, transient diarrhoea with cefoperazone, vomiting with cefsulodin, and very frequent eosinophilia with ceftazidime should be mentioned . These five drugs offer, in varying degree, alternatives to traditional anti pseudomonas antibiotics in cystic fibrosis pulmonary infections, but they should be used only against well-proven resistant strains . Ceftazidime is best and cefotaxime and latamoxef (moxalactam) least useful. Pediatrics, 1983 Jul, 72(1), 118 - 21 New Haemophilus influenzae type b control strategy: premature commitment to prophylaxis? Mann JM, Hull HF. Recent promulgation of an official policy on prevention of secondary cases of Haemophilus influenzae type b disease illustrates the challenges and frustrations inherent in the policy-making process . Despite evidence that H influenzae type b disease is "contagious" in households and probably also in day care centers and despite demonstration that rifampin eradicates nasopharyngeal H influenzae type b carriage, the single field study of rifampin use to prevent secondary cases of H influenzae type b disease remains unpublished and has yet to receive broad critical scrutiny . Promulgation of the rifampin strategy prior to publication of this critical study is unfortunate, as public and private providers are now committed to a policy that will be difficult to evaluate or alter . Now that the strategy has been issued, the central question regarding rifampin prophylaxis has changed from "Is this strategy effective?" to "Can this strategy be shown to be ineffective?" When policies are issued prior to publication of key supporting data, or when such studies are either missing or highly controversial, the policy-making committee might publish, along with its recommendations, explicit criteria for continuation, modification, or withdrawal of the new policy . This structured reassessment approach could accommodate the critical need to proceed with disease control recommendations--even though based on incomplete information--yet underscore the policy's tentative nature and provide direction for future assessment and study. J Bacteriol, 1983 Jul, 155(1), 246 - 53 DNA-binding proteins of Haemophilus influenzae: purification and characterization of a major intracellular binding protein; Sutrina SL et al.; A heat- and acid-stable protein which bound both native and denatured DNA but not RNA was extensively purified from extracts of Haemophilus influenzae Rd strain com-58-A . The active species had an apparent subunit molecular weight of 15,000 . The interaction of the protein with denatured DNA appeared to be cooperative, as judged by the sigmoid shapes of binding curves . This cooperativity increased with increasing ionic strength and was more pronounced with sodium ions than with potassium ions . Gel filtration suggested that the native protein formed aggregates in solution . The presence of the binding protein protected single-stranded DNA from the action of S1 endonuclease; approximately 30 nucleotide residues were protected per subunit equivalent of protein . The number of subunit equivalents per cell of this protein has been estimated at 10,000 . The protein, which we designate DNA-binding protein II, is most probably a major histone-line protein of H . influenzae. Comput Radiol, 1983 Jul-Aug, 7(4), 243 - 9 CT evaluation of Haemophilus influenzae meningitis with clinical and pathologic correlation; Centeno RS et al.; Ten proven cases of Haemophilus influenzae meningitis have been reviewed, in which all had CT scans during their first 3 weeks of illness . An attempt was made to correlate the neuropathologic basis of the disease with the CT findings . Progression of the CT changes with the course of illness and treatment is emphasized . Usual indications for CT imaging of the brain in patients with meningitis are: detection of subdural empyema or effusion, hydrocephalus, infarct, cerebritis and abscess . Widespread cerebral damage can be more fully evaluated with iodine contrast infusion if clinically indicated . CT scanning has proven to be a valuable indicator of such complications and useful predictor of clinical recovery or residual neurologic sequelae. Sem Hop, 1983 Jun 16, 59(24), 1819 - 21 {Microbiological diagnosis of epiglottitis}; Geslin P et al.; Forty patients, between July 1977 and April 1982, with clinical diagnosis of epiglottitis were studied for the presence of capsular antigen by counter-immunoelectrophoresis (CIE) and for positive blood culture . Blood culture was positive, for Haemophilus influenzae only, in 15 patients . Haemophilus influenzae type b antigen was present in blood and/or urine of 25 patients (blood 14 patients, urine 18 patients) . CIE associated with blood culture give conclusive proofs of Haemophilus influenzae etiology in 30 patients. Lancet, 1983 Jun 4, 1(8336), 1241 - 4 Ceftriaxone versus ampicillin and chloramphenicol for treatment of bacterial meningitis in children; del Rio MA et al.; 78 patients with bacterial meningitis were evaluated in a prospective, randomised study comparing twice-daily ceftriaxone as single-drug therapy with ampicillin and chloramphenicol given every 6 h . The groups were comparable in age, sex, days of illness before admission, and bacterial colony counts in cerebrospinal fluid (CSF) . The pathogens were Haemophilus influenzae type b (54 cases), streptococci (9 cases), meningococci (9 cases), and unknown (6 cases) . In 40 CSF specimens obtained 4-12 h after initiation of therapy, cultures were negative in 57% of the ceftriaxone patients and in 42% of the others . The mean falls in the CSF bacterial colony counts were 4.7 and 5.0 log10 colony-forming units/ml, respectively . Mean bactericidal activity in CSF was significantly greater in the ceftriaxone than in the conventional treatment group at the beginning and end of therapy . There were no significant differences in clinical responses or in frequency of complications, except for mild diarrhoea, which occurred in 16 ceftriaxone patients and in 8 in the other group (p less than 0.05). Sem Hop, 1983 Jun 2, 59(22), 1665 - 7 {Haemophilus influenzae in respiratory pathology in adults}; Lemenager J et al.; Fifty patients were diagnosed bronchopulmonary Haemophilus infections, because of the production of a purulent sputum, containing at least 10(8) Haemophilus influenzae per ml . Among them were 36 males (average 52 years old) and 14 females (average 58 years old) . There was a high percentage (64%) of smokers (over 30 packs/year) within this population, which also included heavy drinkers . The top incidence occurred in winter and spring . Most cases were related to an acute infection in a chronic bronchitis (26 cases) . The other cases included 6 cancers, 6 sequelae of tuberculosis, 4 bronchiectasis, 4 asthma, and only 3 pulmonary consolidations . There usually was a low grade fever (only 8 cases reached or went beyond 38 degrees, while in 29 cases the body temperature kept below 38 degrees) . The return to a normal temperature was obtained after 4 to 10 days of ampicillin therapy, with no fatal case within this series . The 50 strains were studied by the microbiology laboratory . The minimum inhibitory concentrations showed an elective response to ampicillin and erythromycin, and a less dramatic response to chloramphenicol and tetracyclin . Some strains were proved resistant (MIC over 4 micrograms per ml) to cefoxitin and cefamandole. J Clin Microbiol, 1983 Jun, 17(6), 958 - 64 Serological classification of Haemophilus paragallinarum with a hemagglutinin system; Kume K et al.; Antigens, prepared from 17 strains of Haemophilus paragallinarum by treatment with potassium thiocyanate followed by sonication, uniformly agglutinated glutaraldehyde-fixed chicken erythrocytes and formed specific hemagglutination inhibition antibodies in rabbits . Attempts were made to classify the strains into serotypes by a combination of cross-hemagglutination inhibition and cross-absorption tests, using the hemagglutinating antigens, designated as HA-L hemagglutinin, and their antisera . The cross-hemagglutination inhibition tests showed the existence of three distinct groups among the 17 strains . Further cross-absorption studies indicated that two of the three groups could be subdivided into three serotypes each, forming a total of seven serotypes, designated HA-1 through HA-7 . Classification based on the serotype-specific HA-L system was found to be superior in its wider and more clearly defined specificities to other previous classifications, which are based on the agglutination test . There appeared to be a correlation between serotypes and geographic origins of the strains. Br J Exp Pathol, 1983 Jun, 64(3), 268 - 76 Opsonization and phagocytosis of Haemophilus influenzae type B organisms by mouse polymorphonuclear leucocytes and antiribosomal serum; Katz MA et al.; Sera from rabbits immunized with ribosomes passively protect mice challenged with Haemophilus influenzae type b . The protective antibody interacted with organisms in the blood and possibly at the sites of dissemination, but not at the site of inoculation . Macrophages did not phagocytize oposonized bacteria in our system . However, immune serum enhanced phagocytosis and intracellular killing by polymorphonuclear leucocytes (PMN) by reducing viable counts by 77 to 93% and 35 to 50%, respectively . There was a strong correlation between opsonizing activity and passive protection in immune and normal serum . Inactivation of complement significantly reduced the opsonizing activity of the immune serum . A significant portion of the protection associated with the immune serum is localized in the IgM fraction . Immune serum, depleted of IgG, enhanced phagocytosis to a degree similar to intact immune serum . However, immune serum depleted of IgM, opsonized bacteria to the same degree as normal serum . Therefore, the immune component of serum responsible for protection and opsonization appears to be localized in the IgM fraction . These data indicate that protection induced by antiribosomal antibodies results from an interaction with the cell surface of H . influenzae organisms, leading to increased phagocytosis by PMN. J Clin Microbiol, 1983 Jun, 17(6), 1177 - 9 Advantages of BACTEC hypertonic culture medium for detection of Haemophilus influenzae bacteremia in children; La Scolea LJ Jr et al.; The hypertonic and aerobic culture media in the BACTEC system were compared for the detection of Haemophilus influenzae bacteremia in children . Of 1,611 blood cultures, 30 were positive for this pathogen . The aerobic and hypertonic media gave positive results in 28 and 29 cultures, respectively . Within the first 12 h, H . influenzae was detected in the hypertonic medium in 48.5% of the positive cultures as compared to 35% for the aerobic medium . Importantly, after the first 12 h, the hypertonic medium yielded positive results sooner than did the aerobic medium, the difference being statistically significant (P less than 0.01) . The hypertonic medium yielded positive results earlier than the aerobic medium in nine cultures; the reverse was seen in only one culture . Furthermore, the aerobic medium gave negative growth index readings despite growth, as shown by microscopy and subculture, in 43% of the total cultures in contrast to only 13% for the hypertonic medium, a significant difference (P less than 0.05) . Thus, the present study indicates a distinct advantage of hypertonic medium compared with aerobic medium in the automated BACTEC system for earlier detection of