Exchange transfusion of whole blood in the treatment of cerebral malaria.

A case of cerebral malaria in a young British traveller, successfully treated by exchange transfusion of whole blood, is reported and the literature regarding the use of this technique in P. falciparum malaria is briefly reviewed.

Identification of Branhamella catarrhalis in 2.5 min with an indoxyl butyrate strip test.

Branhamella catarrhalis, an occasional cause of human respiratory infections, unlike most other members of the family Neisseriaceae, produces a butyrate esterase. This is capable of breaking the ester linkage between butyryl groups and carrier molecules. B. caviae and B. ovis, which are rarely encountered in pathological specimens, also produce butyrate esterase. This property can be used as a rapid test in the identification of B. catarrhalis. The recently reported rapid test for butyrate esterase relies on the release of methylumbelliferate, which can be detected only by using UV light after 5 min of incubation. In the rapid test described here, indoxyl is liberated from indoxyl butyrate by butyrate esterase and spontaneously forms indigo in the presence of oxygen. B. catarrhalis can be distinguished from other oxidase-positive, gram-negative cocci after 2.5 min by inoculating the organism onto a filter paper strip containing this compound.

Pneumonia due to Branhamella catarrhalis.

In 12 of 451 patients diagnosed as having pneumonia in a single hospital over 18 months the causative organism appeared to be Branhamella catarrhalis.

Imipenem-cilastatin in the treatment of respiratory infections in patients with chronic airways obstruction.

Chest infections with organisms resistant to conventional antibiotics are common in patients with chronic lung disease. We have studied the use of imipenem in 40 (28 M 12 F) patients admitted for treatment of chest infections. Patients were treated with imipenem 0.5 g four times daily by intravenous infusion for 6.3 +/- 1.6 (S.D.) days. Forty-six respiratory pathogens were cultured from 36 patients including 18 Haemophilus influenzae, 6 H. parainfluenzae, 6 Streptococcus pneumoniae, 8 Pseudomonas aeruginosa, and 6 Branhamella catarrhalis. Forty-three of the 46 isolates were sensitive to imipenem, 28 to ampicillin, 33 to tetracycline and 35 to cotrimoxazole. Thirty-eight of the 40 patients improved clinically, and 34 of the 36 patients with positive sputum culture had no pathogens in their sputum after treatment. Twenty patients developed minor phlebitis at the infusion site but there were few other side effects. Imipenem may prove useful in the treatment of chest infections, particularly when the organism is resistant to conventional antibiotics.

Characterisation of Branhamella catarrhalis and differentiation from Neisseria species in a diagnostic laboratory.

To distinguish Branhamella catarrhalis from Neisseria species a study of 140 strains was made on simple laboratory media, with particular reference to deoxyribonuclease (DNase) production, superoxol reaction, and growth characteristics. All 97 clinical isolates of B catarrhalis (58 of which were beta-lactamase positive) and eight strains of B catarrhalis from the National Collection of Type Cultures were DNase positive and superoxol positive. None grew on modified New York City medium, modified Thayer Martin medium, MacConkey agar, crystal violet blood agar, nor under anaerobic conditions. Of the 16 different non-pathogenic Neisseria species tested, all were DNase negative, eight (50%) were superoxol reaction negative, and 13 (81%) grew on crystal violet blood agar. Using simple laboratory media, DNase, and superoxol tests, it was possible to identify B catarrhalis and to distingish it from pathogenic and non-pathogenic Neisseria species.

Lack of immunoglobulin A1 protease production by Branhamella catarrhalis.

Clinical isolates of Branhamella catarrhalis from the sputum of 20 patients with acute bronchopulmonary infection were examined for synthesis of immunoglobulin A1 protease by immunoelectrophoresis. Ten strains produced beta-lactamase, and 10 were beta-lactamase negative. None of the strains demonstrated immunoglobulin A1 protease activity despite the fact that three different culture media were used.

Increase in bronchopulmonary infection due to branhamella catarrhalis.

In a six month prospective study during the winter Branhamella catarrhalis was isolated from the sputum of 63 patients with symptoms of bronchopulmonary infection: 49 isolates were in pure culture and 14 were with another pathogen, Haemophilus influenzae being the commonest (found with 10 of the 14 B catarrhalis isolates). Of 36 patients infected in the community, 26 required admission to hospital. The remaining 27 patients were infected while in hospital. Forty four of the 63 isolates produced beta lactamase; 26 of these had been acquired in the community. As a result 29 patients were treated inappropriately with ampicillin and did not respond to this treatment. beta Lactamase produced by B catarrhalis may also protect other pathogens normally susceptible to beta lactam antibiotics. Most patients had chronic lung diseases or lung cancer, but three otherwise healthy patients who did not smoke developed bronchitis. B catarrhalis contributed to the death of five patients. A survey of the antibiotic prescribing habits of the referring general practitioners together with the sensitivity results of B catarrhalis suggest that changes in antibiotic prescribing habits in the community may be responsible for the increase in B catarrhalis infection.

The incidence and antibiotic susceptibility of Branhamella catarrhalis in respiratory infections.

The incidence of Branhamella catarrhalis in respiratory infections at City Hospital, Edinburgh from January 1981 to April 1984 is described. Beginning in January 1982 there was an increased incidence associated with a high proportion of beta-lactamase-producing strains. The number of these strains increased: from January 1981 to April 1983, 61% of strains produced beta-lactamase, and 83% produced beta-lactamase from January to April 1984. 53% of patients were infected in hospital. Environmental studies showed that 7% of staff and 8% of patients were carriers; there was also circumstantial evidence of ward and patient-to-patient infection. The antimicrobial susceptibility of 54 clinical strains was tested: all strains were resistant to trimethoprim but were susceptible to clavulanic acid plus amoxycillin, chloramphenicol, erythromycin, co-trimoxazole, cefotaxime and cefuroxime. beta-Lactamase-negative strains were uniformly susceptible to penicillin and ampicillin.

Bronchopulmonary infection due to B. catarrhalis. Clinical features and therapeutic response.

A study was made of the clinical features and therapeutic response of 144 patients from whose sputum Branhamella catarrhalis was isolated. Typically, features of bronchopulmonary infection with cough productive of moderate amounts of purulent sputum, fever and dyspnoea were present. Of 74 patients who were infected in the community, 50 required hospital admission. Nosocomial infection occurred in the remaining 70 patients. Most patients had chronic pulmonary diseases or carcinoma bronchus; pneumonia occurred in 12 patients. Acute tracheobronchitis developed in 4 healthy non-smokers after viral illnesses. B. catarrhalis contributed to the death of 8 patients. Overall, 59% of isolates produced beta-lactamase but the proportion had risen to 70% by the end of the study; half of these were community acquired. 41% of patients who were treated initially with ampicillin did not respond. Clavulanic acid plus amoxycillin, co-trimoxazole, erythromycin, tetracycline, cefuroxime and cefotaxime are useful alternative antibiotics. All strains of B. catarrhalis were resistant to trimethoprim.

Antimicrobial susceptibility of Branhamella catarrhalis isolates from bronchopulmonary infections.

Fifty-four clinical isolates of Branhamella catarrhalis from patients with bronchopulmonary infections were studied. The MICs for 50 and 90% of the isolates and the geometric mean MICs were determined for 11 antimicrobial agents. All the strains were resistant to trimethoprim but were susceptible to clavulanate-potentiated amoxicillin (Augmentin; Beecham Research Laboratories, London), chloramphenicol, co-trimoxazole, erythromycin, cefotaxime, and cefuroxime. Beta-lactamase-negative strains were uniformly susceptible to penicillin and ampicillin.