Streptococci

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 streptococci; Ericson D et al.; Freshly collected human submandibular/sublingual saliva contained between 1.0 and 26.1 micrograms/ml of fibronectin as determined by ELISA . 10(9) organism of 12 oral streptococcal strains tested removed between 2.6 and 89.4% of the fibronectin present in 400 microliters saliva . Fibronectin was retained in bacterial pellets after washings in buffer but could be eluted using 1 M NaCl.

J Antimicrob Chemother, 1986 Aug, 18(2), 159 - 62
In-vitro activity of Sch 34343, a new penam, against gram-positive isolates from cancer patients; Rolston KV et al.; The in-vitro activity of Sch 34343, a new penam antibiotic, was tested against 257 Gram-positive isolates from cancer patients, and compared with that of imipenem and amifloxacin . Sch 34343 was extremely active against beta-haemolytic streptococci (Lancefield groups A, B and G) with MIC90s ranging from 0.025 to 0.05 mg/l . It was also active against methicillin-susceptible Staphylococcus aureus and had variable activity against coagulase-negative staphylococci . MIC90 for Listeria monocytogenes was 0.78 mg/l and 84% of enterococcal isolates were inhibited by 6.25 mg/l.

Appl Environ Microbiol, 1986 Aug, 52(2), 255 - 61
Development of high-level streptomycin resistance affected by a plasmid in lactic streptococci; Sinha RP; Some lactose-negative (Lac-) mutants of Streptococcus lactis C2 and ML3 exhibited development of very high level streptomycin resistance after incubation with subinhibitory concentrations of the drug for 18 to 22 h . These drug-resistant mutants showed no loss of resistance even after 6 months of subculturing in broth without any drug . The parental Lac+ strains did not show mutation to high-level streptomycin resistance . The Lac+ characteristic of the parental strain was conjugally transferred to Lac- derivatives of C2 and ML3, showing the ability to mutate to high-level resistance . When transconjugants were analyzed for this characteristic, they showed both mutable and nonmutable Lac+ types . The results suggested that genetic information for mutation to high-level streptomycin resistance in lactic streptococci resides on the chromosome, and its expression is affected by a plasmid . The plasmid profiles of strains C2, ML3, C2 Lac-, ML3 Lac-, and two kinds of transconjugants confirmed the presence of a plasmid of approximately 5.5 megadaltons in strains showing no mutation to high-level streptomycin resistance, while strains missing such a plasmid exhibited high-level streptomycin resistance after incubation with subinhibitory concentrations of the drug.

J Dent Res, 1986 Aug, 65(8), 1094 - 100
Interaction of salivary fibronectin with oral streptococci; Babu JP et al.; Immunoreactive Fibronectin (Fn) has been demonstrated in stimulated human parotid saliva by western blot analysis and also found to be a component of the artificial tooth pellicles derived from hydroxyapatite (HA) beads coated with parotid saliva . Saliva depleted of gelatin-binding components showed a significantly lower degree of reactivity with anti-Fn antibodies than did the control saliva when tested by and enzyme-linked immunosorbent assay (ELISA) . Depletion of gelatin-binding components from saliva was also found to affect the degree of saliva-mediated aggregation of four of the seven oral streptococci tested {Streptococcus mutans strains GS-5 and OMZ 176, S . sobrinus, and S . rattus} . Similarly, the adherence of the same four micro-organisms to the artificial tooth pellicles (derived form saliva which had previously been depleted of gelatin-binding component) was significantly inhibited (37-53%) when compared with the control saliva-coated HA beads . Pre-treatment of streptococci with 100 micrograms of soluble Fn also caused a 34-57% inhibition of adherence of the same oral streptococci to saliva-treated HA beads . Quantitation of Fn in human parotid saliva showed that the amounts of immunoreactive Fn varied form 2 to 6 micrograms/mL of parotid saliva . Furthermore, the Fn from parotid saliva was found to be adsorbed onto the bacterial surfaces, as demonstrated by immunofluorescence and ELISA . The presence of Fn in parotid saliva and its ability to bind to HA beads (artificial pellicles), in conjunction with the ability of soluble Fn to inhibit the adherence of streptococcal strains to the artificial tooth pellicles, suggest that the microbial ecology of the oral cavity may, in part, be influenced by the interactions mediated by salivary fibronectin.

Mol Immunol, 1986 Aug, 23(8), 811 - 21
Comparison of type III Fc receptors associated with group C and group G streptococci; von Mering GO et al.; The type III Fc receptors present on or secreted by a series of group C and G streptococcal strains were studied . All strains capable of binding radiolabeled human IgG were shown to do so via an antigenically related Fc receptor . Treatment of any of the bacterial strains with papain or trypsin resulted in solubilization of Fc receptor activity . The pattern of Fc receptor activity recovered following enzyme treatment was not uniform . Differences were observed both between group C and G strains as well as within group C and G strains . Analysis of secreted Fc receptors indicated the presence of five molecular forms of Fc receptor . Each form was present at some level in the supernatant of every group C and G strain studied . The relative concn of each form of receptor secreted varied from strain to strain . The Fc receptor activity secreted by each strain demonstrated a similar affinity for the Fc region of human IgG and all were antigenically related . These results suggest that there is a family of closely related Fc receptors associated with group C and G streptococcal strains.

Microb Pathog, 1986 Aug, 1(4), 399 - 407
Role of interferon in streptococcal infection in the mouse; Weigent DA et al.; In previous studies, we have shown the rapid in vitro induction of IFN gamma from human T cells by highly purified peptic extracts of M proteins from Streptococcus pyogenes . The present report extends these in vitro studies and shows that a mixture of both alpha/beta and gamma IFN were present in spleen cell homogenates after in vivo treatment with M protein wild-type (M+) or mutant (M-) S . pyogenes strains . The levels of bacterial-induced IFN were found to be greater in M+ treated animals . Additional studies in vivo showed that pretreatment of mice with heat-killed M+ S . pyogenes organisms significantly protected mice to pneumococcal infection compared to similarly treated M- or control animals (P less than 0.001) . Further, antibodies to mouse IFN alpha/beta and antibodies specific to a synthetic N-terminal peptide of mouse IFN gamma enhanced the death of animals due to pneumococcal infection and blocked the protection observed in animals previously treated with heat-killed M+ organisms . Most importantly, treatment of mice with either type of IFN alone enhanced the survival of mice to levels similar to that observed by treatment with M+ organisms (P less than 0.05) . The results strongly suggest that IFN can play a crucial role, directly or indirectly, in controlling infection by Streptococcus pneumoniae and perhaps other streptococci.

Clin Immunol Immunopathol, 1986 Aug, 40(2), 335 - 46
The mechanism of enhancement of natural killer cell activity by soluble streptococcal products; Lapham C et al.; Products prepared from broth extracts of beta-hemolytic Group A streptococci activate human natural killer (NK) cells . The active moiety is likely a protein since the enhancing capability is destroyed by the proteolytic enzyme pronase, although not by trypsin . The enhancement in NK cytotoxicity is due at least in part to lymphokines, since normal peripheral blood mononuclear cells and T cells, upon incubation with streptococcal products (SP), release supernatant factors which augment NK activity . These cell culture supernatants contain interferons (IFN) as well as low levels of interleukin-2 (IL-2) . Treatment of supernatants with anti-IFN antibodies has variable effects, depending on the donor cells used to produce the factors . In most cases, anti-IFN-gamma totally abrogates enhancement . Treatment of supernatants with antibodies to IFN-alpha modestly decreases enhancement of most donor cells; however, IFN-alpha appears not to be a major factor in SP-activated lymphokines . Pretreating effector cells with a monoclonal antibody directed against the IL-2 receptor (anti-Tac) usually reduces the supernatant effect . The combination of anti-Tac and anti-IFN-gamma totally nullifies enhancement . Thus T lymphocytes stimulated with streptococcal products augment NK activity at least in part by producing IFN-gamma and a factor whose activity is reduced by the interaction of the IL-2 receptor with anti-Tac.

N Z Med J, 1986 Jul 23, 99(806), 536 - 8
Peritonsillar infection in Christchurch 1981-1984; Stegehuis HR et al.; Retrospective review of the notes of 83 peritonsillar infection sufferers over three years at Christchurch Hospital reveals that the typical sufferer is a young adult male who is most likely to present in winter or summer . Only a quarter of the patients had a significant recent history of tonsillitis but four had had a previous quinsy and six had had a previous tonsillectomy in childhood . Length of symptoms does not appear helpful in differentiating an abscess from a cellulitis . Anaerobic organisms were found in 49% of aspirates and streptococci were the most important aerobic organism . Potential beta lactamase producing organisms, H influenzae, Staph aureus and Bacteroides sp were infrequent and penicillin remains the drug of choice . Appropriate antibiotics and drainage are the essentials of management and tonsillectomy may be indicated.

Antimicrob Agents Chemother, 1986 Jul, 30(1), 187 - 8
Comparative in vitro evaluation of cefonicid, cefazolin, and penicillin against viridans group streptococci isolated from blood; Weinstein MP; The in vitro activity of cefonicid against 60 strains of viridans group streptococci isolated from blood of patients with bacteremia and infective endocarditis was compared with those of cefazolin and penicillin . Cefonicid was less active than cefazolin, and both cephalosporins were less active than penicillin . The MIC50 and MIC90 for the strains tested were 0.06 and 1 microgram/ml for penicillin, 0.125 and 8 micrograms/ml for cefazolin, and 4 and 32 micrograms/ml for cefonicid.

Antimicrob Agents Chemother, 1986 Jul, 30(1), 105 - 9
Therapeutic efficacy of cefadroxil and cephalexin for pneumonia in a rat test model; Chisholm DR et al.; The therapeutic efficacies of cefadroxil and cephalexin were compared in a Streptococcus pyogenes-induced lung infection in rats . Although MICs, rates of in vitro killing in rat serum, and antibiotic serum levels after oral administration were similar for both drugs, cefadroxil was about eight times more effective than cephalexin in reducing the number of viable streptococci at the site of infection . This excellent in vivo bactericidal activity of cefadroxil in lung tissue and bronchial secretions was reflected in the 50% protective dose (PD50) after single or multiple oral treatments . A single treatment given 24 h after infection resulted in a PD50 of 2.8 mg of cefadroxil per kg, compared with 21 mg of cephalexin per kg . When treatment was administered three times, at 24, 27, and 30 h postinfection, the PD50s of cefadroxil and cephalexin were 0.7 and 8.0 mg/kg, respectively . In infected animals, treated 24 h postinfection, the area under the lung tissue concentration versus time curve for cefadroxil was significantly greater than that of cephalexin . This difference in pharmacokinetic behavior may account, at least in part, for the superior therapeutic results obtained with cefadroxil in this experimental pulmonary infection.

J Clin Microbiol, 1986 Jul, 24(1), 81 - 5
High-performance liquid chromatographic analysis of bacterial fatty acid composition for chemotaxonomic characterization of oral streptococci; Tsuchiya H et al.; A high-performance liquid chromatographic method was developed to analyze the fatty acid composition of bacterial lipids . After saponification of lipids extracted from bacteria, the liberated fatty acids were labeled with a fluorescence reagent, 4-bromomethyl-7-acetoxycoumarin, followed by reversed-phase high-performance liquid chromatographic separation and fluorescence detection . All bacterial fatty acids were simultaneously separated within 30 min and sensitively determined . This method was applied to the chemotaxonomic characterization of oral streptococci . The fatty acid composition of phospholipids and total lipids distinguished Streptococcus mutans from any other species examined and showed that Streptococcus sanguis had a close taxonomic relationship with Streptococcus salivarius.

Arch Intern Med, 1986 Jul, 146(7), 1345 - 8
Bacterial esophagitis in immunocompromised patients; Walsh TJ et al.; We studied the clinical and pathologic features of bacterial esophagitis in three index cases identified by endoscopic biopsy and in 20 autopsy cases . Fourteen of the 23 patients had malignant hematologic conditions, aplastic anemia, or solid tumors; ten were profoundly neutropenic (white blood cell count, less than 100/mm3 {less than 0.1 X 10(9)/L}) . The organisms involved in bacterial esophagitis were gram-positive cocci in 14, gram-negative bacilli in three, mixed gram-negative bacilli and gram-positive cocci in five, and gram-positive bacilli in one . Four patients had bacteremic bacterial esophagitis; all were immunocompromised, three by profound neutropenia and one by gestational prematurity . Bacteria causing bacteremic bacterial esophagitis were all gram-positive: viridans-group streptococci . Staphylococcus aureus, Staphylococcus epidermis, and Bacillus species . Our study suggests that bacterial esophagitis is more common than has been recognized in the past and should be considered as a potential source of bacteremia in immunocompromised patients.

J Antimicrob Chemother, 1986 Jul, 18(1), 113 - 7
The effect of a single large dose of amoxycillin on oral streptococci; MacGregor AJ et al.; Salivary samples were examined for a period three weeks before, and three weeks after the administration of 3 g of amoxycillin in ten volunteers . There was a marked drop in the concentration of streptococci in all subjects in the first 4 h but most had substantially recovered within 48 h . All had recovered at seven days . No strains were resistant to 1 mg/l amoxycillin in the pre-treatment control series, and no resistant streptococci emerged.

Zentralbl Bakteriol Mikrobiol Hyg {A}, 1986 Jul, 261(4), 432 - 46
Albumin bound to the surface of M protein-positive streptococci increased their phagocytosis by human polymorphonuclear leukocytes in the absence of complement and bactericidal antibodies; Wagner B et al.; Using a phagocytosis assay (Leijh 1980, Infect . Immun . 30, 421), determination of chemiluminescence, and transmission electron microscopy, the influence of the binding of albumin to M protein-positive group A streptococci on their phagocytosis by human polymorphonuclear leukocytes (PMNL) was investigated . Coating of streptococci with albumin in the absence of other serum components enhanced phagocytosis but not killing of the bacteria . Complement had no additional effect on engulfment . Fibrinogen reduced the enhancing effect of albumin . Albumin had no additional effect on the high phagocytosis rate of an M-protein-negative strain . It could be demonstrated that human PMNL bound human serum albumin-gold conjugate . The results are discussed with regard to the role of plasma proteins in the phagocytosis of streptococci under in vivo-conditions.

J Pediatr, 1986 Jul, 109(1), 20 - 4
Group A streptococcal supraglottitis; Lacroix J et al.; We describe four children with severe supraglottic infections caused by group A beta-hemolytic streptococci . In each case the clinical presentation suggested Hemophilus influenzae epiglottitis . In only one patient was there significant involvement of the epiglottis, whereas all had striking inflammation of the aryepiglottic folds . Group A beta-hemolytic streptococcus was isolated in blood cultures in two patients and from the supraglottic area and trachea in two others . Fever persisted for 6 to 22 days, and tracheal intubation was necessary for 2 to 16 days, despite appropriate antibiotic therapy . The evolution of streptococcal supraglottitis may be protracted, and it must be managed accordingly.

J Infect Dis, 1986 Jul, 154(1), 47 - 54
The role of complement and antibody in opsonophagocytosis of type II group B streptococci; Baker CJ et al.; The role of complement and antibody in the opsonophagocytosis of type II group B streptococci (type II GBS) was defined with sera from healthy adults and two populations with theoretical susceptibility to type II GBS infection--neonates and insulin-dependent diabetics . Significant opsonophagocytosis (bactericidal index, greater than or equal to 90%) of five clinical isolates of type II GBS lacking components of protein antigen c was demonstrated by each of 12 adult sera, as well as by agammaglobulinemic serum, a result indicating that opsonophagocytosis can proceed by antibody-independent activation of the classic complement pathway . Strains containing components of protein antigen c were somewhat more resistant to opsonin-binding activity . Four of 10 neonatal sera and nine of 15 diabetic sera exhibited inefficient opsonophagocytosis . Some of the adult sera with either high or low concentrations of specific antibody to type II GBS promoted opsonophagocytosis via the alternative complement pathway, but this response was not observed with neonatal sera . The addition of sufficient amounts of specific antibody to type II GBS to neonatal and adult diabetic sera in vitro, however, promoted efficient opsonophagocytosis via the alternative pathway.

Pediatr Infect Dis, 1986 Jul-Aug, 5(4), 435 - 9
Peritonsillitis: abscess or cellulitis?
Shoemaker M, Lampe RM, Weir MR.
Peritonsillitis encompasses both cellulitis and abscess . To determine the distinguishing factors for cellulitis and abscess, we reviewed 29 patients, 15 with cellulitis and 14 with abscess . Common presenting complaints included dysphagia, trismus, drooling, voice change and fever . Unilateral tonsillar enlargement was usually present, and uvular deviation was noted in 10 of 29 patients . The mean ages of patients with abscess was 15.0 years, and that of patients with cellulitis was 10.8 years . The two groups differed significantly by age (P = 0.02), and discriminant analysis showed age, dysphagia and drooling to be discriminators for abscess patients, while bilaterality or fever were not . Trismus was a discriminator for cellulitis patients . Etiology for abscess included Group A and non-Group A beta-hemolytic streptococci, Group D streptococcus, alpha-streptococcus, anaerobic diphtheroids and coagulase-negative staphylococci . The etiology of the cellulitis was Group A and non-Group A beta-hemolytic streptococci and Streptococcus pneumoniae . Peritonsillitis appeared to increase in frequency . On presentation patients with cellulitis are similar to patients with abscess . Abscess is more likely in adolescents . Recommended therapy is intravenous penicillin and prompt drainage for patients failing to respond.

EMBO J, 1986 Jul, 5(7), 1567 - 75
Structure of the IgG-binding regions of streptococcal protein G; Guss B et al.; The gene encoding the IgG-binding protein G from Streptococcus G148 was isolated by molecular cloning . A subclone containing a 1.5-kb insert gave a functional product in Escherichia coli . Protein analysis of affinity-purified polypeptides revealed two gene products, both smaller than protein G spontaneously released from streptococci, but with identical IgG-binding properties . The complete nucleotide sequence of the insert revealed a repeated structure probably evolved through duplications of fragments of different sizes . The deduced amino acid sequence revealed an open reading frame extending throughout the insert, terminating in a TAA stop codon . Analysis of the two gene products by N-terminal amino acid determination suggests that two different TTG codons are recognized in E . coli for initiation of translation to yield the two products . Based on these results several truncated gene constructions were expressed and analysed . The results suggest that the C-terminal part of streptococcal protein G consists of three IgG-binding domains followed by a region which anchors the protein to the cell surface . Structural and functional comparisons with streptococcal M protein and staphylococcal protein A have been made.

N Engl J Med, 1986 Jun 26, 314(26), 1665 - 9
Prevention of early-onset neonatal group B streptococcal disease with selective intrapartum chemoprophylaxis; Boyer KM et al.; Most cases of neonatal group B streptococcal disease with early onset have an intrapartum pathogenesis . Attack rates are increased substantially in infants born to mothers with prenatal group B streptococcal colonization and various perinatal risk factors (premature labor, prolonged membrane rupture, or intrapartum fever) . In a randomized controlled trial, we studied the effect of selective intrapartum prophylaxis with ampicillin in 160 such high-risk women . In infants born to mothers who received intravenous ampicillin during labor, as compared with controls who received no treatment, neonatal colonization with group B streptococci was present in 8 of 85 (9 percent) versus 40 of 79 (51 percent; P less than 0.001), colonization at multiple (greater than or equal to 3) sites was observed in 3 of 85 (4 percent) versus 24 of 79 (30 percent; P less than 0.001), and bacteremia occurred in none of 85 versus 5 of 79 (6 percent; P = 0.024) . The side effects of ampicillin were limited to a single episode of urticaria in a mother who had no history of penicillin allergy . We conclude that intrapartum ampicillin prophylaxis in women with positive prenatal cultures for group B streptococci who have certain perinatal risk factors can prevent early-onset neonatal group B streptococcal disease.

J Immunol Methods, 1986 Jun 24, 90(2), 197 - 201
A colorimetric microassay for opsonins by reduction of NBT in phagocytosing bovine polymorphs; Rainard P; The adaptation of the reduction of nitro blue tetrazolium (NBT) by phagocytes to the measurement of the opsonising capacity of serum or milk whey is described . A dose-response curve of the absorbance of solubilised reduced NBT to the concentration of opsonins, along with a close correlation (r = 0.94) between the colorimetric NBT assay and ingestion of group B streptococci (as measured by reduction of {3H}thymidine incorporation by extracellular bacteria), was established . This NBT reduction test, employing 96-well flat-bottom microtitre plates, is simple, semiautomated, requires a low number of PMN, and is applicable to a large number of samples, which renders it useful as a screening test for the opsonising capacity of sera or other biologic fluids.

Lancet, 1986 Jun 14, 1(8494), 1341 - 3
Fever during treatment of infective endocarditis; Douglas A et al.; In 83 episodes of culture-positive infective endocarditis (IE) of a native valve, fever persisted or recurred in 42 (50%) despite appropriate bactericidal antibiotics . The commonest cause of fever was extensive infection of the valve ring and adjacent structures, even when the infecting organisms were viridans streptococci; urgent surgery was required . Less frequent causes were systemic and pulmonary emboli and drug hypersensitivity . Infected intravenous access sites were seldom responsible . In no case was fever due to antibiotic resistance of the infecting organism . In patients with a definite microbiological diagnosis who have been given appropriate antibiotics, the temptation to alter antibiotic therapy because of persistent or recurrent fever should be resisted unless there are features of drug hypersensitivity . When fever persists or recurs during treatment of IE, the opinions of a cardiologist and cardiac surgeon should be obtained as soon as possible; delay in valve replacement may prove fatal in patients with extensive infection.

J Immunol Methods, 1986 Jun 10, 90(1), 47 - 50
Screening for bacterial Fc-receptor activity on nitrocellulose membranes; Lammler C et al.; Fc receptors released from staphylococci and streptococci could be readily detected by direct cultivation of the bacteria on nitrocellulose membranes or by microfiltration of their culture supernatants . The nitrocellulose membranes used in both assays were subsequently treated with human immunoglobulin (Ig) G . The reactions of the Fc receptor with IgG could be demonstrated by use of the respective peroxidase-labelled antibodies against IgG . The resulting color formation, which indicated Fc-receptor activity of the bacterial culture, closely corresponded to the 125I-labelled IgG-binding reactivity.

Vestn Khir Im I I Grek, 1986 Jun, 136(6), 72 - 5
{Treatment of phlegmonous and necrotic forms of erysipelas}; Kuznetsov RV et al.; Clinical observations, bacteriological examinations in 220 patients operated upon for phlegmonous and necrotic erysipelas and investigation of the immunological background (in 48 of them) have shown that phlegmono-necrotic erysipelas develops due to the displacement of streptococci from the inflammatory center of the secondary infection against the background of the venous and lymphostasis with reduced local immunity.

Gan To Kagaku Ryoho, 1986 Jun, 13(6), 2082 - 8
{Antitumor efficacy of activated macrophages against murine glioma cells}; Miyao Y et al.; A crucial manifestation of malignant gliomas is the regrowth of already-invaded neoplastic cells after surgical intervention . One possible approach for inhibiting such tumor growth is to utilize the tumoricidal potential of macrophages . In order to investigate the clinical application of this concept, peritoneal exudate cells (PEC) activated in vitro and in vivo by immunomodulating agents were tested for cytotoxic activity against murine glioma (203-glioma) cells . As immunomodulating agents, heat-killed Propionibacterium acnes (P . acnes), OK-432 and Concanavilin A supernatant (Con A sup) were used in these experiments . P . acnes was provided by Kowa Pharmaceutical Co., Tokyo, and OK-432 by Chugai Pharmaceutical Co., Ltd., Tokyo . Klinische Einheit (KE) units were used to express the strength of the preparation, with 1 KE equal to 0.1 mg of dried streptococci . Con A sup was produced by Con A pulsing of BALB/c splenocytes resuspended in complete medium . PEC harvested from mice to which 5% glycogen in saline had been inoculated intraperitoneally 6 d previously were activated in vitro by P . acnes (P . acnes-PEC), OK-432 (OK-432-PEC) and Con A sup (Con A-PEC) . The cytotoxic activities of P . acnes-PEC, OK-432-PEC and Con A-PEC were approximately 25%, 65% and 60%, respectively . PEC were then collected from mice into which either 100 micrograms of P . acnes or 1 KE of OK-432 had been injected intraperitoneally several times . The antitumor effects of P . acnes-PEC and OK-432-PEC were about 35% and 50%, respectively . These activated PEC demonstrated cytotoxic activity against murine glioma in the tumor neutralization assay (Winn assay) . Also, the antitumor efficacy of OK-432-PEC belonged mainly to adherent cells . Meningeal gliomatosis (MG) models were prepared for clinical studies . Viable 203-glioma cells (5 X 10(6) were injected percutaneously into the cisterna magna of C57BL/6 mice . The median survival time (MST) of the untreated group was 8.5 days . The MST of the groups treated by intraperitoneal and intracisternal administration of P . acnes were 26 and 33 days . This therapy significantly prolonged the survival time of these models, particularly by the intracisternal treatment . The differential cell count by Giemsa staining and latexphagocytic cell findings revealed that macrophages accounted for more than 90% of the P . acnes-PEC . These results may indicate that activated (PEC) macrophages were induced intracisternally by P . acnes and that activated macrophages induced intraperitoneally exerted antitumor effects in MG models.

Surg Gynecol Obstet, 1986 Jun, 162(6), 531 - 5
Microflora of the gallbladder related to duration of acute cholecystitis; Claesson BE et al.; The microflora of the bile and wall of the gallbladder was prospectively investigated in 104 nonselected consecutive patients treated with early cholecystectomy for acute cholecystitis after an average hospital stay of 1.8 days . The chief purpose was to relate the findings of cultures to duration of the illness . Special attention was paid to anaerobic isolation techniques . The cultures yielded 107 strains, representing 36 species, with overall agreement between four different sampling procedures . Aerobic gram-negative rods predominated, followed by streptococci and anaerobes (48, 31 and 15 per cent, respectively) . The incidence of positive culture results (always greater than or equal to 10(6) colon forming units per milliliter) was 81 per cent among the patients who underwent operation within two days from the onset of symptoms and 50 to 65 per cent after longer preoperative intervals . The shorter interval was significantly more often associated with growth solely of anaerobes (p = 0.03) . Postoperative sepsis was caused by biliary bacteria and not related to preoperative duration of illness . Appropriate perioperative antibiotic coverage significantly reduced sepsis--3 versus 20 per cent (p = 0.05).

Infect Immun, 1986 Jun, 52(3), 897 - 901
Estimation of growth parameters for some oral bacteria grown in continuous culture under glucose-limiting conditions; Rogers AH et al.; The coexistence of bacteria in natural environments can often be explained in terms of competition for a growth-limiting substrate(s), and the outcome of such competition depends upon relevant growth parameters such as substrate affinity and yield . Dental plaque bacteria are frequently carbon and energy limited . Growth parameters for seven oral Streptococcus species and one Actinomyces viscosus strain were estimated under glucose-limited conditions in continuous culture . In all strains, mixed-acid fermentation occurred at low growth rates, while amounts of lactate increased at higher growth rates . Two important growth parameters, mumax and Y glucose, were very similar in the two serotype c Streptococcus mutans strains (T8 and Ingbritt), one of the serotype d/g Streptococcus mutans strains (OMZ65), and the two Streptococcus milleri strains (699B3 and B448) . Two other serotype d/g S . mutans strains (KIR and B13) were divergent from this group and had lower mumax values and a lower Y glucose . The maintenance energy coefficients were lower in the S . mutans serotype c strains, and the highest values were observed in the S . milleri strains . While A . viscosus had a lower mumax, its lower maintenance rate and significantly higher yield indicate that it deals much more efficiently with glucose than do the streptococci . The most striking feature of amino acid utilization was that arginine was completely consumed by S . milleri strains; similarly, A . viscosus used up all available asparagine as did one of the S . milleri strains at faster growth rates . It is suggested that the ability of strains of S . milleri and S . sanguis to utilize arginine in addition to carbohydrate as a source of energy may explain why such organisms increase in proportion in the plaque of subjects consuming diets almost devoid of fermentable carbohydrate.

J Antimicrob Chemother, 1986 Jun, 17(6), 815 - 9
Increased resistance to penicillin of oral viridans streptococci in dental students; MacGregor AJ et al.; Salivary samples were taken annually in October from 48 dental students as they progressed from pre-clinical studies to final year . The MICs of penicillin for the viridans streptococci were determined . Over the three years these organisms became progressively more resistant but not to a level of clinical significance . The findings were confirmed by a cross-sectional study of 57 pre-clinical and 37 final year students . The increase in resistance might have been related to age, but a further study of 20 postgraduate chemistry students of the same age as the final year dental students showed that the former had a population of streptococci similar to that found in the pre-clinical students . Whether the increase in resistance is a result of the dental students working in the clinic or having penicillin more frequently prescribed for them personally is a matter for speculation.

Eur J Clin Microbiol, 1986 Jun, 5(3), 317 - 9
Rapid coagglutination test for the direct detection of group A streptococci from throat swabs; Ogay K et al.; A one-minute antigen detection test was compared with a conventional culture method for detecting group A beta-hemolytic streptococci . The test detects coagglutination between protein A and streptococcal antigen extracted directly from throat swabs . Of the 307 specimens tested, 66 (21.5%) were positive for group A streptococci by culture and 16 specimens (5.2%) were positive for other beta-hemolytic streptococci . The direct test agreed with the culture in 274 of 307 specimens (accuracy 89.3%) . The sensitivity of the test was 86.4% (57/66), the specificity 90% (217/241), the positive predictive value 70.4% and the negative predictive value 96% . If only throat cultures with more than 100 colonies of group A streptococci per plate were considered, the sensitivity of the direct test rose to 96% . If only a strong agglutination was considered positive, the specificity of the direct test rose to 98% . Further studies are needed to determine whether this test could be used alone or in addition to culture.

Acta Pathol Microbiol Immunol Scand {B}, 1986 Jun, 94(3), 139 - 43
Influence of polysaccaride capsule and ionic strength on buoyant density of group B streptococci; Hakansson S et al.; Density fluctuation during the cell cycle was investigated with group B streptococcus (GBS), type Ia, in isotonic medium . Maximum density occurred at late lag-phase, with a minimum at the middle of logarithmic growth . During the stationary phase the density remained stable . The buoyant density of serotypes Ia, Ib, II, III and a rough variant was determined by means of gradient centrifugation . In an isotonic milieu at the early stationary phase, the density of the strains varied in the range between 1.06 and 1.11 g/ml . Low ionic strength reduced the density of all strains . Neuraminidase-treatment increased the buoyant density of types Ia, Ib and III . The same pattern was seen in isotonic and hypotonic medium, although low ionic strength markedly augmented these differences . The influence of tonicity and neuraminidase-treatment was most prominent with types Ia and III, which may be due to relatively thicker polysaccaride capsules in these types.

J Med Virol, 1986 Jun, 19(2), 101 - 10
Detection of early hemagglutination inhibitory antibodies to rubella virus by pretreatment of sera with streptococcal cells; Kawano K et al.; A technique that is based on absorption of sera with streptococcal cells and hemagglutination inhibition (HI) was evaluated for its feasibility for serologic diagnosis of recent rubella . The mixture of AR1 and AW43 cells removes IgG and IgA from the kaolin-treated sera, leaving IgM and a trace of IgA, probably oligomeric IgA . Consequently, after the absorption with streptococci, the HI antibodies are detectable exclusively in the early sera of patients with rubella . The streptococci (AR1 and AW43) have several advantages as the absorbent over the staphylococcus (Cowan I) that has been used routinely.

J Exp Med, 1986 Jun 1, 163(6), 1451 - 8
Opsonic antibodies evoked by hybrid peptide copies of types 5 and 24 streptococcal M proteins synthesized in tandem; Beachey EH et al.; The protective immunogenicity of a hybrid peptide containing tandem copies of types 5 and 24 epitopes was investigated . Carboxy-terminal peptides of the cyanogen bromide-derived fragment 7 (CB7) of type 24 M protein were chemically synthesized, and then extended to include the first 20 residues of the amino-terminus of type 5 M protein . When emulsified in CFA and injected into rabbits without conjugation to a carrier, each of the synthetic hybrid peptides, designated S-M5(1-20)-S-CB7(23-35)C and S-M5(1-20)-S-CB(19-34), evoked opsonic antibodies against both types 5 and 24 streptococci without raising heart tissue-crossreactive immunity . These results suggest that tandem hybrid peptides may provide a new approach to the development of multivalent vaccines, not only to different serotypes of group A streptococci but perhaps also to a variety of other infectious agents.

J Dent Res, 1986 Jun, 65(6), 895 - 8
The effects of sorbate on oral streptococci grown in continuous culture; Rogers AH; The antimicrobial effect of potassium sorbate on Streptococcus mutans and S . milleri grown in continuous culture was determined at pH values of 7.0, 5.5, and 5.0 . Organisms were grown glucose-limited at a dilution rate of D = 0.1 h-1, corresponding to a doubling time of ca . seven hours, in a chemically defined medium under an atmosphere of 5% CO2 in N2 . After equilibration at the appropriate pH level, the culture vessel was pulsed with potassium sorbate to a final concentration of 20 mmol L-1 or with sorbate followed almost immediately by a pulse of glucose (to 40 mmol L-1); that is, the cultures were exposed to transient excesses of sorbate with and without glucose--such as might occur during meals . At pH 7.0, sorbate had virtually no effect on glucose uptake and on the, albeit transient, increase in growth rate and acid production by both organisms . At pH 5.5 and 5.0, both cell viability and acid production in S . milleri were depressed following a pulse of sorbate, the effect being even more marked after a sorbate/glucose pulse . At low pH, the uptake of glucose in the presence of sorbate was drastically reduced . The effect on S . mutans was less marked, but growth and acid production were greatly depressed at pH 5.0 following consecutive pulses of sorbate . The antimicrobial effect of the widely used preservative potassium sorbate, at low pH, is confirmed for oral streptococci, and it is suggested that continuous culture offers a relevant system for testing potential antimicrobial agents.

Zh Mikrobiol Epidemiol Immunobiol, 1986 Jun, (6), 26 - 9
{Biotyping of pathogenic cocci using mathematical methods}; Usviatsov BIa et al.; The differential information content of biological signs in the ecology of different staphylococcal and streptococcal species has been studied by the mathematical method . The method for the intraspecific differentiation of staphylococci, streptococci and gonococci into pathovars with the use of programs for the computerized analysis of the material has been proposed . The mathematical models of strain virulence in different coccal species are described.

Int J Oral Maxillofac Surg, 1986 Jun, 15(3), 288 - 91
Anaerobic bacteria in dentoalveolar abscesses; Sklavounos A et al.; The present study was initiated to determine the bacteriology of 40 orofacial abscesses of dental origin in patients who had taken antibiotics for several days . Bacteria were isolated from all but 2 specimens . Aerobic or facultative anaerobic bacteria were isolated in 21 cases, obligate anaerobic bacteria in 17 cases, whereas in 11 cases, polymicrobial growth was revealed . The average number of bacterial species was 2.1 per specimen . Gram positive aerobic micro-organisms predominated, namely, Staphylococcus epidermidis followed by Streptococci (group A) and Staphylococcus aureus . Among obligate anaerobes, Gram positive micro-organisms, peptostreptococci and peptococci were more often isolated, in the following decreasing order: Ps . productus, Ps . intermedius, Ps . parvulus, Ps . anaerobius, Pc . constellatus, Pc . prevotii . Gram negative anaerobic rods were detected in a small number of cases, namely B . corrodens, B . fragilis, B . melaninogenicus, B . ochraceus, B . oralis . Quantitative determination did not show any meaningful difference between aerobic and anaerobic isolates . Susceptibility tests against a series of antibiotics showed that ampicillin was the most active in aerobes and cefoxitin in anaerobes.

Infect Immun, 1986 Jun, 52(3), 803 - 11
Modulation of complement fixation and the phlogistic capacity of group A, B, and D streptococci by human lysozyme acting on their cell walls; Spitznagel JK et al.; Streptococci and streptococcal cell wall fragments induce arthritis in rats, with the severity and duration depending on the capacity of the cells or cell fragments to resist degradation by tissue enzymes . Their phlogogenic effects are apparently related to their ability to activate the alternate complement pathway (ACP) . The in vitro activation of the ACP by lysozyme-treated cells and cell walls of group A, B, and D streptococci suggests that both rat and human lysozyme can modulate this activity, i.e., increasing it, decreasing it, or doing both in that order . The effects of the lysozymes also correlated with the degree to which they can unmask the aminosugar-reducing groups detectable in a given amount of cell wall, which suggests that partial depolymerization of the cell wall is critical for ACP activation . The effects of mutanolysin and C phage lysin on ACP activation were found to be correlated with their action on streptococcal cell walls . Neuraminidase had relatively little effect on ACP activation by most streptococcal strains tested . We conclude that the participation of tissue enzymes, including but not necessarily limited to lysozyme, is an important determinant for the clinical arthritis induced by group A, B, or D streptococci . Experimental arthritis induced in rats with whole (or disrupted) streptococci may depend both on the capacities of the cell walls to activate the ACP and on the capacities of the host tissue enzymes to modulate this activation . Great severity and long durations of the disease were determined by the capacity of the enzymes to degrade cell wall antigens to a degree sufficient to ensure efficient activation of the ACP without completely degrading the material so that it no longer activates complement . In this model, the limited resistance of group B peptidoglycan to lysozyme was a critical pathogenic factor.

Immunology, 1986 Jun, 58(2), 251 - 5
Interaction between herpes simplex type 1-induced Fc receptor and human and rabbit immunoglobulin G (IgG) domains; Johansson PJ et al.; Cells infected with herpes simplex virus type 1 (HSV-1) express a cell surface receptor able to bind to the Fc region of immunoglobulin G (IgG) . The ability of HSV-1-infected cells to bind 125I-labelled human and rabbit IgG and IgG fragments was studied to localize the site of interaction to the C gamma 2 or C gamma 3 domains of IgG . 125I-labelled IgG and IgG Fc fragments consisting of C gamma 2 and C gamma 3 domains bound strongly to HSV-infected cells and did not bind to uninfected cells . In contrast, 125I-labelled F(ab')2, Facb {consisting of F(ab')2 and C gamma 2 domains} and pFc' (consisting of C gamma 3 domains) fragments did not bind to any of these cells . Unlabelled IgG and IgG Fc fragments inhibited the interaction between 125I-labelled rabbit IgG Fc and the HSV Fc receptor, whereas F(ab')2, Facb and pFc' fragments failed to inhibit this interaction . These data indicate that the HSV Fc receptor requires both the C gamma 2 and C gamma 3 domains for interaction with the IgG molecule analogous to the known interaction of protein A of Staphylococcus aureus, the Fc binding proteins of Group A, C and G streptococci, and certain human rheumatoid factors.

Presse Med, 1986 May 17, 15(20), 919 - 22
{Infectious endocarditis, complication of mitral valve prolapse}; Benichou M et al.; Among 77 patients with bacterial endocarditis on native valves explored by echocardiography, 12 (7 male, 5 female, mean age: 50 years) presented with mitral valve prolapse . This condition is relatively common, being found in 15.5% of patients with bacterial endocarditis and in 32% of those with mitral valve endocarditis . Two-dimensional TM echocardiography showed the mitral valve prolapse in every case and, in 11/12 cases, a vegetation associated with a varying degree of thickening of the valve due to myxoid degeneration . Although cardiac signs were sometimes minimal . Ten hemocultures were positive: 7 for streptococci, 2 for staphylococci and 1 for Hemophilus para-aphrophilus . Two patients died of cerebral haemorrhage, and there were 2 cases of hemiplegia, 4 cases of transient left ventricular failure and 2 cases of spleen embolism . These findings suggest that prophylactic treatment of bacterial endocarditis should be undertaken in patients with mitral valve prolapse and signs of myxoid degeneration at echocardiography.

JAMA, 1986 May 16, 255(19), 2638 - 42
Detection of group A streptococci in the laboratory or physician's office . Culture vs antibody methods; Kellogg JA et al.; Much controversy has existed concerning the clinical significance of small numbers of group A streptococci (eg, one to ten or even 50 colonies) recovered in culture . The relative quantity of streptococci recovered is, in part, technique dependent . This review documents the need for sensitive throat culture technology, addresses technical problems associated with the culture procedure, and, in light of these problems, explores the need for very carefully performed studies on streptococcal antigen detection kits before their implementation as a routine test either in physicians' offices or in microbiology laboratories.

J Biol Chem, 1986 May 5, 261(13), 6004 - 9
Solubilization of hyaluronic acid synthetic activity from streptococci and its activation with phospholipids; Triscott MX et al.; To date all hyaluronic acid synthetic systems have been of a particulate nature, and attempts at solubilization have been unsuccessful . This has hampered attempts to elucidate the mechanism by which hyaluronic acid is produced . In this paper we demonstrate that the hyaluronic acid synthetic activity from group C streptococcal membranes was solubilized using 2% digitonin and that the activity was optimized by reconstitution with cardiolipin at an optimum phospholipid/protein ratio (microgram/microgram) of 5:1 . Furthermore, chromatography of the solubilized synthetase demonstrated that it eluted after the void volume of a Sepharose CL-6B column . CHAPSO, octyl glucopyranoside, sodium cholate, Triton X-100, and zwittergent 314 either inhibited or failed to solubilize the synthetic activity . Phospholipids other than cardiolipin also reconstituted the activity from the digitonin extract, particularly phosphatidylethanolamine and phosphatidylserine . In our system, the specific activity of hyaluronic acid synthetase was increased up to 63 times that of the system of the intact membrane . Furthermore, the total activity of the reconstituted system was 4.9 times greater than that of intact membranes . The soluble enzyme system showed similarities to the membrane-bound synthetase in the kinetics of production of trichloroacetic acid-soluble and -insoluble hyaluronic acid, and the hyaluronic acid produced was of comparable molecular weight.

Infection, 1986 May-Jun, 14(3), 139 - 41
Comparative in vitro activity of cefpirome (HR 810) against gram-positive isolates from cancer patients; Rolston KV et al.; The activity of cefpirome against gram-positive isolates from cancer patients was compared to that of currently available extended-spectrum cephalosporins . Cefpirome was active against methicillin-susceptible, coagulase-positive, and coagulase-negative staphylococci . It was the most active agent against streptococci belonging to Lancefield groups A, B and G and Streptococcus pneumoniae . 76% of enterococcal isolates were susceptible to cefpirome - far more than any of the other agents tested.

J Clin Microbiol, 1986 May, 23(5), 843 - 6
Accuracy and reproducibility of the IDS rapID STR system for species identification of streptococci; Appelbaum PC et al.; The RapID STR system (Innovative Diagnostic Systems, Inc., Atlanta, Ga.) was evaluated in the identification of 266 streptococci . Organisms included 60 beta-hemolytic streptococci, 71 group D strains (48 enterococci and 23 nonenterococci), 26 Streptococcus pneumoniae, and 109 viridans group strains . With concomitant optochin testing, as is currently recommended by the manufacturer for all alpha-hemolytic strains, the RapID STR system correctly identified 100% of beta-hemolytic strains, 87.3% of group D strains (93.7% of enterococci, 73.9% of nonenterococci), 88.5% of S . pneumoniae, and 72.5% of viridans strains . Without the use of optochin, the correct identification of S . pneumoniae and the viridans group was 26.9 and 52.3%, respectively . The RapID STR system incorrectly identified 3.0% of strains, including four group D streptococci, three pneumococci, and one viridans isolate . Reproducibility was excellent, with 95% of strains tested in triplicate yielding identical results on each of the three occasions . The RapID STR system represents a worthwhile advance in streptococcal species identification, especially for group D and viridans strains.

J Med Microbiol, 1986 May, 21(3), 275 - 7
A new scheme for serotyping group-G streptococci; Lawal SF et al.; Ten antisera, prepared against nine selected strains of group-G streptococci and a strain of group-A streptococci of M-type 12, were used to serotype 102 isolates of group-G streptococci by means of precipitation reactions between the sera and hot-acid extracts of the streptococci . Fifty-six (54.9%) of the streptococci could be typed; eight serotypes were identified, of which type VIII was the most common (18.6%) . The M12 and the R28 antigens, previously recorded in group-G streptococci, were not detected . The type antigens were trypsin sensitive and resembled the M antigens of group-A streptococci.

Infect Immun, 1986 May, 52(2), 620 - 2
Variable colonization by oral streptococci in molar fissures of monoinfected gnotobiotic rats; van Houte J et al.; Germfree Sprague-Dawley rats, fed a high-sucrose diet, were monoinfected with strains of Streptococcus mitis, Streptococcus sanguis, and Streptococcus mutans . Viable cell recoveries from six molar teeth, considered to reflect mainly bacterial colonization of intact fissures, were in the order of 10(6), 10(7), and 10(8) CFU, respectively . Some of the implications of the variation of bacterial plaque-forming ability in the rat model are discussed.

Rev Infect Dis, 1986 May-Jun, 8(3), 364 - 73
Bacteremia in narcotic addicts at the Detroit Medical Center . I . Microbiology, epidemiology, risk factors, and empiric therapy; Crane LR et al.; The changing microbiology of bacteremia among narcotic addicts in Detroit raised concerns about current presumptive antimicrobial therapy . In a one-year study of incidence, microbiology, sites, and risk factors, 180 bacteremic addicts (15% of addict-related admissions) were followed prospectively . Cases of bacteremia were caused by methicillin-sensitive Staphylococcus aureus (33%), methicillin-resistant S . aureus (MRSA, 24%), streptococci (20%), mixed organisms (11%), Pseudomonas aeruginosa (9%), and miscellaneous other single organisms (3%) . Endocarditis (41%) and abscess or cellulitis (34%) were usually found . Multivariate analysis of host factors and addiction habits yielded results predictive of bacterial species but not of infection sites . Previous hospitalization, long-term addiction, and nonprescribed antibiotic use were associated with MRSA acquisition (odds ratio, 8.6:1) . All addicts with polymicrobial or P . aeruginosa bacteremia abused pentazocine and tripelennamine (P = .05) . Many of the addicts with streptococcal bacteremia were women who did not abuse antibiotics (odds ratio, 20.7:1) . Physicians inappropriately prescribed empiric antibiotics for 67 of 72 addicts with MRSA, P . aeruginosa, or polymicrobial infection . The results of regression analysis suggest that, guided by the patient's history, the physician can prescribe appropriate empiric antimicrobial therapy for bacteremia in the febrile addict in Detroit.

Pathol Biol (Paris), 1986 May, 34(5), 530 - 3
{Optimum choice of antibiotic treatment in neonatal infections due to group B streptococci}; Bingen E et al.; Morbidity and mortality among neonates with group B streptococcal infections remain high . As delays in bacterial killing may be responsible for these poor results, there is a need for studies into killing kinetics . We investigated antimicrobial sensitivity and killing effect time lags for penicillin, ampicillin and mezlocillin, alone and in combination with gentamicin or amikacin, against 20 strains of group B streptococci isolated in cultures of blood and cerebrospinal fluid from neonates . A culture of each strain (10(5) germs/ml) was exposed to the antibiotics individually or in combination . Antibiotics were used in the concentrations achieved clinically . Surviving bacteria were counted after 2 h 30, 4 h 30 and 24 h . incubation . Mean killing curves showed that the time interval until onset of a killing effect was 24 hours with either penicillin or ampicillin alone, against 4 h 30 with penicillin-amikacin or ampicillin-gentamicin . The most rapid killing effect (2 h 30) was observed with mezlocillin alone and ampicillin-amikacin . No antagonism was found between mezlocillin and aminoglycosides . Choice of the best antibiotic treatment for group B streptococcal infections should be based on both the rapidity of the in vitro killing effect and the antibiotic's diffusion into the site of the infection.

J Pediatr Orthop, 1986 May-Jun, 6(3), 346 - 8
Group C streptococcal osteomyelitis; Barson WJ; A case of hematogenous osteomyelitis due to a group C Streptococcus (Streptococcus equisimilis) is presented because of the unusual nature of the infecting organism . Group C streptococci are common pathogens in animals but are infrequent causes of human infections . Of therapeutic concern is the observation that these isolates are frequently penicillin-tolerant . For this reason, it is important to speciate beta-hemolytic streptococcal isolates and to perform antimicrobial susceptibility studies.

J Clin Microbiol, 1986 May, 23(5), 929 - 33
Role of proteinase in the formation of inhibitory levels of hematin by group A streptococcus cultures on blood-containing media; Hynes WL et al.; Group A streptococci were tested for proteinase production and for the possible relationship of this production to the generation of bacteriocinlike inhibitor activity . Of 126 strains tested, 83% were positive for proteinase, and a similar distribution was found among strains isolated in association with rheumatic fever (89%) and nephritis (94%) and from uncomplicated acute infections (78%) . Although application of an inhibitor production (P) typing scheme demonstrated a variety of P types, all of the proteinase-positive strains produced inhibitory activity and over 65% of these strains were P type 204 . It was shown that hematin was responsible for this P type 204 activity and that it was produced only by actively proteolytic strains when grown on a hemoglobin-containing medium . Conditions optimizing proteinase production (anaerobic incubation at 37 degrees C on a test medium prepared from Columbia agar base {GIBCO Laboratories, Grand Island, N.Y.}) increased P type 204 activity . Interference with proteinase activity either by growth of the cultures at an alkaline pH or by incorporation of sub-growth inhibitory concentrations of either iodoacetic acid or lincomycin into the medium prevented production of P type 204 activity . Whether significant conversion of hemoglobin to hematin occurs in vivo and the possible implications of this conversion with regard to the pathogenesis of group A streptococcal infections remain to be determined.

Am J Obstet Gynecol, 1986 May, 154(5), 1111 - 2
The in vivo effect of amniotic fluid on endocervical microflora; Patterson RM et al.; To test the in vivo effect of amniotic fluid on endocervical microflora, we performed endocervical cultures before and after rupture of the membranes in 20 patients in term labor . There were no significant qualitative or quantitative differences in aerobic or anaerobic isolates for up to 4 hours after membrane rupture . Group B streptococci, isolated in two patients (10%), persisted after rupture of the membranes . These data suggest that endocervical cultures are minimally influenced by rupture of the chorioamnion for at least 4 hours.

J Med Microbiol, 1986 May, 21(3), 189 - 97
Differentiation of Streptococcus sanguis and S . mitior by whole-cell rhamnose content and possession of arginine dihydrolase; Price T et al.; Whole-cell rhamnose concentrations were measured in 48 strains of streptococci resembling Streptococcus sanguis and S . mitior . Physiological characteristics were tested by the API-20/Strep system, and it was found that "typical" S . sanguis (arginine positive, aesculin positive) contained significant amounts of rhamnose, while "typical" S . mitior (arginine negative, aesculin negative) contained very low or undetectable amounts of rhamnose . Both groups contained dextran-positive and dextran-negative strains . Organisms that were more difficult to speciate (those giving positive results in the arginine or the aesculin test, but not in both) could also be divided into a rhamnose-positive and a rhamnose-negative group; with one exception, all of the rhamnose-positive strains gave a positive result with arginine in the API-20/Strep test . There were several discrepancies between the results of conventional tests for arginine and aesculin hydrolysis and those of the corresponding API test . The results of conventional tests for arginine hydrolysis did not correlate closely with rhamnose content, and conventional tests for aesculin hydrolysis were less sensitive than API tests . With the API-20/Strep system, S . sanguis can almost always be distinguished from S . mitior by its ability to hydrolyse arginine.

Infect Immun, 1986 May, 52(2), 609 - 12
Homologous regions within M protein genes in group A streptococci of different serotypes; Scott JR et al.; DNA hybridization with probes from the structural gene for the M6 protein shows that the carboxy-terminal region (proximal to the cell surface) is conserved among strains of different M serotypes . The amino-terminal region, which is more available to immunological surveillance, exhibits greater variation.

Infect Immun, 1986 May, 52(2), 459 - 67
In vivo degradation of bacterial cell wall by the muralytic enzyme mutanolysin; Janusz MJ et al.; The muralytic enzyme mutanolysin can act in vivo to eliminate chronic erosive arthritis induced in rats by polymers of peptidoglycan-polysaccharide isolated from group A streptococci (PG-APS) . The amounts of PG-APS in the livers and spleens of rats treated with mutanolysin were significantly reduced compared with the amounts in control rats treated with phosphate-buffered saline . However, the amounts of PG-APS in the limbs of mutanolysin- and phosphate-buffered saline-treated rats were comparable . PG-APS polymers extracted from the livers, spleens, and limbs of mutanolysin-treated rats were extensively degraded, whereas PG-APS extracted from phosphate-buffered saline-treated rats had a high molecular weight . We propose that mutanolysin abrogates arthritis in rats by degrading PG-APS polymers to a size which is no longer able to induce chronic erosive arthritis, even though the polymers are still present in the limbs.

Infect Immun, 1986 May, 52(2), 390 - 6
Comparison of in vivo degradation of 125I-labeled peptidoglycan-polysaccharide fragments from group A and group D streptococci; Stimpson SA et al.; The in vivo degradation and persistence of 125I-labeled peptidoglycan-polysaccharide (PG-PS) fragments from the cell walls of group A and D streptococci were compared by group after intraperitoneal injection into rats . The quantity of PG-PS in the livers and spleens of group D PG-PS-injected rats was less than the quantity in rats injected with group A PG-PS throughout the course of the experiment . Gel filtration analyses of liver and spleen homogenates indicated that group A PG-PS was relatively resistant to degradation, whereas group D PG-PS was extensively degraded to yield a heterogeneous mixture of fragments of lower molecular weight . There was no significant difference in the content of group A PG-PS versus that of group D in joints or blood samples . Analysis of fragment sizes in these tissues also indicated more extensive degradation of group D PG-PS . However, the majority of group A PG-PS in blood samples and joints was a lower molecular weight than that found in the livers or spleens . We conclude that group A PG-PS undergoes a significant but low level of degradation and that group D PG-PS is much less persistent and more extensively degraded than group A PG-PS is in vivo . These differences in PG-PS catabolism may account, in part, for the capacity of group A PG-PS to induce chronic, recurrent arthritis of longer duration than that induced by group D PG-PS.

Biochem J, 1986 May 1, 235(3), 887 - 9
Isolation of streptococcal hyaluronate synthase; Prehm P et al.; Hyaluronate synthase was isolated from protoblast membranes of streptococci by Triton X-114 extraction and cetylpyridinium chloride precipitation . It was identified as a 52,000-Mr protein, which bound to nascent hyaluronate and was affinity-labelled by periodate-oxidized UDP-glucuronic acid and UDP-N-acetylglucosamine . Antibodies directed against the 52,000-Mr protein inhibited hyaluronate synthesis . Mutants defective in hyaluronate synthase activity lacked the 52,000-Mr protein in membrane extracts . Synthase activity was solubilized from membranes by cholate in active form and purified by ion-exchange chromatography.

Am J Obstet Gynecol, 1986 May, 154(5), 973 - 7
An obstetric approach to the prevention of early-onset group B beta-hemolytic streptococcal sepsis; Minkoff H et al.; Group B beta-hemolytic streptococcus is one of the most common causes of neonatal sepsis . Despite its relationship to neonatal morbidity and mortality, no consensus exists for an approach to its prevention . Several characteristics of the organism such as high maternal carriage rates, the intermittent nature of this carriage, and the failure of antibiotics to permanently eliminate carriage have limited the success of proposed intervention protocols . In this clinical opinion we review characteristics of the organism and previously suggested intervention protocols . Then, based on this review and an analysis of recently published data, a protocol focusing on preterm births is presented . This proposal favors intrapartum treatment of all mothers who are delivered of preterm infants and who are either carriers of group B beta-hemolytic streptococci or whose carriage status is unknown . A comparison of the costs and benefits of this and other approaches is made.

J Bacteriol, 1986 May, 166(2), 658 - 65
Characterization of genetic transformation in Streptococcus mutans by using a novel high-efficiency plasmid marker rescue system; Lindler LE et al.; We developed a marker rescue system for study of competence development and genetic transformation in Streptococcus mutans . The system involved the recombinational rescue of a tetracycline resistance (Tcr) determinant by a homologous, inactive locus (Tcs because of a small deletion) . Streptococcal cells harboring this in vitro-prepared Tcs construct (pVA1208) were restored to Tcr when plasmid (pVA981) DNA was used as donor material . pVA981 contained the intact streptococcal Tcr locus and was unable to autonomously replicate in streptococci . Marker rescue with this system followed first-order kinetics and occurred at a frequency 8- or 160-fold higher than did transformation with homologous chromosomal or plasmid DNA, respectively . By using the rescue system, we were able to confirm that competence of S . mutans appeared to be inducible . This was indicated by a sequential increase and then decrease in Tcr transformation frequencies during growth in complex medium . Also, donor DNA binding was not sequence specific, since the recovery of Tcr transformants was reduced by increasing the concentrations of heterologous DNA . We investigated the fate of donor DNA and the kinetics of plasmid establishment in the transformation of S . mutans with plasmid DNA . Monomeric plasmid molecules transformed S . mutans as a second-order process, whereas multimeric plasmid DNA and chromosomal markers were recovered as a first-order process . Approximately 50% of the initially bound donor plasmid DNA was found to remain in a trichloroacetic acid-insoluble form . Our results suggested that molecular cloning in S . mutans would be conducted most efficiently by using helper plasmid systems or shuttle vectors and that gene transfer by transformation of S . mutans occurred in a manner similar to that observed in Streptococcus sanguis.

J Gen Microbiol, 1986 May, 132 ( Pt 5), 1389 - 400
Comparison of extracellular protein profiles of seven serotypes of mutans streptococci grown under controlled conditions; Hardy LN et al.; Extracellular proteins produced by the four human commensal species of mutans streptococci were analysed . The organisms used were Streptococcus mutans, serotypes c, e and f, Streptococcus cricetus, serotype a, Streptococcus rattus, serotype b, and Streptococcus sobrinus, serotypes d and g . They were grown in continuous culture at different generation times and pH values in media containing either glucose or fructose to determine the extent of variation in extracellular protein production that could occur for an individual strain . The results for different organisms grown under the same conditions were then compared . The total amount of protein of molecular mass greater than or equal to 60 kDa varied considerably with the growth conditions and with the strain . Generally more protein was present at a higher pH, conditions under which the organisms also form more lipoteichoic acid . With respect to individual protein components SDS-PAGE proved better than isoelectric focusing for detecting phenotypic responses by a particular strain to environmental changes and differences between the different strains . Differences in the molecular masses of protein components were particularly pronounced in the regions designated P1 (185-200 kDa), P2 (130-155 kDa) and P3 (60-95 kDa) . Every strain produced at least one component in the P1 region that cross-reacted with antiserum to the purified protein from S . mutans serotype c, a protein which is indistinguishable from antigens B and I/II . Two components in the P2 region were dominant in the case of S . cricetus and S . sobrinus strains and showed glucosyltransferase (GTF) activity . GTF activity was also detected in the P3 region, particularly with S . mutans strains.

J Hosp Infect, 1986 May, 7(3), 289 - 94
Masks: a ward investigation and review of the literature; Ransjo U; The use of masks was related to the acquisition from patients of beta-haemolytic streptococci and Staphylococcus aureus in the nose/throat of staff in a burns unit . The study took place over 10 weeks; wearing multi-layer operating room masks for every visit to patient rooms had no effect on nose or throat carriage rates, although airborne dispersal from patients was high.

J Exp Med, 1986 May 1, 163(5), 1191 - 202
Localization of protective epitopes of the amino terminus of type 5 streptococcal M protein; Dale JB et al.; We have used a set of overlapping chemically synthesized peptides representing the amino terminus of type 5 streptococcal M protein to localize protective, as opposed to nonprotective and tissue-crossreactive epitopes that might be appropriate for vaccine formulations . Rabbit antisera raised against SM5(1-35) reacted in high titer with pep M5 by ELISA and opsonized type 5 streptococci . None of the antisera crossreacted with human heart tissue or myosin . Antisera against SM5(26-35) reacted with SM5(1-35) and pep M5 but failed to opsonize type 5 streptococci . Particle-phase ELISA indicated that SM5(26-35) antibodies were directed against nonprotective determinants of pep M5 that were not exposed on the surface of viable organisms . Opsonization and ELISA inhibition assays showed that, of the SM5(1-35) antibodies that reacted with M5, all were inhibited by SM5(14-35), whereas none was inhibited by SM5(26-35), suggesting that the protective epitopes of SM5(1-35) resided between residues 14 and 26 . This was confirmed by subsequent chemical synthesis of this region; SM5(14-26) totally inhibited SM5(1-35) antibodies that reacted with pep M5 in ELISA, and completely inhibited opsonization of type 5 streptococci by SM5(1-35) antibodies . SM5(14-26) evoked high titers of type-specific, opsonic antibodies against type 5 streptococci, confirming the protective immunogenicity of this 13-residue peptide of type 5 M protein.

Cell Immunol, 1986 Apr 15, 99(1), 38 - 43
Anti-DNA antibodies and the problem of autoimmunity; Schwartz RS; Several different classes of autoreactive antibodies are known to exist: those that are stimulated by bacterial infection (e.g., streptococci/rheumatic fever), those that react with tissue-specific antigens (e.g., thyrotropin receptor/Graves' disease), and those that bind to ubiquitous autoantigens (e.g., DNA/systematic lupus) . The origin of the last kind of autoantibody is unknown, but it now seems that their production is an inherent property of the normal immune system . Indeed, it would appear that autoantibodies of the lupus variety actually have a physiological role in normal immunity . The development of the autoimmune disease may occur when there is an "escape" from the normal function of lupus autoantibodies.

Mol Immunol, 1986 Apr, 23(4), 425 - 31
Extraction and characterization of IgG Fc receptors from group C and group G streptococci; Reis KJ et al.; Immunoglobulin G (IgG) Fc receptors (FcRs) were extracted by proteolytic digestion of four strains each of group C and group G streptococci . The solubilized proteins were analyzed in Western blots and multiple IgG-binding bands were obtained . The banding patterns of some of the strains were very similar, but this property was independent of which streptococcal group the strains belonged to . Highly purified FcRs were prepared from one group C and one group G strain . The 13 N-terminal amino acids were determined, and found to be identical, whereas comparison with the sequence of staphylococcal protein A did not reveal any homology . The isolated streptococcal FcRs also appeared closely related antigenically and functionally . Thus, both molecules were capable of inhibiting each others binding to immobilized IgG, and the radiolabelled group G FcR was completely inhibited from binding to IgG by an antibody to the group C FcR . Finally, in a direct binding assay both proteins were capable of reacting to a similar degree with a wide variety of IgGs, thereby demonstrating the great potential of streptococcal FcRs as tools for binding and detection of IgG antibodies.

Zentralbl Bakteriol Mikrobiol Hyg {A}, 1986 Apr, 261(2), 248 - 53
Determination of asymptomatic carrier rate of beta-haemolytic group B Streptococcus in vaginas of pregnant women in Ibadan, Nigeria; Olanisebe SB et al.; Bacteriological studies of 500 vaginal swabs from pregnant women in second and third trimester from 4 government hospitals in Ibadan showed that 8 (1.6 per cent) were found to be culture-positive for Group B Streptococcus . Five (1.0 per cent) were found to harbour group D streptococci . All the 8 group B Streptococcus isolates were sensitive to erythromycin, methicillin, penicillin G, ampicillin and chloramphenicol in decreasing order . They were resistant to tetracycline, sulphafurazole and streptomycin.

J Clin Microbiol, 1986 Apr, 23(4), 700 - 3
Performance characteristics of a commercially prepared biphasic blood culture bottle; Weckbach LS et al.; A biphasic blood culture bottle (BiPB: GIBCO Laboratories, North Andover, Mass.) with an architectural design that physically separates the agar slant from the broth was compared with a conventional vented monophasic bottle (MPB-A) for use in the routine culture of blood . Both bottles contained tryptic soy broth . Tryptic soy agar was used for the BiPB slant . A third unvented bottle (MPB-N) with Columbia broth was included as part of the blood culture set . Of 3,537 sets collected, 444 were positive; 57 of these 444 sets were positive by virtue of an exclusively positive anaerobic bottle . Both BiPB and MPB-A were positive in 235 of the remaining 387 positive sets . A total of 521 isolates was recovered during the study . Of these isolates, 252 were recovered in both the BiPB and the MPB-A from the same set; 105 isolates grew in the BIPB but not in MPB-A, 95 isolates grew only in the MPB-A but not in BiPB, and 69 grew exclusively in the MPB-N . The BiPB allowed more rapid recovery of Candida spp., J-K diphtheroids, Pseudomonas spp . Making BiPB subcultures was easy enough to permit both early and daily subculture, which provided isolated colonies sooner than could be done by using the MPB-A . Isolated colonies and, therefore, identification and susceptibility results were available at least 1 day earlier for the BiPB isolates in approximately 50% of instances when both the BiPB and the MPB-A were positive . Staphylococcus epidermidis and streptococci were recovered more frequently in the BiPB, while gram-positive anaerobes were detected at a significantly (P less than 0.025) more frequent rate in the MPB-A than in the BiPB . Either bottle, however, should be used in conjunction with an anaerobic bottle for optimal recovery of anaerobic bacteria.

J Lab Clin Med, 1986 Apr, 107(4), 322 - 6
Type-specific antibody prevents platelet aggregation induced by group B streptococci type III; Wood EG et al.; Group B streptococci (GBS) type III organisms readily induced platelet aggregation and serotonin release in human platelet-rich plasma (PRP) . In a system using a GBS/platelet ratio of 1.5, aggregation occurred after 2 to 9 minutes (maximum aggregation, 73% +/- 11%) . Serotonin release began within the first minute, reaching 40% before aggregation was detected . Maximum release was 65% +/- 9% . The addition of type-specific rabbit antisera inhibited aggregation and release in a dose-dependent fashion, whereas rabbit antisera against GBS type II and a pneumococcus type 14 and 19 had no effect . To test the activity of different isotypes, monoclonal antibodies against the sialic acid determinant of the GBS type III antigens were used . IgG, IgM, and IgA antibodies were all effective in blocking aggregation and serotonin release . Although the significance of this phenomenon is not clear, it may represent a protective function of antibody that is not directly related to opsonization and phagocytosis.

Clin Pediatr (Phila), 1986 Apr, 25(4), 185 - 8
Children less than three-years-old with pharyngitis . Are group A streptococci really that uncommon?
Schwartz RH, Hayden GF, Wientzen R.
During a 15-month period, 148 infants and children less than 3-years-old who presented with signs and/or symptoms of pharyngitis were monitored in a private pediatric practice . Clinical signs included fever (95 or 64%), tonsillar exudate (16 or 11%), and cervical adenopathy (5 or 3%) . Beta-hemolytic streptococci (BHS) from group A were isolated from throat swabs in 37 (25%) instances . These isolations were more common among children 25-35 months old than among children less than 2 years old (35% vs . 19%, p less than 0.05), and were significantly more likely when overnight anaerobic culture techniques were used rather than conventional aerobic methods (23% vs . 11%, p less than 0.01) . Group A BHS may be isolated relatively frequently from symptomatic children under 3-years-old . Whether these isolations reflect invasive infection or asymptomatic carriage is uncertain.

Gan To Kagaku Ryoho, 1986 Apr, 13(4 Pt 2), 1285 - 9
{The influence of a biological response modifier on thoracic lymphocytes--a study involving clinical cases and animal experiments}; Hanaue H et al.; The influence of a biological response modifier on thoracic lymphocytes was studied clinically and experimentally . The thoracic lymphocytes and peripheral blood were taken from nine cases of gastric cancer relapse before and after the administration of hemolytic streptococci, OK-432 (PIC), for immunological examination . T: B cell ratio, T cell ratio and ADCC activity of the thoracic lymphocytes and peripheral blood were not changed but the NK activities of both were increased . The juvenilization of lymphocytes was reduced but that of the peripheral blood was not changed . The number and the ratio of T cells in the thoracic lymphocytes of Wistar rats were considerably increased by the administration of PIC but they were reduced in the peripheral blood . T-cell subsets of thoracic lymphocytes and peripheral blood were hardly changed by the administration of PIC . In the case immunological treatment, the thoracic lymphocytes and blood lymphocytes should be monitored because their biological specificities are different.

Zentralbl Bakteriol Mikrobiol Hyg {A}, 1986 Apr, 261(2), 167 - 9
beta-D-galactosidase activity in streptococci of serological group B; Lammler C et al.; Group B streptococci isolated from humans differed significantly in beta-D-galactosidase-activity from those of bovine mastitis . This could be demonstrated in a relatively simple and rapid test using a fluorogenic 4-methylumbelliferyl-beta-D-galactoside conjugate . Only 10 (12%) of 82 group B streptococcal cultures from human produced beta-D-galactosidase . On the other hand, 74 (96%) of 77 "bovine" cultures formed this enzyme . Thus, beta-D-galactosidase activity could be used as an additional marker for the differentiation between group B streptococci of human and bovine origin.

Zh Mikrobiol Epidemiol Immunobiol, 1986 Apr, (4), 18 - 21
{Microbial associations in chronic respiratory tract diseases}; Gorina LG et al.; In the peripheral blood of patients with chronic bronchitis the presence of Mycobacterium pneumoniae antigens has been registered in 20.0% of cases and the presence of group A Streptococcus haemolyticus antigens, in 24.0% of cases, the transformation of streptococci into the L-form being observed in 12.0% of cases . The presence of M . pneumoniae, streptococci and their L-forms, as well as associations of these microorganisms, is characteristic of patients with chronic obstructive bronchitis, which is, probably, one of the reasons for the maintenance of bronchial obstruction . In patients with chronic pneumonia and fibrosing alveolitis the antigens of the bacterial form of streptococcus and its L-forms have been detected only in a few cases.

Eur J Immunol, 1986 Apr, 16(4), 332 - 8
Macrophage activation by trehalose dimycolate requirement for an expression signal in vitro for antitumoral activity; biochemical markers distinguishing primed and fully activated macrophages; Grand-Perret T et al.; It was possible to define the effects of trehalose dimycolate (TDM), a glycolipid extracted from Mycobacterium tuberculosis, on mouse peritoneal macrophages more precisely using endotoxin-free culture conditions . TDM-elicited macrophages, when assayed in vitro in the absence of endotoxin, were unable to limit tumor growth; however, after a short treatment (4 h) with low doses of lipopolysaccharide (LPS; 1-10 ng/ml), they exhibited a strong cytostatic capacity against P815 mastocytoma cells . Thus, TDM injected in vivo did not activate macrophages fully but it primed them to respond in vitro to low doses of LPS, which provided the final stimulus for activation to antitumor competence . Macrophages elicited by an injection of killed group C Streptococci were also in a primed state; in contrast, thioglycollate-elicited macrophages were in a nonreceptive state . Besides LPS, concanavalin A (5 micrograms/ml), MDP (0.2-1 microgram/ml) and the ionophore A23187 (5 microM) can deliver the activation signal to TDM-primed macrophages . Primed macrophages were found to express several biochemical markers previously described as specific for activated macrophages (low levels of alkaline phosphodiesterase and beta-galactosidase, for example) and, although they were not cytotoxic for tumor cells, they had the capacity to release large amounts of H2O2 . However, when pulsed by LPS or MDP, primed macrophages responded by further modifications in their metabolism: the rate of glucose consumption and the labeling of glycoproteins by D-{2-3H}mannose were greatly increased and the secretion of a polypeptide of 22 kDa was enhanced . The activation-associated biochemical markers are thus acquired in two steps . The ability to produce activated oxygen species is expressed earlier than the antitumoral activity.

J Immunol, 1986 Apr 1, 136(7), 2670 - 3
Identification of a unique receptor on a group A streptococcus for the Fc region of human IgG3; Yarnall M et al.; Receptors that bind to the Fc region of all four human IgG subclasses have been described on a number of strains of group A streptococci . In this study, we have demonstrated that these immunoglobulin binding properties are mediated by two distinct Fc receptors . The first receptor, with a Mr of approximately 56,000, binds to human IgG1, IgG2, and IgG4, but not to IgG3 . A second receptor, with a Mr of approximately 38,000, binds exclusively to human immunoglobulins of the IgG3 subclass.

Zentralbl Bakteriol Mikrobiol Hyg {A}, 1986 Apr, 261(2), 161 - 6
Binding of human haptoglobin to streptococci of serological group A; Lammler C et al.; All 11 streptococcal cultures of serological group A possessing antigen T4 bound human 125I-labelled haptoglobin (hp) and fibronectin (fbn) . Most of these cultures also interacted with alpha 2-macroglobulin (alpha 2m), immunoglobulin G (IgG) and fibrinogen (fib), none with albumin . The binding of the labelled hp could be completely inhibited by unlabelled hp . It was not significantly affected by the other plasma proteins, except alpha 2m . Trypsinization of the streptococci reduced their binding activities for hp, fbn, fib and alpha 2m, but not for IgG . Extraction with guanidine hydrochloride removed non-covalently bound substances from the streptococci without loss in binding-activity for hp.

J Immunol, 1986 Mar 15, 136(6), 2287 - 92
Protective and nonprotective epitopes of chemically synthesized peptides of the NH2-terminal region of type 6 streptococcal M protein; Beachey EH et al.; The protective immunogenicity of chemically synthesized copies of the NH2-terminal region of type 6 streptococcal M protein was investigated . Four overlapping peptides were synthesized by copying residues 1-20, 10-20, 12-31, and 22-31 . Rabbit antisera raised against whole cells of type 6 streptococci reacted at high dilutions (1/12,800 to 1/51,200) with S-M6(1-20) and S-M6(10-20), and at low dilutions (1/100-1/800) with S-M6(12-31) and S-M6(22-31), indicating that the NH2-terminal region of type 6 M protein bears immunodominant epitopes . When covalently linked to tetanus toxoid and emulsified in complete Freund's adjuvant, the synthetic peptides S-M6(1-20), S-M6(10-20), and S-M6(12-31), but not S-M6(22-31), evoked type-specific opsonic antibodies against type 6 streptococci . Although the immune sera reacted in low dilutions by enzyme linked immunoabsorbent assay (ELISA) with the heterologous M protein polypeptides pep M5, pep M19, and pep M24, they failed to opsonize the streptococci from which these M protein polypeptides were derived . Each of the immune sera reacted in high dilution by ELISA with the respective immunizing peptides . All except those against S-M6(22-31) also reacted with pep M6 . None of the immune sera reacted with human cardiac tissue by immunofluorescence or with muscle myosin by ELISA . The pattern of the inhibition of opsonization by each of the synthetic peptides of each of the immune sera indicates the presence of at least three protective epitopes in the NH2-terminal region of type 6 M protein . Our results indicate that the NH2-terminal region of type 6 M protein contains both protective and nonprotective epitopes, and chemically synthesized copies of this region lack cardiac tissue cross-reactive epitopes . These studies hold promise for the development of safe and effective vaccines against group A streptococci, especially against the strains giving rise to rheumatic fever and rheumatic heart disease.

Diagn Microbiol Infect Dis, 1986 Mar, 4(3), 255 - 7
Group G streptococcal sacroiliitis; Raucher BG et al.; We describe herein an unusual case of recurrent pyogenic sacroiliitis in an intravenous drug abuser . Blood cultures grew group G streptococcus . The patient was treated effectively with 7 wk of penicillin G . Group G streptococci are emerging as important pathogens of serious infections.

Am Fam Physician, 1986 Mar, 33(3), 147 - 51
Neonatal septicemia due to Pseudomonas aeruginosa; Barton LL et al.; Group B streptococci and Escherichia coli are the most frequently isolated etiologic agents in neonatal septicemia . Neonatal infection that is caused by Pseudomonas aeruginosa is usually late in onset, nosocomial in origin and epidemic in pattern . However, P . aeruginosa must be considered in all neonatal infections, regardless of the age of onset, so that early, appropriate and often lifesaving antibiotic therapy may be instituted.

J Immunol, 1986 Mar 1, 136(5), 1796 - 802
Biosynthesis of paf-acether: VIII: Impairment of paf-acether production in activated macrophages does not depend upon acetyltransferase activity; Roubin R et al.; Activated peritoneal macrophages (M phi) from mice injected with Bacilli Calmette-Guerin, trehalose dimycolate, a defined immunostimulant derived from Mycobacterium tuberculosis, or streptococci C74 (St), synthesized two to three times less paf-acether (1-O-alkyl-2-acetyl-sn-glycero-3-phosphocholine) in response to a zymosan challenge than did (0.7 +/- 0.2 nmol/mg protein) resident-M phi (R-M phi) . To assess at which step the paf-acether biosynthetic pathway was impaired, the content in phospholipid paf-acether precursors was evaluated . The alkyl-acyl-glycerophosphocholine content was comparable in R-M phi (50.4 +/- 18.6 nmol/mg protein) and activated-M phi (40.0 +/- 6.5 to 63.9 +/- 7.7 nmol/mg protein), as well as the lyso paf-acether content (0.85 +/- 0.18 nmol/mg protein for R-M phi vs 0.63 +/- 0.16 to 1.23 +/- 0.21 nmol/mg protein for activated macrophages) . The nonlimiting rate of the phospholipid substrate was strengthened by experiments showing that incubation of the various populations with lyso paf-acether did not yield increased amounts of paf-acether . Similarly, incubation of R-M phi or St-M phi with sodium acetate increased paf-acether production to the same extent in both populations, ruling out the acetate substrate deficiency as the cause of the impaired production . The level of acetyltransferase activity, the enzyme that transfers an acetate moiety of acetyl coenzyme A (acetyl-CoA) onto lyso paf-acether, was very low in thioglycolate (TG)-elicited M phi but high in R-M phi and activated ones . In all cases, it was increased by two to three times upon zymosan challenge . This suggested that increased paf-acether catabolism and not impaired anabolism could be responsible for the marked reduced formation noted in activated macrophages . The addition of acetyl-CoA (200 microM) to the various macrophage monolayers restored paf-acether formation by activated cells to R-M phi values but with delayed kinetics as compared with paf-acether formation induced by zymosan . The enhancing effect of acetyl-CoA on paf-acether production was inhibited upon oleyl-CoA addition, suggesting that acetyl-CoA may increase paf-acether production by preventing the reacylation of lyso paf-acether resulting from paf-acether degradation . In conclusion, the paf-acether output in some inflammatory macrophages may be regulated by the level of acetyltransferase activity, because it is observed in TG-M phi . However, we present the first evidence for another mechanism of regulation, most probably related to the deacylation/reacylation of paf-acether precursors and metabolites.

Southeast Asian J Trop Med Public Health, 1986 Mar, 17(1), 32 - 7
Persistent bacterial endocarditis caused by three isolates of satellite streptococci; Sukroongreung S et al.; Three isolates of satellite streptococci were cultivated from the blood of a patient affected persistent bacterial endocarditis . They had distinguishable ultrastructural abnormalities . Their cell wall architecture changed from a fuzzy coat (first isolate) to a thick electron transparent layer covered with a rough fuzzy coat (second isolate), and to electron dense globular material which detached from the wall in small patches (third isolate) . The antibiotics probably played an important role in changing their architecture . These three isolates were probably derived from the same strain, since they had common biochemical characteristics and they were isolated from the same patient during the course of his endocarditis.

Antimicrob Agents Chemother, 1986 Mar, 29(3), 418 - 23
Discrepancies between MBC and actual killing of viridans group streptococci by cell-wall-active antibiotics; Meylan PR et al.; We determined the MBC of amoxicillin and vancomycin, two antibiotics advocated for treatment and prophylaxis of bacterial endocarditis, for 24 strains of viridans group streptococci isolated from patients with endocarditis . We found that the MIC of amoxicillin for all strains was less than or equal to 0.25 micrograms/ml and the MBC was either low (less than 0.5 micrograms/ml) in 6 nontolerant strains or high (greater than 128 micrograms/ml) in 18 tolerant strains . The MIC of vancomycin for the 24 strains was less than or equal to 1 microgram/ml, and the MBC was either low (less than 1 microgram/ml) for 3 nontolerant strains or high (greater than 128 micrograms/ml) for 21 tolerant strains . In addition to the MBC, we determined the actual reduction of the viable bacterial counts in each tube dilution after 24 h of incubation . This determination was made by subtracting the number of colonies observed on the subculture plate from the number of bacteria contained in the initial inoculum . For both antibiotics we found that the maximal reduction in viable counts was achieved at or very close to the MIC and did not increase with increasing antibiotic concentrations (up to 128 micrograms/ml) . As expected, the six strains for which the amoxicillin MBC was less than 0.5 micrograms/ml and the three strains for which the vancomycin MBC was less than 1 microgram/ml had a reduction of viable counts of more than 3 log10 (greater than 99.9% killing) . In contrast, among the strains defined as tolerant to amoxicillin and vancomycin, there were wide variations in the actual reduction of bacterial counts, ranging from 3 log10 to less than 1 log10 . Therefore our observations suggest that the reduction of viable streptococcal counts reflects more accurately the bactericidal effect of amoxicillin and vancomycin than does the MBC, which artificially divides the strains into sensitive or tolerant strains.

Tokai J Exp Clin Med, 1986 Mar, 11(1), 51 - 66
Review and current status of thrombolytic therapy with streptokinase; Stehle G et al.; In 1933 Streptokinase (SK) was isolated from bacterial strains of haemolytic Streptococci . Since then it has become the widest spread drug for fibrinolysis . SK, a protein, consists of 415 aminoacids and has a molecular weight of 47,000u . Together with the plasminogen (PLG) of the blood it forms activator complexes, which then convert other PLG molecules of the blood to plasmin . Plasmin attacks and dissolves fibrin deposits . As a substance produced by bacteria SK stimulates antibody formation in the body, the titer will increase during therapy, and SK lysis should be terminated after 6 days of treatment . Usually SK is administered intravascularly to treat a wide range of diseases, associated with pathological activation of hemostasis, like deep vein thrombosis, pulmonary embolism, myocardial infarction etc. . Contraindications can be traced back to the effects of SK on coagulation and the immune system . Bleeding is the most common side effect, but also a few anaphylactic reactions, caused by massive antigen-antibody precipitation have been observed . The rate of lethality of the treatment was established at 0.7% of the cases . To reduce the incidence of side effects modifications of the drug have been proposed, such as activator complex, light B chain SK, and acylated activator therapy . Compared with Urokinase, SK shows a higher rate of side effects, especially in the field of the immune system . Therapy with Urokinase can be controlled more easily . Nevertheless because of considerable price differences and logistics, SK is preferred in Europe and the USA . If strict guidelines in therapeutic use are followed, the rate of side effects of the drug can be curtailed and will be comparable to those of Urokinase.

J Gen Microbiol, 1986 Mar, 132 ( Pt 3), 633 - 40
Immunoelectrophoretic analysis of Streptococcus agalactiae serotype Ia antigens; Somerset SM et al.; Rabbit antibodies to heat-killed whole cells of Streptococcus agalactiae serotype Ia were used to establish an antigen map using Triton X-100 sonicates of homologous cells and crossed immunoelectrophoresis . A total of 11 antigens were identified but the density of immunoprecipitates was varied and only seven could be reliably detected, one of which dominated the immunoprecipitate pattern by its intensity . The antigens were partially characterized by immunological, chemical and cell-location methods . Five of the antigens contained carbohydrate and two of those were sensitive to trypsin and probably represent cell-wall compounds . Of the three most prominent antigens, one was surface located and represented the type and shared type antigens (Iabc), one was a cell-wall carbohydrate and very sensitive to periodate, and one was a protein/carbohydrate complex which was heat-labile and trypsin sensitive . Group B epitopes were detected in three immunoprecipitates . Cross-reactions between type Ia and other serotypes and streptococci were recorded.

Infection, 1986 Mar-Apr, 14(2), 74 - 8
Colonization of Nigerian neonates with group B streptococci and its rapid detection; Hoppe JE et al.; The rate of colonization by group B streptococci among Nigerian neonates in Abeokuta was found to be 19% (38 of 200 newborns) . The recently described serotype IV was the commonest (35.1%) among the strains isolated . Three methods for the rapid detection of heavy colonization by group B streptococci in neonates were compared: Gram stain of the pharyngeal aspirate collected immediately post-partum; direct application of latex agglutination to the first post-partum pharyngeal aspirate; and application of latex agglutination to selective Todd Hewitt broth, inoculated with pharyngeal aspirate and body swabs, after five hours of incubation . It seems that both latex agglutination methods can rapidly detect a considerable proportion of neonates heavily contaminated with group B streptococci intra-partum; therefore both methods deserve further evaluation.

Trop Geogr Med, 1986 Mar, 38(1), 55 - 7
Prevalence of pathogenic bacteria in patients with sore throat; Talukder MA; From 361 females and 452 males (527 primary care out-patients and 286 in-patients) a total of 813 throat swabs were examined for bacterial pathogens by conventional bacteriological techniques . Beta-haemolytic streptococci were grouped by the coagglutination method . Throat swabs from 14% of males and 15.6% of females were positive for bacterial pathogens; 75 (64% specimens grew BHS group A . All age groups of both sexes yielded a similar proportion of organisms . All pathogens were sensitive to penicillin, erythromycin and cephradine.

J Clin Microbiol, 1986 Mar, 23(3), 489 - 92
Reduction of morbidity and mortality rates for neonatal group B streptococcal disease through early diagnosis and chemoprophylaxis; Lim DV et al.; Pregnant women, part of the term service population at Orlando Regional Medical Center, were screened for group B streptococci (GBS), using Lim Group B Strep Broth (GIBCO Laboratories, Madison, Wis.) and the Phadebact Strep B Test (Pharmacia Diagnostics, Piscataway, N.J.) . Of the 803 women screened, 173 were confirmed as colonized with GBS at the time of admission in labor . Eighty of these women were treated with ampicillin at least 6 h prior to delivery . The remaining 93 women received no ampicillin . None of the infants born to the treated women was colonized with GBS at surface culture sites . Forty-three of the infants born to untreated women were colonized . Rapid identification of GBS colonization in women, combined with ampicillin chemoprophylaxis, significantly reduced vertical transmission of GBS.

Pediatr Infect Dis, 1986 Mar-Apr, 5(2), 208 - 12
Rapid latex agglutination compared with the throat culture for the detection of group A streptococcal infection; White CB et al.; The Culturette Brand rapid latex agglutination test was compared with the throat culture for accuracy in detecting Group A beta-hemolytic streptococci (GABHS) on paired throat swabs from 1047 children with suspected streptococcal pharyngitis . In this comparison the rapid latex agglutination test had a sensitivity of 78%, a specificity of 88%, a positive predictive value of 52% and a negative predictive value of 96% . In 45 study patients from whom it was possible to obtain paired acute and convalescent sera, the latex agglutination test and the throat culture were compared against each other for detection of infection due to GABHS as evidenced by a 4-fold or greater titer rise of serum antistreptococcal antibodies . The latex agglutination test detected and failed to detect the same number of infections as the throat culture . Thus although a significant number of false positive latex agglutination tests occurred when compared to the throat culture, there is limited evidence in this study that the latex agglutination test is equal to the throat culture in detecting patients who have serologically confirmed infection due to GABHS.

J Pediatr, 1986 Mar, 108(3), 347 - 51
Comparison of a latex agglutination test and four culture methods for identification of group A streptococci in a pediatric office laboratory; Roddey OF et al.; A latex agglutination test and four culture methods for the detection of group A hemolytic streptococci were compared in a pediatric office laboratory . The anaerobic (GasPak) and Detekta-Kit methods produced the highest recovery rates, but aerobic incubation of 5% blood agar plates gave very acceptable results (sensitivity 92%, or 98% if the 1+ positive cultures were eliminated; specificity 100%), and had fewer disadvantages . Delaying inoculation of plates for 2 to 6 hours resulted in significantly greater numbers of strongly positive (3+ and 4+) cultures . The group A selective sheep blood agar media as used in this study offered no advantage . The Culturette test had a sensitivity of 72% and specificity of 98%, compared with the GasPak method, and 77% and 97%, respectively, compared with standard aerobic cultures . Thus it appears too insensitive to be used alone, but might complement culture methods in selected patients.

J Fam Pract, 1986 Mar, 22(3), 245 - 8
Comparison of throat culture and latex agglutination test for streptococcal pharyngitis; Fischer PM et al.; Numerous reports have recently appeared in the clinical microbiology literature that describe agglutination tests for identifying patients with group A streptococcal pharyngitis . These studies have indicated a close correlation between the results of the agglutination tests and traditional throat culturing . This paper describes a comparison study of 100 consecutive throat swab specimens using a commercially available agglutination test and routine throat culturing . The cultures were interpreted by an individual who was blinded to the agglutination test results . All agglutination testing was done by two laboratory members of a family practice office staff . The agglutination procedure was easy to perform and clear to interpret . The test sensitivity and specificity compared well with that reported in the literature from microbiology laboratories . The new agglutination tests are useful in the office laboratory for the identification of group A streptococci . Their primary advantage compared with throat culturing is the rapid availability of test results.

Jpn J Antibiot, 1986 Mar, 39(3), 842 - 52
{In vitro susceptibilities of BRL 25000 (clavulanic acid-amoxicillin) against causative organisms in the field of obstetrics and gynecology}; Deguchi K et al.; The in vitro susceptibilities of various causative organisms recently isolated from patients with genital infections to BRL 25000 (a formulation with 2 parts of amoxicillin and 1 part of potassium clavulanate), amoxicillin (AMPC), cefaclor (CCL), cephalexin (CEX), cefadroxil (CDX) and cefroxadine (CXD) were determined . beta-Lactamase-producing strains were detected by the nitrocefin disc method . Frequencies of isolation of beta-lactamase producing strains of E . coli, K . pneumoniae and B . fragilis were 36%, 96% and 100%, respectively . The activity of BRL 25000 against S . agalactiae and anaerobic GPC (anaerobic Streptococci, Peptostreptococcus spp.) was slightly less than that of AMPC but was 2- to 4-fold higher than CCL and 8- to 16-fold higher than CEX, CDX and CXD . Against E . coli and K . pneumoniae, the activity of BRL 25000 was superior to that of AMPC and approximately equal to CEX, CDX and CXD but 2-fold less than CCL . Against the B . fragilis group, BRL 25000 was much more active than AMPC or any of the cephalosporins tested, clearly demonstrating the beta-lactamase inhibitory properties of the clavulanic acid in BRL 25000 . At inocula of 10(6) CFU/ml, MIC values of BRL 25000 were 12.5-50 micrograms/ml against some strains of E . coli, K . pneumoniae and B . fragilis . A mechanism of resistance other than beta-lactamase production is obviously prevalent in these strains . It is speculated that the resistance may be due to a low affinity of the drug to target proteins . Mixed infections of B . fragilis and E . coli or K . pneumoniae are commonly found in the obstetric and gynecological patients . BRL 25000 shows activity against these strains and also against both aerobic and anaerobic GPC . Therefore, BRL 25000 is considered useful for the treatment of genital infections.

J Dent Res, 1986 Mar, 65(3), 448 - 51
Characterization of human dental plaque formed on hydrogen-ion-sensitive field-effect transistor electrodes; Chida R et al.; The purpose of this study was to evaluate (with scanning electron microscopy and microbiological characterization) the bacterial deposits which accumulate on hydrogen-ion-sensitive field-effect transistor electrodes (pH-ISFET) under conditions normally employed for telemetric monitoring of changes in human dental plaque pH . Electrodes were mounted in a carrier appliance which was worn for two, four, and six days . The plaque pH response to a sucrose solution increased with the age of the plaque, as expected from previous studies . After two days, the electrode was shown to be almost completely covered with cocci . At days 4 and 6 there was a dramatic increase in the number of rods present in the plaque . Adjacent enamel surfaces showed similar accumulations of bacteria . The total number of bacteria which had accumulated per unit area by day 4 was very similar for the electrode and enamel surfaces . On both surfaces the plaque contained approximately 25% streptococci, and the dominant species was Streptococcus sanguis (approximately 75%) . The plaque which accumulated on pH-ISFET electrodes could not be distinguished visually or microbiologically from that which formed on control enamel surfaces.

Public Health Rep, 1986 Mar-Apr, 101(2), 211 - 5
Foodborne streptococcal pharyngitis after a party; Berkley SF et al.; Following a private party in Rio Piedras, PR, 23 (56 percent) of those who attended developed an illness characterized by pharyngitis, myalgia, fatigue, headache, and fever . Consumption of carrucho (conch) salad was significantly associated with illness (P = 0.013, Fisher's exact test) . Group A beta-hemolytic streptococci (M nontypable T12, serum opacity factor positive) were isolated both from throat cultures in 11 of 47 persons who attended the party and from the implicated food . The original source of contamination of the conch salad was not identified . Because complications may still occur from such infections and only a small percentage of persons with sore throats seek medical attention and ultimately receive treatment for their illnesses, it is important to recognize these outbreaks.

Z Naturforsch {C}, 1986 Mar, 41(3), 258 - 62
Activation of streptolysin S in vitro by oligonucleotides; Taketo A et al.; When washed streptococci were incubated in a phosphate buffer containing MgSO4 and maltose (Bernheimer's basal medium) and centrifuged, no hemolytic activity was detected in the supernatant . Although incubation of the spent medium with carrier oligonucleotide did not yield active hemolysin, the mixture turned to be significantly hemolytic, upon ethanol precipitation and dehydration . Oxygen stability, sensitivity to trypan blue, absence in the spent medium from strain C203U, as well as chromatographic properties demonstrated that the hemolytic activity was due to streptolysin S-oligonucleotide complex . The latent streptolysin S was detected in the streptococcal culture supernatant as well . These results indicate that, even in the absence of exogenous carrier, streptolysin S is produced extracellularly by hemolytic streptococci but suffers rapid denaturation, and that the carrier oligonucleotide serves as an effector for the toxin peptide to assume active conformation, through noncovalent interaction . Effects of several protein denaturants were investigated on the toxin activation in vitro.

J Med Microbiol, 1986 Mar, 21(2), 93 - 100
The relationship between Fusobacterium species and other flora in mixed infection; Brook I et al.; Mixed infections with three Fusobacterium species and seven other bacterial species were studied in a subcutaneous abscess model in mice . Fifteen Fusobacterium isolates (eight F . nucleatum, four F . necrophorum, and three F . varium) and one isolate each of Bacteroides fragilis, B . asaccharolyticus, Staphylococcus aureus, Group A beta-haemolytic streptococcus, Escherichia coli, Klebsiella pneumoniae and Pseudomonas aeruginosa were studied . Electronmicrographs showed the presence of a thin mucopolysaccharide wall before and after inoculation into mice in 12 isolates which included all of 11 Fusobacterium isolates that induced subcutaneous abscesses . After co-inoculation of Fusobacterium isolates with other species and selective therapy with antimicrobial agents, S . aureus and K . pneumoniae were found to be of equal or greater importance in abscess induction than were Fusobacterium isolates, while Fusobacterium isolates were found to be more important than Group A streptococci and E . coli . Mutual enhancement of the numbers of organisms in mixed infections was observed with Fusobacterium spp . and K . pneumoniae, P . aeruginosa or Bacteroides spp . Suppression of Fusobacterium spp . was noticed only when they were co-inoculated with Group A streptococci . The additive or synergistic capabilities of Fusobacterium species highlighted their potential pathogenicity in infection.

J Hosp Infect, 1986 Mar, 7 Suppl A, 65 - 72
Activity of teicoplanin compared with vancomycin alone, and combined with gentamicin, against penicillin tolerant viridans streptococci and enterococci causing endocarditis; Shanson DC et al.; Teicoplanin had greater inhibitory activity than vancomycin against most of 22 penicillin tolerant strains of streptococci, but both drugs failed to kill 99.9% of the inoculum when tested alone at concentrations less than 16mg 1(-1) . Bactericidal synergy between teicoplanin combined with gentamicin and vancomycin combined with gentamicin was always demonstrated in further tests with 16 penicillin tolerant strains . Teicoplanin had greater bactericidal activity than vancomycin against five of seven strains of viridans streptococci and five of nine strains of enterococci in MBC experiments, where each drug was combined with gentamicin . Killing curve experiments with five penicillin tolerant streptococci showed teicoplanin and vancomycin to have similar bactericidal activity within 24 h when tested at 5 mg 1(-1) with 2 mg 1(-1) gentamicin . However, at 0.5 mg 1(-1) only teicoplanin had a bactericidal synergic effect with gentamicin.

Biochem J, 1986 Feb 15, 234(1), 43 - 8
Use of the photoaffinity cross-linking agent N-hydroxysuccinimidyl-4-azidosalicylic acid to characterize salivary-glycoprotein-bacterial interactions; Bergey EJ et al.; The present study has utilized the iodinatable cross-linking agent N-hydroxysuccinimidyl-4-azidosalicylic acid (ASA) to examine the specific interaction between the proline-rich glycoprotein (PRG) of human parotid saliva and Streptococcus sanguis G9B . The binding of 125I-ASA-PRG to Streptococcus sanguis G9B displayed saturation kinetics, reversibility and was inhibited by unlabelled PRG . Inhibition studies with other glycoproteins and saccharides indicated that binding was mediated by a bacterial adhesin with specificity towards N-acetylneuraminic acid, galactose, and N-acetylgalactosamine . After cross-linking, the 125I-ASA-PRG-adhesin complex could be extracted with SDS and separated from uncoupled 125I-ASA-PRG by gel filtration on Sepharose CL-6B . Approx . 1% of the 125I-ASA-PRG was cross-linked to the bacterial surface . Examination of the 125I-ASA-PRG-adhesin complex by SDS/polyacrylamide-gel electrophoresis/fluorography on 5% -(w/v)-polyacrylamide gels revealed that PRG was bound to two bacterial components . These findings support our previous suggestion that human salivary glycoproteins can specifically interact with oral streptococci and that these interactions occur between the glycoprotein's carbohydrate units and lectin(s) on the bacterial cell surface.

Arch Biochem Biophys, 1986 Feb 15, 245(1), 37 - 43
Crosslinking of actin filaments and inhibition of actomyosin subfragment-1 ATPase activity by streptococcal M6 protein; Chalovich JM et al.; M proteins are antiphagocytic molecules on the surface of group A streptococci having physical characteristics similar to those of mammalian tropomyosin . Both are alpha-helical coiled-coil fibrous structures with a similar seven-residue periodicity of nonpolar and charged amino acids . To determine if M protein is functionally similar to tropomyosin we studied the interaction of M protein with F-actin . At low ionic strength, M protein binds to actin weakly with a stoichiometry different from that of tropomyosin . M protein does not compete with tropomyosin for the binding to actin, indicating that it is functionally different from tropomyosin . M protein does compete with myosin subfragment-1 for binding to actin and induces the formation of bundles of actin filaments . The formation of actin aggregates is associated with a sharp reduction in the rate of ATP hydrolysis by subfragment-1 . Intact streptococci having M protein on their surface are shown to bind to actin.

J Biol Chem, 1986 Feb 5, 261(4), 1677 - 86
Complete nucleotide sequence of type 6 M protein of the group A Streptococcus . Repetitive structure and membrane anchor; Hollingshead SK et al.; The DNA sequence of the gene for type 6 M protein of Streptococcus pyogenes contains two extended tandem repeat regions and one nontandem repeat region . We suggest that the duplication and deletion of these repeats generates the observed diversity in size and sequence among the family of M proteins in the group A streptococci . In addition, the DNA sequence reveals the presence of a 42-amino-acid signal peptide, a region rich in proline that is thought to be located in the cell wall, and a membrane anchor sequence at the carboxyl-terminal end of the protein . Signals similar to the consensus sequences recognized for the initiation of transcription and translation in Gram-positive bacteria have been identified in the DNA sequence . Codon usage is similar to that of other Gram-positive bacteria and significantly different from that of Escherichia coli.

Arch Intern Med, 1986 Feb, 146(2), 295 - 7
Microbiologic evaluation of cutaneous cellulitis in adults; Hook EW 3rd et al.; Fifty patients with cellulitis were evaluated prospectively using cultures of aspirates from the advancing edge of cellulitis, skin biopsy specimens, and blood . Potential microbial pathogens were isolated in 13 patients . Biopsy specimen cultures were positive in ten patients, while aspirate and blood cultures were positive in five and two, respectively . Aspirate, biopsy, or blood cultures were more often positive in patients with apparent primary lesions than in patients without such lesions . Apparent primary sites of infection were identified and cultured in 24 patients . beta-Hemolytic streptococci were isolated from 17 primary lesions, and coagulase-positive staphylococci were present in 13 . Both organisms were isolated from ten primary lesions . Among patients with positive aspirate, biopsy, and/or blood cultures, the same pathogens were also isolated from primary sites in ten of ten patients . Clinical features, including temperature, white blood cell count, and erythrocyte sedimentation rate, were not predictive of positive aspirate, biopsy, or blood cultures . These cultures provided no microbiologic information that was not obtainable from culture of primary lesions.

Infect Immun, 1986 Feb, 51(2), 440 - 4
Immunological cross-reactivity of anionic proteins from caries-free and caries-active salivas which differ in biological properties toward oral streptococci; Obenauf SD et al.; We examined whether the anionic antimicrobial proteins in the saliva of certain caries-free (CF) individuals are immunologically cross-reactive with proteins in caries-active (CA) saliva which display identical isoelectric points but which exhibit growth-supportive properties for the oral streptococci . In the immunoblotting experiments reported here, the proteins present in CF and CA whole salivas reacted similarly with an antiserum prepared against the anionic inhibitory proteins . This antiserum also showed identical reactivity with the purified protein fraction containing the anionic proteins of interest from whole saliva of either CF or CA subjects . Additionally, an antiserum to CA saliva was found to react with the CF anionic inhibitory proteins . The fact that the inhibitory and noninhibitory proteins react similarly with the antisera used provides further evidence for similarity between both classes of proteins.

Br Heart J, 1986 Feb, 55(2), 191 - 7
Heart failure associated with infective endocarditis . A review of 40 cases; Varma MP et al.; Thirty one (78%) of 40 consecutive patients (aged 13-79, mean 44 years) with infective endocarditis had congestive heart failure at presentation . Twenty six (65%) had had rheumatic heart disease and 17 (43%) patients had prosthetic valves . Eight (20%) patients had undergone dental procedures within three months of presentation . Blood cultures were positive in only 22 (55%) of the patients . In nine (41%) of them streptococci of the viridans group were isolated and in seven (32%) patients endocarditis was due to Staphylococcus aureus . Eight patients had Q fever endocarditis . Sixteen patients required operation because of haemodynamic deterioration while they were in hospital; 11 patients had native valves and five had prosthetic valves . Seven had emergency operations and were pyrexial at that time . Four of the seven died in hospital . Of the 12 who were alive and well after surgery only two required further surgery two and three years after the initial operation . Twelve (30%) of the 40 patients died in hospital; in 10 death was mainly due to left ventricular failure or congestive heart failure . All patients died who had renal failure (four cases), myocardial infarction (two cases), complete heart block (one case), or ventricular fibrillation (two cases) before operation . Six (33%) of the 18 patients with culture negative endocarditis died . Two of the four patients seen and treated more than 12 weeks after the onset of symptoms died, as did three of the five patients with prosthetic valves who required surgery while in hospital . Three patients with neurological complications survived and only two (29%) of the seven patients with blood cultures that were positive for Staphylococcus aureus died . Of these 40 high risk patients optimal antibiotic treatment and early surgery for haemodynamic difficulty ensured that 28 (70%) were discharged from hospital alive and well.

J Antimicrob Chemother, 1986 Feb, 17(2), 161 - 3
In-vitro activity of RU 28965, a new macrolide, compared to that of erythromycin; Rolston KV et al.; The activity of a novel macrolide, RU 28965, was compared to that of erythromycin against Gram-positive organisms isolated mainly from cancer patients . RU 28965 was active against streptococci including Streptococcus pneumoniae and streptococcal groups A, B and G . It was also active against methicillin-susceptible staphylococci, Bacillus cereus and Listeria monocytogenes . Its activity against these organisms was generally equal to that of erythromycin . RU 28965 was moderately active against enterococci and inactive against JK diphtheroids and three different species of coagulase-negative staphylococci . Organisms resistant to erythromycin were also resistant to RU 28965.

Pathol Biol (Paris), 1986 Feb, 34(2), 119 - 28
{Lincosamides}; Pechere JC; The two main antibiotics that make up the group of lincosamides are lincomycin and its more recent derivative clindamycin; the latter, more active drug is gaining preference over the former . These antibiotics are active primarily against Gram positive cocci (i.e . staphylococci, pneumococci and group A and unclassifiable streptococci) and against most anaerobes (including Bacteroides fragilis) . This action originates in binding to the 50S ribosomal fraction . Lincosamides may be given per os, intramuscularly or intravenously . After an oral dose of clindamycin, 90% of the drug is absorbed, and the peak serum level is reached within the first hour . Drug absorption is not modified by meals . Regardless of the route of administration, the serum half life of clindamycin is 2 to 3.8 hours in healthy individuals . Longer half lives are observed in patients with severe renal or hepatic failure, requiring that lower dosages be given by widening the intervals between doses . Diffusion of lincosamides into tissues is of clinical significance except for the central nervous system, especially the cerebrospinal fluid . On the whole, lincosamides are well tolerated . Pseudomembranous colitis is a potential hazard . The main indications of clindamycin are infections due to anaerobes, especially intestinal and vaginal infections . As clindamycin has virtually no effect against Gram negative aerobic pathogens, in most instances another antibiotic, usually an aminoglycoside, is given simultaneously . Other less common indications are some instances of aspiration pneumonia, septicemias due to B . fragilis, and actinomycoses . Because of the risk of pseudomembranous colitis, prophylactic use of clindamycin to prevent postoperative infections following colorectal surgery seems unadvisable.

Vet Immunol Immunopathol, 1986 Feb, 11(2), 193 - 8
The loss of opsonic activity of bovine milk whey following depletion of IgA; Mackie DP et al.; The role of the IgA antibody to Streptococcus agalactiae found in the whey of milks 12 hours after the first intramammary infection of six Friesian first lactation heifers was assessed using an in vitro bactericidal assay . The mean percentage kill of the streptococci by neutrophils in the presence of these wheys was 36.2% while the equivalent figure for the non-infected quarter whey was 0% . When the IgA antibody was absorbed from the infected quarter wheys using class specific IgA antiserum cross linked with glutaraldehyde the percentage kill of the test system fell to 0% . Elution of the absorbed antibody partially restored the activity to a mean percentage kill of 18.2% . The results indicated that the IgA antibody found in infected quarter whey during the acute stages of intramammary infection with Streptococcus agalactiae was responsible for the opsonic activity which pertained at that time.

Immun Infekt, 1986 Feb, 14(1), 6 - 10
{Causative spectrum of bacteremia and sepsis: significance for therapy}; Ringelmann R et al.; Nowadays, infection with septicemia still can be a life-threatening disease . We evaluated the therapeutic behavior of clinicians basing on our diagnostic experiences during the last years and data from continuous epidemiological analysis . Important statements resulted on therapy without knowledge of the pathogen . Our results allow us to calculate the probabilities of various kinds of pathogens as well as their resistance patterns, dependent on the ward . One third of our isolates were staphylococci, followed by about 15% E . coli . The portions of all the other pathogens, e.g . other gram-negative rods, streptococci or anaerobs, were 2% or less . The application of various classes of antibiotics has been rather constant in the years 1981-1984, the penicillins showing a slight increase while the cephalosporins decreased . However, our data proved the cephalosporins to be of marked better efficacy . This points out the importance of such evaluations, whose results must be given to the physicians.

Diagn Microbiol Infect Dis, 1986 Feb, 4(2), 177 - 9
Lack of correlation between streptococcal Fc receptors and symptomatic pharyngitis; Fisher PR et al.; To determine whether bacterial Fc(gamma) surface receptors are associated with symptomatic streptococcal pharyngitis, throat cultures were obtained from 264 children (grouped according to symptoms of pharyngeal infection) and from 328 who were asymptomatic . Group A beta-hemolytic streptococci which were recovered were tested for the presence of Fc(gamma) surface receptors . There were no statistically significant differences in the incidence of Fc(gamma) surface receptors on strains from the various patient groups.

J Med Microbiol, 1986 Feb, 21(1), 75 - 81
Pigment production by Lancefield-group-B streptococci (Streptococcus agalactiae); Tapsall JW; Cells of group-B streptococci harvested in the late exponential phase of growth and suspended in starch-glucose phosphate-buffered saline extractor solution were observed to form and release pigment into solution . Filtrates of these solutions were analysed spectrophotometrically and two varieties of pigment were detected . Pigment, when freshly produced or in the presence of starch, had four absorption peaks at 520, 485, 455 and 435 nm . If albumin was substituted for starch in the extractor solution or if the starch-pigment complex was disrupted by treatment with amylase or by boiling, the four-peak pigment rapidly and irreversibly degraded to a second type with a single absorption band at 415 nm . The pigments formed by washed cell suspensions had absorption spectra identical to those produced by pigment formed during growth in Todd-Hewitt Broth . The formation and release of soluble pigment appeared to be an active metabolic process; a carrier molecule and an energy source were both required . Pigment yields were increased when the pH of the extractor solution was in the range 7.0-7.4 and when Mg2+, but not other divalent cations, was present . No differences in yield or type of pigment were observed when pigment was formed in anaerobic conditions . These findings support an earlier observation that group-B streptococcal pigment resembles a beta carotenoid . There is some added support for the suggestion that haemolysin and pigment production by these organisms are closely linked characteristics.

J Med Microbiol, 1986 Feb, 21(1), 69 - 74
Surface proteins in the transduction of groups A and G streptococci; Skjold SA et al.; Four pairs of M+SOR+ and M-SOR- variants of group-A type-49 streptococci were compared as receptor strains in transduction of a streptomycin-resistance marker . The yield of transductants was 5-9-fold greater with the M-SOR- variants than with the corresponding M+SOR+ variants . Treatment of M+SOR+ variants of type-49 streptococci with trypsin enhanced the rate of transduction by 16-35-fold whereas trypsin treatment of corresponding M-SOR- variants resulted in minimal enhancement (5-fold or less) . With trypsin treatment the numbers of transductants were approximately equal in pairs of M+SOR+ and M-SOR- variants . Enhanced transduction (10-26-fold) of streptomycin resistance was obtained by trypsin treatment of another seven M+SOR+ type-49 strains, of diverse phage subtypes and from various geographical locations . A wide range of enhancement (5-46-fold) was found in eight of nine M+ strains of group-A type-6 streptococci . With trypsin treatment, three of 10 transducible group-G strains showed enhanced transduction (10-13-fold) of a plasmid containing a determinant for erythromycin resistance . Transductional enhancement is proteolytic in nature, being enhanced by trypsin, chymotrypsin, papain, pronase and streptococcal proteinase . Although interference with phage adsorption by surface proteins would appear to be the most obvious explanation for these findings, further studies are required to define more clearly the mechanism of trypsin enhancement.

Immunology, 1986 Feb, 57(2), 305 - 9
Interaction between streptococcal IgG Fc receptors and human and rabbit IgG domains; Schroder AK et al.; Groups A, C and G streptococci were tested for their ability to bind 125I-labelled fragments of human and rabbit IgG in order to localize their sites of interaction with IgG domains . Among the Group A streptococci, strains with IgG Fc receptors bound 85% of the added IgG Fc fragments in the test systems, whereas these strains showed practically no reactivity with F(ab')2, Facb (F(ab')2 + C gamma 2 domains) or pFc' (C gamma 3 domains) . The Group C and Group G strains bound 48-100% of IgG Fc, but could also bind up to 36% of the added F(ab')2 in accordance with a previously described 'alternative' Fab reactivity . However, unlabelled IgG F(ab')2 or Facb showed no, or only slight, inhibitory capacity for the binding of 125I-labelled IgG Fc to the C and G strains . Collectively, these results indicate that Groups A, C and G streptococci require both the C gamma 2 and C gamma 3 domains for interaction with IgG, and most probably also bind in the interface region between the C gamma 2 and C gamma 3 domains as has been shown for staphylococcal protein A.

Immunology, 1986 Feb, 57(2), 249 - 53
Rapid killing of actinomycin D-treated tumour cells by mononuclear phagocytes: reactivity in mouse strains with defective classical tumour cytotoxicity; Collota F et al.; In confirmation of previous data, macrophages from C3H/HeJ, C57BL/10ScCR and A/J mice, exposed in vivo to BCG or in vitro to lymphokines, had little tumoricidal activity, as assessed in a 48-hr {3H}thymidine release assay against TU5 tumour cells, compared to macrophages from C3H/HeN, C57BL/6 and (BALB/c X DBA/2)F1 mice . Macrophages from these mouse strains were examined for their capacity to kill actinomycin D-pretreated WEHI 164 sarcoma cells in a 6-hr 51chromium release assay (drug-dependent cellular cytotoxicity, DDCC) . Peptone-elicited macrophages from C3H/HeN, C57BL/6, (BALB/c X DBA/2)F1, C57BL/10ScCR and A/J mice had high DDCC activity, whereas C3H/HeJ macrophages expressed little cytotoxicity against actinomycin D-pretreated WEHI 164 cells . In vivo exposure to BCG or inactivated streptococci caused a modest augmentation of the DDCC effector function of C3H/HeJ macrophages, but levels of reactivity remained 20-fold less than those of similarly treated normal mice . Thus, C57BL/10ScCR and A/J macrophages have defective classical direct cytotoxicity but mediate DDCC efficiently, whereas C3H/HeJ macrophages are defective in both effector functions.

Obstet Gynecol, 1986 Feb, 67(2), 269 - 76
Pathophysiology and management of postcesarean endomyometritis; Duff P; Endomyometritis is the most common complication associated with cesarean delivery . The incidence varies from 5 to 85%, depending upon the patient population surveyed . The major risk factors for postcesarean endomyometritis are young age, low socioeconomic status, and extended duration of labor and ruptured membranes . The principal microorganisms responsible for infection are group B streptococci, aerobic gram-negative bacilli, anaerobic gram-positive cocci, and anaerobic gram-negative bacilli . The mean incidence of bacteremia in patients with endomyometritis is 10% . Less than 2% of infected patients develop life-threatening complications such as septic shock, pelvic abscess, or septic pelvic thrombophlebitis . Antibiotics of proved value in treatment of postcesarean endomyometritis include the newer broad-spectrum cephalosporins and ureidopenicillins and the combination regimen of clindamycin plus aminoglycoside.

Infect Immun, 1986 Feb, 51(2), 529 - 35
Release of fibronectin-lipoteichoic acid complexes from group A streptococci with penicillin; Nealon TJ et al.; Fibronectin binds to Streptococcus pyogenes, and this binding is inhibited by lipoteichoic acid (LTA) . Previous studies have shown that LTA can be released from S . pyogenes by treatment with penicillin . Penicillin released LTA from both S . pyogenes and Staphylococcus aureus; however, the binding of fibronectin correlated with the amount of LTA released only in the case of S . pyogenes . Contrarily, clindamycin decreased the ability of S . aureus to bind fibronectin without affecting the binding of fibronectin to S . pyogenes . Further studies indicated that LTA does not inhibit the binding of fibronectin to S . aureus . Fibronectin bound to S . pyogenes could be released from the cell surface by penicillin . Immunological analysis of the released fibronectin indicated that LTA was the only surface component which could be detected as a soluble complex with the released fibronectin . These studies suggest that LTA plays a central role in the binding of fibronectin to S . pyogenes and is not involved in the binding of fibronectin to S . aureus.

Acta Odontol Scand, 1986 Feb, 44(1), 1 - 9
Streptococci and activities of sucrases and alpha-amylases in supragingival dental plaque and saliva in three caries activity groups; Fiehn NE et al.; Thirty-eight young adults participated in the study . They were divided in a caries-inactive group, a low caries activity group and a moderate to high caries activity group . Total cultivable bacteria, Streptococcus salivarius, and S . mutans in plaque and saliva were quantitated on TSA, MS, and MSB plates, respectively . Sucrase activity was determined by measuring reducing sugars in plaque and saliva after incubation with sucrose . alpha-Amylase activity was determined by Pharmacia Phadebas Amylase test . The data were analyzed with the non-parametric Mann-Whitney U test . The only significant difference was observed for plaque alpha-amylase activity between the caries-inactive group and the moderate-high caries activity group (P less than 0.05) . The lack of differences concerning the other variables is discussed mainly on the basis of the multifactorial character of dental caries and the possible insufficiency of the applied methods.

Acta Pathol Microbiol Immunol Scand {B}, 1986 Feb, 94(1), 25 - 31
Related bindings of aggregated beta 2-microglobulin, IgG Fab, kappa and lambda light chains to group A streptococci; Persson MH et al.; Aggregates of various mammalian beta 2-microglobulin (beta 2m) homologues were tested in binding experiments with group A streptococcal strains of different M types . The binding patterns obtained were similar, suggesting that evolutionarily conserved parts of the beta 2m molecule are responsible for the interaction with group A streptococci . An N-terminally abnormal beta 2m showed binding characteristics similar to those of normal human beta 2m, indicating that the amino-terminal does not participate in this interaction . Aggregates of human IgG Fab fragments, kappa chains and lambda chains, were also analyzed . Whereas several of the beta 2m-reactive M types did not interact with any of these aggregates, all strains binding aggregated Fab, kappa or lambda, also bound aggregated beta 2m . Strains of M types 4, 12, 23 and 53 bound all the tested proteins; M type 1 bound all but IgG Fab, whereas M types 46, 49 and 53 showed affinity for beta 2m and lambda chains only . In inhibition experiments, unlabelled aggregated beta 2m in excess completely blocked the uptake of radiolabelled aggregated IgG Fab, kappa and lambda chains . Conversely, Fab, kappa and lambda aggregates inhibited the binding of radiolabelled beta 2m aggregates . Our results indicate that the differences in reactivity recorded between beta 2m and IgG Fab, kappa and lambda chains, all structurally related, are quantitative rather than qualitative . Thus, a common binding structure for these aggregated proteins on group A streptococci appears probable.

Zh Mikrobiol Epidemiol Immunobiol, 1986 Feb, (2), 73 - 6
{Immunochemical analysis in research on antibodies to Streptococcus group A ribosomes}; Shikhman AR et al.; The use of the competitive enzyme immunoassay (EIA) has made it possible to demonstrate that antiserum to the ribosomes of group A streptococcus, type 29 M, contains antibodies to homologous protein M and does not contain antibodies to group A polysaccharide, lipoteichoic acid and peptidoglycan . Ribosomal antiserum has been found to bind with the surface of heterologous type M streptococci in EIA, while forming no precipitation lines with heterologous proteins M in the double immunodiffusion test, which indicates that the binding of ribosomal antibodies with the surface of group A streptococcal cells is not type-specific . Antibodies to the ribosomes of group A streptococcus recognize some of the antigenic determinants of E . coli ribosomes.

Med Microbiol Immunol (Berl), 1986, 175(1), 35 - 41
Release of Fc-receptors after streptococcal lysis induced by a lytic enzyme from Streptomyces globisporus; Tille D et al.; Streptomyces globisporus produced an enzyme which had lytic effects on streptococci and was able to solubilize their Fc-receptors . A new method for rapid purification of this enzyme was described . It consisted of adsorption to Amberlite CG 50 and subsequent chromatography on CM-cellulose Whatman CM 52 . The purified enzyme was free of proteases and had lysed streptococci of serological groups A, B, C, G and L . It released Fc-receptors from the streptococcal surface in a biologically active form.

Arch Dis Child, 1986 Jan, 61(1), 20 - 3
Bacterial infection and atopic eczema; David TJ et al.; One hundred and ninety children with atopic eczema were studied prospectively for two and a half years . The mean period of observation was 13 months . Seventy six children (40%) had between them 164 episodes of exacerbation of eczema due to bacterial infection, and in 52 (32%) infection recurred within three months of a previous infection . Twenty five episodes (15%) led to admission to hospital . Staphylococcus aureus was recovered in 97% of episodes, in combination with beta haemolytic streptococci in 62% . Physical signs suggesting infection were pustules, crusting, and a weeping discharge, but these signs alone are not diagnostic, and an exacerbation was only attributed to infection if there was a response to anti-infective treatment . Exacerbation of atopic eczema due to bacterial infection is common, the physical signs of infection are not always clear, and there is a case for a trial of oral antibiotics in any child with troublesome atopic eczema.

Rev Infect Dis, 1986 Jan-Feb, 8(1), 54 - 60
Streptococcal endocarditis: single vs . combination antibiotic therapy and role of various species; Tuazon CU et al.; Forty-eight patients with 51 episodes of infective endocarditis caused by streptococci were studied in a comparison of the efficacy of single antibiotic therapy versus that of combination therapy . There was no statistical difference in terms of clinical course, toxicity, and mortality between the group given a single drug and that given combination therapy . However, one patient experienced two relapses, in both instances after high-dose penicillin therapy . The species and antibiotic susceptibilities of the infecting organisms were determined . The majority of isolates were alpha-hemolytic, with Streptococcus sanguis recovered most commonly . Streptococcus bovis and group B beta-hemolytic streptococci were the next most frequent isolates.

Am J Obstet Gynecol, 1986 Jan, 154(1), 180 - 8
Infective endocarditis in obstetric and gynecologic practice; Seaworth BJ et al.; Infective endocarditis is an important but uncommon complication in obstetric or gynecologic practice; we found only 124 cases reported in English and selected European papers during the last 40 years . The majority of cases (74%) were caused by streptococci; viridans streptococci predominated, while enterococci and group B streptococci were uncommon except after abortion . The overall mortality rate was 29%, while the mortality rate for the fetus when the mother developed infective endocarditis was 23% . The incidence of endocarditis in this setting is low and seems to be decreasing . Therefore, the risk-benefit ratio may not favor routine use of prophylaxis for endocarditis . We conclude that antibiotics need not be given for prevention of endocarditis before most common obstetric and gynecologic procedures . These include uncomplicated vaginal deliveries, uncomplicated spontaneous or induced abortions, dilatation and curettage, insertion or removal of intrauterine contraceptive devices (in the absence of pelvic infection), and biopsies of the cervix . For patients in whom both the underlying heart lesion and the obstetric or gynecologic procedure seem to pose significant risk for endocarditis, prophylaxis should be given . Two parenteral regimens for patients at highest risk are recommended: ampicillin plus gentamicin or vancomycin plus gentamicin . For lower-risk situations, one oral regimen is suggested: amoxicillin.

Diagn Microbiol Infect Dis, 1986 Jan, 4(1), 43 - 7
Value of the L-pyrrolidonyl-beta-naphthylamide hydrolysis test for identification of select gram-positive cocci; Oberhofer TR; A 4 hr test for hydrolysis of L-pyrrolidonyl-beta-naphthylamide (PYR) was evaluated for its use in identifying group A beta-hemolytic streptococci, group D enterococci, and Staphylococcus haemolyticus . All of the group A streptococci and the enterococci tested were positive in the PYR test, whereas all of the nongroup A, B, or D beta-hemolytic streptococci, all of the viridans, and all of the Streptococcus pneumoniae isolates tested were PYR negative . Two strains of Aerococcus species were PYR positive and could not be differentiated from enterococci in this test . All strains of S . haemolyticus, a single strain of S . intermedius and two of seven strains of S . warneri were PYR positive whereas all other staphylococci tested were PYR negative . The PYR test is suitable for routine, presumptive identification of group A streptococci, group D enterococci and S . haemolyticus in the clinical laboratory.

J Infect Dis, 1986 Jan, 153(1), 116 - 21
Enzyme-linked immunosorbent assay for the detection of antibodies to nutritionally variant streptococci in patients with endocarditis; van de Rijn I et al.; The viridans streptococci are responsible for 50%-55% of microbial endocarditis . Among these varied species, the nutritionally variant streptococci (NVS) have recently been associated with culture-negative endocarditis and are responsible for 5%-10% of all streptococcal endocarditis . The isolation and identification of these bacteria has been hampered by the extremely fastidious nature of their growth requirements as well as by their slow growth rate . In addition, their antibiotic sensitivity varies greatly, a characteristic leading to a higher rate of morbidity and mortality than is found in patients with non-NVS endocarditis . For these reasons sera from patients with NVS endocarditis were examined for antibodies to the NVS serotype I antigen by using an enzyme-linked immunosorbent assay . Seventy-four percent of patients with NVS endocarditis had elevated titers to this antigen . None of the sera from controls and only 6.7% of the sera from patients with non-NVS streptococcal endocarditis showed increased titers . These results indicate that antibody to the NVS serotype I antigen can serve as a marker for NVS endocarditis.

Infect Immun, 1986 Jan, 51(1), 240 - 9
Arthropathic properties of cell wall polymers from normal flora bacteria; Stimpson SA et al.; Peptidoglycan-polysaccharide (PG-PS) fragments were purified from cell walls of group D streptococci (Streptococcus faecium, strains ATCC 9790 and F-24) with a protocol which minimizes autolytic activity and tested for ability to induce arthritis in rats . PG-PS fragments from cell walls of other normal flora bacteria (Peptostreptococcus productus, and Propionibacterium acnes), group A streptococci, and pseudomurein-PS fragments from cell walls of Methanobacterium formicicum, were similarly purified and tested . Upon intraarticular injection into rat ankles, all PG-PS polymers induced acute inflammation; pseudomurein-PS fragments were approximately five times less active than the PG-PS preparations . After intraperitoneal injection, P . acnes PG-PS induced a minimal acute arthritis, Peptostreptococcus productus PG-PS induced a moderately severe acute joint inflammation followed by a mild chronic arthritis, and both group A and group D streptococcal PG-PS induced severe acute arthritis which evolved into chronic, erosive joint disease; pseudomurein-PS fragments were without effect, consistent with a crucial role for the PG moiety of PG-PS . Chronic arthritis induced by group D streptococcal PG-PS subsided after 60 days, whereas that induced by group A streptococcal PG-PS was still active after 128 days . The arthropathic properties of this modest number of common normal flora bacteria suggest that different PG-PS structures derived from the normal flora have the potential to induce a wide range of responses, from transient acute to chronic erosive joint disease.

Scand J Infect Dis, 1986, 18(6), 519 - 24
Epidemiological, bacteriological and complicating features of erysipelas; Jorup-Ronstrom C; 233 patients with erysipelas, admitted to the Department of Infectious Diseases, Danderyd Hospital, during a 2-year period were analysed for epidemiological, bacteriological and complicating features . Erysipelas was defined clinically as a febrile skin infection with a sudden onset of a red indurated expanding plaque with a distinct border . Common predisposing factors were alcohol abuse, diabetes mellitus and venous insufficiency, and complications were more common among such patients . No seasonal variation was found . 5% of patients with blood culture had streptococcemia (7/149) . Erysipelas emerging from an infected ulcer was seen in 52% (122/233) and in 46% of these streptococci were isolated (57/122), 67% of which were of type A (38/57) . Staphylococcus aureus was isolated from 59% of ulcerative cases (72/122) and in 3 of them staphylococci were found in the blood.

Drugs, 1986, 32 Suppl 3, 43 - 9
Efficacy of a twice-daily regimen of cefadroxil in the treatment of respiratory tract infections; Quintiliani R; This multicentre open study evaluated the responses of 474 adult and paediatric patients with upper or lower respiratory tract infections to treatment with cefadroxil (25 to 50 mg/kg in children and 500 mg to 1 g in adults) twice daily for 10 to 30 days . Complete or partial cures seen in 81% to 100% of all patients correlated with the eradication of 87% to 100% of the causative pathogens, most commonly beta-haemolytic streptococci, S . aureus or S . pneumoniae . Mild, transient side effects, usually gastrointestinal disturbances or hypersensitivity reactions, were reported in 4.8% of patients . Thus, the safety and efficacy of this oral cephalosporin recommends its use in the treatment of infections of the respiratory tract.

Scand J Infect Dis, 1986, 18(4), 305 - 11
Predisposing factors, bacteriology and antibiotic therapy in 35 cases of septic bursitis; Soderquist B et al.; In a retrospective study the etiology was verified in 35/52 patients with suspected septic prepatellar or olecranon bursitis . Staphylococcus aureus was the most common pathogen and 86% of them were penicillinase-producing . Other strains were streptococci . Mean age was 47 (18-83) years and males predominated (91%) . Predisposing factors were seen in most cases . Preceding trauma was found in 27 and/or associated diseases (e.g . diabetes mellitus) in 11 patients . Hyperglycemia was found in 38% of the patients . Treatment with antimicrobial agents, mostly penicillins, and bursal drainage were successful in 32 cases . Two patients had local spread of the infection and 1 patient chronic bursitis.

Microbios, 1986, 45(182), 41 - 53
Amoxycillin-resistant streptococci in dental plaque; Koh J et al.; This investigation was undertaken to study the prevalence of amoxycillin-resistant oral streptococci in normal healthy patients and patients with a cardiac condition, susceptible to infective endocarditis . Samples of supragingival dental plaque were collected from two test groups, children with congenital heart disease and adults with a history of rheumatic fever, and two control groups comprising normal healthy children and normal healthy adults . Bacteria from these samples were grown on a medium selective for oral streptococci, as well as on the same medium containing known concentrations of amoxycillin . The results indicate that a high percentage of rheumatic heart patients and children with congenital heart disease harboured amoxycillin-resistant oral streptococci . The level of amoxycillin resistance in the plaque of adults with rheumatic heart disease was significantly greater than in that of normal adults . In view of the high percentage of patients at risk harbouring amoxycillin-resistant streptococci, it is important that the individual clinical situation be monitored . Perhaps antibiotic sensitivity tests should be performed to select an appropriate antibiotic for prophylaxis of infective endocarditis.

Pediatr Cardiol, 1986, 6(4), 183 - 6
Infective endocarditis in childhood; Sholler GF et al.; A total of 37 cases of infective endocarditis, in children aged two days to 13 years, were seen from 1971 to 1983 at the Children's Hospital, Camperdown . Structural heart disease was known to preexist in 95% . Cyanotic congenital heart disease was present in 15 children, of whom 11 had been palliated by a systemic-to-pulmonary artery shunt . In five children, there was infection of a prosthetic valve . Identifiable precipitants of infection were rare . In particular, no child had had a preceding dental procedure within three months, while only 19% had had recent cardiac surgery . Organisms were identified by blood culture in 92%, the majority being streptococci (43% of cases) and staphylococci (27% of cases) . While 59% of all organisms were penicillin sensitive, six of the seven early postoperative children were infected with organisms not sensitive to antibiotics, given for wound infection prophylaxis in the perioperative period . The overall death rate was 13.5% . Of the children infected with Staphylococcus aureus, 40% died, while no child with Streptococcus viridans endocarditis died . Of the survivors, four needed urgent valve replacement, and three had major central nervous system complications . Using these figures, a current profile of patients with infective endocarditis is presented.

Dig Dis, 1986, 4(2), 93 - 118
Microflora of the biliary tree and liver--clinical correlates; Claesson BE; Microbiologic aspects of hepatobiliary tracts are reviewed . The gallbladder, the common duct and the liver are discussed separately . Special attention is paid to bacteriologic sampling technique . Factors associated with bactibilia are surveyed . The relation between biliary bacteria and stone formation is evaluated . The etiology of acute calculous and acalculous cholecystitis, cholangitis and pyogenic liver abscess is discussed from a microbiological point of view . The importance of new imaging techniques, such as ultrasound, radionuclide scanning and computerized tomography, in the diagnosis and treatment of biliary obstruction or hepatic abscess is recognized . The type of bacteria and their incidence in bile was strongly associated with the underlying condition and various host factors . The flora in acute cholecystitis closely resembled that of the small intestine, while cholangitis and hepatic abscess specimens grew species often found in the colon . In addition, 'microaerophilic streptococci' were especially abundant in hepatic abscess . Nonetheless, coliforms predominated at all loci . Depending on selection criteria of the study population, bacteria of biliary origin played varying roles in the development of postoperative sepsis . Principles of perioperative antibiotic prophylaxis and treatment of manifest infection are outlined.

Veroff Pathol, 1986, 125, 1 - 105
Postinfectious glomerulonephritis . Subtypes, clinico-pathological correlations, and follow-up studies; Sorger K; APGN (WHO: diffuse endocapillary proliferative glomerulonephritis) has long been considered one of the best described kidney afflictions, clinically characterized by the sudden development of a nephritic syndrome after a latency period following a nasopharyngeal infection or pyoderma . Proliferation of mesangial and endothelial cells in the endocapillary space, aggregation of polymorphonuclear granulocytes in the capillary lumina, and deposition of predominantly subepithelial immune complexes on the glomerular basement membrane (so-called "humps") are to the present day considered characteristic of renal morphology . However, the nature of the antigen (or antigens) as well as the determining mechanisms in the pathogenesis of APGN still are unclear . Considerable disagreement also exists regarding the prognosis . An analysis of APGN is once again presented to elucidate whether the morphological picture of APGN is really as uniform as has been generally assumed . A large number of kidney biopsies was examined and subjected to the triad of light microscopy (LM), immunofluorescence microscopy (IFM) and electron microscopy (EM) . The findings, which were recorded at an early stage of APGN in all cases (i.e . during the first 9 weeks), were related to clinical data, age (childhood or adulthood), and etiology (e.g . streptococci, staphylococci) . In addition, clinical and morphological follow-up over a period of up to 10 years in those cases, which had been carefully documented in the early stages, afforded an insight into the dynamics and the prognosis of APGN . Light microscopy of APGN showed a certain spectrum of variation even during the rather limited period of 9 weeks, due to the varying number of granulocytes and a varying degree of cell proliferation, as we could show semiquantitatively . With the triad of methods, especially by IFM and EM, three separate morphological patterns were distinguishable: the starry sky pattern, the garland pattern and the mesangial pattern . Based on clinico-pathological correlations, these patterns were shown to permit the nosological subdivision of APGN . The following features merit special emphasis: The starry sky pattern occurred most often during the first few weeks, the mesangial pattern increased in frequency after the 3rd week, and the garland pattern could occur at any time . In the starry sky and garland patterns immunoglobulins (mainly IgG) generally appeared in combination with C 3 . The mesangial pattern was characterized by C 3 appearing alone . These three immunohistological patterns, which also showed transitional and combined forms, had certain characteristic features by electron microscopy.(ABSTRACT TRUNCATED AT 400 WORDS)

Med Microbiol Immunol (Berl), 1986, 175(6), 355 - 62
Passive protection by human sera in mice against challenge with strains of group B streptococci; Ichiman Y et al.; The passive protective activity of 100 human sera in mice challenged with strains of group B streptococci (GBS), types Ia, Ib, Ic, II and III, was investigated . The number of sera which offered protection against type strains III, II and Ib were 10, 6 and 1, respectively, while 5 sera gave protection against type strains Ia and Ic . The activity was 2-mercaptoethanol sensitive while anti-human IgG, IgA and IgM rabbit sera were capable of negating the protective activity . Furthermore, type antigens removed the protective activity, resulting in the reduction of the amounts of IgG, IgA and IgM in normal human serum . These findings suggest that the protective activity of human sera is related to specific immunoglobulins against type antigens of GBS.

J Gen Intern Med, 1986 Jan-Feb, 1(1), 1 - 7
The prediction of streptococcal pharyngitis in adults; Komaroff AL et al.; The usefulness of clinical and laboratory findings for prediction of the presence of Group A streptococci on throat culture and of an increase in antistreptococcal antibodies was investigated in 693 adult patients . Several findings were shown to increase the likelihood of streptococcal isolation, alone and in combination: tonsillar exudate, tonsillar enlargement, tender anterior cervical adenopathy, myalgias, and a positive throat culture in the preceding year . Compared with a frequency of 9.7% in all patients, the probabilities of a positive culture were quite different (ranging from 2 to 53%) in subgroups of patients with different combinations of these clinical findings . The results of a leukocyte count and measurement of C-reactive protein added little additional predictive information . While clinical findings can never predict perfectly the results of a throat culture, they nevertheless can provide useful information--particularly in tending to "rule out" streptococcal infection--in adult patients with pharyngitis.

Dev Pharmacol Ther, 1986, 9(4), 260 - 5
Influence of prostaglandin D2 on hemodynamic effects of group B streptococcus in neonatal lambs; Huddleston KW et al.; Infusions of group B streptococci cause pulmonary hypertension in several neonatal animal models . A continuous infusion of prostaglandin D2 reduced the magnitude of this pulmonary hypertensive response; indomethacin completely blocked the response . Prostaglandin D2 or cyclooxygenase inhibitors may be important therapeutic agents for infants with group B streptococcal sepsis who manifest pulmonary hypertension.

Dev Pharmacol Ther, 1986, 9(4), 249 - 59
Effects of phenylephrine on systemic and pulmonary artery pressure during sepsis-induced pulmonary hypertension in piglets; Meadow WL et al.; The effects of intravenous phenylephrine (PE) on aortic blood pressure (AOP), pulmonary artery pressure (PAP), and cardiac output (CO) were evaluated in piglets with normal PAP and piglets with sepsis-induced pulmonary hypertension . Anesthetized, ventilated piglets (1-4 weeks; n = 22) were divided into four groups - group 1 (n = 5) received group B beta streptococci (GBS) followed by PE (300 micrograms/kg); group 2 (n = 6) received GBS alone; group 3 (n = 6) received placebo infusion; group 4 (n = 5) received PE alone (300 micrograms/kg) . Infusion of GBS in piglets (groups 1 and 2) elevated PAP by 149 and 176%, reduced CO by 34 and 28%, and did not affect AOP . Administration of PE (groups 1 and 4) raised AOP by 30 and 27% without significantly affecting PAP . However, CO fell after PE by 31 and 39%, respectively . If selective elevation of systemic blood pressure is to become an effective strategy for human newborns with right-to-left shunts caused by sepsis-induced pulmonary hypertension, agents other than PE, with less associated reduction of CO, need to be identified.

Circ Shock, 1986, 19(4), 347 - 56
Early and late hemodynamic consequences of group B beta streptococcal sepsis in piglets: effects on systemic, pulmonary, and mesenteric circulations; Meadow WL et al.; We have modified our previously described experimental model of neonatal sepsis using group B beta hemolytic streptococci (GBS) in piglets and report here early and late hemodynamic responses to GBS infusion in the systemic, pulmonary, and mesenteric circulations . Piglets were anesthetized, intubated, and ventilated . Aortic blood pressure (AOP), pulmonary artery pressure (PAP), central venous pressure (CVP), left atrial pressure (LAP), cardiac index (CI), mesenteric blood flow index (MBFI), and heart rate (HR) were measured directly . Systemic vascular resistance index (SVRI), pulmonary vascular resistance index (PVRI), mesenteric vascular resistance index (MVRI), and stroke volume index (SVI) were calculated . Sepsis was induced by continuous IV infusion of live GBS beginning at 0.5 X 10(7) organisms/kg/min . LAP was held constant throughout the sepsis protocol . PAP and PVRI were the most sensitive hemodynamic indices of early GBS sepsis, rising to greater than two times baseline levels within 11 min of the onset of bacteremia (approximately 1.0 X 10(8) cumulative organisms/kg) . In contrast, AOP was unaffected during the first 83 min of GBS sepsis (approximately 25 X 10(8) organisms/kg) but fell from 84 to 47 mmHg in the final 31 min of the experiment . Both CI and MBFI fell monotonically as a function of cumulative GBS dose, reaching 72% and 64% of baseline at 55 min (approximately 12.5 X 10(8) organisms/kg) and 40% and 34% of baseline by 3 hr of sepsis (approximately 125 X 10(8) organisms/kg), respectively . At every GBS dose, the fall in CI was entirely accounted for by a reduction in SVI . SVRI, MVRI, and PVRI were elevated at all times during GBS sepsis . Despite a 34% reduction in systemic oxygen delivery during the first 83 min of GBS infusion (approximately 25 X 10(8) organisms/kg), arterial pH and base excess did not change significantly . Thereafter, pH fell monotonically reflecting the progressive development of metabolic acidosis.

Microbiol Immunol, 1986, 30(4), 297 - 305
Protective efficacy against group B streptococcal infection in neonatal mice delivered from preimmunized pregnants; Itoh T et al.; Neonatal mice delivered from mothers preimmunized with heated or formalinized whole cell vaccines of type Ia, Ia/c and III/c group B streptococci were infected with each type of bacteria, and then serum antibodies of mothers and neonates who survived the experiments were measured by enzyme-linked immunosorbent assay . The relationship between the protectivity in neonate mice and the antibody titers to the type specific polysaccharide antigens and the protein c antigen of their sera were examined . In the Ia-immunized group which showed high protection against the type Ia infection, anti-Ia IgG antibody titers were low, and anti-protein c IgG antibody was not detected . Type Ia/c and III/c vaccines were highly effective against both type Ia/c and III/c infection, but less effective in type Ia infection . The protein c antigen was identified in both type strains by the double diffusion assay, and the IgG antibodies to the protein c were significantly high in sera of both maternal mice immunized with types Ia/c or III/c organisms and their newborn infants . High titers of the protein c IgG antibody retained 3 to 4 weeks after the last injection of vaccines which corresponded to the period of pregnancy and lactation . Small amounts of IgM antibody to all antigens were detected only in maternal sera . These results suggest that IgG antibodies to the protein c antigen and to the type-specific polysaccharide antigens are equally important protective factors which are transferable from preimmunized mothers to their newborn infants through placenta and/or lactation.

Boll Ist Sieroter Milan, 1986, 65(1), 69 - 72
A method for the rapid detection of streptococcal group A antigen by specific monoclonal antibody; Savoia D et al.; In this study we evaluate the efficacy of a method for the rapid detection of group A streptococci employing a hybridoma mouse antibody specific against group A streptococcal carbohydrate . Using coagglutination technique we demonstrated an absolute specificity . The sensitivity was absolute if the preparation contained greater than or equal to 5 X 10(4) cocci . This test seems therefore a valid criterion for symptomatic patients with a larger number of group A streptococci in throat specimens, more sensitive than other methods, but not sensitive enough for carriers of few bacteria.

Scand J Infect Dis, 1986, 18(1), 85 - 6
A comparison between a commercial coagglutination test and conventional throat culture for the detection of group A streptococci in throat swabs; Stromberg A et al.; A co-agglutination test (Phadirect Strep A) for rapid detection of group A streptococci in throat swabs was compared with conventional throat culture in 264 patients with pharyngotonsillitis and fever . The test was easy to perform and proved to have a satisfactory sensitivity and specificity . The predictive value of a positive test will be high also when the prevalence of streptococcal disease is low.

Rev Infect Dis, 1986 Jan-Feb, 8(1), 117 - 37
Infective endocarditis complicating mitral valve prolapse: epidemiologic, clinical, and microbiologic aspects; Baddour LM et al.; Cases of infective endocarditis superimposed upon prolapsing mitral valves were first described two decades ago . In the intervening years 72 reports in the English-language literature have described 267 such cases . Men predominated numerically in cases occurring after the age of 40 years and in surgical and autopsy series . In cases with auscultatory abnormalities documented before the onset of infective endocarditis, murmurs-and not merely isolated systolic clicks--were usually present . Complications of infective endocarditis were relatively common, and at least 42 patients required valve replacement in the acute phase of illness or during convalescence . Although viridans streptococci were the most frequent etiologic agents (46% of cases), deaths occurred primarily among patients infected with other organisms and among those over 40 years of age . Mitral valve prolapse is increasingly being recognized as a precursor of infective endocarditis because of its high prevalence in the general population and the wider availability of echocardiographic diagnostic techniques . The risk/benefit and cost/benefit ratios for endocarditis prophylaxis in patients with prolapsing mitral valves remain controversial.

Infect Control, 1986 Jan, 7(1), 36 - 41
Eikenella corrodens; Decker MD; Eikenella corrodens is a microaerophilic gram-negative rod which is a normal inhabitant of human mucosal surfaces, particularly the oral cavity . Although an uncommon cause of infection, it is by no means rare . It is found most often as part of a mixed infection, particularly with streptococci, but is capable of independently causing serious infection in both normal and immunocompromised hosts . Given its slow growth, requirement for hemin when grown aerobically, and preference for CO2 enrichment, it is likely that the involvement of Eikenella in an infection is not always recognized, and it would be prudent to alert the laboratory in situations where isolation of Eikenella is likely (especially in head and neck infections or infected wounds caused by a human bite) . Although mixed infections which include Eikenella may resolve with treatment directed at the other infecting organisms, treatment of such infections with antibiotics to which Eikenella is resistant may result in a pure Eikenella infection . Such an outcome may occur, for example, when a human bite wound is treated with clindamycin or metronidazole . Among the oral antibiotics, penicillin, tetracycline, and chloramphenicol are generally effective, whereas cephalexin, dicloxacillin and their relatives are not . Cefoxitin and the third-generation cephalosporins are highly effective against Eikenella.

Arch Intern Med, 1986 Jan, 146(1), 81 - 3
Transportability of a decision rule for the diagnosis of streptococcal pharyngitis; Wigton RS et al.; Use of existing decision rules could improve management of streptococcal pharyngitis, but the validity of such rules outside their original patient population is not known . We applied a four-item decision rule derived at the Medical College of Virginia, Richmond, to 516 patients at the University of Nebraska, Omaha, to test how accurately it would predict outcome of throat culture . After correction for differences in the prevalence of a positive culture (17% in Virginia, 26% in Nebraska), the rule closely predicted the frequency of positive cultures in five subgroups based on the presence of clinical findings . We conclude that this rule transported well to a different patient population and would have been useful in identifying patients with pharyngitis who had a high likelihood of throat cultures positive for group A streptococci.

J Immunol, 1986 Jan, 136(1), 293 - 8
A study of anti-group A streptococcal monoclonal antibodies cross-reactive with myosin; Cunningham MW et al.; Anti-group A streptococcal monoclonal antibodies were obtained from BALB c/BYJ mice immunized with purified membranes from M type 5 Streptococcus pyogenes . Two of the anti-streptococcal monoclonal antibodies were previously shown to cross-react with muscle myosin . In this study the monoclonal antibodies were reacted with tissue sections of normal human heart and skeletal muscle . Antibody binding was estimated by indirect immunofluorescence and immunoperoxidase techniques . Both of the monoclonal antibodies (36.2.2 and 54.2.8) investigated in this report reacted with heart and/or skeletal muscle sections . When evaluated by immunofluorescence, monoclonal antibody 54.2.8 demarcated the periphery of cardiac striated muscle cells and reacted to a lesser degree with subsarcolemmal components . Monoclonal antibody 36.2.2 failed to react with heart sections, but both of the monoclonal antibodies reacted strongly with skeletal muscle sections . Results similar to those observed with indirect immunofluorescence were obtained with the immunoperoxidase technique . By Western immunoblotting and competitive inhibition assays, monoclonal antibodies 36.2.2 and 54.2.8 both were found to react with the heavy chain of skeletal muscle myosin . However, only 54.2.8 reacted with the heavy chain of cardiac myosin . The specificity of the monoclonal antibodies for subfragments of skeletal muscle myosin indicated that monoclonal antibody 36.2.2 was specific for light meromyosin fragments, whereas 54.2.8 reacted with both heavy and light meromyosin . The data demonstrated that two monoclonal antibodies against streptococci were specific for skeletal muscle and/or cardiac myosin and for subfragments of the myosin molecule . The reactions of the monoclonal antibodies with human tissue sections were consistent with the immunochemical reactions of the monoclonal antibodies with both denatured and native myosin.

G Batteriol Virol Immunol, 1986 Jan-Jun, 79(1-6), 16 - 24
In vitro comparative study of RU 28965 against organisms from oral and vaginal flora; Romeo MA et al.; The Authors studied the activity of RU 28965, a new macrolide antibiotic, in comparison whith erytromycin, josamycin, miocamycin, ampicillin and rifampicin against oral streptococci (45 strains), coryneform bacteria (23 strains) and G . vaginalis (15 strains) . Minimum inhibitory concentrations (MIC), minimum bactericidal concentrations (MBC) and the effect of inoculum size on MICs were determined . RU 28965 showed better activity than the other macrolides . The MICs of RU 28965 were eightfold higher than the corresponding MICs . The MICs of RU 28965 showed up to 10 fold increase by increasing the inoculum density from 10(3) to 10(7) CFU/ml.

Arch Oral Biol, 1986, 31(7), 449 - 54
The influence of diet on the growth of streptococcal bacteria on the molar teeth of monkeys (Macaca fascicularis); Beighton D et al.; The rates of regrowth of bacteria in developmental grooves on these teeth were determined . Plaque was removed from palatal grooves up to 96 h after cleaning and the number of bacteria and of individual streptococcal species were determined; Streptococcus sanguis, Streptococcus mutans and Streptococcus mitior were the major ones . In monkeys fed one of three different diets, the numbers of each species reached stable levels 18-24 h after tooth cleaning . The median doubling times of the streptococcal population were 4.69, 3.82 and 4.25 h for two maintenance diets and a sucrose diet, respectively . The median doubling times of individual species ranged from 2.01 to 4.38 h and appeared to be independent of the composition of the various diets . There was no difference in the number of bacteria in 18 h-old plaque from discrete sites in fed or fasted monkeys, nor in the numbers of streptococci, except that the size of the Strep . mitior population increased significantly with fasting . Thus host-derived substrates, possibly salivary components, may be used by plaque bacteria and support their on growth in developmental grooves in the absence of food.

Arch Oral Biol, 1986, 31(4), 229 - 34
Enamel demineralization by acid produced from endogenous substrate in oral streptococci; Zero DT et al.; Bovine enamel blocks were covered by a bacterial cell mass and held in the mouths of human volunteers by a palatal appliance, to study the effects of acid production from endogenous bacterial substrate on the pH of the mass and on enamel demineralization . Variables were cells with and without endogenous substrate, rinsing with 10 per cent glucose or sucrose solution, or no rinsing and the type of organism . Acid production from endogenous substrate by Streptococcus mutans strain IB-1600, due, at least in part, to intracellular glycogen degradation, caused a marked and prolonged pH drop and significant enamel demineralization . A similar but less marked effect was obtained with a strain of Streptococcus mitis, Streptococcus sanguis and Actinomyces viscosus . Thus acid production from endogenous sources by plaque bacteria may be of importance in the aetiology of dental caries.

Oral Surg Oral Med Oral Pathol, 1986 Jan, 61(1), 96 - 104
Acute pulpal-alveolar cellulitis syndrome . IV . Clinical parameters, demographics, and affirmation of a traditional etiologic theory . Part 2; Matusow RJ; The Part 1 report revealed the microbiologic etiology and introduced the oxidation-reduction potential (Eh) as a major factor in acute cellulitis exacerbations during endodontic therapy . Facultative streptococci were the predominant group of microbes specifically isolated . This Part 2 study revealed a 9.5% incidence of cellulitis exacerbations in patients during endodontic treatment of 168 primarily intact nonvital teeth . These teeth were usually asymptomatic, manifesting radiographic periapical lesions without fistulous tracts and necrotic canals . This category of pulpal periapical inflammation is virtually the only type of tooth that is predisposed to cellulitis exacerbations . A frequency distribution of the 34 permanent teeth studied revealed a spectrum of mandibular and maxillary molars, premolars, and anterior teeth involved with the exacerbations . Sex and age did not appear to be factors . Further clinical evidence is cited, which support the concept of altering the tissue oxidation-reduction potential as the prime etiologic factor in favoring the growth of aerobic microbial pathogens.

Oral Surg Oral Med Oral Pathol, 1986 Jan, 61(1), 90 - 5
Acute pulpal-alveolar cellulitis syndrome . IV . Exacerbations during endodontic treatment: a clinical study of specific microbial isolates and their etiologic role . Part 1; Matusow RJ; A statement has been made by Sundqvist that it has not been possible to isolate the specific bacteria that is responsible for acute exacerbations during endodontic treatment of existing periapical inflammation . This clinical study presents specific microbial isolates from 34 intact nonvital teeth involved with acute cellulitis exacerbations during endodontic therapy . No obligate anaerobes were isolated . Forty-seven aerobic and facultative microbes were isolated . Streptococci, primarily facultative, were the major group of microbes isolated (80%); alpha hemolytic streptococci and the group D enterococcus were predominant as mixed and pure culture specimens . Gram-negative microbes as strict aerobic and facultative microbes were also reported as specific isolates . The biological role of anaerobes were discussed in primary pulpal-periapical infections . The alteration of the tissue oxidation-reduction potential, (Eh) is proposed as an etiologic factor in cellulitis exacerbations during endodontic treatment . This is further substantiated in the Part 2 report . Attention is drawn to the pathogenic potential of streptococci and other microbes isolated in this study.

G Batteriol Virol Immunol, 1986 Jan-Jun, 79(1-6), 61 - 76
{Surface characteristics of Streptococci: evaluation technics}; Savoia D et al.; We examined the surface characteristics of 41 strains of Streptococci by using the salt aggregation technique (SAT) . While group B, C, D and G Streptococci showed a clearly hydrophilic surface, 57.5% of group A strains revealed so hydrophobic characters as to be autoaggregating . Either the hydrophobicity or the autoaggregation of these Streptococci decreased after subsequent culture passages . A comparison has been done for 5 strains by the hydrophobic interaction chromatography (HIC) demonstrating a good correlation between the two techniques . As the only presence of M protein did not seem to condition the surface characteristics, however treatments with different proteolytic enzymes modify greatly the bacterial surface suggesting the involvement of various protein structures.

J Basic Microbiol, 1986, 26(10), 587 - 95
Codon usage in streptococci; Malke H; Codon usage was analysed for 14 streptococcal genes or significant open reading frames and found to be different from that in Escherichia coli and Bacillus subtilis . In particular, the preferred use of WWT codons over WWC was inconsistent with the rule of optimal codon-anticodon interaction energy . On the other hand, for SSTC codons, adherence to this rule was better in streptococci than in E . coli . A preliminary codon bias table generated with the Pustell computer program for the analysed streptococcal genes may prove useful for the detection of protein coding regions in newly sequenced DNAs from both streptococci and staphylococci.

Curr Med Res Opin, 1986, 10(5), 339 - 45
A comparison of the new topical antibiotic mupirocin ('Bactroban') with oral antibiotics in the treatment of skin infections in general practice; Villiger JW et al.; A trial was carried out in general practice in 200 patients presenting with skin infections to compare topical antibiotic treatment with mupirocin ointment with orally administered flucloxacillin or erythromycin . Patients were assigned at random to receive 4 to 10 days' treatment with either mupirocin applied 3-times daily or one of the oral antibiotics in the dosage normally used by the general practitioner for skin infections . The majority of infections were impetigo and infected wounds/lacerations; the main organisms isolated initially from 127 of the patients were either Staphylococcus aureus or beta-haemolytic Group A streptococci . Clinical response to mupirocin ointment (86% cured, 13% improved) was significantly better than that seen with erythromycin (47% cured, 26% improved) and similar to that with flucloxacillin (76% cured, 23% improved) . Treatment outcome was not related to treatment duration with either the topical or oral preparations . Post-treatment samples from 76 patients showed that in the mupirocin group all the pathogens originally isolated were eliminated, including Gram-negative organisms.

Folia Microbiol (Praha), 1986, 31(5), 394 - 401
The adhesin structures involved in the adherence of group B streptococci to human vaginal cells; Bulgakova TN et al.; The adherence of group B streptococci (GBS) of serotypes Ia, II and III to human vaginal cells was studied in vitro . The adherence was not dependent on the viability of bacteria; killing of GBS by UV irradiation or glutaraldehyde treatment did not inhibit the adherence . Killing of GBS by heating to 56 degrees C for 1 h led to a pronounced decrease of adherence, demonstrating the thermosensitivity of the GBS structures involved . The protein nature of these structures was proved by a significant reduction of adherence after pretreatment of GBS with trypsin or pepsin . Pretreatment of GBS with sialidase had no influence on the adherence . Such a pretreatment of vaginal cells caused an increase of adherence showing that the receptors on epithelial cells may be partly masked by sialic acid.

Scand J Infect Dis, 1986, 18(4), 313 - 9
Evaluation of beta-lactamase activity and microbial interference in treatment failures of acute streptococcal tonsillitis; Roos K et al.; Out of 169 patients with streptococcal tonsillitis treated with phenoxymethylpenicillin, 13 (8%) developed a new clinical infection with the same streptococcal strain within 2 weeks of completing the therapy (clinical treatment failure) and 24 (14%) were clinically healthy but harboured the same streptococcal strain after treatment (bacterial treatment failure) . Patients with clinical treatment failure showed beta-lactamase activity in their saliva pellet significantly more often than patients with bacterial treatment failure, healed streptococcal tonsillitis or non-streptococcal tonsillitis as well as healthy controls . In an interference study, clinical treatment failures were compared with healthy streptococcal carriers, i.e . persons living in the same household and harbouring the same beta-streptococcal strain . 11/12 healthy carriers had alpha-streptococci with interfering activity against their own beta-streptococcal strain, while the corresponding figure for the clinical treatment failures was 2/13 . Furthermore, 6/12 healthy carriers had beta-streptococci inhibiting their own alpha-strains, while the streptococci in 11/13 clinical treatment failures had this ability . The beta-lactamase activity and the interference between alpha- and beta-streptococci may be a contributory cause to treatment failure in streptococcal tonsillitis.

Acta Histochem Suppl, 1986, 33, 17 - 22
Receptors for erythrogenic toxin A of Streptococcus pyogenes on human peripheral blood lymphocytes and other blood cells; Scriba S et al.; The binding of erythrogenic toxin A (ETA) of group A streptococci on human peripheral blood cells was demonstrated light- and electronmicroscopically by labelling with ETA-gold . Double labelling experiments of lymphocytes and the use of purified T-lymphocytes revealed that the ETA-receptor was confined to T cells . Besides lymphocytes, monocytes and especially granulocytes and thrombocytes showed a significant ETA-gold labelling . The lymphocyte ETA-receptor was found to be not sensitive to trypsin and neuraminidase and was not identical with the receptors for concanavalin A, Helix pomatia-lectin and sheep erythrocytes.

Arch Mal Coeur Vaiss, 1986 Jan, 79(1), 54 - 60
{Infectious endocarditis surgically-treated in the active phase . Apropos of 46 cases}; Hannachi N et al.; The clinical and microbiological characteristics, the surgical indications and procedures, the evolution and the principal prognostic factors were reviewed in 46 cases of infectious endocarditis operated in the active phase . Using this date, the authors try to determine the optimal time for surgery during the acute active phase of infectious endocarditis . The study population comprised 28 men and 18 women aged 7 to 64 years (average age: 30) . The patients were selected on strict criteria: positive blood cultures during the 48 hours prior to surgery (29 cases), positive valve or valve prosthesis culture (15 cases), the presence of an active cardiac abscess at surgery (7 cases), the presence of a large number of bacteria on histological examination of the valve (17 cases) . The patients were divided into two groups: those with endocarditis of native valves (27 cases) and those with endocarditis on prosthetic valves (19 cases) . The preoperative clinical features included all the classical signs of IE but congestive cardiac failure was particularly prevalent (62% of cases) . Microbiologically, most cases of native valve endocarditis (67%) were due to sensitive organisms (streptococci) whilst the more virulent organisms (staphylococci, gram-negative bacteria and fungi) were observed in prosthetic valve endocarditis (64% of cases) . The commonest surgical indication was haemodynamic deterioration (30 cases) . The indications were mixed in 15 cases but only one case was operated for uncontrolled infection alone in this series . The surgical procedure was technically complex in 6 cases . Operative mortality was high (18 cases, 39%) . The main cause of death was low cardiac output (13 cases).(ABSTRACT TRUNCATED AT 250 WORDS)

Antimicrob Agents Chemother, 1986 Jan, 29(1), 40 - 3
In vitro evaluation of A-56619 and A-56620, two new quinolones; Barry AL et al.; The in vitro activities of two new aryl-fluoroquinolones (A-56619 and A-56620) were compared with those of ciprofloxacin, ofloxacin, enoxacin, and norfloxacin . All six quinolones had broad spectra of antibacterial activity; the streptococci, Pseudomonas maltophilia, and Pseudomonas cepacia were the least susceptible . A-56619, A-56620, and chloramphenicol had similar activity against anaerobic bacteria . With both drugs, a low frequency of resistant variants (less than 10(-8)) was observed . By regression analysis, A-56619 MICs correlated best with ofloxacin MICs and A-56620 was most similar to ciprofloxacin.

Zh Mikrobiol Epidemiol Immunobiol, 1986 Jan, (1), 44 - 9
{Manifestations of angina morbidity as a reflection of the self-regulation of the epidemic process in streptococcal infection}; Beliakov VD et al.; The data on the application of the principles of the self regulation of the epidemic process for understanding the annual dynamics of angina morbidity in organized groups of adults are presented . In this case the reservation of group A streptococci occurs in chronic (resident) carriers, whose proportion was found to be 15.8 +/- 2.6% . The epidemic manifestations of morbidity are regulated mainly by the concentration of newly arrived members in the groups, i . e . by the size of the stratum providing the optimum conditions for the parasitization of the streptococcal population . The annual morbidity levels depend essentially not only on the heterogeneity of the group members with respect to their susceptibility to streptococcal infection, but also on the conditions of their accommodation, affecting the transmission of droplet infection . The role of individual risk factors in the variation of the quantitative characteristics of the angina morbidity manifestations under study is calculated.

Int Arch Allergy Appl Immunol, 1986, 80(1), 52 - 6
Binding of IgM rheumatoid factor to group A, C and G streptococci with IgG Fc receptors; Schroder AK et al.; The possibility that IgM rheumatoid factors bind to streptococci was studied . Using a sequence of Sephadex G200 gel filtration, protein A-Sepharose CL-4B chromatography and preparatory electrophoresis, IgM was isolated from the sera of 2 patients with rheumatoid arthritis and then radiolabelled with 125I . There was significant binding of radiolabelled IgM to group-A streptococci types M1, M15 and M22, and to a group-C and a group-G strain, all expressing IgG Fc receptors, but none to Staphylococcus aureus, Escherichia coli or to 11 other strains of streptococci without IgG Fc receptors . The radiolabelled IgM was separated by affinity chromatography on a column containing human IgG . Types M1 and M15 bound the fraction retained on the column, whereas M22 bound both this fraction and the non-retained fraction . Commercial human IgG, even at high concentrations, did not inhibit binding . The binding reaction, which is perhaps triggered either by the IgM rheumatoid factor or by IgG complexed with rheumatoid factor, could be a useful tool for removal of anti-immunoglobulin from the blood of patients with rheumatoid arthritis.

Dev Biol Stand, 1986, 63, 101 - 8
Synthetic peptide fragments of streptococcal M proteins; Seyer JM et al.; The surface M proteins of group A streptococci prevent phagocytosis by the non-immune host but antibodies subsequently developed against these M proteins opsonize the organism to allow phagocytosis and killing . In some cases, antibodies developed against M proteins are cross-reactive with host tissue and have been implicated in rheumatic fever . Peptide fragments of several serotypes, namely type 24, 5 and 6 M proteins were chemically synthesized and tested for their ability to induce protective and tissue cross-reactive antibodies in rabbits . Two synthetic 35 residue peptides of type 24 M protein, S-CB3 and S-CB7 had previously been shown to evoke high ELISA titers as well as opsonic antibody titers in each of three rabbits . Neither contained host tissue cross-reactive antibodies when examined with human heart tissue . Subpeptides of CB7 were synthesized to identify the smallest protective epitope . Three synthetic subpeptides (S-CB7-(13-35), - (18-35) and - (23-35) C were covalently linked to tetanus toxoid and evoked opsonic antibodies in rabbits and thus protective immunity with no tissue cross-reactive epitopes . Synthetic peptides of the NH2-terminal region of peptide M 5, which is known to contain cardiac tissue cross-reactive epitopes, were also tested . When covalently linked to tetanus toxoid, the synthetic peptide S-M 5 (1-20), but not S-M5 (20-40), evoked antibodies which were protective against type 5 streptococci; no heart cross-reactive antibodies were evoked even when large excesses of the synthetic peptides were injected.(ABSTRACT TRUNCATED AT 250 WORDS)

J Clin Microbiol, 1985 Dec, 22(6), 1030 - 4
Characterization of nutritionally variant streptococci by biochemical tests and penicillin-binding proteins; Bouvet A et al.; A comparative study of 60 strains of nutritionally variant streptococci (NVS) with 34 strains of Streptococcus mitis and 37 strains of Streptococcus sanguis II showed the presence of a red chromophore which was absent in the other streptococcal species . By using the conventional microbiological tests, only small differences were found between the NVS and the two other related species . In contrast a clear-cut delineation was found by the API 20 Strep system of identification . All NVS contained pyrrolidonylarylamidase, an enzyme which was absent in S . mitis and S . sanguis II strains, and lacked the alkaline phosphatase enzyme which was present in 56% of S . mitis strains and 62% of S . sanguis II strains . According to the additional enzymatic and biochemical tests of the API 20 Strep system, there were three biotypes among NVS . The major biotype included 33 of 60 strains which were characterized by the presence of both alpha- and beta-galactosidases and the capacity to hydrolyze trehalose . This biotype also showed a specific pattern of penicillin-binding proteins . These results show that NVS are recognized as a separate variety distinct from S . mitis and S . sanguis II species, despite some common biochemical properties . Moreover, the delineation of 33 strains with a specific biotype and a specific penicillin-binding protein pattern strongly suggests that a large part of NVS strains belong to an individual species.

Infect Immun, 1985 Dec, 50(3), 641 - 6
Role of culture conditions and immunization in experimental nutritionally variant streptococcal endocarditis; van de Rijn I; The nutritionally variant streptococci (NVS) are usually isolated from patients with NVS endocarditis and recently have been serotyped into three groups . In the past, studies on microbial endocarditis have not analyzed the effect of the growth medium or growth phase on the bacteria used to induce the disease in the experimental rabbit model . Therefore, in this study various bacterial growth parameters were examined, including growth in semisynthetic or complex medium to the exponential or stationary phase of growth . The 50% infective dose ranged from 3.7 X 10(5) to 8.5 X 10(6) CFU for representative strains from each of the three serotypes grown under these conditions, indicating that there was no significant difference . The role of immunization was also examined in this model using organisms grown to the exponential phase in semisynthetic medium . Rabbits were immunized with heat-killed whole cells, high titres of specific antibody were produced as demonstrated by enzyme-linked immunosorbent assay, and then the rabbits were challenged with 20- to 100-fold 50% infective dose of the homologous strain . A total of 90 to 100% of the rabbits were protected from the disease process, as shown by the absence of the organisms from the heart valve 3 days after the challenge . Rabbits immunized with the amphiphile that replaces lipoteichoic acid in these organisms were not protected from challenge, demonstrating that another surface component is responsible for adherence or colonization or both . Finally NVS were incubated with radioiodinated fibronectin, fibrinogen, or laminin to determine whether these molecules aided in the adherence of the organisms to the heart valve . Only minor amounts of these components were bound to NVS as compared with controls . Therefore, NVS bind directly to the damaged heart valve or through an unknown mechanism.

Zentralbl Bakteriol Mikrobiol Hyg {B}, 1985 Dec, 182(1), 78 - 88
{An information system for hospital hygiene . II . Germ spectrum and resistance representation--an example of use in 2 intensive care units}; Martiny H et al.; By examples it is shown, that there are various possibilities to evaluate the 5380 microbiological findings of patients . 87 different species were isolated and out of these the most frequent species were determined (S . aureus, coagulase-negative staphylococci, D-streptococci, E . cloacae, E . coli, K . pneumoniae, P . mirabilis and P . aeruginosa) . By different graphical manners of representation it is shown, how often (absolute and relative) this spectrum of germs occurred within selected periods . The most frequent sampling spots were bronchial and tracheal secretion with a part of 45% and belonging to these sampling spots the spectrum of germs is shown as an example . The recorded findings are appointed to 1020 patients . The possibility of control individual patients by data processing is demonstrated . As examples susceptibility patterns of three species (S . aureus, E . coli and P . aeruginosa) are shown by different manners of representation--spread of resistant strains to several antibiotics, percentage of resistant strains in a certain period and finally a combination of these manners.

Quad Sclavo Diagn, 1985 Dec, 21(4), 406 - 11
{Group B streptococci in women admitted to the obstetric and gynecologic division of the hospital of Pistoia, for imminent parturition}; Rossetti R et al.; The infections caused by Group B Streptococci (GBS) are particularly serious in newborns . Colonized mothers are responsible for the infection's transmission at delivery . The aim of our work has been to estimate the number of carriers of GBS among women recovered at the Hospital of Pistoia.

Acta Pathol Microbiol Immunol Scand {C}, 1985 Dec, 93(6), 251 - 6
Opsonization of group B streptococci in properdin deficient serum; Soderstrom C et al.; Phagocytic killing of group B streptococci serotypes Ia, Ib, IIR- (R protein negative), IIR+ (R protein positive), IIIR- and IIIR+ by human granulocytes was studied after opsonization in properdin deficient serum, pooled normal human serum and in selected sera with high or low concentrations of antibody to group B streptococci . All serotypes were killed by granulocytes after opsonization in normal serum, but serotype IIIR- was comparatively resistant . Properdin deficient serum showed no opsonic activity for type IIIR- . A reduced opsonic capacity of properdin deficient serum for serotypes Ib and IIR+ was demonstrated, whereas the other serotypes were efficiently opsonized . The reduced or absent opsonic activity of properdin deficient serum could be restored by addition of purified properdin . Antibody levels did not appear to be limiting in the assay system . Blocking of C1 activation with MgEGTA in normal serum delayed, but did not abolish opsonization of the various group B streptococcal serotypes, while the opsonic activity in chelated properdin deficient serum was markedly reduced . Taken together, the findings suggest that an intact classical pathway is crucial in group B streptococcal opsonization . However, efficient opsonization of some strains apparently requires that C3 activation on the bacterial surface is amplified through recruitment of the alternative pathway.

Jpn J Exp Med, 1985 Dec, 55(6), 233 - 7
Separation of hemolytic substances from anticancer preparations of hemolytic streptococci; Kawajiri H et al.; Preparations 60F and 50F isolated from the cell-free extract of anticancer hemolytic streptococci possessed not only anticancer activity but hemolytic activity . Thus, the experiment to separate hemolytic substances from 60F and 50F were carried out . Three kinds of fractions were obtained from 60F or 50F by dissolving them in ammonium sulfate solutions of various concentrations . These fractions were named 60F-I, 60F-II and 60F-III, and 50F-I, 50F-II and 50F-III, respectively . 60F-I and 50F-I possessed neither anticancer activity nor hemolytic activity . 60F-II and 50F-II possessed only anticancer activity, and 60F-III and 50F-III possessed only hemolytic activity . Thus, hemolytic substances were separated from 60F and 50F, and it was demonstrated that the anticancer activity of hemolytic streptococci was not due to their hemolysins or hemolytic activity.

Jpn J Exp Med, 1985 Dec, 55(6), 225 - 32
Production of potent immunoglobulins by group A streptococcus for antibody dependent cell-mediated cytotoxicity in mice; Murayama T et al.; Antibody-dependent cell-mediated cytotoxicity (ADCC) through serum, which was obtained from B6D2F1 mice pretreated with heated group A streptococci, and spleen cells of normal B6D2F1 mice was examined for different kinds of mouse tumor cell line by using methods to estimate specific 51Cr-release from each 51Cr-labeled target cells . Serum obtained from mice 14 days after the injection with heated streptococci was evidently potent to cause ADCC for all tumor cells tested . When the experiments were carried out under the condition which E/T ratio is 50:1, specific 51Cr-release from each target cells were about 32% for L1210 cells, about 12% for MOPC 31C cells, and about 23% for MH 134 and about 10% for P 388 cells, respectively . Meanwhile, serum obtained from either BCG-injected mice or normal mice was not so much potent for these tumor cells . Experiments to identify immunoglobulin subclasses participating in antibody-dependent cell-mediated cytotoxic reactions clearly showed that only IgG2a immunoglobulin was effective to induce cytotoxic reaction . All classes or subclasses of serum immunoglobulins from mice pretreated with group A streptococci were estimated using single radial immunodiffusion plates which were incorporated with monospecific rabbit antiserum for each classes or subclasses . Results showed that either IgM or IgG2a levels were significantly increased 7 days and 14 days after the injection, but other immunoglobulin classes or subclasses did not . A possible consideration on the production of immunoglobulin to cause ADCC in mice treated with heated streptococci was discussed.

Acta Pathol Microbiol Immunol Scand {B}, 1985 Dec, 93(6), 401 - 5
Induction of local immunity to group A streptococci type M50 in mice by non-type-specific mechanisms; Kurl DN et al.; The possibility of inducing immunity in the upper respiratory tract against type M50 group A streptococci was studied in mice . The M50 type exhibited an LD100 a of 10(5) colony-forming units (CFU) when administered intranasally (i.n.), and of 10(7) CFU when introduced intraperitoneally (i.p.) . I.n . administered vaccines prepared from M types 12, 18, 30, 49, 50 and 55 were equally efficient in preventing lethal infection after i.n . challenge with type M50 . Subcutaneous (s.c.) immunization with type 18 had no effect, whereas s.c . immunization with type 50 was effective against i.n . challenge with type 50 . Neither with i.n . nor s.c., did vaccination with type 18 - in contrast to with type 50 - protect against i.p . challenge with type 50 . The results strongly suggest that local immunity against M50 group A streptococci can be achieved using a non-type-specific mechanism . Once the local barrier had been overcome, protection against systemic infection was type-specific in accordance with classic concepts.

Acta Pathol Microbiol Immunol Scand {B}, 1985 Dec, 93(6), 395 - 400
Blocking of antibody complement-dependent effector functions by streptococcal IgG Fc-receptor and staphylococcal protein A; Schalen C et al.; Using haemolysis in gel, two bacterial IgG-binding substances, an Fc-receptor isolated from group A streptococci type M15, and protein A from Staphylococcus aureus, were shown to inhibit complement-mediated lysis of sheep erythrocytes sensitized with rabbit IgG . When the crude alkaline extracts of ten types of group A streptococci were tested to see whether streptococcal components other than Fc-binding material might affect lysis, the degree of inhibition was found to be correlated with Fc-binding activity . In no case was the lysis of IgM-coated cells inhibited . Opsonophagocytosis experiments showed that both purified streptococcal Fc-receptor and protein A impaired antibody complement-dependent killing by human polymorphonuclear leukocytes of each of two strains of group B streptococci (lacking IgG Fc-receptors) . Furthermore, the impairment was ascribable to interference with the fixation of complement to the antibodies, as demonstrated in pre-opsonization experiments with one of the strains . Our results suggest that blocking of the binding of complement to IgG is an important virulence mechanism in Fc-receptor-bearing streptococci and staphylococci.

Jpn Circ J, 1985 Dec, 49(12), 1254 - 7
A follow-up study of throat carriers of streptococci among schoolchildren in Otsu City; Takeuchi T et al.; Studies on the prevalence of beta-hemolytic streptococci in throats among primary school children were performed in Otsu City . In the first study, evidence of streptococcal infections was investigated in 41373 children of first grade of all primary schools for the 13 years from 1970 to 1982 . An average of 12.2% of the strains isolated belonged to group A . The order of frequency of the other Groups was B, C and G respectively . The most predominant type of Group A streptococci was Type 12 . In the second study, evidence of streptococcal infections was investigated in 87 children of the first grade of one primary school for the 5 years from 1977 to 1982 . Throat cultures were repeated four times a year during the period of five years . Entire negative throat cultures over a 5-year period were observed in only 4 children . The prevalence of beta-hemolytic streptococci and Group A streptococci in throats were higher than those observed in the first study . The predominant types of Group A were Types 1, 6 and 28, although the relative predominance of these Types varied at different times during 5 years . High serum ASO titers were observed in the children who harbored Type 6 strains of Group A streptococci in throats . In 5 children Group A streptococci were frequently recovered from throats during the study period, and the same type of strains of Group A streptococci were isolated repeatedly.

Proc Natl Acad Sci U S A, 1985 Dec, 82(23), 8144 - 8
Mechanism of action of the group A streptococcal C5a inactivator; Wexler DE et al.; Virulent group A streptococci have been found to express a cell-surface factor that has the capability of inactivating complement-derived chemotactic factors . To determine the mechanism of action of this factor, we examined the interaction of purified inactivator with pure C5a chemotaxin . Ligand-receptor binding studies demonstrated that streptococcal chemotactic factor inactivator (SCFI)-treated C5a expressed a greatly reduced ability to bind to receptors of polymorphonuclear leukocytes as compared with native C5a . The inactivation of C5a occurred by a nonstoichiometric and temperature-dependent process . NaDodSO4/PAGE analysis indicated that SCFI mediated a small decrease in the molecular weight of C5adesArg, and sequencing of the carboxyl terminus of inactivated C5a demonstrated that a six-residue peptide was lost . The release of discrete peptide fragments from denatured bovine serum albumin upon prolonged incubation with SCFI was indicative of endoprotease activity . Although denatured bovine serum albumin was inefficiently cleaved, native bovine serum albumin and other native proteins were highly resistant to SCFI proteolysis; this indicated that activity was specific in nature.

J Exp Med, 1985 Dec 1, 162(6), 1983 - 97
Inhibition of complement-mediated opsonization and phagocytosis of Streptococcus pyogenes by D fragments of fibrinogen and fibrin bound to cell surface M protein; Whitnack E et al.; The biological effects of the binding of fibrin(ogen) degradation products to M protein-bearing group A streptococci were investigated . Type 24 group A streptococci bind fibrinogen degradation products of the D family, but not fragment E . Binding appears to be mediated by M protein, since a large peptide of this molecule (pep M24) bound to fragments containing the terminal domains of the fibrinogen molecule (D, X, and Y), but not fragment E, and pep M24 inhibited the binding of digested fibrinogen to streptococcal cells . An M protein-binding site occurs on fragment D3 and, therefore, differs from several functional sites present on D1 but not D3, including the fibrin polymerization site, the two gamma chain crosslink sites, and the bindings sites for platelet fibrinogen receptor, staphylococcal clumping factor, and ionized calcium . Bound fibrinogen degradation products prevented deposition of C3 on the streptococcal cell surface, and, in consequence, prevented phagocytosis by neutrophils in nonimmune blood . The average affinity of D fragments for the streptococcal cell surface was approximately 30 times lower than that of native fibrinogen, and a terminal plasmic digest was approximately 50 times less potent in inhibiting opsonization by C3 . However, physiologic concentrations of digested fibrinogen sufficed to inhibit opsonization and phagocytosis completely . Digests of crosslinked fibrin clot also inhibited opsonization, although slightly less effectively than did fibrinogen digests . The antiopsonic effect of fibrin(ogen) degradation products may be relevant to circumstances in which fibrin(ogen)olysis is occurring, e.g., exudation and suppuration.

Infect Immun, 1985 Dec, 50(3), 757 - 64
Purification and characteristics of the streptococcal chemotactic factor inactivator; Wexler DE et al.; The biochemical and immunological characteristics of the chemotactic factor inactivator of group A streptococci (SCFI) were examined . SCFI was extracted from intact M+ bacteria by limited trypsin digestion and purified sequentially by ammonium sulfate fractionation, hydrophobic interaction chromatography, and anion-exchange chromatography . SCFI activity was associated with multiple species as indicated by gel permeation chromatography and DEAE high-pressure liquid chromatography analyses . Polyacrylamide gel electrophoresis of the column-purified protein also demonstrated a high degree of molecular heterogeneity, with most of the material in a 103,000 to 114,000 Mr cluster . SCFI activity was sensitive to destruction by several proteolytic enzymes, and polyclonal antiserum to SCFI was able to neutralize its antichemotactic activity . Two-dimensional immunoelectrophoresis of SCFI indicated that the various copurified species were immunologically cross-reactive and indicated a high degree of antigenic homogeneity within the preparation . Western blot analysis of crude detergent extracts of M+ bacteria identified a major antigenic species corresponding to 135,000 Mr and a less abundant species of 137,000 Mr . SCFI antiserum was not reactive with M protein, and therefore SCFI appeared to be a distinct molecule, despite its close association with the M+ phenotype.

Infect Immun, 1985 Dec, 50(3), 610 - 3
Unimpaired function of human phagocytes in the presence of phagocytosis-resistant group A streptococci; Manjula BN et al.; The resistance to phagocytosis of the group A streptococci has been attributed mainly to the presence of the surface antigen, M protein . In the present study, we addressed the question of whether the phagocytosis resistance of the group A streptococci is due to their ability to impair the function of the phagocytic cells . The results of these studies demonstrate that the presence of a large excess of a phagocytosis-resistant strain of streptococci does not significantly interfere with either the antibody-independent or the antibody-dependent phagocytosis of streptococci . Apparently, a phagocytosis-resistant strain of streptococci does not bring about a generalized deactivation of the phagocytic plasma membrane . This suggests that if the resistance of the group A streptococci is due to any deactivating influence at all on the phagocytic plasma membrane, it is likely to be confined to the contact area of the cocci with the phagocyte.

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