Microb Pathog, 2002 Apr, 32(4), 191 - 204 Streptococcus anginosus adheres to vascular endothelium basement membrane and purified extracellular matrix proteins; Allen BL et al.; The mechanisms of bacterial adherence in the initial stages of native valve endocarditis are unclear, especially in patients without valve disease or the presence of a platelet-fibrin thrombus . Extracellular matrix may act as a ligand in areas of exposed basement membrane on the endothelial monolayer . In this study, adherence of 55 clinical blood and 21 oral viridans streptococcal isolates was examined using purified extracellular matrix compounds . The majority of blood and oral isolates exhibited adherence to purified laminin, fibronectin, and fibrinogen, with lesser adherence to type I and IV collagens . Adherence to laminin and fibronectin was concentration dependent, saturable, and competitively inhibited with soluble ligand . A Streptococcus anginosus isolate and other viridans strains exhibiting a strong laminin adherence phenotype bound extensively to the endothelial aspect of human and porcine valve tissue sections and were inhibited by soluble laminin and anti-laminin antibody fragments . Using a novel native porcine valve explant adherence model, we localized binding to areas of exposed basement membrane by confocal and scanning electron microscopy . These studies support the hypothesis that bacterial adherence to exposed basement membrane plays a role in the initial phase of native valve endocarditis . Chang Gung Med J, 2002 Apr, 25(4), 266 - 70 Oral wooden stick injury complicated by meningitis and brain abscess; Chang CJ et al.; Meningitis is rarely seen following oral injury . We describe a 3-year-old boy developing meningitis and brain abscess following a penetrating oral wooden stick injury . There was no cerebrospinal fluid rhinorrhea noted . A cerebrospinal fluid culture yielded viridans streptococcus . Brain magnetic resonance imaging and computed tomography revealed a multiloculated ring-enhancing mass . This patient underwent surgical drainage and completed 8-week antibiotic therapy . The patient demonstrated a late and dismal complication of a penetrating oral injury . At 2-year follow-up the patient was in good condition . A penetrating oral wooden stick inury should be regarded as potentially serious. Implant Dent, 2002, 11(2), 162 - 9 Crestal bone loss around submerged and exposed unloaded dental implants: a radiographic and microbiological descriptive study; Barboza EP et al.; The successful maintenance of crestal bone surrounding dental implants is imperative for long-term implant success . Crestal bone loss is reportedly related to stress . However, early perforation and partial exposure of the implant's covering device are a focus for plaque accumulation, which, if left untreated, may result in inflammation . The objective of this study was to evaluate the crestal bone levels adjacent to submerged and exposed unloaded dental implants during the initial healing phase . In addition, the microbiota around exposed implants were studied . Bilateral implants were placed in the mandible of 10 patients . In one quadrant, the implants were covered by the flap . In the other quadrant, the flap was sutured, leaving the cover screws completely exposed . Standardized periapical radiographs were obtained at implant placement and 4 months later . Radiographs were digitalized, aligned, and analyzed with a computer-assisted method . Cultures were obtained from exposed implant sites . All patients showed more crestal bone loss around exposed dental implants compared to submerged implants . Prevotella sp., Streptococcus beta-hemoliticus, and Fusobacterium sp . were the microorganisms identified in most of the sites . The exposure of the implant covering device created foci for bacterial plaque accumulation, which may have facilitated periimplant crestal bone loss . The initial healing phase follow-up may be critical for implant success. Hua Xi Kou Qiang Yi Xue Za Zhi, 1998 Feb, 16(1), 76 - 9 {Study on the adhesion of an endemic strain of Streptococcus mutans serotype C to acquired pellicle . II . Isolation and extraction of adhesins of an endemic strain of Streptococcus mutans serotype C}; Zhan L et al.; Surface proteins of S . mutans WD9463 A(c) were separated by DEAE-Sephadex A25 Chromatography and Sepharose C1-6B Chromatography . The adhesins were distinguished by bacterial adhesin inhibition experiment and were identified by PAGE, SDS-PAGE, IEP-PAGE, immunol diffusion test, GTF activity test and annalization of the sorts of amino acid . The results showed P1, two proteins with molecular weight of 117 kD and 127 kD and two proteins with GTF activity could inhibit the adhesion effectively . On the other hand, another kind of GTF could improve the adhesion of the strain . These indicated that S . mutans may be many kinds of adhesins. Hua Xi Kou Qiang Yi Xue Za Zhi, 1998 Feb, 16(1), 73 - 5 {Study on the adhesion of an endemic strain of Streptococcus mutans serotype C to acquired pellicle . I . A comparison of the methods to extract adhesins from Streptococcus mutans}; Zhan L et al.; The adhesins of S . mutans serotype c endemic strain WD9463A were extracted from culture superant by cold ethol precipitation, or were extracted from cell surface by 0.5 mol/L phosphate buffer, 6 mol/L urea or 2% SDS solution . The composition and adhesive activities of the extracts were compared by SDS-PAGE and bacterial adhesion inhibition experiments . The results showed that the protein composition of the four extracts were similar, and all extracts inhibited the adhesion of the endemic strain dramatically . It indicates that four methods can be used to extract adhesins of S . mutans, but extracting adhesins from culture superant is better than the others. FEMS Microbiol Lett, 2002 Jun 18, 212(1), 133 - 8 The membrane-associated F(0)F(1) ATPase is essential for the viability of Streptococcus pneumoniae; Ferrandiz MJ et al.; Genetic studies aimed at eliminating expression of the atp operon (F(0)F(1) H(+)-ATPase) of Streptococcus pneumoniae by genetic disruption of atpC, the first gene of the operon, with a chloramphenicol-resistance cassette were performed . Resistant transformants were obtained only when the recipient strain had a duplication of atpC, recombination occurring in such a way that transcription of the operon from its own promoter was allowed . These results imply that the atp operon is essential for the viability of the cells. Clin Ther, 2002 May, 24(5), 818 - 34 Length of hospital stay and cost of Staphylococcus and Streptococcus infections among hospitalized patients; Zhao SZ et al.; BACKGROUND: Staphylococcus (Staph) and Streptococcus (Strep) infections are important causes of morbidity and mortality worldwide . The economic burden of these infections is also significant, especially among hospitalized patients . OBJECTIVE: The aim of this study was to estimate length of hospital stay (LOS) and total payments for hospital admissions for patients with Staph or Strep infection as a first (primary) or second or higher (comorbid) diagnosis . METHODS: From the 1994-1997 MarketScan inpatient database, admissions with Staph (n = 2,042) or Strep (n = 1,401) infection (905 as primary and 2,538 as comorbid diagnosis) and 89,899 control admissions without a diagnosis of gram-positive infection were identified . Crude and category-specific mean LOS and anti-log mean total payments were compared between admissions with Staph or Strep infection and admissions without a diagnosis of any gram-positive infection within major diagnostic categories and principal surgical procedures (SPs) . RESULTS: For admissions with Staph or Strep infection as first (primary) diagnosis (n = 905), the mean LOS was 4.68 days (95% CI, 4.44-4.93) and 4.78 days (95% CI, 4.35-5.26), respectively . The mean total payments were $6,445 (95% CI, $6,045-$6,870) and $6,821 (95% CI, $6,149-$7,566), respectively . In contrast, the average LOS and total payment for the control group were 2.99 days (95% CI, 2.98-3.01) and $6,325 (95% CI, $6,284-$6,365) . For admissions with infection as the comorbid diagnosis (n = 2,538), mean LOS and total payment were 4 days longer and $6,000 higher for Staph infections and 1.2 days longer and $1,200 higher for Strep infections than the control group . Within each SP, LOS and total payments were substantially higher for patients with Staph and Strep infections . Conclusions: The results of this study indicate that infections with the pathogens Staph and Strep substantially increase LOS and total payments among hospitalized patients. Pediatr Infect Dis J, 2002 Apr, 21(4), 297 - 303 Comparison of two dosages of azithromycin for three days versus penicillin V for ten days in acute group A streptococcal tonsillopharyngitis; Cohen R et al.; BACKGROUND: Three-day, 10 mg/kg/day azithromycin (AZM) studies in pediatric acute group A streptococcal tonsillopharyngitis have shown contradictory bacteriologic results . This study investigates the efficacy and tolerability of two dosages of 3-day azithromycin (20 mg/kg/day and 10 mg/kg/day) compared with 10-day penicillin V . METHODS: This was a prospective, comparative, randomized, multicenter trial . Children were scheduled to return for visits at 14 days (main end point) and 1 month after the onset of treatment for clinical and bacteriologic assessment . Molecular tools were used to compare pre- and posttreatment group A beta-hemolytic Streptococcus (GABHS) isolates . RESULTS: Between November, 1997, and July, 1998, 501 patients (169 AZM 10 mg, 165 AZM 20 mg, 167 penicillin V) between 2 and 12 years old were enrolled; 500 were assessable for safety, 469 for intent to treat analysis and 420 for efficacy in the per protocol analysis . Before treatment 25 (7.9%) of 315 GABHS stains isolated from patients receiving AZM were resistant to this compound . On Day 14 pretreatment GABHS were eradicated from 78 (57.8%) of the 135 children receiving the AZM 10 mg regimen, 131 (94.2%) of the 139 receiving AZM 20 mg and 123 (84.2%) of the 146 taking penicillin . One month after the outset of treatment, bacteriologic relapses were observed in 40.5% (n = 30) of the children receiving AZM 10 mg, 14.8% (n = 18) of children taking AZM 20 mg and 13.2% (n = 15) of those treated with penicillin V . AZM 20 mg/kg/day was statistically superior to AZM 10 mg/kg/day microbiologically on Day 14 (P = 0.0001) and Day 30 (P = 0.0001) and clinically on Day 14 (P = 0.0035) . AZM 20 mg/kg/day was statistically equivalent both microbiologically and clinically to standard therapy with penicillin V at all endpoints . The incidence of treatment-related adverse events was similar in the two azithromycin groups {AZM 10 mg, 31 of 169 (18.3%); AZM 20 mg, 37 of 164 (23%)} but significantly higher than those observed in the penicillin V group {5 of 166 (3%); P < 0.0001} . Most treatment-related adverse events were gastrointestinal and of mild-to-moderate severity . Fourteen patients withdrew from the trial because of adverse events (1 in the penicillin V group, 7 in the AZM 10 mg group and 6 in the AZM 20 mg group) . CONCLUSION: This is the first study to demonstrate a daily dose-dependent difference in microbiologic efficacy of a regimen; 3-day AZM 20 mg/kg/day is a more effective regimen than 3-day AZM 10 mg/kg/day for pediatric GABHS tonsillopharyngitis. Pediatr Infect Dis J, 2002 Apr, 21(4), 278 - 82 Invasive pneumococcal infections in children with asplenia; Schutze GE et al.; BACKGROUND: Asplenia is associated with an increased risk of infections caused by Streptococcus pneumoniae . Overwhelming infection can be fulminate and lead to a fatal outcome . OBJECTIVE: To review the epidemiology and clinical course of invasive S . pneumoniae infections in children with asplenia before the release of the conjugate pneumococcal vaccine . METHODS: Children with S . pneumoniae infections from eight children's hospitals in the US were identified prospectively from September, 1993, to August, 1999 . Further demographic, medical and microbiologic information was gathered retrospectively from the charts of patients with asplenia . RESULTS: Twenty-two asplenic patients with 26 episodes of invasive S . pneumoniae were identified . This represents 1% of the 2,581 episodes of invasive S . pneumoniae infections identified in our study . Twelve had congenital asplenia (CA), and 10 had undergone surgical splenectomy . Nine of the patients with CA had associated complex congenital heart disease . The median age at first infection was 12.5 months for CA patients as compared with 69 months in children with surgical splenectomy (P < 0.001) . Seventy-five percent of those eligible had received the polysaccharide pneumococcal vaccine . The most common serotypes isolated were 6B (8), 23F (7), 18C (2) and 19A (2) . Antimicrobial prophylaxis had been prescribed for 82% of the study cohort . Clinical presentations of the 26 episodes included fever (22), shock (7), petechiae or purpura (7), disseminated intravascular coagulation (5) and respiratory distress (5) . Clinical illness included bacteremia alone (12), meningitis alone (8), bacteremia with otitis media-sinusitis (3), bacteremia with pneumonia (2) and meningitis with osteomyelitis (1) . Five of the 6 patients who died had meningitis . Three of the survivors (19%) had significant morbidity, and all of them had meningitis . Two patients had 2 episodes each, and 1 patient had 3 episodes . All but 1 of the multiple episodes was with a different serotype . Forty-six percent of isolates were nonsusceptible to penicillin, and 19% were nonsusceptible to ceftriaxone . There was no association between antimicrobial resistance and mortality . CONCLUSIONS: Invasive pneumococcal disease in patients with asplenia has a high mortality, especially in those with meningitis . Even though the new conjugate vaccine might increase protection, 19% of patients had disease caused by serotypes not included in the current heptavalent vaccine . Clinicians should continue to be aggressive in evaluating asplenic patients with unexplained fevers. Otolaryngol Head Neck Surg, 2002 May, 126(5), 490 - 8 A rat model of otitis media with effusion caused by eustachian tube obstruction with and without Streptococcus pneumoniae infection: methods and disease course; Piltcher OB et al.; OBJECTIVE: To describe the clinical and histopathologic progression of a rat model of otitis media with effusion caused by eustachian tube obstruction (ETO) with and without Streptococcus pneumoniae infection . METHODS: In 164 rats, the left, bony eustachian tube was approached via a ventral incision and obstructed with dental material . Then 108 rats were infected via an intrabullar injection with S pneumoniae . At 48 hours, the infected rats were treated for 5 days with ampicillin . All ears were evaluated by weekly otomicroscopy . On each of days 1, 2, 7, 21, 35, 56, and 112, four rats were killed for histologic study . All effusions were cultured for bacteria . RESULTS: Fourteen rats died of surgical complications; effusion resolved by 2 weeks in 9 rats . During the first few days, infected ears with ETO had bulging tympanic membranes, followed by tympanic membrane retraction, purulent effusion, and otorrhea (50%) over the next few weeks, whereas uninfected ears with ETO developed retraction and serous effusion during the same time frame . At later times, all ears with ETO presented with retraction and serous or serous-mucoid effusion . S pneumoniae was recovered only from the infected ears with ETO (days 1 and 2), with some colonization by nonpathogenic microorganisms observed equally in both groups of ears . Histology showed a typical acute inflammatory reaction in the challenged ears with ETO through day 14 and then a chronic inflammation for all ears with ETO . CONCLUSION: The experimental methods provoked reproducible pathologic signs similar to those for otitis media with effusion . Given the availability of rat-specific reagents, this model is well suited for studies of cytokine elaboration during disease pathogenesis. Eur J Clin Microbiol Infect Dis, 2002 May, 21(5), 389 - 92 Epub 2002 May 17. Streptococcus pneumoniae-infected aneurysm extending from a persistent lobar pneumonia: case report and review of the literature; Nijs A et al.; Presented here is the case of a 63-year-old patient with a Streptococcus pneumoniae-infected aneurysm extending from a persistent lobar pneumonia of the left lung into the thoracic aorta . The patient was successfully treated with surgery and high-dose penicillin, and he remained well at 6-month follow-up . A review of the English-language literature over the past 25 years revealed 22 cases of mycotic or infected aortic aneurysms due to Streptococcus pneumoniae; however, none of these cases resulted in a positive outcome for the patient . The characteristics of these cases are discussed. J Oral Rehabil, 2002 Jun, 29(6), 553 - 8 Antibacterial and physical properties of resin modified glass-ionomers combined with chlorhexidine; Sanders BJ et al.; The purpose of this study was to determine the effect on mechanical properties and antimicrobial activity of the addition of chlorhexidine (CHX) to a resin modified glass-ionomer (Photac-fil, ESPE, Norristown, PA, USA) . Chlorhexidine diacetate was combined with a resin modified glass-ionomer material at a concentration of 5% . The samples were tested for hardness, tensile strength and erosion at 24 h and 6-week intervals and for elution of CHX and antimicrobial activity weekly for 6 weeks . At 24 h there was no significant difference in hardness between the two groups, but at 6 weeks the resin modified glass-ionomer group was significantly harder than the CHX groups (P < 0.05) . The diametral tensile strength test indicated no difference between the control and CHX groups at 24 h or at 6 weeks . The jet erosion test demonstrated significantly less erosion with the CHX group at 24 h but at 6 weeks the CHX group showed significantly more erosion than the control group . The chemical assay data demonstrated a peak elution of CHX at week 1 with residual amounts at weeks 2 and 3 . The microbial data demonstrated that the CHX group had a significant reduction in Streptococcus mutans numbers for weeks 1-3, but after week 4 there was no difference between the glass-ionomer with and without CHX . The addition of CHX to resin modified glass-ionomer altered hardness and erosion of the resin-modified glass-ionomer, but because there are no material specifications, it is difficult to determine clinical implications . Chlorhexidine did significantly improve the antimicrobial effect of the glass-ionomer which was consistent with the chemical assay data . The results indicated that the addition of CHX to resin modified glass-ionomer material (Photac-fil) did not seriously degrade the physical properties during the time period tested and that the addition of CHX resulted in a greater reduction in S . mutans when compared with glass-ionomer alone. Antimicrob Agents Chemother, 2002 Jul, 46(7), 2269 - 72 Fluorescence assay for studying the ability of macrolides to induce production of ribosomal methylase; Clarebout G et al.; A screening assay to test the inducing capacity of macrolides by fusing the attenuator of the inducible erm(B) gene from Streptococcus pneumoniae HM28 with the gfpmut1 gene has been designed . Fluorescence was detected under UV light around disks impregnated with inducer macrolides (erythromycin or azithromycin) but not with noninducer ketolides . Induction could be quantified by fluorometry. J Microbiol Methods, 2002 Sep, 51(1), 111 - 8 Evaluation of gene-technological and conventional methods in the identification of Streptococcus pneumoniae; Kaijalainen T et al.; To find reliable methods able to identify the "difficult" Streptococcus pneumoniae isolates, an in-house polymerase chain reaction (PCR) for pneumolysin gene (Ply-PCR) and a commercial RNA hybridisation test (AccuProbe) were evaluated . Selected isolates of suspected pneumococci, sent for confirmation of identification and for serotyping, were classified into four groups based on their optochin sensitivity and capsule reaction . All isolates in Group 1, which consisted of 24 typical, optochin-sensitive, encapsulated pneumococcal strains, were positive in the Ply-PCR and AccuProbe tests . In Group 2, which consisted of 25 optochin-sensitive, but unencapsulated pneumococcal strains, all the isolates were positive in the Ply-PCR test, and 23 were positive in the AccuProbe test . In Group 3, which consisted of 15 atypical, optochin-resistant but encapsulated pneumococci, 12 of the isolates were positive in the Ply-PCR and 12 in the AccuProbe test, and 11 of these 12 strains were positive in both tests . In Group 4, which consisted of 36 equivocal optochin-resistant, unencapsulated isolates, 15 strains were positive in the Ply-PCR test and 8 strains in the AccuProbe test . As a conclusion, the Ply-PCR and AccuProbe tests identified similarly typical optochin-sensitive pneumococci, but gave partly controversial results about atypical pneumococci . Thus, they did not reliably help in the identification of suspected pneumococcal isolates lacking the conventional characteristics of pneumococcus. J Microbiol Methods, 2002 Sep, 51(1), 35 - 42 Flow cytometric evaluation of adhesion of Streptococcus pyogenes to epithelial cells; Sethman CR et al.; The precise roles of various surface molecules in the attachment of Streptococcus pyogenes to host epithelia are currently unclear . A flow cytometry assay that facilitates the analysis of the kinetics of S . pyogenes adhesion to epithelial cells was developed . Dose- and time-dependent adhesion isotherms with both buccal epithelial cells (BECs) and Hep-2 cells as substrata were obtained . Although binding equilibrium is reached within 2 h on both cell types, saturation of binding sites on BECs is not achieved within a wide range of experimental conditions . This indicates a high degree of non-specific attachment to that cell type . Since no rinsing step is necessary when using flow cytometry to analyze adhesion, low-affinity associations were observable . This was confirmed by determining bacterial desorption rates early and late in the adsorption process . Binding irregularities were also easily detected since the cytometer records and displays data for up to 10,000 epithelial cells per time point . It is proposed to use this methodology to assign roles to particular surface molecules/characteristics during distinct phases of adhesion. JAMA, 2002 Jun 19, 287(23), 3103 - 9 Changes in antibiotic prescribing for children after a community-wide campaign; Perz JF et al.; CONTEXT: Overuse of antibiotics has contributed to microbial resistance, compromising the treatment of bacterial infections . Very high levels (>50%) of antibiotic resistance among invasive Streptococcus pneumoniae have been documented in Knox County, Tennessee . OBJECTIVE: To determine the effectiveness of a community-wide intervention aimed at reducing inappropriate antibiotic use among children . DESIGN, SETTING, AND PARTICIPANTS: The Knox County Health Department led a multifaceted year-long campaign (May 1997 through April 1998) aimed at decreasing unnecessary antibiotic use among children . Tennessee's 3 other major urban counties (Shelby, Hamilton, and Davidson) did not conduct similar campaigns and served as controls . Evaluation included white and black children (aged <15 years) enrolled in Tennessee's Medicaid Managed Care Program in the 4 study counties, representing 36% of the study counties' children (464 200 person-years observed) . INTERVENTION: Educational efforts were directed toward health care practitioners (primarily via peer leader presentations) and to the parents of young children and the public (primarily via printed materials) . MAIN OUTCOME MEASURE: The intervention-attributable effect on antibiotic use, defined as the excess percentage change in oral antibiotic prescription rates in Knox County between the 12-month preintervention and postintervention periods, relative to that of control counties . RESULTS: Antibiotic prescription rates declined 19% and 8% among Knox County and control county children, respectively, yielding an 11% intervention-attributable decline (95% confidence interval, 8%-14%; P<.001) . The intervention-attributable decrease in prescription rates was greatest among children aged 1 to less than 5 years (among white children, 8% {P<.001}; among black children, 18% {P<.001}) . CONCLUSIONS: A community-wide educational intervention reduced antibiotic prescription levels among children in Knox County. Biomaterials, 2002 Jul, 23(14), 2835 - 40 Bacterial adhesion to titanium-oxy-nitride (TiNOX) coatings with different resistivities: a novel approach for the development of biomaterials; Koerner RJ et al.; In this study the quantitative adhesion of a strain of Staphylococcus epidermidis, Streptococcus mutans and Pseudomonas aeruginosa to and the ease of removal from different TiNOX coatings was investigated by means of a parallel plate flow chamber and in situ image analysis . Quality of adhesion was determined by counting bacteria which remained attached to the surface after exposure to an air-liquid interface . S . epidermidis and S . mutans showed a bipolar adhesion pattern with highest numbers of adhesion at low and high resistivity with lowest adhesions at a resistivity of 10(4) microohms cm . P . aeruginosa was the least adherent organism . These results indicate that the affinity of these three strains under the current experimental conditions is minimal for TiNOX coatings with a specific resistivity . TiNOX coatings with pre-adsorbed fibrinogen showed different numbers of S . epidermidis adhered to the different coatings . However, the affinity of this strain for fibrinogen-coated TiNOX remains low when the resistivity is around 10(4) microohms cm . This indicates that the specific influence of the resistivities of the TiNOX coatings is transferred through the adsorbed fibrinogen film to the interface with adhering bacteria. J Vet Med B Infect Dis Vet Public Health, 2002 May, 49(4), 185 - 7 Studies on Streptococcus agalactiae isolated from bovine mastitis in Indonesia; Estuningsih S et al.; All 83 bacterial strains isolated from seven farms in three areas of the island of Java in Indonesia investigated in the present study could be identified as Streptococcus agalactiae . Identification was performed by cultural, biochemical and serological properties and by polymerase chain reaction amplification of species-specific parts of the gene encoding the 16S rRNA, the 16S-23S rDNA intergenic spacer region and the CAMP factor (cfb) gene . All isolates were unpigmented . almost all of the isolates had the serotype pattern II/X . Despite these similarities a macrorestriction analysis of the chromosomal DNA of the bacteria revealed no significant homologies of the DNA-fingerprints of the S . agalactiae from the various areas . This last finding might possibly indicate that a single ancestral unpigmented serotype II/X S . agalactiae clone was responsible for the mastitis situation on Java and had evolved separately in the various farms and regions. Aust N Z J Obstet Gynaecol, 2002 May, 42(2), 182 - 6 Late antenatal carriage of group B Streptococcus by New Zealand women; Grimwood K et al.; OBJECTIVES: To determine in New Zealand women the prevalence of group B Streptococcus (GBS) carriage late in pregnancy and to identify GBS colonisation risk factors, antibiotic susceptibility and serotype distribution . DESIGN: Prospective, observational study . SETTING: Community and hospital antenatal clinics in Wellington and Auckland during 1998-1999 . SAMPLE: Convenience sample of 240 women between 35-37 weeks gestation . METHODS: Sociodemographic data, obstetric details and anogenital swabs were collected from each subject . Swabs were inoculated into selective media . GBS isolates underwent serotyping and antibiotic susceptibility testing . RESULTS: Two hundred and forty women (9% Maori, 11% Pacific) aged 15-41 years were recruited . Fifty-two (22%; 95% CI 17, 27) were colonised by GBS . Carriage was independently associated with younger age (59% < or = 30 years; adjusted OR 3.25; 95% CI 1.53, 6.95) and least social deprivation (57% NZ Dep 96 score +/- 3; adjusted OR 1.22; 95% CI 1.06,1.39) . All GBS isolates were penicillin-susceptible, but resistance to clindamycin (15%) and erythromycin (7.5%) was detected and associated with serotype V strains . Predominant serotypes were: III (29%), Ia (21%), Ib (20%) and V (20%) . CONCLUSIONS: Approximately 20% of New Zealand women carry GBS late in pregnancy, with young age a major risk factor . Increased risk in the socially advantaged, development of resistance to erythromycin and clindamycin, and emergence of new GBS serotypes are findings with important implications for prevention strategies requiring further confirmation. Scand J Infect Dis, 2002, 34(5), 323 - 6 Serum level of YKL-40 is elevated in patients with Streptococcus pneumoniae bacteremia and is associated with the outcome of the disease; Kronborg G et al.; YKL40 is secreted by activated macrophages and neutrophils . Elevated serum concentrations of YKL40 are found in patients with diseases characterized by inflammation or ongoing fibrosis . The aim of this study was to evaluate serum YKL-40 levels in patients with Streptococcus pneumoniae bacteremia and to correlate these levels with clinical findings and outcomes . YKL40 was determined by ELISA and 89 patients were included in the study . Serum YKL-40 levels were significantly higher in patients with S . pneumoniae bacteremia (median 342 microg/l; range 20-20,400 microg/l) than in age-matched healthy subjects (44 microg/l; 20-184; p < 0.001) . Serum YKL-40 levels were related to the severity of the infection, with significantly higher serum YKL-40 levels being observed in patients who needed hemodialysis (p < 0.001), pharmacological treatment of hypotension (p < 0.001) and mechanical ventilation (p = 0.003) compared to those in patients who did not need this supportive treatment . Nineteen patients died and these patients had significantly higher serum YKL-40 levels (980 microg/l; 88-20,400 microg/l) than those of survivors (256 microg/l; 20-9,100 microg/l; p < 0.001) . Serum YKL40 level was an independent prognostic factor of survival in logistic multivariate regression analysis (p = 0.002) . In conclusion, high serum levels of YKL40 indicated a poorer prognosis for patients with S . pneumoniae bacteremia. Res Microbiol, 2002 May, 153(4), 243 - 7 Construction of new unencapsulated (rough) strains of Streptococcus pneumoniae; Pearce BJ et al.; To construct rough strains of Streptococcus pneumoniae in which the capsule locus was completely deleted, a genetic cassette to be used as a donor DNA in transformation was developed . The cassette contained an aphIII gene, conferring kanamycin resistance, flanked by segments of dexB and aliA . Since, in all strains of S . pneumoniae the capsule locus is between dexB and aliA, the DNA segments of these two genes allow insertion of a 1354-bp DNA fragment containing aphIII into the pneumococcal chromosome, determining the deletion of the whole capsule locus . The capsule locus was deleted from the classic type 2 and type 3 Avery's strains, from R6 (whose complete genome sequence is released) and Rx1 (the two most commonly used transformation recipients), from a type 3 clinical strain and type 19F clinical isolate G54 (whose draft genome sequence is annotated) . The effect of capsule removal was tested in 4 isogenic pairs . In unencapsulated strains, growth rate increased up to 56% and transformation frequency increased up to 1075-fold . A correlation was observed between the increase in growth rate and an increase in transformation frequency. Chest, 2002 Jun, 121(6), 1776 - 81 Clinical presentation of community-acquired Chlamydia pneumoniae pneumonia in adults; Miyashita N et al.; STUDY OBJECTIVE: To investigate the clinical presentation of community-acquired Chlamydia pneumoniae pneumonia in adults . DESIGN: Prospective study . SETTING: Kawasaki Medical School Hospital, Kawasaki Medical School Kawasaki Hospital, and Kurashiki Daiichi Hospital in Japan . PARTICIPANTS: Forty patients with community-acquired pneumonia with C pneumoniae as the only pathogen identified admitted to three hospitals between April 1996 and March 2001 and their clinical presentations were compared to patients with Streptococcus pneumoniae and Mycoplasma pneumoniae pneumonia . MEASUREMENTS: The diagnosis of C pneumoniae infection was based on isolation and serologic testing of antibodies by the microimmunofluorescence test . RESULTS: The clinical presentations, except for shortness of breath, were similar for the three major etiologic agents . The mean temperature of C pneumoniae patients on hospital admission was 37.9 degrees C, which was lower than that of patients with S pneumoniae and M pneumoniae . The mean WBC count on hospital admission was lower in the patients with C pneumoniae (mean, 9,100/microL) than in those with S pneumoniae pneumonia but higher than in those with M pneumoniae pneumonia . No patients required respiratory support or admission to an ICU, and no deaths occurred among the C pneumoniae pneumonia patients . CONCLUSIONS: Our results indicate that C pneumoniae pneumonia as a single etiologic agent is mild and that the underlying conditions and clinical symptoms closely resemble those of S pneumoniae pneumonia . However, the physical examinations, laboratory findings, and prognostic factors of the C pneumoniae patients resembled those of patients with M pneumoniae pneumonia. Rev Med Interne, 2002 May, 23(5), 469 - 73 {Cerebral hemorrhage due to a ruptured mycotic aneurysm . Two cases}; le Bayon A et al.; INTRODUCTION: Cerebral hemorrhages due to rupture of mycotic aneurysms are rare but severe complications of infective endocarditis . We report two cases with a good outcome . EXEGESIS: The first patient presented with a parieto-occipital hematoma which occurred in the course of a relapsing infective endocarditis due to Streptococcus mitis . She fully recovered after neurosurgical treatment . In the second case, a right frontal hematoma revealed two mycotic aneurysms and an infective endocarditis due to Streptococcus gordonii . Motor weakness partially recovered after antibiotic therapy and angiography demonstrated complete resolution of aneurysms . CONCLUSION: Ruptured mycotic aneurysms are poor prognosis factors in infective endocarditis . Adapted antibiotic therapy is the first-intent treatment . Neurosurgery is indicated when hematomas are poorly tolerated and in cases requiring anticoagulant therapy. HNO, 2002 Apr, 50(4), 332 - 8 {Clinical aspects of abscess development in parotitis}; Thiede O et al.; OBJECTIVE: The purpose of this paper was to analyse parotideal abscesses on the basis of a larger number of patients . PATIENTS AND METHODS: The data of 36 patients (mean age 44 years) with a parotideal abscess was analysed . RESULTS: Ultrasound scan was always necessary to verify the diagnosis . The surgical drainage was done under myoelectric monitoring of the facial nerve . Only in 1 patient a temporary minor paralysis of the mandibular branch was noticed . The most common bacteria were Staph . aureus, Streptococcus, and Peptostreptococcus . In 2 cases a tuberculosis and in 2 children an atypical mycobacterial infection was discovered . In another patient a metastasis of a squamous cell carcinoma was found . CONCLUSIONS: In every patient with an acute swelling of the parotid region without consideration of age, number of leucocytes or a typical fluctuation, an ultrasound scan should be used . The surgical drainage of the abscess should be done under myoelectric monitoring (Cave: muscle relaxant) . In every case, a specimen for microbiological analysis (bacterial determination) and a biopsy (to exclude malignoma or atypical mycobacteria) are necessary . A peri- and post-operative therapy with a combination of aminopenicillin and clavulanic acid or with cephalosporine is recommended. Naturwissenschaften, 2002 Apr, 89(4), 137 - 46 A review on usnic acid, an interesting natural compound; Cocchietto M et al.; Lichens are a world-widespread consortium of fungal and photosynthetic partners . Usnic acid is one of the most common and abundant lichen metabolites, well known as an antibiotic, but also endowed with several other interesting properties . This review summarises the most relevant studies on usnic acid, focusing on a number of biological activities in different fields . On the basis of the existing literature, usnic acid seems to be an exclusive lichen product . No synthetic derivatives more effective than the natural form are known . Both the (+) and (-) enantiomers of usnic acid are effective against a large variety of Gram-positive (G+) bacterial strains, including strains from clinical isolates, irrespective of their resistant phenotype . Of particular relevance is the inhibition of growth of multi-resistant strains of Streptococcus aureus, enterococci and mycobacteria . The (+)-usnic acid enantiomer appears to be selective against Streptococcus mutans without inducing perturbing side effects on the oral saprophyte flora . On the other hand, the (-)-usnic acid enantiomer is a selective natural herbicide because of its blocking action against a specific key plant enzyme . Other recognised characteristics of usnic acid are ultraviolet absorption and preserving properties . The toxicology, the in vitro anti-inflammatory effects and the mechanism of action of usnic acid need to be investigated in greater detail in order to reach clinical trials and to allow further applications . Furthermore, more research is needed to make possible intensive lichen culture, in order to produce large quantities of lichen substances for pharmaceutical, cosmetic and agricultural purposes . Some biological aspects, i.e . the possible biological roles of usnic acid, are discussed. Acta Paediatr, 2002, 91(4), 391 - 8 Early prediction of neurological sequelae or death after bacterial meningitis; Oostenbrink R et al.; This study determined independent predictors of the occurrence of permanent neurological sequelae or death after childhood bacterial meningitis . Data were used from a large study on children (aged 1 mo to 15 y) initially presenting with meningeal irritation . A nested case-control study was performed on children with (n = 23) and without (n = 70) permanent neurological sequelae (hearing impairment, locomotor dysfunction, mental retardation or epilepsy) or death after bacterial meningitis . Predictors obtained from clinical evaluation and laboratory tests at presentation and during the clinical course were identified by multivariate logistic regression and receiver operating characteristic (ROC) curve analyses . The study population comprised 23 cases and 70 controls (52% boys, median age 2.8 y) . Independent predictors for an adverse outcome after bacterial meningitis were male gender, atypical convulsions in history, low body temperature at admission and the pathogen Streptococcus pneumoniae . The area under the ROC curve of this prediction rule was 0.87 (95% confidence interval: 0.78-0.96), which was not improved by adding other characteristics . A score including these independent predictors could classify patients into categories with increasing risk for an adverse outcome . Conclusion: Clinical characteristics available early in the clinical course, such as gender, atypical convulsions in history, low body temperature at admission and the pathogen, are predictive for the occurrence of permanent neurological sequelae or death after bacterial meningitis in childhood . The pathogen type, in particular, is the main prognostic determinant of childhood bacterial meningitis. Proc Natl Acad Sci U S A, 2002 Jun 25, 99(13), 8962 - 7 Epub 2002 Jun 11. Assembling the glycopeptide antibiotic scaffold: The biosynthesis of A47934 from Streptomyces toyocaensis NRRL15009; Pootoolal J et al.; The glycopeptide antibiotics vancomycin and teicoplanin are vital components of modern anti-infective chemotherapy exhibiting outstanding activity against Gram-positive pathogens including members of the genera Streptococcus, Staphylococcus, and Enterococcus . These antibiotics also provide fascinating examples of the chemical and associated biosynthetic complexity exploitable in the synthesis of natural products by actinomycetes group of bacteria . We report the sequencing and annotation of the biosynthetic gene cluster for the glycopeptide antibiotic from Streptomyces toyocaensis NRRL15009, the first complete sequence for a teicoplanin class glycopeptide . The cluster includes 34 ORFs encompassing 68 kb and includes all of the genes predicted to be required to synthesize and regulate its biosynthesis . The gene cluster also contains ORFs encoding enzymes responsible for glycopeptide resistance . This role was confirmed by insertional inactivation of the d-Ala-d-lactate ligase, vanAst, which resulted in the predicted -sensitive phenotype and impaired antibiotic biosynthesis . These results provide increased understanding of the biosynthesis of these complex natural products. Int Endod J, 2002 Apr, 35(4), 345 - 51 Direct amplification of rRNA gene sequences for identification of selected oral pathogens in root canal infections; Siqueira JF et al.; AIM: The purpose of this study was to assess the prevalence of selected oral pathogens in root canal infections and their relationship with symptoms using a highly sensitive technique, the polymerase chain reaction . METHODOLOGY: Samples were obtained from 91 infected teeth associated with periradicular lesions, including cases of acute periradicular abscesses . DNA was extracted from the samples and analysed for the presence of target microbial species using a PCR-based identification assay . RESULTS: All samples were positive for the presence of bacteria . Streptococcus anginosus group was detected in 16.7%, Fusobacterium nucleatum in 14.3%, and Bacteroides forsythus in 7.1% of the abscess samples . No pus sample yielded Actinomyces israelii, Actinobacillus actinomycetemcomitans or fungal species . In general, B . forsythus was found in 20% of the cases (16 of 80), S . anginosus in 12% (6 of 50), F . nucleatum in 10% (6 of 60) and A . israelii in 5% (two of 40) . A . actinomycetemcomitans was not detected in any case . Fungi were present in only one of 50 cases (2%) . There was no correlation between the species and symptoms . CONCLUSIONS: Direct molecular approaches appear to be a valuable tool for the rapid and reliable diagnosis of infectious diseases, as well as for research purposes . There was no correlation between target microbial species and symptoms. Acta Anaesthesiol Scand, 2002 Jul, 46(6), 639 - 46 Post spinal meningitis and asepsis; Videira RL et al.; BACKGROUND: Post spinal meningitis (PSM) is a complication still currently being reported . After two PSM cases in our hospital an epidemiological study was initiated, which included a survey of techniques for asepsis that are applied in our department . METHODS: Cases defined as PSM comprised meningitis within a week after spinal anesthesia . Anesthesia records, anesthesia complication files and the records of the Hospital Commission for Infection Control from 1997 to 2000 were reviewed . Asepsis techniques applied were surveyed by a questionnaire answered by all our department's anesthesiologists . The equipment and procedures for spinal anesthesia were listed . Current anesthesia textbooks were reviewed for recommendations regarding asepsis techniques in conjunction with spinal anesthesia . RESULTS: Three cases of PSM were identified following 38,128 spinal anesthesias whereas none was observed in 12,822 patients subjected to other types of regional or general anesthesia (P>0.05) . Culture of cerebrospinal fluid yielded Streptococcus in two patients and was negative in the other patient . The asepsis technique applied by the anesthesiologists varied considerably . The literature review showed that aspects on asepsis for spinal anesthesia are poorly covered . CONCLUSION: The incidence of meningitis was similar in patients subjected to spinal anesthesia and in those subjected to other anesthetic techniques . Asepsis techniques were found to differ considerably among our staff members, reflecting the lack of well-defined published standards for this procedure . We recommend that asepsis for spinal anesthesia should not be less rigorous than for surgical asepsis. J Bacteriol, 2002 Jul, 184(13), 3508 - 20 Global transcriptional analysis of clpP mutations of type 2 Streptococcus pneumoniae and their effects on physiology and virulence; Robertson GT et al.; Streptococcus pneumoniae is an important human pathogen that contains single copies of genes encoding the ClpP and FtsH ATP-dependent proteases but lacks the Lon and HslV proteases . We constructed and characterized the phenotypes of clpP, clpC, and clpX deletion replacement mutants, which lack the ClpP protease subunit or the putative ClpC or ClpX ATPase specificity factor . A DeltaclpP mutant, but not a DeltaclpC or DeltaclpX mutant, of the virulent D39 type 2 strain of S . pneumoniae grew poorly at 30 degrees C and failed to grow at 40 degrees C . Despite this temperature sensitivity, transcription of the heat shock regulon determined by microarray analysis was induced in a DeltaclpP mutant, which was also more sensitive to oxidative stress by H2O2 and to puromycin than its clpP+ parent strain . A DeltaclpP mutant, but not a DeltaclpC mutant, was strongly attenuated for virulence in the murine lung and sepsis infection models . All of these phenotypes were complemented in a DeltaclpP/clpP+ merodiploid strain . Consistent with these complementation patterns, clpP was found to be in a monocistronic operon, whose transcription was induced about fivefold by heat shock in S . pneumoniae as determined by Northern and real-time reverse transcription-PCR analyses . Besides clpP, transcription of clpC, clpE, and clpL, but not clpX or ftsH, was induced by heat shock or entry into late exponential growth phase . Microarray analysis of DeltaclpP mutants showed a limited change in transcription pattern (approximately 80 genes) consistent with these phenotypes, including repression of genes involved in oxidative stress, metal ion transport, and virulence . In addition, transcription of the early and late competence regulon was induced in the DeltaclpP mutant, and competence gene expression and DNA uptake seemed to be constitutively induced throughout growth . Together, these results indicate that ClpP-mediated proteolysis plays a complex and central role in numerous pneumococcal stress responses, development of competence, and virulence. J Bacteriol, 2002 Jul, 184(13), 3426 - 32 Competence without a competence pheromone in a natural isolate of Streptococcus infantis; Ween O et al.; Many streptococcal species belonging to the mitis and anginosus phylogenetic groups are known to be naturally competent for genetic transformation . Induction of the competent state in these bacteria is regulated by a quorum-sensing mechanism consisting of a secreted peptide pheromone encoded by comC and a two-component regulatory system encoded by comDE . Here we report that a natural isolate of a mitis group streptococcus (Atu-4) is competent for genetic transformation even though it has lost the gene encoding the competence pheromone . In contrast to other strains, induction of competence in Atu-4 is not regulated by cell density, since highly diluted cultures of this strain are still competent . Interestingly, competence in the Atu-4 strain is lost if the gene encoding the response regulator ComE is disrupted, demonstrating that this component of the quorum-sensing apparatus is still needed for competence development . These results indicate that mutations in ComD or ComE have resulted in a gain-of-function phenotype that allows competence without a competence pheromone . A highly similar strain lacking comC was isolated independently from another individual, suggesting that strains with this phenotype are able to survive in nature in competition with wild-type strains. Curr Opin Microbiol, 2002 Jun, 5(3), 338 - 42 Streptococcus pneumoniae as a genomics platform for broad-spectrum antibiotic discovery; Glass JI et al.; Streptococcus pneumoniae is a useful tool for the discovery of broad-spectrum antibiotics because of its genetic malleability and importance as a pathogen . Recent publications of complete chromosomal DNA sequences for S . pneumoniae facilitate rapid and effective use of genomics-based technology to identify essential genes encoding new targets for antibacterial drugs . These methods include computational comparative genomics, gene disruption studies to determine essentiality or identify essential genes, and gene expression analysis using microarrays and gel-based proteomics . We review how genomics has transformed the use of the pneumococcus for the pursuit of new antibiotics, and made it the best species for the identification and validation of new antibiotic targets. Vaccine, 2002 Jun 7, 20(19-20), 2474 - 84 Development of a high-performance anion-exchange chromatography with pulsed-amperometric detection based quantification assay for pneumococcal polysaccharides and conjugates; Talaga P et al.; A method, using high-performance anion-exchange chromatography with pulsed-amperometric detection (HPAEC-PAD), has been developed to determine the concentrations of Streptococcus pneumoniae capsular polysaccharides and polysaccharide conjugates used in formulating a conjugate vaccine for the prevention of pneumococcal infections . In an effort to determine optimum hydrolysis conditions for the analysis, pneumococcal polysaccharides were subjected to three different hydrolysis methods: trifluoroacetic acid (TFA) hydrolysis, methanolysis followed by TFA hydrolysis, or hydrofluoric acid (HF) hydrolysis followed by TFA hydrolysis . For quantification purposes, best results were obtained by methanolysis followed by TFA hydrolysis for uronic acid-containing polysaccharides, and by TFA hydrolysis for all the others.For the quantification of all the polysaccharides (from native to conjugated forms), a monosaccharide reference mixture (Rha, Gal and GlcA) hydrolyzed along with the samples can be used as standards for routine analysis . This is much more convenient than to hydrolyze a well-characterized reference polysaccharide (necessary standard only for type 1 capsular polysaccharide).This method is rapid, very sensitive (less than 10 microg of polysaccharide is required), and may replace advantageously the currently used colorimetric assays used to determine polysaccharides content . Moreover, it can be readily adapted for use with other bacterial polysaccharide preparations as well. Stomatologiia (Mosk), 2002, 81(2), 40 - 4 {Clinical and laboratory studies of bacterial adhesion to validate the choice of material for making provisional dentures for patients with periodontal diseases}; Ibragimov TI et al.; Adhesion of bacteria favoring the development of oral inflammations, including cariesogenic and periodontopathogenic (Actinobacillus actinomycetemcommitans, Streptococcus sanguis, Fusobacterium nucleatum, Staphylococcus warneri) and yeast fungi (Candida albicans), to 13 materials used for making provisional dentures was studied . Adhesion of all the studied bacteria and fungi to Russian material Esterfil Foto was the minimum . Clinical use of this material in patients with chronic generalized periodontitis showed that it was well tolerated and the treatment led to improvement of oral microbiocenosis. Microbiology, 2002 Jun, 148(Pt 6), 1747 - 55 Organization and characterization of the capsule biosynthesis locus of Streptococcus pneumoniae serotype 9V; van Selm S et al.; The capsular polysaccharide (CPS) synthesis locus of Streptococcus pneumoniae serotype 9V was amplified by long-range PCR and sequenced . The locus was 17368 bp in size and contained 15 ORFs . The genetic organization of the cluster shared many features with other S . pneumoniae capsule loci, including the presence of four putative regulatory genes at the 5' end . Comparative sequence analyses allowed putative functions to be assigned to each of the gene products . The ORFs appeared to encode, besides the four regulatory genes, five glycosyltransferases, two O-acetyltransferases, an N-acetylglucosamine 2-epimerase, a glucose 6-dehydrogenase, an oligosaccharide transporter protein and a polysaccharide repeating unit polymerase . These functions covered the steps proposed in the CPS biosynthesis of serotype 9V . TLC of carbohydrate intermediates formed after incubation of bacterial membrane preparations with 14C-labelled precursors demonstrated that the fifth ORF (cps9vE) encoded a UDP-glucosyl-1-phosphate transferase . This function was confirmed with the help of a cps9vE mutant that carried a deletion of a guanine residue located adjacent to a stretch of adenines . The identification and characterization of the serotype 9V locus is a major step in unravelling the 9V capsule biosynthesis pathway and broadens the insight into the genetic diversity of the S . pneumoniae capsule loci. Microbiology, 2002 Jun, 148(Pt 6), 1615 - 25 Expression of fibronectin-binding protein FbpA modulates adhesion in Streptococcus gordonii; Christie J et al.; Fibronectin binding is considered to be an important virulence factor in streptococcal infections . Adhesion of the oral bacterium Streptococcus gordonii to immobilized forms of fibronectin is mediated, in part, by a high molecular mass wall-anchored protein designated CshA . In this study, a second fibronectin-binding protein of S . gordonii is described that has been designated as FbpA (62.7 kDa) . This protein, which is encoded by a gene located immediately downstream of the cshA gene, shows 85 and 81% identity to the fibronectin-binding proteins PavA, of Streptococcus pneumoniae, and FBP54, of Streptococcus pyogenes, respectively . Purified recombinant FbpA bound to immobilized human fibronectin in a dose-dependant manner, and isogenic mutants in which the fbpA gene was inactivated were impaired in their binding to fibronectin . This effect was apparent only for cells in the exponential phase of growth, and was associated with reduced surface hydrophobicity and the surface expression of CshA . Cells in the stationary phase of growth were unaffected in their ability to bind to fibronectin . By utilizing gene promoter fusions with cat (encoding chloramphenicol O-acetyltransferase), it was demonstrated that cshA expression was down-regulated during the exponential phase of growth in the fbpA mutant . Expression of fbpA, but not cshA, was sensitive to atmospheric O2 levels, and was found to be up-regulated in the presence of elevated O2 levels . The results suggest that FbpA plays a regulatory role in the modulation of CshA expression and, thus, affects the adhesion of S . gordonii to fibronectin. J Immunol, 2002 Jun 15, 168(12), 6375 - 81 Protection from Streptococcus pneumoniae infection by C-reactive protein and natural antibody requires complement but not Fc gamma receptors; Mold C et al.; Streptococcus pneumoniae is an important human pathogen and the most common cause of community-acquired pneumonia . Both adaptive and innate immune mechanisms provide protection from infection . Innate immunity to S . pneumoniae in mice is mediated by naturally occurring anti-phosphocholine (PC) Abs and complement . The human acute-phase reactant C-reactive protein (CRP) also protects mice from lethal S . pneumoniae infection . CRP and anti-PC Ab share the ability to bind to PC on the cell wall C-polysaccharide of S . pneumoniae and to activate complement . CRP and IgG anti-PC also bind to Fc gamma R . In this study, Fc gamma R- and complement-deficient mice were used to compare the mechanisms of protection conferred by CRP and anti-PC Ab . Injection of CRP protected wild-type, FcR gamma-chain-, Fc gamma RIIb-, and Fc gamma RIII-deficient mice from infection . Complement was required for the protective effect of CRP as cobra venom factor treatment eliminated the effect of CRP in both gamma-chain-deficient and wild-type mice, and CRP failed to protect C3- or C4-deficient mice from infection . Unexpectedly, gamma-chain-deficient mice were extremely sensitive to pneumococcal infection . This sensitivity was associated with low levels of natural anti-PC Ab . Gamma-chain-deficient mice immunized with nonencapsulated S . pneumoniae produced both IgM- and IgG PC-specific Abs, were protected from infection, and were able to clear the bacteria from the bloodstream . The protection provided by immunization was eliminated by complement depletion . The results show that in this model of systemic infection with highly virulent S . pneumoniae, protection from lethality by CRP and anti-PC Abs requires complement, but not Fc gamma R. Int J Syst Evol Microbiol, 2002 May, 52(Pt 3), 939 - 44 Isolation from a shea cake digester of a tannin-degrading Streptococcus gallolyticus strain that decarboxylates protocatechuic and hydroxycinnamic acids, and emendation of the species; Chamkha M et al.; A facultatively anaerobic, mesophilic, non-motile, non-sporulating bacterium, designated strain B7, was isolated from an anaerobic digester fed with shea cake rich in tannins and aromatic compounds, after enrichment on tannic acid . The coccoid cells (less than 2 microm in diameter) occurred in pairs or short chains and stained gram-positive . Strain B7 fermented a wide range of carbohydrates (cellobiose, fructose, galactose, glucose, lactose, maltose, mannitol, melibiose, raffinose and trehalose), grew optimally at pH 7.0 and had a G+C content of 40.4+/-0.3 mol% . Strain B7 was closely related to Streptococcus gallolyticus ACM 3611T, a member of the Streptococcus bovis rRNA cluster, with a sequence similarity of 98% and a DNA hybridization value of 86 mol% . Isolate B7 hydrolysed tannic acid and decarboxylated gallic acid to pyrogallol, traits also observed in S . gallolyticus ACM 3611T . In addition, both strains decarboxylated protocatechuic acid to catechol, p-coumaric acid to 4-vinylphenol, caffeic acid to 4-vinylcatechol and ferulic acid to 4-vinylguaiacol . An unsubstituted para-hydroxyl group on the benzene ring was required for decarboxylation . Glucose addition markedly increased the conversion rate . As these traits were not described previously, emendation of the description of the species Streptococcus gallolyticus is proposed. Vojnosanit Pregl, 2002 Mar-Apr, 59(2), 203 - 7 {Necrotizing fasciitis caused by group A streptococcus}; Mikic D et al.; The first case of the confirmed necrotizing fasciitis caused by Group A Streptococcus in Yugoslavia was presented . Male patient, aged 28, in good health, suddenly developed symptoms and signs of severe infective syndrome and intensive pain in the axillary region . Parenteral antibiotic, substitutional and supportive therapy was conducted along with the radical surgical excision of the necrotizing tissue . The patient did not develop streptococcal toxic shock syndrome thanks to the early established diagnosis and timely applied aggressive treatment . He was released from the hospital as completely cured two months after the admission. Obstet Gynecol, 2002 Jun, 99(6), 1036 - 9 Perianal versus anorectal specimens: is there a difference in Group B streptococcal detection? Orafu C, Gill P, Nelson K, Hecht B, Hopkins M. OBJECTIVE: To investigate whether specimens obtained from the perianal area have a Group B streptococcal culture detection rate similar to anorectal specimens . METHODS: This is a prospective cohort study at a tertiary care university-affiliated teaching hospital . A total of 136 pregnant women between 33 and 40 weeks' gestation were recruited . Three samples for Group B streptococcal culture detection were obtained from each subject in the following order: perianal sample, vaginoperianal sample, and an anorectal sample . The women were asked to rank their pain or discomfort with obtaining the anorectal sample . The vaginoperianal specimen is the standard sample obtained from antepartum patients in this clinic, and, therefore, it serves as the control . RESULTS: Of the 136 subjects, 26.5% of the control, vaginoperianal samples were positive for Group B streptococcal culture . In comparison, 27.2% of the anorectal specimens and 28.7% of the perianal specimens were positive for Group B streptococcal culture . There was no statistically significant difference in the detection of Group B streptococcal culture among the three sample sites . Evaluation of the pain experienced with an anorectal sampling showed that 68% of subjects ranked their pain between mild to moderate, and 5% noted severe pain . CONCLUSION: The Group B streptococcal detection rate was not different among the three sampling sites . Therefore, pregnant women do not need to be subjected to the additional pain of anorectal sampling to detect Group B Streptococcus. Vet Immunol Immunopathol, 2002 Aug, 87(1-2), 51 - 63 Changes in the leucocyte subpopulations of the palatine tonsillar crypt epithelium of pigs in response to Streptococcus suis type 2 infection; Salles MW et al.; The tonsils are portal of entry and a site of multiplication and persistence for a variety of pathogens, including Streptococcus suis (S . suis), which is a common cause of meningitis, septicemia and arthritis in pigs . Understanding the early changes that occur in the first barrier of the tonsil, i.e . the crypt epithelium, in response to S . suis infection is critical in clarifying the pathogenesis of this disease and for the future development of efficient methods of mucosal vaccination . In this study, we investigated the early changes, from 18 to 72 h, that occur in leucocyte subpopulations of the crypt epithelium of the palatine tonsils of 3-week-old pigs in response to S . suis type 2 infection . Monoclonal antibodies against leucocyte markers CD3, CD4, CD8, gammadelta T cell receptor, lambda-immunoglobulin light-chain, myeloid cells, and major histocompatibility complex class II molecule (MHC-II) were used in an avidin-biotin immunoperoxidase technique . An increase in the number of lambda-immunoglobulin light-chain positive cells (B cell subset) was noticed in crypts of S . suis-infected animals from 18 h after infection onwards . This increase was significant at 18 and 48 h after infection . The number of CD4 and CD8 cells was greater from 18 h onwards, with a significant increase at 24 and 72 h post-infection . No significant difference in numbers of CD3, gammadelta T cell receptor and MHC-II positive cells was detected in the crypts of infected animals compared to controls . Macrophages, neutrophils and crypt epithelial cells stained positively with the myeloid marker, and the area of crypt epithelium positive for this marker was increased in the crypts of infected animals, with a significant difference detected at 24 and 72 h after infection . These results suggest that there is participation of the innate immunity in the early phase of S . suis infection, represented by neutrophils, macrophages and likely epithelial cells, and that there is a potential for the initiation of both humoral and cellular responses against S . suis within the crypt epithelium of the palatine tonsil. J Biol Chem, 2002 Aug 30, 277(35), 32109 - 15 Epub 2002 Jun 05. Identification of the bacteria-binding peptide domain on salivary agglutinin (gp-340/DMBT1), a member of the scavenger receptor cysteine-rich superfamily; Bikker FJ et al.; Salivary agglutinin is encoded by DMBT1 and identical to gp-340, a member of the scavenger receptor cysteine-rich (SRCR) superfamily . Salivary agglutinin/DMBT1 is known for its Streptococcus mutans agglutinating properties . This 300-400 kDa glycoprotein is composed of conserved peptide motifs: 14 SRCR domains that are separated by SRCR-interspersed domains (SIDs), 2 CUB (C1r/C1s Uegf Bmp1) domains, and a zona pellucida domain . We have searched for the peptide domains of agglutinin/DMBT1 responsible for bacteria binding . Digestion with endoproteinase Lys-C resulted in a protein fragment containing exclusively SRCR and SID domains that binds to S . mutans . To define more closely the S . mutans-binding domain, consensus-based peptides of the SRCR domains and SIDs were designed and synthesized . Only one of the SRCR peptides, designated SRCRP2, and none of the SID peptides bound to S . mutans . Strikingly, this peptide was also able to induce agglutination of S . mutans and a number of other bacteria . The repeated presence of this peptide in the native molecule endows agglutinin/DMBT1 with a general bacterial binding feature with a multivalent character . Moreover, our studies demonstrate for the first time that the polymorphic SRCR domains of salivary agglutinin/DMBT1 mediate ligand interactions. Int J Pediatr Otorhinolaryngol, 2002 Jun 17, 64(2), 133 - 41 Deficient IgA and IgG2 anti-pneumococcal antibody levels and response to vaccination in otitis prone children; Dhooge IJ et al.; OBJECTIVE: To evaluate the isotype and IgG subclass distribution of anti-pneumococcal antibodies and response to polysaccharide vaccination in otitis prone children . METHODS: IgG1, IgG2 and IgA antibodies to pneumococcal serotypes 3, 4, 6B, 9V, 14, 19F and 23F were determined in otitis prone children and in an age-matched healthy control population . Patients were immunized with a 23-valent pneumococcal polysaccharide vaccine . The antibody response was measured 4 weeks later . RESULTS: Geometric mean IgA and IgG2 antibody levels for all seven pneumococcal serotypes tested were significantly lower in otitis prone children than in the control population . After immunization, there was no significant increase in geometric mean IgG2 anti-serotype 6B, 19F and 23F pneumococcal polysaccharide (weak immunogenic), but also no increase for IgG2 anti-serotype 4 and 14 . Post immunization IgG2 antibody titers for serotypes 6B, 9V and 19F even remained below titers of non-vaccinated controls . Nine out of 29 otitis prone children were colonized nasopharyngeally with Streptococcus pneumoniae during the time of vaccination; these children had an even more severely impaired systemic antibody response . CONCLUSIONS: Otitis prone children, while having normal IgG1 antibody levels, have low IgG2 and IgA anti-polysaccharide antibody levels and fail to respond in these subclasses upon vaccination with pneumococcal polysaccharide vaccine. Arch Otolaryngol Head Neck Surg, 2002 Jun, 128(6), 660 - 3 Suppurative complications of acute otitis media in the era of antibiotic resistance; Zapalac JS et al.; OBJECTIVE: To review our experience with suppurative complications of acute otitis media (AOM) in the era of antibiotic resistance, given a perceived increase in the number of such cases in recent years requiring surgical intervention . DESIGN: Retrospective review of pediatric patients presenting with suppurative complications of AOM from January 1993 to June 2000 . SETTING: Academic tertiary care children's medical center . PATIENTS: A total of 90 pediatric patients, ranging in age from 3 months to 16 years (mean age, 45 months) . RESULTS: A total of 104 suppurative complications of AOM occurred in 90 patients over the 7.5-year study period . The incidence of noncoalescent, coalescent, and total cases of mastoiditis and total number of suppurative complications all increased over the study period, with coalescent outpacing noncoalescent disease during the last 3 years of the study . A trend toward an increasing number of cases requiring surgical intervention was noted during the study period, corresponding to an increasing number of resistant Streptococcus pneumoniae isolates . Ten of 16 S pneumoniae isolates were resistant, primarily collected from younger children ranging in age from 4 to 24 months (mean age, 11.9 months) . CONCLUSION: The rising incidence of resistant S pneumoniae corresponded to the increasing number of suppurative complications of AOM during the study period and seemed to contribute to more aggressive infectious processes requiring surgical intervention. Lancet, 2002 May 4, 359(9317), 1569 - 73 MBL genotype and risk of invasive pneumococcal disease: a case-control study; Roy S et al.; BACKGROUND: Streptococcus pneumoniae is a major cause of morbidity and mortality in developed and developing countries . No common genetic determinants of susceptibility have been defined . Mannose-binding lectin (MBL) is a key mediator of innate host immunity that activates the complement pathway and directly opsonises some infectious pathogens . Mutations in three codons in the MBL gene have been identified, and individuals homozygous for a mutant genotype have very little or no serum MBL . We did a case-control study in the UK to assess whether these mutant genotypes were associated with invasive pneumococcal disease . METHODS: The frequencies of genotypes defined by the three mutations in codons 52, 54, and 57, and a functional promoter polymorphism at -221, were compared in a two-stage study of 337 patients with invasive pneumococcal disease and 1032 controls . All individuals were recruited from an ethnically homogeneous white population in Oxfordshire, UK . Patients had S pneumoniae isolated from a normally sterile site . FINDINGS: In our initial set of participants, 28 (12%) of 229 patients and 18 (5%) of 353 controls were homozygotes for MBL codon variants (odds ratio 2.59 {95% CI 1.39-4.83}, p=0.002) . Neither heterozygosity for these codon variants nor the promoter polymorphism was associated with susceptibility . In a confirmatory study, 11 (10%) of 108 patients were MBL homozygotes compared with 36 (5%) of 679 controls (p=0.046) . INTERPRETATION: Homozygotes for MBL codon variants, who represent about 5% of north Europeans and north Americans and larger proportions of populations in many developing countries, could be at substantially increased risk of invasive pneumococcal disease. J Paediatr Child Health, 2002 Jun, 38(3), 272 - 7 Early-onset neonatal group B streptococcal infections in New Zealand 1998-1999; Grimwood K et al.; OBJECTIVE: To determine in New Zealand infants the attack rates, risk factors, preventive policies, strain serotype and antibiotic susceptibilities of early-onset neonatal group B streptococcus (GBS) infection . METHOD: A 2-year prospective active surveillance study was conducted in New Zealand's 19 neonatal units . Cases had to present within 48 h of delivery, be unwell, possess abnormal haematological indices and have GBS isolated from sterile sites . RESULTS: Of the 112 402 infants born in New Zealand during 1998-1999, 56 had early-onset GBS infection, an attack rate of 0.5 per 1000 live births (95% confidence interval {CI} 0.38, 0.65) . Seven had meningitis and there was one death (case fatality rate of 1.8%; upper 95% CI 9.5%) . Univariate analysis identified young maternal age, parity, preterm labour, prolonged membrane rupture, maternal fever and assisted delivery as risk factors . Preventive policies for GBS were reported by 14 (74%) obstetric centres associated with neonatal units . Of the 56 cases, five (9%) were born to mothers receiving intrapartum antibiotics, 32 (57%) had mothers with risk factors but were not treated with antibiotics, and 19 (34%) were born to mothers without identifiable risk factors for GBS prevention . Serotypes Ia and III predominated, while two isolates were resistant to erythromycin and/or clindamycin . CONCLUSIONS: Rates of early-onset GBS infection are similar to other countries following the introduction of prevention policies . Further reductions are possible with full implementation of these guidelines . Meanwhile, emergence of antibiotic resistance complicates the management of women with penicillin allergy . Vaccine development therefore remains a priority. J Paediatr Child Health, 2002 Jun, 38(3), 246 - 51 Sepsis in neonatal intensive care in the late 1990s; Mehr SS et al.; AIM: To determine the incidence and clinical characteristics of sepsis in ventilated infants from an Australian neonatal intensive care unit (NICU) in the late 1990s . METHODS: Demographic data was collected from babies requiring assisted ventilation (AV) over the 6-month period from 1 July to 31 December 1998 . Sepsis was divided into early onset sepsis (EOS; " 72 h of age) and late onset sepsis (LOS; >72 h of age), including both definite (culture-proven + abnormal markers) and probable (culture negative + abnormal markers) episodes . RESULTS: Two hundred and eleven babies required AV over this period . Of these, 64 (30.3%) had at least one infection, with 85 episodes of sepsis (40.3 episodes per 100 admissions requiring AV) . There were 22 babies with 22 episodes of EOS, and 45 with 63 episodes of LOS . Three babies had both EOS and LOS . The rate of EOS was 10.4 infected infants (10.4 infections per 100 admissions requiring AV) . The rate of LOS was 21.3 infected infants (29.9 infections per 100 admissions requiring AV) . The rates of both EOS and LOS were higher than previously reported by Australian studies in the early 1990s . In both EOS and LOS, risk factors for infection were common . Group B streptococcus was the commonest cause of definite EOS . The mortality rate from sepsis in the EOS group was 14% (3/22) . Coagulase-negative staphylococci were the commonest cause of LOS . The mortality rate from sepsis in the LOS group was 11% (5/45) . CONCLUSIONS: EOS and LOS are significant problems in ventilated NICU infants in the late 1990s. Orbit, 2001 Sep, 20(3), 243 - 248 Orbital streptococcal gangrene and AIDS; Francis BA et al.; Streptococcal gangrene can present to the ophthalmologist as a fulminant orbital cellulitis involving the eyelids, globe and orbit . Compromised vision is likely, as well as serious systemic illness and death . It commonly affects young and healthy hosts and, prior to this presentation, has never been reported in a patient with HIV infection . We studied a case of streptococcal gangrene of the eyelids and orbit in a patient with AIDS . The infection was treated with debridement and intravenous antibiotics, and showed eventual improvement with the exception of visual function . A biopsy of the lesion exhibited extensive soft tissue necrosis with a predilection for blood vessels, resulting in thrombosis and infarction . Cultures grew out heavy group A beta-hemolytic Streptococcus . This case illustrates that streptococcal gangrene can occur with HIV, although to date this combination has been rare . Early diagnosis is crucial and includes recognition of incipient cutaneous, histopathological and anterior segment ischemia signs . FEBS Lett, 2002 Jun 5, 520(1-3), 68 - 72 Group B streptococcus (GBS) modifies macrophage phosphatidylserine metabolism during induction of apoptosis; Buratta S et al.; Group B streptococcus (GBS) induced macrophage apoptosis by which it could avoid host defence mechanisms . Macrophages, which constitutively express phosphatidylserine (PtdSer) on the outer leaflet of plasma membrane, increased PtdSer exposure during GBS-induced apoptosis . Induction of apoptosis decreased PtdSer radioactivity of macrophages incubated with {(3)H}serine . The effect appeared not due to increasing conversion of PtdSer to phosphatidylethanolamine or phosphatidylcholine nor to the release of radioactive membrane vesicles . The radioactivity in lysoPtdSer was also reduced . These results confirm that induction of apoptosis involves a modification of PtdSer metabolism and point out the typical features of the GBS-induced apoptosis with respect to other models of apoptosis. Int J Infect Dis, 2002 Mar, 6 Suppl 1, S38 - 46 Novel agents for resistant Gram-positive infections--a review; Strahilevitz J et al.; Gram-positive infections have increased in recent years, particularly those that are of nosocomial origin, leading to a broad use of agents with activity against these pathogens . Concomitantly, antimicrobial resistance of these pathogens also became widespread . Among the most common Gram-positive resistant pathogens are: Streptococcus pneumoniae, resistant to penicillin and macrolides, methicillin-resistant Staphylococcus aureus (MRSA), glycopeptide-intermediately-resistant S . aureus (GISA), methicillin-resistant S . epidermidis, glycopeptide-resistant enterococci and vancomycin-resistant enterococci (VRE) . The response of the pharmaceutical industry to this challenge was the development of new antibiotics active against these pathogens . Among these antibiotics, this review will focus on: linezolid, an oxazolidinone; GAR-936, a tetracycline derivative; daptomycin, a lipopeptide; and ortivancin (LY-333328), a glycopeptide related to vancomycin . Except for linezolid, which has been recently launched in many countries, all other agents referred to in this review are still at various developmental stages . It is hoped that in the near future most of these agents will be approved and thus the grim outlook of patients infected with resistant Gram-positive bacteria may improve. Int J Infect Dis, 2002 Mar, 6 Suppl 1, S14 - 20 Penicillin-resistant pneumococci-implications for management of community-acquired pneumonia and meningitis; Ziglam HM et al.; Penicillin-nonsusceptible Streptococcus pneumoniae isolates have become increasingly prevalent worldwide . They are well-known agents of community-acquired infections such as otitis media, pneumonia and bacterial meningitis . Therapy of pneumococcal infections is made difficult by the emergence and spread of bacterial resistance to penicillin and other beta-lactams, as well as other antimicrobials such as macrolides . This article reviews current concepts of epidemiology and the implications of penicillin-nonsusceptible pneumococci for management of community-acquired pneumonia and meningitis. J Endod, 2002 Apr, 28(4), 279 - 82 An optimal host response to a bacterium may require the interaction of leukocytes and resident host cells; Jiang Y et al.; Bacterial infection results in inflammatory responses that may lead to soft-tissue damage and bone resorption . However, the mechanisms by which different bacteria contribute to lesions of endodontic origin are not fully understood . This study examined the response to Streptococcus mutans and Porphyromonas endodontalis in two cell types that are involved in periapical pathology, mononuclear and osteoblastic cells . This was accomplished by measuring the induction of chemokines (monocyte chemoattractant protein-1, macrophage inflammatory protein-2) and proinflammatory cytokines (interleukin-1beta, tumor necrosis factor-alpha, interleukin-6, interferon-gamma) . The results demonstrated that S . mutans more efficiently stimulate inflammatory cytokine production by mononuclear cells, whereas P . endodontalis is relatively more potent in activating osteoblastic cells . Moreover, optimal activation of osteoblastic cells by S . mutans requires soluble mediators produced by mononuclear cells, whereas P . endodontalis does not . These results suggest that the association of different bacteria with specific pathologic processes may be partially explained by their capacities to activate specific host cells. Ugeskr Laeger . 2002 May 13;164(20):2629. {Bacteremia and meningitis caused by Streptococcus pneumoniae during treatment with azithromycin}; Lisby JG et al.; After absorption, azithromycin is concentrated intracellularly, with a correspondingly low serum concentration . A case of bacteriemia and meningitis caused by macrolide-sensitive Streptococcus pneumoniae during treatment with azithromycin is presented and discussed. Rev Med Chil, 2002 Mar, 130(3), 304 - 8 {In vitro susceptibility of streptococcus pneumoniae strains isolated from lower respiratory infections in Instituto Nacional del Tórax (INT)}; Soler T et al.; BACKGROUND: The rising antimicrobial resistance of streptococcus pneumoniae, requires permanent surveillance . Antimicrobial treatments of invasive infections must be modified accordingly . AIM: To assess the in vitro antimicrobial susceptibility of streptococcus pneumoniae strains isolated from lower respiratory infections . MATERIAL AND METHODS: Seventy five strains isolated during three periods in consecutive years were studied . In vitro susceptibility towards penicillin, erythromycin and ceftriaxone was studied using E-test technique minimal inhibitory concentrations . RESULTS: Five percent of strains were penicillin resistant and 11% had an intermediate sensitivity . Erythromycin resistance was observed in 1.3% of strains . Eight percent of strains had an intermediate sensitivity towards ceftriaxone and no resistance was observed . Comparing susceptibility in the three studied periods, it remained low and stable . CONCLUSIONS: High and intermediate resistance of Streptococcus pneumoniae towards penicillin is less prevalent than in other countries . A close surveillance must be maintained (Rev Med Chile 2002; 130: 304-8). Zh Mikrobiol Epidemiol Immunobiol, 2002 Mar-Apr, (2), 94 - 102 {Superantigens of Group A Streptococcus}; Danilova TA; In this review the superantigens (SAG) of group A Streptococcus, mainly pyrogenic toxins, and the coding genes are characterized . Specific sites on the molecules of the main histocompatibility complex, class II, and T-receptors, interacting with SAG, are described . This interaction results in hyperproduction of cytokines posing a systemic influence and leading to severe consequences . The data on the state of protective immunity in SAG-associated diseases and some approaches to their treatment are given. An Esp Pediatr, 2002 Jun, 56(6), 556 - 63 {Neonatal meningitis . Epidemiological study of the Grupo de Hospitales Castrillo}; Grupo de Hospitales Castrillo; OBJECTIVES: A prospective multicenter study was designed to assess the incidence, etiology, risk factors and outcomes of vertically transmitted and nosocomial meningitis in neonates over a two-year period . PATIENTS AND METHODS: Cases of neonatal meningitis diagnosed between January 1, 1997 and December 31, 1998 in the neonatology departments of 28 acute-care hospitals in Spain ("Grupo de Hospitales Castrillo") were prospectively studied . Bacteriological meningitis was considered confirmed when cerebrospinal fluid culture (CSF) was positive for bacteria, virus or fungi, probable when CSF culture was negative but blood culture was positive, and unconfirmed when both cultures were negative . RESULTS: During the study period, 151 cases of meningitis were diagnosed . Transmission was vertical in 84 cases and nosocomial in 67 . The incidence of vertically transmitted meningitis was 0.51 of live births, and was significantly higher in very low birth weight (VLBW) infants . Confirmed bacteriological meningitis was diagnosed in 66 patients (78.6 %) . No risk factors were identified in 46.4 % of the patients . Group B Streptococcus (agalactiae) was isolated in 48.5 % of cases of confirmed meningitis and Escherichia coli was isolated in 18.2 % . In 69.7 % of cases the results of blood culture were in agreement with those of CSF culture . The overall mortality rate was 8.3 %; mortality was significantly higher in VLBW infants (33.3 % vs 4.2 % in infants weighing 1,500 g) . Thirteen percent of survivors had sequelae.The incidence of meningitis of nosocomial transmission was 0.2 % of admissions and was more frequent in VLBW infants . Confirmed bacteriological meningitis was diagnosed in 49 patients (73.1 %) . Two or more risk factors were present in 62.7 % of patients . E . coli was isolated in 26.5 % of cases of nosocomial meningitis and Staphylococcus epidermidis was isolated in 24.5 % . In 55 % of patients the results of blood culture agreed with those of CSF culture . The overall mortality rate was 19.4 % . Mortality was significantly higher in VLBW infants and 18.5 % of survivors showed sequelae . CONCLUSIONS: The incidence, mortality and sequelae of neonatal meningitis in Spain were similar to those reported in recent studies . The most commonly isolated pathogens were group B Streptococcus in vertically transmitted meningitis and E . coli and S . epidermidis in nosocomial meningitis . We believe the distinction between vertical and nosocomial meningitis to be appropriate because the epidemiology of these diseases is different, which implies a different therapeutic approach . The high percentage of positive blood cultures indicates the need to include lumbar puncture whenever systemic infection is suspected in the neonatal period. J Chemother, 1991 Jan, 3 Suppl 1, 224 - 6 Efficacy and safety of teicoplanin in gram-positive pulmonary infections; Sanduzzi A et al.; Teicoplanin is a new antibiotic obtained from a culture filtrate of Actinoplanes teichomyceticus with potent activity against aerobic and anaerobic gram-positive bacteria and having a high affinity for healthy or inflamed bronchial mucosa and pulmonary parenchyma . To investigate the efficacy and safety of this drug, we selected 13 patients suffering from lower respiratory tract infections caused by gram-positive organisms . Pathogens isolated from sputum or bronchial aspirate were: 8 Staphylococcus aureus, 1 Staphylococcus epidermidis, 3 Streptococcus pneumoniae and 1 Streptococcus species . We began treatment as monotherapy at the dosage of 400 mg daily (200 mg x 2) I.M . only after microbiological evaluation . 11 patients (84.6%) were clinically and bacteriologically cured, 1 (7.7%) showed definite clinical improvement but persistence of causative agent and 1 (7.7%) failed to respond . The mean treatment period was 8.3 days . No major adverse effect was observed . We conclude that teicoplanin is a very efficacious and well-tolerated antibiotic for therapy of gram-positive pulmonary infections. J Chemother, 1991 Jan, 3 Suppl 1, 105 - 11 Antibiotics and expression of microbial virulence factors: implications for host defense; Gemmell CG; The discovery that antibiotics are capable of modifying both the structural appearance and physiology of pathogenic bacteria when they are incorporated in the culture medium at sub-growth inhibitory concentrations, has led to numerous examples in which the expression of one or more virulence factors (both structural and soluble) is inhibited or potentiated--some of these bacterial products are recognized in their own right as substances which can interfere with one or more stages of the normal process of phagocytosis viz, chemotaxis and Staphylococcus aureus alpha-toxin; opsonization and M protein of Streptococcus pyogenes; phagocytic ingestion and capsule of Bacteroides fragilis; phagocytic killing and streptolysin O of Streptococcus pyogenes . Exposure to these bacteria to low concentrations of various chemotherapeutic drugs can alter the efficacy of the phagocytic process . However, many examples exist in which no specific biochemical lesion induced by exposure to the antibiotic has been recognized . By way of contrast some recent experimental studies using genetically defined variants of S . aureus expressing protein A, alpha-toxin, beta-toxin or coagulase have allowed some discrimination as to the specifity of the drug action and the relative role of each virulence factor in bacterial pathogenicity . In particular it can be recognized that the presence or absence of protein A either through drug treatment (clindamycin or fusidic acid) or through gene delation is critical in determining bacterial susceptibility to opson-ophagocytosis . Extension of these studies to in vivo models will shed light on possible antibiotic-host defence interaction during chemotherapy. J Antimicrob Chemother, 2002 Jun, 49(6), 1015 - 8 Characterization of clinical Streptococcus pneumoniae strains from Germany with decreased susceptibility to fluoroquinolones; Reinert RR et al.; Fourteen pneumococcal strains isolated in three nationwide studies were characterized for amino acid changes in the enzymes GyrA, GyrB, ParC and ParE, and for the in vitro activity of eight fluoroquinolones and the new non-fluorinated quinolone BMS 284756 . Gemifloxacin and BMS 284756 exhibited the best in vitro activity against all 14 isolates tested . In nine of the 14 isolates mainly classical alterations in ParC (D83N/Y, S79Y/F), as well as rarer alterations such as S80P and D78N, contributed to the decreased susceptibility to fluoroquinolones . In two of the 14 isolates the classical alteration in GyrA (S81F) was found . In only one isolate did alterations in ParC and GyrA exist in parallel. J Antimicrob Chemother, 2002 Jun, 49(6), 935 - 9 Resistance to macrolides in clinical isolates of Streptococcus pyogenes due to ribosomal mutations; Malbruny B et al.; OBJECTIVE: Two clinical strains of Streptococcus pyogenes, 237 and 544, one isolated in Slovakia and the other in Croatia, that were resistant to azithromycin (MIC 8 and 2 mg/L, respectively) but susceptible to erythromycin (MIC 0.5 and 0.12 mg/L, respectively) did not contain any gene known to confer macrolide resistance by ribosomal modification (erm gene) or efflux {mef(A) and msr(A) genes} . The aim of the study was to determine the mechanisms of macrolide resistance in both strains . METHODS: Portions of genes encoding ribosomal proteins L22 and L4, and 23S rRNA (domains II and V) in the two macrolide-resistant strains and in control strains susceptible to macrolides, were analysed by PCR and single-strand conformational polymorphism, to screen for mutations . The DNA sequences of amplicons from resistant strains that differed from those of susceptible strains, in terms of their electrophoretic migration profiles, were determined . RESULTS: S . pyogenes 237 displayed a KG insertion after position 69 in ribosomal protein L4 . S . pyogenes 544 contained a C2611U mutation in domain V of 23S rRNA . CONCLUSION: Mutations at a similar position in ribosomal protein L4 and 23S rRNA have been reported previously in macrolide-resistant pneumococci . This report shows that similar mutations can be found in macrolide-resistant S . pyogenes. Med Pregl, 2002 Jan-Feb, 55(1-2), 41 - 3 {Bacteriologic study of the contents of radicular cysts}; Hrvacanin S; INTRODUCTION: Radicular cysts are, most often, oral tissue cysts . The basis for their development are the remains of Hertwig's epithelial sheath, which is stimulated to proliferate by infectious agents, mostly periapical granuloma or pulp necrosis . The cyst contents can be liquid, either clear or milky-white, or thick and yellowish-caseous pus . Bacteriological and histopathological researches have shown that development of radicular cysts from periapical lesions is a consequence of penetration of normal bacterial flora of the oral cavity . MATERIAL AND METHODS: The study has bacteriologically examined contents of 50 radicular cysts . They were operated between 1993 and 1995 at the Department of Oral Surgery of the Outpatient Health Care Centre Banja Luka . Pathological substrate of the cyst was punctured by a sterile needle and bacteriologically examined at the Microbiological Laboratory of the Clinical Centre in Banja Luka . DISCUSSION AND CONCLUSION: Radicular cysts contents most often consisted of: alpha-hemolytic streptococcus, Streptococcus pneumoniae, Staphyilococcus epidermidis, Streptococcus group B and alpha-hemolytic Streptococcus . It is concluded that normal oral cavity flora is present in the cysts contents, the infection penetrated through the root canal to periapex, where, due to the course of time, radicular cyst develops from periapical granuloma. Caries Res, 2002 Mar-Apr, 36(2), 116 - 21 Lactoperoxidase inhibits glucosyltransferases from Streptococcus mutans in vitro; Korpela A et al.; This study examines the possible effect of the antimicrobial peroxidase system on the activity of streptococcal glucosyltransferases B, C and D (GtfB, GtfC and GtfD), either in solution (GtfB and GtfC) or when adsorbed to hydroxyapatite (GtfC and GtfD) at pH 6.5 . The lactoperoxidase (LP) system (LP, H(2)O(2), SCN(-)) had no effect on the activity of dissolved GtfC, but the activity of dissolved GtfB was enhanced . The LP system, however, strongly inhibited the activities of both GtfC and GtfD in their adsorbed form . LP enzyme, without its substrates, inhibited all three Gtf enzymes: GtfB and GtfC in concentrations between 10 and 100 microg/ml in liquid phase and adsorbed GtfC and GtfD in concentrations between 25 and 50 microg/ml . This inhibition was in part abolished in liquid phase, but not in solid phase, if the substrates of LP were added . This study shows that the lactoperoxidase system can exert inhibitory activity against streptococcal Gtfs without generating oxidizing agents . Caries Res, 2002 Mar-Apr, 36(2), 101 - 7 Antibacterial activity of restorative dental biomaterials in vitro; Boeckh C et al.; This study investigated the antibacterial effects against Streptococcus mutans of a fine-hybrid resin composite (FH-RC; Tetric ceram), an ion-releasing resin composite (Ariston pHc), a self-curing glass ionomer cement (SC-GIC; Ketac-Molar), a resin-modified GIC (RM-GIC; Photac-Fil), and a zinc oxide eugenol cement (ZOE; IRM) . In a novel assay, bacterial suspensions were placed into narrow 20-microl conical cavities within the materials . After 0, 4, 8, 24, 48 h and 1 week of incubation, the suspensions were removed from the restoratives and the numbers of viable bacteria were determined . After incubation periods of 8 h or more, all restorative materials except the FH-RC showed significant growth inhibition when compared with controls . The strongest antibacterial activity was observed with ZOE . The inhibitory effect of Ariston pHc was similar to that of the SC-GIC and the RM-GIC . In the second assay, growth inhibition was evaluated in liquid cultures by incubating eluates of the materials with suspensions of S . mutans . Bacterial growth was determined up to 6 h by measuring absorption at 600 nm . The most marked inhibitory effect was again observed with ZOE . The SC-GIC caused a significant inhibition at all time intervals but the FH-RC, the RM-GIC and Ariston pHc exhibited no significant antibacterial effects . It is recommended to employ more than one method for assessing the antibacterial potential of restorative materials . Long-term clinical trials are necessary to determine whether the antimicrobial effects of dental materials are able to reduce the risk of secondary caries formation . J Clin Microbiol, 2002 Jun, 40(6), 2311 - 2 Fatal case of pneumonia caused by a nonhemolytic strain of Streptococcus pyogenes; Taylor MB et al.; We report a case of pneumonia with a fatal outcome caused by a nonhemolytic strain of Streptococcus pyogenes . This strain was isolated in pure growth from blood cultures and was fully identified biochemically . Such strains will be difficult to recognize and isolate from sites with heavy growth of normal flora . This phenomenon has been reported sporadically before, and it is unknown how common such strains may be in pharyngeal samples. Curr Treat Options Neurol, 2002 Jul, 4(4), 323 - 332 Central Nervous System Infections in the Immune-competent Adult; Smith TL et al.; The clinician must maintain a high level of suspicion for central nervous system infections even if not all of the classic signs are present, because prompt treatment may make a difference in patient outcome . If bacterial meningitis is suspected, a CT scan of the head should be obtained prior to lumbar puncture if there is papilledema, a focal neurologic exam, or if the patient is comatose . In bacterial meningitis, empiric antibiotics should be chosen based on a patient's risk factors and should be started immediately . Depending on the resistance patterns of the institution, Streptococcus pneumoniae may be resistant to penicillins and cephalosporins . Corticosteroids are of uncertain benefit in bacterial meningitis and may decrease the penetration of antibiotics into the central nervous system . The dosage for acyclovir treatment in herpes simplex encephalitis is 10 to 15mg/kg every 8 hours . Subdural empyema is a neurosurgical emergency . Brain abscesses should be surgically drained if they exceed 2.5 centimeters. Aust Dent J, 2002 Mar, 47(1), 21 - 6 Comparison of five selective media for the growth and enumeration of Streptococcus mutans; Wan AK et al.; BACKGROUND: Although a few growth media are available for selective isolation of the cariogenic bacteria, Streptococcus mutans (S . mutans), it is still unclear as to which is the most efficacious . This study compared the selectivity and sensitivity of five different media for growing a laboratory strain of S . mutans (NCTC 10449), and for enumerating S . mutans from teeth of a group of young children, aged 2-10 years . METHODS: The media tested in this study were mitis salivarius with bacitracin (MSB), mitis salivariuskanamycin-bacitracin (MSKB), glucose-sucrose-tellurite-bacitracin (GSTB), trypticase soy-sucrose-bacitracin (TYS20B) and tryptone-yeast-cysteine-sucrose-bacitracin (TYCSB) agars . These were prepared according to the respective manufacturer's instructions . RESULTS: The results showed that at concentrations of bacteria 1 x 10(3) to 1 x 10(10)/mL, the recovery of the laboratory S . mutans strain was highest in TYCSB agar, followed by in descending order by TYS20B, MSB, GSTB, and MSKB (p<0.01) . Similar results were obtained using dental plaque samples collected from swabs of the teeth of a group of children . In the clinical samples, TYCSB again showed the highest recovery rates of S . mutans compared to the other four media . Results were reproduced at dilutions of the samples at 1:20 x 10(6) to 1:2 x 10(6), and S . mutans concentrations of 1.6 to 7.7 Log 10 CFU/mL . In addition, there were highest ratios of mutans to non-mutans bacteria in TYCSB compared to the other media, suggesting high selectivity of this media for mutans species . CONCLUSION: The results of our study suggest that TYCSB is the most sensitive and selective media for culture of S . mutans for laboratory and clinical studies. Ann Fr Anesth Reanim, 2002 Apr, 21(4), 295 - 8 {Severe pneumococcal meningitis and ceftriaxone allergy}; Merat S et al.; We report the case of a 51-year-old man with an allergy to amoxicillin/acid clavulanique who presented with Streptococcus pneumoniae meningitis . Initial treatment consisted of an association of antibiotics including ceftriaxone . Six days after treatment was initiated the patient developed skin reaction and the diagnosis of allergy to ceftriaxone was established by the dosage of specific IgE . Typically Streptococcus pneumoniae meningitis is treated with vancomycin and a third-generation cephalosporin . This association had to be modified because cross allergy to cephalosporins could have developed in this patient who had previously reacted to penicillins. Clin Infect Dis, 2002 Jun 15, 34(12), 1613 - 20 Epub 2002 May 16. Resistance among Streptococcus pneumoniae: Implications for drug selection; Appelbaum PC; Streptococcus pneumoniae is an important pathogen in many community-acquired respiratory infections in the United States and a leading cause of morbidity and mortality worldwide . Unfortunately, S . pneumoniae is becoming increasingly resistant to a variety of antibiotics . Results of recent surveillance studies in the United States show that the prevalence of penicillin-nonsusceptible S . pneumoniae ranges from 25% to >50%, and rates of macrolide resistance among pneumococci are reported to be as high as 31% . A high prevalence of resistance to other antimicrobial classes is found among penicillin-resistant strains . Newer quinolones (e.g., gatifloxacin, gemifloxacin, and moxifloxacin) that have better antipneumococcal activity in vitro are the most active agents and therefore are attractive options for treatment of adults with community-acquired respiratory infections . Efforts should be made to prevent pneumococcal infections in high-risk patients through vaccination. Clin Infect Dis, 2002 Jun 15, 34(12), 1576 - 84 Epub 2002 May 24. Streptococcus agalactiae infective endocarditis: analysis of 30 cases and review of the literature, 1962-1998; Sambola A et al.; We describe 30 cases (1.7%) of community-acquired penicillin-susceptible Streptococcus agalactiae endocarditis among 1771 episodes of endocarditis diagnosed in 4 Spanish hospitals from 1975 through 1998 . Endocarditis affected a native valve (most often the mitral valve) in 25 cases (83%) . Surgical valve replacement was performed for 12 patients (40%) . Fourteen patients (47%) died . Mortality rates for patients with native and prosthetic valve endocarditis were 36% and 100%, respectively (P=.01) . The mortality rate for native valve endocarditis decreased during the last 6 years of the study (from 61% in 1975-1992 to 8% in 1993-1998; P<.05) . Additionally, 115 cases in the literature from 1962-1998 were reviewed . During 1980-1998, the percentage of patients who underwent cardiac surgery increased from 24% (in the previous period, 1962-1979) to 43% (P=.05) and the mortality rate decreased from 45% to 34% (P=NS) . S . agalactiae is an uncommon cause of endocarditis with a high mortality rate, although the prognosis of native valve endocarditis has improved in recent years, probably because of an increased use of cardiac surgery. Clin Infect Dis, 2002 Jun 15, 34(12), 1543 - 50 Epub 2002 May 21. Changes in antibiotic-prescribing practices and carriage of penicillin-resistant Streptococcus pneumoniae: A controlled intervention trial in rural Alaska; Hennessy TW et al.; From 1998 to 2000, 13 rural Alaskan villages (population, 3326) were surveyed annually by nasopharyngeal cultures for Streptococcus pneumoniae carriage . Data regarding antibiotic use for the entire population was abstracted from clinic records . In 1999, education of medical providers and the community about appropriate antibiotic use began in 4 villages; this program was expanded to include all villages in 2000 . Antibiotic courses per person decreased by 31% in the initial intervention villages and by 35% in the remaining villages after education (P<.01 for each) . Samples were obtained for culture from a mean of 31% of the population each year; 31% carried pneumococcus . No sustained decrease in carriage of penicillin-nonsusceptible strains was observed . When linear regression was used, serotype accounted for 81% of the variance in pneumococcal minimum inhibitory concentrations after the intervention, compared with 7% for antibiotic use . This suggests that reducing the carriage of serotypes associated with antibiotic resistance by use of pneumococcal conjugate vaccines may have a greater short-term impact than does decreasing antibiotic use. Panminerva Med, 2002 Jun, 44(2), 151 - 4 Pneumococcal septic arthritis of the shoulder . Case report and literature review; Bertone C et al.; Septic arthritis due to Streptococcus Pneumoniae appears to be relatively uncommon . Single- or clustered-case histories constitute the majority of reports on pneumococcal septic arthritis . A 70-year-old man presented with a 7-day history of pain, erythema and swelling of the left shoulder . Physical examination of the left shoulder revealed a warm, swollen, erythematous, and markedly tender to light palpation . The patient was unable to elevate his arm more than 30 degrees without pain . Arthrocentesis performed on admission produced 30 cc of grossly purulent fluid whose culture demonstrated S . Pneumoniae . The septic arthritis was treated with intravenous vancomycin and imipenem . The antibiotics were substituted when the sensitivities were known with oral ciprofloxacin and rifampycin to complete 8 weeks' total treatment . On follow-up examination 1 year later, the patient has remained afebrile and asymptomatic without evidence of increasing joint effusion or acute joint inflammation . Pneumococcal arthritis is classically described as a painful monoarticular arthritis complicating an active pneumococcal infection, generally a primary pulmonary infection . Pneumococcal arthritis appears to be predominantly a disease affecting the elderly . Clinical presentation ranges from septicemia to indolent infection with few systemic symptoms . With adequate antibiotic therapy and aspiration or drainage of the joint, the prognosis for return of normal joint function appears to be excellent . Although pneumococcal organisms are not likely causes, this bacteria should certainly be considered as a possible cause of arthritis or prosthetic infection. Proc Natl Acad Sci U S A, 2002 May 28, 99(11), 7646 - 51 Insight into the molecular basis of pathogen abundance: group A Streptococcus inhibitor of complement inhibits bacterial adherence and internalization into human cells; Hoe NP et al.; Streptococcal inhibitor of complement (Sic) is a secreted protein made predominantly by serotype M1 Group A Streptococcus (GAS), which contributes to persistence in the mammalian upper respiratory tract and epidemics of human disease . Unexpectedly, an isogenic sic-negative mutant adhered to human epithelial cells significantly better than the wild-type parental strain . Purified Sic inhibited the adherence of a sic negative serotype M1 mutant and of non-Sic-producing GAS strains to human epithelial cells . Sic was rapidly internalized by human epithelial cells, inducing cell flattening and loss of microvilli . Ezrin and moesin, human proteins that functionally link the cytoskeleton to the plasma membrane, were identified as Sic-binding proteins by affinity chromatography and matrix-assisted laser desorption/ionization time-of-flight mass spectrometry analysis . Sic colocalized with ezrin inside epithelial cells and bound to the F-actin-binding site region located in the carboxyl terminus of ezrin and moesin . Synthetic peptides corresponding to two regions of Sic had GAS adherence-inhibitory activity equivalent to mature Sic and inhibited binding of Sic to ezrin . In addition, the sic mutant was phagocytosed and killed by human polymorphonuclear leukocytes significantly better than the wild-type strain, and Sic colocalized with ezrin in discrete regions of polymorphonuclear leukocytes . The data suggest that binding of Sic to ezrin alters cellular processes critical for efficient GAS contact, internalization, and killing . Sic enhances bacterial survival by enabling the pathogen to avoid the intracellular environment . This process contributes to the abundance of M1 GAS in human infections and their ability to cause epidemics. Mol Pathol, 2002 Jun, 55(3), 182 - 5 Identification by 16S ribosomal RNA gene sequencing of Arcobacter butzleri bacteraemia in a patient with acute gangrenous appendicitis; Lau SK et al.; AIMS: To identify a strain of Gram negative facultative anaerobic curved bacillus, concomitantly isolated with Escherichia coli and Streptococcus milleri, from the blood culture of a 69 year old woman with acute gangrenous appendicitis . The literature on arcobacter bacteraemia and arcobacter infections associated with appendicitis was reviewed . METHODS: The isolate was phenotypically investigated by standard biochemical methods using conventional biochemical tests . Genotypically, the 16S ribosomal RNA (rRNA) gene of the bacterium was amplified by the polymerase chain reaction (PCR) and sequenced . The sequence of the PCR product was compared with known 16S rRNA gene sequences in the GenBank by multiple sequence alignment . Literature review was performed by MEDLINE search (1966-2000) . RESULTS: The bacterium grew on blood agar, chocolate agar, and MacConkey agar to sizes of 1 mm in diameter after 24 hours of incubation at 37 degrees C in 5% CO2 . It grew at 15 degrees C, 25 degrees C, and 37 degrees C; it also grew in a microaerophilic environment, and was cytochrome oxidase positive and motile, typically a member of the genus arcobacter . Furthermore, phenotypic testing showed that the biochemical profile of the isolate did not fit into the pattern of any of the known arcobacter species . 16S rRNA gene sequencing showed one to two base differences between the isolate and A butzleri, but 35 to 39 base differences between the isolate and A cryaerophilus, indicating that the isolate was a strain of A butzleri . Only three cases of arcobacter bacteraemia with detailed clinical characteristics were found in the English literature . The sources of the arcobacter species in the three cases were largely unknown, although the gastrointestinal tract is probably the portal of entry of the A butzleri isolated from the present case because the two concomitant isolates (E coli and S milleri) in the blood culture were common flora of the gastrointestinal tract . In addition, A butzleri has previously been isolated from the abdominal contents or peritoneal fluid of three patients with acute appendicitis . CONCLUSIONS: 16S rRNA gene sequencing was useful in the identification of the strain of A butzleri isolated from the blood culture of a patient with acute gangrenous appendicitis . Arcobacter bacteraemia is rare . Further studies using selective medium for the delineation of the association between A butzleri and acute appendicitis are warranted. J Microbiol Methods, 2002 Aug, 50(3), 313 - 8 Detection of Streptococcus pneumoniae DNA by using polymerase chain reaction and microwell hybridization with Europium-labelled probes; Rintamaki S et al.; The present paper describes a novel modification of polymerase chain reaction (PCR) for the detection of Streptococcus pneumoniae DNA in clinical specimens . PCR was based on the detection of a 209-base pair segment of the S . pneumoniae pneumolysin gene . For the demonstration of the amplification product, microwell hybridization with a Europium-labelled oligonucleotide probe complementary to a biotinylated strand of the PCR product was performed, and the presence of the PCR product was monitored by time-resolved fluorescence (TRF) of the Europium chelate . The sensitivity of the assay for purified S . pneumoniae DNA was 50 fg DNA corresponding to 20 genome equivalents of S . pneumoniae DNA . The efficiency of the hybridization step was monitored by using known amounts of synthetic target oligonucleotides as standards . Sensitivity of 3 x 10(8) molecules per individual reaction well was achieved with a 30-min attachment time and a 3-h hybridization time.Detection of PCR-amplified products by the microwell hybridization technique and TRF was compared to agarose gel electrophoresis in 50 middle ear fluid samples obtained from children with acute otitis media . The agarose gel and TRF detection methods identified all culture-positive samples, but both were also positive for 55% of the culture-negative samples . The results suggest that the detection of amplified PCR products by microwell hybridization using Europium-labelled oligonucleotides is a reliable method for the demonstration of the pneumolysin gene fragment . Furthermore, the method is suitable for automation and, thus, for testing high numbers of samples . The clinical significance of the PCR findings remains to be studied. Oral Microbiol Immunol, 2002 Jun, 17(3), 177 - 80 In vivo induction of proinflammatory cytokines in mouse tissue by Porphyromonas gingivalis and Actinobacillus actinomycetemcomitans; Kesavalu L et al.; Periodontitis is a chronic inflammatory dis