Arch Facial Plast Surg, 2001 Oct-Dec, 3(4), 277 - 9 Group A streptococcal fasciitis after submental tumescent liposuction; Beeson WH et al.; Tumescent liposuction is a procedure with a good safety record . Local infection is rare but can result in devastating consequences . We report a rare case of group A streptococcal fasciitis complicating tumescent liposuction and highlight the importance of early diagnosis and treatment of this condition . A 62-year-old woman presented 8 days after submental liposuction and a platysmal plication procedure with signs and symptoms of cervical fasciitis . Microbiological analysis confirmed a group A streptococcal infection . By using early aggressive medical and surgical treatments, the disease was arrested before the onset of any necrotizing process . A high index of suspicion is required to make an early diagnosis of this potentially disfiguring and life-threatening infection. Pediatrics, 2001 Nov, 108(5), 1094 - 8 Early-onset neonatal sepsis in the era of group B streptococcal prevention; Baltimore RS et al.; OBJECTIVE: To determine whether intrapartum antibiotic prophylaxis for neonatal group B streptococcal (GBS) disease has resulted in an increased rate of non-GBS or antibiotic-resistant early-onset invasive neonatal disease . METHODS: Maternal and infant chart review of all infants with bacteria other than GBS isolated from blood or spinal fluid in 1996 through 1999 in 19 hospitals (representing 81% of in-state births to state residents) throughout Connecticut . Suspected cases were identified through clinical microbiology laboratory records or through International Classification of Diseases, Ninth Revision codes when microbiology records were incomplete . RESULTS: Ninety-four cases of non-GBS early-onset sepsis or meningitis were detected between 1996 and 1999 . The rate of GBS-related early-onset infection (days 0-6 of life) dropped from 0.61/1000 to 0.23/1000 births, but the annual rate of non-GBS sepsis remained steady, ranging from 0.65 to 0.68/1000 during the surveillance period . There was an increase in the proportion of Escherichia coli infections that were ampicillin resistant between 1996 and 1998, but the proportion decreased . in 1999 CONCLUSION: There was no increase in the incidence of non-GBS early-onset neonatal infections between 1996 and 1999 . Fluctuations in the annual incidence of E coli infections, including ampicillin-resistant infections, suggest the need for continuation of surveillance in Connecticut and expansion to monitor larger populations. J Neuroimmunol, 2001 Nov 1, 120(1-2), 146 - 51 Progress toward analysis of D8/17 binding to B cells in children with obsessive compulsive disorder and/or chronic tic disorder; Murphy TK et al.; BACKGROUND: Previous research has suggested that a subgroup of children with obsessive compulsive disorder (OCD) have neuropsychiatric sequelae of streptococcal pharyngitis, similar to that seen in the neurological manifestation of rheumatic fever (RF) . Monoclonal antibody D8/17 demonstrates increased binding to B cells in patients with RF and in patients with neuropsychiatric disorders using immunofluorescent microscopy . OBJECTIVE: The aim of this study was to determine if an earlier immunofluorescent microscopy study of monoclonal antibody D8/17 in childhood-onset OCD and/or chronic tic disorder (CTD) could be replicated using the more objective method of flow cytometric analysis . METHOD: D8/17 binding to B cells was determined in patients with OCD and or CTD (N=32), and healthy controls (N=12) by flow cytometric analysis . RESULTS: Subjects with OCD/CTD showed increased mean cell binding (26.0%) of monoclonal antibody compared with healthy controls (9.1%) (p<0.001) . When using the threshold of greater than 19% binding (95% upper confidence interval) as a measure of positivity, 65.6% of patients compared with 8.3% of controls showed increased antibody binding to B cells (p=0.01) . CONCLUSIONS: Although this study reports positive results, many methodological issues will need to be addressed before generalized use of assay for diagnostic purposes. Biol Psychiatry, 2001 Oct 15, 50(8), 566 - 77 Antibodies against neural, nuclear, cytoskeletal, and streptococcal epitopes in children and adults with Tourette's syndrome, Sydenham's chorea, and autoimmune disorders; Morshed SA et al.; BACKGROUND: Some cases of Tourette's syndrome (TS) are hypothesized to be caused by autoantibodies that develop in response to a preceding group A beta hemolytic streptococcal infection . METHODS: To test this hypothesis, we looked for the presence ot total and IgG antibodies against neural, nuclear, cytoskeletal and streptococcal epitopes using indirect immunofluorescent assays and Western blot techniques in three patient groups: TS (n = 81), SC (n = 27), and a group of autoimmune disorders (n = 52) and in normal controls (n = 67) . Subjects were ranked after titrations of autoantibodies from 0 to 227 according to their level of immunoreactivity . RESULTS: TS patients had a significantly higher mean rank for total antineural and antinuclear antibodies, as well as antistreptolysin O titers . However, among children and adolescents, only the total antinuclear antibodies were increased in TS patients compared to age matched controls . Compared to SC patients, TS patients had a significantly lower mean rank for total and IgG class antineural antibodies, significantly lower IgG class anticytoskeletal antibodies, and a significantly higher rank for total antinuclear antibodies . Compared to a mixed group of autoimmune disorders, the TS patients had a significantly lower mean rank for total and IgG class antineural antibodies, total and IgG class antinuclear antibodies, IgG class anticytoskeletal antibodies, and a significantly higher rank for antistreptococcal antibodies . CONCLUSIONS: TS patients had significantly higher levels of total antineural and antinuclear antibodies than did controls . Their relation to IgG class antineural and antinuclear antibodies, markers for prior streptococcal infection, and other clinical characteristics, especially chronological age, was equivocal. Vaccine, 2001 Nov 12, 20(3-4), 370 - 6 Preclinical evaluation of group B streptococcal polysaccharide conjugate vaccines prepared with a modified diphtheria toxin and a recombinant duck hepatitis B core antigen; Paoletti LC et al.; An effective vaccine against group B streptococcal (GBS) disease will undoubtedly include capsular polysaccharides (CPSs) from each of the five serotypes prevalent in the United States individually coupled to immunogenic proteins . This formulation may require the use of two or more different protein carriers . We preclinically examined the potential of two proteins to serve as effective carriers for GBS type III CPS . Recombinant duck hepatitis B core antigen (rdHBcAg), a particulate protein of viral origin, and a newly mutated form of diphtheria toxin (DTm) were covalently and directly coupled to purified type III CPS by reductive amination . Seventy-seven of 79 (97%) newborn pups born to mouse dams actively vaccinated with type III CPS-rdHBcAg conjugate survived GBS type III challenge, whereas none of the pups born to dams that received an uncoupled mixture of type III CPS and rdHBcAg or saline survived . Likewise, 64 (98%) of 65 pups born to dams vaccinated with type III CPS-DTm conjugate survived challenge, in sharp contrast to no survivors among the pups born to dams vaccinated with an uncoupled mixture of type III CPS and DTm . The presence of type III CPS-specific IgG in serum from dams correlated with pup survival in groups that received a conjugate vaccine, and this serum was opsonically active in vitro against GBS type III . In addition, carrier-specific IgG was also measured in serum from vaccinated mice . These data suggest that the rdHBcAg and DTm may be effective carriers for GBS CPSs. J Laryngol Otol, 2001 Oct, 115(10), 792 - 5 Nasopharyngeal endoscopy adds to reliability of clinical diagnosis of infectious mononucleosis; Weber R et al.; Frequently, the clinical picture in the oropharynx alone does not lend itself to a reliable differentiation between acute pharyngotonsillitis in infectious mononucleosis and a streptococcal inflammation . Such a differentiation, however, is essential for the indication of antibiotic therapy . Therefore, it was the aim of the present study to investigate whether or not endoscopic verification of larger-than-normal lymphatic tissue with fibrinous membranes in the nasopharynx would enhance the reliability of diagnosis . Fifty hospitalized patients exhibiting the clinical picture of acute pharyngotonsillitis were examined for the following parameters: nasopharyngeal endoscopy, determination of glutamine-oxaloacetic transaminase (GOT), glutamine-pyruvic transaminase (GPT), C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), leucocytes and haemogram, antibodies to viral capsid antigen (VCA)-IgM, Epstein-Barr virus nuclear antigen (EBNA), and cytomegalovirus (CMV) . In 24 patients with acute tonsillitis/peritonsillar abscess, and in 26 patients with infectious mononucleosis, the total leucocyte count in the blood and the blood/erythrocyte sedimentation rate were comparable . Atypical lymphocytes or absolute lymphocytosis were not seen in acute tonsillitis, but were found in 88.5 per cent of patients with infectious mononucleosis . Elevated transaminase levels were noted in 77 (GOT) and 88.5 per cent (GPT) of patients with infectious mononucleosis, and in acute tonsillitis in 4.2 (GOT) and 12.5 per cent (GPT) of patients . The CRP was higher than normal in 91.7 per cent of patients with acute tonsillitis, and in 57.7 of patients with infectious mononucleosis . In none of the patients with acute tonsillitis was lymphatic tissue with fibrinous membranes seen in the nasopharyngeal cavity . In contrast, nasopharyngeal endoscopy in infectious mononucleosis was positive in 24 out of 26 patients . Hence, the sensitivity was 92.3 per cent, the specificity 100 per cent, and the prediction value for a positive test turned out to be 1 . Endoscopy of the nasopharngeal cavity employed as a simple and supplementary procedure adds to the reliability of diagnosis of infectious mononucleosis. FASEB J, 2001 Nov, 15(13), 2524 - 6 Epub 2001 Sep 17. Monovalent fusion proteins of IgE mimotopes are safe for therapy of type I allergy; Ganglberger E et al.; By screening phage display random peptide libraries with purified immunoglobulin E (IgE) from birch pollen-allergic patients, we previously defined peptides mimicking natural IgE epitopes (mimotopes) of the major birch pollen allergen Bet v 1 . The present study aimed to define a monovalent carrier for the IgE mimotopes to induce protective antibodies directed to the IgE epitopes, suitable for mimotope-specific therapy . We expressed the selected mimotopes as fusion proteins together with streptococcal albumin binding protein (ABP) . The fusion proteins were recognized specifically by anti-Bet v 1 human IgE, which demonstrated that the mimotopes fused to ABP resemble the natural IgE epitope . Bet v 1-specific IgG was induced by immunization of BALB/c mice with fusion proteins . These IgG antibodies could inhibit IgE binding to Bet v 1 . Skin testing of Bet v 1 allergic mice showed that the ABP mimotope constructs did not elicit type I skin reactions, although they possess IgE binding structures . Our data suggest that IgE mimotopes are safe for epitope-specific immunotherapy of sensitized individuals, when presented in a monovalent form . Therefore, ABP-fused mimotopes are promising candidates for a new type of immunotherapy based on the precise induction of blocking antibodies. J Am Acad Dermatol, 2001 Nov, 45(5), 770 - 2 Varicella complicated by group A streptococcal facial cellulitis; Santos-Juanes J et al.; An increase has been recently noted in the incidence of life-threatening group A beta-hemolytic streptococcal (GABHS) infections in children recovering from varicella . We report our experience with a patient who required pediatric intensive care unit admission because of a serious GABHS infection 1 week after the onset of varicella . Emergency physicians must look for this complication in patients with varicella remaining abnormally febrile and presenting unusual manifestations. J Microbiol Immunol Infect, 2001 Sep, 34(3), 195 - 200 Characteristics of group A streptococcal bacteremia with comparison between children and adults; Huang YC et al.; This retrospective study aimed to compare the characteristics of group A streptococcal bacteremia in children and adults . A total of 76 (12 children and 64 adults) patients with group A streptococcal bacteremia treated from October 1995 through September 2000 at the Linko Chang Gung Memorial Hospital were included . The mean age was 47.6 years (range, 12 days-90 years) . Forty-four (57.9%) patients had predisposing medical conditions . Malignant cancer (23.7%) and diabetes (22.4%) were the 2 most common conditions, which occurred only in adults . Two (16.7%) children had chickenpox associated with secondary group A streptococcal bacteremia . Skin and soft tissue infection (60.5%) was the most common clinical manifestation . The mortality rate related to group A streptococcal bacteremia was 25% . Twelve patients met the criteria of streptococcal toxic shock syndrome and 6 (50%) were children (p<0.05) . Despite immediate and aggressive treatment, mortality due to streptococcal toxic shock syndrome was 66.7% . The incidence of streptococcal toxic shock syndrome was much higher in children (50%) than in adults (9.4%) . Early diagnosis of invasive group A streptococcal infections and streptococcal toxic shock syndrome requires awareness of the presentations and a high level of suspicion . For fulminant group A streptococcal infection, a combination of a beta-lactam antibiotic plus clindamycin and/or adjuvant therapy with intravenous immunoglobulin is recommended. Acta Trop, 2001 Oct 22, 80(2), 163 - 8 Tonsillar actinomycosis: a clinicopathological study; Bhargava D et al.; Actinomycosis has been known to involve virtually every anatomic site in the body . Although actinomycosis has been identified in resected tonsils, its possible role in adeno-tonsillar disease has received little attention . A clinicopathological study of 302 patients who had adeno-tonsillar surgery is presented . Tonsillar actinomycosis was present in 86 (28.5%) patients . The statistical analysis revealed a significant association (P<0.0001) of actinomycosis and tonsillar hypertrophy (56.8%) compared to only 10.3% in the recurrent tonsillitis group . A statistically significant association (P<0.0001) of tonsillar actinomycosis and sickle cell anaemia, beta thalassaemia, bronchial asthma and beta haemolytic streptococcal infections was also seen . This data supports a predisposition of the above conditions to tonsillar actinomycosis and adeno-tonsillar hypertrophy and a possible etiopathologic role of this organism in adeno-tonsillar hypertrophy and disease . Although the clinical association of actinomycosis and tonsillar hypertrophy and beta haemolytic streptococcal infection has been described before the association of actinomycosis with sickle cell anaemia, beta thalassaemia and bronchial asthma is being observed for the first time in literature. Infect Immun, 2001 Nov, 69(11), 6696 - 701 Effects of alum adjuvant or a booster dose on immunogenicity during clinical trials of group B streptococcal type III conjugate vaccines; Paoletti LC et al.; Phase 1 and 2 clinical trials of group B streptococcal (GBS) capsular polysaccharide (CPS)-protein conjugate vaccines in healthy adults have demonstrated their safety and improved immunogenicity compared with uncoupled CPSs . Two recent trials sought to determine (i) whether adsorption of conjugate vaccine to aluminum hydroxide would improve immunogenicity and (ii) whether the CPS-specific immunoglobulin G (IgG) response could be boosted by administration of a second dose . Adsorption of GBS type III CPS-tetanus toxoid (III-TT) conjugate vaccine to alum did not improve the immune response to a 12.5-microg dose in healthy adult recipients . Four weeks after vaccination, the geometric mean antibody concentrations (GMCs) for the 15 recipients of III-TT with or without alum were 3.3 and 3.6 microg/ml, respectively . In the second trial, 36 healthy adults vaccinated previously with GBS III-TT conjugate were given a second 12.5-microg dose 21 months later . At 4 weeks after the second dose, the GMCs of type III CPS-specific IgG were similar to those measured 4 weeks after the primary vaccination, suggesting a lack of a booster response . However, 8 (22%) of the 36 participants who had undetectable III CPS-specific IgG (<0.05 microg/ml) before the first dose of III-TT conjugate exhibited a booster response to the second dose, with a fourfold-greater GMC of type III CPS-specific IgG than after the initial immunization . These results suggest that prior natural exposure to type III GBS or a related antigen may be responsible for the brisk IgG response to CPS noted in most adults after vaccination . However, a second dose of GBS III-TT conjugate vaccine may be required for adults whose initial CPS-specific IgG concentrations are very low and would also restore the initial peak-specific III CPS-IgG in responders to previous vaccination. Klin Med (Mosk), 2001, 79(8), 47 - 50 {Evolutionary trends in symptoms of acute glomerulonephritis in adult population of the Novosibirsk region}; Movchan EA et al.; Acute glomerulonephritis (AGN) trends in the last 3 decades in the Novosibirsk Region have been analysed basing on the data from 308 AGN case histories . The results of the analysis demonstrate that AGN occurs not often but with stable rate . It is encountered more frequently in young men . The last decade is characterized by higher morbidity after streptococcal infection, high percentage of women at reproductive age, aggravation of the clinical course with marked edemas, severe arterial hypertension, renal dysfunction (acute renal failure in 10.4%), cases of left ventricular failure (5.2%) and eclampsia (1.7%) not registered earlier. Structure (Camb), 2001 Aug, 9(8), 679 - 87 Complex between Peptostreptococcus magnus protein L and a human antibody reveals structural convergence in the interaction modes of Fab binding proteins; Graille M et al.; BACKGROUND: Peptostreptococcus magnus protein L (PpL) is a multidomain, bacterial surface protein whose presence correlates with virulence . It consists of up to five homologous immunoglobulin binding domains that interact with the variable (VL) regions of kappa light chains found on two thirds of mammalian antibodies . RESULTS: We refined the crystal structure of the complex between a human antibody Fab fragment (2A2) and a single PpL domain (61 residues) to 2.7 A . The asymmetric unit contains two Fab molecules sandwiching a single PpL domain, which contacts similar VL framework regions of two light chains via independent interfaces . The residues contacted on VL are remote from the hypervariable loops . One PpL-Vkappa interface agrees with previous biochemical data, while the second is novel . Site-directed mutagenesis and analytical-centrifugation studies suggest that the two PpL binding sites have markedly different affinities for VL . The PpL residues in both interactions are well conserved among different Peptostreptococcus magnus strains . The Fab contact positions identified in the complex explain the high specificity of PpL for antibodies with kappa rather than lambda chains . CONCLUSIONS: The PpL-Fab complex shows the first interaction of a bacterial virulence factor with a Fab light chain outside the conventional combining site . Structural comparison with two other bacterial proteins interacting with the Fab heavy chain shows that PpL, structurally homologous to streptococcal SpG domains, shares with the latter a similar binding mode . These two bacterial surface proteins interact with their respective immunoglobulin regions through a similar beta zipper interaction. Arch Pediatr, 2001 Sep, 8 Suppl 4, 769s - 775s {Staphylococcal and streptococcal pediatric toxic syndrome from 1998 to 2000 . Data from the National Center for Staphylococcal Toxemia}; Lina G et al.; The clinical and microbial settings of staphylococcal and streptococcal toxemia in pediatric patients were investigated by the French National Reference Center for Staphylococcal Toxemia . From 1998 to 2000, the number of cases was low in regard to the usual putative incidence of these toxemia; this low incidence was probably linked to the passive collection of cases . The most significant finding was the evidence of skin infections as the source of the majorities of staphylococcal toxic shock syndrome and staphylococcal scarlet fever as described for streptococcal toxic shock syndrome or nosocomial suppurative infections . Moreover, most of scalded skin syndrome were from pediatric patients and were exceptional in adults . For other syndromes, no significant original findings were observed. Int Immunol, 2001 Oct, 13(10), 1335 - 43 Antibody levels to the class I and II epitopes of the M protein and myosin are related to group A streptococcal exposure in endemic populations; Brandt ER et al.; Rheumatic fever (RF)/rheumatic heart disease (RHD) and post-streptococcal glomerulonephritis are thought to be autoimmune diseases, and follow group A streptococcal (GAS) infection . Different GAS M types have been associated with rheumatogenicity or nephritogenicity and categorized into either of two distinct classes (I or II) based on amino acid sequences present within the repeat region ('C' repeats) of the M protein . Sera from ARF patients have previously been shown to contain elevated levels of antibodies to the class I-specific epitope and myosin with the class I-specific antibodies also being cross-reactive to myosin, suggesting a disease association . This study shows that immunoreactivity of the class I-specific peptide and myosin does not differ between controls and acute RF (ARF)/RHD in populations that are highly endemic for GAS, raising the possibility that the association is related to GAS exposure, not the presence of ARF/RHD . Peptide inhibition studies suggest that the class I epitope may be conformational and residue 10 of the peptide is critical for antibody binding . We demonstrate that correlation of antibody levels between the class I and II epitope is due to class II-specific antibodies recognizing a common epitope with class I which is contained within the sequence RDL-ASRE . Our results suggest that antibody prevalence to class I and II epitopes and myosin is associated with GAS exposure, and that antibodies to these epitopes are not an indicator of disease nor a pathogenic factor in endemic populations. Harefuah, 2001 Sep, 140(9), 810 - 2, 896 {Overuse of antibiotics with upper respiratory tract infections in a primary care clinic}; Cohen AD et al.; In the majority of cases upper respiratory tract infections (URI's) are caused by viruses . Nonetheless, in many instances, patients with URI's are over-treated with antibiotics . In order to evaluate the use of antibiotic therapy in patients with URI's, we recorded medications prescribed for URI's in 394 young adults seeking care in a primary care clinic . The following parameters were assessed: rhinnorhea, cough, sore throat, dysphagia, tonsillar exudates, tonsillar enlargement and cervical lymphadenopathy . Throat cultures were taken from all the patients . RESULTS: Antibiotic therapy was prescribed for 99 of the 370 patients (26.8%) with URI's and negative throat cultures . Among these patients, a high prevalence of the following findings was evident: tonsillar enlargement (66.7%), tonsillar exudates (48.5%), cervical lymphadenopathy (42.4%), lack of rhinorrhea (40.4%), lack of cough (32.0%) and fever (31.3%) . CONCLUSIONS: Excess antibiotic therapy was prescribed for patients with URI's . Possible explanations are: clinical findings that suggest a diagnosis of follicular tonsillitis, early antibiotic treatment that is not based on throat cultures or antigen detection tests, and multiple treating physicians . RECOMMENDATIONS: We recommend that in cases of patients with URI's, antibiotics should not be prescribed unless diagnosis of a streptococcal infection is supported by results of throat cultures or antigen detection tests . Furthermore, in primary care clinics with a number of physicians, treatment should guarantee appropriate medical follow-up. Anesth Analg, 2001 Oct, 93(4), 986 - 90 Epidural labor analgesia and neonatal sepsis evaluation rate: a quality improvement study; Kaul B et al.; Labor epidural analgesia (LEA) is allegedly associated with maternal fever and an increase in the newborn sepsis work-up (SWU) rate . In this study, we evaluated whether LEA causes an increase in the SWU rate compared with a Control group given parenteral narcotics for labor pain . Maternal and neonatal data were collected prospectively for a continuous quality improvement database . Odds ratios were calculated by using multiple logistic regression for various triggers for SWU in the neonate . Of the 1177 primiparous women and their neonates studied, 922 women received LEA and 255 women received parenteral analgesics . A small but statistically significant increase in maternal and neonatal temperatures occurred in parturients receiving LEA . The SWU rates were 7.5% in the LEA group and 9.4% in the Controls (not significant) . Triggers identified for SWU were birth weight (odds ratio = 116, P = 0.000), gestational age (odds ratio = 86.6, P = 0.000), meconium aspiration and respiratory distress requiring intubation (odds ratio = 8.6, P = 0.000), hypothermia at birth (odds ratio = 7.1, P = 0.001), maternal Group B beta-hemolytic streptococcal colonization (odds ratio = 6, P = 0.000), and preeclampsia or hypertension (odds ratio = 3.5, P = 0.03) . There was no association between LEA and SWU . IMPLICATIONS: Although it has been suggested that epidural analgesia for labor contributes to an increase in neonatal sepsis work-up (SWU), this retrospective analysis shows that epidural analgesia is not associated with an increase in SWU . The factors that were found to contribute to SWU included low birth weight, low gestational age, meconium aspiration or respiratory distress at birth, hypothermia at birth, maternal group B beta-hemolytic colonization, and preeclampsia or hypertension. Microbiol Res, 2001, 156(2), 133 - 8 Isolation and characterization of enterocin BC25 and occurrence of the entA gene among ruminal gram-positive cocci; Morovsky M et al.; Enterocin BC25, a bacteriocin produced by Enterococcus faecium BC25 isolated from the rumen of cow was purified to homogeneity and sequenced . Twenty amino acids were identified in the peptide chain (TTHSGKYYGNGVYCT-KNKCT), identical to the N-terminal sequence of enterocin A . The DNA sequence of the enterocin BC25 structural gene and putative immunity protein exhibited high similarity to the entA gene . The occurrence of a 726 bp amplicon containing the enterocin A structural gene was studied among gram-positive ruminal cocci by PCR . Our results showed wide occurrence of the entA structural gene among ruminal enterococcal and streptococcal bacterial strains tested, and indicate variable ability to express bacteriocin production and resistance. Lakartidningen, 2001 Aug 22, 98(34), 3545 - 9 {Rheumatic fever behind acute chorea in a young girl . A case report}; Malmborg P et al.; This article presents the case of a 13-year old girl who was admitted to the emergency department because of rapidly evolving, seriously disabling impairments in movement and speech . Investigation led to the conclusion that her problems were caused by Sydenham's chorea as a manifestation of rheumatic fever . A neuropsychiatric examination performed one year after the onset of disease revealed a hitherto unknown mild mental retardation . The case description is followed by a clinical update on rheumatic fever focusing on cerebral manifestations . The theories concerning the existence of PANDAS--an autoimmune neuropsychiatric disorder following streptococcal infections, distinct from rheumatic fever--are presented. Laryngoscope, 2001 Sep, 111(9), 1515 - 9 Pediatric autoimmune neuropsychiatric disorders and streptococcal infections: role of otolaryngologist; Orvidas LJ et al.; OBJECTIVE: To increase awareness and understanding of the putative role of streptococcal infection in the development of neuropsychiatric disorders in children and to discuss therapeutic options in this group of patients . METHODS: Case illustration and literature review . RESULTS: Two siblings, one with obsessive-compulsive disorder (OCD) and one with a tic disorder, had tonsillectomy for recurrent streptococcal pharyngitis . At the latest follow-up visit (11 mo postoperatively), both patients exhibited significant improvement in their psychiatric illnesses . We discuss these cases as well as the diagnosis, pathophysiology, and treatment of pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS) . CONCLUSION: PANDAS is an active area of research investigating the relationship between streptococcal infections and the development of obsessive-compulsive disorder or tic disorders (or both) in children . The etiopathogenesis of PANDAS is thought to reflect autoimmune mechanisms and involvement of the basal ganglia of susceptible hosts . Because otolaryngologists evaluate a large portion of pediatric patients with recurrent streptococcal pharyngitis, it is important to be aware of this association and to manage these patients appropriately. Laryngoscope, 2001 Aug, 111(8), 1413 - 22 Surgical management of retropharyngeal space infections in children; Kirse DJ et al.; OBJECTIVE: To study the perioperative management strategies in a large group of pediatric patients undergoing surgical therapy for suppurative adenitis of the parapharyngeal and retropharyngeal spaces . STUDY DESIGN: Retrospective analysis of all patients treated surgically from January 1, 1989, to December 31, 1998, in a tertiary care pediatric hospital . METHODS: Charts were reviewed for demographic data, duration and nature of symptoms, radiological workup, surgical approach, complications, duration of medical therapy and antibiotic choice, and bacteriological findings . Computed tomography (CT) results were correlated to surgical findings . RESULTS: A dramatic increase in the incidence of deep neck space infection was seen during the study period; this increase was congruent with the increase in culture-positive group A beta-hemolytic streptococcal abscesses . More than two-thirds of the patients were boys with the peak incidence being in the 3- to 5-year-old group . The duration of symptoms before presentation was less than might be expected, especially in the younger age groups . Seventy of 73 children were treated with a transoral approach . Sixty-eight of 73 were successfully treated with one operative intervention . Irregularity of the abscess wall was found to be a stronger predictor of the presence of pus than the presence of ring enhancement . CONCLUSIONS: The current study represents the largest series of pediatric retropharyngeal abscesses in the modern medical literature . Changes in the disease process and in management from the first half of the century to today are reviewed, and recommendations for optimal management presented . The data in this series support a transoral approach to these abscesses unless there is extension lateral to the great vessels. Protein Sci, 2001 Oct, 10(10), 2138 - 9 Heparin binding by the HIV-1 tat protein transduction domain; Hakansson S et al.; The protein transduction domain from the HIV-1 tat protein (termed PTD-tat) has been fused to the C-terminus of a model cargo protein, the IgG binding domain of streptococcal protein G . We demonstrate that PG-Ctat (PTD-tat fused to the C-terminus of protein G) binds to a heparin affinity column . PG-Ctat binds with relatively high affinity, as shown by its elution at 1.6 M NaCl . The heparin binding properties of PTD-tat are consistent with the idea that heparan sulfate, an analog of heparin found at the cell surface, plays a role in the translocation of PTD-tat fusions . We suggest that the heparin-binding properties of PTD-tat can be exploited for purification of PTD-tat fusions in the absence of affinity tags. J Immunol, 2001 Oct 1, 167(7), 3870 - 7 Isolated hypervariable regions derived from streptococcal M proteins specifically bind human C4b-binding protein: implications for antigenic variation; Morfeldt E et al.; Antigenic variation in microbial surface proteins represents an apparent paradox, because the variable region must retain an important function, while exhibiting extensive immunological variability . We studied this problem for a group of streptococcal M proteins in which the approximately 50-residue hypervariable regions (HVRs) show essentially no residue identity but nevertheless bind the same ligand, the human complement regulator C4b-binding protein (C4BP) . Synthetic peptides derived from different HVRs were found to retain the ability to bind C4BP, implying that the HVR corresponds to a distinct ligand-binding domain that can be studied in isolated form . This finding allowed direct characterization of the ligand-binding properties of isolated HVRs and permitted comparisons between different HVRs in the absence of conserved parts of the M proteins . Affinity chromatography of human serum on immobilized peptides showed that they bound C4BP with high specificity and inhibition experiments indicated that different peptides bound to the same site in C4BP . Different C4BP-binding peptides did not exhibit any immunological cross-reactivity, but structural analysis suggested that they have similar folds . These data show that the HVR of streptococcal M protein can exhibit extreme variability in sequence and immunological properties while retaining a highly specific ligand-binding function. Curr Rheumatol Rep, 2001 Oct, 3(5), 445 - 52 Rheumatic fever; Rullan E et al.; Rheumatic fever is a multisystem inflammatory disease that occurs as a delayed sequel to group A streptococcal pharyngitis . It is less common than it was 50 years ago but is still a major cause of heart disease in developing areas of the world . The relationship between the site of infection, the type of causative organism, and susceptibility of the host is essential in the development of the disease . Its major clinical manifestations include carditis, migratory polyarthritis, chorea, erythema marginatum, and subcutaneous nodules . It can manifest as an acute febrile illness consisting of migratory polyarthritis involving the large joints, as carditis and valvulitis, or as Sydenham's chorea with involvement of the central nervous system . The disorder in its milder form resolves itself without sequelae . Carditis is the condition most associated with increased mortality and morbidity and may be fatal in its severe forms . Penicillin is the most appropriate primary and secondary prophylaxis . Anti- inflammatory agents provide symptomatic relief but do not prevent rheumatic heart disease. Curr Rheumatol Rep, 2001 Oct, 3(5), 363 - 4 Clinical trials for post-streptococcal reactive arthritis; Lehman TJ et al.; Post-streptococcal reactive arthritis is a frequently observed entity that has an uncertain relationship with acute rheumatic fever . Although different criteria have been suggested for delineating these two conditions, none have been validated . In the absence of a clear definition, it has been impossible for investigators to carry out meaningful studies . Some children who were initially labeled as having post-streptococcal reactive arthritis later suffered from carditis and definite rheumatic fever with subsequent streptococcal infections . Some physicians now recommend that all children with post-streptococcal reactive arthritis receive penicillin prophylaxis . However, the proper duration of treatment and appropriate guidelines for patient selection have not been determined . It will be impossible to answer these questions until collaborative efforts are made to accurately define this illness and then begin a careful analysis of its etiopathogenesis and natural history . In the interim, each physician must evaluate the potential risks and benefits of penicillin prophylaxis in view of the risk of rheumatic fever in the community. Proteins, 2001 Nov 1, 45(2), 144 - 58 Protein molecular dynamics with the generalized Born/ACE solvent model; Calimet N et al.; Implicit solvent models are increasingly important for the study of proteins in aqueous solution . Here, the generalized Born (GB) solvent polarization model as implemented in the analytical ACE potential {Schaefer and Karplus (1996) J Phys Chem 100:1578} is used to perform molecular dynamics simulations of two small, homologous proteins: the immunoglobulin-binding domain of streptococcal protein G and the Ras binding domain of Raf . Several model parameterizations are compared through more than 60 ns of simulation . Results are compared with two simpler solvent models-an accessible surface area model and a distant-dependent dielectric model, with finite-difference Poisson calculations, with existing explicit solvent simulations, and with experimental data . The simpler models yield stable but distorted structures . The best GB/ACE implementation uses a set of atomic Voronoi volumes reported recently, obtained by averaging over a large database of crystallographic protein structures . A 20% reduction is applied to the volumes, compensating in an average sense for an excessive de-screening of individual charges inherent in the ACE self-energy and for an undersolvation of dipolar groups inherent in the GB screening function . This GB/ACE parameterization yields stable trajectories on the 0.5-1-ns time scale that deviate moderately (approximately 1.5-2.5 A) from the X-ray structure, reproduce approximately the surface distribution of charged, polar, and hydrophobic groups, and reproduce accurately backbone flexibility as measured by amide NMR-order parameters . Over longer time scales (1.5-3 ns), some of the protein G runs escape from the native energy basin and deviate strongly (3 A) from the native structure . The conformations sampled during the transition out of the native energy basin are overstabilized by the GB/ACE solvation model, as compared with a numerical treatment of the full dielectric continuum model . Neurol Med Chir (Tokyo), 2001 Aug, 41(8), 387 - 92 Adoptive immunotherapy for malignant brain tumors using human peripheral blood mononuclear cells activated by the Streptococcal preparation OK-432; Hirotsu T et al.; Adoptive immunotherapy using OK-432-activated mononuclear cells (OK-MCs) offers cell-mediated and cytokine-mediated pathways for antitumor activity . The effectiveness of direct intratumoral administration of OK-MCs via a catheter/reservoir system was studied in patients with malignant brain tumors . Seventeen patients, 12 with malignant glioma, four with metastatic adenocarcinoma, and one with primary sarcoma of the brain, were treated by OK-MC therapy (1.0 to 11.2 x 10(7) cells/person) between June 1989 and April 1999 . The OK-MC therapy was given to patients with tumors progressing despite previous cytoreductive surgery, radiation, or chemotherapy . Adverse effects seen after the therapy were fever in 10 patients, seizure in two patients, and hypotension in one patient . Evaluation by computed tomography or magnetic resonance imaging revealed that seven patients showed no change including three with minor response, and 10 showed progressive disease . Adoptive immunotherapy using OK-MC was safe and well tolerated, but the therapeutic potential is limited. Rheumatology (Oxford), 2001 Sep, 40(9), 978 - 87 Suppression of chronic streptococcal cell wall-induced arthritis in Lewis rats by liposomal clodronate; Richards PJ et al.; OBJECTIVES: To investigate the role of macrophages in the pathogenesis of chronic streptococcal cell wall (SCW)-induced arthritis using liposomal clodronate . METHODS: Female Lewis rats with SCW-induced arthritis received a single intravenous injection of 20 mg of clodronate encapsulated within small unilamellar vesicles (SUVc) 10 days post-arthritis induction . RESULTS: SUVc significantly suppressed the development of chronic SCW-induced arthritis for up to 26 days after treatment . At this time point, ED1(+) macrophages were significantly depleted in the liver and ankle joints, although splenic macrophage numbers were not significantly different from control groups . Macrophage elimination induced a significant reduction in local levels of interleukin (IL)-1beta, IL-6, tumour necrosis factor-alpha (TNFalpha) and matrix metalloproteinase-9 (MMP-9) from ankle joints . CONCLUSIONS: Macrophage elimination by SUVc inhibits local production of IL-1beta, IL-6, TNFalpha and MMP-9, and the pathogenesis of inflammatory arthritis. Trop Anim Health Prod, 2001 Oct, 33(5), 355 - 65 An outbreak of respiratory disease complex in sheep in Central Ethiopia; Tibbo M et al.; An investigation was carried out into an outbreak of respiratory disease complex (RDC) in 3641 Menz and Awassi x Menz cross sheep in Central Ethiopia between 1998 and 1999 by clinical, serological, microbiological, post-mortem and histopathological examinations . The monthly incidence of RDC varied from 2.8% to 4.0% and the prevalence was as high as 17% . The case fatality rate was 18%, despite culling of sick sheep . Over 76% of the morbidity occurred in adults, followed by 19% among weaners . Similarly, 62% of the mortality was in adults . However, 27% of the mortality occurred in lambs despite the low morbidity in the group . Significant breed and age differences were seen in the morbidity and mortality rates (p < 0.05) . Clinical signs, gross and microscopic lesions and serological and bacteriological examinations showed an interplay of several causes of the RDC, including pestes des petits ruminants (PPR) (72.3%, serologically confirmed), lung worms, maedi-visna, bacterial bronchopneumonia (staphylococcal and streptococcal), enzootic pneumonia and some fungal infections . Cold temperatures, which may be as low as -8.5 degrees C at night, are major predisposing factors along with managemental stresses . Vaccination of animals with a homologous PPR vaccine appeared to decrease dramatically the occurrence of the disease, showing that PPR played an important role in the outbreak . Several of the pathogens do not appear to be individually capable of causing the respiratory disease . Appropriate strategies for the prevention of RDC are suggested. J Infect, 2001 Apr, 42(3), 195 - 200 Toxic shock-like syndrome with flu-like prodrome: a possible role of 'enhancing tissue focus' for streptococcal toxic shock; Hirose Y et al.; We describe three patients with invasive group A streptococcal infection, admitted during the 3 months between November 1996 and February 1997 . All patients were previously healthy Japanese women who developed a profound shock, with a rapidly fatal outcome, after experiencing flu-like symptoms . All cases conformed to the case definition of toxic shock-like syndrome (TSLS).Currently, the pathogenic mechanism of TSLS remains unclear . Known microbial virulence factors can not sufficiently explain the occurrence of TSLS, and it has been generally considered that host factors may be contributory . On pathological examination, each patient had one organ or tissue that was most severely involved: Case 1 a non-penetrating trauma; Case 2 a pregnant uterus; and Case 3 a pulmonary lesion reminiscent of lymphocytic interstitial pneumonia . On the basis of clinicopathological features of these cases, we propose that the coexistence of 'enhancing tissue focus' may be one of host factors for the progression of TSLS in patients infected with non-invasive GAS . Brain Res, 2001 Sep 14, 913(1), 95 - 105 Serum cleaved Tau protein and neurobehavioral battery of tests as markers of brain injury in experimental bacterial meningitis; Irazuzta JE et al.; Brain injury due to bacterial meningitis affects multiple areas of the brain with a heterogeneous distribution generating a challenge to assess severity . Tau proteins are microtubular binding proteins localized in the axonal compartment of neurons . Brain injury releases cleaved Tau proteins (C-tau) into the extracellular space where they are transported to the cerebral spinal fluid . We hypothesized that C-tau crosses the blood-brain barrier during inflammation and that it can be detected in serum . The correlation between serum C-tau levels and the extent of the meningitic insult was examined . Furthermore, we studied whether the use of a subset of neurobehavioral tasks can assess the extent of brain injury after meningitis . The tests were chosen primarily for their ability to detect deficits in the acoustic system, low brain, reflexive responding, as well as for impaired motor coordination and the higher brain functions of learning and memory . A rat model of group B streptococcal meningitis with variable severity was utilized . At five days after bacterial inoculation followed by antibiotic therapy neurobehavioral tests were performed and serum C-tau and histologic samples of the brain were obtained . Our study shows that during meningitis C-tau appears in serum and reflects the extent of neurologic damage . Neurobehavioral performance was altered after bacterial meningitis and could be correlated with histologic and biochemical markers of neurologic sequelae . We conclude that serum C-tau and a composite of neurobehavioral tests could become useful markers for assessing the severity of neurological damage in experimental bacterial meningitis. Br J Dermatol, 2001 Aug, 145(2), 280 - 4 The importance of serum creatine phosphokinase level in the early diagnosis, and as a prognostic factor, of Vibrio vulnificus infection; Nakafusa J et al.; BACKGROUND: Vibrio vulnificus infection causes rapidly progressive skin lesions and sepsis in compromised hosts with liver cirrhosis, and is often fatal . Early diagnosis and rapid treatment are important . OBJECTIVES: To clarify the characteristics of V . vulnificus infection that distinguish it from other cutaneous and soft-tissue bacterial infections and to confirm that serum creatine phosphokinase (CPK) levels are useful in early diagnosis, and are a prognostic factor for, V . vulnificus infection . METHODS: We analysed the clinical and laboratory findings (especially serum CPK levels) in eight patients with V . vulnificus infection who were treated at the Saga Medical School Hospital between January 1989 and December 1999 . RESULTS: All eight patients had liver dysfunction and typical skin manifestations . Six had eaten raw seafood before onset . Seven patients had initial skin manifestations in their legs or feet and eventually died, despite prompt therapy in the intensive care unit . CPK levels of six of these seven patients were already elevated at their initial presentation . Only one patient, with skin manifestations solely on his left hand, showed and maintained a normal CPK level and survived . In 23 patients with cutaneous and soft-tissue infections (10 with necrotizing fasciitis, three with erysipelas, 10 with cellulitis), only three patients with necrotizing fasciitis and streptococcal toxic shock syndrome (STSS) showed CPK elevation . CONCLUSIONS: A high level of serum CPK in cutaneous or soft-tissue bacterial infection is considered useful for an early diagnosis of V . vulnificus infection and STSS . A history of eating raw seafood, underlying liver disease and multiple lesions suggest a diagnosis of V . vulnificus infection, rather than STSS. Br J Dermatol, 2001 Aug, 145(2), 245 - 51 Contrasting patterns of streptococcal superantigen-induced T-cell proliferation in guttate vs . chronic plaque psoriasis; Davison SC et al.; BACKGROUND: Streptococcal infection is strongly associated with guttate psoriasis (GP) and may also exacerbate chronic plaque psoriasis (CPP), possibly through the release of superantigenic toxins . OBJECTIVES: To investigate superantigen-induced generation of cutaneous lymphocyte associated antigen (CLA) -positive lymphocytes in GP compared with CPP . METHODS: Peripheral blood lymphocyte (PBL) expression of CLA and T-cell receptor Vbeta chain was assessed in patients with CPP and with active and resolved GP . Expression of superantigen-reactive Vbeta families was compared with in vitro superantigen-induced peripheral blood mononuclear cell (PBMC) proliferation . RESULTS: Peripheral blood mononuclear cells from patients with active GP showed a twofold increased proliferation after stimulation with streptococcal pyogenic toxins A and streptococcal pyogenic toxins C compared with controls (P < 0.01), whereas the response to the staphylococcal toxins and mitogenic stimulation was the same in all groups . Peripheral blood lymphocytes (PBL) from patients with active GP showed increased use of the superantigen-reactive families Vbeta2 (P < 0.01) and Vbeta17 (P < 0.05), which was not evident in the other patient groups or controls . This pattern of Vbeta expression was only observed in CLA-positive T cells . Furthermore, there was a positive correlation between Vbeta2 expression and enhanced proliferation after stimulation with SPEA (r = 0.82, P < 0.01) and SPEC (r = 0.74, P < 0.05) in active GP . CONCLUSIONS: This study supports the concept that streptococcal infection precipitates acute GP at least in part through superantigen driven generation of Vbeta-restricted CLA-positive skin homing lymphocytes, whereas we could find no evidence for a similar mechanism occurring in the maintenance of stable CPP. Nurse Pract, 2001 Aug, 26(8), 34, 37 - 42, 44-7; quiz 48-9 Identifying poststreptococcal glomerulonephritis; Lang MM et al.; Expedient antimicrobial treatment of group A beta-hemolytic streptococcal tonsillopharyngitis prevents suppurative complications and rheumatic fever; however, timely therapy does not prevent acute poststreptococcal glomerulonephritis . Acute poststreptococcal glomerulonephritis is the most common form of postinfectious glomerulonephritis and a leading cause of acute and chronic renal failure in childhood . This article discusses clinical presentation, diagnostic workup, treatment, and prevention of poststreptococcal glomerulonephritis in adults and children in the primary care setting. Int J Med Inform, 2001 Sep, 63(1-2), 31 - 40 Generation of an intelligent medical system, using a real database, to diagnose bacterial infection in hospitalized patients; Cundell DR et al.; The initial diagnosis of bacterial infections in the absence of laboratory microbiological data requires physicians to use clinical algorithms based on symptoms, patient history and infection site . Optimization of such algorithms would be achieved by including as many variables associated with bacterial infection as possible . Demographic data are easily available and frequently used to sub-group human populations . A prospective investigation was, therefore, undertaken to examine the influence of demographic variables on bacterial infection rates, using data obtained from 173 patients presenting to Albert Einstein Medical Center . Data was randomly selected from 149 of these patients and used to generate fuzzy rules to model an intelligent medical system . To test the accuracy of this system at determining bacterial infection, based solely on demographic data, the program was given the remaining 24 patients' information . All 18 patients with either streptococcal, staphylococcal or Escherichia coli infections were correctly diagnosed . Non-E.coli GNR were misdiagnosed as E . coli infections in two patients resulting in an overall prediction rate for the 24 patients of 91.66% . This study suggests that the direct correlation of demographic variables with a predisposition to bacterial infection allow the design of an intelligent medical system, which shows great future potential as a diagnostic tool for all physicians. J Biol Chem, 2001 Oct 26, 276(43), 39832 - 5 Epub 2001 Aug 21. Functional molecular mass of a vertebrate hyaluronan synthase as determined by radiation inactivation analysis; Pummill PE et al.; Hyaluronan (HA), a linear polysaccharide composed of N-acetylglucosamine-glucuronic acid repeats, is found in the extracellular matrix of vertebrate tissues as well as the capsule of several pathogenic bacteria . The HA synthases (HASs) are dual-action glycosyltransferases that catalyze the addition of two different sugars from UDP-linked precursors to the growing HA chain . The prototypical vertebrate hyaluronan synthase, xlHAS1 (or DG42) from Xenopus laevis, is a 588-residue membrane protein . Recently, the streptococcal enzyme was found to function as a monomer of protein with approximately 16 lipid molecules . The vertebrate enzymes are larger than the streptococcal enzymes; based on the vertebrate HAS deduced amino acid sequence, two additional membrane-associated regions at the carboxyl terminus are predicted . We have utilized radiation inactivation to measure the target size of yeast-derived recombinant xlHAS1 . The target size of HAS activity was confirmed using two internal standards . First, samples were spiked with glucose-6-phosphate dehydrogenase, an enzyme of known molecular weight . Second, parallel samples of native xlHAS1 and a xlHAS1-green fluorescent protein fusion (833 residues) were compared; substantial confidence was gained by using this novel internal standard . Our test also corroborated the basic tenets of radiation inactivation theory . We found that the vertebrate HAS protein functions catalytically as a monomer. Arch Dis Child, 2001 Sep, 85(3), 223 - 7 Rheumatic fever in a high incidence population: the importance of monoarthritis and low grade fever; Carapetis JR et al.; AIMS: To describe the clinical features of rheumatic fever and to assess the Jones criteria in a population and setting similar to that in many developing countries . METHODS: The charts of 555 cases of confirmed acute rheumatic fever in 367 patients (97% Aboriginal) and more than 200 possible rheumatic fever cases from the tropical "Top End" of Australia's Northern Territory were reviewed retrospectively . RESULTS: Most clinical features were similar to classic descriptions . However, monoarthritis occurred in 17% of confirmed non-chorea cases and 35% of unconfirmed cases, including up to 27 in whom the diagnosis was missed because monoarthritis is not a major manifestation . Only 71% and 25% of confirmed non-chorea cases would have had fever using cut off values of 38 degrees C and 39 degrees C, respectively . In 17% of confirmed non-chorea cases, anti-DNase B titres were raised but antistreptolysin O titres were normal . Although features of recurrences tended to correlate with initial episodes, there were numerous exceptions . CONCLUSIONS: Monoarthritis and low grade fever are important manifestations of rheumatic fever in this population . Streptococcal serology results may support a possible role for pyoderma in rheumatic fever pathogenesis . When recurrences of rheumatic fever are common, the absence of carditis at the first episode does not reliably predict the absence of carditis with recurrences. Mt Sinai J Med, 2001 Sep-Oct, 68(4-5), 336 - 8 Cutaneous polyarteritis nodosa after streptococcal necrotizing fasciitis; Stein RH et al.; Polyarteritis nodosa (PAN) is a necrotizing arteritis of small and medium-sized vessels . It may present with hypertension and/or renal insufficiency . Peripheral neuropathy, myopathy, joint pains, testicular pain, and ischemic myalgias may also be seen . Gastrointestinal involvement may lead to gangrene of the bowel, peritonitis, perforation, intra-abdominal hemorrhage, and pancreatitis . The cutaneous manifestations include tender subcutaneous nodules grouped along the course of superficial arteries of the lower extremities, with or without an overlying livedo reticularis . Although multisystem involvement is characteristic, sometimes only one organ or system may be involved . Associations with viral hepatitis (both B and C) and streptococcal infection have been established for PAN . Recurrent strep infections of the upper respiratory tract, streptococcal glomerulonephritis and rheumatic fever have previously been linked to PAN . This report extends the spectrum of associated streptococcal infections to include necrotizing fasciitis. BJOG, 2001 Aug, 108(8), 840 - 7 Choosing a strategy to prevent neonatal early-onset group B streptococcal sepsis: economic evaluation; Stan CM et al.; OBJECTIVE: To determine the most appropriate strategy to prevent neonatal streptococcal sepsis in a setting with a low incidence of the disease . DESIGN: Decision analysis and economic evaluation . SETTING: Geneva University Hospitals, Switzerland . POPULATION: Pregnant women at 35-37 weeks of gestation and in labour . METHODS: Local data and data from the literature were used in a decision analysis to compare the current policy of antibiotic administration at Geneva University Hospitals with the recommended preventive strategies . MAIN OUTCOME MEASURES: Number of episodes of sepsis averted; cost and number needed to treat to prevent one episode of sepsis; and proportion of women receiving antibiotics during labour . RESULTS: Compared with the current policy, the risk factors strategy would prevent 69 streptococcal sepsis per million deliveries and the screening strategy would prevent 102 cases of sepsis per million deliveries . Cost per averted sepsis case would be 60 pounds, 700 and 473 pounds, 600, respectively . The number needed to treat to prevent one sepsis would be 1,087 with a risk factors strategy and 1,029 with a screening strategy . Preventive strategies would increase the proportion of women receiving antibiotics during labour from 6% with the current policy, to 13.5% and 16.5% respectively . CONCLUSIONS: Preventive strategies are more effective than the current policy, but imply increased hospital costs and a notable increase in the proportion of women receiving antibiotics during labour, which may be unjustified in a low incidence setting. Horm Res, 2001, 55(2), 77 - 80 Frasier syndrome with childhood-onset renal failure; Buzi F et al.; BACKGROUND: The Wilms' tumour 1 (WT1) gene encodes a protein which is believed to exert transcriptional and tumour-suppressor activities . Mutations of this gene have occasionally been associated with Wilms' tumour (<15% of cases) and, more consistently, with three syndromes characterized by urogenital abnormalities (WAGR, Denys-Drash and Frasier syndrome) . SUBJECT/METHOD: A 25-year-old phenotypic female with a 46,XY karyotype presented with amenorrhoea . An ultrasound scan showed streak gonads and a rudimentary uterus . The patient had a history of post-streptococcal glomerulonephrosis, when aged 4 years, which had rapidly progressed to kidney failure, requiring transplantation at age 8 . RESULT: Frasier syndrome was suspected and confirmed by genetic analysis . In fact, direct sequencing of the PCR product of the intron 9 donor splice site revealed a substitution of guanine for adenine in position +5 . CONCLUSION: Besides being one of the few Frasier syndrome cases to be genetically characterized, this case is interesting because of the unusually early-onset renal failure . Folia Microbiol (Praha), 2001, 46(1), 61 - 2 Bacteriocins of ruminal bacteria; Morovsky M et al.; Similar sequences of distribution of structural genes encoding enterocin A (isolated from the ruminal strain E . faecium BC25) and enterolysin A (isolated from the ruminal amylolytic strain S . bovis II/1) were demonstrated by PCR using oligonucleotide primers specific for these bacteriocins within the ruminal enterococcal and streptococcal strains . Variable occurrence of these bacteriocins was found within the populations of Gram-positive ruminal cocci. Infect Immun, 2001 Sep, 69(9), 5345 - 51 T-cell reactivity against streptococcal antigens in the periphery mirrors reactivity of heart-infiltrating T lymphocytes in rheumatic heart disease patients; Guilherme L et al.; T-cell molecular mimicry between streptococcal and heart proteins has been proposed as the triggering factor leading to autoimmunity in rheumatic heart disease (RHD) . We searched for immunodominant T-cell M5 epitopes among RHD patients with defined clinical outcomes and compared the T-cell reactivities of peripheral blood and intralesional T cells from patients with severe RHD . The role of HLA class II molecules in the presentation of M5 peptides was also evaluated . We studied the T-cell reactivity against M5 peptides and heart proteins on peripheral blood mononuclear cells (PBMC) from 74 RHD patients grouped according to the severity of disease, along with intralesional and peripheral T-cell clones from RHD patients . Peptides encompassing residues 1 to 25, 81 to 103, 125 to 139, and 163 to 177 were more frequently recognized by PBMC from RHD patients than by those from controls . The M5 peptide encompassing residues 81 to 96 {M5(81-96) peptide} was most frequently recognized by PBMC from HLA-DR7+ DR53+ patients with severe RHD, and 46.9% (15 of 32) and 43% (3 of 7) of heart-infiltrating and PBMC-derived peptide-reactive T-cell clones, respectively, recognized the M5(81-103) region . Heart proteins were recognized more frequently by PBMC from patients with severe RHD than by those from patients with mild RHD . The similar pattern of T-cell reactivity found with both peripheral blood and heart-infiltrating T cells is consistent with the migration of M-protein-sensitized T cells to the heart tissue . Conversely, the presence of heart-reactive T cells in the PBMC of patients with severe RHD also suggests a spillover of sensitized T cells from the heart lesion. Arch Pediatr, 2001 Jul, 8(7), 700 - 6 {Treatment of acute group A beta-hemolytic streptococcal tonsillitis in children with a 5-day course of josamycin}; Portier H et al.; MATERIAL AND METHODS: In this randomized open study, 325 children aged two to 15 years with acute tonsillitis and a positive test of GA beta H streptococcal antigen were treated with josamycin 50 mg.kg-1.day-1 b.i.d for 5 days, or penicillin 50,000 to 100,000 IU/day t.i.d for 10 days . Clinical assessments and throat cultures for GA beta HS isolation were performed at the inclusion visit (V1), at the end of treatment visit (V2: day 12 for all patients) and at the follow-up visit (V3: day 30) . In case of positive GA beta HS culture, the bacterial DNA by RFLP was performed to differentiate between the persistence (presence of original strain at V2), relapse (eradication at V2 and acquisition of same strain at V3) and reinfection (eradication at V2 and acquisition of different strain at V3) . RESULTS: Two hundred and twenty-three patients were included in the bacteriological and clinical criteria per protocol analysis . At V2, eradication rates were comparable: 82% in josamycin and 80% in penicillin patients; clinical cure rates were 90% and 89% . At V3, relapse of GAS assessed only on clinically and bacteriologically cured patients at V2 occurred in 12% of josamycin patients and 12.8% of penicillin patients . Tolerance was good; 14% and 10% of josamycin and penicillin patients respectively experienced an adverse event . CONCLUSION: In this non-inferiority study, the efficacy of a 5-day course of josamycin is comparable to reference treatment in GA beta HS tonsillitis in children. Jpn J Thorac Cardiovasc Surg, 2001 Jun, 49(6), 373 - 6 Mitral valve replacement through right thoracotomy after coronary arterial bypass grafting with functioning conduits; Wakiyama H et al.; A 67-year-old man who had undergone coronary artery bypass grafting 3 years previously suffered from severe mitral regurgitation associated with Streptococcal infective endocarditis . He was placed in New York Heart Association functional class III . Preoperative angiography demonstrated good opacification of all 3 conduits implanted in the previous operation . We replaced the mitral valve through an anterolateral right thoracotomy, approaching the mitral valve as an alternative to redoing sternotomy to minimize potential injury to patent grafts . His postoperative course was uneventful . After a 1-month course of antibiotics, the patient was discharged as New York Heart Association class II and at present, 3 months after discharge, is doing well . This approach is an effective alternative to redoing sternotomy for mitral valve operation, especially in patients undergoing a previous coronary arterial bypass grafting via median sternotomy. Vojnosanit Pregl, 2001 Mar-Apr, 58(2), 161 - 6 {Acute post-streptococcal glomerulonephritis in adults--corticosteroid therapy, yes or no?}; Jovanovic D et al.; The aim of this study was to investigate the influence of the corticosteroid therapy on the development and prognosis of proststreptococcal glomerulonephritis (PSGN) in the period of five years . The investigation included a group of 54 patients who were in the acute phase of poststreptococcal glomerulonephritis (PSGN) when they were 18-22 years old . Corticosteroids were administered per os with the starting dose of 0.5 mg/kg bm, and the dose was subsequently decreased by 5 mg every 10 days to 20 mg/per day within 8 weeks of therapy . We have treated ten patients and all were with severe clinical manifestations of the disease (acute renal failure, oliguria, edemas, hypertension) and severe histopathologic (HP) finding of kidney tissue on the initial biopsy . On the basis of clinical parameters, HP changes on the repeated biopsy of the kidney and five years follow-up, we have concluded that the remission of the disease was achieved in patients who had received corticosteroid therapy . Clinical findings were confirmed by PH findings of repeated biopsies with less expressed residues of the disease . Corticosteroid therapy should be administered in adult patients who are in the acute phase of the disease, with clinical and HP severe form of PSGN, since the risk for the further progress of more serious sequelae of the disease is significantly decreased. Pediatr Int, 2001 Aug, 43(4), 364 - 7 Prognosis of acute poststreptococcal glomerulonephritis (APSGN) is excellent in children, when adequately diagnosed; Kasahara T et al.; BACKGROUND: Recently, the prognosis of acute poststreptococcal glomerulonephritis (APSGN) has been reported as improved, compared with the results of previous studies . In an attempt to clarify this, we analyzed the clinical course of patients with APSGN . METHODS: A total of 220 children with acute nephritic syndrome were treated in the affiliated hospitals of our department, between January 1988 and December 1997 . Among them, 138 children who were diagnosed with APSGN according to the presence of hematuria, transient hypocomplementemia and evidence of group A beta-hemolytic streptococcal infection, were studied . RESULTS: Serum creatinine and blood urea nitrogen levels at onset were 0.5 +/- 0.2 mg/dL and 20 +/-12 mg/dL, respectively . There were no patients with renal dysfunction (serum creatinine level > or = 1.5 mg/dL), but one patient with nephrotic syndrome . Blood pressure was well controlled in all patients and there were no patients with persistent hypertension . Serum complement levels were normalized within 12 weeks (100%), hematuria disappeared within 4 years (100%) and proteinuria disappeared within 3 years (100%) from the onset . CONCLUSIONS: These data indicate that the prognosis of APSGN during childhood is excellent, when adequately diagnosed and treated. J Rheumatol, 2001 Jul, 28(7), 1681 - 8 Acute rheumatic fever and poststreptococcal reactive arthritis: diagnostic and treatment practices of pediatric subspecialists in Canada; Birdi N et al.; OBJECTIVE: We conducted a survey of pediatric specialists in rheumatology, cardiology, and infectious diseases to ascertain present Canadian clinical practice with respect to diagnosis and treatment of acute rheumatic fever (ARF) and poststreptococcal reactive arthritis (PSReA), and to determine what variables influence the decision for or against prophylaxis in these cases . METHODS: A questionnaire comprising 6 clinical case scenarios of acute arthritis occurring after recent streptococcal pharyngitis was sent to members of the Canadian Pediatric Rheumatology Association, and to heads of divisions of pediatric cardiology and pediatric infectious diseases at the 16 university affiliated centers across Canada . RESULTS: There is considerable variability with respect to diagnosis in cases of ReA following group A streptococcal (GAS) infection both within and across specialties . There is extensive variability regarding the decision to provide prophylaxis in cases designated as ARF or PSReA . Findings indicated that physicians are most comfortable prescribing antibiotic prophylaxis in the presence of clear cardiac risk and are less inclined to such intervention for patients diagnosed with PSReA . When prophylaxis was recommended for cases of PSReA, the majority of respondents prescribed longer term courses of antibiotics . CONCLUSION: The lack of observed consistency in diagnosis and treatment in cases of reactive arthritis post-GAS infection likely reflects the lack of universally accepted criteria for diagnosis of PSReA and insufficient longterm data regarding carditis risk within this population . There is a need for clear definitions and treatment guidelines to allow greater consistency in clinical practice across pediatric specialties. Ann Pharm Fr, 2001 Jul, 59(4), 246 - 77 {The worldwide challenges of "new" or reemerging communicable diseases at the dawn of the 21st century}; Werner GH; In the first part of this review, AIDS, prion diseases, Hantavirus and arbovirus infections, Ebola hemorrhagic fever, legionellosis, hepatitis C, enterotoxigenic Escherichia coli infections, Lyme disease, tuberculosis have provided alarming examples of emerging or reemerging infectious diseases . In this second part, the stress is placed on the reemergence of diphtheria and of serious streptococcal infections, on bartonelloses, Chlamydia infections, fungal infections, while malaria and cholera are still prevalent in several areas . The increasing resistance of too many pathogens to antimicrobial agents is a major source of concern, directly related to the challenge of nosocomial infections . An infectious cause has been demonstrated (or strongly suspected) for various diseases and the scope of infectiology keeps widening, while the threat of bioterrorism cannot be neglected . The causes of the emergence or reemergence of infectious diseases are multiple and diverse, often in direct relation with human activities (population migrations, changes in husbandry or farming practices, worldwide exchanges of goods and foods, inadequate uses of antibiotics) but also with climatic variations in several areas . The challenge represented by this unexpected comeback of infections to the forefront of human and animal pathology can only be met with a significant improvement of hygienic practices, cessation of certain dangerous behaviors and also, of course, with the development of novel antimicrobial molecules (acting on original targets) as well as of a whole series of new specific vaccines. Epidemiol Infect, 2001 Jun, 126(3), 365 - 72 Acute poststreptococcal glomerulonephritis: public health implications of recent clusters in New South Wales and epidemiology of hospital admissions; Muscatello DJ et al.; Acute poststreptococcal glomerulonephritis (APSGN) is an inflammatory kidney condition that can complicate Group A streptococcal infections . Two clusters of APSGN occurred recently in New South Wales (NSW), Australia; one in a rural town in December 1999 and the other in a Sydney suburb in January 2000 . We interviewed carers of the affected children but found no common exposures except three of the Sydney cases were cousins in frequent contact . To assess the probability of these clusters occurring, we analysed hospital admissions for acute glomerulonephritis, as a proxy for APSGN in younger patients . The incidence of acute glomerulonephritis in NSW during 1989/90-1997/8 in residents aged under 20 years was 2.2/100000/year (95% CI 2.0-2.5) . Incidence was highest in children aged 5-9 years, boys and Aboriginal children . We found no evidence for other clusters during that period . The recent clusters highlight the continued potential for unexpected future outbreaks of APSGN. Int J Neuropsychopharmacol, 2001 Jun, 4(2), 191 - 8 Paediatric autoimmune neuropsychiatric disorders associated with streptococcal infection (PANDAS); Leonard HL et al.; The evidence to date, both published and unpublished, which addresses the validity of the proposed unique subgroup of children with early and abrupt onset of obsessive--compulsive disorder (OCD) and/or tic disorders subsequent to streptococcal infections was reviewed . The aetiology of OCD and tic disorders is unknown, although it appears that both disorders may arise from a variety of genetic and environmental factors . Post-streptococcal autoimmunity has been postulated as one possible mechanism for some . The acronym PANDAS (for paediatric autoimmune neuropsychiatric disorders associated with streptococcal infections) has been given to a subgroup of paediatric patients who meet five inclusionary criteria: presence of OCD and/or tic disorder, pre-pubertal symptom onset, sudden onset or episodic course of symptoms, temporal association between streptococcal infections and neuropsychiatric symptom exacerbations, and associated neurological abnormalities . The proposed model of pathophysiology provides for several unique treatment strategies, including the use of antibiotic prophylaxis to prevent streptococcal-triggered exacerbations, and the use of immunomodulatory interventions (such as intravenous immunoglobulin or therapeutic plasma exchange) in the treatment severe neuropsychiatric symptoms . For the latter study group, long-term (2--5 yr) follow-up revealed continued symptom improvement for the majority of patients, particularly when antibiotic prophylaxis had been effective in preventing recurrent streptococcal infections . In addition, the episodic nature of the subgroup's illness provides for opportunities to study brain structure and function during health and disease, as well as allowing for investigations of the aetiologic role of anti-neuronal antibodies and neuroimmune dysfunction in both OCD and tic disorders . Although much research remains to be done, an increasing body of evidence provides support for the postulate that OCD and tic disorders may arise from post-streptococcal autoimmunity . The unique clinical characteristics of the PANDAS subgroup, the presence of volumetric changes in the basal ganglia, and the dramatic response to immunomodulatory treatments, suggest that symptoms arise from a combination of local, regional and systemic dysfunction . Ongoing research is directed at understanding the nature of the abnormal immune response, as well as identifying at-risk children, in order to provide for novel strategies of prevention and treatment. Pediatr Nephrol, 2001 Jul, 16(7), 598 - 600 Recurrence of acute poststreptococcal glomerulonephritis; Watanabe T et al.; Recurrence of acute poststreptococcal glomerulonephritis (APSGN) is a rare phenomenon . We present an 8-year-old boy with a second episode of APSGN 12 months following a complete clinical recovery from his initial attack . Renal histology, obtained from renal biopsies of the patient during the second attack, showed diffuse endocapillary proliferation, granular deposition of C3, IgG, IgA, and fibrinogen along capillary walls, and subepithelial electron-dense deposits . A new streptococcal cytoplasmic antigen (nephritis-associated plasmin receptor protein, NAP1r), which was recently identified as the pathogenic antigen in APSGN, was detected in the glomeruli of an early kidney biopsy specimen from the patient during the second attack of APSGN, using fluorescein isothiocyanate-labeled rabbit anti-NAP1r . However, antibodies against NAP1r, examined by Western blotting, were not present in sera from the patient . These results suggest that recurrence of APSGN in some patients may be caused by an absence of a natural immune response to NAP1r. Vaccine, 2001 Jul 20, 19(30), 4143 - 52 A novel bipolar mode of attachment to aluminium-containing adjuvants by BBG2Na, a recombinant subunit hRSV vaccine; Dagouassat N et al.; Human respiratory syncytial virus (hRSV) is a major pathogen responsible for bronchiolitis and severe pulmonary disease in very young children, immunodeficient patients and the elderly . BBG2Na, a recombinant chimeric protein produced in Escherichia coli, is a promising subunit vaccine candidate against this respiratory pathogen, composed of G2Na, the central domain of RSV G glycoprotein, and BB, an albumin binding domain of streptococcal protein G . BBG2Na has a basic isoelectric point (pI 9.3) and as expected, is strongly adsorbed by aluminium phosphate (AP) . Surprisingly, BBG2Na is also strongly adsorbed by aluminium hydroxide (AH), which normally binds molecules with acidic isoelectric points . This behaviour was unexpected according to the well established adsorption model of Hem and co-workers . Our observations may be explained by the bipolar two-domain structure of the BBG2Na chimera which is not reflected by the global basic isoelectric point of the whole protein: the BB domain has an acidic isoelectric point (pI 5.5) and the G2Na domain a highly basic one (pI 10.0) . Importantly, formulation in either aluminium salt resulted in equally high immunogenicity and protective efficacy against RSV in mice . From a physicochemical point of view, this unique property of BBG2Na makes it eminently suitable for combination to either paediatric or elderly multivalent AH- or AP-containing vaccines already in the market or in development. J Am Chem Soc, 2001 Jan 31, 123(4), 526 - 33 Synthesis of peptides and proteins without cysteine residues by native chemical ligation combined with desulfurization; Yan LZ et al.; The highly chemoselective reaction between unprotected peptides bearing an N-terminal Cys residue and a C-terminal thioester enables the total and semi-synthesis of complex polypeptides . Here we extend the utility of this native chemical ligation approach to non-cysteine containing peptides . Since alanine is a common amino acid in proteins, ligation at this residue would be of great utility . To achieve this goal, a specific alanine residue in the parent protein is replaced with cysteine to facilitate synthesis by native chemical ligation . Following ligation, selective desulfurization of the resulting unprotected polypeptide product with H(2)/metal reagents converts the cysteine residue to alanine . This approach, which provides a general method to prepare alanyl proteins from their cysteinyl forms, can be used to chemically synthesize a variety of polypeptides, as demonstrated by the total chemical syntheses of the cyclic antibiotic microcin J25, the 56-amino acid streptococcal protein G B1 domain, and a variant of the 110-amino acid ribonuclease, barnase. Fam Med, 2001 Jul-Aug, 33(7), 516 - 21 Use of a template to improve documentation and coding; Rose EA et al.; BACKGROUND AND OBJECTIVES: Accurate assignment of evaluation and management (E&M) codes is a challenge for physicians . Having guidelines close at hand during patient visits might improve appropriateness and accuracy of E&M coding . We developed a template based on a clinical prediction rule for group A beta-hemolytic streptococcal (GABHS) pharyngitis to improve documentation and coding decisions . METHODS: Fifty office visits for sore throat were documented using templates and were compared with 50 sore throat visits that were documented using progress notes . We counted history and physical examination items and compared the level of service charged to the level of service supported by the note . RESULTS: Significantly more history of present illness and physical examination items were recorded on templates . Decisions related to treatment for patients with a low probability of GABHS were also improved by the templates . Templates had no effect on billing and coding errors . CONCLUSIONS: The template resulted in more-thorough documentation but had no effect on coding and billing errors relative to progress notes. Eye, 2001 Jun, 15(Pt 3), 390 - 5 Structure and composition of drusen associated with glomerulonephritis: implications for the role of complement activation in drusen biogenesis; Mullins RF et al.; PURPOSE: The ocular fundi of many patients with membranoproliferative glomerulonephritis type II (MPGN-II) are characterised by the presence of deposits within Bruch's membrane that resemble drusen, hallmark lesions associated with age-related macular degeneration (AMD) . Glomerulonephritis (GN)-associated drusen appear at a younger age, however, than do drusen in individuals with AMD . In light of recent evidence that immune-mediated events participate in drusen biogenesis and AMD, we examined the structure and composition of drusen in eyes obtained from human donors with two distinct glomerulopathies, both of which involve complement deposition within glomeruli . These features were compared with those of drusen from patients with clinically documented AMD . METHODS: Eyes obtained from two human human donors diagnosed with membranous and post-streptococcal GN, respectively, were analysed histochemically, immunohistochemically and ultrastructurally . RESULTS: Subretinal pigment epithelial (RPE) deposits in both types of GN are numerous and indistinguishable, both structurally and compositionally, from drusen in donors with AMD . GN-associated drusen exhibit sudanophilia, bind filipin, and react with antibodies directed against vitronectin, complement C5 and C5b-9 complexes, TIMP-3 and amyloid P component . Drusen from the membranous GN donor, but not the post-streptococcal GN donor, reacted with peanut agglutinin and antibodies directed against MHC class II antigens and IgG . The ultrastructural characteristics of these deposits were also identical with those of AMD-associated drusen . CONCLUSIONS: The composition and structure of ocular drusen associated with membranous and post-streptococcal/segmental GN are generally similar to those of drusen in individuals with AMD . In view of the recent data supporting the involvement of complement activation in drusen biogenesis and the pathobiology of AMD, further studies of the biological relationships between AMD and diseases associated with complement activation are warranted. Am J Health Syst Pharm, 2001 Jun 15, 58(12), 1133 - 8 Economic burden of influenza-like illness in long-term-care facilities; Carroll NV et al.; Direct medical costs and medically related transportation costs incurred by patients in long-term-care facilities (LTCFs) as a result of influenza-like illness (ILI) were studied . The study was conducted from the payer's perspective . Charts were reviewed retrospectively for all patients who were residents of four Richmond, Virginia, LTCFs between January 1 and May 31, 1999 . Consultant pharmacists gathered data on patient demographics, ILI status, vaccination for influenza and streptococcal pneumonia, diagnosis of asthma or chronic obstructive pulmonary disease, and utilization of health care services related to ILI . Services included the use of antimicrobials, antivirals, and respiratory drugs; emergency room visits; diagnostic tests; hospitalizations; and medically related transportation . Costs were based on average wholesale prices (for drugs) and Medicare or Medicaid reimbursement rates . Data were collected for 551 patients . Of these, 112 patients had been diagnosed with 128 cases of ILI during the study period . Twenty-two patients with ILI had 28 visits to emergency rooms, and 30 patients with ILI had 36 hospitalizations . The mean +/- S.D . cost per case of ILI was $1341 +/- $2063; inpatient hospital costs accounted for 84% of this amount . Centers for Disease Control and Prevention criteria for ILI provided a lower incidence of ILI and, consequently, a lower mean +/- S.D . cost of $968 +/- $1806 per case . ILI in patients in four LTCFs in Richmond, Virginia, generated substantial costs, the bulk of which resulted from hospitalization . A substantial percentage of the patients apparently were not immunized. Infect Immun, 2001 Aug, 69(8), 4988 - 95 Reciprocal, temporal expression of SpeA and SpeB by invasive M1T1 group a streptococcal isolates in vivo; Kazmi SU et al.; The streptococcal pyrogenic exotoxins (Spes) play a central role in the pathogenesis of invasive group A streptococcal (GAS) infections . The majority of recent invasive GAS infections have been caused by an M1T1 strain that harbors the genes for several streptococcal superantigens, including speA, speB, speF, speG, and smeZ . However, considerable variation in the expression of Spe proteins among clonal M1 isolates has been found, and many of the speA-positive M1 strains do not produce detectable amounts of SpeA in vitro . This study was designed to test the hypothesis that speA gene expression can be induced in vivo . A mouse infection chamber model that allows sequential sampling of GAS isolates at various time points postinfection was developed and used to monitor the kinetics of Spe production in vivo . Micropore Teflon diffusion chambers were implanted subcutaneously in BALB/c mice, and after 3 weeks the pores became sealed with connective tissue and sterile fluid containing a white blood cell infiltrate accumulated inside the infection chambers . Representative clonal M1T1 isolates expressing no detectable SpeA were inoculated into the implanted chambers, and the expression of SpeA in the aspirated aliquots of the chamber fluid was analyzed on successive days postinfection . Expression of SpeA was detected in the chamber fluid as early as days 3 to 5 postinfection in most animals, with a significant increase in expression by day 7 in all infected mice . Isolates recovered from the chamber and grown in vitro continued to produce SpeA even after 21 passages in vitro, suggesting stable switch on of the speA gene . A temporal relation between the upregulation of SpeA expression and the downregulation of SpeB expression was observed in vivo . These data suggest that in vivo host and/or environmental signals induced speA gene expression and suppressed speB gene expression . This underscores the role of the host-pathogen interaction in regulating the expression of streptococcal virulence factors in vivo . The model described here should facilitate such studies. Medicina (B Aires), 2000, 60(6), 953 - 5 {Streptococcal infection, acute kidney failure and interstitial nephritis}; Faurie RE et al.; The relationship between streptococcal infection and renal disease has been object of multiple studies . Streptococcal infection may induce acute glomerulonephritis or interstitial nephritis . We report a patient with a streptococcal infection who developed acute renal failure . The renal biopsy showed an acute interstitial nephritis, with an interstitium infiltrate with a significant number of eosinophils . We review the causes of acute renal failure associated with streptococcal infection, specially acute interstitial nephritis. Obstet Gynecol, 2001 Jul, 98(1), 7 - 13 Group B streptococcal disease prevention practices of obstetrician-gynecologists; Watt JP et al.; OBJECTIVE: To describe group B streptococcal (GBS) disease prevention practices of obstetrician-gynecologists . METHODS: We surveyed 1019 ACOG Fellows-the 419 members of the Collaborative Ambulatory Research Network (CARN) and 600 randomly selected non-CARN Fellows . RESULTS: There were 601 eligible respondents . More than 95% in both the CARN and the non-CARN groups reported adopting one of three GBS prevention strategies . The most commonly reported strategy was a combination approach not described in the consensus guidelines . The second most common strategy was the screening-based strategy; the risk-based strategy was third . Most respondents provided GBS information to all prenatal patients, but those using a risk-based strategy and those in solo practice were less likely to do so . Less than 60% in each group used penicillin as their first choice for GBS prophylaxis . More than 20% in each group who routinely screened for GBS did not collect both vaginal and rectal cultures . Respondents rated ACOG publications as the most important influence on their GBS prevention approach . CONCLUSION: Almost all ACOG Fellows have adopted a GBS prevention strategy . The importance of providing GBS prevention information to all patients, use of penicillin, and collection of both vaginal and rectal cultures should be reinforced. J Mol Biol, 2001 Jul 6, 310(2), 403 - 17 Plasmid transcriptional repressor CopG oligomerises to render helical superstructures unbound and in complexes with oligonucleotides; Costa M et al.; CopG is a 45 amino acid residue transcriptional repressor involved in the copy number control of the streptococcal plasmid pMV158 . To do so, it binds to a DNA operator that contains a 13 bp pseudosymmetric DNA element . Binding of CopG to its operator results in repression, at the transcriptional level, of its own synthesis and that of the initiator of replication protein, RepB . Biochemical experiments have shown that CopG co-operatively associates to its target DNA at low protein:DNA ratios, completely protecting four helical turns on the same face of the double helix in both directions from the inverted repeat that constitutes the CopG primary target . This has been correlated with a CopG-mediated DNA bend of about 100 degrees . Here, we show that binding of CopG to DNA fragments containing the inverted repeat just at one end led to nucleation of the protein initiating from the inverted repeat . Nucleation extended to the entire fragment, with CopG-DNA contacts occurring on the same face of the DNA helix . The protein, the prototype for a family of homologous plasmid repressors, displays a homodimeric ribbon-helix-helix arrangement . It polymerises within the unbound crystal to render a continuous right-handed protein superhelix of homodimers, around which a bound double-stranded (ds) DNA could wrap . We have solved the crystal structure of CopG in complex with a 22 bp dsDNA oligonucleotide encompassing the cognate pseudosymmetric element . In the crystal, one protein tetramer binds at one face of the DNA with two parallel beta-ribbons inserted into the major groove . The DNA is bent about 50 degrees under compression of both major and minor grooves . A continuous right-handed complex helix made up mainly by protein-protein and some protein-DNA interactions is observed . The protein-protein interactions involve regions similar to those observed in the oligomerisation of the native crystals and those employed to set up the functional tetramer . A previously solved complex structure of the protein with a 19 bp dsDNA had unveiled a left-handed helical superstructure just made up by DNA interactions . Am J Perinatol, 2001 May, 18(3), 147 - 9 Spontaneous rupture of the liver presenting as scrotal bruising; Vachharajani A et al.; We describe a case of spontaneous rupture of the liver in a neonate, presenting with features consistent with testicular torsion . Ruptured liver has been well described in neonates following birth trauma, coagulation defects, and Group B Streptococcal infection . The etiology in our case remains undefined. Clin Chim Acta, 2001 Jun, 308(1-2), 155 - 61 Lipid peroxidation, osmotic fragility and antioxidant status in children with acute post-streptococcal glomerulonephritis; Devasena T et al.; Plasma and erythrocyte samples from acute post-streptococcal glomerulonephritis (APSGN) children and control children were enrolled in this study . Lipid peroxidation (LPO), measured in terms of thiobarbituric acid-reactive substances (TBARS) was found to be significantly increased in plasma and RBCs of APSGN children (P<0.05) than in control children . Osmotic fragility of erythrocytes was examined . RBCs of APSGN patients were found to be osmotically more sensitive towards hypotonic saline (50% hemolysis at 7 g/l saline) when compared to control RBCs (50% hemolysis at 4 g/l saline) . The activities of antioxidant enzymes superoxide dismutase (SOD), catalase (CAT), glutathione peroxidase (GPx) and glutathione S-transferase (GST) were significantly lowered (P<0.05) in APSGN RBCs when compared to control RBCs . Plasma ascorbic acid, reduced glutathione (GSH), RBC ascorbic acid, GSH and RBC total sulphydryl content (TSH) were significantly depleted in APSGN children relative to controls . The susceptibility of RBCs of APSGN children to lipid peroxidation was confirmed in this study. Clin Exp Rheumatol, 2001 May-Jun, 19(3), 349 - 51 Severe abdominal involvement as the initial manifestation of cutaneous polyarteritis nodosa in a young girl; Falcini F et al.; We report a young girl who developed ingravescent intestinal symptoms as the first manifestation of cutaneous polyarteritis nodosa (PAN) while the typical skin nodules developed later during the disease course . Cutaneous PAN predominantly affects children and presents with crops of painful skin nodules in the medial aspect of the foot, often preceded by sore throat . Visceral manifestations including gut involvement are commonly associated with the classical form of PAN while they are rarely reported in the cutaneous form . In our patient the severity of the abdominal symptoms required a laparoscopy, which revealed diffuse erythematosus swelling of the intestine on the serosal side . The administration of penicillin and steroids was followed by a dramatic improvement in the disease course . Chronic anterior uveitis developed 4 months after the disease onset and responded to local treatment . At a 2-year follow-up the girl is in good condition under prophylaxis with benzathine-penicillin with no recurrence of the illness . Our case confirms that cutaneous PAN is often related to streptococcal infection, and suggests that ASO titers should be determined in children with vasculitides to ensure a timely diagnosis and treatment of the condition if present. Rev Argent Microbiol, 2001 Jan-Mar, 33(1), 28 - 35 Influence of bacterial factors on proliferation of bovine mammary epithelial cells; Calvinho LF et al.; Effects of bovine mastitis pathogen virulence factors on mammary epithelial cell function are not clearly understood . In this study, the effect of streptococcal lipoteichoic acid (LTA), streptokinase, and Escherichia coli lipopolysaccharide (LPS) on proliferation of a primary bovine mammary epithelial cell culture (BTE) and on an established bovine mammary epithelial cell line (MAC-T) was evaluated . Mammary epithelial cells were cultured in the presence of bacterial virulence factors for 48 h at 37 degrees C . BTE cell proliferation was inhibited by streptococcal LTA at 8 and 16 micrograms/ml whereas MAC-T cell proliferation was reduced significantly by concentrations of LTA > or = 2 micrograms/ml . Streptokinase had no effect on proliferation of either MAC-T or BTE cells and LPS inhibited proliferation of BTE but not of MAC-T cells . Effect of LTA and LPS on mammary epithelial cell proliferation could be relevant during the periparturient period when mammary glands are markedly susceptible to new intramammary infection and when mammary epithelial cells undergo extensive proliferation, differentiation and synthesis of milk components. Inflammation, 2001 Jun, 25(3), 137 - 44 Hypothermia attenuates beta1 integrin expression on extravasated neutrophils in an animal model of meningitis; Rowin ME et al.; Brain injury in meningitis occurs in part as a consequence of leukocyte migration and activation . Leukocyte integrins are pivotal in the inflammatory response by mediating adhesion to vascular endothelium and extracellular matrix proteins . We have demonstrated that moderate hypothermia early in the course of meningitis decreases leukocyte sequestration within the brain parenchyma . This study examines whether hypothermia alters neutrophil integrin expression in a rabbit model of bacterial meningitis . Prior to the induction of meningitis, peripheral blood samples were obtained and the neutrophils isolated . Sixteen hours after inducing group B streptococcal meningitis, animals were treated with antibiotics, i.v . fluids, and mechanically ventilated . Animals were randomized to hypothermia (32-33 degrees C) or normothermia conditions . After 10 hours of hypothermia or normothermia, neutrophils were isolated from the blood and cerebral spinal fluid (CSF), stained for beta1 and beta2 integrins, and analyzed using flow cytometry . Cerebral spinal fluid neutrophil beta1 integrin expression was significantly decreased in hypothermic animals . Beta-1 integrins can assume a higher affinity or "activated" state following inflammatory stimulation . Expression of "activated" beta1 integrins was also significantly decreased in hypothermic animals . Beta2 CSF neutrophil integrin expression was decreased in hypothermic animals, but failed to reach significance . These data suggest hypothermia may attenuate extravasated leukocyte expression of both total and "activated" beta1 integrins. Drugs, 2001, 61(6), 747 - 61 Fluoroquinolones: place in ocular therapy; Smith A et al.; The fluoroquinolones have become widely used antibacterial agents in the treatment of ocular infections, with topical, intravitreal and systemic routes of administration being used . In general, fluoroquinolones (such as ciprofloxacin, ofloxacin, lomefloxacin and norfloxacin) have good activity against gram-negative and gram-positive bacteria . Therapeutic concentrations are achieved in the cornea after topical administration so that the fluoroqinolones have largely replaced combination therapy for the treatment of bacterial keratitis . However, a second line agent is needed when resistance is likely, such as in disease caused by streptococcal species . Reversal of resistance to quinolones may not occur with withdrawal of the antibacterial . This stresses the importance of prudent prescribing to reduce the occurrence of resistance to quinolones . When used in therapeutic topical dosages, corneal toxicity does not occur . Similarly, retinal toxicity is not seen when fluoroquinolones are used at therapeutic dosages, systemically or topically . Corneal precipitation occurs, particularly with ciprofloxacin and to a lesser extent norfloxacin, but does not appear to interfere with healing . In the treatment of endophthalmitis there is reasonable penetration of systemic fluoroquinolones into the vitreous but sufficiently high concentrations to reach the minimum inhibitory concentration for 90% of isolates (MIC90) of all important micro-organisms may not be guaranteed . Systemic administration may be useful for prophylaxis after ocular trauma. Int J Antimicrob Agents, 2001 Jun, 17(6), 439 - 42 The role of beta-lactamase producing bacteria and bacterial interference in streptococcal tonsillitis; Brook I; The causes of penicillin failure in eradicating group A beta-haemolytic streptococcal pharyngo-tonsillitis are described . The mechanisms accounting for the failure include the presence in the tonsils of beta-lactamase producing bacteria and the absence of bacterial interference . The use of antimicrobials that can overcome and modulate these two phenomena and achieve better cure of the infection is described. Pediatrics, 2001 May, 107(5), 1181 - 3 A family cluster of streptococcal toxic shock syndrome in children: clinical implication and epidemiological investigation; Huang YC et al.; BACKGROUND: Most invasive group A streptococcal (GAS) disease occurs sporadically . Reports of family clusters of these infections are scanty, and most invasive disease occurs in adults . We describe a family cluster of streptococcal toxic shock syndrome (STSS) involving 3 children and present the results of an epidemiologic investigation . PATIENTS AND METHODS: During a 16-day period, 3 children in a family developed STSS with an interval of 7 and 9 days, respectively, between the onset of disease . Cases 2 and 3 had GAS isolated from blood culture . Case 2 was fatal . Pharyngeal culture survey of the family members and schoolchildren was conducted . Antibiogram, serotyping, detection of exotoxin genes, and random amplified polymorphic DNA patterns of the disease strains and survey strains were examined . RESULTS: One of 15 family members sampled-the sister of the index case-and 7 (5.6%) of 125 schoolchildren sampled had GAS isolated from pharyngeal cultures . Of the 10 strains examined, 2 isolates from the patients, 1 from the sister of index case, and 2 from the classmates of case 2 (the fatal case) had an identical pattern of both genotype and phenotype . CONCLUSION: We describe a family cluster of STSS involving 3 children caused by a single clone and provide additional data regarding invasive GAS infection subsequent to household contact . Additional studies should be conducted in conjunction with surveillance to define better the magnitude of risk in household contacts and to identify settings in which subsequent infections may occur. Pediatrics, 2001 May, 107(5), 1108 - 15 Invasive group A streptococcal infection and nonsteroidal antiinflammatory drug use among children with primary varicella; Lesko SM et al.; OBJECTIONS: To test the hypothesis that nonsteroidal antiinflammatory drug use increases the risk of necrotizing soft tissue infections and, secondarily, all invasive group A streptococcal (GAS) infections in children with primary varicella infection . METHODS: We conducted a prospective, multicenter case-control study among children <19 years old . Cases were children hospitalized with primary varicella complicated by invasive GAS infection or necrotizing soft tissue infection identified by a network of 45 pediatric infectious disease specialists located throughout the United States . Controls were children with uncomplicated primary varicella residing in the same communities as the cases . Data on medical history, clinical features of the varicella infection, signs and symptoms of infectious complications, and medication use were collected by structured telephone interviews . Univariate and multivariate matched odds ratios were calculated using conditional logistic regression . RESULTS: Between June 1996 and September 1998, 52 cases of invasive GAS infection, including 21 with necrotizing soft tissue infection, and 172 controls with uncomplicated primary varicella were enrolled . Risk of invasive GAS infection was increased among children who were nonwhite (multivariate odds ratio {OR} 3.8, 95% confidence interval {CI}: 1.4-11), living in low-income households (OR 5.1, 95% CI: 1.7-15), exposed to varicella at home (OR 6.4, 95% CI: 2.6-16), or had a persistent high fever (OR 9.6, 95% CI: 2.8-33) . Antipyretic regimen was associated with several measures of varicella illness severity among the controls . The risk of necrotizing soft tissue infection was not associated with the use of ibuprofen before the development of signs or symptoms of this complication (OR 1.3, 95% CI: 0.33-5.3) . Risk of any invasive GAS infection was increased among children who had received ibuprofen (OR 3.9, 95% CI: 1.3-12), but not acetaminophen (OR 1.2, 95% CI: 0.50-3.0) . However, there was no evidence of increasing risk with increasing duration of ibuprofen use . Subgroup analyses revealed that the risk of invasive GAS infection was increased only among children who had received both acetaminophen and ibuprofen . CONCLUSIONS: These data do not support the hypothesis that nonsteroidal antiinflammatory drugs, or ibuprofen in particular, increase the risk of necrotizing GAS infections . A statistically significant association was observed between nonnecrotizing invasive GAS infection and ibuprofen use; however, because of potential confounding, the meaning of this unexpected result is unclear . Nonetheless, these data suggest that parents use ibuprofen or ibuprofen together with acetaminophen to treat high fever and severe illness, which seems to identify children at high risk for invasive GAS infection. Posit Aware, 1998 Jan-Feb, 9(1), 43 - 4 Latest opportunistic infection prevention guidelines; D'Amico R; AIDS: Although people with HIV are living longer than ever before, they continue to suffer from infections that are associated with low T4-cell counts . The U.S . Public Health Service (PHS) and the Infectious Diseases Society of America (IDSA) have updated the guidelines for preventing opportunistic infections, including their positions on when prophylaxis is indicated . Summaries are given for preventing the following infections: cytomegalovirus (CMV), cryptosporidiosis, fungal infections, human papillomavirus (HPV), herpes-related infections, mycobacterium avium complex (MAC), pneumocystis carinii pneumonia (PCP), streptococcal pneumonia, toxoplasmosis, and tuberculosis . Posit Aware, 1996 Jan-Feb, 7(1), 16 - 7 Early intervention and prevention options; Multifocal streptococcal pyomyositis complicated by acute compartment syndrome: case report; Department of Orthopaedics, Leeds General Infirmary, Leeds, UKA 5-year-old girl sought treatment for pyrexia of unknown origin . Despite prompt surgical drainage of a streptococcal septic arthritis of the ankle joint, her condition deteriorated . Multifocal pyomyositis was subsequently diagnosed . This was complicated by acute compartment syndrome in three extremities . With aggressive surgical and medical management, the child made a complete recovery . Orthopaedic clinicians in nontropical areas must familiarize themselves with this rare, potentially life-threatening, but eminently curable disease. Am J Obstet Gynecol, 2001 May, 184(6), 1204 - 10 The effectiveness of risk-based intrapartum chemoprophylaxis for the prevention of early-onset neonatal group B streptococcal disease; Lin FY et al.; OBJECTIVE: Our purpose was to evaluate the effectiveness of a risk-based intrapartum antibiotic prophylaxis strategy for the prevention of early-onset neonatal group B streptococcal disease . STUDY DESIGN: Cases and controls were selected from infants born to women with one or more risk factors: preterm labor or rupture of membranes, prolonged rupture of membranes (>18 hours), fever during labor, or previous child with group B streptococcal disease . Cases were matched with controls by birth hospital and gestational age . Data abstracted from medical records were analyzed to estimate the effectiveness of intrapartum antibiotic prophylaxis . RESULTS: We analyzed data from 109 cases and 207 controls . Nineteen (17%) case versus 69 (33%) control mothers received an acceptable regimen of intrapartum antibiotic prophylaxis . In adjusted analyses, the effectiveness of intrapartum antibiotic prophylaxis was 86% (95% confidence interval, 66%-94%) . When the first dose of antibiotics was given > or =2 hours before delivery, the effectiveness increased to 89% (95% confidence interval, 70%-96%); when it was given within 2 hours of delivery, the effectiveness was 71% (95% confidence interval, -8%-92%) . Effectiveness was lowest in mothers with intrapartum fever (72%, 95% confidence interval, -9%-93%) . On the basis of a 70% prevalence of maternal risk factors expected among cases in the absence of intrapartum antibiotic prophylaxis, we estimate that the risk-based strategy could reduce early-onset group B streptococcal disease by 60% . CONCLUSIONS: The risk-based approach to intrapartum antibiotic prophylaxis is effective in preventing early-onset group B streptococcal disease . To achieve the maximum preventive effect, the first dose of antibiotics should be administered at least 2 hours before delivery. Infect Immun, 2001 Jun, 69(6), 4072 - 8 Induction of autoimmune valvular heart disease by recombinant streptococcal m protein; Quinn A et al.; Rheumatic heart disease is an autoimmune sequela of group A streptococcal infection . Previous studies have established that streptococcal M protein is structurally and immunologically similar to cardiac myosin, a well-known mediator of inflammatory heart disease . In this study, we investigated the hypothesis that streptococcal M protein could produce inflammatory valvular heart lesions similar to those seen in rheumatic fever (RF) . Fifty percent (3 of 6) of Lewis rats immunized with recombinant type 6 streptococcal M protein (rM6) developed valvulitis as well as focal lesions of myocarditis . Valvular lesions initiated at the valve surface endothelium spread into the valve . Anitschkow cells and verruca-like lesions were present . T cells from rM6-immunized rats proliferated in the presence of purified cardiac myosin, but not skeletal myosin . A T-cell line produced from rM6-treated rats proliferated in the presence of cardiac myosin and rM6 protein . The study demonstrates that the Lewis rat is a model of valvular heart disease and that streptococcal M protein can induce an autoimmune cell-mediated immune attack on the heart valve in an animal model . The data support the hypothesis that a bacterial antigen can break immune tolerance in vivo, an important concept in autoimmunity. Pediatrics, 1998 Jan, 101(1 Pt 1), 136 - 40 American Academy of Pediatrics . Committee on Infectious Diseases . Severe invasive group A streptococcal infections: a subject review; American Academy of Pediatrics . Committee on Infectious Diseases; The course of severe invasive group A beta-hemolytic streptococcal (GABHS) infections is often precipitous, requiring prompt diagnosis and rapid initiation of appropriate therapy . Therefore, physicians must have a high index of suspicion of this disease, particularly in patients at increased risk (e.g., those with varicella or diabetes mellitus) . Although a relationship between the use of nonsteroidal antiinflammatory drugs and severe invasive GABHS infections has been suggested, at present data on which to base a clinical decision about the use or restriction of nonsteroidal antiinflammatory drugs in children with varicella are insufficient . When necrotizing fasciitis is suspected, prompt surgical drainage, debridement, fasciotomy, or amputation often is necessary . Many experts recommend intravenously administered penicillin G and clindamycin for the treatment of invasive GABHS infections on the basis of animal studies . Some evidence exists that intravenous immunoglobulin given in addition to appropriate antimicrobial and surgical therapy may be beneficial . Although chemoprophylaxis for household contacts of persons with invasive GABHS infections has been considered by some experts, the limited available data indicate th