Sera from 33 patients with cystic fibrosis and two pediatric patients being treated for chronic pulmonary infections not related to cystic fibrosis and six sera or serum pools from uninfected individuals were tested with a microtiter radioimmunoassay for reactivity against exotoxin A and two proteases from Pseudomonas aeruginosa. Exotoxin A was purified from a low-protease strain of P. aeruginosa and shown to have adenosine diphosphate-ribose transferase activity and mouse lethality. Proteases were purified from an isolate of P. aeruginosa from a patient with cystic fibrosis and had proteolytic activity against elastin and collagen in an assay employing dimethylated protein substrates. The antibody responses of the patients detected using 125I-labeled antibody to human immunoglobulin were correlated with clinical evaluations expressed as a composite score based on pulmonary findings, case histories, growth and nutrition, and chest X rays. Values in the radioimmunoassay for patients' sera were compared with those of a control serum pool and expressed as the ratio of counts per minute (cpm) in patient serum to the cpm in the control pool. Inverse correlations were found between these ratios for each of the pseudomonas exoproducts and clinical scores; highest ratios occurred in patients showing the lowest clinical scores. These results confirm that proteases and exotoxin A of P. aeruginosa are produced in cystic fibrosis pulmonary infections due to P. aeruginosa and suggest that they may serve as significant virulence factors in these chronic infectious states.

Complement fixing antibody titers to the adenoviruses were determined in 251 newborn infants, using cord blood. Approximately 95% of these were found to have CF titers of 1:16 or over, the majority (75%) were 1:32 or more. Material from the pharyngeal and rectal swabs of these infants on tissue culture studies (542) on HeLa and amnion cells showed no cytopathic effect in oven 96% of these infants. A longitudinal study of 114 of these infants was made at 3 months intervals; 67 have been observed for one year. At 3 months, only 12% still showed CF antibody titers, and these were chiefly at a low level, 1:16. At the subsequent 3-month interval observations, a gradual rise in CF antibodies were found. At one year of age, approximately 37% had titers of 1:32 on over. The findings of this report support the statement that CF antibodies to adenovirus pass the placental barrier. There is a gradual increase in the percentage of infants with positive CF antibodies after 3 months.

This is apropos of the article by Dr. Thomas E. Cone, Jr., "Diagnosis and Treatment: Some Syndromes, Diseases, and Conditions Associated with Abnormal Coloration of the Urine or Diaper" (Pediatrics, 41:654. 1968). Recently we have noted a blue-green discoloration of urine during the first 3 to 4 days of life from infants whose mothers had received intravenous methylene blue in conjunction with propitocain hydrochloride (Citanest registered) an anesthetic agent used for caudal anesthesia. Since this anesthetic agent is capable of producing methemoglobinemia, a number of obstetricians routinely administer 1 to 2 mg per kilogram of a 1% solution of methylene blue to the mother intravenously and this produces a blue-green color to the infant's urine.