J Antimicrob Chemother, 1986 Dec, 18(6), 719 - 27 Enoxacin in lower respiratory tract infections; Wijnands WJ et al.; In this open, non-comparative study 45 lower respiratory tract infections were treated with the new 4-quinolone, enoxacin . Special attention was paid to infections caused by Pseudomonas aeruginosa . Pseudomonas infections were treated with 600 mg bd . whereas infections caused by other bacteria were treated with 400 mg enoxacin bd . In 43 cases efficacy could be assessed . In six out of 23 cases Pseudomonas spp . were eradicated from the sputum . In 12 of the remaining 17 cases a clear reduction in bacterial numbers and a decrease of sputum volume and purulence were obtained . Clinical improvement or cure was obtained in 20 out of the 23 cases . Most of the causative microorganisms in the other infections were eradicated . In two patients Staphylococcus aureus persisted . Overgrowth with streptococci occurred in three patients . Adverse reactions were frequent and occurred in 29 out of 45 treatment periods . They were mainly related to the gastrointestinal tract and the central nervous system . In 25 out of 30 patients on concomitant treatment with theophylline an elevation of plasma theophylline concentrations occurred . Twelve of these patients developed signs and symptoms possibly related to theophylline toxicity . After treatment with enoxacin the MICs of most persisting Pseudomonas strains were two to four times higher than pre-treatment values. Infect Immun, 1986 Dec, 54(3), 846 - 54 Potential role of lysozyme in bactericidal activity of in vitro-acquired salivary pellicle against Streptococcus faecium 9790; Germaine GR et al.; The adherence of Streptococcus faecium 9790 to hydroxyapatite (HA) coated with whole saliva supernatant proteins (S-HA) or parotid fluid proteins was studied . The organism was labeled with {3H}thymidine, and adherence was estimated as the radioactivity remaining associated with the variously coated HA preparations after incubation and removal of unbound microbes by washing the adherence substratum . Adherence was time dependent and saturable, characteristics typical of oral streptococci in this in vitro adherence model system . However, adherence to S-HA, but not bare HA, was decreased 20-fold at 4 degrees C compared with room temperature . Furthermore, adherence at 4 degrees C to S-HA was decreased 20-fold relative to bare HA at 4 degrees C . Adherence to HA coated with parotid fluid proteins also was reduced at 4 degrees C . The magnitude of the temperature dependence and the inhibitory effect at 4 degrees C of whole saliva or parotid fluid pellicles on HA was unexpected . Of several sugars and amino sugars tested, the chitin saccharides, chitotriose, chitobiose, and N-acetylglucosamine caused greater than 90% inhibition of adherence to S-HA . These same saccharides were previously shown to inhibit lysozyme, polylysine, or autolytic lysis of the organism (N . J . Laible and G . R . Germaine, Infect . Immun . 48:720-728, 1985) . Examination of unbound and adherent microbes revealed that lysis of the organism occurred during the adherence assays . A strong association (r = 0.83) between the extent of lysis and the extent of adherence was found under a variety of conditions . Depletion of lysozyme from saliva specimens used to coat HA resulted in a greater than 90% decrease in both cell lysis and adherence . Lysis of the microbe appeared dependent upon the presence of the saliva pellicle (coating) on HA, since solutions containing proteins desorbed from HA during mock-adherence incubations possessed lytic activity that was 2- to 10-fold too low to account for the extents of lysis observed with greater than or equal to 10(8) input cells . These results demonstrate the potential antibacterial activity of acquired salivary pellicle on enamel in vivo and the likely role of lysozyme in this activity . The data also serve to caution that this widely used in vitro adherence model will not distinguish whole-cell adherence from the adsorption of radiolabeled DNA released from lysing cells . Several additional controls are suggested that will indicate whether test microbes remain intact or lyse during adherence trials. J Immunol Methods, 1986 Nov 20, 94(1-2), 113 - 8 Assessment by a fluorochrome microassay of phagocytic killing of group B streptococci adherent to glass; Rainard P; An in vitro adherence assay was developed to study the interaction between bovine polymorphonuclear cells (PMN) and group B streptococci (GBS) on glass . The kinetics of uptake and killing of GBS in the presence and absence of opsonins were compared by staining bacteria with a fluorochrome (acridine orange) . Opsonization was not required for the PMN to ingest and kill glass-adherent GBS . Nevertheless, the presence of serum during the phagocytosis incubation, or preopsonization of bacteria, both increased the rate of ingestion and the number of bacteria per PMN at the end of the reaction (90 min) . Precolostral calf serum (PCS), almost devoid of antibodies, was as effective as normal bovine serum in this respect . By contrast, PCS was not an effective opsonin source when phagocytosis took place in suspension, demonstrating further that different underlying mechanisms operate depending on the physical presentation of bacteria to phagocytes . It was noted that PMN monolayers were able to ingest unopsonized bacteria that merely settled on the glass surface during phagocytosis incubation . The method should permit investigations on the mechanisms involved in surface phagocytosis, a defense mechanism of potential importance in local infections. JAMA, 1986 Nov 7, 256(17), 2386 - 8 Gianotti-Crosti syndrome associated with infections other than hepatitis B; Draelos ZK et al.; Although the Gianotti-Crosti syndrome (GCS) is regularly associated with hepatitis B infection elsewhere, in North America that association is rarely made . Accordingly, we studied nine children with acral, symmetrical eruptions typical of GCS for evidence of other infections . All were negative for hepatitis B surface antigen . Viral cultures were done in nine patients, and viruses isolated in two . One patient with a respiratory prodrome had respiratory syncytial virus (RSV) isolated, and a second patient studied simultaneously showed serological evidence of RSV infection . A third patient with both respiratory tract and gastrointestinal tract symptoms yielded a polio-vaccine enterovirus . Two patients with fever and pharyngitis had group A beta-hemolytic streptococci isolated from the throat . Skin biopsies were done in three cases, and findings were consistent with GCS . Electron microscopy of two lesional biopsy specimens failed to demonstrate viral particles . Epstein-Barr virus serological findings were negative in six cases and showed evidence of past infection in three cases . This study strengthens the observation that hepatitis B is not the causative agent of GCS in this country and suggests that multiple infectious agents may be associated with this distinctive exanthem. J Antimicrob Chemother, 1986 Nov, 18 Suppl D, 159 - 64 Ciprofloxacin for soft tissue infections; Wood MJ et al.; Twenty-one patients with cellulitis or other bacterial soft-tissue infections were treated with oral ciprofloxacin . One patient developed nausea and vomiting and was withdrawn from the study, but 19 of the other 20 were clinically cured or improved . Only nine of the original 18 bacterial isolates were completely eradicated, however, the majority of the failures being staphylococci or streptococci . There was no evidence from disc sensitivity testing of resistance developing during treatment . No serious toxicity was seen. Medicine (Baltimore), 1986 Nov, 65(6), 415 - 31 Brain abscess . A study of 45 consecutive cases; Chun CH et al.; Clinical features, findings of diagnostic studies, results of therapy, and prognostic factors were analyzed in 45 patients with brain abscesses . The number of patients diagnosed yearly has increased since CT scanning became available, but despite the enhanced sensitivity, the time from either onset of symptoms or hospital admission until initiation of therapy was not decreased and there was no dramatic effect upon morbidity or mortality in this series . Infections of paranasal sinuses, ears, lungs, and odontogenic foci were predisposing factors in approximately 70% of cases . Single abscesses, present in 75% of patients, were distributed equally in both hemispheres, with more than half in the frontal and parietal lobes . Common signs and symptoms included headache, fever, chills, seizures, nausea, vomiting, altered sensorium, nuchal rigidity, and localizing neurologic signs . Blood cultures were positive in 11% . Lumbar puncture rarely provided data from which a diagnosis could be established; CSF cultures were positive in only 7% of patients, and there was a 15% temporally associated incidence of brain herniation and death . Diagnostic information was most readily obtained using imaging techniques such as CT and 99mTc scanning, and arteriography was invasive and of no added value . CT scans are however, often initially negative in patients presenting with clinical signs of meningitis presumably following rupture of an abscess into the subarachnoid space, and the average time for changes to appear on CT scan is 9 days . It is, therefore, recommended that when the clinical assessment suggests the possibility of brain abscess the patient be treated empirically with antibiotics and that lumbar puncture be performed only after thoughtful assessment of the risk-to-benefit ratio for each patient . Causative organisms were isolated from more than 80% of abscesses despite prior antibiotic treatment; more than half grew a single pathogen, most commonly streptococci . Anaerobic and microaerophilic bacteria accounted for 62% of all isolates, and were the only organisms in 33% of patients . Computerized tomographic scans in 30 patients showed "ring-enhancing" lesions, nodular enhancement, or areas of low attenuation . Complete resolution of abscesses on CT scans rarely occurred during hospitalization and took as long as 5 months . Decrease in the size of abscesses on CT scan correlated well with clinical improvement and was seen within a week when abscesses were excised, but was often not obvious for 6 to 8 weeks if antibiotics were used alone.(ABSTRACT TRUNCATED AT 400 WORDS) J Exp Med, 1986 Nov 1, 164(5), 1407 - 21 Subcellular location and properties of bactericidal factors from human neutrophils; Gabay JE et al.; We examined the subcellular location of bactericidal factors (BF) in human neutrophils, using an efficient fractionation scheme . Nitrogen bomb cavitates of DIFP-treated PMN were centrifuged through discontinuous Percoll gradients, each fraction extracted with 0.05 M glycine, pH 2.0, and tested for the killing of Escherichia coli . greater than 90% of BF coisolated with the azurophil granules . After lysis of azurophils, 98% of azurophil-derived BF (ADBF) sedimented with the membrane . ADBF activity was solubilized from azurophil membrane with either acid or nonionic detergent (Triton X-100, Triton X-114) . Bactericidal activity was linear with respect to protein concentration over the range 0.3-30 micrograms/ml . 0.1-0.3 microgram/ml ADBF killed 10(5) E . coli within 30 min at 37 degrees C . At 1.4 micrograms/ml, 50% of 2 X 10(5) bacteria were killed within 5 min . ADBF was effective between pH 5-8, with peak activity at pH 5.5 . Glucose (20 mM), EDTA (1-25 mM), and physiologic concentrations of NaCl or KCl had little or no inhibitory effect on ADBF . ADBF killed both Gram-positive and Gram-negative virulent clinical isolates, including listeria, staphylococci, beta-hemolytic streptococci, and Pseudomonas aeruginosa . Thus, under these conditions of cell disruption, fractionation, extraction, and assay, almost all BF in human PMN appeared to be localized to the membrane of azurophilic granules as a highly potent, broad-spectrum, rapidly acting protein(s) effective in physiologic medium . Some of these properties appear to distinguish ADBF from previously described PMN bactericidal proteins. J Clin Microbiol, 1986 Nov, 24(5), 705 - 7 Human Fc(gamma) receptors for differentiation in throat cultures of group C "Streptococcus equisimilis" and group C "Streptococcus milleri"; Lebrun L et al.; The biochemical characteristics and the presence of human Fc(gamma) receptors of 52 throat isolates of group C beta-hemolytic streptococci were examined . Among these isolates, 38 were identified as "Streptococcus milleri" and 14 were identified as "Streptococcus equisimilis." The differentiation of group C "S . equisimilis" from "S . milleri" with identical group antigens was easy to perform by the measurement of the size of the hemolytic zone on a sheep blood agar plate in an anaerobic atmosphere and by biochemical tests (Voges-Proskauer test) . A clear-cut criterion for differentiation was noted among these isolates, i.e., the presence of Fc(gamma) receptors . "S . equisimilis," which are generally associated with pharyngitis, possess human Fc(gamma) receptors, while "S . milleri", which are generally isolated from healthy persons, have no such receptors. Infect Control, 1986 Nov, 7(11), 558 - 60 The Streptococcus milleri group; Verrall R; The Streptococcus milleri group is newly recognized as a cause of pyogenic infection . It is important that microbiologists and physicians become aware of these organisms . The heterogeneous nature of this group of streptococci does mean that laboratories will have to use a combination of antigenic, physiologic, and hemolytic characteristics to identify these pathogenic streptococci . Physicians need to recognize that these microorganisms as a group are able to cause serious infections that may require prolonged treatment and/or surgical drainage of abscesses. Zentralbl Bakteriol Mikrobiol Hyg {A}, 1986 Nov, 262(4), 492 - 9 Adherence of vaginal and pharyngeal strains of group B streptococci to human vaginal and pharyngeal epithelial cells; Jelinkova J et al.; In vitro tests for adherence to human vaginal and pharyngeal epithelial cells were used to study the problem of tissue-specific tropism in group B streptococci (GBS) . Twenty-two vaginal or pharyngeal clinical isolates of GBS (serotypes Ia, Ib, II, and III) were used . No significant differences in adherence to vaginal and pharyngeal epithelial cells were found between GBS from both sources: statistical analysis furnished no evidence for tissue-specific tropism . Serotype III vaginal GBS adhered better to vaginal and pharyngeal epithelial cells than did serotype III GBS strains isolated from the pharynx . However, pronounced differences in the level of adherence were found among strains of the same serotypes and from the same sources . Thus, the results obtained suggest that differences in adherence may rather be strain-dependent that type-dependent. Pediatr Infect Dis, 1986 Nov-Dec, 5(6), 754 - 9 Diagnosis and management of children with streptococcal pharyngitis; McCracken GH Jr; Physicians must be aware that rheumatic fever can no longer be considered a disease of the past and be prepared to diagnose and treat promptly children with streptococcal pharyngitis . Although the rapid diagnostic kits for detecting Group A streptococci in pharyngeal swabs are not perfect, they can be useful to the practitioner if positive because the specificity of the test is excellent . Thus, a child with pharyngitis who has a positive rapid test should be treated immediately to shorten the period of morbidity and to reduce the risk of nonsuppurative sequelae . Upon completion of a 10-day treatment course there is usually no reason to reculture the pharynx if the child is asymptomatic . Recurrence of symptoms is an indication to perform another culture and to retreat with either benzathine penicillin G or erythromycin depending on compliance of the patient and the agent used initially for therapy . Eradication of Group A streptococci from the pharynx of children who are carriers is usually a difficult and unnecessary task . When eradication is indicated, such as when the carrier has had contact with a person who had rheumatic fever, rifampin should be added to the penicillin regimen (Table 4). Vet Microbiol, 1986 Nov, 12(4), 297 - 328 Biology of the group E streptococci: a review; Wessman GE; Group E streptococci are identified by a group antigen consisting of a cell wall rhamnose-glucose polymer . Other specific cell wall polysaccharides separate the group into at least six serotypes (II, IV, V, VI, VII and VIII) . No species name has been accepted for the group E Streptococcus, although the organism is often designated as Streptococcus infrequens or S . lentus . Recently, the name S . porcinus has been proposed for a species that would include streptococci of groups E, P, U and V . Group E streptococci are fairly widely distributed in animals, especially swine, and are occasionally isolated from bovine milk . They cause streptococcal lymphadenitis of swine, an economically important disease, particularly in the United States . They do not appear to be the primary cause of any other disease or condition . The organisms enter the swine host through the mucosa of the pharyngeal or tonsillar surfaces, and are carried to the lymph nodes, primarily of the head and neck region, where abscesses are formed . Cell wall antigens induce the formation of serum agglutinins; a microtitration agglutination test, based upon reactions involving the type IV antigen, is considered a reliable test for detection of infection in animals . Antigenic components include group and type antigens, extra-cellular enzymes, and an antiphagocytic factor which may be associated with virulence of the organism and with protective immunity to streptococcal lymphadenitis of swine . This factor, a surface protein, develops on cells cultured in media fortified with serum, rendering the cells resistant to phagocytosis by porcine leukocytes . The classification, morphology, physiology, biochemistry and nutrition of the group E streptococci, and methods for their isolation, cultivation, and identification are reviewed. Diagn Microbiol Infect Dis, 1986 Nov, 5(4), 323 - 6 Group A streptococcal pharyngitis and bacteremia associated with a Ludwig's angina-like syndrome; Dolan S et al.; Ludwig's Angina (LA) is an infection of the submandibular and sublingual spaces usually initiated by abscesses of the inferior molars due to mixed oral flora . Pharyngitis due to group A beta-hemolytic streptococci (GABHS) rarely results in bacteremia . A patient presented with the classical findings of LA, and had no odontogenic focus but had GABHS pharyngitis and bacteremia . Attempts to isolate other microbiological organisms from the submandibular and sublingual spaces were unsuccessful . The patient required emergent tracheostomy and was treated with penicillin G for 4 wk with complete resolution of his clinical illness . The case demonstrates a previously unreported association between GABHS pharyngitis and the development of LA. Diagn Microbiol Infect Dis, 1986 Nov, 5(4), 293 - 8 Comparative evaluation of PathoDx Strep A test and culture for the detection of group A streptococci in pharyngeal specimens; Granato PA et al.; The PathoDx Strep A kit, a 10-min acid extraction and latex agglutination test, was compared with routine culture for the direct detection of group A beta-hemolytic streptococci (BHS) in 414 pharyngeal specimens collected from children with pharyngitis . The results showed that the latex test compared favorably with culture for detecting group A BHS in pharyngeal specimens (sensitivity 96.7%, specificity 97.9%, and positive and negative predictive values of 97.2% and 97.4%, respectively) . The comparable number of false-positive (five) and false-negative (six) latex tests along with review of patient histories suggest that these discrepant results were attributable to sampling error during specimen procurement rather than deficiencies in the latex kit . In addition, clear-cut, agglutination reactions were obtained in over 96% of positive latex tests regardless of the amount of group A BHS that was recovered by culture . The PathoDx Strep A test is a rapid, reliable noncultural alternative for the detection of group A BHS in pharyngeal specimens. Am J Obstet Gynecol, 1986 Nov, 155(5), 979 - 83 Prevention of neonatal group B streptococcal sepsis by the use of a rapid screening test and selective intrapartum chemoprophylaxis; Morales WJ et al.; A randomized 18-month study was conducted to determine the effect of intrapartum chemotherapy in the prevention of neonatal group B streptococcal disease . Twelve hundred seven indigent patients at term were screened weekly for group B streptococci antenatally with a rapid test based on coagglutination methods and at the time of admission in labor, 263 (22%) were confirmed to have colonization, 67 of which had heavy colonization . One hundred thirty-five of these mothers were randomized to a group treated with 1 gm of ampicillin intravenously every 6 hours until delivery . The remaining 128 mothers were not treated . None of the infants born to the treated mothers had colonization with group B streptococci at surface culture sites . Fifty-nine (46%) of the infants born to untreated mothers, including 24 of 30 (80%) from mothers with heavy colonization, had colonization . Ampicillin treatment administered during labor to pregnant patients with heavy colonization significantly reduced vertical transmission of group B streptococci. Am J Clin Pathol, 1986 Nov, 86(5), 624 - 8 Suitability of a throat culture method for evaluation of group A streptococcal antigen detection kits; Kellogg JA et al.; Previous reports have indicated a wide variation in observed sensitivity of antigen-detection kits for group A streptococci . Before undertaking an evaluation of these new kits, the sensitivity of the throat culture technic routinely used by this laboratory was reexamined . Each throat swab was directly inoculated to sheep blood agar containing trimethoprim-sulfamethoxazole (SXT X BA) and drug-free sheep blood agar (SBA) plates . Swabs were then washed in saline and the saline used to inoculate one more of each type of medium . SXT X BA cultures were incubated aerobically (5 to 10% CO2), and SBA cultures were incubated anaerobically, both for two days at 35 degrees C . From 726 patients, 164 (22.6%) of the specimens contained group A streptococci, 99% detected on directly inoculated cultures and 100% on cultures inoculated with the saline wash . Either an aerobically (CO2) incubated SXT X BA or an anaerobically incubated SBA, directly inoculated and held for two days, appears to offer a satisfactory reference culture method for the recovery of group A streptococci. J Med Microbiol, 1986 Nov, 22(3), 257 - 64 Proteinase-related broad-spectrum inhibitory activity among group-A streptococci; Hynes WL et al.; Some 10% of group-A streptococci have inhibitory activity against all nine strains (eight of them streptococci) in a set of indicators in an inhibitor-production typing (P-typing) scheme . This activity was associated with the concurrent synthesis of cell-associated proteinase by the streptococcal strain . Inhibitor production was prevented either by incubation of the test strain in conditions inimical to proteinase production, e.g., at low temperature and alkaline pH, or by addition to the medium of substances, such as glucose, iodoacetic acid, lincomycin, Congo red or trypan blue, that had an anti-proteinase effect . Inhibitory activity was not detectable in liquid cultures, but freeze-thaw extracts of cultures of group-A streptococcus strain A1013 on Gibco Columbia Agar Base (Gibco Diagnostics, Madison, WI, USA) had some inhibitory activity . The inhibitor was concentrated and partially purified, and the active agent was shown to be a high-mol.-wt cationic protein which was bactericidal for various bacteria in the logarithmic growth phase, including the homologous producer strain. J Fam Pract, 1986 Nov, 23(5), 439 - 41 Evaluation of the fluorescent test for office-based detection of group A beta-hemolytic streptococci infection; Bracker MD et al.; Primary care physicians are frequently called upon to diagnose and treat streptococcal illness . Group A beta-hemolytic species have been associated with serious complications, making accurate diagnosis important to the clinician . This study was designed to compare a new test using a fluorescent tag with the traditional blood agar-bacitracin disc method and the capillary precipitin test . The fluorescent test for group A beta-hemolytic streptococci has been shown to be rapid and simple to perform . More important, the sensitivity and specificity appear to be equal to the capillary precipitin test and superior to the commonly used blood agar-bacitracin disc method. J Clin Microbiol, 1986 Nov, 24(5), 903 - 4 Effective murolytic solubilization of streptococcal-group-specific antigen; Lammler C et al.; Streptococcal-group-specific antigens were solubilized with a murolytic enzyme contained in the culture supernatant of Streptomyces globisporus . This facilitated the effective serogrouping of streptococci from humans and animals. J Dent Res, 1986 Nov, 65(11), 1332 - 4 Evidence suggesting multiple binding sites in experimental pellicles for Streptococcus mutans JBP; Peros WJ et al.; This study presents evidence suggesting that multiple binding sites exist for S . mutans JBP (serotype c) in experimental salivary pellicles formed on hydroxyapatite surfaces . Adsorption isotherms were performed using S . mutans JBP cells at concentrations ranging from 1-1000 (x 10(7) streptococci per mL to pellicles prepared from whole clarified saliva and from saliva which had been previously absorbed with JBP cells . The isotherms were analyzed using a one- and a two-site model . Adsorption of S . mutans JBP cells to pellicles formed from untreated saliva was statistically significantly better described by the two-site model, and the two classes of binding sites present had widely different affinities . Also, there were approximately one-third fewer high-affinity sites than low-affinity sites . In contrast, adsorption of S . mutans JBP cells to pellicles formed from JBP-absorbed saliva was better described by the one-site model, and the sites present were of low affinity . Thus, the absorption process appeared to remove or alter specific salivary molecules which comprise the high-affinity binding sites for S . mutans JBP cells. J Antimicrob Chemother, 1986 Nov, 18 Suppl D, 165 - 74 Preliminary evaluation of ciprofloxacin, a new 4-quinolone antibiotic, in the treatment of febrile neutropenic patients; Smith GM et al.; Twenty-four episodes of fever in neutropenic patients with haematological malignancy were treated with ciprofloxacin . In 13 episodes ciprofloxacin was used after failure of first-line antibiotic therapy, and in 11 episodes because of a history of allergy to the proposed first line antibiotics . Improvement or temporary improvement was seen in 64% of patients with evaluable infection . Fifty per cent of patients with bacteraemia improved . Resistance to ciprofloxacin developed in strains of staphylococci and streptococci, but Gram-negative organisms were generally extremely sensitive to the antibiotic . One patient developed a severe photosensitivity rash but there were no other adverse reactions . Preliminary pharmacokinetic data were obtained following intravenous infusion of 400 mg of ciprofloxacin in five patients . The mean plasma half-life was 3.6 +/- 1.0 h and the mean plasma clearance was 8.42 +/- 2.5 ml/min/kg. Rev Infect Dis, 1986 Nov-Dec, 8(6), 904 - 11 Bone and joint infections in intravenous drug abusers; Chandrasekar PH et al.; An analysis of data on 45 intravenous drug abusers treated for skeletal infection in 1982-1983 is presented . Eighty percent of patients were younger than 40 years old . None had any serious underlying illnesses . Septic arthritis was noted in 33 patients, osteomyelitis in seven, and both in five . Bone or joint infection involved the extremities in 78% of patients . The knee joint (left, 11 patients; right, four) was most commonly affected, and the left groin was the most frequent site of drug injections, a finding that suggests a relationship between the sites of injection and infection . Fever was absent in 16 (36%) of 45 patients . The predominant pathogens isolated were methicillin-resistant Staphylococcus aureus and groups A and G streptococci . Pseudomonas aeruginosa was much less common (11% of patients) . Treatment included bed rest, intravenous antibiotics, and arthrocentesis when needed . Surgery was required in only seven (16%) of 45 patients . The immediate prognosis for intravenous drug abusers with skeletal infection was excellent . Attempts to obtain follow-up information from most patients, however, were unsuccessful. Pediatr Infect Dis, 1986 Nov-Dec, 5(6), 649 - 54 Comparison of oral cephalosporins with penicillin therapy for group A streptococcal pharyngitis; Stillerman M; The purpose of the study was to compare the efficacy of cefaclor with that of penicillin V potassium (penicillin) in patients with Group A streptococcal pharyngitis . One hundred four children with pharyngitis and serologically confirmed Group A streptococci were randomly treated with cefaclor or penicillin using a mean dosage of 20 mg/kg/day for 10 days . The difference in failure rates (14% for 51 cefaclor- and 30% for 53 penicillin V-treated patients) was statistically significant (P = 0.04) . In four earlier similar studies I found that cephaloglycin, cephalexin (two studies) and cefatrizine were consistently but not significantly more effective than penicillin therapy . When the data from the five studies are combined the difference between the failure rates (11% for 263 oral cephalosporin- and 23% for 230 penicillin-treated patients) becomes highly significant (P less than 0.001) . The 95% confidence interval for the odds for treatment failure are 2.4 times greater for patients receiving penicillin than for those receiving one of the oral cephalosporins . On the basis of these data I conclude that the oral cephalosporins appear to be more effective than penicillin for therapy of Group A streptococcal pharyngitis. Drugs, 1986 Nov, 32(5), 425 - 44 Mupirocin . A review of its antibacterial activity, pharmacokinetic properties and therapeutic use; Ward A et al.; Mupirocin (pseudomonic acid A) is a novel topical antibacterial agent which inhibits bacterial protein and RNA synthesis . It has excellent in vitro activity against staphylococci and most streptococci, but has less activity against other Gram-positive and most Gram-negative bacteria . Its rapid systemic metabolism means it will only be used topically which, combined with its novel chemical structure, should make cross-resistance less likely to occur than with other currently available topical antibacterial agents . Mupirocin 2% ointment administered 2 or 3 times daily has shown excellent efficacy in both primary and secondary superficial skin infections, usually with at least 80% of patients being clinically cured or markedly improved, and over 90% eradication of the bacterial pathogen involved . Efficacy in impetigo and, to a somewhat lesser extent, infected wounds has been particularly convincingly demonstrated, while in other secondary skin infections the clinical response seen with mupirocin was often similar to the high success rate of vehicle alone . Limited evidence suggests that mupirocin may be as effective as chlortetracycline, fusidic acid, neomycin and other antibacterial agents, but more controlled, comparative studies are needed . The evidence of efficacy against nasal carriage of Staphylococcus aureus, including methicillin-resistant forms, is encouraging and currently work is being undertaken to improve the acceptability of the vehicle for this use . Side effects are limited to local reactions (in less than 3% of patients) and are no more frequent than observed with the vehicle alone . Thus, mupirocin appears to be a useful addition to the agents available for the treatment of superficial primary skin infections, such as impetigo, although its precise place in therapy remains to be established. Arch Dermatol, 1986 Nov, 122(11), 1273 - 6 Topical antibiotic treatment of impetigo with mupirocin; Eells LD et al.; Because the effectiveness of topical antimicrobials in the treatment of ecthyma, impetigo, and pyoderma is not well established, the US Food and Drug Administration has recently proposed guidelines for tests of topical antimicrobial efficacy in primary skin infections . The guidelines require both comparison with the agent's base and microbiologic documentation of efficacy . These guidelines were followed in this double-blind, eight-day evaluation of impetigo/ecthyma treated with mupirocin, a new agent that is only active topically . All cultures, before and after therapy, were taken using swabs dipped in neutralizing broth plus 10% fetal bovine serum to minimize antimicrobial "carry over" to the culture plate . Staphylococcus aureus, which was isolated from 94% of the patients before therapy, was eliminated in 88% of the mupirocin-treated patients and 47% of the vehicle-treated patients . Group A beta-hemolytic streptococci were eliminated in 100% of the mupirocin-treated and 0% of the vehicle-treated patients . To our knowledge, this is the first topical antibacterial treatment for primary skin infections proved superior to its vehicle using the proposed US Food and Drug Administration guidelines. Antimicrob Agents Chemother, 1986 Nov, 30(5), 781 - 4 In vitro activity of LY146032 against staphylococci, streptococci, and enterococci; Fass RJ et al.; The in vitro activities of LY146032 and seven comparative antimicrobial agents against 14 species of staphylococci, streptococci, and enterococci were studied . MICs of LY146032 were less than or equal to 0.5 microgram/ml for all staphylococci, including oxacillin-resistant strains; less than or equal to 0.25 microgram/ml for all streptococci (except viridans group streptococci); and less than or equal to 4 micrograms/ml for all viridans group streptococci and enterococci . MICs were minimally affected by variations in inoculum size, and LY146032 was bactericidal against all species tested. J Med Microbiol, 1986 Nov, 22(3), 251 - 6 Monoclonal opsonic mouse antibodies specific for streptococcal IgG Fc-receptor; Svensson M et al.; Spleen cells from mice immunised with group-A type-M15 streptococci and boosted with purified IgG Fc-receptor (FcR) from this type were fused with Sp 2/0 mouse myeloma cells . The resulting hybridomas were screened by ELISA for antibody production . Two IgM-secreting cell lines were selected . The monoclonal antibodies and ascites fluids inhibited the binding of 125I-labelled human IgG and IgG Fc-fragments to group-A type-M15 streptococci . The monoclonal antibodies also displaced purified FcR towards the anode in electrophoresis . They opsonised group-A type M-15 streptococci for phagocytosis by human granulocytes in the presence of fresh human serum . It was concluded that FcR is important for group-A streptococcal virulence. Anal Biochem, 1986 Nov 1, 158(2), 365 - 70 Renaturation of dextranase activity from culture supernatant fluids of Streptococcus sobrinus after sodium dodecylsulfate polyacrylamide gel electrophoresis; Barrett JF et al.; A rapid and reproducible method for the assay of individual fractions of the multicomponent dextranase activity of Streptococcus sobrinus after reduction/denaturation and electrophoresis in acrylamide gels is described . Multiple forms of dextranase, possible virulence factors in the formation of dental caries by oral Streptococci (S . mutans, S . sobrinus, S . sanguis, S . cricetus, and S . rattus), have been separated in sodium dodecylsulfate-polyacrylamide gels into which an indicator substrate, blue dextran, has been incorporated, and identified after renaturation to remove the reducing/denaturing agents of the Laemmli buffer system. Presse Med, 1986 Oct 25, 15(37), 1855 - 8 {Infectious endocarditis in France . Epidemiological characteristics}; Goulet V et al.; The epidemiological characteristics of infective endocarditis in France were established in a one-year survey of strictly defined cases . The incidence of the disease is 18 cases per year and per million inhabitants, i.e . 970 cases annually . Patients are generally treated in Teaching Hospitals (80% of the cases were at the end of the hospitalization period) . The predominant pathogens are the streptococci non groupable in 40.4% of the cases (group D in 21.9%) and the staphylococci (20.8%) . Patients with group D streptococci endocarditis are the older ones (mean age: 60 years) . Staphylococcal endocarditis occurs in younger patients (mean age: 43 years), especially after cardiac valve prosthesis or unrecognized cardiac valve disease, and it is the most serious form, with a 45% mortality rate (overall mortality rate: 21%) . One quarter of the patients undergo a surgical operation. J Clin Microbiol, 1986 Oct, 24(4), 607 - 11 New test system for identification of Aerococcus, Enterococcus, and Streptococcus species; You MS et al.; A total of 244 strains of Aerococcus, Enterococcus, and Streptococcus species were tested by the RapID STR system (Innovative Diagnostic Systems Inc., Atlanta, Ga.) for identification . Strains were identified without additional tests or with additional conventional tests suggested by the IDS compendium manual . Our data indicate that the RapID STR system identifies 89% of the beta-hemolytic Streptococcus species if serological procedures are used in conjunction with the rapid physiological procedures . Of the group D streptococci, 98% of the Enterococcus species and 100% of the group D non-Enterococcus species were correctly identified . Of the commonly occurring viridans group Streptococcus species, 93% were correctly identified, and 79% of the less frequently occurring viridans group Streptococcus species were correctly identified . All of the Streptococcus pneumoniae and Aerococcus strains tested were correctly identified. J Antimicrob Chemother, 1986 Oct, 18(4), 491 - 8 Activity of penicillin combined with an aminoglycoside against group B streptococci in vitro and in experimental endocarditis; Backes RJ et al.; Group B streptococci were less susceptible in vitro to penicillin and to aminoglycosides with an inoculum size of 10(7)-10(8) cfu/ml than with an inoculum size of 5.5 X 10(5)-10(6) cfu/ml . With a rabbit model of experimental group B streptococcal endocarditis, after one or three days of therapy with procaine penicillin alone, the mean log10 cfu/g of valve vegetation was significantly lower (P less than 0.01) than that of the control groups . After one day of therapy, procaine penicillin combined with streptomycin was significantly more effective (P less than 0.01) than was treatment with procaine penicillin alone . There was no significant difference (P greater than 0.05) in the results of treatment of animals for one day with procaine penicillin combined with streptomycin compared with those of animals treated for three days with procaine penicillin alone. Ann Thorac Surg, 1986 Oct, 42(4), 372 - 9 Patch closure of aortic annulus mycotic aneurysms; Fiore AC et al.; Twenty-three patients with bacterial endocarditis and mycotic aneurysms of the aortic annulus were treated between 1978 and 1985 . There were 18 men and 5 women ranging from 24 to 72 years old . All patients had congestive heart failure and positive blood cultures as a complication of the endocarditis and were in New York Heart Association (NYHA) Functional Class III or IV . The aneurysm complicated late prosthetic valve endocarditis in 7 patients and native valve endocarditis in 16 . The most common infecting organisms were streptococci (12 patients) and staphylococci (7 patients) . The noncoronary sinus was the most frequent site for aneurysm formation . Following debridement of the abscess cavity, the orifice of the aneurysm was closed with a patch of Dacron in 20 patients and autologous pericardium in 3 . A prosthetic valve (18 bioprosthetic and 5 mechanical) was secured to the noninfected portion of the native annulus and to the patch at the level of annulus . There were 3 deaths, 1 perioperative and 2 late, each without evidence of residual infection or aortic insufficiency . There are 20 late survivors (87%) . After a mean follow-up of 1 year, all patients are in NYHA Functional Class I . Patch closure of mycotic aneurysms involving the aortic annulus permits aggressive debridement of the abscess cavity and affords closure of the orifice without tension . The prosthetic valve can be seated at the level of the native annulus, thus avoiding complicated reconstructive procedures of the aortic root and coronary arteries . This technique is an effective alternative in selected cases of mycotic aneurysms involving the aortic annulus. South Med J, 1986 Oct, 79(10), 1313 - 4 Streptococcus MG-intermedius endocarditis; Wallis DE et al.; Subspeciation of penicillin susceptible alpha-hemolytic streptococci is not routinely performed . However, Streptococcus MG-intermedius is an extremely virulent organism in this strep subgroup and is associated with abscess formation . Our patient, who had endocarditis due to this organism, remained chronically ill despite appropriate antibiotic therapy, and had a perforated aneurysm of the sinus of Valsalva with a myocardial abscess that required extensive surgical debridement . Persistent fever in patients with S MG-intermedius endocarditis should warrant further work-up for metastatic or myocardial abscess formation. Clin Pediatr (Phila), 1986 Oct, 25(10), 496 - 502 Group C and group G streptococci . In-office isolation from children and adolescents with pharyngitis; Schwartz RH et al.; The importance of non-group A streptococci as etiologic agents of acute pharyngitis in endemic circumstances is unclear . The authors attempted to clarify this issue in patients undergoing throat culture for acute pharyngitis in a suburban pediatric practice . Of 6,694 throat cultures, 2,243 (34%) yielded B-hemolytic streptococci, 83 percent (1,783) of which were bacitracin-sensitive and presumptive group A organisms . A random selection of 279 of the 460 bacitracin-resistant streptococci yielded 56 group C, 42 group G, 35 group F, 2 group A, and 3 mixed groups of streptococci . Paired serologic specimens were obtained from 12 children with group C or G streptococci . Four of six group C subjects from whom paired serum specimens were obtained had a significant increase in anti-streptolysin O titer . However, no change in anti-C/G hyaluronidase or anti-C carbohydrate titer was observed . Similarly, two of six subjects with group G streptococci on throat culture in whom paired serum specimens were obtained showed an increase in ASO titer . No seroconversion to anti-C/G hyaluronidase, anti-C, or anti-G carbohydrates was demonstrated . Despite substantial clinical and circumstantial evidence, it could not be confirmed serologically that group C and G streptococci produced acute pharyngitis in this endemic setting. J Infect Dis, 1986 Oct, 154(4), 597 - 603 Viridans streptococcal endocarditis: clinical, microbiological, and echocardiographic correlations; Sussman JI et al.; Infections caused by species within the viridans streptococci have been associated with different clinical characteristics . We studied 36 patients with viridans streptococcal endocarditis . Complications were seen in 10 (32%) of 31 patients with native valve endocarditis and four (80%) of five with prosthetic valve endocarditis and included death in two, valve replacement in six, persistent infection in three, emboli in two, and congestive heart failure in nine . Two-dimensional echocardiograms demonstrated vegetations in 26 (72%) of 36, flail mitral valves in seven, disruption of aortic valve prosthesis in one, and perivalvular abscesses in three (two Streptococcus sanguis I and one Streptococcus intermedius I) . All twelve patients with native valve endocarditis who suffered complications had vegetations detected by two-dimensional echocardiography, whereas seven patients with native valve endocarditis without vegetations, as detected by two-dimensional echocardiography, had no complications (P = .03) . We found no significant correlation between streptococcal species and clinical outcome . To confirm our identifications, we sent 16 identical viridans streptococcal endocarditis isolates to five institutions; only three of 16 were identified as the same species by all five institutions . We conclude that viridans streptococcal endocarditis can be associated with a virulent clinical course and that there is marked variability in species designations of individual strains by different laboratories. Gastroenterology, 1986 Oct, 91(4), 987 - 93 Liver abscess in Crohn's disease . Report of four cases and review of the literature; Mir-Madjlessi SH et al.; Four patients with liver abscesses and Crohn's disease are described, and reports of 14 cases in the English language literature are reviewed . The incidence of liver abscess in patients with Crohn's disease (114-297 per 100,000) appears to be higher than that of liver abscess in the general population (8-16 per 100,000) . Frequently the clinical manifestations of liver abscess are mistaken for a reactivation of Crohn's disease, and diagnosis is delayed . In comparison to patients with liver abscess in the general population, patients with Crohn's disease and liver abscess are considerably younger, are more likely to have multiple rather than solitary abscesses, and usually have a predisposing intraabdominal focus of infection, rather than a biliary one . Streptococci, especially Streptococcus milleri, are the most frequent cause of liver abscess in patients with Crohn's disease . Liver scanning should be performed routinely in patients with Crohn's disease in whom a febrile illness cannot be completely explained by bowel disease, or in whom fever does not respond to drainage of intraabdominal abscesses. Mikrobiyol Bul, 1986 Oct, 20(4), 230 - 41 {Anaerobic bacteria in various infections and their antibiotic susceptibility patterns}; Tunckanat F et al.; In this study we have examined antibiotic susceptibility of anaerobic bacteria isolated from various samples of 75 patients . Anaerobic bacteria from 22 (29.3%) patients, and only aerobic bacteria from 29 (38.7%) patients have been isolated; there has been no growth in cultures from 24 (32%) patients . Of 75 isolates from 51 patients 38 (50.6%) are anaerobic and 37 (49.4%) are aerobic bacteria . Following anaerobic bacteria have been isolated: Peptostreptococcus (13), Peptococcus (5), microaerophilic streptococci (2), Veillonella (1), Bacteroides (9), Fusobacterium (4) and non spore forming anaerobic gram positive bacilli (4) . Among the 38 anaerobic bacteria the highest resistance has been shown against tetracycline (65.8%) . Resistance rates for cephalothin, erythromycin and penicillin G are 28.9%, 15.8% and 7.8% . In our investigation we have shown no resistance against carbenicillin, clindamycin and chloramphenicol. Clin Exp Immunol, 1986 Oct, 66(1), 132 - 8 Mitogenic activity of extracellular cationic products produced by group A streptococci; analysis of the lymphocyte response; Suzuki M et al.; The cationic fraction (isoelectric point greater than 8.5) of supernatant products of group A streptococcal cultures exerted a strong mitogenic effect on human peripheral lymphocytes at concentrations as low as 1 ng/well . Incorporation rates were highest at concentrations of 1-10 micrograms; rabbit peripheral lymphocytes also responded strongly, only a weak response was seen with mouse peripheral lymphocytes and rabbit thymocytes . Purified OKT4 positive (T helper) and OKT8 positive (T suppressor) lymphocyte subpopulations both responded, the former more strongly . Although accessory cells (monocytes) were not absolutely necessary, in their presence higher incorporation of 3H-thymidine was observed . Isolated B cells did not respond. Br J Exp Pathol, 1986 Oct, 67(5), 629 - 35 Possible induction of disseminated intravascular coagulation in the mouse by group B streptococcal clumping factor; Usui Y et al.; A hydrochloric acid extract, the clumping factor fraction, obtained from a clumping factor-positive strain of group B streptococci, was capable of killing mice by administration after injection of heat-killed cells of group B streptococci or Escherichia coli intravenously . In mice killed between 24 and 48 h later, fibrin thrombi were observed in the renal glomeruli, as well as in the heart, lung, liver, and pancreas . These findings suggest the possible induction of disseminated intravascular coagulation by these organisms in the mouse. Acta Pathol Microbiol Immunol Scand {B}, 1986 Oct, 94(5), 347 - 50 Commercial kits are not equally sensitive in detecting the group antigen of group A streptococcus; Hoffmann S et al.; The relative sensitivities of four commercially available kits for the demonstration of the group antigen of group A streptococcus were estimated in laboratory experiments . Two kits gave positive reactions with swabs charged with approximately 10(5) colony-forming units of group A hemolytic streptococci of five common T-types . The two other kits required inocula ten times higher . Application of the antigen detection reagents from each kit to antigen extracts prepared by extraction reagents from the other kits revealed that the differences in sensitivity were largely attributable to differences in the extraction abilities . The four kits did not differ appreciably in their ability to demonstrate group A antigen in human pus mixed with group A streptococci; the minimum inoculum detectable was approximately 10(6) colony-forming units per 0.04 ml of pus. Acta Pathol Microbiol Immunol Scand {B}, 1986 Oct, 94(5), 333 - 8 Independent binding of native and aggregated IgG in group A streptococci; Schalen C et al.; Irrespective of IgG Fc-receptor activity, earlier characterized, many group A streptococci were recently found to bind aggregated IgG Fab and/or light chains . In the present study, binding of glutaraldehyde-aggregated, radiolabelled, intact human IgG (a*IgG) to group A streptococci was tested, and strains representing several M-types were found reactive . In particular, high binding was observed among type M12 strains, earlier found devoid of Fc-receptors for monomeric IgG; accordingly, unlabelled, native IgG had little influence on the binding . The sites binding a*IgG were highly sensitive to trypsin and relatively resistant to heat treatment . The binding to M12 was inhibited by human fibrinogen and, to a lesser extent, by heat-aggregated serum albumin . Rabbit antiserum to M12 was more inhibitory than antiserum to a heterologous type of group A streptococci or normal rabbit serum . Our results indicate that streptococcal M-protein binds a*IgG by a multipoint requiring interaction of low specificity and that previously described Fc-receptors binding native IgG are not involved . For comparison, in Cowan I staphylococci and one strain of group G streptococci tested, high binding of a*IgG was also observed; however, this binding was inhibited by native IgG, indicating that protein A and group G streptococcal Fc-receptor, earlier known to bind untreated IgG, also bound a*IgG. Indian J Med Res, 1986 Oct, 84, 358 - 60 Group B streptococci in IUCD users; Chaudhary U et al.; PIP: 200 women attending a family planning clinic for IUD insertion were surveyed for carriage of group B streptococci at various sites and to determine the effect of such device on the carriage rate . Group I comprised women who were coming for the 1st time (preinsertion); Group II were women already fitted with an IUD (postinsertion and followup) . Urethral, vaginal, and rectal samples were taken from each woman with serum coated and cotton tipped swabs . Final identification was done by serological grouping of streptococci by Fuller's method . All the strains of group B streptococci were sent to the World Health Organization Collaborating Center for Reference and Training in Streptococcal Disease (New Delhi, India) for serotyping . The postinsertion group (8%) had higher carriage than the preinsertion group (5%) . The vagina and urethra were important sites colonized; the rectum was not colonized . Among the isolates, 3 isolates of a new serotype IV/C were seen . It was found that the postinsertion group had double the carriage rate of group B streptococci (4% versus 2%) . Chronic inflammatory response to an IUD may enhance the growth of group B streptococci . Overall vaginal carriage rate for normal women in this study was 3%, even with the use of selective media . The urethral carriage rate (3.5%) was slightly higher than the vaginal carriage rate (3%), but in venereal disease clinics very high rate for this site are reported . No group B streptococci could be isolated from the rectum . The high incidence of non-typable strains in nonpregnant women found in this study has been observed previously by some workers yet not by others . Pediatr Res, 1986 Oct, 20(10), 933 - 6 IgG subclasses and antibodies to group B streptococci, pneumococci, and tetanus toxoid in preterm neonates after intravenous infusion of immunoglobulin to the mothers; Morell A et al.; High doses of intravenous immunoglobulin were given to seven pregnant women between the 27th and 36th wk of gestation who were at risk for preterm delivery . Determinations of IgG subclasses and of antibodies against group B streptococcal serotypes, pneumococcal polysaccharides, and tetanus toxoid were done in maternal serum before and after intravenous IgG infusion and after delivery in cord serum . Substantial transplacental passage of the infused material could be observed in five cases where delivery occurred at the 34th wk or later . After the 36th wk of gestation, IgG subclass and antibody concentrations in cord serum were increased up to the levels in the maternal serum. Am J Med, 1986 Oct, 81(4), 723 - 6 Explosive pleuritis . Manifestation of group A beta-hemolytic streptococcal infection; Braman SS et al.; Two young adults had clinical and roentgenographic evidence of explosive pleuritis that was caused by group A beta-hemolytic streptococci . Persistent high fever and intense pleuritic pain following severe pharyngitis should suggest streptococcal pleural infection and prompt careful roentgenographic investigation . These cases show that group A beta-hemolytic streptococcal infection can cause explosive pleuritis in the absence of apparent bronchopneumonia. Am J Clin Pathol, 1986 Oct, 86(4), 529 - 32 Comparison of two rapid latex agglutination methods for detection of group A streptococcal pharyngitis; Reichwein B et al.; Throat swabs from 404 patients with suspected pharyngitis were collected using duplicate swabs . Both swabs were used to inoculate 5% sheep blood agar plates, which were incubated in an anaerobic atmosphere for the isolation of Group A streptococci . The throat swabs were tested for the presence of Group A antigen using the Culturette Brand 10-Minute Group A Strep ID kit (Marion Scientific, Kansas City, MO), and the Direct Antigen Identification D.A.I . Strep A Test (Difco Laboratories, Inc., Detroit, MI) . We found that 77 of the 404 specimens were culture positive for Group A streptococci . The Strep ID kit had a sensitivity of 83.7% and a specificity of 91.6% . The positive and negative predictive values were 72% and 95.6%, respectively . The D.A.I . test had a sensitivity of 80.2% and a specificity of 100% . The positive and negative predictive values were 100% and 94.5%, respectively . There was not a significant difference in the sensitivity of the two kits (P less than 0.1), but there was a significant difference in the specificity (P less than 0.01). J Fam Pract, 1986 Oct, 23(4), 337 - 40 The value of needle aspiration in the management of cellulitis; Epperly TD; Needle aspirations from 103 young, healthy patients (mean age 22 years) with cellulitis were prospectively analyzed to determine the percentage yield and causative organisms . A standard technique of needle aspiration was performed using a 22-gauge needle, a 10-cc syringe, and 1 cc of sterile water . Aspirations were performed at the leading edge and midpoint of the cellulitis (halfway between the leading edge and the center of the cellulitis) . Fifteen of the 103 patients (14.5 percent) had positive aspirates . Nine of the 103 aspirates were positive at the leading edge (8.7 percent) and 6 of 70 were positive at the midpoint (8.6 percent), giving a total aspiration positivity of 8.7 percent (15/173) . The organisms recovered were Staphylococcus aureus (53 percent) . Staphylococcus epidermidis (27 percent), alpha-hemolytic streptococci (13 percent) and Streptococcus pyogenes (7 percent) . The low-percentage yield and predictable organisms recovered speak against needle aspiration being a necessary procedure in a young, healthy population . Similarly, the site of aspiration does not increase yield . Empiric treatment with antibiotics aimed at staphylococcal and streptococcal organisms is appropriate. J Exp Med, 1986 Oct 1, 164(4), 998 - 1012 Polyspecificity of antistreptococcal murine monoclonal antibodies and their implications in autoimmunity; Cunningham MW et al.; mAbs produced by immunization of BALB/c mice with Streptococcus pyogenes M type 5 membranes were further characterized for their reaction with S . pyogenes pep M5 protein and with autoantigens associated with human cell lines . mAbs 36.2.2 and 54.2.8 simultaneously reacted with M protein and a membrane protein(s) of S . pyogenes . When cell lines were mixed with 54.2.8, we saw nuclear fluorescence along with staining of the cytoskeleton . Subsequent experiments revealed that 54.2.8 was an anti-DNA antibody that reacted with DNA, poly(I), poly(dT), and weakly with cardiolipin . Its reactivity with the cytoskeleton could be blocked with anti-vimentin . On the other hand, 36.2.2 reacted with the cytoskeleton, sparing the nucleus, and was inhibited by the alpha helical proteins myosin, actin, and keratin . mAb 54.2.8 was inhibited with myosin, but not with actin and keratin . None of the antibodies studied were inhibited by collagen, and none of them were rheumatoid factors . The results imply that Group A streptococci can activate B cell clones against myosin, alpha helical proteins, or DNA, thereby contributing to the enhancement of autoantibody production. Mikrobiyol Bul, 1986 Oct, 20(4), 248 - 55 {Neonatal group B colonization and maternal urogenital and anorectal system carriage}; Gokalp A et al.; In pregnant women, the main reservoirs of group B streptococci (GBS) are rectum and urethra . The mother's birth canal and the newborn infant easily contract the organisms from these sites . We studied 100 women and their newborn babies to determine the relation between the maternal carriage and the neonatal group B streptococcal colonization . Vaginal, urethral and rectal swabs obtained from all pregnant women during labor . Within a few minutes after birth and on day 4 of life swab specimens were also taken from the external auditory canal, throat and umbilicus of the infants . The overall maternal carriage rate was found to be 7.00 percent . The frequency of transmission to the neonates was found to be 57.14 percent among maternal carriers . In early neonatal period, the colonization rate of GBS was found to be % 4.0 percent and the infection rate of GBS was found to be 2.0 percent among the newborn population. J Clin Microbiol, 1986 Oct, 24(4), 644 - 6 Effect of medium and cultivation conditions on comparisons between latex agglutination and culture detection of group A streptococci; Graham L Jr et al.; In the laboratory diagnosis of pharyngitis, results from latex agglutination tests (LAT) performed directly on throat swabs are often compared with the isolation of group A beta-hemolytic streptococci (GABHS) from simultaneously obtained swabs cultivated on a variety of media under different atmospheric conditions . In this study, results of an LAT, Directigen, were compared with those of two different media: sheep blood agar (SBA) and group A selective strep agar (ssA) . Specimens inoculated on SBA were incubated in three different atmospheres: air, 3 to 5% CO2, and anaerobically . Those inoculated on ssA were incubated in 3 to 5% CO2 only . Isolation of GABHS was confirmed by coagglutination . The standard for true positivity was the isolation of GABHS from at least one of the simultaneous cultures . Comparisons were made with samples from 693 adult patients . GABHS was isolated on at least one of the three cultures in 143 patients, demonstrating an isolation rate of 20.6% . LAT exhibited a sensitivity of 95.1% . SBA incubated in air, in CO2, or anaerobically had sensitivities of 86.2, 85.9, and 93.7%, respectively . The ssA detected 99.3% of the positive specimens . Single SBA culture proved to be inferior to LAT and therefore was a poor standard for measuring LAT performance . Single ssA cultures demonstrated the greatest sensitivity in GABHS detection and therefore could serve as a standard for measuring LAT performance. Antimicrob Agents Chemother, 1986 Oct, 30(4), 532 - 5 In vitro and in vivo activity of LY 146032, a new cyclic lipopeptide antibiotic; Eliopoulos GM et al.; The in vitro activity of LY 146032, a cyclic lipopeptide antibiotic belonging to the class of agents designated A21978C, was compared with those of vancomycin, cefpirome, cefotaxime, and clindamycin against selected gram-positive bacteria . The new drug inhibited all staphylococcal isolates, including methicillin-resistant strains, at concentrations of less than or equal to 1.0 microgram/ml . The activity of LY 146032 was comparable to that of vancomycin against most streptococci, but the latter demonstrated greater potency against Streptococcus faecium and penicillin-resistant strains of pneumococci and viridans group streptococci . LY 146032 was markedly less active than vancomycin against Listeria monocytogenes (MICs for 90% of strains tested, 16 and 1.0 microgram/ml, respectively) . The activity of LY 146032 was enhanced as the concentration of calcium in the test medium was increased . MBCs were within eightfold of the MIC for each of 12 strains tested . In a rat model of enterococcal endocarditis, the administration of LY 146032 resulted in increased survival and a reduction in the bacterial titer within cardiac vegetations compared with untreated control animals. Zh Mikrobiol Epidemiol Immunobiol, 1986 Oct, (10), 22 - 5 {Comparative biological characteristics of the L-form of Streptococcus group A and B}; Goncharova SA et al.; The comparative study of the biological and serological properties of the L-forms of streptococci, groups A and B, has been made . Their morphological similarity on the level of light microscopy has been demonstrated . The use of ring precipitation, gel diffusion, passive hemagglutination, aggregate hemagglutination, as well as the immunoferritin technique, has made it possible to establish the presence of specific antigens in the L-forms of streptococci, groups A and B . Serological cross reactions are negligible . The future development of a diagnosticum for the specific indication of these antigens is proposed . The fact of the presence of specific antigens in the L-forms of streptococci in comparison with the initial streptococcal strains has been confirmed. Minerva Med, 1986 Sep 29, 77(37), 1679 - 88 {Serologic diagnosis of streptococcal diseases . Ulterior data on the comparison of 2 methods (streptozyme and antistreptolysin O}; Braida M et al.; Increasingly thorough analysis of the antigen structures of Group A beta-haemolytic streptococci has revealed the presence of antigen components with differentiated immune responses in relation to common streptococcal conditions . It is therefore extremely useful in laboratory practice to have a multiple antigen that reveals the immune response to a streptococcal infection so that we can study the serological behaviour of individual streptococcal pictures with their complications and sequelae . Research conducted to date indicates that the streptozyme test can explore the five main streptococcal isoenzymes both for rapid screening and for the quantification of the degree of antibody response . This is confirmed by the results obtained by numerous Authors over the past 15 years, results that demonstrate the high sensitivity of STZ (Streptozyme) at antibody level that single antibody reactions are apparently not capable of revealing . The polyvalent antigen represented by STZ seems to be the best tool for the demonstration of responses to the individual isoenzymes of the very numerous streptococcal strains in circulation (Group A, C and G beta-haemolytics) . The possibility of using microtiter techniques for serum assays is also emphasised . These techniques have given repeatable results and are also easy to read. Antimicrob Agents Chemother, 1986 Sep, 30(3), 465 - 7 Antimicrobial therapy of experimental endocarditis caused by nutritionally variant viridans group streptococci; Henry NK et al.; Rabbits with nutritionally variant viridans group streptococcal experimental endocarditis were treated three times daily for 3 days with procaine penicillin (1.2 X 10(6) U) alone or together with low-dose streptomycin (2 mg/kg), high-dose streptomycin (8 mg/kg), low-dose gentamicin (0.32 mg/kg), or high-dose gentamicin (1.05 mg/kg) . The mean 0.5-h serum concentrations of streptomycin were 5.3 and 22.5 micrograms/ml in the low- and high-dose group, respectively, and the concentrations of gentamicin were 0.7 and 2.5 micrograms in the low- and high-dose groups, respectively . The combination of procaine penicillin with each dose of aminoglycoside was significantly more effective (P less than 0.001) than was procaine penicillin alone . In combination with procaine penicillin, the higher dose of streptomycin was significantly more effective (P less than 0.02) than the lower dose of streptomycin . The higher dose of streptomycin was not significantly more effective than either dose of gentamicin . The results of treatment with the high or low dose of gentamicin were virtually identical. J Infect, 1986 Sep, 13(2), 115 - 23 Group G streptococcal infection of joints and joint prostheses; Gaunt PN et al.; Eight cases of septic arthritis caused by beta-haemolytic streptococci of Lancefield group G are presented and compared with others previously reported . Involvement of prosthetic joints is notable (25%) as is accompanying cellulitis (75%) which is probably related to the portal of entry of the organism . Other associated conditions were rheumatoid arthritis (38%) and malignant neoplastic disease (25%) . Carriage of the group G streptococcus was detected in two of the eight patients . Serological tests for streptococcal antibodies were found to be less useful in the diagnosis of septic arthritis due to group G streptococci than culture of aspirated fluid . In the absence of endocarditis, which was not present in any of our patients, the prognosis appears to be good after treatment with appropriate antibiotics and open drainage of the joint . Both affected joint prostheses, however, required removal. Proc Soc Exp Biol Med, 1986 Sep, 182(4), 522 - 30 Morphological changes caused by experimental Streptococcus uberis mastitis in mice following intramammary infusion of pokeweed mitogen; Sordillo LM et al.; Mice were used as models for bovine mastitis in an attempt to modify the susceptibility of mammary glands to Streptococcus uberis infection . Murine mammary glands were injected with pokeweed mitogen (PWM) prior to experimental bacterial challenge to accelerate involution and enhance antimicrobial mechanisms . PWM injection reduced the numbers of streptococci recovered when compared to controls . Histological examination of tissues from PWM-treated mice revealed a reduction in secretory activity and advanced involution . PWM-treated tissues had considerably more leukocytes infiltrating the epithelium, lumen, and underlying connective tissue . Bacteria were observed within the epithelium and alveolar lumen and internalized within neutrophils and macrophages in both PWM-injected and control tissue . Results of this study suggest PWM injection provided some protection against S . uberis mastitis by accelerating mammary involution, enhancing antimicrobial defenses, and facilitating a marked cellular response prior to bacterial challenge. Eur J Epidemiol, 1986 Sep, 2(3), 205 - 7 Evaluation of the direct detection of group A beta-hemolytic streptococcal antigen in a pediatric population: comparison with the traditional culture technique; Jonckheer T et al.; An evaluation of the Directigen Group A Strep Test (DGAST) in comparison with the traditional culture technique, was carried out on 1907 throat specimens, obtained from pediatric patients suspected of having a group A beta-hemolytic streptococcal pharyngitis . Of the 344 specimens positive by culture, 277 were DGAST positive (sensitivity, 81%) . Of the 1563 specimens negative by culture, 1511 were DGAST negative (specificity, 97%) . Nineteen isolates of non-group A beta-hemolytic streptococci were recovered, primarily group C, B and G . The DGAST is easy to perform, rapid and very specific, but lower sensitivity indicates that a back up traditional culture is still necessary, especially in pediatric patients. Zentralbl Bakteriol Mikrobiol Hyg {A}, 1986 Sep, 262(3), 385 - 95 Streptococcal group A polysaccharide antibodies assayed by an ELISA determination of antibodies in rabbit hyperimmune sera; normal levels in man and comparison with levels in patients with rheumatic fever and with poststreptococcal glomerulonephritis; Benslimane A et al.; An enzyme-linked immunosorbent assay (ELISA) was adapted to measure antibodies to streptococcal group A polysaccharide . The components of the reaction were studied, including the concentration of the polysaccharide antigen, the suppression of non-specific reactions, optimal conjugate binding conditions and the most suitable plates . The specificity of this test was documented by studies using immune sera and polysaccharide antigens of various groups of beta-hemolytic streptococci . In addition dynamics of the antibody response in animals as well as in man were investigated . The upper limit of normal level of this antibody in normal healthy persons was determined by this technique . We found that 80% of patients with rheumatic fever and acute glomerulonephritis showed an elevation of the group A polysaccharide antibody titer . Determination of this antibody response by the ELISA technique is clinically useful in evaluation patients with the nonsuppurative sequelae of group A streptococcal infections. Zentralbl Bakteriol Mikrobiol Hyg {A}, 1986 Sep, 262(3), 346 - 56 The concurrent associations of group A streptococcal serotypes in children with acute rheumatic fever or pharyngitis-associated glomerulonephritis and their families in Kuwait; Majeed HA et al.; A group of 146 children with acute rheumatic fever and 256 members from their families, and a group of 125 children with post-streptococcal glomerulonephritis and 199 family members, together with a group of 145 children with non-complicated group A streptococcal pharyngitis were examined over a period of three years . The purpose of the study was to explore the concurrent association and distribution of group A streptococcal serotypes among the three groups . Strains isolated from the children with non-complicated group A streptococcal pharyngitis represented the prevalent strains of group streptococci in the childhood community during the period of study . Rheumatic fever was encountered in a non epidemic situation . As expected, the recovery of group A streptococci was low . The strains however belonged mainly to two patterns, namely type M1 and M non-typable strains . Nephritis was pharyngitis-associated and occured also sporadically throughout the year . Types M12 and 49 accounted for the majority of the isolates . Type M12 accounted for 34.4% of the group A isolates from family members of children with nephritis and was totally absent in family members of children with rheumatic fever (p less than 0.001) . The T pattern 8/25/Imp . 19 accounted for 40% of the group A isolates from family members of rheumatic patients compared to 3.3% from family members of nephritis patients (p less than 0.005) . Data from this study show that the group A streptococcal serotypes, concurrently isolated from children with acute rheumatic fever and their families are disparately different from those of children with pharyngitis-associated glomerulonephritis and their families in the same population . These findings support the concept of "nephritogenicity" and "rheumatogenicity" and indicated the important role of the biological characteristics of the streptococcal serotypes in the aetiology of acute rheumatic fever and acute poststreptococcal glomerulonephritis. Klin Monatsbl Augenheilkd, 1986 Sep, 189(3), 251 - 3 {Group B streptococcal panophthalmia in neonatal infection}; Bialasiewicz AA et al.; Hemolyzing streptococci of group B were isolated from an ulcerative keratitis in a 14-day-old girl (gestational age: 39 weeks, birth weight: 3230 g) suffering from septicemia . The differential diagnosis includes all bacteria and virus species able to penetrate the intact cornea, e.g . Pseudomonas sp., N . gonorrhoeae and Herpes simplex virus II . Perinatal infection may be via the birth canal. J Appl Bacteriol, 1986 Sep, 61(3), 219 - 23 Rapid method for the detection of group B streptococci from human sources; Jewes LA et al.; A modification of the classical CAMP test has been devised for the rapid detection of streptococci of serological Group B from human sources . The method was compared with detection based on the development of orange pigmented colonies on a starch-based medium and with detection by conventional methods . In a survey of vaginal carriage of Group B streptococci in parturient women, the modified CAMP test detected a carriage rate of 13.09%, the starch-based, pigment enhancing medium, 5.76% and the conventional methods, 8.38% . It proved to be particularly useful for detecting the organisms in the presence of other bacteria. J Clin Microbiol, 1986 Sep, 24(3), 431 - 4 Clinical trial comparing bacitracin with Strep-A-Chek for accuracy and turnaround time in the presumptive identification of Streptococcus pyogenes; Yajko DM et al.; In a clinical trial, Strep-A-Chek (a 10-min chromogenic test) was compared with the bacitracin disk susceptibility test for accuracy and turnaround time in the presumptive identification of Streptococcus pyogenes . Among 461 isolates of beta-hemolytic streptococci (344 throat isolates and 117 isolates from other sites), 303 group A S . pyogenes isolates were found . The sensitivities of the Strep-A-Chek and bacitracin tests were high (96.4 and 100%, respectively), but the bacitracin test had a lower specificity (84.2%) than the Strep-A-Chek test (98.7%) . The predictive values for positive and negative test results were 99.3 and 93.4%, respectively, for Strep-A-Chek and 92.4 and 100%, respectively, for bacitracin . Strep-A-Chek correctly identified all isolates upon repeat testing . All bacitracin tests were performed on subcultures of isolates from the primary plate . Strep-A-Chek testing was performed on colonies from the primary plate when isolated colonies were available . This shortened the turnaround time for Strep-A-Chek compared with bacitracin by at least 24 h on nearly one-half (45%) of the isolates . A peripheral finding of this study was that sulfamethoxazole-trimethoprim blood agar offered no advantage over conventional blood agar with regard to the number of false-positive bacitracin tests obtained from each medium. J Med Microbiol, 1986 Sep, 22(2), 101 - 5 A search for new group-B streptococcal serotypes; Motlova J et al.; New serotypes were sought among 165 clinical isolates of group-B streptococci that were untypable by antisera for the conventional types Ia, Ib, II and III . The strains were tested for sialic acid, an integral component of the group-B streptococcal type-polysaccharides; trypsin-treated bacteria were tested by slide-agglutination with the sialic-acid-specific lectin from the snail Cepaea hortensis . Sialic acid was detected in 96 of the strains; in 95 of these, new type antigens were identified serologically (type IV, 52; provisional type V, 34; candidate type NT6, seven; provisional type V and candidate type NT6, one; candidate type 7271, one); the remaining strain was found to possess a small amount of Ia antigen . Sialic acid was not detected in 69 strains, and none of these possessed a polysaccharide type-antigen . Chemical measurement of the sialic-acid content of cultures by Aminoff's method gave results in conformity with the lectin-agglutination test and the presence of polysaccharide type-antigens. Infect Immun, 1986 Sep, 53(3), 454 - 9 Binding of Streptococcus pyogenes to soluble and insoluble fibronectin; Courtney HS et al.; The interaction of soluble and insoluble fibronectin with Streptococcus pyogenes was investigated . Soluble fibronectin bound to S . pyogenes in a dose-dependent and irreversible manner . Lipoteichoic acid competitively inhibited the binding of fibronectin to S . pyogenes but had little effect on the binding of fibronectin to staphylococci or pneumococci . The phase of growth of the streptococci had a slight effect on binding of fibronectin, with optimal binding occurring in the late log phase . S . pyogenes cells bound to fibronectin immobilized on microtiter plates in a dose-dependent and saturable manner . Both soluble fibronectin and lipoteichoic acid inhibited the binding of streptococci to immobilized fibronectin, suggesting that streptococci interact with soluble and insoluble fibronectin in a similar manner . Antibodies to fibronectin blocked the attachment of streptococci to immobilized fibronectin, whereas normal serum had no effect . Adherence of streptococci to buccal epithelial cells was inhibited by antibodies to fibronectin, but not by normal sera or by antibodies to buccal epithelial cells . The data suggest that lipoteichoic acid on the surface of S . pyogenes binds to fibronectin exposed on the host cell and that such binding mediates the attachment of streptococci to host cells. J Invest Dermatol, 1986 Sep, 87(3), 367 - 71 Monoclonal antibodies cross-reactive with group A streptococci and normal and psoriatic human skin; Swerlick RA et al.; Infection with group A streptococci has been implicated as a factor capable of exacerbating psoriasis . In order to explore the possibility of cross-reactivity between streptococcal antigens and human skin in this phenomenon, skin from psoriatic patients and control subjects was reacted with 3 monoclonal antibodies against group A streptococci and antibody binding was estimated by the indirect immunofluorescence technique . Monoclonal antibody 54.2.8 stained the nuclei and cytoplasm of cells within the epidermis and epidermal appendages, as well as cells scattered throughout the dermis . In contrast, monoclonal antibodies 49.8.2 and 36.2.2 labeled the cytoplasm of epidermal cells and epidermal appendages but did not react with nuclei . No difference in the staining patterns of control skin and uninvolved skin from patients with psoriasis was observed . However, skin from psoriatic lesions contained large amounts of cross-reactive skin component(s) . Sera from patients with guttate psoriasis did not react differently with normal or psoriatic skin when compared with normal sera . Western immunoblots of skin extracts demonstrated that monoclonal antibody 54.2.8 reacted with a family of proteins in the molecular weight range of 60-70K . The results indicate that component(s) in human skin share cross-reactive epitopes with group A streptococci . Immunologic cross-reactions between group A streptococci and human skin may play an important role in the exacerbation of certain skin disorders following streptococcal infections. J Dent Res, 1986 Sep, 65(9), 1149 - 53 In vitro studies of growth and competition between S . salivarius TOVE-R and mutans streptococci; Kurasz AB et al.; Streptococcus salivarius TOVE-R has previously been reported as a successful competitor with Streptococcus mutans 10449S and Streptococcus sobrinus 6715-13 WT on the teeth of rats . We studied, in vitro, some possible bases for this competition, including hydrogen peroxide or catalase production, bacteriocin or enocin production, and growth rates . Growth rates were measured spectrophotometrically in both complex and defined media . We studied conditions of aerobic and anaerobic incubation; glucose and sucrose medium supplementation at three concentrations each; various initial pH's; singly- or doubly-inoculated cultures; and half-strength, normal, or double-strength broth used both fresh and as culture filtrates . TOVE-R grew as well as did mutans streptococci at acid pH, decidedly better at alkaline pH, and nearly twice as fast near neutral pH . The average doubling time for TOVE-R was about 0.5 hr, while that for the mutans streptococci was about 1.0 hr . When TOVE-R was grown together with a mutans streptococcus, the growth rate observed for the doubly-inoculated culture was equal to or less than that of TOVE-R alone, never greater . The presence and proportions of both organisms in mixed cultures were confirmed by plate counts, direct specific immunofluorescence, and Nomarski interference microscopy . There was no evidence, by any of the methods employed, to indicate the production of an inhibitory substance against mutans streptococci by TOVE-R, or vice versa . Also, there was no evidence that the faster growth rate of TOVE-R could be attributed to nutrient limitation of the mutans streptococci.(ABSTRACT TRUNCATED AT 250 WORDS) JPEN J Parenter Enteral Nutr, 1986 Sep-Oct, 10(5), 503 - 7 Bacterial contamination of enteral nutrient solutions: intestinal colonization and sepsis in mice after ingestion; Van Enk RA et al.; Contaminated enteral nutrient solution (ENS) was used to assess the risks of intestinal colonization and invasive sepsis using normal mice . Dilute Osmolite containing 10(6) Group B Streptococci/ml given for 2 to 10 consecutive days resulted in the detection of organisms by rectal washing sampling and in the recovery of 10(3) to 10(4) organisms from the cecum, large intestine, and rectum . Only 10(1) organisms survived in the small intestine . Colonization, or the persistence of organisms for 10 days after exposure, was produced after 2 days of ingestion in 44% of animals and in 100% after exposure for 5 days . There were 39 septic deaths . During the 7-day ingestion interval 15 died and 24 died within 10 days after exposure . The risk of sepsis was highest for young mice . Ways to minimize bacterial contamination of ENS intended for administration to patients are discussed. Pediatr Res, 1986 Sep, 20(9), 872 - 5 Selective elevation of systemic blood pressure by epinephrine during sepsis-induced pulmonary hypertension in piglets; Meadow WL et al.; In a piglet model of group B beta Streptococci (GBS)-induced pulmonary hypertension, we have determined hemodynamic responses to epinephrine (EPI) infusion in both the systemic and pulmonary circulations . Three groups of piglets (GBS + EPI, n = 6; GBS + placebo, n = 6; placebo, n = 6) were studied . GBS, infused intravenously at approximately 5 X 10(7) organisms/kg/min, reduced cardiac index and stroke volume index while elevating pulmonary artery pressure and pulmonary vascular resistance index . Systemic vascular resistance index, heart rate and aortic pressure did not change during GBS infusion . Six piglets received intravenous EPI after cardiac index had fallen by 30% during GBS infusion . At 3.5, 7.0, and 15 micrograms/kg/min, respectively, EPI raised aortic pressure by 18.5, 31.0, and 45.0 mm Hg while EPI reduced pulmonary artery pressure by 5.2, 6.3, and 8.2 mm Hg . At each dose, EPI elevated systemic vascular resistance index and lowered pulmonary vascular resistance index . At 3.5 micrograms/kg/min, the elevation of aortic pressure was associated with an increase in both cardiac index and systemic vascular resistance index . At higher EPI doses, the rise in aortic pressure was accounted for entirely by an increase in systemic vascular resistance index . Systemic acid/base status and PaO2 did not differ among piglets who received GBS + EPI, GBS alone, or placebo . Extrapolation of these data to human infants must be approached with extreme caution . However, selective elevation of systemic blood pressure may be a feasible strategy for some infants to impede right-to-left shunting of blood often associated with sepsis-induced pulmonary hypertension. Infection, 1986 Sep-Oct, 14(5), 237 - 42 Effects of cancer chemotherapy on the human aerobic oropharyngeal flora; Renard KW et al.; Since various agents used in cancer chemotherapy exhibit antimicrobial activity in vitro, we performed sequential quantitative cultures of saline gargles obtained from patients receiving cancer chemotherapy to determine if such chemotherapy alters the composition of the aerobic oropharyngeal flora . When we compared results of cultures obtained from 12 patients just before and at various times after receiving courses of cancer chemotherapy, we observed small, though significant reductions in the numbers of total bacteria, alpha-hemolytic streptococci and inhibitory streptococci two to seven days after courses of chemotherapy . A concomitant increase in the percentage of patients colonized by gram-negative bacilli occurred . Of the chemotherapeutic agents used to treat our subjects, only doxorubicin exhibited antimicrobial activity in vitro . All four alpha-hemolytic streptococci, but none of the seven strains of gram-negative bacilli examined, were inhibited by doxorubicin at concentrations of less than or equal to 12.5 mg/l . Doxorubicin had a modest enhancing effect on in vitro adherence of gram-negative bacilli to human embryonic lung cells . These data suggest that cancer chemotherapy might play a role in colonization of cancer patients by gram-negative bacilli by creating a microbiologic vacuum conducive to such colonization . In this way, cancer chemotherapy might contribute to the high incidence of gram-negative bacillary pneumonia among patients with malignant neoplasms. J Med Microbiol, 1986 Sep, 22(2), 165 - 9 Coagglutination reactions between Candida albicans and oral bacteria; Bagg J et al.; An agglutination assay for detecting intermicrobial adherence between the cells of Candida albicans and various oral bacteria is described . Strains of Streptococcus sanguis, S . salivarius, S . mutans, S . mitis, Fusobacterium nucleatum and Actinomyces viscosus all coagglutinated with C . albicans . No interaction could be demonstrated between the cells of Bacteroides melaninogenicus and those of C . albicans . Preliminary investigations of these interactions suggest that binding of F . nucleatum and A . viscosus to C . albicans is mediated by bacterial proteins, possibly lectins . Other mechanisms must account for the binding of oral streptococci to C . albicans . The possible implications of these findings in relation to oral mucosal colonisation and oral candidal clearance are discussed. J Exp Med, 1986 Sep 1, 164(3), 762 - 76 Induction of antibodies to hyaluronic acid by immunization of rabbits with encapsulated streptococci; Fillit HM et al.; The immunogenicity of hyaluronic acid was investigated . Rabbits were immunized with encapsulated group A and C streptococci . Intact long-chain hyaluronate was conjugated to BSA for use as antigen in an ELISA . Antibodies to the hyaluronate-BSA conjugate were detected in peak immune sera . The specificity of the antibodies for both mammalian and streptococcal hyaluronate was shown by inhibition studies . To further confirm the presence of antihyaluronate antibodies, hyaluronidase-digested streptococcal hyaluronate was conjugated to biotin and used as an antigen in the ELISA . A clear immunization effect was shown for each rabbit by the study of preimmune and postimmunization bleedings . Titers for each rabbit increased by greater than 32 - 256 - fold . Inhibition studies using hyaluronidase-digested hyaluronate and periodate-treated hyaluronate showed that the immunodominant site of antibody reactivity was a terminal glucuronic acid residue . Further studies showed that the carboxyl group of the terminal glucuronide was the major immunoreactive site . Both mammalian and streptococcal hyaluronate inhibited the immune rabbit sera reaction to streptococcal hyaluronate, demonstrating crossreactivity of these molecules . Thus, hyaluronate was shown to be immunogenic in rabbits. Lancet, 1986 Aug 9, 2(8502), 305 - 9 T lymphocytes of rheumatoid arthritis patients show augmented reactivity to a fraction of mycobacteria cross-reactive with cartilage; Holoshitz J et al.; An acetone-precipitable fraction of Mycobacterium tuberculosis cross-reacts with human cartilage . Immune responses to this antigen were assessed in 34 patients with rheumatoid arthritis, 16 patients with degenerative joint disease, and 15 healthy controls . The RA patients differed from the other two groups in having more pronounced T lymphocyte responses to the antigen; their serum antibody levels were not higher . The responses of RA patients varied with duration of disease . In the first year (7 patients) T lymphocyte reactivity was increased in the synovial exudates of affected joints but not in peripheral blood, whereas the 19 with disease of 1-10 years' duration showed high reactivity in peripheral blood; in the 8 with disease for more than 10 years, lymphocyte reactivity did not differ from that in the patients with degenerative joint disease or the healthy controls . The observation that the three groups did not differ in their responses to streptococci and a T-cell mitogen indicates that reactivity of the RA patients to the mycobacterial fraction was specific . These results raise the possibility that bacterial antigens cross-reactive with cartilage proteoglycans may be relevant to the pathogenesis of RA. Acta Pathol Microbiol Immunol Scand {B}, 1986 Aug, 94(4), 239 - 43 Xylitol metabolism in xylitol-sensitive and xylitol-resistant strains of streptococci; Assev S et al.; The metabolism of xylitol in xylitol-sensitive strains (strains whose growth is inhibited by xylitol) and xylitol-resistant strains (growth not inhibited) of oral streptococci was compared . Both xylitol-sensitive and xylitol-resistant strains took up xylitol . In the sensitive cells, the xylitol was probably transported via a phosphotransferase system . This resulted in intracellular accumulation of xylitol-5-phosphate and xylulose-5-phosphate . These metabolites were not detected in the xylitol-resistant strains, which probably transported xylitol via a permease system . It appeared that the resistant strains were able to utilize xylitol as carbon and energy source in the absence of other carbohydrates. J Clin Pathol, 1986 Aug, 39(8), 871 - 5 Identifying non-capsulate strains of Streptococcus pneumoniae isolated from eyes; Pease AA et al.; Over six months 10 biochemically and physiologically atypical strains of Streptococcus pneumoniae were isolated from eye swabs . Conventional methodology showed that these strains possessed characteristics of both S pneumoniae and other alpha haemolytic streptococci . The use of sodium dodecyl sulphate - polyacrylamide gel electrophoresis (SDS-PAGE) enabled us to characterise these strains as S pneumoniae . Loss of the capsule seemed to be associated with atypical biochemical properties. Pediatr Res, 1986 Aug, 20(8), 707 - 10 The effect of naloxone on the hemodynamics of the newborn piglet with septic shock; Miller RR et al.; Naloxone has been shown to reverse the hemodynamic sequelae of experimental septic shock in adult animal models . Its effectiveness in the newborn has not been studied . To further investigate the efficacy of naloxone, we instrumented 18 piglets for continuous measurement of mean arterial pressure, mean pulmonary arterial pressure, central venous pressure, heart rate, left ventricular pressure, contractility, cardiac output, and O2 . Oxygen consumption, systemic vascular resistance, and pulmonary vascular resistance were calculated . Following a stabilization period, group B beta-hemolytic Streptococci were infused over 30 min . Following the infusion, naloxone (1 mg/kg) was given followed by a continuous infusion of 1 mg/kg/h in nine treatment animals . Nine control animals were given an equal volume of saline . Both groups developed significant increases in mean pulmonary arterial pressure followed by a return to baseline . Oxygen consumption, cardiac output, contractility and mean arterial pressure decreased in both groups . Treatment with naloxone was associated with a cessation in the fall in the mean arterial pressure and the contractility . The difference in mean arterial pressure and contractility between groups was significant . The naloxone group had significantly improved 5-h survival . We speculate that naloxone may reverse some of the hemodynamic sequelae and improve survival in newborns with septic shock. Infect Immun, 1986 Aug, 53(2), 359 - 65 Preparation of a sialic acid-binding protein from Streptococcus mitis KS32AR; Murray PA et al.; A recent report has identified a lectin on the surfaces of several strains of Streptococcus mitis and Streptococcus sanguis with specificity for an N-acetylneuraminic acid alpha 2,3-galactose-beta 1,3-N-acetylgalactosamine sequence (P.A . Murray, M.J . Levine, L.A . Tabak, and M.S . Reddy, Biochem . Biophys . Res . Commun . 106:390-396, 1982) . In the present study, purification and characterization of this sialic acid-binding protein (SABP) was begun . A clinical isolate of S . mitis was grown to mid stationary phase in synthetic FMC medium and then extracted with lithium 3,5-diiodosalicylate . Lyophilized extract was subjected to gel filtration on a Sephadex G-200 column, giving four protein peaks (A to D) . Peak B, shown by hemagglutination assay to contain SABP, was next subjected to affinity chromatography on a Sepharose-4B matrix coupled to fetuin glycopeptides . After an extensive washing, peak B materials bound to the affinity matrix were eluted with buffered N-acetylneuraminic acid . Sodium dodecyl sulfate-polyacrylamide gel electrophoresis with 2-mercaptoethanol on 7.5% gels of affinity-purified materials revealed components of 96, 70, and 65 kilodaltons (kDa) . Without reducing agent, only the 65-kDa band and materials which did not penetrate the gel were visualized, suggesting that the 96- and 70-kDa components were disulfide linked . The chemical cross-linking agent, disuccinimidyl suberate, was used to demonstrate specific interactions between the SABP preparation and {14C}fetuin glycopeptides . After cross-linking, sodium dodecyl sulfate-polyacrylamide gel electrophoresis and fluorography revealed the 96- and 70-kDa components, indicating that the SABP is at least bivalent . These findings support our previous suggestion that human salivary glycoproteins facilitate clearance of selected oral streptococci via specific interactions between sialic acid-containing oligosaccharides and a carbohydrate-binding protein on the bacterial cell surface. Antibiot Med Biotekhnol, 1986 Aug, 31(8), 628 - 33 {Antibiotic resistance of revertant cultures of Streptococcus group A and of unclassified streptococci isolated from the blood of rheumatism patients}; Vul'fovich IuV et al.; Sensitivity of one strain of group A Streptococcus, its L-form and revertant was tested to 7 antibiotics and it was observed that the revertant was highly resistant to beta-lactam antibiotics and lincomycin, tolerant to ristomycin and had a high value of MBcC/MIC for erythromycin and tetracycline . Testing of other analogous revertant strains showed the same results . In streptococcal strains freshly isolated from blood of patients with rheumatism and resistant to some antibiotics there were recorded by electron microscopy heterogeneity of their population and presence in it of a significant number of cells with altered (unevenly thickened) cell walls and cells with microcapsules on the cell wall surface characteristic of the revertants . In vivo occurrence of streptococcal revertants may be the cause of their antibiotic resistance which obviously requires correction of the rational antibiotic therapy schemes. Eur J Clin Microbiol, 1986 Aug, 5(4), 405 - 10 In vitro killing of erythromycin-exposed group A streptococci by polymorphonuclear leukocytes; Pruul H et al.; After exposure to erythromycin, group A streptococci were tested for susceptibility to the antimicrobial activity of human peripheral blood neutrophils in the absence of the antibiotic . Bacterial susceptibility to phagocytic killing increased after prior exposure to supra-inhibitory levels of erythromycin for even as brief as three minutes . Extended exposure and higher concentrations of erythromycin increased phagocytic killing . Although the degree of sensitization varied in different strains of streptococci, all strains tested were significantly more susceptible to phagocytic killing after erythromycin exposure . Killing of erythromycin-treated bacteria that occurred in the absence of antibiotic was dependent upon internalization of the bacteria . Thus, the brief exposure of group A streptococci to inhibitory levels of erythromycin increases their susceptibility to phagocytic killing by peripheral blood neutrophils. J Clin Microbiol, 1986 Aug, 24(2), 296 - 7 Evaluation of spot CAMP test for identification of group B streptococci; Ratner HB et al.; The CAMP (Christie-Atkins-Munch-Petersen) test is commonly used for the presumptive identification of Streptococcus agalactiae (Lancefield group B) . Using 350 clinical isolates of beta-hemolytic streptococci, we compared a 30-min spot CAMP test with the standard overnight CAMP test and the Lancefield precipitin test . We found 99% agreement among all three tests for all streptococci tested . The spot CAMP test is a rapid, inexpensive, and accurate method for identifying group B streptococci. South Med J, 1986 Aug, 79(8), 952 - 4 Group F streptococci in the pharynx: pathogens or innocent bystanders? Schwartz RH, McCoy P, Hayden GF, Hallas G. beta-Hemolytic streptococci (BHS) of Lancefield group F were isolated in moderate to heavy growth from throat cultures taken from 46 children and adolescents with symptomatic pharyngitis . In most instances, oxygen deprivation by means of an anaerobe jar was required for these beta-hemolytic organisms to grow . In relation to a comparison group of children with throat cultures positive for group A BHS, children with group F isolates were more likely to be adolescents and less likely to have fever and cervical adenopathy . It appears that group F BHS are not a major cause of nonepidemic pharyngitis in the pediatric age group . More precise determination of how commonly these organisms cause pharyngitis will require either comparison of isolation rates of group F BHS from the throats of both sick and well children, or further elucidation of the serologic response to these organisms so as to distinguish invasive infection from asymptomatic carriage. J Hyg (Lond), 1986 Aug, 97(1), 133 - 8 Evaluation of a two-minute strep A direct swab test (SADST) on patients with pharyngitis at a primary care clinic; Araj GF et al.; A two-minute strep A direct swab test (SADST) was used to detect the presence of Lancefield group A streptococci (GAS) from the throats of 207 patients with pharyngitis at a primary-care clinic . The results were compared with a standard culture method . Fifty-one specimens were positive and 156 specimens were negative for GAS by culture . The SADST had a sensitivity of 96% (49 of 51) and specificity of 98.7% (154 of 156) . The predictive values of a positive and negative SADST, for GAS, were 96% and 98.7% respectively . The SADST showed negative reactions with five specimens containing beta-haemolytic streptococci other than GAS and 34 known stock cultures other than GAS . Our results indicate that SADST is a rapid, simple, convenient and reliable test to use for diagnosis of GAS pharyngitis at primary care clinics, physicians' offices and clinical laboratories. J Dent Res, 1986 Aug, 65(8), 1101 - 4 Humoral responses and cross-reactivity to viridans streptococci in recurrent aphthous ulceration; Hoover CI et al.; It has been proposed that recurrent aphthous ulceration (RAU) is caused by hypersensitivity to oral streptococci . This hypothesis is based on reports that RAU patients have increased levels of circulating IgG antibodies against oral streptococci, and that rabbit antisera prepared against oral streptococci are cross-reactive with oral mucosa . Using indirect immunofluorescence, we have investigated both of these reported phenomena . End-point titers of serum antibodies against three different strains of oral streptococci were assayed from nine RAU subjects with active ulcers and compared with those of nine control subjects . Titers ranged from 1:2 to 1:64 in both groups and do not appear to have any clinical or immunopathogenic significance . Cross-reactivity was studied using hyperimmune rabbit antisera raised against five different strains of oral streptococci . Homologous bacterial titers ranged from 1:1024 to 1:8192, but none of these anti-streptococcal sera produced heterologous titers greater than 1:32 with oral mucosa . This apparent low level of cross-reactivity with oral mucosal antigens appears to be non-specific and clinically insignificant . In previous reports, we have used both leucocyte migration and lymphocyte blast transformation to study cell-mediated immunity to viridans streptococci in RAU (Gadol et al., 1985; Greenspan et al., 1985) . None of our results supports an immunopathogenic role for oral streptococci in RAU. Infect Immun, 1986 Aug, 53(2), 432 - 4 Localization of the streptococcal C5a peptidase to the surface of group A streptococci; O'Connor SP et al.; Immunofluorescent staining was used to determine that the streptococcal C5a peptidase (SCP) exists as a cell surface antigen on group A streptococci . The ability of hyperimmune serum to neutralize cell-associated SCP activity provided further evidence for the location of SCP . Quantification of SCP during growth in vitro by indirect enzyme-linked immunosorbent assay showed that approximately 90% of the measurable antigen is cell bound. Clin Rheum Dis, 1986 Aug, 12(2), 423 - 35 Septic arthritis and osteomyelitis in children; Fink CW et al.; Most of the data for this paper were taken from a 30-year follow-up of septic arthritis and a 25 year series of osteomyelitis seen in Dallas, Texas . A specific bacterial aetiology was determined in about 70% of patients with septic arthritis, utilizing culture of multiple fluids . The aetiological agent was influenced by the age of the patient . In the newborn Staph . aureus, group B streptococci and gram-negative organisms are found most commonly . In the older infant H . influenzae becomes a prominent pathogen, and in those over 2 years of age staphylococci, streptococci, H . influenzae and N . gonorrhoea are the predominant organisms . Ninety-three per cent of arthritis was monoarticular . A slightly higher percentage (78%) of children with osteomyelitis had a specific bacterial aetiology determined . Staph . aureus was the most common pathogen found at all ages, averaging 53% of all cases and in all age groups, and followed in frequency by various types of streptococci . Diagnosis was delayed in osteomyelitis compared to septic arthritis . In the Dallas patients a single bone was involved in 316 compared to 24 with polyosteal disease . In both infections the initial antibiotic chosen is determined by the gram strain of material obtained from joint aspiration, pus, or other secretions . If no specific bacterial aetiology is found, treatment is begun for the most likely organism considering the age of the patient and the clinical situation . Recently oral therapy has been used extensively in specific instances after an initial period of parenteral therapy . A limited number of follow-up studies have shown that the age of the patient, the bone and/or joint involved, and the organism responsible all influence the long-term results in both septic arthritis and osteomyelitis . The poorest long-term prognosis is in the neonate, especially where the hip joint is involved either alone or with a concomitant osteomyelitis. Cell Immunol, 1986 Aug, 101(1), 204 - 12 Modulation of the locomotory capacity of human large granular lymphocytes; Polentarutti N et al.; The regulation of the migratory capacity of Percoll-purified large granular lymphocytes (LGL) into nitrocellulose filters was studied in a 2-hr assay with the use of modified Boyden chambers . Compounds that stimulate the natural killer cytotoxic function of LGL, such as interferons (natural beta, recombinant alpha A, recombinant hybrid alpha A/D, recombinant gamma), recombinant interleukin-2, and inactivated streptococci (OK 432), augmented the capacity of LGL to penetrate into filters spontaneously in the absence of chemoattractants in the lower compartment of the chamber . These compounds did not increase the LGL responsiveness to chemoattractants . Phorbol 12-myristate 13-acetate did not appreciably affect the locomotory capacity of LGL but augmented their cytotoxic activity . Thus the cytotoxic function and locomotion of LGL in response to biological response modifiers can be dissociated. Scand J Dent Res, 1986 Aug, 94(4), 377 - 9 Absorption of fibronectin from human saliva by strains of oral