Evaluation of sampling sites for detection of upper respiratory tract carriage of Streptococcus pneumoniae and Haemophilus influenzae among healthy Filipino infants.

Two sampling techniques, nasal swabbing and oropharyngeal swabbing, for detection of the upper respiratory tract carriage of Streptococcus pneumoniae and Haemophilus influenzae were studied prospectively with 296 healthy Filipino infants at various ages: 6 to 8, 10 to 12, 14 to 17, 18 to 22, 32 to 39, and 46 to 65 weeks. In all age groups S. pneumoniae was isolated significantly more often (P < 0.0001) from the nasal site than from the oropharyngeal site. H. influenzae was found equally often at both sites.

Evidence for capsule gene sequences among pharyngeal isolates of nontypeable Haemophilus influenzae.

Haemophilus influenzae is a common commensal organism of the human respiratory tract and is an important cause of localized and systemic disease. While isolates recovered from the respiratory tract are generally nonencapsulated (serologically nontypeable), isolates from systemic sites typically express a polysaccharide capsule. To explore the possibility that nontypeable strains evolved from encapsulated organisms, a series of serologically nontypeable isolates were examined for the presence of capsule gene sequences. Pharyngeal isolates (123) were collected from healthy 3-year-old Finnish children and examined by Southern hybridization with pUO38, a plasmid that contains one complete set of cap genes from an H. influenzae type b strain. Twenty-four isolates (20%) demonstrated homology with capsule-specific sequences. Of these 24, 18 in addition to 14 others had evidence of one or more copies of IS1016, an insertion element that has been associated with encapsulation in H. influenzae. These results support the hypothesis that nontypeable strains of H. influenzae arose from an encapsulated ancestor. Possibly the selective pressure driving the loss of encapsulation relates to the disadvantage associated with encapsulation during respiratory tract colonization.

Use of nasopharyngeal isolates of Streptococcus pneumoniae and Haemophilus influenzae from children in Pakistan for surveillance for antimicrobial resistance.

Antimicrobial resistance of Streptococcus pneumoniae and Haemophilus influenzae presents a challenge to clinical case management, particularly in programs for acute respiratory tract infection (ARI), including pneumonia, in developing countries. To determine whether nasopharyngeal isolates of S. pneumoniae and H. influenzae from a clinically defined group of children could be used to predict the prevalence of antimicrobial resistance of strains that cause disease, 601 urban children with ARI, 133 healthy urban children and 285 rural children were evaluated in Pakistan. Of the urban children with ARI, 216 (35.9%) were bacteremic, predominantly with S. pneumoniae (108 children) and H. influenzae (100 children). Overall 631 (61.9%) children carried S. pneumoniae and 381 (37.4%) carried H. influenzae. The proportions of nasopharyngeal isolates of both organisms from urban children with ARI resistant to penicillin or ampicillin, trimethoprim/sulfamethoxazole, chloramphenicol and erythromycin were similar to the proportions of resistant blood isolates. Nasopharyngeal isolates from rural children had lower rates of resistance to some antimicrobial agents. These findings suggest that nasopharyngeal isolates of S. pneumoniae and H. influenzae from children with ARI can be used to conduct surveillance for antimicrobial resistance in a defined geographic area. Such surveillance would aid programs in developing countries in making a rational choice of antimicrobial agents for use in clinical management of bacterial diseases, including pneumonia.

Vaccination with Haemophilus influenzae type b meningococcal protein conjugate vaccine reduces oropharyngeal carriage of Haemophilus influenzae type b among American Indian children.

The effect of Haemophilus influenzae type b (Hib) meningococcal protein conjugate vaccine (Hib-OMPC; Merck, Sharp & Dohme) on oropharyngeal (OP) carriage of Hib was evaluated in Navajo and Apache Indian children, who are known to be at high risk for invasive Hib disease. We obtained 1423 OP swabs at well child visits from 1321 children 3 months to 4 years of age: 293 of the swabs were obtained from children before the administration of any Hib-OMPC; 1119 were taken after the primary vaccination series; and 11 after the booster dose. Swabs were tested for the presence of Hib capsular polysaccharide antigen by enzyme-linked immunosorbent assay. Forty of 1423 swabs were positive for Hib. Among the 40 positive swabs 5 (13%) were obtained from children who had received Hib-OMPC vaccine appropriate for age at swabbing, compared with 500 of 1383 (36%) of negative swabs. Children who were OP carriers of Hib were older than noncarriers (mean age, 13 and 9 months, respectively) and a greater proportion of carriers (48%) had symptoms of respiratory infection at the time of swabbing than noncarriers (30%). These variables were significantly related to increased risk of OP carriage of Hib when incorporated jointly in a logistic regression model: not vaccinated according to age (odds ratio 2.7, 95% confidence interval 1.00 to 7.05); increase of age in months (odds ratio 1.1, 95% confidence interval 1.02-1.10); and respiratory infection symptoms present (odds ratio 2.0, 95% confidence interval 1.06-3.77). Thus besides preventing invasive Hib disease, appropriate vaccination with Hib-OMPC appears to reduce OP carriage of Hib.

New method to assess dilution of secretions for immunological and microbiological assays.

Accurate quantitation of pathogens and antibody concentrations in secretions has been difficult because of unpredictable dilution of secretion with th diluent at the time of sample collection. We added an inert substance, lithium chloride (LiCl), to the sample diluent and measured its concentration with an atomic absorption spectrometer before and after the specimen was added. LiCl, at a concentration of 2 mmol of Li per liter, has no negative effect on the survival of common respiratory pathogens or on the results of immunoassays. The method is applicable to any sample collecting in which dilution of the specimen is necessary.

Comparative in vitro activity of norfloxacin and seven other antimicrobial agents against clinical isolates from urinary tract infections.

The in vitro activity of norfloxacin, a new quinolone derivative, was tested against 469 clinical isolates derived mainly from urinary samples from outpatients. It inhibited all Escherichia coli, Klebsiella oxytoca and Proteus strains at a concentration of 0.25 micrograms/ml, and all Pseudomonas aeruginosa, Enterobacter, Klebsiella pneumoniae, Staphylococcus and Enterococcus strains at a concentration of 8 micrograms/ml or less. Norfloxacin proved to be more effective than nalidixic acid, trimethoprim, mecillinam and nitrofurantoin against all gram-negative rods tested.