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Haemophilus, Bordetella, & Branhamella Species

Before 1990, strains of Haemophilus influenzae type b were found in the upper respiratory tract of 3-5% of children and a small percentage of adults. Colonization rates with type-b strains are even lower now, reflecting routine immunization of infants against H influenzae type b. Non-type-b encapsulated H influenzae are present in the nasopharynx of < 2% of individuals, whereas nonencapsulated (nontypable [see below]) strains colonize the respiratory tract of 40-80% of children and adults.

Haemophilus Influenzae: Clinical Syndromes

H influenzae was first isolated during the 1892 influenza pandemic and was originally believed to be the causative agent of influenza. Although subsequent studies revealed the fallacy of this idea, H influenzae has proved to be a common cause of localized respiratory tract and systemic disease, including meningitis, epiglottitis, pneumonia, pyogenic arthritis, cellulitis, otitis media, and sinusitis, among others (Box 1). Meningitis is the most common and serious form of invasive H influenzae type-b disease. In the mid-1980s, before the introduction of effective vaccines, ~ 10,000-12,000 cases of H influenzae type-b meningitis occurred in the United States each year, and 95% of cases involved children < 5 years old.

Enteric Fever

Patients are asymptomatic during the incubation phase. Early in the course of disease, patients may experience diarrhea or constipation. Patients then develop a variety of nonspecific symptoms, such as fever, chills, weakness, malaise, myalgia, and cough.

Other Bacillus Species

Bacillus species other than B anthracis are found in soil, decaying organic matter, and water, but they are rare causes of disease. Risk factors associated with Bacillus infection include the presence of intravascular catheters, intravenous drug use, sickle cell disease, and immunosuppression — particularly corticosteroid use, transplantation, AIDS, and neutropenia secondary to chemotherapy.

Streptococcus Pneumoniae

S pneumoniae may exist in humans as either a nasopharyngeal colonist or as a pathogen in one of many clinical syndromes (Box 1). Although S pneumoniae has been found in other mammals, humans are thought to be the principal reservoir. As a colonist, S pneumoniae is found in up to 40% of children and 10% of adults.

Parainfluenza Virus

Parainfluenza is a ubiquitous virus. It is the primary cause of acute laryngotracheobronchitis (croup) in children aged 6 months to 3 years. It is capable of infecting the lower respiratory tract as well by manifesting as bronchiolitis or pneumonia. Outbreaks can follow regular epidemic patterns or be sporadic. Certain antigenic types (described below) do follow epidemic patterns.

Penicillins: Organs and Systems: Skin

Skin reactions are the commonest adverse effects of therapeutically administered penicillins. Penicillin-contaminated milk or meat can cause itching or generalized skin reactions or even anaphylaxis. The overall annual incidence of severe erythema multi-forme (toxic epidermal necrolysis and Stevens-Johnson syndrome) is about one case per million, antibiotics being involved in 30-40%. The clinical differentiation between these syndromes can be difficult.

Albendazole: Observational and Comparative studies

Albendazole has been used in the treatment of human hookworm and trichuriasis. In a mass-treatment report from Western Australia 295 individuals in a remote rural area were treated with albendazole 400 mg/day for 5 days because of possible Giardia lamblia and hookworm infections. The 37% prevalence of Giardia fell to 12% between days 6 and 9, but rose again to 28% between days 18 and 30. The effect on hookworms (Ankylostoma duodenale) was more pronounced and more sustained with a reduction of the pretreatment prevalence of hookworm infections from 76% before treatment to 0% after 3^1 weeks.