Quantitative analyses of the normal throat flora of children with upper respiratory tract infections]

Relationship between the normal throat flora and pathogenic bacteria recovered from the throat in 139 children with upper respiratory tract infections in winter were studied using quantitative analyses. Pathogenic bacteria examined include S. pyogenes, H. influenzae, S. aureus, and S. pneumoniae, and the normal floras include alpha-streptococci, gamma-streptococci, Neisseria species, and Micrococci. Children with S. pyogenes in their throats (S. pyogenes group) were examined with anti-streptococcal antibodies such as anti-streptolysin O, anti-streptokinase, and anti-deoxyribonuclease B. Eighty seven pathogenic bacteria were recovered from 72 children (51.8%) out of 139. S. pyogenes and S. pneumoniae groups showed significantly lower alpha-streptococci and gamma-streptococci in incidence of appearance when compared with children with the no pathogenic bacteria in their throats (no bacteria group). H. influenzae group showed significantly lower gamma-streptococci and higher Neisseria sp. in incidence of appearance compared with the no bacteria group. Positive cases for anti-streptococcal antibodies showed a significantly lower alpha-streptococci in number compared with negative cases for antibodies and the no bacteria group, and a significantly lower gamma-streptococci in incidence of appearance compared with the no bacteria group. These data suggest that the normal throat flora may have a role in prevention of colonization by the pathogenic bacteria in vivo, as were shown in vitro by many authors, and that the quantitative analysis of the normal flora is useful because this methodology might reveal whether the bacteria recovered from the throat show the pathogenicity.     

Identification and characterization of soil-isolated Streptomyces SJE177 producing actinomycin

One hundred seventy-seven actinomycetes strains were isolated from soils collected from fruit orchards in Thailand. All were tested for antibacterial activity against seven pathogenic bacteria using co-cultivation methods. Forty strains (22.6%) were active against at least one indicator bacteria. Twenty-seven strains (15.3%) inhibited only gram-positive bacteria, four strains (2.3%) inhibited only gram-negative bacteria, and nine strains (5.1%) showed activity against both. Strain SJE177 had potent activity against all tested bacteria, and was selected for further investigation. A crude ethyl acetate extract of this strain retained inhibitory activity as tested by disk-diffusion method. Analysis of morphological and biochemical characteristics and the 16S rRNA gene sequence indicated this strain belonged to the genus Streptomyces. The strain formed a monophyletic line in a phylogenetic tree of 16S rRNA gene sequences with other Streptomyces reference strains. High performance liquid chromatography (HPLC) analysis showed SJE177 produced actinomycin. Since many isolates showed inhibitory activity against indicator bacteria, these results suggest Thai soil could be an interesting source to explore for antibacterial substances.     

The antimicrobial activity of fluoroquinolone agents against pathogenic organisms in respiratory tract infections and its clinical effect

The efficacy rate, minimal inhibitory concentrations (MICs), and resistance of fluoroquinolone agents against causative organisms in respiratory tract infections from January to March, 1988 were investigated. Of 333 pathogenic strains 85% consisted of 5 major causative organisms of respiratory tract infection (Haemophilus influenzae, Pseudomonas aeruginosa, Streptococcus pneumoniae, Branhamella catarrhalis, and Staphylococcus aureus). In 61 (59 cases) of these 333 strains, including 3 cases of acute pharyngitis, 5 of acute bronchitis, 3 of pneumonia, and 48 of chronic lower respiratory tract infection fluoroquinolone agents were administered. The efficacy rate was 76.3% in all cases, and 75% in cases with chronic lower respiratory tract infection. The fluoroquinolone agents were 100% effective in H. influenzae and B. catarrhalis, though the efficacy rate was 67% in S. aureus and 40% in P. aeruginosa. The susceptibility of all strains to fluoroquinolone agents were investigated. There was no resistant strain in H. influenzae and B. catarrhalis, though resistant strains to fluoroquinolone agents have increased in S. aureus and P. aeruginosa. The efficacy rate was investigated using the MIC of administered fluoroquinolone agent against causative organisms. It is surmised that the efficacy of that agent has an MIC of 1.56-3.13 micrograms/ml.     

Antibiotic susceptibility and T-serotypes of group A hemolytic streptococci, clinically isolated in 1986 and 1987

Determination of T-serotype for a total 245 strains (157 strains in 1986, 88 strains in 1987) of Streptococcus pyogenes (Group A hemolytic streptococci) isolated from clinical specimens (throat swab) of pediatric patients in Fukuoka Prefecture from 1986 until 1987 were performed. The susceptibilities of 9 antibiotics against 241 strains were studied. The most dominant strain was T-12 (57 strains, 36.3%) and followed by T-4 (32 strains, 20.4%) and T-28 (30 strains, 19.1%) in 1986. The total of these three strains was 75.8% of all strains. In 1987, T-4 (41 strains, 46.6%) was the dominant strain instead of T-12 (14 strains, 15.9%). T-28 was isolated only 4 strains (4.5%) in 1987, although it was isolated in 30 stains (19.1%) in 1986. In susceptibility-tests, no strains of 1986 and 1987 was resistant to beta-lactams. Resistant strains (MIC greater than or equal to 25 micrograms/ml) to erythromycin (EM), tetracycline (TC) and chloramphenicol (CP) were 4 (2.6%), 51 (33.3%) and 1 (0.7%), respectively in 1986. In 1987, resistant strains to EM and CP were not detected, to TC were 52 strains (59.1%), so there was an increase of susceptibility to EM and CP. As for relationship between T-serotype and antibiotic resistance, only one strain (T-12) showed multiple resistance in 1986, however in 1987, multiple resistant strain was not detected. In 1986 and 1987, 31 of 49 only TC resistant strains (63.3%) and 41 of 52 only TC resistant strains (78.8%) were T-4, respectively.     

PROTEKT 1999-2000: a multicentre study of the antimicrobial susceptibility of respiratory tract pathogens in Japan.

DESIGN: A six-centre study in Japan during the winter of 1999-2000 assessed the in vitro activity of >20 antimicrobial agents against the common respiratory pathogens Streptococcus pneumoniae, Streptococcus pyogenes, Haemophilus influenzae, and Moraxella catarrhalis. The minimum inhibitory concentrations (MIC) of each antimicrobial was determined against these isolates using National Committee for Clinical Laboratory Standards (NCCLS) methodology. RESULTS: Among S. pneumoniae isolates, 44.5% were penicillin resistant. The macrolide resistance rate was 77.9% with 90.5% of penicillin-resistant strains also being macrolide resistant. Resistance mechanisms in macrolide-resistant isolates were identified as mef(A) or erm(B) in 42.5% and 52.5%, respectively. Of the fluoroquinolone-resistant isolates (1.3%), most were also penicillin and macrolide resistant. All strains were inhibited by telithromycin at 相似文献   

2002～2003年中国社区呼吸道感染常见病原菌的耐药性监测

目的　调查 2 0 0 2～ 2 0 0 3年中国社区呼吸道感染常见病原菌的耐药性。方法　收集2 0 0 2年 4月～ 2 0 0 3年 4月全国 5个地区 5家医院社区呼吸道感染患者中分离的 779株肺炎链球菌、流感嗜血杆菌、卡它莫拉菌、A群 β溶血链球菌及苯唑西林敏感的金黄色葡萄球菌 (MSSA) ;同时收集北京市两家幼儿园儿童鼻咽携带的 185株肺炎链球菌、流感嗜血杆菌及卡它莫拉菌。琼脂稀释法测定头孢丙烯等 10种抗生素的最低抑菌浓度 (MICs)。结果　全国 5个地区 ,青霉素中介的肺炎链球菌(PISP)为 2 3 9% ,青霉素耐药 (PRSP)为 2 2 7%。PISP发生率从高至低依次为杭州 (4 4 1% )、武汉(2 6 2 % )、沈阳 (2 1 5 % )、上海 (2 0 8% )、北京 (18 5 % )、北京幼儿园 (12 7% ) ;而PRSP的排序则为北京幼儿园 (34 9% )、上海 (31 9% )、武汉 (2 7 9% )、杭州 (2 2 1% )、沈阳 (13 8% )、北京 (8 6 % )。肺炎链球菌对左氧氟沙星的敏感率为 96 3%。 9 5 %的流感嗜血杆菌和 87 4 %的卡它莫拉菌产生 β内酰胺酶 ,这两种菌对阿莫西林 /克拉维酸、头孢克洛、头孢丙烯、头孢呋辛、头孢曲松、阿奇霉素、左氧氟沙星的敏感率在 96 4 %～ 10 0 %之间。肺炎链球菌、A群 β溶血链球菌、MSSA对阿奇霉素耐药率高于 6 0 %。头孢丙烯对PISP     

The Use of Probiotics in Head and Neck Infections

Recurrent episodes of infections in the upper respiratory tract are very common. The pathogenesis behind these recurrences is still not well understood, but much attention has been paid to the adherence of the microorganisms to epithelial structures and to the protective function of the normal bacterial flora (bacterial interference). Thus, in vitro as well as in vivo studies have shown that both aerobic and anaerobic bacteria of the normal flora in the upper respiratory tract can hinder the growth of pathogens and the establishment of a renewed infection. Studies have shown that lack of interfering bacteria facilitates recurrence of these diseases. Recolonization with interfering alpha-streptococci has been performed successfully in acute streptococcal pharyngotonsillitis, as well as in acute otitis media. The number of recurrences has significantly been lowered in these diseases after recolonization with alpha-streptococci, which is the dominating normal bacteria in the upper respiratory tract. Several mechanisms have been proposed to be responsible for this interaction, such as competition of the adhering sites at the epithelial cells, production of hydrogen peroxide, competition for nutritients, and production of specific growth inhibiting factors such as bacteriocins. Other human components like lactoferrin are also important in the defense against microorganisms, and are important parts of the unspecific and specific immune system.     

A comparative study of antibacterial activity of ceftibuten, ceftazidime, cefuroxime and ampicillin against clinical isolates

Ceftibuten is an orally active third generation new cephalosporin. Its antibacterial activity in vitro was tested to many clinical isolates and was compared to the activity of ceftazidime, cefuroxime and ampicillin, by twofold serial dilution method in Müller-Hinton agar--detection of minimum inhibitory concentrations (MIC) and by the disc-diffusion method of Kirby-Bauer. The new cephalosporin demonstrated great activity against the different clinical important strains. Many resistant strains to ampicillin were high susceptible to ceftibuten. The majority of Gram-negative organisms, including Enterobacteriaceae, the respiratory pathogens M.(B.) catarrhalis and H. influenzae are highly susceptible to Ceftibuten, however Pseudomonas, Acinetobacter are resistant. The majority of methicillin-susceptible strains of Staphylococcus are resistant too. New cephallosporin was also active against S. pyogenes (Streptococcus gr. A) and penicillin-susceptible pneumococci, but was inactive against S. agalactiae (Streptococcus gr. B), S. pneumoniae penicillin-resistant strains and enterococci, similar to the other cephalosporins. The activity of ceftibuten was higher than that of ampicillin and cefuroxime against beta-lactamases positive strains of H. influenzae and M.(B) catarrhalis, also against tested strains of Enterobacteriaceae. The major priority of the new antibacterial agent over other cephalosporins and ampicillin is its stability to hydrolysis by the main broad-spectrum beta-lactamases producing E. coli and K. pneumoniae sp.     

184例儿童感染肺炎链球菌的血清型分布及其耐药性分析

目的分析184例儿童感染肺炎链球菌的血清型分布及其耐药性情况。方法选取2014年1月至2017年12月我院呼吸道感染患儿2828例,进行痰液培养,分析病原菌检出情况,肺炎链球菌分布情况、血清分型以及对抗生素耐药性情况。结果2828例患儿的痰标本共检出674株病原菌(23.83%),其中肺炎链球菌184例,检出率为6.51%。年龄1个月~1岁患儿感染肺炎链球菌发生率为52.17%,明显高于1~3岁、3~6岁患儿的25.54%、22.28%(P<0.05);冬季患儿感染肺炎链球菌发生率为53.26%,明显高于春季、夏季、秋季的19.02%、13.05%、14.67%(P<0.05);184株肺炎链球菌共涉及11个血清型/群,主要分布于19F、19A、14型、9V、23F、6B、8型、7F、7A、其他等,另有11株未能分型。青霉素(脑膜炎)的不敏感率高达83.33%,明显高于青霉素(非脑膜炎)的63.24%(P<0.05);而头孢曲松对感染肺炎链球菌脑膜炎或非脑膜炎患儿的敏感率比较,无统计学意义(P>0.05)。患儿感染肺炎链球菌的青霉素(脑膜炎)、红霉素、四环素、复方新诺明、头孢克罗、克林霉素耐药检出率分别为72.91%、86.96%、89.13%、79.89%、80.43%、77.23%;而万古霉素、氯霉素、左氧氟沙星、氧氟沙星、莫西沙星、头孢曲松敏感率分别为100.00%、95.65%、98.38%、91.85%、92.94%、91.85%。结论儿童感染肺炎链球菌存在明显的年龄、季节、血清分布与耐药性差异,此研究结果对儿童肺炎抗感染治疗经验性抗生素选择有指导意义。     

儿科重症监护室先天性心脏病合并呼吸道感染患儿的病毒性病原学研究

目的：总结儿科重症监护室中先天性心脏病合并呼吸道感染患儿的病毒性病原谱。方法收集2010年6月至2012年6月因呼吸道感染入住本院儿科重症监护室的患儿咽拭子标本622份,其中先天性心脏病合并呼吸道感染患儿咽拭子34份。应用多重聚合酶链反应(PCR)技术对呼吸道病毒进行检测,并对照分析合并先天性心脏病患儿的病毒性病原学特点。结果①34份先天性心脏病组咽拭子标本中,呼吸道病毒检测阳性20份(58.8%),588份非先天性心脏病组咽拭子标本中,呼吸道病毒检测阳性368份(62.6%)。②先天性心脏病组中,最常见的病毒分别为人鼻病毒(human rhinovirus,HRV)8份,呼吸道合胞病毒(respiratory syncytial virus, RSV)6份,人博卡病毒(human bocavirus,HBoV)4份,腺病毒(adenovirus,ADV)2份;非先天性心脏病组中,最常见的病毒分别为 HRV 160份,RSV 104份,ADV 72份,HBoV50份;其他病毒阳性率较低。③先天性心脏病组中,混合病毒感染有2份(2/20,10.0%),非先天性心脏病组中,混合病毒感染有110份(110/368,29.9%)。结论本地区儿科重症监护室中先天性心脏病合并呼吸道感染患儿的病原体中病毒性病原体检出率高,以鼻病毒、呼吸道合胞病毒、人博卡病毒和腺病毒最常见,病毒谱和非先天性心脏病组相似。     

Antibacterial resistance among children with community-acquired respiratory tract infections (PROTEKT 1999-2000)

OBJECTIVE: To determine the susceptibility of bacterial respiratory tract pathogens, isolated from children (0-12 years) as part of the global PROTEKT surveillance study (1999-2000), to a range of antibacterials, including the ketolide telithromycin. METHODS: Minimum inhibitory concentrations of the antibacterials studied were determined at a central laboratory using the NCCLS microdilution broth method. Macrolide resistance mechanisms were detected by PCR. RESULTS: Of 779 Streptococcus pneumoniae isolates worldwide, 43% were non-susceptible to penicillin (18% intermediate; 25% resistant) and 37% were resistant to erythromycin, with considerable intercountry variation. Eighteen per cent of 653 Haemophilus influenzae and >90% of 316 Moraxella catarrhalis isolates produced beta-lactamase. Of 640 Streptococcus pyogenes isolates, 10% were resistant to erythromycin, with considerable intercountry variation. All S. pneumoniae and 99.8% of H. influenzae isolates were susceptible to telithromycin using breakpoints proposed to the NCCLS (相似文献   

Prevalence of Moraxella catarrhalis colonization in asymptomatic carriers under 6 years of age

OBJECTIVE: To determine the prevalence of upper respiratory tract colonization by Moraxella catarrhalis in children under six years of age. MATERIAL AND METHODS: A survey was conducted between January and December 1998 in Mexico City, among children aged 2 months to 5 years, selected through cluster sampling. Pharyngeal samples were taken for M. catarrhalis identification. The minimal inhibitory concentration to different antibiotics was obtained and beta-lactamases were determined by the iodometric test. Statistical analysis consisted of frequency distributions, odds ratios, 95% confidence intervals, and Mantel-Haenszel chi 2. Statistical significance was set at p < 0.05. RESULTS: After excluding 37 children, the study population was 604 children from Mexico City; M. catarrhalis was present in 130 pharyngeal specimens (22.9%). Most of the strains were positive for beta-lactamase production (75.4%). Eighty percent of the strains was resistant to penicillin and 70% to ampicillin and amoxicillin. None were resistant to cefotaxime, imipenem, meropenem and erythromycin. CONCLUSIONS: Prevalence of M. catarrhalis upper respiratory tract colonization is similar to that of other respiratory pathogens. These findings warrant future research on the role of M. catarrhalis as an etiologic agent in acute and chronic respiratory infections in Mexico.     

A three-year review of acute respiratory tract infections caused by Streptococcus milleri group

The objective of our study is to understand the clinical features of patients with acute respiratory tract infection associated with Streptococcus milleri group (SMG). Fifteen patients with SMG respiratory tract infection visited our hospital from July, 1997 through May, 2000. There were seven cases of pneumonia, two pulmonary abscess, three thoracic empyema and three acute bronchitis. The mean age of the patients was 57.8 years (range 16-87), twelve were males, and seven were smokers. The moderately to severe underlying diseases existed in thirteen patients (86.7%) and included the following: respiratory diseases (20.0%), history of the esophageal or gastric surgery (26.7%), central nerve system diseases (13.3%), alcohol intake (60.0%), hepatitis and pancreatitis (33.3%), diabetes mellitus (13.3%) and malignancy (6.7%). The species of SMG detected were as follows: S. constellatus, 8, S. anginosus, 6 and S. intermedius, 1. Anaerobic organism and other microorganisms were detected in five patients. A patient with SMG nosocominal pneumonia who previously had thoracic surgery for esophageal cancer died. Antibiotics therapy with carbapenem or combination therapy, drainage and no surgery, were successful in 14 of the 15 cases (93.3%). The number of intermediately or complete resistant strains against penicillin G, ampicillin and cefmetazole were 5 (33.3%), 8 (53.3%) and 12 (80.0%), respectively in this series. Recently, it is seemed that acute respiratory tract infections caused by SMG are increasing in the patients with moderately to severe underlying diseases, and several clinical strains of SMG are acquiring a tolerance to antibiotics.     

Definition of a bacterial virulence factor: sialylation of the group B streptococcal capsule.

Sialylation of bacterial capsules has been proposed as an important virulence factor for several species of encapsulated pathogens, including group B Streptococcus. We have constructed a transposon mutant strain of type III group B Streptococcus that expresses a capsular polysaccharide differing from the wild type only in that the mutant strain's capsule lacks sialic acid. The mutant polysaccharide is antigenically identical to the capsular polysaccharide of type 14 Streptococcus pneumoniae, as predicted by the structures of the type III group B Streptococcus and S. pneumoniae polysaccharides. Loss of capsular sialic acid was associated with loss of virulence in the mutant strain in a neonatal rat model of lethal group B Streptococcus infection. These studies demonstrate directly that capsular sialic acid is a critical virulence determinant for type III group B Streptococcus and support the general hypothesis that surface sialylation aids pathogenic microorganisms in evading host defenses.     

Resistance against oral antibiotics to Streptococcus pneumoniae isolated from adult respiratory tract infections

The resistance against oral antibiotics to Streptococcus pneumoniae (S. pneumoniae) isolated from adult patients with respiratory tract infections in the Kurume area in 1998 was studied. The frequency of resistant strains, which were isolated penicillin-intermediate S. pneumoniae and resistant S. pneumoniae (PISP, PRSP) were both 41.2%. We examined the minimal inhibitory concentrations (MIC) of oral antibiotics and the susceptibility ratio of the strains for the drugs based on the breakpoint MIC. The breakpoint MIC of pneumonia against oral beta-lactam antibiotics to PISP, PRSP, which were determined by Japan Society of Chemotherapy, were high in the order of FRPM > CDTR, CFPN > CFTM > CFDN, CPDX. In the case of the new oral quinolones, DU6859a > SPFX > LVFX > CPFX showed good results, in this order, DU6859a showed the most significant inhibitory effect to PISP, PRSP (MIC90 0.06 microgram/ml). By serotyping the percentage of 19, 6, 23 was 42.9%, 21.4% and 14.3%.     

Antibiotic sensitivity and serotypes of group A hemolytic streptococci isolated from clinical specimens and healthy pupils in Japan, 1986-1988

As an epidemiological survey for streptococcal infection, antibiotic sensitivity test and T-serotyping were made on 2,735 strains of group A hemolytic streptococci isolated from clinical specimens and healthy pupils between 1986 through 1988 in Japan. Most dominant serotype in clinical isolates was T-4 (26.8%) and it was followed T-12 (25.5%), T-1 (11.2%) and T-3 (8.5%), on the other hand, dominant serotypes of the isolates from healthy pupils were T-12 (30.4%), T-1 (19.3%), T-4 (15.3%) and T-28 (13.4%). All of the isolates tested were sensitive to the beta-lactam antibiotics which was found as same as consequence of the previous surveys. However 36.4% to tetracycline, 2.1% to chloramphenicol and 1.4% to oleandomycin of the clinical isolates were resistant. Similarly, 16.2% to tetracycline, 2.3% to chloramphenicol 1.7% to oleandomycin, of the isolates from healthy pupils were resistant. Multi-resistant strains were found 1.4% in clinical isolates and 1.7% in the isolates from healthy pupils. Relation between distribution of multiresistant strain and T-serotypes was found. In T-12, multiresistant strains were encountered at a relatively high rate compared with other serotypes, representing 3.5% in clinical isolates and 5.6% in the isolates from healthy pupils. However this tendency was decreased than previous surveys, while incidence of tetracycline resistant strains in T-4 remained at high level, representing about 94% as same as in the past.     

Upper respiratory tract spread of group B streptococci type I b in a kindergarten.

In a kindergarten with 42 children and 17 female staff members, an epidemic of group B streptococcal carriage in the upper respiratory tract occurred. In the middle of February 1978, 6 children and 5 adults carried type I b streptococci in the throat while only 2 of these 11 were carriers 2 weeks later. Only one other streptococcus, belonging to type II, was found in the throat specimens. Five strains other than type I b were found in the urogenital tract of the staff. Three type I b throat carriers were also urogenital carriers of this type. The spread of type I b streptococci could have resulted from co-spreading with other upper respiratory tract pathogens found, including group A streptococci of type 12. Haemophilus influenzae, Branhamella catarrhalis and pneumococci. Estimation of antibodies with radiolabelled protein A indicated an immune response to type I b, but not to types I a, II or III group B streptococci in the staff compared with healthy blood donors.     

Moxifloxacin and ciprofloxacin protect human respiratory epithelial cells against Streptococcus pneumoniae, Staphylococcus aureus, Pseudomonas aeruginosa, and Haemophilus influenzae in vitro

The fluoroquinolones moxifloxacin and ciprofloxacin display excellent in vitro activities against many respiratory tract pathogens. Here we show that moxifloxacin and ciprofloxacin accumulate approximately 7- to 10-fold in primary human respiratory epithelial cells, derived from nasal polyps and grown in 3-dimensional vesicles. Furthermore, using these vesicles, we assessed the bactericidal effect of moxifloxacin on Staphylococcus aureus and Streptococcus pneumoniae and that of ciprofloxacin on Pseudomonas aeruginosa and Haemophilus influenzae. Finally, we determined the protective effect of the fluoroquinolones on vesicles infected with these pathogens. All four bacterial strains were highly toxic for vesicles. S. aureus and S. pneumoniae were readily killed by moxifloxacin regardless whether the antibiotics were present intra/extracellularly or only intracellularly in vesicles. Similar results were obtained for the killing of H. influenzae and P. aeruginosa. Exclusively intracellularly located fluoroquinolones rescued 42% to 76% of the cells after bacterial challenge compared to the rescue of 48% to 94% cells when the fluoroquinolones were present intra/ extracellularly. Without addition of fluoroquinolones cell survival in vesicles was 0% to 38%. The results suggest that intracellular accumulation of moxifloxacin and ciprofloxacin is important for the protection of respiratory epithelial cells from the cytotoxic effects of major respiratory tract pathogens.     

Studies on respiratory infections in the field of primary care (I). Correlation between viral infection and secondary bacterial infection in patients visiting a doctor in private practice

We attempted to find out whether there is a correlation between viral infection and secondary bacterial infection on the basis of the analysis of the results of the culture of virus and bacteria in the same specimen from the throat swabs of 95 patients who had an acute upper respiratory inflammation when they visited a doctor in private practice in Sendai city during the epidemic caused by influenza virus. Viral culture was performed by a microplate-method devised originally by Numazaki. The influenza virus was recovered from 56 cases (59%) consisting of 43 cases of type A (Hong-Kong) and 13 cases of type B. From 73 cases, (77%), 79 strains of possibly pathogenic bacteria were recovered, consisting of 43 strains of H. influenzae, 18 strains of S. aureus, seven strains of S. pneumoniae, four strains each of C. freundii and S. liquefaciens and one strain each of beta-haemolytic Streptococcus and B. catarrhalis. The incidence of positive culture of both virus and possibly pathogenic bacteria was high already at the early stage (2-3 days) of the disease. We found no correlation between the type of virus and the species of the microbial isolates. There was no difference in the incidence of positive bacterial culture in relation to age group. We suggest that a secondary bacterial infection occurs already at the early stage of the disease after viral infection because the incidence of positive culture of possibly pathogenic bacteria was high at the above stage.