Epidemiology and predictive values of risk factors for neonatal group B streptococcal sepsis.

OBJECTIVES: To determine the incidence of and factors affecting risk factors for neonatal group B streptococcal (GBS) sepsis and their predictive values for intrapartum GBS carriage; to calculate the proportions of women eligible for intrapartum antibiotic prophylaxis (IAP) using different selection protocols. DESIGN: Cohort study. SETTING: Antenatal clinics and labour wards of a community hospital and a tertiary referral centre in western Sydney POPULATION: Women attending antenatal clinics during the study periods were invited to participate. METHODS: Approximately 500 women attending antenatal clinics were screened for GBS carriage at 26-32 weeks gestation and at delivery, using several screening methods. Clinical risk factors for neonatal sepsis were recorded during labour. MAIN OUTCOME MEASURES: Incidence of antenatal anovaginal GBS carriage and clinical risk factors during labour, their predictive values for intra-partum GBS carriage and their relationship, if any, to demographic and obstetric factors. RESULTS: Antenatal and intra-partum GBS carriage rates were similar but varied from 18% to 27%, depending on screening methods. The best positive and negative predictive values of antenatal GBS culture, for intra-partum carriage, were 69% (95% confidence interval (CI) 64-74) and 92% (95% CI 50-94) respectively Clinical risk factors occurred in similar proportions of GBS carriers and non-carriers. CONCLUSIONS: Neither early antenatal screening nor clinical risk factors are reliable predictors of intra-partum GBS carriage. Intra-partum antibiotic prophylaxis based on GBS carriage or risk factors when carrier status is unknown would involve approximately 35% of women, compared with approximately 16% if based on risk factors only Both strategies would prevent similar proportions of neonatal deaths from GBS sepsis. Compliance with a preventive protocol is the most likely determinant of its overall effectiveness.

Automated solid-phase synthesis of a branched Leishmania cap tetrasaccharide.

[reaction--see text] Described is the first automated solid-phase synthesis of a branched oligosaccharide by stepwise assembly from monosaccharides. Cap tetrasaccharide 1, found as part of the cell surface lipophosphoglycan (LPG) of the protozoan parasite Leishmania, was readily prepared using glycosyl phosphate and glycosyl trichloroacetimidate building blocks.

Solution and solid-support synthesis of a potential leishmaniasis carbohydrate vaccine.

The synthesis of a potential carbohydrate vaccine for the parasitic disease leishmaniasis is described. New solution- and solid-phase synthetic strategies were explored for the assembly of a unique tetrasaccharide antigen found on the Leishmania lipophosphoglycan. An initial solution-phase synthesis relied on thioglycosides as building blocks and the establishment of the central disaccharide from lactal via an oxidation-reduction sequence. A second approach was completed both in solution and on solid support. The solid-phase synthesis relied on assembly from monosaccharide units and was used to evaluate different glycosylating agents in the efficient installation of the galactose beta-(1-->4) mannoside. Glycosyl phosphates proved most successful in this endeavor. This first solid-phase synthesis of the Leishmania cap provided rapid access to the tetrasaccharide in 18% overall yield while requiring only a single purification step. The synthetic cap tetrasaccharide was conjugated to the immunostimulator Pam3Cys to create fully synthetic carbohydrate vaccine 1 and to the carrier protein KLH to form semisynthetic vaccine 2. Currently, both constructs have entered initial immunological experiments in mice targeted at the development of a vaccine against the parasitic disease leishmaniasis.

Invasive Haemophilus influenzae type b disease in elderly nursing home residents: two related cases.

We investigated two fatal cases of invasive Haemophilus influenzae type b (Hib) infection in a community nursing home in western Sydney, Australia. Two elderly women had lived in the same room, and the onset of their illness was 5 days apart. Hib isolates from blood cultures showed identical profiles by pulsed field gel electrophoresis. These findings suggest that Hib infection was transmitted within this nursing home. Serious Hib disease may be underrecognized in this setting. Continued surveillance and serotyping of invasive H. influenzae disease is essential for identifying groups at increasing risk that may benefit from immunization against Hib.