[Monitoring of microflora localized at the pharyngeal tonsil surface in the children residing in the city of Chelyabinsk and presenting with chronic adenoiditis]

The objective of the present retrospective study based on the analysis of 791 medical cards was to investigate microflora localized at the pharyngeal tonsil surface in the children living in the city of Chelyabinsk and presenting with exacerbation of chronic adenoiditis. 66% of the patients with this condition were 4-6 year old children. The most commonly documented were the associations composed of resident species S. alpha-haemoliticus and S. epidermidis together with pathobiontic S. aureus. S. beta-haemoliticus and S. pneumoniae occurred most frequently whereas H. influenza and some representatives of the genus Enterobacteriaceae were less numerous. Fungi of the genus Candida were identified in 25.4% of the samples at a titer above 10^4. In 23.7% of the cases, these fungi were found in the associations with S. aureus which resulted in mutual potentiation of the pathogenicity factor.

Nasopharyngeal Infection of Mice with Streptococcus pyogenes and In Vivo Detection of Superantigen Activity

Streptococcus pyogenes is a globally prominent human-specific pathogen that is responsible for an enormous burden of infectious disease. Despite intensive experimental efforts to understand the molecular correlates that contribute to invasive infections, there has been less focus on S. pyogenes carriage and local infection of the nasopharynx. This chapter describes an acute nasopharyngeal infection model in mice that is utilized in our laboratory to study the role of superantigen toxins in the biology of S. pyogenes. We also describe a method to detect superantigen-specific T cell activation in vivo.

Nasopharyngeal Proteobacteria are associated with viral etiology and acute wheezing in children with severe bronchiolitis

In the nasopharyngeal microbiome of children with severe bronchiolitis, Proteobacteria, specifically Haemophilus influenzae and Moraxella catarrhalis , were associated with the viral etiology of bronchiolitis, and Moraxella species were more common among children with acute wheezing.

[Biological characteristics of translocating bacteria during experimental otitis media]

AIM

To study dynamics of species composition, factors of pathogenicity and persistence, index of microbial load by bacteria translocating to tympanic cavity from nasal cavity.

MATERIALS AND METHODS

Translocation of bacteria was reproduced on the model of experimental staphylococcal purulent otitis media in 22 adult rabbits from "chinchilla" breed. Identification of translocating strains was performed by radioisotope label. Microflora of nasopharynx and middle ear was studied on day 4, 6, 10, 20, 30, and 180 after inoculation.

RESULTS

Translocating strains differed from nontranslocating by higher level of antilysozyme activity (> or =3 mcg/ml) and higher proportion of their microbial load in total index of microbial load of source biotope (> or =5%). During unfavorable course of otitis, increase of pathogenicity of strains-translocants in circumstances of microbial interaction was observed.

CONCLUSION

One of the mechanisms for the development of otitis media is translocation of indigenous bacteria and their associates to the inflammation site in middle ear where microbial interactions determine the outcome of infection. Results of experimental studies allowed to develop the method for prediction of otitis media course.

Colonization and turnover of Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis in otitis-prone children

Recurrent otitis media are frequently intractable during childhood. It is unclear whether recurrent otitis media is caused by etiological bacteria colonization or by new infections. Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis were isolated from the nasopharynx of 7 otitisprone and 2 non-prone children with recurrent otitis media. Plural bacterial species and strains were found in all children while affected by otitis media. The same strain was repeatedly isolated from all otitisprone children even after administration of antibiotics but was not from the non-prone children. Antibiotic susceptibility did not differ significantly among the same repeatedly isolated strains. This pilot study suggests that the etiological bacteria tend to colonize and is hard to eliminate in otitis-prone children.

[Survey of nasopharyngeal carriage of Haemophilus influenzae and Streptococcus pneumoniae in infants at day care centers]

Infants at day care centers tend to contract repetitive upper respiratory infections and prolonged otitis media. The increase in antimicrobial-resistant bacteria, particularly in infants, has given rise to a stubborn therapeutic problem. We studied the nasopharyngeal carriage and drug resistance to Haemophilus influenzae (H. influenzae) and Streptococcus pneumoniae (S. pneumoniae), the most common pathogens of upper respiratory infections, in infants at day care centers. Nasopharyngeal cultures of infants between the ages of 0 and 6 years were conducted at two day care centers in July 2004 ("summer"; n=183), and in February 2005 ("winter"; n=182). Isolated H. influenzae and S. pneumoniae were subjected to antibiotic susceptibility tests by broth microdilution. We also conducted an otolaryngological examination and a survey on past and life histories. H. influenzae in summer (38.3%) increased significantly in winter (57.7%). Beta-lactamase-negative and positive ampicillin-resistant H. influenzae (BLNAR+ BLPAR) in summer decreased significantly in winter. S. pneumoniae did not differ in summer (42.1%) or in winter (43.4%). Penicillin-resistant and intermediate S. pneumoniae (PRSP+PISP) was 41.3% in summer and decreased significantly to 19.0% in winter. BLNAR + BLPAR and PRSP + PISP differed with the day care center. In otolaryngological examination, rhinosinusitis was commonest (28.4% in summer and 30.8% in winter), followed by allergic rhinitis (8.7% in summer and 6.0% in winter) and otitis media (8.2% in summer and 6.0% in winter). Tonsillitis was minor (0.5% in both seasons). Rhinosinusitis in winter was significantly higher in carriers of H. influenzae and/or S. pneumoniae than in non carriers (36.4% versus 16.0%). Breast-fed infants tended to have less otitis media than bottle-fed infants (38.2% versus 52.9%). H. influenzae and/or S. pneumoniae plateaued (75-80%) after 12 months in day care centers. These results suggest that infants attending day care centers are immediately colonized by H. influenzae and S. pneumoniae in the nasopharynx after entering the centers. Nasopharyngeal drug-resistant H. influenzae and S. pneumoniae varied during the seasons and between day care centers. Further prospective studies are needed to determine upper respiratory tract infection in infants at day care centers and to evaluate carriage, epidemiology, and the drug-resistance rates of these pathogens.

Microbial dynamics of purulent nasopharyngitis in children

This review presents the microbiological dynamic and therapeutic options in the management of purulent nasopharyngitis (NPT). The nasopharynx (NP) of healthy children is generally colonized by relatively non-pathogenic aerobic and anaerobic organisms, some of, which possess the ability to interfere with the growth of potential pathogens. Conversely, carriage of potential respiratory aerobic pathogen such as Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis, as well as some anaerobic bacteria (Peptostreptococcus, Fusobacterium and Prevotella spp.) increases during purulent NPT. The development of purulent NPT in children is associated with the pre-existing colonization by potential pathogens and the absence of interfering organisms in the NP. Controversy exists regarding the management of NPT as no conclusive evidence exists to date that the administration of antimicrobials will shorten the illness.

[Primary acute rheumatic fever in juveniles from an organized community]

A closed population of juveniles was studied to follow-up manifestations of primary rheumatic fever. In line with other unfavourable factors, the onset of the disease within the first 6 months of the observation was due to cross streptococcal infection (foci of chronic nasopharyngeal infection were detected in 68.6% examinees, rheumatism debut after acute nasopharyngeal infection was in 91.0% patients). Persistence of streptococci was established in many blood counts in immunofluorescence reaction in 88.2% patients in acute disease, in more patients with lingering rheumatic process. Clinical manifestations include, aside from arthritis and rheumocarditis, frequent thyroid and gastrointestinal lesions. It is thought valid to raise the dose and duration of administration of penicillin in patients with primary rheumatic fever as it eradicates chronic infection foci, prevents recurrences, reduces the number of patients with a lingering course of the disease, with recurrences and valvular defects of the heart.

Nasopharyngeal carriage and susceptibility patterns of Streptococcus pneumoniae in Kumasi, Ghana

Penicillin resistant Streptococcus pneunmoniae poses an increasing problem in paediatrics, particularly in less developed countries. Outside of South Africa, little is known about S. pneumoniae susceptibilities in Sub-Saharan Africa. The objective of this study was to determine the prevalence of pneumococcal colonization and antimicrobial susceptibility among children in urban Ghana.

METHODS

Nasopharyngeal pneumococcal colonization was examined in 311 children attending a polyclinic for sick children and an immunization clinic in Kumasi, Ghana. Isolates were tested for antibiotic susceptibility to penicillin, tetracycline, erythromycin, chloramphenicol, cefuroxime, cefotaxime, ceftriaxone, and trimethoprim-sulfamethoxazole.

RESULTS

Over half (51.4%) of subjects were colonized with S. pneumoniae and 17% of isolates were resistant to penicillin, all demonstrating intermediate resistance. S. pneumoniae strains were also frequently resistant to trimethoprim-sulfamethoxazole and tetracycline, less so to chloramphenicol and cefuroxime and were almost uniformly sensitive to cefotaxime, cefriaxone and erythromycin.

CONCLUSIONS

Our study shows a high rate of pneumococcal nasopharyngeal colonization and a concerning level of penicillin resistance although at a less alarming rate than seen in some other countries. Multiple antimicrobial resistance was also noted especially among drugs readily available and commonly used. These data impact treatment choices in pneumococcal disease. Vaccine may play an important role in disease limitation. An effort to curtail the misuse of antibiotics, by prescription and otherwise, may prevent further increases in resistance rates.

The nasopharynx and the middle ear. Inflammatory reactions in middle ear disease

The host-parasite interactions in the nasopharynx with bacterial colonization and antigen uptake in the lymphoid tissue, the adenoid, has an impact on the maturation of local and systemic immunity. The adenoid is a part of mucosa associated lymphoid tissue and is responsible for both effector and inductor functions in the nasopharynx. Increasing evidence supports the role of serum antibody in protecting the middle ear cavity from disease. There is evidence for a minor immunologic defect in a number of children with recurrent episodes of AOM.

Genetic diversity among strains of Moraxella catarrhalis cultured from the nasopharynx of young and healthy Brazilian, Angolan and Dutch children

The present study describes the carriage patterns and genetic variability of Moraxella catarrhalis strains isolated from children living in different countries. Moraxella catarrhalis is genetically heterogeneous, but little is known about its geographic distribution and phenotypic and genetic diversity in warm-climate countries. A collection of 99 isolates from 30 Brazilian, 19 Angolan and 50 Dutch healthy children, all less than 5 years of age, was investigated for phenotypic and genotypic relatedness. The isolates from the three countries were similar where biochemical reactivity was concerned: 89 strains were beta-lactamase-producing and 87 were complement-resistant as determined by phenotype. There was no geographical difference in the prevalence of beta-lactamase-producing isolates, but the carriage rate of complement-resistant strains was significantly higher in Dutch than in Angolan children (P=0.004). Complement resistance of 66 randomly selected strains was genetically confirmed in a Southern hybridization assay by a novel DNA probe that is specific for complement-resistant strains and that demonstrated a sensitivity of 97% and a specificity of 100%. PCR amplification based on the probe sequence had a sensitivity of 98% and a specificity of 57% when compared to the outcome of a conventional culture spot test. PCR restriction fragment length polymorphism analysis of the MU 46 locus and pulsed-field gel electrophoresis of SpeI DNA macrorestriction fragments revealed genetic heterogeneity of strains from within and between the three countries, and no geographical clustering could be established. In conclusion, similar phenotypic characteristics but genotypic heterogeneity was found among Moraxella catarrhalis strains colonizing children in three different continents.

Upper respiratory tract infections in adolescents

While upper respiratory tract infections (URTIs) cause much infectious morbidity in infants and young children, adolescents are not immune to infections. Adolescents experience two to four episodes of viral nasopharyngitis annually. In addition to group A streptococcus (GAS), pharyngitis may occur with other streptococci, Arcanobacterium haemolyticum, Epstein-Barr virus, Neisseria gonorrhoeae, and other pathogens. Uvulits, typically in association with GAS, occurs occasionally. Peritonsillar abscess is the most common deep neck space infection seen in adolescents, but retropharyngeal and parapharyngeal abscesses also occur, causing major morbidity. Adolescents experience fewer cases of otitis media than younger children. Rhinosinusitis occurs commonly in adolescents, occasionally leading to chronic sinusitis and serious sequelae such as osteomyelitis. This article reviews the major URTIs likely to be encountered by physicians caring for adolescents. For each entity there is a brief description of the epidemiology, morbidity, microbiology, clinical and laboratory features, treatment, and prevention.

Dynamics of nasopharyngitis in children

PURPOSE

Our goal was to characterize the dynamics and bacterial interaction of the aerobic and anaerobic flora of nasal discharge of children at different stages of uncomplicated nasopharyngitis.

METHODS AND PATIENTS

Serial semiquantitative nasopharyngeal (NP) and quantitative nasal discharge (ND) cultures were taken every 3 to 5 days from 20 children in whom purulent discharge eventually developed (group 1), and a single culture was obtained from a group of 20 who had only clear discharge (group 2).

RESULTS

Aerobic and anaerobic bacteria were isolated from all NP cultures. Bacterial growth was present in 8 (40%) NDs of group 2. Only 7 (35%) of the clear NDs of group 1 showed bacterial growth; the number increased to 14 (70%) at the mucoid stage and 20 (100%) at the purulent stage. It declined to 6 (30%) at the final clear stage. The number of species and total number of organisms increased in the NDs of group 1. Group 1 patients had higher recovery rates of Streptococcus pneumoniae and Haemophilus influenzae in their NP cultures than group 2 patients (P < 0.05). During the purulent stage, Peptostreptococcus species were isolated in 15 (75%), Fusobacterium species in 10 (50%), Prevotella species in 9 (45%), H influenzae in 8 (40%), S pneumoniae in 6 (30%), and beta-hemolytic streptococci in 5 (25%) of group 1 NDs. This was higher than their recovery in the clear stages of both groups and the mucoid stage of group 1. A total of 8 organisms capable of interfering with the growth of potential pathogens were isolated from the NPs of group 1, as compared with 35 from group 2 (P < 0.001).

CONCLUSIONS

The development of purulent nasopharyngitis is associated with the pre-existing presence of potential pathogens and the absence of interfering organisms.

ENT manifestations of Pseudomonas aeruginosa infection in HIV and AIDS

In acquired immunodeficiency syndrome (AIDS), opportunistic infections occur which are usually related to defects in cell-mediated immunity. However, there has also been an increase in the incidence of bacterial infections in this population, including infections caused by Pseudomonas species. This study reveals the wide range of ear, nose and throat manifestations which can be caused by Pseudomonas aeruginosa in patients with HIV and AIDS and illustrates the need for a high index of clinical suspicion combined with accurate microbiological data for treating these potentially life-threatening infections. In addition, treatment using combination chemotherapy, such as ciprofloxacin and ceftazidime, is advised, as it has been shown that dual therapy results in a significantly lower mortality.

[The colonization resistance of the tonsils in healthy and frequently ill children]

State of colonization resistance was studied in healthy children and those presenting with recurring infectious and inflammatory diseases of the upper respiratory tract. Identification of representatives of tonsil anaerobic and aerobic floras was carried out. Lactic acid bacteria (LAB), alpha-Streptococcus, were present in tonsil flora of healthy children. Pathogenic microorganisms and opportunistic pathogens were recoverable from always ailing children with tonsillitis, with alpha-streptococcus being recoverable very seldom and no decrease in LAB levels being seen. In patients--candidates for tonsillectomy, pathogenic microorganisms were identifiable, with LAB levels decrease by a factor of 10(3-4). The above findings suggest development of dysbacteriosis, decrement of tonsil colonization resistance in always ailing children, which fact is to be considered in designing and implementing therapeutic measures.

[Bacteriological study of purulent nasopharyngitis in children in Senegal]

BACKGROUND

S pneumoniae, H influenzae and M catarrhalis are the main bacteria isolated from rhinopharynx in Europe. The purpose of this work was to study the frequency of potential pathogenic bacteria isolated from acute purulent rhinopharyngitis among children in Senegal.

POPULATION AND METHODS

Ninety-three children from one month to 7-years old suffering from purulent rhinopharyngitis were recruited from April 1 to July 1996. The withdrawal samples were taken from the cavum with a swab which was immediately immersed in an agar shipping medium. Bacteria's grouping and serotyping were made by immunoagglutination. A standard antibiogram was made for all isolates and furthermore the minimal inhibitory concentration (MIC) were determined for S pneumoniae.

RESULTS

Two hundred bacterial strains were isolated: S pneumoniae 28% (60% of the children), C group streptococci: 19% (41% of the children), H influenzae: 15.5% (33% of the children), S pyogenes: 9.5% (20% of the children), S aureus: 8% (17% of the children) and M catarrhalis: 6% (13% of the children). The other isolates were: B and D groups streptococci, P aeruginosa and Klebsiella spp. S pnuemoniae strains belonged to serogroups 6, 19 and 23. Only three strains of H influenzae were capsulated (serotype b). Infants aged from 6 to 18 months were the most affected. No resistance to penicillin was observed for S pneumoniae and S pyogenes. Ampicillin (81%) and chloramphenicol (96%) both inhibited the majority of H influenzae strains.

CONCLUSIONS

This descriptive bacterial epidemiology study of children's rhinopharynx's flora in Senegal allowed us to identify three major pathogenic germs: S pneumoniae, H influenzae and S pyogenes contributing to a better knowledge of these microorganisms' serotypes, biotypes and antibiotypes.

Studies on haemagglutination and serum resistance status of strains of Moraxella catarrhalis isolated from the elderly

A total of 40 strains of Moraxella catarrhalis, isolated from the sputum of elderly persons with respiratory tract infections and from nasopharyngeal swabs from healthy elderly, were examined for haemagglutination of human red blood cells and resistance to bactericidal activity in normal human serum (NHS). 15 of 20 strains isolated from the infected elderly and 3 of 20 strains isolated from the healthy elderly showed haemagglutinating properties (p < 0.001). Similarly, 13 of 20 strains from the infected group and 2 of 20 strains from the healthy group were found to be resistant to the bactericidal activity of NHS (p < 0.001). Strains of M. catarrhalis which were associated with respiratory tract infections in the elderly, in contrast to strains colonizing the healthy elderly, were found to be predominantly haemagglutinating for human red blood cells and resistant to complement killing in NHS.

Reduction of nasopharyngeal carriage of pneumococci during the second year of life by a heptavalent conjugate pneumococcal vaccine

Children 12-18 months old were randomized to receive one dose of a conjugate heptavalent pneumococcal vaccine, two doses of the same vaccine, or one dose of a 23-valent native polysaccharide vaccine. Before immunization, pneumococci included in the conjugate vaccine were isolated from 24% of the children, and an antibiotic-resistant pneumococcus was isolated from 22% of the children. The vaccines had no effect on carriage of non-vaccine-type pneumococci. In contrast, there was a significant reduction in carriage of vaccine-type pneumococci 3 months after one dose and 1 month after a second dose of conjugate vaccine (from 25% to 9% and 7%, respectively; P < .001). No effect was seen after vaccination with the nonconjugate vaccine. One year after immunization, carriage of antibiotic-resistant vaccine-type pneumococci in children receiving conjugate vaccine was lower than that in children receiving the nonconjugate vaccine (4% vs. 14%, P = .042). Conjugate pneumococcal vaccines may reduce spread of pneumococci in the community.

[The range of individual sensitivity to adhesion by Neisseria meningitidis serogroup B in young men]

5,340 young adult males, including 5,149 healthy persons, 141 N. meningitidis carriers, 25 patients with generalized meningococcal infection and 6 patients with nasopharyngitis of meningococcal etiology, were examined. The study revealed that red blood cells of 17.4% of healthy persons were highly sensitive to N.meningitidis adhesion (adhesion indices equal to 0.25 and less), red blood cells of 20.4% of persons had low sensitivity to N.meningitidis adhesion (adhesion indices equal to 2 and greater). All other persons with high sensitivity of their red blood cells proved to be patients with meningococcal infection or carriers of N.meningitidis of the same group.

Epstein-Barr virus genotypes in NPC biopsies from north Africa

The genotypes of Epstein-Barr virus (EBV) were investigated in North African nasopharyngeal carcinoma (NPC) biopsies, nasopharyngeal chronic inflammation (NCI) biopsies, and saliva of healthy individuals from Algeria and Tunisia where there is an intermediate incidence of NPC. The prevalence of A-type virus in NPC, NCI biopsies and saliva of healthy individuals was found in these regions by means of a PCR assay. Restriction enzyme polymorphism analysis by Southern blotting revealed that all North African EBV variants have a conserved restriction site on BamHI W'-I' and XhoI LMP gene. No additional BamHI enzyme site on the BamHI-F fragment was observed; however, the presence of an extra BamHI site on the BamHI-H fragment giving 2 HI and H2 fragment-like EBV M-ABA strains was found. All EBV strains present in NPC or NCI biopsies at all ages were homogeneous in these polymorphisms and no correlation was observed between the EBV genotypes from NPC patients and clinical stages of the cancer. These characteristics revealed a significant difference between the EBV variants common in Chinese NPC and those in North African NPC.

Adult bacterial nasopharyngitis: a clinical entity?

OBJECTIVE

To investigate bacterial nasopharyngitis as a cause of adult upper respiratory infection.

DESIGN

Prospective case series.

SETTING

Walk-in medical clinic of a university hospital.

PATIENTS

507 patients with cold or flu symptoms, sore throat, or recent cough; 21 control subjects without symptoms of upper respiratory infection.

MEASUREMENTS AND MAIN RESULTS

After thorough history and physical examination, the patients underwent nasopharyngeal aspiration and throat culture. Nasopharyngeal specimens were cultured for both bacteria and viruses; antigens for influenza, parainfluenza, and respiratory syncytial virus were sought by enzyme-linked immunosorbent assay (ELISA); serum antibodies to viral respiratory pathogens were determined. Group A beta-hemolytic streptococci grew from the throat specimens of 39 of the 507 patients (8%) or 38 of 334 patients (11%) who had clinical diagnoses of pharyngitis. Thirty-three cases of influenza A, 20 cases of influenza B, and seven cases of parainfluenza infections were diagnosed. Bacteria were cultured from the nasopharyngeal secretions of 284 patients (56%). In contrast to pharyngeal culture, commensal mixed flora were rarely found in nasopharyngeal culture. Nasopharyngeal culture of bacteria usually considered to be respiratory pathogens was significantly associated with the presence of leukocytes. Streptococcus pneumoniae (odds ratio 6.0, 95% confidence interval 2.6-14.2), Moraxella catarrhalis (odds ratio 12.9, 95% confidence interval 3.1-79.5), and Hemophilus influenzae (odds ratio 3.0, 95% confidence interval 1.2-7.4) were all associated with the presence of leukocytes. In contrast, nasopharyngeal culture of coagulase-negative staphylococci, mixed flora, and the documentation of a viral infection were not associated with the presence of leukocytes. For none of 21 control subjects were "pathogenic" bacteria found.

CONCLUSIONS

These data suggest that potentially pathogenic bacteria may have a causal role in adult nasopharyngitis, although further data are needed to confirm this hypothesis.

Epstein-Barr virus DNA in nasopharyngeal biopsies

The Epstein-Barr virus (EBV) has been closely associated with the undifferentiated form of nasopharyngeal carcinoma (NPC), which is particularly common in the high risk area in southeast China. We have examined 37 nasopharyngeal biopsies from patients within this high risk area, including 31 cases of undifferentiated NPC and 6 cases of patients with nasopharyngitis, for the presence of EBV DNA. We found that 26 of 31 biopsies from NPC patients were EBV DNA positive; 3 of the 6 biopsies from patients diagnosed with nasopharyngitis were also EBV DNA positive. Southern blot analysis of the DNAs obtained from the EBV genome positive biopsies, digested with EcoRI, showed that all preparations from the NPC tumors had only one band corresponding to the EcoRI A fragment when a BamHI W fragment was used as a probe. However, one tumor had an additional band with a molecular weight larger than EcoRI A. The presence of this novel band could indicate the integration of viral DNA into host cellular DNA. DNA from the same biopsies were restricted with BamHI and PstI restriction enzymes. The data obtained from these experiments suggest that the EBV genomes in both the NPC tumor biopsies and biopsies from nasopharyngitis patients obtained from an endemic area in South China may be similar to each other and to the B95-8 EBV isolate with respect to the BamHI Y region of the EBV genome. The data also demonstrate that infection of normal nasopharyngeal epithelial cells with EBV takes place in patients with nasopharyngitis.

Aerobic and anaerobic bacteriology of purulent nasopharyngitis in children

Cultures of aerobic and anaerobic bacteria were obtained from the inferior nasal meatus of 25 children with purulent nasopharyngitis and from 25 controls. Microorganisms were isolated from all specimens. A total of 98 isolates (3.9 per patient), 45 aerobes (1.8 per patient) and 53 anaerobes (2.1 per patient), were isolated in patients with purulent nasopharyngitis. Seventy-three isolates (2.9 per patient), 47 aerobes (1.9 per patient) and 26 anaerobes (1.0 per patient) were found in the controls. The organisms recovered in statistically significantly higher numbers in patients with nasopharyngitis were Streptococcus pneumoniae, Haemophilus sp., Peptostreptococcus spp., Fusobacterium spp., and Bacteroides spp. The organisms recovered in significantly higher numbers in controls were Staphylococcus aureus and Propionibacterium acnes. beta-Lactamase activity was detected in 19 isolates recovered from 15 individuals (9 patients and 6 controls). These findings demonstrate the aerobic-anaerobic polymicrobial flora associated with purulent nasopharyngitis. Further studies are indicated to evaluate the pathogenic role of these organisms in this condition.

Hemophilus species in the pharynx. Comparison of sampling sites

In a study of 170 young children, we compared the number and serotype of ampicillin-sensitive and ampicillin-resistant Hemophilus species recovered from throat cultures with those recovered from nasopharyngeal cultures obtained simultaneously. Hemophilus species were recovered from 107 (63%) of the 170 throat cultures and from 79 (46%) of the 170 nasopharyngeal cultures (chi 2 = 12.6). In only five of the pairs of cultures did the nasopharyngeal culture contain Hemophilus species without simultaneous recovery of this organism from the throat culture. Ampicillin-resistant Hemophilus species were recovered from 29 throat swabs and from ten nasopharyngeal swabs.

Bacteriology and treatment of purulent nasopharyngitis: a double blind, placebo-controlled evaluation

One hundred forty-two children with purulent nasopharyngitis were randomized to four treatment groups with an antibiotic (cephalexin) alone or combined with a decongestant/antihistamine (pseudoephedrine/triprolidine) or their corresponding placebo equivalents. Follow-up evaluations by parents and physicians and bacteriologic evaluations were performed after 5 to 6 days of therapy. Groups were comparable with regard to age, sex, race, number of patients withdrawn from the study, fever greater than 38.0 degrees C, appearance of nasal discharge, nasal crusting and number of days until follow-up. Initial cultures from patients grew: Streptococcus pneumoniae, 46%; Haemophilus influenzae type b, 21%; and Streptococcus pyogenes, 8%. Nasal crusting was significantly associated with the growth of S. pneumoniae or H. influenzae type b. There were no significant differences between active drug and placebo treatment groups for change in nasal discharge, complications or apparent drug benefit. Cephalexin therapy did not result in a decrease in cultivation of pathogenic organisms from the nasopharynx. Significantly more side effects were attributed to pseudoephedrine/triprolidine treatment than to placebo. Routine culture or treatment of purulent nasopharyngitis should not be considered unless future controlled clinical trials demonstrate some therapeutic benefit.

Haemophilus influenzae b bacteremia and meningitis in infant rabbits after intranasal inoculation

A suitable model of Haemophilus influenzae meningitis will facilitate better understanding of the pathophysiology, therapy, and prevention of the disease and its sequelae. Bacteremia and meningitis were induced in infant New Zealand white rabbits by intranasal inoculation of H. influenzae type b. Intranasal trypsin prior to challenge significantly increased (p = 0.002) the rate of bacteremia from 64% (7/11) to 100% (45/45). In the trypsin-treated group, H. influenzae b was isolated from the CSF of 89% (25/28) of 17- to 21-day-old rabbits and from 76% (13/17) of 23- to 30-day-old animals, p = 0.3; fatality rates were 88% and 31%, respectively, p = 0.001. Bacteremia developed within 24 hr of inoculation and meningitis within 96 hr. Death occurred 1 to 7 days after the development of meningitis. Histologic evidence of nasopharyngitis and meningitis was found at autopsy. The intranasal route of infection, the age-dependent outcome, the size of the animal, and its low cost and availability make the infant rabbit an appropriate model of H. influenzae b meningitis.

[Haemophilus colonization in children: serotypes, biotypes and antibiotic sensitivity]

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

Isolation of Tettnang coronavirus from man?

A virus, identified as Tettnang virus, was isolated from the cerebrospinal fluid (CSF) of an 18 months old child with pharyngitis accompanied by an encephalitic reaction. The isolation of virus was followed by seroconversion. The aetiological role of the virus in the given disease is discussed.