E. Richard Moxon

C-Reactive protein in spinal fluid of children with meningitis

We have evaluated a commercially available latex agglutination system for the detection of C-reactive protein in CSF by a prospective study of 56 patients with CSF pleocytosis. On initial lumbar puncture, C-RP was detected in 100% (24/24) of patients with culture-proven bacterial meningitis, compared to 6% (2/32) of patients in the nonbacterial group (chi 2 c = 44.8, P less than 0.0001). C-RP in CSF had a sensitivity of 1.0 and a specificity of 0.94 for detecting culture-positive, bacterial meningitis. It was a more sensitive test for differentiating bacterial from nonbacterial meningitis on initial CSF examination than was the number of CSF leukocytes, the absolute number of CSF polymorphonuclear leukocytes, CSF glucose concentration, CSF protein concentration, or Gram staining of CSF. Detection of C-RP by latex agglutination may prove to be a practical and reliable method for differentiating bacterial from nonbacterial meningitis.

Detection and quantitation of bacteremia in childhood

Quantitative blood cultures were sought in 383 children, from whom routine blood cultures were obtained because of fever, by direct plating of 10 and 100 microliter blood onto solidified media. There were 14 positive cultures from 12 patients. These were 7 Hemophilus influenzae type b, 5 Streptococcus penumoniae, and 2 Staphylococcus aureus. The direct-plating technique permitted more rapid identification of positive cultures, and detected three episodes not identified by routine broth culture. Bacterial counts ranged from 20 to greater than 10(4) bacteria/ml blood. In the three cases of H. influenzae type b meningitis, bacteremia exceeded 10(3)/ml. Among nine patients in whom bacteremia was unassociated with meningitis, (bacteremia without evident localized disease 5, pneumonia 2, epiglottitis 1, peritonitis 1), bacteremia was less than 10(3)/ml. This technique may aid detection of bacteremia and help identify those children at highest risk for developing septic complications, such as meningitis.

Indirect enzyme-linked immunosorbent assay for the quantitation of the type-specific antigen of Haemophilus influenzae b: A preliminary report**

Infections with Haemophilus influenzae type b are major causes of morbidity and mortality in young children. We developed an enzyme-linked immunosorbent assay for the diagnosis of Hib infections. The ELISA was more sensitive than both counterimmunoelectrophoresis and latex agglutination for the detection of Hib antigen in serum, urine, and cerebrospinal fluid. In addition, no false positive ELISA reactions were noted. The increased sensitivity of ELISA was especially valuable in the detection of Hib antigen following antibiotic therapy, in which case cultures are often sterile and CIE and LA can be negative. ELISA is thus a valuable tool for the early diagnosis of Hib infections.

811 COURSE AND SEOUELAE OF H. INFLUENZAE B (HIB) EMPYEMA

The natural course and sequelae of HIB Empyema have not been well characterized. Among 12 cases seen between 1966-1977, 8 were aged 6 months to 6 years and 4 were aged 6 - 11 years. Although 8 received antibiotics prior to diagnosis, 6 had positive blood cultures and 5 had positive cultures of pleural fluid. Among 4 receiving no prior treatment, none had positive blood cultures, 3 had positive pleural fluid cultures and 1 had sterile fluid with HIB antigen detected by CIE. All survived. Chest tube drainage was required in 3. Additional complications included pericarditis (2), Meningitis (1), and cellulitis (1). Mean duration of hospital stay was 21 days (range 9 - 35).Chest radiographs 6 months after diagnosis were available in 8 patients. 6 had pleural thickening, 4 had scoliosis and 2 had prominent hilum. Lung function studies were also performed on 5, 18-36 months following discharge. Four patients demonstrated a restrictive and 1 patient an obstructive ventilatory defect by plethysmography or helium dilution. 3 of the 5 patients with abnormal lung function studies showed simultaneous residual pleural thickening. Persisting defects of lung function may be a sequel of HIB empyema.

797 PROTECTION AGAINST HEMOPHILUS INFLUENZAE (HITB) MENINGITIS RESULTING FROM FEEDING OF E. COLI 075: K100: H5 (E.C. 89)

Serum antibody to HITB capsular polysaccaride (ACAB) has been induced by gastrointestinal colonization with genetically unrelated bacteria possessing cross-reactive antigen (CRA). To investigate whether immunization with CRA results in altered susceptability to HITB meningitis, rats aged 5 days were fed either 107 E.C. 89 or saline (controls) on 3 successive days. All rats thrived normally. Stool cultures from 95% of 76 E.C. 89-fed rats yielded bacteria with CRA for ≥ 7 days, and 42% for 35 days; none of 68 controls were thus colonized. When aged 42 days, all rats were inoculated intransally with 107 HITB. After 5 days comparison of blood and CSF cultures showed a significantly (p<0.05) decreased incidence of bacteremia (41% vs. 62%) and meningitis (7% vs. 20%) in E.C. 89-fed rats. Pre-challenge serum levels of ACAB were undetectable (<20 ng/ml.) in both E.C. 89-fed and control rats. Five days after HITB challenge ≥200 ng/ml ACAB was detected in 32/46 E.C. 89-fed rats compared to 19/44 control rats (p<0.01). Levels of ACAB correlated with protection against bacteremia and meningitis; rats with meningitis had ACAB levels < 30 ng/ml. These data are consistent with priming of ACAB following colonization with E.C. 89 and extends previous observations to include protection against meningitis in a model in which the evolution of invasive HITB infection simulates that occurring in humans.