JOURNAL OF CLINICAL MICROBIOLOGYVOLUME 31 * NOVEMBER 1993 o NUMBER 11

Richard C. Tilton, Editor in Chief (1994)North American Laboratory Group, Ltd.New Britain, Conn.Richard F. D'Amato, Editor (1997)The Catholic Medical Center ofBrooklyn and Queens, Inc.

Jamaica, N. YPatrick R. Murray, Editor (1994)Washington University School ofMedicineSt. Louis, Mo.

Andrew B. Onderdonk, Editor (1998)Channing LaboratoryBoston, Mass.

Frank G. Rodgers, Editor (1996)University ofNew HampshireDurham, N.H.

Ira F. Salkin, Editor (1995)N. Y State Department of HealthAlbany, N.Y

Joseph L. Staneck, Editor (1994)University HospitalCincinnati, Ohio

Stephen A. Spector, Editor (1997)University of California, San DiegoLa Jolla, Calif

EDITORIAL BOARDDonald G. Ahearn (1993)William L. Albritton (1993)Daniel Amsterdam (1994)Peter Appelbaum (1994)Michael Ascher (1995)Ellen Jo Baron (1994)Arthur L. Barry (1993)Vickie S. Baselski (1994)Barry J. Beaty (1993)M. J. Blaser (1993)Barbara A. Body (1995)Victor D. Bokkenhauser (1994)Carol A. Bolin (1993)William Bonnez (1994)Patrick J. Brennan (1993)Don J. Brenner (1995)Kenneth Bromberg (1994)George F. Brooks (1993)Arnold Brown (1993)Kay Buchanan (1993)Joseph M. Campos (1995)Roberta B. Carey (1994)Stephen J. Cavalieri (1995)Walter S. Ceglowski (1993)H. Fred Clark (1994)Richard B. Clark (1995)Dennis J. Cleri (1993)Richard W. Cone (1995)Chester R. Cooper (1994)Alan L. Coykendall (1995)Jack T. Crawford (1993)George Cukor (1993)Paola DeGirolami (1995)Dennis Dixon (1994)Sam T. Donta (1995)Edward J. Dubovi (1994)Stephen C. Edberg (1995)Paul H. Edelstein (1994)John A. Elliott (1994)Mario R. Escobar (1995)J. J. Farmer III (1995)Daniel P. Fedorko (1995)Paul M. Feorino (1993)Mary Jane Ferraro (1993)

Patricia Ferrieri (1995)Marianne Forsgren (1993)Rita M. Gander (1995)Lynn S. Garcia (1995)Claude F. Garon (1995)Michael A. Gerber (1993)Mary J. Gilchrist (1993)Monica Grandien (1993)Larry D. Gray (1993)Harry Greenberg (1993)Peter A. Gross (1995)Wendy M. Gross (1995)Joseph J. Guarneri (1993)Ian D. Gust (1994)Margaret R. Hammerschlag (1993)Maurice W. Harmon (1994)William J. Hausler (1995)George R. Healy (1995)Klaus Hedman (1995)Nancy K. Henry (1994)John E. Herrman (1995)Kenneth L. Herrmann (1994)Dwight C. Hirsh (1995)Rick Hodinka (1995)Barry Holmes (1994)Russell C. Johnson (1994)Wendy M. Johnson (1994)Ronald N. Jones (1993)James H. Jorgensen (1994)Daniel L. Kacian (1995)Naynesh Kamani (1993)Raymond L. Kaplan (1993)Neil E. Kay (1994)Mark G. Keen (1995)George E. Kenny (1994)Pamela C. Kibsey (1994)Mogens Kilian (1994)Wesley E. Kloos (1994)Peter J. Krause (1993)Geoffrey A. Land (1993)Alan Landay (1994)Brent A. Lasker (1995)Rance B. LeFebvre (1995)Paul F. Lehmann (1995)

Phyllis A. Leist (1993)Walter J. Loesche (1994)Louis A. Magnarelli (1995)James B. Mahony (1994)W. J. Martin (1995)Octavio V. Martinez (1995)Kenneth H. Mayer (1994)Leonard W. Mayer (1993)Dennis J. McCance (1994)Joseph E. McDade (1994)Patrick L. McDonough (1993)Geoffrey A. McKinley (1994)John C. McKitrick (1993)James C. McLaughlin (1993)Patricia Mickelsen (1995)J. Michael Miller (1995)Roger H. Miller (1994)Lillian V. H. Moore (1994)Josephine A. Morello (1993)Stephen A. Morse (1995)Brian R. Murphy (1994)Irving Nachamkin (1994)Cynthia Needham (1993)Marguerite A. Neill (1993)David E. Normansell (1994)Paul A. Offit (1995)Orjan Olsvik (1995)Joseph V. Osterman (1994)Timothy L. Overman (1994)Andrew Pachner (1993)Charlotte D. Parker (1995)A. William Pasculle (1995)John L. Penner (1993)David H. Persing (1995)Edward Pesanti (1994)Ellena M. Peterson (1995)Stephen R. Petteway, Jr. (1993)Marie T. Pezzlo (1995)Michael A. Pfaller (1993)M. John Pickett (1994)David H. Pincus (1995)Leon N. D. Potgieter (1994)Lucille E. Rasmussen (1994)Russell L. Regnery (1995)

Jack S. Remington (1995)Michael Rinaldi (1994)W. Gerard Robey (1994)Barbara Robinson-Dunn (1995)Richard F. Ross (1995)Steve Rowell (1995)Lorry G. Rubin (1993)Kathryn L. Ruoff (1993)Raymond W. Ryan (1994)Eugene W. Rypka (1995)R. Bradley Sack (1993)Daniel F. Sahm (1993)Paul C. Schreckenberger (1993)Tom G. Schwan (1994)Joseph D. Schwartzman (1994)Susan E. Sharp (1995)Emmett B. Shotts, Jr. (1995)Lynne Sigler (1994)Paul E. Steele (1994)Charles W. Stratton (1993)Nancy A. Strockbine (1994)Terrence L. Stull (1994)Richard Summerbell (1994)Ella M. Swierkosz (1993)Phillip Tarr (1994)Patricia E. Taylor (1994)Kenneth W. Theil (1994)Grace M. Thorne (1994)Lauri D. Thrupp (1995)Thomas J. Tinghitella (1994)Bent Faber Vestergaard (1993)Alexander von Graevenitz (1995)I. Kaye Wachsmuth (1993)Thomas J. Walsh (1994)Joseph L. Waner (1995)Lawrence G. Wayne (1995)Melvin P. Weinstein (1995)Robert W. Wilmott (1994)Kwei-Hay D. Wong (1995)G. N. Woode (1994)Charles H. Zierdt (1994)Steven Zuckerman (1994)

Barbara H. Iglewski, Chairman, Publications Board Linda M. lhlig, Director, JournalsKathleen M. Whalen, Production Editor

The Journal of Clinical Microbiology, a publication of the American Society for Microbiology (ASM), 1325 Massachusetts Ave., N.W., Washington, DC20005-4171, is devoted to the dissemination of new knowledge concerning the applied microbiological aspects of human and animal infections and infestations,particularly regarding their etiologic agents, diagnosis, and epidemiology. Papers dealing with antibiotics and antimicrobial agents and chemotherapy, withfundamental aspects of infection and immunity, and with food or dairy microbiology fall within the scope of other ASM publications. Instructions to authors arepublished in the January issue each year; reprints are available from the editors and the Journals Division. The Journal is published monthly, one volume per year.The nonmember print subscription prices are $251 (U.S.) (Canadians add 7% GST) and $295 (other countries) per year; single copies are $40 (Canadians add 7%GST). The member print subscription prices are $46 (U.S.) (Canadians add 7% GST) and $77 (other countries); single copies are $10 (Canadians add 7% GST).For prices of CD-ROM versions, contact the Subscriptions Unit, ASM. Correspondence relating to subscriptions, defective copies, missing issues, andavailability of back issues should be directed to the Subscriptions Unit, ASM; correspondence relating to reprint orders should be directed to the Reprint OrderUnit, ASM; and correspondence relating to disposition of submitted manuscripts, proofs, and general editorial matters should be directed to the Journals Division,American Society for Microbiology, 1325 Massachusetts Ave., N.W., Washington, DC 20005-4171. Phone: (202) 737-3600.Claims for missing issues from residents of the United States, Canada, and Mexico must be submitted within 3 months after publication of the issues; residentsof all other countries must submit claims within 6 months of publication of the issues. Claims for issues missing because of failure to report an address changeor for issues "missing from files" will not be allowed.Second-class postage paid at Washington, DC 20005, and at additional mailing offices.POSTMASTER: Send address changes to Journal of Clinical Microbiology, ASM, 1325 Massachusetts Ave., N.W., Washington, DC 20005-4171.Made in the United States of America. Printed on acid-free paper.Copyright © 1993, American Society for Microbiology. All Rights Reserved. ISSN 0095-1137 CODEN: JCMIDWThe code at the top of the first page of an article in this journal indicates the copyright owner's consent that copies of the article may be made for personal useor for personal use of specific clients. This consent is given on the condition, however, that the copier pay the stated per-copy fee through the Copyright ClearanceCenter, Inc., 27 Congress St., Salem, MA 01970, for copying beyond that permitted by Sections 107 and 108 of the U.S. Copyright Law. This consent does notextend to other kinds of copying, such as copying for general distribution, for advertising or promotional purposes, for creating new collective works, or for resale.

EDITORIAL POLICY STATEMENT

The editors of the Journal of Clinical Microbiology (JCM) wish to renew their commitment to clinicalmicrobiology in response to some concerns registered by our readers. As a consequence, we haveproposed changes to the arrangement of papers within the journal.We recognize that the nature of some of the papers published in JCM has changed because of a

growing emphasis on molecular technology for the detection and identification of microorganisms. Thisis as inevitable as the evolution of our discipline. However, the scope of JCM has not changed. Thejournal exists to meet the educational and scientific communication needs of practicing clinicalmicrobiologists, researchers, and teachers. JCM will continue to welcome the submission of manu-scripts of a practical nature as well as those that are at the forefront of our science. We urge ourcolleagues to submit well-written case reports and papers on comparisons of products used in clinicalmicrobiology and serology laboratories as well as articles of a fundamental and developmental naturewhich advance our knowledge of clinical microbiology. We remind the authors of such studies that afavorable review generally depends on a well-constructed and -controlled study design, a test samplenumber adequate to demonstrate statistically significant findings (particularly reactive specimens), andthe novelty of the work.

Beginning with this issue, the Table of Contents has been simplified. The editors have chosen toreturn to the roots of the journal. The Table of Contents in the November 1993 issue of JCM bears astriking resemblance to that of January 1976. This should be construed not as a regressive step, butrather one which aids readers in locating articles of interest. Whenever possible, articles will be listed byorganism group. The following major headings have been adopted: Bacteriology, Chlamydiology andRickettsiology, Mycobacteriology and Aerobic Actinomycetes, Mycology, Parasitology, and Virology.Clinical Veterinary Microbiology and Epidemiology, because of their unique natures, will retain theirseparate designations. Solicited guest commentaries as well as minireviews on topical issues andletters to the editor responding to articles previously published in JCM will complete the Table ofContents. As the journal name indicates, all papers submitted to JCM must have relevance to clinicalmicrobiology; therefore, it was felt that the major headings General Clinical Microbiology and MolecularClinical Microbiology were redundant, and these have been deleted. All papers formerly assigned tothese sections will now be distributed to the appropriate organism group. A few papers in the oldImmunology section will be assigned to the newest ASM journal, Clinical and Diagnostic LaboratoryImmunology. Serology papers will continue to be published in JCM but will also be assigned to theappropriate section.The editors recognize that gene amplification and other molecular techniques are important tools in the

clinical microbiology laboratory. However, of primary interest to the readership is the application of thesetools to laboratory diagnosis and epidemiologic characterizations. Editorial priority will be given to thosepapers which document the value of such methods in providing a diagnostic advantage and the resolutionof epidemiological dilemmas.JCM covers a broad range of interests. To be faithful to its readers, JCM must continue to publish papers

that can be directly applied to practical problems. Equally important, JCM must continue to be at the forefrontof those technologies that are inexorably moving us toward the rapid and relevant detection of microorgan-isms, the diagnosis of diseases, and the identification of effective therapeutic agents well into the 21stcentury.

The Editors

Author IndexAbd-Alla, Mohammed D.,

2845Ajello, Libero, 2967Alstad, A. D., 3028Anderson, Eileen C., 2981Anderson, John F., 2857Arnold, C., 3007Aymard, M., 2890Ayoub, Elia M., 3058

Bag, Prasanta K., 3068Bange, Franz-Christoph, 2882Baranton, G., 2873Bart-Delabesse, Emmanuelle,2933

Barton, Leslie L., 3058Bauwens, J. Eric, 3013, 3023Belfaiza, J., 2873Bellenger, E., 2873Bhattacharya, S. K., 3068Boiron, Patrick, 2933Bono, Fulvia, 2913B6ttger, Erik C., 2882Brown, D. W. G., 3007Bruckner, D. A., 3056

Carlotti, Arnaud, 2933Carson, M., 3001Casillas, Silvia M., 2901Cerino, Antonella, 2913Christensson, Bertil, 3036Clark, Agnes M., 3013, 3023Clarke, I. L., 2895Colley, Jane, 2927Corney, Bruce G., 2927Coyle, Marie B., 3060

Daly, Judy A., 2996Dawson, Jacqueline E., 3058Day, Rosmini, 2947Deau, Marie-Christine, 2918Desmond, Edward, 3040de Wit, Madeleine Y. L., 2947Dillon, Jo-Anne R., 3053Dimech, W. J., 3001Djordjevic, Steven P., 2927Dupont, Bertrand, 2933

Egnell, Per, 3036El-Hawey, Ahmed M., 2845Ellis, S., 3001Essig, A., 3050Estes, Mary K., 2866

Favre, Michel, 2918Ferguson, David, 2851, 3031Flock, Jan-Ingmar, 3036

Flores, Martha, 3040Fuchs, F., 2890Funke, Guido, 2907

Gathiram, Vindoh, 2845Gill, Vee J., 3071Gilligan, Peter H., 2861Glass, R. I., 2866Goldwater, Paul N., 3063Gorziglia, Mario, 3075Graham, Glenn C., 2927Green, J., 3007Groman, Neal B., 3060Gumery, L. B., 3017Gustafson, G. A., 3028

Hajdu, Marie-Paule, 2952Hampson, D. J., 2895Hellyar, A. G., 3001Heneine, Walid, 3042Henkel, W., 3050Herd, R. P., 2944Herman, Steven A., 3013Hernandez, Francisco, 2967Hindler, J., 3056Hirokawa, M., 2974Horigome, Kazuki, 3068

Ichihara, K., 2974Ishihara, Yuichi, 2938Isomura, Shin, 2938

Jablonska, Stefania, 2918Jackson, Terry F. H. G., 2845Jiang, Xi, 2866Jordens, J. Zoe, 2981Jorgensen, James H., 2841

Kai, Akemi, 3034Katz, J. B., 3028Katzenstein, David A., 2960Kaufmann, M. E., 3017Kelly, William F., 2861Kiekenbeck, Monika, 2882Kirschner, Philip, 2882Klatser, Paul R., 2947Koella, Jacob C., 3044Kopecka, H., 2890Korgenski, E. Kent, 2996Kotiw, M., 3001Kudoh, Yasuo, 3034Kurozano, Hisao, 3068

Landry, Marie L., 2851, 3031Leaves, Nicholas I., 2981Leparc, I., 2890Lewis, D., 3007

Li, Baoguang, 3075Loeffelholz, Michael J., 3013Lucchini, Gladys Martinetti,2907

Maass, M., 3050Madjid, Baedah, 2947Magnarelli, Louis A., 2857Manning, Paul A., 3063Marchiani, Marcello, 2907Marcon, D., 3001Marre, R., 3050Marti, Hanspeter, 3044Matsuda, N., 2974Matsuda, Yukihisa, 3046Matsushita, Shigeru, 3034Mbithi, John N., 2988McLeod, Rima, 2952McMillon, Lewis T., 2861Meier, Albrecht, 2882Mendoza, Leonel, 2967Merigan, Thomas C., 2960Mollby, Roland, 3036Mondelli, Mario U., 2913Monroe, Stephan S., 2866Moser, K. M., 3028Mwaniki, C. G., 2895

Nair, G. Balakrish, 3068Nakagiri, I., 2974Nakagomi, Osamu, 3046Ng, Lai-King, 3053Norcott, J. P., 3007Novak, S. M., 3056Nowowiejski, David J., 3060

Ohmoto, K., 2974Orth, Gerard, 2918

Pacquette, Michelle, 2988Pal, Amit, 3068Paton, Adrienne W., 3063Paton, James C., 3063Pfyffer, Gaby E., 2907Piazza, Valter, 2913Pitt, T. L., 3017Postic, D., 2873

Ramamurthy, T., 3068Ramirez, Raymund, 2952Rathore, Mobeen H., 3058Ravdin, Jonathan I., 2845Reddy, P. Gopal, 3042Regnery, Russell L., 3058Remington, Jack S., 2952Robertson, I. D., 2895Rueda, Luis-Alfredo, 2918

Russell, Jennifer Q., 3060

Saint Girons, I., 2873Sakae, Kenji, 2938Salinas-Carmona, Mario C.,2901

Sanekata, Takeshi, 3046Sapp, Walter J., 3042Sato, Mitsuo, 3046Sattar, Syed A., 2988Shapiro, Daniel S., 2861Shih, Chien-Ming, 2878Silini, Enrico, 2913Slack, Mary P. E., 2981Smith, D. L., 3017Smith, E. G., 3017Solcia, Enrico, 2913Spielman, Andrew, 2878Springer, Burkhard, 2882Springthorpe, V. Susan, 2988Stableforth, D. E., 3017Stamm, Walter E., 3013, 3023Steed, Lisa L., 2996Stine, Sarah E., 2866Suzuki, Yoshiyuki, 3046

Tajima, Kazuhiko, 3046Takeda, Tae, 3068Takeda, Yoshifumi, 3068Tan, Lily B., 2960Thulliez, Philippe, 2952Trott, D. J., 2895

Uesaka, Yoshihiko, 3068Utagawa, Etsuko, 2938

van Beers, Stella, 2947Vogel, Ulrich, 2882von Graevenitz, Alexander,

2907

Wait, Kimberley J., 2861Walden, T. Paul, 2861Welsh, Oliverio, 2901Whittier, Susan, 2861Whittington, Richard, 2927Winters, Mark A., 2960Wrede, Annette, 2882

Xiao, Lihua, 2944

Yamada, Sumio, 3034Yamasaki, Shinji, 3068Yamashita, Teruo, 2938Yeung, Kwok-Him, 3053Yew Wong, Sin, 2952

Zierdt, Charles H., 3071Zierdt, Willadene S., 3071

1994 APPLICATION FOR FULL MEMBERSHIP IN THEAMERICAN SOCIETY FOR'MICROBIOLOGY

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Call for Papers

CLINICAL AND DIAGNOSTIC LABORATORY IMMUNOLOGY

The American Society for Microbiology will commence publication of a bimonthly journal, Clinical andDiagnostic Laboratory Immunology, in January 1994 that will bring together information on the latestdevelopments in human immune response assessment, including indications for testing, methods, andinterpretation of results.

Peer-reviewed research articles describing the laboratory diagnostic aspects of the following will be featured:

* humoral and cellular immunity, including specific immune cell functions (B cells, T cells, and their subsets)* mediators and cytokines, complement components, and other serum proteins* natural killer cells, monocytes/macrophages, neutrophils, and myeloid cells* immune responses to infection caused by bacteria, viruses, fungi, and parasites* AIDS and other retroviral diseases* primary and secondary immunodeficiency disorders* evaluation of hypersensitivity and autoimmune diseases* histocompatibility and transplantation immunology* lymphoreticular malignancies and cancer immunology* immunogenetic testing applied to human disease diagnosis and evaluation* immunologic monitoring, including flow cytometry and vaccine therapy* laboratory immunology as related to allergy, dermatology, immunohematology, rheumatology, neurology,

oral medicine, and other medical and surgical subspecialties

Novel animal models relevant to the diagnosis of human disease, animal studies on how to assess theimmune response, new or evolving technology in diagnostic methods, establishment of normal immunert.responses and/or values, case reports, quality control, and biostatistics are also suitable topics for thejournal.

Minireviews, guest commentaries, and letters to the editor will be included.

Editor in Chief: Steven D. Douglas. Editors: James D. Folds, David E. Normansell, Noet-R. Rose,Daniel P. Stites, and Theresa L. Whiteside.

Editorial Board: P. W. Askenase, J.-F. Bach, Z. H. Bentwich, G. F. Bottazzo, R. A. Bray, C. L Burek,D. E. Campbell, C. B. Carpenter, W. S. Ceglowski, 1. J. Check, L. Cook, K. M. Cast, S. Cunningham-Rundles, B. Detrick, J. Y. Djeu, P. Dore-Duffy, A. Etzioni, J. L. Fahey, T. Feizi, P.-J. Felsburg,T. A. Fleisher, M. M. Frank, H. Friedman, P. C. Giclas, B. C. Gilliland, J. A. Goeken, Ricard L. Gregory,R. J. Harbeck, R. B. Herberman, R. L. Hodinka, T. Hoffman, P. E. Hurtubise, J. C. Jennette, J. M. Kagan,N. R. Kamani, D. F. Keren, T. Kishimoto, P. Lalezari, A. L. Landay, S. A. Larsen, M. F. La Via,M. S. Leffell, J. A. Levy, S. A. Lobel, L. F. Mayer, J. B. Natvig, K. Okumura, C.-K. Osterland,L. M. Pachman, J. E. W. Palmblad, G. M. Penn, R. Per._y, J. B. Peter, P. K. Peterson, C. A. Phillips,C. D. Platsoucas, S. A. Plotkin, H. E. Prince, B. S. Rabin, E. Reiss, N. J. Roberts, J. L Rossio*R. F. Schell, R. T. Schooley, P. H. Schur, S. A. Schwartz, N. H. Sigal, L. E. Silberstein, S. C.-Specter,E. R. Stiehm, J. Verhoef, G. Virella, G. N. Vyas, M. E. Weksler, J. A. Winkelstein, A. Zeevi, S. Zoll4-Pazner,D. Zucker-Franklin, S. H. Zuckerman, and B. Zweiman.

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