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We studied the effect of penicillin on early-onset Group B streptococcal disease over a 52-month period in neonates who were at high risk of infection. Shortly after birth, 1187 neonates weighing 2000 g or less had blood samples taken for cultures and were randomized into an early-treatment group (given intramuscular penicillin G within 60 minutes of birth) or a control group. The incidence of early-onset disease was 20 per 1000 live births (24 of 1187); the number of infants in the early-treatment group who had disease (10 of 589) was similar to that in the control group (14 of 598). The fatality rates were similar in both groups (6 of 10 vs. 8 of 14). Cultures from blood obtained with one hour of birth were positive in 21 of the 24 infants with disease; 22 of the 24 were symptomatic within four hours of birth. Thus, infection was well established before the first hour of postnatal life. At autopsy, gram-positive cocci were seen in lung sections of four infants in whom cultures of blood obtained after treatment had been sterile; this indicates that giving routine antibiotic therapy before culture samples are obtained can obscure bacteriologic diagnosis. We conclude that penicillin given at birth to neonates weighing 2000 g or less does not prevent early-onset streptococcal disease or reduce excess mortality associated with disease.

In a ten-year period we identified 305 hospitalized children with a pneumococcal bacteremia. From these children 293 pneumococcal isolates were serotyped, and 90% belonged to a group of 11 "prevalent serotypes." These 11 serotypes were the prevalent serotypes isolated from children in all disease categories, as well as from children with sickle-cell disease. No more than 1% of the isolates belonged to any one of the other serotypes. A pneumococcal vaccine effective against these 11 prevalent serotypes should be optimal for use in children. Our highest case fatality rates were noted in children with meningitis (13%) and children with sickle-cell disease (20%). A polysaccharide pneumococcal vaccine might not have prevented most of our pneumococcal meningitis, as 80% of these children were less than 1 year old, an age when polysaccharide vaccines are poor antigens. On the other hand, many of our children with sickle-cell disease acquired their pneumococcal bacteremia at an older age and should have benefitted from such a vaccine.

Maduromycosis is a rare fungal infection in the northern United States, most frequently caused by Allescheria boydii, usually in debilitated or immunosuppressed patients. An 18-year-old Mexican-American, in excellent health, developed multiple draining sinuses at the sites of insertion of Ender nails for a closed tibial fracture. Madurella mycetomi was cultured from black granules in a biopsy specimen. The source of fungal infection remained unknown, although it probably did not occur during the surgical procedure. Since no specific antibiotic treatment is available, it is possible that with progression of the infection, amputation may be necessary in the future.

This paper describes a patient with spontaneous bacterial peritonitis caused by a group IIk-2 strain. No other organism was isolated from the peritoneal fluid cultured aerobically and anaerobically.