1081 BACTERIOPHAGE ARE PRESENT IN THE SPUTUM OF PATIENTS WITH BRONCHOPULMONARY Ps. AERUGINOSA INFECTIONS

Although it is generally appreciated that Ps. aeruginosa specific-phage can be isolated from natural sources in which Ps. aeruginosa can be found, such as seawater and sewage, the presence of phage at the sites of Pseudomonas infection in man is not widely recognized. Using routine bacteriological procedures we show that species-specific phage can be consistently recovered from the sputum of patients with chronic Ps. aeruginosa bronchopulmonary infections, including 6 patients with cystic fibrosis and one non CF individual. Ps. aeruginosa specific-phage were present in sputum at concentrations ranging between 103 to 107 viable particles/ml with as many as 4 different phage strains recovered from a single individual. Of the 16 phage isolates, at least 12 different phage strains could be identified based on bacterial host sensitivity and electron microscopic morphology. It would appear that Ps. aeruginosa and its phage commonly coexist at the site of human bronchopulmonary infections, and most probably at all sites of Ps. aeruginosa infection, and should be considered as possible factors influencing the pathogenicity of Ps. aeruginosa.


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Although it is generally appretiated that Ps. aeruginosa specific-phage can be isolated from natural sources in which Ps. aeruginosa can be found, such as seawater and sewage, the presence of phage at the sites of Pseudomonas infection in man is not widely recognized. Using routine bacteriological procedures we show that species-specific phage can be consistently recovered from the sputum of patients with chronic Ps. aeruginosa bronchopulmonary infections, including 6 patients with cystic fibrosis and one non CF individual. Ps. aeruginosa specific-ph3ge werrf present in sputum at concentrations ranging between 10 to 10 viable particledm1 with as many as 4 different phage strains recovered from a single individual. Of the 16 phage isolates, at least 12 different phage strains could be identified based on bacterial host sensitivity and electron microscopic morphology. It would appear that Ps. aeruginosa and its phage commonly coexist at the site of human bronchopulmonary infections, and most probably at all sites of Ps. aeruginosa infection, and should be considered as possible factors influencing the pathogenicity of Ps. aeruginosa. To determine effects of PMEE occurring during the first 3 yrs. of life, we sdministered tests of S&L to 218 3 y.o., white, English-speaking children with normal developmental histories. All had been followed prospectively since birth; we stratified according to duration of PMEE, sex, type of health-care, and socio-economic status (SES).

EFFECTS OF PERSISTENT MIDDLE EAR EFFUSION (PMEE) ON DEVELOPMENT OF SPEECH AND LANGUAGE (S&L
Below are selected results for children with PMEE (130+ days) and those without PMEE (430 days) in a suburban, private practice (I) and an urban clinic (11 Moxalactam (MOX),a new oxa-B-lactam antibiotic,is active against an expanded spectrum of gram negative organisms including Haemophilus influenzae. It has also been reported to diffuse into cerebrospinal fluid. We administered IV MOX to children (6 wks-44 yrs) receiving conventional antimicrobial therapy for bacterial meningitis. Plasma and CSF specimens were collected 2 to 3 hours after a dose and assayed for MOX concentration by HPLC (capable of detecting 1 ~g/ml of MOX). Eight patients received single doses of 15 or 25 mg/kg. In 11 determinations the plasma levels ranged between 4.7 and 29.4 Ug/ml but MOX was detected in the CSF in only one instance. Eight patients received 50 mg/kg of MOX every 8 hours for 3 doses, and in 5 patients the drug diffused into CSF. MOX was detectable in 3/5 of CSF specimens early in the course of illness (2nd or 3rd day) and averaged 20% (range 2.5 to 30%) of plasma concentration. It was detectable in 5/11 of CSF specimens obtained later in the illness (13th to 22nd day) and averaged 15.7% (6 to 36%) of plasma concentration. There was no correlation between the diffusion of MOX into CSF and the CSF white cell count, however MOX diffused to a greater extent in patients with higher CSF protein content. In summary, MOX diffuses into CSF but such diffusion is unpredictable. Caution must be exercised in using MOX alone in the treatment of meningitis. Echovirus 11(E-11) was isolated from the cerebrospinal fluid (CSF) of 22 children in a 1980 summer outbreak of meningitis. Seventeen(77%) were <6 mos old(range 2 wk-9 yr). 54% had CSF cell counts >300/mm3 and 14% had >500/mm3(range 0-2250). 59% had 250% polymorphonuclears(P) and 24% had >90% P. None had CSF glucose <40mg/dl; 41% had CSF protein >45mg/dl and 6% had >75mg/dl. Three patients(pts) had entirely norzal CSF. In 86% peripheral WBC was 5000-15000/mm3; only 3 had >75% P but 20% had absolute band count >500/mm? Four pts(<3 mos old) had repeat CSF exams. All had 21 50 cells/mm3 and the two youngest(age 2 wk) still had >50% P after 1 and 3 days. CSF findings were compared with data from pts with bacterial meningitis(B). Cell count >500/mm3, glucose 45mg/dl, and protein >75mg/dl were statistically associated with B. However, 14% of E-11 pts had at least one of these findings and 20% of B pts had none of these findings. CSF P >75% was as fre uent 1 in E-11 pts as in B pts. Peripheral WBC <5000 or >15000/mm and absolute band count >500/mm3 were statistically associated with B but 38% of E-11 pts had one of these abnormalities.
Certain CSF findings in our pts have not been reported for E-11 and are uncharacteristic of viral meningitis: 1) leukocyte response more characteristic of bacterial meningitis: CSF P >go%, persistence of CSF P beyond 24 hrs, peripheral band count >500, and 2) entirely normal CSF. 132 children with purulent nasopharyngitis and no other indication for specific treatment had gram stain and bacterial culture of nasopharyngeal discharge and were randomized to 4 treatment groups with antibiotic (A=cephalexin) or decongestantlantihistamine (D=pseudoephedrine/triprolidine) or their corresponding placebo equivalents (A+D+, A+D-, A-D+, A-D-).

DIAGNOSIS AND TREATMENT OF PURULENT NASOPHARYNGITIS -
Follow-up parent, physician, and bacteriologic evaluations were performed after 5 days of therapy without knowledge of active drug status. Groups were comparable for age, sex, race, number of patients withdrawn from study, days ill, fever >38.0 C, appearance of discharge, nasal crusting, and number of days until follow-up. 21% of patients grew H. influenzae type b and only 8% 5. pyogenes on initial culture. Nasal crusting was significantly (p<0.01) associated with the growth of 2. pneumoniae or g. influenzae type b, suggesting a possible pathologic relationship. There were, however, no significant differences between active drug and placebo treatment groups for change in nasal discharge, complications, apparent drug benefit, or change in nasal flora with active antibiotic treatment. Significantly (p<0.05) more side effects were attributed to the D+ treatment groups. Routine culture and/or treatment of purulent nasopharyngitis cannot be recommended unless properly controlled studies demonstrate a significant drug benefit. Coronavirus-like particles (CVLP) are associated with gastrointestinal (GI) symptoms (sx) in mammals, including man. We report an intensive care nursery (NICU) outbreak of GI sx associated with CVLP, identified by electron microscopy, in the stools of affected infants. Immune aggregation of stool CVLP occurred with sera of CVLP positive (+) infants only.

CORONAVIRUS-LIKE PARTICLES
Prevalence of stool CVLP, ascertained by 8 NICU-wide surveys over 40 weeks, fell from 67% to less than lo%, paralleling prevalence changes in the community. Most infants surveyed were premature. Overall, 36% (32188) of all infants were CVLP +. Prenatal or intrapartum acquisition was suggested by the finding that 34% (11132) of the CVLP + infants were examined within 72 hours of birth.
CVLP + infants were also more likely to have multiple sx and to have feeds discontinued for more than 3 days due to GI sx.
We conclude that stool Coronavirus-like particles are associated with clinically significant GI disease in the newborn.