J Bacteriol, 1982 Oct, 152(1), 332 - 7 Action of restriction endonucleases on transforming DNA of Haemophilus influenzae; Beattie KL et al.; Cleavage of DNA from Haemophilus influenzae with restriction endonucleases caused inactivation of transforming ability to an extent that depended on the genetic marker and the enzyme . The rate of inactivation, but not the final level of survival, depended on the concentration of enzyme in the restriction digest . In general, the greatest extent of inactivation of transforming activity was obtained with endonucleases that are known to produce the shortest fragments . We electrophoresed restriction digests of H . influenzae DNA in agarose gels and assayed transforming activity of DNA extracted from gel slices . In this way, we determined the lengths of restriction fragments that contain genetic markers of H . influenzae . For the marker that we studied most thoroughly (nov), the shortest restriction fragment that possessed detectable transforming activity was a 0.9-kilobase pair fragment produced by endonuclease R . PstI . The shortest marker-bearing restriction fragment that retained substantial transforming activity (50% of value for undigested DNA) was a 2.1-kilobase pair EcoRI fragment bearing the kan marker . Among marker-bearing restriction fragments 1 to 4 kilobase pairs in length, survival of transforming activity varied 10,000-fold . We relate these observations to the recent findings by Sisco and Smith (Proc . Natl . Acad . Sci . U.S.A . 76:972-976, 1979) that efficient entry of DNA into competent H . influenzae cells appears to require the presence of a recognition sequence that is scattered throughout the Haemophilus genome in many more copies than in unrelated genomes. Antimicrob Agents Chemother, 1982 Oct, 22(4), 652 - 6 Comparison of cefoperazone with penicillin, ampicillin, gentamicin, and chloramphenicol in the therapy of experimental meningitis; Scheld WM et al.; Cefoperazone was compared with penicillin against Streptococcus pneumoniae, gentamicin against Escherichia coli, and ampicillin and chloramphenicol against Haemophilus influenzae in the therapy of experimental meningitis in rabbits . Meningitis was produced by intracisternal inoculation into cerebrospinal fluid, and all antibiotics were administered intravenously over 8 h in dosages that would achieve serum levels comparable to those found in humans . The mean percent penetration into purulent cerebrospinal fluid, expressed as (cerebrospinal fluid concentration/serum concentration) x 100%, was 2.6% for penicillin, 22.0% for gentamicin, 12.1% for ampicillin, 23.8% for chloramphenicol, and 6.4% for cefoperazone . The mean cerebrospinal fluid antibiotic concentrations exceeded the minimum bactericidal concentration for the test strain in each experimental model, except for ampicillin in experimental meningitis due to the beta-lactamase-producing H . influenzae . Cefoperazone produced a significantly faster bactericidal effect after 4 h of treatment when compared with penicillin (P = 0.037) and ampicillin (P = 0.01) in meningitis caused by S . pneumoniae and H . influenzae (ampicillin susceptible), respectively . In meningitis caused by E . coli, cefoperazone was significantly (P = 0.006) more rapidly bactericidal after 8 h of treatment when compared to gentamicin . In addition, cefoperazone was significantly more rapidly bactericidal than either ampicillin or chloramphenicol in experimental meningitis due to beta-lactamase-producing H . influenzae . Cefoperazone deserves further evaluation in the therapy of bacterial meningitis in humans. Lancet, 1982 Sep 4, 2(8297), 509 - 11 Treatment of chancroid by clavulanic acid with amoxycillin in patients with beta-lactamase-positive Haemophilus ducreyi infection; Fast MV et al.; Multiresistant strains of Haemophilus ducreyi, the aetiological agent of chancroid, are prevalent in Nairobi, Kenya, where tetracyclines and sulphonamides are no longer very effective in the treatment of chancroid . The following regimens (given three times daily for seven days) were compared in a double-blind randomised trial--amoxycillin 500 mg, amoxycillin 500 mg and clavulanic acid 125 mg, and amoxycillin 500 mg and clavulanic acid 250 mg . 68 of 100 ulcers were culture-positive for H . ducreyi . All strains of H . ducreyi produced beta-lactamase . At day 7 none of the amoxycillin-treated patients had responded clinically or bacteriologically, whereas all but 2 of 56 patients treated with an amoxycillin/clavulanic-acid regimen had responded clinically and H . ducreyi had been eradicated from their ulcers . The combination of amoxycillin-clavulanic acid appears to be very effective for the treatment of chancroid . The results of this study accord with H . ducreyi as the primary pathogen of chancroid. Infect Immun, 1982 Sep, 37(3), 1241 - 7 Phagocytosis and intracellular killing of the contagious equine metritis organism by equine neutrophils in serum; Bertram TA et al.; Equine neutrophils were combined with Haemophilus equigenitalis (contagious equine metritis organism; CEMO) or Escherichia coli in low- and high-antibody-titer serum to evaluate the neutrophils ability to phagocytize and kill these bacteria . More E . coli than CEMO were phagocytized at each time period . After 120 min in low-antibody-titer serum, 56.3% of the E . coli and 34.3% of the CEMO were phagocytized . A total of 45% of CEMO and 74.9% of E . coli were phagocytized by 120 min when neutrophils were in high-antibody-titer serum . More than 75% of the ingested E . coli and 90% of the ingested CEMO were killed within 210 min of incubation . Fewer E . coli than CEMO were killed at any given time period . Ultrastructural examination showed CEMO to be degraded in the neutrophil . Degradation was the most extensive in neutrophils in high-titer serum . It is suggested that CEMO is a pathogenic extracellular bacterium incapable of prolonged intracellular survival and that it is slower to be phagocytized than a nonpathogenic E . coli. Infection, 1982 Sep-Oct, 10(5), 261 - 6 Lethal Haemophilus influenzae type b infection in mice; Marks MI et al.; Previous animal models of invasive Haemophilus influenzae type b (HITB) infection are characterized by a low mortality rate . We produced a highly lethal infection in CF1 mice using mouse passage, mucin, and hemoglobin to enhance infectivity . Infection by the intraperitoneal route was followed by progressive peritonitis and bacteremia with subsequent HITB infection of the brain and meninges, and death . Death occurred between eight and 72 hours after infection and was associated with 10(6) to 10(9) HITB per ml of blood and with 10(2) to 10(5) HITB per g of brain . Mucin-hemoglobin did not augment HITB growth, but impaired macrophage adherence to glass in vitro, without decreasing cellular viability . In vivo, mucin-hemoglobin decreased the rate of disappearance of 51Cr-labelled HITB from the blood by impairment of hepatic clearance . This technically simple and inexpensive model is useful for the study of HITB infections in which bacterial multiplication, invasion and host lethality are desired features. Ann Microbiol (Paris), 1982 Sep-Oct, 133(2), 311 - 5 Detection of chloramphenicol acetyltransferase (CAT) activity in a strain of Haemophilus ducreyi; Sanson-Le Pors MJ et al.; The minimal inhibitory concentration (MIC) of chloramphenicol for a clinical isolate of Haemophilus ducreyi, strain CEB-10, was 16 micrograms/ml . This strain was also resistant to tetracycline (MIC = 64 micrograms/ml) and ampicillin . The presence of a chloramphenicol acetyltransferase (CAT) activity was demonstrated. Clin Allergy, 1982 Sep, 12(5), 439 - 50 Specific serum IgE antibodies to bacterial antigens in allergic lung disease; Tee RD et al.; A radio-allergosorbent test (RAST) to measure specific IgE antibodies in man to whole bacterial cells of Streptococcus pneumoniae, Staphylococcus aureus and Haemophilus influenzae was developed to investigate different well-defined lung diseases (chronic bronchitis, allergic bronchopulmonary aspergillosis (ABPA), bronchial asthma allergic rhinitis, cystic fibrosis) and also in urticaria as compared with non-atopic blood donors . In addition, total IgE values and skin prick tests were assessed in these patients . The ABPA group gave the highest specific IgE RAST scores to all three bacteria, whilst the chronic bronchitis and cystic fibrosis groups also gave raised RAST scores with H . influenzae . There was a positive correlation between the patients' Sta . aureus and Str . pneumoniae immediate-type skin reactions and their RAST scores and total serum IgE concentrations, but there was only a low incidence of immediate-type skin test positivity to H . influenzae. Antimicrob Agents Chemother, 1982 Sep, 22(3), 531 - 3 Mutation frequency of Haemophilus influenzae to rifampin resistance; Mendelman PM et al.; Twenty-two susceptible strains of Haemophilus influenzae were examined for mutation to rifampin resistance (minimal inhibitory concentration, greater than or equal to 10 micrograms/ml) . All strains had detectable apparent mutation frequencies with a median minimal inhibitory concentration 2,000-fold greater than that of their wild-type parents . Of the type b strain mutants, 80% (8 of 10) expressed high-level resistance (minimal inhibitory concentration, 750 micrograms/ml) that was 75-fold greater than readily achievable serum concentrations. J Bacteriol, 1982 Sep, 151(3), 1358 - 62 Novobiocin resistance marker in Haemophilus influenzae that is not expressed on a plasmid; Setlow JK et al.; The plasmid pNov2, carrying a cloned chromosomal marker conferring resistance to at least 2.5 micrograms of novobiocin per ml, was constructed with a new Haemophilus influenzae cloning vehicle, pDM2 . The novobiocin marker of pNov2 was not normally expressed, but in Rec+ cells approximately one in 10(4) cells in a culture of a transformant became novobiocin resistant, a frequency about four orders of magnitude higher than the spontaneous mutation frequency . Variants of such cells that had lost the plasmid were also novobiocin resistant . Since Rec- cultures bearing pNov2 showed novobiocin resistance only at the normal mutation frequency, we concluded that the Rec+ novobiocin-resistant transformants arose because of a rare recombination between plasmid and chromosome in which the chromosome acquired the novobiocin marker from the plasmid . Evidence is presented that novobiocin sensitivity is dominant over this particular novobiocin resistance marker. Vet Microbiol, 1982 Sep, 7(4), 359 - 67 Further characterization of Haemophilus paragallinarum and Haemophilus avium; Blackall PJ et al.; A total of 60 isolates of Haemophilus spp . from chickens, including four reference strains of H . paragallinarum and one of H . avium, were examined for their physiological and biochemical properties . The isolates could be placed into two groups . One group was identified as H . paragallinarum and consisted of 43 isolates including the four reference strains of H . paragallinarum . The other group was identified as H . avium and consisted of 17 isolates including the reference strain of H . avium . H . avium can be differentiated from H . paragallinarum by its possession of the enzymes catalase and alpha-glucosidase, capacity to grow in air, production of acid from galactose, and by the fact that its growth is not improved by the addition of chicken serum . In addition, the majority of H . avium isolates, unlike H . paragallinarum, possess a yellow pigment and produce acid from trehalose. J Clin Microbiol, 1982 Sep, 16(3), 531 - 5 Determination of bacterial meningitis: a retrospective study of 80 cerebrospinal fluid specimens evaluated by four in vitro methods; Wasilauskas BL et al.; A total of 80 cerebrospinal fluid specimens were analyzed for bacterial meningitis by four procedures readily available to most laboratories . These tests included routine culturing . Gram staining, countercurrent immunoelectrophoresis, staphylococcal coagglutination (CoA) with laboratory-prepared reagents, and CoA with Pharmacia Diagnostics reagents . A total of 56 specimens were positive for bacterial agents by routine culturing: Gram stain results were positive for 64% of all specimens positive by culturing . For 36 specimens from patients with suspected meningitis due to either Haemophilus influenzae type b, Streptococcus pneumoniae, or group B streptococci, detection was 97% with Pharmacia CoA reagents, 94% with laboratory-prepared CoA reagents, 89% with routine culturing, 78% with countercurrent immunoelectrophoresis, and 75% with Gram staining . One specimen which contained Klebsiella pneumoniae was false positive for S . pneumoniae in tests with both of the CoA reagents and in countercurrent immunoelectrophoresis . A Gram stain of this specimen clearly showed gram-negative bacilli, which were confirmed by culturing . Although a positive culture and a positive Gram stain are definitive evidence of bacterial meningitis, rapid immunological tests can provide valuable clinical information as an adjunct to culture and Gram stain results . Serological tests with Pharmacia CoA reagents produced more positive results than either laboratory-prepared CoA reagents or countercurrent immunoelectrophoresis. Naunyn Schmiedebergs Arch Pharmacol, 1982 Sep, 320(3), 235 - 9 Involvement of catecholamines in Haemophilus influenzae induced decrease of beta-adrenoceptor function; Schreurs AJ et al.; The deeper airways of patients with asthmatic bronchitis are often infected with Haemophilus influenzae . Vaccination of guinea pigs with H . influenzae resulted in a significant impairment of the isoproterenol induced relaxation of isolated tracheal spirals by approximately 50% 4 days following vaccination . In the present study we further investigated the effects of some drugs affecting catecholamine release on the H . influenzae induced functional desensitization of tracheal spirals . Benserazide, an inhibitor of dopa-decarboxylase, completely prevented the reduction in isoproterenol-induced relaxation after H . influenzae vaccination, while no effect on relaxation of tracheal spirals from control animals was detected . On the other hand, inhibiting the re-uptake of catecholamines with desipramine did not influence the relaxation in the H . influenzae vaccinated tracheal spirals . Treatment of control animals with desipramine however resulted in a decreased relaxation of the isolated spirals by 40% . One day following vaccination with H . influenzae the level of norepinephrine in lung tissue was significantly elevated by 71%, and in plasma by 77%, while after 4 days no significant effects were observed . The spontaneous release of norepinephrine, epinephrine and dopamine of tracheal incubates was increased at days 1 and 4 following vaccination . The release of catecholamines from minced lung incubates of H . influenzae pretreated guinea pigs did not differ from that of controls . On the basis of these results it may be suggested that catecholamine metabolism is changed in lungs from H . influenzae vaccinated animals . Catecholamines, accordingly may play a role in the desensitization of beta-adrenoceptors by H . influenzae. J Bacteriol, 1982 Sep, 151(3), 1605 - 7 A plasmid cloning vehicle for Haemophilus influenzae and Escherichia coli; McCarthy D et al.; A new plasmid cloning vehicle (pDM2) was used to introduce a library of Haemophilus influenzae chromosomal fragments into H . influenzae . Transformants of the highly recombination-defective rec-1 mutant were more likely to contain exclusively recombinant plasmids after exposure to ligated DNA mixtures than was the wild type . pDM2 could replicate in Escherichia coli K-12. Monatsschr Kinderheilkd, 1982 Aug, 130(8), 630 - 1 {Should splenic tissue be re-implanted after splenectomy due to birth trauma?}; Bauer M et al.; Splenectomy results in loss of about 1/4 of the reticulo-endothelial system and 1/3 of the lymphatic tissue . Reduced phagocytosis and "clearing" capacity are reflected in the appearance of Howell Jolly bodies, thrombocytosis and decreased circulating immune-complexes . Reduction of IgM and compensatory increase of IgG and IgA levels further indicate immunological impairment . Transitory reduction of complement activity and the number of T-lymphocytes in the first weeks post-splenectomy constitute a significant limitation of immunological function and are accompanied by low serum tuftsin levels . These factors help explain the increased susceptibility to overwhelming infection seen in splenectomized patients . The lethality rate due to sepsis has been reported to be as high as 50% . Patients with hematological disorders, with systemic malignancies and children under 4 years of age who undergo splenectomy because of abdominal trauma are at especially high risk . The most common infectious agents are Haemophilus influenzae and Pneumococcus . The present report describes 2 infants who underwent splenectomy for the treatment of splenic rupture due to birth trauma . In one case, splenic tissue was homogenized and re-implanted; in the second case, splenectomy was followed by penicillin prophylaxis . The clinical course in the latter patient was complicated by Candida meningitis. Am J Vet Res, 1982 Aug, 43(8), 1436 - 9 Ischemia: a cause of hepatic telangiectasis in cattle; Jensen R et al.; We histologically examined (i) 73 bovine livers condemned by packing house inspectors for telangiectasis, (ii) 15 bovine livers passed by the same inspectors as normal, and (iii) 8 livers from cattle given an injection into their mesenteric veins: 6 with a suspension of agar particles containing viable Haemophilus somnus and 2 with diluent only . The injected cattle were killed and necropsied 2 to 12 days after the inoculations . Of the 73 telangiectatic livers, 57 (78%) had thrombosed and occluded or contracted and empty portal veins (venopathies), whereas 1 of the 15 normal livers contained one microscopic focus of telangiectasis and nearby venopathy . Of the 6 livers injected with suspended particles, all had venopathies and telangiectasis and the 2 control livers had neither. Am J Vet Res, 1982 Aug, 43(8), 1339 - 42 Vaccination of cattle against experimentally induced thromboembolic meningoencephalitis with a Haemophilus somnus bacterin; Stephens LR et al.; The capability of a commercial Haemophilus somnus bacterin to protect cattle against experimentally induced thromboembolic meningoencephalitis was examined . Eighteen cattle were vaccinated twice, 8 were vaccinated once, and 14 were nonvaccinated controls . Serum antibody responses to vaccination were measured by gel immunodiffusion, bacterial agglutination test, and complement-fixation test . Deaths occurred in 8 of the 14 controls, 3 of the cattle vaccinated once, and 3 of the cattle vaccinated twice . Two vaccinations were found to give significant protection against challenge exposure (P less than 0.05) . There were no cattle which gave positive reactions in the gel immunodiffusion test, and significant changes in bacterial agglutination test titers were not seen in the cattle after vaccination . There was a significant (P less than 0.01) increase in the complement-fixation test titers of cattle vaccinated twice . Serum antibody titers were unrelated to the outcome of challenge infection, regardless of vaccination status, in any of the serotests. Zh Mikrobiol Epidemiol Immunobiol, 1982 Aug, (8), 56 - 9 {Duration of preservation of Streptococcus pneumoniae and Haemophilus influenzae in the sputum and bronchial washings of patients with acute and chronic pneumonias}; Vishniakova LA et al.; The study of 108 samples of pathological material stored in a common refrigerator revealed that S . pneumoniae survived, on the average, for 7.6 days in sputum samples and for 4.2 days in bronchial washings, while Haemophilus influenzae could be detected in these materials, on the average, only within 48 hours . After 24-hour storage at 4-8 degrees C pneumococci were detected in all sputum samples and in 88.2% of bronchial washings, H . influenzae was detected ins 85% of these samples; the concentration of the above-mentioned microorganisms in the pathological material stored at 4-8 degrees C for 24 hours decreased, on the average, by 2.3-2.6 lg per ml. Acta Pathol Microbiol Immunol Scand {C}, 1982 Aug, 90(4), 209 - 16 Target antigens for bactericidal and opsonizing antibodies to Haemophilus influenzae; Dahlberg-Lagergard T; Three components of Haemophilus influenzae (capsular polysaccharide, lipopolysaccharide and proteins of the outer membrane) were studied concerning their possible role as target antigens for bactericidal and opsonizing antibodies . In rabbit antisera against capsulated H . influenzae the bactericidal antibodies were mainly directed against the capsular polysaccharide but also, to a smaller extent, against the outer membrane antigens . Using a non-capsulated mutant of H . influenzae type b it was demonstrated that both the lipopolysaccharide and the proteins of the outer membrane are target antigens for bactericidal antibodies . In antisera against whole bacteria antibodies against the lipopolysaccharide and the outer membrane, proteins were in equal concentrations, while in antisera against the outer membrane a greater proportion of the bactericidal antibodies were directed against the lipopolysaccharide . Some of the outer membrane target proteins for bactericidal antibodies were common to various serotypes of H . influenzae . The capsular polysaccharide as well as the lipopolysaccharide and the proteins of the outer membrane constituted target antigens also for opsonizing antibodies to capsulated H . influenzae type b. J Infect Dis, 1982 Aug, 146(2), 249 - 54 Protection from infection with Haemophilus influenzae type b by monoclonal antibody to the capsule; Gigliotti F et al.; Monoclonal antibodies to Haemophilus influenzae type b were produced by fusing splenic lymphocytes from immunized C57BL/6 mice with the mouse myeloma line P3-X63-Ag8.653 . The antibody produced by one hybridoma (5M1H9) bound the capsular polysaccharide, as determined by a radiolabeled antigen-binding assay . The antibody was of the IgM class and was bactericidal in vitro with complement . The protective and therapeutic capacity of antibody 5M1H9 was examined in the infant rat model of H . influenzae type b disease . Antibody (0.1 ml), either undiluted or diluted 1:2, 1:10, or 1:100, administered 4 hr before intraperitoneal injection of 10(4)-10(5) H . influenzae type b organisms protected 100%, 90%, . 55% and 10% of the animals, respectively . To determine the efficacy of antibody 5M1H9 in treating established infection, antibody was given at 24-hr intervals after intraperitoneal injection of bacteria . Delayed administration of antibody 5M1H9 was effective in reducing both the level and incidence of bacteremia. J Infect Dis, 1982 Aug, 146(2), 243 - 8 Relationship between naturally occurring human mucosal and serum antibody to the capsular polysaccharide of Haemophilus influenzae type b; Pichichero ME et al.; The prevalence of natural mucosal antibody to the capsular polysaccharide (polyribosylribitolphosphate {PRP}) of Haemophilus influenzae type b in adults at multiple secretory sites and the relationship between natural serum and mucosal antibodies with respect to their amount and fine binding specificity were examined . All of 16 lactating women had antibody to PRP in serum and mammary samples; 11 of 14 studied had nasal antibody and 12 of 14 had salivary antibody . The amount of serum antibody to PRP in an individual positively correlated with the amount of mucosal antibody at each of the three secretory sites examined, and the antibody amount between certain secretions were also positively correlated . Antibody to PRP that is cross-reactive with Escherichia coli K100 or Streptococcus pneumoniae type 6 capsular polysaccharides was detected in the secretions of seven and one subjects, respectively, but the amount was not correlated with serum cross-reactive antibody. Br J Vener Dis, 1982 Aug, 58(4), 239 - 42 Characteristics of Haemophilus ducreyi . A study; Sng EH et al.; In a study of 13 local and four reference strains of Haemophilus ducreyi all grew well on a selective medium consisting of Bacto proteose No 3 agar (Difco), soluble starch, IsoVitalex, human blood, and vancomycin . All the strains reduced nitrate, were alkaline-phosphatase-positive, and (with one exception) used glucose, fructose, and mannose, beta-lactamase was produced by 12 local strains . Erythromycin was the the most effective antibiotic tested, followed by streptomycin, co-trimoxazole, and spectinomycin. Arch Otolaryngol, 1982 Aug, 108(8), 515 - 6 Acute epiglottitis and bacteremia with ampicillin-resistant Haemophilus influenzae; Gorse GJ et al.; Acute epiglottitis in adults occurs more frequently than generally realized . Haemophilus influenzae type b is the major causative agent . While H influenzae resistant to ampicillin sodium has been associated with epiglottitis in children, no adult cases have been reported . We describe a 48-year-old woman with epiglottitis and associated typical rapid onset of sore throat, fever, respiratory distress, and swollen, red supraglottic structures . Blood cultures were positive for beta-lactamase-producing, ampicillin-resistant H influenzae . We conclude that H influenzae resistant to ampicillin should be considered when diagnosing and treating adult epiglottitis. J Infect Dis, 1982 Aug, 146(2), 266 - 74 Relationship between the specificity of IgA proteases and serotypes in Haemophilus influenzae; Mulks MH et al.; Haemophilus influenzae is one of five bacterial species known to produce IgA proteases, enzymes that specifically cleave the human IgA1 heavy chain . Strains of H . influenzae produce three distinct types of IgA proteases that cleave different peptide bonds within the IgA1 hinge region . Type 1 protease cleaves the prolyl-seryl bond at position 231-232; type 2 protease cleaves the prolyl-threonyl bond at position 235-236, the same bond attacked by Neisseria gonorrhoeae and Neisseria meningitidis type 2 proteases . Type 3 protease yields a unique double Fd cleavage pattern; the exact peptide bonds cleaved have not been determined . The type of protease produced correlates with the serotype, but not with the biotype, of the isolate; serotypes A, B, D, and F produce primarily type 1 protease, whereas serotypes C and E produce only type 2 enzyme . Each nontypable strain yields one of the three protease types . These data further extend our knowledge of the extreme specificity of the IgA proteases and suggest that IgA protease type may be useful in the taxonomy and epidemiology of H . influenzae. J Bacteriol, 1982 Aug, 151(2), 737 - 41 Molecular characterization of three chloramphenicol acetyltransferases isolated from Haemophilus influenzae; Roberts M et al.; Three plasmid-mediated chloramphenicol acetyltransferases isolated from different Haemophilus influenzae strains were purified and characterized . All three enzymes had properties in common with the gram-negative family of chloramphenicol acetyltransferase . The Haemophilus enzymes and the enteric type II enzyme were sensitive to 5,5'-dithiobis(2-nitrobenzoic acid), gave the same elution patterns from a highly substituted resin containing a bound chloramphenicol base, and had similar reactions to antisera . All four differed from each other in subunit molecular weight, enzyme activity, and partial protein digestion patterns . The data suggest that the three Haemophilus enzymes belong to the less common type II group and are related, but is not identical, to each other and to the enteric type II enzyme. S Afr Med J, 1982 Jul 28, 62(5 Spec No), 3A - 4A The history and background of Augmentin; Rolinson GN; Bacterial resistance to the beta-lactam group of antibiotics is frequently due to the production of beta-lactamase which brings about the inactivation of the antibiotic . Clavulanic acid is a naturally occurring inhibitor of beta-lactamase which is capable of rendering penicillin- and cephalosporin-resistant organisms sensitive . The compound is obtained by fermentation from Streptomyces clavuligerus . Clavulanic acid shows some structural similarity to the penicillins and cephalosporins and functions as a progressive inhibitor of a wide range of beta-lactamases including those found in Escherichia coli, Klebsiella aerogenes, Proteus species, Bacteroides fragilis, Haemophilus influenzae, Neisseria gonorrhoeae and Staphylococcus aureus . Clavulanic acid is well absorbed when given by mouth and a formulation with amoxycillin (Augmentin; Beechams) is now available for clinical use. Med J Aust, 1982 Jul 24, 2(2), 77 - 80 Systemic Haemophilus influenzae infection in childhood; Koo W et al.; Forty-nine children who had systemic Haemophilus infection and were treated at the Westmead Centre, Sydney, over a two-year period are described . The majority (29 of 49 children) were aged two years or less . Epiglottis and meningitis accounted for 77% of these infections . All H . influenzae isolates associated with clinical disease were of the capsular type b . Eight per cent (four of 50) of H . influenzae infections were caused by beta-lactamase producing strains . There was no geographic clustering or seasonal variation . There was no mortality . Major morbidity included two patients who had epiglottis and required tracheostomy, and two patients who had meningitis developed bilateral profound sensorineural deafness . No secondary cases were detected in household contacts of 21 patients with H . influenzae meningitis during the study period . Epiglottis frequently occurs in very young children . The rapid response to antibiotic treatment suggests that early cases of epiglottis may be undiagnosed, but treated with antibiotic agents in the community. Res Vet Sci, 1982 Jul, 33(1), 76 - 88 Tylosin tartrate and tiamutilin effects on experimental piglet pneumonia induced with pneumonic pig lung homogenate containing mycoplasmas, bacteria and viruses; Hannan PC et al.; The effects of tylosin tartrate and tiamutilin were examined in pneumonias induced experimentally in neonatal piglets with a homogenate of pneumonic pig lung, obtained from pigs with naturally acquired enzootic pneumonia . The homogenate contained mycoplasmas, including Mycoplasma hyopneumoniae (M suipneumoniae) and M hyorhinis, and certain bacteria and viruses . The experimental pneumonias generally resembled mycoplasmal pneumonia histologically but were complicated by aspiration pneumonia in some animals . both tylosin tartrate (50 mg/kg) and tiamutilin (10 mg/kg) administered orally twice daily for 10 days, beginning 14 days after intranasal infection, significantly reduced the incidence and severity of macroscopical pneumonic lung lesions . M hyopneumoniae could be isolated from the lungs of the unmedicated piglets, but not from drug-treated piglets . The numbers of M hyorhinis, Acholeplasma granularum, Haemophilus parasuis, Pasteurella multocida and P haemolytica in the lung tissue of the infected piglets were significantly reduced by drug therapy . The role of bacterial in the experimental infection appeared to be that of secondary invaders. Arch Dis Child, 1982 Jul, 57(7), 539 - 43 Cefuroxime in bacterial meningitis; Pfenninger J et al.; In order to find an alternative antimicrobial treatment for childhood bacterial meningitis 30 infants and children with meningitis, due to Haemophilus influenzae (n = 13), Neisseria meningitis (n = 9), Streptococcus pneumoniae (n = 5), or meningitis of unknown aetiology (n = 3), were treated with cefuroxime, 200 mg/kg a day, as the only antibiotic . Prompt clinical and bacteriological responses were noted and every patient was cured . Cefuroxime concentrations in cerebrospinal fluid ranged from 1.1 to 18.8 (mean 7.0) mg/l at the beginning and from 0.5 to 4.1 (mean 1.6) mg/l at the end of treatment . Three infants developed symptomatic sterile subdural effusions which were managed by repeated subdural aspirations while still on antibiotics . Cefuroxime concentrations in the subdural fluid ranged from 17.4 to 32.4 mg/l . At follow-up 2 patients had moderate unilateral hearing loss and one had mild ataxia . We conclude that cefuroxime is effective and safe for the treatment of childhood bacterial meningitis caused by any of these common organisms. Am J Vet Res, 1982 Jul, 43(7), 1160 - 4 Host humoral factors in natural resistance to Haemophilus somnus; Simonson RR et al.; Natural serum bactericidal activity against Haemophilus somnus in various age groups of cattle was investigated . The level of antibacterial reactivity correlated with the agglutinating titer and age of the given animal . This activity was complement dependent, but the concentration of bactericidal antibody appeared to be the limiting factor in sera which had reduced killing capacity . Immunized animals developed high serum concentrations of bactericidal activity . The results of this study indicated that bactericidal antibodies may be important in host defense from H somnus infection and that immunization can enhance this resistance by stimulating high serum concentrations of bactericidal activity. J Clin Microbiol, 1982 Jul, 16(1), 30 - 3 Rapid microbiochemical method for identification of Gardnerella (Haemophilus) vaginalis; Yong DC et al.; A rapid biochemical method for the identification of Gardnerella vaginalis has been developed . The method is based on the fermentation of starch and raffinose and on the hydrolysis of hippurate . With this new procedure, identification was confirmed for 390 of 396 G . vaginalis isolates within 1 h after their inoculation into the three substrates. Arch Dermatol, 1982 Jul, 118(7), 494 - 7 Pseudogranuloma inguinale caused by haemophilus ducreyi; Kraus SJ et al.; We used a new selective culture medium to isolate Haemophilus ducreyi from a penile ulcer that had the clinical appearance of granuloma inguinale . The isolation of the organism in pure culture permitted us to make a definitive diagnosis and obtain antimicrobial susceptibility data in a relatively short period . As a result, we were able to change therapy from sulfamethoxazole to erythromycin, and the infection rapidly healed. Antimicrob Agents Chemother, 1982 Jul, 22(1), 162 - 4 Pyridinium-2-azo-p-dimethylaniline chromophore, a new chromogenic cephalosporin for rapid beta-lactamase testing; Jorgensen JH et al.; A new chromogenic cephalosporin, pyridinium-2-azo-p-dimethylaniline chromophore, was evaluated for use in a rapid paper strip or tube test for the detection of beta-lactamases from a variety of microorganisms . A 1-min pyridinium-2-azo-p-dimethylaniline chromophore paper strip test was found to be a convenient and accurate method for the detection of beta-lactamase-producing strains of Haemophilus influenzae and Neisseria gonorrhoeae, although it could not be relied upon to detect beta-lactamases produced by staphylococci, enteric organisms, or Bacteroides fragilis. Eur J Respir Dis, 1982 Jul, 63(4), 325 - 9 Erythromycin and bromhexine in acute exacerbations of chronic bronchitis . A study on sputum penetration and clinical effectiveness; Maesen FP et al.; A group of 22 patients with acute purulent exacerbations of chronic bronchitis were treated with 1 g erythromycin ethyl succinate granules twice daily orally for 10 days . Half the patients were given bromhexine additionally and the other half received placebo instead . Serum and sputum erythromycin concentrations were measured microbiologically at intervals after the first dose . The clinical results in both treated groups were rather poor, with many patients becoming infected again immediately after the chemotherapy . Blood and sputum concentrations of erythromycin did not greatly differ in the two patient groups . The sputum concentration of erythromycin was often higher than the blood concentration at the same time . The MIC's of erythromycin (in particular, those for the Haemophilus influenzae strains) were often higher than the drug concentrations attained in the sputum. Infect Immun, 1982 Jul, 37(1), 82 - 8 Antibody response of infants to cell surface-exposed outer membrane proteins of Haemophilus influenzae type b after systemic Haemophilus disease; Gulig PA et al.; The immune response of nine infants with Haemophilus influenzae type b meningitis was examined by using a radioimmunoprecipitation procedure designed to detect antibodies directed against cell surface-exposed outer membrane proteins of this pathogen . Using intrinsically or extrinsically radiolabeled intact H . influenzae type b cells with acute- and convalescent-phase human sera in this radioimmunoprecipitation system, we found that all of the infants produced an antibody response directed against several different H . influenzae type b outer membrane proteins . Anti-H . influenzae type b outer membrane protein antibodies present in convalescent sera, but not found in acute sera, were directed against cell surface-exposed H . influenzae type b outer membrane proteins . In contrast, both acute and convalescent sera contained antibody activity directed against numerous H . influenzae type b outer membrane proteins whose antigenic determinants were apparently inaccessible to antibody on intact H . influenzae type b cells . The ability of infants to develop an antibody response to cell surface-exposed, antibody-accessible H . influenzae type b outer membrane proteins indicates that these proteins may have vaccinogenic potential. Am J Vet Res, 1982 Jul, 43(7), 1311 - 4 Hemagglutinin of Haemophilus paragallinarum serotype 2 organisms: occurrence and immunologic properties of hemagglutinin; Sawata A et al.; Hemagglutinating properties of Haemophilus paragallinarum serotype 2 and serotype C against freshly collected and glutaraldehyde (GA)- fixed chicken RBC were investigated . Different from serotype 1, the nontreated organisms of serotype 2 and serotype C lacked hemagglutinating activity . However, when the organisms were treated with potassium thiocyanate (KSCN) and/or sonication, activity occurred not only against GA-fixed chicken RBC, but also against GA-fixed RBC of various animal species . The maximum hemagglutination titer (1:64 to 1:256) was obtained against GA-fixed RBC with the KSCN-treated organisms that were also sonicated . The activity was inactivated by heating at 100 C or by treatments with formalin or trypsin, but not by treatments with hyaluronidase or neuraminidase . By using KSCN-treated and sonicated organisms and GA-fixed chicken RBC, a detection of hemagglutination-inhibition (HI) antibody was possible . The HI tests showed that serotype 2 hemagglutinin was immunologically distinct from serotype 1 and that the HI antibody correlated to protective activity against challenge exposure with serotype 2 and serotype C . Chicks having HI antibody greater than 1:5 were protected against challenge exposure with homologous type, but were not protected with serotype 1 . Applicability of the HI test was also shown for evaluating protective potency in the serotype 2 vaccine, as well as in the serotype 1 vaccine. Clin Pharm, 1982 Jul-Aug, 1(4), 315 - 20 Chloramphenicol: recent developments and clinical indications; Marks MI et al.; Recent developments (including more accurate assays) that have led to revised recommendations for route of administration, dosage, and indications for chloramphenicol are reviewed . Chloramphenicol is most bioavailable by the oral route; doses of 75 mg/kg/day provide adequate therapeutic concentrations for most clinical indications . Serum concentrations of the drug should be monitored to ensure adequate therapeutic concentrations and to avoid toxicity . This is particularly important in newborns, in patients with liver dysfunction, and in those receiving concomitant drugs that may influence free chloramphenicol concentrations . The indications for chloramphenicol therapy evaluated are: Haemophilus influenzae infections, anaerobic infections, salmonellosis, Rocky Mountain spotted fever, and eye infections . Chloramphenicol is useful in the treatment of invasive Haemophilus influenzae infections resistant to ampicillin, in selected anaerobic and ocular infections, and for rickettsioses in patients under the age of eight years . Because the rare but life-threatening complication of chloramphenicol (aplastic anemia) persists, indications for the drug's clinical use are narrowing once again with the advent of third-generation cephalosporins highly active against gram-negative bacilli including ampicillin-resistant H . influenzae . Similarly, metronidazole or clindamycin may be preferred for some anaerobic infections. Rev Ig Bacteriol Virusol Parazitol Epidemiol Pneumoftiziol Bacteriol Virusol Parazitol Epidemiol, 1982 Jul-Sep, 27(3), 157 - 65 {Haemophilus influenzae from the point of view of its resistance to antibiotics}; Buiuc D et al.; The authors review: 1 . The frequency of resistance to antibiotics among the H . influenzae populations, outlining the geographical areas representative of the evolution of the phenomenon . 2 . The mechanisms and phenotypical peculiarities of the resistance of H . influenzae to antibiotics, emphasizing the peculiarities of its behaviour to beta-lactam antibiotics, with implications in the diagnosis and correct treatment of the infection . 3 . Genetic mechanisms of resistance and hypothesis regarding the natural evolution of H . influenzae resistance to antibiotics . 4 . Conclusions concerning the diagnosis and treatment of influenza today: methods for testing the infectious strains, associated antibiotherapy and new election antibiotics. N Engl J Med, 1982 Jun 10, 306(23), 1377 - 83 A longitudinal study of respiratory viruses and bacteria in the etiology of acute otitis media with effusion; Henderson FW et al.; We analyzed data from a 14-year longitudinal study of respiratory infections in young children to determine the relative importance of viral respiratory infection and nasopharyngeal colonization with Streptococcus pneumoniae and Haemophilus influenzae as factors influencing the occurrence of acute otitis media with effusion . The incidence of this disorder was increased in children with viral respiratory infections (average relative risk, 3.2; P less than 0.0001) . Infection with respiratory syncytial virus, influenza virus (type A or B), and adenovirus conferred a greater risk of otitis media than did infection with parainfluenza virus, enterovirus, or rhinovirus . Colonization of the nasopharynx with Str . pneumoniae or H . influenzae had a lesser effect on the incidence of the disease (average relative risk; 1.5; P less than 0.01) . Infections with the viruses more closely associated with acute otitis media (respiratory syncytial virus, adenovirus, and influenza A or B) were correlated with an increased risk of recurrent disease . Prevention of selected otitis-associated viral infections should reduce the incidence of this disease. J Infect Dis, 1982 Jun, 145(6), 815 - 21 Penetration of amoxicillin, cefaclor, erythromycin-sulfisoxazole, and trimethoprim-sulfamethoxazole into the middle ear fluid of patients with chronic serous otitis media; Krause PJ et al.; Penetration into the middle ear of four antibiotics commonly used in treatment of otitis media was studied by administering a single oral dose of amoxicillin, cefaclor, erythromycin-sulfisoxazole, or trimethoprim-sulfamethoxazole to 83 children with chronic serous otitis media . The antibiotic was given 15-240 min before the removal of middle ear fluid (MEF) by ventilation tubes inserted through the tympanic membrane . At the time MEF was obtained, a sample of blood was drawn from the patient, and concentrations of antibiotic in both specimens were assayed either microbiologically by a disk diffusion method or by high-pressure liquid chromatography . Amoxicillin had the highest ratio of mean peak concentration in MEF to minimal inhibitory concentration (MIC) for the three most common pathogens of otitis media (Streptococcus pneumoniae, ampicillin-sensitive Haemophilus influenzae, and Streptococcus pyogenes), whereas trimethoprim-sulfamethoxazole had the highest ratio of mean peak concentration in MEF to MIC for ampicillin-resistant Haemophilus influenzae. Can J Microbiol, 1982 Jun, 28(6), 696 - 702 Nicotinamide adenine dinucleotide and nicotinamide adenine dinucleotide phosphate splitting enzyme(s) of sheep and rabbit erythrocytes: their effect on the growth of Haemophilus; Artman M et al.; Fragility of rabbit erythrocytes in agar plates results in gradual release of their NAD and NADP contents into the medium . Due to high NADase and negligible NADPase activity of rabbit red blood cell stroma at neutral pH, the NAD released into the medium is hydrolyzed and NADP remains intact . Thus, rabbit erythrocytes and their lysates support the growth of NAD(P)-requiring Haemophilus by serving as a source of NADP . Stability of sheep erythrocytes in agar plates results in retention of their NAD and NADP contents and consequently in inhibition of growth of NAD(P)-requiring Haemophilus . The highly active NAD- and NADP-splitting enzyme(s) of sheep red blood cell stroma prevent(s) the growth of Haemophilus on sheep blood lysates through inactivation of both NAD and NADP which are released into the medium. J Clin Microbiol, 1982 Jun, 15(6), 1019 - 23 Evaluation of slide agglutination and ring precipitation tests for capsular serotyping of Haemophilus pleuropneumoniae; Mittal KR et al.; Rapid slide agglutination (RSA), quantitative plate agglutination, slow tube agglutination (STA), and ring precipitation (RP) tests were performed on 200 isolates of Haemophilus pleuropneumoniae by using the type sera produced in rabbits against five known serotype strains and one strain 202 . RSA and RP tests both yielded the same results as those by STA . None of the agglutination procedures could be used for serotyping isolates that autoagglutinated in saline . The RP test was successfully used for serotyping such strains . The specificity of the RSA and RP tests was confirmed by cross-absorption studies . All of the isolates except two had strong serotype-specific activities . The most common serotype isolated in Quebec was serotype 1, followed by serotypes 5 and 2 . None of the isolates belonged to serotypes 3 and 4 . Only two isolates were found to be untypable; they could possibly belong to serotype(s) not yet defined . The RSA and RP tests may be at least as reliable as the STA test, but easier to perform, less expensive, and much more rapid than any of the other methods reported . Of all the procedures studied by us, the RP test proved to be the method of choice for serotyping H . pleuropneumoniae; hence, it should replace the STA test for serotyping H . pleuropneumoniae. J Hyg (Lond), 1982 Jun, 88(3), 383 - 401 Bacterial meningitis--ten years experience; Davey PG et al.; Between January 1968 and December 1977, 635 cases of acute bacterial meningitis were admitted to hospitals in the Birmingham Area Health Authority . The epidemiology of these cases was analysed and compared with the 270 cases which were admitted to the regional infectious diseases unit at East Birmingham Hospital (E.B.H.) . In children and young adults the meningococcus was the commonest causative organism while over the age of 25 pneumococcal meningitis predominated . Although Haemophilus influenzae was the second commonest infecting organism it was a rare cause of meningitis in school children and adults, only four cases presenting in these age groups in the Birmingham Area . A detailed analysis was made of the symptoms, signs, laboratory investigations and clinical course of the 270 cases treated at E.B.H . The mortality in the patients with pneumococcal meningitis was 30% . In the meningococcal group it was 3.5% and in the haemophilus groups 7.7% . An analysis of the various treatment regimes employed in the 270 E.B.H . patients supports the view that a single antibiotic is sufficient for the therapy of most forms of bacterial meningitis . Intrathecal antibiotic administration is unnecessary in pyogenic meningitis caused by meningococci, pneumococci or H . influenzae. J Clin Microbiol, 1982 Jun, 15(6), 1150 - 2 Novel method of biotyping Haemophilus influenzae that uses API 20e; Holmes RL et al.; One hundred Haemophilus influenzae isolates from various body sites were biotyped by conventional methods and by the API 20E system (Analytab Products, Plainview, N.Y.) . By using a hemin- and a nicotinamide adenine dinucleotide-enriched saline solution as the inoculating fluid for the API 20E, a 100% correlation of results was obtained between the two methods . Ninety percent of the blood and cerebrospinal fluid isolates were biotype I . Biotype II was the predominant biotype encountered overall . No correlation was observed between beta-lactamase production and biotype . The API 20E is a reliable method and should prove useful for routine biotyping of H . influenzae in the clinical laboratory. Eur J Clin Microbiol, 1982 Jun, 1(3), 131 - 3 Rapid detection of Haemophilus influenzae type b in cerebrospinal fluid by commercial coagglutination and latex agglutination kits; Burdash NM et al.; The ability of two commercial kits to detect Haemophilus influenzae type b antigen in cerebrospinal fluid was evaluated . Results obtained by Bactogen, a latex agglutination test, and Phadebact, a coagglutination test, were compared to counterimmunoelectrophoresis, Gram stain and culture results . One hundred and seven specimens of cerebrospinal fluid were tested . Thirty were found to contain bacteria, 20 of which were Haemophilus influenzae type b . All 20 were positive by Bactogen and Phadebact testing, 19 were culture positive, 18 were positive by counterimmunoelectrophoresis and 15 had gram-negative bacilli seen on Gram stain . The culture negative specimen contained microscopically visible gram-negative bacilli and was from a patient on antimicrobial therapy who was previously Haemophilus influenzae type b culture positive . No false positives from other genera or the 77 culture negative specimens occurred with Phadebact, Bactogen or counterimmunoelectrophoresis. Int J Pediatr Otorhinolaryngol, 1982 Jun, 4(2), 139 - 48 Acute sinusitis in children--symptoms, clinical findings and bacteriology related to initial radiologic appearance; Jannert M et al.; In a series of 175 children with suspected sinusitis the symptoms and clinical signs were compared with the radiologic and bacteriologic findings . URI, purulent nasal secretion and pain were the main symptoms predicting radiologic changes . In 75% of the patients the presence of two or three of these symptoms was co-existent with major radiological changes . As assessed by nasopharyngeal culture Haemophilus influenzae seemed to be the major pathogen. J Clin Microbiol, 1982 Jun, 15(6), 1167 - 8 Rapid detection in spinal fluid of beta-lactamase produced by ampicillin-resistant Haemophilus influenzae; Boughton WH; The chromogenic cephalosporin nitrocefin was used to detect the presence of beta-lactamase in cerebrospinal fluid of patients suffering from ampicillin-resistant Haemophilus influenzae meningitis . Five samples of spinal fluid containing ampicillin-resistant isolates were studied, and all had beta-lactamase activity . When samples of spinal fluid containing 33 ampicillin-sensitive isolates and 234 sterile specimens were tested, no beta-lactamase activity was detected. J Clin Microbiol, 1982 Jun, 15(6), 1153 - 6 Clinical studies of a new latex particle agglutination test for detection of Haemophilus influenzae type b polyribose phosphate antigen in serum, cerebrospinal fluid, and urine; Shaw ED et al.; A new latex particle agglutination test for direct detection of Haemophilus influenzae type b polyribose phosphate antigen in serum, cerebrospinal fluid, or urine was evaluated from studies at four clinical centers . Although use of a serum buffer significantly reduced inconclusive agglutination of the latex particles, the retesting of serum samples, after heat inactivation and dilution, resolved all serum samples, with one exception, as reactive or nonreactive for the presence of the polyribose phosphate antigen . A clinical accuracy of 100% was obtained for the latex particle agglutination method in respect to its capability for detection of polyribose phosphate antigen in all patients with confirmed infection by H . influenzae type b. South Med J, 1982 Jun, 75(6), 753 - 4 Invasive disease due to nontypable Haemophilus influenzae in children; Liston TE et al.; Its virulence factors, immune responses, and sites of isolation characterize nontypable Haemophilus influenzae as a pathogen of mucosal surfaces which rarely causes invasive disease . We isolated nontypable H influenzae in pure culture from thoracentesis fluid in a child with pneumonia . An extensive review of the literature in which serotyping of H influenzae was reported revealed that nontypable strains have accounted for only six other cases of pneumonia diagnosed by blood culture, lung puncture, or thoracentesis fluid . The only isolate reported to cause disease outside the neonatal age group may have been a typable strain . Because this organism rarely causes invasive disease, its isolation from sputum is of questionable significance and other causes should be sought. South Med J, 1982 Jun, 75(6), 736 - 7 Haemophilus influenzae infection of an existing lung cyst; Wewers MD et al.; Although Haemophilus influenzae is becoming recognized as a cause of serious pulmonary infections in adults, it has not been previously reported to infect lung cysts . We describe a 25-year-old man who had a lung cyst in which a serious infection developed . Both needle aspiration of the cyst and blood culture confirmed that the infection was caused by H influenzae. South Med J, 1982 Jun, 75(6), 734 - 6 Haemophilus influenzae implicated in puerperal infection; Pastorek J 2nd et al.; We have described two cases of Haemophilus influenzae isolation, one from a patient with chorioamnionitis and one from a patient with bacteremia and endomyometritis . The first patient responded to cefoxitin and delivery, while the second patient failed to improve satisfactorily with clindamycin and tobramycin therapy, but responded to ampicillin. Pediatrics, 1982 Jun, 69(6), 695 - 8 Conjunctivitis-otitis syndrome; Bodor FF; Purulent conjunctivitis associated with otitis media was studied in 124 patients in a private practice over a period of one year . Of the 132 patients seen with purulent conjunctivitis, 96 (73%) concurrently had otitis media . In 29 (47%) of 60 families with more than one child, siblings of the index cases had either purulent conjunctivitis or otitis media, or both, simultaneously or within one month . During the study period, conjunctival cultures were obtained from 75 patients with purulent conjunctivitis-otitis media and patients with purulent conjunctivitis whose siblings had purulent conjunctivitis-otitis media or otitis media . Haemophilus influenzae was isolated from 55 (73%) . Thirty-one of the patients had nasal cultures done simultaneously with conjunctival cultures . An identical pathogen was isolated from 27 (87%) patients. Clin Pediatr (Phila), 1982 Jun, 21(6), 360 - 4 Systemic Hemophilus influenzae infection . A study of risk factors; Lerman SJ; In Omaha, from 1974 to 79, 30 (12.5%) of 240 patients with Haemophilus influenzae bacteremia or meningitis had a wide variety of conditions known to be associated with increased susceptibility to bacterial infection . Neonates and adults accounted for 47 per cent of the infections . Non-type b and non-typable strains caused 41 per cent of the episodes . Forty-one per cent of patients had bacteremia with no detectable focus of infection . The incidence of meningitis was low . Mortality was 28 per cent, considerably higher than in patients who were previously healthy . A review of the medical literature indicated that low-birth weight infants and patients with leukemia and other malignancies undergoing chemotherapy, splenectomy, congenital asplenia, sickle cell anemia, immunoglobulin deficiency diseases, cerebrospinal fluid shunts, and skull defects are at greater risk for systemic H . influenzae disease than the general population. Pediatrics, 1982 Jun, 69(6), 699 - 702 Relationship between the magnitude of bacteremia in children and the clinical disease; Sullivan TD et al.; The relationship between the magnitude of bacteremia due to Haemophilus influenzae, Streptococcus pneumoniae, and Neisseria meningitidis and the clinical diagnosis was determined on 79 children who were not receiving prior antibiotic therapy and had fever, either in the presence or absence of focal signs of infection . Bacteremia was quantitated by the recently described Quantitative Direct Plating procedure in which heparinized blood (0.5 ml each) is plated onto blood and chocolate agar plates . Additionally, blood was cultured by means of the radiometric Bactec technique . In the case of H . influenzae and S pneumoniae, 23 (92%) of 25 patients with more than 100 organisms per milliliter of blood had meningitis or epiglottitis in contrast to only four (9.5%) of 42 patients with less than 100 organisms (P less than .001) . No significant difference was noted in the magnitude of bacteremia due to N meningitidis among 12 patients with meningitis or other serious infections . The possible predictive value of the quantitation of bacteremia is illustrated by the observation of three children with seemingly mild respiratory infection and counts in excess of 100 organisms per milliliter who, within 20 hours, developed meningitis or epiglottitis . High bacterial counts of H influenzae and S pneumoniae in excess of 100 organisms per milliliter of blood should alert the physician to the existence or possible development of serious disease. Antimicrob Agents Chemother, 1982 Jun, 21(6), 857 - 63 Molecular epidemiology of beta-lactamase-specifying plasmids of Haemophilus ducreyi; Brunton J et al.; We have studied the genetic basis of beta-lactamase production in eight strains of Haemophilus ducreyi isolated in diverse areas of the world . Beta-lactamase production in all strains was mediated by plasmids having a molecular mass of either 5.7 or 7.0 megadaltons . Plasmids of 5.7 megadaltons were shown to carry the entire sequence of pFA7, the beta-lactamase specifying plasmid found in isolates of Neisseria gonorrhoeae epidemiologically linked to West Africa . Plasmids of 7.0 megadaltons were shown to carry the entire sequence of pFA3, the beta-lactamase specifying plasmid found in Far Eastern isolates of N . gonorrhoeae . Both groups of H . ducreyi plasmids were shown to carry physically complete and functional TnA sequences . Thus we have identified two types of H . ducreyi beta-lactamase plasmid which are identical to the two types of N . gonorrhoeae beta-lactamase plasmid, except that they carry complete TnA sequences. Zh Mikrobiol Epidemiol Immunobiol, 1982 Jun, (6), 56 - 7 {Isolation and purification of restriction endonuclease BpeI from Bordetella pertussis}; Kazennova EV et al.; New restriction endonuclease has been isolated from Bordetella pertussis vaccine strain 305 and purified in 1 stage on Sepharose covalently bound with blue dextran . The isolated restrictase has been found capable of breaking down lambda-phag DNA into 7 fragments . According to its specificity, Bpe I is the isoschizomer of Hind III obtained from Haemophilus influenzae strain Rd. J Clin Microbiol, 1982 Jun, 15(6), 1009 - 15 Serological diversity in Haemophilus somnus; Canto GJ et al.; Serological interrelations among 46 strains of Haemophilus somnus of various geographical and pathological origins were studied by agglutination and agglutinin adsorption procedures . Sera prepared against nine representative American and Swiss isolates agglutinated all other strains to various titers . Adsorption of antisera to American strains by Swiss cultures tended to remove mainly the reactivity with Swiss antigens, whereas adsorption of such antisera to American strains in most instances abolished all agglutinating activity . Analogous observations were made when sera against Swiss cultures were adsorbed with cells of American and Swiss origin, respectively . Results of tests involving unadsorbed and adsorbed sera suggest the existence of at least three sets of antigen in H . somnus: American, Swiss, and common, which appear to exist in various combinations, accounting for four agglutination groups . These reflect to a considerable degree the geographical, although not the pathological or anatomical, origin of the respective strains. Br Med J (Clin Res Ed), 1982 May 29, 284(6329), 1597 - 9 Increase in antibiotic resistance in Haemophilus influenzae in the United Kingdom since 1977: report of study group; Philpott-Howard J et al.; A survey of antibiotic resistance in Haemophilus influenzae was carried out in the United Kingdom with 25 laboratories participating . The incidence of resistance in the 1841 strains examined was: tetracycline 3.1%, ampicillin 6.2%, chloramphenicol 1.03%, trimethoprim 1.4%, and sulphamethoxazole 1.5% . Of the 115 strains resistant to ampicillin, 106 produced beta-lactamase . Seventy-nine strains were capsulate, none of which was chloramphenicol resistant, but nine produced beta-lactamase (11.4%) . Comparison of these figures of antibiotic resistance with those from a similar survey performed in 1977 showed a significant increase in resistance of H influenzae to ampicillin, chloramphenicol, and trimethoprim. J Clin Microbiol, 1982 May, 15(5), 791 - 4 Cellular fatty acid composition of Haemophilus equigenitalis; Sugimoto C et al.; The cellular fatty acid composition of eight Haemophilus equigenitalis strains was determined by gas-liquid chromatography . All strains showed a grossly similar pattern characterized by large amounts of 18:1 and 16:0 . The amounts of 16:1, 18:2, 18:0, 3-OH 14:0, 3-OH 16:0, and 3-OH 18:1 were relatively small. Am J Vet Res, 1982 May, 43(5), 791 - 5 Prevalence and distribution of Haemophilus somnus in the male bovine reproductive tract; Humphrey JD et al.; "Haemophilus somnus' was isolated from 77% of 31 reproductive tracts of bulls from an Ontario slaughterhouse . Identification of H somnus was based on morphologic and cultural characteristics and on fluorescent antibody and immunodiffusion tests, using antisera prepared against a known pathogenic encephalitic isolate of H somnus . The infection rate and distribution of H somnus within the tract were as follows: preputial orifice--71% preputial cavity--71%; urinary bladder--26%; accessory sex glands--19% and ampulla of ductus deferens--10% . Isolates were not obtained from the testes or epididymides . On 2 occasions, H somnus was isolated in pure culture from the preputial cavity . A higher prevalence of infection was found in young bulls . There were no differences found in infection rates between breeds . Differences in hemolytic activity and minor antigenic variation between isolates indicated that a series of biotypes within the species H somnus may exist . The study indicates that organisms presently identified as H somnus may normally form part of the flora of the bovine prepuce and that dissemination from the male bovine reproductive tract is one possible means of infection in H somnus-associated diseases . The pathogenic significance of genital isolates of H somnus awaits further study. J Clin Microbiol, 1982 May, 15(5), 976 - 8 Rapid biotyping of Haemophilus influenzae and Haemophilus parainfluenzae with PathoTec strips and spot biochemical tests; Juni BA et al.; PathoTec strips and spot biochemical tests were evaluated for the ability to biotype Haemophilus influenzae and Haemophilus parainfluenzae . Indole, urease, and ornithine decarboxylase reactions were tested . The results of PathoTec strips compared favorably with those conventional methods; the percent agreements were as follows: indole, 100; urease, 99.5; and ornithine, 95.5 . Spot tests were simple and rapid, and the results also compared favorably with those of conventional tests; the percent agreements were as follows: indole, 99; urease, 100; and ornithine, 96. J Clin Microbiol, 1982 May, 15(5), 757 - 60 Comparison of fluorescent and colorigenic substrates for enzyme immunoassays; Yolken RH et al.; A variety of substrates can be employed in enzyme immunoassays (EIAs) for the measurement of enzyme-labeled immunoreactants . We compared the sensitivities of a fluorescent and a colorigenic substrate in an EIA system for the measurement of Haemophilus influenza purified polyribose phosphate . After a 10-min substrate incubation, the EIA in which the fluorescent substrate was used could detect 10 pg of polyribose phosphate per ml, whereas the EIA in which the colorigenic substrate was used required the addition of 640 pg of polyribose phosphate per ml to generate a positive reading . However, the use of longer substrate incubation periods led to an increase in sensitivity of the colorigenic EIA . After an incubation period of 240 min, the sensitivity was equal to that of the EIA in which the fluorescent substrate was used . These results suggest that the ultimate limit of sensitivity of EIA systems is determined by the nature of the antigen-antibody reactions . However, the use of high-energy substrates in EIA systems can allow for the attainment of maximal sensitivity after short enzyme-substrate incubation periods. Antimicrob Agents Chemother, 1982 May, 21(5), 734 - 9 Characterization of ampicillin-resistant Haemophilus parainfluenzae; Scheifele DW et al.; Carriage of ampicillin-resistant (Ampr) Haemophilus parainfluenzae has become frequent among children in our community, although carriage of Ampr Haemophilus influenzae remains uncommon . In this study we characterized the mechanism of ampicillin resistance in 27 representative isolates of H . parainfluenzae . As determined by isoelectric focusing, each isolate had a TEM-1 beta-lactamase; substrate profiles assessed for enzymes from 10 strains were also consistent with TEM-1 enzyme . Agarose gel electrophoresis revealed a plasmid of 23 to 34 megadaltons in each isolate and a small plasmid (less than or equal to 4 megadaltons) in 14 isolates . Transfer of ampicillin resistance to H . influenzae Rd was achieved during membrane mating with 14 of 15 donors . The transconjugants exhibited high-level ampicillin resistance (greater than or equal to 50 micrograms/ml), which was stable despite serial passage of isolates on antibiotic-free media . The transconjugants tested retained fertility . Cryptic plasmids were discovered in 7 of 25 antibiotic-susceptible H . parainfluenzae isolates . Our data suggest that H . parainfluenzae may play an important role in the exchange of Ampr genes among throat bacteria. Infect Immun, 1982 May, 36(2), 603 - 8 In vitro immunological activities of the polysaccharide fraction from Haemophilus influenzae type a endotoxin; Guenounou M et al.; Mild hydrolysis of Haemophilus influenzae type a lipopolysaccharide by ion exchangers in the presence of chloroform, to remove the lipid moiety, yielded a nontoxic and immunogenic polysaccharide fraction . This polysaccharide selectively triggered murine B lymphocytes in vitro: (i) it induced enhancement of thymidine incorporation and stimulated antibody secretion in cultures of normal and nude mouse spleen cells; (ii) it did not stimulate splenic T lymphocytes; (iii) the activation of B lymphocytes was not absolutely dependent on the presence of macrophages . Sepharose 4B gel filtration showed that this polysaccharide consisted at least of two fractions: PS I (molecular weight {MW} 10(6)) and PS II (MW 10(4)) . Only PS I was found to act as a polyclonal B cell activator . EDTA treatment dissociated the polysaccharide into PS III (MW 10(6)) and PS IV (MW 10(4)), which was not reassembled after the addition of 0.02 M CaCl2 . Both fractions PS III and PS IV were unable to stimulate B lymphocytes . The immunological active fraction of H . influenzae polysaccharide is PS I . This fraction consists of a high-molecular-weight group (10(6)) and an association of 10(4)-MW aggregated units. Infect Immun, 1982 May, 36(2), 535 - 40 Outer membrane protein and biotype analysis of pathogenic nontypable Haemophilus influenzae; Barenkamp SJ et al.; The techniques of biotype determination and sodium dodecyl sulfate-polyacrylamide gel electrophoresis of outer membrane protein preparations were applied to 35 epidemiologically unrelated isolates of pathogenic nontypable Haemophilus influenzae . Three of five isolates obtained from the blood of unrelated newborns with sepsis had concordant major outer membrane from the blood of unrelated older children or adults with bacteremia had concordant major outer membrane protein profiles, distinct from the common profile of neonatal strains, and were biotype II . The outer membrane protein profiles of the remaining 5 isolates from blood, 2 isolated from cerebrospinal fluid, and 23 isolated from middle ear aspirates of children with otitis media were unique, although each isolate had peptides with apparent molecular weights of 16,000 and 31,500 . These results suggest that a subset of nontypable isolates associated with bacteremia has distinctive strain markers . Their pathogenicity may relate to a prediction for colonizing the female genital tract in the case of the common neonatal strain or an increased ability to evade host defenses. J Gen Microbiol, 1982 May, 128 (Pt 5), 1159 - 61 Haemophilus influenzae and Neisseria gonorrhoeae recognize different specificity determinants in the DNA uptake step of genetic transformation; Mathis LS et al.; Cross-transformation and quantitative competition experiments showed that Neisseria gonorrhoeae and Haemophilus influenzae do not interact with each other's DNA in transformation . These organisms must interact with different recognition sequences during DNA uptake. Parasite Immunol, 1982 May, 4(3), 157 - 70 The unspecific antibody response to N . meningitidis group A capsular polysaccharide often seen in bacteraemic diseases; Kayhty H; When studying acute and convalescent phase sera of patients with bacteraemic diseases, an unexpected rise of antibody activity (measured as binding of radioactive antigen) towards the capsular polysaccharide of Neisseria meningitidis group A (MenA) was observed in 59 out of 292 patients whose infection was caused by other organisms (other groups of N . meningitidis, Haemophilus influenzae, Streptococcus pneumoniae, Escherichia coli or Staphylococcus aureus) . This non-specific reaction was not seen in non-bacteraemic diseases (Mycoplasma pneumonia, viral meningitis) or after immunization with H . influenzae type b capsular polysaccharide or Salmonella and cholera whole cell vaccines . The 'unspecific' anti-MenA antibodies were of all immunoglobulin classes A, G and M tested, and had lower avidity than did those in the specific response . They were clearly inhibitable by N-acetylmannosamine which inhibited the specific antibodies only marginally. Pediatr Infect Dis, 1982 May-Jun, 1(3), 159 - 63 Cefuroxime therapy for pneumonia in infants and children; Nelson JD et al.; Because Streptococcus pneumoniae, Haemophilus influenzae b and Staphylococcus aureus are the major causes of bacterial pneumonia in infancy, we customarily have given a beta-lactam antibiotic and chloramphenicol as initial antibiotic therapy . Cefuroxime (75 mg/kg/day divided every 8 hours iv or im) was evaluated as single drug therapy in an open study of 100 infants and children with suspected bacterial pneumonia . The mean serum concentration of cefuroxime 30 minutes after a 15-minute infusion of 25 mg/kg iv was 29.1 micrograms/ml, and the volume of distribution was 695 ml/kg . Pleural fluid concentrations in 3 specimens were 2.2, 8.5 and 11 micrograms/ml . Median age of patients was 15 months . Bacterial etiology was established in 20 patients: H . influenzae b (8 patients); pneumococcus (8 patients); S . aureus (2 patients); Group A streptococcus (1 patient); Neisseria meningitidis B (1 patient) . All organisms were susceptible to 1.25-micrograms/ml doses or less of cefuroxime . The mean number of days was 3.1 until patients became afebrile and 5.1 until respiratory symptoms were gone . Eosinophilia occurred in 10 patients . Cefuroxime is safe and effective single drug therapy for pneumonia in infants and children. J Med Microbiol, 1982 May, 15(2), 243 - 5 Identification of Haemophilus ducreyi in the clinical laboratory; Nobre GN; Some of the characteristics of 42 clinical isolates of Haemophilus ducreyi are reported . Only six of the 42 strains were able to grow on horse-blood agar . All strains gave a positive oxidase test with tetramethyl-p-phenylenediamine and a negative result with dimethyl-p-phenylenediamine . All of 15 test strains were negative in the porphyrin test . Tests for haemin requirement were inconclusive because of difficulties encountered in obtaining growth on a basal medium. Jpn J Antibiot, 1982 May, 35(5), 1187 - 98 {Clinical bacteriological studies on cefotiam and cefsulodin in the field of otorhinolaryngology}; Deguchi K et al.; Clinical bacteriological studies on cefotiam and cefsulodin in the field of otorhinolaryngology were carried out and the following results were obtained . 1) Aerobic and anaerobic Gram-positive bacteria were dominantly isolated from the clinical materials sent to the center from the clinical institutes . 2) It was considered that Streptococcus pneumoniae, Haemophilus influenzae and beta-Streptococcus played an important role in the primary infections in the field of otorhinolaryngology . Staphylococcus aureus was also frequently isolated from the primary infections . Peptostreptococcus spp . was dominantly isolated from peritonsillar abscess . Gram-negative bacilli (GNB) were mainly isolated from the chronic secondary infections . Among GNB, Pseudomonas aeruginosa and Proteus spp . were more frequently isolated . Staphylococcus aureus was also constantly detected in the secondary infections together with GNB . Anaerobic bacteria were isolated from 20.1% of the patients with chronic otitis media and 27.1% of sinusitis . 3) Cefotiam showed potent antibacterial activities against most isolates of Gram-positive and Gram-negative bacteria . 4) Cefsulodin showed potent antibacterial activities against clinically isolated Pseudomonas aeruginosa . Staphylococcus aureus and beta-Streptococcus were also susceptible to cefsulodin. Arch Intern Med, 1982 May, 142(5), 939 - 40 Gram-negative bacillary meningitis . New therapy and changing concepts; Landesman SH et al.; Because the CSF is deficient in opsonic and phagocytic activity, optimal therapy for meningitis mandates the use of antibiotics that are bactericidal at achievable CSF concentrations . This therapeutic principles is satisfied for the common meningeal pathogens (Streptococcus pneumoniae, Haemophilus influenzae, Neisseria meningitidis) but is not readily achieved for the pathogens causing Gram-negative bacillary meningitis (GNBM), such as Klebsiella and Escherichia coli . The antibiotics used to treat GNBM, chloramphenicol and aminoglycosides, are not bactericidal against enteric pathogens at achievable CSF levels . Two new beta-lactam antibiotics, moxalactam disodium and cefotaxime sodium, are suitable agents for the treatment of GNBM . These antibiotics possess potent bactericidal activity against most enteric pathogens and achieve high levels in the CSF (15 to 35 micrograms/mL for moxalactam disodium and 2 to 10 micrograms/mL for cefotaxime sodium) . Recent clinical studies document an 85% cure rate when these agents are used to treat GNBM. Lancet, 1982 May 1, 1(8279), 980 - 2 C-reactive protein for rapid monitoring of infections of the central nervous system; Peltola HO; Serum C-reactive protein (CRP) was measured nephelometrically or turbidimetrically for rapid differential diagnosis of sixteen bacterial and fifteen viral infections of the central nervous system in patients aged from 2 weeks to 49 years . On hospital admission CRP levels were far above the upper limit of normal (19 mg/l) in all patients with bacterial meningitis, regardless of the duration of illness, the age of the patient, the bacterium involved, fever, the erythrocyte sedimentation rate, or the cerebrospinal-fluid cell count . In contrast, a slight rise in CRP level was seen in only one case of viral meningitis . CRP was useful also in monitoring the clinical course of the illnesses and in the detection of subdural effusion in one patient with Haemophilus influenzae meningitis and of otitis media in another patient with coxsackie B meningitis . If no complications developed, CRP levels returned to normal within 7 days in the bacterial meningitis group . The rapid measurement of CRP levels is of importance and should be used more often in clinical practice. Can J Comp Med, 1982 Apr, 46(2), 215 - 7 Occurrence of "Haemophilus somnus" in bovine semen and in the prepuce of bulls and steers; Humphrey JD et al.; Haemophilus somnus was isolated from 40 of 79 unprocessed bovine semen samples, 14 of 23 preputial washings of bulls and three of eight preputial washings of steers . The results indicate nonvenereal colonization of the male urogenital tract . It is suggested that dissemination of H . somnus from the urogenital tract may be of significance in the epizootiology of H . somnus associated diseases. South Med J, 1982 Apr, 75(4), 448 - 50 Bacterial meningitis without clinical signs of meningeal irritation; Geiseler PJ et al.; A clinical diagnosis of meningitis in neonates is difficult because of paucity of physical findings . In older infants and children, nuchal rigidity, Kernig's or Brudzinski's sign, or bulging fontanelles are sought . A review of 1,064 cases of bacterial meningitis beyond the neonatal period revealed that 16 (1.5%) patients had none of those meningeal signs during the entire hospitalization, despite CSF pleocytosis . Eight patients (50%) were 2 years old or older . Lumbar punctures were done because of unexplained fever, changes in behavior or mental status,, seizures, or occurrence of skin petechiae in febrile patients . These patients frequently had moderate pleocytosis and all survived . The meningitis was caused by Neisseria meningitidis in seven patients, Haemophilus influenzae in six, Streptococcus pneumoniae in two, and Salmonella enteritidis in one patient . CSF should be examined in a patient of any age whenever meningitis is a consideration, even if patients lack meningeal signs. South Med J, 1982 Apr, 75(4), 399 - 403 Early diagnosis and airway management of acute epiglottitis in children; Diaz JH et al.; The technics for early diagnosis and airway management of acute epiglottitis in children continue to provoke disagreement . In 104 cases of children with acute epiglottitis, early diagnosis was confirmed by cervical roentgenograms, direct pharyngoscopy, or both . Airway maintenance was provided by nasotracheal intubation of conscious patients in most cases . No tracheostomies were performed . Blood cultures obtained after, rather than before, nasotracheal instrumentation resulted in a significant increase in positive Haemophilus influenzae cultures. J Clin Microbiol, 1982 Apr, 15(4), 606 - 9 Selective medium for isolation of Actinobacillus actinomycetemcomitans; Slots J; A selective medium, TSBV (tryptic soy-serum-bacitracin-vancomycin) agar, was developed for the isolation of Actinobacillus actinomycetemcomitans, TSBV agar contained (per liter) 40 g of tryptic soy agar, 1 g of yeast extract, 100 ml of horse serum . 75 mg of bacitracin, and 5 mg of vancomycin . The TSBV medium suppressed most oral species and permitted significantly higher recovery of A . actinomycetemcomitans than nonselective blood agar medium . The distinct colonial morphology and positive catalase reaction of A . actinomycetemcomitans easily distinguished this bacterium from Haemophilus aphrophilus, Capnocytophaga species, and a few other contaminating organisms . With the TSBV medium, even modestly equipped laboratories will be able to isolate and identify A . actinomycetemcomitans from clinical specimens. J Clin Invest, 1982 Apr, 69(4), 742 - 9 Induction of immunity against lethal Haemophilus influenzae type b infection by Escherichia coli core lipopolysaccharide; Marks MI et al.; Efforts to prevent Haemophilus influenzae type b (HIB) infections in infancy have been hampered by the low immunogenicity of capsular polysaccharide vaccines in children younger than 18 mos . In searching for alternate immunogens, we have studied the protective potential of polysaccharide-poor, lipid-rich endotoxin (LPS) core in experimental HIB infections . Because all gram-negative bacteria have similar LPS core structures, we were able to use as vaccine the J5 mutant of Escherichia coli 0111, the LPS of which consists only of core components, and thus to avoid problems in interpretation arising from vaccine contamination with non-LPS HIB immunogens . Mice were given graded inocula of HIB and developed lethal infection analogous to human HIB disease when virulence was enhanced with mucin and hemoglobin . After active immunization with heat-killed E . coli J5, 40/50 (80%) of infected mice survived, compared with 14/50 (28%) of saline-immunized controls (P less than 0.005) . Passive immunization with rabbit antiserum against E . coli J5 prevented lethal HIB infection when administered 24 or 72 h before or 3 h after infection . This protection was abolished by adsorption of antiserum with purified J5 LPS, with survival reduced from 14/24 to 0/24 (P less than 0.005) . Furthermore, rabbit antiserum to purified J5 LPS gave just as potent protection against death as antiserum to whole J5 cells . These studies demonstrate that immunity to core LPS confers protection against experimental murine HIB infection and provide the framework for a new approach to prevention of human disease from HIB. Aust N Z J Med, 1982 Apr, 12(2), 182 - 5 Haemophilus influenzae meningitis in adults; Whitby M et al.; Three cases of pyogenic Haemophilus influenzae meningitis in adults have been diagnosed within the Brisbane Metropolitan area in the last twelve months . This had been considered a very unusual cause of meningitis in adults which has not previously been recorded in the Australian literature, and should alert clinicians to a possible alteration in the age specificity of this disease . Two of the three isolates proved resistant to ampicillin; this emphasizes the need to exclude beta lactamase production in all Haemophilus isolates from critical infections . All three patients recovered without significant sequelae but the choice of primary antimicrobial in adult meningitis remains open to question. Acta Pathol Microbiol Immunol Scand {B}, 1982 Apr, 90(2), 89 - 93 Method for isolation of gardnerella vaginalis (Haemophilus vaginalis) . Characterization of isolates by gas chromatography; Csango PA et al.; A method for the isolation of Gardnerella vaginalis (Haemophilus vaginalis) is presented . Bacteria isolated from 48-hour cultures grown on human blood agar were identified by means of beta-hemolysis, colony morphology, sensitivity to antimicrobial agents, oxydase and catalase reactions . Thirty-eight clinical isolates and one test strain were examined for fatty acid composition . Hexadecanoic (16:0), octadecenoic (18:1) and octadecanoic (18:0) were the major fatty acids . Also present, but in minor quantities, were myristic (14:0), hexadecenoic (16:1) and octadecadienoic (18:2) acids . Only insignificant differences between isolates could be detected . No hydroxy fatty acids commonly found in gram-negative bacteria were encountered . Gas chromatographic analysis of G . vaginalis revealed a characteristic and relatively simple pattern . The results support the use of the isolation method, which provides conditions highly selective for G . vaginalis. Acta Pathol Microbiol Immunol Scand {B}, 1982 Apr, 90(2), 109 - 12 Differentiation of Haemophilus aegyptius and Haemophilus influenzae; Mazloum HA et al.; This study aimed at clarifying the relationship of Haemophilus aegyptius and Haemophilus influenzae isolated from acute conjunctivitis in Egypt . Twenty-nine freshly isolated strains selected from a large clinical material were examined for morphological and growth characteristics, biochemical properties and susceptibility to selected antibiotics . H . aegyptius strains were clearly differentiated from strains of H . influenzae by their inability to grow on tryptic soy agar containing X + V factors, by their susceptibility to trooleandomycin, by a distinct bacillary morphology, and, in part, by not fermenting xylose . The results confirm that H . aegyptius is distinct from H . influenzae and provides reproducible means of differentiating the two species. J Submicrosc Cytol, 1982 Apr, 14(2), 215 - 25 Ultrastructural histopathology of experimental Haemophilus influenzae type B meningitis in the infant rat . II . Phagocytosis and lysis of microorganisms by leptomeningeal leukocytes; Merchant RE et al.; We examined the events associated with phagocytosis, lysis and digestion of Haemophilus influenzae type b (Hib) by subarachnoid leukocytes in infant rats with experimental Hib meningitis . In early stages of infection, large numbers of bacteria were attached to the surfaces of neutrophils and macrophages invaded the subarachnoid space and actively ingested Hib . The bacteria, coccobacillary in shape with an approximate length of 1.0 micrometers and 0.3 micrometer in width, were interiorized after fusion of leukocyte microplicae which had arisen around them . Ingested Hib were sequestered within large, membrane-bound vacuoles containing five or more microbes . Following the fusion of primary lysosomes with the membrane of the phagocytic vacuole, bacteria were lysed and degraded . In later stages of infection, macrophages possessed large numbers of inclusions containing extensively digested Hib and myelin figures . Histochemical analysis of subarachnoid leukocytes revealed that macrophages actively synthesized acid phosphatase and that this enzyme aided in the digestion of phagocytosed bacteria . Peroxidase was also demonstrated within phagocytic vacuoles of neutrophils . Our results suggest that subarachnoid macrophages and neutrophils actively lyse and digest ingested Hib through the direct action of their hydrolytic enzymes. Pediatrics, 1982 Apr, 69(4), 466 - 71 Evaluation of a commercial latex particle agglutination test for rapid diagnosis of Haemophilus influenzae type b infection; Daum RS et al.; The effectiveness of a commercially available latex particle agglutination test (Bactogen) in the diagnosis of invasive Haemophilus influenzae type b infection was evaluated . Bactogen correctly diagnosed all 27 patients with bacteriologically proven H influenzae type b infection (sensitivity 100%) . Two of 39 patients with proven, non-H influenzae type b infections had false-positive tests (specificity 95%) . One of 103 sera and 0 of 55 urine specimens from hospitalized adults contained detectable H influenzae type b antigen . Bactogen is a sensitive, specific, commercially available test for rapid diagnosis of H influenzae type b infection. J Clin Microbiol, 1982 Apr, 15(4), 543 - 6 Serotype and ampicillin susceptibility of Haemophilus influenzae causing systemic infections in children: 3 years of experience; Mason EO Jr et al.; Over a 3-year period, 96% of systemic infections in children caused by Haemophilus influenzae were of serotype b . Of 346 invasive infections, 15 (4%) were caused by non-type b H . influenzae . The monthly prevalence of ampicillin resistance in all isolates was highly variable (0 to 63%) . Ampicillin resistance in H . influenzae causing invasive disease occurred in 13% of non-type b and 21.8% of type b isolates . There was no significant difference (x2 - 0.21; p greater than 0.10) in the rate of ampicillin resistance between type b and non-type b H . influenzae causing systemic illness in children over a 3-year period. J Immunol, 1982 Apr, 128(4), 1772 - 5 The requirement of specific anticapsular IgG for killing of Haemophilus influenzae by the alternative pathway of complement activation; Tarr PI et al.; Employing an in vitro bactericidal assay using C4-deficient guinea pig serum (C4D-GPS), we evaluated the ability of the alternative pathway to kill a number of strains of encapsulated and unencapsulated Haemophilus influenzae (HI) . Complement activation occurred, but no bactericidal activity was observed against any of the tested HI in nonimmune C4D-GPS without detectable antibody to HI-type b (HIb) capsular polysaccharide (HIb-ps) . In the presence of high-titered human anti- (type b) IgG, C4D-GPS killed the encapsulated strains . Restoration of classical pathway activity by the addition of purified C4 to C4D-GPS, which contained antibody to somatic antigens, resulted in killing of some strains of both encapsulated and unencapsulated HI . In nonimmune C4D-GPS the alternative pathway is activated but does not mediate bactericidal activity . The addition of specific high-titered anticapsular IgG results in killing of encapsulated HI by the alternative pathway in guinea pig serum. J Clin Microbiol, 1982 Apr, 15(4), 625 - 9 Isolation and cultivation of Haemophilus ducreyi; Oberhofer TR et al.; A useful method for isolating and recognizing Haemophilus ducreyi from chancres and buboes of male patients is presented . A total of 41 clinical isolates of H . ducreyi were recovered from 33 patients over an 8-year period, and the experience with the 15 most recent isolates is presented in detail . Chocolate agar supplemented with 1% Iso VitaleX and 5% sheep blood agar were prepared, using Trypticase soy and Mueller-Hinton Agar bases, and incubation conditions included ambient, capneic, and anaerobic environments . Mueller-Hinton agar was clearly superior over Trypticase soy agar for isolation of H . ducreyi, although there was little difference between 5% sheep blood and supplemented chocolate agar . Growth in ambient air and under anaerobiasis was poor or lacking, whereas growth in 5 to 7% CO2 was good to luxuriant . Heat-inactivated and fresh (unheated)human blood clot tubes also were used for selective isolation . Although the rates of isolation from the two types of clot tube were not significantly different, unheated clot tubes were superior to heated clot tubes because of reduced level of contaminants . Gram stain characteristics taken from blood clot tubes and solid media, cellular and colonial morphology of the bacilli, and lack of oxidase, catalase, and biochemical activity except nitrate reductase were determinant factors . The results of this study demonstrated that successful isolation of H . ducreyi can be achieved with a minimal amount of resources and expertise. Gene, 1982 Apr, 18(1), 101 - 5 Plasmid cloning vectors resistant to ampicillin and tetracycline which can replicate in both E . coli and Haemophilus cells; Danner DB et al.; We have constructed two plasmid vectors, pHCV5 and pHVTl, which will replicate both in Haemophilus and in Escherichia coli . Both contain the ampicillin-resistance gene and the replication origin from a Haemophilus plasmid, pRSF0885 . Both also contain the pBR322 origin and therefore can be amplified in E . coli by chloramphenicol treatment . The plasmid pHCV5 contains the tetracycline-resistance gene of pBR322, and pHVT1 contains the analogous region from the transposon Tn10. Proc Natl Acad Sci U S A, 1982 Apr, 79(7), 2393 - 7 Construction of DNA recognition sites active in Haemophilus transformation; Danner DB et al.; Competent Haemophilus cells recognize and preferentially take up Haemophilus DNA during genetic transformation . This preferential uptake is correlated with the presence on incoming DNA of an 11-base-pair (bp) sequence, 5'-A-A-G-T-G-C-G-G-T-C-A-3' . To prove that this sequence is the recognition site that identifies Haemophilus DNA to the competent cell, we have now constructed a series of plasmids, each of which contains the 11-bp sequence . Using two different assay systems we have tested the ability of fragments from these plasmids to compete with cloned Haemophilus DNA fragments that naturally contain the 11-bp sequence . We find that the addition of the 11-bp sequence to a DNA fragment is necessary and sufficient for preferential uptake of that fragment . However, plasmid DNAs containing this sequence may vary as much as 48-fold in uptake activity, and this variation correlates with the A+T-richness of the DNA flanking the 11-mer. Antimicrob Agents Chemother, 1982 Apr, 21(4), 622 - 7 Characterization of ampicillin resistance plasmids from Haemophilus ducreyi; Totten PA et al.; Seven strains of Haemophilus ducreyi from diverse geographic origins were analyzed for their plasmid content . All strains were multiply resistant, but only resistance to ampicillin was transferred to Escherichia coli by transformation . The H . ducreyi plasmids encoding for ampicillin resistance were 7.4, 5.7, and 3.6 megadaltons and encoded for part or all of TnA, and ampicillin transposon . The relatedness of these plasmids was examined by restriction endonuclease digestion and DNA-DNA homology with isolated DNA fragments from TnA. Antimicrob Agents Chemother, 1982 Apr, 21(4), 551 - 3 Moxalactam penetration into cerebrospinal fluid in patients with bacterial meningitis; Modai J et al.; Penetration of moxalactam into the cerebrospinal fluid was studied in 11 patients with bacterial meningitis undergoing treatment with other antibiotics . Moxalactam at a dose of 20 mg/kg was administered as three 30- to 45- min infusions at 8-h intervals, once between days 2 and 4 and a second time between days 11 and 20 of treatment with the other antibiotics . Serum and cerebrospinal fluid were sampled 60, 90, or 120 min after the third moxalactam dose for measurement of the concentration of this drug by high-performance liquid chromatography . The concentration of moxalactam in cerebrospinal fluid ranged from 1.5 to 11 micrograms/ml, depending on the sampling time and the time elapsed since the onset of the disease . These concentrations in cerebrospinal fluid were equal to or higher than the minimum inhibitor concentrations for Neisseria meningitidis, Streptococcus pneumoniae, Haemophilus influenzae (including ampicillin-resistant strains), and most of the gram-negative bacilli except for Pseudomonas aeruginosa . These results show that moxalactam has good penetrability when the meninges are inflamed and that it might be considered in cases of bacterial meningitis when the susceptibility of the pathogen indicates its usefulness. Can J Comp Med, 1982 Apr, 46(2), 109 - 14 Evaluation of the complement fixation test for the diagnosis of pleuropneumonia of swine caused by Haemophilus pleuropneumoniae; Lombin LH et al.; Evaluation of diagnostic sensitivity and specificity was based on test results of 346 sera from pigs known to be infected and 139 sera from pigs known not to be infected . All sera were tested with a monospecific antigen (serotype 1) and a polyspecific antigen (serotypes 1-5) . The sensitivity of the polyspecific antigen was approximately 85% at serum dilution 1:2 and was significantly higher than the monospecific antigen at all serum dilution levels . The specificity of the two antigen preparations was not significantly different at any dilution and increased from approximately 78% to 1:2 to 100% at 1:128 . When pigs from herds with unknown incidence of infection were studied, it was found that a high proportion seroconverted, presumably as a response to subclinical infection . However, the antibody titres waned rapidly . This indicated that seroreaction expresses current or recent infection . Thus, the complement fixation test provides a reliable means of diagnosing pleuropneumonia of pigs and might be useful as a tool to control this disease. Infect Immun, 1982 Apr, 36(1), 80 - 8 Monoclonal antibodies directed against a cell surface-exposed outer membrane protein of Haemophilus influenzae type b; Robertson SM et al.; Monoclonal antibodies directed against several different Haemophilus influenzae type b outer membrane proteins with apparent molecular weights of 45,000, 39,000, and 37,000 were identified by a radioimmunoprecipitation method . Five monoclonal antibodies, including both immunoglobulin G and M isotypes, were specific for the same H . influenzae type b major outer membrane protein (39,000 molecular weight) . One of these immunoglobulin G monoclonal antibodies (6A2) was shown to be directed against a cell surface-exposed antigenic determinant of the 39,000-molecular-weight protein, whereas the other monoclonal antibodies directed against this same protein were apparently specific for antigenic determinants not exposed on the H . Influenzae type b cell surface . The cell surface-exposed protein antigenic determinant recognized by monoclonal antibody 6A2 was not unique to the H . influenzae type b strain used as the source of outer membrane vesicles for generating immune spleen cells, but was found in a majority of independently isolated strains of H . influenzae type b . These data indicate that there is antigenic cross-reactivity among H . influenzae type b strains with regard to cell surface-exposed proteins. Nouv Presse Med, 1982 Mar 20, 11(13), 999 - 1002 {Haemophilus influenza infections in infants and mothers . Three cases (author's transl)}; Pinon G et al.; The three cases reported were diagnosed at the time of contamination by direct examination and culture, at birth, of placental tissue, gastric fluid and peripheral specimens . The culture media included a chocolate agar medium favourable to the growth of H . influenzae . One of the isolates was beta-lactamase producer and therefore resistant to the group A penicillins usually prescribed . Determination of the M.I.C.s of eight antibiotics showed that cefotaxime constitutes, for the time being, a suitable alternative to penicillins against such strains . Early detection of H . influenzae perinatal infections make it possible to treat neonates before complications develop . Among the 19 cases published, there were 4 cases of meningitis, 8 cases of septicaemia and 1 case of arthritis. Lancet, 1982 Mar 13, 1(8272), 609 - 11 Acute osteomyelitis in a district general hospital; Glover SC et al.; A survey of the 58 patients with acute osteomyelitis seen in one general hospital between 1969 and 1979 has shown that, although the condition is less common now than in the pre-antibiotic era, it remains a serious disease . Bone pain and tenderness are still the commonest symptoms, but the source of the infection is less apparent now than it used to be, and this may lead to delay in diagnosis . The antecedent trauma experienced by nearly half the patients probably predisposes to infection by causing local bone damage and thus a focus for secondary infection . The pattern of infecting organisms has not changed much over the past 11 years, but Haemophilus influenzae must be considered in children aged under 5 years . Treatment was the use of antibiotics, with surgical drainage if necessary . The commonest antibiotic used was clindamycin, and chronic osteomyelitis did not develop in patients treated with this antibiotic, whereas all 9 patients who had chronic sequelae necessitating sequestrectomy had received cloxacillin either alone or in combination with another antibiotic. Pediatr Infect Dis, 1982 Mar-Apr, 1(2), 91 - 4 Periorbital cellulitis and paranasal sinusitis: a reappraisal; Shapiro ED et al.; The terms periorbital (preseptal) and orbital cellulitis are often used interchangeably, obscuring important differences in their pathogenesis, bacterial etiology, clinical presentation and appropriate therapy . A review of 56 cases of periorbital cellulitis indicated that the patients could be divided into three groups: Group 1, cases secondary to paranasal sinusitis, more correctly termed inflammatory edema because the periorbital swelling is due to venous obstruction (a specific bacterial etiology is rarely documented in these patients because aspiration and culture of the sinuses are usually not performed and the infection is not associated with bacterial invasion of either the soft tissue or the blood stream); Group 2, cases associated with disruption of local skin integrity which are usually due to Staphylococcus aureus or Group A streptococci; and Group 3, cases associated with bacteremia usually occurring in infants and young children without other apparent foci of infection and caused by Haemophilus influenzae type b or Streptococcus pneumoniae . Actual infection of the orbital contents (orbital cellulitis or abscess), marked by proptosis and ophthalmoplegia, is rare and is due either to advanced purulent sinusitis or to penetrating orbital trauma. Antimicrob Agents Chemother, 1982 Mar, 21(3), 468 - 71 Penetration of cefoxitin into cerebrospinal fluid of infants and children with bacterial meningitis; Feldman WE et al.; Three consecutive doses of 75 mg of cefoxitin per kg were given intravenously every 6 h (225 mg/kg), in addition to penicillin or ampicillin, to 24 patients on days 4 and 5 and 9 and 10 of therapy for meningitis . Haemophilus influenzae b was isolated from cerebrospinal fluid (CSF) of 21 patients, Streptococcus pneumoniae from 2 patients, and Neisseria meningitidis from 1 patient . The median minimal inhibitory and bactericidal concentrations of cefoxitin for 16 isolates of H . influenzae b were 0.312 and 0.625 micrograms/ml, respectively . Sixteen of 18 isolates of H . influenzae b and S . pneumoniae were killed by 2.5 micrograms of cefoxitin per ml . Mean levels in CSF peaked at 1 h at 6 and 4.9 micrograms/ml on days 5 and 10, respectively . CSF levels on days 5 and 10 were greater than or equal to twice the median minimal inhibitory and bactericidal concentration in 20 and 18 patients, respectively . However, bacterial levels in CSF were greater than or equal to 2.5 micrograms/ml in only 11 of 23 patients on days 5 and 10 . No significant adverse effects were found . These data indicate that at this dosage, cefoxitin may not reach levels in the CSF required for killing all susceptible strains of H . influenzae b and S . pneumoniae. Am J Vet Res, 1982 Mar, 43(3), 505 - 6 Characterization and chemical nature of Haemophilus avium hemagglutinin; Iritani Y et al.; Haemophilus avium hemagglutinin properties were studied . Hemagglutination titer was decreased by proteolytic enzyme treatments, but was not affected by glycosidase, lipase, phospholipase, and neuraminidase treatments . Cell-free hemagglutinin was found in supernatants of centrifuged sonicate and centrifuged agitate of H avium and was precipitated with ammonium sulfate with no loss of hemagglutinating activity . The H avium hemagglutinin showed different patterns of activity against the RBC of different avian species . Hemagglutination of chicken RBC was not inhibited by D-mannose. Int J Clin Pharmacol Ther Toxicol, 1982 Mar, 20(3), 113 - 7 Oral cefaclor for treatment of bronchitis--a comparative double-blind study versus amoxycillin; Beumer HM et al.; Either 500 mg cefaclor or amoxycillin was administered at random thrice daily to 50 adult outpatients with acute or acute-to-chronic bronchitis . A total of 31 pathogens were isolated from sputum, mostly Streptococcus pneumoniae {17} or Haemophilus influenzae {3}, or both {2} . All pathogens but one were susceptible to cefaclor; all but six were susceptible to amoxycillin . Satisfactory clinical results were obtained in 62.5% of the patients treated with cefaclor and 66% of the patients treated with amoxycillin. Mayo Clin Proc, 1982 Mar, 57(3), 145 - 8 Symposium on infective endocarditis . III . Endocarditis due to gram-negative bacteria . Report of 56 cases; Geraci JE et al.; At the Mayo Clinic, 56 patients with infective endocarditis caused by gram-negative bacteria were seen from 1958 through 1979, 35 of whom were seen from 1970 through 1979 . The patients were categorized into two divisions: those with medical, naturally acquired valve infections (40 {71%}) and those with infective endocarditis after cardiac operation (16 {29%}) . The overall cure rate was 82% (46 of 56 patients); 35 of 40 patients (88%) were cured in the medical group, and 11 of 16 patients (69%) were cured in the surgical group . The patients were further classified on the basis of organism: group 1 (33 patients)--infections caused by Haemophilus (18), Actinobacillus actinomycetemcomitans (4), Cardiobacterium hominis (6), Eikenella corrodens (2), Kingella kingii (2), and Bordetella bronchiseptica (1); 32 of these 33 patients (97%) were cured, and 6 of these infections were on prosthetic valves; group 2 (21 patients)--infections caused by enteric aerobic bacilli; 13 of the 21 patients (62%) were cured; group 3 (1 patient)--infection caused by anaerobes (Bacteroides fragilis); this patient died; and group 4 (1 patient)--infection caused by Neisseria gonorrhoeae; this patient was cured . The gram-negative bacteria in the survivors and nonsurvivors and the curative antibiotic regimens were tabulated . Among the 35 survivors in the medical group, a combined antibiotic regimen cured 21 patients (60%) and a single antibiotic agent cured 14 (40%) . Among the 11 survivors in the surgical group, combined therapy was given to 8 (73%), a single drug was used once, and operation alone achieved a cure in 2 patients . Compared with past data, the current study indicates an increasing incidence of gram-negative bacterial endocarditis (approximately 10%) and an improving cure rate 82%). Zh Mikrobiol Epidemiol Immunobiol, 1982 Mar, (3), 74 - 7 {Systemic and local humoral immunity study using the indirect immunofluorescence reaction in chronic inflammatory lung disease patients . II . Serological research results with Haemophilus influenzae autostrains and their comparison with the level of systemic antipneumococcal immunity}; Veselova TA et al.; The indirect immunofluorescence test with the use of H . influenzae autostrains, carried out in patients with chronic bronchitis at the acute stage of the disease, did not reveal any correlation between the presence of these bacteria in the bronchial contents and systemic immune response in 26-39% of the patients . During the acute stage of chronic bronchitis a tendency towards enhancement of immune response to H . influenzae autostrains was observed . As indicated by the repeated test, this tendency was manifested by the prevalence of high antibody titers, the increase of the mean geometrical titer (p less than 0.05) reaching the dilution 1:1135 +/- 216 and the fold increase of the initial antibody level in 18.5 +/- 5.2% of the patients . 50 patients with chronic bronchitis were found to both pneumococci and H . influenzae in their bronchial contents; as indicated by the results of the indirect immunofluorescence test with the use of autostrains of these bacteria, in 18 patients (36 +/- 6.7%) equal antibody titers (+/- 1 dilution) were detected, while more than a half of serum samples (56 +/- 7%) showed the 4-fold an greater increase of th antipneumococcal antibody level, and only 4 samples proved to have the same prevalence of activity against H . influenzae. J Clin Microbiol, 1982 Mar, 15(3), 528 - 30 Superiority of hypertonic culture medium for detection of Haemophilus influenzae by the BACTEC procedure; Crist AE Jr et al.; A comparison of hypertonic (sucrose), aerobic, and anaerobic media for the detection of eight recent clinical isolates of Haemophilus influenzae type b by the BACTEC procedure revealed that the hypertonic medium, without exception, yielded diagnostic growth index values of 30 or above from 4 to 24 h earlier than did the other media . This culture medium was also superior when an increase in growth index units of 10, before a value of 30 was reached, was taken as a criterion . The number of colony-forming units increased more rapidly in the hypertonic medium as compared with the other media . These results, together with limited observations on blood cultures from patients, suggest that the sucrose medium may permit earlier detection of H . influenzae bacteremia than the aerobic medium, particularly since a growth index of 20 rather than 30 is used for the indication of bacterial growth. South Med J, 1982 Mar, 75(3), 376 - 7 Cavitary pulmonary nodule caused by Haemophilus influenzae in a renal transplant recipient; Esler WV et al.; Primary Haemophilus influenzae lung abscess has not previously been reported in renal transplant recipients . Our patient had a single cavitary pulmonary nodule and a subacute clinical course . This case demonstrates that infections in immunosuppressed patients may behave in uncharacteristic fashion, and exhaustive attempts must be made to secure the diagnosis so that proper therapy can be instituted. Oral Surg Oral Med Oral Pathol, 1982 Mar, 53(3), 250 - 5 A retrospective study of microbiologic samples from oral mucosal lesions; Dahlen G et al.; This report describes findings in microbial samples from 271 patients with lesions of the oral mucous membranes . Analyses were made on the basis of direct microscopy and cultivation on nonselective and selective media incubated under aerobic and anaerobic conditions . Growth of bacteria was semiquantitatively determined according to a five-grade scale . Among the 134 samples for direct microscopy, fungi in yeast as well as hyphae phase, were identified in 39 cases . Among the cultivated samples, Candida albicans was detected in 107 cases, of which 71 were full-denture wearers . Staphylococcus aureus, coliform bacteria and Klebsiella were the most frequently isolated "nonoral&qu