Streptococci

Am J Vet Res, 1984 Nov, 45(11), 2445 - 7
Isolation and characterization of nutritionally variant streptococci from animal sources; Chengappa MM et al.; Ten nutritionally variant streptococci were recovered from clinical specimens submitted to the Kansas State University Veterinary Clinical Bacteriology laboratory over a 4-year period . Isolates were recognized visually on primary blood agar plates by their satellite growth around a previously overlaid Staphylococcus aureus culture . All isolates grew within 24 hours in Todd-Hewitt and heart infusion broths supplemented with 5% bovine fetal serum and 5% S aureus filtrate . They also grew anaerobically in supplemented broths within 48 hours . However, isolates did not grow aerobically or anaerobically in the absence of supplements up to a 7-day postinoculation period . As determined by the standard Kirby-Bauer technique, the isolates were highly susceptible to antimicrobial agents commonly recommended in veterinary medicine . The isolates did not react with the corresponding Lancefield group-specific antisera, as tested by the capillary precipitin test.

J Clin Microbiol, 1984 Nov, 20(5), 894 - 8
Evaluation of the Rapid Strep system for the identification of clinical isolates of Streptococcus species; Facklam RR et al.; A total of 247 strains of streptococci isolated from humans were tested for identification in the Rapid Strep system . The identification rates and identification levels were different for each Streptococcus species . Our data indicate that the Rapid Strep system will identify nearly all 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 enterococci and 95% of the non-enterococci were correctly identified . Of the commonly occurring viridans species, 85% were correctly identified, but only 10% of the less frequently occurring viridans species were identified . A total of 90% of the Streptococcus pneumoniae and 60% of the Aerococcus strains were correctly identified.

Forensic Sci Int, 1984 Nov, 26(3), 193 - 7
The survival of oral streptococci on human skin and its implication in bite-mark investigation; Brown KA et al.; Ten-microlitre aliquots of whole saliva applied to human skin were sampled for periods up to 6.25 h . The rate of loss of recoverable bacteria was 45-50% per hour . After 6.25 h, viable oral streptococci could be recovered . The implications for using a "fingerprint" typing method for these bacteria with regard to the identification of bite-marks are discussed.

Infect Immun, 1984 Nov, 46(2), 442 - 7
Penicillin-induced lysis of Streptococcus mutans; Kral TA et al.; Treatment of Streptococcus mutans GS-5 cells with concentrations of penicillin G within a relatively narrow range resulted in substantial lysis . This penicillin-induced lysis was dependent upon cell density and pH of the lysis medium . Other oral streptococci (Streptococcus sobrinus, Streptococcus rattus, and Streptococcus cricetus) also demonstrated substantial levels of penicillin-induced lysis under appropriate conditions . Lesser degrees of lysis were seen in a related organism, Streptococcus ferus.

Infect Immun, 1984 Nov, 46(2), 394 - 400
Isolation and identification of two hemolytic forms of streptolysin-O; Bhakdi S et al.; Streptolysin-O was isolated from culture supernatants of group-A beta-hemolytic streptococci (Richards strain) by ammonium sulfate and polyethylene glycol precipitation, DEAE-ion exchange chromatography, preparative isoelectric focusing, and chromatography on Sephacryl S-300 . Two forms of the toxin possessing similar hemolytic capacity were identified . The native toxin was a single polypeptide chain devoid of amino sugars with a sedimentation coefficient of 3.9S and a molecular weight of 69,000, and was isoelectric at pH 6.0 to 6.4 . Partial degradation of the native toxin occurred during the isolation procedure, yielding a hemolytically active polypeptide with a molecular weight of 57,000 and a pI of 7.0 to 7.5 . Both forms of the toxin generated the typical, heterogeneous, open and closed ring-structured channels in erythrocyte membranes . Structural considerations indicated that between 25 and 100 monomer toxin molecules constituted the individual ultrastructurally recognizable channels . Hemolytic titrations indicated that the presence of 70 to 125 toxin molecules per erythrocyte was required to generate an average of one functional lesion per cell . The data are consistent with the concept that one or very few streptolysin-O channels will cause hemolysis.

Mol Immunol, 1984 Nov, 21(11), 1011 - 3
Cross-reactions of polysaccharides of staphylococci and streptococci in antipneumococcal and other antisera; Heidelberger M; Relationships between chemical structure and immunological specificity, deduced from cross-precipitation with antibodies to polysaccharides of known structure, are drawn for polysaccharides of strains of staphylococci and of groups D and H streptococci.

J Immunol, 1984 Nov, 133(5), 2706 - 11
Capsular polysaccharides of nongroupable streptococci that cross-react with pneumococcal group 19; Lee CJ et al.; The cross-reactivity and chemical characterization of the nongroupable streptococcal and pneumococcal group 19 polysaccharides (PS) have been studied . Extensive cross-reactions were observed between capsular PSs of streptococcal strains 14636/74, 4907, 4731 and pneumococcal type 19F and 19A antisera . Streptococcal 14636/74 PS had an identical composition to that of pneumococcal 19F PS . Type 19F and 14636/74 PS were composed of equimolar amounts of rhamnose, glucose, N-acetyl mannosamine, and phosphorus . The capsular PS of strains 4731 and 4907 contained rhamnose, glucose, ribose, N-acetyl mannosamine, and N-acetyl glucosamine in different molar ratios . Extensive immunologic reactivity was observed between the 19F and 14636/74 PS, as determined by light scattering rate nephelometry, passive immune hemolysis, and precipitin reaction . There was an identity reaction by immunodiffusion between type 19F and 14636/74 PS when reacted with rabbit antiserum against either organism . Biochemical studies showed that strain 14636/74 was not a pneumococcus, because it was optochin resistant, was bile insoluble, did not possess the C-carbohydrate antigen common to all pneumococci, and produced neither pneumolysin nor IgA protease . Furthermore, it grew in comparatively simple media in contrast to the complex nutritional requirements of pneumococci . The 13C-NMR spectra of the 19F and 14636/74 PS were identical . These two capsular PS can, therefore, be considered identical.

Am J Otolaryngol, 1984 Nov-Dec, 5(6), 382 - 6
The presence of beta-lactamase-producing bacteria as a guideline in the management of children with recurrent tonsillitis; Brook I; Thirty-eight children who had recurrent tonsillitis and who were chronic carriers of group A beta-hemolytic streptococci (GABHS) were treated with oral clindamycin . Surface tonsillar cultures, obtained prior to therapy and two weeks after the termination of therapy, were processed for aerobic and anaerobic microorganisms . Mixed aerobic and anaerobic flora were obtained from all cultures . Prior to therapy, the average yield was 9.3 isolates (5.2 aerobes and 4.1 anaerobes) per specimen; after the completion of therapy, the average yield was 5.5 isolates (3.0 aerobes and 2.5 anaerobes) . The GABHS were completely eliminated after clindamycin therapy, and the numbers of isolates of Bacteroides spp and Staphylococcus aureus were reduced . Beta-lactamase production was detected prior to therapy in 57 isolates recovered from all tonsillar surfaces . This group included all isolates of S . aureus (15) and Bacteroides fragilis (eight), 19 of 34 Bacteroides melaninogenicus isolates (56 per cent), and seven of 12 Bacteroides oralis isolates (58 per cent) . Only four isolates of beta-lactamase-producing bacterial strains were recovered after the conclusion of therapy . Follow-up study of 33 children for eight to 16 months (average, 13 months) showed no recurrence of GABHS in 31.

J Gen Microbiol, 1984 Nov, 130 ( Pt 11), 3059 - 61
Electron microscopic evidence of antibody entry into neutrophils after phagocytosis of highly virulent group B streptococci; Cleat PH et al.; An electron microscopic study was undertaken of the entry of specific antibody into neutrophils containing surviving intracellular highly virulent group B streptococci after phagocytosis of the organisms had occurred . Electron micrographs are presented to demonstrate that specific antibody gains access to the ingested bacteria . This antibody binds to the surface of the streptococci, which subsequently permits the neutrophils to kill these organisms.

Antibiotiki, 1984 Nov, 29(11), 814 - 9
{Sensitivity of 56 strains of Streptococcus group B to 12 antibiotics: its determination by dilution and diffusion in agar}; Giventel' NI et al.; Sensitivity of 56 streptococcal strains of group B to 12 antibiotics was studied with the method of dilution in a special solid medium for cultivation of streptococci and with the method of agar diffusion in the same medium . All the strains were found to be sensitive to chloramphenicol, ristomycin and erythromycin . The predominating majority of the strains were sensitive to beta-lactam antibiotics and lincomycin . All the strains were resistant to aminoglycoside antibiotics, such as streptomycin and gentamicin . More than 85 per cent of the strains were resistant to tetracycline . Strains with multiple resistance to 2-7 antibiotics were detected . Satisfactory correlation between the two methods was observed . It was shown to be clinically advisable to determine the sensitivity of streptococci of group B to beta-lactam antibiotics, erythromycin and lincomycin.

Rev Infect Dis, 1984 Nov-Dec, 6 Suppl 4, S853 - 6
Comparison of cefonicid and cefazolin for treatment of soft-tissue infections; Slutkin G et al.; Cefonicid was compared with cefazolin for the treatment of serious infections of soft tissue . According to a randomized, prospective protocol designed to assign twice as many patients to cefonicid, 38 patients were treated with cefonicid and 19 patients, with cefazolin . Dosages used were 1.0 g once daily intramuscularly or intravenously for cefonicid and 0.5-1.0 g three times a day intramuscularly or intravenously for cefazolin . Clinical diagnoses included cellulitis (39 patients), abscesses (14), infected ulcers (3), and bursitis (1) . Bacteriologic diagnoses included Staphylococcus aureus alone (8 patients), group A Streptococcus alone (13), combined S . aureus plus streptococci (8), viridans group streptococci alone (1), and mixed anaerobes (1) . Gram-negative rods were isolated from 11 patients, all in mixed cultures with gram-positive species . For two patients, gram-negative organisms were thought to be etiologic . All 57 patients responded satisfactorily to treatment . Treatment with either drug was neither interrupted nor discontinued because of toxicity . Both cefonicid and cefazolin appear to be effective for the treatment of infections of skin and soft tissues . Cefonicid has the advantage of once-daily dosing.

Infection, 1984 Nov-Dec, 12(6), 367 - 8
Bactericidal kinetics of newborn polymorphonuclear leukocytes against group B streptococci type III; Lopez-Osuna M et al.; In vitro intracellular and total bacterial group B Streptococcus type III (GBS-III) survival as well as bactericidal indices at incubation times ranging from 0 to 120 minutes were comparable in newborn and adult polymorphonuclears (PMN) . It appears that under appropriate opsonic conditions the phagocytic kinetics of normal newborn PMN against GBS-III are not different from those of adult PMN.

Pediatr Res, 1984 Nov, 18(11), 1141 - 4
Effects of methylprednisolone on the response to group B streptococcal toxin in sheep; Rojas J et al.; The effects of pretreatment with methylprednisolone on the reaction to a toxin isolated from group B beta-hemolytic streptococci, type III, were studied in seven sheep instrumented for chronic measurements of pulmonary lymph flow and pulmonary artery and left atrial pressure . Each sheep was infused with toxin alone on one day and with methylprednisolone plus toxin on a different day in random order . The toxin alone caused a two-phase reaction . After the infusion of toxin, alone, in the initial phase, pulmonary artery pressure increased from 16 +/- 1 to 45 +/- 5 mm Hg and the rectal temperature rose from 39.5 +/- 0.14 to 40.8 +/- 0.18 degree C . During the second phase, the peripheral blood granulocyte count decreased to 10% of baseline values and the lung lymph protein clearance increased from 5.1 +/- 1.1 to 11.2 +/- 1.8 ml/h, suggesting increased pulmonary vascular permeability . Methylprednisolone pretreatment did not alter the initial phase of pulmonary hypertension or the febrile response but completely abolished the granulocytopenia and the increased pulmonary vascular permeability . These effects are unlikely to be related to inhibition of prostaglandin synthesis . Prevention of the lung vascular injury by methylprednisolone may be related to inhibition of granulocyte accumulation in the lung.

Pediatr Res, 1984 Nov, 18(11), 1093 - 6
Treatment of experimental group B streptococcal infection with hybridoma antibody; Christensen RD et al.; Previous studies have shown a reduction in mortality rate from 90% to zero when neonatal rats, inoculated with group B streptococci (GBS) were injected with type-specific IgM antibody . However, in those studies, the antibody was administered simultaneously with the bacteria and at the same site, unlike the situation which would exist if antibody was used clinically to treat established infection . In the present experiments, we administered antibody intraperitoneally at various intervals following intrathoracic inoculation of GBS . When antibody was administered immediately after, or up to 2 h following bacterial inoculation, all animals survived . When antibody administration was delayed for 4, 5, or 6 h, survival rates of 92, 60, and 29% were observed . When antibody administration was delayed for more than 6 h, no survival occurred . Failure of antibody to protect animals from death coincided temporally with profound depletion of the neutrophil storage pool . In other experiments, depletion of the neutrophil storage pool was produced by a separate, noninfectious mechanism (subcutaneous implantation of sterile polyvinyl sponge discs) after which animals were inoculated with GBS . Antibody did not provide protection from death in animals with neutrophil storage pool depletion.

J Clin Microbiol, 1984 Nov, 20(5), 846 - 8
Evaluation of the Directigen Group A Strep test kit; Miller JM et al.; The Directigen Group A Strep test kit (Hynson, Wescott, and Dunning, Baltimore, Md.) was tested for its ability to detect group A streptococci directly from 147 throat swabs . The results were compared with results from conventional culture and Lancefield serological grouping tests . The data showed that 121 of 124 culture-negative throat specimens were also Directigen negative (98%) and that 21 of 23 culture-positive specimens were Directigen positive (91%) . If specimens that provided less than 10 colonies per plate of beta-hemolytic streptococci were eliminated, all of the culture-positive specimens were Directigen positive . Positive or negative results were available within 65 to 70 min of testing . The Directigen method is relatively simple to perform and easy to interpret and provides accurate assessment of the presence or absence of group A streptococci in throat swabs, with little or no cross-reactivity with other beta-hemolytic groups.

Ann R Coll Surg Engl, 1984 Nov, 66(6), 432 - 3
Trial of the use of masks in the gynaecological operating theatre; Chamberlain GV et al.; A randomly controlled trial was performed on 41 women having gynaecological surgery in which the team of surgeons and nurses wore or did not wear masks . After major abdominal surgery, 3 of 5 patients in the unmasked group developed wound infections whereas no infection was observed in the 4 patients of the masked group . A greater number of Streptococci were also found by settle-plates on the operating table in the unmasked group . No infection was recorded after minor or vaginal surgery.

Scand J Immunol, 1984 Nov, 20(5), 433 - 9
Effect of mouse passage on Fc receptor expression by group A streptococci; Reis KJ et al.; The expression and stability of receptors for the Fc region of human IgG on the surface of group A streptococci was studied . Two strains were sequentially passed in mice 22 times . The Fc-receptor expression on one group A strain, 529, was unaltered while the expression of Fc receptor on a second, 64, was enhanced and approached the level of Fc-receptor expression of the protein A-rich Staphylococcus aureus Cowan strain . The level of Fc-receptor expression on this organism remained stable for over 18 months of laboratory subculture . Mouse passage did not result in the production of a soluble Fc receptor from either of the streptococcal strains . Heat extraction of the Fc-receptor-positive group A strain resulted in solubilization of an Fc-receptor activity which was functionally distinct from either staphylococcal protein A or the Fc receptor isolated from a group C streptococcus.

J Pediatr, 1984 Nov, 105(5), 702 - 5
Latex agglutination tests for rapid identification of group A streptococci directly from throat swabs; Gerber MA et al.; A comparison of the accuracy and practicality of two new latex agglutination tests for the rapid identification of group A beta-hemolytic streptococci directly from throat swabs was performed in a busy pediatric office . The Directigen Group A Strep Test kit had a sensitivity of 84%, specificity 99%, positive predictive value 99%, and negative predictive value 93% when compared with blood agar cultures . The Culturette Brand 10-Minute Group A Strep ID Kit had a sensitivity of 83%, a specificity 99%, positive predictive value 97%, and negative predictive value 93% when compared with blood agar cultures . When cultures with less than 10 colonies of group A beta-hemolytic streptococci per plate were not considered positive, both rapid tests had a sensitivity of 95% . The Culturette Brand test required considerably less time, equipment, supplies, and skill than the Directigen test . Only the Culturette Brand test appeared to be practical for routine use in a pediatrician's office . Further investigations of the accuracy of both of these rapid tests need to be performed before either is accepted as a substitute for the throat culture.

J Exp Med, 1984 Nov 1, 160(5), 1476 - 84
Identification of protein antigens of group B streptococci, with special reference to the Ibc antigens; Russell-Jones GJ et al.; The protein antigens of prototypes of five types of group B streptococcal strains were extracted with HCl or Triton X-100, separated by sodium dodecyl sulfate polyacrylamide electrophoresis, transferred to nitrocellulose, and examined by immunochemical staining . The Ibc proteins are shown to consist of at least two distinct protein antigens and their breakdown products . One antigen, the "beta" antigen, exists primarily as a 130,000 mol wt protein that is also able to bind human IgA . The "alpha" antigen, which has no known function, appears as a number of proteins of various molecular weights from 20,000 to 120,000 . Another set of antigens, the R protein antigens of type III strains, has been identified as a group of acid-labile proteins varying in molecular weight from 100,000 to 130,000 . In addition, two previously undescribed antigens have been found that are common to all five group B types.

J Exp Med, 1984 Nov 1, 160(5), 1467 - 75
A surface receptor specific for human IgA on group B streptococci possessing the Ibc protein antigen; Russell-Jones GJ et al.; A number of group B streptococcal strains of various serotypes, Ia, Ib, Ic, II, and III were examined for their ability to bind human IgG and IgA . No strains of group B streptococci were found to bind IgG, but many strains possessing the Ibc protein antigen(s) were found to bind a significant amount of IgA . The extent of IgA binding correlated with the amount of a 130,000 mol wt, detergent-extractable protein, and reactivity with the Ic typing sera . Using nitrocellulose blots, it was found that the 130,000 mol wt protein bound human IgA . A method was developed to purify the protein while retaining its ability to bind human IgA . Using solid phase radioimmunoassays, it was determined that the protein bound to the Fc region of monomeric or polymeric IgA and that it failed to bind IgM or any IgG isotype.

J Exp Med, 1984 Nov 1, 160(5), 1360 - 74
Treatment of experimental erosive arthritis in rats by injection of the muralytic enzyme mutanolysin; Janusz MJ et al.; A single intravenous injection into rats of 0.4 mg of the muralytic enzyme mutanolysin, given as long as 3 d after an arthropathic dose of peptidoglycan-polysaccharide polymers derived from group A streptococci (PG-APS), resulted in a complete resolution of acute arthritis and the prevention of chronic joint disease . When administration of mutanolysin was delayed until 14 d after the injection of PG-APS, a great reduction in the severity of chronic inflammation was still observed . Quantitation of the amount of PG-APS present in the limbs, spleen, and liver by a solid phase enzyme-linked immunoassay indicated that the tissues of mutanolysin-treated rats contained as much PG-APS as tissues of PBS-treated control rats . In addition, rats treated with mutanolysin immediately after receiving an intraperitoneal injection of PG-APS developed a transient limb edema similar to that seen in rats after the injection of PG-APS digested to a small fragment size in vitro with mutanolysin . We hypothesize that mutanolysin acts in vivo by degrading PG-APS to small fragments that persist but are no longer arthropathic.

Z Naturforsch {C}, 1984 Nov-Dec, 39(11-12), 1128 - 31
Effects of membrane-acting drugs and aerobiosis on production of streptolysin S and nuclease in hemolytic streptococci; Taketo A et al.; Yield of streptolysin S (SLS) in streptococcal culture was considerably reduced by procaine, dibucaine, atropine or chlorpromazine at concentrations which scarcely affected production of an extracellular nuclease as well as the bacterial growth . Cerulenin was also inhibitory to SLS formation, but its effect was more pronounced on the nuclease production . By aerobiosis, amount of SLS produced into culture supernatant was increased significantly, whereas yield of the nuclease was rather unaffected.

Rev Infect Dis, 1984 Nov-Dec, 6(6), 832 - 9
Autoimmune mechanisms in the pathogenesis of rheumatic fever; Senitzer D et al.; The etiologic agent of acute rheumatic fever is the group A streptococcus; however, its role in the pathogenesis of this disease is not well understood . Epidemiologic and immunologic evidence suggests that there is a population at risk and that the nature of the host response to streptococcal antigens and the physicochemical nature of the streptococcal antigens all play a significant role in determining the natural history of the disease process . Furthermore, the genetic control of the interaction of the host with the streptococci is clearly involved in a set of events--as yet obscure--that result in acute rheumatic fever . Neither antibody-mediated nor cell-mediated hypersensitivity reactions have been demonstrated in vivo or in vitro that wholly reproduce the characteristics of this disease . Additional studies of the regulation of the immune response and of human immunogenetics are essential for gaining further insight into the pathogenesis of acute rheumatic fever.

Am J Obstet Gynecol, 1984 Oct 15, 150(4), 385 - 8
An epidemic of "childbed fever"; McGregor J et al.; Postpartum infection remains a cause of considerable maternal morbidity and occasional maternal mortality . Puerperal sepsis mediated by what is now known as group A beta-hemolytic streptococci or Streptococcus pyogenes was once a common and lethal nosocomial scourge . Fortunately, multiple developments have decreased the incidence and ameliorated the clinical course of group A beta-hemolytic streptococcal postpartum sepsis . Despite these developments, epidemic group A streptococcal sepsis still jeopardizes modern mothers . We describe an epidemic of five women with group A beta-hemolytic streptococci-mediated postpartum infections which occurred at Mather Air Force Base Hospital, Sacramento, California . The remarkable, yet characteristic signs, symptoms, and clinical course of these patients are briefly reviewed along with the epidemiologic methods which led to the discovery of the common nosocomial source . Familiarization of the clinical aspects of these patients and the methods used to eradicate this epidemic will facilitate the protection and care of other women . Unfortunately, modern mothers still remain in jeopardy from "childbed fever."

Eur Heart J, 1984 Oct, 5 Suppl C, 39 - 44
Viridans streptococci in infective endocarditis: species distribution and susceptibility to antibiotics; Horaud T et al.; A method for the speciation of viridans streptococci (non-groupable) is described . The major identification criteria are based on the reactions to a series of biochemical tests, including acid production in lactose, inulin, raffinose, mannitol and sorbitol, hydrolysis of arginine, esculin and Na hippurate, and production of polysaccharides in 5% sucrose media . A total of 450 strains was isolated from blood cultures, 183 of which were from confirmed cases of subacute endocarditis . The latter were identified as follows (%): Streptococcus sanguis I (25.7), S . mitis (19.7), S . sanguis II (19.7), S . mutans (17.5), S . milleri (12), S . morbillorium (3.2) and S . salivarius (2.2) . Susceptibility to antibiotics was studied for 129 of these strains: 68% were susceptible to all drugs tested, 20% were resistant only to tetracycline, 4% only to penicillin (MIC = 0.5-4 micrograms ml-1) and 8% were multiply resistant (tetracycline, macrolides and related drugs, chloramphenicol, penicillin, high-level resistance to kanamycin and/or streptomycin {MIC = 1000-80.00 micrograms ml-1}.

Eur Heart J, 1984 Oct, 5 Suppl C, 139 - 43
Late prosthetic valve endocarditis . Bacteriological findings and prognosis in 29 cases; Leport C et al.; Of 296 incidences of infectious endocarditis seen between 1971 and 1980, 29 cases of late prosthetic valve endocarditis (10%) occurred in 26 patients who had undergone valve replacement more than two months previously . The prosthesis was mitral in 8 cases, aortic in 9 cases, and multiple in 12 cases . The clinical picture consistently associated fever together with a regurgitation murmur in 12 cases (41%), a splenomegaly in 7 cases, a neurologic accident in 13 cases and other signs of endocarditis in 10 cases . Blood cultures were positive in 28 cases . The diagnosis was confirmed anatomically in 11 cases . Thirty-one causative agents were identified: 15 streptococci (48%), most of them were group D (11/15), 11 staphylococci (35%) 6 Staphylococcus aureus, 5 Staphylococcus coagulase negative and 5 other species . Two relapses and 3 recurrent infections were noted . The death rate was 58% with some factors being associated with a higher death rate: non-streptococcal micro-organism (87%) regurgitation murmur (83%) cardiac failure with dysfunction of the prosthesis (89%) neurologic complication (91%) . Eight valve replacements were performed within a mean period of 32 days after the onset of the antibiotherapy with a death rate of 75% . It decreased to 50% for patients treated with antibiotic alone, and as low as 23% for Streptococcal endocarditis . These results suggest that earlier and more frequent indications for cardiac valve replacement could be an alternative to improve the prognosis.

Eur Heart J, 1984 Oct, 5 Suppl C, 133 - 7
Indices of effectiveness of medical and surgical treatment in 40 cases of prosthetic valve endocarditis; Gayet JL et al.; Forty patients with prosthetic valve endocarditis (PVE) presenting during a 12-year period at a single hospital were studied . Twenty-six were male and 14 female and ages ranged from 19 to 67 years . During the first six post-operative months, most episodes were caused by staphylococci (38%) and Gram negative bacilli (24%) . Between 6 and 11 months no episodes were seen, but thereafter streptococci predominated (50%) . The overall mortality was 58% (66% during first six months; 36% thereafter) . Nine of 23 patients undergoing re-operation died, most deaths occurring in patients in cardiac failure prior to surgery . Eleven deaths occurred in the 17 patients treated with antibiotics alone . Six of these were pyrexial at death and all but one was infected by a virulent organism . The remaining five were apyrexial at death and all had staphylococcal PVE . Our findings suggest: (1) all cases occurring during the first six months should be initially treated as 'early' PVE; (2) in staphylococcal PVE, apyrexia may not mean cure; (3) the principal guides to prognosis in PVE are the patient's cardiac status and the nature of the infecting organism.

Eur Heart J, 1984 Oct, 5 Suppl C, 129 - 32
Late prosthetic valve endocarditis; Permanyer-Miralda G et al.; A report is given of 13 patients with late prosthetic valve endocarditis (1975-1982) . Follow-up ranged from 1 to 8 years (mean 33 months) . Causative organisms were streptococci in 8 cases, staphylococci in 2, and Cardiobacterium hominis in 1 . Cultures were negative in 2 . Surgical treatment in the acute phase was performed in 3 patients . At the latest clinical control, 3 patients had died and 10 patients were asymptomatic, 3 of them having required late operation . These fair results are attributable to the particular spectrum of causative organisms and to the proper timing of surgical treatment in the 3 patients operated during the acute phase.

Eur Heart J, 1984 Oct, 5 Suppl C, 123 - 7
Prosthetic valve endocarditis: diagnosis and prognosis; Brottier E et al.; From 1972 to 1982, 22 patients were admitted for prosthetic valve endocarditis on homografts (3), bioprostheses (2) or mechanical prostheses (17) . Staphylococcus epidermidis was the most common aetiologic agent in early-onset endocarditis and streptococci in late-onset . Echo-cardiographic or cinefluoroscopic findings enhanced diagnosis mainly in advanced stages of the disease . Despite medical therapy and prompt reoperation in most cases, mortality remains high: 66%, 80% in the early group, 50% in the late group; the prognosis was definitely improved, however, by surgical treatment.

Eur Heart J, 1984 Oct, 5 Suppl C, 117 - 22
Prosthetic valve endocarditis: clinical findings and management; Horstkotte D et al.; Prosthetic valve endocarditis (PVE) was shown in 46 patients out of a group of 2163 carrying prosthetic heart valves . The cumulative rate of early PVE was 1.4% and 1.5% for PVE occurring between the 60th day and 10 years after surgery . In 37% of all cases this was caused by staphylococci, 20% by streptococci, and 13% Gram negative species . Fungi were found in 9% and mixed infections in 21% . The incidence of staphylococci, Gram negative pathogens and fungi was significantly higher in early PVE . In 5 patients, valve involvement consisted in echocardiographically shown vegetations and/or obstructive thromboendocarditis . In 90% of 37 patients who developed paravalvular leakages, there was high intravascular haemolysis uncharacteristic of the type of prosthesis implanted . In 70% fluoroscopy revealed disproportionate tilting of the prosthetic annulus, and in 75% there was a distinct echocardiographic pattern in the closing movement of the valve poppet . The cumulative survival rate after six months was 31% for the conservatively treated, and 66% for the medically plus surgically treated patients . Survival rates at the end of a maximum follow-up of 20 years was 15% with conservative treatment and 51% after primary surgical therapy . The prognosis was worse (P less than 0.01) in patients who, during aortic PVE, developed heart failure refractant to therapy due to haemodynamically significant prosthetic valve dysfunction, to sepsis that persisted for more than 72 h despite antibiotic therapy, to major septic embolism or to acute renal failure . The retrospective prognosis was more favourable for patients with early aortic (P less than 0.02) or mitral (P less than 0.05) valve re-replacement than for patients who had been treated medically only.

Eur Heart J, 1984 Oct, 5 Suppl C, 111 - 5
Tricuspid infective endocarditis: 56 cases; Rouveix E et al.; Fifty six cases of tricuspid infective endocarditis (TIE) were seen over a period of 15 years . The patients were divided into three groups, on the basis of the site of entry: (a) Thirty one TIE after abortion (6 cases) or in association with drug addiction (25 cases) are characterized by the young age of the patients and the organism (29 staphylococci), the existence of repeated pulmonary emboli and the relatively favourable prognosis (3 deaths) . (b) Twelve TIE due to an intravenous infusion catheter (9 cases) or a visceral site of entry: older patients, resistant organisms (3 gram negative bacilli, 8 staphylococci, 5 of which were methicillin-resistant) and with poor prognosis (8 deaths) . (c) Thirteen TIE where the site of entry was unidentified, running a sub-acute course, 7 due to streptococci, and often associated with involvement of the left side of the heart, which was the dominant prognostic feature (6 deaths) . Mortality was 30% . Of predominant importance in prognosis was the sensitivity of the organism: 6 deaths out of 9 TIE due to methicillin-resistant Staphylococcus aureus and 3 out of 31 TIE due to a sensitive staphylococcus (P less than 0.01) . Seventeen underwent surgery . Tricuspidectomy (8 patients) should be reserved for cases of uncontrolled infection . Surgery is not justified by the persistence of pulmonary emboli.

J Gen Microbiol, 1984 Oct, 130 ( Pt 10), 2497 - 500
Genetic exchange between oral streptococci during mixed growth; Kuramitsu HK et al.; To determine whether oral streptococci might exchange genetic information in the oral cavity, paired transformable strains of Streptococcus mutans, Streptococcus sanguis and Streptococcus milleri were growth together . Chromosomal and plasmid-borne antibiotic resistance markers could be readily transferred from S . mutans GS-5 to S . milleri NCTC 10707 or S . sanguis Challis during mixed growth . However, no exchange from the latter two organisms to strain GS-5 could be detected under these conditions . The transfer of genetic information from S . sanguis to S . milleri was also observed.

Antibiotiki, 1984 Oct, 29(10), 760 - 5
{A method of diffusion in agar for determining streptococcal sensitivity to antibiotics}; Givental' NI et al.; An agar diffusion method for determination of antibiotic sensitivity to streptococci of different serological groups with semiquantitative estimation of the results was developed with the use of the dry nutrient medium of the I . I . Mechnikov Central Research Institute of Vaccines and Sera for isolation of hemocultures and cultivation of streptococci . The addition of blood or serum to this medium is not required . The standard inoculum (2 milliard microbial bodies) is added into the depth of the nutrient agar thus providing the optimal conditions for the growth of the facultative anaerobes . The MICs of the antibiotics and the diameters of the growth inhibition zones of 150 streptococcal strains were compared and an estimation table for interpretation of the data of the agar diffusion test was presented . This simple method provides a sufficient accuracy and satisfactory reproducibility in the clinical tests.

Infect Immun, 1984 Oct, 46(1), 245 - 50
Cell surface proteins of oral streptococci; Appelbaum B et al.; Whole cells of representative strains of oral streptococci (Streptococcus sanguis, S . mitis, and S . salivarius) were radiolabeled by the lactoperoxidase method of radioiodination . The labeled polypeptides obtained by extraction of whole cells with boiling sodium dodecyl sulfate were analyzed by polyacrylamide gel electrophoresis and autoradiography . Of the total radioactivity, ca . 70% was released by treating whole cells with trypsin, suggesting that the labeling was confined to proteins located on the cell surface . Most S . sanguis strains studied gave a characteristic banding pattern consisting of a high-molecular-weight (120,000 {120K} to 63K) group of six proteins . Three low-molecular-weight (12K, 16K, and 18K) proteins were also detected in many strains.

J Immunol, 1984 Oct, 133(4), 2220 - 5
Immunochemical study of nutritionally variant streptococci; van de Rijn I et al.; Nutritionally variant streptococci (NVS) have been characterized by their growth as satellite colonies around colonies of staphylococci or several other gram-positive or gram-negative bacterial strains . The majority of the NVS strains were isolated from patients with subacute bacterial endocarditis . Organisms identified as NVS were subdivided into three serotypes by rocket-line electrophoresis and hemagglutination inhibition assays . Ninety-nine of 103 strains expressed one or more of the three serotype antigens; however, a group antigen was not demonstrated in the various extracts of these streptococci . Surface protein studies confirmed the NVS differentiation into serotypes . Serotype I organisms expressed surface protein(s) specific for the serotype, whereas the serotype II and III NVS demonstrated common protein(s) on their surface . Furthermore, SDS extraction released a greater amount of radioiodinatable surface protein from serotypes I and III bacteria than serotype II . Finally, there was no correlation between the serotype or the disease of the patients from which the NVS strains were isolated.

Zentralbl Bakteriol Mikrobiol Hyg {A}, 1984 Oct, 258(1), 74 - 9
A new approach for presumptive identification of clinically important streptococci; Hussain Z et al.; Several tests, bacitracin, CAMP, pyroglutamic acid-B-naphthylamide test (PYR test), bile aesculin hydrolysis, salt tolerance and pigment production tests were evaluated for their reliability and speed in presumptive identification of streptococci . Bacitracin correctly identified all of the group A streptococci but 5% of other beta haemolytic streptococci were misidentified as group A . The PYR reaction was just as sensitive but more specific for group A streptococci and the results were available within 2-3 h . The PYR reaction also effectively differentiated between enterococcal and non-enterococcal group D streptococci . Both the salt tolerance test and the PYR reaction misidentified bile aesculin positive non-group D streptococci as non-enterococcal group D streptococci . Pigment production by group B streptococci was more reliable than the CAMP test for identifying group B streptococci . The combination of PYR, bile aesculin and pigment production allowed rapid differentiation of several medically important groups of streptococci.

Eur Heart J, 1984 Oct, 5 Suppl C, 33 - 7
Antibiotic susceptibility of streptococcal strains associated with infective endocarditis; Etienne J et al.; Seventy-six strains of various species of streptococci isolated from patients with infective endocarditis were tested for their susceptibility to 13 antibiotics by an agar dilution method . The antibiotics tested were: benzyl-penicillin, ampicillin, cefotaxime, vancomycin, erythromycin, rifampicin, pristinamycin, gentamicin, netilmicin, tobramycin, amikacin, dibekacin and streptomycin . Excluding enterococci, 91% of strains were sensitive to benzylpenicillin . Resistance to benzylpenicillin was only found in some strains of S . sanguis I, S . sanguis II and S . mitis . Enterococci were more sensitive to ampicillin . Cefotaxime was highly active against all strains, except enterococci . Vancomycin was active against all strains . Resistance to erythromycin was found in 16% of isolates . Rifampicin and pristinamycin were highly active against all strains, except some enterococci . Gentamicin and netilmicin were the most active of the six aminoglycosides tested . High level resistance to streptomycin was seen in six strains . Overall, S . agalactiae was more resistant to the aminoglycosides than the other species . Among the non-groupable streptococci, strains of S . mitis, S . sanguis I and S . sanguis II were the least sensitive to many antibiotics . Benzylpenicillin remains the antibiotic of choice for the treatment of IE caused by streptococci . If the MIC exceeds 0.1 mg l-1, an aminoglycoside (netilmicin or gentamicin) should be added and the duration of treatment increased from 4 to 6 weeks.

Eur Heart J, 1984 Oct, 5 Suppl C, 25 - 7
Evaluation of the API 20 STREP system for species identification of streptococci associated with infective endocarditis; Etienne J et al.; A rapid commercial system (API 20 STREP gallery, API System, France) for the identification of streptococci was compared with conventional biochemical or serological methods . 77 clinical isolates from patients with infective endocarditis and six reference strains were tested . Biochemical tests showing differences between conventional methods and the API gallery were the acidification of inulin and the Voges-Proskauer reaction, but these differences did not affect the final identification of any strain . 75 strains were identified by the API system and 70 by conventional methods . 69 strains (25 groupable and 44 of 51 non-groupable streptococci) were given the same identity by both methods . One S . morbillorum was only identified by the conventional method . Seven S . sanguis I strains were identified only by the API system and confirmed by additional biochemical tests . The API gallery is a useful method for identifying streptococci associated with infective endocarditis, agreeing with conventional methods in 90% of strains . Results are usually available in 24 h.

J Hyg (Lond), 1984 Oct, 93(2), 339 - 44
A bacteriocin produced by certain M-type 49 Streptococcus pyogenes strains when incubated anaerobically; Tagg JR et al.; Bacteriocin production (P)-typing of 75 M-type 49 group-A streptococci obtained from a variety of epidemiological incidents in different countries gave no evidence of production under the usual aerobic test conditions . However, with anaerobic incubation, 28% of the strains gave a pattern of inhibitory activity against the indicator strains which was indistinguishable from that previously attributed to the bacteriocin, streptococcin A-FF22 (SA-FF22) . Isolation and partial purification of the M type 49 bacteriocin (SA-M49) by freeze-thaw elution from anaerobically grown lawn cultures, followed by ammonium sulphate precipitation and Sephadex chromatography, showed the activity to be associated with a heat-stable proteinaceous molecule of molecular weight approximately 8000 - properties similar to those of SA-FF22 . SA-FF22 and SA-M49 were found to have identical inhibitory spectra including immunity of the producer strains to the inhibitory activity of both the homologous and heterologous bacteriocin preparations . SA-M49 production occurred in some strains of phage subtypes II, III and provisional VI and, since it was a consistent property for all isolates from single outbreaks of infection, it provides a means of discriminating between strains of each of these three phage subtypes . There was no evidence of any increased incidence of SA-M49 production in M-type 49 strains associated with nephritic sequelae.

J Dairy Sci, 1984 Oct, 67(10), 2436 - 40
Prevalence of mastitis pathogens in herds participating in a mastitis control program; Oliver SP et al.; Bacteriological data from herd surveys by the Massachusetts Mastitis Laboratory were analyzed . Comparisons of percent cows and quarters with major mastitis pathogens and types of bacteria isolated were between Streptococcus agalactiae-positive (1105 cows from 17 herds) and Streptococcus agalactiae-negative herds (1088 cows from 17 herds) . Major mastitis pathogens were isolated from 58.5% of cows and 37.0% quarters in Streptococcus agalactiae-positive herds . The most frequently isolated bacteria were Streptococcus agalactiae and Staphylococcus aureus, and together these accounted for 87% of organisms isolated . In contrast, major mastitis pathogens were isolated from only 26.3% of cows and 10.2% of quarters in Streptococcus agalactiae negative herds . Streptococci other than Streptococcus agalactiae, Staphylococcus aureus, and coliforms were the predominant organisms isolated . Seventeen additional Streptococcus agalactiae negative herds were surveyed annually over 6 yr . An average of 25.8% of cows and 10.3% of quarters were positive for major mastitis pathogens during this time . The predominant bacteria isolated were streptococci other than Streptococcus agalactiae, Staphylococcus aureus, and coliforms . There was little variation between years.

J Appl Bacteriol, 1984 Oct, 57(2), 317 - 23
The effect of udder infection on the bacterial flora of the bulk milk of ten dairy herds; Bramley AJ et al.; The significance of udder infection as a factor increasing the bacterial count of herd bulk milk was measured monthly for one year in ten dairy herds in Southern England . Staphylococcus aureus or mastitis streptococci were detected in 86% of samples, usually in numbers between 1000 and 10 000 c.f.u./ml of milk . However, in 8 and 2% of samples respectively greater than 20 000 or 100 000 c.f.u . of mastitis pathogens/ml of milk were detected . This occurred most commonly in the herds with a high incidence of Streptococcus uberis mastitis . The total bacterial counts of the herds' milks varied between 13 960 and 46 230 c.f.u./ml in the winter and between 6510 and 63 000 c.f.u./ml in the summer . No correlation was found between bacteriological quality of herd milk and the cleanliness of the milking machine and pipeline as assessed by plant rinses.

J Appl Bacteriol, 1984 Oct, 57(2), 273 - 8
Human and bovine group B streptococci: two distinct populations; Finch LA et al.; Group B streptococci (Streptococcus agalactiae) from humans and animals were compared for cultural, biochemical, serological and bacteriocin sensitivity properties . Each isolate possessed the group B carbohydrate antigen, hydrolysed hippurate, and was CAMP test positive . Most human isolates were characterized as bacitracin resistant, pigment producing, haemolytic, and salicin but not lactose utilizing . In contrast bovine isolates were usually bacitracin sensitive, non-pigment producing, non-haemolytic, salicin and lactose utilizing . Isolates from other animals behaved similarly to those from humans . Whereas human isolates belonged to a variety of serotypes and were uniformly sensitive to bacteriocins, bovine isolates showed varying sensitivity to bacteriocins and most belonged to serotype II or were non-typable . We believe these results support the belief that Strep . agalactiae from humans and cattle are separate populations sharing the same group B carbohydrate antigen.

J Clin Microbiol, 1984 Oct, 20(4), 824 - 5
Comparison of Directigen Group A Strep Test with a traditional culture technique for detection of group A beta-hemolytic streptococci; McCusker JJ et al.; The Directigen Group A Strep Test (DGAST), a new rapid method of detecting group A beta-hemolytic streptococci directly from throat swabs, was compared with a traditional culture technique for the detection of group A beta-hemolytic streptococci . Five hundred oropharyngeal swabs from pediatric and adult patients were cultured and then processed by using the DGAST . Of the 144 specimens positive by culture, 131 were DGAST positive (sensitivity, 90.9%) . Of the 356 specimens negative by culture, 353 were DGAST negative (specificity, 99.2%) . Twelve of the 13 false-negative DGAST results were from pediatric patients . One hundred isolates of non-group A beta-hemolytic streptococci were recovered, primarily groups C, F, and G . The DGAST is easy to perform, rapid, sensitive, and very specific for detection of group A beta-hemolytic streptococci directly from swabs . Supplementing the DGAST with a culture on a 5% sheep blood agar plate would enhance detection of group A beta-hemolytic streptococci, especially in pediatric patients.

Infect Immun, 1984 Oct, 46(1), 98 - 104
Immunoglobulin G and M composition of naturally occurring antibody to type III group B streptococci; Anthony BF et al.; Human sera were examined by an enzyme-linked immunosorbent assay for immunoglobulin G (IgG) and IgM antibodies to purified type III polysaccharide of group B streptococci . The antigen-binding capacity of a reference human serum was determined by a radioimmunoassay, and the total antibody content was determined by quantitative precipitation . The serum was then depleted of IgM and IgA to determine the effect on the antigen-binding capacity . Duplicate samples of 81 sera were tested by the enzyme-linked assay in comparison with reference standard serum . Although levels of IgG antibody were greater in subjects who had carried type III streptococci during pregnancy, concentrations of this antibody were generally low . Only 2 of 28 sera (7%) from parturient subjects and 7 of 25 sera (28%) from adult volunteers contained greater than or equal to 1 microgram of IgG antibody per ml; the mean levels were 0.13 and 0.53 micrograms/ml, respectively . In contrast, 19 of 28 maternal sera (68%) and 22 of 25 (88%) volunteer adult sera contained greater than or equal to 1 microgram/ml of IgM antibody; mean levels were 1.33 and 1.54 micrograms/ml, respectively . The cord serum levels of IgG antibody were almost identical to maternal serum concentrations, whereas IgM antibody was essentially undetected.

Infect Immun, 1984 Oct, 46(1), 34 - 41
Murine monoclonal antibodies reactive with human heart and group A streptococcal membrane antigens; Cunningham MW et al.; Ten selected murine hybridoma cell lines that produce monoclonal antibodies against M type 5 Streptococcus pyogenes and human heart antigen were isolated . All of the monoclonal antibodies studied were determined to be the immunoglobulin M isotype . The antibodies were characterized on the basis of their reactions with Triton X-100-extracted whole human heart antigens, sodium dodecyl sulfate-extracted sarcolemmal antigens, and whole streptococci or their membranes . Enzyme-linked immunosorbent assays and Western immunoblotting techniques were used to compare the reactivity of the monoclonal antibodies . All 10 of the antibodies were first selected for their reactivity with Triton X-100-extracted heart antigens and whole group A, M type 5 streptococci . These antibodies were then divided into two categories: strong reactors or weak reactors with human sarcolemmal and streptococcal membranes . Among the strong reactors, two different types of monoclonal antibodies were observed on the basis of their immunobanding patterns with sarcolemmal and streptococcal membranes on Western blots . Monoclonal antibodies that were strong reactors with sarcolemmal and group A streptococcal membrane antigen were directed against a determinant on a family of proteins . The major reactants of sarcolemmal extracts were high-molecular-weight proteins near 200,000 . Some monoclonal antibodies demonstrated more specificity for the heart than did others when reacted with separated Triton X-100-extracted tissue antigens from the heart, kidney, and skeletal muscle . One of the monoclonal antibodies that reacted with group A streptococci reacted with a Triton X-100-extracted heart antigen ca . 40,000 daltons in size . None of these monoclonal antibodies opsonized type 5 Streptococcus pyogenes, and in enzyme-linked immunosorbent assays most of the antibodies were found to react to a lesser degree with other groups of streptococci . Monoclonal antibody was used to probe normal and rheumatic sarcolemma for differences in reactivity . Although the rheumatic heart reacted more intensely, no major differences between the immunobanding patterns of normal and rheumatic hearts were observed.

Am J Dis Child, 1984 Oct, 138(10), 915 - 6
Purpura fulminans following late-onset group B beta-hemolytic streptococcal sepsis; Issacman SH et al.; A 16-day-old male infant initially was in septic shock . Following intensive resuscitation, thrombohemorrhagic lesions developed over his extremities, except for the limb with an arterial line maintained by a continuous heparin sodium infusion . Blood and CSF cultures yielded group B beta-hemolytic streptococci . Results of laboratory studies and clinical appearance supported the diagnosis of purpura fulminans (PF) . Systemic heparinization was therefore started, and subsequently his condition improved . Because of the distinct difference in limb sparing, we concluded heparin has a beneficial effect on the evolution of PF.

Eur J Clin Microbiol, 1984 Oct, 3(5), 424 - 6
Exogenous thymidine and reversal of the inhibitory effect of sulfamethoxazole-trimethoprim on streptococci; Coll PF et al.; The practice of using sulfamethoxazole-trimethoprim (SXT) for the selective isolation of Streptococcus pyogenes and as a taxonomic character in the presumptive identification of streptococci was applied to 17 strains of different groups of streptococci to determine their characteristic behaviour in the presence of exogenous thymidine . Streptococcus pyogenes, Streptococcus agalactiae and group D enterococci utilized thymidine, the first two species obtaining a maximum reversal of the inhibitory effect of SXT at thymidine concentrations of 1.2 micrograms/ml and 0.6 micrograms/ml or higher, respectively . For group D enterococci, the degree of reversal of the inhibitory effect was proportional to the thymidine concentration . In contrast, the four viridans species studied (Streptococcus sanguis I, Streptococcus salivarius, Streptococcus mitis and Streptococcus sanguis II) and Streptococcus pneumoniae were unable to utilize thymidine from an exogenous source and thus growth remained inhibited even at the highest concentrations of thymidine tested . For selective isolation and identification of streptococci only stable media with batch-to-batch consistency are recommended together with a known quantity of thymidine.

Appl Environ Microbiol, 1984 Oct, 48(4), 726 - 31
Construction of plasmid cloning vectors for lactic streptococci which also replicate in Bacillus subtilis and Escherichia coli; Kok J et al.; The cryptic Streptococcus cremoris Wg2 plasmid pWV01 (1.5 megadaltons) was genetically marked with the chloramphenicol resistance (Cmr) gene from pC194 . The recombinant plasmid (pGK1, 2.4 megadaltons) replicated and expressed Cmr in Bacillus subtilis . From this plasmid an insertion-inactivation vector was constructed by inserting the erythromycin resistance (Emr) gene from pE194 cop-6 . This plasmid (pGK12, 2.9 megadaltons) contained a unique BclI site in the Emr gene and unique ClaI and HpaII sites outside both resistance genes . It was stably maintained in B . subtilis at a copy number of approximately 5 . pGK12 also transformed Escherichia coli competent cells to Cmr and Emr . The copy number in E . coli was about 60 . Moreover, pGK12 transformed protoplasts of Streptococcus lactis . In this host both resistance genes are expressed . pGK12 is stably maintained in S . lactis at a copy number of 3.

J Med Microbiol, 1984 Oct, 18(2), 189 - 95
Surface receptors for human serum albumin in Peptococcus magnus strains; Myhre EB; Eighty-one bacterial strains representing 16 anaerobic species were tested in a sensitive binding assay for uptake of 125I-labelled human serum proteins . Fifteen of 36 Peptococcus magnus strains (42%) bound significant amounts of human serum albumin (HSA) . None of the other bacterial species showed any affinity for HSA . All strains studied were incapable of uptake of human fibrinogen, fibronectin, haptoglobin or aggregated beta 2-microglobulin . P . magnus strain Ra 4 was tested for binding of purified serum albumin from 11 animal species, and showed a binding profile similar to human group-C and -G streptococci, but different from Streptococcus pyogenes, Strep . zooepidemicus and Strep . dysgalactiae . Kinetic experiments showed that albumin binding was a rapid displaceable, time-dependent process, that could take place over a wide range of pH or salt concentrations . The albumin-binding component of P . magnus strain Ra 4 was resistant to heat and to periodate treatment, but sensitive to proteolytic enzymes.

J Biol Chem, 1984 Sep 10, 259(17), 11041 - 5
The mixed disulfide in the zymogen of streptococcal proteinase . Characterization and implication for its biosynthesis; Lo SS et al.; The identity of the volatile mercaptide and the metabolic pathway by which it becomes combined with the zymogen of streptococcal proteinase in the mixed disulfide were investigated . Mass spectrometric analysis identified the oxidized form of the volatile mercaptan as methanesulfonic acid . The mass spectrum of a peptide isolated from tryptic and subsequent chymotryptic digests of the zymogen was shown to be consistent with the previously reported amino acid sequence for a chymotryptic peptide with the sequence Val-Gly-Gln-Ala-Ala-Thr-Gly-His-Cys(SCH3)-Val . Studies using {35S} cystine, {methyl-35S}methionine and {methyl-14C}methionine in a cell suspension system revealed that the biosynthesis of the mixed disulfide in the zymogen may involve the formation of protein-S-SH followed by transmethylation rather than result from a direct transfer of an intact methanethiol to the cysteinyl residue of the zymogen . It is proposed that the attachment of the CH3-SH group to the protein-SH to form protein-S-S-CH3 is a process that is intimately related to the mechanism of secretion of the proteinase into the culture fluid by streptococci.

J Clin Microbiol, 1984 Sep, 20(3), 592 - 3
Evaluation of the Pneumoslide latex agglutination test for identification of Streptococcus pneumoniae; Smith SK et al.; The Pneumoslide latex agglutination tests was evaluated with 106 strains of Streptococcus pneumoniae and 56 strains representing seven species of viridans streptococci . The Pneumoslide test gave one false-positive and one false-negative reaction . Testing of isolated colonies for solubility in 10% sodium deoxycholate was as accurate but was simpler and less expensive to perform.

Diagn Microbiol Infect Dis, 1984 Sep, 2(4), 301 - 7
An analysis of Streptococcus pneumoniae identification using biochemical and serological procedures; Wasilauskas BL et al.; Five methods for identification of Streptococcus pneumoniae were evaluated with stock strains representing all 83 capsular types and 130 fresh clinical isolates of alpha-hemolytic streptococci . The identification methods included bile solubility, optochin sensitivity, countercurrent-immunoelectrophoresis (CIEP), and coagglutination (CoA) using laboratory-prepared reagents (LPR) and the Phadebact Pneumococcus Test (Phadebact) . The Quellung reaction was performed on the 83 capsular types of S . pneumoniae and on the clinical isolates that produced serological cross reactions with the three serological tests and those that were bile-soluble and optochin-sensitive . All 83 pneumococcal types were in complete agreement with each of the different test methods . Of the 130 alpha-hemolytic streptococci, 26 were identified as S . pneumoniae, and 104 isolates were identified as viridans streptococci using biochemical, physiologic, Quellung, or mouse virulence tests . All 104 viridans streptococci were bile-insoluble and optochin-resistant; however, 63 reacted with either one, both, or all three serological methods . Our data suggest that bile solubility and optochin tests are more reliable for pneumococcal identification than serological methods currently available.

Medicine (Baltimore), 1984 Sep, 63(5), 291 - 302
Single and multiple pyogenic liver abscesses . Natural history, diagnosis and treatment, with emphasis on percutaneous drainage; McDonald MI et al.; The presenting features, modes of treatment and clinical course were reviewed for 55 patients with pyogenic liver abscess, seen at Duke University Medical Center over a 15-year period . Thirty-three patients had a solitary abscess and 22 had multiple abscesses . Most patients were between the ages of 40 and 60 years . Males predominated, 2.4:1 . Major underlying conditions included biliary tract disease, malignancy and colonic disease . Eight patients, each with a solitary abscess, had no identifiable underlying condition . Symptoms and signs were nonspecific: fever, chills, focal abdominal tenderness and hepatomegaly were common . A raised serum alkaline phosphatase level was the most consistent abnormal laboratory finding . CT with contrast enhancement, radioisotope scanning and ultrasonography all accurately defined solitary hepatic abscesses . However, CT scan was more successful than other imaging techniques in detecting multiple abscesses . In seven patients the diagnosis was made only at laparotomy . Overall, a diagnosis of liver abscess was made in 50 living patients (91%) . Microorganisms were recovered from pus and/or blood cultures of 44 patients (80%) . Most common were enteric gram-negative facultative rods, anaerobic gram-negative rods, and microaerophilic streptococci . Single abscesses were more likely than multiple abscesses to contain more than one organism . All patients received antibiotics; the choice of antibiotic does not appear to be critical provided the regimen has a broad spectrum including activity against anaerobes . Surgical or percutaneous drainage was successful when attempted in all patients with a single abscess, but the outcome was less favorable in those with multiple abscesses . Percutaneous drainage is currently replacing open operative drainage as the method of choice . Overall mortality in patients with single abscesses was 15% (5/33) and in those with multiple abscesses 41% (9/22).

Zh Mikrobiol Epidemiol Immunobiol, 1984 Sep, (9), 25 - 8
{Streptococcus group B in meningitis and infection of newborn infants}; Kostiukova NN et al.; Streptococci were isolated from the liquor or blood of 102 newborn infants and 16 infants in the first month of their life, suspected of having purulent meningitis, in 22 cases (18,5%) . 5 isolated streptococcal strains were classified with group B on the basis of their cultural, biochemical and serological features . All of these strains were isolated from newborn infants during the first 3-4 days of their life . The occurrence of group B streptococci among all examined newborn infants was 4.8%; among the newborns with the positive results of bacteriological examination (73 infants) this figure was as high as 6.8% . The authors emphasize the necessity of producing, on an industrial scale, diagnostic preparations for the identification of group B streptococci playing a significant role in septic diseases and meningitides in newborns.

Rev Infect Dis, 1984 Sep-Oct, 6(5), 601 - 7
The role of beta-lactamase-producing bacteria in the persistence of streptococcal tonsillar infection; Brook I; The failure of penicillin to eradicate group A beta-hemolytic streptococci (GABHS) is a growing problem . This review summarizes current data concerning the role of aerobic and anaerobic beta-lactamase-producing bacteria in the persistence of tonsillar infection caused by GABHS . Clinical studies have demonstrated the recovery of beta-lactamase-producing bacteria and detectable levels of the enzyme beta-lactamase in cultures of core tonsillar specimens in greater than 80% of the patients . The predominant bacteria have been Bacteroides melaninogenicus, Bacteroides oralis, Bacteroides ruminicola, and Staphylococcus aureus . These organisms have emerged in about one-third of patients after one course of penicillin therapy and can be transferred to patient's household contacts . These organisms were present in tonsillar cultures in higher numbers in children with acute tonsillitis who did not respond to penicillin therapy than in those who were cured . Protection of GABHS by beta-lactamase-producing organisms has been demonstrated in vitro and in vivo . Several studies, including a recent double-blinded study, have demonstrated the ability of clindamycin to eradicate the streptococcal carrier state and to prevent recurrent infection in selected patients.

J Clin Microbiol, 1984 Sep, 20(3), 461 - 4
Successive extraction of specific protective immunoglobulins from pooled human sera; Yoshida K et al.; By use of pooled human sera, specific protective immunoglobulins against the Smith-diffuse strain of Staphylococcus aureus, strains SS-620 and SS-619 of types III and II group B streptococci, and strain K-9 of Klebsiella pneumoniae were successively extracted from their whole cell and antibody complexes by elution with propionic acid containing 5% sucrose . Injection of 0.14, 0.05, 0.09, and 0.15 mg of these eluates in mice gave protection against lethal infection only with homologous strains . However, no protective effect was observed against these infections, even with considerably higher amounts of a conventional immunoglobulin preparation . The major components of the eluates were the three major immunoglobulins, immunoglobulin G (IgG), IgA, and IgM, although nonspecific proteins were also included . Protective activities of these eluates were absorbed out by their protection-inducing antigens, indicating that they contained specific protective immunoglobulins.

J Clin Microbiol, 1984 Sep, 20(3), 438 - 40
Group B streptococcal colonization patterns in mothers and their infants; Jones DE et al.; Maternity patients and their newborn infants were cultured for group B streptococci (GBS) at Tampa General Hospital, Tampa, Fla., from September 1982 to May 1983 . Culture swabs were placed into Lim Group B Strep Broth (GIBCO Laboratories, Madison, Wis.) and quantitated for GBS . A strong correlation was found between the numbers of GBS in the maternal vagina and the infant rectum . Infants symptomatic for early-onset GBS disease were delivered by mothers heavily colonized (greater than or equal to 3 X 10(4) GBS per swab) at the vagina . Such mothers were identified as GBS carriers by slide coagglutination and latex agglutination after their broth cultures had been incubated for 5 h . These data indicate that maternity patients at high risk of delivering infants heavily colonized with GBS and potentially symptomatic for early-onset GBS disease can be rapidly and selectively identified.

J Clin Microbiol, 1984 Sep, 20(3), 413 - 6
Comparison of lysis-centrifugation with a biphasic blood culture medium for the recovery of aerobic and facultatively anaerobic bacteria; Henry NK et al.; The Du Pont Isolator tube and Roche Septi-Chek blood culture bottle employ solid media which facilitate the removal of bacteria from static or cidal substances in blood to increase recovery and decrease detection time . In a comparison of 11,567 blood culture sets, the Isolator tube and vented Roche Septi-Chek bottle were positive for 533 (80%) and 494 (74%) of the aerobic and facultatively anaerobic organisms recovered, respectively . This difference was not significant . A significant difference was found in the overall detection time . The Isolator tube recovered the bacteria ca . 1 day earlier . The earlier detection time was most notable with Staphylococcus aureus, viridans streptococci, and Pseudomonas aeruginosa . Among the 355 bacteremic episodes analyzed by a computer program, the Isolator tube was responsible more often for the first report of bacteremia in a given patient . Both systems performed well for the recovery of aerobic and facultatively anaerobic bacteria, but it is recommended that either be used in combination with an unvented broth-containing bottle.

Pediatr Res, 1984 Sep, 18(9), 874 - 8
Cardiovascular changes in group B streptococcal sepsis in the piglet: response to indomethacin and relationship to prostacyclin and thromboxane A2; Runkle B et al.; Seventeen piglets were infected with a continuous intravenous infusion of live group B beta-hemolytic streptococci (GBS) . Hemodynamic changes were recorded, and blood samples were drawn for measurement of thromboxane B2 (TxB2) (stable metabolite of thromboxane A2) and 6-keto-PGF1 alpha (stable metabolite of prostacyclin) . Control animals (n = 9) received only bacteria, while treatment animals (n = 8) received indomethacin, 3 mg/kg IV, 15 min after the start of the bacterial infusion . Control animals responded to the bacteria within 15 min with marked elevation in mean pulmonary artery pressure (Ppa) from 15 +/- 8 to 39 +/- 6 mm Hg and decline in PaO2 from 80 +/- 11 to 51 +/- 6 mm Hg and cardiac output (CO) from 0.24 +/- 0.07 to 0.13 +/- 0.07 liters/min/kg . Mean arterial blood pressure (AoP) significantly decreased from baseline value of 95 +/- 13 to 51 +/- 32 mm Hg by 180 min . In animals treated with indomethacin, these changes were reversed or significantly attenuated . The hemodynamic changes were associated temporally with elevations in plasma concentrations of TxB2 or 6-keto-PGF1 alpha . In the first 60 min, TxB2 levels in both groups correlated with Ppa (r = 0.72, p less than 0.001) and PaO2 (r = -0.60, p less than 0.001) . A strong negative correlation between TxB2 and CO was observed over the first 180 min (r = -0.73, p less than 0.001) . There was a statistically significant correlation between AoP and 6-keto-PGF1 alpha concentration between 60 and 180 min (r = -0.54, p less than 0.002) . Indomethacin improved the hemodynamic function in this model of GBS sepsis.(ABSTRACT TRUNCATED AT 250 WORDS)

J Laryngol Otol, 1984 Sep, 98(9), 895 - 9
Complications of sinusitis caused by Streptococcus milleri; Blayney AW et al.; Complications of sinusitis caused by 'viridans' streptococci, mainly Streptococcus milleri, are described . The identification, bacteriology and pathogenicity of the organism are discussed and an approach to antimicrobial therapy outlined.

J Antimicrob Chemother, 1984 Sep, 14(3), 261 - 5
A double-blinded comparative study of sultamicillin and potassium penicillin V in the treatment of childhood streptococcal pharyngitis; Aronoff SC et al.; Fifty-two children with positive pharyngeal cultures for group A streptococci were randomized to receive phenoxymethyl penicillin or sultamicillin, an ester of ampicillin and sulbactam . By serological and bacteriological criteria, sultamicillin was effective in 100% of the 20 evaluable cases of infection and carriage while penicillin was effective in six out of eight (75%) and three out of eight (93%) respectively . Of the eight children with infections treated with sultamicillin, three (37.5%) became recolonized with the organism compared to none of the children in the penicillin group . These differences were not statistically significant.

Science, 1984 Aug 31, 225(4665), 935 - 8
Small DNA deletions creating avirulence in Streptococcus pyogenes; Spanier JG et al.; The M protein is the antigen on the surface of group A streptococci that allows these bacteria to resist phagocytosis . DNA encoding the M12 protein was cloned into Escherichia coli and used as an isotopically labeled hybridization probe to compare genomic DNA's isolated from M+ and M- isogenic cultures in an effort to elucidate the genetic basis of this variation . DNA's from two spontaneous, independent M- variants contained small (approximately 50 base pairs) deletions which were mapped to identical restriction fragments within or adjacent to the M protein coding sequence . Taken together with the pleiotropic nature of these deletions, this suggests that they define a regulatory switch.

J Immunol Methods, 1984 Aug 3, 72(1), 269 - 77
Interaction of group B streptococcal type-specific polysaccharides with wheat germ agglutinin and other lectins; Gray BM et al.; The group B streptococci (GBS) are known to have type-specific polysaccharides rich in N-acetylneuraminic acid end groups, which are thought to be important immunological determinants . Wheat germ agglutinin (WGA) has affinity for N-acetylneuraminic acid as well as N-acetylglucosamine, and readily precipitates the type but not the group polysaccharide . A WGA-Sepharose affinity column was used to isolate complete type polysaccharides of representative strains of the 4 major GBS types . WGA, other lectins, and rabbit antisera were then used to characterize the products of various extraction procedures and chemical degradations, including mild acid hydrolysis and treatment with neuraminidase . Results of lectin binding studies were consistent with proposed chemical structures of types Ia, Ib and II . Differences were noted, however, between the cross-reactive antigens of pneumococcus type 14 and the desialated GBS type III polysaccharide . Although structurally similar, indirect evidence from lectin binding studies suggest that these antigens may not be identical.

Infect Immun, 1984 Aug, 45(2), 433 - 6
Binding sites for streptococci and staphylococci in fibronectin; Kuusela P et al.; Purified cathepsin G fragments of fibronectin were used to locate the binding sites for streptococci and staphylococci in the fibronectin molecule . The iodinated, NH2-terminal, 30-kilodalton (kd) fragment bound to group A and G streptococci and to Staphylococcus aureus . The 125I-labeled, COOH-terminal, 120- to 140-kd fragment bound weakly to group A streptococcus strain and to S . aureus when tested in a buffer of low ionic strength . The 30- and 120- to 140-kd fragments inhibited the binding of iodinated fragments to bacteria . The two fragments were, on a molar basis, equally effective, and they were more potent inhibitors than intact fibronectin . The gelatin-binding 40-kd fragment neither bound to any of the bacterial strains nor inhibited the binding of 125I-labeled 30-kd or 125I-labeled 120- to 140-kd fragments to bacteria . The results indicate that fibronectin has at least two separate binding sites for streptococci and staphylococci, one in the NH2-terminal region and another in the COOH-terminal region of the molecule, both capable of specific interaction with a complementary structure exposed on streptococcal and staphylococcal cell surfaces.

Am J Dis Child, 1984 Aug, 138(8), 720 - 5
Changing spectrum of infective endocarditis in children . Analysis of 26 cases, 1970-1979; Stanton BF et al.; The decade of the 1970s was marked by an increased survival of children with complex heart lesions, use of prosthetic material in open heart surgery, and placement of indwelling central catheters in critically ill patients . We analyzed all 26 cases of children with infective endocarditis (IE) seen at Yale University, New Haven, Conn, from 1970 through 1979 to determine whether these and other factors resulted in a change in pediatric IE . A larger proportion of cases arose postoperatively as compared with previous series . Among the postsurgical and catheterization-related cases, the most common infecting agents were streptococci, not the expected staphylococci . Although the number of cases was small, IE associated with prosthetic material had a favorable prognosis; all survivors of IE with prosthetic material were cured by medical regimens alone . The IE cases in children with previously normal hearts were associated with indwelling central catheters.

J Dent Res, 1984 Aug, 63(8), 1047 - 50
Relatedness and classification of Streptococcus mutans and "mutans-like" streptococci; Schleifer KH et al.; The "mutans-like" streptococci can be separated into five species (Streptococcus mutans, S . rattus, S . sobrinus, S . cricetus, and S . ferus) that belong to the same rRNA homology cluster . New valuable chemical characters for differentiation of the five species--such as peptidoglycan type, presence of cell wall teichoic acid, and cell wall sugar composition--are described . The peptidoglycan type and the cell wall sugar composition can be determined by rapid procedures.

Pharmacol Res Commun, 1984 Aug, 16(8), 821 - 9
Amiloride, a diuretic with in vitro antimicrobial activity; Giunta S et al.; The effect of amiloride, an inhibitor of passive sodium influx in animal cells, was investigated on the in vitro bacterial growth . Amiloride blocked the growth of different bacterial strains at concentrations ranging from 25 to 1,300 micrograms/ml . While generally the block was bacteriostatic and bacteria, on amiloride removal, recovered their ability to growth, the drug showed a killing activity on hemolytic streptococci . Gram-positive bacteria revealed a greater susceptibility to amiloride than gram-negative ones . Although an hitherto unknown effect of amiloride cannot be excluded, from the known mechanism of action of amiloride on animal cells it might be suggested that sodium permeability plays a critical role on bacterial multiplication.

J Clin Microbiol, 1984 Aug, 20(2), 223 - 6
Identification of Streptococcus bovis and Streptococcus salivarius in clinical laboratories; Ruoff KL et al.; Streptococci identified as Streptococcus bovis, S . bovis variant, and Streptococcus salivarius were examined with respect to physiological and serological characteristics and cellular fatty acid content . Similarities in physiological reactions and problems encountered in serological analysis were noted, suggesting that an expanded battery of physiological tests is needed to definitively identify these streptococci . Cellular fatty acid analysis provided an accurate method for distinguishing S . salivarius from S . bovis and S . bovis variant.

Zentralbl Bakteriol Mikrobiol Hyg {A}, 1984 Aug, 257(3), 364 - 71
{Bacteriological characterization of gingivitis-inducing plaque depending on different sugar levels of the diet}; Pfister W et al.; In a time period of 21 days an experimental gingivitis was induced in 8 volunteers . Four volunteers received a carbohydrate-reduced, the other 4 persons a carbohydrate-enriched diet . Clinical investigations on the development of plaque and gingivitis and bacteriological examinations of the supragingival microflora were performed simultaneously . The change in the composition of the supragingival plaque-microflora were nearly independent of the amount of food-carbohydrate . In the beginning of the experiment all volunteers had an almost pure streptococcal microflora but during the course of the experiment, the supragingival flora developed to a complex microflora with 50% anaerobes . The reduction of the number of streptococci was accompanied by an increase in the number of Gram-negative rods and actinomycetes . The development of gingivitis in persons with carbohydrate-enriched food was more rapid than in persons with carbohydrate-reduced food . It was striking that the occurrence of clinical symptoms correlated with the increase of the number of Actinomyces viscosus in the plaque material.

J Clin Microbiol, 1984 Aug, 20(2), 171 - 4
Evaluation of rapid identification of gram-positive cocci in positive blood cultures by use of the AutoMicrobic system Gram-Positive Identification Card; Hamoudi AC et al.; Because rapid identification of gram-positive organisms from blood cultures may provide valuable information for patient care and because the AutoMicrobic system Gram-Positive Identification (AMS-GPI) Card (Vitek Systems, Inc., Hazelwood, Mo.) is designed for the identification of these organisms in 4 to 13 h, we designed this study to evaluate the performance of the AMS-GPI Card in the direct identification of gram-positive organisms upon detection of growth in blood culture bottles . We compared direct identification by the AMS-GPI Card with the final AMS-GPI Card identification and with our standard identification methods . We evaluated 51 gram-positive organisms from clinical blood cultures as well as 49 simulated blood cultures . The isolates included Streptococcus pneumoniae (17), Streptococcus pyogenes (13), group D enterococci (12), Streptococcus agalactiae (11), viridans streptococci (10), coagulase-negative staphylococci (21), Staphylococcus aureus (15), and Listeria monocytogenes (1) . The AMS-GPI Card identified all of the group D enterococci, viridans streptococci, and coagulase-negative staphylococci and all but one each of the Streptococcus pyogenes and Streptococcus agalactiae isolates . L . monocytogenes was also correctly identified . However, the AMS-GPI Card identified only 12 of 17 Streptococcus pneumoniae and 9 of 15 Staphylococcus aureus isolates by direct inoculation . We therefore conclude that the results of direct identification of gram-positive organisms by the AMS-GPI Card may be used cautiously for rapid direct identification of gram-positive organisms from positive blood cultures.

J Appl Bacteriol, 1984 Aug, 57(1), 1 - 14
Identification of streptococci in a medical laboratory; Colman G et al.; A total of 965 cultures of streptococci received at a reference unit for identification were examined with API-20 Strep kits and also by established methods . The API method, although it needed to be supplemented with additional tests, largely overcame the difficulty that pyogenic streptococci are usually identified by their serological reactions and that biochemical tests are used for the identification of the other streptococci . Representatives of at least 24 established or possible species were identified.

Acta Pathol Microbiol Immunol Scand {B}, 1984 Aug, 92(4), 223 - 7
Repeated passage of freshly isolated group A streptococci on blood agar . I . Effect on M protein, opacity factor and IgG Fc-receptor activity; Stjernquist-Desatnik A et al.; Seventy-six strains, 20 T-type 1, 20 T-type 2, 18 T-type 4 and 18 T-type 12 group A streptococci were isolated from throat cultures and subjected to 25 serial passages on blood agar . A single "glossy" colony was selected from each passage in order to diminish the M protein content of the strains . In accordance with previous results, the M protein synthesis, as estimated by an electro-immuno assay diminished in the T1 strains, in mean from 23.8 to 15.5% of a reference M protein preparation (p less than 0.01) . Opacity factor (OF)-production was used as a measure for M protein in the T-type 2, the T-type 4 and the OF-positive T-type 12 strains . OF-excretion decreased significantly in the T-types 2 and decreased, though not significantly in the T-type 12 strains but increased (unexpectedly) in the T-type 4 isolates during subculture . However, irrespective of the changes in M protein/OF production these types all increased significantly in capacity to bind radiolabelled IgG via the Fc-fragment . It is known that streptococci isolated during convalescence resemble subcultured strains; it is suggested that IgG Fc-receptors are important for protection of the streptococci against phagocytosis in the asymptomatic carrier state.

Infect Immun, 1984 Aug, 45(2), 378 - 83
Group A streptococcal peptidoglycan-polysaccharide inhibits phagocytic activity of human polymorphonuclear leukocytes; Leong PA et al.; Injection of sterile aqueous preparations of the peptidoglycan-polysaccharide of group A streptococci (PG-APS) produces chronic inflammation in several animal models . Chronic bacterial infection may be involved in some aspects of the pathogenesis of inflammation associated with the accumulation of PG-APS . Accordingly, the effect of PG-APS on human neutrophil (polymorphonuclear leukocyte {PMN}) bactericidal activity was studied with the supposition that this interaction may contribute to the inflammation observed . Concentrations of PG-APS greater than 10 micrograms/ml inhibited the ability of PMNs to kill Staphylococcus aureus . This inhibition was not due to a cytotoxic effect of PG-APS on PMNs, nor did PG-APS inhibit PMN metabolism required for the formation of microbicidal oxygen reduction products . PG-APS concentrations of 10 micrograms/ml or greater in the presence of 10% normal serum inhibited the attachment of bacteria to PMNs by 49% as compared with control cell populations . The concentrations of PG-APS required to inhibit uptake of Staphylococcus aureus were identical to those required for inhibition of PMN bactericidal activity . This inhibition did not occur in the presence of serum-free medium or medium with sera that had been heated to inactivate complement . These results show that PG-APS interacts with serum to inhibit PMN-mediated killing of S . aureus, most probably by interfering with bacterial uptake.

Arch Surg, 1984 Aug, 119(8), 942 - 5
Eclectic drainage of subphrenic abscesses; Serrano A et al.; In 196 cases of subphrenic abscess from 1964 through 1979, 56% were attributable to gastric, hepatic, and colonic disease or surgery . Posttraumatic abscesses in younger patients became more frequent . Synchronous suprahepatic and subhepatic abscesses or bilateral abscesses accounted for 19% . Streptococci, Escherichia coli, Klebsiella, and Bacteroides species were the most frequently isolated organisms . Although the overall mortality rate was 40%, the surgical mortality rate decreased from 33% initially to 17% recently . The mortality rate of transperitoneal drainage decreased from 41% to 16% . From 1980 through early 1983, a success rate of 84%, with no fatalities, was achieved in percutaneous radiologic drainage of 25 unilocular abscesses . At present, radiologically guided drainage should be considered for unilocular abscesses and some bilocular ones . Although extraperitoneal, extrapleural surgical drainage remains an expeditious form of treatment, it may give way to radiologic drainage . Transperitoneal drainage is preferable for multifocal abscesses and for many abscesses secondary to complications of intraabdominal surgery.

Clin Immunol Immunopathol, 1984 Aug, 32(2), 234 - 47
Modulation of human lymphocyte functions by group A streptococci; Gross WL et al.; Intact (heat-inactivated) bacteria and isolated cellular components of pathogenic group A (M type 5 or 12) . B . C . and G streptococci were used to evaluate the in vitro reactivity of mononuclear cells (MNC) from peripheral blood of healthy donors and from human tonsils . High doses of A-streptococcal cells, cell walls, and cell membranes stimulated DNA synthesis, production of leukocyte migration inhibitory factor (LIF), and immunoglobulin (Ig) secretion in MNC from all donors . A streptrococci stimulated higher proliferation rates and larger numbers of plaque-forming cells (PFC) in tonsil cell cultures than in blood MNC cultures . Polyclonal activation of both tonsil and blood B lymphocytes by A-streptococcal cell components was T cell and monocyte dependent, thus showing a similarity between these structures and pokeweed mitogen (PWM), which is a polyclonal T-cell activator (PTA) . Cocultivation studies demonstrated that, in the presence of A streptococci, precultured MNC and T cells can suppress the blastogenic and PFC responses of autologous fresh MNC stimulated by phytomitogen or antigen, which is very similar to the concanavalin A (Con A)-induced activation of suppressor cells . In contrast, similar group B-, C-, and G-streptococcal cell envelope biostructures failed to activate blood or tonsil lymphocytes to proliferate, differentiate, or produce LIF.

Acta Pathol Microbiol Immunol Scand {B}, 1984 Aug, 92(4), 229 - 36
Interaction of thermally aggregated human IgG with bacteria; Myhre EB et al.; Ninety-three bacterial strains, representing 16 Gram-positive and Gram-negative species, were tested for quantitative binding of 125I-labelled monomeric and thermally aggregated human IgG . Aggregated IgG bound to all bacterial species studied, in contrast to monomeric IgG, which interacted only with S . aureus, group A, C and G streptococci, viz . bacteria possessing previously described IgG-Fc receptors . A positive correlation was observed between binding of monomeric IgG and the uptake of thermally aggregated IgG (r = 0.92) . Monomeric IgG inhibited effectively the binding of monomeric IgG but only partially the uptake of aggregates . Absorption with bacteria revealed that only a fraction of aggregated IgG could interact with bacteria lacking specific IgG-Fc receptors . A human group G streptococcus strain (G-148), tested with increasing amounts of immunoglobulin, was capable of binding at least ten times as much aggregates as monomeric IgG, implying binding to separate binding sites . These data indicate that polymeric IgG produced by thermal aggregation of human polyclonal IgG can interact with bacterial surface components found in most pathogenic microorganisms . This interaction seems to be less specific than the binding to previously described IgG-Fc receptors.

Antimicrob Agents Chemother, 1984 Aug, 26(2), 260 - 2
In vitro bactericidal synergy of gentamicin combined with penicillin G, vancomycin, or cefotaxime against group G streptococci; Lam K et al.; The in vitro bactericidal interactions of penicillin G, cefotaxime, or vancomycin in combination with gentamicin were compared against 20 group G streptococci by the timed kill curve method . Synergy was noted at the following frequencies: penicillin plus gentamicin, 80%; cefotaxime plus gentamicin, 85%; vancomycin plus gentamicin, 90% . There was no bactericidal antagonism observed.

Laryngoscope, 1984 Jul, 94(7), 963 - 5
Changes in the bacterial flora of the external ear canal from the wearing of occlusive equipment; Brook I et al.; External otitis has been associated with wearing obstructive gear covering the earlobe and external ear canal . In this study we investigated the changes in the bacterial flora of the external ear canal after wearing rubber hoods . The bacterial flora of external ear canals surfaces was investigated in a group of 19 volunteers who wore rubber hoods for a period of 25 to 30 minutes while doing manual work . The protective effect of 2% acetic acid was tested by instilling it in the left ear of all participants . Staphylococcus epidermidis, Propionibacterium acnes, and alpha-hemolytic streptococci were the predominant isolates from the ear samples . After hoods were worn, there was a substantial increase in the number of these organisms in 7 (36.8%) of the external ears . However, an increase in the bacterial counts in the external ear canals occurred in only 2 (10.5%) of the individuals treated prophylactically with acetic acid drops (P less than 0.02).

Acta Paediatr Scand, 1984 Jul, 73(4), 498 - 504
Prevention and control of neonatal pyoderma with chlorhexidine; Seeberg S et al.; The extent of staphylococcal colonisation and neonatal pyoderma was studied in 5 220 infants in two large Swedish hospitals in 1979-1982 . A method for routine cord care with 4% chlorhexidine detergent solution was evaluated in one hospital . Nursery colonisation with Staph . aureus and streptococci decreased significantly . The method proved to be clinically efficient for prevention of pyoderma in the nursery as well as for controlling staphylococcal infection after discharge from hospital . The combined use of a quantitative sampling method and phage-typing showed that most post-discharge lesions were nursery-derived . In one of the hospitals, daily cord care with 70% ethanol failed to prevent streptococcal and staphylococcal omphalitis in the nursery whereas daily cord care with chlorhexidine reduced the incidence of omphalitis from 21 to 1%.

Pathology, 1984 Jul, 16(3), 261 - 2
Inhibitory substances in horse sera used in the preparation of microbiological culture media; Mugg PA et al.; The failure of N . gonorrhoeae to grow on isolation media was found to be due to inhibitory substances present in commercially available horse sera . Subsequent investigations indicated that the inhibitory action of the horse serum may have been due to antibodies to N . gonorrhoeae, H . influenzae, H . parainfluenzae and beta hemolytic streptococci . This experience highlights the need for media quality control programmes in laboratories which prepare microbiological culture media.

G Batteriol Virol Immunol, 1984 Jul-Dec, 77(7-12), 155 - 63
{Adhesion of Streptococci to different types of cells}; Savoia D et al.; 15 Streptococcus strains of different groups and types were assessed to evaluate the capacity to adhere to tissue culture cells "in vitro" (WISH, MDCK, RK-13 cells) . This ability is not similar for different cells and not type-specific in group A Streptococci, but it seems more elevated in M+ strains . The microscopic technique generally agree to the radioactive one, nevertheless using both methods it is possible to improve the results.

G Batteriol Virol Immunol, 1984 Jul-Dec, 77(7-12), 145 - 54
{Group A streptococci: serotypes isolated in a pediatric environment}; Magliano M et al.; We examined the incidence of different types of group A Streptococci in children with various (mostly respiratory) diseases . The 85.6% of strains assayed were T typable; they belonged more frequently to "5-11-12-27-44" T complex, to type T12, T1, "3-13-B3264" T complex and T4 . An increase of type 1 and 4 was found in streptococcal strains isolated more recently.

Am J Perinatol, 1984 Jul, 1(4), 319 - 21
Pathogenicity of alpha hemolytic streptococci in the neonate; Moomjian AS et al.; Alpha hemolytic Streptococcus viridans (AHSV) was found to be the predominant pathogen in neonatal septicemia from 1979 to 1981 at a 1,000-bed voluntary hospital with 5,000 deliveries per year . All but three of the 30 neonates with blood cultures positive for AHSV presented within the first week of life . Most were born at term and had good Apgar scores . The majority of the infants were symptomatic, with respiratory distress being the most common presenting sign . Other common signs included unexplained hyperbilirubinemia and gastrointestinal problems . The one mortality in the group was the smallest and most premature neonate . In the remainder there was good correlation between institution of antibiotic treatment and clinical improvement . Alpha hemolytic Streptococcus viridans should no longer be considered a contaminant if isolated from the blood of a neonate suspected of having sepsis or from cervical or placental cultures in obstetrical patients with complications.

J Infect, 1984 Jul, 9(1), 43 - 50
A profile of skin sepsis in meat handlers; Barnham M et al.; Four hundred and sixty-seven episodes of sepsis associated with meat handling and poultry processing occupations were seen in two Health Districts of North Yorkshire in a period of just over five years . Altogether 389 patients were infected in 16 outbreaks and 24 sporadic incidents; spread of infection was noted in families of nine workers . The variety of skin infections included septic cuts and scratches, paronychia, abscess, lymphangitis as well as infection in pierced ear lobes and in tattoos . Beta-haemolytic streptococci or Staphylococcus aureus were present in 96 per cent of the 303 episodes that yielded positive cultures . These included 203 episodes with Streptococcus pyogenes and 170 with S . aureus . Skin sepsis appears to be common among meat handlers in this part of England.

Scand J Immunol, 1984 Jul, 20(1), 69 - 79
On the interaction between beta 2-microglobulin and group A streptococci; Bjorck L et al.; beta 2-microglobulin (beta 2m) was found to interact with many group A streptococcal strains . The interaction appeared to require multipoint attachment, since monomeric beta 2m in solution showed no binding, whereas both beta 2m monomers bound to liposomes, and beta 2m in aggregates showed affinity for the bacteria . Aggregated HLA antigens (-A, -B and -C) and aggregated beta 2m exhibited the same binding patterns when tested in binding experiments with various group A streptococcal strains . Furthermore, beta 2m aggregates in excess completely blocked the binding of aggregated HLA antigens, thereby demonstrating that beta 2m is able to interact with streptococcal surface structures also when it is part of the HLA antigen complex . M protein-positive group A streptococcal strains bound significantly more beta 2m than M protein-negative variants of these strains . Purified M 12 protein partly inhibited the binding of radiolabelled beta 2m aggregates to whole streptococci, and in gel filtration and affinity chromatography experiments, the M 12 protein interacted with beta 2m . These various data suggest that the interaction between beta 2m and group A streptococci could be mediated by M protein . Lipoteichoic acid (LTA) is a constituent of the streptococcal cell wall that has been reported to form complexes with M protein at the bacterial cell surface . However, LTA did not influence the interaction between beta 2m and streptococci, suggesting that the binding of beta 2m to streptococcal M protein represents a pure protein-protein interaction . In vivo such an interaction could be established between infecting streptococci and host cells . Among 45 strains of different M types large differences in beta 2m binding were recorded, whereas among 60 strains of the classical nephritogenic M types 12 and 49, all were highly beta 2m-reactive, which points towards a role for beta 2m in streptococcal pathogenicity.

J Infect Dis, 1984 Jul, 150(1), 63 - 70
Absolute requirement for complement in monoclonal IgM antibody-mediated protection against experimental infection with type III group B streptococci; Shigeoka AO et al.; The role of complement in the protective and opsonic activity of monoclonal IgM antibody to type III group B streptococci (GBS) was examined in a neonatal rat model of infection and in vitro with human sera as the complement source . C3 levels in uninfected neonatal rats were less than 50% of those in adult rats, similar to the low complement levels observed in human neonates . The monoclonal type III-specific IgM antibody provided protection to neonatal rats (with unaltered complement levels) that were infected intra-peritoneally or intranasally with type III GBS . In contrast, neonatal rats depleted of complement by administration of cobra venom factor were not protected by IgM antibody . In vitro, classical complement pathway activity was adequate in sera from well, term neonates and GBS-infected neonates in the presence of higher concentrations of the monoclonal IgM antibody . At lower IgM levels, however, the alternative complement pathway was less efficient in both neonatal sera and adult sera.

J Clin Pathol, 1984 Jul, 37(7), 790 - 5
Impaired opsonophagocytosis of serotypes Ib and II of group B streptococci as compared with serotypes Ia and III: role of the alternative pathway of complement in opsonisation of serotype III of group B streptococci; Hindocha P et al.; Using the technique of phagocytic chemiluminescence, we have shown that serotypes Ib and II of group B streptococci are resistant to opsonophagocytosis . The resistant strains became susceptible to opsonophagocytosis by trypsin treatment, but neuraminidase had no effect . Several studies have failed to define a significant role for the alternative pathway of complement in opsonisation of group B streptococci . By simple chelation and heat inactivation studies, we have shown that the alternative pathway of complement is activated by serotype III of group B streptococci.

J Clin Microbiol, 1984 Jul, 20(1), 12 - 4
Evaluation of the Culturette Brand Ten-Minute Group A Strep ID technique; Slifkin M et al.; A direct extraction of the antigens of group A beta-hemolytic streptococci from 557 throat swabs was performed by a new microtechnique of the nitrous acid extraction method with the Culturette Brand Ten-Minute Strep ID technique from Marion Scientific, Division of Marion Laboratories, Inc., Kansas City, Mo . This group A latex reagent kit contains the reagents for the micronitrous acid extraction of throat swabs and does not require a centrifugation step in its protocol . There was a 99.3% (553 of 557) total agreement between the direct nitrous acid extraction-latex agglutination method and the standard culture method . The direct extraction method yielded an identification of 95.1% (78 of 82) of the group A streptococci identified by the standard method . Throat swabs used for standard culture may also be extracted with nitrous acid for the detection of group A antigen . A 5-min nitrous acid extraction destroys the viability of bacteria associated with normal throat flora as well as group A streptococci and Mycobacterium tuberculosis . This highly rapid method is simple to perform and requires no costly instrumentation . Accordingly, it would be most applicable in a hospital laboratory as well as in a physician's office.

Arch Ophthalmol, 1984 Jul, 102(7), 1063 - 7
Experimental uveitis . Elicited by peptidoglycan-polysaccharide complexes, lipopolysaccharide, and muramyl dipeptide; Fox A et al.; Uveitis could be a reaction to bacterial debris disseminated to the eye from extraocular sites of infection . In this study, we relate the composition of several bacterial components to their inflammatory properties in the eye . Groups of rabbits were injected intravitreously with peptidoglycan-polysaccharide (PG-PS) complexes isolated from group A streptococci, Escherichia coli lipopolysaccharide (LPS), or synthetic muramyl dipeptide (MDP) . The lipid A region of LPS and the glycan backbone of PG are chemical analogues; MDP is the minimal biologically active subunit of PG . All of these molecules elicited uveitis as observed both clinically and histologically . The MDP elicited an acute inflammation characterized by a heterophil and monocyte infiltrate that subsided within 16 days . The PG-PS and LPS elicited chronic inflammation characterized by mononuclear and lymphocyte infiltration and severe necrosis of the retina.

Am J Med, 1984 Jul, 77(1), 86 - 92
Central nervous system infections associated with hereditary hemorrhagic telangiectasia; Press OW et al.; The clinical courses of 31 episodes of brain abscess and one episode of meningitis occurring in patients with hereditary hemorrhagic telangiectasia are reviewed . Pulmonary arteriovenous malformations were demonstrable in all but two patients and presumably permitted septic microemboli to evade the normal pulmonary capillary filter and lodge in the brain . Obtundation, headache, visual disturbances, hemiplegia, and seizures were the most common presenting features . Cyanosis, clubbing, polycythemia, and hypoxemia were routinely encountered, but leukocytosis and fever were present in a minority of cases, and all blood cultures were sterile . Anaerobic and microaerophilic streptococci were the commonest pathogens found in the brain abscesses . Thirteen patients died, and patients without abscess drainage or with delayed diagnosis had a higher mortality rate . A brain abscess may develop in approximately 1 percent of patients with hereditary hemorrhagic telangiectasia, and awareness of this risk should lead to early investigation of any patient with hereditary hemorrhagic telangiectasia who has neurologic symptoms.

Am J Med, 1984 Jul, 77(1), 151 - 3
Streptococcal lymphadenitis in homosexual men with chronic lymphadenopathy; Ho DD et al.; Lymphadenopathy is an important clinical problem in homosexual men . Over a period of 10 months, three homosexual patients were treated for chronic lymphadenopathy and spontaneous lymphadenitis of the inguinal lymph nodes . All patients presented with fever, chills, and rapidly enlarging inguinal masses . In each case, cultures showed group A beta-hemolytic streptococci . None of the patients had an obvious portal of entry for infection, and all had responses to penicillin and surgical drainage . Streptococcal lymphadenitis should be considered in any homosexual man with chronic lymphadenopathy in whom rapidly enlarging inguinal nodes develop.

Infect Immun, 1984 Jul, 45(1), 160 - 5
Interaction of group A streptococcal peptidoglycan polysaccharide with human polymorphonuclear leukocytes: implications for pathogenesis of chronic inflammation; Leong PA et al.; Injection of sterile aqueous preparations of the peptidoglycan polysaccharide of group A streptococci produces chronic inflammation in several animal models . Accordingly, the effect of peptidoglycan and group A-specific polysaccharide (PG-APS) polymers on human polymorphonuclear neutrophil oxidative metabolism was studied with the supposition that this interaction may contribute to the inflammation observed . PG-APS in concentrations of 1.0 to 100 micrograms/ml stimulated oxygen consumption and hexose monophosphate shunt activity in the presence of 10% normal serum in a dose-related manner . Stimulation did not occur in serum-free media and was reduced in media with heat-treated serum . The stimulation of hexose monophosphate shunt activity by PG-APS opsonized with normal serum (bound complement components) and the activated supernatant from which PG-APS had been removed by centrifugation (presumably containing the soluble complement component, C5a) demonstrated 79 and 75%, respectively, of the stimulation with PG-APS in the presence of 10% normal serum . PG-APS triggered release of O2- (3.4 +/- 2.0 nmol by 10(6) human polymorphonuclear neutrophils over 30 min), which was significantly enhanced (9.6 +/- 2.9 nmol O2-) by treatment of cells with cytochalasin B . These results show that PG-APS interacts with serum in such a fashion as to activate human polymorphonuclear neutrophil metabolism and increase secretion of O2-.

Infect Immun, 1984 Jul, 45(1), 13 - 7
Disseminated tetracycline resistance in oral streptococci: implication of a conjugative transposon; Hartley DL et al.; A DNA sequence specifying tetracycline resistance (Tcr) has been previously cloned from a clinical isolate of Streptococcus mutans designated U202 (J . A . Tobian and F . L . Macrina, J . Bacteriol . 152:215-222, 1982) . We used this sequence as a molecular probe in studying the dissemination of Tcr among oral streptococcal species isolated from patients treated with tetracycline . Eleven strains (including S . sanguis I, S . sanguis II, S . mitis, and S . salivarius) from seven patients were examined by Southern blot analysis . Seven strains showed strong hybridization to the Tcr probe, two showed weak hybridization, and two did not display detectable hybridization . Based on previous characterization of the cloned sequence, our data suggest the dissemination of the tetM class of resistance determinants among these oral streptococci . One of the clinical S . sanguis I isolates studied was able to transfer its Tcr phenotype to other oral streptococci and to enteric streptococci in the absence of plasmid DNA . This transfer appeared to be conjugation-like on the basis of its insensitivity to DNase and its dependence on intimate cell-to-cell contact . Using the cloned Tcr sequence, we were able to study the progeny of the matings . Our data suggest that this resistance transfer element occupies a chromosomal location in streptococcal cells and that it strongly resembles the conjugative transposon Tn916 in its behavior.

Aust N Z J Surg, 1984 Jun, 54(3), 253 - 5
Antimicrobial management of intracranial abscess; Gillet GR et al.; Forty-four patients were treated over eight years with intracranial abscess . The bacterial flora of these abscesses was determined in 34 cases and 92 organisms of 54 different species were isolated . Presentation and treatment details were standard and are not covered in depth . The most common organisms isolated were aerobic streptococci and Bacteroides species . All organisms isolated were sensitive to chloramphenicol . An empirical regime of penicillin and chloramphenicol proved satisfactory in all cases after culture . The drug of choice could usually be selected from penicillin, chloramphenicol, or metronidazole . Antibiotics were usually continued for 6-8 weeks following diagnosis.

J Antimicrob Chemother, 1984 Jun, 13 Suppl C, 49 - 55
Rifampicin-containing antibiotic combinations in the treatment of difficult infections; Gruneberg RN et al.; Combination of rifampicin with trimethoprim, erythromycin, tetracycline or fusidic acid have some desirable features in the treatment of difficult infections . They are active against a very wide range of possible pathogens . Resistance to rifampicin is rare . Such combinations may be bactericidal and may be usefully synergistic . They may prevent or delay the emergence of bacterial resistant seen when some single agents are used . They can be used in patients with penicillin hypersensitivity . A series of life-threatening infections has been treated with rifampicin-containing combinations . The infections included endocarditis, meningitis, pneumonia, Legionnaire's disease, and head and neck sepsis . A major reason for the choice of drug was often penicillin hypersensitivity . A second reason was the presumption (mostly subsequently confirmed) that streptococci and/or staphylococci were implicated . The clinical outcome of these infections was generally satisfactory, with few side effects and little evidence of the emergence of antibiotic resistance.

J Antimicrob Chemother, 1984 Jun, 13(6), 629 - 32
The effect of probenecid on serum amoxycillin concentrations up to 18 hours after a single 3 g oral dose of amoxycillin: possible implications for preventing endocarditis; Shanson DC et al.; Serum concentrations of amoxycillin were significantly higher with probenecid than without probenecid for up to 18 h after administration of a single 3 g oral dose of amoxycillin . At 12 to 16 h after this dose the mean serum amoxycillin concentrations exceeded the expected minimum bactericidal concentrations of amoxycillin for viridans streptococci when probenecid was given together with amoxycillin . The concurrent oral administration of probenecid with amoxycillin is discussed for the prophylaxis of endocarditis in susceptible patients who require dental procedures under general anaesthesia.

Infect Immun, 1984 Jun, 44(3), 660 - 4
Reaction of human colostral and early milk antibodies with oral streptococci; Eggert FM et al.; Colostrum or early breast milk or both from each of 16 healthy women contained agglutinating antibodies for all normal streptococcal inhabitants of the human oral cavity (S . mutans, S . sanguis, S . mitis, and S . salivarius), including those which colonize the neonatal oral cavity in significant numbers . Agglutination correlated with the amount of immunoglobulin A (IgA) binding to bacterial surfaces as measured by mixed reverse passive antiglobulin hemagglutination . Surprisingly, colostral IgA agglutinated our control organism, Brucella abortus . Low levels of colostral or milk IgM and IgG antibodies also reacted with all of the test bacteria . Absorption studies with an enzyme-linked immunosorbent assay showed that a proportion of antibodies in colostrum and early milk is specific for each of the different oral streptococci . Fractionation on Sepharose 4B indicated that 11S secretory IgA is the predominant form of colostral and milk antibody for all of the test bacteria, including B . abortus . No evidence was found that reactions other than antigen-antibody reactions resulted in binding of colostral immunoglobulins by any of the test bacteria.

J Clin Microbiol, 1984 Jun, 19(6), 884 - 7
Production of bacteriocin-like inhibitors by group A streptococci of nephritogenic M types; Tagg JR; Application of a bacteriocin-typing scheme that had been designed to minimize the inhibitory effects of hydrogen peroxide and acidic metabolites demonstrated a high incidence (72%) of bacteriocin-like inhibitors belonging to 5 different production (P) types in 61 strains of group A streptococci isolated in association with the development of acute glomerulonephritis . By contrast, only 4 of 16 (25%) rheumatic fever-associated strains were inhibitor positive, and 3 of these strains were P type 604, a P type not detected in any of the nephritis isolates . The P type designation was found to be identical for all inhibitor-positive strains within each particular M serotype, regardless of whether the source was a nephritis patient or an individual having an uncomplicated streptococcal infection . The incidence of inhibitor-positive strains was particularly high in strains of M types 2, 4, 12, 25, 57, and 60; it was moderately high in M types 49, 52, and 55 and absent in M1 and M3 . Although the results indicate that the bacteriocin-like inhibitors detected in this study are probably unlikely to have a direct pathogenetic role in either rheumatic fever or acute glomerulonephritis, it does seem that the present P-typing scheme is a useful epidemiological tool, particularly for the presumptive identification of and differentiation among group A streptococcus strains of nephritogenic serotypes.

Eur J Pediatr, 1984 Jun, 142(2), 86 - 8
Correlation between serum antibody-levels against group B streptococci and gestational age in newborns; Christensen KK et al.; Sera from 33 newborn infants with gestational ages ranging from 27 to 41 weeks were tested by radioimmunoassay for IgG antibodies to surface antigens of group B streptococci (GBS) types Ia, Ib, II and III . Antibody levels to GBS antigens were positively correlated to gestational age and birthweight . However, only the correlations for anti-Ia and anti-II antibody levels reached statistical significance . Mean antibody concentrations in infants below 34 weeks of gestation were significantly lower for type Ia (P less than 0.001), type II (P less than 0.001) and type III (P = 0.05) than in infants above this limit . These findings might explain the higher rate of serious GBS-infections found among prematures as compared to full-term infants.

Appl Environ Microbiol, 1984 Jun, 47(6), 1348 - 51
Detection of streptococcal mutants presumed to be defective in sugar catabolism; Feary TW et al.; The tetrazolium method for detection of bacterial mutants defective in sugar catabolism was modified for use with streptococci . The critical factors were (i) the concentration of tetrazolium, which must be titrated to determine the optimum concentration for each species or even strain, and (ii) anaerobic incubation of tetrazolium-containing agar plates . When used with standard mutagenesis protocols, this method yielded lactose-negative mutants of nine streptococcal strains representing six species . A collection of lactose-negative mutants of streptococcus, sanguis Challis was characterized and contained phospho-beta-galactosidase, lactose phosphotransferase, and general phosphotransferase mutants.

Infect Control, 1984 Jun, 5(6), 275 - 8
Influence of ethanol with and without chlorhexidine on the bacterial colonization of the umbilicus of newborn infants; Bygdeman S et al.; The effect of daily treatments with 70% ethanol and with 0.5% chlorhexidine in 70% ethanol, respectively, on navel colonization in newborns has been studied in 624 infants in two maternity wards during a four-month period . Staphylococcus aureus, group B and G streptococci, E . coli and anaerobes were significantly less often isolated from newborns whose umbilical cord was treated with chlorhexidine in ethanol than from those treated with ethanol only . Staphylococcus epidermidis and enterococci, on the other hand, were significantly more often isolated from the chlorhexidine-ethanol than from the ethanol group . More infants without colonization of the umbilicus on their fourth day of life were found in the chlorhexidine in ethanol than in the ethanol group . The infants in the ethanol group were colonized with significantly more bacterial species than the infants in the other group . Signs of dissemination of group B and group G streptococci between babies were seen more often in the group of infants treated with ethanol than in the one treated with chlorhexidine-ethanol.

J Med Microbiol, 1984 Jun, 17(3), 347 - 51
Colonisation of the upper respiratory tract of mice with group B streptococci type III with reference to the R-protein; Kurl DN et al.; Nine strains of group B streptococci type III, five with R-protein (R+) and four without (R-) were tested for capacity to colonise the upper respiratory tract in mice and to adhere to human buccal cells . In the mouse model, 80-microliter inocula of dilutions of overnight cultures of the strains in Todd Hewitt broth were placed in the external nares under light ether anaesthesia . A pilot experiment demonstrated that it was reasonable to study the throat colonisation 2 and 4 days after inoculation . Groups of 18-20 mice were then given inocula containing 8 X 10(6) cfu/ml of five R+ and four R- strains . At day 4, significantly more mice were colonised with type III, R+ strains (73% of the animals) than with type III, R- strains (44%) (p less than 0.01) . In adherence experiments with human buccal cells, no difference was found between the R+ and R- strains . The results indicated that the higher colonisation rate among R+ strains was mediated by mechanisms other than adherence.

J Fam Pract, 1984 Jun, 18(6), 857 - 63
A five-year experience with throat cultures; Shank JC et al.; This study addresses the usefulness of the throat culture in a family practice residency setting and explores the following questions: (1) Do faculty physicians clinically identify streptococcal pharyngitis better than residents? (2) With time, will residents and faculty physicians improve in their diagnostic accuracy? (3) Should the throat culture be used always, selectively, or never? A total of 3,982 throat cultures were obtained over a five-year study period with 16 percent positive for beta-hemolytic streptococci . The results were compared with the physician's clinical diagnosis of either "nonstreptococcal" (category A) or "streptococcal" (category B) . Within category A, 363 of 3,023 patients had positive cultures (12 percent clinical diagnostic error rate) . Within category B, 665 of 959 patients had negative cultures (69 percent clinical diagnostic error rate) . Faculty were significantly better than residents in diagnosing streptococcal pharyngitis, but not in diagnosing nonstreptococcal sore throats . Neither faculty nor residents improved their diagnostic accuracy over time . Regarding age-specific recommendations, the findings support utilizing a throat culture in all children aged 2 to 15 years with sore throat, but in adults only when the physician suspects streptococcal pharyngitis.

J Exp Med, 1984 Jun 1, 159(6), 1618 - 28
Fibronectin enhances the opsonic and protective activity of monoclonal and polyclonal antibody against group B streptococci; Hill HR et al.; We have investigated the opsonic and protective effects of fibronectin (FN) against type III group B streptococci . When used by itself, the FN failed to promote actual internalization of group B organisms . The addition of FN to group B streptococci that had been preopsonized in an immunoglobulin preparation modified for intravenous use ( IgIV ) or a type-specific, murine monoclonal antibody of IgG isotype markedly enhanced interaction with human polymorphonuclear leukocytes (PMN) . A similar enhanced effect was observed when the FN was combined with type-specific monoclonal antibody preparations of IgM and, surprisingly, IgA isotype . Preincubation experiments indicated that the major effect was upon the PMN rather than directly on the bacteria, but we could not demonstrate an effect of FN on cell surface receptors for the Fc fragment of Ig or C3b using rosetting techniques . In addition to enhancing the in vitro opsonic activity of Ig, the FN significantly increased the protective effect of the polyclonal and monoclonal Ig preparations in an animal model of neonatal group B streptococcal disease . Thus, FN appears to have a critical role in the host defense mechanisms against group B streptococci.

Infect Immun, 1984 Jun, 44(3), 653 - 9
Adherence of oral streptococci: evidence for nonspecific adsorption to saliva-coated hydroxylapatite surfaces; Staat RH et al.; It is proposed that binding of oral streptococci to saliva-coated hydroxylapatite (SHA) surfaces is a multifactorial process involving both specific and nonspecific receptors . In this context, specific binding is described as a high-affinity, saturable interaction between the cell and binding surface . Conversely, nonspecific binding is considered to be a nonsaturable, generalized, low-affinity reaction . Experimental differentiation of specific binding from nonspecific binding was achieved with a competition assay which utilized a large excess of nonradiolabeled bacteria to compete with the 3H-labeled cells for attachment to receptors on 1.5 mg of SHA crystals . Competition assays of Streptococcus sanguis and Streptococcus mitis adhesion clearly demonstrated that the total binding isotherm was composed of a saturable specific binding reaction and a minor nonspecific binding component . This was further substantiated by analysis of nonlinear Scatchard plots of the total binding data . The competition data for Streptococcus mutans binding indicated that ca . 50% of the S . mutans binding appeared to be specific, although saturation of the SHA surfaces with bacterial cells could not be demonstrated . Experiments measuring desorption of radiolabeled cells from SHA crystals into buffer showed that ca . 50% of the bound S . mutans cells were removed after 4 h, whereas less than 5% of the S . sanguis cells were eluted from the SHA surfaces . The kinetics of attachment were studied by using an extract of Persea americana as a noncompetitive inhibitor of adherence . The total cell binding data for these experiments suggested a very rapid binding reaction followed by a slower rate of attachment . It was concluded from these three different experimental approaches that adherence of selected oral streptococci to SHA surfaces involves specific, high-affinity and nonspecific, low-affinity binding reactions . The concept is developed that in vitro streptococcal attachment to SHA can be described as a two-reaction process in which the low-affinity interaction of the cell with the SHA surface precedes the establishment of the stronger, specific bonds needed for the maintenance of streptococci in the oral cavity.

Nippon Geka Gakkai Zasshi, 1984 May, 85(5), 492 - 8
{Surgical treatment of infective endocarditis in childhood--report of 3 cases}; Aoyagi S et al.; This is the case report of 3 surgical patients with infective endocarditis in childhood . Case 1: A 8 year-old boy was admitted with high fever and congestive heart failure . Aureus staphylococci were identified by blood culture . Echocardiogram showed a vegetating mass on the posterior mitral leaflet . This patient was cured by emergency mitral valve replacement during the active phase of infection . Case 2: A 3 year-old girl was admitted with infective endocarditis related to VSD . Viridans streptococci were identified by blood culture . Echocardiogram showed a vegetating mass on the septal tricuspid leaflet . After successful antibiotic therapy, this patient underwent the closure of VSD and tricuspid valvuloplasty . Case 3: A 7 year-old boy was admitted with infective endocarditis related to VSD . Aureus staphylococci were identified with blood culture . Echocardiogram showed a vegetating mass on the anterior tricuspid leaflet and moderate tricuspid regurgitation . After successful antibiotic therapy, this patient underwent the closure of VSD and tricuspid valvuloplasty . We believe that echocardiography plays an important role in the diagnosis and management of infective endocarditis and that tricuspid valvuloplasty is the method of first choice in treatment of the patient with regional tricuspid infective endocarditis.

J Infect, 1984 May, 8(3), 195 - 9
Antimicrobial effect of chlorhexidine and povidone-iodine on vaginal bacteria; Vorherr H et al.; The antimicrobial potency of 4 per cent chlorhexidine gluconate was compared with that of 10 per cent povidone-iodine (1 per cent free iodine) on the vaginal bacteria of 150 premenopausal, non-pregnant women . From 30 of the women blood samples were taken before and at either 15, 30 or 60 minutes after vaginal cleansing with chlorhexidine for chlorhexidine analysis . Five minutes after applying either chlorhexidine or povidone-iodine almost 99 per cent of bacteria present on the lateral wall of the vagina were killed . Chlorhexidine was significantly more effective than povidone-iodine . Serosanguineous , mucoid or white-yellowish vaginal discharge did not alter the effectiveness of either antimicrobial agent . In contrast to povidone-iodine, vaginally applied chlorhexidine was not absorbed in measurable amounts (sensitivity of detection method: 0 X 1 mg/l) into the bloodstream . Chlorhexidine may therefore prove of value for treating vaginitis especially during pregnancy and also for combating microbes such as Group B streptococci which are potentially harmful to the newly-born child.

J Clin Microbiol, 1984 May, 19(5), 649 - 50
Detection of pneumococci in blood cultures by latex agglutination; Browne K et al.; Latex agglutination by use of the Pneumoslide test on clinical blood cultures detected 22 Streptococcus pneumoniae strains as the etiological agents in 47 streptococcal septic episodes . The other 25 isolates were identified as viridans streptococci or streptococci of groups A, B, D, or G . The test demonstrated 100% sensitivity, 92% specificity, and predictive values for positive and negative reactions of 91 and 92%, respectively . Two false-positive reactions were caused by strains of viridans streptococci . The two strains continued to give positive reactions when colonies from blood agar plates were tested according to the instructions of the manufacturer . This latex agglutination test is an effective tool for the rapid diagnosis of pneumococci in blood cultures.

Am J Med Sci, 1984 May-Jun, 287(3), 54 - 8
Endocarditis caused by Streptococcus morbillorum; Coto H et al.; Although patients with nutritionally variant streptococcal endocarditis have been reported in recent years, the specific clinical features of this disease have not been well characterized . We report here the clinical and laboratory features of a particularly unusual case of persistent bacteremia caused by Streptococcus morbillorum , one of the nutritionally variant streptococci . The patient was successfully treated with a combination of penicillin and rifampin after two treatment failures . We also review cases of nutritionally variant streptococcal endocarditis published in the English literature since 1971, in an attempt to understand some difficulties encountered in diagnosing and treating this type of endocarditis.

J Clin Pathol, 1984 May, 37(5), 592 - 5
The bacteriology of infected malignant ulcers; Rotimi VO et al.; Infected ulcerated malignant tumours are often foul smelling and covered with necrotic tissue . We have studied 70 patients with infected ulcers; 30 of the underlying lesions in these patients were carcinoma of the breast, and 19 were a variety of skin cancers . Anaerobes were the predominant organisms isolated from individual ulcers . Of the 179 anaerobes isolated, 37 were Bacteroides asaccharolyticus, 31 each were B melaninogenicus and anaerobic streptococci, 29 B fragilis, and 17 B ureolyticus . Among the facultative organisms Escherichia coli was the commonest and was isolated mainly from patients with carcinoma of the breast . Most infections were mixed, yielding both anaerobes and aerobes and this made interpretation of the role of individual pathogens difficult to assess.

J Dent Res, 1984 May, 63(5), 653 - 7
Factors involved in artificial caries induction by oral streptococci in extracted human teeth; Kaufman HW et al.; This study assesses the abilities of S . mutans GS5 and BHT and S . sanguis G9B to produce subsurface lesions on smooth surfaces of extracted human teeth and examines factors which might be responsible for any differences encountered . Teeth were incubated in Brain Heart Infusion broth containing 2% sucrose and a pure culture of the organism to be tested, the media being changed each day for eight days . Surface and media pH's were measured . The mineral content of both the surface enamel and the subsurface lesions was determined by contact microradiography . Significantly deeper and more demineralized lesions were produced by GS5 than by either BHT or G9B . GS5 also produced a lower surface and medium pH and a more dense coating on the teeth . Similar results were obtained with GS5 and G9B when the BHI broth was replaced with FMC synthetic media . It is concluded that the system described is suitable for studying cariogenic potential and will be useful in measuring the anticariogenicity of suspected therapeutic agents.

J Antibiot (Tokyo), 1984 May, 37(5), 431 - 40
Cepacin A and cepacin B, two new antibiotics produced by Pseudomonas cepacia; Parker WL et al.; Two new acetylenic antibiotics, cepacins A and B, have been isolated from the fermentation broth of Pseudomonas cepacia SC 11,783 and assigned structures 1 and 2 . Cepacin A has good activity against staphylococci (MIC 0.2 micrograms/ml) but weak activity against streptococci (MIC 50 micrograms/ml) and the majority of Gram-negative organisms (MIC values 6.3 approximately greater than 50 micrograms/ml) . Cepacin B has excellent activity against staphylococci (MIC less than 0.05 micrograms/ml) and some Gram-negative organisms (MIC values 0.1 approximately greater than 50 micrograms/ml).

Andrologia, 1984 May-Jun, 16(3), 269 - 75
Microbial flora in semen of asymptomatic infertile men; Busolo F et al.; A microbiological examination has been carried out in 116 patients with unexplained infertility and with asymptomatic bacteriospermia . Organisms more frequently isolated were Staphylococcus epidermidis (81.9%), non hemolytic streptococci (23.3%), diphtheroids (25%) and alpha-hemolytic streptococci (18.1%) . None of the 103 patients were positive for C . trachomatis . Mycoplasmas were isolated in 56 (48.3%) of the 116 examined samples, U . urealyticum was present in 49 (42.2%), M . hominis in 3 (2.6%) and both species in 4 (3.5%) samples of examined fluids . Forty-one of the 56 mycoplasmas-positive patients have been treated with doxycycline therapy . The treatment improved motility and caused decrease of coiled tails in 12 cases . Conception occurred in 5 (26.3%) of the 19 treated patients whose cultures were negative for mycoplasmas . These 5 pregnancies occurred in the patients that had high titers (greater than 10(5) c.c.u./ml) of ureaplasmas and in which the antibiotic therapy was successful . No pregnancy was seen in the other 22 patients where treatment failed to eradicate mycoplasmas.

Vet Med (Praha), 1984 May, 29(5), 263 - 70
{Submicroscopic aspects of the adherence of group B streptococci to vaginal epithelial cells}; Ryc M et al.; The submicroscopic structure of surfaces in the streptococci of group B, type III (strain 13/63) and the ultrastructure of the interaction of this streptococcus strain with human vaginal cells were studied . The surface of the majority of B streptococci was smooth after using the conventional fixing techniques of electron microscopy; however, about 25% of streptococcal cells had an additional layer of filamentous protrusions on their surface . A marked layer of capsular material was visualized by means of the preincubation of this streptococcus strain with a type-specific antiserum . The incubation of B streptococci with vaginal cells without any addition of antibody allowed for the demonstration of the contact of a part of the cells of the bacterial population with the epithelial cells through filamentous protrusions . However, the majority of the smooth-surface cells was separated from vaginal cells by a gap wide up to 150 nm . It was demonstrated by additional incubation with type-specific antiserum that the above mentioned gap corresponded to the capsular substance of bacteria . Hence the capsule of streptococci in group B is the basic component of their surface responsible for adherence to vaginal cells . Adherence of B streptococci to vaginal epithelia was accompanied neither by bacterium ingestion nor by the destruction of epithelial cells.

J Antimicrob Chemother, 1984 May, 13(5), 505 - 9
Impact of phenoxymethylpenicillin, erythromycin, clindamycin and doxycycline on Streptococcus salivarius in the oropharynx; Heimdahl A et al.; Streptococcus salivarius plays a role in the normal oropharyngeal resistance to colonization with group A streptococci . Suppression of Str . salivarius may increase the risk of colonization . Ten subjects were given phenoxymethylpenicillin, ten were given erythromycin, ten were given clindamycin and ten were given doxycycline for seven days . The numbers of Str . salivarius in the oral cavity were determined before, during and after the administration periods . Phenoxymethylpenicillin and doxycycline only slightly suppressed the numbers of Str . salivarius, while erythromycin and clindamycin markedly decreased the numbers . In four and five subjects respectively, Str . salivarius could no longer be isolated after seven days of the drug administration.

Pediatr Med Chir, 1984 May-Jun, 6(3), 373 - 6
{Frequency of colonization of beta-hemolytic group B streptococci in a sample of 939 pregnant women . Epidemiologic and clinical study}; Ronconi GF et al.; A prospective study of group B Streptococcus colonization in 939 pregnant women from Vicenza and its region, disclosed an overall rate of 9.58% of genital colonization . Only two cases of group B streptococcal infant disease occurred in the study period (0.21%) . No statistically significant difference between culture-positive and culture-negative pregnant women was found in mean age, parity, place of residence, blood group, presence of clinical disease during pregnancy, type of delivery and gestational age, birth weight and presence of any clinical disease over five days from birth of the newborn infants . The Authors make some recommendations based upon the best understanding of the epidemiology of group B streptococci available at this time.

Zentralbl Bakteriol Mikrobiol Hyg {A}, 1984 May, 257(1), 60 - 7
Evaluation of a typing scheme for group A streptococci based upon bacteriocin-like inhibitor production; Tagg JR et al.; A method of typing (P-typing) streptococci according to their production of inhibitory activity against a set of 9 indicator strains has been evaluated . Modifications to a previously described P-typing procedure have been made which improve the reproducibility of the method and also reduce the proportion of untypable strains . The test conditions, particularly medium composition, incubation temperature and aeration were found to be critical determinants of inhibitor production and must be carefully controlled . The use of certain commercial sources of Blood Agar Base and the presence of human blood in the typing medium are requirements for detection of some inhibitors, particularly for P-type 777 strains . The previously "standardized" conditions for P-typing specify incubation of the test strains aerobically at 32 degrees C . However, in order to increase the proportion of typable strains an additional set of cultures should be incubated anaerobically . Anaerobic incubation was found to be essential for the production of bacteriocin-like inhibitors by M-type 49 strains and markedly increased inhibitor production by M-type 4 and M-type 57 strains . Also associated with anaerobic incubation was an increase in the amount of non-specific, acid-mediated inhibition, but this could be eliminated by buffering the typing medium with 0.5% (w/v) calcium carbonate . The epidemiological validity of P-typing was tested in a survey of group A streptococcus carriage in a school and in 9 family groupings . Inhibitor production appeared to be a stable strain marker and the occurrence of some P-type subdivisions within clusters of strains having identical serotype patterns indicates that combined application of serotyping and P-typing may give improved strain discrimination.

Zentralbl Bakteriol Mikrobiol Hyg {A}, 1984 May, 257(1), 27 - 37
Hyaluronidase production by groups A, B, C, and G streptococci: a statistical analysis; Benchetrit LC et al.; Production of hyaluronidase by 147 strains of beta hemolytic streptococci was studied employing a sensitive dye-binding assay and levels of enzyme activity were evaluated statistically . The analysis of variance showed that group A strains isolated in Rio de Janeiro produced significantly smaller amounts of enzyme than group A strains from a Minneapolis (USA) collection or than groups B and G brazilian isolates . The t test revealed that M not typable nose/throat group A strains produced more hyaluronidase than skin isolates . The analysis of variance did not show a significant difference in the enzyme production between M typable and not typable brazilian strains of group A streptococci . High enzyme--producing strains were not restricted to a few serotypes of group B streptococci.

J Clin Microbiol, 1984 May, 19(5), 588 - 91
Evaluation of the rapid strep system for species identification of streptococci; Appelbaum PC et al.; The Rapid Strep system (API System S.A., Montalieu-Vercieu, France) was evaluated, without additional tests, in the identification of 209 streptococci . Organisms included 59 beta-hemolytic, 36 group D, 24 Streptococcus pneumoniae, and 90 viridans group streptococci . The Rapid Strep system correctly identified to species level 69.5% of the beta-hemolytic strains, 100% of the group D strains, none of the S . pneumoniae strains, and 84.5% of the viridans group streptococci . The method provided excellent identification rates of groups A, B, and D but failed to differentiate between groups C and G . The method for preparation of suspensions for the Rapid Strep system, as initially recommended by the manufacturer, was responsible for the failure to identify S . pneumoniae . This method was subsequently modified to yield a heavier inoculum; all 10 pneumococcal strains tested with the revised inoculum method were correctly identified . Good identification rates of commonly encountered viridans strains were found . The Rapid Strep system represents a worthwhile advance in streptococcal species identification, especially for group D and viridans strains.

Ann Otol Rhinol Laryngol, 1984 May-Jun, 93(3 Pt 1), 277 - 8
Epiglottic abscess due to group B Streptococcus . Communication; Ridgeway NA et al.; A group B Streptococcus caused epiglottitis with abscess formation in an adult with diabetes mellitus . Group B streptococci are being more commonly isolated from adults, and epiglottitis is another infection in which this organism has been implicated.

J Clin Pathol, 1984 May, 37(5), 568 - 70
Effect of volume of blood cultured on detection of Streptococcus viridans bacteraemia; Shanson DC et al.; Fifty eight patients undergoing dental extraction each had 45 ml blood collected . This was divided into 30 ml and 15 ml blood samples for culture . The 30 ml sample was inoculated into 120 ml nutrient broth with 0.05% liquoid and the 15 ml sample into 60 ml of identical broth so that the final dilution of blood in broth was always 1/5 . Bacteraemia due to viridans streptococci was found in 27 and 15 patients by culturing the 30 ml and 15 ml blood samples respectively . Only one further case of streptococcal bacteraemia was detected by culture of the total volume of blood collected (45 ml) rather than culture of the 30 ml blood sample alone . These findings suggest that the culture of 30 ml blood results in the detection of up to 80% more blood cultures yielding Streptococcus viridans than the culture of only 15 ml blood . The collection of more than 30 ml blood for each culture is unlikely to prove worthwhile . It is suggested that 30 ml rather than 15 ml blood is probably the optimal volume of blood for each culture of S viridans when patients with suspected infective endocarditis are investigated.

Am J Med, 1984 May, 76(5), 910 - 5
Group B streptococcal arthritis in adults; Laster AJ et al.; Group B beta-hemolytic streptococci (Streptococcus agalactiae) have been a rare cause of septic arthritis in adults . Only 18 cases have been cited in the literature, eight of which were described since 1976 . Two additional cases occurring in the last year are described herein . Like other infections caused by group B streptococci, the incidence of septic arthritis due to these organisms appears to be increasing . A review of these 20 cases revealed a history of prior arthritis or trauma to the involved joints in 30 percent, and an additional 30 percent occurred in potentially immunocompromised hosts . Four of the patients had probable oligoarticular group B streptococcal arthritis . Although most deaths occurred in the pre-penicillin era, early recognition and treatment are essential to prevent joint destruction.

Infect Immun, 1984 May, 44(2), 257 - 61
Class specificity of naturally acquired and vaccine-induced antibody to type III group B streptococcal capsular polysaccharide: determination with a radioimmunoprecipitin assay; Edwards MS et al.; A radioimmunoprecipitin test was developed to determine the immunoglobulin class distribution of naturally acquired and vaccine-induced antibody to the native capsular polysaccharide of type III group B streptococci (III-GBS) . In sera from adults and pregnant women with naturally acquired antibody, the mean percentage of antigen bound by immunoglobulin G (IgG) was 74.9 and 78.6, respectively, whereas antigen bound by IgM comprised less than 10% of the total . In contrast, early-convalescent-phase sera (mean, 16.3 days) from neonates responding to III-GBS infection with an increase in specific antibody had significantly more IgM (mean, 36%; P less than 0.001, unpaired t test) . However, in late convalescence, the immunoglobulin class distribution in sera from these neonates was similar to that of naturally immune adults . Four weeks after immunization with III-GBS polysaccharide vaccine, sera from adults with low (less than 2 micrograms/ml) preimmunization antibody levels in their sera and from those with moderate (mean, 5.5 micrograms/ml) preimmunization levels contained specific antibody predominantly of the IgG class . Although the percentage of IgG-specific antibody was greater in sera from naturally immune adults than in that from vaccinees with a presumed primary immune response, the major portion of antigen bound by sera at 4 weeks postimmunization (62.5%) was associated with IgG . These observations support the opinion that immunization of pregnant women with III-GBS capsular polysaccharide could be efficacious for the prevention of invasive neonatal III-GBS disease.

Infect Immun, 1984 May, 44(2), 228 - 33
Effect of saliva on coaggregation of oral Actinomyces and Streptococcus species; Kolenbrander PE et al.; Human oral actinomyces and streptococci that exhibit specific coaggregation patterns when the cells are suspended in buffer were tested for their ability to coaggregate in saliva . Of 53 paired combinations of actinomyces (Actinomyces viscosus, A . naeslundii, or Actinomyces sp . WVa 963) and streptococci (Streptococcus sanguis or S . morbillorum) that exhibited coaggregation in buffer, all but 4 pairs also coaggregated when suspended in saliva . Twenty-four pairs exhibited lactose-inhibited coaggregation in buffer: 19 of these were identical in saliva . The other five pairs either did not coaggregate or formed coaggregates that were not inhibited by lactose . Highly specific coaggregations known to occur with buffer-suspended cells (e.g., a streptococcal strain that coaggregates with a single strain of actinomyces) were unchanged when cells were suspended in saliva . These results indicate that the coaggregation properties of both oral actinomyces and streptococci are very similar with cells suspended in either saliva or coaggregation buffer . Thus, the potential for coaggregation among bacteria in the oral cavity is evident . The possible mechanisms which mediate coaggregation in saliva are discussed.

Infect Immun, 1984 May, 44(2), 217 - 21
Biosynthetic capacity for type-specific antigen synthesis determines the virulence of serotype III strains of group B streptococci; Yeung MK et al.; The level of type-specific antigen (that covalently associated with the cell wall peptidoglycan and that released extracellularly) synthesized by virulent and avirulent strains of type III group B streptococci was quantitated and compared . Additionally, the effect of the physiological age of the cells and the influence of the exogenous phosphate ion concentration on the level of antigen synthesis by these organisms were also examined . Approximately 4% of the total antigen synthesized by the organism is noncovalently bound to the cell surface, and the difference in level of the noncovalently associated type-specific antigen between virulent and avirulent strains was negligible . In contrast, when the cell-associated covalently bound type antigens were evaluated, virulent strains were demonstrated to have two- to threefold higher levels than those of avirulent strains during the exponential and stationary phases of growth under various growth conditions . Furthermore, virulent strains that had high levels of cell-associated type antigen also secreted more extracellular type antigen than did avirulent strains . Thus, the data were consistent with the hypothesis that an overall production of type-specific antigen correlated with virulence in mice . However, the cell-associated type-specific antigen probably represented a better indicator for virulence potential since the addition of purified extracellular type-specific antigen to a mutant strain that lacks cell surface type antigen did not alter the 50% lethality value of the organism . To account for variation in the level of type-specific antigen produced by these strains, the kinetics of both the group- and type-specific antigens synthesis was investigated at the cell membrane level by utilizing an intact protoplast system.(ABSTRACT TRUNCATED AT 250 WORDS)

J Pediatr, 1984 May, 104(5), 725 - 8
Rapid diagnosis of adenoviral tonsillitis: a prospective clinical study; Ruuskanen O et al.; Adenovirus antigen was detected by radioimmunoassay in the nasopharyngeal specimens of 30 of 74 children with febrile exudative tonsillitis . In the other 44 children, the cause of tonsillitis was identified in 16 (beta-hemolytic streptococci or Epstein-Barr, parainfluenza, or herpes simplex viruses) . The clinical picture of adenoviral tonsillitis was difficult to differentiate from that of streptococcal disease; 20 of the patients had originally been given antibiotics . In 68% of patients without complications, the serum concentration of C-reactive protein was less than 20 mg/L, suggesting a viral disease . No other hematologic test was found helpful in identifying the adenoviral tonsillitis . The rapid detection of adenovirus antigen permitted withdrawal of unnecessary and ineffective antibiotic treatment in most patients.

Pediatr Res, 1984 May, 18(5), 478 - 82
Human IgG antibodies to carbohydrate and protein antigens in mouse protection tests with group B streptococci; Christensen KK et al.; The protective effect of four commercial human gammaglobulin batches (I-IV) in mice was studied using six different strains of group B streptococci (GBS): types Ia; Ib; II, R-protein negative (R-); II, R+; III, R-; and III, R+ . Each mouse received 1.0 ml gammaglobulin and 0.5 ml bacteria, 10(6)-10(8) colony forming units (CFU) . There was a close correlation between antibody levels measured by the use of radiolabeled protein A and the mouse-protective effect of the gamma-globulins . The mouse-protection tests demonstrated that batch I protected against GBS types Ia and III, R- at low concentration (65 mg/kg mouse weight), against type Ib at medium (260 mg/kg) and against type III, R+ at high concentration . Batch IV protected against types Ia and Ib, although the doses were four times higher than those in batch I, but did not protect against type III, R+ . There was no mouse protection by any of the batches against type II . Antibody levels against Ibc and R, protein antigens, were substantially lower in batch IV . Because the results of these mouse-protection studies indicate the importance of such antibodies against protein antigens, batches I-III might be more useful for therapy of neonatal GBS-septicemia.

Med J Aust, 1984 Apr 28, 140(9), 528 - 30
Penicillin in the treatment of skin sores in children; Bower M et al.; Skin infections are a common cause of morbidity in children, particularly in tropical areas . Cultures from such lesions often grow both penicillin-resistant staphylococci and penicillin-sensitive streptococci . In a controlled trial of the treatment of septic skin lesions in 227 paediatric outpatients at Goroka Hospital, sequential analysis of the response to treatment showed that washing plus the intramuscular administration of procaine penicillin was more effective than washing plus placebo (P less than 0.05) after the 25th preference had been decided . When the amount of healing in the two groups was compared, washing plus penicillin was again more effective than washing plus placebo (P less than 0.001; Wilcoxon's rank-sum test) . Because it eradicates beta-haemolytic streptococci, penicillin is a safe and effective agent for the treatment of large, multiple, or badly infected skin sores, even in countries such as Australia and Papua New Guinea in which most staphylococci are resistant to penicillin.

N Z Med J, 1984 Apr 11, 97(753), 226 - 9
Autumn--the season for post-streptococcal acute glomerulonephritis in New Zealand; Meekin GE et al.; Post-streptococcal acute glomerulonephritis, which may follow either streptococcal throat or skin infection, continues to be prevalent among New Zealand school children . Group A streptococci were cultured from 41 patients with acute glomerulonephritis between 1978 and 1983 . The skin was the predominant site of infection (68%) . Streptococci belonging to major pyoderma-associated nephritogenic serotypes 49, 57 and 60 accounted for 19/30 (63%) M-typable isolates . A seasonal peak in hospital admissions was observed during the months April, May and June . From April to July peak rates for streptococcal skin infection also occurred during a one year community study . In this study group A streptococci were recovered from 83% of skin lesions . The predominance of pyoderma-associated nephritogenic serotypes among acute glomerulonephritis patients and their relative absence in uncomplicated skin infection implies an association with acute glomerulonephritis . We believe that streptococcal skin infection may be an important factor in the epidemiology of acute glomerulonephritis in New Zealand.

Mikrobiyol Bul, 1984 Apr, 18(2), 81 - 9
{Importance of classifying beta hemolytic Streptococci and comparison of various tests used for the classification}; Ayhan Z et al.; We grouped hundred beta hemolytic streptococci, isolated from several clinical specimens with precipitation, coagglutination test and biochemical properties . Among the hundred isolates, 64 percent belonged to group A, 19 percent to group B . 3 percent to group C, 2 percent to group D and 12 percent to group G with the precipitation test . The positive correlation between biochemical and precipitation tests was determined to be 91 percent, where as 99 percent of the strains were correctly identified with the coagglutination test . It is important to group Streptococci, from the epidemiological and clinical aspects, with a rapid and reliable method, chosen due to laboratory feasibilities.

Can J Microbiol, 1984 Apr, 30(4), 495 - 502
Structure and properties of the phosphoenolpyruvate: glucose phosphotransferase system of oral streptococci; Vadeboncoeur C; The presence of three distinct enzymes II that catalysed the phosphoenolpyruvate-dependent phosphorylation of glucose, fructose, and mannose was established in membranes of glucose-grown cells of Streptococcus salivarius 25975 and various strains of Streptococcus mutans . The enzyme II mannose phosphorylated mainly mannose, glucose, and 2-deoxyglucose, and the enzyme II glucose phosphorylated glucose, alpha-methylglucoside, and 2-deoxyglucose . The phosphoenolpyruvate-dependent phosphorylation of glucose and alpha-methylglucoside by isolated membrane of wild-type or EII mannose negative mutant cells did not require the presence of any soluble protein other than enzyme I and the phosphocarrier protein HPr . This result suggested that oral streptococci do not possess a soluble factor III glucose . The enzyme II activities varied as a function of the growth sugar but were not coordinately regulated . The variation elicited by specific sugars was not identical for all the strains tested . Nevertheless, in the case of the S . mutans strains, growth at the expense of lactose always caused a significant decrease in the level of enzyme II activities . Finally, experiments conducted with EII mannose negative mutants and also with a pseudorevertant isolated from one of these mutants indicated that the preferential utilization of glucose over lactose by cells growing in mixtures depended on the presence of the EII mannose, but not on glucose-derived metabolites.

J Gen Microbiol, 1984 Apr, 130 ( Pt 4), 809 - 16
The conditioning role of saliva in streptococcal attachment to hydroxyapatite surfaces; Abbott A et al.; The solution properties of saliva and its role in conditioning both the substrate and the bacterial surface have been investigated with regard to the attachment of oral streptococci to hydroxyapatite surfaces . Saliva from eight subjects was used and the attachment of three organisms, Streptococcus mutans strains FA-1 (serotype b) and KPSK2 (serotype c) and S . sanguis T175-1, was studied . An adsorbed salivary layer on a hydroxyapatite surface substantially reduced the affinity of the organisms for the surface . Adsorbed saliva on the bacterial surfaces, however, tended to increase the organisms' affinity for saliva-coated apatite . The source of saliva was important in determining the extent of inhibition of attachment . The data indicated that the negatively charged and hydrophilic nature of salivary conditioning films was important in controlling bacterial adsorption to hydroxyapatite . The results also suggested that hydrophobic salivas could promote binding of the more hydrophobic bacteria known to be early colonizers of the teeth.

Arch Dis Child, 1984 Apr, 59(4), 346 - 50
Latamoxef and the newborn; de Louvois J et al.; Thirty one preterm neonates who had clinical, radiological, or bacteriological evidence of infection and who would normally have received gentamicin and penicillin were treated with latamoxef (Moxalactam) 100 mg/kg/day . All were examined prospectively for clinical improvement and possible side effects . Biochemical and haematological values were monitored and pharmacokinetic variables determined . Thirty babies improved during treatment; latamoxef was effective in eradicating the infecting organisms in 7 of 9, including three babies infected with Lancefield group B streptococci . High serum concentrations of latamoxef were achieved after either intravenous or intramuscular administration and accumulation did not occur . Treatment had no effect on renal or hepatic function nor did it result in increased serum values of non-protein bound bilirubin . Clotting studies, where performed, were normal and no babies had bloody stools . Two disulfiram-like reactions were recorded . Latamoxef proved a safe and efficacious alternative to gentamicin with penicillin in the initial treatment of neonates with clinical evidence of infection.

Am J Clin Pathol, 1984 Apr, 81(4), 482 - 6
Subchorionic fibrin cultures for bacteriologic study of the placenta; Aquino TI et al.; Previous bacteriologic studies of the placenta have been hampered by a high rate of contamination of vaginal flora . In the present study, cultures of the subchorionic fibrin layer of the placenta were compared to conventional swab-cultures of the surface of the fetal membranes for recovery of aerobic and anaerobic bacteria . Parallel cultures of membrane surface and subchorionic fibrin (SCF) were done in the placentas of 33 deliveries suspected clinically of being complicated by infection (CD) . Placentas from 46 uncomplicated deliveries were similarly cultured to serve as controls . SCF cultures were positive in 11 of 33 CD placentas and in only 1 of 46 controls (P less than 0.001) . SCF cultures showed contaminating vaginal flora in 2 of 79 while surface cultures showed vaginal contamination in 16 of 79 (P less than 0.01) . Recovery of pathogens was similar by the two methods: 10 of 33 and 14 of 33 respectively . One hundred ninety-one additional CD placentas were cultured by the SCF technique . Forty-nine of the 224 SCF cultures yielded pathogens with a predominance of group B hemolytic streptococci, anaerobic gram positive cocci and anaerobic gram negative rods (81 total isolates) . Escherichia coli was isolated in 5 cases . Cultures showing exclusively contaminating vaginal flora were obtained from only 3 of the 224 placentas . Subchorionic fibrin cultures combine technical simplicity, low rate of contamination and excellent recovery of pathogens . The bacterial types found by this method are the predominant species that cause endometritis, pelvic infections, and neonatal septicemia . Subchorionic fibrin culture is a useful technique for the bacteriologic diagnosis of infection in the placenta.

J Antimicrob Chemother, 1984 Apr, 13(4), 389 - 92
Antimicrobial tolerance in group C and group G streptococci; Rolston KV et al.; The in-vitro activity of various antimicrobial agents against 61 clinical isolates (35 group G streptococci and 26 group C streptococci) was studied . Penicillin, cephalothin and vancomycin were the most active agents with MIC90 values of 0.03, 0.06 and 0.12 mg/l respectively . Tolerance, defined as an MIC to MBC ratio of 32 or greater, was observed in six isolates (four group G--11.4% and two group C-7.7%) . Two isolates were tolerant to penicillin alone and one each to cephalothin, vancomycin, latamoxef (moxalactam) and cefotaxime . No cross-tolerance was observed . The addition of gentamicin to the beta-lactam agents and of gentamicin or rifampicin to vancomycin resulted in bactericidal activity . None of the combinations were antagonistic . Our results demonstrate that various bactericidal antimicrobial combinations are available for therapy against tolerant organisms.

Appl Environ Microbiol, 1984 Apr, 47(4), 677 - 80
Microscale method for rapid isolation of covalently closed circular plasmid DNA from group N streptococci; Orberg PK et al.; A method for rapid purification of plasmid DNA from lactic streptococci, utilizing microliter quantities of reagents, was developed by combination of a short lysozyme-mutanolysin cell wall digestion with a modification of the Escherichia coli plasmid isolation procedure of McMaster et al . (Anal . Biochem . 109:47-54, 1980) . The preparations obtained were highly enriched for covalently closed circular DNA, and the method was applicable to plasmids of at least 40 megadaltons . Centrifugation in CsCl-ethidium bromide density gradients was not required.

Infect Immun, 1984 Apr, 44(1), 86 - 90
Interbacterial adherence between Actinomyces viscosus and strains of Streptococcus pyogenes, Streptococcus agalactiae, and Pseudomonas aeruginosa; Komiyama K et al.; Interbacterial adherence was sought between strains of Actinomyces viscosus indigenous to the human mouth and strains of Streptococcus pyogenes, Streptococcus agalactiae, and Pseudomonas aeruginosa . Six of nine strains of S . pyogenes, three of five strains of S . agalactiae, and two of four strains of P . aeruginosa were found to coaggregate with each of five strains of A . viscosus tested . Some coaggregation reactions were inhibited by 0.05 M lactose and were dependent upon heat- and protease-sensitive Actinomyces components . Such reactions appear to involve the galactosyl-binding adhesin previously described in type 2 fimbriae on A . viscosus . Other coaggregation reactions were dependent upon heat- and protease-sensitive components of the pathogen . That such pathogen strains possessed an adhesin(s) was further suggested by the observation that they agglutinated human erythrocytes . The ability of coaggregation-positive and -negative strains of S . pyogenes and S . agalactiae to adhere to Actinomyces-coated agarose beads was also studied . Coaggregation-positive streptococcal strains attached in higher numbers to the Actinomyces-coated beads than did strains which were coaggregation negative . Lactose (0.05 M) inhibited the attachment of those streptococcal strains which coaggregated with A . viscosus in a lactose-sensitive manner . The adherence of those streptococcal strains whose coaggregation appeared to depend upon the galactosyl-binding adhesin of A . viscosus was also reduced by components of human saliva . Crude sonic extracts of coaggregation-positive streptococci or of P . aeruginosa were also effective in aggregating Actinomyces cells . The effect of lactose and of salivary components on this extract-induced aggregation of Actinomyces cells generally paralleled that observed in other assays . The apparent prevalence and diversity of adherent reactions between the pathogens studied and indigenous strains of A . viscosus suggest that some may affect host susceptibility to these infectious agents.

Zentralbl Bakteriol Mikrobiol Hyg {A}, 1984 Apr, 256(4), 475 - 8
Phadebact coagglutination test for the rapid identification of pneumococci; Qadri SM et al.; Conventional tests for the presumptive identification of Streptococcus pneumoniae from culturally similar non-pneumococcal alpha hemolytic streptococci include optochin sensitivity, bile solubility and inulin fermentation . These tests require up to 24 h for completion . In this paper we report the evaluation of a simple and rapid coagglutination procedure that requires less than 5 min . Of the 150 clinical isolates of pneumococci that were identified by conventional methods, all were correctly recognized by the Phadebact coagglutination technique within one minute . Forty strains of non-pneumococcal alpha hemolytic streptococci were also tested to determine the specificity of the method . Of these, 32 (80%) did not react in either the typing or control reagents, whereas 8 (20%) showed coagglutination in the control . The Phadebact coagglutination test for the definitive identification of pneumococci is simple, rapid, and easy to perform and interpret.

J Clin Microbiol, 1984 Apr, 19(4), 534 - 7
Streptococcus pyogenes streptolysin O as a cause of false-positive CAMP reactions; Tapsall JW et al.; The synergistic hemolysis of sheep erythrocytes in the CAMP reaction by the sequential action of staphylococcal beta-lysin and the CAMP factor of group B streptococci is the only known function of this extracellular product of group B streptococci . The reaction forms the basis of the CAMP test used to identify group B streptococci because the CAMP factor is believed to be restricted to this group of organisms . However, on occasion other streptococci, notably group A streptococci, may produce a similar synergistic lysis of sheep erythrocytes . The nature of the synergistic lytic factor of group A streptococci responsible for this sequential hemolysis was investigated in a tube CAMP reaction system . The properties of this synergistic lytic factor were found to correspond to those of streptolysin O of group A streptococci . The synergistic lytic factor, like streptolysin O, was produced during the logarithmic phase of growth; the activity was increased by reducing agents and greatly decreased or abolished by heat, trypsin, cholesterol, and anti-streptolysin O, and it was immunogenic in rabbits . This would suggest that the synergistic hemolysis seen in the CAMP reaction system with group A streptococci is due to the action of those small amounts of streptolysin O which remain unoxidized and thus have a capacity to lyse the fragile beta-lysin-treated sheep erythrocytes.

Diagn Microbiol Infect Dis, 1984 Apr, 2(2), 113 - 8
Clinical evaluation of the improved streptex method for grouping streptococci; Bixler-Forell E et al.; The improved Streptex method for serogrouping streptococci incorporates a new extraction enzyme and a simplified procedure requiring no centrifugation . A total of 114 clinical isolates of beta-hemolytic streptococci were serogrouped from primary plates, isolation plates, and Todd-Hewitt broth cultures using this system . Results were compared to those of the heat extraction Lancefield precipitin method . An additional 33 stock culture isolates of related streptococcal species and 5 strains of Listeria were serogrouped to assess the specificity of the test . Agreement between the two methods was 82.5% with primary plates and 96.5% with both isolation plates and broth cultures . Four isolates from three different serogroups were nongroupable by the Lancefield method, but did agglutinate in specific Streptex antisera; therefore, the enzyme extraction procedure appeared more sensitive than the heat extraction method . Streptex accurately grouped five isolates of gamma-hemolytic group B streptococci, but failed to detect antigen in 33% of the group D streptococcal extracts tested . In addition, cross-reactions were observed with strains of alpha-hemolytic streptococci . Streptex produced fewer ambiguous results and required fewer repeat tests . When used with isolation plates or broth cultures, Streptex is both sensitive and specific for the grouping of beta-hemolytic streptococci of groups A, B, C, F, and G.

J Exp Med, 1984 Apr 1, 159(4), 1201 - 12
Common protective antigens of group A streptococcal M proteins masked by fibrinogen; Whitnack E et al.; The influence of fibrinogen on the opsonization of Group A streptococci by type-specific and cross-reactive anti-M protein antisera was investigated . As previously reported for type 24 streptococci, fibrinogen inhibited the complement-mediated opsonization of types 5, 6, and 19 organisms . Rabbit antisera against large peptide fragments of purified homologous M proteins (pep M proteins) overcame the anti-opsonic effect of fibrinogen in a dose-dependent manner . In the presence of optimal amounts of antibody, bacterial uptake by PMN was equal in serum and plasma, and greater than could be obtained in serum in the absence of antibody . Polyclonal anti-pep M sera contained antibodies directed against fibrinogen-binding as well as fibrinogen-nonbinding sites or regions of the M protein molecule . Three cross-reactive anti-pep M sera included antibodies directed against fibrinogen binding sites or regions of the cross-reacting M proteins . In the two sera studied in detail, these antibodies accounted for a large part of the cross-reacting anti-M antibody present in the sera . We suggest that fibrinogen binding sites on different serotypes of M protein may be structurally and therefore antigenically similar . Conservation of fibrinogen binding sites on M proteins may be related to their protective anti-opsonic function.

J Exp Med, 1984 Apr 1, 159(4), 1083 - 95
Streptococcal M6 protein expressed in Escherichia coli . Localization, purification, and comparison with streptococcal-derived M protein; Fischetti VA et al.; Type 6 streptococcal M protein produced by E . coli bearing plasmid pJRS42.13 (ColiM6) accumulates in the periplasmic space of this new host . No immunoreactive M protein was found either on the surface of the organism or in the culture medium . The ColiM6 protein was purified from the periplasm and the final preparation consisted of three protein bands of apparent molecular weight 55,000, 57,000, and 59,000 . These three bands were identical in migration in SDS PAGE to that of the M protein present in freshly prepared crude periplasm . The amino acid composition of the ColiM6 protein was nearly identical to that of M protein isolated from streptococci with phage lysin (LysM6) . Furthermore, except for the amino terminal residue of the LysM6 molecule, the amino terminal sequence of the ColiM6 molecule was identical to those of both LysM6 and M protein released from the streptococcus by limited peptic digestion (PepM6) . These results reveal that the molecule produced in the E . coli and transported into the periplasm may be the complete M protein as it exists on the streptococcus . The results also indicate that the systems that process M protein for transport through the cytoplasmic membrane are similar in the streptococcus and E . coli . The purified ColiM6 protein was able to remove opsonic antibodies from both human and rabbit serum, as well as to stimulate the production of opsonic antibodies in rabbits, indicating that the immunodeterminants on this molecule are the same as those found on streptococcal-derived M molecules.

J Adolesc Health Care, 1984 Apr, 5(2), 96 - 100
Incidence of beta hemolytic streptococcal pharyngitis in adolescent with infectious mononucleosis; Collins M et al.; Reports on the incidence of beta-hemolytic group A streptococci (BHGAS) in the pharynx of patients with infectious mononucleosis (IM) have varied from 3% to 33% . To ascertain the rate of infection, we prospectively performed serial throat cultures and determined anti-streptococcal antibody titers on 45 students with confirmed IM by Epstein-Barr virus-specific serology . One hundred healthy control students had throat cultures for comparison . The rate of recovery of BHGAS was similar in patients with IM (4%) and controls (3%) . No students with IM had a fourfold rise of anti-streptococcal antibodies . We conclude that routine culture for BHGAS and/or treatment with antibiotic agents is not indicated in all patients with IM.

Clin Pediatr (Phila), 1984 Apr, 23(4), 224 - 7
Use of an anaerobic culture jar in processing pediatric throat cultures; Hayden GF et al.; Two hundred consecutive throat cultures from a Pediatric Walk-in Clinic were processed, using both aerobic and anaerobic culture techniques . The 35 aerobic isolates of group A beta-hemolytic streptococci (BHS) were all confirmed anaerobically as well, and there were two additional isolates detected only by the anaerobic technique . Of these 37 bacitracin-sensitive isolates, only 24 (65%) could be identified at 24 hours using the aerobic technique, compared to 29 (78%) using the anaerobic technique . In contrast to this relatively small effect upon the isolation of group A BHS, the yield of BHS from groups B, C, F, and G was more than doubled by the anaerobic technique . The confusion engendered by the improved detection of these bacitracin-resistant BHS using the anaerobic technique offset the small advantage in thoroughness and speed of detection of group A organisms . On this account, until more is known about the possible significance of isolating nongroup A BHS in the pharynx, the advisability of using an anaerobic culture jar to process pediatric throat cultures remains uncertain.

J Infect Dis, 1984 Apr, 149(4), 511 - 7
Correlation between opsonic activity for various microorganisms and composition of gammaglobulin preparations for intravenous use; van Furth R et al.; In this study 12 commercial immunoglobulin preparations for intravenous administration were investigated with respect to their opsonic activity for various strains of Staphylococcus aureus, Escherichia coli, Streptococcus pyogenes, and group B streptococci, and in addition, the concentration of unsplit IgG molecules, IgG fragments, and IgG aggregates (dimers) was determined . The results show that four preparations that had been treated with enzyme or by reduction and alkylation had hardly any opsonic activity; the other preparations were as effective as inactivated serum . A statistical analysis showed an excellent correlation between the concentration of intact IgG molecules in a preparation and the opsonic activity for the various bacteria; a negative correlation between the concentration of IgG fragments and the opsonic activity was found . The combination of the two techniques used in this study provides a basis for recommendations on the choice of gammaglobulin preparations for clinical use.

J Clin Microbiol, 1984 Apr, 19(4), 506 - 10
Group B streptococcal Ibc protein antigen: distribution of two determinants in wild-type strains of common serotypes; Johnson DR et al.; Studies were carried out on the distribution of the Ibc protein antigenic marker in wild-type strains of group B streptococci of diverse serotypes isolated from epidemiological studies . Rabbits were immunized with group B streptococcal strain H36B, a prototype Ib strain, to produce antibody to the Ibc protein antigens . One antiserum (no . 970) contained antibody only against the trypsin-sensitive (TS) portion of the Ibc antigen . A second antiserum (no . 973), however, contained antibody to both the TS and the trypsin-resistant (TR) determinants or components of the antigen . A total of 785 wild-type strains of group B streptococci were serotyped by using antiserum 973 as well as antisera to the polysaccharide types Ia, Ib, II, III, and IV . Remarkably, 59% of all the strains tested (462 of 785) reacted positively with the Ibc antiserum, although not all carried both components of the Ibc antigen . Of the 99 Ib strains examined, 84% carried both TS and TR components . In contrast, 96% of the 202 Ic strains carried only the TR component of the Ibc antigen . Antiserum 970 failed to identify these strains . Routine typing with an antiserum which contains antibodies to only one portion of the Ibc antigen could result in significant serotype misidentification . Differentiation of group B streptococcal strains by the presence or absence of individual TS or TR components of the Ibc antigen could prove to be a useful additional epidemiological and serological marker . It is noteworthy that wild-type Ic strains carry, ordinarily, only the TR component, in contrast to the prototype Ic strain, which possesses the complete Ibc protein antigen . The possible contribution of the Ibc antigen to group B streptococcal virulence is of interest and requires further study.

Br J Exp Pathol, 1984 Apr, 65(2), 257 - 65
Role of granulocytes in the induction of an experimental endocarditis with a dextran-producing Streptococcus sanguis and its dextran-negative mutant; Meddens MJ et al.; The role of granulocytes in the induction of endocarditis with a dextran-producing Streptococcus sanguis and a dextran-negative mutant of this strain was studied . The number of colony-forming units of Streptococcus sanguis needed to colonize the vegetations in 50% of the rabbits (ID50) was significantly lower for the parent strain than for the dextran-negative mutant . However, in granulocytopenic rabbits the ID50s of both strains did not differ measurably . Dextran-negative streptococci were more readily cleared from the circulation than dextran-positive, but in this respect no difference was found between control and granulocytopenic rabbits, which indicates that clearance cannot account for the difference in ID50 between the two strains in the control group . At serum concentrations of 5% and lower, in-vitro granulocytes phagocytosed the dextran-negative streptococci more rapidly than the dextran-positive . The intracellular killing of the streptococci was no influenced by dextran production . This study suggests that an impaired phagocytic removal of attached bacteria from the vegetational surface can be a factor promoting the induction of endocarditis by dextran-producing streptococci.

Vet Rec, 1984 Mar 31, 114(13), 318 - 20
Microflora and somatic cell content of goat milk; Hunter AC; The results of tests to determine the microflora and somatic cell content of 483 milk samples from 250 dairy goats in the North of Scotland are presented . Milk from uninfected udders had extremely low levels of bacterial contamination, 80 per cent of such samples having less than 100 bacteria/ml . One quarter of all samples were infected, the organisms isolated being coagulase negative staphylococci (83.5 per cent), coagulase positive staphylococci (12.4 per cent) streptococci (3.3 per cent) and Escherichia coli (0.8 per cent) . Streptococcus agalactiae was not detected . Somatic cell count levels were higher than those usually found in cows' milk: 33 per cent more than 2,000,000/ml; 22 per cent between 1,000,000 and 2,000,000/ml; 25 per cent between 500,000 and 1,000,000/ml; 22 per cent less than 500,000/ml . The levels of cell counts were similar for uninfected halves and halves infected with coagulase negative staphylococci . Halves infected with coagulase positive staphylococci had much higher cell counts, eg, 73 per cent in excess of 2,000,000/ml . The interpretation of tests based on somatic cell content as indicators of mastitis in goats is discussed.

Am J Med, 1984 Mar 30, 76(3A), 117 - 23
Intravenous immunoglobulin in neonatal group B streptococcal disease . Pharmacokinetic and safety studies in monkeys and humans; Fischer GW et al.; Numerous studies have suggested that opsonic antibody is important in neonatal immunity to group B streptococci . Immunoglobulin G is primarily transferred from the mother to the fetus across the placenta in the last few weeks of pregnancy . Premature babies may, therefore, not acquire sufficient opsonic antibody to protect them from infection with group B streptococci . Although maternal immunization may provide adequate maternal opsonic antibody, premature infants with antibody deficiency may remain susceptible to infection . Intravenous immunoglobulin administered to term pregnant rhesus monkeys did not provide reliable levels of serum opsonic activity to group B streptococci in their offspring . Pharmacokinetic and safety studies were also performed in human neonates . Significant elevations in group B streptococcal-specific IgG did occur in human neonates given 500 mg/kg intravenous immunoglobulin and the infusions appeared safe and well tolerated . The availability of intravenous immunoglobulin with functional activity against group B streptococci may provide a rapid and effective method of delivering opsonic antibody to neonates.

Am J Med, 1984 Mar 30, 76(3A), 7 - 18
Immunoglobulin G (IgG) subclasses and human disease; Oxelius VA; The isotypes of IgG, IgG1, IgG2, IgG3, and IgG4 were determined in immunoglobulin preparations and the effect on serum levels of treated patients . Serum IgG subclass deficiencies were recorded in different patient groups: (1) IgG2-IgG4 deficiency was associated with IgA deficiency . (2) IgG2-IgG4 deficiency was found in patients with ataxia telangiectasia . (3) Low IgG2 levels were recorded in patients with SLE; one of these patients with recurrent pericarditis was treated with immunoglobulin with good results . (4) Low IgG2 and/or low IgG3 levels were found in patients with juvenile diabetes mellitus . (5) Mothers giving birth to severely group B streptococci infected infants showed low levels of IgG subclasses indicating that the newborns were IgG subclass deficient at birth . (6) In a prospective study of children with recurrent otitis media aged 12 and 32 months the IgG2 levels were significantly reduced in the group with considerably high otitis proneness . In patients with IgG2-IgG4 deficiency, absence of antibodies to polysaccharide antigen teichoic acid and the protein antigen alpha-toxin of staphylococci was demonstrated . Imbalanced IgG subclass pattern with increased IgG4 was recorded in patients with different diseases such as atopic diseases and also in combination with increased IgE, Henoch-Schonlein vasculitis, idiopathic pulmonary hemosiderosis, chronic mucocutaneous candidiasis, and in patients with Trichuris trichiura infection.

J Biol Chem, 1984 Mar 25, 259(6), 3686 - 93
The complete amino acid sequence of a biologically active 197-residue fragment of M protein isolated from type 5 group A streptococci; Manjula BN et al.; The complete amino acid sequence of a peptic fragment (Pep M5) of the group A streptococcal type 5 M protein, the antiphagocytic cell surface molecule of the bacteria, is described . This fragment, comprising nearly half of the native M molecule, is biologically active in that it has the ability to interact with opsonic antibodies as well as to evoke such an antibody response in rabbits . The sequence of Pep M5 was determined by automated Edman degradations of the uncleaved molecule and its enzymatically derived peptides . The primary peptides for Edman degradation were the arginine peptides obtained by tryptic digestion . The tryptic cleavage of Pep M5 was limited to the arginyl peptide bonds by derivatizing the epsilon-amino groups of lysine residues by reductive dihydroxypropylation . The overlapping peptides were generated by digestion of the unmodified Pep M5 with chymotrypsin, V8 protease, and subtilisin . The sequence thus established for the Pep M5 molecule consists of a total of 197 residues (Mr = 22,705) . The Pep M5 protein contains some identical, or nearly so, repeating sequences: four 7-residue segments and two 10-residue segments . However, extensive sequence repeats of the kind previously reported within the partial sequence of another M protein serotype, namely Pep M24, were absent . The Pep M5 sequence is distinct from, but exhibits some homology with, the partial sequences of two other M protein serotypes, namely, Pep M6 and Pep M24 . Furthermore, the 7-residue periodicity of the nonpolar and charged residues, an alpha-helical coiled-coil structural characteristic that was previously observed within the partial sequences of M proteins, was found to extend over a significant part of the Pep M5 sequence . The implication of these results to the function and immunological diversity in M proteins is discussed.

J Biol Chem, 1984 Mar 25, 259(6), 3734 - 8
Binding of Streptococcus pyogenes to laminin; Switalski LM et al.; Some strains of Streptococcus pyogenes isolated from infected human tissues were shown to bind laminin, a major component of basement membranes . Binding of 125I-laminin to bacteria was time dependent and functionally irreversible . Of several unlabeled proteins tested in competition experiments, laminin and fibrinogen inhibited binding of the radiolabeled protein . The inhibitory effect exerted by fibrinogen was apparently not caused by a binding to the laminin receptors . The number of receptors available for laminin on cells of the strain examined ranged from 0 to 10(3) depending on the media used to grow the bacteria and an apparent KD of 4 X 10(-8)M was calculated for the reaction . Bacterial cells incubated with proteolytic enzymes lose the ability to bind laminin, and a trypsin digest contained active receptors capable of competing with intact cells for 125I-laminin . Active receptors may be adsorbed on a column of laminin-Sepharose but not on Sepharose gels substituted with fibrinogen or fibronectin . After radiolabeling the proteins in the trypsin digest a laminin-binding 125I-labeled protein (Mr greater than 10(6} was isolated by affinity chromatography from a receptor positive strain . Similar components could not be isolated from a strain apparently lacking laminin receptors . Therefore, this protein was tentatively identified as a laminin receptor of streptococci.

Vet Pathol, 1984 Mar, 21(2), 152 - 7
Lesions of porcine necrotic ear syndrome; Richardson JA et al.; Porcine necrotic ear syndrome is a disease of swine characterized by large erosive lesions at the margin of the pinna(e) . The gross and microscopic characteristics of the lesions were studied in 38 pigs selected from eight affected swine herds . The progression of the lesions was examined in a herd of 174 weaned pigs in a total confinement nursery . The lesions began as a superficial vesicular dermatitis associated with superficial auricular trauma and progressed to become exudative and encrusted . Localized lesions slowly healed or sporadically progressed to deep necrotic ulcers . The early lesions resembled the epidermal changes produced by Staphylococcus hyicus . Deep ulceration and necrosis was attributed to the invasion of streptococci into the dermis resulting in cellulitis, vasculitis, thrombosis, ischemia, and necrosis.

J Gen Microbiol, 1984 Mar, 130 ( Pt 3), 657 - 64
Comparative studies on surface hydrophobicity of streptococcal strains of groups A, B, C, D and G; Wadstrom T et al.; Cell surface hydrophobicity of group A, B, C, D and G streptococcal strains has been studied and compared in a new test based on the fact that the degree of bacterial aggregation in ammonium sulphate depends on amphiphilic surface antigens . M-positive group A strains showing good growth in normal human blood aggregated in the standard salt aggregation test at very low concentrations of ammonium sulphate, while M-negative strains, which were killed in normal human blood, usually aggregated at high salt concentrations . Agents such as 2 M-KSCN, 2 M-guanidine . HC1 or 2 M-urea decreased the aggregation of the M-positive strains in the salt aggregation test while non ionic detergents such as Tween 20 (1%, w/v) and ethylene glycol (2 M) did not affect cell aggregation . Binding of fibrinogen and albumin resulted in a decrease of surface hydrophobicity of the group A M-positive strains . Group B strains possess a hydrophilic surface character and did not aggregate, while group C and G strains behaved in the salt aggregation test like M-negative strains of group A streptococci . Group D strains did not aggregate even at high ammonium salt concentrations . The results are discussed in relation to the influence of lipoteichoic acid and other surface antigens on strains of the various groups, and it is suggested that M protein and possibly also other surface proteins contribute to the high surface hydrophobicity of group A strains.

Int J Pediatr Otorhinolaryngol, 1984 Mar, 7(1), 51 - 61
Concentrations of cloxacillin and erythromycin in the tonsils of children after administration of therapeutic doses; Brzezinska H et al.; The treatment of infections in the ring of Waldeyer in children is an ever present problem . Most infections are caused by group A streptococci, and various antibiotics are routinely used for their treatment . In many cases, however, this treatment is ineffective as demonstrated by prolonged disease duration and recurrences . This may be due to the resistance of the pathogens to the used antibiotic, too low dose, or inadequate penetration of the drug into the focus of infection . To explain this problem the reported investigation was undertaken carrying out bacteriological investigations of the removed tonsils and determining antibiotic concentrations in tonsil homogenates and in the serum after cloxacillin and erythromycin treatment of 45 children aged 4-14 years subjected to tonsillectomy or adenotomy . It was found that the most frequent aetiological factors in angina and adenoiditis were group A streptococci . Cloxacillin and erythromycin are the antibiotics penetrating well into the lymphoid tissue and reaching high concentrations in the focus of infection but the courses of treatment should not be shorter than 10 days.

Can J Microbiol, 1984 Mar, 30(3), 406 - 11
Nutritional factors affecting the synthesis of an antiphagocytic factor by group E streptococci; Wessman GE; Effects of components of the cultural medium on formation of a group E streptococcal antiphagocytic factor (APF), as detected by an indirect bactericidal test, were studied . Bovine serum albumin (BSA) replaced serum in promoting synthesis of APF in a chemically defined medium (CDM), Todd--Hewitt broth (THB), or tryptose phosphate broth ( TPB ) . Stimulatory factors in BSA were not retained by diafiltration membranes of nominal molecular weight cutoff limits of 10 000 or greater . Citrate, lactate, pyruvate, or oleate, often found in BSA, could not replace BSA in stimulating synthesis of APF . Cells cultured in THB were more resistant to phagocytosis by porcine leukocytes than those grown in CDM or TPB , and the addition of varying amounts of THB to CDM stimulated a measurable response in synthesis of APF . Specific substrates caused different rates of APF synthesis; in decreasing order of effectiveness were glucose or mannose, sucrose, fructose, and trehalose . Proteolytic activity, which might cause the production of phagocyte-sensitive cells by destroying APF activity during culture, was not detectable in significant amounts in subcultures of the age employed in bactericidal tests.

J Clin Microbiol, 1984 Mar, 19(3), 432 - 3
Early detection of streptococci in swabs by latex agglutination before culture; Petts DN; A commercial streptococcal grouping system was used to demonstrate streptococcal antigen in swabs before culture . The method detected 81% of the streptococci of groups A, B, C, and G subsequently isolated in culture . The method offers a sensitive and specific method for the early detection of beta-hemolytic streptococci.

J Infect, 1984 Mar, 8(2), 173 - 6
Group G streptococcal septicaemia: report of six cases; Dickie AS et al.; The increased isolation of Group G streptococci from blood cultures in our laboratory is reported and the association between Group G streptococcal septicaemia and underlying malignancy is confirmed.

J Dent Res, 1984 Mar, 63(3), 389 - 92
A conceptual model for the co-existence of Streptococcus spp . and Actinomyces spp . in dental plaque; van der Hoeven JS et al.; One of the most important questions in ecology is how to explain the co-existence of the variety of physiologically related organisms in the same habitat . A model is presented for the co-existence of Streptococcus species and Actinomyces species in dental plaque . The hypothesis is that these organisms co-exist because they simultaneously utilize several carbon and energy substrates . The hypothesis follows from the observation that the growth yield of oral streptococci and actinomyces in saliva is limited by carbohydrate . Preliminary experiments were undertaken to test the hypothesis using mixed chemostat cultures and gnotobiotic rats . Competition between S . mutans K1R and A . viscosus Ut2 in mixed chemostat cultures on glucose and asparagine was hampered by the early appearance of high-glucose-affinity variants of A . viscosus . From the physiological characteristics of S . sanguis and S . milleri, it might be predicted that simultaneous utilization of carbohydrate and arginine would enable these organisms to co-exist with S . mutans in an ecosystem . To test this mechanism under natural conditions, germ-free rats were inoculated with a combination of S . mutans K1R and S . sanguis P4A7 or the combination S . mutans K1R and S . milleri B448 . The rats were fed on three different diets: (1) 58% cornstarch; (2) 48% cornstarch and 10% sucrose; and (3) 53% cornstarch and 5% arginine . The results of this experiment demonstrated that dietary arginine caused a significant decrease of the ratios K1R/P4A7 and K1R/B448 in dental plaque.(ABSTRACT TRUNCATED AT 250 WORDS)

Acta Paediatr Scand, 1984 Mar, 73(2), 197 - 202
Interferon production in children with undue susceptibility to infections; Bondestam M et al.; The interferon-producing ability of peripheral blood mononuclear leukocytes obtained from children with undue susceptibility to infections was investigated . Patients were grouped according to three clinical patterns, i.e . children with mainly upper respiratory tract infections, with lower respiratory tract infections and with frequent middle ear infections . There was no evidence of impaired mean interferon-alpha responses to the inducers Sendai virus and beta-hemolytic Group G streptococci in patients compared with control children, and there were no differences in this respect between the patient subgroups . A tendency to increased Concanavalin A-induced interferon-gamma production was seen in patients, particularly those with middle ear infections . Leukocytes from patients displayed a higher proliferative response to the T cell mitogens Concanavalin A and Lens culinaris lectin . In a minority of patients (5/28) reproducibly low interferon responses to Sendai virus were found but only one of these patients showed a response below the -2 SD limit for the control group . The results therefore indicate no major defects in the interferon responses of infection-prone children, and at the most suggest that a minority of such patients may be low responders to a viral interferon inducer.

J Antimicrob Chemother, 1984 Mar, 13(3), 295 - 8
Pseudomonic acid--a new antibiotic for skin infections; Reilly GD et al.; A preliminary trial is reported studying the effectiveness of pseudomonic acid in primary superficial skin infections in 20 patients . Staphylococcus aureus was isolated in 18 patients and beta-haemolytic streptococci group A in two . Only on one occasion was a pathogenic organism, Staph . aureus, isolated post-treatment and clinical cure or improvement was achieved in 19/20 (95%) of patients . All isolates were found to have pseudomonic acid MICs of between 0.06 and 0.25 mg/l.

Vet Med (Praha), 1984 Mar, 29(3), 129 - 32
{Frequency of excretion of group B streptococci (Streptococcus agalactiae) in the milk during subclinical forms of mammary gland diseases in cows}; Kubin V et al.; The milk excretion of group B streptococci (Streptococcus agalactiae) from the udder quarters was examined in thirty cows of a heavily infected herd . Six samplings were performed in ten- to fourteen-day intervals . With respect to excretion rate, the set of cows could be divided into three groups: 1 . group of cows excreting S . agalactiae from all udder quarters permanently and absolutely regularly; 2 . cows excreting S . agalactiae regularly only from some quarters, certain quarter being negative at all samplings; 3 . cows excreting streptococci from all quarters absolutely irregularly, without any conclusive order or dependence . The cytological picture of all samples exhibited no signs of inflammation . The discussion deals with some factors that may influence the excretion of streptococci with milk.

Infection, 1984 Mar-Apr, 12(2), 151 - 6
Immunoprophylaxis and immunotherapy of neonatal group B streptococcal infections; Gotoff SP; With emphasis on work from our laboratory, this paper briefly reviews previous studies which have established the basis for immunity to group B streptococcal infections . Quantitative data are presented on the concentration of antibody to the type-specific polysaccharides of group B streptococci in normal adults and infected infants, the protective level in experimental animals, and the influence of prematurity on transplacental passage of antibody . The role of the polymorphonuclear leukocyte in immunity to group B streptococcal infections is critical as supported by in vitro and in vivo experiments as well as clinical observations . Strategies for prevention include antimicrobial chemoprophylaxis and active immunization . Alternative approaches to adjunctive therapy such as administration of specific immune globulin, polymorphonuclear leukocytes, and exchange transfusions are discussed.

Rev Infect Dis, 1984 Mar-Apr, 6(2), 147 - 55
Septic arthritis in young infants: clinical and microbiologic correlations and therapeutic implications; Dan M; In order to assess and correlate the bacteriology of neonatal septic arthritis with its clinical presentation, the records of nine infants with this disease that were diagnosed at Edmonton hospitals between 1964 and 1981 were reviewed and 92 other cases reported in the English-language literature since 1960 were evaluated . All Edmonton cases developed outside of the hospital in previously healthy infants . A Streptococcus species was isolated in four of six patients from whom joint fluid was obtained before antibiotic therapy . Analysis of cases from the literature revealed a more variable bacteriology that seemed dependent on whether the case was hospital or community acquired . In 52 hospital-acquired cases, staphylococci were the predominant isolates (62%); next in frequency were Candida species (17%) and gram-negative enteric bacilli (15%) . Community-acquired neonatal septic arthritis was most often caused by streptococci (52% of cases), staphylococci (26%), and gonococci (17%) . Since 1970 the relative imbalance between staphylococcal (5%) and streptococcal (75%) isolates in community-acquired neonatal septic arthritis is even more pronounced . This pattern emphasizes the importance of ensuring optimal coverage against penicillin-sensitive organisms in community-acquired neonatal septic arthritis; this is in contrast to the situation with hospital-acquired arthritis, where wider-spectrum coverage against staphylococci and gram-negative enteric bacilli remains mandatory.

Pediatr Res, 1984 Mar, 18(3), 266 - 9
Studies of short-term pulmonary and peripheral vascular responses induced in oophorectomized sheep by the infusion of a group B streptococcal extract; Hemming VG et al.; Short-term (0-30 min) pulmonary and systemic vascular responses of oophorectomized ewes infused intravenously with a trichloroacetic acid (TCA) extract of a type III (strain 878) group B streptococcus (GBS) were studied . TCA-878 extract induced significant pulmonary hypertension, reduction in femoral artery pressure and reduced femoral artery PO2 . These responses were similar to those observed after the infusion of sublethal doses of E . coli endotoxin and could be prevented by priming the animal with ibuprofen or indomethacin . Ewes rechallenged 48 h after their initial dose of TCA-878 extract experienced pulmonary arterial pressure significantly higher than those induced by the first infusion . Similar augmented responses were not seen after rechallenge with endotoxin . Larger doses of TCA-878 extract resulted in increasingly higher pulmonary arterial pressure . We conclude that the venous infusion of TCA extracts of GBS-878 induces significant pulmonary hypertension in sheep and that this response may be mediated by prostaglandins . The vasoactive substance extracted from these streptococci could play a role in promoting the vascular instability experienced by the human neonate with early onset GBS disease.

J Infect, 1984 Mar, 8(2), 100 - 9
The role of infectious agents in the aetiology and pathogenesis of childhood nephrotic syndrome in Africa; Abdurrahman MB; Childhood nephrotic syndrome is common in Africa where infectious agents are prevalent . This paper reviews the possible aetiological role of infectious agents in childhood nephrotic syndrome in Africa . There is a strong association, possibly causal, between childhood nephrotic syndrome on the one hand and Plasmodium malariae, Schistosoma mansoni and hepatitis B antigens on the other . Beta-haemolytic streptococci are less strongly associated with nephrotic syndrome, and a few other organisms are suspect . The many ubiquitous infectious agents and the prevalence of multiple infections make it difficult to define the role of any single infectious agent or to determine the interaction between the various agents . Control or eradication of infectious diseases should lower the incidence of childhood nephrotic syndrome in Africa.

J Infect Dis, 1984 Mar, 149(3), 363 - 72
Protective efficacy of hybridoma type-specific antibody against experimental infection with group-B Streptococcus; Shigeoka AO et al.; Murine monoclonal antibodies to group-B Streptococcus type III were developed by fusion of splenic lymphocytes from immunized BALB/c mice with the mouse-myeloma cell line SP 2/0 . The four type III-specific antibodies, which were of the IgM class, protected neonatal rats against intraperitoneal infection with homologous-type group-B streptococci; survival rates were 95%-100% for protected rats but only 17% for unprotected rats . One antibody preparation offered excellent protection against any of five type-III strains employed . Monoclonal antibody provided protection when administered 4, 8, or 12 hr after infection, although delayed administration was less efficacious against more virulent strains . Monoclonal IgM also protected against intranasal inoculation of bacteria . These results indicate the potential therapeutic efficacy of monoclonal antibody in neonatal group-B streptococcal disease, but further laboratory investigations must precede clinical investigation of monoclonal or polyclonal antibody therapy in humans.

Br J Obstet Gynaecol, 1984 Mar, 91(3), 237 - 9
Intrauterine infections with group B beta-haemolytic streptococci; Desa DJ et al.; The case records of 15 infants with intrauterine infections due to group B beta-haemolytic streptococci were traced from the records of two geographically separate centres over a 4-year period (1979-1982) . Six infants were stillborn and the other nine died within the first 6 h . All the infants weighed less than 1000 g and were less than 28 weeks gestation . Placental examination in 14 of the 15 infants showed the presence of chorioamnionitis and funisitis . The infants also showed evidence of pneumonitis . Four infants had evidence of otitis media, two had evidence of an early meningitis . A history of antepartum bleeding was present in six infants and abundant retroplacental clot was noted in four of them . The membranes had been ruptured for greater than 24 h in only three infants . In six of the infants the membranes were intact at the time of delivery . A history of intact membranes at the time of delivery does not exclude a diagnosis of an intrauterine infection with this organism, and this series of infants highlights the importance of routine bacteriologic studies of all perinatal deaths.

Am J Obstet Gynecol, 1984 Mar 1, 148(5), 575 - 8
Evaluation of a rapid method for the detection of vaginal group B streptococci in women in labor; Reardon EP et al.; Group B streptococci infection is an important cause of neonatal morbidity and mortality . Effective therapeutic intervention has been prevented to date by our inability to rapidly detect vaginal colonization . Material obtained from the lower vagina of 414 women in labor was cultured, incubated in modified Islam serum starch broth and observed on the ward for the production of orange carotenoid pigment specific for group B streptococci . Subcultures yielded 48 true group B streptococci-positive results . For the Islam broth, the pigment appeared in 2 to 22.5 hours (median, 12.5 hours) . The test was shown to have a sensitivity of 96% and a specificity of 100% for group B streptococci . This study demonstrated a simple inexpensive method of detecting vaginal group B streptococci colonization which does not require sophisticated 24-hour laboratory facilities . The method holds promise as a screening test for future intervention studies.

Am J Dis Child, 1984 Mar, 138(3), 274 - 6
Throat cultures for group A beta-hemolytic Streptococcus . Importance of anaerobic incubation; Belli DC et al.; The bacteriologic detection of group A Streptococcus in pharyngitis is vital in everyday practice to prevent serious potential sequelae . The purposes of this study were to determine whether throat cultures should be incubated in anaerobic atmosphere and whether an increased recovery rate could be obtained by stabbing of the plates (partial anaerobiosis) and by using a sulfamethoxazole-trimethoprim disk to enhance growth and identification . We examined 243 throat cultures, in duplicate, which were incubated in room air and in anaerobiosis (carbon dioxide, 10%) . We found that, in aerobic incubation, the recovery rate of group A streptococci was 5.7%; in anaerobic incubation it was 19.8% . Stabbing of the agar to create a partial anaerobiosis was useless . When directly placed on the plate, the sulfamethoxazole-trimethoprim disk facilitated the identification of beta-hemolysis areas . To achieve maximum detection of group A streptococci in specimens obtained from the throats of infected children, we found that anaerobic incubation should be used.

Laryngoscope, 1984 Mar, 94(3), 354 - 62
Life-threatening soft-tissue infections of the neck; Beck HJ et al.; Four adult patients had life-threatening soft-tissue infections of the neck . One had Hemophilus influenzae infection, one had Streptococcus pyogenes infection, and two had polymicrobial mixed aerobic and anaerobic infections . Three of the four patients died despite appropriate antimicrobial therapy and surgical intervention . These cases demonstrate the spectrum of serious soft-tissue infections of the neck in both the compromised and the uncompromised host . Soft-tissue infections of the neck may be necrotizing or nonnecrotizing . Cellulitis secondary to H . influenzae and beta-hemolytic streptococci is usually non-necrotizing, whereas necrotizing infections are caused most commonly by synergistic organisms . Potential complications include septic shock, disseminated intravascular coagulation, acute renal failure, adult respiratory distress syndrome, mediastinitis, and pericarditis . Early recognition with aggressive medical and surgical therapy is essential to reduce the mortality.

Inflammation, 1984 Mar, 8(1), 1 - 26
Poly-L-arginine and an N-formylated chemotactic peptide act synergistically with lectins and calcium ionophore to induce intense chemiluminescence and superoxide production in human blood leukocytes . Modulation by metabolic inhibitors, sugars, and polyelectrolytes; Ginsburg I et al.; Various cationic polyelectrolytes (poly-alpha-amino acids and histones), lectins, the chemotactic peptide, f-methionyl-leucyl-phenylalanine (fMLP), the calcium ionophore A23187, and phorbol myristate acetate (PMA) were investigated regarding their capacity to induce luminol-dependent chemiluminescence (LDCL) and superoxide production by human blood leukocytes . Although when tested individually, poly-L-arginine (PARG), phytohemagglutinin (PHA), concanavalin A (Con A), or fMLP induced only a low to moderate LDCL response, very intense synergistic CL reactions were obtained by mixtures of PARG + PHA, PARG + Con A, PARG + PHA + fMLP, Ca2 + ionophore + PARG + PHA + fMLP, and PARG + PMA . The sequence of addition of the various agents to WBC in the presence of luminol absolutely determined the intensity of the LDCL signals obtained, the highest reactions being achieved when the WBC were preincubated for 2-3 min with A23187 followed by the sequential addition of fMLP, PARG, and PHA . These "multiple hits" induced CL reactions which were many times higher than those obtained by each factor alone . On the other hand, neither poly-L-lysine, poly-L-ornithine, poly-L-histidine, nor poly-L-asparagine, when employed at equimolar concentrations, cooperated efficiently with PHA and fMLP to trigger synergistic LDCL responses in leukocytes . Concomitantly with the induction of LDCL, certain ligand mixtures also triggered the production of superoxide . The LDCL which was induced by the "cocktail" of agents was markedly inhibited by sodium azide (93% inhibition), but to a lesser extent by catalase (10% inhibition) or by superoxide dismutase (20%-60% inhibition) . On the other hand, scavengers of singlet oxygen and OH (sodium benzoate, histidine) did not affect the synergistic LDCL responses induced by these multiple ligands . Cytochalasin B also markedly inhibited the LDCL responses induced either by soluble stimuli or by streptococci preopsonized either with histone or with polyanethole sulfonate . The LDCL responses which were induced by mixtures of PARG and concanavalin A were also strongly inhibited by mannose, alpha-methyl mannoside, and poly-L-glutamic acid . The data suggest that the LDCL responses induced by the soluble ligands involved a myeloperoxidase-catalyzed reaction . The possible employment of "cocktails" of ligands to enhance the bactericidal effects of PMNs, macrophages, and natural killer cells on microbial cells and mammalian targets is discussed.

Virology, 1984 Mar, 133(2), 403 - 15
The DNA of bacteriophage 643: isolation and properties of the DNA of a bacteriophage infecting lactic Streptococci; Lyttle DJ et al.; The DNA extracted from bacteriophage 643, which infects group N strains of Streptococci, could be separated into four components by electrophoresis on agarose gels . Electron microscopy established the predominant form of the DNA to be a relaxed, circular molecule of molecular weight 14.9 X 10(6) . The four species observed on electrophoresis are believed to be a circular monomeric form, a linear form derived from it, a circular dimeric form, and the corresponding linear dimer . Two DNA components were demonstrated by sedimentation velocity in the analytical ultracentrifuge and by zone sedimentation in sucrose gradients . These corresponded to a circular monomeric form and a circular dimeric form; no evidence for supercoiled forms was found by sedimentation in either neutral or denaturing solvents . Bacteriophage 643 DNA was sensitive to cleavage by single-strand-specific nuclease S1 and could be labeled in vitro by the PolI-catalyzed incorporation of {alpha-32P}dATP into the molecule under conditions that did not permit nick translation, suggesting that the circular duplex molecule is interrupted by a single-stranded gap.

J Bacteriol, 1984 Mar, 157(3), 833 - 8
Conjugal transfer and characterization of bacteriocin plasmids in group N (lactic acid) streptococci; Neve H et al.; Thirteen bacteriocin-producing strains of group N (lactic acid) streptococci were screened for their potential to transfer this property by conjugation to Streptococcus lactis subsp . diacetylactis Bu2-60 . Bacteriocin production in three strains was plasmid encoded as shown by conjugal transfer and by analysis of cured, bacteriocin-negative derivatives of the donor strains and the transconjugants . With Streptococcus cremoris strains 9B4 and 4G6 and S . lactis subsp . diacetylactis 6F7 as donors, bacteriocin-producing transconjugants were isolated with frequencies ranging from ca . 2 X 10(-2) to 2 X 10(-1) per recipient cell . Bacteriocin-producing transconjugants had acquired a 39.6-megadalton plasmid from the donor strains 9B4 and 4G6, and a 75-megadalton plasmid from the donor strain 6F7 . As shown by restriction endonuclease analysis, the plasmids from strains 9B4 and 4G6 were almost identical . The plasmid from strain 6F7 yielded some additional fragments not present in the two other plasmids . In hybridization experiments any of the three plasmids strongly hybridized with each other and with some other bacteriocin but nontransmissible plasmids from other S . cremoris strains . Homology was also detected to a variety of cryptic plasmids in lactic acid streptococci.

J Hosp Infect, 1984 Mar, 5(1), 63 - 9
Streptococcal infection in a regional burns centre and a plastic surgery unit; Whitby M et al.; An outbreak of infection due to group A streptococci of M-type 49 involved first a regional burns centre followed by spread to the intensive care ward of the plastic surgery unit in an associated hospital . Eleven patients and two staff were involved: two of the infected patients developed septicaemia . Serological tests demonstrated marked antibody response to DNAase B(ADB) and there were lesser reactions to other extracellular streptococcal products . Screening of patients and staff identified the likely source of the epidemic which was rapidly controlled by penicillin prophylaxis and other measures.

Int J Dermatol, 1984 Mar, 23(2), 112 - 6
Immunologic and biochemical studies on a patient with pyoderma gangrenosum; Asghar SS et al.; A patient with pyoderma gangrenosum without associated disease was studied . Routine investigations showed several abnormalities . High ESR, high alkaline phosphatase and glutamyl transferase (gamma-GT) levels, low iron and iron binding capacity, altered protein spectrum, presence of Staphylococcus aureus and group G hemolytic streptococci in ulcer culture, higher than normal antistreptolysin titers in the serum, and perivascular infiltration in the skin . Biochemical investigations aimed at finding any excessive hydrolytic activity did not reveal the presence of neutral proteases in circulation leaked out from PMN-leukocytes or elsewhere . Lysozyme levels were higher than normal, amylase and lipase levels were normal and 5' nucleotidase levels were below normal range . TCA-soluble polypeptides were present in the serum at levels two times higher than those in normal individuals . Immunochemical investigations showed the absence of immune complexes in the serum but presence of high amounts of C-reactive protein . Total complement activity was higher than normal and so was C3c level . Clq, C4, and C3d levels were within normal range . Biologic studies showed the presence of a factor in patient serum that made guinea pig skin hard, painful, erythematous, and eventually hairless, but not necrotic . A similar factor was either absent in normal serum or present in very low concentration . After salazopyrine treatment, all the above mentioned abnormalities corrected except that 5' nucleotidase activity remained slightly lower than normal, alkaline phosphatase levels remained slightly higher than normal, and C-reactive protein levels remained very high, though lower than those during intense disease activity.

Afr J Med Med Sci, 1984 Mar-Jun, 13(1-2), 15 - 20
Effects of saliva and alpha-amylase on antibiotic sensitivity of bacteria; Eke PI et al.; Two hundred and ninety-six bacterial isolates were investigated for the effects of saliva and alpha-amylase on their susceptibility to ampicillin, tetracycline, chloramphenicol and gentamicin . When the test organisms were primed with normal and 'diseased' saliva there were no observable differences in the MICs of ampicillin and chloramphenicol for group-A streptococci, but alpha-amylase significantly reduced the MIC of tetracycline from 2 to 0.25 mg/1 . With Staphyloccus aureus, priming with saliva and alpha-amylase had no effect on the MICs of gentamicin and ampicillin, whereas the MICs of tetracycline and chloramphenicol were increased . The effect of saliva on the susceptibility of E . coli to tetracycline was also significant; MIC50 and MIC90 were reduced from 128 to 8 and 32 mg/1 respectively . Chloramphenicol was however increased from less than 0.125 to 1 and 2 mg/1 when E . coli was primed with amylase and saliva respectively . The general significance of these observations is discussed.

S Afr Med J, 1984 Feb 4, 65(5), 169 - 71
Tonsillitis in the paediatric outpatient; Reader WJ et al.; A study of tonsillitis in paediatric outpatients was carried out . In this group the aetiology is multifactorial and is clearly associated with sinusitis and nasal allergy . No features of the history or examination were reliable in differentiating between bacterial and viral infection . Lancefield Group A beta-haemolytic streptococci were isolated from the throat swabs of one-third of the patients, bacteria being isolated from half of the cases altogether . The use of an antibiotic before the results of throat swab culture are available appears to be justified . It is suggested that sinusitis and nasal allergy be excluded before tonsillectomy is considered.

J Appl Bacteriol, 1984 Feb, 56(1), 175 - 7
A note on the effect of combined ultrasonic and heat treatments on the survival of thermoduric streptococci; Ordonez JA et al.; The combined destructive effect of ultrasonic waves and heating on micro-organisms has been investigated using as a model two species of thermoduric streptococci . Ultrasonic and heat treatments applied simultaneously were much more destructive than the additive effect of the two agents considered independently . Compared with heat alone, the simultaneous application of ultrasonic vibration and heat reduced the resistance of the organisms 6-11 fold.

J Bacteriol, 1984 Feb, 157(2), 560 - 7
Regulation of glucose metabolism in oral streptococci through independent pathways of glucose 6-phosphate and glucose 1-phosphate formation; Keevil CW et al.; In vivo rates of glucose uptake and acid production by oral streptococci grown in glucose- or nitrogen-limited continuous culture and batch culture were compared with the glucose phosphorylation activities of harvested, decryptified cells . The strains examined contained significant phosphoenolpyruvate-phosphotransferase system (PTS) activity, measured by a glucose 6-phosphate (G6P) dehydrogenase-linked assay procedure, but this activity was insufficient to account for the in vivo glucose uptake rates . However, ATP was a superior phosphoryl donor to phosphoenolpyruvate, and unlike the PTS, phosphoryl transfer with ATP was insensitive to bacteriostatic concentrations of chlorhexidine, suggesting glucokinase-mediated G6P formation . Again, G6P formation from the PTS and glucokinase reactions was not commensurate with some of the glucose uptake rates observed, implying that other phosphorylation reactions must be occurring . Two novel reactions involving carbamyl phosphate and acetyl phosphate were identified in some of the strains . No G6P formation was detected with these potential phosphoryl donors, but in the presence of phosphoglucomutase, glucose 1-phosphate (G1P) formation was evident, which was insensitive to chlorhexidine . G1P is a precursor of glycogen, and good correlation was obtained between G1P formation activity and endogenous metabolism of washed cells measured either as a rate of acid production at a constant pH 7 or as a decrease in pH with time in the absence of titrant . A "league table" of abilities to synthesize G1P and produce acid from endogenous metabolism was compiled for oral streptococci grown in batch culture . This indicated that Streptococcus mutans Ingbritt and Streptococcus sanguis Challis were unable to form G1P or produce much acid endogenously, whereas increasing activities were obtained with Streptococcus salivarius, Streptococcus sanguis, and Streptococcus mitis . In particular, S . mitis had the highest G1P formation activities and was able to decrease the pH to less than 5 in 15 min by endogenous metabolism alone . The data are consistent with the intracellular accumulation of free glucose driven by proton motive force when PTS activities are low and the subsequent phosphorylation to either G6P for metabolism via glycolysis or G1P for glycogen biosynthesis . The accumulation of acetyl phosphate during glucose-limited growth and the availability of arginine for catabolism to carbamyl phosphate provide an explanation as to why some glucose-limited oral streptococci continue to synthesize glycogen under these conditions, which might prevail in plaque.

Scand J Dent Res, 1984 Feb, 92(1), 43 - 9
Polysaccharide production by cell free transferases in saliva in relation to salivary microflora; Scheie AA et al.; The supernatant of centrifuged whole saliva was incubated with radiolabeled sucrose to measure polysaccharide production by cell free transferases and to examine whether water-insoluble polysaccharides were produced . Amounts of polysaccharides were considered to reflect the level of cell free transferases in saliva . Plating samples on blood agar, MS and MSB plates gave salivary counts of total CFU, total streptococci, S . salivarius and S . mutans . The capability of the cell free portion of saliva to produce polymers was confirmed and it appeared that the cell free transferases were able to produce water-insoluble polysaccharides . Significant correlations were found between the total and the insoluble polysaccharides from 14C-G'-sucrose and total CFU, total streptococci, S . salivarius and S . mutans, respectively . Heavily S . mutans infected subjects seemed to produce particularly large amounts of water-insoluble polysaccharides from 14C-G'-sucrose . The apparently water-insoluble 14C-F'-polysaccharides correlated significantly to the number of S . salivarius . It was thus concluded that the constitution of the oral microflora and particularly the levels of S . mutans and S . salivarius were of importance for the level of cell free transferase activity.

Acta Pathol Microbiol Immunol Scand {B}, 1984 Feb, 92(1), 23 - 30
Surface characteristics of group A streptococci with and without M-protein; Miorner H et al.; Twenty M protein-positive and eight M protein-negative strains of group A streptococci were investigated with respect to surface hydrophobicity and amount of lipoteichoic acid (LTA) . Surface hydrophobicity as determined in polymer two-phase systems varied substantially between individual strains and there was no correlation to the presence of antiphagocytic M protein . The amount of LTA on the surface of the bacteria varied with hydrophobic affinity of the cells . Strains with a high content of surface LTA were found among both M-positive and M-negative streptococci . Cellular and extracellular LTA was estimated on six strains by the ability of hot phenol extracts and culture fluids to sensitize erythrocytes and by rocket immunoelectrophoretic quantitation . Differences in content of surface LTA did not correlate to differences in the total amount of cellular LTA . Pepsin digestion of M-positive group A streptococci at suboptimal pH resulted in a loss of M antigen whereas surface LTA and the hydrophobic interaction liability was retained . The results indicate that the degree of surface hydrophobicity as measured by two-phase partitioning is not correlated to either the type-specific or the antiphagocytic moiety of M protein . The results support the correlation between surface LTA and surface hydrophobicity of group A streptococci.

Acta Pathol Microbiol Immunol Scand {B}, 1984 Feb, 92(1), 65 - 9
The genetic control of virulence in group A streptococci . III . Plasmid-induced "switch-off"--effect on some pathogenic properties; Ravdonikas LE et al.; Recently, we reported that conjugal transfer of plasmid pERL1, determining i.a . erythromycin resistance (Emr), into group A streptococci could trigger the expression of anti-phagocytic activity, adhesiveness, opacity factor and capacity to bind immunoglobulin Fc-parts and beta 2-microglobulin . In the present study, ethidium bromide treatment of Emr transconjugants allowed the selection of "cured", erythromycin sensitive (Ems) mutants . This procedure did not affect the expression of the abovementioned characteristics . However, when plasmid pERL1 was again transferred to two such mutants, the "secondary", Emr transconjugants obtained showed lack of each of these properties . Our experiments thus demonstrated a "switch-on" as well as a "switch-off" effect, exerted by the same plasmid, pERL1, on some major pathogenic properties of group A streptococci.

Eur J Clin Microbiol, 1984 Feb, 3(1), 14 - 8
Assay of type-specific M antigens on whole group A streptococci; Miorner H et al.; A novel radioimmunoassay of type-specific M antigens on whole group A streptococcal cells is described . Absorbed rabbit anti-M antisera directed against M types 12 and 49 were used for determining M antigens on intact bacterial organisms . Staphylococcal protein A labelled with 125I was used as an anti-antibody reagent . The absorbed antisera were tested against ten homologous and 48 heterologous serotypes . All homologous serotypes gave an unequivocal reaction distinct from the weaker reaction with the heterologous serotypes . The type-specificity of the reaction was confirmed by the removal of type-specific antibodies after absorption to purified M protein coupled to Sepharose 4B . The results indicate that the described method is a simple and reliable technique for the recognition of M types of group A streptococci and offers a valuable tool for studies of M antigen in situ.

Br J Vener Dis, 1984 Feb, 60(1), 56 - 7
Urethritis caused by group B streptococci: a case report; Chowdhury MN et al.; We describe a case of urethritis caused by group B streptococci . The diagnosis was confirmed by examination of a Gram stained smear, isolation of the organism from the urethral discharge, and also by the clinical response to treatment with phenoxymethyl penicillin.

Infect Immun, 1984 Feb, 43(2), 555 - 60
Peptide utilization by oral streptococci; Andersson C et al.; Streptococcus mitis ATCC 903 and Streptococcus sanguis 804 could utilize large peptides present in proteose peptone as their sole source of nitrogen but grew poorly in amino acid medium . By contrast, Streptococcus mutans BHT and S . mutans IB grew in amino acid medium but could not utilize large peptides . Streptococcus sp . strain Bravato had requirements for both peptides and amino acids . Peptide size did not seem important for the utilization of peptides by S . mitis except that dipeptides were not utilized . Large peptides were essential for depressed hyaluronidase synthesis in nongrowing S . mitis . Intracellular aminopeptidase activities were high in S . mitis ATCC 903 and Streptococcus sp . strain Bravato, intermediate in S . sanguis 804, and low in S . mutans BHT and S . mutans IB.

Infect Immun, 1984 Feb, 43(2), 523 - 30
Role of cellular lipoteichoic acids in mediating adherence of serotype III strains of group B streptococci to human embryonic, fetal, and adult epithelial cells; Nealon TJ et al.; Lipoteichoic acids (LTA) of serotype III strains of group B streptococci (GBS) were shown to mediate adherence of these organisms to human embryonic (HEC), fetal (HFC), and adult buccal (HBEC) epithelial cells . The binding of GBS was temperature dependent, and maximum attachment occurred at 37 degrees C . HEC, HFC, and HBEC preincubated with purified LTA significantly inhibited attachment of GBS, whereas the group B and type III antigens had no effect . Under phosphate-limiting conditions in which cell-associated LTA could not be detected in these organisms, bacterial adherence did not take place . GBS (virulent) that were isolated from infected infants and previously shown to have significantly higher quantities of cell-associated LTA in comparison to GBS strains from asymptomatically colonized infants adhered with greater binding avidity to HEC and HFC and in greater numbers than to HBEC . It was determined that the mechanism of LTA-mediated adherence of GBS to HBEC differed from adherence to embryonic and fetal cells for both virulent and asymptomatic GBS strains bound to HBEC in a similar manner, enhanced by the lipid portion of the LTA . In contrast, the binding of GBS to HEC and HFC was mediated by hydrophobic as well as specific interactions due to the glycerolphosphate polymer of LTA . These results indicate that possible receptor sites for LTA present on cells in prenatal stages of development may differ from those of adult cells, which may result in increased susceptibility of newborn infants to group B streptococcal disease . The implications of LTA-mediated adherence of GBS and their possible role as virulence factors are discussed.

J Bacteriol, 1984 Feb, 157(2), 420 - 7
Fibronectin binding to a Streptococcus pyogenes strain; Speziale P et al.; In previous studies, Staphylococcus aureus has been shown to bind fibronectin (P . Kuusela, Nature (London) 276:718-720, 1978), an interaction that may be important in bacterial attachment and opsonization . Recently some strains of streptococci of serological groups A, C, and G were also found to bind fibronectin . The binding to one selected strain of Streptococcus pyogenes has been characterized here . The binding of {125I}fibronectin to streptococcal cells resembles that to staphylococcal cells and was found to be time dependent, functionally irreversible, and specific in the sense that unlabeled proteins other than fibronectin did not block binding . Bacteria incubated with proteases largely lost their ability to bind fibronectin, and material released from the streptococci by a brief trypsin digestion contained active fibronectin receptors . This material inhibited the binding of {125I}fibronectin to the streptococci . The inhibitory activity was adsorbed on a column of fibronectin-Sepharose but not on a column of unsubstituted Sepharose 4B or egg albumin Sepharose . The receptor appeared to be a protein nature since the inhibitory activity of the trypsinate was destroyed by papain and was not absorbed on a column containing monoclonal antibodies directed against lipoteichoic acid bound to protein A-Sepharose . Binding sites in fibronectin for streptococci and staphylococci, respectively, were localized by analyzing the ability of isolated fragments to inhibit {125I}fibronectin binding to bacteria and by adsorbing 125I-labeled tryptic fragments with staphylococcal and streptococcal cells . Both species of bacteria appeared to preferentially bind a fragment (Mr = approximately 25,000) originating from the N-terminal region of the protein . In addition, streptococci also bound a slightly smaller fragment (Mr = approximately 23,000) . Fibronectin receptors solubilized from either streptococci or staphylococci inhibited the binding of fibronectin to both species of bacteria.

J Clin Lab Immunol, 1984 Feb, 13(2), 75 - 80
Identification of distinct Fc-receptor molecules on streptococci and staphylococci; Reis KJ et al.; The structural similarity between staphylococcal protein A and streptococcal Fc receptors was examined . Antibody to staphylococcal protein A, proven not to bind to protein A through Fc, was used to determine if the Fc receptors on 4 Fc-receptor positive streptococcal strains were antigenically related to staphylococcal protein A . Anti-protein A antibody bound to Staphylococcus aureus Cowan I, but failed to bind to any of the streptococci . Additionally, when the Cowan strain and 9 other Staphylococcus aureus isolates demonstrating various levels of IgG adsorption capacity were preincubated with antiprotein A antibody, the ability of these bacteria to adsorb IgG was completely inhibited . These results suggest that all the Fc receptors on Staphylococcus aureus are antigenically similar or identical to protein A . Fc receptors on streptococci, while sharing with staphylococcal protein A the capacity to bind to Fc of human IgG, were not antigenically crossreactive with protein A.

Mayo Clin Proc, 1984 Jan, 59(1), 47 - 8
Aerococcus viridans endocarditis; Pien FD et al.; Aerococcus viridans organisms are gram-positive cocci with a strong tendency to form tetrads . These bacteria have infrequently been encountered as a human pathogen, particularly in bacterial endocarditis . A review of the literature suggests that treatment of A . viridans endocarditis should be similar to that for endocarditis caused by penicillin-susceptible streptococci.

Ann Surg, 1984 Jan, 199(1), 97 - 100
Soft tissue infections in parenteral drug abusers; Orangio GR et al.; Thirty-four parenteral drug abusers admitted with soft tissue infections underwent bacteriologic and immunologic evaluation . Staphylococcus aureus and beta hemolytic streptococci were the most common organisms recovered . Enteric gram negative aerobes and oral flora were common and enteric anaerobes rare . Absolute lymphopenia and elevations in the IgA, IgG and IgM fractions of the immunoglobulins were common as were false positive VDRL examinations . Cutaneous anergy was found in 83% of the group and 70% of a simultaneously noninfected addict group . Staphylococcal carriage was frequent . Because of variation in the flora between this and other reported groups, ongoing bacteriologic surveillance could be a useful guide to initial antibiotic therapy . Differences in the pattern of immune reaction in this group when compared to different addict groups suggest a difference in antigenic stimulation, possibly as a result of differences in bacteriologic exposure.

Infect Immun, 1984 Jan, 43(1), 386 - 90
Inhibition of bacterial aggregation by serum- and blood-derived proteins; Malamud D et al.; Human and animal sera contain potent inhibitors of saliva-mediated aggregation of oral streptococci . The inhibitors consist of a high-molecular-weight heat-labile factor and a lower-molecular-weight heat-activated factor . The latter appears to be serum albumin . Analyses of purified blood-derived proteins indicated that several high-molecular-weight proteins (fibrinogen, fibronectin, and ferritin) were able to inhibit aggregation at low concentrations . These data suggest that high-molecular-weight proteins may modulate the aggregation process.

Infect Immun, 1984 Jan, 43(1), 359 - 67
Exopolysaccharide production by viridans streptococci in experimental endocarditis; Mills J et al.; Light and electron microscopy with histochemical staining were used to estimate exopolysaccharide production by strains of viridans streptococci recovered from patients with endocarditis . Six strains were selected for study because they represented a wide range of in vitro polysaccharide production . By light microscopy, there was good agreement between three polysaccharide stains (ruthenium red, periodic acid-Schiff and calcifluor white) in the amount of glycocalyx produced, which ranged from minimal (0 to 1+) to maximal amounts (4+) . Two strains selected for minimal (strain 1) and maximal (strain 6) in vitro exopolysaccharide production were studied after we used them to experimentally infect cardiac vegetations . Glycocalyx could be demonstrated surrounding organisms in cardiac vegetations, and the relative amounts produced were similar to those seen in vitro . Vegetations formed by glycocalyx-producing strains were also larger than those formed by glycocalyx-deficient strains . Viridans group streptococci which produce exopolysaccharide in vitro also do so within cardiac vegetations . The relationship of exopolysaccharide production to maintenance of endocardial infection is discussed.

Infect Immun, 1984 Jan, 43(1), 308 - 13
Amount and avidity of salivary and serum antibodies against Streptococcus mutans in two groups of human subjects with different dental caries susceptibility; Lehtonen OP et al.; Immunoglobulin A (IgA) and IgG antibodies against Streptococcus mutans K1R and 10449 were measured in serum and in stimulated whole saliva from two groups of naval recruits, representing high or low caries susceptibility . The antibody assays were performed by using the enzyme-linked immunosorbent assay, and the results were expressed by a method able to estimate the amount of high-avidity and total specific antibodies . As a control, concentrations of salivary total immunoglobulins were related to the amounts of specific antibodies . Further, antibodies were assayed against three antigens, unrelated to the streptococci . No clear differences were observed in serum antibodies between the subjects with high or low caries susceptibility . However, in saliva, low caries susceptibility was associated with a high amount of total antigen-specific IgA, and possibly IgG, against S . mutans . This difference between the groups still existed when the amounts of specific antibodies were related to the amounts of salivary immunoglobulins . There were no differences in the amounts of total specific antibodies against the unrelated antigens . No differences were observed in the estimates of high-avidity anti-S . mutans antibodies between the groups, either in serum or saliva . Thus, within the limitations of the assays and crude antigen, lack of high-avidity antibodies is not responsible for caries susceptibility . Instead, the amount of anti-S . mutans antibodies seems to be linked with caries protection . The results of the present study indicate that salivary antibodies are linked with the control of human dental caries.

Infect Immun, 1984 Jan, 43(1), 28 - 31
Characterization of a pH-dependent chromophore from nutritionally variant streptococci; van de Rijn I et al.; Strains of nutritionally variant streptococci and Streptococcus mitis produce a chromophore when they are heated at acid pH . No other strains of streptococci elaborated this chromophore . Furthermore, the nutritionally variant streptococci produced approximately twice the amount of chromophore as the S . mitis strains . The chromophore was localized in the cell wall of these streptococcal strains and appeared to be resistant to trypsin treatment . Hydrolysis apparently is required because elevated temperatures at pH 2 are necessary for demonstration of the chromophore . The chromophore has a maximal absorbance at 504 nm with a pKa of 3.6 . The chromophore absorbance spectrum showed an isosbestic point at 400 nm . This is the first example of a pH-dependent chromophore to be found in streptococci and serves as a positive characteristic for the description of nutritionally variant streptococci as well as S . mitis.

Int J Tissue React, 1984, 6(5), 373 - 8
The role of immunomodulators in the production of lipid mediators by macrophages (M phi); Roubin R et al.; There is evidence indicating that bioreactive lipid mediators, PAF-acether (platelet-activating factor: 1-0-alkyl-2-acetyl-sn-glycero-3-phosphocholine) and arachidonic acid (AA) metabolites, are formed upon deacylation of ether lipids . M phi obtained from mice treated with the sterile irritant thioglycolate exhibited an impaired formation of PAF-acether, leucotrienes (LT) C4 and prostaglandins (PG) . In order to assess whether the impaired formation in lipid mediators is a general feature of M phi found at inflammatory sites, we have compared the capacity of resident (R-M phi) and immunostimulant-activated M phi to release, upon a zymosan challenge, PAF-acether and cyclooxygenase and lipoxygenase products . Activated M phi was obtained from mice injected intraperitoneally with non-viable C74 streptococci (St-M phi), bacilli Calmette-Guerin (BCG-M phi) or trehalose dimycolate (TDM-M phi), a defined immunostimulant isolated from Mycobacterium tuberculosis . All populations were capable of releasing PAF-acether . However, the amount of cell-associated PAF-acether was reduced by 75-90% in activated M phi populations as compared to R-M phi . Although the acetyltransferase level was comparable, acetyl-CoA supplementation restored the formation of PAF-acether by activated M phi to control (R-M phi) level . The amount of 14C-AA metabolites released by St-M phi was much lower compared with TDM-M phi or R-M phi, as was the amount of LTC4 detected as SRS contractile activity after HPLC.(ABSTRACT TRUNCATED AT 250 WORDS)

Arch Oral Biol, 1984, 29(4), 323 - 6
An investigation of the effects of maltose and sucrose in the diet on the microbiology of dental plaque in man; Skinner A et al.; In a double-blind cross-over study, 24 dental students consumed 150 g of sucrose or maltose a day in various foods . After 15 days, plaque samples were collected from the distal surface of upper right first premolars; post-diet samples were collected four months later . The median total anaerobic count of plaque exposed to sucrose was significantly lower compared with maltose samples (p less than 0.05) . Glucan-producing organisms per 100 anaerobes in the sucrose samples compared with the maltose (p less than 0.05) . Streptococcus sanguis and Streptococcus mitior were the most frequently-isolated streptococci.

Acta Neuropathol (Berl), 1984, 65(2), 166 - 7
Hypotensive brain stem necrosis in a stillborn; Taylor SR et al.; Hypotensive brain stem necrosis is reported in a stillborn . Additional postmortem findings included evidence of intrauterine distress, shock, and a pure blood culture of group B beta-hemolytic streptococci . These findings suggest group B beta-hemolytic streptococcal sepsis in utero, with a subsequent episode of transitory circulatory failure prior to intrauterine demise.

Scand J Thorac Cardiovasc Surg, 1984, 18(3), 259 - 61
Microbial flora associated with pulmonary neoplasms; Pieper R et al.; The microbial flora associated with various tumors of the lung was studied in 19 patients . Biopsy specimens taken from the resected bronchus and from peripheral lung tissue at thoracotomy were cultured for aerobic and anaerobic microorganisms prior to administration of prophylactic antibiotics . Bacterial growth was obtained in bronchial and/or pulmonary biopsy culture in eight patients, with additional growth of fungi (Candida parapsilosis) in one of them . The microflora was of oropharyngeal origin, with streptococci and staphylococci predominating . The remaining 11 patients were culture-negative . The results of the study suggest that a prophylactic antibiotic regimen consisting of antistreptococcal and antistaphylococcal drugs is appropriate.

Acta Chem Scand B, 1984, 38(8), 647 - 55
Synthesis of D-Ala--D-Ala analogues with postulated antibacterial activity; Loennechen T et al.; The syntheses of the L,L- and D,D-stereoisomers of N-phenoxyacetyl-X-alanine in which X=His, Tyr, or Lys, are described . The antibacterial activity of some of the peptide derivatives and their synthetic intermediates have been examined . Some of the intermediates exhibited moderate activity against viridans streptococci, enterococci and Streptococcus agalactiae . None of the compounds were active against beta-lactamase producing bacteria or served as beta-lactamase inhibitors.

Acta Microbiol Hung, 1984, 31(3), 173 - 8
Possible role of lincomycin-therapy in the genetic alteration of a staphylococcus epidemic population; Barcs I et al.; In a staphylococcosis epidemic occurring in a child community, the proportion of inducible lincomycin resistance has risen significantly in the bacterium population . This conveyed the possibility that lincomycin or its derivatives may induce a lincomycin resistance in Staphylococcus aureus as it is already known in streptococci . Examination of human and animal samples obtained during lincomycin treatment showed that lincomycin had no role in the induction of resistance; the agent can effectively be applied against pathogens of the above-mentioned phenotype . Immunological examination of serum samples provided opportunity for a more exact localization of the protein-linkage of lincomycin.

Pediatr Cardiol, 1984 Jan-Mar, 5(1), 61 - 3
Group C beta-hemolytic streptococcal endocarditis: report of a pediatric case; Robinson P et al.; A 9-year-old boy with a ventricular septal defect and a bicuspid aortic valve developed bacterial endocarditis due to group C streptococci . He responded to an initial antibiotic regimen of nafcillin plus gentamicin and was cured by the use of penicillin G following the isolation of the organism . The unusual nature of this case is discussed and physicians are cautioned to recognize this organism as a potential cause of infectious endocarditis in the pediatric population.

G Batteriol Virol Immunol, 1984 Jan-Jun, 77(1-6), 113 - 22
{Effect of gamma-interferon on the adherence of streptococci to different murine cell lines}; Savoia D et al.; In the present study we analyze IFN-gamma capability to modulate bacterial adherence of group A Streptococci to murine cells such as fibroblast (L-929) or phagocytic cells (P 388 and PP-induced macrophages) . IFN-gamma increases adherence of Streptococci to macrophages but not to L-929 cells . This finding could have important implication for the "in vivo" adhesion of bacteria to phagocytic cells.

Z Allg Mikrobiol, 1984, 24(10), 719 - 23
{Conjugational plasmid transfer from A, B and H streptococci to N streptococci}; Riemelt I et al.; Plasmid-mediated resistance to erythromycin and chloramphenicol was successfully transferred from group A, B and H streptococci to group N streptococci by a process akin to conjugation . The results showed that plasmids from streptococcal groups other than N were able to replicate in lactic streptococci as well . The transfer experiments were carried out by using a membrane filter mating technique . Four of the five plasmids used (pSM15346, pSM10419, pIP501, and pEL1) were transferred at frequencies ranging from 10(-1) to 10(-8) transconjugants per donor colony-forming unit . The highest transfer frequencies were obtained when S . pyogenes strain 15346 (pSM15346) served as the donor strain . The identy of transconjugants was verified by testing for the presence of unselected markers of the recipient strains, and both transduction and transformation were ruled out as the mechanisms of transfer.

Anal Biochem, 1984 Jan, 136(1), 89 - 92
Intracellular form of streptococcal proteinase: a clue to a novel mechanism of secretion; Lo SS et al.; The intracellular form of streptococcal proteinase has been isolated and compared with its extracellular form . As shown by double-immunodiffusion studies and radiosequence analysis, the intracellular proteinase was identical to that of the extracellular proteinase . However, the unusual mixed disulfide, protein-S-SR, shown to be present in the extracellular proteinase, was missing in the intracellular proteinase . Protease activity is dependent upon the free sulfhydryl group of the proteinase . Thus, the intracellular proteinase was enzymatically active, while the extracellular proteinase requires activation by exposure to a reducing agent . Because this appears to be the only difference between the intracellular and extracellular protease, it is proposed that the modification of the protein-SH to form protein-S-SR is a process that is intimately related to the mechanism of secretion of the proteinase into the culture fluid by streptococci.

J Clin Microbiol, 1984 Jan, 19(1), 4 - 7
Colistin-oxolinic acid-blood agar: a new selective medium for streptococci; Petts DN; The development and evaluation of a new selective medium (colistin-oxolinic acid-blood agar) for streptococci is described . Streptococci of medical and veterinary importance grew well on the medium . Gram-negative organisms, staphylococci . Bacillus spp., and coryneforms are all inhibited . It was concluded that the medium is valuable for the isolation of streptococci in pure culture from mixed flora and has advantages over other media previously described . Increased isolation rates were obtained together with earlier identification of the isolated strains.

J Bacteriol, 1984 Jan, 157(1), 28 - 34
Properties of a Streptococcus lactis strain that ferments lactose slowly; Crow VL et al.; Streptococcus lactis 7962, which ferments lactose slowly, has a lactose phosphoenolpyruvate-dependent phosphotransferase system and low phospho-beta-galactosidase activity, in addition to high beta-galactosidase activity . Lactose 6'-phosphate accumulated to a high concentration (greater than 100 mM) in cells growing on lactose . In contrast, lactic streptococci, which ferment lactose rapidly and use only the lactose-phosphotransferase system for uptake, contained high phospho-beta-galactosidase activity and low concentrations (0.9 to 1.6 mM) of lactose 6'-phosphate . It is concluded that rate-limiting phospho-beta-galactosidase activity is primarily responsible for defective lactose metabolism in S . lactis 7962.

Cornea, 1984, 3(2), 105 - 8
Donor-to-host transmission of streptococcal infection by corneas stored in McCarey-Kaufman medium; Matoba A et al.; Two patients developed streptococcal endophthalmitis following penetrating keratoplasty . These cases may represent the third and fourth cases of donor-to-host transmission of streptococcal infection by corneas stored in McCarey-Kaufman (M-K) medium . Streptococcal agents now account for 50-59% of the total number of reported cases of M-K medium contamination by donor tissue with resultant infection in the host . Gentamicin sulfate, the sole antibiotic used in the M-K medium in all cases, has poor activity against most streptococci . The addition of a second antibiotic to the M-K medium to provide an improved spectrum of antimicrobial activity should be considered.

Clin Invest Med, 1984, 7(4), 311 - 4
Overview of neonatal listeriosis; Albritton WL et al.; Neonatal listeriosis accounts for the largest recognizable group of infections due to Listeria monocytogenes . Fetal wastage with early gestational infection is a recognized complication of maternal infection . Late gestational maternal infection or asymptomatic colonization may be associated with neonatal infection . Early-and late-onset clinical forms are recognized and the epidemiology, and clinical features of neonatal listeriosis resemble neonatal infections due to group B streptococci . The source of L . monocytogenes in most cases of neonatal listeriosis, particularly the late-onset form, remains obscure.

Zentralbl Gynakol, 1984, 106(23), 1544 - 6
{Scalp infection caused by B-streptococci in a newborn infant following internal cardiotocography}; Handrick W et al.; The paper reports on a newborn developing a scalp abscess 10 days after birth due to fetal monitoring with scalp electrodes . B-streptococci were isolated from purulent material after surgical intervention . The recovery was uneventful after therapy with appropriate antibiotics and removal of the pus (incision) . In a short review of literature the authors discuss some of the aspects of infections arising in connection with use of scalp electrodes for fetal monitoring.

Acta Otolaryngol Suppl, 1984, 407, 26 - 9
Antibiotic treatment of secretory otitis media; Sundberg L; There is increasing evidence for an infectious etiology of secretory otitis media (SOM) . Respiratory pathogens (S . pneumoniae, H . influenzae, B . catarrhalis and group A streptococci) have been found in cases of long-standing SOM, with a frequency of 18% in the middle ear and 79% in the nasopharynx . Erythromycin has been shown to penetrate into the middle ear effusion of SOM and into adenoid tissue . The concentrations surpassed the MIC's of most respiratory pathogens, with the exception of certain strains of H . influenzae . In agreement with this, a ten day course of erythromycin in children with SOM eradicated practically all nasopharyngeal strains of S . pneumoniae and B . catarrhalis, while there was no significant decrease in the number of strains of H . influenzae . The present study consisted of 119 children with SOM lasting three months or more . One group of 47 consecutive children was treated with erythromycin (Abboticin), given orally twice a day, in a dose of 40-60 mg/kg/24 hours, for ten days . The rate of resolution in this test group was 45% (21/47 cases) . Another group of 72 consecutive children with SOM of a similar duration received no antibiotics . The cure rate in this control group was 15% (11/72 cases) . The difference between the two groups is statistically significant (chi 2 = 11054; df = 1; p less than 0.001) . The results suggest that a ten day course of erythromycin could reduce the need for surgical treatment in children with long-standing SOM.

Med Microbiol Immunol (Berl), 1984, 173(2), 65 - 74
The mode of action of antibody in neutrophil bactericidal activity against highly pathogenic group-B streptococci; Cleat PH et al.; An investigation was undertaken into the post-phagocytic action of specific antibody in initiating neutrophil bactericidal activity against highly pathogenic group-B streptococci that survive within these cells . Specific antibody appears to gain access to the interior of the neutrophil and binds to the intracellular bacteria . Activation of Fc receptors on the neutrophil surface is not sufficient to initiate bactericidal activity, but the antibody may utilise the surface Fc receptors to gain access to the ingested organisms . Fusion of the lysosomes with the phagosomes containing the streptococci occurs normally in the cells, and proceeds in both the presence and absence of specific antibody . The organisms are resistant, however, to the microbicidal agents of lysosomes . A significant role is demonstrated for specific antibody in "masking" protective determinants on the bacterial surface during the destruction of these organisms by neutrophils . The relevance of antibody entry into neutrophils in relation to the treatment of bacterial infection is discussed.

J Emerg Med, 1984, 1(3), 195 - 9
Facial and periorbital cellulitis in children; Barkin RM; Facial and periorbital cellulitis require emergent recognition and treatment . Hemophilus influenzae type B is the most common pathogen, with Streptococcus pneumoniae being cultured less frequently . Infections following injury are usually caused by Staphylococcus aureus and group A streptococci . Initial evaluation must exclude more severe orbital involvement . Appropriate bacteriological specimens should be obtained . Management requires parenteral antibiotics and careful monitoring for a clinical response or dissemination to other sites of infection.

Gerontology, 1984, 30(5), 316 - 26
Infective endocarditis in the aging patient; Cantrell M et al.; Infective endocarditis has become a disease affecting primarily elderly persons . The etiology of infective endocarditis in the elderly is predominantly streptococci and staphylococci . The clinical features of this infection in the aged may be atypical or nonspecific, which often leads to delays in diagnosis . Mortality is extremely high for elderly patients with infective endocarditis.

Med Microbiol Immunol (Berl), 1984, 173(1), 19 - 27
Guanidine extraction enhances the binding of human fibrinogen to group-B streptococci; Chhatwal GS et al.; Treatment of group-B streptococci with guanidine chloride significantly enhanced their capacity to bind 125I-labelled fibrinogen . The increase in binding activity was almost proportional in the range of 0.05 M to 6 M guanidine chloride . Repeated extractions with guanidine chloride further increased the capacity of B streptococci to bind the labelled fibrinogen . On the other hand, urea, even at concentrations up to 8 M, did not alter the fibrinogen binding . The enhancement was most pronounced with B streptococci of serotypes III and III-R . Cultivation of these streptococci in Baker and Kasper medium, which is known to stimulate formation of microcapsules, reduced 125I-fibrinogen binding . Subsequent treatment with guanidine increased their binding activity, presumably by facilitating the accessibility of the binding sites.

Acta Chem Scand B, 1984, 38(1), 5 - 14
Synthesis of analogs of D-Ala-D-Ala as potential inhibitors of bacterial cell wall biosynthesis; Hagen EA et al.; The syntheses of the L,L- and D,D-stereoisomers of N- phenoxyacetyl -X-alanine in which X = Ser, Ala( beta Cl ) or Arg, are described . The antibacterial activity of these peptides and some of their synthetic intermediates has been examined . Four of the intermediates in which X = Ala( beta Cl ) and Arg(NO2), which possess C-terminal benzyl ester groups, were active against viridans streptococci and Streptococcus agalactiae . The D,D-enantiomers were more active than the corresponding L,L-isomers . None of the compounds were active against beta-lactamase producing bacteria or acted as beta-lactamase inhibitors.

Vet Med Nauki, 1984, 21(2), 91 - 5
{Streptococci and staphylococci in raw cow's milk on the market}; Mladenov M et al.; Studied were a total of 649 batches of raw cow milk produced on 42 farms, and 1100 flushing samples taken from 370 containers for the presence of pathogenic streptococci and staphylococci . It was found that 26.5 per cent, resp., 18.03 per cent of the batches contained coagulase-positive staphylococci and pathogenic streptococci (in 8.94 per cent--Str . agalactiae, in 6.0 per cent--Str . uberis, and in 3.08 per cent--Str . dysgalactiae ) . In 28.3 per cent of the batches there were both strepto - and staphylococci that had pathogenic character . The study of the flushing material showed that the cleaning of containers for shipping the milk from the farms to the dairy processing enterprises was effective--only 1.62 per cent of the cisterns were contaminated with pathogenic strepto - and staphylococci.

Microbios, 1984, 40(159), 7 - 14
Polysaccharide storage in different streptococci; McFarland CR et al.; Calf serum, pooled human plasma, polyvinylpyrollidones (PVP) and polyethylene glycols (PEG) were required as medium components by many cultures of group A.S . pyogenes for intracellular polysaccharide accumulation . These supplements produced a stabilizing effect, probably at the cell surface, and were not associated with nutrition during intracellular iodophilic polysaccharide (IPS) storage . Medium stabilization and the presence of maltose or maltose yielding polysaccharides was found to be a property unique to the group A streptococci . Cariogenic streptococci and Streptococcus agalactive did not require medium stabilization for IPS storage although addition of PVP or PEG was stimulatory . Different degrees of IPS storage in group A.S . pyogenes was found to be strain related and probably dependent on the size and degree of branching of the storage polymer.

Microbiologica, 1984 Jan, 7(1), 75 - 8
Group B streptococci: extracellular neuraminidase production and virulence in mouse; Orefici G et al.; Neuraminidase production by reference strains of various group B streptococci serotypes was investigated before and after serial passages in mouse . The enzyme production was tested in culture filtrates using bovine submaxillary mucin as substrate . Although passages in mouse markedly increased the virulence of all the strains it was not possible to demonstrate a relationship between the increased virulence and the enzyme production.

Clin Nephrol, 1984 Jan, 21(1), 21 - 8
Extracellular neuraminidase production of streptococci associated with acute nephritis; Mosquera J et al.; The possibility that streptococcal neuraminidase has a pathogenic role in acute poststreptococcal glomerulonephritis is reviewed . Experimental and clinical evidence suggesting autologous immune phenomena and anti-Ig reactivity in this disease is discussed . Neuraminidase may also induce sialic acid depletion that would be expected to result in changes of the electrical charge in the immune complex as well as in the glomerular polyanion filtration barrier . The nature of these changes will facilitate penetrability of material with nephritogenic potential . Neuraminidase production was detected in the majority of streptococcal isolates obtained from patients with glomerulonephritis and the best substrate for screening purposes appears to be bovine submaxillary gland mucin . On the basis of available evidence, it is suggested that the development of glomerulonephritis after streptococcal infection probably does not depend on neuraminidase production by the bacteria; however, this enzyme may be responsible for the anti-Ig reactivity demonstrated in some patients and thereby influence the course of the disease.

Pathol Biol (Paris), 1984 Jan, 32(1), 35 - 9
{Antibiotic sensitivity of Streptococcus group B}; Borderon JC et al.; The minimal inhibitory and bactericidal concentration of 18 antibiotics for 412 isolates of group B streptococci from newborns, mothers or pregnant women were determined . 3.2% of these strains were less susceptible to penicillin G, 1% failed to be inhibited by erythromycin and 1% by chloramphenicol . Antibiotic-killing kinetics was studied with beta-lactams, aminoglycosides, and in combination for 20 isolates . Killing was accelerated by the combination . For these reasons, at least at the beginning of the treatment, the association of ampicillin and an aminoglycoside can be recommended.

J Lab Clin Med, 1984 Jan, 103(1), 34 - 43
Bacterial adherence to fibronectin and endothelial cells: a possible mechanism for bacterial tissue tropism; Vercellotti GM et al.; In the pathophysiology of endocarditis, bacteria must initially adhere to the endothelial surface components of the cardiac valve before invasion and colonization . The attachment of bacteria to endothelial cell surfaces is dependent on surface characteristics of both the bacteria and the endothelial cell . Fibronectin, a glycoprotein produced by endothelial cells, binds to some bacteria but not all . This report examines bacterial adherence to human endothelial cells and to fibronectin-coated surfaces . Radiolabeled Staphylococcus aureus (Cowan I strain) and viridans streptococci avidly bound to fibronectin-coated surfaces and endothelial cell monolayers . In contrast, gram-negative organisms such as Escherichia coli bound poorly to both substrates . The adherence of S . aureus was dependent on time as well as on the concentration of fibronectin or the endothelial cell number . Bacterial adherence was specific for endothelial cells or fibronectin, since none occurred to plastic or to wells coated with collagen or albumin . The binding of S . aureus to fibronectin or endothelial cells appeared dependent on a bacterial surface protein, since treatment of the bacteria with proteases markedly decreased adherence . S . aureus was not dependent on the protein A or teichoic acid content of the cell wall, but adherence was markedly decreased in bacterial strains that had a carbohydrate capsule . S . aureus pretreated with serum or purified fibronectin manifested enhanced adherence to endothelial cells, suggesting fibronectin-fibronectin interactions . Bacteria specifically attach to endothelial cells and to fibronectin-coated surfaces, which suggests that the ability of a bacterium to attach to these substrates may reflect the propensity to invade and colonize vascular tissues such as cardiac valves.

Pathology, 1984 Jan, 16(1), 79 - 82
Acute tonsillitis in children: microbial pathogens in relation to age; Douglas RM et al.; Tonsil swabs were collected from 248 children (1 through 10 yr) who presented with acute tonsillitis . A beta-hemolytic streptococcus was grown from 129 (53%) of 244 cases and as the sole pathogen from 83 (47%) of 178 cases . Beta-Hemolytic streptococci were especially common over the age of 6 yr (68% of children) relatively uncommon under the age of 4 yr (18%); most (90%) streptococci belonged to group A; 18 streptococcal T types were represented amongst 88 group A strains; the potentially nephritogenic serotypes 4 and 12 were prominent and accounted for 42 (47%) of typable isolates . Eight (8%) of 96 unmatched children (1 through 10 yr) who served as controls were found to be carrying beta-hemolytic streptococci, 5 of which belonged to group A . A virus was grown from 52 (29%) of 182 children and as the sole pathogen from 40 (22%) of 178 children . Only echoviruses (8 serotypes) and adenoviruses (5 serotypes) were common; younger children showed a higher isolation rate of viruses . The clinical picture in children yielding a virus was indistinguishable from that of cases who yielded a beta-hemolytic streptococcus.

Scan Electron Microsc, 1984, (Pt 4), 1793 - 800
Microbial hydroxyapatite formation as a model of proteolipid-dependent membrane-mediated calcification; Boyan BD et al.; The study of calcium hydroxyapatite (HA) formation in bacteria can be used as a model for membrane-associated normal and pathologic calcification in vertebrates . While the ability to deposit HA is common to a wide variety of microorganisms, the characteristic is not universal, even within closely related species (e.g., oral streptococci) . Clues as to why some microorganisms can support HA formation while others cannot have been derived from analysis of calcification of Bacterionema matruchotii . These bacteria form intracellular HA which is crystallographically indistinguishable from bone mineral . Calcification is proteolipid (Pr)-dependent and involves Ca-phospholipid-Pi (CPLX) formation . Crystal deposition follows a defined series of events including changes in Ca:Mg:Pi ratios, membrane lipids, Pr concentration, protein and phospholipid composition, and mineral phase . Comparison with non-calcifiable Actinomyces naeslundii indicates that under appropriate conditions, most Pr-containing membranes can function as nucleating sites . Enrichment of Pr and CPLX in pathologic calcifications and matrix vesicle membranes suggests that similar mechanisms may operate in vertebrate HA formation.

Med Microbiol Immunol (Berl), 1984, 173(3), 145 - 53
Quantitative differences in specific binding of fibrinogen fragment D by M-positive and M-negative group-A streptococci; Schmidt KH et al.; Selected M-positive and M-negative group-A streptococcal strains were investigated with respect to their selective absorption of plasmin fibrinogen degradation products (FDP) in a simple batch technique . After incubation of killed streptococci with the FDP mixture, the centrifuged supernatants were investigated by SDS-electrophoresis and the binding capacity of the strains was calculated by evaluation of the scanning curves of stained gels . It was found that there is a specific uptake of the C-terminal fragment D by both M-positive and M-negative strains . Although the M-positive strains bound more fragment D (30%-80%) than did the M-negative strains (10%-15%), it could be clearly shown that the loss of M-protein was not necessarily linked with a total disappearance of fibrinogen binding activity . Fragment D blocked the agglutination of streptococci by fibrinogen . Washing the streptococci preincubated with FDP with a 0.1 M citric acid, 6 M urea buffer, pH 3.0, restored agglutination . Treatment of FDP-incubated bacteria with this buffer was found to be a means of recovering pure fragment D from streptococcal cells . It is suggested that M-positive and M-negative streptococci have qualitatively similar binding sites . These receptors might be reduced in the M-negative streptococci . Human serum albumin and Tween 20 did not influence the interaction between streptococcus and fibrinogen.

Vopr Onkol, 1984, 30(11), 67 - 71
{Antibodies induced by group A Streptococcus reacting with epidermis elements in patients with basalomas}; Bukhova VP et al.; Microbial mass of cultured streptococci treated with pepsin as an immunosorbent was used for isolation of an immunoglobulin factor which specifically reacted with elements of basal membrane of epidermis of basal cell cancer patients in an immunofluorescence test . The reaction took place in skin bioptates obtained both from the zone of tumor growth and distant regions . Antigens isolated from the basal membrane of skin epithelium of healthy subjects did not react with immunoglobulin factor.

Lancet, 1983 Dec 24-31, 2(8365-66), 1452 - 4
Septicaemia caused by viridans streptococci in neutropenic patients with leukaemia; Cohen J et al.; 10 neutropenic leukaemic patients had septicaemia caused by viridans streptococci, organisms not commonly recognised as opportunist pathogens . 1 patient died; in the remainder recovery was generally dependent on an adequate circulating granulocyte count (seven patients) rather than specific antimicrobial therapy . Seven of the infections were caused by Streptococcus mitis, and seven of the eight strains tested were resistant to cotrimoxazole, which the patients had received as prophylaxis against infection . It is suggested that oral ulceration caused by cytotoxic chemotherapy provided a portal of entry for cotrimoxazole-resistant viridans streptococci . The increasing incidence of infections with gram-positive organisms as a complication of neutropenia prompts a reconsideration of current empirical antimicrobial therapy.

Dtsch Med Wochenschr, 1983 Dec 16, 108(50), 1908 - 14
{Septicemia . Etiology, epidemiology, clinical aspects and prognosis in 446 patients}; Lode H et al.; Between 1979 and 1982 446 patients with clinically and bacteriologically established septicaemia were ascertained in a prospective study in a university hospital complex with 1200 beds . This corresponded to an incidence of 8,4 cases of septicaemia in 1000 admissions . In 47.1% of patients the infection had been acquired as out-patient, 52.9% were hospital-acquired . 53.1% of patients were more than 60 years of age, 71.3% had predisposing underlying diseases or risk factors . Main signs of infection were increased temperatures of more than 38.5 degrees C (77.8%), anaemia and leukocytosis . The fairly equal distribution of gram-positive (207) and gram-negative (200) organisms was remarkable . The most frequently isolated bacterial species were E . coli (25.3%), Staph . aureus (21.8%), streptococci (11.1%), Staph . epidermidis (8.4%), enterococci (8.2%), and Klebsiellae (6.5%) . 29.1% of patients succumbed . Nosocomial disease, liver cirrhosis, underlying malignant diseases, infections with Staph . aureus, enterococci, pneumococci, Pseudomonas aeruginosa and polymicrobial aetiology had an unfavourable prognostic influence . Thus, frequency and mortality of septicaemic diseases remain of unchanged considerable relevance in medical and surgical units . At present, aetiology and treatment will again have to consider gram-negative organisms to an increased extent.

Zentralbl Bakteriol Mikrobiol Hyg {B}, 1983 Dec, 178(4), 364 - 79
{Microbial contamination of hospital waste}; Kalnowski G et al.; Hospital wastes from a surgical department (operating unit, intensive care unit, nursery) and household refuse were examined with respect to their bacterial concentrations and species' pattern . The waste samples were processed by active suspending - a new method in the field of waste examination - which allowed gentle homogenization and quantitative microbial counts . Among several established features the most relevant ones like bacterial concentration and relative frequency of bacterial groups (aerobic bacteria, (facultative) anaerobic bacteria, gramnegative bacteria and D-streptococci) indicated, that hospital wastes were not more contaminated than household refuse . Under this aspect, the present practice of hospital waste management, whose main concern is the spread of infectious agents outside the hospital, deserves a reevaluation.

Diagn Microbiol Infect Dis, 1983 Dec, 1(4), 273 - 5
Effect of pyridoxal on growth of nutritionally variant streptococci and other bacteria on sheep blood agar; Reimer LG et al.; Supplementation of sheep blood agar with pyridoxal hydrochloride or pyridoxamine dihydrochloride aided recovery of nutritionally variant streptococci; however, it was found to prevent recovery of 6 of 173 (3%) primary isolates of Streptococcus pyogenes and to adversely affect laboratory recognition of other streptococci . Pyridoxal hydrochloride or pyridoxamine dihydrochloride should not be a routine supplement in all sheep blood agar.

Herz, 1983 Dec, 8(6), 332 - 43
Cardiac valve replacement in patients with active infective endocarditis; Wilson WR et al.; Since the introduction of effective antimicrobial therapy, the leading cause of death in patients with infective endocarditis is no longer sepsis but, rather, congestive heart failure . The mortality is higher in patients with severe heart failure due to infective endocarditis who are treated with medical therapy only than in those who additionally undergo cardiac valve replacement . The mortality is also higher in patients with severe heart failure due to aortic infective endocarditis (40 to 93%) than in those with heart failure due to mitral infective endocarditis (17 to 66%) . In patients with and in those without infective endocarditis, surgical intervention can be carried out with comparable mortality not only for aortic valve replacement (9 vs 8.4%) but also overall for valve replacement (10 vs 12%) . In patients with class IV heart failure, overall mortality of valve replacement was higher (17%) than in patients with class II (8%) or class III heart failure (7%) and, similarly, comparable with that of matched groups of patients without infective endocarditis . In patients with class IV disability, the mortality of valve replacement was higher in those with active infective endocarditis (19%) than in those with inactive infective endocarditis, possibly due to a higher incidence of sudden onset of severe aortic regurgitation and myocardial abscess . No patient with valve replacement for inactive infective endocarditis developed prosthetic valve endocarditis; a single case of prosthetic valve endocarditis occurred in a patient with active infective endocarditis . In general, early surgical intervention is preferable to procrastination in the management of patients with progressive or severe heart failure due to infective endocarditis . Although, in at least 70% of patients, blood cultures may be rendered sterile within one week of initiation of appropriate antimicrobial therapy, patients with infective endocarditis due to staphylococci, multiply-resistant gram-negative bacilli, fungi, Q-fever or those with myocardial abscess or multiple relapses may require surgical intervention . While the overall incidence of clinically apparent emboli has been reported to be as high as 30%, in a ten-year observation period at the Mayo Clinic, the rate was 5.6% . Patients with echocardiographic evidence of large or mobile vegetations and those with infective endocarditis cause by microorganisms associated with a high risk of embolization such as slow-growing fastidious gram-negative bacilli, fungi (especially Aspergillus) and nutritionally-variant viridans streptococci should be considered candidates for surgery irrespective of a history of emboli.(ABSTRACT TRUNCATED AT 400 WORDS)

Herz, 1983 Dec, 8(6), 311 - 9
{Antibiotic therapy in infectious endocarditis}; Adam D; The most common causes of infective endocarditis, accounting for 65 to 85% of all cases, are viridans streptococci and other nonhemolytic streptococci . Enterococci are the offending microorganisms in 5 to 15%, staphylococci in 5 to 15% and gram-negative bacteria from the intestinal tract in 2 to 6% . In rare cases, infective endocarditis may be caused by any of a number of other pathogenic and nonpathogenic bacteria . Men over 60 years of age and women under 40 have a higher likelihood of contracting enterococcal endocarditis subsequent to febrile infections of the urogenital tract or after abortion; intravenous drug users tend to infections with gram-negative bacteria; patients with intravascular catheters who are administered cortisone, broad-spectrum antibiotics or cytostatic drugs are at risk of endocarditis from Candida or Aspergillus . At least two, but in general, five blood cultures should be drawn in short intervals . With the use of proper techniques for detection of aerobic and anaerobic microorganisms as well as fungi, positive blood cultures can be obtained in 95% of the patients . Antibiotics may be discontinued temporarily in pretreated patients . Bactericidal antibiotics are indicated . The following rule is valid as a guideline for adequate antibacterial chemotherapy: at maximal concentration after antibiotic administration, a bactericidal effect should still be demonstrated after 1:8 dilution of the patient's serum . Prior to receipt of blood culture findings, in forms tending to be subacute, treatment should be directed at streptococci and enterococci . If the course is more acute, in the presence of an intracardiac foreign body or in intravenous drug users, the antibiotic employed should also be effective against staphylococci.(ABSTRACT TRUNCATED AT 250 WORDS)

Br Heart J, 1983 Dec, 50(6), 513 - 9
The microbiology and pathogenesis of infective endocarditis; Bayliss R et al.; Some details of 544 episodes of infective endocarditis occurring in 541 patients during 1981 and 1982 are reported . The mean age of patients was 51.6 years and there was a greater proportion of males (2:1) . Of the 544 episodes 347 (63%) were due to streptococci, 19% to staphylococci, and 14% to bowel organisms . A wide variety of other organisms were responsible for a few cases, and 10% were culture negative . In 60% the portal of entry of the infection could not be ascertained: 19% were probably of dental origin: 16% arose from the alimentary, genitourinary, or respiratory tracts or from the skin or in association with drug addiction, fractures, or pregnancy; the remaining 5% were related to cardiac or other vascular surgery, cardiac catheterisation, haemodialysis, or other procedures involving the blood stream . Seventy-four (14%) of the 541 patients (mean age 59.0 years) died; the mortality was 30% in staphylococcal cases, 14% in infections due to bowel organisms, and 6% in other streptococcal infections . One hundred and seventy-one (32%) of the patients appeared to have had normal hearts before the onset of illness and another 59 (11%) had cardiac lesions not previously recognised . The aortic valve was the most common site of infection . Ninety (17%) of the patients had prosthetic valves or had undergone other cardiac surgery while 34 (6%) had had a previous episode of infective endocarditis . Nine (1.6%) episodes were not diagnosed until necropsy or operation and 34 (6.3%) required urgent valve replacement.

Antimicrob Agents Chemother, 1983 Dec, 24(6), 871 - 5
Resistance to penicillin-streptomycin synergy among clinical isolates of viridans streptococci; Farber BF et al.; Viridans streptococci are thought to be highly susceptible to penicillin and streptomycin . We recently encountered a unique group of 15 isolates from South Africa epidemiologically related to the isolation of penicillin-resistant pneumococci . These organisms were highly resistant to penicillin (PCN) (minimal inhibitory concentration, 1 to 32 micrograms/ml) and streptomycin (SM) (minimal inhibitory concentration, greater than or equal to 2,000 micrograms/ml) . Two additional organisms with high-level streptomycin resistance were identified when 168 clinical isolates from Boston were screened . Time-kill studies with four organisms resistant to high levels of SM demonstrated lack of synergy between PCN and SM but marked synergy between PCN and gentamicin . Adenylylating, acetylating, and phosphorylating activity could not be detected in three organisms studied, and novobiocin failed to cure the SM resistance . Protein synthesis by ribosomes isolated from these organisms was dramatically reduced in the presence of gentamicin but was relatively resistant to inhibition by SM.

NIPH Ann, 1983 Dec, 6(2), 119 - 23
Serotyping and bacteriophage typing of group B streptococci; Haug RH et al.; Three hundred and eighty-two human streptococcal strains of serogroup B, collected from different sources and from different parts of Norway have been serotyped and phagetyped . The results of serotyping show a predominance of serotype Ia; 150 strains belonged to this type . Only 32 strains belonged to serotype III, a serotype well-known as the dominating cause of neonatal septicemia and meningitis (11, 23) . The other serotypes were evenly represented . The phagetyping was performed by the procedure and with phages described by Stringer (19) . The strains were lysed by phages at a frequency of 70% . A total of 145 strains (38%) was lysed by one or two phages, while 124 strains (32%) were typable by different phage patterns . When combined with serotyping, phagetyping of group B streptococci is an important tool in characterizing these microbes for epidemiological and other purposes.

Zh Mikrobiol Epidemiol Immunobiol, 1983 Dec, (12), 45 - 6
{Streptococcus group A L-form survival in mouse peritoneal macrophages}; Neustroeva VV et al.; The survival of the L-forms of group A streptococci in peritoneal macrophages of SHR mice has been studied microbiologically and by the method of indirect immunofluorescence in vitro and in vivo . The phagocytosis of the L-forms, proceeding more actively in vivo, has been found to occur within 1-3 days after inoculation . The preservation of some viable L-forms in macrophages for 6-7 days may apparently facilitate their persistence in the body.

J Antimicrob Chemother, 1983 Dec, 12(6), 599 - 606
In-vivo protection of group A beta-haemolytic streptococci from penicillin by beta-lactamase-producing Bacteroides species; Brook I et al.; The incidence of persistent group A beta-haemolytic streptococci in tonsils, despite penicillin therapy, has increased in recent years . beta-Lactamase-producing organisms have previously been recovered from 74% of patients with persisting group A streptococci . We investigated the possibility that beta-lactamase-producing strains of Bacteroides spp . can protect streptococci from penicillin . A mixed infection was induced in mice in the form of a subcutaneous abscess involving a penicillin-susceptible group A streptococcus, and a beta-lactamase-producing strain of either Bact . melaninogenicus or Bact . fragilis . The infected animals were treated for seven days with parenteral penicillin, penicillin and clavulanic acid or clindamycin . Penicillin treatment prevented the formation of abscesses in animals inoculated with group A streptococci alone, but not in those inoculated with group A streptococci and Bacteroides spp . We attributed this resistance to penicillin therapy, and the subsequent formation of abscesses in mice, to protection of the streptococci from penicillin by beta-lactamase-producing strains of Bacteroides spp . Effective therapy for mixed infections was achieved when clavulanic acid, a beta-lactamase inhibitor, was administered with penicillin . A similar effect was noted with clindamycin, which is active against both group A streptococci and Bacteroides spp.

Herz, 1983 Dec, 8(6), 320 - 31
Prosthetic valve endocarditis: an overview; Gnann JW et al.; Infection of an intracardiac prosthesis, the incidence of which is about 2.5% among patients having undergone valve replacement, is a serious complication with considerable morbidity and mortality . Early prosthetic valve endocarditis (PVE), with an onset within 60 days of valve replacement, accounts for approximately one-third of all cases, while the remaining two-thirds, occur more than two months postoperatively (late prosthetic valve endocarditis) . Prosthetic valve endocarditis is most commonly caused by Staphylococcus epidermidis, less frequently by viridans streptococci, Staphylococcus aureus, and gram-negative bacilli . The most likely pathogenetic mechanisms in prosthetic valve endocarditis are intraoperative contamination and postoperative infections at extracardiac sites . Prominent clinical features include fever, new or changing heart murmurs, leukocytosis, anemia and hematuria . The etiologic microorganism can be isolated in more than 90% of all cases . Patients with proven prosthetic valve endocarditis should be examined daily to detect signs of congestive heart failure and changes in murmurs; electrocardiographic monitoring is essential for documentation of arrhythmias . With limitations, echocardiography, especially two-dimensional, may help to demonstrate vegetations or valvular dehiscence . Cinefluoroscopy may reveal loosening or dehiscence of the sewing ring or impaired motion of a radio-opaque poppet due to thrombus or vegetation . Cardiac catheterization, not always necessary even when surgical intervention is anticipated, may provide valuable information on the degree of dysfunction, multiple valve involvement, left ventricular function and extent of concomitant coronary artery disease . In patients with mechanical valves, prosthetic valve endocarditis may be associated with a high incidence of valve ring and myocardial abscesses; the reported frequency of valve ring abscesses is lower with porcine heterografts . Infections on mechanical valves characteristically localize to the sewing ring with subsequent detachment of the prosthesis and valvular incompetence; infections on porcine heterografts tend to localize to the cusps, leading to valvular incompetence because of leaflet destruction . Large vegetations may result in functional stenosis . Over the last ten years the overall mortality of prosthetic valve endocarditis was 53.8%; 73.6% in early and 43% in late prosthetic valve endocarditis . More recently, however, the survival rate appears to be improving . In general, the mortality associated with prosthetic valve endocarditis caused by fungi and Staphylococcus aureus is highest and that of streptococci lowest.(ABSTRACT TRUNCATED AT 400 WORDS)

Pediatr Res, 1983 Dec, 17(12), 1002 - 8
Pulmonary hemodynamic and ultrastructural changes associated with Group B streptococcal toxemia in adult sheep and newborn lambs; Rojas J et al.; A toxin isolated from Group B beta-hemolytic streptococci, Type III was infused into adult sheep and newborn lambs . A two-phased reaction was observed . There was an initial phase of pulmonary hypertension and high flow of protein-poor lymph . This was followed by a second phase when pressures returned to baseline but lymph flow remained twice the baseline values and protein concentration in lymph increased . During the second phase there was a significant increase in lymph protein clearance, suggestive of increased microvascular permeability to protein . The absolute granulocyte count decreased to 10% of baseline values by 60 min after the infusion, and was followed by a variable return to baseline . The sheep with the largest changes in protein clearance were those who had the slowest return to baseline values . Pathologic examination of lung tissue revealed there was capillary dilation, interstitial edema, and large numbers of granulocytes in the lungs . The basement membranes of both capillaries and arterioles showed disruption and widening, along with fragmentation of the internal elastic membrane . This study provides morphologic and physiologic evidence of increased pulmonary vascular permeability after injection of streptococcal toxin associated with granulocyte trapping in the lung . We postulate that granulocytes may be involved as mediators of the pulmonary vascular injury.

J Dent Res, 1983 Dec, 62(12), 1209 - 11
Enhancement of Streptococcus mutans colonization by direct bonded orthodontic appliances; Mattingly JA et al.; Patients undergoing orthodontic therapy were evaluated for longitudinal changes in relative S . mutans numbers in plaque at discrete sites on the tooth surface associated with direct bond appliances . There was a significant linear increase in the percentage of S . mutans in the total streptococci isolated from the last pre-bracket sample through the last bracket sample.

J Clin Pathol, 1983 Dec, 36(12), 1353 - 6
Detection of penicillin tolerance in streptococci; Slater GJ et al.; "Tolerance" to penicillin in streptococci was investigated by two different techniques . Of 70 strains examined, 35 appeared tolerant in conventional titrations and 31 appeared tolerant when tested by a recently-described disc method . There was 88% agreement between the two methods, but the disc test failed to detect tolerance shown by titrations in six strains of streptococci, including three beta-haemolytic strains belonging to Lancefield's group D . A significant relationship was observed between tolerance and Eagle's optimum dosage effect: 71% of tolerant strains examined displayed the Eagle effect, whereas only 17% of non-tolerant strains exhibited the effect.

J Bacteriol, 1983 Dec, 156(3), 1059 - 65
Streptococcal hyaluronic acid: proposed mechanisms of degradation and loss of synthesis during stationary phase; van de Rijn I; Streptococcal hyaluronic acid was found to distribute into two discrete sizes . Cellular hyaluronic acid from strain D181 had an average molecular weight of 10 X 10(6), whereas the average molecular weight of extracellular hyaluronic acid from the same strain was 2 X 10(6) . Cellular streptococcal hyaluronic acid was purified to homogeneity . Proteases were unable to cleave the purified cellular polymer, indicating that a peptide was not involved in cross-linking five extracellular hyaluronate polymers to form a cell-bound complex . Lipids apparently are not part of the cellular hyaluronic acid because phosphorus and glycerol were not detected by radioisotopic techniques, and denaturing conditions did not change the size of the polymer . Membranes obtained from various strains of group A and C streptococci cleaved the cellular form of the hyaluronate polymer demonstrating the presence of a membrane-bound hyaluronidase-like activity . By contrast, this activity was not found in the extracellular products of the strains studied . Furthermore, membranes derived from streptococci at the stationary phase of growth no longer had the capacity to synthesize hyaluronic acid . The loss of this property appeared to be due to changes in the structure of the membrane.

Arch Otolaryngol, 1983 Dec, 109(12), 818 - 20
Bacteroides melaninogenicus . Its recovery from tonsils of children with acute tonsillitis; Brook I et al.; The presence of encapsulated and abscess-forming organisms belonging to the Bacteroides melaninogenicus group was investigated in 25 children with acute tonsillitis, and in 23 children without tonsillar inflammation (control) . Encapsulated organisms of the B melaninogenicus group were found in 23 of 25 children with acute tonsillitis as compared with five of 23 controls . Subcutaneous inoculation into mice of the Bacteroides strains isolated from patients with tonsillitis produced abscesses in 17 of 25 instances, as compared with nine of the 23 of the controls . Group A streptococci were recovered from the tonsils of five children with tonsillitis and from four of the control group . These findings suggest a possible pathogenic role for the B melaninogenicus group in acute tonsillar infection in children.

N Engl J Med, 1983 Nov 10, 309(19), 1149 - 54
Sphenoid sinusitis . A review of 30 cases; Lew D et al.; We studied 30 patients with infectious sphenoid sinusitis (15 acute cases and 15 chronic cases) in an effort to characterize the clinical presentation, bacteriology, and associated complications of this frequently misdiagnosed infection . Severe frontal, temporal, or retro-orbital headache that radiated to the occipital regions or pain in the trigeminal (V1 to V3) distribution or both were the most prominent presenting symptoms . In acute cases, purulent exudate was frequently seen in the middle and superior nasal turbinates . Computerized axial tomography or sinus tomography and cannulation of the sphenoid sinus proved to be the most useful diagnostic studies . Organisms detected in acute cases included streptococci other than Streptococcus pneumoniae (41 per cent), Staphylococcus aureus (29 per cent), and Str . pneumoniae (17 per cent) . In chronic infections, gram-negative bacilli (43 per cent) and staphylococcal species (24 per cent) were the predominant organisms . In acute disease, early diagnosis and aggressive therapy, including surgical drainage, were important . Delay in treatment was always associated with serious morbidity or mortality . Fatal complications included cavernous sinus thrombosis and bacterial meningitis.

S Afr Med J, 1983 Nov 5, 64(20), 779 - 81
Pharyngeal carriage of group A beta-haemolytic streptococci in coloured and Indian schoolchildren; Ransome OJ et al.; Throat swabs for group A beta-haemolytic streptococci were taken from 120 Coloured children and 126 Indian children at approximately 3-monthly intervals during 1980 . The prevalence of positive throat swabs was related to crowding at home as measured by the number of people per bedroom . Coloured homes were much more crowded than Indian homes, but no statistical relationship was found between the number of persons per bedroom and the positivity rates . Both groups of children had high positivity rates in summer (24,4% and 21,3% for Coloureds and Indians respectively) but low rates in spring (4,3% and 3,4% respectively) . These positivity rates do not support the provision of primary prophylaxis against acute rheumatic fever for these children.

JAMA, 1983 Nov 4, 250(17), 2318 - 22
Apparent failures of endocarditis prophylaxis . Analysis of 52 cases submitted to a national registry; Durack DT et al.; Fifty-two cases of apparent endocarditis prophylaxis failure were reported to a national registry established by the American Heart Association (AHA) . Mitral valve prolapse was the single most common underlying cardiac lesion (17 cases, 33%), followed by various congenital abnormalities (15 cases, 29%) and rheumatic heart disease (11 cases, 21%) . Ten patients (19%) had prosthetic valve endocarditis . Forty-eight cases (92%) occurred after a dental procedure . Symptoms began within two weeks after the procedure suspected to have caused endocarditis in 50% and within five weeks in 79% . Thirty-nine cases (75%) were caused by viridans streptococci and seven (14%) by Staphylococcus aureus . Most patients received oral penicillin as prophylaxis . Only six patients (12%) received regimens currently recommended by the AHA . In 27 (63%) of the 43 cases for which antimicrobial susceptibility data were available, the infecting microorganism was sensitive to the antibiotic(s) used for prophylaxis . After diagnosis of endocarditis, the prognosis for bacteriologic cure was good; 47 patients (90%) were cured, of whom seven underwent valve replacement . These data indicate that endocarditis prophylaxis failures may be more common than was previously believed and that failures occur even when the infecting organism is susceptible to the antibiotics used . Most antimicrobial regimens used in patients with prophylaxis failures did not conform to current recommendations.

J Gen Microbiol, 1983 Nov, 129 ( Pt 11), 3427 - 31
Streptococcus garvieae sp . nov . and Streptococcus plantarum sp . nov; Collins MD et al.; Biochemical and chemotaxonomical studies were performed on some streptococci from frozen peas and bovine mastitis in an attempt to clarify their taxonomy . The results of the present and earlier studies indicate the pea and mastitis isolates represent two new species of the genus Streptococcus . The isolates from frozen peas are named Streptococcus plantarum sp . nov . and those from mastitis, Streptococcus garvieae sp . nov . The type strains are NCDO 1869 and NCDO 2155, respectively.

Antimicrob Agents Chemother, 1983 Nov, 24(5), 771 - 6
Effects of antibiotic treatment of nonlactating dairy cows on antibiotic resistance patterns of bovine mastitis pathogens; Berghash SR et al.; Antibiotic resistance patterns of the major groups of bovine mastitis pathogens (Streptococcus agalactiae, other streptococci, Staphylococcus aureus, and Staphylococcus epidermidis) were examined by determining the minimum inhibitory concentration (MIC) of 13 different antibiotics against bacterial isolates from dairy cattle . The bacterial strains were obtained from milk samples from each cow in 21 New York state dairy herd surveys . In 12 herd surveys (high antibiotic-use group), all 365 cows received antibiotic infusions into the udder at the cessation of each lactation cycle . The 324 animals in the other nine herd surveys (low antibiotic-use group) did not routinely receive antibiotics during the nonlactation period . The MICs from the two groups were compared by calculating for each bacterial group the average MIC, the antibiotic concentration necessary to inhibit 90% of the isolates, and the antibiotic concentration necessary to inhibit 50% of the isolates . Increased resistance to all 13 antibiotics was observed with Streptococcus agalactiae isolates from the high antibiotic use herds . However, there was relatively little difference between the two groups in the resistance patterns of the other bacterial species examined . The most important finding of the study was the identification of a multiple beta-lactam resistance phenotype in Streptococcus agalactiae.

Antonie Van Leeuwenhoek, 1983 Nov, 49(4-5), 353 - 60
Virulence of beta-hemolytic and non-hemolytic Streptococcus mutans: lethal dose determinations in neonatal mice; Woltjes J et al.; The virulence of beta-hemolytic and non-hemolytic strains of Streptococcus mutans was studied in neonatal mice by LD50 determinations after intracerebral injection of the bacteria . Although the differences in LD50 values are small the results may indicate that beta-hemolytic S . mutans strains (mean LD50 of 6.3 X 10(7) c.f.u.) were more virulent than non-hemolytic S . mutans strains (mean LD50 of 47.7 X 10(7) c.f.u.) . The LD50 values of other viridans streptococci varied between 4.8 and 10(7) c.f.u . Strains of S . pyogenes and S . agalactiae were highly virulent in this animal model with LD50 values lower than 10(5) c.f.u.

J Med Microbiol, 1983 Nov, 16(4), 497 - 9
Clinical comparison of glucose broth with nutrient broth blood cultures for the detection of "Streptococcus viridans" bacteraemia; Shanson DC et al.; Viridans streptococci were isolated from the blood stream of half of 50 patients undergoing dental extractions approx . 2 min before blood culture . Glucose and nutrient broths were tested in parallel . There was no significant difference between the isolation rates of streptococci by the two methods after incubation for 7 days, nor did the addition of glucose 0.1% to nutrient broth significantly increase the speed of detection of streptococci; the isolation rates of streptococci during the first 48 h of incubation were similar with both types of broth . Although there were a few more isolations of streptococci from the glucose broth than from the nutrient broth during the first 20 h, the difference was not statistically significant . No rapid lethal effect against streptococci was observed in glucose broth during incubation for 7 days . These results suggest that adding glucose 0.1% to nutrient broth for blood culture does not influence the recovery of organisms from patients with "Streptococcus viridans" bacteraemia after incubation of the broth for 2-7 days.

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