Haemophilus

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 H . influenzae bacteremia and is recommended for those age groups in which this pathogen plays a predominant role.

J Clin Microbiol, 1983 Jun, 17(6), 1163 - 5
Selective media for recovery of Haemophilus influenzae from specimens contaminated with upper respiratory tract microbial flora; Chapin KC et al.; Isolation of Haemophilus influenzae from specimens contaminated with upper respiratory tract microbial flora was attempted with three different media: enriched chocolate agar, chocolate agar plus vancomycin, and chocolate agar plus vancomycin, bacitracin, and clindamycin . Recovery rates of H . influenzae from 852 pediatric pharyngeal swab specimens were 6.0, 28.5, and 59.9%, respectively.

J Clin Microbiol, 1983 Jun, 17(6), 1005 - 8
Comparison of Phadebact coagglutination, Bactogen latex agglutination, and counterimmunoelectrophoresis for detection of Haemophilus influenzae type b antigens in cerebrospinal fluid; Collins JK et al.; Cerebrospinal fluid specimens from patients with suspected meningitis were screened with the Phadebact Haemophilus Test (Pharmacia Diagnostics), with Bactogen (Wampole Laboratories), and by counterimmunoelectrophoresis . With culture-positive fluids, Phadebact coagglutination detected 95%, Bactogen latex agglutination detected 91%, and counterimmunoelectrophoresis detected only 79% . Both agglutination techniques were 25-fold more sensitive than counterimmunoelectrophoresis when tested with dilutions of positive fluids . To obtain specific reactions with the Phadebact reagents it was necessary to heat treat (95 degrees C, 5 min) the fluid; with Bactogen and counterimmunoelectrophoresis this was not necessary.

Pediatrics, 1983 Jun, 71(6), 927 - 31
Is there an increased risk of Haemophilus influenzae septicemia in children with sickle cell anemia?
Powars D, Overturf G, Turner E.
The risk of Haemophilus influenzae septicemia/meningitis to children who have sickle cell anemia (SS) has been determined to be greater than that seen among normal infants . Of ten bacteriologically proven cases, eight episodes of infection were observed among 234 children with sickle cell anemia (645 person-years), who were less than 5 years of age . There was one case per 69 infants with sickle cell anemia who were less than 18 months old and one case per 36 children with sickle cell anemia between 19 and 59 months of age . Unexpectedly, two infections occurred among 224 children (824 person-years), aged 5 to 9 years; both died . Contrary to the rapid clinical course of pneumococcal infections in children with sickle cell anemia H influenzae septicemia was regularly heralded by a greater than 24-hour prodrome of upper respiratory tract infection, low-grade fever, and otitis media . Three (30%) preventable deaths occurred . Antibiotic therapy for the febrile child with sickle cell anemia must be predicated on the known 400-fold increased risk of pneumococcal septicemia in those less than 5 years old and the fourfold risk of H influenzae septicemia in those less than 9 years of age.

J Pediatr, 1983 Jun, 102(6), 820 - 4
Nosocomial spread of Haemophilus influenzae type b infection documented by outer membrane protein subtype analysis; Barton LL et al.; This report provides evidence of nosocomial transmission of Haemophilus influenzae type b infection between two children in an acute care hospital . In the past, transmission of infection between these children would have gone unrecognized, because the isolates from the respective cases differed in susceptibility to ampicillin . However, the outer membrane protein profile of the two isolates was identical and has previously been observed in less than 2% of type b Haemophilus isolates from patients with invasive disease in the St . Louis area . Thus the likelihood is very low that these two children were both infected with this strain by chance alone (P less than 0.0004) . From previous experience, the risk of transmission of Haemophilus in an acute care setting would appear to be very low . However, nosocomial transmission may occasionally occur.

Diagn Microbiol Infect Dis, 1983 Jun, 1(2), 95 - 106
Use of a bronchoscopic protected catheter technique in the clinical evaluation of a new antibiotic; Bass JB Jr et al.; We prospectively compared the usefulness of a bronchoscopic protected catheter technique with the results from sputum cultures in the evaluation of moxalactam, a new beta-lactam antibiotic . The significance of a given isolate on protected catheter culture was determined by quantitative bacteriology . 32 patients with community-acquired pneumonia were enrolled in the study and 31 grew common lower respiratory tract pathogens from their protected catheter specimen . The most common single pathogens recovered were Streptococcus pneumoniae (11 patients) and Haemophilus influenzae (2) . Mixed flora, predominantly anaerobes, were isolated from 15 patients, and 3 patients had mixed aerobic infections . All seven bacteremic cases had the identical organism isolated from the protected catheter specimen, confirming the accuracy of the technique . Comparisons with sputum cultures showed that the predominant organism on sputum culture was the same as that obtained from the protected catheter culture in only 13% of the cases . Sputum cultures revealed either no pathogen or a different pathogen in 23 cases, and no sputum could be obtained in 4 . Compared to cultures of expectorated sputum, we found the protected catheter bronchoscopic culture technique to have the following advantages in the bacteriologic evaluation of moxalactam: 1) greater accuracy and sensitivity in bacteremic patients; 2) accurate delineation of the bacteriology of infections; and 3) a higher percentage of patients with evaluable bacteriology leading to greater efficiency during the investigation.

Eur J Clin Microbiol, 1983 Jun, 2(3), 196 - 9
Potential significance of colonization with beta-lactamase-producing Haemophilus parainfluenzae in children; Scheifele DW et al.; Recent surveys in Vancouver showed most healthy children were colonized with beta-lactamase-producing Haemophilus parainfluenzae . Such organisms might alter the effects of penicillins on throat bacteria by local inactivation . To test this hypothesis in vitro, three isolates of beta-lactamase-producing Haemophilus parainfluenzae were each mixed on a membrane with ampicillin-sensitive strains of Haemophilus influenzae type b or group A Streptococcus pyogenes and exposed to ampicillin . When tested alone, susceptible strains were rapidly killed but when tested together with a beta-lactamase producer, they were protected, indicating efficient ampicillin degradation by Haemophilus parainfluenzae strains . If similar interactions occur in vivo, the effects of beta-lactams on throat bacteria could be significantly altered in the presence of beta-lactamase-producing Haemophilus parainfluenzae.

Am J Infect Control, 1983 Jun, 11(3), 79 - 82
Community-acquired bacterial pneumonia requiring admission to hospital; Klimek JJ et al.; Patients who develop bacterial pneumonia in the community often require admission to acute-care hospitals . Knowledge of the incidence of pneumonia due to different pathogens that are brought into an institution from the community may play a role in determining the patterns of infecting organisms responsible for hospital-acquired pneumonia . For 1 year, we prospectively reviewed the records of patients admitted to our 1000-bed community hospital with community-acquired bacterial pneumonia (CABP) . Patients had clinical signs and symptoms, positive radiologic findings, and pure cultures of potential pathogens from sputum, blood, pleural fluid, lung aspirate, lung biopsy, or transtracheal aspirate . Pneumonia due to Legionella pneumophila was diagnosed by serum indirect fluorescent antibody (IFA) titer greater than or equal to 1:256 and clinical signs and symptoms along with response to erythromycin . Of 204 patients with bacterial pneumonia, the following pathogens were implicated: Streptococcus pneumoniae, Haemophilus species, L . pneumophila, Staphylococcus aureus, Klebsiella pneumoniae, Escherichia coli, oral anaerobic bacteria, Psuedomonas aeruginosa, Serratia marcescens, and others . Most patients were more than 50 years of age and many had evidence of underlying pulmonary disease . The etiology of CABP may not be as predictable as in the past . Empiric antimicrobial therapy for CABP should include agents with activity against the pathogens prevalent in the community.

Pediatr Res, 1983 Jun, 17(6), 472 - 3
Viral enhancement of nasal colonization with Haemophilus influenzae type b in the infant rat; Michaels RH et al.; Infant rats infected with influenza A virus, Sendai (parainfluenza 1) virus or rat coronavirus were used to determine whether viral infection increases the intensity of nasal colonization with Haemophilus influenzae type b (HIB) . Intranasal inoculation of HIB in rats previously infected with each of these viruses resulted in nasal HIB titers at least 100-fold higher than those for controls during the first 2 wk after HIB inoculation, and as much as 10,000-fold higher during the first week . Children with cough, sneezing, or rhinorrhea could be effective disseminators of HIB if they were as heavily and persistently colonized as these virus-infected animals.

Biochim Biophys Acta, 1983 May 20, 740(1), 108 - 17
Correlation of enzyme-induced cleavage sites on negatively superhelical DNA between prokaryotic topoisomerase I and S1 nuclease; Shishido K et al.; Negatively superhelical pNS1 DNA with a molecular weight of 2.55 MDa (4 kbp) was found to contain 13 specific, unbasepaired sites that are sensitive to a single-strand-specific S1 nuclease cleavage . The S1-cleavage occurred once at these sites . In the absence of added Mg2+, the topoisomerase I purified from Haemophilus gallinarum formed a complex with the superhelical pNS1 DNA which has a hidden strand cleavage . Extensive proteinase K digestion of the complex led to cleavage of the DNA chain . Then the proteinase K-cleaved product was digested with S1, which can cut the opposite strand at the preexisting strand cleavage to generate unit-length linear DNA . Restriction endonuclease analysis of the linear DNA shows that the topoisomerase-induced cleavage occurred once at ten specific sites on the DNA . The topoisomerase caused mainly single-strand cleavage at these sites, but infrequently also caused double-strand cleavage at the same sites . Of interest is the fact that these sites considerably coincide with the S1-cleavable, unbasepaired sites.

Pediatr Infect Dis, 1983 May-Jun, 2(3), 222 - 4
Etiology and treatment of facial cellulitis in pediatric patients; Carter S et al.; By a retrospective chart review patients with buccal cellulitis were divided into groups with and without a probable portal of entry of infection at the time of diagnosis . Tooth abscesses or breaks in the skin were the usual portals of entry . Patients with a portal of entry were significantly older (P less than 0.001), had lower white blood cell counts on admission (P less than 0.01) and recovered more rapidly (P = 0.001) . Haemophilus influenzae type b was recovered only from those with no portal of entry . Staphylococcus aureus and Streptococcus pyogenes caused infection in both groups but were more frequent in those with a portal of entry . Bacteremia was proved only in the group with no portal, and H . influenzae b grew from 14 to 15 positive blood cultures . All cultures of cerebrospinal fluid yielded no growth . We suggest that patients with no portal of entry on presentation receive initial parenteral therapy for H . influenzae b and Gram-positive cocci . Our current regimen is a combination of a semisynthetic penicillinase-resistant penicillin such as oxacillin and chloramphenicol . Oxacillin alone is indicated for those with a break in the skin leading to infection, whereas penicillin is appropriate for patients with dental infection . This initial therapy should be altered depending upon culture results when available.

South Med J, 1983 May, 76(5), 587 - 9
Gnat sore eyes: seasonal, acute conjunctivitis in a southern state; Buehler JW et al.; In late summer 1981, a widespread outbreak of acute bacterial conjunctivitis occurred in southeast Georgia, affecting primarily grade-school children . This outbreak was similar to previously described seasonal conjunctivitis in the South . As suggested in previous studies, the eye gnat, Hippelates pusio, may serve as a mechanical vehicle in the transmission of the suspected causative agent, a possible Haemophilus species . The 1981 Georgia outbreak illustrates that "gnat sore eyes" is not obsolete and apparently can occur unpredictably during warm months in the southern states . Physicians and other health-care workers should be aware of the unique clinical and epidemiologic features of acute seasonal conjunctivitis.

Jpn J Antibiot, 1983 May, 36(5), 1103 - 8
{Susceptibility of clinically isolated Haemophilus influenzae to cephamycin antibiotics}; Deguchi K; Susceptibility of 100 clinical isolates of H . influenzae (84 beta-lactamase non-producing strains and 16 beta-lactamase producing strains) to 5 cephamycin antibiotics was studied in comparison with 3 reference antibiotics . In MIC90 against beta-lactamase non-producing strains, LMOX and ABPC were the most excellent, followed by T-1982, CTT, CTM, CMZ, CFX and CEZ . Against beta-lactamase producing strains, all the cephamycin antibiotics were as active as against beta-lactamase non-producing strains, whereas ABPC was extremely less active with the MIC90 of greater than 100 micrograms/ml . CTM and CEZ were about 1 tube less active than against beta-lactamase non-producing strains . Thus, it was confirmed that the cephamycin antibiotics were stable to beta-lactamase.

J Infect, 1983 May, 6(3), 269 - 72
Cellulitis in children caused by Haemophilus influenzae type b; Pedler SJ et al.; Of 31 episodes of invasive infection by Haemophilus influenzae capsular type b, occurring in children during a 26-month period, five (16 per cent) had cellulitis as the presenting feature . In four of the five patients bacteraemia was detected . This frequency of presentation is not reflected in reports in the British literature . Prompt recognition of this aetiology of cellulitis is important for effective chemotherapy.

Pediatr Infect Dis, 1983 May-Jun, 2(3), 193 - 8
Haemophilus influenzae type b disease after rifampin prophylaxis in a day care center: possible reasons for its failure; Murphy TV et al.; Five infants enrolled in a day care center (DCC) developed invasive disease due to Haemophilus influenzae type b during a 25-week period . The isolates from four patients had identical outer membrane proteins and were biotype 1 . Although rifampin prophylaxis was recommended on two different occasions, retrospective surveys demonstrated that 39 and 60%, respectively, of infants failed to receive the agent for various reasons . Pharyngeal cultures were obtained from infants, their families and DCC staff after prophylaxis was given the second time . Forty-seven % of DCC infants had positive cultures, and 59% of their households had at least one carrier of the invasive strain . Rifampin prophylaxis administered a third time to infants and members of their households was unsuccessful in eradicating the invasive Haemophilus influenzae type b strain from DCC infants . The possible reasons for failure of rifampin in this DCC outbreak included incomplete understanding by physicians and health department officials of the factors affecting a DCC outbreak of Haemophilus influenzae type b disease and failure properly to implement rifampin prophylaxis to all contacts and the index cases.

J Clin Microbiol, 1983 May, 17(5), 844 - 7
Naturally occurring antibodies in human sera that react with Haemophilus influenzae type b ribosomal vaccine; Lynn M et al.; Sera from populations of normal adults and children as well as sera from children with systemic Haemophilus influenzae type b disease were tested for antibodies reacting with ribosomes from H . influenzae type b . Adults generally had high titers of antibody, with 90% having titers greater than 1:64 . The distribution of titers approximated a normal curve . Among normal children, there was more variability between individual titers, with the median titers ranging between 1:64 and 1:128 . In contrast, acute-phase sera from children with systemic H . influenzae type b disease all had titers of 1:16 or less . Two convalescent-phase sera had high titers . Absorption experiments ruled out cross-reaction between ribosomes and type b capsular material . Ribosomes from two unrelated type b strains were completely cross-reactive, whereas absorption with ribosomes from a type c strain led to significantly decreased titers in three of four sera . Absorption of sera with ribosomes from Pseudomonas aeruginosa and Streptococcus pneumoniae also decreased titers, indicating that these antibodies may have been induced by ribosomes of other bacteria.

J Infect Dis, 1983 May, 147(5), 838 - 46
A subtyping system for nontypable Haemophilus influenzae based on outer-membrane proteins; Murphy TF et al.; Outer-membrane proteins from 48 isolates of nontypable Haemophilus influenzae from adults and children were examined by sodium dodecyl sulfate-polyacrylamide gel electrophoresis and the biotypes were determined . Each strain had two principal outer-membrane proteins in the 32,000-42,000 molecular-weight range . Eight subtypes were identified based on the differences in molecular weights of the two principal outer-membrane proteins . The lower molecular-weight protein of those two major proteins was heat modifiable . There was no definite relationship between subtype and biotype . Future studies on the pathogenesis and epidemiology of infections due to nontypable H . influenzae must take into account the differences in outer-membrane proteins among various strains . A subtyping system based on major outer-membrane proteins may provide a basis for such studies.

J Infect Dis, 1983 May, 147(5), 800 - 6
Biotype of Haemophilus influenzae: correlation with virulence and ampicillin resistance; Long SS et al.; Biotype and serotype were determined for 473 isolates of Haemophilus influenzae from 399 children . Patients with invasive disease usually had serotypable (86%) and biotype 1 (80%) isolates . Respiratory isolates from well children and children whose illness was not caused by H . influenzae were rarely serotypable (1%) or biotype 1 (8%) . Respiratory isolates from children whose illness was possibly or probably related to H . influenzae and isolates from children with cystic fibrosis were more frequently biotype 1, serotypable, or both (P less than 0.01 for all comparisons) . Ten (67%) of 15 children with acute otitis media due to H . influenzae had tympanocentesis isolates which were biotype 1; only one isolate was serotypable . Isolates from inflamed conjunctivae had biotypes and serotypes similar to respiratory isolates from well children . Ampicillin resistance was less frequent among biotype 1 isolates (9%) compared with other biotypes (19%) (P less than 0.01) . The data suggest that H . influenzae is biochemically heterogeneous and that noncapsular factors, frequently predictable by biotype, contribute to virulence.

J Bacteriol, 1983 May, 154(2), 686 - 92
Inhibition of DNA replication by transformation in a Haemophilus influenzae mutant carrying an altered Rec-1 protein; Kooistra J et al.; In the HM5 mutant of Haemophilus influenzae, which carries a mutation in the rec-1 gene region and in which the replication of donor-recipient DNA complexes formed in transformation is inhibited, the transformation frequency could be greatly enhanced by inhibition of protein synthesis during transformation, indicating that transformation in the HM5 mutant induces the synthesis of a protein that inhibits the replication of the donor-recipient DNA complexes . This induction occurred in an early step of the recombination . Synthesis of the wild-type Rec-1 protein after transformation of the HM5 mutant with wild-type DNA could diminish the inhibiting effect on DNA replication . The HM5 mutant synthesized an altered Rec-1 protein (molecular weight, 38,000) whose pI differed from that of the wild type . As a result of the mutation in the rec-1 gene, two other proteins (molecular weights, 37,500 and 43,000) are lacking in the HM5 mutant.

Pediatrics, 1983 May, 71(5), 780 - 3
Counterimmunoelectrophoresis of urine for diagnosis of bacterial pneumonia in pediatric outpatients; Turner RB et al.; Thirty-eight pediatric outpatients with pneumonia were studied by counterimmunoelectrophoresis for the presence of Haemophilus influenzae type b or pneumococcal antigenuria . Of the 38 patients eight (21%) had H influenzae type b antigenuria and two (5%) had pneumococcal antigenuria . H influenzae type b antigenuria was detected more frequently in patients less than 2 years of age than in older children . Urine counterimmunoelectrophoresis appears to be a useful tool for the etiologic diagnosis of bacterial pneumonia and should facilitate further studies of the epidemiology, pathogenesis, and clinical spectrum of this disease.

J Clin Microbiol, 1983 May, 17(5), 728 - 37
Morphological, biochemical, antigenic, and cytochemical relationships among Haemophilus somnus, Haemophilus agni, Haemophilus haemoglobinophilus, Histophilus ovis, and Actinobacillus seminis; Stephens LR et al.; Morphology, biochemical reactions, pigmentation, antigens, and cell envelope proteins were examined in 12 strains of Haemophilus somnus, Haemophilus agni, Histophilus ovis, and Actinobacillus seminis . All of the strains except A . seminis are related and are considered as a single Haemophilus-Histophilus (HH) group . In immunodiffusion tests, HH group bacteria had at least two antigens common to all members of the group, and sodium dodecyl sulfate-polyacrylamide gel electrophoresis showed that they have similar cell envelope protein profiles . A quantitatively variable yellow pigment with absorption maxima of 430 to 435 nm was present in strains of H . somnus and H . agni . The HH group did not produce catalase and grew only in air containing 10% CO2 . Of 10 HH group bacteria, 9 required thiamine monophosphate for growth . A . seminis was distinguished from the HH group by its lack of yellow pigment, production of catalase, growth in air, lack of a thiamine monophosphate requirement, and different cell envelope protein profile . In gel immunodiffusion tests, A . seminis antigens produced two lines of partial identity with the HH group when antiserum against H . somnus was used . Reference strains of Haemophilus influenzae, Actinobacillus lignieresii, and Haemophilus haemoglobinophilus were compared with the test strains . In immunodiffusion tests, a single antigen was found to be common to H . haemoglobinophilus, A . seminis, and the HH group . No similarities between any of the test strains and H . influenzae or A . lignieresii were noted . The close relationship of H . somnus, H . agni, and Histophilus ovis suggests that these unofficially named bacteria may belong to a single taxon.

Pathol Biol (Paris), 1983 May, 31(5), 413 - 8
{Comparative activity of tetracycline, doxycycline and minocycline against Haemophilus}; Dabernat H et al.; A total of 90 isolates of Haemophilus were studied for susceptibility to tetracycline, doxycycline and minocycline . In vitro activity was determined by agar dilution method (MIC) and disk diffusion test . Disk diffusion tests were done on chocolate agar and on supplemented Mueller-Hinton agar . MICs rang from greater than or equal to 128 to 0,25, 32 to 0,5 and 32 to 0,25 micrograms/ml for tetracycline, doxycycline and minocycline respectively . Strains can be divided into tetracycline-sensitive strains which are inhibited by concentration less than or equal to 2 micrograms/ml and tetracycline-resistant strains inhibited by greater than or equal to 16 micrograms/ml . Sensitive strains are inhibited by 0,5-1 microgram/ml of doxycycline and 0,25-2 micrograms/ml of minocycline . Resistant strains are inhibited by concentrations from 2 to 32 micrograms/ml of doxycycline and from 0,5 to 32 micrograms/ml of minocycline . All but one resistant strains were inhibited by a concentration of less than or equal to 4 micrograms/ml of minocycline; all but two resistants strains were inhibited by doxycycline at a concentration greater than or equal to 4 micrograms/ml . The correlation coefficients are the following: for tetracycline, r = -0,95; for doxycycline r = -0,83 when disk diffusion test is done on supplemented Mueller-Hinton and r = -0,94 on chocolate agar; for minocycline r = -0,62 on supplemented Muller-Hinton and r = -0,75 on chocolate agar.

Proc Natl Acad Sci U S A, 1983 May, 80(9), 2681 - 5
IgA1 proteases of Haemophilus influenzae: cloning and characterization in Escherichia coli K-12; Bricker J et al.; Haemophilus influenzae is one of several bacterial pathogens known to release IgA1 proteases into the extracellular environment . Each H . influenzae isolate produces one of at least three distinct types of these enzymes that differ in the specific peptide bond they cleave in the hinge region of human IgA1 . We have isolated the gene specifying type 1 IgA1 protease from a total genomic library of H . influenzae, subcloned it into plasmid vectors, and introduced these vectors into Escherichia coli K-12 . The enzyme synthesized by E . coli was active and had the same specificity as that of the H . influenzae donor . Unlike that of the donor, E . coli protease activity accumulated in the periplasm rather than being transported extracellularly . The position of the protease gene in H . influenzae DNA and its direction of transcription was approximated by deletion mapping . Tn5 insertions, and examination of the polypeptides synthesized by minicells . A 1-kilobase probe excised from the IgA1 protease gene hybridized with DNA restriction fragments of all H . influenzae serogroups but not with DNA of a nonpathogenic H . parainfluenzae species known to be IgA1 protease negative.

Pathol Biol (Paris), 1983 May, 31(5), 304 - 7
{Course of ampicillin sensitivity in Haemophilus influenzae responsible for purulent meningitis in children . Therapeutic consequences}; Joly C et al.; Bacterial meningitis caused by Haemophilus influenzae observed from 1976 to 1980 (10 cases) are compared with those observed in 1981 (9 cases) . From 1976 to 1980, 9 strains (90%) are ampicillin-sensitive . In 1981, 5 strains (55,5%) are ampicillin-sensitive and 4 strains (45,5%) are ampicillin-resistant and betalactamase positive . These 9 strains are serotype b . Therefore, since 1981, initial treatment of bacterial meningitis in infancy is a new cephalosporin, in this study is cefotaxime.

J Clin Microbiol, 1983 May, 17(5), 787 - 90
Determination of antigenic specificity and relationship among Haemophilus pleuropneumoniae serotypes by an indirect hemagglutination test; Mittal KR et al.; Serological properties of antigens extracted from strains of Haemophilus pleuropneumoniae belonging to seven different serotypes were investigated . Antisera were prepared in rabbits against Formalin-treated whole cell suspensions as well as autoclaved cell suspensions . Saline and heat extracts and their alcohol precipitate antigens of H . pleuropneumoniae were used in the indirect hemagglutination test . All the antigens used were easily adsorbed directly onto sheep erythrocytes . Saline extract antigen showed maximum type specificity . Heating of the whole cell suspension revealed the cross-reactive minor antigenic determinants . Thus, the heat extract preparations had both type-specific and species-specific antigens . It is suggested that the indirect hemagglutination test may be useful for both serotyping and serodiagnosis of H . pleuropneumoniae infections in pigs.

Sex Transm Dis, 1983 Apr-Jun, 10(2), 56 - 61
Isolation of Haemophilus species from the genital tract; Messing M et al.; Haemophilus influenzae was isolated from the urethra of three of 85 men attending a sexually transmitted diseases clinic . These isolates of H . influenzae were nonencapsulated; one was biotype III, and two were biotype IV . Haemophilus parainfluenzae was isolated from the urethra or coronal sulcus of five men; three isolates were biotype II, and two were biotype III . Neither H . influenzae nor H . parainfluenzae was isolated from the genital secretions of 84 women . Haemophilus ducreyi and Haemophilus equigenitalis (contagious equine metritis bacterium) were not isolated from any of the 169 patients.

Zh Mikrobiol Epidemiol Immunobiol, 1983 Apr, (4), 39 - 42
{Characteristics of Haemophilus influenzae strains isolated from the sputum of acute pneumonia patients with influenza}; Shapiro AV; The morphological, cultural, biochemical and antigenic properties of 232 H . influenzae strains isolated from the sputum of patients with acute pneumonia were studied . Biochemical typing carried out by Kilian's method permitted the division of the strains into 5 biovars; of these, 94.5 +/- 2.0% belonged to biovars I, II and III . For serological typing the test of coagglutination with staphylococcal protein A was used . This test proved to be highly sensitive, economical in respect of antiserum consumption and did not require the use of agglutinating sera free from cross-reacting antibodies . H . influenzae strains, biovar II and capsular serovar b, prevailed in the sputum of pneumonia patients.

Pathology, 1983 Apr, 15(2), 175 - 6
An easily prepared and accurate test strip for the detection of beta-lactamase production by both gram negative and positive organisms; Mugg PA; A simple method is described for the preparation of a paper test strip for the rapid detection of the beta-lactamase enzymes of Haemophilus sp., N . gonorrhoeae, S . aureus and S . epidermidis . The test strips were compared with the chromogenic cephalosporin technique for beta-lactamase detection and found to give 100% agreement . The beta-lactamase detection strips were easily prepared, very inexpensive, required no special equipment and could be stored for up to 6 mth.

Jpn J Antibiot, 1983 Apr, 36(4), 728 - 35
{Clinical evaluation of T-1982 (cefbuperazone) in the pediatric infections}; Mashiko J et al.; T-1982 (cefbuperazone) was evaluated in 25 children with a suspicion of bacterial infections, of the 21 confirmed bacterial infections, 18 were shown to be effective (efficacy rate, 85.7%) . The diagnosis included pneumonia (4), bronchopneumonia (3), acute bronchitis (4), acute pharyngitis (1), acute laryngitis (1), acute epiglottitis (1), acute enterocolitis (3), cervical lymphadenitis (1), acute pyelonephritis (1) and suspected septicemia (2) . The etiologic pathogens recovered were Haemophilus influenzae (4), Staphylococcus aureus (2), Salmonella typhimurium (1), Salmonella subgenus (1), and enteropathogenic Escherichia coli (2) . Among these strains, 7 strains were eradicated after treatment . A case of suspected septicemia and 2 cases of acute enterocolitis with Salmonella infection were not effectively treated with T-1982 . The serum half-life of T-1982 was 1.2 hours after an intravenous bolus injection . No severe adverse reaction was encountered with the T-1982 therapy . The data suggest that T-1982 is an effective and safe parenteral antibiotic in the treatment of susceptible pediatric bacterial infections.

Lab Anim, 1983 Apr, 17(2), 156 - 60
Pasteurella pneumotropica and the prevalence of the AHP (Actinobacillus, Haemophilus, Pasteurella)-group in laboratory animals; Kunstyr I et al.; 134 bacterial isolates originally identified as Pasteurella pneumotropica were cultured from healthy, ill or dead mice, rats, hamsters, guinea pigs, rabbits and cats originating from 7 conventional laboratory animal facilities . They occurred seldom in pure culture and were found in a variety of organs . Thorough identification (41 criteria) revealed that only 83 isolates (62%) were P . pneumotropica and could be subdivided into 3 biotypes . 3 isolates were P . aerogenes, 1 was P . ureae, 11 (8%) were qualified as Actinobacillus spp . and 13 (10%) as Haemophilus spp . Close relationship of the 3 genera--the 'AHP-group' --made the differentiation difficult . 23 atypical cultures were discarded at the beginning of the study as not belonging to the 'AHP-group' . Two-thirds of isolates were associated with inflammation or suppuration; Haemophilus spp . seemed to be more pathogenic than Pasteurella and Actinobacillus species.

Antimicrob Agents Chemother, 1983 Apr, 23(4), 551 - 4
Effect of growth phase on the bactericidal action of chloramphenicol against Haemophilus influenzae type b and Escherichia coli K-1; Feldman WE et al.; The bactericidal action of chloramphenicol against six Haemophilus influenzae type b isolates and six Escherichia coli K-1 isolates was compared . Cells were grown in antibiotic-free medium into the late-stationary and mid-exponential phases of growth, and inocula of 10(5) to 10(6) cells per ml were added to fresh media containing 1 or 10 micrograms of chloramphenicol per ml for H . influenzae isolates, 80 micrograms of chloramphenicol per ml for E . coli isolates, or no chloramphenicol (antibiotic free) . Quantitative kinetic studies indicated that each chloramphenicol concentration killed H . influenzae cells in the stationary phase of growth significantly more rapidly than it did those in the exponential phase of growth (P less than 0.001; analysis of variance) . E . coli in either the stationary or the exponential phase were killed at the same rate by 80 micrograms of chloramphenicol per ml (P greater than 0.05) . These results suggest that chloramphenicol may kill these organisms by different mechanisms.

Carbohydr Res, 1983 Mar 16, 114(1), 103 - 21
31P- and 13C-n.m.r.-spectral and chemical characterization of the end-group and repeating-unit components of oligosaccharides derived by acid hydrolysis of Haemophilus influenzae type b capsular polysaccharide; Zon G et al.; Haemophilus influenzae type b capsular polysaccharide {repeating unit, leads to 3)-beta-D-Ribf-(1 leads to 1)-D-Ribol-5-(PO2H leads to} was partially hydrolyzed with HCl to give oligosaccharides that were isolated by size-exclusion chromatography, and then characterized by 31P- and 13C-n.m.r.-spectral and chemical methods, in order to determine the end-group composition and, hence, the number-average chain-length (L) . The ratio (approximately 17:8) of monophosphate end-groups to D-ribofuranose end-groups revealed the relative rates of hydrolysis of the phosphoric diester linkage and the glycosidic linkage in the repeating-unit structure . Cleavage of the phosphoric diester linkage was approximately 92% regioselective, as indicated by the approximately 12:1 ratio of D-ribofuranose monophosphate end-groups to D-ribitol monophosphate end-groups . The n.m.r . spectra of the oligosaccharide repeating-unit provided evidence for partial stereomutation (approximately 3-8%) that involved rearrangement of the D-ribofuranose phosphoric diester linkage and anomerization at C-1 of D-ribofuranose . Variously sized oligosaccharides (L = 4, 7, and 12), that had D-ribofuranose end-groups reacted with bovine serum albumin that had an average of approximately 9 adipyl hydrazide functionalities, to give, within experimental error, quantitative yields of the corresponding hydrazone-linked, oligosaccharide-protein conjugates.

J Clin Microbiol, 1983 Mar, 17(3), 450 - 7
Inoculum standardization in antimicrobial susceptibility testing: evaluation of overnight agar cultures and the Rapid Inoculum Standardization System; Baker CN et al.; Using the Rapid Inoculum Standardization System {RISS; Minnesota Mining & Manufacturing Co . (3M Co.)}, we investigated the use of overnight agar cultures in the preparation of inocula for disk diffusion and microdilution susceptibility tests and compared our results with susceptibility results obtained with the standard methods . The 3M system consists of an inoculation wand, with which a reproducible number of bacteria can be removed from an agar plate, and a diluent in which to suspend the organisms . We used 25 gram-positive cocci, 75 enteric and nonfermentive gram-negative bacilli, and 40 more fastidious bacteria (Haemophilus, Neisseria, and pneumococci) for the evaluation . The geometric mean inoculum size for all organisms tested was 9.7 X 10(7) CFU/ml by the standard method and 1.1 X 10(8) CFU/ml for the RISS . The categories of susceptibility obtained by both methods in the disk diffusion tests were comparable, as were the minimal inhibitory concentrations . We recommend that the use of overnight agar cultures and the use of the RISS to prepare inocula for susceptibility tests be acceptable alternative procedures in the standard methods for susceptibility tests.

Diagn Microbiol Infect Dis, 1983 Mar, 1(1), 65 - 70
Haemophilus influenzae in genitourinary tract infections; Hall GD et al.; PIP: This report was prompted by the isolation of Haemophilus influenza from cultures of specimens from genital sites in 11 patients . All cervical, vaginal, and urethral specimens submitted to the Section of Clinical Microbiology Department of Laboratory Medicine, Mayo Clinic, Rochester, Minnesota, for bacterial culture are routinely inoculated onto blood agar, eosinmethylene blue (EMB) agar, chocolate blood agar, Columbia colistin-nalidixic acid (CNA) blood agar, and unless previously directly inoculated by the attending physician, modified Thayer-Martin medium . As a rule, identification and reporting of isolates is limited to Neisseria gonorrhoeae, N . meningitidis, Gardnerella vaginalis, beta-hemolytic streptococci, Listeria monocytogenes, and Staphylococcus aureus . Cultures for anaerobic bacteria are restricted to endocervical or endometrial aspirates which are submitted to the laboratory in anaerobic transport vials . Cultures for fungi, Chlamydia trachomatis, and Ureaplasma urealyticum are performed by specific request, as is miscroscopic examination for Trichomonas vaginalis . Haemophilus influenzae was identified with the porphyrin test according to the Kilian's taxonomic system . Genital tract specimens from 11 patients yielded H . influenzae in pure or predominant culture . 9 patients were females, of whom 4 had vaginitis, usually with a yellowish, foul smelling discharge . 2 had IUD-related endometritis and parametritis, 1 had an incomplete septic abortion, and 1 had probable urethral syndrome . 2 males had urethritis . Cultures were negative for N . gonorrhoeae in every case and for C . trachomatis in the 6 patients whose specimens were cultured for this agent . Only 2 women -- 1 with vaginitis and 1 with probable urethral syndrome -- had G . vaginalis in cultures of vaginal secretions, while U . urealyticum was isolated from vaginal or cervical secretions of 3 of 4 women cultured for the organism .

Pediatr Infect Dis, 1983 Mar-Apr, 2(2), 119 - 22
Statewide survey of the antimicrobial susceptibilities of Haemophilus influenzae producing invasive disease in Tennessee; Gustafson TL et al.; Between October 1, 1980, and September 30, 1981, a prospective statewide study of Haemophilus influenzae infections identified 220 culture-proved systemic infections . Of these, 92% were caused by H . influenzae type b . Antimicrobial susceptibility testing of the type b isolates showed that 17% were resistant to ampicillin, but virtually all were susceptible to chloramphenicol, trimethoprim-sulfamethoxazole, cefaclor and rifampin . Ampicillin resistance is common in all parts of Tennessee and chloramphenicol remains the drug of choice for initial therapy of systemic H . influenzae infections.

Antimicrob Agents Chemother, 1983 Mar, 23(3), 364 - 8
Chloramphenicol kills Haemophilus influenzae more rapidly than does ampicillin or cefamandole; Schauf V et al.; The bactericidal effects of chloramphenicol and three beta-lactams (ampicillin, cefamandole, and penicillin G) were measured for 27 strains of Haemophilus influenzae type b isolated from the blood or cerebrospinal fluid of infected infants . Of the ampicillin-susceptible strains, 75% were killed by less than 2.0 micrograms of each antibiotic per ml; however, the concentration of the beta-lactam agents required for bactericidal activity was higher than that required for inhibitory activity . Chloramphenicol was the only agent which had no marked discrepancy between inhibitory and bactericidal concentrations regardless of beta-lactamase production . Importantly, chloramphenicol was more rapidly bactericidal than either ampicillin or cefamandole . The bactericidal requirement of ampicillin was increased by the presence of chloramphenicol for about one-third of the isolates examined . Neither the inhibitory nor the bactericidal activity of chloramphenicol was influenced by ampicillin . Synergy occurred for only two beta-lactamase-positive isolates . The more rapid bactericidal action of chloramphenicol persisted even in the presence of ampicillin . The rapid bactericidal action of chloramphenicol with or without ampicillin supports the use of chloramphenicol alone or with ampicillin for H . influenzae infections.

J Clin Microbiol, 1983 Mar, 17(3), 428 - 31
Bactericidal antibodies against noncapsular components of Haemophilus influenzae; Dahlberg-Lagergard T; Bactericidal antibodies against components of Haemophilus influenzae other than the capsular polysaccharide were analyzed in sera from patients infected with this organism and compared with the antibody levels in sera from a normal population . Such antibodies could be demonstrated in sera from about one-third of patients infected with H . influenzae type b, including children less than 1 year old . It is possible that these antibodies were directed against outer membrane proteins, since they persisted after absorption with capsular polysaccharide type b and lipopolysaccharide . These findings suggest a protective role for antibodies directed against outer membrane components, possibly proteins, in infections caused by capsulated strains of H . influenzae.

J Antimicrob Chemother, 1983 Mar, 11(3), 271 - 80
In-vitro susceptibility of thirty strains of Haemophilus ducreyi to several antibiotics including six cephalosporins; Sanson-Le Pors MJ et al.; We have studied the in-vitro susceptibility of 30 strains of Haemophilus ducreyi to 22 antibacterial agents . Twenty-seven strains produced a beta-lactamase that had an isoelectric point similar to the isoelectric point of the TEM 1 type beta-lactamase produced by pSF 2124 . Except for cefamandole, the 30 strains had similar susceptibilities to the different cephalosporins, cefotaxime being the most active compound . Twenty-two isolates were resistant to tetracycline and doxycycline; minimal inhibitory concentration (MIC) of minocycline was 4 mg/l for all the strains . One isolate was resistant to chloramphenicol (MIC = 16 mg/l) . All strains were relatively resistant to colistin and nalidixic acid, and susceptible to streptomycin, kanamycin, gentamicin, erythromycin, rifampicin and vancomycin.

Infect Immun, 1983 Mar, 39(3), 1196 - 200
Evaluation of the protective efficacy of Haemophilus influenzae type b vaccines in an animal model; Halsey NA et al.; The infant rat model for Haemophilus influenzae type b (Hib) disease was modified to test the protective efficacy of candidate vaccines . The administration of 0.4 micrograms of polyribosylribitol phosphate (PRP) combined with pertussis vaccine or with diphtheria toxoid-tetanus toxoid-pertussis vaccine (DTP) to infant rats at 5, 10, and 15 days of age resulted in significant (P less than 0.001) protection against Hib bacteremia after challenge at 20 days of age . A dose-response effect was demonstrated, and suppression of the protective effect was noted with high doses of PRP . The administration of pertussis vaccine alone or DTP alone did not protect against Hib bacteremia . The degree of protection against Hib bacteremia correlated (P less than 0.005) with the serum anti-PRP antibody response measured before bacterial challenge . High-molecular-weight PRP preparations administered alone or in combination with pertussis vaccine were less effective than standard PRP combined with pertussis vaccine . These data compare favorably with the antibody response in human infants receiving the same vaccines . The observations in this animal model should facilitate the development and testing of other vaccine preparations for human infants.

J Clin Microbiol, 1983 Mar, 17(3), 400 - 4
Identification of pathogenic Neisseria species with the RapID NH system; Robinson MJ et al.; The RapID NH system (Innovative Diagnostics Systems, Inc., Decatur, Ga.) is a 4-h test used in the identification of Neisseria and Haemophilus species . The system was evaluated for accuracy and reliability and compared with conventional (cystine proteose peptone agar; Prepared Media Laboratory, Tualatin, Ore.) carbohydrate degradation tests with Neisseria gonorrhoeae and N . meningitidis, as well as a variety of Neisseria, Branhamella, and Moraxella species . The RapID NH system correctly identified all N . gonorrhoeae, N . meningitidis, and N . lactamica isolates, but the level of accuracy varied considerably for the remaining organisms . One strain of N . subflava was misidentified as a pathogenic Neisseria strain . The RapID NH tests were concluded in 4 h, whereas the cystine proteose peptone agar tests required up to 48 h for results to be useful . The RapID NH system is an accurate, reliable, and useful method for the identification of pathogenic Neisseria species . It has been proven that it shortens identification time and specimen turnaround time by at least 24 h.

Acta Otolaryngol, 1983 Mar-Apr, 95(3-4), 351 - 7
Isolation of nasopharyngeal beta-lactamase producing Haemophilus influenzae, in relation to antibiotic treatment of acute otitis media in infants; Freijd A et al.; This report is a compilation of clinical data involving the isolation of beta-lactamase producing H . influenzae made during a prospective study of 82 children suffering from different degrees of otitis media . Nineteen strains were isolated from the nasopharynx of 17 infants . Of these 63% were treated with amoxicillin because of acute otitis media within one month prior to isolation . These bacteria were found significantly more often in children who were heavily otitis prone than less so (p less than 0.01) . beta-lactamase-producing H . influenzae were also found more often after treatments with amoxicillin than after penicillin-V (p less than 0.01) . At the time of the next nasopharyngeal culture taken 5 to 69 days later, beta-lactamase-producing . H . influenzae could no longer be found, except in 2 cases . In the absence of antibiotics these strains seem to be replaced by other bacteria, such as Streptococcus pneumoniae and non-beta-lactamase H . influenzae.

Rev Infect Dis, 1983 Mar-Apr, 5 Suppl 1, S32 - 9
Selection of antimicrobial agents for initial treatment of suspected septicemia in infants and children; Cherry JD; Septicemia is relatively common in infants and children, and empiric antimicrobial therapy is frequently necessary . In immunocompetent children the most likely causative agents are Streptococcus pneumoniae, Haemophilus influenzae, Neisseria meningitidis, and Salmonella species . Effective empiric therapy is often the combination of ampicillin and chloramphenicol . In immunocompromised children the etiologic possibilities in septicemia include a large number of opportunistic pathogens, the most common of which are Escherichia coli and other enteric bacilli, Pseudomonas species and other hospital-related bacilli, and Staphylococcus aureus . Empiric therapy often consists of an aminoglycoside, a penicillinase-resistant penicillin or cephalosporin, and carbenicillin or ticarcillin . The third-generation cephalosporins offer considerable promise in the empiric treatment of septicemia in children.

J Antimicrob Chemother, 1983 Mar, 11(3), 281 - 6
The isolation of thymidine-requiring Haemophilus influenzae from the sputum of chronic bronchitic patients receiving trimethoprim; Platt DJ et al.; Two different strains of thymidine-requiring Haemophilus influenzae (thy-) were isolated from the sputum of two patients with chronic obstructive airways disease, during therapy with oral trimethoprim for the treatment of an acute exacerbation of chronic bronchitis . Both patients responded clinically . Since trimethoprim levels in sputum and serum were very low the patients were probably non-compliant . Isolates of H . influenzae prototrophic for thymidine (thy+) were isolated from both patients in remission before, at the onset of exacerbation and also within two weeks of stopping therapy . Thy- and thy+ isolates from the same patient were of identical biotype but isolates from the two patients were of different biotypes . The minimum inhibitory concentration (MIC) of trimethoprim for the thy+ isolates obtained after therapy was significantly higher than the MIC for the isolates obtained at the onset of exacerbation . Thy- isolates were further investigated and a novel mechanism of low-level trimethoprim resistance is proposed.

Rev Infect Dis, 1983 Mar-Apr, 5 Suppl 1, S137 - 44
Multicentered clinical evaluation of cefoperazone for the treatment of lower respiratory tract infections; Gardner WG; Adult patients with bacterial infections of the lower respiratory tract were given either cefoperazone or cefamandole in a multicenter clinical study of the clinical and bacteriologic efficacy of cefoperazone . Clinical diagnoses included pneumonia, bronchitis, lung abscess, and bronchiectasis . Efficacy was evaluated in 119 patients given cefoperazone and 73 patients given cefamandole . Major pathogens isolated included Streptococcus pneumoniae, Haemophilus influenzae, Staphylococcus aureus, Klebsiella pneumoniae, and Pseudomonas aeruginosa . Satisfactory clinical responses were noted for 96% of the patients in both treatment groups, including 14 of 17 patients given cefoperazone who were primarily infected with P . aeruginosa . Satisfactory bacteriologic responses were noted for 88% of the group given cefoperazone and 89% of the group given cefamandole . Adverse reactions related to the antibiotic occurred infrequently in each treatment group . The results of this study indicate that cefoperazone is a safe and effective antibiotic for the treatment of lower respiratory tract infections due to S . pneumoniae, H . influenzae, S . aureus, and many gram-negative bacilli, including susceptible strains of P . aeruginosa, in adult patients.

J Am Vet Med Assoc, 1983 Feb 15, 182(4), 372 - 4
Association of sexual experience with isolation of various bacteria in cases of ovine epididymitis; Bulgin MS et al.; Testicles from rams in flocks experiencing ram epididymitis in Idaho and eastern Oregon were cultured . Twenty-six breeding rams from 6 flocks were cultured and only Brucella ovis was isolated . Virgin rams (65) harbored numerous species of small fastidious gram-negative rods, including Actinobacillus actinomycetemcomitans, Haemophilus spp, Moraxella spp, and Pasteurella spp . Thus, there appeared to be 2 separate disease entities, dependent on sexual experience of the animal.

S Afr Med J, 1983 Feb 12, 63(7), 236 - 7
Isolation of Haemophilus ducreyi from genital ulcerations in white men in Johannesburg; Mauff AC et al.; An analysis of sexually acquired genital ulcerations in 31 White patients who were examined microbiologically in Johannesburg showed Haemophilus ducreyi to be the causative agent in 23 (74%), whereas syphilis was the confirmed diagnosis in only 6 (19%) . All the H . ducreyi isolates produced beta-lactamase . Previously, chancroid was considered to be an infrequent cause of genital ulceration in this population group . Unlike those with syphilitic ulceration, patients with chancroid usually do not respond to penicillin . The improved isolation procedures for H . ducreyi now enable the laboratory to confirm most cases.

J Immunol Methods, 1983 Feb 11, 56(3), 319 - 27
Enzyme immunoassays for the detection of bacterial antigens utilizing biotin-labeled antibody and peroxidase biotin--avidin complex; Yolken RH et al.; This report describes the use of biotin-labeled antibodies in sensitive enzyme immunoassay systems for the measurement of bacterial antigens . Biotinylated immunoglobulins could be reproducibly formulated using N-hydroxysuccinimide biotin ester to link biotin to the immunoglobulin . Binding of the biotinylated antibody to solid-phase antigen was efficiently measured by reaction with a complex consisting of biotinylated antibody and unlabeled avidin . This immunoassay system was at least as sensitive as ones which utilized enzyme-labeled or fluorescein-labeled antibodies for the detection of antigens from Streptococcus pneumoniae and Haemophilus influenzae type b . In the case of Streptococcus pneumoniae the assay system could detect antigen in the supernatants from broth cultures containing as few as 10(3) organisms/ml . Assay systems utilizing biotinylated antibody and avidin-biotin complex can provide for sensitive, specific assays for the measurement of microbial antigens.

Med J Aust, 1983 Feb 5, 1(3), 130 - 1
Isolation of Haemophilus ducreyi from a chancroid in Papua New Guinea; Phillips PA et al.; Haemophilus ducreyi was isolated from a patient who presented with a genital ulcer at the Port Moresby Clinic for Sexually Transmitted Diseases . This provides documentation for the occurrence of chancroid in Papua New Guinea . The differentiation of this disease from donovanosis is discussed.

Antimicrob Agents Chemother, 1983 Feb, 23(2), 252 - 5
Single-dose pharmacokinetics of intravenous clavulanic acid with amoxicillin in pediatric patients; Schaad UB et al.; Pharmacokinetics of a parenteral formulation comprised of 5 parts of amoxicillin and 1 part of clavulanic acid were determined in 12 pediatric patients, 2 to 14 years of age . A single dose amounting to 25 mg of amoxicillin and 5 mg of clavulanic acid per kg of body weight was infused intravenously over 2 min . Mean plasma concentrations 5 min after dosing were 89.4 micrograms of amoxicillin per ml and 19.5 micrograms of clavulanic acid per ml . Terminal phase plasma half-lives were 1.2 and 0.8 h, respectively . The data acquired in this study indicate that amoxicillin and clavulanic acid are pharmacokinetically compatible . Moreover, taken with assessment of microbiological activities by others, the present data suggest that intravenous administration of 25 mg of amoxicillin plus 5 mg of clavulanic acid per kg every 6 h is a reasonable starting regimen for assessing the activity of the combined drug formulation in noninvasive childhood diseases caused by Haemophilus influenzae, Staphylococcus aureus, Streptococci spp., Neisseria spp., Branhamella catarrhalis, and other susceptible organisms.

Clin Otolaryngol, 1983 Feb, 8(1), 25 - 30
Acute epiglottitis in children: experiences with tracheotomy and intubation; Kinnefors A et al.; Acute epiglottitis is one of the most serious and potentially fatal conditions dealt with in paediatric laryngology . The infectious agent is mostly Haemophilus influenzae . An active and planned treatment to secure the airway is necessary to reduce the morbidity and mortality . The 'watch and wait' attitude should be abandoned . Tracheotomy or intubation should be performed . Mostly literature today is in favour of intubation . However, both tracheotomy and intubation can be used, and if properly managed the complication rate with both methods is low . This series comprised 102 children of whom 79 were tracheotomized and 23 were intubated . No differences could be found between intubation or tracheotomy time (2.3 and 2.9 days respectively) or in hospital stay (6.7 and 6 days) . The complication rate was low in both groups except for subcutaneous and mediastinal emphysema in the tracheotomy group but these did not cause any serious problems.

Am J Vet Res, 1983 Feb, 44(2), 344 - 7
Characterization of the hemolysin produced by haemophilus pleuropneumoniae; Nakai T et al.; Production and characterization of Haemophilus pleuropneumoniae hemolysin were investigated by using 5 serotype 2 strains . The hemolysin was produced in chicken meat-infusion broth medium both in stationary and in shaking cultures . In stationary culture, hemolytic activity against horse RBC reached maximum at postincubation day 5 (at the late stage of stationary phase), and the activity was maintained at the same level for 2 days thereafter . The hemolytic activity of shaking culture reached a maximum at postincubation hour 9 (at the early stage of logarithmic-growth phase), gradually decreased, and disappeared at postincubation day 2 . The hemolysin was shown to be an extracellular product of the bacterial cells . The RBC of horses, rabbits, and sheep were highly susceptible to the hemolysin, and those of pigs and guinea pigs were less susceptible, whereas RBC of 60-day-old chicks were not susceptible . The hemolysin was not inactivated by autoclaving at 121 C for 2 hours, and by treatments with formalin, trypsin, or pronase . The presence of calcium or magnesium ions did not change the activity, whereas iodoacetic acid significantly reduced the activity.

Mayo Clin Proc, 1983 Feb, 58(2), 92 - 8
Tetracyclines, chloramphenicol, erythromycin, and clindamycin; Wilson WR et al.; The tetracyclines are active in vitro against many urinary tract pathogens such as Chlamydia, Mycoplasma pneumoniae, Brucella, rickettsiae, and Nocardia . Chloramphenicol is used primarily for anaerobic infections, Haemophilus influenzae meningitis, and infections due to Salmonella typhi . Erythromycin is active in vitro against M . pneumoniae, Legionella spp., Streptococcus pneumoniae, and group A beta-hemolytic streptococci; it may also be used as prophylactic therapy for subacute bacterial endocarditis and for recurrence of acute rheumatic fever in patients who are allergic to penicillin . Clindamycin should be used primarily for the treatment of anaerobic infections . The tetracyclines may cause gastrointestinal upset; phototoxic dermatitis; hepatitis, especially in pregnant women; discoloration of the teeth and bone dysplasia in the human fetus and in children; and superinfections, especially oral and anogenital candidiasis . The tetracyclines should be used with caution in patients with renal insufficiency . The most important toxic effect of chloramphenicol is bone marrow suppression, which is dose related or idiosyncratic . The incidence of undesirable side effects associated with the use of erythromycin is low; gastrointestinal irritation is the most common, and cholestatic hepatitis may occur with the use of erythromycin estolate . Pseudomembranous colitis is the most important toxic effect associated with the use of clindamycin.

J Antimicrob Chemother, 1983 Feb, 11(2), 109 - 13
A simple oral antimicrobial regimen effective in severe chronic bronchial suppuration associated with culturable Haemophilus influenzae; Cole PJ et al.; Three grams of amoxycillin administered twice daily for seven days, as an oral powder (Amoxil 3G sachets, Bencard) dispersed in water, to 17 patients with bronchiectasis resulted in striking clinical, spirometric and bacteriological improvement in 11 of 12 patients who were producing purulent sputum from which Haemophilus influenzae was cultured by a selective bacteriological technique (Roberts & Cole, 1980) . In the five patients from whose sputum this organism could not be cultured, and in one from whom it could, there was no improvement . Untoward effects were limited to nausea in one patient and acceptability of the regimen by the remaining patients was unanimous . There was no evidence of accumulation of the drug in serum or sputum . The rapidity of effect and oral form of the treatment suggest that it may provide a simple out-patient regimen for chronic bronchial sepsis and severe purulent exacerbations of chronic bronchitis from which H . influenzae can be cultured.

J Bacteriol, 1983 Feb, 153(2), 852 - 60
Characterization of a conditionally transformation-deficient mutant of Haemophilus influenzae that carries a mutation in the rec-1 gene region; Kooistra J et al.; A mutant of Haemophilus influenzae, designated HM5, carrying a mutation in the rec-1 gene region, is described . This mutant transformed approximately 100-fold less well than does the wild type, but approximately 100-fold better than rec1 mutants . The mutant was less sensitive to UV irradiation and less "reckless" than rec1 mutants . In contrast to rec1 lysogens, HP1c1 lysogens of the mutant were inducible, and during transformation, recombinant-type activity was formed to the same extent as in the wild type . Although the integration of donor DNA was complete, the integrated DNA was not replicated at 36 degrees C . Both the inhibition of replication of the donor-recipient DNA complex and the transformation deficiency could be suppressed when, after DNA entry, the cells were incubated under suboptimal conditions . The loss of colony formation after UV irradiation was suppressible by the same conditions.

Pathol Biol (Paris), 1983 Feb, 31(2), 97 - 101
{Latex agglutination test and counterimmunoelectrophoresis in the diagnosis of Haemophilus influenzae meningitis}; Denis F et al.; Authors have searched for Haemophilus influenzae by culture and by detection of capsular antigens in CSF of 1.700 bacterial meningitis in Dakar . Culture has been positive in 71.9%, counter-immunoelectrophoresis in 94.9% and latex (slidex meningitis kit) in 91.2% of cases . Diagnosis results are improved of 39% comparatively with bacteriologic culture . False positive results caused by antigenic cross-reactions have been observed only in 1.3% of others bacterial meningitis . Latex-test is allowing a diagnosis in three minutes and a quantitative determination of antigens (useful for pronostic).

Pathol Biol (Paris), 1983 Feb, 31(2), 93 - 6
{Antigenic detection and identification of Haemophilus influenzae and quantitative immunoelectrophoresis}; Guinet R et al.; A one-step polyvalent rocket-line immunoelectrophoresis (PRLIE) for antigenic detection and identification of Haemophilus influenzae is described . A standard pattern of six lines corresponding to each individual antigen-antibody system has been established . The polyvalent antigen was an adequate mixture of each serotype antigen and the polyvalent antiserum was a pool of the six monospecific antiserum raised in rabbits (Institut Pasteur de Lyon) . Each line has been identified with six reference individual antigens in PRLIE . The resulting sum pattern of rockets standing on the corresponding lines permits a direct characterization of the antigen content in a number of samples by means of a known line spectrum . The method is simple, reproducible, inexpensive (the polyvalent antiserum was used at 1% in the antibody-containing gel) and allowed quantitative determination.

Pathol Biol (Paris), 1983 Feb, 31(2), 89 - 92
{Contribution of rapid methods to the diagnosis of Haemophilus influenzae infections and the conduct of antibacterial treatment}; Courtieu AL et al.; In the last decade medical microbiologists could make use of a great number of techniques that allow to shorten length of time of report from the arrival of specimens in laboratory . The direct microscopical examination has been considerably revalued: it is very important . Now it can be completed by use of reagents that allow the presumptive identification of various bacteria . For Hemophilus influenzae the efforts are devoted only to serovar b . In the absence of visible bacteria, the research of the presence of bacterial antigen is now possible . The semiautomatic apparatus allows also to watch over the cultures and to detect the beginning of development more accurately than macroscopically . Finally, for antibiotic sensitivity test, we can also use the automatic apparatus that shortens length of time of report to clinician.

Pathol Biol (Paris), 1983 Feb, 31(2), 81 - 5
{Clinical results of a multicenter study of Haemophilus infection}; Antiphon P; 2379 cases of infections due to Haemophilus are reported in a one year long French multicenter study . There were 1368 low respiratory and 540 high respiratory infections, 22 epiglottitis, 86 meningitis, and 68 septicemia (bacteremia) . Four hundred and one times, we considered that the bacteria was not the cause of the infection . For each type of infection, we studied the distribution according to the age, the sex and the period of the year, the eventual associations and the involved serotypes . The lethality was low (22), mainly due to a particular deficiency . At last, we compared the different methods to obtain the pathologic products from the upper bronchial tract.

Pathol Biol (Paris), 1983 Feb, 31(2), 73 - 6
{Results of a multicenter study of the identification of Haemophilus}; Dublanchet A et al.; We report the bacteriologic results of a French multicentric study on the Haemophilus infection in humans . A total of 2.379 strains were isolated during one year (oct 1980-sept 1981), 1.808 strains were H . influenzae and 353 H . parainfluenzae . We have determined the relationship between the biotypes, the serotypes and the origin of the clinical specimens . The majority of H . influenzae strains belong to the biotypes I, II et III accounting for 21, 32 et 23% respectively . Biotype III was the most frequent for H . parainfluenzae.

Pathol Biol (Paris), 1983 Feb, 31(2), 144 - 8
{Prospects for the vaccinal prevention of Haemophilus influenzae type b meningitis}; Armand J; Haemophilus influenzae type b remains the major cause of bacterial meningitis in infants and children . Serum antibodies against the capsular polysaccharide--polyribosylribitolphosphate (PRP)--are protective, but its immunogenicity is poor in children under two years of age . Clinical trials actually in progress concerning an association of PRP with Bordetella pertussis are presented . Other vaccinal preparations are possible, such outer membrane protein, but prospects offered by polysaccharide-protein conjugates appear as the most encouraging.

Pathol Biol (Paris), 1983 Feb, 31(2), 141 - 3
Efficacy of Haemophilus influenzae type b capsular polysaccharide vaccine on the incidence of epiglottitis and meningitis; Peltola H et al.; 48,997 children of 3 months to 5 years were vaccinated with Haemophilus influenzae type b (Hib) capsular polysaccharide vaccine in a double blind study carried out in Finland in 1974 . A clear-cut effect was obtained in the incidence of epiglottitis . The number of patients decreased 58% for three years when compared with the three-year-period before vaccination (p less than 0.002) . On the other hand, the number of cases during the three years following vaccination was 65% less than during the next three year period (p less than 0.001) . The efficacy implies an exceptionally strong herd immunity, because only 37.7% of the children in the area were vaccinated . Regarding meningitis, no herd immunity was observed but vaccination induced a highly significant (p less than 0.001) individual protection (2 cases in the specifically vaccinated versus 20 in the control group in four years' time), provided the vaccine was given at the age of 18 months or later . No efficacy was obtained before this age limit . It was calculated that approximately 90 per cent of cases of epiglottitis and 50 per cent of meningitis would be prevented with the vaccine currently available . Taking also into account the strong herd immunity tendency, vaccination is likely to offer even larger benefits.

Pathol Biol (Paris), 1983 Feb, 31(2), 138 - 40
{Fetal and neonatal transmission of type-b anti-haemophilus influenzae antibodies protecting the newborn rat}; Robert A et al.; Haemophilus influenzae type b is the most common cause of bacterial meningitis in children . Intranasal or intraperitoneal inoculation of infant rats with Haemophilus influenzae type b results in bacteremia and meningitis and has been proved to be a reproductible model of the human disease . For these reasons, it was of interest to use rats as experimental model for the study of anti-Haemophilus influenzae type b vaccine . Immune serum against Haemophilus influenzae type b cell surface extracts was prepared on rabbit . In a first experiment, pregnant rats were passively immunized with either immune rabbit serum or normal rabbit serum or saline . In a second experiment, suckling rat mothers were passively immunized with either immune rabbit serum or normal rabbit serum or saline . All infant rats were inoculated intraperitoneally at 6 days of age with Haemophilus influenzae type b . Bacteremia was determined in all infected rats 24 h after challenge . Only infant rats from immune serum-treated mothers were protected . This protection may be transferred from mother to young rat either before of after the birth.

Pathol Biol (Paris), 1983 Feb, 31(2), 134 - 7
{Public health problems posed by the occurrence of Haemophilus meningitis in limited communities and especially its chemophophylaxis}; Carrere C et al.; In Val-de-Marne District there is a permanent medical network to check up all cases of infectious meningitis . H . influenzae meningitis are increasing and represent 25% of all purulent meningitis (mainly infants of less than 6 years old) diagnosed in this area, second only to the meningococcus . English authors find Haemophilus influenzae to be as contagious as the meningococcus . Public Health physicians have to know these informations in order to prevent infection in communities; systematic throat culture with antibiograms, regular medical check-up, disinfection, exclusion from school and the choice of prophylactic anti-biotherapy are discussed . Many drugs have been proposed ampicillin, rifampicin, spiramycin, erythromycin, pristinamycin, tetracyclin . None of them managed to get a unanimous approval . The probably temporary solution is to follow the same guidelines than for the meningococcus infections and contaminations . They are described in details in the n degrees 8 Ministerial Memorandum dated January 28, 1980 . About chimioprophylaxy, the physicians have to judge any single case as a whole . First ENT infections in those communities have to be totally treated.

Pathol Biol (Paris), 1983 Feb, 31(2), 128 - 33
{Epidemiology and prognosis of Haemophilus influenzae meningitis in Africa (901 cases)}; Cadoz M et al.; Haemophilus influenzae meningitis are frequent in Africa in infants between 6 months and two years of age . Type b is observed in 97% of cases . In Dakar, 2% of strains are resistant to ampicillin and 0% to chloramphenicol . Lethality is about 30% and sequellae are very frequent . Prognosis can be predicted by a cotation scale including consciousness, tonus, seizures, nutritional status, delay before treatment and initial bacterial antigen level in CSF.

Pathol Biol (Paris), 1983 Feb, 31(2), 123 - 7
{Haemophilus infections in pediatrics . Characterization of strains by biotype, serotype and the production of beta-lastamase}; Megraud F et al.; During 1980 and 1981, an epidemiological survey (biotyping, serotyping, beta-lactamase production) of Haemophilus strains isolated in our hospital was performed . One hundred sixty-one Haemophilus were isolated among 146 patients: 17 H . parainfluenzae and 144 H . influenzae . Most of the infections occurred in patients, under 3 years old (77%), during cold weather (63%), and in males (55%) . Biotypes I, II and III were the most common isolates (88%) . Capsulated strains were frequent (53%) . A beta-lactamase occurred in 9, 5% of cases . Distribution of serotypes and biotypes will be discussed in relation to clinical findings (meningitis: 21, septicemia from other origins: 9, arthritis: 2, and other non-systemic infections).

Pathol Biol (Paris), 1983 Feb, 31(2), 120 - 2
{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.

Pathol Biol (Paris), 1983 Feb, 31(2), 115 - 9
{Haemophilus influenzae and parainfluenzae in children . A retrospective study of 52 cases}; Guillot F et al.; Fifty-two children hospitalized in the Pediatric service of a general hospital between January 1978 and December 1979 were found to be infected with Haemophilus influenzae or para-influenzae (43 with H . influenzae and 9 with para-influenzae) . Most of these children (34/52) were less than 4 years of age . The localizations of infections were as follow: 5 meningitis with satisfactory resolution except for 1 who developed slight deafness, 1 epiglotitis, 11 pneumonias or bronchopneumonias, 1 arthritis, 10 otitis medias, 6 conjunctivitis, 3 sinusitis, 10 upper airway infections and 1 neonatal infection . On 8 of these cases the patients were felt to be carriers of H . influenzae or para-influenzae, the signs and symptoms beeing not related to these bacteria . These results are compared with those found in the literature.

Pathol Biol (Paris), 1983 Feb, 31(2), 112 - 4
{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 a peculiar 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 cefoxitine and cefamandole.

Pathol Biol (Paris), 1983 Feb, 31(2), 107 - 11
{Rapid methods of detecting enzymatic resistance to ampicillin and chloramphenicol in Haemophilus influenzae}; Dabernat H; Several methods used for the detection of beta-lactamase activity in Haemophilus influenzae are described . The rapid iodemetric, acidimetric, and chromogenic cephalosporin techniques are specific tests for the presence of beta-lactamase . The Gots test can also be used for the detection of enzymatic resistance to ampicillin and chloramphenicol.

Pathol Biol (Paris), 1983 Feb, 31(2), 103 - 6
{Haemophilus colonization in children: serotypes, biotypes and antibiotic sensitivity}; Dabernat H et al.; The occurrence of Haemophilus in throat swabs from 273 hospitalized children aged 0-15 years has been investigated . Haemophilus was detected in 124 children . H . influenzae was observed in 15.7% of the children and 37.6% of the carriers . H . parainfluenzae was observed in 31.8% of the children and 70% of the carriers . The carriage rate of Haemophilus influenzae type b occurred in 6.6% of the children and was not observed in children aged less than six months . One nontypable, biotype II strain of H . influenzae (2.2%) was resistant to ampicillin and tetracycline; one biotype I, type b strain was resistant to tetracycline . Among 90 strains of H . parainfluenzae, 20 were beta-lactamase-producing strains; 80% of these strains were isolated in children aged more than two years . Beta-lactamase-producing Haemophilus was detected in 7.7% of children but only 0.36% of children were carrier of ampicillin-resistant H . influenzae . No chloramphenicol-resistant strain was isolated during this study.

Antimicrob Agents Chemother, 1983 Feb, 23(2), 213 - 7
Pharmacokinetics and bacteriological effect of ceftazidime in experimental Streptococcus pneumoniae, Haemophilus influenzae, and Escherichia coli meningitis; Sakata Y et al.; The pharmacokinetics and bacteriological effect of ceftazidime were evaluated in rabbits experimentally infected with Streptococcus pneumoniae, Haemophilus influenzae type b, and Escherichia coli K1 . The mean penetration of ceftazidime into cerebrospinal fluid after single-dose or constant-infusion administration ranged from 7.8 to 14.9% . The median cerebrospinal fluid bactericidal titers were 1:64 against S . pneumoniae and H . influenzae and 1:128 against E . coli . The bacterial colony counts in cerebrospinal fluid were reduced by 58% to 100% (-2.3 to -3.9 log10 CFU/ml) in 3 h and by 100% (-3.2 to -5.1 log10 CFU/ml) in 9 h of constant infusion, whereas in untreated infected animals, bacterial counts increased from +1.4 to +2.1 log10 CFU/ml in 9 h . These data on ceftazidime compare favorably with those on penicillin, chloramphenicol, netilmicin, and moxalactam in this experimental meningitis model.

Infect Immun, 1983 Feb, 39(2), 491 - 6
Specific immune response in the respiratory tract after administration of an oral polyvalent bacterial vaccine; Clancy RL et al.; An oral killed polyvalent bacterial vaccine was assessed in a double-blind trial involving healthy volunteers . Three courses of oral vaccine were given over a 2-month period; each course contained 10(10) Haemophilus influenzae and 7 X 10(9) Staphylococcus aureus organisms . Immunity was assessed by monitoring antibody in saliva and serum over a 3-month period . No evidence of a nonspecific effect on immune parameters (immunoglobulin levels and Escherichia coli antibody) was detected in saliva or serum . An increase in H . influenzae antibody in saliva was detected in 55% of subjects receiving the vaccine compared with 6.7% of the placebo group . Antibody was associated with immunoglobulin A (IgA), IgG, and IgM, but the greatest increases over preimmunization levels were detected in the IgA class . No increase in serum antibody levels was detected . Subjects with higher preimmunization levels of salivary antibody to H . influenzae were less likely to respond to the oral bacterial vaccine . No increase in S . aureus antibody was detected in saliva or serum.

Pediatrics, 1983 Feb, 71(2), 196 - 9
Cyclacillin versus amoxicillin as treatment for acute otitis media; McLinn SE et al.; A double-blind study of 240 pediatric outpatients with acute otitis media demonstrated that cyclacillin, administered three times a day for ten days, is as effective as and better tolerated than a similar regimen of amoxicillin . Clinical success was achieved in 96% of the children treated with each drug, and the bacteriologic cure rate was 98% in each treatment group . Only three of the 119 children (2.5%) treated with cyclacillin had drug-related diarrhea, in contrast to 17/121 children (14%) treated with amoxicillin (P less than .01) . This greater tolerance for cyclacillin may be due to its more effective and rapid absorption in the upper gastrointestinal tract . The results are discussed in terms of the low incidence of resistant strains of Haemophilus influenzae and the advantages of cyclacillin as the first-line treatment for acute otitis media.

J Antimicrob Chemother, 1983 Feb, 11(2), 115 - 23
Latamoxef (moxalactam) in acute exacerbations of chronic bronchitis; Maesen FP et al.; Forty-three patients admitted to the hospital with acute exacerbations of chronic bronchitis were treated with latamoxef (moxalactam) twice daily intramuscularly for 10 days . Five patients received 0.5 g injections, 23 patients 1 g and 15 patients were given 2 g . Three patients dropped out of the study; one died suddenly, one was treated with another antibiotic because of suspected Gram-negative pneumonia and one developed pneumococcal septicaemia after the active treatment course . Most strains of Haemophilus influenzae, H . parainfluenzae and Branhamella catarrhalis were successfully eradicated but, by day 17, there were 7 patients with reinfections with Streptococcus pneumoniae . Latamoxef MIC values for Str . pneumoniae varied from 0.03 to 2 g mg/1, but most were in the region of 1 mg/1 . Sputum concentrations reached approximately 1.5 mg/1 on the highest dosage but only 0.25 to 1 mg/1 on the lower doses . Peak Serum concentrations with the increasing doses averaged 14, 27 and 45 mg/1 respectively . The role and dosage of latamoxef in respiratory infections in the possible presence of streptococci are discussed.

Pediatrics, 1983 Feb, 71(2), 187 - 91
Moxalactam treatment of serious infections primarily due to Haemophilus influenzae type b in children; Kaplan SL et al.; Thirty-eight children completed therapy with moxalactam for a variety of non-CNS infections . Haemophilus influenzae type b (seven ampicillin-resistant strains) was the etiologic agent for 32 children . Doses of moxalactam ranged from 113 to 200 mg/kg/d in three or four divided doses administered parenterally . All children with infections due to H influenzae type b had excellent responses to moxalactam therapy . Children treated for infections due to other agents also responded satisfactorily to moxalactam therapy . Moxalactam concentrations in joint and pleural fluids greatly exceeded the minimal bactericidal concentrations of moxalactam for H influenzae type b . Adverse reactions included neutropenia, eosinophilia, thrombocytosis, and transient elevation of transaminase levels . Moxalactam administered parenterally, at a dose of 113 to 150 mg/kg/d in three or four divided doses is effective therapy for serious infections in children due to H influenzae type b and selected other organisms.

Eur J Pharmacol, 1983 Jan 28, 87(1), 127 - 32
Bacterial cell wall components decrease the number of guinea-pig lung beta-adrenoceptors; Schreurs AJ et al.; Infections of the deeper respiratory airways can contribute to the progression of chronic asthmatic bronchitis . In the present report a number of microorganisms affecting the number of beta-adrenoceptors in guinea-pig lung homogenates are described . Haemophilus influenzae, Streptococcus pneumoniae, Bordetella pertussis and Escherichia coli O111B4 induced a significant decrease of the number of beta-adrenoceptors (by approximately 20%) . Staphylococcus aureus, influenza A virus and Escherichia coli J5 were not active . These data point to a common factor shared by gram-negative bacilli; i.e . endotoxin . Purified endotoxin of E . coli O111B4 also decreased the number of beta-adrenoceptors, while E . coli J5-LPS did not . This suggests that neutral polysaccharides of bacterial cell walls, especially those in the 'O'-antigenic side chain of gram-negative endotoxins may be responsible for the decrease of beta-adrenoceptor number and therefore contribute to the pathogenesis of chronic asthmatic bronchitis . Intact endotoxin seems to be necessary since neither the isolated lipid nor the polysaccharide part of E . coli O111B4 LPS affected the number of beta-adrenoceptors in the lung.

Methods Find Exp Clin Pharmacol, 1983, 5(2), 127 - 9
The efficacy of a new formulation of trimethoprim and sulphadiazine in acute exacerbations of chronic bronchitis; Robertson CE et al.; Thirty-four acute exacerbations of chronic bronchitis were treated using a new formulation of trimethoprim and sulphadiazine . Significant bacterial isolates were obtained in 18 exacerbations of which 12 comprised Haemophilus influenzae . Adverse effects of treatment, principally nausea, occurred in 5 patients . A satisfactory clinical response in association with the achievement of mucoid sputum was obtained in 94% and the mean time for sputum conversion of 3.8 days compares favourably with other antibiotics.

Sex Transm Dis, 1983 Jan-Mar, 10(1), 45 - 6
Urethritis associated with Haemophilus parainfluenzae: a case report; Chowdhury MN et al.; Haemophilus parainfluenzae was isolated from the urethral discharge of a man with urethritis . The patient responded favorably to treatment with amoxicillin . Although the facts suggest that this case of urethritis may have been caused by H . parainfluenzae, a possible etiologic role of other microorganisms is not ruled out.

Scand J Infect Dis, 1983, 15(1), 75 - 80
Acute purulent arthritis in children; Peltola H et al.; Acute purulent arthritis (APA) in children is a rare disease . A series comprising 25 children with APA seen in 1960-79 was analysed with regard to clinical problems of diagnosis and treatment . The sex ratio of boys to girls was 2.5:1 . The knee joint was most commonly affected (76% of the cases) . The other joints affected were the hip (16%), ankle (4%), and elbow (4%), 56% of the patients were 1-2 yr old at the onset of the disease . A bacterial etiology was established in 44% of cases; a positive culture in 36% . Staphylococcus aureus, Haemophilus influenzae, streptococci, and pneumococci were isolated . All but 2 patients received antimicrobial therapy; the duration of therapy averaged 35 days . Seven patients were treated operatively . The usual procedure was arthrotomy, and closed irrigation was performed in 2 cases only . The end result was good in all cases . There were no fatalities.

Can J Comp Med, 1983 Jan, 47(1), 1 - 5
Epidemiology of Haemophilus pleuropneumoniae infection in pigs: a survey of Ontario Pork Producers, 1981; Rosendal S et al.; Information about factors associated with the spread and the effect of pleuropneumonia was obtained from 418 pork producers in Ontario, who returned a mailed questionnaire . The overall herd prevalence of pleuropneumonia was 23.2% . The prevalence among herds with feeder pigs only was 34.3% and 16% among sow herds . The chance of pleuropneumonia breaking out in a herd was increased with increased traffic of pigs into the herd . The source of supplementary stock had an important effect on the chance of pleuropneumonia occurring . The highest risk resulted from introducing stock from salesbarns and the lowest from stock of health status known to the purchaser and supplied by one breeder only . Mortality, primarily among feeder pigs, and unthriftiness were the major effects of Haemophilus pleuropneumoniae infection . Stress, such as crowding or inclement climatic conditions, was associated with outbreaks of pleuropneumonia . This would suggest that the infection with H . pleuropneumoniae can be subclinical until stress precipitates the disease.

Antimicrob Agents Chemother, 1983 Jan, 23(1), 163 - 5
In vitro susceptibility of Haemophilus somnus to 33 antimicrobial agents; Sugimoto C et al.; Minimal inhibitory concentrations of 33 antimicrobial agents for Haemophilus somnus were determined by the agar dilution method . The tested H . somnus strains were highly susceptible to penicillin G, ampicillin, colistin, and novobiocin . They were not susceptible to spiramicin and sulfadimethoxine, and streptomycin-resistant strains were found.

Acta Otorhinolaryngol Belg, 1983, 37(4), 574 - 83
Focus on sinusitis . Host-microorganism relation; Holm SE; The author reviews the modern insights in host factors which protect from infection and explains how microorganisms such as Streptococcus pneumoniae, Haemophilus influenzae and Streptococcus pyogenes can escape from host-defence mechanisms thus infecting the host.

Clin Ther, 1983, 5(6), 644 - 50
The efficacy of cefuroxime in the treatment of bacterial meningitis in infants and children; Bahaeldin HK et al.; Forty-eight infants and children with bacterial meningitis received daily dosages of cefuroxime ranging from 90 to 300 mg/kg during the first two to four days of treatment and 45 to 149 mg/kg during the subsequent six to eight days of treatment . Cefuroxime was clinically and bacteriologically effective in 40 (83%) of the patients . All strains of Streptococcus pneumoniae, Neisseria meningitidis, and Salmonella typhi were sensitive to cefuroxime . Fourteen strains of Haemophilus influenzae were sensitive, and one was moderately sensitive, to the drug . Nine strains of Staphylococcus aureus were sensitive to cefuroxime, but three were resistant, as was Pseudomonas aeruginosa . No toxicity was encountered.

Acta Microbiol Hung, 1983, 30(3-4), 247 - 53
Effect of irradiated haemophilus influenzae endotoxin preparations in mice; Csukas Z et al.; A detoxified substance (rdLPS) was produced from Haemophilus influenzae endotoxin by ionizing radiation and its capacity to prevent attacks of dyspnoea elicited by endotoxin inhalation in mice has been studied . The rdLPS proved to be an effective stimulant of aspecific immune resistance of mice but it could only partly prevent attacks of dyspnoea.

Scand J Infect Dis Suppl, 1983, 40, 37 - 40
Pathogenicity of Gardnerella vaginalis (Haemophilus vaginalis); Gardner HL; The controversy over the pathogenicity of Gardnerella vaginalis has a variety of explanations, including difficulty in isolating the organism on cultures, failure to employ established criteria for recognizing the clinical entity, and failure of some to employ orthodox investigate protocols . Briefly reviewed is the evidence that the bacterium is the index organism of a precisely defined specific vaginal infection . Any thesis that anaerobic bacteria are co-pathogens and essential for establishment of the classic clinical entity G . vaginalis vaginitis is challenged . That anaerobic bacteria can live in symbiosis with G . vaginalis and that they may account for some variations in clinical features of the disease are consistent with the fact that various indigenous bacteria often modify the clinical characteristics of most specific infections of open body cavities . The author believes that G . vaginalis is never indigenous, that it is never commensal, and that it consistently induces a recognizable vaginal disease.

Acta Microbiol Hung, 1983, 30(2), 139 - 46
Respiratory effect of Haemophilus influenzae endotoxin in mice; Csukas Z et al.; The effect of the endotoxin of a noncapsulated Haemophilus influenzae strain isolated from bronchitis was studied on the respiration of mice . Inhalation of the H . influenzae endotoxin resulted in heavy attacks of dyspnoea with non-specific histological changes in the lung . The endotoxin elicited no direct response in isolated organs, but produced cytotoxic changes in HEp-2 tissue cultures . The experiments led to the conclusion that the clinical signs and the histological changes may be explained by the direct damaging effect of endotoxin on the cells and by the released mediator substances.

Trans R Soc Trop Med Hyg, 1983, 77(5), 665 - 7
Chancroid in Nigeria; Joshi RM et al.; The present paper records the incidence of chancroid in northern Nigeria . Out of 776 new patients registered at the Special Treatment Clinic (STC) of the Ahmadu Bello University Teaching Hospital (ABUTH) Zaria during February to August 1982, 34 cases (4.38%) were diagnosed as chancroid . Direct smear examination for Haemophilus ducreyi was positive in 33 cases and bacterial bodies devoid of cell wall (probably L-forms of H . ducreyi) were demonstrated in one . Culture for H . ducreyi was positive in only three cases . All the patients responded to co-trimoxazole and tetracyclines.

Scand J Infect Dis Suppl, 1983, 39, 109 - 11
Activity of cephalosporin antibiotics against Haemophilus influenzae; Philpott-Howard J et al.; Minimum inhibitory concentrations (MICs) of nine cephalosporins were determined for 90 isolates of Haemophilus influenzae including 70 amoxycillin-resistant strains . Cefotaxime was the most active of the parenteral antibiotics tested, with a modal MIC of 0.03 mg/l, compared with ceftazidime 0.12 mg/l, cefamandole 0.25 mg/l, cefuroxime 0.5 mg/l and cefathiamidine 4 mg/l . Cefaclor was the most active of the oral cephalosporins tested, with a modal MIC of 2 mg/l compared with cephalexin 8 mg/l and cephradine 32 mg/l . Amoxycillin-sensitive and beta-lactamase-producing haemophili had similar MICs for all cephalosporins . Twenty amoxycillin-resistant beta-lactamase non-producing strains showed high MICs for all beta-lactams tested . A cell permeability barrier is postulated as a mechanism of resistance in these strains.

Scand J Infect Dis Suppl, 1983, 39, 106 - 8
Antibacterial activity of nine oral antibiotics against Streptococcus pneumoniae, Haemophilus influenzae and Branhamella catarrhalis; Renkonen OV; The efficacy of nine oral antibiotics were analyzed by the agar dilution method against clinical isolates consisting of 87 beta-lactamase positive and negative Haemophilus influenzae and Branhamella catarrhalis strains and 30 Streptococcus pneumoniae strains . The following drugs were tested: cefaclor, cefalexin, cefadroxil, cefradin, phenoxymethylpenicillin, ampicillin, amoxycillin, erythromycin and doxycycline . Inoculations of 10(4) bacteria/plate were made with a Steers inoculator on Mueller-Hinton agar containing 5% blood . Cefaclor was more effective than the other cefalosporins against all H . influenzae and B . catarrhalis strains, regardless of their beta-lactamase production . Cefaclor and cefradin were more effective than cefalexin and cefadroxil against S . pneumoniae strains . Cefaclor was less effective than erythromycin against pneumococci, B . catarrhalis and beta-lactamase positive H . influenzae strains and equally effective against beta-lactamase negative H . influenzae strains . Cefaclor was less active than doxycycline against the B . catarrhalis and H . influenzae strains and showed similar efficacy as doxycycline against pneumococci.

Med Microbiol Immunol (Berl), 1983, 172(3), 161 - 4
Evaluation of the Phadebact coagglutination test for the rapid serotyping of Haemophilus influenza; Qadri SM et al.; Conventional tests for the indentification of Haemophilus species require 24-48 h for completion . In this study, we evaluated the Phadebact coagglutination method for the serotyping of Haemophilus that yields results within 2 min . Of the 150 strains tested, 148 were H . influenzae and 2 were H . parainfluenzae . Of the 83 H . influenzae isolates from cerebrospinal fluid and blood 80 were correctly typed as b by the Phadebact test . Of the 51 sputum isolates, 48 (94%) were nontypable . Eleven (69%) of the remaining sixteen isolates from secondary and unknown sources were type b, four (25%) were nontypable, and one (6%) was in the acdef group . Thirty gram-positive and gram-negative bacteria other than Haemophilus were also tested with no false-positive reactions . The Phadebact test is rapid and easy to perform and interpret.

Eur J Respir Dis Suppl, 1983, 127, 118 - 28
Bronchopulmonary symptoms in primary ciliary dyskinesia . A clinical study of 27 patients; Pedersen M et al.; Lower airway symptoms in 27 patients with primary ciliary dyskinesia (Kartagener's syndrome, "immotile cilia syndrome") are presented . Nine of the patients had reduced ciliary beating (defective dynein arms), ten asynchroneous ciliary beating pattern (7 spoke defects and 3 other microtubular abnormalities) and eight a newly described type of abnormal bearing "hypermotile cilia" (normal cilia ultrastructure) . Seventeen (63%) had partial or total situs inversus . All had absent or markedly reduced mucociliary transport in the nose and chronic rhinosinusitis since early childhood, whereas lower airway symptoms had a tendency to start later on in life . This was especially found in patients with hypermotile cilia, who also had less pronounced pulmonary disease . The most characteristic feature of the disease was a slow chronic course with a daily productive cough . Half of the patients were not even affected in their daily activities . Fifteen (56%) had bronchiectasis, and atelectasis occurred in 12 (44%) . With a few exceptions the lung function was normal or only slightly reduced . Haemophilus influenzae was the most common pathogen found in sputum, but some had chronic pulmonary pseudomonas or coli infection . Improvement was seen in the patients who were regularly given antibiotics and prophylactic treatment against mucus accumulation.

J Infect, 1983 Jan, 6(1), 33 - 7
Antibiotic susceptibility of pneumococci and Haemophilus influenzae isolated from patients with acute exacerbations of chronic bronchitis: prevalence of tetracycline-resistant strains in Hong Kong; Ling J et al.; The susceptibility of 119 respiratory isolates of Haemophilus influenzae and 87 respiratory isolates of Streptococcus pneumoniae to various antibiotics was tested by means of an agar dilution method and an inoculum size of 10(3) colony forming units (c.f.u.) . The antibiotics tested included penicillin/ampicillin, erythromycin, tetracycline, chloramphenicol and four third-generation cephalosporins, cefotaxime, cefoperazone, ceftriaxone and moxalactam . Fifty-eight per cent of the pneumococcal strains and 23 per cent of the H . influenzae strains tested were found resistant to tetracycline (MICs = 4-128 mg/l and 4-64 mg/l, respectively) . None of the isolates tested was resistant to erythromycin or chloramphenicol . Three per cent of Haemophilus strains tested were beta-lactamase producing and thus resistant to ampicillin (MICs = 2-8 mg/l), while none of the pneumococcal strains tested was penicillin-resistant . Three of the newer third-generation cephalosporins--cefotaxime, cefoperazone and ceftriaxone--were highly active against both H . influenzae and Str . pneumoniae while moxalactam, though also active, was comparatively less effective.

Chemotherapy, 1983, 29(4), 262 - 4
In vitro activity of rosoxacin against Haemophilus influenzae; Jurek EA et al.; The in vitro activity of rosoxacin was compared to that of ampicillin, cefoxitin, chloramphenicol, and rifampin, against 94 clinical isolates of Haemophilus influenzae . The results indicated that rosoxacin had significantly better in vitro activity against H . influenzae than the other antibiotics evaluated in this study . In addition, rosoxacin was an effective antimicrobial agent against isolates of H . influenzae that were resistant to ampicillin due to beta-lactamase production.

Mol Gen Genet, 1983, 189(1), 118 - 22
Repair of methyl methane sulfonate-damaged phage by Haemophilus influenzae; Stuy JH et al.; Seven mutants of Haemophilus influenzae strain Rd (mmsA-) have been isolated that are more sensitive to methyl methane sulfonate (mms) than recombination-deficient (recA-) mutants . The mutations cotransformed about 25% with the strA locus while the five studied clustered tightly; they are all probably allelic . The mutants are not sensitive to ultraviolet radiation, X-rays, or nitrous acid . Mms-damaged phage HP1 plated very inefficiently on these mutants, indicating that they lack the first step in the excision repair of the lesion N3-methyladenine (m3A) . Incubation of damaged phage at 30 degrees C in the absence of mms resulted in a steady decline of viability when the phage were plated on the wild mmsA+ host but an initial steep rise was seen when it was plated on an mmsA- mutant . The rise is explained by the assumption that m3A lesions hydrolyzed off the DNA giving rise to repairable apurinic sites by both the mmsA+ and mmsA- hosts . No decline in viability was observed when hydroxylamine was present in the medium . This compound is known to prevent or slow down beta-elimination . The delayed decline in viability is therefore explained by assuming that apurinic sites give rise to beta-elimination-induced single strand breaks in the phage DNA that cannot be repaired by either host . Marker rescue experiments indicated that these breaks did not interrupt injection of phage DNA.

Sex Transm Dis, 1983 Jan-Mar, 10(1), 1 - 6
Antimicrobial therapy of chancroid: an evaluation of five treatment regimens correlated with in vitro sensitivity; Fast MV et al.; One hundred fifty-one men with genital ulcer disease were assigned randomly to treatment with one of five oral antimicrobial regimens: (1) sulfadimidine (1 g four times daily for seven days); (2) tetracycline (500 mg four times daily for seven days); (3) trimethoprim-sulfamethoxazole (TMP-SMZ; 160 mg of TMP and 800 mg of SMZ twice daily for seven days); (4) doxycycline (300 mg as a single dose); or (5) TMP-sulfametrole (640 mg of TMP and 3,200 mg of sulfametrole once as a single dose) . Haemophilus ducreyi was isolated from 81 (54%) of the men, and 35 strains were available for testing of antimicrobial susceptibility . The TMP-SMZ and TMP-sulfametrole regimens were more effective than sulfadimidine, tetracycline, or single-dose doxycycline in curing ulcers . Only one of 35 strains tested was susceptible to tetracycline (less than or equal to 8 mg/liter), and only ten of 35 strains were susceptible to doxycycline (less than or equal to 4 mg/liter), whereas all were susceptible to trimethoprim (less than or equal to 2 mg/liter) . The correlation between in vitro susceptibility and bacteriologic response to the antimicrobial agents requires further investigation . In particular, sulfonamide resistance did not always identify failure to respond to sulfadimidine.

Pediatr Infect Dis, 1983 Jan-Feb, 2(1), 34 - 8
Emergence of beta-lactamase-producing strains of Branhamella catarrhalis as important agents of acute otitis media; Shurin PA et al.; We performed a prospective study to monitor changes in the bacterial etiology of acute otitis media . Branhamella catarrhalis was isolated from middle ear exudates of 3 of 47 children (6.4%) studied between September 1979 and September 1980 and from 26 of 98 children (26.5%) studied between October 1980 and February 1982 (P = 0.0055) . Twenty of 26 B . catarrhalis strains (76.9%) were found to be resistant to ampicillin and to produce beta-lactamase . In contrast only 2 of 26 strains of Haemophilus influenzae (7.7%) isolated from the same group of patients were resistant to ampicillin . We could not detect changes in culture methods, in demographic features, in patterns of medical care or in prior middle ear disease or antimicrobial drug usage, which might explain this striking increase in the relative importance of resistant strains of B . catarrhalis.

Pediatr Infect Dis, 1983 Jan-Feb, 2(1), 27 - 9
Erythromycin-sulfisoxazole for persistent acute otitis media due to ampicillin-resistant Haemophilus influenzae; Rodriguez WJ et al.; In patients with acute otitis media who had failed to improve with ampicillin therapy, 35% of Haemophilus strains isolated from the middle ear were ampicillin-resistant . Twenty-nine children (24 of whom had failed to respond to ampicillin) were treated with 40 mg erythromycin ethylsuccinate per kg per day and 100 to 150 mg sulfisoxazole per kg per day . Middle ear exudate was cultured on chocolate and 5% sheep blood agar . Twenty-three of 29 Haemophilus isolates were nontypable, 10% (3 children) were type b, 2 were Haemophilus parainfluenzae and one was not typed . All strains were resistant to ampicillin by disc susceptibility testing, and 28 of 29 strains produced beta-lactamase . The minimal inhibitory concentration of ampicillin for 15 strains ranged from 3.12 to 100 micrograms/ml (median, 6.25 micrograms/ml) . The erythromycin ethylsuccinate and acetyl sulfisoxazole combination was effective in treatment of acute otitis media secondary to ampicillin-resistant Haemophilus influenzae . After 10 days of erythromycin ethylsuccinate-sulfisoxazole therapy, 18 patients had normal tympanic membranes . Of 11 with middle ear effusion, 7 cleared, 3 had recurrent otitis media within 1 month and 1 had persistent otitis media with effusion . Our experience suggests the efficacy of this combination in otitis media caused by ampicillin-resistant H . influenzae.

Antimicrob Agents Chemother, 1983 Jan, 23(1), 182 - 4
Comparative in vitro and in vivo activity of temocillin (BRL 17421) and ampicillin against Haemophilus influenzae type b; Yogev R et al.; A total of 42 strains of Haemophilus influenzae type b isolated from pediatric patients were sensitive in vitro to temocillin (90% minimal inhibitory concentration = 0.25 microgram/ml) . No difference in mean minimal inhibitory concentration between beta-lactamase producer (0.25 microgram/ml) and nonproducer (0.23 microgram/ml) strains was found . Various dosages of ampicillin or temocillin for the treatment of infant rats with ampicillin-resistant H . influenzae bacteremia and meningitis yielded no difference in cure rates . These results suggest that temocillin may not be as effective as other new cephalosporins for the treatment of H . influenzae type b infections.

Acta Otolaryngol, 1983 Jan-Feb, 95(1-2), 105 - 10
Haemophilus influenzae in acute otitis media; Karma P et al.; We studied the occurrence of Haemophilus influenzae (Hi) in 2625 middle ear fluid (MEF) specimens obtained from 523 children with otitis media, aged 3 months to 6 years, between October 1977 and May 1979 . In clinically acute cases 12.3% of the MEFs grew Hi; 6.3% (13/206) of the strains were of type b and 4.9% (10/206) were beta-lactamase producing . In the very first acute case of a child 8.0% (21/263) of the MEFs grew Hi, but in acute recurrences it was cultured in 17.0% (184/1082) (p less than 0.001) . In non-acute persistent MEFs obtained during control visits Hi was found in no less than 21.7% (198/913); as many as 12.6% (25/198) of them were beta-lactamase producing . Both of these figures, but not the proportion of type b strains (8.6%), were significantly (p less than 0.001 and p less than 0.01, respectively) greater than in clinically acute MEFs . Hi was grown in 13.1% of the acute MEFs taken from children less than 4 years old, but in only 8.6% of the older children (p less than 0.05) . The annual survey of all the 1816 Hi strains isolated from the MEFs of acute or subacute cases of otitis media in one laboratory in 1976-81 showed the proportion of beta-lactamase producing strains of all Hi strains to be gradually increasing from 8.0% (17/212) in 1976 to 15.2% (16/105) in 1981 (p less than 0.05).

Rev Infect Dis, 1983 Jan-Feb, 5(1), 123 - 36
Nontypable Haemophilus influenzae (biotype 4) as a neonatal, maternal, and genital pathogen; Wallace RJ Jr et al.; Between 1976 and 1981 Haemophilus influenzae was identified in 16 women with postpartum bacteremia and 36 neonates with bacteremia or meningitis . H . influenzae was also recovered from neonatal or genital cultures of 50 additional patients . By counter-immunoelectrophoresis 17% of neonatal isolates from blood or cerebrospinal fluid (CSF) were type b . All remaining strains (94% overall) were nontypable (NT) . Of the NT blood or CSF isolates, 38% belonged to biotype 4 . Of all the NT biotype 4 isolates referred to the Centers for Disease Control during the study, 82% were of genital, neonatal, or maternal origin, a finding that suggests that this isolate is a genital biotype . Clinical disease was similar to that observed in patients infected with group B Streptococcus except for the infrequent (11%) occurrence of meningitis . Maternal bacteremia resulted in mild febrile illness, while neonatal bacteremia was associated with a high incidence of shock, respiratory distress (50%), and death (30%) . H . influenzae bacteremia in these two patient groups was rare in Houston before 1976, but since then it has been responsible for 2.5% of cases of significant bacteremia . NT H . influenzae should be recognized as a definite neonatal, maternal, and genital pathogen.

J Clin Microbiol, 1983 Jan, 17(1), 143 - 5
Bacteremic infections caused by nontypable Haemophilus influenzae in patients with dysgammaglobulinemia; Musher DM et al.; Two patients with dysgammaglobulinemia had bacteremic infections due to nontypable Haemophilus influenzae . The regular use of counterimmunoelectrophoresis or the more careful use of existing agglutination techniques to serotype Haemophilus isolates may identify nontypable H . influenzae in this clinical setting more frequently than has been though possible.

Infect Immun, 1983 Jan, 39(1), 297 - 304
Opsonizing and bactericidal effects of normal human serum on nontypable Haemophilus influenzae; Musher DM et al.; The observation that nontypable (NT) Haemophilus influenzae causes serious infection in adults has stimulated interest in mechanisms that may protect the human host against NT H . influenzae infection . Incubating NT H . influenzae with normal human serum (NHS) caused dose- and time-dependent killing that varied with the individual NHS and NT H . influenzae . Adsorption of NHS with NT H . influenzae removed bactericidal activity against the adsorbing isolate but not necessarily that against others, suggesting antigenic diversity and supporting recent studies that show different outer membrane protein profiles among NT H . influenzae . Heating NHS to 56 degrees C for 30 min abolished bactericidal activity; this activity was not restored by complement-rich guinea pig serum or NT H . influenzae-adsorbed NHS . This is analogous to the "third factor" needed for intraleukocytic killing of pneumococci . Optimal opsonization of NT H . influenzae for phagocytosis by human polymorphonuclear leukocytes required antibody and complement, but other serum factors also played a role . Bactericidal activity generally, but not uniformly, correlated with opsonizing activity of individual NHS . Humoral factors may be important in host defenses against NT H . influenzae infection; their emergence during convalescence warrants further study.

Scand J Infect Dis Suppl, 1983, 39, 9 - 13
Bacteriological aspects of infections of the upper respiratory tract; Kallings LO; In this introductory presentation, the bacteriology of acute otitis media, sinusitis and orofacial infections is surveyed, and recent data on antibiotic resistance of the most common pathogenic bacteria are reported . In addition, the difference in the immunogenic effect of capsular polysaccharides from pneumococci and Haemophilus influenzae in children of different ages is mentioned . In acute otitis media and sinusitis, pneumococci and H . influenzae are the most common isolates followed in frequency by Branhamella catarrhalis and streptococci group A . It should be emphasized that the average relative risk of otitis media with effusion is much higher in children with viral respiratory infections than in children with nasopharyngeal colonization with pneumococci or H . influenzae . Anaerobic bacteria are the most common causes of odontogenic infections . Penicillin remains the most active of the currently available antibiotics against streptococci group A . Resistance to penicillin of clinical isolates has still not been documented, although resistance may occur to erythromycin and tetracycline . In pneumococci isolates obtained in Sweden, a relative resistance to penicillin occurs in a low percentage . They may also be resistant to erythromycin and tetracycline . The frequency of beta-lactamase producing H . influenzae has been followed nation-wide in Sweden during recent years . The mean frequency varies around 3-4% with local and seasonal peaks up to 12% . The majority of the H . influenzae isolates in Sweden are not fully sensitive to erythromycin, but resistance to chloramphenicol occurs . Most strains (including beta-lactamase producing) are sensitive to co-trimoxazole, cefuroxime, cefotaxime, cefotriaxone and cefaclor . Over 40% of clinical isolates of B . catarrhalis in Sweden produce beta-lactamase.(ABSTRACT TRUNCATED AT 250 WORDS)

Scand J Infect Dis Suppl, 1983, 39, 56 - 8
Treatment of maxillary sinusitis; Ekedahl C; Most patients with sinusitis are treated by general practitioners . Since these doctors generally do not puncture the maxillary sinus, they can not be certain that the patient has a purulent sinus infection, which is the most important sign for determining whether or not the patient should have an antibiotic . Thus, the doctor has to rely on symptoms that are most characteristic of a purulent sinusitis . The symptoms are described and the bacteria most frequently seen in sinusitis are mentioned (Haemophilus influenzae, Streptococcus pneumoniae and anaerobic bacteria) . Treatment of maxillary sinusitis should primarily consist of restoring the normal milieu within the sinus by antral puncture and lavage . Penicillin V is still the first antibiotic drug of choice, because of its effectiveness in vitro and in vivo . In therapeutic failure, aeration of the maxillary sinus is first recommended . Cefaclor, tetracyclines or trimethoprim are recommended in patients allergic to penicillins . The agents are also recommended when beta-lactamase-producing strains of H . influenzae and Branhamella catarrhalis are isolated.

Ann Biol Clin (Paris), 1983, 41(6), 427 - 33
{Rapid diagnosis of purulent meningitis}; Husson MO et al.; The cerebrospinal fluid of 589 subjects, 78 of whom were suffering from a purulent meningitis were examined . Comparatively by classical bacteriological techniques (direct examination and culture) and by electro-immunodiffusion, latex agglutination, and Limulus endotoxin assay . Soluble bacterial Haemophilus influenzae type B, Neisseria meningitidis group A, C, and Streptococcus pneumoniae antigens, were tested by electro-immunodiffusion and latex agglutination, and soluble bacterial N . meningitidis group B, Listeria monocytogenes and Streptococcus agalactiae antigens by electro-immunodiffusion . Specific antigens and endotoxin were found in 75.8 per cent of the specimens with a rapid answer (120 min) . The three tests revealed also only the diagnosis in 29.1 per cent of cases of pneumococcal meningitis, in 33.3 per cent of meningococcal meningitis and in 47 per cent of Gram-negative bacteria meningitis . Only five cerebrospinal fluid from the 589 specimens tested were given a non-specific reaction . These two advantages--sensitivity and specificity--of these three tests render them techniques of the future in the diagnosis of purulent meningitis.

Scand J Infect Dis Suppl, 1983, 39, 83 - 5
Betalactamase-producing microorganisms in recurrent tonsillitis; Tuner K et al.; In 73% of 167 patients with recurrent tonsillitis, colonization with betalactamase-producing microorganisms was found . Betastreptococci group A were recovered in 6% of the patients and group C and G streptococci in 23% . Other microorganisms found were Staphylococcus aureus in 42%, Haemophilus species in 52%, bacteroides species in 80% and fusobacteria in 40% . Ninety-eight per cent of Staph . aureus, 60% of bacteroides species and 10% of fusobacteria were betalactamase-producing . Phenoxymethylpenicillin (1 g twice a day for ten days) diminished 50% of group A, C and G streptococci . No other microorganisms were affected by this antibiotic . Clindamycin (0.15 g four times a day for ten days) eradicated Staph . aureus, group A, C and G streptococci, bacteroides and fusobacteria . Haemophilus species were not affected by clindamycin . Tinidazole (1 g once a day for 10 days) diminished bacteroides and fusobacteria . Aerobic microorganisms, Staph . aureus, streptococci and Haemophilus, were not affected by tinidazole.

Can J Comp Med, 1983 Jan, 47(1), 48 - 53
A model aerosol exposure system for induction of porcine Haemophilus pleuropneumonia; Sebunya TN et al.; One group of six pigs and another group of three pigs were separately exposed in a polyethylene enclosed chamber for ten minutes, respectively, to Haemophilus pleuropneumoniae serotype 1 and Bacillus subtilis aerosols generated by an ultrasonic nebulizer . Haemophilus pleuropneumoniae and B . subtilis were deposited throughout the lungs immediately following aerosol exposure . The number of H . pleuropneumoniae and B . subtilis deposited varied within and between lungs in each group . The mean numbers of both organisms deposited in the posterior (caudal and accessory) lobes were significantly greater than those in the anterior (cranial and middle) lobes (P less than 0.001) . The four principals that received H . pleuropneumoniae aerosols and the two contact controls developed fatal fibrinous pneumonia which simulated that seen in natural infections . Since this exposure system consistently resulted in clinical disease it has good potential as a model for the study of pathogenesis of the disease and more specifically for the evaluation of vaccines.

Infect Immun, 1983 Jan, 39(1), 253 - 61
Identification and characterization of the major cell envelope proteins of oral strains of Actinobacillus actinomycetemcomitans; Di Rienzo JM et al.; The major cell envelope protein compositions of seven Actinobacillus actinomycetemcomitans strains of human origin were compared by sodium dodecyl sulfate-polyacrylamide gel electrophoresis . The major envelope polypeptides were homogeneous, in relation to molecular weight, in all of the strains that were examined . The characterization of the five major proteins, designated Env1 through Env5, in the leukotoxic strain Y4 revealed that proteins Env2 to -5 may reside in the outer membrane as suggested by differential detergent extractions and 125I-labeling experiments . The proteins did not demonstrate covalent or ionic interactions with the peptidoglycan; however, one protein, Env2, displayed heat-modifiable properties, having apparent molecular weights of 32,000 and 45,000 when heated in sodium dodecyl sulfate at 50 and 100 degrees C, respectively . The protein composition of the extracellular "bleb" material, normally released by strain Y4, was determined, and proteins Env1 to -4 were the predominant protein species found . A comparison of the cell envelope proteins of strain Y4 with those of other members of the human oral flora, including species within the genera Capnocytophaga, Bacteroides, and Fusobacterium, revealed distinct differences on the basis of molecular size and heat-modifiable properties . However, the membrane proteins of Haemophilus aphrophilus showed a remarkable degree of homology with those of A . actinomycetemcomitans.

Postgrad Med J, 1983, 59 Suppl 5, 9 - 15
The antimicrobial activity of cephalexin against old and new pathogens; Jones RN et al.; The present report reviews the significant in vitro characteristics of cephalexin based on data published since 1967 (Wick, 1967) . Whenever possible, current data on the action spectrum of cephalexin are compared with previous results, and the significance of in vitro activity to therapeutic efficacy is evaluated in the light of current clinical reports . Recent observations are presented on the in vitro action of cephalexin against newly recognized bacterial pathogens, such as beta-lactamase-producing Haemophilus influenzae and Branhamella catarrhalis (formerly Neisseria catarrhalis) . Data are presented on the stability of cephalexin to various beta-lactamases . Current information on the types of penicillin-binding proteins that interact with cephalexin is briefly noted . Finally, consideration is given to the effects of inoculum density on the minimum inhibitory and bactericidal concentrations of cephalexin . The continued utility of the 30 micrograms cephalothin-class disc to predict cephalexin susceptibility is emphasized.

Postgrad Med J, 1983, 59 Suppl 5, 32 - 9
Cephalexin in lower respiratory tract infections; Raff MJ; Cephalexin has had 12 years of extensive clinical usage in the management of respiratory tract and other infections . It is reliably absorbed from the gastrointestinal tract and reaches therapeutic levels in serum and tissues . Toxicity and adverse side effects are minimal . The antimicrobial spectrum includes a majority of the pathogens usually associated with community-acquired lower respiratory tract infections with the significant exception of Haemophilus influenzae . Resistance of H . influenzae strains reduces the uses of cephalexin in the paediatric population and may limit its effectiveness in some patients with acute exacerbations of chronic bronchitis . In contrast, it is inordinately effective in managing most adult patients with lower respiratory tract infections, either as a primary agent, as a substitute for penicillins or other antimicrobial agents in patients unable to receive these, or for continuation of therapy in individuals who no longer require parenteral compounds . As with other cephalosporins, caution should be exercised to exclude meningitis when treating patients with respiratory tract infections since the majority of these compounds, including cephalexin, produce little or no cerebrospinal fluid levels.

Postgrad Med J, 1983, 59 Suppl 5, 28 - 31
Cephalexin in the treatment of upper respiratory tract infections; Disney FA; Cephalexin, a semisynthetic cephalosporin antibiotic, has wide clinical application in respiratory infections of children and adults . In pharyngitis and tonsillitis due to beta-haemolytic streptococci, it is comparable to penicillin, cyclocillin, and cephaloglycin, as measured by clinical response, bacteriological cure rate, and incidence of relapse and reinfection . In otitis media, it is effective at dosages of 50-100 mg/kg/day except in those infections caused by Haemophilus influenzae, in which there is failure in 50% of the cases . In other infections of the upper respiratory tract, it appears to be effective except, again, in those caused by H . influenzae . Dosages of 1-2 g/day have been used in adults and 20-100 mg/kg/day in children . Adverse effects, mostly gastrointestinal upsets, rash, and urticaria, have been relatively infrequent and have not required discontinuance of the drug.

Clin Invest Med, 1983, 6(3), 207 - 12
Bacterial plasmids--an overview; Falkow S et al.; Resistance to antimicrobial substances and various factors contributing to pathogenicity are only some of the bacterial traits that can be determined by plasmid genes . Not all plasmids are involved with resistance, nor is all resistance to antimicrobials plasmid-mediated . Nevertheless, the impact of R-plasmids on the choice of antimicrobial therapy is substantial, especially in hospital and when dealing with certain community pathogens, such as Haemophilus influenzae . The discovery of transposition elements has helped us to understand the rapidity with which certain resistance determinants develop and become disseminated among diverse microbial species . Similarly, not all determinants of microbial pathogenicity are plasmid encoded and the genes for many toxins, cellular attachment pili, iron sequestration systems, etc . are found on the bacterial chromosomes . In Yersinia, pathogenicity is even more complex in that plasmid determinants play an essential role, but only in concert with chromosomal genes . The particularly significant features of such pathogenicity-determined plasmid-mediated genes is not that they are found on extrachromosomal elements, but that they may possess greater genetic mobility . Another consequence of the presence of virulence genes on bacterial plasmids is that it makes them easier to study by the newer techniques of microbial genetics and molecular biology.

Scand J Infect Dis Suppl, 1983, 39, 59 - 67
Respiratory tract infections at a community care centre--with emphasis on group A streptococci; Hovelius B et al.; Antibiotics were prescribed for 60% of 1538 patients who consulted a community care centre due to respiratory tract infections . Potential respiratory tract pathogens (betahaemolytic streptococci group A, C, G, Haemophilus influenzae, pneumococci) were isolated from almost half (46%) of the patients . The prescribing of antibiotics was correlated to the isolation of potentially pathogenic bacteria, except for patients with pharyngitis, sinusitis and bronchitis . Betahaemolytic streptococci group A were isolated from 14% of the patients . Recurrence of group A streptococcal infection occurred within 3 months in 24% of patients harbouring such bacteria at the first visit . Poststreptococcal subclinical acute glomerulonephritis (AGN) was diagnosed in 9 (4%) of 220 patients with group A streptococci . The patients with AGN had been treated with antibiotics significantly later than patients without signs of AGN.

Scand J Infect Dis Suppl, 1983, 39, 100 - 5
Antibiotic sensitivity of Haemophilus influenzae, Streptococcus pneumoniae, Streptococcus pyogenes and Branhamella catarrhalis isolated from upper respiratory tract infections in Sweden; Kallings I et al.; Isolates of Haemophilus influenzae, Streptococcus pneumoniae, Streptococcus pyogenes and Branhamella catarrhalis were collected from five laboratories in different geographical areas in Sweden . Nine hundred and fortyfour strains were tested by the agar dilution method for susceptibility to seven oral antibiotics: phenoximethylpenicillin, ampicillin, cefaclor, erythromycin, doxycycline, trimethoprim-sulfamethoxazole and chloramphenicol . The H . influenzae and B . catarrhalis strains were also tested for beta-lactamase production . Of the H . influenzae strains, 8% were beta-lactamase-producing, while 35% of B . catarrhalis strains produced beta-lactamase . The latter value is higher than has earlier been reported in Sweden . Five S . pneumoniae strains showed decreased sensitivity to penicillin, and 9.5% of the S . pneumoniae strains showed a decreased sensitivity to one or more of the seven antibiotics tested . The S . pyogenes strains were sensitive to all the antibiotics tested with the exception of 4% of the strains, which showed a decreased sensitivity to doxycycline.

Clin Ther, 1983, 5(5), 472 - 4
Clinical trial of bacampicillin in acute bacterial infections; Ogunyemi O; A clinical trial of bacampicillin was carried out in 20 patients . The antibiotic was found to be effective in acute lobar pneumonia, pyogenic meningitis, acute and chronic bronchitis, acute pharyngitis, acute tonsillitis, cellulitis, furunculosis, and pyomyositis caused by such ampicillin-sensitive organisms as Neisseria meningitidis, Diplococcus pneumoniae, Staphylococcus aureus, Haemophilus influenzae, Streptococcus pyogenes, Klebsiella pneumoniae, and Escherichia coli . Rash in three patients was the only side effect encountered . It is concluded that while bacampicillin may have overcome some of the disadvantages of ampicillin, it retains its main attributes and some shortcomings.

Pediatr Infect Dis, 1983 Jan-Feb, 2(1), 30 - 3
A controlled trial of cefaclor versus amoxicillin for treatment of acute otitis media in early infancy; Berman S et al.; Optimal antimicrobial therapy of acute otitis media with effusion in early infancy is controversial . We studied the efficacy of cefaclor and amoxicillin in the treatment of 40 nonconsecutive infants less than 3 months of age in a double blind comparative trial . Infants were randomly assigned to receive either oral amoxicillin or cefaclor in a dosage of 40 mg/kg/day divided into 3 doses for 10 days . Clinical responses and adverse drug effects were evaluated at 48 to 72 hours, 5 to 7 days, 2 weeks and 3 weeks . Pathogenic bacteria isolated from ear aspirates in 24 cases included Streptococcus pneumoniae (14), Haemophilus influenzae type b (5), H . influenzae nontypeable (3), Staphylococcus aureus (4), Branhamella sp . (2), and Streptococcus pyogenes (1) . Nonpathogenic bacteria isolated in 14 cases included Streptococcus epidermidis, diphtheroids and Streptococcus viridans . Two aspirates were sterile . A satisfactory clinical response was achieved in 15 of 21 cases (71%) treated with amoxicillin and 14 of 19 cases (74%) treated with cefaclor . We conclude that amoxicillin and cefaclor are comparable in efficacy for the therapy of acute otitis media with effusion in early infancy.

Infection, 1983, 11 Suppl 1, S32 - 4
In vitro activity of ceftazidime (GR 20263) and other beta-lactam antibiotics against Haemophilus influenzae; Piot P et al.; Minimal inhibitory concentrations (MIC) and minimal bactericidal concentrations (MBC) were determined for ceftazidime (GR 20263 - pentahydrate), RO 13-9904, cefoperazone, cefotaxime, lamoxactam, cefamandole and ampicillin using clinical isolates of beta-lactamase-producing and beta-lactamase-negative Haemophilus influenzae . RO 13-9904 and cefotaxime were the most active, followed by ceftazidime, lamoxactam and cefoperazone . Ceftazidime displayed high stability against the beta-lactamase-producing strains with a low MBC:MIC ratio.

Am J Clin Pathol, 1983 Jan, 79(1), 73 - 7
Biotypes of Haemophilus influenzae: relationship to clinical source of isolation, serotype, and antibiotic susceptibility; Granato PA et al.; A total of 94 clinical isolates of Haemophilus influenzae were studied to analyze the relationship of biotype to site of isolation, serotype, and pattern of antimicrobial susceptibility . Systemic infections were caused most commonly by biotype I, and the majority of these isolates possessed type b capsular polysaccharide . Other noncapsulated biotypes of H . influenzae, particularly biotype V, also were associated with invasive disease . Antimicrobial susceptibility testing was performed on all isolates by an agar dilution method against ampicillin, chloramphenicol, cefoxitin, rifampin, and rosoxacin, and all isolates were screened for beta-lactamase activity . Except for 15 isolates that produced beta-lactamase, no other substantial differences in antimicrobial susceptibilities among biotypes of H . influenzae were detected . Encapsulated strains of biotype I had the highest frequency of ampicillin resistance.

Clin Invest Med, 1983, 6(3), 221 - 8
Evolution of antibiotic resistance plasmids in Neisseria gonorrhoeae and Haemophilus species; Brunton JL et al.; The emergence of beta-lactamase producing strains of Haemophilus influenzae and Neisseria gonorrhoeae has required fundamental changes in the antimicrobial therapy of disease caused by these organisms . Ampicillin resistance in both organisms is caused by plasmid mediated production of TEM beta-lactamase . This enzyme is specified by a sequence of mol . wt 3.2 X 10(6) which is capable of inserting itself at multiple sites in DNA replicons without the requirement for significant base sequence homology between donor and recipient replicon . Further, it does so without requirement for conventional recombination enzymes . Analysis of beta-lactamase specifying plasmids of H . influenzae show that they generally have a molecular mass in the order of 30 X 10(6) and contain the complete TnA sequence . They are conjugative but are incapable of mobilizing smaller beta-lactamase plasmids . Previous studies have presented evidence suggesting that these plasmids may have evolved by insertion of the TnA sequence (perhaps introduced from enteric bacteria) into a phenotypically cryptic plasmid of mol . wt 27 X 10(6) resident in rare strains of H . influenzae . In this study, we review data showing a high degree of homology between the small (3--7 X 10(6) mol . wt), nonconjugative beta-lactamase specifying plasmids of N . gonorrhoeae, H . parainfluenzae and H . ducreyl and present new evidence that cryptic plasmids highly homologous to the beta-lactamase plasmids are present in many strains of H . parainfluenzae . This suggests that the small beta-lactamase specifying plasmids of H . parainfluenzae, H . ducreyi and N . gonorrhoeae may have arisen by insertion of TnA into phenotypically cryptic plasmids present in H . parainfluenzae.

Can J Comp Med, 1983 Jan, 47(1), 54 - 6
Dose response relationship of Haemophilus pleuropneumoniae aerosols in pigs; Sebunya TN et al.; The virulence of Haemophilus pleuropneumoniae was quantitated for ten and 12 week old pigs following aerosol exposure . The volume and concentration of culture aerosolized, the estimated numbers of organisms inhaled by the pigs and the mortality rates at 72 hours postexposure were computed and used to calculate the LD50 . There was correlation between the concentration of culture aerosolized, the amount of the estimated inhaled dose and the mortality rates . The ten week old pigs were apparently more susceptible to aerosols of H . pleuropneumoniae than the 12 week old pigs . The LD50 value or a multiple of it appears to be a reasonable basis for a standardized aerosol challenge of the immunity of pigs vaccinated with experimental or commercial H . pleuropneumoniae vaccines.

J Hyg (Lond), 1982 Dec, 89(3), 467 - 78
Haemophilus ducreyi infections--time for reappraisal; McEntegart MG et al.; As the literature on Haemophilus ducreyi and clinical chancroid is reviewed, it becomes obvious that many significant findings have been forgotten over the years . As a result, from the time of Ducrey's original description of the organism in 1890 until about 1977, both clinical and laboratory experts in the United Kingdom believed that H . ducreyi infections were rare, generally acquired abroad, and almost impossible to confirm in the routine laboratory! In consequence it was a common view that it was not worth looking for H . ducreyi until all other possible causes of genital ulceration had been excluded . Moreover, the search for such an infection stopped as soon as any other cause for the patient's lesions had been found . A decision to ignore this 'rule' in Sheffield led to our looking for H . ducreyi in specimens from an unselected series of patients with genital ulceration including a number with herpes genitalis infections . The surprise finding of H . ducreyi in circumstances suggesting that it was a secondary invader made us re-examine the whole question of H . ducreyi infections and chancroid and wonder if the same organism can act as a primary pathogen and as a secondary invader . An account of the media and methods we used and of the characteristics of the organism is presented . In an attempt to find out more about the characteristic coherent colonies of H . ducreyi we studied them with the scanning electron microscope . It is clear that the whole subject of H . ducreyi infections has been neglected in the United Kingdom, but we believe that interest has now been aroused and progress will surely follow . Some areas for further investigation are suggested.

Ann Rheum Dis, 1982 Dec, 41(6), 615 - 6
Pneumococcal epiglottitis in systemic lupus erythematosus on high-dose corticosteroids; Shalit M et al.; A patient with systemic lupus erythematosus who developed pneumococcal epiglottitis is described and the literature reviewed . This infection is extremely rare in adults, and only 10 cases, none of them with SLE, have so far been reported . Epiglottitis is usually caused by Haemophilus influenzae . However, in immunocompromised hosts the probability of Streptococcus pneumoniae as the infecting agent is considerable . Penicillin should therefore be part of the antimicrobial regimen in such patients.

An Esp Pediatr, 1982 Dec, 17(6), 435 - 44
{Haemophilus influenzae meningitis . Review of 21 cases}; Vazquez C et al.; Twenty-one cases of "Haemophilus influenzae" meningitis occurred over a seven year period . An ampicillin-resistant strain was isolated in three (14,2%), but the percentage of ampicillin-resistant strains rose to 33% over the last two years, in meningitis and to 38% in all patients whose blood or CSF grew "Haemophilus influenzae" . One case (4,7%) had severe neurologic damage, and 3 (14%) had minor damage . The estimated duration of symptoms prior to proper treatment correlated with duration of fever conscience depression, and hospital stay . Both of the patients with symptoms prior to treatment lasting over 72 hours had sequellae . Chloramphenicol should be included in the therapy of every patient suspected of having severe "Haemophilus influenzae" infection in our region.

Monatsschr Kinderheilkd, 1982 Dec, 130(12), 905 - 8
{Phlegmona ("cellulitis") and Haemophilus influenzae meningitis}; Staudt F et al.; Soft tissue inflammation is a rare manifestation of H . influenzae infection . It is known in the anglo-american literature as "cellulitis" . Usually there is concomitant bacteremia or septicemia . The combination of cellulitis and meningitis is rare and not well known in German pediatric literature . Three children with facial cellulitis together with H . influenzae meningitis are described . In comparison to the literature some unusual observations were made: Early appearance of cellulitis at the age of six weeks in two infants, cellulitis of the lower extremities at the same time in one, and biphasic course with cellulitis and meningitis secondary to mastoiditis in another infant.

J Bacteriol, 1982 Dec, 152(3), 1066 - 70
Transfer of Haemophilus influenzae chromosomal genes by cell-to-cell contact; Albritton WL et al.; A low-frequency exchange of chromosomal markers was observed in matings of Haemophilus influenzae . Transfer did not appear to be due to classical transformation or to be plasmid mediated, and chromosomal gene transfer differed in several respects from plasmid transfer by conjugation.

Br J Vener Dis, 1982 Dec, 58(6), 377 - 80
Pathogenic microbial flora of genital ulcers in Sheffield with particular reference to herpes simplex virus and Haemophilus ducreyi; Kinghorn GR et al.; The pathogenic microbial flora of genital ulcers in 161 (80 men and 81 women) unselected patients was studied prospectively . In only one case was Treponema pallidum responsible whereas herpes simplex virus was considered to be the cause of 130 (80.8%) genital ulcers . H ducreyi was isolated from 46 (28.6%) patients, most commonly as a secondary pathogen in herpetic lesions . Two or more pathogens were isolated from the ulcers in 67 (41.6%) patients, and in 21 (13%) patients no pathogens were isolated . Our results indicate an urgent need for antiviral treatment to reduce the local reservoir of genital herpes, challenge traditional concepts about the prevalence of H ducreyi in Britain, and call for a reappraisal of its role in the causation of genital ulcers.

J Bacteriol, 1982 Dec, 152(3), 1071 - 7
Sequence-specific DNA uptake in transformation of Neisseria gonorrhoeae; Graves JF et al.; Piliated, competent gonococci are known to preferentially take up homologous transforming DNA into the cell . We examined the mechanism for DNA uptake with pFA10, a hybrid 11.5-kilobase (kb) penicillin-resistant (Pcr) plasmid composed of heterologous DNA from a 7.2-kb Pcr plasmid and homologous DNA from a 4.2-kb gonococcal cryptic plasmid . The presence of the gonococcal cryptic plasmid DNA in the hybrid resulted in markedly increased transformation efficiencies in isogenic crosses as compared with the parent 7.2-kb Pcr plasmid . Uptake of 32P-end-labeled MspI or TaqI restriction fragments of the hybrid was limited to fragments entirely derived from the 4.2-kb gonococcal cryptic plasmid, indicating that DNA uptake was probably dependent on the presence of a specific DNA sequence . Since Haemophilus DNA did not inhibit transformation by the hybrid Pcr plasmid, the gonococcal DNA uptake sequence is different from the known sequence involved in homologous DNA uptake by Haemophilus spp.

Dtsch Med Wochenschr, 1982 Nov 26, 107(47), 1796 - 9
{Diagnosis of vertebral diseases by vertebral biopsy}; Ernst HU et al.; Vertebral biopsies were performed in 28 patients, 17 males and 11 females, because of vertebral body and disc changes between June 1978 and May 1982 . In two patients biopsy was performed in two segments . Punctures were done in local and superficial anaesthesia of the vertebral body periosteum during continuous fluoroscopy control using Jamshidi's instrumentation . Aspiration and tissue cylinders were evaluated histologically and bacteriologically . There were no complications among the 8 thoracic and 22 lumbar biopsies . A histologic diagnosis could be established in 22 cases (78.6%): plasmocytoma (n = 2), spontaneous deformation of the spine in osteoporosis (n = 3), Scheuermann's disease (n = 1), specific (n = 2) and nonspecific (n = 14) spondylitis . Demonstration of bacteria was possible in 5 out of the 16 cases of spondylitis (31.25%): in two cases tubercle bacilli were demonstrated and once each salmonella group B, Haemophilus aphrophilus and coagulase-negative staphylococci . Only in 6 cases a diagnosis could not be established from the biopsy material.

Pediatr Infect Dis, 1982 Nov-Dec, 1(6), 402 - 4
Lack of relationship of community patterns of respiratory viral activity to systemic Haemophilus influenzae disease in children; McKee KT Jr et al.; The occurrence of epidemics of respiratory viral illness was monitored by virus isolations in a population of young children living in the greater Nashville area over a 4-year period . Epidemic disease due to influenza, respiratory syncytial virus and parainfluenza type 1 was present during discrete time blocks over this interval . Occurrence of systemic Haemophilus influenzae type b disease in the community was also documented by review of bacteriologic records of Vanderbilt Children's Hospital over the same interval . No correlation of the occurrences of epidemic viral disease and systemic H . influenzae type b disease was evident by this comparison.

J Clin Microbiol, 1982 Nov, 16(5), 840 - 3
Haemophilus pleuropneumoniae serotyping; Rosendal S et al.; A total of 126 Haemophilus strains isolated from porcine pneumonia were serotyped, using the indirect fluorescent-antibody technique . Of these, 103 were successfully typed within the recognized scheme of serotypes 1 to 5 . Eleven strains were antigenically similar but were different from other strains of H . pleuropneumoniae or H . parasuis . These strains are proposed as serotype 7 . Eight strains were not identified as serotype 1 when serum against strain Shope 4074 was used, but their identity as type 1 strains was concluded on the basis of complete cross-titrations, using unabsorbed and absorbed sera and indirect fluorescent-antibody and agglutination tests . The type-specific antigen of these strains may have been masked by an additional antigen . A similar situation was believed to exist for four strains which belonged to serotype 5 but did not react with serum against strain K17 (reference strain) in the indirect fluorescent-antibody test . Strain Femo was antigenically different from other H . pleuropneumoniae or H . parasuis strains and was proposed as serotype 6, thus replacing the "minor group" (represented by strain 202), which is of uncertain taxonomical status within the genus Haemophilus.

J Clin Microbiol, 1982 Nov, 16(5), 798 - 802
Growth requirements of Haemophilus somnus; Merino M et al.; The growth factor needs of Haemophilus somnus, which have not been defined to date, were found to be provided by 1% IsoVitaleX (IVX; BBL Microbiology Systems) in tryptose broth . Some growth, however, occurred in unsupplemented tryptose broth . Of the ingredients of IVX, cocarboxylase was found to stimulate growth to about the same degree as the total supplement . Cocarboxylase was without direct effect in 2% peptone broth, which supported no growth of 25 H . somnus strains until supplemented with IVX, optimally at the 10% level . This could be substituted for by proportional amounts of cysteine or cystine, but by no other IVX ingredient . Cysteine-cystine and IVX but not cocarboxylase supplementation allowed H . somnus to grow in Eagle minimal medium, a completely synthetic medium, but attempts at serial passage were unsuccessful.

Acta Neurol Scand, 1982 Nov, 66(5), 529 - 35
The incidence and aetiology of central nervous system infections in Helsinki in 1980; Ponka A et al.; The aetiology of central nervous system infections was surveyed in a study at Aurora Hospital, Helsinki, in 1980 . Of the 146 patients with central nervous system infections, 113 had aseptic meningitis, 23 bacterial and one tuberculous meningitis, and nine meningoencephalitis or encephalitis . The probable aetiology of aseptic meningitis was established in 67% of the 106 patients properly tested, the commonest agents being mumps (27%), Coxsackie (24%) and ECHO (9%) viruses . Haemophilus influenza type b was the most frequent cause of bacterial meningitis (39%), occurring solely among infants and young children . There were no cases due to Neisseria meningitidis group A, which used earlier to be epidemic in Finland . The incidences of aseptic, bacterial and tuberculous meningitis in Helsinki in 1980 (based on a total of 174 patients treated in the three hospitals admitting patients with central nervous system infections) were 26.7, 5.2 and 0.2 cases per 100,100 annually, and those of encephalitides and myelitis 3.5 and 0.6 cases per 100,000 annually.

Ann Microbiol (Paris), 1982 Nov-Dec, 133(3), 415 - 25
{Haemophilus influenzae: sensitivity to 12 antibiotics, analysis according to capsular serotype, biotype and source of isolation, and epidemiologic implications}; Pinon G; A total of 129 strains of Haemophilus influenzae were tested for susceptibility to twelve antibiotics . Capsular serotypes and biotypes were determined, and the relation between these parameters and minimal inhibitory concentrations (MIC) were analysed . Non-capsulated strains were more susceptible to streptomycin than capsulated ones . The distribution of MIC of chloramphenicol among biotypes was different . The distribution of MIC of penicillin G, tetracycline and chloramphenicol among sources of isolation was also different . Therefore the strains did not have the same origin, and one should look at the concept of organotropism for H . influenzae.

Zentralbl Bakteriol Mikrobiol Hyg {A}, 1982 Nov, 253(2), 236 - 46
Biochemical differentiation of Haemophilus influenzae . Additional characterization of biotypes by carbohydrate fermentation patterns; Tiller FW; A total of 295 strains of H . influenzae was characterized by serotyping and biochemotyping following the scheme of Kilian . Biotype II was the biotype most frequently seen (41.4% of the strains) . The strong correlation of serotype b with biotype I was confirmed . Carbohydrate degradation was evaluated as a possible aid for further characterization of biotypes . Differing results were obtained concerning the fermentation of fructose, maltose and xylose which were classified into five carbohydrate fermentation patterns A-E . To a certain degree the carbohydrate fermentation patterns of the strains could be associated with biotypes . No conclusion could be drawn, however, from carbohydrate fermentation patterns regarding sites of isolation and probable virulence of H . influenzae strains . The results of serotyping, biochemotyping according to Kilian and carbohydrate fermentation pattern analysis were correlated with clinical syndromes associated with isolation of the strains . Carbohydrate fermentation patterns permit a further differentiation of the serotype b/biotype I strains which can cause meningitis and other severe H . influenzae infections . A far more heterogeneous distribution of biochemical characteristics in strains isolated from the respiratory tract might facilitate epidemiological studies on respiratory diseases due to H . influenzae.

J Clin Microbiol, 1982 Nov, 16(5), 905 - 8
Evaluation of Bactogen and Phadebact for detection of Haemophilus influenzae type b antigen in cerebrospinal fluid; Welch DF et al.; Latex agglutination and coagglutination tests are commercially available as Bactogen and the Phadebact Haemophilus Test, respectively . We evaluated both for the detection of Haemophilus influenzae type b in cerebrospinal fluids . Both tests were positive in all of 51 culture-positive cases of meningitis caused by H . influenzae . Both were more sensitive than counterimmunoelectrophoresis . Antigen was also detected by Bactogen in seven of seven additional cerebrospinal fluid specimens (compared with four of seven by Phadebact) after 1 to 15 days of antimicrobial therapy . The cerebrospinal fluid of infants with meningitis owing to other common causative agents did not react with Bactogen or Phadebact . However, the cerebrospinal fluid of one patient with overwhelming infection owing to Proteus mirabilis reacted positively with Bactogen . Cost analysis revealed that Phadebact was less expensive to perform than Bactogen.

J Clin Microbiol, 1982 Nov, 16(5), 861 - 4
Isolation and rapid identification of Haemophilus ducreyi; Hannah P et al.; During a 2-month period, 62 strains of Haemophilus ducreyi were isolated from 168 genital lesions and 2 lymph node aspirates . Of these strains, 22 were found on both chocolate agar and fetal bovine serum agar supplemented with vancomycin, 29 were found only on chocolate agar, and 9 were found only on fetal bovine serum agar . Two additional strains were isolated on sheep blood agar . All of these isolates were correctly identified with the RapID NH system (Innovative Diagnostic Systems, Inc., Decatur, Ga.) a new identification kit that has a database for Haemophilus, Neisseria, and other genera that include fastidious gram-negative bacilli.

J Clin Microbiol, 1982 Nov, 16(5), 832 - 5
Rapid method for determining antimicrobial susceptibility of Haemophilus influenzae; Smith JA et al.; A method was developed to determine the susceptibility of Haemophilus influenzae to ampicillin, cefamandole, and chloramphenicol by using the MS-2 system (Abbott Laboratories) for determining minimum inhibitory concentrations (MIC) . The MS-2 results for 132 strains of H . influenzae were compared with the results of agar disk diffusion, agar dilution, and beta-lactamase tests . Twenty-four strains (18.2%) of H . influenzae were resistant to ampicillin by the agar dilution method, as opposed to 25 strains by the MS-2 method . For a beta-lactamase-negative strain, the agar dilution MIC was 4 micrograms/ml, and the MS-2 MIC was 16 micrograms/ml . Twenty-one strains produced beta-lactamase; two beta-lactamase-negative strains were resistant by MS-2, agar dilution, and agar disk diffusion . In addition, one beta-lactamase-negative strain, for which the agar dilution MIC was 32 micrograms/ml and the MS-2 MIC was 16 micrograms/ml, was sensitive by agar disk diffusion . Overall, the MS-2 method compared favorably with the agar dilution method for determining the MIC of ampicillin, cefamandole, and chloramphenicol for H . influenzae.

J Clin Microbiol, 1982 Nov, 16(5), 826 - 31
Haemophilus influenzae: comparison of respiratory tract isolates with genitourinary tract isolates; Albritton WL et al.; Haemophilus influenzae isolates recovered from the genitourinary (GU) tract were shown to have a significantly different biotype distribution compared with respiratory tract isolates . Biotype IV strains were recovered more commonly from the GU tract, and most strains were non-serotypable . Antibiotic-susceptible strains isolated from the GU tract more frequently harbored plasmids of less than 10 megadaltons than did antibiotic-susceptible respiratory tract strains . One 2.8-megadalton plasmid resident in a GU tract isolate and one 1.8-megadalton plasmid resident in a respiratory tract isolate were shown to be related to the small ampicillin resistance plasmids previously described in H . influenzae, Haemophilus parainfluenzae, Haemophilus ducreyi, and Neisseria gonorrhoeae . This supports the suggestion that these ampicillin resistance plasmids originated by transposition or recombination of the ampicillin transposon (TnA) with cryptic endogenous Haemophilus plasmids.

Antimicrob Agents Chemother, 1982 Nov, 22(5), 923 - 5
Susceptibility of Haemophilus influenzae type b to cefaclor and influence of inoculum size; Levin RM et al.; Cefaclor appeared to be an effective antibiotic against both beta-lactamase-positive and beta-lactamase-negative strains of Haemophilus influenzae type b when tested with 10(5) colony-forming units per ml . With inocula in excess of 10(6) colony-forming units per ml, these organisms were neither inhibited nor killed at concentrations of 400 micrograms/ml . This inoculum effect was also demonstrated in time-kill curve studies.

Infect Immun, 1982 Nov, 38(2), 610 - 9
Infant rat model of attenuation for recombinant influenza viruses prepared from cold-adapted attenuated A/Ann Arbor/6/60; Ali M et al.; The pathogenicity of 6 wild-type influenza A viruses and 21 recombinant strains prepared from wild-type viruses and cold-adapted A/Ann Arbor/6/60 virus for infant rats was determined . Thus, the titers of virus present in the turbinates and lungs of virus-infected animals was measured serially for 5 days after intranasal infection, and the ability of virus strains to promote subsequent systemic bacterial infection by Haemophilus influenzae was measured at 48 h after virus infection . The results obtained were assessed with reference to the genetic constitution of the virus strains and to virus virulence for volunteers . The results showed that virulent viruses grew to relatively high titers in rat turbinates and significantly promoted systemic infection by H . influenzae . In contrast, attenuated strains grew to lower titers and failed to promote systemic H . influenzae infection . For the strains tested, the results showed clear differences for attenuated and virulent strains, and the model was a reliable indication of virulence for humans . Although the virulent strains tended to grow to higher titers in rat lungs than did attenuated strains, exceptions were found, and this measurement could not reliably discriminate virulent and attenuated virus strains . The results suggest that infant rats can be used to assess the virulence of cold-adapted recombinant influenza virus strains, and thus, they can facilitate the development of such strains for vaccine production.

J Bacteriol, 1982 Nov, 152(2), 855 - 64
Generation and release of DNA-binding vesicles by Haemophilus influenzae during induction and loss of competence; Deich RA et al.; Genetic transformation of bacterial cells required the induction of a state of competence to bind and absorb free DNA molecules . Induction of competence in Haemophilus influenzae was accompanied by the generation on the cell surface of membrane extensions ("blebs") 80 to 100 nm in diameter . When competent cells were returned to normal growth conditions, they shed these structures as free vesicles with a concomitant loss of cellular DNA-binding activity . Purified vesicle preparations retained the ability to bind double-stranded DNA in a nuclease-resistant, salt-stable form . Binding was specific for DNA molecules containing the 11-base pair Haemophilus uptake sequence, required Na+ and divalent cations (Mg2+, Ca2+, or Mn2+), and was inhibited by the presence of EDTA or high concentrations of salt (greater than 0.5 M NaCl) . Binding was not stimulated by nucleotide triphosphates and was insensitive to the uncoupling agents dinitrophenol and carbonyl cyanide m-chlorophenylhydrazone . Vesicles contained the major Haemophilus outer membrane proteins and were enriched in several minor proteins.

Clin Allergy, 1982 Nov, 12(6), 547 - 59
Bronchial obstructive reactions after inhalation with endotoxin and precipitinogens of Haemophilus influenzae in patients with chronic non-specific lung disease; Van der Zwan JC et al.; Bronchial obstructive reactions occur after inhalation of Haemophilus influenzae in the absence of proteolytic activity in patients with CNLSD and a lowered histamine threshold in whom specific precipitins are demonstrated . It may be presumed, that the direct bronchial reaction is caused by its content of endotoxin, whereas the late bronchial reaction is the result of a toxic action and a type III allergic reaction . When proteolytic activity is present it lowers the histamine threshold and may influence the endotoxin effect in this way.

J Infect Dis, 1982 Nov, 146(5), 589 - 93
Bacteriology of the maxillary sinuses in patients with cystic fibrosis; Shapiro ED et al.; The maxillary sinuses of 20 patients (median age, 15 years) with cystic fibrosis were examined with ultrasound, radiography, and transantral sinus aspiration (14 bilateral and six unilateral for a total of 34 aspirates) . The sinus aspirations were performed with careful sterile techniques, and the material that was recovered was cultured quantitatively for both aerobic and anaerobic bacteria . Nineteen (95%) of the 20 patients had at least one positive (greater than or equal to 10(4) colony-forming units/ml) culture of sinus aspirate . The organisms most commonly recovered from the sinus aspirates were Pseudomonas aeruginosa (13), Haemophilus influenzae (10), streptococci (five), and anaerobes (five) . There was no association between the bacterial species recovered from the sinus and the predominant bacterial species in the nasopharyngeal, throat, or sputum culture . Although most patients had been chronically receiving therapeutic oral doses of antimicrobial agents, bacteria sensitive to the antimicrobial agents that the patient had been taking (excluding P . aeruginosa) were recovered from the sinuses of nine of these 10 patients.

Ann Microbiol (Paris), 1982 Nov-Dec, 133(3), 379 - 88
The enzymatic profile of Haemophilus ducreyi; Casin IM et al.; The enzymatic activities of two reference strains of Haemophilus ducreyi and thirty clinical isolates were investigated by conventional biochemical tests and the API-ZYM test kit system which included 97 synthetic substrates . No strains converted delta-aminolevulinic acid to porphyrins, but they all reduced nitrates to nitrites . All strains possessed aminopeptidase activity against beta-naphthylamide derivatives of L-alanine, L-arginine, L-glutamine, glycine, L-leucine, L-lysine and L-serine . No trypsinor chymotrypsin-like activities were detected . All strains had phosphatase activity with broad pH range, and phosphoamidase activity . No glycosidase was detected by the substrates tested.

Rev Infect Dis, 1982 Nov-Dec, 4 Suppl, S597 - 602
Pharmacology and cerebrospinal fluid penetration of moxalactam in children and dosage recommendations; Kaplan SL et al.; The pharmacokinetics and penetration into cerebrospinal fluid (CSF) of moxalactam were evaluated in 20 children with bacterial meningitis . After moxalactam was given iv as a loading dose of 100 mg/kg followed by two doses of 50 mg/kg every 6 hr, the mean serum concentrations were 205 micrograms/ml at the end of the last infusion and 11 micrograms/ml at 6 hr . The beta elimination half-life was 3.6 hr for children younger than nine months of age and 1.7 hr for children older than nine months of age . The mean CSF concentration of moxalactam was 3.8 micrograms/ml (range, 0.9-22.6 micrograms/ml) . The mean concentration of moxalactam in CSF was 19.1% (range, 3.1%-97%) that in serum . Bactericidal titers were at least 1:32 in 12 CSF specimens . Concentrations of moxalactam in CSF correlated significantly (P less than 0.001) with concentrations of protein in CSF . Concentrations of moxalactam in CSF were greatly in excess of minimal inhibitory/bactericidal concentrations for Haemophilus influenzae type b . Dosages of moxalactam for the treatment of systemic infections due to H . influenzae type b in children are proposed.

Lancet, 1982 Oct 30, 2(8305), 960 - 2
Do pili play a role in pathogenicity of Haemophilus influenzae type B?
Pichichero ME, Loeb M, Anderson, Smith DH.
Surface components of Haemophilus influenzae type b (Hib) responsible for mucosal adherence were identified through assay of in-vitro attachment to human buccal epithelial cells (EC) . Among many Hib strains from cerebrospinal fluid, blood, or the nasopharynx (NP), two isolates from NP were found to be exceptionally adherent . Adherence correlated with agglutination of human red blood cells (RBC) . The adherent strains displayed pili, not previously described for Hib or other encapsulated H . influenzae . Moreover, highly adherent, piliated subpopulations of bacteria could be selected from any strain, but were lost upon subculture . Thus, the potential to express pili may be general for Hib and may aid the NP colonisation which precedes systemic invasion by this organism . Piliation was correlated with the amount of an outer membrane protein with a molecular weight of about 20,000 daltons, which had proved to be immunogenic in an 8-month-old child.

Lancet, 1982 Oct 9, 2(8302), 798 - 9
Antibacterial activity of a human monoclonal antibody to haemophilus influenzae type B capsular polysaccharide; Hunter KW Jr et al.; Human splenic lymphocytes were fused with a new mutant human myeloma cell line (HFB-1) to produce hybridomas that secrete human monoclonal antibodies . A cloned hybridoma line was selected that secretes IgG antibodies reactive with Haemophilus influenzae type b polyribosylribitolphosphate (PRP) capsular polysaccharide . This human monoclonal antibody was active in an in-vitro neutrophil-mediated bactericidal assay, and provided significant protection in an animal model of H . influenzae type b disease . Human monoclonal antibody to H . influenzae type b may have prophylactic value in man, particularly in infants who do not produce protective antibody after active immunisation with PRP.

Am J Vet Res, 1982 Oct, 43(10), 1848 - 51
Prevalence of antibodies to Haemophilus pleuropneumoniae in Iowa swine; Schultz RA et al.; The prevalence of complement-fixing (CF) antibodies to Haemophilus pleuropneumoniae in Iowa swine was determined by testing samples collected randomly from each of 9 crop-reporting areas (9 to 12 counties) in Iowa in approximate proportion to the number of swine marketed annually from each area . For testing, a pooled antigen composed of serotypes 1 to 5 of H pleuropneumoniae was used in a modified direct Microtiter complement-fixation test . Of 7,348 sera tested, 2,362 or 32.1% had CF antibodies (titer greater than or equal to 1:4) to the organism . On a herd basis, 417 of 597 herds or 68.8% had at least 1 animal with CF antibodies (titer greater than or equal to 1:4) to the organism . The clinical problem with H pleuropneumoniae has become significant in recent years, but by no means is the overt disease as prevalent as animals or herds with CF antibodies to the organism.

Am J Vet Res, 1982 Oct, 43(10), 1793 - 8
Studies on immunity to Haemophilus pleuropneumoniae infections in mice; Sebunya TN et al.; A murine model of experimentally induced Haemophilus pleuropneumoniae respiratory tract infections was developed and used to evaluate the efficacy of bacterins . Various doses of 3 H pleuropneumoniae strains (serotype 1 and 5) were administered intranasally (IN) to groups of anesthetized Swiss White mice . The accumulated mortality per group at 5 days after they were inoculated was used to calculate the median lethal dose (LD50), which ranged between 1.4 x 10(6) and 5.4 x 10(7) bacteria . There was correlation between dose administered, incubation period of the disease, and mortality . The induction of H pleuropneumoniae disease in the mouse was reproducible and resembled that of naturally occurring porcine Haemophilus pleuropneumonia . The murine model of exposure was used to evaluate the efficacy of H pleuropneumoniae serotype 5 (strain B78-3760) bacterins administered subcutaneously (SC) and IN . Vaccination by SC route induced slightly higher titers of specific seroagglutinins, compared with the response induced by the IN route, and the former was more effective in protecting mice against IN challenge with H pleuropneumoniae . However, vaccination was not efficacious in mice given a challenge dose greater than 1.2 LD50 . The percentage survival rates in the SC and IN vaccinated mice were significantly greater than in the control groups at P less than 0.01 and P less than 0.05, respectively.

Am J Vet Res, 1982 Oct, 43(10), 1790 - 2
Model infection of the chicken embryo with Haemophilus somnus; Nivard JL et al.; Infectious thromboembolic meningoencephalitis of cattle which is caused by Haemophilus somnus has been difficult to study due, in part, to lack of model infection in a laboratory animal . Model infection was induced in 12-day-old chicken embryos after IV injection of H somnus . Death with typical lesions (hemorrhage, degeneration of brain, congestion of venules with leukocytes and meningitis) was seen in the chicken embryo between 2 and 6 days after injection of organisms . Bacteria could be demonstrated in lesions, using Warthin-Starry silver strain . Three stable colonial variants of H somnus were cultured from dead embryos . They appeared as small translucent (ST), small opaque (SO), and large opaque (LO) . Lethal dose50 values of ST was 4.4 x 10(4); for SO, 3.6 x 10(4); and for LO, 8 x 10(6) . Statistical analysis indicated that ST and SO were significantly more lethal (P less than 0.001) than LO.

Pediatr Res, 1982 Oct, 16(10), 874 - 6
Lysozyme activity in cystic fibrosis; Hughes WT et al.; The activity of lysozyme in saliva and serum was determined in 51 patients with cystic fibrosis . Measurements were made on two occasions at least 1 month apart and compared to those of 25 normal healthy individuals of the same ages, sex, and race . The mean serum lysozyme activity of normal individuals was 5.8 micrograms/ml (S.E . = 0.4), whereas that of cystic fibrosis patients was 10.8 micrograms/ml (S.E . = 0.5) . The difference is significant (P less than 0.05) . Initial mean values compared to those of repeated samples from the cystic fibrosis group were similar, whereas individual fluctuations occurred between test periods . The mean lysozyme activity of the saliva sample of normal individuals was 63.5 micrograms/ml (S.E . = 9.3) and the mean value from cystic fibrosis patients was 82.7 (S.E . = 6.9) . This difference was not significant (P greater than 0.1) . Mean values from specimens obtained a month or longer after the initial saliva samples were similar for the two episodes . There was no correlation between the serum and salivary values and the age, sex or race of the subjects, the Shwachman-Kulczycki scores, colonization with Pseudomonas aeruginosa, Staphylococcus aureus or Haemophilus influenzae or absolute white blood cell counts . In vitro studies failed to demonstrate bactericidal activity for mucoid and nonmucoid strains of P . aeruginosa or for S . aureus . Elevated lysozyme activity in cystic fibrosis may be related to either an increased granulocyte turnover because of chronic bacterial infection of the respiratory tract or to a basic defect in the lysosomal membrane allowing an increased release of the enzyme, or a combination of both.

Br J Obstet Gynaecol, 1982 Oct, 89(10), 793 - 801
Premature rupture of the membranes and ascending infection; Evaldson GR et al.; The association of premature rupture of the membranes (PROM) and ascending infection was investigated in 15 women . Bacteriological, histological and immunofluorescence methods were used to study infection at various levels in the birth canal . In most of the women the membranes as well as the placentae showed heavy bacterial invasion . Bacterial distribution within the membranes showed a choriodecidual preponderance . Ascending infection appears to follow the choriodecidual route and may be a primary pathogenetic event in many instances of PROM . The anaerobe Bacteroides fragilis, which is very infrequently isolated in normal pregnant women, was found in five out of 15 women . Two infants had congenital pneumonia caused by group B streptococci and Haemophilus influenzae respectively . The neonatal outcome with PROM may be influenced by the efficiency of the individual defence mechanisms including the antimicrobial capacity of amniotic fluid.

Arch Neurol, 1982 Oct, 39(10), 650 - 2
Ischemic cerebrovascular complications of Haemophilus influenzae meningitis . The value of computed tomography; Dunn DW et al.; In an effort to define the value of computed tomographic (CT) scanning in assessment of cerebral involvement in children with severe Haemophilus influenzae meningitis, we studied 12 children who had focal neurologic deficits on admission or within the early days of illness . The CT scan reliably excluded abscess and cerebritis and suggested ischemic cerebrovascular lesions in 11 of 12 children . Scans performed early in the hospital course generally showed low-density lesions occurring in a vascular distribution without detectable mass effect or enhancement . Later in the clinical course there was consistent enhancement of gray matter or diffuse enhancement in the area of the vascular lesion . The duration of symptoms of meningitis ranged from five to 21 days (mean, 13 days) and appeared to predispose to these vascular lesions . A CT scan consistent with infarction of brain parenchyma occurred predictably in patients with persistent focal neurologic deficits and was correlated with poor outcome.

Antimicrob Agents Chemother, 1982 Oct, 22(4), 689 - 92
Plasmid-coded ampicillin resistance in Haemophilus ducreyi; Thomson JA et al.; Seven of the 96 ampicillin-resistant isolates of Haemophilus ducreyi reported in the preceding article (Bilgeri et al., Antimicrob . Agents Chemother . 22:686-688, 1982) were investigated and found to harbor plasmids of 3.95, 5.2, 5.8, and 6.4 megadaltons . All except the 5.8-megadalton plasmid have been shown to code for beta-lactamase . The 6.4- and 5.2-megadalton plasmids of three isolates were conjugally transferable to a streptomycin-resistant mutant of H . ducreyi at high frequencies, perhaps due to the presence in these strains of a high-molecular-weight plasmid.

Antimicrob Agents Chemother, 1982 Oct, 22(4), 686 - 8
Antimicrobial susceptibility of 103 strains of Haemophilus ducreyi isolated in Johannesburg; Bilgeri YR et al.; Of 103 strains of Haemophilus ducreyi isolated in Johannesburg, 96 produced beta-lactamase and were resistant to penicillin and ampicillin . Most strains showed resistance to tetracycline, sulfisoxazole, and sulfamethoxazole . All isolates were susceptible to rifampin, erythromycin, and cefoxitin, moderately susceptible to trimethoprim-sulfamethoxazole (1:19) and minocycline, and somewhat less susceptible to doxycycline.

J Pediatr, 1982 Oct, 101(4), 626 - 30
Antibiotic prophylaxis in cystic fibrosis: inhaled cephaloridine as an adjunct to oral cloxacillin; Nolan G et al.; The effect of prophylactic antibiotics on bacterial colonization of the respiratory tract and on general progression of cystic fibrosis was studied in a two-year prospective study of 47 mildly to moderately affected patients . One group of patients received inhaled cephaloridine and the other received no inhaled antibiotic; both groups received cloxacillin orally . Carriage of Haemophilus influenzae was greater in the group not receiving inhaled antibiotic (55% vs 20%) . Rates of carriage of Staphylococcus aureus (23%) . Pseudomonas aeruginosa (greater than 90%) . Pseudomonas cepacia (45%), and other organisms were similar in both groups . There were no significant differences between the two groups in incidence of respiratory tract infections or hospital admissions, clinical scores, radiologic scores, or rate of change of pulmonary function . Although continuous antistaphylococcal antibiotic prophylaxis may be successful in suppressing colonization with S . aureus, it may also contribute to the high rates of carriage of Ps . aeruginosa and Ps . cepacia observed in patients with cystic fibrosis.

J Bacteriol, 1982 Oct, 152(1), 441 - 50
DNA-binding vesicles released from the surface of a competence-deficient mutant of Haemophilus influenzae; Concino MF et al.; Haemophilus influenzae com-51, a mutant deficient in DNA uptake, produces an extracellular DNA-binding activity . The activity was specific for Haemophilus DNA and was isolated from cell-free competence medium after incubation for 100 to 130 min . Initial steps in the purification procedure resulted in the loss of detectable binding activity, but activity was restored by the addition of a nonionic detergent . The active fractions contained vesicles derived from the outer membrane of the cells . The vesicles were produced only under conditions that normally lead to competence development . The lack of competence of com-51 cells was not due to loss of protein synthesis in M-IV competence medium or to competition of extracellular protein for exogenous DNA . Results suggest that the inability of cells to bind DNA was due in part to the loss of DNA receptors that are released into the medium in membrane fragments.

Proc Natl Acad Sci U S A, 1982 Oct, 79(20), 6370 - 4
Possible mechanism for donor DNA binding and transport in Haemophilus; Kahn ME et al.; Morphological differences were observed in competent and noncompetent Haemophilus parainfluenzae and Haemophilus influenzae when thin sections of these cells were examined by electron microscopy . The membranous extensions present on the surface of competent H . parainfluenzae cells disappeared on treatment with transforming DNA, while vacuole-like structures appeared in the periplasm . Noncompetent cells had 1/5th as many extensions on their surface as competent cells, and no vacuoles were observed after treatment with homologous DNA . Competent cells treated with radiolabeled DNA were disrupted and the clarified lysate was centrifuged on CsCl density gradients . Material having a density of 1.34 g/ml was found to contain the majority of the DNase-resistant radioactive DNA recovered from the bacteria and was shown by electron microscopy to be composed of membrane vesicles . The polypeptide composition of this dense membrane fraction was similar to that of H . parainfluenzae outer membrane.

Zh Mikrobiol Epidemiol Immunobiol, 1982 Oct, (10), 87 - 92
{Circulating immune complexes in inflammatory lung diseases and their relation to infectious factors}; Movchan NS et al.; The results obtained in the study of the intensity and duration of the circulation of immune complexes in the peripheral blood in 59 patients with acute pneumonia and in 120 patients with chronic bronchitis, as well as the reaction of these complexes to etiologically important bacterial antigens (pneumococcal, staphylococcal, type b Haemophilus influenzae, streptococcal), are presented.

Am J Vet Res, 1982 Oct, 43(10), 1799 - 801
Pulmonary clearance of Haemophilus pleuropneumoniae and Serratia marcescens in mice; Sebunya TN et al.; Bacterial counts (per lung) were made from Swiss White and/or C3H mice, inoculated intranasally with either Haemophilus pleuropneumoniae or Serratia marcescens and killed at specific times . The percentages of bacterial survival and clearance at each time were determined . Serratia marcescens was cleared progressively, but not completely, from the lungs of C3H and Swiss White mice . The overall pulmonary clearance of S marcescens by Swiss White mice was significantly greater than that of C3H mice (P less than 0.01) . The pulmonary clearance pattern of H pleuropneumoniae in C3H mice differed according to the dose inoculated . With a larger H pleuropneumoniae median lethal dose (0.1 LD50), the organism multiplied consistently up to 25 times by 12 hours after the inoculations were done, when clinical signs and lesions appeared in a few of the mice . The clearance rates at 24 and 48 hours after inoculations were 60.65% and 10.3%, respectively . Mice given 0.04 LD50 H pleuropneumoniae showed a 10-fold increase of H pleuropneumoniae in the first 4 hours, with clearances reaching 33%, 66%, and 99% at 8, 12, and 24 hours, respectively.

Jpn J Antibiot, 1982 Oct, 35(10), 2459 - 67
{Laboratory and clinical studies of cefmenoxime in pediatric infections}; Miyachi Y et al.; The antimicrobial activity of cefmenoxime (CMX) against clinical isolated organisms was measured; CMX was more active than cefotiam and cefazolin against Escherichia coli and Haemophilus influenzae . The serum concentrations of CMX following intravenous injection of 20 mg/kg were 25.6, 10.3, 3.0 micrograms/ml at 30, 60, 120 minutes after injection, respectively . CMX was excreted 60.9% in urine within 6 hours after injection . CMX was administered clinically to 22 pediatric patients with various infections (respiratory tract infection 16 including 1 pyothorax, urinary tract infection 4, tonsillitis with sinusitis 2) at the dose of 39 approximately 96 mg/kg/day for 4 approximately 9 days, and the following satisfactory results were obtained; excellent in 11, good in 9, and poor in 2 . The rate of satisfactory clinical response was 90.9% . Eosinophilia 2 cases, slight elevation of transaminase 3 cases, slight elevation of BUN 1 case and transient diarrhea 1 case were observed . But no other serious side effects were observed.

Jpn J Antibiot, 1982 Oct, 35(10), 2405 - 13
{Clinical evaluation of cefmenoxime in the pediatric infections}; Meguro H et al.; Cefmenoxime (CMX) was evaluated in 25 children with a suspicion of bacterial infection . Of the 20 confirmed bacterial infections, 19 were cured by CMX therapy (effective rate, 95%) . The diagnoses included acute pharyngotonsillitis (4), acute bronchitis (1), pneumonia (7), streptococcal dacryocystitis (1), infections accompanied with acute leukemia (4), and acute urinary tract infections (3) . The etiologic pathogens were beta-hemolytic Streptococcus group A (1), and F (1), Staphylococcus aureus (4), Haemophilus influenzae (4), Escherichia coli (4), Klebsiella pneumoniae (2), etc . CMX was very effective for 2 children with respiratory infections due to ampicillin resistant H . influenzae type b . The half life of serum concentration of CMX was 0.76 +/- 0.17 hour after an intravenous bolus injection . A cerebrospinal fluid level of CMX was 5.2 mcg/ml 1 hour after intravenous injection of 1 g (23.8 mg/kg) in a child with inflamed meninges . However this level was not as high as those of cefotaxime, latamoxef, or ceftizoxime measured in the same case . No severe adverse reaction was encountered with CMX therapy . The data suggest that CMX is a safe and effective parenteral antibiotic when used in children with susceptible bacterial infections.

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