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 . Bacte