Streptococcal

Pharmacotherapy, 2002 Mar, 22(3), 395 - 9
Levofloxacin treatment failure in a patient with fluoroquinolone-resistant Streptococcus pneumoniae pneumonia; Kays MB et al.; The frequency of fluoroquinolone-resistant Streptococcus pneumoniae has increased as fluoroquinolone administration for treatment of respiratory tract infections has increased . Levofloxacin treatment failed in a patient who had pneumococcal pneumonia and had received three previous courses of levofloxacin therapy . Susceptibility testing revealed high-level resistance to levofloxacin (minimum inhibitory concentration {MIC} > 32 microg/ml), and cross-resistance to moxifloxacin (MIC 4 microg/ml), trovafloxacin (6 microg/ml), and gatifloxacin (12 microg/ml) . Sequencing of the quinolone-resistance determining region revealed a mutation of serine-81 to phenylalanine (Ser81-->Phe) in the gyrA region of DNA gyrase and a Ser79-->Phe mutation in the parC region of topoisomerase IV The patient was treated successfully with intravenous ceftriaxone followed by oral cefprozil . Clinicians must be aware of local resistance patterns and the potential for fluoroquinolone treatment failures in patients with infections caused by S . pneumoniae.

Vet Dermatol, 2002 Feb, 13(1), 29 - 36
Use of computerized image analysis to quantify staphylococcal adhesion to canine corneocytes: does breed and body site have any relevance to the pathogenesis of pyoderma?
Forsythe PJ, Hill PB, Thoday KL, Brown J.
An optimized system of computerized image analysis was used to investigate variations in the adherence of Staphylococcus intermedius to canine corneocytes from four different breed groups and six different anatomical sites . S . intermedius showed significantly greater adherence to the head and neck compared with the dorsum, but adherence to the limb, axilla and groin did not differ from other sites . Furthermore, there was significantly greater adherence of S . intermedius to corneocytes from the dorsum, forelimb, axilla and groin of Boxers and Bull Terriers than Spaniels and Hounds . S . intermedius, and also Pseudomonas aeruginosa, exhibited abundant adherence, which was significantly greater than Staphylococcus aureus, Streptococcus canis, Klebsiella pneumoniae and Escherichia coli . In addition, S . intermedius adherence demonstrated a sigmoid dose-response curve with increasing bacterial concentration . These results suggest that S . intermedius adheres to canine corneocytes by a specific receptor-ligand interaction and adheres to the skin of some breeds more avidly than others . However, variations in adherence between body regions would not account for the predilection sites of canine bacterial pyoderma.

Infect Immun, 2002 Apr, 70(4), 1971 - 83
Influence of recombination and niche separation on the population genetic structure of the pathogen Streptococcus pyogenes; Kalia A et al.; The throat and skin of the human host are the principal reservoirs for the bacterial pathogen Streptococcus pyogenes . The emm locus encodes structurally heterogeneous surface fibrils that play numerous roles in virulence, depending on the strain . Isolates harboring the emm pattern A-C marker exhibit a strong tendency to cause throat infection, whereas emm pattern D strains are usually recovered from impetigo lesions; as a group, emm pattern E organisms fail to display obvious tissue tropisms . The peak incidence for streptococcal pharyngitis and impetigo varies with season and locale, leading to wide spatial and temporal distances between throat and skin strains . To assess any impact of niche separation on genetic variation, the extent of recombinational exchange between emm pattern A-C, D, and E subpopulations was evaluated . Analysis of nucleotide sequence data for internal portions of seven housekeeping loci from 212 isolates provides evidence of extensive recombination between strains belonging to different emm pattern subpopulations . Furthermore, no fixed nucleotide differences were found between emm pattern A-C and D strains . Thus, despite some niche separation created by distinct epidemiological trends and innate tissue tropisms there is little evidence for neutral gene divergence between throat and skin strains . Maintenance of a relationship between emm pattern and tissue tropism in the face of underlying recombination suggests that tissue tropism is associated with emm or a closely linked gene.

Infect Immun, 2002 Apr, 70(4), 1724 - 38
Type III group B streptococcal polysaccharide induces antibodies that cross-react with Streptococcus pneumoniae type 14; Guttormsen HK et al.; Covalent linkage of a bacterial polysaccharide to a protein greatly enhances the carbohydrate's immunogenicity and its binding to solid surfaces in immunoassays . These findings have spurred the development of glycoconjugate vaccines to prevent serious bacterial infections as well as the use of glycoconjugates as coating antigens in bioassays . We evaluated sera from women immunized with unconjugated group B streptococcal (GBS) type III (GBS III) polysaccharide (IIIPS) or with IIIPS covalently linked to tetanus toxoid to assess specificity, sensitivity, and parallelism in dilution curves in two GBS III enzyme-linked immunosorbent assays (ELISAs) . One assay used IIIPS mixed with methylated human serum albumin (IIIPS + mHSA) as the coating antigen, and the other used IIIPS covalently linked to HSA (III-HSA) . Each coating antigen was associated with a highly specific GBS III bioassay . The sensitivity was higher in the III-HSA ELISA, in which conjugated IIIPS is bound to the plates . Parallelism in titration curves was observed in the III-HSA but not in the IIIPS + mHSA ELISA . The excellent correlation between the concentrations of GBS IIIPS-specific immunoglobulin G (IgG) and the opsonophagocytic activity of these antibodies indicated that the III-HSA assay can predict functionality of vaccine-induced IgG against GBS III disease . The structure of the repeating unit of the capsular polysaccharide of GBS III differs from that of Streptococcus pneumoniae type 14 (Pn14 PS) only by the presence on GBS III of a sialic acid residue at the end of the side chain . The majority of healthy adults responding to GBS III vaccines with a fourfold or greater increase in GBS III-specific IgG antibodies developed antibodies cross-reacting with Pn14 PS (i.e., desialylated GBS IIIPS) . The proportion of GBS vaccine responders who developed IgG to the desialylated IIIPS did not depend on whether IIIPS was given in the unconjugated or conjugated form . When present, these vaccine-induced cross-reacting antibodies conferred in vitro antibody-mediated opsonophagocytosis and killing of both GBS III and Pn14, two pathogens that cause invasive disease in young infants.

J Clin Periodontol, 2002 Feb, 29(2), 159 - 67
Subgingival microbiota of indigenous Indians of Central America; Dowsett SA et al.; OBJECTIVE: To define the subgingival microbial profiles of adult subjects from a previously identified rural community of indigenous Indians in Guatemala, Central America . MATERIALS AND METHODS: A full-mouth periodontal examination was performed in 114 adult subjects from 45 families . Plaque samples were collected from both deep and shallow periodontal pockets and checkerboard DNA-DNA hybridization was employed to identify 17 species previously associated with periodontitis or health . RESULTS: Plaque deposits and gingivitis were universal and widespread, and periodontal pocketing > or =5 mm was highly prevalent (84% of subjects) . Streptococcus sanguis, Actinomyces naeslundii genospecies 2 and Fusobacterium nucleatum were significantly more prevalent in shallow sites . At the subject level, Actinomyces naeslundii and Peptostreptococcus micros were significantly more prevalent in periodontally-healthy subjects . Actinobacillus actinomycetemcomitans was not detected in any sample . CONCLUSION: There was no association between periodontal disease status and presence of suspected periodontal pathogens . These latter results conflict somewhat with those from treated populations . However, in this population where extensive plaque deposits and gingivitis are universal, the presence of putative pathogens may be more reflective of the local environment.

Eur J Biochem, 2002 Mar, 269(6), 1678 - 83
Increase of the deacylation rate of PBP2x from Streptococcus pneumoniae by single point mutations mimicking the class A beta-lactamases; Chesnel L et al.; The class A beta-lactamases and the transpeptidase domain of the penicillin-binding proteins (PBPs) share the same topology and conserved active-site residues . They both react with beta-lactams to form acylenzymes . The stability of the PBP acylenzymes results in the inhibition of the transpeptidase function and the antibiotic activity of the beta-lactams . In contrast, the deacylation of the beta-lactamases is extremely fast, resulting in a high turnover of beta-lactam hydrolysis, which confers resistance to these antibiotics . In TEM-1 beta-lactamase from Escherichia coli, Glu166 is required for the fast deacylation and occupies the same spatial location as Phe450 in PBP2x from Streptococcus pneumoniae . To gain insight into the deacylation mechanism of both enzymes, Phe450 of PBP2x was replaced by various residues . The introduction of ionizable side chains increased the deacylation rate, in a pH-dependent manner, for the acidic residues . The aspartic acid-containing variant had a 110-fold faster deacylation at pH 8 . The magnitude of this effect is similar to that observed in a naturally occurring variant of PBP2x, which confers increased resistance to cephalosporins.

Rinsho Biseibutshu Jinsoku Shindan Kenkyukai Shi, 2002, 12(2), 91 - 5
{Evaluation of the diagnostic reagents which detect group A Streptococcus with the immunochromatographical method}; Kojima T et al.; Dipstick 'Eiken' Strep A was evaluated for this sensitivity and specificity . Dipstick 'Eiken' Strep A had a capacity to detect Group A Streptococcus in 1.5x10(5) cfu/swab . The sensitivity of Dipstick 'Eiken' Strep A was 4 times higher than the sensitivity of the latex agglutination test (Serodirect 'Eiken' Strep A) and was almost the same as the immunochromatography test (TESTPACK Plus STREP A, CLEARVIEW STREP A and ImmunoCard STAT! STREP A TEST) . No cross reaction was observed among 27 strains of 25 species microorganisms with Dipstick 'Eiken' Strep A . Dipstick 'Eiken' Strep A was compared with TESTPACK Plus STREP A among throat swabs from 50 patients with pharyngitis . Dipstick 'Eiken' Strep A had a sensitivity of 92.9%, a specificity of 90.5% and an agreement of 91.8% . Dipstick 'Eiken' Strep A is found to be useful diagnostic assay in the clinical laboratories.

Ann Pharmacother, 2002 Mar, 36(3), 416 - 22
Broth microdilution and E-test for determining fluoroquinolone activity against Streptococcus pneumoniae; Kays MB et al.; OBJECTIVE: To compare broth microdilution and E-test minimum inhibitory concentrations (MICs) of 4 fluoroquinolones against Streptococcus pneumoniae and to determine the effect of these in vitro MIC methods on the calculation of AUC00-24/MIC ratios . METHODS: Levofloxacin, gatifloxacin, moxifloxacin, and gemifloxacin MICs were determined by broth microdilution (incubated in air) and E-test (incubated in CO2) for 100 clinical isolates of S . pneumoniae . MIC50, MIC90, and geometric mean MIC were calculated . Steady-state serum concentration-time profiles were simulated for once-daily, oral dosing of levofloxacin 500 mg, gatifloxacin 400 mg, moxifloxacin 400 mg, and gemifloxacin 320 mg . After correcting for protein binding, AUC0-24 of unbound drug was calculated for each regimen, and AUC0-24/MIC ratios were calculated using MIC data from both in vitro methods . Differences in MICs between methods were determined for each agent using the paired t-test (after logarithmic transformation of MICs) and the Wilcoxon signed-rank test . Differences in AUC0-24/MIC ratios were also determined using the paired t-test and the Wilcoxon signed-rank test . The level of significance for all analyses was p < 0.05 . RESULTS: Broth microdilution and E-test MICs were within +/- 1 log2 dilution for 94%, 93%, 61%, and 35% of the isolates for levofloxacin, gatifloxacin, moxifloxacin, and gemifloxacin, respectively . Broth microdilution MICs were significantly lower than E-test MICs for all 4 agents (p < 0.001) . However, a categorical change in susceptibility was seen for only 1 isolate with gatifloxacin and moxifloxacin (intermediate by broth microdilution, resistant by E-test) . AUC0-24/MIC ratios were significantly higher for each regimen when MICs were determined by broth microdilution compared with E-test (p < 0.001) . CONCLUSIONS: There is a significant difference in the activity of the newer fluoroquinolones against S . pneumoniae when MICs are determined by broth microdilution and E-test . When evaluating fluoroquinolone activity and pharmacodynamics against this organism, clinicians must be aware that MIC testing methodology may have a significant impact on the results.

Vestn Otorinolaringol, 2002, (1), 18 - 21
{Immune status of patients with chronic tonsillitis before and after tonsillectomy}; FIlatova SV et al.; Immune status was examined before and after tonsillectomy in 35 patients with various forms of chronic tonsillitis (CT) . Measurements were made of main lymphocyte populations, IgA, IgG, IgM levels, functional activity of neutrophils, titers of antibodies to opportunistic microorganisms of the upper airways . It is shown that tonsillectomy produces positive changes in some immunological indices: serum IgG normalized, titers of antibodies to Haemophillus influenzae, Streptococcus pneumoniae and streptolysin-0 lowered, initially low count of B-lymphocytes, natural killers, T-helpers rose, neutrophil chemiluminescence normalized.

Semin Respir Infect, 2002 Mar, 17(1), 3 - 9
Update on pneumococcal infections of the respiratory tract; Tan TQ; Respiratory illnesses are the leading reason for seeking medical care here in the United States . Streptococcus pneumoniae is the most common bacterial pathogen causing acute otitis media (AOM), sinusitis, and community-acquired pneumonia in both the pediatric and adult populations . The continued development of antibiotic resistance to an increasing number of different antibiotic classes by this organism has made the treatment of some of these infections more difficult . Recently, a heptavalent pneumococcal conjugate vaccine was approved for infants and toddlers, beginning at 2 months of age . Widespread implementation of this vaccine in the childhood population may have a significant impact on the amount of systemic disease seen with this organism.

Brain Dev, 2002 Mar, 24(2), 88 - 90
Acute disseminated encephalomyelitis and poststreptococcal acute glomerulonephritis; Ito S et al.; We experienced the case of a boy suffering from acute disseminated encephalomyelitis and concomitant acute glomerulonephritis . The multiple lesions observed on MR images, which located mainly in the cortical gray matter, quickly responded to methyl prednisolone pulse therapy . Renal biopsy confirmed the diagnosis of poststreptococcal acute glomerulonephritis . Streptococcus pyogenes was identified by pharyngeal culture, and the infection was serologically confirmed . We speculated that S . pyogenes infection was coincidentally involved in both diseases.

Gene, 2002 Feb 6, 284(1-2), 63 - 71
Allelic variation in the highly polymorphic locus pspC of Streptococcus pneumoniae; Iannelli F et al.; PspC, also called SpsA, CbpA, PbcA, and Hic, is a surface protein of Streptococcus pneumoniae studied for its antigenic properties, its capability to bind secretory IgA, C3 and complement factor H, and its activity as an adhesin . In this work we characterized the pspC locus of 43 pneumococcal strains by DNA sequencing of PCR fragments . Using PCR primers designed on two unrelated open reading frames, flanking the pspC locus, it was possible to amplify the pspC locus of each of the 43 strains of S . pneumoniae . In 37 out of 43 strains there was a single copy of the pspC gene, while two tandem copies of pspC were found in the other six strains . The sequence of the pspC locus was different in each of the 43 strains . Insertion sequences were found in the pspC locus of 11 out of 43 strains . Analysis of the deduced amino acid sequence of the PspC variants showed a common organization of the molecules: (i) a 37 amino acid leader peptide which is conserved in all proteins, (ii) an N-terminal portion which is essentially alpha-helical, and is the result of assembly of eight major sequence blocks, (iii) a proline-rich region, and (iv) a C-terminal anchor responsible for the cell surface attachment . By sequence comparison we identified 11 major groups of PspC proteins . Proteins within one group displayed only minor variations of the amino acid sequence . An unexpected finding was that PspC variants could differ in the anchor sequence . While 32 of the PspC proteins displayed the typical choline binding domain of pneumococcal surface proteins, 17 other PspCs showed the LPXTG motif, which is typical of surface proteins of other gram-positive bacteria . This major difference in the anchor region was also observed in the adjacent proline-rich regions which differed considerably in size and composition.

APMIS, 2001 Oct, 109(10), 665 - 9
An enzyme-based in situ hybridisation method for the identification of Streptococcus suis; Madsen LW et al.; A method for enzyme-based in situ hybridisation of Streptococcus suis was developed . It enables the light microscopic localization of bacterial ribosomal RNA (rRNA) in formalin-fixed paraffin-embedded tissues . A unique sequence in the 16S rRNA of S . suis was targeted . Different pretreatment protocols were applied to facilitate probe penetration and multiple detection systems were tested . The results were compared to those obtained by immunohistochemistry . Pretreatment was necessary to obtain a signal by in situ hybridisation . The use of proteinase-K pretreatment was optimal regarding sensitivity and preservation of tissue morphology . A strong specific in situ hybridisation signal was achieved in tissue sections containing S . suis in microcolonies and the microanatomy of the surrounding tissue was easily assessed . However, the signal distribution differed from that found immunohistochemically and low-grade infection could not be detected by in situ hybridisation . These findings were interpreted as reflecting the physiological state of the bacteria . Thus, this method could prove useful in future studies of the infection pathogenesis.

Crit Care Med, 2002 Feb, 30(2), 393 - 5
Liquid ventilation with perflubron in the treatment of rats with pneumococcal pneumonia; Dickson EW et al.; OBJECTIVE: To determine the efficacy of liquid ventilation using a medical-grade perfluorocarbon (perflubron) combined with parenteral or intratracheal antibiotics in a rat model of pneumonia . DESIGN: Prospective, laboratory investigation . SETTING: Experimental laboratory in a university medical center . SUBJECTS: Wistar rats (n = 112) . INTERVENTIONS: One day after intratracheal inoculation with Streptococcus pneumoniae, rats received one of five experimental treatments or no treatment (control): modified liquid ventilation (MLV), intramuscular ampicillin, MLV plus intramuscular ampicillin, MLV with intratracheal ampicillin, or MLV plus ampicillin PulmoSpheres . MEASUREMENTS AND MAIN RESULTS: Animals receiving MLV plus intramuscular ampicillin, MLV with intratracheal ampicillin, or MLV plus ampicillin PulmoSpheres had significantly improved 10-day survival rates (85%, 72%, and 72%, respectively) compared with all other groups (0% to 25%) . CONCLUSIONS: MLV in combination with either intramuscular, intratracheal, or PulmoSpheres ampicillin improved survival as compared with MLV alone or the same dose of antibiotics delivered intramuscularly.

J Bacteriol, 2002 Apr, 184(7), 2050 - 7
Evidence for lateral transfer of the Suilysin gene region of Streptococcus suis; Takamatsu D et al.; Suilysin is a cholesterol-binding cytolysin encoded by sly in Streptococcus suis . DNA sequence determination of the sly locus in a strain lacking sly revealed the presence of another gene, designated orf102, in the place of sly . No transposable element or long-repeat sequence was found in the close vicinity . Except for six strains whose corresponding loci have been rearranged, all of the remaining 62 strains examined had either sly or orf102 at the same locus and their flanking regions were conserved . The genetic organizations having either sly or orf102 were found in the strains whose 16S rRNA sequences were identical . These results suggest that S . suis acquired sly or orf102 from a foreign source and that these genes subsequently spread among S . suis strains by homologous recombination.

J Bacteriol, 2002 Apr, 184(7), 1925 - 31
Membrane topology of the Streptococcus pneumoniae FtsW division protein; Gerard P et al.; The topology of FtsW from Streptococcus pneumoniae, an essential membrane protein involved in bacterial cell division, was predicted by computational methods and probed by the alkaline phosphatase fusion and cysteine accessibility techniques . Consistent results were obtained for the seven N-terminal membrane-spanning segments . However, the results from alkaline phosphatase fusions did not confirm the hydropathy analysis of the C-terminal part of FtsW, whereas the accessibility of introduced cysteine residues was in agreement with the theoretical prediction . Based on the combined results, we propose the first topological model of FtsW, featuring 10 membrane-spanning segments, a large extracytoplasmic loop, and both N and C termini located in the cytoplasm.

Vet Microbiol, 2002 Apr 22, 86(1-2), 115 - 29
Simultaneous intramammary and intranasal inoculation of lactating cows with bovine herpesvirus 4 induce subclinical mastitis; Wellenberg GJ et al.; In this study, we examined whether an experimental bovine herpesvirus 4 (BHV4) infection can induce bovine mastitis, or can enhance bovine mastitis induced by Streptococcus uberis (S . uberis) . Four lactating cows were inoculated intramammarily and intranasally with BHV4, and four lactating control cows were mock-inoculated . After 14 days, two of four cows from each group were inoculated intramammarily with S . uberis . No clinical signs were recorded in cows inoculated only with BHV4, and their milk samples showed no abnormal morphology, despite the fact that BHV4 replicated in inoculated quarters . Somatic cell count increased significantly in milk from three of six BHV4-inoculated quarters, compared to the non-inoculated quarters of the same cows (within-cow) and the quarters of mock-inoculated cows (control group) on days 8, 9 and 11 post-inoculation (pi) . BHV4 was isolated from nasal swabs between days 2 and 9 pi . Clinical mastitis was observed in all four cows intramammarily inoculated with S . uberis . A preceding BHV4 infection did not exacerbate the clinical mastitis induced by S . uberis . S . uberis infections appeared to trigger BHV4 replication . From one quarter of each of two cows inoculated with BHV4 and S . uberis, BHV4 was isolated, and not from quarters inoculated with BHV4 only . In conclusion, BHV4 did not induce bovine clinical mastitis after simultaneous intranasal and intramammary inoculation . However, the BHV4 infection did induce subclinical mastitis in 50% of the cows and the quarters.

Ann Thorac Cardiovasc Surg, 2001 Dec, 7(6), 381 - 3
Simultaneous mitral valve replacement and bypass grafting for mycotic aneurysm of the femoral artery during the active phase of infective endocarditis: a case report; Shinonaga M et al.; A 52-year-old woman with a 3-week history of fever and cough was diagnosed as having bacterial endocarditis with vegetation and severe mitral valve insufficiency by echocardiography . Blood culture revealed Streptococcus mitis . After antibiotic treatment for 3 weeks, the patient noticed swelling with pain in her left groin . Computed tomography revealed an occluded aneurysm in the left common femoral artery . Simultaneous surgical treatments of mitral valve replacement and bypass grafting using a saphenous vein following resection of the mycotic femoral arterial aneurysm were performed . Pathohistological examination of surgical specimens revealed acute inflammatory findings, but no microorganisms were found, probably because of the preoperative antibiotic therapy . Her postoperative course was uneventful, and there was no recurrence of mycotic aneurysms in a period of 10 months after the operation . Prompt recognition and urgent simultaneous surgical treatments for mycotic aneurysms complicated with infective endocarditis were effective.

Rev Mal Respir, 2001 Oct, 18(5), 545 - 7
{Endocarditis, meningitis, pneumopathy and pneumococcal cerebral abscess in an alcoholic smoker}; Vandenbos F et al.; We report a case of mitral endocarditis caused by Streptococcus pneumoniae in a 43 year old man with history of alcohol abuse and cigarette smoking . The pneumococcal endocarditis was associated with pneumonia, meningitis and brain abscess . Only transesophageal echocardiography could confirm the presence of vegetation . The patient was treated medically with good results.

Odontostomatol Trop, 2001 Dec, 24(96), 17 - 20
The antimicrobial effects of seven different types of Asian chewing sticks; Almas K; There are various plants, which are used as chewing sticks in different parts of the world . Several studies have been reported on the antimicrobial effects of chewing sticks on oral bacteria . The aim of this study was to compare the antimicrobial effect of aqueous extract of seven different types of chewing sticks found in Pakistan and other Asian countries . The ditch plate method was used to test the antimicrobial activity of seven Asian chewing sticks . It was found that at there was antimicrobial effect on Streptococcus fecalis at 50% concentration of Kikar (Acacia arabica) from Pakistan and Arak (Salvadora persica) from Saudi Arabia . The inhibition zones up to 2 mm were found in those two chewing stick extracts . It is recommended that the chewing sticks will be a great help in developing countries with financial constraints and limited oral health care facilities for their populations.

FEMS Microbiol Lett, 2002 Jan 22, 207(1), 87 - 90
Identification of lactoferrin-binding proteins in Streptococcus dysgalactiae subsp . dysgalactiae and Streptococcus agalactiae isolated from cows with mastitis; Park HM et al.; Three strains of Streptococcus dysgalactiae subsp . dysgalactiae (S . dysgalactiae) and five strains of Streptococcus agalactiae were used to identify lactoferrin-binding proteins (LBPs) . LBPs from extracted surface proteins were detected by polyacrylamide gel electrophoresis and Western blotting . All strains of S . dysgalactiae evaluated had 52- and 74-kDa protein bands . All strains of S . agalactiae evaluated had 52-, 70- and 110-kDa protein bands . In addition, a 45-kDa band was detected in two of five S . agalactiae strains evaluated . This study demonstrated that S . dysgalactiae and S . agalactiae of bovine origin contain two and three major LBPs, respectively.

Acta Odontol Latinoam, 1993, 7(2), 3 - 11
Bacterial inhibition produced by substances for dentin pretreatment; Molgatini S et al.; Dentin treatment before adhesion of composites is performed both to enhance adhesion and to remove the microbial contents of the smear layer . The purpose of these experiments was to evaluate the germicide potential of several dentin treatments used in adhesive systems and of some cleansing solutions . Different germs involved in caries processes were used (Candida Albicans, Streptococcus mutans and Actinomyces naeslundii) to prepare suspensions . Half a milliliter of each of the suspensions was transferred to test tubes and an equal volume of the following substances was added: Scotch Prep Dentin Primer (P), Gluma Cleanser (G), Cleaner Sol . (C), Tubulicid Blue (TB) and Red Label (TR), Blue Experimental Solution (SB) and Red Experimental Solution (SR) and sterile distilled water (control) . The preparation was incubated at 37 degrees C for seven days to test viability . P, TR, TB and SB produced complete inhibition of germs tested . The results reveal that, "in vitro", not all the substances tested exert a germicide effect on the microorganisms analyzed.

Acta Odontol Latinoam, 1994-1995, 8(2), 37 - 47
Antimicrobial power of composite resin adhesion systems; Molgatini SL et al.; The adherence of microorganisms to dentin that had been contaminated and then treated with conditioning substances was evaluated . The germicide effect of those products and their possible substantivity was also evaluated . Dentin slices were contaminated with Candida albicans, Streptococcus mutans and Actinomyces naeslundii and then treated with the following substances: 1 . Experimental Blue Solution A, 2 . Experimental Red Solution B; 3 Tubulicid Blue Label; 4 . Tubulicid Red Label; 5 Scotchprep Dentin Primer; 6 ventura Dentin Bond Cleaner; 7 ventura Dentin Bond Primer, 8 . Gluma dentin Bond; 9 Tenure Conditioner; 10 . All Bond Dentin Conditioner; 11 Syntac Primer; 12 . Clearfil New Bond acid + adhesive; 13 Prisma Universal Bond 3 Primer; 14 . Denthesive Cleaner; 15 . Control (Distilled water) . Adherence was evaluated using scanning electron microscopy and viability tests were performed . Substances 1, 2, 3, 4, 5, 7, 8, and 11 impair adherence; the control and substances 6 and 9 produced no afforded intermediate results effect while substances 10, 12, 13 and 14 . Viability tests afforded results similar to those obtained for adherence . Several substances that are used for dentin treatment or for dentin priming for adhesion could be useful in preventing microorganism viability and so contribute to the protection of pulp vitality.

J Gynecol Obstet Biol Reprod (Paris), 2001 Oct, 30(6), 521 - 31
{Neonatal bacterial infection by maternal-fetal contamination: for a change in approach? 1 . Detection of Streptococcus agalactiae infection: methods and evaluation of results}; Blond MH et al.; Perinatal group B streptococcal infection has been the subject of numerous studies and despite guidelines established during the last decade remains a frequent disease with high mortality . The basic aim of the guidelines is to screen for Streptococcus agalactiae during the antepartum period in order to institute antibiotic therapy during delivery . A critical review of the literature highlights the real impact and adverse effect of these guidelines: difficult application (only two-thirds of all maternity units have a protocol and compliance is only 75%), maternal risks of antibiotic therapy (especially the emergence of resistant Gram negative bacteria), fetal risks (accentuation of neonatal sepsis with resistant strains, retarded neonatal infections, frequent use of antibiotics with a broader spectrum, higher frequency of nosocomial sepsis).

Microbiology, 2002 Mar, 148(Pt 3), 755 - 62
Evidence that ORF3 at the Streptococcus parasanguis fimA locus encodes a thiol-specific antioxidant; Spatafora G et al.; Streptococcus parasanguis is a primary colonizer of dental plaque and a major player in subacute bacterial endocarditis . In the present study, the authors report that an ORF (ORF3) located 77 bp downstream of the fimA operon on the S . parasanguis FW213 chromosome complements an Escherichia coli thiol peroxidase (tpx) mutation in glutamine synthetase (GS) protection assays and that GS is protected by the ORF3 gene product in S . parasanguis cell extracts . In addition, the putative streptococcal peroxidase (Tpx(Sp)) protects S . parasanguis from stress caused by H2O2 and is induced by oxygen, as revealed by Northern blot analysis . Taken collectively, these findings support a thiol-dependent antioxidant activity for Tpx in S . parasanguis.

Acta Clin Belg, 2001 Nov-Dec, 56(6), 349 - 53
In vitro activity of the new ketolide telithromycin and other antibiotics against Streptococcus pneumoniae in Belgium; Verhaegen J et al.; In Belgium more than 17% of the invasive pneumococci are not susceptible to penicillin, and more than 38% not to macrolides . The most prevalent mechanism of macrolide resistance in Europe is modification of the drug target site leading to cross-resistance to lincosamides and group B streptogramines (MLSB resistance) . Telithromycin is the first antibiotic of the family of ketolides, which differ from erythromycin by having a 3-keto group instead of the neutral sugar L-cladinose . We tested the susceptibility of 637 pneumococci, recently isolated from patients in Belgium, to telithromycin and five other antibiotics . Data generated by this study show that telithromycin inhibits 98.4% of pneumococci at a breakpoint concentration of 1 mg/L in spite of a high percentage (> 30%) of strains with the MLSB constitutive type of resistance . Susceptibilities to the five comparator drugs were: penicillin (81.8%), tetracycline (67.0%), levofloxacin (98.9%), erythromycin (61.5%) and clindamycin (66.6%) . Consequently telithromycin looks to have considerable potential for the empiric treatment of community-acquired respiratory tract infections.

J Clin Microbiol, 2002 Mar, 40(3), 1106 - 8
Unusual outbreak of clinical mastitis in dairy sheep caused by Streptococcus equi subsp . zooepidemicus; Las Heras A et al.; This work describes an outbreak of clinical mastitis affecting 13 of 58 lactating ewes due to Streptococcus equi subsp . zooepidemicus . S . equi subsp . zooepidemicus was isolated in pure culture from all milk samples . All the clinical isolates had identical biochemical profiles and antimicrobial susceptibility patterns and also exhibited indistinguishable macrorestriction patterns by pulsed-field gel electrophoresis, indicating that all cases of mastitis were produced by a single strain.

J Clin Microbiol, 2002 Mar, 40(3), 1044 - 7
Periodontal bacteria in rabbit mandibular and maxillary abscesses; Tyrrell KL et al.; Despite the high incidence of odontogenic abscesses in pet rabbits, published data on the bacteriology of these infections are lacking, and clinical cultures are often ambiguous, making antibiotic choices difficult . In order to define the bacteriology of these infections, 12 rabbit mandibular and maxillary abscesses were cultured aerobically and anaerobically . All specimens yielded pathogenic bacteria, including Fusobacterium nucleatum, Prevotella heparinolytica, Prevotella spp., Peptostreptococcus micros, Streptococcus milleri group, Actinomyces israelii, and Arcanobacterium haemolyticum . These organisms are consistent with the characterized bacteriology of periodontal disease in human and other mammalian studies . The isolates were tested against 10 antimicrobial agents commonly used to treat rabbits; 100% of the strains tested were susceptible to clindamycin, 96% were susceptible to penicillin and ceftriaxone, 54% were susceptible to ciprofloxacin, and only 7% were susceptible to trimethoprim-sulfamethoxazole.

J Clin Microbiol, 2002 Mar, 40(3), 805 - 10
Streptococcus sinensis sp . nov., a novel species isolated from a patient with infective endocarditis; Woo PC et al.; A bacterium was isolated from the blood culture of a patient with infective endocarditis . The cells were facultative anaerobic, nonsporulating, gram-positive cocci arranged in chains . The bacterium grows on sheep blood agar as alpha-hemolytic, gray colonies of 0.5 to 1 mm in diameter after 24 h of incubation at 37 degrees C in ambient air . Growth also occurs in 10 or 40% bile and on bile esculin agar but not in 6% NaCl . No enhancement of growth is observed in 5% CO(2) . It is nongroupable with Lancefield groups A, B, C, D, F, or G antisera and is resistant to optochin and bacitracin . The organism is aflagellated and is nonmotile at both 25 and 37 degrees C . It is Voges-Proskauer test positive . It produces leucine arylamidase and beta-glucosidase but not catalase, urease, lysine decarboxylase, or ornithine decarboxylase . It hydrolyzes esculin and arginine . It utilizes glucose, lactose, salicin, sucrose, pullulan, trehalose, cellobiose, hemicellulase, mannose, maltose, and starch . 16S rRNA gene sequencing showed that there were 3.6, 3.7, 4.3, 4.7, and 5.9% differences between the 16S rRNA gene sequence of the bacterium and those of Streptococcus gordonii, Streptococcus intermedius, Streptococcus constellatus, Streptococcus sanguis, and Streptococcus anginosus, respectively . The G+C content of it (mean plus minus standard deviation) was 53.0% plus minus 2.9% . Based on phylogenetic affiliation, it belongs to the mitis or anginosus group of Streptococcus . For these reasons a new species, Streptococcus sinensis sp . nov., is proposed, for which HKU4 is the type strain . Further studies should be performed to ascertain the potential of this bacterium to become an emerging cause of infective endocarditis.

J Clin Microbiol, 2002 Mar, 40(3), 774 - 8
Macrolide efflux genes mef(A) and mef(E) are carried by different genetic elements in Streptococcus pneumoniae; Del Grosso M et al.; Susceptibilities to macrolides were evaluated in 267 Streptococcus pneumoniae isolates, of which 182 were from patients with invasive diseases and 85 were from healthy carriers . Of the 98 resistant isolates, 20 strains showed an M phenotype and carried mef . Strains that carried both mef(A) and mef(E) were found: 17 strains carried mef(A) and 3 carried mef(E) . The characteristics of the strains carrying the mef genes and the properties of the mef-containing elements were studied . Strains carrying mef(A) belonged to serotype 14, were susceptible to all the antibiotics tested except erythromycin, and appeared to be clonally related by pulsed-field gel electrophoresis (PFGE) . The three mef(E) strains belonged to different serotypes, showed different susceptibility profiles, and did not appear to be related by PFGE . The sequences of a fragment of the mef-containing element, which encompassed mef and the msr(A) homolog, were identical among the three mef(E)-positive strains and among the three mef(A)-positive strains, although there were differences between the sequences for the two variants at 168 positions . In all mef(A)-positive strains, the mef element was inserted in celB, which led to impairment of the competence of the strains . In line with insertion of the mef(E) element at a different site, the competence of the mef(E)-positive strains was maintained . Transfer of erythromycin resistance by conjugation was obtained from two of three mef(A) strains but from none of three mef(E) strains . Due to the important different characteristics of the strains carrying mef(A) or mef(E), we suggest that the distinction between the two genes be maintained.

Int Rev Immunol, 2001, 20(2), 275 - 87
Recombinant Streptococcus gordonii for mucosal delivery of a scFv microbicidal antibody; Oggioni MR et al.; The gram-positive bacterium Streptococcus gordonii was engineered to express the microbicidal molecule H6, which is an antiidiotypic single chain antibody mimicking a yeast killer toxin . S . gordonii is a human commensal which we developed as a model system for mucosal delivery of heterologous proteins . The in vivo candidacidal activity of both H6-secreting and H6-surface-displaying streptococcal strains were assayed in a well-established rat model of vaginal candidiasis . At day 21 full clearance of Candida albicans infection was observed in 75% of animals treated with the H6-secreting strain, and in 37.5% of animals treated with the strain expressing H6 on the surface, while all animals treated with the control strain were still infected . The observed candidacidal effect was comparable with that observed with the antimycotic drug fluconazole . These data confirm the potential of H6 as a candidacidal agent and show how promising is the approach of using recombinant bacteria for mucosal delivery of biologically active molecules.

Clin Exp Immunol, 2002 Feb, 127(2), 344 - 53
Age-dependent preference in human antibody responses to Streptococcus pneumoniae polypeptide antigens; Lifshitz S et al.; Vulnerability to Streptococcus pneumoniae is most pronounced in children . The microbial virulence factors and the features of the host immune response contributing to this phenomenon are not completely understood . In the current study, the humoral immune response to separated Strep . pneumoniae surface proteins and the ability to interfere with Strep . pneumoniae adhesion to cultured epithelial cells were analysed in adults and in children . Sera collected from healthy adults recognized Strep . pneumoniae separated lectin and nonlectin surface proteins in Western blot analysis and inhibited on average 80% of Strep . pneumoniae adhesion to epithelial cells in a concentration-dependent manner . However, sera longitudinally collected from healthy children attending day care centres from 18 months of age and over the course of the following 2 years revealed: (a) development of antibodies to previously unrecognized Strep . pneumoniae surface proteins with age; (b) a quantitative increase in antibody responses, measured by densitometry, towards separated Strep . pneumoniae surface proteins with age; and (c) inhibition of Strep . pneumoniae adhesion to epithelial cells, which was 50% on average at 18 months of age, increased significantly to an average level of 80% inhibition at 42 months of age equalling adult sera inhibitory values . The results obtained in the current study, from the longitudinally collected sera from healthy children with documented repeated Strep . pneumoniae colonization, show that repeated exposures are insufficient to elicit an immune response to Strep . pneumoniae proteins at 18 months of age . This inability to recognize Strep . pneumoniae surface proteins may stem from the inefficiency of T-cell-dependent B-cell responses at this age and/or from the low immunogenicity of the proteins.

Clin Exp Immunol, 2002 Feb, 127(2), 243 - 54
CD14-dependent and -independent cytokine and chemokine production by human THP-1 monocytes stimulated by Streptococcus suis capsular type 2; Segura M et al.; Streptococcus suis capsular type 2 is an important aetiologic agent of swine meningitis, and it has been highlighted as a cause of occupational disease leading to meningitis and fulminant sepsis in humans . The objective of the present work was to study the ability of S . suis type 2 to induce the release of tumour necrosis factor alpha (TNF-alpha), interleukin-1 (IL-1), IL-6, IL-8 and monocyte chemotactic protein one (MCP-1) by human monocytic THP-1 cells . The induction of these five cytokines was dose- and incubation time-dependent, and it was significantly enhanced by pre-treatment of cells with interferon gamma . IL-8 levels were markedly higher compared with those obtained with the other cytokines . However, elevated levels of MCP-1 and IL-6 were also observed . Levels of cytokine induced by heat-killed or live bacteria were similar . Pre-treatment of cells with anti-CD14 monoclonal antibodies suggested that this important host receptor is partially implicated in TNF, IL-1, IL-6 and MCP-1 production, while CD14-independent pathways seem to be responsible for IL-8 production after S . suis stimulation . In addition, blocking studies with anti-TNF and anti-IL-1 antibodies revealed that these cytokines are involved in amplification of the S . suis-induced cytokine cascade . When several different S . suis strains of human or porcine origin were compared, a very heterogeneous pattern of cytokine production was observed . Human strains did not exhibit a clear tendency to induce higher cytokine release by human THP-1 monocytes . The synergistic effect of the up-regulation of cytokines during S . suis meningitis may mediate many of the inflammatory reactions, including the sequestration of leucocytes at the site of infection.

Acta Otolaryngol, 2002 Jan, 122(1), 72 - 7
Nasopharyngeal carriage of drug-resistant Streptococcus pneumoniae in children with acute otitis media evaluated by polymerase chain reaction-based genotyping of penicillin-binding proteins; Hotomi M et al.; A polymerase chain reaction (PCR)-based genotyping of the penicillin-binding protein (PBP) genes pbp1a, pbp2x and pbp2b was used to characterize Streptococcus pneumoniae isolated from the nasopharynx of children with acute otitis media (AOM) . Mutations were observed in pbp1a, pbp2x and pbp2b genes in 36.5% of the strains . Decreased susceptibility to beta-lactam antibiotics was closely associated with the frequency of mutations in the three PBP genes . Of penicillin-intermediately-resistant S . pneumoniae strains, 54.5% appeared to be genetically similar to penicillin-resistant S . pneumoniae strains . Of penicillin-susceptible S . pneumoniae strains, 33.3% had mutations in the pbp2x gene and showed relatively high MICs to cephalosporins . Strains with mutations in the three PBP genes were often isolated from children < or = 2 years old . Evaluation of mutations in PBP genes using PCR will prove useful for studying the epidemiology of antibiotic resistance.

Infect Control Hosp Epidemiol, 2001 Dec, 22(12), 767 - 70
Neonatal bacteremia: patterns of antibiotic resistance; Bromiker R et al.; OBJECTIVE: To determine the incidence and evaluate the antimicrobial-susceptibility patterns of bacterial infections in our neonatal units . DESIGN: Retrospective surveillance study . SETTING: The neonatal units of the Hadassah University Hospitals, Jerusalem, Israel . PATIENTS: All newborns admitted from January 1994 through February 1999 . METHODS: The records of all patients with positive blood and cerebrospinal fluid cultures were reviewed . Bacteremia was considered early-onset (vertical) when occurring within the first 72 hours of life and late-onset (nosocomial) when occurring later . The prevalence and antibiotic-resistance patterns of vertically transmitted and nosocomially acquired strains were compared and studied over time . RESULTS: 219 of 35,691 newborn infants had at least one episode of bacteremia (6.13/1,000 live births) . There were 305 identified organisms, of which 21% (1.29/1,000 live births) were considered vertically transmitted and 79% nosocomially acquired . The most common organism causing early-onset disease (29.2%) was group B streptococcus (0.38/1,000 live births), whereas coagulase-negative staphylococci (51%) were the most prevalent in late-onset disease . All gram-positive bacteria were susceptible to vancomycin . Most gram-positive organisms other than staphylococci were susceptible to ampicillin . Gram-negative organisms represented 31% of all isolates . Generally, there was a trend of increasing resistance to commonly used antibiotics among nosocomially acquired gram-negative organisms, compared to those vertically transmitted, with statistically significant differences for ampicillin and mezlocillin (P<.05 and P<.01, respectively) . Over the years, a trend toward an increasing resistance to antibiotics was observed among gram-negative organisms . CONCLUSIONS: The trend of increasing bacterial resistance to commonly used antibiotics necessitates the implementation of a rational empirical treatment strategy, based on local susceptibility data, reserving certain agents for emerging resistant pathogens.

Life Support Biosph Sci, 1998, 5(3), 325 - 37
Microbial contamination of advanced life support (ALS) systems poses a moderate threat to the long-term stability of space-based bioregenerative systems; Schuerger AC; Microbial contamination of terrestrial hydroponic plant-growing systems provides an effective analogue for studying microbial contamination issues for space-based advanced life support (ALS) systems . If aggressive root or foliar pathogens are introduced into ALS hydroponic systems, severe epidemics are probable . Greater than 80% of the reported outbreaks of root pathogens in terrestrial hydroponic systems describe epidemics caused by fungal species of Fusarium, Phytophthora, and Pythium . However, it is likely that a comprehensive sanitation and quarantine program for space-based ALS modules will prevent contamination by Phytophthora and Pythium spp . because these pathogens are general soilborne . However, Fusarium spp . are typically airborne, can grow saprophytically on diverse substrates, and have been common contaminants of American spacecraft . If comprehensive sanitation and quarantine programs are established for space-based ALS modules, then the threat of pathogen introductions into these systems will be significantly mitigated . Microbial contamination studies in spacecraft over the last 30 years indicate that a high diversity of bacteria, fungi, and actinomycetes are commonly carried on board probably via clothing, equipment, air currents during spacecraft handling and loading, food, and the astronauts themselves . Species of Alternaria, Aspergillus, Botrytis, Candida, Cephalosporium, Cladosporium, Fusarium, Mucor, Penicillium, Phoma, and Trichoderma were the most prevalent fungi recovered, and species of Bacillus, Escherichia, Klebsiella, Micrococcus, Pseudomonas, Staphylococcus, and Streptococcus were the most prevalent bacteria recovered from spacecraft . Most of these genera contain species that have been reported as plant pathogens . Strict quarantine procedures were not effective in preventing contamination of spacecraft during these missions . Research must be initiated to better understand how microorganisms interact with plants and animals in microgravity environments because microbial contamination of spacecraft and ALS modules cannot be avoided . An integrated pest management (IPM) program likely will be developed for managing plant disease outbreaks in space-based ALS systems.

Pediatrics . 2002 Mar;109(3):E51.
Retropharyngeal cellulitis in a 5-week-old infant; Bourgeois FT et al.; An infant who presents with acute, unexplained crying requires a thorough examination to identify the source of distress . We report the case of a 5-week-old infant who had sudden irritability and was found to have retropharyngeal cellulitis caused by group B Streptococcus.

Am J Respir Crit Care Med, 2002 Mar 1, 165(5), 713 - 7
Pneumococcal meningitis in the intensive care unit: prognostic factors of clinical outcome in a series of 80 cases; Auburtin M et al.; We have undertaken this retrospective study to determine factors associated with in-hospital mortality and morbidity in 80 adult patients with severe Streptococcus pneumoniae meningitis . Clinical characteristics at admission of patients infected with susceptible (n = 54) and nonsusceptible (n = 17) strains to penicillin G were similar: age: 51 +/- 19 versus 58 +/- 15 yr (p = 0.16); Simplified Acute Severity Score (SAPS II): 39 +/- 14 versus 41 +/- 11 (p = 0.68); and Glasgow Coma Score: 8 +/- 3 versus 9.5 +/- 3 (p = 0.21), respectively . In-hospital mortality was 25% (20/80), with one death among the 17 patients (6%) infected with a nonsusceptible strain (p = 0.03) . High-dose dexamethasone was used in 22 cases . By multivariate analysis, three factors were independently associated with death: platelet count < 100 G/L (adjusted odds ratio {aOR} = 32.7; 95% CI = 3.2 to 332.5; p = 0.0032), arterial pH > 7.47 (aOR = 33.1; 95% CI = 3.4 to 319.7; p = 0.0025), and mechanical ventilation (aOR = 48.8; 95% CI = 2.6 to 901.5; p = 0.009) . When adjusting for the identified prognostic factors, corticosteroids significantly reduced the risk of death (aOR = 0.069; 95% CI = 0.005 to 0.9; p = 0.048) . Only SAPS II was predictive of adverse outcome (death or neurologic deficit) . We conclude that in intubated patients with S . pneumoniae meningitis, hyperventilation should be used with caution . Nonsusceptibility to penicillin G is not associated with a worse outcome . High-dose corticosteroids may be beneficial in the most severely ill patients.

Scand J Infect Dis, 2002, 34(1), 63 - 4
Streptococcus bovis meningitis in a neonate with Ivemark syndrome; Koh TH et al.; Although Streptococcus bovis infections in adults are associated with endocarditis and bowel neoplasms, S . bovis-associated meningitis is rare in neonates . We describe the case of a neonate with Ivemark syndrome, which possibly predisposed her to infection with this bacterium.

Scand J Infect Dis, 2002, 34(1), 61 - 2
Streptococcus bovis meningitis in a healthy adult patient; Vilarrasa N et al.; We describe the first case in the English language of Streptococcus bovis meningitis in a 45-y-old patient without any underlying disease or predisposing condition . S . bovis biotype II was isolated from his spinal fluid and blood . The illness was community-acquired and was clinically and biologically similar to disease caused by the classical meningeal pathogens . The patient was cured after 10 d of therapy with ceftriaxone and, 2.5 y later, is currently healthy . As a result of this case and a similar case published recently in the Spanish literature we conclude that S . bovis should be considered a microorganism capable of causing meningitis in the absence of any underlying condition or clear focus of infection.

Braz Dent J, 2002, 13(1), 27 - 32
Cariogenicity of different types of milk: an experimental study using animal model; Peres RC et al.; This study evaluated the cariogenic potential of infant formulas and cow's milk, using a high cariogenic challenge in the animal model . Sixty female Wistar rats infected with Streptococcus sobrinus and desalivated were randomly divided into 6 groups, which received ad libitum: 1) sterilized deionized distilled water (SDW) with 5% sucrose; 2) cow's milk; 3) Nan 2; 4) Nestogeno 2; 5) Ninho growth supporting; 6) SDW . Groups 1 and 6 also received essential diet NCP#2 by gavage, twice a day . After 21 days, the animals were killed and evaluated according to recovered oral microbiota and caries score by using a modified Keyes method . The analysis of the carbohydrates in the milk samples was performed using HPLC . The results were analyzed by Shapiro-Wilk and Kruskal-Wallis tests . Cow's milk had the lowest cariogenic potential compared to the other test groups, but it was not statistically different from group 6 . The percentage of S . sobrinus obtained from the oral cavity of the animals was not statistically different among the groups studied, except for the SDW group . It was concluded that cow's milk was not cariogenic and infant formulas showed some cariogenic potential.

Stat Med, 2002 Mar 15, 21(5), 773 - 91
Combining regression and association modelling for longitudinal data on bacterial carriage; Ekholm A et al.; A longitudinal data set, from the Finnish Otitis Media (FinOM) Studies, reporting carriage or non-carriage of Streptococcus pneumoniae at 2, 3, 4, 5, 6, 9, 12, 15 and 18 months of age of 329 children living in Tampere, Finland, is analysed . A logistic regression model on five time varying explanatory variables is fitted . The temporal association between presence at different ages is measured by dependence ratios and the structure of these is shown to be well described by a model indicating that roughly 10 per cent of the children are not susceptible to the bacteria, while for those that are susceptible, carriage status at a future observation age is conditionally independent of past observed statuses, given the present status . The dependence ratios between carriage at adjacent observation ages decay exponentially with age . Maximum likelihood estimates are obtained for the parameters of the full model, which is the combination of the marginal logistic regression and the association models . The parameter estimates of the full model, strengthened by non-testable Markov assumptions, are used for assessing the median duration of carriage and the acquisition rate as functions of age .

Eur Radiol, 2002 Feb, 12(2), 391 - 6 Epub 2001 Aug 28.
Imaging of cavitary necrosis in complicated childhood pneumonia; Hodina M et al.; The aim of this study was to illustrate the chest radiographs (CR) and CT imaging features and sequential findings of cavitary necrosis in complicated childhood pneumonia . Among 30 children admitted in the Pediatric Intensive Care Unit for persistent or progressive pneumonia, respiratory distress or sepsis despite adequate antibiotic therapy, a study group of 9 children (5 girls and 4 boys; mean age 4 years) who had the radiographic features and CT criteria for cavitary necrosis complicated pneumonia was identified . The pathogens identified were Streptococcus pneumoniae( n=4), Aspergillus( n=2), Legionella( n=1), and Staphylococcus aureus( n=1) . Sequential CR and CT scans were retrospectively reviewed . Follow-up CR and CT were evaluated for persistent abnormalities . Chest radiographs showed consolidations in 8 of the 9 patients . On CT examination, cavitary necrosis was localized to 1 lobe in 2 patients and 7 patients showed multilobar or bilateral areas of cavitary necrosis . In 3 patients of 9, the cavitary necrosis was initially shown on CT and visualization by CR was delayed by a time span varying from 5 to 9 days . In all patients with cavities, a mean number of five cavities were seen on antero-posterior CR, contrasting with the multiple cavities seen on CT . Parapneumonic effusions were shown by CR in 3 patients and in 5 patients by CT . Bronchopleural fistulae were demonstrated by CT alone ( n=3) . No purulent pericarditis was demonstrated . The CT scan displayed persistent residual pneumatoceles of the left lower lobe in 2 patients . Computed tomography is able to define a more specific pattern of abnormalities than conventional CR in children with necrotizing pneumonia and allows an earlier diagnosis of this rapidly progressing condition . Lung necrosis and cavitation may also be associated with Aspergillus or Legionella pneumonia in the pediatric population.

Cochrane Database Syst Rev . 2002;(1):CD002165.
Pneumococcal vaccine for asthma; Sheikh A et al.; BACKGROUND: Infection with Streptococcus pneumoniae is an important cause of pneumonia and other serious illnesses, particularly amongst those with certain high-risk medical conditions such as asthma . Although pneumococcal vaccine is routinely advocated for people with asthma, there is uncertainty about the evidence base that underpins this recommendation . OBJECTIVES: To determine the efficacy of pneumococcal vaccine in reducing mortality or morbidity from pneumococcal disease in asthmatics . SEARCH STRATEGY: Randomised controlled trials were identified using the Cochrane Airways Group's register derived from MEDLINE, EMBASE, and CINAHL electronic databases and hand searched respiratory journals and meeting abstracts . SELECTION CRITERIA: Randomised controlled trials, with or without blinding, in which pneumococcal vaccine has been compared with placebo or no treatment in people with clinician diagnosed asthma . DATA COLLECTION AND ANALYSIS: Two reviewers independently reviewed all abstracts and full papers of all articles of potential relevance were retrieved . Methodological quality was rated using the Cochrane approach and the Jadad rating scale . Data extraction was performed by one reviewer and checked independently by a second . We planned to perform quantitative analyses of outcomes on an intention-to-treat basis, where possible . MAIN RESULTS: Of the three papers retrieved, only one satisfied the inclusion criteria and the methodological quality of this study was low (unblinded and inadequate allocation concealment) . None of the data could be aggregated in a meta-analysis . Comparisons in a sub-set of 30 asthmatic children prone to recurrent episodes of otitis media, showed that pneumococcal vaccination decreased the incidence of acute asthma exacerbations from 10 to 7 (per child per year) . A further search conducted in September 2001 did not yield any further studies . REVIEWER'S CONCLUSIONS: This review found very limited evidence to support the routine use of pneumococcal vaccine in people with asthma . A randomised trial of vaccine efficacy in children and adults with asthma is needed.

Clin Microbiol Infect, 1998 Mar, 4 Suppl 1, S1 - S8
Introduction: Evolving needs in respiratory tract infections; Mandell LA; Two issues that have become clinically relevant to the treatment of pneumonia over the past few years are the development of antibiotic resistance among respiratory pathogens and the increasing importance of the atypical respiratory pathogens---Mycoplasma pneumoniae, Chlamydia pneumoniae and Legionella spp . Resistance has become an important issue in Streptococcus pneumoniae, methicillin-resistant Staphylococcus aureus and Gram-negative rods . The ways by which bacteria become resistant to antibiotics include production of antibiotic-modifying enzymes, reduced access to target sites, efflux of antibiotic, change in the bacterial target site and the bypassing of inhibited pathways . In Streptococcus pneumoniae that are penicillin resistant, the mechanism is through alteration of the target site for penicillins (penicillin-binding proteins) and this may also confer resistance to some cephalosporins . Multidrug resistance has also been reported in some strains of pneumococci . Of particular concern is resistance to macrolides mediated by the ermAM gene, which also confers resistance to lincosamides and streptogramin-B drugs . In Staphylococcus aureus, resistance to virtually all beta-lactam drugs is mediated by acquisition of the mecA gene, which codes for the drug-resistant beta-lactam target PBP2a . Antimicrobials are now needed that have enhanced activity against aerobic Gram-negative rods, atypical respiratory pathogens and Gram-positive cocci.

J Assoc Physicians India, 2001 Nov, 49, 1125 - 6
Streptococcus agalactiae endocarditis; Kannan R et al.; Streptococcus agalactiae (S . agalactiae) is a rare cause of infective endocarditis, which is associated with a high mortality rate . Endocarditis in adults is generally related to immunocompromised states . We hereby report the case of a 35 year old man who presented with fever and delirium in whom aortic valve endocarditis due to S . agalactiae was detected . Though most patients with S . agalactiae endocarditis need surgical intervention along with antibiotics, our patient improved with medical therapy alone.

Scand J Infect Dis, 2001, 33(12), 927 - 8
Recurrent septicemia caused by Streptococcus canis after a dog bite; Takeda N et al.; Human infection with Streptococcus canis is extremely rare . We describe herein a case of septicemia with cellulitis caused by S . canis in a 75-y-old woman, which developed 2 weeks after a dog bite . Macrorestriction analysis with pulsed-field gel electrophoresis demonstrated that the organism had been transmitted by means of a dog bite to her hand.

Gene, 2002 Jan 23, 283(1-2), 125 - 31
Diversity of Streptococcus mutans bacteriocins as confirmed by DNA analysis using specific molecular probes; Bekal-Si Ali S et al.; Mutacin-producing strains have been classified into 24 groups (designated by letters A to X) by similarity in activity spectra and cross-immunity . Similarity in primary structure among these groups can be revealed using DNA hybridization . The amino acid sequences of four mutacins (B-Ny266, 1140/mutacin III and mutacin II) were used to design two DNA probes in order to detect similar genes among groups of Streptococcus mutans strains demonstrating inhibitory activity . In addition to the appropriate parent strain, each probe hybridized with the total DNA from only two out of the 24 mutacin group type strains . Thus, the remaining 18 groups of strains produce mutacins that differ from the mutacins sequenced to date . In order to explore the similarity between genes coding for mutacins B-Ny266 and JH1140, the group B specific probe was utilized to detect a DNA fragment of 1.9 kb in the genome of S . mutans strain Ny266 . The sequence of the cloned fragment codes for three open reading frames (lanA, lanA' and lanB) similar to those of strains JH1140 and UA787 . The gene lanA' is strongly similar to the structural gene lanA (67%), but only one RNA transcript of about 300 bases was detected by Northern hybridization using the lanA-lanA' probe . Transcription of lanA alone was verified by RT-PCR.

Arch Pediatr, 2002 Jan, 9(1), 45 - 8
{Group B streptococcal infection with 2 recurrences in a newborn}; Lalande M et al.; Group B III streptococcus (GBS) is a predominant pathogen in neonates in France . Relapse is rare and two successive relapses are exceptional: only three cases have been yet reported . CASE REPORT: A newborn infant of 18 days of age presented a first episode of invasive group B III streptococcal infection with meningitis and ventriculitis . At 53 days of age, a second episode with bacteriemia and parotidis appeared . At 63 days of age, she presented a third episode with meningitis . Genome analysis of the three bacterial strains isolated during the three episodes showed the same clonal origin . COMMENTS: We discuss the incidence of the treatment, the eventual presence of a penicillin-tolerant GBS, the possible relapse or recurrence of the pathogen and the role of the relative immunodeficiency in infant.

J Antimicrob Chemother, 2002 Mar, 49(3), 553 - 6
Non-PmrA-mediated multidrug resistance in Streptococcus pneumoniae; Pestova E et al.; The PmrA multidrug transporter protein gene was inactivated in Streptococcus pneumoniae strains CP1000 (wild-type) and EBR (mutant with enhanced active multidrug efflux) . While the resistance to fluoroquinolones and ethidium bromide shown by EBR was reduced to the wild-type level, neither the susceptibility to reserpine in the presence of ethidium bromide and selected fluoroquinolones, nor the ability to produce ethidium bromide-resistant mutants was eliminated in the CP1000 pmrA mutant, indicating the presence of an additional multidrug export protein(s).

J Antimicrob Chemother, 2002 Mar, 49(3), 455 - 65
In vitro and in vivo antibacterial activity of T-3912, a novel non-fluorinated topical quinolone; Yamakawa T et al.; The in vitro and in vivo activity of T-3912, a novel non-fluorinated topical quinolone, was compared with that of nadifloxacin, ofloxacin, levofloxacin, clindamycin, erythromycin and gentamicin . The in vitro activity of T-3912 against methicillin-susceptible Staphylococcus aureus, ofloxacin-resistant and methicillin-resistant S . aureus, Staphylococcus epidermidis, ofloxacin-resistant S . epidermidis, penicillin-resistant Streptococcus pneumoniae and Propionibacterium acnes was four-fold to 16 000-fold greater than that of other agents at the MIC90 for the clinical isolates . The activity of T-3912 was not influenced by grlA mutation in S . aureus, and the degree of MIC increase of T-3912 for grlA-gyrA double and triple mutants was lowest among the quinolones tested (nadifloxacin, levofloxacin and ofloxacin) . The inhibitory activity of T-3912 was compared with other quinolones for DNA gyrase and topoisomerase IV of S . aureus SA113 . T-3912 showed the greatest inhibitory activity for both enzymes among the quinolones tested . The isolation frequency of spontaneous mutants resistant to T-3912 was < 1.7 x 10(-9) and < 2.0 x 10(-9) for S . aureus SA113 and P . acnes JCM 6425, respectively . Furthermore, resistance to T-3912 could not be clearly detected in the 28th transfer by the serial passage method . T-3912 exhibited more potent bactericidal activity against S . aureus and P . acnes than nadifloxacin and clindamycin in a short time period . T-3912 in a 1% gel formulation showed good therapeutic activity against a burn infection model caused by S . aureus SA113, P . acnes JCM6425 and multidrug-resistant S . aureus F-2161 . These results indicate that T-3912 is potentially a useful quinolone for the treatment of skin and soft-tissue infections and that its potent bactericidal activity might be able to shorten the treatment period.

An Esp Pediatr, 2002 Mar, 56(3), 251 - 2
{Group B streptococcus cellulitis-adenitis syndrome in neonates . Is it a marker of bacteremia?}; Artigas Rodriguez S et al.; We report the case of an infant in whom facial cellulitis was the only initial sign of a group B streptococcal bacteriemia . Adenitis-cellulitis syndrome is a rare clinical manifestation of group B streptococcal infection in infants . Local infection together with the onset of fever can be the only signs of bacteriemia in newborns and infants.

Clin Microbiol Infect, 1998 May, 4(5), 264 - 270
Bactericidal effects of levofloxacin in comparison with those of ciprofloxacin and sparfloxacin; Odenholt I et al.; OBJECTIVE: To investigate and compare the in vitro activity of levofloxacin with the activities of ciprofloxacin and sparfloxacin . METHODS: The following experiments were performed: (1) comparative studies of the rate of killing by the three quinolones of different strains of Streptococcus pneumoniae at a concentration corresponding to the 1-h serum level following a 500-mg dose in humans; (2) comparative studies of the rate of killing by levofloxacin and ciprofloxacin of different strains of Staphylococcus aureus, Escherichia coli and Pseudomonas aeruginosa at the same concentrations as above; (3) comparative studies of the rate of killing by levofloxacin at four different concentrations of reference and clinical strains of Streptococcus pneumoniae, Staphylococcus aureus, E . coli and P . aeruginosa . RESULTS: Levofloxacin exhibited statistically significantly higher bactericidal activity than sparfloxacin after 2 and/or 3 h against all strains of Streptococcus pneumoniae . Compared to ciprofloxacin, levofloxacin showed a statistically significantly higher bactericidal activity after 2 and/or 3 h against all strains of Streptococcus pneumoniae except the one resistant to both penicillin and cefotaxime . No differences in killing rate between levofloxacin and ciprofloxacin were seen against Staphylococcus aureus, E . coli and P . aeruginosa, with almost complete killing after 3 h of the P . aeruginosa strains and after 6 h for the E . coli strains . No concentration-dependent killing was seen at concentrations above 4xMIC of levofloxacin against Staphyloccus aureus, E . coli and P . aeruginosa . CONCLUSION: Levofloxacin was shown to be active against both Gram-positive and Gram-negative bacteria . In terms of MIC values, ciprofloxacin was the most active drug against the Gram-negative organisms, and sparfloxacin against the strains of Streptococcus pneumoniae, but levofloxacin exhibited a similar or even better bactericidal activity against the investigated strains compared with the other two fluoroquinolones when killing curves were compared.

Clin Microbiol Infect, 1998 Mar, 4(3), 135 - 143
Sparfloxacin as alternative treatment to standard therapy for community-acquired bacteremic pneumococcal pneumonia; Lode H et al.; OBJECTIVE: To assess the effectiveness of a single daily dose of sparfloxacin in comparison with standard antibacterial therapy for the treatment of pneumococcal bacteremic community-acquired pneumonia (CAP) . METHODS: The results were analyzed of four comparative trials in CAP, in which 107 adult patients with CAP confirmed by blood cultures positive for Streptococcus pneumoniae were included . Sparfloxacin was given at a loading dose of 400 mg followed by 200 mg daily . Comparator drugs included amoxycillin 3 g/day, amoxycillin/clavulanate 1.5/0.375 g/day and erythromycin 2 g/day . Dosing was for 7--14 days (mean 10 days) . Success was determined by a combination of clinical and microbiological assessment and radiologic changes . RESULTS: Sparfloxacin was as effective as the comparator drugs, with an overall success rate of 80% at the end of treatment (comparators 78%), and a 79% success rate at follow-up (76% for comparators) . There were no pneumococcal isolates resistant to sparfloxacin, but eight of 56 were either resistant (four) or had reduced susceptibility to penicillin G, and two strains were resistant to erythromycin . Tolerance to sparfloxacin was good, with fewer patients reporting drug-related adverse events (15.8%) than with the comparator drugs (33.3%) . CONCLUSIONS: This analysis suggests that sparfloxacin would be an alternative candidate for empirical therapy in moderately severe CAP.

Clin Microbiol Infect, 1998 Feb, 4(12), 695 - 700
Serotyping and antibiotic resistance of Streptococcus pneumoniae isolated from pediatric infections in central Greece; Kouppari G et al.; OBJECTIVE: To determine the distribution of serogroups/serotypes and antibiotic resistance pattern of Streptococcus pneumoniae isolated from pediatric infections in central Greece . METHODS: In total, 306 S . pneumoniae strains isolated from children, aged from 18 days to 14 years (median 18 months), during a 21-month period, from different specimen sources, were studied . Susceptibility testing was carried out by the Kirby---Bauer method and by the Etest, and serotyping by the Quellung reaction . RESULTS: Of the S . pneumoniae isolates, 3.9% were highly resistant to penicillin (PR), while 17.6% were intermediately resistant (IPR) . PR and IPR isolates were found to be, in general, more resistant to other antibiotics than penicillin-susceptible isolates . The PR and IPR isolates belonged to the serogroup/serotypes 19, 23, 9, 6 and 14 (in descending order of frequency) . The penicillin-susceptible isolates belonged to 20 different groups/serotypes, the most common being 19, 6, 14, 9, 3, 23 and 1 (in descending order of frequency) . Serogroup 23 was often found to be multiresistant . CONCLUSIONS: Resistance to penicillin in S . pneumoniae isolates is relatively low and differs according to the specimen type . All the pneumococcal serogroups/serotypes isolated from the children were found to be included in the 23-valent polysaccharide vaccine . Most of the children with a pneumococcal infection, however, were less than 2 years old and could not be protected by the existing vaccine.

Clin Microbiol Infect, 1998 Jan, 4(11), 622 - 626
Antimicrobial susceptibility of Streptococcus pneumoniae from children attending day-care centers in a central Italian city; Ronchetti MP et al.; OBJECTIVE: To undertake a survey of nasopharyngeal carriage of Streptococcus pneumoniae, which reflects strains causing infection, in 100 children under 3 years of age attending day-care centers in Frosinone, a city near Rome . METHODS: Fifty-three unique isolates of S . pneumoniae, isolated from 41 of the children tested, were tested for antimicrobial susceptibility to penicillin, cefotaxime, erythromycin, clindamycin, tetracycline, chloramphenicol and trimethoprim---sulfamethoxazole . RESULTS: Resistance rates were as follows: penicillin, 20.7% (15% intermediate; 5.7% resistant); trimethoprim---sulfamethoxazole, 64.2%; erythromycin, 64.2%; clindamycin, 30.2%; tetracycline, 32.1%; and chloramphenicol, 3.8% . Except for three intermediate strains, all strains were susceptible to cefotaxime . Only five strains were susceptible to all of the antibiotics tested . An unusual finding of this study was that 23 of the 34 erythromycin-resistant strains were penicillin susceptible, whereas erythromycin-resistant strains found in other countries are predominantly penicillin resistant as well . In addition, 18 of the 34 erythromycin-resistant strains were susceptible to clindamycin . Serogroups 6, 14, 19 and 23 accounted for 84.9% of the isolates . CONCLUSIONS: These data show that carriage of antibiotic-resistant pneumococci in children under 3 years of age is high in Frosinone, Italy . Information on resistance rates in pneumococcal disease in different age groups and on prevalence of drug resistance in other parts of the country is urgently needed.

Clin Microbiol Infect, 1998 Jan, 4(1), 11 - 17
Epidemiology of penicillin resistance in Streptococcus pneumoniae isolates in eastern France; Talon D et al.; OBJECTIVE: To assess the rates of intermediate and high-level resistance to penicillin among Streptococcus pneumoniae isolates and to identify clonal relationship of isolates within the different serotypes by means of pulsed-field gel electrophoresis . METHODS: We studied all clinical isolates obtained between April 1995 and March 1996 from patients admitted to 10 hospitals in eastern France . Antibiotic susceptibility testing and serotyping were performed on all isolates . The genetic polymorphism of isolates susceptible, intermediately resistant and highly resistant to penicillin was studied by using pulsed-field gel electrophoresis with ApaI and SmaI endonucleases . RESULTS: The prevalence of intermediate and high-level resistance was respectively 30.3% and 9.7% . Diminished sensitivity to penicillin was mainly encountered in serotypes 6, 9V, 14 and 23F . The 9V isolates from the different hospitals were genetically closely related, unlike the 23F isolates . Different levels of resistance (MICs from 0.5 to 2 mg/L) were expressed by closely related isolates . Three 9V isolates, three capsular-type 14 isolates and one non-typeable isolate were genetically closely related in studies with the two endonucleases . CONCLUSIONS: The capsular type was not a good indicator of genetic relatedness . The level of penicillin resistance was independent of the clonal classification . Horizontal gene transfer may be the main factor determining the degree of resistance.

Clin Microbiol Infect, 1997 Feb, 3(6), 608 - 615
In vivo efficacy of cefotaxime and amoxicillin against penicillin-susceptible, penicillin-resistant and penicillin---cephalosporin-resistant strains of Streptococcus pneumoniae in a mouse pneumonia model; Moine P et al.; OBJECTIVE: To compare cefotaxime (CTX) to amoxicillin (AMO) (usually considered the definitive therapy for penicillin-susceptible Streptococcus pneumoniae infections) in an immunocompromised mouse pneumonia model . METHODS: Three S . pneumoniae clinical isolates were used: two serotype 19 strains, a penicillin-susceptible (Ps) strain (penicillin MIC=0.03 microg/mL) and a highly penicillin-resistant (Pr) strain (penicillin MIC=4 microg/mL), and one serotype 23F strain, a penicillin---cephalosporin-resistant (CFTR) strain (CTX MIC=4 microg/mL) . RESULTS: CTX activity in this mouse model of pneumonia induced by the highly penicillin-resistant strain of S . pneumoniae was lower than expected from its low MIC against this organism . Furthermore, AMO had greater efficacy than CTX against a CFTR S . pneumoniae strain . CONCLUSION: Our data suggest that there is no major difference in the in vivo efficacy of the two agents, cefotaxime and amoxicillin, against penicillin-resistant and penicillin---cephalosporin-resistant S . pneumoniae.

Clin Microbiol Infect, 1997 Aug, 3(4), 474 - 479
Evaluation of the E-test for routine testing of the susceptibility of Streptococcus pneumoniae to benzylpenicillin, amoxicillin and cefotaxime; Tande D et al.; OBJECTIVE: To study the routine use of the E-test for susceptibility testing of penicillin-resistant Streptococcus pneumoniae . METHODS: A multicenter study of penicillin-resistant S . pneumoniae (PRSP) was carried out in Brittany, France (10 general hospitals, and two university hospitals including a coordinating center) . Each hospital detected PRSP by the oxacillin (5- micro g) disk method and determined the MICs of penicillin G, amoxicillin and cefotaxime by the E-test under routine conditions . All the PRSP strains were collected in a coordinating center and the MICs were checked by the agar dilution method . The classifications obtained from the MICs determined by the E-test and by the reference method were compared . RESULTS: Between 1 July 1993 and 30 June 1994, 128 PRSP strains were collected . Agreement within 1 log2 dilution was obtained for only 62% of strains with benzylpenicillin, 72.5% with amoxicillin and 76% with cefotaxime . These data are well below published values . In addition, 52% of the strains found to be penicillin-resistant by the reference technique were of intermediate resistance according to the E-test . There were major differences in the quality of the results obtained by the participating laboratories . CONCLUSIONS: There are problems of standardization in the routine use of the E-test . Microbiologists should therefore take particular care when performing the test and when reading the results, and ensure that reference strains are included in the assay.

Clin Microbiol Infect, 1997 Jun, 3(3), 324 - 328
Carriage of group B Streptococcus in pregnant women and newborns: a 2-year study at Perugia General Hospital; Sensini A et al.; OBJECTIVE: To study the prevalence of group B Streptococcus (GBS) colonization in pregnant women and their newborns at Perugia General Hospital . METHODS: The number of mother---child pairs examined was 2300 . Vaginal swabs were collected from the mothers at delivery, and auricular and pharyngeal swabs and gastric aspirate from the newborns at birth . Maternal risk factors for GBS disease, including premature delivery, intrapartum fever, prolonged rupture of membranes and multiple births, were evaluated . RESULTS: Maternal and neonatal colonization rates were 11.3% and 4.6%, respectively . GBS was isolated in 41.5% of the neonates born to colonized mothers and in 0.1% of those born to non-colonized mothers . No significant difference was observed in vertical transmission rates in the presence or absence of maternal risk factors . The external auditory canal was the most frequent (93.5%) and heavily colonized body site . Type Ib was the most common serotype among GBS isolates from mothers and babies . C surface protein was not detected in serotype V and VIII isolates, but was frequent in all other serotypes . Early-onset disease was observed in 0.4/1000 live births . CONCLUSIONS: The prevalence of maternal and neonatal colonization at Perugia General Hospital was similar to that obtained in other studies performed in Italy . The external auditory canal was confirmed as the most reliable body site to be sampled for the detection of neonates exposed to maternal GBS colonization.

Clin Microbiol Infect, 1997 Apr, 3(2), 180 - 186
Microbial etiology of acute community-acquired pneumonia in adult hospitalized patients in Yaounde-Cameroon; Koulla-Shiro S et al.; OBJECTIVE: To determine the microbial etiology of acute community-acquired pneumonia in Yaounde . METHODS: Ninety-one consecutive adult patients admitted to hospital for radiologically confirmed acute community-acquired pneumonia were studied prospectively . Sputum microscopy and culture, blood cultures, pneumococcal antigen detection in serum and serologic analysis for agents of atypical pneumonia and for human immunodeficiency virus (HIV) were performed for most patients . RESULTS: There were 65 men and 26 women, mean age 36.5 years . Of 91 patients, 70.3% had at least one predisposing factor and 21.7% (20 of 81) were seropositive for HIV . A microbial etiology was identified in 48 (52.7%) cases . A single pathogen was identified in 42 (85.4%) and double pathogens in six (14.6%) . Bacteremia occurred in 12 of 81 patients and was significantly more common in HIV-seropositive than in HIV-seronegative patients . Streptococcus pneumoniae was the commonest causative agent, identified in 22 of 91 (24.2%) patients, 10 of whom were bacteremic . Atypical pathogens were diagnosed in 14 of 65 patients with serologic tests . Mycoplasma pneumoniae and Coxiella burnetii were diagnosed in six of 65 (9.2%) cases each, and Chlamydia pneumoniae in three (4.6%) patients . Mycoplasma pneumoniae and Chlamydia pneumoniae occurred as a dual infection in one case . Seven of 91 patients died, and death was not associated with any particular etiology . CONCLUSION: Streptococcus pneumoniae remains the predominant etiologic pathogen of community-acquired pneumonia . For this reason, and also because ampicillin used empirically to treat patients with this disease in the same setting has been shown to be efficacious, we propose the use of an aminopenicillin in the initial treatment of acute community-acquired pneumonia in adults in Yaounde . However, patients who fail to respond clinically to such treatment should benefit from either a macrolide or a tetracycline in order to cover for atypical pathogens.

Clin Microbiol Infect, 1997 Feb, 3(1), 58 - 62
Susceptibility of Streptococcus pyogenes from throat cultures to macrolide antibiotics and influence of collection criteria; Giovanetti E et al.; OBJECTIVE: To assess the incidence of resistance to erythromycin and to the three other macrolide antibiotics most extensively used in Italy (azithromycin, clarithromycin and roxithromycin) among clinical strains of Streptococcus pyogenes freshly isolated from throat cultures of pediatric patients in an area of Central Italy . METHODS: Two sets of isolates were examined . The strains of the first set (n=100) were collected according to a protocol admitting only throat swabs from untreated patients with symptoms of acute pharyngotonsillitis . The second set (n=180) consisted of strains isolated from throat cultures during the routine activity of diagnostic laboratories, no particular protocol being applied . RESULTS: A trimodal distribution of strains was observed in relation to their macrolide susceptibility levels: two clusters were constituted by highly susceptible and highly resistant strains, respectively; a third, middle cluster consisted of strains displaying low-level resistance (or even intermediate susceptibility, in a minority of isolates, to clarithromycin) . The distribution of individual isolates in the three modal clusters was the same with all four drugs . Both MIC ranges and MIC50s almost overlapped in the isolates of the two sets, whereas MIC90s were far higher in the strains of the second set (4 micro g/mL for clarithromycin, 8 micro g/mL for erythromycin and azythromycin, and 16 micro g/mL for roxithromycin) than in those of the first (0.125 micro g/mL for all four drugs) . Resistant strains were 5% among the isolates of the first set and three times as many among those of the second . CONCLUSIONS: The lower incidence of macrolide resistance recorded in the first set is probably more reliable: the threefold incidence observed in the second set may be overestimated due to the lower frequency of strains involved in drug-responsive infections and to the increased occurrence of strains from unsuccessfully treated patients.

Pediatr Res, 2002 Mar, 51(3), 304 - 9
Cytokine expression of cord and adult blood mononuclear cells in response to Streptococcus agalactiae; Berner R et al.; Neonatal bacterial sepsis is often characterized by a fulminant clinical course and highly elevated plasma levels of proinflammatory cytokines . To evaluate in vitro activation of the neonatal immune system by specific infectious stimuli, cord blood cells from healthy neonates were examined for expression of tumor necrosis factor-alpha (TNF-alpha), IL-1beta, IL-6, and IL-8 in response to Streptococcus agalactiae (GBS), lipopolysaccharide (LPS), and lipoteichoic acid (LTA) . Cytokine-expression was compared in mononuclear cells from cord and adult peripheral blood . TNF-alpha and IL-6 levels in the supernatant of cord blood cell cultures were significantly higher after stimulation with heat-killed GBS (10(7)/mL) than with LPS (2 microg/mL) or LTA (2 microg/mL) (TNF-alpha: 2215 versus 267.5 versus 40 pg/mL, p = 0.001; IL-6: 9667 versus 4909 versus 919 pg/mL, p = 0.006) . mRNA expression of TNF-alpha, IL-1beta, IL-6, and IL-8 was equally pronounced after stimulation with either GBS, LPS, or LTA in cord or adult blood cells at various times . A MAb directed against the monocyte receptor molecule CD14 did not inhibit the release of cytokines in cord blood mononuclear cells after stimulation with GBS . In summary, activation of cord blood cells by infectious stimuli is comparable to the adult immune response in terms of expression of proinflammatory cytokines . GBS in particular proves to be a potent activator of the neonatal immune system when compared with LPS and LTA . CD14 seems not to be a crucial molecule for activation of cord blood cells by GBS.

Zhonghua Liu Xing Bing Xue Za Zhi, 2000 Dec, 21(6), 427 - 9
{Homogeneity study on the Streptococcus suis isolated from human and swine}; Zhu F et al.; OBJECTIVE: To identify S . suis and to evaluate the homogeneity of isolates of S . suis from human and swine . METHODS: Culture, morphology, API biochemical tests and serum coagulate tests were used . All the 7 strains of streptococcus were confirmed to be S . suis serotype 2 . Two strains and 1 strain were isolated from blood and cerebrospinal fluid (CSF) of patients, respectively, while the other 4 strains were obtained from the infected swine or their corpses . Seven strains of S . suis serotype 2 and reference strain SS2 were analyzed by randomly amplified polymorphic DNA analysis with six primers and Rep PCR with four primers and thalli fatty acid profile analysis . Cluster and principal compound analysis of results were performed with RAPD, Phylip and Treeview software . RESULTS: By analysis on RAPD patterns, a close relationship among 7 strains of S . suis serotype 2 and reference strain SS2 was discovered . Human-born strains and swine-born strains exhibit similar RAPD patterns . There was a same clonal relationship between strains originated from the blood and CFS of the patients . These results were confirmed by thalli fatty acid profile to have genotypic and phenotypic identity . CONCLUSION: Homogeneity exists among the 7 strains and reference strain SS2.

Oral Microbiol Immunol, 2002 Feb, 17(1), 22 - 31
Initial characterization of the Streptococcus gordonii htpX gene; Vickerman MM et al.; Examination of the Streptococcus gordonii chromosomal region, which lies immediately upstream of the glucosyltransferase positive regulatory determinant rgg, revealed two open reading frames . Based on nucleotide sequences, these genes were similar to the Listeria monocytogenes lemA gene, which is involved in antigen presentation, and the Escherichia coli htpX heat shock gene, which has an unknown function . Northern hybridization analysis indicated that S . gordonii lemA and htpX genes were associated with a ca . 1.7-kb polycistronic transcript . Although levels of the lemA/htpX transcript did not increase in response to heat to levels seen with dnaK controls, insertional inactivation of htpX resulted in changes in adhesiveness, cellular morphology and detergent-extractable surface antigens in cells grown at 41 degrees C, implying that htpX may be involved in surface protein expression . Insertional inactivation of lemA and htpX indicated that, despite their proximity to rgg and the structural gene, gtfG, these upstream genes do not affect S . gordonii glucosyltransferase activity.

Oral Microbiol Immunol, 2002 Feb, 17(1), 1 - 8
The transcriptional regulation of the Streptococcus mutans bgl regulon; Cote CK et al.; A beta-glucoside utilization regulon recently isolated from Streptococcus mutans has been shown to contain genes involved in beta-glucoside hydrolysis and a putative regulator . The bglP gene encodes a beta-glucoside-specific enzyme II (EII) component of the phosphoenolpyruvate-dependent phosphotransferase system, the bglC gene encodes a putative transcriptional regulator, and the bglA gene encodes a putative phospho-beta-glucosidase . To investigate the transcriptional activity of these genes, the putative promoter regions of the bglP, bglC and bglA genes were fused with the E . coli lacZ reporter gene . The resultant reporter plasmids were used to monitor the transcriptional activity of these loci in S . mutans . The results illustrate that these genes are not repressed by glucose in the presence of an inducing beta-glucoside, esculin, to the levels of expression observed in the absence of esculin . Therefore, these loci are not subject to catabolite repression by glucose to noninduced levels of expression . The bglC gene product was determined to be a positive transcriptional regulator of the bglA gene but does not regulate the expression of the bglP gene . Thus, regulation of these loci requires different and multiple control mechanisms.

Fundam Clin Pharmacol, 2001 Dec, 15(6), 419 - 24
Pharmacokinetic-pharmacodynamic modeling of the inhibitory effect of erythromycin on tumour necrosis factor-alpha and interleukin-6 production; Guchelaar HJ et al.; Erythromycin inhibits the production of tumour necrosis factor-alpha (TNF-alpha) and interleukin-6 (IL6) induced by heat-killed Streptococcus pneumoniae in human whole blood ex-vivo . The objective of the present study was to determine and characterize the concentration-effect relationship of this phenomenon in order to predict its possible clinical relevance.Six healthy volunteers received a single intravenous dose of 1000 mg erythromycin . Blood samples were obtained up to 4 h after drug administration . Samples were assayed for erythromycin concentrations and (after heat-killed Streptococcus pneumoniae stimulation) for TNF-alpha and IL6 concentrations . Effect vs . time data from individual subjects were fitted to the indirect response model with an Emax concentration-effect relationship . Simulations of these effects were performed for therapeutic intravenous and oral erythromycin dosage regimens . The geometric means of the values of Kin, Kout and EC50 were 15.4 microg/h, 0.82/h, 9.4 mg/L for TNF-alpha and 321 microg/h, 2.02/h, 18.3 mg/L for IL6 . Simulations revealed a maximal inhibition of TNF-alpha concentrations of 35%, 50%, 16% and 27% at erythromycin dosages of 500 mg i.v., 1000 mg i.v., 500 mg p.o and 1000 mg p.o . q 6 h, respectively, whereas a maximal inhibition of IL6 of 29%, 44%, 13% and 22% are predicted for the respective regimens . The inhibitory effect of erythromycin on TNF-alpha and IL6 production can be adequately described by the indirect response model with an Emax concentration-effect relationship . Simulations predicted a substantial decrease of production of these cytokines at intravenous and to a much lesser extent at oral erythromycin dosage regimens.

J Dairy Sci, 2002 Jan, 85(1), 258 - 62
Reduction of mastitis caused by experimental challenge with Staphylococcus aureus and Streptococcus agalactiae by use of a quaternary ammonium and halogen-mixture teat dip; Boddie RL et al.; A teat-dip formulation containing sodium dichloro isocyanuric acid, bronopol, and quaternary ammonium was tested for efficacy against Staphylococcus aureus and Streptococcus agalactiae intramammary infections (IMI) using an experimental challenge model . Sixty-two Jersey cows from the Hill Farm Research Station (Homer, LA) were used in an 8-wk controlled infection trial to evaluate the teat dip . During the afternoon milking, Monday through Friday for 8 wk, all teats of each cow were immersed to a depth of approximately 25 mm in a challenge suspension containing approximately 5 x 10(7) cfu of Staphylococcus aureus and approximately 5 x 10(7) cfu of Streptococcus agalactiae immediately after milking machines were removed . Immediately after challenge, the distal 25 mm of two contralateral teats were dipped with the experimental teat dip; the remaining two teats served as undipped controls . The experimental teat dip reduced the number of new Staph . aureus IMI by 70.9% and reduced the number of new Strep . agalactiae IMI by 60.0% . Teat end and teat skin condition were characterized as normal and without irritation at the completion of the study . The combination of the three germicides in this experimental teat dip is unique and an effective formulation without adverse effects on condition of teat ends or teat skin.

J Dairy Sci, 2002 Jan, 85(1), 252 - 7
Efficacy of two acidified chlorite postmilking teat disinfectants with sodium dodecylbenzene sulfonic acid on prevention of contagious mastitis using an experimental challenge protocol; Oura LY et al.; Two acidified sodium chlorite postmilking teat disinfectants were evaluated for efficacy against Staphylococcus aureus and Streptococcus agalactiae by using National Mastitis Council experimental challenge procedures . The effect of these teat dips on teat skin and teat end condition was also determined . Both dips contained 0.32% sodium chlorite, 1.32% lactic, and 2.5% glycerin . Dips differed in the amount of sodium dodecylbenzene sulfonic acid (0.53 or 0.27%) added as a surfactant . Both dips significantly reduced new intramammary infection (IMI) rates compared with undipped controls . The dip containing 0.53% dodecylbenzene sulfonic acid reduced new IMI by Staph . aureus by 72% and Strep . agalactiae by 75% . The dip containing 0.27% dodecylbenzene sulfonic acid reduced new IMI by Staph . aureus by 100% and by Strep . agalactiae by 88% . Changes in teat skin and teat end condition for treatment and control groups varied in parallel over time . Teats treated with either teat dip had higher mean teat skin and teat end scores than control teats at some weeks . However, teat skin and teat end condition did not tend to change from the start to the completion of the trial . Application of the two new postmilking teat dips was effective in reducing new IMI from contagious mastitis pathogens . (Key words: teat dip, contagious mastitis, chlorous acid)

Diagn Microbiol Infect Dis, 2002 Feb, 42(2), 129 - 35
Antimicrobial susceptibilities of Streptococcus pyogenes isolated from respiratory and skin and soft tissue infections: United States LIBRA surveillance data from 1999; Critchley IA et al.; This study evaluated current levels of antimicrobial resistance and associated demographic trends among clinical isolates of Streptococcus pyogenes in the United States as part of the LIBRA surveillance initiative . In 1999, 2,742 isolates of S . pyogenes (2,039 respiratory; 405 skin and soft tissue; 148 blood) were collected from 324 clinical laboratories and centrally tested for antimicrobial susceptibility by the broth microdilution method . All isolates were susceptible to penicillin (MIC(90,) < or = 0.06 microg/mL), ceftriaxone (MIC(90,) < or =0.03 microg/mL), vancomycin (MIC(90,) 0.5 microg/mL), levofloxacin (MIC(90,) 1 microg/mL), and moxifloxacin (MIC(90,) 0.25 microg/mL) . Twenty-four (0.9%) azithromycin-intermediate (MIC, 1 microg/mL) and 170 (6.2%) azithromycin-resistant (MIC, > or = 2 microg/mL) isolates were identified . Regionally, azithromycin resistance varied by < 5%, ranging from 3.0% in New England to 7.7% in the Pacific region . Azithromycin resistance was significantly higher (P < 0.001) among patients aged 15-64 years (8.3%) than patients < or =14 years (4.3%) . This study found higher rates of macrolide resistance among S . pyogenes than previously reported in the United States and suggests that macrolide resistance is common among respiratory isolates from both younger and older patients . Fluoroquinolones (moxifloxacin > levofloxacin) demonstrated potent in vitro activity against all isolates of S . pyogenes tested, including those from skin and soft tissue infections . Given the higher rates of macrolide resistance reported in other countries and the seriousness of invasive infections, continued antimicrobial surveillance of S . pyogenes in the United States would be prudent.

Vaccine, 2002 Feb 22, 20(11-12), 1653 - 9
Nasal mucosal immunogenicity for the horse of a SeM peptide of Streptococcus equi genetically coupled to cholera toxin; Sheoran AS et al.; The intranasal immunogenicity of cholera toxin (CT) genetically coupled to peptide sequence aa236-334 (F3) of the SeM protein of Streptococcus equi was studied in five young adult Welsh ponies . All ponies made rapid CTB- and SeMF3-specific serum antibody responses following the first immunization . Specific nasal IgA responses were detected in two ponies 14 days after the first immunization, in another two 14 days after a second immunization on day 14, and in all ponies 28 days after a third immunization on day 42 . SeMF3-specific antibody responses in sera and nasal washes were dominated by IgGb and IgA, respectively, and remained elevated for at least 140 days . Strong serum IgGa and IgG(T) responses were also observed . These antibody responses were qualitatively similar to those induced during recovery from equine strangles . Antibody responses in mucosal secretions were boosted in some ponies by immunizations subsequent to the first immunization, but antibodies in serum were never boosted . In vitro survival of S . equi was significantly reduced by SeMF3-specific antibodies in sera obtained 14 days after the second immunization but survival increased in sera collected following subsequent immunizations, possibly due to absence of synthesis of high affinity antibodies . Finally, the susceptibility of all immunized ponies to commingling challenge by S . equi indicated either that SeMF3 lacks protective epitopes or that the antibodies induced by the chimera were not at effective levels.

Can J Vet Res, 2002 Jan, 66(1), 8 - 14
Antibody response to an autogenous vaccine and serologic profile for Streptococcus suis capsular type 1/2; Lapointe L et al.; An autogenous vaccine was developed, using sonicated bacteria, with a strain of Streptococcus suis capsular type 1/2 . The objectives of this study were to evaluate the antibody response following vaccination and to assess the changes in antibody levels in pigs from a herd showing clinical signs of S . suis capsular type 1/2 infection in 6- to 8-week-old pigs . An enzyme-linked immunosorbent assay using the vaccine antigen was standardized . Results from a preliminary study involving 2 control and 4 vaccinated 4-week-old pigs indicated that all vaccinated pigs produced antibodies against 2 proteins of 34 and 43 kDa, respectively, and, in 3 out of 4 vaccinated pigs, against the 117-kDa muramidase-released protein . For the serologic profile, groups of 30 pigs from the infected herd were blood sampled at 2, 4, 6, 8, and 10 weeks of age . The lowest antibody level was observed between weeks 6 and 8, presumably corresponding to a decrease in maternal immunity . A marked increase was seen at 10 weeks of age, shortly after the onset of clinical signs in the herd . For the vaccination field trial, newly weaned, one-week-old piglets were divided into 2 groups of 200 piglets each (control and vaccinated); blood samples were collected from 36 piglets in each group at 2-week intervals for 12 weeks . A significant increase (P < 0.05) in antibody response was observed 4 weeks following vaccination and the level of antibodies stayed high until the end of the experiment . In the control group, the increase was only observed at 13 weeks of age, probably in response to a natural infection . The response to the vaccine varied considerably among pigs and was attributed, in part, to the levels of maternal antibodies at the time of vaccination . No outbreak of S . suis was observed in the control or vaccinated groups, so the protection conferred by the vaccine could not be evaluated.

Ter Arkh, 2001, 73(12), 65 - 8
{Post-respiratory infection reactive arthritis--etiology, clinical and laboratory characteristics and early prognosis}; Dimov D et al.; AIM: To study etiology, clinico-laboratory characteristics and early prognosis of reactive arthritis developing after respiratory infections (priReA) . MATERIAL AND METHODS: Blood samples from 69 priReA patients aged 17-45 years were examined for specific antibodies to 28 bacterial and viral infectious agents, and antigens of group HLA-B7-CREG (B7, B13, B22, B27, B40, B73, Cw2) . The test were made in hospital and 3 months after the patients' discharge . RESULTS: The priReA respiratory etiology was discovered in 31 patients, urogenital--in 14 cases and enterocolitic one--in 7 patients . Streptococcus and pneumoneal chlamydia cause priReA most frequently . HLA-B40 carriers are more predisposed to priReA . priReA runs with less frequent Reiter's syndrome and lesions of axial and extraarticular structures, better early prognosis . CONCLUSION: In young patients with early ReA respiratory etiology is observed more frequently than urogenital and enterocolitic ones . Compared to other kinds of ReA, priReA demonstrates some genetic, clinical and prognostic peculiarities.

Rev Esp Quimioter, 2001 Dec, 14(4), 345 - 50
{Activity of different antimicrobial agents against penicillin-resistant Streptococcus pneumoniae}; Calvo A et al.; Since the first strains of penicillin-resistant Streptococcus pneumoniae were isolated in the 1960s, the rate of resistance has increased world- wide, though with geographic variations . Currently, the prevalence and patterns of antibiotic resistance in this microorganism vary widely from one country to another, as well as within in the same country . In our study we evaluated the in vitro susceptibility of 299 isolates of S . pneumoniae from patients with community-acquired respiratory tract infections from 1998-2000 to different antimicrobial agents . The following resistance results were obtained: 32.11% to penicillin, 4.35% to amoxicillin, 3.68% to amoxicillin-clavulanic acid, 69.9% to cefaclor, 32.44% to cefpodoxime, 34.11% to cefuroxime, and 24.41% to azithromycin . For cefixime and ceftibuten there are no NCCLS breakpoint criteria.

Clin Microbiol Infect, 1999 Feb, 5(2), 88 - 91
A new biotyping method for Streptococcus mutans with the API ZYM system; De La Higuera A et al.; OBJECTIVE: To test a new system for the biotyping of Streptococcus mutans, based on the measurement of enzyme activity, and to investigate the relationship between biotype and in vitro susceptibility to seven clinically useful antibiotics . METHODS: In total, 160 oral isolates of S . mutans were classified into different biotypes with the APIZYM test for enzyme activity, excluding results that were positive or negative in >80% of the strains . The susceptibility of all 160 strains to amoxycillin, cefazolin, erythromycin, clindamycin, vancomycin, teicoplanin and imipenem was tested by dilution in a solid medium . Statistical analysis of susceptibility (mean minimum inhibitory concentrations (MICs)) was based on chi-squared tests . RESULTS: Eight different biotypes (1-8) were identified on the basis of three kinds of enzyme activity: valine aryl amidase, acid phosphatase and alpha-galactosidase . Biotype 5 was found to be the most common . The mean MIC values showed strains belonging to biotype 4 to be the most susceptible to amoxycillin, cefazolin and erythromycin, whereas biotype 1 was the least susceptible to teicoplanin . CONCLUSIONS: The proposed biotyping method, which is relatively fast and simple to perform, provided reproducible results, and may contribute to clinically effective treatment of S . mutans infections.

Clin Microbiol Infect, 1999 Jan, 5(1), 12 - 15
The antibacterial effects of ciprofloxacin and trovafloxacin against Streptococcus pneumoniae in an in vitro dynamic model; O'Brien M et al.; OBJECTIVE: To determine whether the newer fluoroquinolone antibiotics such as trovafloxacin posses enhanced activity against Gram-positive organisms, including Streptococcus pneumoniae, because the clinical activity of older quinolones against pneumococci has been questioned . METHODS: In this study, the bactericidal activities of ciprofloxacin and trovafloxacin against six strains of penicillin-resistant and -sensitive strains of Streptococcus pneumoniae were compared using an in vitro model that simulates human pharmacokinetics . Ciprofloxacin was administered at 750 mg every 12 h, higher than the usual daily dose of 500 mg twice a day . Trovafloxacin was administered at 300 mg every 24 h for the six strains and at 200 mg every 24 h for three of the strains . RESULTS: The single 300-mg dose of trovafloxacin killed five of the six strains in 4 h, with no bacterial regrowth . Ciprofloxacin reduced the initial inoculum by 3--5 logs by 24 h . Although the 300-mg dose of trovafloxacin more rapidly eradicated susceptible strains, the activity of trovafloxacin at 200 mg every 24 h was similar to that of ciprofloxacin at 750 mg every 12 h against the three strains tested . CONCLUSION: Trovafloxacin (and ciprofloxacin at high doses) eradicates susceptible strains of pneumococci in an in vitro dynamic model.

Microb Pathog, 2002 Mar, 32(3), 105 - 16
Streptococcus sanguis secretes CD14-binding proteins that stimulate cytokine synthesis: a clue to the pathogenesis of infective (bacterial) endocarditis?
Banks J, Poole S, Nair SP, Lewthwaite J, Tabona P, McNab R, Wilson M, Paul A, Henderson B.
Streptococcus sanguis is the major causative organism of infective (bacterial) endocarditis but, surprisingly, almost nothing is known about how it induces endocardial inflammation . In earlier studies we have shown that many bacteria secrete potent cytokine-inducing or -inhibiting proteins . We have therefore isolated the material secreted by S . sanguis grown on blood agar or in broth culture and have tested its ability to induce human peripheral blood monocytes to synthesize pro-inflammatory cytokines . The activation of monocytes by the secreted components of S . sanguis was almost totally blocked by heat and trypsin treatment but not by the lipopolysaccharide-inactivating antibiotic, polymyxin B, suggesting that activity is due to secreted proteins . The activity of the secreted material was significantly reduced by anti-CD14 monoclonal antibodies suggesting that the active protein (or proteins) was binding to the CD14/Toll-like receptor (TLR)4 complex . Fractionation of the secreted proteins by high performance liquid chromatography (HPLC) identified two proteins as being responsible for the majority of the cytokine induction: a manganese-dependent superoxide dismutase and a 190 kDa protein, which could not be sequenced, but which was neither CshA nor the PI/II proteins . These proteins, or the receptors to which they bind, may be therapeutic targets and may allow the development of adjunctive therapies to prevent endocardial damage during the often prolonged treatment of infective endocarditis with antibiotics . In addition, blocking of CD14 may have some therapeutic benefit .

Proc Natl Acad Sci U S A, 2002 Feb 19, 99(4), 2100 - 5
Homologous recombination at the border: insertion-deletions and the trapping of foreign DNA in Streptococcus pneumoniae; Prudhomme M et al.; Integration of foreign DNA was observed in the Gram-positive human pathogen Streptococcus pneumoniae (pneumococcus) after transformation with DNA from a recombinant Escherichia coli bacteriophage lamda carrying a pneumococcal insert . Segments of lamda DNA replaced chromosomal sequences adjacent to the region homologous with the pneumococcal insert, whence the name insertion-deletion . Here we report that a pneumococcal insert was absolutely required for insertion-deletion formation, but could be as short as 153 bp; that the sizes of foreign DNA insertions (289-2,474 bp) and concomitant chromosomal deletions (45-1,485 bp) were not obviously correlated; that novel joints clustered preferentially within segments of high GC content; and that the crossovers in 29 independent novel joints were located 1 bp from the border or within short (3-10 nt long) stretches of identity (microhomology) between resident and foreign DNA . The data are consistent with a model in which the insert serving as a homologous recombination anchor favors interaction and subsequent illegitimate recombination events at microhomologies between foreign and resident sequences . The potential of homology- directed illegitimate recombination for genome evolution was illustrated by the trapping of functional heterologous genes.

J Biol Chem, 2002 Apr 26, 277(17), 14493 - 500 Epub 2002 Feb 19.
Complete inhibition of Streptococcus pneumoniae RecA protein-catalyzed ATP hydrolysis by single-stranded DNA-binding protein (SSB protein): implications for the mechanism of SSB protein-stimulated DNA strand exchange; Steffen SE et al.; The ATP-dependent three-strand exchange activity of the Streptococcus pneumoniae RecA protein (RecA(Sp)), like that of the Escherichia coli RecA protein (RecA(Ec)), is strongly stimulated by the single-stranded DNA-binding protein (SSB) from either E . coli (SSB(Ec)) or S . pneumoniae (SSB(Sp)) . The RecA(Sp) protein differs from the RecA(Ec) protein, however, in that its ssDNA-dependent ATP hydrolysis activity is completely inhibited by SSB(Ec) or SSB(Sp) protein, apparently because these proteins displace RecA(Sp) protein from ssDNA . These results indicate that in contrast to the mechanism that has been established for the RecA(Ec) protein, SSB protein does not stimulate the RecA(Sp) protein-promoted strand exchange reaction by facilitating the formation of a presynaptic complex between the RecA(Sp) protein and the ssDNA substrate . In addition to acting presynaptically, however, it has been proposed that SSB(Ec) protein also stimulates the RecA(Ec) protein strand exchange reaction postsynaptically, by binding to the displaced single strand that is generated when the ssDNA substrate invades the homologous linear dsDNA . In the RecA(Sp) protein-promoted reaction, the stimulatory effect of SSB protein may be due entirely to this postsynaptic mechanism . The competing displacement of RecA(Sp) protein from the ssDNA substrate by SSB protein, however, appears to limit the efficiency of the strand exchange reaction (especially at high SSB protein concentrations or when SSB protein is added to the ssDNA before RecA(Sp) protein) relative to that observed under the same conditions with the RecA(Ec) protein.

Infect Immun, 2002 Mar, 70(3), 1635 - 9
Virulence of Streptococcus pneumoniae: PsaA mutants are hypersensitive to oxidative stress; Tseng HJ et al.; psaA encodes a 37-kDa pneumococcal lipoprotein which is part of an ABC Mn(II) transport complex . Streptococcus pneumoniae D39 psaA mutants have previously been shown to be significantly less virulent than wild-type D39, but the mechanism underlying the attenuation has not been resolved . In this study, we have shown that psaA and psaD mutants are highly sensitive to oxidative stress, i.e., to superoxide and hydrogen peroxide, which might explain why they are less virulent than the wild-type strain . Our investigations revealed altered expression of the key oxidative-stress response enzymes superoxide dismutase and NADH oxidase in psaA and psaD mutants, suggesting that PsaA and PsaD may play important roles in the regulation of expression of oxidative-stress response enzymes and intracellular redox homeostasis.

Infect Immun, 2002 Mar, 70(3), 1547 - 57
Role of inflammatory mediators in resistance and susceptibility to pneumococcal infection; Kerr AR et al.; Variations in the host response during pneumonia caused by Streptococcus pneumoniae in susceptible (CBA/Ca) and resistant (BALB/c) inbred mouse strains were investigated . Significant differences were detected in survival time, core body temperature, lung-associated and systemic bacterial loads, mast cell numbers, magnitude and location of cytokine production, lung disruption, and ability of isolated lung cells to release the cytokine tumor necrosis factor (TNF) alpha in vitro . Overall, the results indicate that the reduced capacity of CBA/Ca mice to induce rapid TNF activity within the airways following infection with S . pneumoniae may be a factor in their elevated susceptibility to pneumococcal pneumonia.

Infect Immun, 2002 Mar, 70(3), 1422 - 33
Differential fluorescence induction analysis of Streptococcus pneumoniae identifies genes involved in pathogenesis; Marra A et al.; Differential fluorescence induction (DFI) technology was used to identify promoters of Streptococcus pneumoniae induced under various in vitro and in vivo conditions . A promoter-trap library using green fluorescent protein as the reporter was constructed in S . pneumoniae, and the entire library was screened for clones exhibiting increased gfp expression under the chosen conditions . The in vitro conditions used were chosen to mimic aspects of the in vivo environment encountered by the pathogen once it enters a host: changes in temperature, osmolarity, oxygen, and iron concentration, as well as blood . In addition, the library was used to infect animals in three different models, and clones induced in these environments were identified . Several promoters were identified in multiple screens, and genes whose promoters were induced twofold or greater under the inducing condition were mutated to assess their roles in virulence . A total of 25 genes were mutated, and the effects of the mutations were assessed in at least two different infection models . Over 50% of these mutants were attenuated in at least one infection model . We show that DFI is a useful tool for identifying bacterial virulence factors as well as a means of elucidating the microenvironment encountered by pathogens upon infection.

Infect Immun, 2002 Mar, 70(3), 1319 - 25
Contribution of fibronectin-binding protein to pathogenesis of Streptococcus suis serotype 2; de Greeff A et al.; In the present study we investigated the role of the fibronectin (FN)- and fibrinogen (FGN)-binding protein (FBPS) in the pathogenesis of Streptococcus suis serotype 2 in piglets . The complete gene encoding FBPS from S . suis serotype 2 was cloned in Escherichia coli and sequenced . The occurrence of the gene in various serotypes was analyzed by hybridization studies . The FBPS protein was expressed in E . coli and purified, and binding to human FN and FGN was demonstrated . The induction of antibodies in piglets was studied upon infection . An isogenic mutant unable to produce FBPS was constructed, and the levels of virulence of the wild-type and mutant strains were compared in a competitive infection model in young piglets . Organ cultures showed that FBPS was not required for colonization of the tonsils but that FBPS played a role in the colonization of the specific organs involved in an S . suis infection . Therefore, the FBPS mutant was considered as an attenuated mutant.

Infect Immun, 2002 Mar, 70(3), 1254 - 9
Identification of major outer surface proteins of Streptococcus agalactiae; Hughes MJ et al.; To identify the major outer surface proteins of Streptococcus agalactiae (group B streptococcus), a proteomic analysis was undertaken . An extract of the outer surface proteins was separated by two-dimensional electrophoresis . The visualized spots were identified through a combination of peptide sequencing and reverse genetic methodologies . Of the 30 major spots identified as S . agalactiae specific, 27 have been identified . Six of these proteins, previously unidentified in S . agalactiae, were sequenced and cloned . These were ornithine carbamoyltransferase, phosphoglycerate kinase, nonphosphorylating glyceraldehyde-3-phosphate dehydrogenase, purine nucleoside phosphorylase, enolase, and glucose-6-phosphate isomerase . Using a gram-positive expression system, we have overexpressed two of these proteins in an in vitro system . These recombinant, purified proteins were used to raise antisera . The identification of these proteins as residing on the outer surface was confirmed by the ability of the antisera to react against whole, live bacteria . Further, in a neonatal-animal model system, we demonstrate that some of these sera are protective against lethal doses of bacteria . These studies demonstrate the successful application of proteomics as a technique for identifying vaccine candidates.

Infect Immun, 2002 Mar, 70(3), 1209 - 18
Identification and characterization of hsa, the gene encoding the sialic acid-binding adhesin of Streptococcus gordonii DL1; Takahashi Y et al.; Oral colonization by Streptococcus gordonii, an important cause of subacute bacterial endocarditis, involves bacterial recognition of sialic acid-containing host receptors . The sialic acid-binding activity of this microorganism was previously detected by bacterium-mediated hemagglutination and associated with a streptococcal surface component identified as the Hs antigen . The gene for this antigen (hsa) has now been cloned in Escherichia coli, and its expression has been detected by colony immunoblotting with anti-Hs serum . Mutants of S . gordonii containing hsa inactivated by the insertion of an erythromycin resistance gene or deletion from the chromosome were negative for Hs-immunoreactivity, bacterium-mediated hemagglutinating activity, and adhesion to alpha 2-3-linked sialoglycoconjugates . The deletion in the latter mutants was complemented by plasmid-borne hsa, resulting in Hs antigen production and the restoration of cell surface sialic acid-binding activity . The hsa gene encodes a 203-kDa protein with two serine-rich repetitive regions in its 2,178-amino-acid sequence . The first serine-rich region occurs within the amino-terminal region of the molecule, between different nonrepetitive sequences that may be associated with sialic acid binding . The second serine-rich region, which is much longer than the first, is highly repetitive, containing 113 dodecapeptide repeats with a consensus sequence of SASTSASVSASE . This long repetitive region is followed by a typical gram-positive cell wall anchoring region at the carboxyl-terminal end . Thus, the predicted properties of Hsa, which suggest an amino-terminal receptor-binding domain attached to the cell surface by a molecular stalk, are consistent with the identification of this protein as the sialic acid-binding adhesin of S . gordonii DL1.

Infect Immun, 2002 Mar, 70(3), 1159 - 67
Genomic localization of a T serotype locus to a recombinatorial zone encoding extracellular matrix-binding proteins in Streptococcus pyogenes; Bessen DE et al.; Streptococcus pyogenes is an important bacterial pathogen afflicting humans . A striking feature is its extraordinary biological diversity, evident in the wide range of diseases it can cause and the antigenic heterogeneity present on its surface . The T antigens form the basis of a major serological typing scheme that is often used as an alternative or supplement to M typing . Unlike M typing, the genetic basis for T typing is poorly understood . In this report, the tee6 gene is localized to a position approximately equal to 3.3 kb downstream from prtF1 (or sfbI), which encodes the Fn-binding protein, protein F, a key virulence factor . Comparison of this portion of the genome with those of four additional strains reveals the presence of genes encoding a collagen-binding protein (Cpa) and a second Fn-binding protein (PrtF2 or PfbpI) . This chromosomal region--here designated the FCT region--is approximately 11 to 16 kb in length and is flanked at both ends by long stretches of highly conserved sequence . For each of the five strains, the FCT region contains a unique combination of semiconserved loci, indicative of extensive intergenomic recombination . The data provide evidence that the highly recombinatorial FCT region of the S . pyogenes genome is under strong selection for change in response to the host environment.

Infect Immun, 2002 Mar, 70(3), 1143 - 9
Cross-protective immunity of mice induced by oral immunization with pneumococcal surface adhesin a encapsulated in microspheres; Seo JY et al.; The global use of a capsular polysaccharide-based pneumococcal vaccine has been limited because of serotype-specific protection and poor effectiveness in individuals with low immunocompetency . The mucosal immune system develops earlier in infants and lasts longer in the elderly than does the systemic immune system . Furthermore, mucosal immunization is beneficial for AIDS patients, because human immunodeficiency virus-infected subjects can develop normal mucosal antibody responses even in late clinical phases . For these reasons, we evaluated recombinant pneumococcal surface adhesin A (rPsaA) of Streptococcus pneumoniae in terms of cross-protective immune responses after oral delivery . Encapsulated rPsaA provided higher immunogenicity than naked rPsaA . Coencapsulation or codelivery of the cholera toxin (CT) B subunit (CTB) and CT also increased the immunogenicity of rPsaA . Cross-protective immunities against five strains of S . pneumoniae (types 4, 6B, 14, 19F, and 23F) were induced after oral immunization with microencapsulated rPsaA . Lung colonization and septicemia caused by the five serotypes were significantly inhibited by oral immunization with microencapsulated rPsaA . These results suggest that rPsaA coencapsulated with CTB can be used as an oral vaccine to induce cross-protective immunity for the prevention of pneumococcal infection.

Infect Immun, 2002 Mar, 70(3), 1136 - 42
Identification and characterization of a nonimmunoglobulin factor in human saliva that inhibits Streptococcus mutans glucosyltransferase; Jespersgaard C et al.; Saliva contains an array of nonimmunoglobulin defense factors which are thought to contribute to the protection of the hard and soft tissue surfaces of the oral cavity by modulating microbial colonization and metabolism . Here we report the discovery of a putative innate defense factor in human saliva that inhibits the glucosyltransferase (GTF) of Streptococcus mutans, a virulence enzyme involved in oral colonization by this pathogen . The GTF-inhibiting factor (GIF) was initially identified as a nonimmunoglobulin salivary component that interfered with detection of antibodies to the glucan-binding region (GLU) of GTF by an enzyme-linked immunosorbent assay . This inhibitory activity was present in whole saliva and submandibular-sublingual saliva, but it was essentially absent from parotid saliva . GIF inhibited the recognition of S . mutans cell surface-associated GTF by specific antibodies but had no effect on antibodies to other cell surface antigens, suggesting that GIF specifically binds to GTF on S . mutans . GIF purified by size exclusion or affinity chromatography was used for biochemical and functional characterization . Analysis of GIF by sodium dodecyl sulfate-polyacrylamide gel electrophoresis revealed a high-molecular-weight glycoprotein after staining with Coomassie blue or Schiff's reagent . Heating and reduction with 2-mercaptoethanol of GIF resulted in the release of a approximately 58-kDa protein that was identified as alpha-amylase by Western blotting using anti-alpha-amylase antibodies . GLU bound blotted alpha-amylase, suggesting that the latter molecule is the GLU-binding component of the GIF complex . The ability of GTF to synthesize extracellular glucans was inhibited by GIF but not by uncomplexed alpha-amylase or an unrelated high-molecular-weight glycoprotein . In conclusion, our findings demonstrate that in human saliva, there is a high-molecular-weight glycoprotein-alpha-amylase complex which is capable of inhibiting GTF and may contribute to control of S . mutans colonization in the oral cavity.

J Agric Food Chem, 2002 Feb 27, 50(5), 1225 - 9
Antiadhesive effect of green and roasted coffee on Streptococcus mutans' adhesive properties on saliva-coated hydroxyapatite beads; Daglia M et al.; Green and roasted coffees of the two most used species, Coffea arabica and Coffea robusta, several commercial coffee samples, and known coffee components were analyzed for their ability to interfere with Streptococcus mutans' sucrose-independent adsorption to saliva-coated hydroxyapatite (HA) beads . All coffee solutions showed high antiadhesive properties . The inhibition of S . mutans' adsorption to HA beads was observed both when coffee was present in the adsorption mixture and when it was used to pretreat the beads, suggesting that coffee active molecules may adsorb to a host surface, preventing the tooth receptor from interacting with any bacterial adhesions . Among the known tested coffee components, trigonelline and nicotinic and chlorogenic acids have been shown to be very active . Dialysis separation of roasted coffee components also showed that a coffee component fraction with 1000 Da < MW < 3500 Da, commonly considered as low MW coffee melanoidins, may sensibly contribute to the roasted coffee's antiadhesive properties . The obtained results showed that all coffee solutions have antiadhesive properties, which are due to both naturally occurring and roasting-induced molecules.

Int J Paediatr Dent, 2002 Jan, 12(1), 2 - 7
Prevalence of salivary Streptococcus mutans in mothers and in their preschool children; Thorild I et al.; OBJECTIVES: To establish the prevalence and possible relationship of oral Streptococcus mutans colonization in mother-child pairs . DESIGN AND SETTING: An analytical cross-sectional study was carried out at a well-baby evaluation clinic held at the Public Dental Clinic, Varberg, Sweden . SAMPLE AND METHODS: Two hundred preschool children, 100 of which were 18 months old and the remaining 100 were 3 years old, and their mothers attended the clinic . All mothers were interviewed and their children's medical history, oral hygiene routines and dietary habits established . All children were clinically examined . The presence and level of S . mutans was estimated in the mother-child pairs with the aid of the Strip mutans chair-side test . RESULTS: Nearly 50% of mothers exhibited high levels of salivary S . mutans, prevalence among the 18-month- and 3-year-olds was 30% and 42%, respectively . A statistically significant (P < 0.01) mother-child relationship was found; a greater presence in mothers led to a higher number of children found harbouring the bacteria . Logistic regression analysis found that high maternal S . mutans levels (P < 0.001), daily sweet intake (P < 0.01) and sugary drinks in feeding bottles (P < 0.05) were significant factors for S . mutans colonization in children . Absence of daily toothbrushing and use of feeding bottles at night failed to fit into the model . Caries prevalence (initial and manifest decayed surfaces) was significantly related to S . mutans colonization (P < 0.01) . CONCLUSION: The results support the concept of vertical transmission (mother-child), emphasizing the importance of the dietary component, and justifying a primary preventive approach with targeted action directed at mothers with high levels of S . mutans colonization.

Kansenshogaku Zasshi, 2002 Jan, 76(1), 72 - 5
{Streptococcus salivarius meningitis after oral trauma by a skewer: a case report}; Maeda H et al.; Although Streptococcus salivarius is one of the normal flora in the oral cavity and gastrointestinal tract, the agent may cause bacteremia, meningitis, endocarditis and sinusitis under certain circumstances . We report a 3-year-old female with meningitis after oral trauma by a skewer due to penicillin resistant S . salivarius . The girl injured her throat accidentally with a skewer . Four hours later, she became febrile and came to our emergency room . Plain CT scan was normal, and cefalexin was prescribed . The next day, she had fever, lethargy, meningeal signs, and her cerebrospinal fluid (CSF) showed neutrophilic pleocytosis . The blood culture was negative, but the CSF culture was positive for S . salivarius . The minimal inhibitory concentrations (MIC) for panipenem, penicillin G, ampicillin, cefotaxime, ceftriaxone, vancomycin were 0.125 microgram/ml, 2 micrograms/ml, 2 micrograms/ml, 0.5 microgram/ml, 0.5 microgram/ml, 0.5 microgram/ml, respectively . Intravenous administration of panipenem betamiprom (PAPM/BP) 2 g/day for 7 days and 8 courses of dexamethasone 0.15 mg/kg/dose were effective, and she has had no apparent sequelae except for a slight abnormality in her electroencephalogram . Traumatic meningitis is often caused by S . pneumoniae, but may be also caused by the normal flora pathogens including S . salivarius . In addition, our case suggests that not only S . pneumoniae but also S . salivarius can be penicillin resistant . Taking the drug resistance into consideration, we have to be careful in choosing antibiotics for treating such patients.

Vet Microbiol, 2002 Mar 22, 85(3), 241 - 9
Effect of preculture freezing and incubation on bacteriological isolation from subclinical mastitis samples; Sol J et al.; In this study the sensitivity of three methods of isolation of udder pathogens from milk samples from subclinical mastitis cases was compared . For analysis 1827 quarter milk samples were selected . Milk was cultured using a standard culture technique (0.01 ml of fresh milk streaked on a sheep blood agar plate and on Edward's medium) . In addition, an inoculum of 0.01 ml of the original milk sample was incubated for 24h at 37 degrees C in broth, followed by culture using the standard culture technique . In the third method, the whole milk sample was frozen for 24h, and then incubated for 24h at 37 degrees C, followed by culture using standard culture technique . The isolation percentage of Staphylococcus aureus was 4.7% for standard culture technique, 14.2% for incubation in broth, and 21.5% for the combination of freezing plus incubation . Isolation percentage of Streptococcus dysgalactiae and Streptococcus agalactiae was highest using the standard culture technique, while isolation rate of Streptococcus uberis was not different among the three methods used . With increasing somatic cell count, the likelihood of S . aureus, S . dysgalactiae and S . uberis isolation increased.Based on the relative sensitivity, defined as the isolation rate using a single technique compared to the isolation rate of the three techniques together, a combination of standard culture technique and freezing plus incubation was most attractive for achieving a high isolation rate of S . agalactiae and S . dysgalactiae . Relative sensitivity of S . uberis isolation was highest using the standard culture technique and incubation in broth, while S . aureus was most often isolated using a combination of incubation in broth and freezing plus incubation . A combination of the three methods increased the isolation rate for S . dysgalactiae, S . uberis and S . aureus . The standard culture technique, together with the combination of freezing plus incubation, can be recommended for isolating major udder pathogens . If S . aureus is the pathogen of main interest, using incubation in broth together with the combination of freezing plus incubation performed best.

Int J Pediatr Otorhinolaryngol, 2002 Feb 25, 62(3), 257 - 60
A case of fatal pharyngitis; Lam YY et al.; Pharyngitis is a common condition and usually does not lead to any major complication . We report a case in which the patient presented with pharyngitis resulting in an unusual fatal complication of pharyngeal and cerebral abscess . The causative organism was Streptococcus milleri that should be readily treatable by penicillin if the condition was recognised earlier.

Int J Pediatr Otorhinolaryngol, 2002 Feb 25, 62(3), 237 - 42
Acute mastoiditis in a Norwegian population: a 20 year retrospective study; Vassbotn FS et al.; We have retrospectively examined the nature of acute mastioditis (in western Norway) during a 20 year period (1980-2000) . Sixty-one cases of AM were identified in 57 patients with a mean age of 3.6 years . We found no significant change in the incidence of AM during the last 20 years . Seven patients were treated solely with intravenous antibiotics and myringotomies . Fifty patients also underwent cortical mastoidectomy, four cases with bilateral surgery . Antibiotic treatment was given to 31 of the patients before admission to hospital and this group had a significant longer duration of symptoms (12.4 days) compared to untreated patients (7.3 days) . Streptococcus pneumoniae was the most common organism recovered from patient cultures . Surgery was found to correlate to patients with retroauricular fluctuation or to children with at least two of the three clinical signs: protrusion of the ear, retroauricular oedema and swelling of the ear canal . Our data show that clinical examination only reveal 50% of the cases with surgically proven retroauricular subperiostal abscess . We therefore recommend a CT scan of patients treated conservatively.

Ther Umsch, 2002 Jan, 59(1), 46 - 50
{Antimicrobial resistance--consequences for ambulatory treatment of infections in children}; Aebi C et al.; Increasing antimicrobial resistance among clinical isolates of Streptococcus pneumoniae calls for a revision of treatment strategies for pediatric infections, particularly for acute otitis media . Restrictive use of antimicrobials is the key strategy for slowing the spread of resistances . Before initiation of antimicrobial therapy, suspected bacterial infections should be confirmed clinically (e.g . by observation of the natural evolution) or microbiologically . For acute otitis media, oral amoxicillin remains the drug of choice because of superior middle ear pharmacokinetics and pharmacodynamics . Treatment failure caused by resistance of the infecting pneumococcus can be overcome be increasing the dose, and not by switching to another class of antibiotics (e.g., cephalosporin, macrolide, cotrimoxazole), which is less likely to achieve middle ear eradication a priori . Widespread macrolide resistance among isolates of S . pneumoniae precludes the use of this class of antimicrobials for empiric therapy of community-acquired pneumonia in children . Aminopenicillins are preferred because of their rapidly bactericidal activity against the most common organisms causing potentially progressive pneumonia in children.

Roum Arch Microbiol Immunol, 2000 Jul-Sep, 59(3), 211 - 26
Correlation between two DNA-based typing methods applied to Streptococcus pneumoniae strains: BOX-PCR assay as an alternative to ribotyping; Straut M et al.; Seventy-nine Streptococcus pneumoniae isolates were characterized by ribotyping and BOX-PCR typing . The isolates comprised 14 most frequently identified serogroups and serotypes, 54 ribotypes (defined as each different combination of two DNA restriction fragment length polymorphism patterns obtained with HindIII and PvuII, respectively) and 51 BoxA-PCR patterns . There was close but not absolute correlation between molecular techniques . However, the discrimination indice of ribotyping--calculated on the basis of combination of the data obtained with both enzymes--equals that of BOX-PCR typing: D = 0.985 and the deduced genetic clustering of the pneumococcal strains was comparable.

Antimicrob Agents Chemother, 2002 Mar, 46(3), 813 - 20
Accumulation of 10 fluoroquinolones by wild-type or efflux mutant Streptococcus pneumoniae; Piddock LJ et al.; A method for measuring fluoroquinolone accumulation by Streptococcus pneumoniae was rigorously examined . The accumulation of ciprofloxacin, clinafloxacin, gatifloxacin, grepafloxacin, levofloxacin, moxifloxacin, norfloxacin, ofloxacin, sitafloxacin, and trovafloxacin in the presence and absence of either carbonyl cyanide m-chlorophenyl-hydrazone (CCCP) or reserpine was determined for two wild-type fluoroquinolone-susceptible capsulated S . pneumoniae strains (M3 and M4) and the noncapsulated strain R6 . Two efflux mutants, R6N (which overexpresses PmrA) and a mutant of M4, M22 (no expression of PmrA), were also examined . Essentially, the fluoroquinolones fell into two groups . (i) One group consisting of ciprofloxacin, grepafloxacin, and norfloxacin accumulated to 72 to 92 ng/mg (dry weight) of cells in all strains . (ii) The remainder of the agents accumulated to 3 to 30 ng/mg (dry weight) of cells . With a decrease in hydrophobicity, there was a decrease in the concentration accumulated . With an increase in the molecular weight of the free form of each agent, there was also a decrease in the concentration accumulated . The strains differed in their responses to reserpine and CCCP . For the three fluoroquinolone-susceptible strains, only reserpine had a significant effect upon accumulation of moxifloxacin and clinafloxacin by M3 and showed no effect for the other agents and strains . For M3 and M4, CCCP enhanced the concentration of ciprofloxacin and norfloxacin accumulated, whereas for R6, the effect was only statistically significant for ofloxacin . Efflux mutant M22 accumulated less ciprofloxacin, gatifloxacin, and ofloxacin than M4 did . M22 accumulated more norfloxacin than M4 did . Reserpine and CCCP had variable effects as for the other strains . Differences in the accumulation of fluoroquinolones by R6 and R6N were highly dependent upon growth phase, and only for norfloxacin was there a significant difference between two strains.

Antimicrob Agents Chemother, 2002 Mar, 46(3), 808 - 12
Expression of efflux pump gene pmrA in fluoroquinolone-resistant and -susceptible clinical isolates of Streptococcus pneumoniae; Piddock LJ et al.; Thirty-four ciprofloxacin-resistant (MIC > or = 2 microg/ml) and 12 ciprofloxacin-susceptible clinical isolates of Streptococcus pneumoniae were divided into four groups based upon susceptibility to norfloxacin and the effect of reserpine (20 microg/ml) . The quinolone-resistance-determining regions of parC, parE, gyrA, and gyrB of all ciprofloxacin-resistant clinical isolates were sequenced, and the activities of eight other fluoroquinolones, acriflavine, ethidium bromide, chloramphenicol, and tetracycline in the presence and absence of reserpine were determined . Despite a marked effect of reserpine upon the activity of norfloxacin, there were only a few isolates for which the activity of another fluoroquinolone was enhanced by reserpine . For most isolates the MICs of acriflavine and ethidium bromide were lowered in the presence of reserpine despite the lack of effect of this efflux pump inhibitor on fluoroquinolone activity . The strains that were most resistant to the fluoroquinolones were predominantly those with mutations in three genes . Expression of the gene encoding the efflux pump PmrA was examined by Northern blotting (quantified by quantitative competitive reverse transcriptase PCR) and compared with that of S . pneumoniae R6 and R6N . Within each group there were isolates that had high-, medium-, and low-level expression of this gene; however, increased expression was not exclusively associated with those isolates with a phenotype suggestive of an efflux mutant . These data suggest that there is another reserpine-sensitive efflux pump in S . pneumoniae that extrudes ethidium bromide and acriflavine but not fluoroquinolones.

Antimicrob Agents Chemother, 2002 Mar, 46(3), 680 - 8
Fluoroquinolone resistance in Streptococcus pneumoniae in United States since 1994-1995; Brueggemann AB et al.; The in vitro activities of ciprofloxacin, levofloxacin, gatifloxacin, and moxifloxacin against a large collection of clinical isolates of Streptococcus pneumoniae (n = 4,650) obtained over a 5-year period, 1994-1995 through 1999-2000, were assessed as part of a longitudinal multicenter U.S . surveillance study of antimicrobial resistance . Three sampling periods were used during this investigation, the winter seasons of 1994-1995, 1997-1998, and 1999-2000; and 1,523, 1,596 and 1,531 isolates were collected during these three periods, respectively . The overall rank order of activity of the four fluoroquinolones examined in this study was moxifloxacin > gatifloxacin > levofloxacin = ciprofloxacin, in which moxifloxacin (MIC at which 90% of isolates are inhibited {MIC(90)}, 0.25 microg/ml; modal MIC, 0.12 microg/ml) was twofold more active than gatifloxacin (MIC(90), 0.5 microg/ml; modal MIC, 0.25 microg/ml), which in turn was fourfold more active than either levofloxacin (MIC(90), 1 microg/ml; modal MIC, 1 microg/ml) or ciprofloxacin (MIC(90), 2 microg/ml; modal MIC, 1 microg/ml) . Changes in the in vitro activities of fluoroquinolones against S . pneumoniae strains in the United States over the 5-year period of the survey were assessed by comparing the MIC frequency distributions of the study drugs against the isolates obtained during the three sampling periods encompassing this investigation . These comparisons revealed no evidence of changes in the in vitro activities of the fluoroquinolones . In addition, the percentages of isolates in the three sampling periods for which MICs were above the resistance breakpoints were compared . Low percentages of resistant strains were detected, and there was no evidence of resistance rate changes over time . For example, by use of a ciprofloxacin MIC of > or = 4 microg/ml to define resistance, the proportions of isolates from the three sampling periods for which MICs were at or above this breakpoint were 1.2, 1.6, and 1.4%, respectively . A total of 164 unique isolates (n = 58 from 1994-1995, 65 from 1997-1998, and 42 from 1999-2000) were examined for evidence of mutations in the quinolone resistance-determining regions (QRDRs) of the parC and the gyrA genes . Forty-nine isolates harbored at least one mutation in the QRDRs of one or both genes (1994-1995, n = 15; 1997-1998, n = 19; 1999-2000, n = 15) . Among the 4,650 isolates of S . pneumoniae examined in the study, we estimated that 0.3% had mutations in both the parC and gyrA loci . The majority of mutations (67.3% of the mutations in 49 isolates with mutations) were amino acid substitutions in the parC locus only . Four isolates had a mutation in the gyrA locus only, and 12 isolates had mutations in both genes (8.2 and 24.5% of isolates with mutations, respectively) . There was no significant difference in the number of isolates with parC and/or gyrA mutations detected during each study period . Finally, because of the magnitude of the study, we had reasonably large numbers of pneumococcal isolates with genotypically defined mechanisms of fluoroquinolone resistance and were thus able to determine the effects of specific resistance mutations on the activities of different fluoroquinolones . In general, isolates with mutations in parC only were resistant to ciprofloxacin but remained susceptible to levofloxacin, gatifloxacin, and moxifloxacin, whereas isolates with mutations in gyrA only and isolates with mutations in both parC and gyrA were resistant to all four fluoroquinolones tested.

Antimicrob Agents Chemother, 2002 Mar, 46(3), 654 - 8
Ribosomal mutations in Streptococcus pneumoniae clinical isolates; Pihlajamaki M et al.; Eleven clinical isolates of Streptococcus pneumoniae, isolated in Finland during 1996 to 2000, had an unusual macrolide resistance phenotype . They were resistant to macrolides and streptogramin B but susceptible, intermediate, or low-level resistant to lincosamides . No acquired macrolide resistance genes were detected from the strains . The isolates were found to have mutations in domain V of the 23S rRNA or ribosomal protein L4 . Seven isolates had an A2059C mutation in two to four out of the four alleles encoding the 23S rRNA, two isolates had an A2059G mutation in two alleles, one isolate had a C2611G mutation in all four alleles, and one isolate had a 69GTG71-to-69TPS71 substitution in ribosomal protein L4.

Int J Antimicrob Agents, 2002 Feb, 19(2), 85 - 93
The burden of invasive pneumococcal disease and the potential for reduction by immunisation; Parsons HK et al.; Streptococcus pneumoniae causes invasive disease world-wide and in all age groups . The reported incidence varies geographically and is increased in certain population groups . The incidence is highest in children less than 2 years and is also increased in the elderly . Mortality remains substantial even in the developed world despite appropriate antimicrobial therapy . The emergence of penicillin-resistant pneumococci highlights the importance of immunisation as a means to prevent disease . This review discusses the burden of invasive pneumococcal disease, identifies high-risk patients and analyses evidence for vaccine efficacy and cost-effectiveness.

Mol Microbiol, 2002 Jan, 43(1), 147 - 57
The Fap1 fimbrial adhesin is a glycoprotein: antibodies specific for the glycan moiety block the adhesion of Streptococcus parasanguis in an in vitro tooth model; Stephenson AE et al.; Streptococcus parasanguis is a primary colonizer of the tooth surface and plays a pivotal role in the formation of dental plaque . The fimbriae of S . parasanguis are important in mediating adhesion to saliva-coated hydroxylapatite (SHA), an in vitro tooth adhesion model . The Fap1 adhesin has been identified as the major fimbrial subunit, and recent studies suggest that Fap1 is a glycoprotein . Monosaccharide analysis of Fap1 purified from the culture supernatant of S . parasanguis indicated the presence of rhamnose, glucose, galactose, N-acetylglucosamine and N-acetylgalactosamine . A glycopeptide moiety was isolated from a pronase digest of Fap1 and purified by immunoaffinity chromatography . The monosaccharide composition of the purified glycopeptide was similar to that of the intact molecule . The functionality of the glycan moiety was determined using monoclonal antibodies (MAbs) specific for the intact Fap1 glycoprotein . These antibodies were grouped into two categories based on their ability to block adhesion of S . parasanguis to SHA and their corresponding specificity for either protein or glycan epitopes of the Fap1 protein . 'Non-blocking' MAb epitopes were mapped to unique protein sequences in the N-terminus of the Fap1 protein using non-glycosylated recombinant Fap1 proteins (rFap1 and drFap1) expressed in Escherichia coli . In contrast, the 'blocking' antibodies did not bind to the recombinant Fap1 proteins, and were effectively competed by the binding to the purified glycopeptide . These data suggest that the 'blocking' antibodies are specific for the glycan moiety and that the adhesion of S . parasanguis is mediated by sugar residues associated with Fap1.

J Oral Sci, 2001 Dec, 43(4), 239 - 43
Identification of 40-kDa outer membrane protein as an aggregation factor of Porphyromonas gingivalis to Streptococcus gordonii; Nonaka E et al.; Porphyromonas gingivalis, an important pathogen in periodontitis, aggregates with other oral microorganisms such as Streptococcus gordonii . We previously succeeded in gene cloning the 40-kDa outer membrane protein (OMP) from P . gingivalis . Although recombinant (r) 40-kDa OMP itself did not show aggregation activity, the affinity-purified antibody against 40-kDa rOMP inhibited the aggregation activity of P . gingivalis cells toward S . gordonii which is one of the first oral bacteria to colonize on tooth surfaces and can be expected to support subsequent colonization of other bacteria . In this study, in order to clarify the pathological role of 40-kDa OMP, we used a cross-linking reagent to construct a polymeric form of r40-kDa OMP and examined its aggregation activity . The polymeric r40-kDa OMP significantly expressed aggregation activity with S . gordonii cells . Moreover, the antibody against r40-kDa OMP inhibited the aggregation activity of the polymeric r40-kDa OMP . These findings clearly demonstrate that 40-kDa OMP, as a multivalent form, is one of the important aggregation factors on the cell surface of P . gingivalis.

APMIS, 2001 Dec, 109(12), 842 - 8
The putative R1 protein of Streptococcus agalactiae as serotype marker and target of protective antibodies; Moyo SR et al.; The streptococcal R1 protein was studied by means of anti-R1 antibodies prepared by appropriate cross-absorption of rabbit antiserum raised against the group B streptococcal (GBS) strain ATCC 12403 (D136C), serotype III/R1 . The protein was a ladder-forming antigen according to banding patterns in immunoblotting, similar to several other GBS proteins, and was susceptible to digestion by both pepsin and trypsin . Antibody-based testing revealed that 10% of Norwegian GBS isolates expressed the R1 protein, most frequently capsular antigen type V strains (72%) and less frequently type III strains (3%) . None of 132 GBS strains from Zimbabwe, including 39 type V strains, expressed the R1 protein . R1-specific rabbit antibodies showed protective activity in mice challenged with a GBS type V/R1 strain . The results show that the R1 protein is an important GBS serotype marker in strains from certain geographical areas, notably for the subtyping of capsular type V strains, and that this protein is a target of protective antibodies.

J Vet Med B Infect Dis Vet Public Health, 2001 Dec, 48(10), 759 - 63
Role of collagen in adherence of Streptococcus uberis to bovine mammary epithelial cells; Almeida RA et al.; We reported previously that pre-incubation of Streptococcus uberis with collagen induced expression of S . uberis surface proteins . In a subsequent study, we showed that incubation of S . uberis with extracellular matrix proteins, particularly collagen, increased adherence and internalization of S . uberis to mammary epithelial cells . In the present report, the potential mechanism by which S . uberis exploits the presence of collagen to enhance adherence to bovine mammary epithelial cells was evaluated . Adherence assays were conducted with S . uberis pre-treated with and without collagen and co-cultured in medium supplemented with or without collagen . Pre-incubation with collagen followed by co-culture in medium containing collagen up-regulated ligands that enhanced adherence of S . uberis to mammary epithelial cells . Collagen-up-regulated ligand(s) also increased adherence of S . uberis to mammary epithelial cells in the absence of collagen, but adherence was lower than when collagen was present during the adherence assay . Chloramphenicol was added to the culture medium to inhibit bacterial protein synthesis . Adherence decreased significantly in chloramphenicol-treated S . uberis pre-treated or co-cultured in the presence of collagen . These results suggest that S . uberis expresses ligands with affinity for collagen that are up-regulated by collagen . We hypothesize that these ligands increase adherence by using collagen as a bridge between the bacterium and host cell and/or by direct interaction with host cell receptor(s).

Tenn Med, 2002 Feb, 95(2), 67 - 9
Rhabdomyolysis associated with pneumococcal pneumonia: an early clinical indicator of increased morbidity?
Garcia MC, Ebeo CT, Byrd RP Jr, Roy TM.
Rhabdomyolysis most commonly results from crushing injuries, the toxic effects of drugs and alcohol, seizures, and strenuous physical activity . Though rhabdomyolysis has been rarely identified with bacterial pneumonia, it has recently been recognized that in the setting of Legionella pneumophila pneumonia it has important prognostic implications . In the English literature, there are 12 well-documented cases of rhabdomyolysis associated with Streptococcus pneumoniae pneumonia . Interestingly, in the majority of these patients, including ours, S . pneumoniae grew from their blood . Bacteremia in patients with S . pneumonia doubles the death rate . Nine of the 12 patients, ours included, with S . pneumoniae pneumonia associated rhabdomyolysis developed renal dysfunction, as evidenced by an elevation in their blood urea nitrogen (BUN) and serum creatinine . Uremia also indicates a poor prognosis in patients with pneumococcal pneumonia . Serum creatinine phosphokinase (CPK) is a simple test that may allow early recognition of S . pneumoniae pneumonia in patients who are at an increased risk for a poor outcome, and permit timely therapeutic intervention.

Roum Arch Microbiol Immunol, 2000 Jan-Jun, 59(1-2), 89 - 102
Molecular subtyping of group A streptococcal strains based on virulence regulon polymorphism; Surdeanu M et al.; A total of 64 Streptococcus pyogenes isolates included in a previous study (Shundi et al., 2000) were further analyzed by Vir typing . Vir typing is based on restriction fragment length polymorphism (RFLP) analysis of a 4- to 8-kb pathogenicity island (vir regulon) encoding emm and other virulence genes . As all our isolates contained a single vir regulon, the stoichiometric yield of restriction fragments avoided ambiguities in interpretation of results . By using both HaeIII and HinfI restriction endonucleases to generate RFLP profiles, the 64 GAS isolates were distributed among 22 Hae- and 26 Hinf-Vir types respectively.

Ann Otolaryngol Chir Cervicofac, 2001 Oct, 118(5), 323 - 9
{Intracranial complications of acute mastoiditis}; Babin E et al.; We report a case of extradural abscess after acute mastoiditis in an 8-years-old boy . The clinic diagnostic of an intracranial complication is difficult . The most common present symptoms are fever, otalgia and otorrhea but are not specific . Neurologic symptoms are suggestive signs of an intracranial complication . We believe that, in acute mastoiditis performance of a CT scan of the brain and temporal bones with intravenous contrast, contribues to the diagnostic of intracranial complication . The diagnostic of thrombosis sinus sigmoid is evoked with slight contrast enhanced sinus sigmoid and failure to opacify . The characterisation of an epidural empyema is a hypodense epidural collection in a contrast-enhanced CT scan . The most common isolated organism are Streptococcus Pneumoniae, Staphylococcus aureus and Pseudomonas aeuginosa . The therapeutic management includes combination of intraveinous antibiotics, mastoidectomy and surgery of the intracranial complication.

J Can Dent Assoc, 2002 Jan, 68(1), 39 - 45
A clinical and microbiological evaluation of denture cleansers for geriatric patients in long-term care institutions; Gornitsky M et al.; Background: Many elderly patients in long-term care hospitals cannot adequately brush their dentures because of disease, dementia and poor dexterity . Such inadequate cleaning may allow for the multiplication of Candida spp . and bacteria, which could serve as reservoirs for disseminating infections . Objective: To assess the efficacy of 3 denture cleansers in reducing the number of microorganisms on dentures in a hospitalized geriatric population . Methods: Three brands of cleanser (Denture Brite, Polident and Efferdent) were compared; water was used as the control . Microbiological samples were obtained before and after 3 one-week periods of cleanser use; these samples were taken by a microbiologist blinded to the assigned treatment . In the statistical analysis, the ranks of the differences between the before-treatment and after-treatment scores of each regimen were compared by means of the general linear model . In addition, the efficacy of each cleanser in reducing accumulation of plaque, stain and food was assessed . Results: The rank of the differences in the number of colony-forming units (CFUs) of Candida spp . before and after one week of use of Denture Brite (p = 0.04) and Polident (p = 0.01), was significantly greater than that of the control group, but there was no difference between Efferdent use and control (p = 0.10) . No significant differences in reduction of Streptococcus mutans were observed between Denture Brite (p = 0.13) or Polident (p = 0.12) and the control group, whereas dentures cleaned with Efferdent exhibited significantly greater reduction in Streptococcus mutans (p = 0.02) than dentures cleaned with water . Over all study periods, there were no significant differences among the cleansers in reduction of Candida spp . or Streptococcus mutans . Dentures cleaned with Denture Brite, Polident or Efferdent appeared to have similar reductions in the level of plaque, stain and food, and all had substantially greater reductions than dentures cleaned with water only . The significant difference in the rank of the reduction in Candida spp . CFUs (p = 0.005) was related to the variance between study periods (p = 0.01) and the variance between subjects (p = 0.008) . Clinical Significance: The use of denture cleansers significantly reduced the number of microorganisms on dentures in a hospitalized geriatric population.

Can Vet J, 2002 Feb, 43(2), 123 - 4
{A case of zoonosis associated with Streptococcus equi ssp . zooepidemicus}; Boucher C et al.; A sexagenarian couple operating a dairy farm, where there were also many horses, suffered a severe respiratory infection associated with the bacterium Streptococcus equi ssp . zooepidemicus . The investigation revealed that the source of infection was due to contacts with a horse having an infected wound from which we isolated this zoonotic agent.

Carbohydr Res, 2002 Feb 18, 337(4), 335 - 44
Structural analysis and chemical depolymerization of the capsular polysaccharide of Streptococcus pneumoniae type 1; Stroop CJ et al.; NMR spectroscopy can be used to characterize bacterial polysaccharides such as that of Streptococcus pneumoniae type 1 which is a component of the 23-valent pneumococcal vaccine in clinical use . This particular polysaccharide gives NMR spectra with wide lines apparently due to restricted molecular mobility and chain flexibility which leads to rapid dipolar T(2) relaxation limiting the possibility of detailed spectral analysis . Removal of O-acetyl groups found on approximately two thirds of the repeating subunits of pneumococcal type 1 capsule leads to narrower NMR lines facilitating a complete assignment of the 1H and 13C NMR spectra . Degradation of the polysaccharide by periodate oxidation followed by base treatment leads to an oligosaccharide fragment of approximately three repeating trisaccharide units . This oligosaccharide has narrow NMR lines and 1H and 13C assignments very similar to those of the O-deacetylated polysaccharide . In the native polysaccharide, O-acetyl groups are located on the 2- and 3-positions of the 4-linked galacturonic acid residue providing protection against periodate oxidation . Analysis of NOESY spectra combined with molecular modeling of the oligosaccharide shows that flexibility occurs in certain of the saccharide linkages.

Biochemistry, 2002 Feb 19, 41(7), 2149 - 57
NMR studies of the antibody-bound conformation of a carbohydrate-mimetic peptide; Johnson MA et al.; Transferred nuclear Overhauser enhancement (TRNOE) experiments have been performed at 800 MHz to investigate the bound conformation of the hexapeptide DRPVPY, a functional molecular mimic of the group A Streptococcus cell-wall polysaccharide . The hexapeptide binds to the monoclonal antibody SA-3, mimicking the branched trisaccharide repeating unit, L-Rha-alpha-(1 --> 2)-(D-GlcNAc-beta-(1 --> 3))-alpha-L-Rha (Rha, rhamnose; GlcNAc, N-acetylglucosamine) . The peptide adopts a tight turn conformation with close contacts between the side chains of valine and tyrosine . Relaxation network editing experiments (QUIET-NOESY) were used to confirm the validity of the observed contacts and to evaluate the presence of spin diffusion pathways . Saturation transfer difference (STD-NMR) experiments with selective saturation of protein resonances revealed enhancements of many of the peptide resonances due to close contacts between the peptide and the protein within the antibody combining site.

Int J Psychiatry Med, 2001, 31(3), 311 - 20
Obsessive-compulsive disorder and immunocompetence; Dinn WM et al.; OBJECTIVE: A postinfectious, autoimmune response may be associated with the development of pediatric obsessive-compulsive disorder (OCD) . According to this model, antistreptococcal antibodies cross-react with basal ganglia neurons following streptococcus infection . This autoimmune reaction disrupts a basal ganglia-thalamocortical circuit and generates obsessive-compulsive symptoms . One implication of this model is that prolonged immunologic stress may be a risk factor for OCD . That is, immunologic stress may compromise the blood-brain barrier and permit the influx of antistriatal antibodies into the central nervous system . This article explores one part of this putative relationship by investigating whether adult OCD patients, compared to members of other psychiatric groups, demonstrate a higher incidence of recurrent infections and other conditions suggestive of compromised immune function . METHOD: To test this hypothesis, we conducted a medical records review of 100 consecutive patients evaluated at a private psychiatric clinic specializing in the treatment of anxiety disorders . Sixty-five patients met diagnostic criteria for an Axis-I syndrome . Primary diagnoses included OCD, posttraumatic stress disorder, social anxiety disorder, generalized anxiety disorder, panic disorder with agoraphobia, and dysthymic disorder . Each medical record was reviewed for the presence of target syndromes or presenting symptoms suggestive of compromised immune function . RESULTS: Chart review revealed an increased rate of immune-related symptoms and syndromes among OCD patients in comparison to other anxiety and mood disorder groups . Groups did not differ significantly in the incidence of non-immune symptoms and syndromes . CONCLUSION: Adult OCD patients appear to have an increased rate of immune-related diseases above and beyond that seen in other psychiatric disorders.

Pediatr Infect Dis J, 2002 Feb, 21(2), 166 - 8
Streptococcus pyogenes pyomyositis; Zervas SJ et al.; Group A beta-hemolytic Streptococcus pyomyositis continues to be an uncommon disease . We present a case of a 7-year-old boy with an M protein type 1, streptococcal pyrogenic exotoxin A and B, Streptococcus pyogenes pyomyositis and streptococcal toxic shock syndrome.

Indian J Pediatr, 2001 Dec, 68(12), 1135 - 8
Upper respiratory tract infections; Jain N et al.; Acute respiratory infections accounts for 20-40% of outpatient and 12-35% of inpatient attendance in a general hospital . Upper respiratory tract infections including nasopharyngitis, pharyngitis, tonsillitis and otitis media constitute 87.5% of the total episodes of respiratory infections . The vast majority of acute upper respiratory tract infections are caused by viruses . Common cold is caused by viruses in most circumstances and does not require antimicrobial agent unless it is complicated by acute otitis media with effusion, tonsillitis, sinusitis, and lower respiratory tract infection . Sinusitis is commonly associated with common cold . Most instances of rhinosinusitis are viral and therefore, resolve spontaneously without antimicrobial therapy . The most common bacterial agents causing sinusitis are S . pneumoniae, H . influenzae, M . catarrhalis, S . aureus and S . pyogenes . Amoxycillin is antibacterial of choice . The alternative drugs are cefaclor or cephalexin . The latter becomes first line if sinusitis is recurrent or chronic . Acute pharyngitis is commonly caused by viruses and does not need antibiotics . About 15% of the episodes may be due to Group A beta hemolytic streptococcus (GABS) . Early initiation of antibiotics in pharyngitis due to GABS can prevent complications such as acute rheumatic fever . The drug of choice is penicillin for 10-14 days . The alternative medications include oral cephalosporins (cefaclor, cephalexin), amoxicillin or macrolides.

Eur J Clin Microbiol Infect Dis, 2001 Dec, 20(12), 883 - 5
Determining the frequency of resistance of Streptococcus pneumoniae to ciprofloxacin, levofloxacin, trovafloxacin, grepafloxacin, and gemifloxacin; Evans ME; Newer fluoroquinolones have good activity against Streptococcus pneunoniae and may be useful clinically for the treatment of pneumonia . Although resistance among Streptococcus pneumoniae has been reported, it is rare . The frequency of single-step resistance and the emergence of resistance were compared in serial transfer of 49 clinical isolates of penicillin-sensitive and -resistant Streptococcus pneumoniae to ciprofloxacin, levofloxacin, trovafloxacin, grepafloxacin, and gemifloxacin . Single-step resistance frequencies to four times the minimum inhibitory concentration were 2.73 x 10(-6) (+/- 8.46 x 10(-6)) for ciprofloxacin, 1.78 x 10(-7) (+/- 4.62 x 10(-7)) for trovafloxacin, 5.45 x 10(-7) (+/- 1.24 x 10(-6)) for grepafloxacin, 6.78 x 10(-7) (+/- 1.38 x 10(-6)) for gemifloxacin, and 9.23 x 10(-8) (+/- 4.47 x 10(-7)) for levofloxacin . In serial transfer experiments, all isolates became resistant to clinically relevant levels of all fluoroquinolones after eight passages . The resistance occurred most rapidly with ciprofloxacin followed by grepafloxacin, gemifloxacin, trovafloxacin, and levofloxacin . These results show that strains with decreased susceptibility to fluoroquinolones occur frequently in cultures of Streptococcus pneumoniae, and this organism can readily become resistant to clinically relevant concentrations of fluoroquinolones in vitro.

New Microbiol, 2002 Jan, 25(1), 31 - 5
Bacterial etiology of otitis media with effusion; focusing on the high positivity of Alloiococcus otitidis; Kalcioglu MT et al.; The etiology of otitis media with effusion (OME) is unclear . The bacterial analyses of middle ear effusion (MEE) in OME may reveal important information regarding its etiology . Alloiococcus otitidis, Heamophilus influenzae, Streptococcus pneumoniae and Moraxella catarrhalis were investigated by using microbiologic culture and a multiplex PCR method in the middle ear fluid of 32 children (54 samples) with chronic OME . PCR yielded positive results in 18 (33.3%) middle ear effusions while culture resulted positive for 3 (5.6%) . The PCR method detected A . otitidis in 10 (18.5%) specimens, H . influenzae in 7 (13%), M . catarrhalis in 4 (7.4%) and S . pneumoniae in 2 (3.7%) specimens . The multiplex PCR method enhances the detection rate significantly compared to that of the conventional culture method . A . otitidis is the most common detected pathogen in the MEE of the OME.

Rev Med Chil, 2001 Nov, 129(11), 1289 - 96
{Pleural effusion and complicated empyema in children . Evolution and prognostic factors}; Paz F et al.; BACKGROUND: Complicated pleural empyema has a torpid and longer clinical evolution, requiring in some patients surgical management . The predictive factors for surgical treatment are not well known . AIM: To search for clinical, laboratory or radiological predictors for the requirement of surgical treatment in pediatric patients with empyema . PATIENTS AND METHODS: A retrospective review of the charts of 108 patients hospitalized for pneumonia plus pleural effusion at the Pediatric Service of the Catholic University Hospital between January 1985 and July 2000 . RESULTS: Eighty one patients had complete radiological evaluation and pleural fluid biochemical analysis . Forty nine (60%) fulfilled the criteria for empyema and 32 (40%) for an exudate . Thirteen patients with empyema required surgery and 36 were treated medically . The mean age was 3 years (range 9 months-6 years) for the surgically treated and 4 years (range 12 months-14 years) for the non-surgical group . The male/female ratio was 5:1 in the surgical group and 1:1 for the non-surgical group . Pleural fluid cultures were positive in 21 of 79 patients . Streptococcus pneumonia was the most frequently isolated agent . No significant differences were found between groups for the average days of fever prior to the diagnosis or total days of fever, days of hospital stay, pleural fluid pH (6.8 and 7.0 respectively) and glucose (21 and 31 mg/dl respectively) . No differences were either observed for pleural fluid risk factors (pH < 7 and glucose < 20 mgdl), the presence of extensive pleural effusions, pleural loculations or bands on pleural ultrasonography and positive Gram stain or cultures in the pleural fluid . Surgical patients required oxygen for more days than medical patients (7.7 and 5.1 days; p = 0.037) . CONCLUSIONS: This study failed to find predictive clinical, radiological or pleural fluid parameters, for the requirement of surgical treatment of empyema.

Zhonghua Kou Qiang Yi Xue Za Zhi, 1999 Mar, 34(2), 109 - 11
{Effect of monoclonal antibody on the colonization of Streptococcus sobrinus and the development of dental caries in rats}; Zhang P et al.; OBJECTIVE: To investigate the effect of local application of monoclonal antibody (McAb) raised against the major cell surface protein antigen of streptococcus sobrinus (PAg) on the colonization of rats' teeth by Streptococcus sobrinus (S . sobrinus) and the development of dental caries . METHODS: 30 wistar rats were divided into three groups: group I received McAb against PAg; group II received unrelated mice ascites; group III received PBS . They were applied on six occasions . After three times of application, streptomycin resistant S . sobrinus 6715 were inoculated onto the teeth and the rats were fed with caries-inducing diet 2000# . The number of colonized S . sobrinus were counted and the presence of caries was examined by the procedure of Keyes' . RESULTS: There was a significant lower level of colonization by S . sobrinus and lower mean caries scores treated with McAb compared with the control groups . CONCLUSION: Local passive immunization with McAb against PAg may be an effective way to prevent the colonization by implanted S . sobrinus and the development of dental caries.

J Soc Biol, 2001, 195(3), 271 - 6
{Validation of the use of aequorin for cytoplasmic free calcium determination by chemiluminescence in Streptococcus pneumoniae}; Chapuy-Regaud S et al.; In the extracellular pathogen Streptococcus pneumoniae, transformable by soluble DNA, calcium transport is shown to play a key role for vegetative growth, developement of competence for genetic transformation and experimental virulence . To get a more precise localisation of Ca2+ in the cell, we cloned the cDNA of apoaequorine in the chromosome of Streptococcus pneumoniae . This allowed the reconstitution of the acquorine system and chemoluminescence measurements of the cytoplasmic free calcium concentration in the bacteria . Intracellular free Ca2+ is 2 microM at the steady state and can reach 14 microM when calcium is added to the bacterial suspension . Increase in free Ca2+ in response to an imposed Ca2+ gradient depends on the initial velocity (Vi) of the DMB-sensitive Ca2+ transport, showing that changes in cytoplasmic Ca2+ involve active transport.

Microbiology, 2002 Feb, 148(Pt 2), 549 - 58
Role of the C-terminal YG repeats of the primer-dependent streptococcal glucosyltransferase, GtfJ, in binding to dextran and mutan; Kingston KB et al.; The recombinant primer-dependent glucosyltransferase GtfJ of Streptococcus salivarius possesses a C-terminal glucan-binding domain composed of eighteen 21 aa YG repeats . By engineering a series of C-terminal truncated proteins, the position at which truncation prevented further mutan synthesis was defined to a region of 43 aa, confirming that not all of the YG motifs were required for the formation of mutan by GtfJ . The role of the YG repeats in glucan binding was investigated in detail . Three proteins consisting of 3.8, 7.2 or 11.0 C-terminal YG repeats were expressed in Escherichia coli . Each of the three purified proteins bound to both the 1,6-alpha-linked glucose residues of dextran and the 1,3-alpha-linked glucose residues of mutan, indicating that a protein consisting of nothing but 3.8 YG repeats could attach to either substrate . Secondary structure predictions of the primary amino acid sequence suggested that 37% of the amino acids were capable of forming a structure such that five regions of beta-sheet were separated by regions capable of forming beta-turns and random coils . CD spectral analysis showed that the purified 3.8 YG protein possessed an unordered secondary structure with some evidence of possible beta-sheet formation and that the protein maintained this relatively unordered structure on binding to dextran.

Zhonghua Fu Chan Ke Za Zhi, 2000 Jan, 35(1), 32 - 5
{Study on perinatal group B Streptococcus carriers and the maternal and neonatal outcome}; Ma Y et al.; OBJECTIVE: To investigate the group B streptococcus (GBS) colonization rate and the relationship between vaginal colonization of GBS and the maternal and neonatal outcome . METHODS: 3% TH selective broth media were used for culture of GBS . The vaginal samples were collected during different pregnant periods (before 20 weeks' gestation; 20-28 weeks; after 34 weeks' gestation) and other samples from different sites after labor (including neonatal throat, ear, umbilicus and placenta, umbilical blood, maternal blood, etc) . RESULTS: The GBS carrier rate in 1 039 pregnant women was 11.07% (115/1,039) . The colonization rate of different treating times was 29.73% (test three times), 15.50% (test twice) and 9.86% (test one time) respectively . The carrier rate of three-time-test was significantly higher than that of two times test (P < 0.01) and that of only one time (P < 0.01) . The carrier rate in three periods was 16.84% (< 20 weeks), 18.40% (20-28 weeks) and 14.90% (> 34 weeks) respectively . Obstetric complications associated with GBS carrier were similar with those of non-carrier . Neonatal carrier rate was 9.95% . The neonatal carrier rate in the group of carrier mothers was higher than that of non-carrier mothers (14.29%:7.26%) . The rate of neonatal pneumonia and the upper respiratory tract infection in GBS-carrier-mother was higher than that of non-carrier mothers (11.01%:9.71%; 8.27%: 6.07%) while it was similar in neonatal carrier group and non-carrier group (20.00%:14.92%; 10.00%:4.97%) . CONCLUSION: GBS might be one of vaginal pathogens in Chinese women, but it is not severe enough to threaten the health of pregnant women and their newborns.

Proc Natl Acad Sci U S A, 2002 Feb 5, 99(3), 1550 - 5
The murMN operon: a functional link between antibiotic resistance and antibiotic tolerance in Streptococcuspneumoniae; Filipe SR et al.; Inactivation of the recently identified murMN operon in penicillin-resistant strains of Streptococcus pneumoniae was shown already to cause two major effects: elimination of branched-structured muropeptides from the cell wall and complete loss of penicillin resistance . We now show that cells with inactivated murMN also have a third phenotype: an increased susceptibility to lysis when exposed to low concentrations of fosfomycin, d-cycloserine, vancomycin, and nisin, indicating a wide-spectrum hypersensitivity to inhibitors of both early and late stages of cell wall biosynthesis . Mutants of murMN also lysed faster than the parental strain when treated with the detergent deoxycholate . Several different alleles of murM cloned in plasmid pLS578 and introduced into a murM deletion mutant of the penicillin-resistant strain Pen6 were able to reconstitute each one of the three mutant phenotypes: the highly branched cell wall structure, original high level of penicillin resistance, and normal sensitivity to lysis . In a penicillin-susceptible strain the same experiments caused increased concentration of cell wall branched peptides and suppression of sensitivity to antibiotic induced lysis . The observations suggest that the murMN operon plays a key role in the regulation of a stress-response pathway that can be triggered by perturbation of cell wall biosynthesis in S . pneumoniae.

J Microbiol Methods, 2002 Apr, 49(2), 163 - 71
Construction of transcriptional and translational lacZ gene reporter plasmids for use in Streptococcus mutans; Honeyman AL et al.; Reporter genes have become standard genetic tools used to evaluate either the transcriptional or the translational activity associated with genes of interest, whose products cannot be easily assayed . The lacZ gene from Escherichia coli has been used very effectively to quantify such regulated activities in many different organisms . This report describes the construction of a pair of plasmids that may be used for either transcriptional or translational lacZ gene fusions in Streptococcus mutans . The translational E . coli beta-galactosidase gene (lacZ) fusion plasmid, pALH109, as well as the transcriptional lacZ gene fusion plasmid, pALH122, have been used successfully in S . mutans to measure the activity of various PTS genes . Both plasmids employ fusions with the E . coli lacZ gene that can be easily quantified using standard O-nitrophenyl-beta-D-galactopyranoside (ONPG) based enzyme assays or the more sensitive fluorometric assays using 4-methyl-umbelliferyl beta-D-galactopyranoside (MUG) as the enzyme substrate . Currently, there has been only one other report of the use of lacZ as a gene reporter in S . mutans . The plasmids described in this paper will provide new tools and techniques for the analysis of S . mutans gene regulation . In addition, we have compiled the complete nucleotide sequences of these gene reporter plasmids.

Expert Opin Pharmacother, 2002 Feb, 3(2), 121 - 9
Current pharmacotherapy of pneumococcal meningitis; Aronin SI; Streptococcus pneumoniae is the leading cause of bacterial meningitis for people of all age groups after infancy . Prior to the emergence of penicillin-resistant pneumococci as the cause of meningitis, penicillin was the traditional therapy for this life-threatening infection . Treatment guidelines for both suspected and confirmed cases of pneumococcal meningitis (PM) have had to evolve in response to the phenomenon of increasing antibiotic resistance . In addition, research efforts have attempted to clarify the role of dexamethasone and the importance of prompt antibiotic therapy in the management of patients with PM . This article provides a review of general therapeutic principles, current treatment guidelines and alternative therapeutic choices for patients with PM.

J Pharm Pharmacol, 2002 Jan, 54(1), 71 - 5
Pharmacokinetics of ABT-773, a new semi-synthetic ketolide in neutropenic lung-infected mice: a population approach; Xuan D et al.; ABT-773 is an investigational ketolide antimicrobial agent with an in-vitro bactericidal activity against macrolide-susceptible and -resistant Streptococcus pneumoniae . The pharmacokinetics of this drug candidate were evaluated in lung-infected (108 CFU mL 1 starting inoculum) mice following a single dose (25, 50, 100 or 200 mg kg(-1)) oral administration as a solution in 10% of 95% ethanol and 90% of 0.1 M pH 6.5 phosphate buffer solution . Serum ABT-773 concentrations were measured using a validated HPLC assay with fluorescence detection (excitation at 324 nm and emission at 364 nm) . Population pharmacokinetic analysis was performed using the NONMEM computer program . Results from data analysis showed non-linear pharmacokinetics of ABT-773, noted by the increases in half-life (3.1 to 27.2 h) and AUC/dose (23.7 to 149 mg h(-1) L(-1) mg(-1)), with doses from 25 to 200 mg kg(-1) . A non-linear one-compartment model with parallel capacity-limited and linear first-order elimination best described the pharmacokinetics of ABT-773 in the mouse . The total volume of distribution was 0.316 L . The clearance for the linear first-order elimination was 0.0027 L h(-1) . The Vm and Km were 0.0385 L h(-1) and 0.141 mg L(-1), respectively, for the capacity-limited elimination.

J Dent Res, 2002 Feb, 81(2), 134 - 9
Immunohistochemical detection of salivary agglutinin/gp-340 in human parotid, submandibular, and labial salivary glands; Bikker FJ et al.; Salivary agglutinin is a Streptococcus mutans binding protein and a member of the scavenger receptor cysteine-rich superfamily . It is identical to lung gp-340 and brain DMBT1, which possibly play a role in innate immunity and tumor suppression, respectively . The goal of this study was to localize salivary agglutinin in human salivary glands . Two monoclonal antibodies, directed against gp-340, were characterized . mAb 213-1 reacted with sialic acid epitopes and cross-reacted with MUC7 . The reaction with mAb 213-6 disappeared after reduction, suggesting that a protein epitope was recognized . In the parotid gland, immunohistochemical labeling with mAb 213-6 was found in the duct cells . In the submandibular gland and labial gland, both serous acini and demilune cells were labeled . In the labial gland, labeling was found at the luminal side of the duct cells . Salivary agglutinin was distinctly localized in salivary glands, but in distinct glandular secretions, no differences in electrophoretic behavior were observed.

J Exp Med, 2002 Feb 4, 195(3), 359 - 65
The immune response to pneumococcal proteins during experimental human carriage; McCool TL et al.; Colonization of the nasopharynx is the initial step in all infections caused by Streptococcus pneumoniae . The antibody response to carriage was examined in an experimental model of human colonization in healthy adults . Asymptomatic colonization was detected in 6/14 subjects and continued for up to 122 d . Susceptibility to carriage did not correlate with total serum immunoglobulin (Ig)G to the homotypic capsular polysaccharide . All of the colonized subjects, in contrast, developed a serum IgG and secretory IgA response to a 22 kD protein, whereas 7 of 8 subjects who did not become colonized had preexisting antibody to this protein . Analysis of the 22 kD protein identified it as the NH(2)-terminal region of pneumococcal surface protein A (PspA) . Our findings provide evidence for the role of antibody to this protein fragment in preventing pneumococcal carriage by humans.

J Dent Res, 2002 Feb, 81(2), 109 - 13
Differential and quantitative analyses of mRNA expression of glucosyltransferases from Streptococcus mutans MT8148; Fujiwara T et al.; Streptococcus mutans produces three glucosyltransferases, coded by gtfB, gtfC, and gtfD, whose cooperative action is essential for sucrose-dependent cellular adhesion . This cellular adhesion plays an important role in the formation of dental plaque and the initiation of dental caries . Since they bear genetic similarities and are large in size, differentiation of their gene expression has been difficult, and little is known about the dynamic process of gtf expression . Using a real-time reverse-transcription/polymerase chain-reaction, we determined the expression of each gtf . Under various conditions, the relative levels of transcription were gtfB > gtfD > gtfC . Sucrose enhanced gtfD expression, whereas it reduced that of gtfB and gtfC, suggesting the presence of independent promoters . Quantitative analyses demonstrated coincidence between the ratio of expression of each gtf and the ratio previously identified as optimal for sucrose-dependent adhesion in vitro, suggesting that S . mutans produces GTF at an optimal ratio to adhere to the tooth surface.

Med Microbiol Immunol (Berl), 2001 Dec, 190(3), 135 - 8
Relationship between penicillin and cephalosporin resistance of Streptococcus pneumoniae strains and its inflammatory activity in the experimental model of meningitis; Fernandez A et al.; Using a rabbit model of meningitis, we sought to compare the inflammatory activity induced by three pneumococcal strains with different susceptibilities to penicillin and cephalosporins, belonging to the serotypes 3, 6B and 23F at different inoculum sizes . These serotypes are prevalent in Western Europe and are believed to produce a moderate-to-severe cerebrospinal fluid (CSF) inflammatory response . Only minor differences were observed in the inflammatory activity evoked by the three strains in the subarachnoid space, and most were probably related to differences in bacterial counts . Infection by serotype 23F caused secondary bacteremia in all challenged animals . Our findings reinforce the concept that resistant pneumococci are not more virulent, a fact that should be taken into account when evaluating the efficacy of different anti-pneumococcal therapies . However, the frequent induction of secondary bacteremia by the resistant serotype 23F requires further study.

Biosci Biotechnol Biochem, 2001 Dec, 65(12), 2682 - 9
Mutational and comparative analysis of streptolysin O, an oxygen-labile streptococcal hemolysin; Yamamoto I et al.; The structural gene of streptolysin O was cloned from Streptococcus pyogenes strain Sa and S . equisimilis H46A, and the nucleotide sequences were compared with those of strain Richards . To obtain the minimal active fragment of the toxin and to elucidate structure-function relationships in hemolytic function, streptolysin O mutants deleted in N- and C-terminal regions were constructed . Internal amino acid residues were also replaced by introduction of point mutations . Analyses of these mutants showed that considerable activity was retained even after deletion of the N-terminal 107 residues, but genetic removal of the ultimate C-terminal residue resulted in a marked decrease in hemolytic function . By removal in succession, hemolytic activity declined exponentially, and only 0.002% of the activity remained after deletion of the C-terminal four residues . Nucleotide replacement experiments indicated pivotal roles of I202, V217, D324-L325, V339, and H469 residues in hemolysis.

Tidsskr Nor Laegeforen, 2001 Nov 20, 121(28), 3310 - 4
{Streptococcus group A infections of skin, soft tissue and blood}; Chelsom J et al.; BACKGROUND: Group A streptococcus is one of the most common bacterial pathogens causing infections in tissue and organs, most frequently throat and skin . Since the late 1980s there have been reports from Scandinavia and many other countries documenting a resurgence of highly invasive infections such as puerperal fever, necrotizing fasciitis, myositis and sepsis . MATERIAL AND METHODS: On the basis of relevant studies and reviews and a clinical study of 61 patients between 1992 and 1999 with necrotizing fasciitis and myositis at Haukeland University Hospital, Bergen, Norway, we present an overview of the prevalence, pathogenesis, clinical features and treatment of group A streptococcal infections in skin, soft tissue and blood . RESULTS AND INTERPRETATION: The reason for the increase in severe group A streptococcal infections is unclear . The clinical features depend on the level of infection (superficial skin, subcutis, fascia and muscle): the deeper the initial infection, the more frequent development of bacteraemia and life-threatening disease . Serious infections are associated with shock and multiorgan failure, i.e . streptococcal toxic shock syndrome . Early surgical debridement is essential in necrotizing fasciitis and myositis . Penicillin is still the drug of choice for milder infections . The addition of clindamycin is recommended in cases of more invasive infection.

J Clin Microbiol, 2002 Feb, 40(2), 682 - 4
Rapid real-time PCR for determination of penicillin susceptibility in pneumococcal meningitis, including culture-negative cases; Kearns AM et al.; A novel real-time PCR-hybridization assay was developed for the rapid (<1 h) detection of penicillin susceptibility in Streptococcus pneumoniae . When applied to 24 pneumococcal DNA-positive cerebrospinal fluid extracts, penicillin-sensitive S . pneumoniae was detected in all instances . Real-time PCR proved more sensitive than culture, microscopy, or antigen detection and provided susceptibility data even in culture-negative cases.

J Clin Microbiol, 2002 Feb, 40(2), 669 - 74
In vitro activities of broad-spectrum cephalosporins against nonmeningeal isolates of Streptococcus pneumoniae: MIC interpretation using NCCLS M100-S12 recommendations; Sahm DF et al.; Publication of the NCCLS M100-S12 document in January 2002 introduced ceftriaxone and cefotaxime MIC interpretative breakpoints of < or =1 microg/ml (susceptible), 2 microg/ml (intermediate), and > or =4 microg/ml (resistant) for nonmeningeal isolates of Streptococcus pneumoniae . To estimate the effect of these breakpoint changes on clinical laboratory susceptibility testing results, nonmeningeal pneumococcal isolate (blood and respiratory) data from The Surveillance Network Database-USA, an electronic surveillance database, for the years 1996 to 2000 were collated and studied . Of 9,863 nonmeningeal isolates tested against ceftriaxone, 82.7% were susceptible, 13.2% were intermediate, and 4.1% were resistant by the M100-S11 NCCLS breakpoints (2001); by M100-S12 breakpoints, 95.9% of the isolates were susceptible, 3.1% were intermediate, and 1.0% were resistant . Of 10,777 nonmeningeal isolates tested against cefotaxime, 79.2% were susceptible, 14.3% were intermediate, and 6.5% were resistant by M100-S11 breakpoints; by M100-S12 breakpoints, 93.5% were susceptible, 4.2% were intermediate, and 2.3% were resistant . Overall, the new M100-S12 ceftriaxone and cefotaxime interpretative breakpoints for nonmeningeal isolates of S . pneumoniae decreased the number of isolates interpreted as intermediate by 10% and as resistant by 3 to 4%.

J Clin Microbiol, 2002 Feb, 40(2), 615 - 9
Genetic diversity of Streptococcus suis strains isolated from pigs and humans as revealed by pulsed-field gel electrophoresis; Berthelot-Herault F et al.; The genetic diversity of 123 Streptococcus suis strains of capsular types 2, 1/2, 3, 7, and 9, isolated from pigs in France and from humans in different countries, was evaluated by pulsed-field gel electrophoresis (PFGE) of DNA restricted with SmaI . The method was highly discriminative (D = 0.98), results were reproducible, and the PFGE analysis was easy to interpret . Among all S . suis strains, 74 PFGE patterns were shown . At 60% homology, three groups (A, B, and C) were identified, and at 69% homology, eight subgroups (a to h) were observed . Strains isolated from diseased pigs or from humans were statistically clustered in group B, especially in subgroup d . By contrast, S . suis strains isolated from clinically healthy pigs were preferentially included in subgroup b of group A . Relationships could be established between capsular types 1/2, 3, and 9 and groups A, e, and B, respectively . S . suis strains isolated from humans were homogeneous, and a very high level of association between these strains and four DNA patterns was observed . The PFGE used in this study is a very useful tool for evaluating the genetic diversity of S . suis strains, and it would be used for epidemiological investigations.

J Clin Microbiol, 2002 Feb, 40(2), 395 - 9
Rapidly increasing prevalence of penicillin-resistant Streptococcus pneumoniae in middle Tennessee: a 10-year clinical and molecular analysis; Tang YW et al.; The clinical and molecular epidemiology of penicillin-resistant Streptococcus pneumoniae and the diagnostic accuracy of a six-primer PCR assay in identifying penicillin resistance were analyzed by using clinical isolates recovered over a 10-year period in middle Tennessee . The prevalence of non-penicillin-susceptible S . pneumoniae isolates (MIC, > or =0.1 microg/ml) increased from 10% in 1990 to 70% in 1999 (P < 0.001) . Among S . pneumoniae isolates for which the penicillin MIC was > or =2 microg/ml (highly penicillin-resistant S . pneumoniae {PRSP}), 23 and 5% were resistant to at least three and at least five other antimicrobial classes, respectively . Pulsed-field gel electrophoresis identified 13 unique strain types, with type B accounting for 33% of PRSP isolates . The sensitivity, specificity, and negative and positive predictive values of the PCR assay in detecting PRSP were 99, 100, 99, and 100%, respectively . Penicillin resistance is rapidly increasing among S . pneumoniae isolates in Tennessee . The simultaneous detection of S . pneumoniae and high-level penicillin resistance can be accurately performed with the six-primer PCR assay.

Soc Sci Med, 2002 Jan, 54(2), 229 - 44
"Tooth worms", poverty tattoos and dental care conflicts in Northeast Brazil; Nations MK et al.; While medical anthropologists have studied doctor-patient clinical conflicts during the last 25-30 years, dentist-patient communication clashes have received scant attention to date . Besides structural barriers and power inequities, such conceptual differences further dehumanize dental care and lower service quality . Potential for dentist-patient discordance is greater in developing regions--such as Northeast Brazil--where there exists a wider socio-economic gap between professionals and laypersons . A critical anthropological evaluation of oral health services quality is undertaken in two rural communities in Ceara, Brazil where the PAHO-inspired Local Oral Health Inversion of Attention Program was implemented in 1994 . This 6-month qualitative field study utilized ethnographic interviews with key informants, participant-observation and projective techniques to probe professionals' and patients' explanatory models (EMs) of oral health . Despite the recent expansion of services into rural regions, the authors conclude that the quality of dental care remains problematic . Patients' culturally constructed EMs of teeth rotted (estraga) by "tooth worms" (lagartas) differ substantively from dentists' model of dental decay by Streptococcus mutans . "Exploding chins" (queixo estourado), "spoiled, rotting teeth" (dente pjdi) and "false plates" or teeth (chapas) tattoo and stigmatize the poor, reinforcing gross class inequities . Dentists' dominant discourse largely ignores lay logic, ridicules popular practices and de-legitimates, even castigates, popular healers despite their pivotal role in primary oral health care . Poor parents are not only barred from clinics but are blamed for children's rotten teeth . In sum, universal access to dental care is more a myth (even nightmare) than a reality . Dentists all too often "avert"--not "invert"--attention from poor Brazilian patients . In order to improve oral health in this setting, both "societal decay" and bacteria-laden plaque deposits must be removed.

Angiogenesis, 2001, 4(1), 61 - 70
CM101 stimulates cutaneous wound healing through an anti-angiogenic mechanism; Nanney LB et al.; CM101, an anti-pathoangiogenic polysaccharide derived from group B streptococcus, has been shown to inhibit inflammatory angiogenesis and accelerate wound healing in a mouse model and minimize scarring/gliosis following spinal cord injury . To evaluate the in vivo effects of CM101 on cutaneous wound healing in the pig, intravenously delivered CM101 or placebo vehicle was given 1 h after cutaneous wounding and again at 72 h after injury . Tissues from partial-thickness and full-thickness excisions were collected at days 4 and 7 after wounding and evaluated for a variety of standard healing parameters . Both types of CM101-treated wounds showed significantly less evidence of inflammatory angiogenesis when assessed by macroscopic photography of the wound surface, qualitative histological observations, laser doppler perfusion imaging, and quantitative morphometric analysis of microvessel area from endothelium selectively immunostained for factor VIII . Resurfacing was accelerated in partial-thickness and full-thickness excisions that received two doses of CM101 as compared to the placebo-treated excisional wounds . Neodermal thickness was increased in CM101-treated wounds at day 4 and was slightly reduced in comparison with placebo by day 7 . New collagen accumulation appeared to be unaffected by the CM101 treatment . Immunohistochemical staining using a polyclonal antisera directed against the anti-pathoangiogenic CM101 target protein HP59 on day 7 indicated a strong immunoreactivity on the microvessels present in the control wounds but not in wounds of the CM101-treated animals . In summary, the immunolocalization HP59 in the microvessels of the cutaneous wound bed in control but not in CM101 treated wounds suggests that CM101 inhibits the pathologic inflammatory angiogenesis accompanying the normal granulation processes . The net biological effect of inhibited inflammatory pathoangiogenesis is a diminished, suggested and purely physiologic, microvascular bed which translates into an enhanced rate of epithelial resurfacing and therefore an overall accelerated rate of wound repair.

J Immunol, 2002 Feb 15, 168(4), 1886 - 94
Streptococcus pneumoniae evades complement attack and opsonophagocytosis by expressing the pspC locus-encoded Hic protein that binds to short consensus repeats 8-11 of factor H; Jarva H et al.; Streptococcus pneumoniae is an important cause of upper and lower respiratory tract infections, meningitis, peritonitis, bacterial arthritis, and sepsis . Here we have studied a novel immune evasion mechanism of serotype 3 pneumococci, which are particularly resistant to phagocytosis . On their surfaces the bacteria express the factor H-binding inhibitor of complement (Hic), a protein of the pneumococcal surface protein C family . Using radioligand binding, microtiter plate assays, surface plasmon resonance analysis, and recombinant constructs of factor H, we located the binding site of Hic to short consensus repeats (SCRs) 8-11 in the middle part of factor H . This represents a novel microbial interaction region on factor H . The only other ligand known so far for SCRs 8-11 of factor H is C-reactive protein (CRP), an acute phase protein that binds to the pneumococcal C-polysaccharide . The binding sites of Hic and CRP within the SCR8-11 region were different, however, because CRP did not inhibit the binding of Hic and required calcium for binding . Binding of factor H to Hic-expressing pneumococci promoted factor I-mediated cleavage of C3b and restricted phagocytosis of pneumococci . Thus, virulent pneumococci avoid complement attack and opsonophagocytosis by recruiting functionally active factor H with the Hic surface protein . Hic binds to a previously unrecognized microbial interaction site in the middle part of factor H.

J Immunol, 2002 Feb 15, 168(4), 1813 - 22
Role of galectin-3 as an adhesion molecule for neutrophil extravasation during streptococcal pneumonia; Sato S et al.; Recruitment of neutrophils from blood vessels to sites of infection represents one of the most important elements of innate immunity . Movement of neutrophils across blood vessel walls to the site of infection first requires that the migrating cells firmly attach to the endothelial wall . Generally, neutrophil extravasation is mediated at least in part by two classes of adhesion molecules, beta(2) integrins and selectins . However, in the case of streptococcal pneumonia, recent studies have revealed that a significant proportion of neutrophil diapedesis is not mediated by the beta(2) integrin/selectin paradigm . Galectin-3 is a beta-galactoside-binding lectin implicated in inflammatory responses as well as in cell adhesion . Using an in vivo streptococcal pneumonia mouse model, we found that accumulation of galectin-3 in the alveolar space of streptococcus-infected lungs correlates closely with the onset of neutrophil extravasation . Furthermore, immunohistological analysis of infected lung tissue revealed the presence of galectin-3 in the lung tissue areas composed of epithelial and endothelial cell layers as well as of interstitial spaces . In vitro, galectin-3 was able to promote neutrophil adhesion to endothelial cells . Promotion of neutrophil adhesion by galectin-3 appeared to result from direct cross-linking of neutrophils to the endothelium and was dependent on galectin-3 oligomerization . Together, these results suggest that galectin-3 acts as an adhesion molecule that can mediate neutrophil adhesion to endothelial cells . However, accumulation of galectin-3 in lung was not observed during neutrophil emigration into alveoli induced by Escherichia coli infection, where the majority of neutrophil emigration is known to be beta(2) integrin dependent . Thus, based on our results, we propose that galectin-3 plays a role in beta(2) integrin-independent neutrophil extravasation, which occurs during alveolar infection with Streptococcus pneumoniae.

Appl Environ Microbiol, 2002 Feb, 68(2), 928 - 32
Alkaline phosphatase reporter transposon for identification of genes encoding secreted proteins in gram-positive microorganisms; Gibson CM et al.; We describe the construction of TnFuZ, a genetic tool for the discovery and mutagenesis of proteins exported from gram-positive bacteria . This tool combines a transposable element (Tn4001) of broad host range in gram-positive bacteria and an alkaline phosphatase gene (phoZ) derived from a gram-positive bacterium that has been modified by removal of the region encoding its export signal . Mutagenesis of Streptococcus pyogenes with TnFuZ ("FuZ" stands for fusions to phoZ) identified genes encoding secreted proteins whose expression was enhanced during growth in an aerobic environment . Thus, TnFuZ should be valuable for analysis of protein secretion, gene regulation, and virulence in gram-positive bacteria.

Microb Drug Resist, 2001 Winter, 7(4), 391 - 401
Antibiotic resistance in Streptococcus pneumoniae in six Latin American countries: 1993-1999 surveillance; Hortal M et al.; The impact of invasive pneumococcal invasive disease is increased by the emergence of antibiotic resistance . We report regional and temporal variations in antibiotic resistance for 4,105 invasive Streptococcus pneumoniae isolates collected from Latin American children <5 years, between 1993 and 1999 . Reduced susceptibility to penicillin was detected in 1,182 isolates (28.8%); 36% of these were resistant (> or = 2 microg/ml), including 12.6% with MIC > or = 4 microg/ml, occurring primarily in serotypes 14 and 23F . Reduced susceptibility to third-generation cephalosporins was detected in 12.1% of the collection . Mexico had the highest proportion of reduced susceptibility to penicillin (51.6%) and to third-generation cephalosporins (22%), whereas Brazil had the lowest at 20.9% and 0.7%, respectively . Isolates cultured from patients with pneumonia were more likely to have reduced susceptibility to third-generation cephalosporins than isolates from patients with meningitis (p < 0.0001) . Susceptibility to trimethoprim-sulfamethoxazole, chloramphenicol, erythromycin, and vancomycin was tested by disk diffusion for 2.899 isolates . Reduced susceptibility was observed for 45.6%, 11.5%, 6.9%, and 0%, respectively . Thirty-one percent of the strains were resistant to > or = 2 drugs . High levels of antibiotic resistance in Latin America emphasize the need for the development of and adherence to rational antibiotic use guidelines . On-going surveillance will monitor the impact of these programs.

Microb Drug Resist, 2001 Winter, 7(4), 383 - 9
Marked differences in antibiotic use and resistance between university hospitals in Vilnius, Lithuania, and Huddinge, Sweden; Gulbinovic J et al.; Antibiotic use and antimicrobial resistance was compared between Vilnius and Huddinge University hospitals . Drug use data were expressed in number of defined daily doses/100 bed-days; antimicrobial resistance were given as percentages of resistant isolates . Thirty-five and 48 different antibiotic drugs were used in Vilnius and Huddinge, respectively . The overall consumption of antibiotics was 15 DDD/100 bed-days in Vilnius and 43 DDD/100 bed-days in Huddinge . Benzylpenicillin, ampicillin, and aminoglycosides were the major antibiotics in Vilnius; beta-lactamase-resistant penicillins, cefalosporins, and quinolones in Huddinge . In Vilnius, gentamicin made up one-quarter of the use . Staphylococcus aureus and Gram-negative isolates from wounds and blood were more resistant to gentamicin in Vilnius . S . aureus was more often methicillin resistant in Vilnius than in Huddinge . There was no S . aureus-resistant to vancomycin in either hospital . The vancomycin-resistant enterococci made up from 4% to 10% in Vilnius hospital, but they were not detected in Huddinge hospital (0%) . The majority of Streptococcus pneumoniae isolates were sensitive to benzylpenicillin in both hospitals . The higher resistance of microorganisms to some antibiotics in Vilnius may be explained by heavy use of few antibiotics . Lower level of hygiene procedures, sampling bias, and other methodological issues may also have contributed . Guidelines for antibiotic use and hygienic procedures are now under development in Vilnius.

Microb Drug Resist, 2001 Winter, 7(4), 323 - 34
Molecular characteristics of penicillin-binding protein genes of penicillin-nonsusceptible Streptococcus pneumoniae isolated in the Netherlands; Overweg K et al.; Recently, a nation-wide molecular epidemiologic survey of penicillin-nonsusceptible Streptococcus pneumoniae has been performed in the Netherlands . In the current study, we analyzed the genes pbp1a, pbp2b, and pbp2x from these clinical isolates at the molecular level, and identified the genetic composition of the penicillin-binding domains . The pneumococcal strains were selected on the basis of differences in restriction fragment length polymorphism (RFLP) patterns of the genes pbp1a, pbp2b, and pbp2x, and represented 8, 7, and 10 distinct patterns, respectively . The genetic heterogeneity observed by sequence analysis of the pbp gene parts was comparable with the heterogeneity of the entire pbp genes as deduced from RFLP analysis . Furthermore, the mutations in the pbp sequences of the Dutch isolates invariably matched with the mutations described in pbp sequences of penicillin-nonsusceptible pneumococci isolated in other countries . Finally, novel mosaic structures were identified indicating horizontal exchange of pbp gene parts among penicillin-nonsusceptible pneumococci.

Microb Drug Resist, 2001 Winter, 7(4), 303 - 16
The role of murMN operon in penicillin resistance and antibiotic tolerance of Streptococcus pneumoniae; Filipe SR et al.; The recently identified murMN operon is essential for the production of branched-structured muropeptides in the cell wall and also for the expression of the resistant phenotype in penicillin-resistant strains of Streptococcus pneumoniae . The purpose of studies described in this communication was to understand better the role of murMN in penicillin resistance . Deletion of murM in the penicillin-resistant strain Pen6, which causes reduction in the penicillin MIC from 6.0 to 0.03 microg/ml, was successfully complemented to recover the original high level of penicillin resistance in transformants that received functional murM alleles cloned in plasmid pLS578 . Inactivation of penicillin resistance was not accompanied by any detectable change in the low affinity or abnormal molecular size pattern of the penicillin-binding proteins (PBPs) nor in the mosaic sequence of PBP2X typical of resistant strain Pen6 . Exposure of strain Pen6 with inactivated murM to 0.05 microg/ml of penicillin (i.e., a concentration more than 100 times below the MIC of the parental strain) initiated a phenotypic response typical of penicillin-susceptible strains of pneumococci: inhibition of growth followed by rapid and extensive loss of viability and lysis . Unexpectedly, inactivation of murMN also caused hypersensitivity to lysis by low concentrations of a variety of cell wall active antibiotics such as fosfomycin, D-cycloserine, and nisin, suggesting that the murMN operon may perform an important regulatory role in the control of the irreversible antimicrobial effects of cell wall inhibitors.

Drugs Exp Clin Res, 2001, 27(4), 121 - 6
Characteristics of Pseudomonas aeruginosa isolated from skin infections; Higaki S et al.; From January 1995 to June 2000, 19 Pseudomonas aeruginosa were detected in 19 cases of infectious skin diseases . Coagulase-negative staphylococci coexisted with P . aeruginosa in 10 cases and P . aeruginosa was also often associated with Enterococcus sp., Staphylococcus aureus, Streptococcus sp . or other species . Twelve cases carried P . aeruginosa more predominantly than the other species . Some coagulase-negative staphylococci, Enterococcus sp., S . aureus and Streptococcus sp . were also predominant . The frequency of predominant P . aeruginosa was significantly higher in secondary infections due to ulcers and decubitus than in secondary infections due to other skin diseases . P . aeruginosa was also often detected in the legs and feet, but not in the trunk . This organism showed high sensitivities to antibiotics, except minocycline . No significant differences in sensitivity or resistance to antibiotics were found between P . aeruginosa when detected as the predominant or single strain and this microorganism when detected as the non-predominant strain . Thus, the detection of P . aeruginosa important in choosing the appropriate antibiotics to be used and this is sometimes influenced by the patient's condition.

FEMS Immunol Med Microbiol, 2002 Jan 14, 32(2), 133 - 40
Development of hematogenous pneumococcal meningitis in adult mice: the role of TNF-alpha; Tsao N et al.; Bacterial penetration across the blood-brain barrier (BBB) into the central nervous system is the first step in development of meningitis . The role of tumor necrosis factor-alpha (TNF-alpha) in the penetration process was examined with peripheral infection of Streptococcus pneumoniae type 6 . After intraperitoneal infection of S . pneumoniae type 6, the BBB opening was increased continuously from 6 h and the mice died of septic shock within 36 h due to bacterial overgrowth . The bacteria crossed the BBB and began to deposit in brain at 6 h post infection . There was strong staining of TNF-alpha on blood vessels of brain from 6 h to 24 h post infection . Anti-TNF-alpha antibody blocked both the BBB opening and the entrance of circulatory S . pneumoniae type 6 into brain, indicating that TNF-alpha played an important role in controlling the opening of BBB . Furthermore, an adult murine model of hematogenous pneumococcal meningitis was developed that is based on opening of the BBB by TNF-alpha and controlling the degree of bacteremia by cefazolin antibiotic . In conclusion, hematogenous meningitis developed as TNF-alpha initiated BBB opening, peripheral bacteria entered into the brain and formed bacterial emboli, and then progressed to meningitis.

Diagn Microbiol Infect Dis, 2002 Jan, 42(1), 59 - 64
In vitro susceptibility of recent clinical isolates of pneumococci to the investigational cephalosporin cefditoren; Karlowsky JA et al.; From February to June 2000, 2,597 isolates of Streptococcus pneumoniae were prospectively collected from 146 clinical laboratories across the United States (US) and tested to evaluate the in vitro activity of cefditoren, an investigational oral cephalosporin . In all, 2,492 isolates (96.0%) had a cefditoren MIC of 0.5 microg/mL or less, 74 isolates (2.8%) had an MIC of 1 microg/mL, 30 isolates (1.2%) had an MIC of 2 microg/mL, and 1 isolate (<0.1%) had an MIC of 4 microg/mL . Among the beta-lactams tested, the rank order of potency (MIC(90,) microg/mL) was cefditoren (0.5) > ceftriaxone (1) > amoxicillin-clavulanate (2) > cefuroxime (4) > cefprozil (8) . Penicillin-resistant isolates (n = 443; 17.1%) were inhibited by lower concentrations (MIC(90,) microg/mL; MIC range,) of cefditoren (1; 0.03-4) than ceftriaxone (2; 0.25- > 2), amoxicillin-clavulanate (8; 0.5- > 8), cefuroxime (16; 2- > 16), and cefprozil (32; 2- > 32) . Cefditoren MIC(90)s against cefuroxime-resistant (n = 640) and ceftriaxone-resistant (n = 89) isolates were 1 and 2 microg/mL, respectively . All isolates with reduced susceptibility to cefditoren (MIC, 2 or 4 microg/mL; n = 31) were resistant to penicillin, cefuroxime, and ceftriaxone . The potent in vitro activity of cefditoren against a recent US collection of pneumococci as demonstrated in this study supports its continued development for oral empiric therapy in outpatients with respiratory tract infections.

Zhonghua Jie He He Hu Xi Za Zhi, 1999 Feb, 22(2), 88 - 91
{A clinical study of bacterial infection in patients with chronic obstructive pulmonary disease}; Zhao M et al.; OBJECTIVE: To investigate the association of bacteriologic characteristics and bacterial infection in small airway disease . METHODS: Fiberoptic bronchoscopy and ultrathin fiberoptic bronchoscopy were performed on outpatients with COPD and chronic bronchitis both during stable stage and acute exacerbation . Samples were obtained from both large and small airways by protective specimen brush, and bacteria were cultured quantitatively . RESULTS: The positive rates for pathogens in patients with COPD and chronic bronchitis during acute exacerbation were 26.6% (8/30) and 23.5% (5/17) respectively . Major pathogens in acute COPD include Staphylococcus aureus, Streptococcus pneumoniae, Hemophilus influenzae, Moraxella catarrhalis, and Pseudomonas aeruginosa . All of the pathogens were present in large airways, with 2 strains present in small airways concurrently . The positive rates for pathogens in stable COPD and chronic bronchitis were 24.0% (6/24) and 11.7% (2/17) respectively . Major pathogens found in stable COPD include Staphylococcus epidermis, Micrococcus and Streptococcus pneumoniae . The bacteria were less than 10 x 10(3) cfu/ml, present mainly in large airways . There was no significant difference in the extent of small airway diseases between COPD with bacterial infection and that without bacterial infection (P > 0.05) . CONCLUSIONS: Bacterial infection is not a major pathogenic factor in stable COPD . There is no direct cause-and-effect relationship between bacterial infection and the extent of small airway diseases in patients with COPD.

J Biochem (Tokyo), 2002 Feb, 131(2), 183 - 91
Molecular characterization of a novel beta1,3-galactosyltransferase for capsular polysaccharide synthesis by Streptococcus agalactiae type Ib; Watanabe M et al.; A group B streptococcus, Streptococcus agalactiae type Ib, produces a high-molecular-weight polysaccharide consisting of the following pentasaccharide repeating unit: -->4)-{alpha-D-NeupNAc-(2-->3)-beta-D-Galp-(1-->3)-beta-D-GlcpNAc-(1-->3)}-beta-D-Galp-(1-->4)-beta-D-Glcp-(1--> . The type-specific capsular polysaccharide (CP) synthesis (cps) genes of this strain were cloned and analyzed . A cloned 10-kb DNA fragment contained cpsIbE to L and neu (neuraminic acid synthesis gene) B . Comparison of the gene products with those of S . agalactiae type Ia, which has a similar but distinct CP, showed that the translation products of cpsIa and cpsIb genes exhibited very high homology except for those of cpsJ and K . In the type Ia strain, cpsIaJ encodes beta1,4-galactosyltransferase, which catalyzes the transfer of galactose as the fourth monosaccharide of the sugar repeating unit . In the type Ib CP, this galactose forms a beta1,3-linkage to GlcNAc . The low homology between the type Ia and Ib CpsJs seems to reflect this difference . By enzymatic activity measurement, the cpsIbJ product was found to display beta1,3-galactosyltransferase activity . Furthermore, hydrophobic cluster analysis clarified the similarities and differences of the structures in N-terminal regions, including the DXD motif, between the galactosyltransferases.

J Dent Res, 2002 Jan, 81(1), 48 - 52
Humans immunized with Streptococcus mutans antigens by mucosal routes; Childers NK et al.; Strategies aimed at the prevention of Streptococcus mutans infection and dental caries include mucosal immunization, which results in salivary anti-S . mutans responses . The purpose of this study was to evaluate the effectiveness of nasal vs . tonsillar immunization with S . mutans antigens in inducing salivary immune responses . Twenty-one adult subjects were immunized twice, within a seven-day interval, with a glucosyltransferase-enriched preparation (E-GTF) administered by nasal or tonsillar topical spray . Parotid saliva, nasal wash, and serum were collected prior to and at one- to two-week intervals for 3 months following immunization and were assayed by ELISA for anti-E-GTF activity . Results were analyzed by means of the mixed-models procedure with p < 0.05 level of significance . Significantly higher anti-E-GTF responses were detected in saliva and nasal wash samples from the group immunized by the nasal compared with the tonsillar route, indicating that nasal immunization was more effective in inducing mucosal responses in adults.

World J Gastroenterol, 1998 Jun, 4(3), 234 - 237
Detection of bacterial DNA from cholesterol gallstones by nested primers polymerase chain reaction; Wu XT et al.; AIM:To search for bacterial DNA sequences in cholesterol gallstones with negative bacterial culture.METHODS:DNA was extracted from cholesterol gallstones in gallbladders and nested primers polymerase chain reaction (NP-PCR) was used to amplify bacterial gene fragments for identifying the existence of bacteria . The samples of bacterial DNA extracted from potentially causative or unrelated living bacteria were amplified in vitro as the standard markers and comparative 16S ribosomal RNA sequence analysis was made for bacterial identification.RESULTS:The gallbladder gallstones of 30 patients were analyzed and bacterial DNA was found in 26 patients . Among them, gallstones with cholesterol content between 30%-69% were seen in 5 (5/5) patients, 70%-90% in 11(11/14) patients, and more than 90% in 10(10/11) patients . There was no difference either in cholesterol and water content of gallstones or in harboring bacterial DNA of gallstones.E.coli-related DNA fragments appeared in the stones of 8 (26.67%) patients; propionibacteria type DNA in 7 (23.33%); and harbored bacterial gene fragments in 2 patients, similar to Streptococcus pyogenes . A more heterogenous sequence collection was found in 7 (23.33%) patients, which could belong to multiple bacterial infections.Two (6.67%) patients had bacterial DNA with low molecular weight which might be related to some unidentified bacteria.CONCLUSION:Most cholesterol gallstones harbor bacterial DNA.It is important to determine whether these microorganisms are innocent bystanders or active participants in cholesterol gallstone formation.

Pediatr Radiol, 2002 Jan, 32(1), 16 - 21 Epub 2001 Nov 15.
The value of early CT in complicated childhood pneumonia; Tan Kendrick AP et al.; OBJECTIVE: To investigate the value of CT in complicated childhood pneumonia and its role in early intervention when chest radiography (CXR) is non-contributory . MATERIALS AND METHODS: Forty-two immunocompetent children, aged 1-11 years, admitted for community-acquired pneumonia from October 1997 to September 1999, had 42 contrast-enhanced CT scans and frontal chest radiographs on the same day, which were assessed independently . CT was performed when the patient remained unwell and the CXR images showed failure of resolution despite 7-10 days of antibiotics and/or drainage with urokinase therapy . RESULTS: Compared to CT, CXR revealed suboptimal accuracy rates of lobar involvement (84%), chest tube placement (73%), fluid loculation (42%), abscess formation (40%) and bronchopleural fistulae (33%) . It could not assess parenchymal or pleural complications such as cavitary necrosis, early abscess formation, empyemas or pericardial effusions . On the basis of the CT findings and poor clinical progress, 16 patients underwent surgical intervention with the aid of video-assisted thorascopic surgery (VATS) . The CT features correlated well with surgical findings . Ten cases required pleural decortication while six with destructive or necrotic lung lesions had surgical resection . Debridement was difficult when the pleura had become thick and fibrotic . Streptococcus pneumoniae was the offending organism in 81% of cases . The right side was affected in 67% of cases . CONCLUSIONS: In complicated childhood pneumonia, CT is far superior to CXR in revealing pleural and parenchymal complications, which may require early surgical intervention.

J Indian Soc Pedod Prev Dent, 2001 Sep, 19(3), 92 - 102
A comparative evaluation of three fluoride varnishes: an in-vitro study; Munshi AK et al.; This study was conducted to compare the caries preventive efficacy of Fluoritop - SR; the first fluoride varnish manufactured in India with Fluor Protector and Bifluorid 12, the two commercially available fluoride varnishes which have to be imported from other countries and are cost prohibitive . The demineralization inhibitory effects and the antibacterial effects on Streptococcus mutans were studied (in vitro) . Calcium and Phosphorus dissolutions were estimated as a measure of the demineralization inhibitory effect . Antibiotic sensitivity tests using the serial tube dilution method and disk diffusion method were used to evaluate the antibacterial effects of the fluoride varnishes . Of the three varnishes, Fluor Protector was seen to exhibit the highest demineralization inhibitory effect, while Fluoritop-SR was found to be comparable to Bifluorid 12 in its caries protective effects.

J Pediatr, 2002 Jan, 140(1), 93 - 6
Sudden death in patients with right isomerism (asplenism) after palliation; Wu MH et al.; OBJECTIVE: To define the risk of sudden death in patients with right isomerism (asplenia) after palliation . STUDY DESIGN: A total of 154 patients with right isomerism was identified from 1980 to 1999 . Sudden death was defined as acute cardiovascular collapse from which death occurred within 24 hours . RESULTS: A total of 620 patient-years were evaluated . The 1-year and 5-year survival was 72% and 50%, respectively . There were 22 sudden unexpected deaths (14%, 35 events/1000 patient-years) . Sudden death tended to occur in infancy or early childhood (12 +/- 9 months; median, 9 months) . The mechanisms were classified as sudden tachyarrhythmic in 2 (9%), sudden cardiac but nontachyarrrhythmic (sudden onset severe cyanosis) in 15 (68%), and sudden noncardiac in 5 (23%)(fulminant sepsis with positive blood culture: streptococcus pneumonia (3), Escherichia coli (1), and yeast-like organism (1)) . The incidence of sudden death steadily decreased with age until the age of 3 years . CONCLUSION: The incidence of sudden death in patients with right isomerism after initial palliation remained high . Sudden death was related to complex cardiac anomalies, a susceptibility to fulminant infection, and arrhythmia.

J Antimicrob Chemother, 2002 Feb, 49(2), 399 - 401
In vitro activity of telithromycin against Streptococcus pneumoniae resistant to other antibiotics, including cefotaxime; Fuchs PC et al.; A total of 407 isolates of Streptococcus pneumoniae, most of which were resistant to one or more antibiotics, were tested for susceptibility to telithromycin and four other agents . Telithromycin was the most active agent tested, with 98% of isolates susceptible to < or = 1.0 mg/L . For strains resistant to the other antibiotics, susceptibility to telithromycin ranged from 98.6% for strains resistant to trimethoprim/sulfamethoxazole to 94.4% for strains resistant to cefotaxime.

J Antimicrob Chemother, 2002 Feb, 49(2), 331 - 5
Beta-lactam modification of the bacteraemic profile and its relationship with mortality in a pneumococcal mouse sepsis model; Yuste J et al.; A sepsis BALB/c mice model was used to investigate the relationship between mortality and the bacteraemic profile produced by a serotype 6B Streptococcus pneumoniae clinical isolate (MIC/MBC of amoxicillin 4/4 mg/L and of cefotaxime 2/4 mg/L) . Animals were treated subcutaneously with doses of amoxicillin or cefotaxime ranging from 6.25 to 50 mg/kg tds for 48 h, starting 1 h after intraperitoneal inoculation (2 x 10(7) cfu/mouse) . Blood cultures were carried out daily over 15 days . A survival rate of 100% was obtained with amoxicillin 25 mg/kg and of 60% with cefotaxime 50 mg/kg . A statistically significant (P = 0.012) relationship was found between the maximum cfu/mL in blood and mortality . A maximum log cfu/mL of 6.5 was associated with an 84% probability of death.

J Comp Pathol, 2002 Jan, 126(1), 57 - 65
Streptococcus suis serotype 2 infection in pigs: new diagnostic and pathogenetic aspects; Madsen LW et al.; In a study aimed at improving the diagnosis and elucidating the pathogenesis of Streptococcus suis serotype 2 infection in pigs, a combination of bacterial culture and histopathological and immunohistochemical examination was applied to a range of tissues from 42 naturally infected pigs with typical macroscopical lesions . By culture, 21 pigs (50%) were shown to be systemically infected with S . suis serotype 2; seven (17%) were infected with S . suis serotype 7, two with other bacteria, and 12 yielded no bacterial pathogens . The highest isolation rate for S . suis serotype 2 was obtained from the lateral cerebral ventricles and other regions of the brain, whereas the bacterium was only rarely isolated from the liver or spleen . Immunohistochemically, a diagnosis of S . suis serotype 2 infection was obtained in two of 12 (17%) animals from which no pathogens had been cultured . Moreover, immunohistochemistry differed from culture in revealing a greater number of positive tissue specimens . The microanatomical distribution of bacteria pointed toward the pharyngeal and palatine tonsils as principal portals of entry . Furthermore, S . suis serotype 2 bacteria were frequently identified immunohistochemically in the regional lymph nodes of the upper respiratory tract, possibly reflecting primary lymphogenous spread from the tonsils.

Cardiol Young, 2001 Nov, 11(6), 647 - 52
Cardiac complications in children following infection with varicella zoster virus; Abrams D et al.; Infection with varicella zoster virus, leading to chicken pox in susceptible hosts, is usually a benign self-limiting disease conferring immunity in those affected . Cardiac complications are rare, but when present may lead to severe morbidity or mortality . We have recently encountered three children, all of whom developed significant cardiac complications secondary to infection with varicella . Myocarditis has long been associated with such infection . The pathological mechanism is presumed similar to other cardiotropic viruses, where both direct cytopathic and secondary auto-immune effects contribute to myocardial cellular destruction and ventricular dysfunction . Complications include arrhythmias and progression to dilated cardiomyopathy . Pericarditis, and secondary pericardial effusion, related to infection with the virus is most commonly associated with secondary bacterial infiltration . Both cardiac tamponade and chronic pericardial constriction may result . Endocarditis complicating varicella has only been described in the last fifteen years, and is associated with the emergence of virulent strains of both streptococcus and staphylococcus, the two organisms most commonly associated with endocarditis . The exact mechanism by which varicella causes secondary bacterial endocarditis remains unclear . Whilst cardiac complications of infection with the varicella zoster virus are rare, the resulting complications are potentially life threatening . Evidence of varicella-induced carditis must be aggressively pursued in any child with signs of acute cardiac decompensation in whom chicken pox is confirmed or suspected.

J Indian Soc Pedod Prev Dent, 1998 Jun, 16(2), 56 - 60
Relationship between caries status, colony forming units (cfu) of Streptococcus mutans and Snyder caries activity test; Ali YA et al.; It is a well established fact that dental caries is caused by streptococcus mutans . For qualitative and quantitative analysis of streptococcus mutans, saliva samples are often preferred and are processed according to Kohler and Brathall method . In the present study an attempt is made to relate caries status (caries free, average caries, and rampant caries group) with cfu counts of streptococcus mutans and Snyder test . The streptococcus mutans were isolated using MSB agar and cfu were determined of each individual from different caries groups . The saliva of the same individual was drooled into a culture bottle containing Snyder test agar and extent of colour change was observed after 24, 48, and 72 hours incubated at 37 degrees C . The time and extent of colour change determined the conduciveness of diet . It has been observed that caries free individuals have low cfu count and their diet was mild or moderately conducive, while the individuals having average caries had medium cfu count and their diet was moderately-high conducive . In rampant caries, individuals however the cfu count were high and the diet was highly conducive . In caries free, average caries and rampant caries group 40, 60, and 80 per cent samples showed colour change, in Snyder test up to full length in 72 hours respectively . Thus a definite correlation exists between caries status, cfu count of streptococcus mutans and Snyder caries activity test.

J Biol Chem, 2002 Apr 12, 277(15), 12642 - 8 Epub 2002 Jan 25.
Streptococcal beta protein has separate binding sites for human factor H and IgA-Fc; Areschoug T et al.; The group B streptococcus (GBS) is the most important cause of life-threatening bacterial infections in newborn infants . Protective immunity to GBS infection is elicited by several surface proteins, one of which, the beta protein, is known to bind human IgA-Fc . Here, we show that the beta protein also binds human factor H (FH), a negative regulator of complement activation . Absorption experiments with whole human plasma demonstrated binding of FH to a GBS strain expressing beta protein but not to an isogenic beta-negative mutant . This binding was due to a direct interaction between beta and FH, as shown by experiments with purified proteins . Inhibition tests and studies with beta fragments demonstrated that FH and IgA-Fc bind to separate and nonoverlapping regions in beta . Heparin, a known ligand for FH, specifically inhibited the binding between beta and FH, suggesting that FH has overlapping binding sites for beta and heparin . Bacteria-bound FH retained its complement regulatory activity, implying that beta-expressing GBS may use bound FH to evade complement attack . The finding that beta protein binds FH adds to a growing list of interactions between human pathogens and complement regulatory proteins, supporting the notion that these interactions are of general importance in bacterial pathogenesis.

Zhonghua Kou Qiang Yi Xue Za Zhi, 2001 May, 36(3), 202 - 5
{Preliminary study on the rules of streptococcus mutans reactive oxygen species metabolism}; Wang C et al.; OBJECTIVE: To study the rules of Streptococcus mutans reactive oxygen species metabolism and its enzymatic basis, and to investigate its significance intermediate to plaque microbial ecology . METHODS: Electron spin trapping method was used to measure reactive oxygen species produced by Streptococcus mutans in the different incubation conditions, and evaluate the efficicay of NADH to hypoxanthine-xanthine oxidase and Fe(2+)-H2O2 system . RESULTS: Electron spin resonance (ESR) spectrum of DMPO-O2- and DMPO-OH . and superoxide dismutase were obtained in Streptococcus mutans culture fluid, these spectrum were strengthened by exogenous sugar, and disappeared when methylene blue was added to culture fluid, but that spectrum was not significantly changed by NADH . ESR spectrum of hypoxanthine-xanthine oxidase and Fe(2+)-H2O2 system were significantly reduced or disappeared by NADH . CONCLUSION: These results suggest that there are O2- and OH in Streptococcus mutans metabolism, and they may come mainly from the reaction catalyzed by NADH oxidase.

Microb Pathog, 2002 Feb, 32(2), 71 - 85
Characterization and immunogenicity of pyrogenic mitogens SePE-H and SePE-I of Streptococcus equi; Artiushin SC et al.; Two pyrogenic mitogens, SePE-H and SePE-I, were characterized in Streptococcus equi, the cause of equine strangles . SePE-H and SePE-I have molecular masses of 27.5 and 29.5 kDa, respectively, and each is almost identical to its counterpart in Streptococcus pyogenes M1 . Both genes are adjacent to a gene encoding a phage muramidase of 49.7 kDa and are located immediately downstream from a phage genomic sequence almost identical to a similar phage sequence in S . pyogenes M1 . Strong mitogenic responses were elicited by both proteins from horse peripheral blood mononuclear cells . However, although both were pyrogenic for rabbits, only SePE-I was pyrogenic in ponies . Convalescent sera contained antibody to each mitogen and horses recovered from strangles or immunized with SePE-I were resistant to the pyrogenic effect of SePE-I . The immunogenicity of SePE-I suggests that it should be included in new generation strangles vaccines . In isolates of S . equi sepe-I and sepe-H were consistently present but they were absent from the closely related Streptococcus zooepidemicus, suggesting that phage mediated transfer was an important event in the formation of the clonal, more virulent, S . equi from its putative S . zooepidemicus ancestor .

Arch Pediatr, 2001 Dec, 8(12), 1325 - 32
{Severe cutaneous Streptococcus pyogenes infections in the child: results of a multicenter survey}; Marie-Cardine A et al.; To assess pediatric cases of severe cutaneous infections due to Streptococcus pyogenes . Since the beginning of 1980, the incidence of cellulitis and necrotizing fasciitis due to S . pyogenes has increased in adults . Serotyping of obtained isolates are in most cases M1, M3 or M5 protein . PATIENTS AND METHOD: A retrospective (1990-2000) survey was carried out in pediatric hospital centers . RESULTS: Three cases of necrotizing fasciitis and 15 of cellulitis were observed . In 30% of the cases, vancella lesions were associated; in the other cases, minor wounds were the site of the infection . Bacteriologic diagnosis was made by local samples in 14 cases; blood cultures were positive in four cases . In 11 cases, initial intravenous treatment consisted of third generation cephalosporin, in six cases of penicillin M or G and in one case of fusidic acid . In the second time, penicillin M was perfused in the majority of the cases . Mean duration of intravenous antibiotics perfusion was 15 days . There were no sequelae or death in this survey . CONCLUSIONS: Despite this study had limited epidemiological characteristics, it confirms that these two infections are rare . The frequency is probably underestimated, due to the difficulty in performing a diagnosis . The major site of infection was the varicella lesion . These two infections are so similar that it is frequent to mistake one infection for the other . Nonsteroidal anti-inflammatory drugs and site of infections did not influence prognosis . The treatment of cellulitis is penicillinotherapy whereas in necrotizing fasciitis early major surgery is often correlated with the rate of survival.

Clin Infect Dis, 2002 Mar 1, 34 Suppl 1, S27 - 46
Clinical relevance of macrolide-resistant Streptococcus pneumoniae for community-acquired pneumonia; Lynch III JP et al.; Macrolides are often the first choice for empirical treatment of community-acquired pneumonia . However, macrolide resistance among Streptococcus pneumoniae has escalated at alarming rates in North America and worldwide . Macrolide resistance among pneumococci is primarily due to genetic mutations affecting the ribosomal target site (ermAM) or active drug efflux (mefE) . Prior antibiotic exposure is the major risk factor for amplification and perpetuation of resistance . Clonal spread facilitates dissemination of drug-resistant strains . Data assessing the impact of macrolide resistance on clinical outcomes are spare . Many experts believe that the clinical impact is limited . Ribosomal mutations confer high-grade resistance, whereas efflux mutations can likely be overridden in vivo . Favorable pharmacokinetics and pharmacodynamics, high concentrations at sites of infections, and additional properties of macrolides may enhance their efficacy . In this article, we discuss the prevalence of macrolide resistance among S . pneumoniae, risk factors and mechanisms responsible for resistance, therapeutic strategies, and implications for the future.

Clin Infect Dis, 2002 Mar 1, 34 Suppl 1, S17 - 26
Appropriate use of antimicrobials for drug-resistant pneumonia: focus on the significance of beta-lactam-resistant Streptococcus pneumoniae; File Jr TM; The beta-lactam antibiotics (penicillins and cephalosporins) are commonly prescribed for the treatment of community-acquired pneumonia . However, Streptococcus pneumoniae, the most common etiologic agent of community-acquired pneumonia, has become increasingly resistant to beta-lactams over the past decade . The results of several studies suggest that penicillins remain effective for streptococcal pneumonia when the infecting pathogen has a minimal inhibitory concentration (MIC) </=2 microgram/mL, presumably because the pharmacokinetic and pharmacodynamic parameters associated with current dosing regimens are still sufficient . However, when the MIC >/=4 microgram/mL, increased rates of mortality (for patients who survive their first 4 days of hospitalization) may occur . Currently, 3.5%-7.8% of S . pneumoniae clinical isolates have MICs that fall in this latter class, but these rates may rise in the future . The clinical relevance of in vitro resistance may be related to at least 3 factors: concordance of antimicrobial therapy, severity of illness, and virulence.

Clin Infect Dis, 2002 Mar 1, 34 Suppl 1, S1 - 3
The continuing challenge of lower respiratory tract infections; Moellering Jr RC; Lower respiratory tract infections have been a major cause of morbidity and mortality among humans since the dawn of history . The initial hope that the era of antibiotics would remove this scourge has been replaced by the more realistic view that although antimicrobial agents represent a major therapeutic advance, they have not yet solved all of the problems of lower respiratory tract infections . The pneumococcus, for example, causes mortality in a certain number of patients despite antimicrobial therapy . An even greater challenge is being imposed by the emergence of antimicrobial resistance among important bacterial pathogens, especially Streptococcus pneumoniae.

J Infect Chemother, 2001 Dec, 7(4), 239 - 42
Random amplified polymorphic DNA analysis applied to acute otitis media caused by penicillin non-susceptible Streptococcus pneumoniae; Nakashima T et al.; The spread of penicillin non-susceptible Streptococcus pneumoniae (PNSSP) is an emerging problem for the treatment of acute otitis media (AOM) . Attendance of children at day care centers, as well as the spread of PNSSP, is a risk factor for AOM . The status of the spread of PNSSP during the acute infection phase of AOM has not been evaluated . We examined the clonality of samples from seven children in a day care center who simultaneously developed AOM caused by PNSSP . The seven isolates from the children, and six control samples were grouped by serotyping, by determining resistance to antimicrobial agents, and by genotyping, carried out by sequencer-based random amplified polymorphic DNA (RAPD), and validated by bootstrap analysis . There was no evidence to indicate the direct dissemination of PNSSP among these patients in the day care center, although the simultaneous occurrence of PNSSP AOM had initially suggested a clonal outbreak . The possible presence of a common ancestral strain suggested the importance of surveillance during the carrier state . The result of RAPD genotyping was highly reproducible, as validated by the high bootstrap score . The use of an automated sequencer, in combination with a careful choice of primers, and commercially established kits, played a significant role in the reproducibility of the studies.

J Infect Chemother, 1999 Dec, 5(4), 217 - 219
Causative bacteria of respiratory tract infections in Kuwait by quantitative culture of sputum; Ahmed K et al.; To determine the bacterial etiology of lower respiratory tract infections in Kuwait, we performed quantitative culture of sputum and measured the susceptibilities of the isolated bacteria against different antibiotics . A total of 140 sputum samples were collected for a period of 14 months for the study . Single and multiple pathogens as a cause of infection were isolated from 55 and 15 samples, respectively . A total of 53.8% of Streptococcus pneumoniae were penicillin-resistant and 52% and 57% of Hemophilus influenzae and Moraxella catarrhalis were beta-lactamase positive, respectively . We concluded that the major pathogens of respiratory tract infections in Kuwait were H . influenzae, M . catarrhalis, S . pneumoniae, and Pseudomonas aeruginosa, and there was an increased resistance among the isolated bacteria against commonly used antibiotics.

J Infect Chemother, 1999 Jun, 5(2), 101 - 103
Bactericidal activity of quinolones against Streptococcus pneumoniae by time-kill methodology; Rodriguez JC et al.; The increase in Streptococcus pneumoniae strains resistant to the drugs traditionally used in treatment has made the search for alternative agents necessary . We studied the bactericidal activity of ciprofloxacin, ofloxacin, levofloxacin, sparfloxacin, and trovafloxacin against six penicillin-resistant Streptococcus pneumoniae strains, using time-kill methodology . Our results indicate that trovafloxacin and sparfloxacin had greater bactericidal activity than ciprofloxacin, ofloxacin, and levofloxacin against all the strains tested, since these two quinolones showed bactericidal activity against all six strains at concentrations of not more than 4 mg/l . Ciprofloxacin and levofloxacin did not have bactericidal activity, in the range of concentrations of antibiotics used, against any of the strains studied; when such activity did exist, the concentration of antibiotic used was higher.

Pediatr Res, 2002 Feb, 51(2), 220 - 7
Effects of surfactant lipids and surfactant protein a on host defense functions of rat alveolar macrophages; Golioto A et al.; Survanta is commonly used as replacement therapy in newborn infants suffering from surfactant deficiency . We investigated the effects of Survanta and surfactant-like liposomes in the presence and absence of surfactant protein A (SP-A) on host defense functions of rat alveolar macrophages (AM) . Phagocytosis of Streptococcus pneumoniae by AM was significantly inhibited in the presence of 100 microg/mL of Survanta . The ability of SP-A to enhance phagocytosis of S . pneumoniae was significantly compromised upon exposure to either Survanta or liposomes, although the overall level of phagocytosis remained higher than in the absence of SP-A . This inhibitory effect was not overcome by opsonization of the bacteria with SP-A before incubation with Survanta and AM . We also found that the ability of SP-A to mediate the association of group B Streptococcus with AM was compromised to a significant degree when exposed to either Survanta or liposomes in concentrations of 150 and 250 microg/mL . However, at most concentrations of Survanta or liposomes tested, the presence of SP-A resulted in significantly higher levels of bacterial association . These data show that Survanta and surfactant-like lipids suppress host defense functions of AM in the presence and absence of SP-A in vitro, although SP-A continues to enhance host defense functions overall.

Lancet, 2002 Jan 12, 359(9301), 124 - 9
Streptolysin S and necrotising infections produced by group G streptococcus; Humar D et al.; BACKGROUND: We encountered three patients with severe necrotising soft tissue infections due to beta-haemolytic group G streptococcus . Due to strong clinical similarities with invasive infections produced by group A streptococcus, we investigated a potential link of shared beta-haemolytic phenotype to disease pathogenesis . METHODS: Hybridisation, DNA sequencing, targeted mutagenesis, and complementation studies were used to establish the genetic basis for group G streptococcus beta-haemolytic activity . The requirement of group G streptococcus beta-haemolysin in producing necrotising infection was examined in mice . FINDINGS: Each patient had an underlying medical condition . beta-haemolytic group G streptococcus was the sole microbial isolate from debrided necrotic tissue . The group G streptococcus chromosome contained a homologue of the nine-gene group A streptococcus sag operon encoding the beta-haemolysin streptolysin S (SLS) . Targeted mutagenesis of the putative SLS structural gene sagA in group G streptococcus eliminated beta-haemolytic activity . Mice injected subcutaneously with wild-type group A streptococcus or group G streptococcus developed an inflammatory lesion with high bacterial counts, marked neutrophil infiltration, and histopathological evidence of diffuse tissue necrosis . These changes were not found in mice injected with the isogenic group A streptococcus or group G streptococcus SLS-negative mutants . INTERPRETATION: In patients with underlying medical conditions, beta-haemolytic group G streptococcus can produce necrotising soft tissue infections resembling those produced by group A streptococcus . The beta-haemolytic phenotype of group G streptococcus is produced by the exotoxin SLS, encoded by a functional homologue of the nine-gene group A streptococcus sag operon . SLS expression contributes to the pathogenesis of streptococcal necrotising soft tissue infection.

J Dent Res, 2001 Dec, 80(12), 2060 - 5
Oral colonization of Streptococcus mutans in six-month-old predentate infants; Wan AK et al.; We hypothesize that S . mutans colonization occurs more frequently in pre-term children due to their relative immaturity . In this study of 172 predentate, six-month-old infants, we found that 50% of pre-term and 60% of full-term children harbored S . mutans . The colonization was confirmed by repeat sampling . Although there were minor differences, factors associated with S . mutans infection in pre-term and full-term infants were generally similar . In both groups, increased frequency of sugar was ranked the most important factor (p < 0.001), followed by breast-feeding (p < 0.001), and habits which allowed saliva transfer from mother to infant (p < 0.01) . By contrast, non-colonization of S . mutans was associated with multiple courses of antibiotics (p < 0.001) . Compared with pre-term children, there were higher percentages of full-term who had night feedings and consumed sugar during sleep times . Mothers with infected infants had S . mutans levels > 5 x 10(5) CFU/mL saliva (p < 0.001), poorer oral hygiene, more periodontal disease, and lower socio-economic status (p < 0.02) and snacked frequently (p < 0.001), compared with mothers with non-infected infants.

Vet Rec, 2001 Dec 22-29, 149(25), 768 - 70
Use of sterile maggots to treat panniculitis in an aged donkey; Bell NJ et al.; An aged female donkey developed a severe, localised, suppurative panniculitis secondary to a skin wound . Bacterial culture of swabs taken from the wound gave a profuse growth of multi-drug-resistant Pseudomonas aeruginosa, a profuse growth of Escherichia coli and a moderate growth of beta-haemolytic Streptococcus species . The lesion did not respond to conventional medical and surgical treatment and continued to progress . Six applications of sterile larvae (maggots) of the common greenbottle, Lucilia sericata, were used to debride the wound successfully.

Rinsho Ketsueki, 2001 Nov, 42(11), 1111 - 6
{CD34+ progenitor cell transplantation from HLA-mismatched donors to two patients with chronic active Epstein-Barr virus infection}; Yasui M et al.; We report two boys with chronic active Epstein-Barr virus infection (CAEBV) refractory to conventional chemotherapy, who received HLA-mismatched allografts of CD34-positive progenitor cells from their fathers . One patient developed veno-occlusive disease (VOD) of the liver on day 18 after transplantation and died on day 26 . The other patient received the allograft during partial remission . Although he suffered recurrent infections due to Streptococcus viridans, he is now doing well 23 months after transplantation . CAEBV refractory to chemotherapy is considered to be a fatal EBV-infected T/NK-cell lymphoproliferative disease, and our experiences suggest that CD34-positive progenitor cell transplantation for patients with CAEBV lacking HLA-matched donors may be a feasible and useful treatment . However, the timing of transplantation is considered to be critical, and should be performed when the patient is in good clinical condition.

Vnitr Lek, 2001 Nov, 47(11), 781 - 9
{Prevention of septic conditions in adult patients with functional hyposplenism and after splenectomy}; Racil Z; Splenectomy and functional hyposplenism predispose the patient to serious life threatening infections . The most frequent pathogenic organism which causes serious infections in splenectomized adults or hyposplenic patients is Streptococcus pneumoniae . In the etiology of these conditions however also a number of other bacterial and non-bacterial microorganisms may be involved . The risk of serious infections and deaths may be markedly reduced by simple preventive measures, education of the patient, vaccination and antibiotic prophylaxis.

Glycobiology, 2001 Dec, 11(12), 1017 - 24
Site-directed mutation of conserved cysteine residues does not inactivate the Streptococcus pyogenes hyaluronan synthase; Heldermon CD et al.; Hyaluronan synthase (HAS), the enzyme responsible for the production of hyaluronic acid (HA), is a well-conserved membrane-bound protein in both prokaryotes and eukaryotes . This enzyme performs at least six discrete functions in producing a heterodisaccharide polymer of several million molecular weight and extruding it from the cell . Among the conserved motifs and domains within the Class I HAS family are four cysteine residues . Cysteines in many proteins are important in establishing and maintaining tertiary structure or in the coordination of catalytic functions . In the present study we utilized a combination of site-directed mutagenesis, chemical labeling, and kinetic analyses to determine the importance of specific Cys residues for catalysis and structure of the HA synthase from Streptococcus pyogenes (spHAS) . The enzyme activity of spHAS was partially inhibited by cysteine-reactive chemical reagents such as N-ethylmaleimide . Quantitation of the number of Cys residues modified by these reagents, using MALDI-TOF mass spectrometry, demonstrated that there are no stable disulfide bonds in spHAS . The six Cys residues of spHAS were then mutated, individually and in various combinations, to serine or alanine . The single Cys-mutants were all kinetically similar to the wild-type enzyme in terms of their V(max) and K(m) values for HA synthesis . The Cys-null mutant, in which all Cys residues were mutated to alanine, retained approximately 66% of wild-type activity, demonstrating that despite their high degree of conservation within the HAS family, Cys residues are not absolutely necessary for HA biosynthesis by the spHAS enzyme.

J Med Assoc Thai, 2001 Oct, 84(10), 1502 - 8
Streptococcus suis infection in northern Thailand; Fongcom A et al.; A ten-case report of Streptococcus suis infection was reported in Lamphun, northern Thailand from 1999 to 2000 . Ten patients were admitted to Lampoon Provincial Hospital with a history of high fever, watery diarrhea, severe myalgia and ecchymosis rashes . The disease progressed rapidly and all patients died within 24-48 hours after admission from complications such as disseminated intravascular coagulation (DIC), acute renal failure (ARF) or acute respiratory distress syndrome (ARDS) . Epidemiological data revealed that all cases were healthy men aged between 40-49, residing in the same geographical area and had a history of raw pork or uncooked pig's blood consumption prior to their illnesses . Blood culture and genetic investigation (16 s rRNA polymerase chain reaction with restriction enzyme PstII) confirmed diagnoses of the same species of Streptococcus suis infections.

J Med Assoc Thai, 2001 Oct, 84(10), 1422 - 9
Prevalence and risk factors of Streptococcus agalactiae (group B) colonization in mothers and neonatal contamination at Srinagarind Hospital; Werawatakul Y et al.; From July 1999 to November 1999, 901 pregnant women at Srinagarind Hospital, who fulfilled the criteria and had signed consent forms, were cultured from the lower vagina and perineum for group B streptococcus (GBS) . Their neonates were also cultured from ears and anuses within 30 minutes after birth . There were 56 cases or 6.22 per cent colonization in pregnant mothers at the onset of labor and 14 cases or 1.55 per cent colonization in their neonates . Risk factors for GBS colonization in mothers were intrapartum fever and episiotomy . The risk factors for GBS colonization in the neonates were; 1 . husband's occupation, 2 . antepartum fever, 3 . intrapartum fever, 4 . postpartum morbidity and 5 . gestational age . No cases during the study period had clinical infection from GBS . The prevalence rate in this study was much lower than the United States but similar to many developing countries . At this moment, it is not possible to culture for GBS in all pregnant women in Thailand . Intrapartum antibiotic prophylaxis for GBS infection was recommended if, 1 . maternal fever was more than 38 degrees C, 2 . ruptured membranes of more than 18 hours and 3 . previous birth with neonatal GBS infection.

Clin Infect Dis, 2002 Mar 1, 34(5), 704 - 7 Epub 2002 Jan 17.
Distribution of penicillin-nonsusceptible pneumococcal clones in the Baltimore metropolitan area and variables associated with drug resistance; McEllistrem MC et al.; We assessed the distribution of the clonal groups (as determined by pulsed-field gel electrophoresis) of penicillin-nonsusceptible Streptococcus pneumoniae that caused invasive pneumococcal infection in the Baltimore metropolitan area during 1995 and 1996 . Although S . pneumoniae caused invasive disease in individuals from a variety of demographic groups and locations, strains isolated during the season in which respiratory infections are most common were more likely to be from clonal groups associated with penicillin resistance than from other groups.

Laryngoscope, 2001 Oct, 111(10), 1732 - 4
Pott's puffy tumor and epidural abscess arising from dental sepsis: a case report; Chandy B et al.; OBJECTIVE: To present an unusual case of two uncommon cranial complications of frontal sinusitis: Pott's puffy tumor and epidural abscess arising from frontal sinusitis of dental origin, and also two systemic complications of sinusitis: septicemia and empyema, all occurring in an immunocompetent patient . STUDY DESIGN: A 21-year-old man presented with a scalp swelling and epidural abscess . Magnetic resonance imaging and computed tomographic scans revealed unilateral opacification of the frontal sinus and an epidural abscess with a direct connection to the scalp abscess . Further history revealed that his symptoms occurred coincidentally with a tooth extraction 2 months before, and he was hospitalized soon after the tooth extraction for sepsis and a lung abscess . METHODS: A combined neurosurgical and otolaryngologic approach was required to treat the sinusitis and the associated epidural and scalp abscess . RESULTS: Cultures returned as Streptococcus intermedius from all three sites . The patient was free of disease at the 3-month follow-up . CONCLUSIONS: Odontogenic maxillary sinusitis is well documented; however, there is little reported of frontal sinusitis arising from dental disease . The prevalence of sinusitis of dental origin will be reviewed, including the microbiology of this particularly virulent organism that persisted despite earlier treatment with ampicillin . Also, the current thoughts on management of these cases will be discussed with particular reference to local therapy for sinusitis in addition to systemic treatment with antibiotics.

BMC Microbiol . 2001;1(1):33 . Epub 2001 Dec 17.
Mouse skin passage of a Streptococcus pyogenes Tn917 mutant of sagA/pel restores virulence, beta-hemolysis and sagA/pel expression without altering the position or sequence of the transposon; Eberhard TH et al.; BACKGROUND: Streptolysin S (SLS), the oxygen-stable hemolysin of Streptococcus pyogenes, has recently been shown to be encoded by the sagA/pel gene . Mutants lacking expression of this gene were less virulent in a dermonecrotic mouse infection model . Inactivation of the sagA/pel gene affect the expression of a variety of virulence factors in addition to the hemolysin . Insertion of a Tn917 transposon into the promoter region of the sagA/pel gene of S . pyogenes isolate CS101 eliminated expression of SLS, as well as decreased expression of the streptococcal pyrogenic exotoxin B, streptokinase and M protein . RESULTS: In this study a mouse skin air sac model was utilized to analyze the effect of biological pressures on expression of SLS and other sagA/pel regulated gene products . The insertion delayed the lethal effect of S . pyogenes in a mouse skin infection model . Despite this, bacteria could be cultured from the kidneys 72 hours post infection . These kidney-recovered isolates were beta-hemolytic despite the transposon being present in its original location and had equivalent virulence to the wild type isolate when re-injected into naive mice . Northern blot analysis of the kidney-recovered isolates confirmed that transcription of sagA/pel was restored; however the expression of all sagA/pel regulated genes was not restored to wild type levels . CONCLUSIONS: These results show that biological pressure present in the mouse can select for variants with altered expression of key virulence factor genes in S . pyogenes.

Clin Oral Investig, 2001 Dec, 5(4), 236 - 9
Antimicrobial activity of four root canal sealers against endodontic pathogens; Lai CC et al.; The antibacterial effects of various types of widely used endodontic sealers have not been compared systematically on facultative or obligate anaerobic endodontic pathogens . The aim of this study was to evaluate the antimicrobial properties of four commonly used endodontic sealers: two epoxy-resin-based sealers (AH26, AH plus), one zinc-oxide eugenol-based sealer (N2), and one calcium hydroxide-based sealer (Sealapex) . The testing microbes were four facultative anaerobic species (Streptococcus mutans, Streptococcus sanguis, Escherichia coli, and Staphylococcus aureus) and four obligate anaerobic species (Porphyromonas gingivalis, Porphyromonas endodontalis, Fusobacterium nucleatum, and Prevotella intermedia) . The freshly mixed sealers were placed into the prepared wells of agar plates inoculated with the test microorganisms . After varying periods of incubation (2 days for facultative anaerobic species and 7 days for obligate anaerobic species), the zones of growth inhibition were observed and measured . All the sealers were distinctly different from each other in their antimicrobial activity . The sealers showed different inhibitory effects depending on the types and bacterial strains . N2 containing formaldehyde and eugenol proved to be the most effective against the microorganisms . The extreme antimicrobial potency of this root canal sealer must be weighted against its pronounced tissue toxic effect.

J Med Assoc Thai, 2001 Sep, 84(9), 1246 - 50
Invasive pneumococcal infection and drug-resistant Streptococcus pneumoniae in Thai children; Pancharoen C et al.; Sixty-eight children with systemic Streptococcus pneumoniae infection were identified by hospital chart review between 1986-1997 . The age distribution varied from 2 days to 15 years, with a mean age of 3.3 years . There were 35 boys and 33 girls . Four clinical entities included 30 cases of meningitis, 20 cases of pneumonia, 10 cases of peritonitis and 8 cases of septicemia/bacteremia . Forty patients (58.8%) had underlying diseases . Seventeen patients (25.0%) developed early complications and the mortality rate was 8.8 per cent . The percentage of susceptible isolates to penicillin, chloramphenicol, cefotaxime/ceftriaxone, ciprofloxacin, imipenem and vancomycin were 69.6, 91.3, 100.0, 87.2, 100.0 and 97.1 per cent, respectively . There were six cases of drug-resistant S . pneumoniae (DRSP) infection; 3 cases of meningitis, one case of pneumonia, one case of infective endocarditis and one case of purpura fulminans . Our data indicate that S . pneumoniae infection is relatively serious and life-threatening . There is a trend of increasing prevalence of invasive pneumococcal and DRSP infections.

CMAJ, 2002 Jan 8, 166(1), 29 - 35
Human surveillance for West Nile virus infection in Ontario in 2000; Ford-Jones EL et al.; BACKGROUND: The first reports of West Nile virus (WNV) infection in the United States in 1999 prompted Ontario to establish a surveillance protocol to monitor for the possible spread of the virus into the province . Surveillance components included evaluation of dead birds, sentinel chickens, mosquito pools and human disease . We report the results of human surveillance in 2000 . METHODS: Between July 1 and Oct . 31, 2000, an active surveillance program was undertaken in which designated site coordinators in sentinel hospitals identified patients who met the suspect case definition (fever and fluctuating level of consciousness {encephalopathy}, with or without muscle weakness) . During the same period, following province-wide distribution of educational material, all other patients tested for WNV antibodies were identified through review of provincial laboratory reports (laboratory-based enhanced passive surveillance) . RESULTS: Of the 60 hospitals contacted, 59 agreed to participate in the active surveillance program; 52 provided information on a regular (weekly) basis, and 7 submitted fewer than 8 reports . Thirty-six (61%) of the sentinel sites reported suspect cases . In total, 188 patients were tested (130 identified through active surveillance and 58 through enhanced passive surveillance) . Patients identified through active surveillance were more likely than those identified through passive surveillance to meet the suspect case definition (43% {n = 56} v . 7% {n = 4}), to be admitted to hospital (75% {n = 99} v . 16% {n = 9}), to have a longer hospital stay (mean 25 v . 3 days), to have had a second (convalescent) serum sample collected (37% {n = 48} v . 31% {n = 18}), to have had a cerebrospinal fluid (CSF) sample banked (56% {n = 73} v . 14% {n = 8}) and to have had a discharge diagnosis reported (79% {n = 103} v . 28% {n = 16}) . Of the 60 patients (32%) who met the suspect case definition, 34 (57% {31 active, 3 passive}) had a discharge diagnosis of encephalitis . Of these, 17 (50% {15 active, 2 passive}) had paired serum samples collected, and 18 (51% {all active}) had a CSF sample banked . The reported causal agents were herpes simplex virus (n = 8), varicelia virus (n = 2), Powassan virus (n = 1), echovirus 30 (n = 1) and group B Streptococcus (n = 1); the cause was unknown in 18 cases . One patient died of encephalitis . The remaining 26 patients who met the suspect case definition were ultimately found to have nonencephalitic infections, vascular events or alcohol- or drug-related illness . The 128 (68%) tested for WNV who did not meet the suspect case definition included 9 patients ultimately discharged with a diagnosis of encephalitis . No cases of WNV infection were identified . INTERPRETATION: Only one-third of the tested patients met the suspect case definition of encephalopathy on admission, and nearly half of them were later found to have another diagnosis; others did not meet the case definition but were later discharged with a diagnosis of encephalitis . This affirms that identification of acute encephalitis on the basis of symptoms at the time of admission is often impossible.

Ann Ital Med Int, 2001 Oct-Dec, 16(4), 205 - 19
{Gram-positive bacterial infections resistant to antibiotic treatment}; Utili R; Antibiotic resistance has become a major problem in the treatment of gram-positive bacterial infections . These organisms are able to escape antibiotic activity through several mechanisms including beta-lactamase production, altered penicillin-binding proteins, aminoglycoside-modifying enzymes, modification of the target site of the antibiotic, and active efflux . Resistant determinants may be carried on the chromosome, and are transmitted vertically by clonal dissemination, or on mobile elements such as plasmids, transposons or integrons capable of horizontal transfer both within and between species . Several resistant genes can be inserted in a given integron, resulting in multi-drug resistance . Antimicrobial resistance mechanisms can be caused or induced following the widespread use of antibiotics . The most important gram-positive resistant organisms include penicillin-resistant Streptococcus pneumoniae, methicillin-resistant Staphylococcus aureus and coagulase-negative staphylococci, methicillin-resistant Staphylococcus aureus with intermediate resistance to vancomycin, and enterococcal strains that express high-level resistance to aminoglycosides and/or resistance to vancomycin . In several instances, these strains show multi-drug resistance and cannot be treated with currently available agents . Therapeutic strategies include the use of a higher antibiotic dosage, the use of alternative, non-conventional drugs, alone or in combination, after demonstration of their efficacy in vitro and in experimental animal models, and the development of new drugs . New agents available include quinupristin/dalfopristin and line-zolid with activity against most resistant gram-positive bacteria . Promising new drugs that may reach the market in the near future include daptomycin and oritavancin . Careful use of antibiotics and adherence to infection control standards are crucial in preventing the development and the spread of resistant organisms.

J Biol Chem, 2002 Apr 19, 277(16), 13943 - 51 Epub 2002 Jan 17.
The streptococcal hyaluronan synthases are inhibited by sulfhydryl-modifying reagents, but conserved cysteine residues are not essential for enzyme function; Kumari K et al.; Hyaluronan (HA) synthase (HAS) is a membrane-bound enzyme that utilizes UDP-glucuronic acid (GlcUA) and UDP-GlcNAc to synthesize HA . The HAS from Streptococcus pyogenes (spHAS, 419 amino acids) contains six Cys residues, whereas the enzyme from Streptococcus equisimilis (seHAS, 417 amino acids) contains four Cys residues . These Cys residues of seHAS are highly conserved in all Class I HAS family members . Here we investigated the structural and functional roles of these conserved cysteines in seHAS by using site-directed mutagenesis and sensitivity to sulfhydryl modifying reagents . Both seHAS and spHAS were inhibited by sulfhydryl reagents such as N-ethylmaleimide (NEM) and iodoacetamide in a dose-dependent and time-dependent manner . These inhibition curves were biphasic, indicating the presence of sensitive and insensitive components . After treatment of seHAS with NEM, the V(max) value was decreased approximately 50%, and the K(m) values changed only slightly . All the Cys-to-Ala mutants of seHAS were partially active . The least active single (C226A), double (C226A,C262A), or triple (C226A,C262A,C367A) Cys mutants retained 24, 3.2, and 1.4% activity, respectively, compared with wild-type enzyme . Surprisingly, the V(max) value of the seHAS(cys-null) mutant was approximately 17% of wild-type, although the K(m) values for both substrates were increased 3-6-fold . Cys residues, therefore, are not involved in a critical interaction necessary for either substrate binding or catalysis . However, the distribution of HA products was shifted to a smaller size in approximately 25% of the seHAS Cys mutants, particularly the triple mutants . Mass spectroscopic analysis of wild-type and Cys-null seHAS as well as the labeling of all double Cys-to-Ala mutants with {(14)C}NEM demonstrated that seHAS contains no disulfide bonds . We conclude that the four Cys residues in seHAS are not directly involved in catalysis, but that one or more of these Cys residues are located in or near substrate binding or glycosyltransferase active sites, so that their modification hinders the functions of HAS.

Zhonghua Yi Xue Za Zhi, 2001 May 25, 81(10), 589 - 92
{Population biology of Streptococcus pneumoniae carried by healthy children in Shanghai}; Yang F et al.; OBJECTIVE: To investigate the population biology of Streptococcus pneumoniae carried by healthy children . METHODS: Drug resistant patterns and serotypes of 222 strains were determined . PFGE, BOX PCR and pbp fingerprint techniques were used to analyze the homology among strains . RESULTS: Among 222 nasopharyngeal isolates from 5 day-care centers, there were 32 penicillin intermediate Streptococcus pneumoniae (PISP, MIC 0.125 approximately 1 mg/L), and no penicillin resistant Streptococcus pneumoniae (PRSP, MIC >/= 2 mg/L) was found . The main serotypes of all strains were 23F (25.7%), 6A (13.1%), 19F (10.8%), and 6B (8.1%) . The serotypes of PISP were mainly 23F (50%), 19A (15.6%) and 19F (15.6%) . Among the 32 PISP strains, 8 BOX PCR clusters and 7 PFGE types were identified . The resistance patterns, serotypes, BOX PCR and pbp fingerprints of PFGE type A strains were highly consistent . In day care center (DCC) SY, the penicillin resistant rate was 31.8%, being much higher than the average level . Twenty of the 21 PISP strains isolated from this DCC belonged to PFGE type A or B . CONCLUSIONS: The penicillin resistant rate of Streptococcus pneumoniae carried by healthy children in 5 DCCs of Shanghai was still low . However in one DCC, there could be a prevalence of some resistant clones which resulted in high penicillin resistant rate.

Zhonghua Nei Ke Za Zhi, 2001 Jan, 40(1), 29 - 31
{A study on the pathogenesis of Streptococcus mitis exotoxin}; Lu H et al.; OBJECTIVE: To study the isolation, purification and pathogenesis of Streptococcus mitis pyrogenic exotoxin causing toxic shock syndrome . METHODS: Streptococcus mitis isolated from patients' throat were shaking cultivated . After being centrifuged, the supernatant fluid of the culture was precipitated with 20%, 40%, 60%, 80% (NH(4))(2)SO(4) respectively and the fast protein liquid chromatography(FPLC) was used for the final step of purification . Rabbits receiving subcutaneous injection with respective purified proteins were monitored daily for fever . The ability of the purified proteins to enhance the susceptibility of the rabbits to lethal Escherichia coli endotoxin shock is recorded, when the endotoxin was injected intravenously 4 hours after administration of 10 microg Streptococcus mitis exotoxin . RESULTS: Only the protein precipitated by 20% (NH(4))(2)SO(4) (molecular weight is 34,000) from culture supernatant fluid was pyrogenic for rabbits (average temperature increase near 1 degrees C), and it can also cause the proliferation of rabbit splenocytes (mitogenicity) . All the animals receiving subcutaneous injection of exotoxin containing purified proteins precipitated with higher concentrations of (NH(4))(2)SO(4) died within 16 approximately 29 hours after intravenous injection of the Escherichia coli endotoxin, demonstrating the enhanced susceptibility of the animals to lethal endotoxin shock . The control rabbits displayed none of these effects . CONCLUSION: Streptococcus mitis exotoxin is a novel streptococcal pyrogenic exotoxin.

Clin Infect Dis, 2002 Feb 15, 34(4), 434 - 40 Epub 2002 Jan 03.
An epidemiological investigation of a sustained high rate of pediatric parapneumonic empyema: risk factors and microbiological associations; Byington CL et al.; We investigated the increasing incidence of pediatric empyema during the 1990s at Primary Children's Medical Center in Salt Lake City . Of 540 children hospitalized with community-acquired bacterial pneumonia (CAP) who were discharged from 1 July 1993 through 1 July 1999, 153 (28.3%) had empyema . The annual population incidence of empyema increased during the study period from 1 to 5 cases per 100,000 population aged <19 years . Streptococcus pneumoniae was identified as the most common cause of CAP with or without empyema; serotype 1 accounted for 50% of the cases of pneumococcal empyema . Patients with empyema were more likely to be >3 years old, to have > or =7 days of fever, to have varicella, and to have received antibiotics and ibuprofen before admission to the hospital, compared with patients without empyema (P<.0001 for each factor) . The increasing incidence of empyema was associated with infection due to S . pneumoniae serotype 1, outpatient treatment with certain antibiotics, ibuprofen use, and varicella.

Postgrad Med J, 2002 Jan, 78(915), 47 - 8
Necrotising fasciitis in a patient receiving infliximab for rheumatoid arthritis; Chan AT et al.; A case of necrotising fasciitis in a patient receiving infliximab, an antitumour necrosis factor alpha (TNF-alpha) agent for rheumatoid arthritis, is presented . A widespread confluent, erythematous, pustular skin rash was the presenting sign . There was no fever throughout this admission . beta-Haemolytic group A streptococcus was isolated from blood cultures and skin swabs . The adductor muscles and fascia around the site of a previous hip arthroplasty were necrotic on exploration . The case highlights the risk of severe sepsis in patients on anti-TNF-alpha treatment.

Infect Immun, 2002 Feb, 70(2), 1017 - 22
Sensitivities of human monocytes and epithelial cells to pneumolysin are different; Hirst RA et al.; The Streptococcus pneumoniae pore-forming toxin, pneumolysin, is an important virulence factor in pneumococcal pneumonia . The effect of pneumolysin on human lung epithelial and monocyte cell viability was compared . Pneumolysin caused a dose-dependent loss of viability of human lung epithelial (A549 and L132) and monocyte (U937 and THP-1) cell lines . Analysis of the dose-response curves revealed similar log 50% inhibitory concentration (pIC(50)) values for A549, L132, and THP-1 of 0.12+/- 0.1, 0.02+/- 0.04, and 0.12+/- 0.13 hemolytic units (HU), respectively, but U937 cells showed a significantly greater pIC(50) of 0.42+/- 0.12 HU . Differentiation of A549 and L132 with phorbol ester or THP-1 with gamma interferon had no effect on their sensitivity to pneumolysin . However, a significant decrease in the potency of pneumolysin against U937 cells followed gamma interferon treatment . The Hill slopes of the inhibition curves were greater than unity, indicating that pneumolysin may act with positive cooperativity . Analysis of pneumolysin-treated THP-1 cells by electron microscopy revealed membrane lesions of between 100 and 200 nm in diameter.

Infect Immun, 2002 Feb, 70(2), 993 - 7
Novel laminin-binding protein of Streptococcus pyogenes, Lbp, is involved in adhesion to epithelial cells; Terao Y et al.; The lbp gene, which encodes a laminin-binding protein (Lbp) of Streptococcus pyogenes, was found in all S . pyogenes M types . An Lbp-deficient mutant showed a significantly lower efficiency of adhesion to HEp-2 cells than did the wild-type strain . These results indicate that Lbp is one of the important S . pyogenes adhesins.

Infect Immun, 2002 Feb, 70(2), 938 - 44
Structural decomposition and heterogeneity of commercial lipoteichoic Acid preparations; Morath S et al.; Fractionation of commercial preparations of lipoteichoic acids (LTA) by hydrophobic interaction chromatography (HIC) and nuclear magnetic resonance spectroscopy revealed very inhomogeneous compositions and decomposition of the LTA structure: LTA content of the preparations averaged 61% for Streptococcus pyogenes, 16% for Bacillus subtilis, and 75% for Staphylococcus aureus . The decomposition was characterized by a loss of glycerophosphate units as well as alanine and N-acetylglucosamine substituents . All preparations contained-to varying degrees-non-LTA, non-lipopolysaccharide (LPS) immunostimulatory components as indicated by their elution profile in HIC, lack of phosphate, and negative Limulus amoebocyte lysate (LAL) test results . After purification, the commercial LTA from Bacillus subtilis and S . pyogenes but not LTA from S . aureus induced the release of tumor necrosis factor alpha, interleukin 1 beta (IL-1beta), IL-6, and IL-10 in human blood . While pure LTA are negative in the LAL assay, endotoxin equivalents of more than 10 ng of LPS/mg of LTA were found in the commercial preparations . Taken together, these data indicate that these crude preparations with relatively high endotoxin contamination are not suitable for characterizing the activation of immune cells by LTA.

Infect Immun, 2002 Feb, 70(2), 762 - 70
Rgg influences the expression of multiple regulatory loci to coregulate virulence factor expression in Streptococcus pyogenes; Chaussee MS et al.; The human pathogen Streptococcus pyogenes secretes many proteins to the cell wall and extracellular environment that contribute to virulence . Rgg regulates the expression of several exoproteins including a cysteine protease (SPE B), a nuclease (MF-1), a putative nuclease (MF-3), and autolysin . The functional heterogeneity of Rgg-regulated exoproteins and the lack of a conserved regulatory motif in the promoter regions of the genes suggested that Rgg interacts with additional regulatory networks to influence gene expression . DNA microarrays were used to test this hypothesis by comparing genomewide transcript profiles of S . pyogenes NZ131 and isogenic derivative NZ131 rgg during the exponential phase of growth . Transcripts of known and putative virulence-associated genes were more abundant in the rgg mutant, including emm, scpA, orfX, scl1, hasAB, slo, sagA, ska, speH, grab, mac, mf-1, and mf-3 . Increased transcription of emm, scpA, and orfX in the rgg mutant was associated with increased production of the corresponding proteins . Differences in the expression of virulence-associated genes were associated with changes in the expression of several regulatory genes, including mga, sagA, csrRS, and fasBCA . The results show that Rgg influences the expression of multiple regulatory networks to coregulate virulence factor expression in S . pyogenes.

Infect Immun, 2002 Feb, 70(2), 749 - 61
Endogenous pro- and anti-inflammatory cytokines differentially regulate an in vivo humoral response to Streptococcus pneumoniae; Khan AQ et al.; Proinflammatory cytokines play a critical role in innate host defense against extracellular bacteria . However, little is known regarding the effects of these cytokines on the adaptive humoral response . Mice injected with a neutralizing anti-tumor necrosis factor alpha (TNF-alpha) monoclonal antibody (MAb) at the time of primary immunization with intact Streptococcus pneumoniae (strain R36A) showed a substantial reduction in both the primary immunoglobulin G (IgG) response specific for the cell wall protein, pneumococcal surface protein A (PspA), as well as in the development of PspA-specific memory . In contrast, anti-TNF-alpha MAb injected only at the time of secondary immunization with R36A failed to alter the boosted anti-PspA response . TNF-alpha was required only within the first 48 to 72 h after primary immunization with R36A and was induced both by non-B and non-T cells and by lymphoid cells, within 2 to 6 h after immunization, with levels returning to normal by 24 h . Thus, the early innate release of TNF-alpha was critical for optimal stimulation of the subsequent adaptive humoral response to R36A . Additional proinflammatory (interleukin 1 {IL-1}, IL-6, IL-12, and gamma interferon {IFN-gamma}) as well as anti-inflammatory (IL-4 and IL-10) cytokines were also transiently induced . Mice genetically deficient in IL-6, IFN-gamma, or IL-12 also showed a reduced IgG anti-PspA response of all IgG isotypes . In contrast, IL-4(-/-) and IL-10(-/-) mice immunized with R36A showed a significant elevation in the IgG anti-PspA response, except that there was decreased IgG1 in IL-4(-/-) mice . In this regard, a marked enhancement in the induction of proinflammatory cytokines was observed in the absence of IL-10, relative to controls . Ig isotype titers specific for the phosphorycholine determinant of C-polysaccharide were similarly regulated, but to a much more modest degree . These data suggest that proinflammatory and anti-inflammatory cytokines differentially regulate an in vivo protein- and polysaccharide-specific Ig response to an extracellular bacteria.

Infect Immun, 2002 Feb, 70(2), 462 - 9
Role of CsrR, hyaluronic acid, and SpeB in the internalization of Streptococcus pyogenes M type 3 strain by epithelial cells; Jadoun J et al.; Internalization of group A streptococcus by human epithelial cells has been extensively studied during the past 6 years . It is now clear that multiple mechanisms are involved in this process . We have previously demonstrated that the CsrR global regulator controls the internalization of an invasive M type 3 strain through regulation of the has (hyaluronic acid synthesis) operon, as well as another, unknown gene(s) . Recently, it was reported that the CsrR-regulated cysteine protease (SpeB) is also involved in bacterial uptake . In this study we have examined the roles of CsrR, hyaluronic acid capsule, and SpeB in streptococcal internalization . We have constructed isogenic mutants of the M3 serotype deficient in the csrR, hasA, and speB genes and tested their ability to be internalized by HEp-2 epithelial cells . Inactivation of csrR abolished internalization, while inactivation of either hasA or speB increased the internalization efficiency . Mutation in csrR derepressed hasA transcription and lowered the activity of SpeB, while no effect on speB transcription was observed . The speB mutant expressed smaller amounts of capsule, while the hasA mutant transcribed more csrR and speB mRNAs . Thus, it seems that complex interactions between CsrR, SpeB, and capsule are involved in modulation of group A streptococcus internalization.

Antimicrob Agents Chemother, 2002 Feb, 46(2), 582 - 5
Grepafloxacin, a dimethyl derivative of ciprofloxacin, acts preferentially through gyrase in Streptococcus pneumoniae: role of the C-5 group in target specificity; Morris JE et al.; Grepafloxacin, a 5-methyl-7-piperazinyl-3"-methyl analogue of ciprofloxacin, was used to obtain stepwise-selected mutants of Streptococcus pneumoniae 7785 . Analysis of the quinolone resistance-determining regions of the gyrA, gyrB, parC, and parE genes in these mutants revealed that gyrA mutations preceded those in parC . Given that ciprofloxacin (5-H,7-piperazinyl) and AM-1121 (5-H,7-piperazinyl-3"-methyl) both act through topoisomerase IV, we conclude that the 5-methyl group of grepafloxacin favors gyrase in S . pneumoniae.

Antimicrob Agents Chemother, 2002 Feb, 46(2), 546 - 9
Susceptibility to telithromycin in 1,011 Streptococcus pyogenes isolates from 10 central and Eastern European countries; Nagai K et al.; Among 1,011 recently isolated Streptococcus pyogenes isolates from 10 Central and Eastern European centers, the MICs at which 50% of isolates are inhibited (MIC(50)s) and the MIC(90)s were as follows: for telithromycin, 0.03 and 0.06 microg/ml, respectively; for erythromycin, azithromycin, and clarithromycin, 0.06 to 0.125 and 1 to 8 microg/ml, respectively; and for clindamycin, 0.125 and 0.125 microg/ml, respectively . Erythromycin resistance occurred in 12.3% of strains . Erm(A) {subclass erm(TR)} was most commonly encountered (60.5%), followed by mef(A) (23.4%) and erm(B) (14.5%) . At <0.5 microg/ml, telithromycin was active against 98.5% of the strains tested.

Antimicrob Agents Chemother, 2002 Feb, 46(2), 538 - 42
Expression of lux genes in a clinical isolate of Streptococcus pneumoniae: using bioluminescence to monitor gemifloxacin activity; Beard SJ et al.; A clinical isolate of Streptococcus pneumoniae was transformed with a plasmid containing the lux operon of Photorhabdus luminescens that had been modified to function in gram-positive bacteria . Cells containing this plasmid produced light stably and constitutively, without compromising the growth rate . Light output was correlated with measurements of optical density and viable counts during exponential growth and provided a sensitive, real-time measure of the pharmacodynamics of the fluoroquinolone gemifloxacin.

Antimicrob Agents Chemother, 2002 Feb, 46(2), 528 - 30
Very low cefotaxime concentrations select for hypermutable Streptococcus pneumoniae populations; Negri MC et al.; A mixed culture of an hypermutable hexA Streptococcus pneumoniae mutant strain and its hexA(+) isogenic ancestor was challenged with low cefotaxime concentrations . Despite identical original cefotaxime MICs, the hexA mutant population was significantly selected at very low concentrations, and all of the tested selected variants harbored the Thr550-->Ala mutation in pbp2x . Since cefotaxime selects hypermutators, the risk of secondary acquisition of antibiotic resistance is increased; as expected, the cefotaxime-resistant mutants had a mutation frequency 10 times higher in response to to ciprofloxacin . The present study presents a model (not necessarily reflecting the clinical setting) illustrating the risk of selection of mutators in the evolution of multiple resistance.

Antimicrob Agents Chemother, 2002 Feb, 46(2), 522 - 4
Selection of Streptococcus pneumoniae mutants having reduced susceptibility to moxifloxacin and levofloxacin; Li X et al.; With Streptococcus pneumoniae, moxifloxacin was 4- and 10-fold more effective than levofloxacin at restricting selection of resistant mutants and at killing resistant mutants, respectively . The selection frequency for first-step topoisomerase mutants was 1,000 times lower for moxifloxacin than for levofloxacin; this difference was lost when second-step mutants were selected.

Antimicrob Agents Chemother, 2002 Feb, 46(2), 413 - 9
Cleavable-complex formation by wild-type and quinolone-resistant Streptococcus pneumoniae type II topoisomerases mediated by gemifloxacin and other fluoroquinolones; Yague G et al.; Gemifloxacin is a recently developed fluoroquinolone with potent activity against Streptococcus pneumoniae . We show that the drug is more active than moxifloxacin, gatifloxacin, levofloxacin, and ciprofloxacin against S . pneumoniae strain 7785 (MICs, 0.03 to 0.06 microg/ml versus 0.25, 0.25, 1, and 1 to 2 microg/ml, respectively) and against isogenic quinolone-resistant gyrA-parC mutants (MICs, 0.5 to 1 microg/ml versus 2 to 4, 2 to 4, 16 to 32, and 64 microg/ml, respectively) . Gemifloxacin was also the most potent agent against purified S . pneumoniae DNA gyrase and topoisomerase IV in both catalytic inhibition and DNA cleavage assays . The drug concentrations that inhibited DNA supercoiling or DNA decatenation by 50% (IC(50)s) were 5 to 10 and 2.5 to 5.0 microM, respectively . Ciprofloxacin and levofloxacin were some four- to eightfold less active against either enzyme; moxifloxacin and gatifloxacin showed intermediate activities . In assays of drug-mediated DNA cleavage by gyrase and topoisomerase IV, the same order of potency was seen: gemifloxacin > moxifloxacin > gatifloxacin > levofloxacin approximately ciprofloxacin . For gemifloxacin, the drug concentrations that caused 25% linearization of the input DNA by gyrase and topoisomerase IV were 2.5 and 0.1 to 0.3 microM, respectively; these values were 4-fold and 8- to 25-fold lower than those for moxifloxacin, respectively . Each drug induced DNA cleavage by gyrase at the same spectrum of sites but with different patterns of intensity . Finally, for enzymes reconstituted with quinolone-resistant GyrA S81F or ParC S79F subunits, although cleavable-complex formation was reduced by at least 8- to 16-fold for all the quinolones tested, gemifloxacin was the most effective; e.g., it was 4- to 16-fold more active than the other drugs against toposiomerase IV with the ParC S79F mutation . It appears that the greater potency of gemifloxacin against both wild-type and quinolone-resistant S . pneumoniae strains arises from enhanced stabilization of gyrase and topoisomerase IV complexes on DNA.

Antimicrob Agents Chemother, 2002 Feb, 46(2), 398 - 401
Selection of zone size interpretive criteria for disk diffusion susceptibility tests of three antibiotics against Streptococcus pneumoniae, using the New Guidelines of the National Committee for Clinical Laboratory Standards; Fuchs PC et al.; Disk diffusion and broth microdilution susceptibility tests were performed with cefotaxime, ceftriaxone, telithromycin, and erythromycin (control) against 407 selected isolates of Streptococcus pneumoniae . Scattergrams were prepared from the results of these tests, and the current NCCLS guidelines for setting disk diffusion test interpretive criteria were applied . Erythromycin zone diameter breakpoints were confirmed . Telithromycin interpretive criteria for the disk test could be easily set with acceptable discrepancy rates . For cefotaxime and ceftriaxone, the minor discrepancy rates for MICs in the intermediate category +/- 1 dilution were far in excess of the acceptable 40% limit, i.e., 52 and 71%, respectively . We conclude that the 30-microg disk of these two drugs cannot be reliably used to test pneumococci.

Antimicrob Agents Chemother, 2002 Feb, 46(2), 371 - 7
Susceptibilities to telithromycin and six other agents and prevalence of macrolide resistance due to L4 ribosomal protein mutation among 992 Pneumococci from 10 central and Eastern European countries; Nagai K et al.; The macrolide and levofloxacin susceptibilities of 992 isolates of Streptococcus pneumoniae from clinical specimens collected in 1999 and 2000 were determined in 10 centers in Central and Eastern European countries . The prevalences of penicillin G-intermediate (MICs, 0.125 to 1 microg/ml) and penicillin-resistant (MICs, < or =2 microg/ml) Streptococcus pneumoniae isolates were 14.3 and 16.6%, respectively . The MICs at which 50% of isolates are inhibited (MIC(50)s) and the MIC(90)s of telithromycin were 0.016 and 0.06 microg/ml, respectively; those of erythromycin were 0.06 and >64 microg/ml, respectively; those of azithromycin were 0.125 and >64 microg/ml, respectively; those of clarithromycin were 0.03 and >64 microg/ml, respectively; and those of clindamycin were 0.06 and >64 microg/ml, respectively . Erythromycin resistance was found in 180 S . pneumoniae isolates (18.1%); the highest prevalence of erythromycin-resistant S . pneumoniae was observed in Hungary (35.5%) . Among erythromycin-resistant S . pneumoniae isolates, strains harboring erm(B) genes (125 strains {69.4%}) were found to be predominant over strains with mef(E) genes (25 strains {13.4%}), L4 protein mutations (28 strains {15.6%}), and erm(A) genes (2 strains {1.1%}) . Similar pulsed-field gel electrophoresis patterns suggested that some strains containing L4 mutations from the Slovak Republic, Bulgaria, and Latvia were clonally related . Of nine strains highly resistant to levofloxacin (MICs, >8 microg/ml) six were isolated from Zagreb, Croatia . Telithromycin at < or =0.5 microg/ml was active against 99.8% of S . pneumoniae isolates tested and may be useful for the treatment of respiratory tract infections caused by macrolide-resistant S . pneumoniae isolates.

Pediatr Nephrol, 2001 Dec, 16(12), 1089 - 92
Vasculitis associated with septicemia: case report and review of the literature; Kodo K et al.; We report an unusual case in which infectious endocarditis presented systemic vasculitis and glomerulonephritis as the initial manifestation of the disease . The patient was a 16-year-old girl with congenital cyanotic heart disease who presented with skin purpura, proteinuria, and hematuria . She had hypergammaglobulinemia, cryoglobulinemia, and positive circulating immune complexes . Renal biopsy revealed crescentic glomerulonephritis . Her serum C3 level, which was initially normal, became decreased, and prednisolone and azathioprine were administered with a tentative diagnosis of systemic lupus erythematosus (SLE) . Soon after, she developed fever and renal failure . Blood culture grew Streptococcus pyogenes, and the diagnosis of infectious endocarditis was made . Eight cases of systemic vasculitis and glomerulonephritis associated with infectious endocarditis have been described in the literature . Infectious endocarditis should be included in the differential diagnosis of systemic vasculitis and glomerulonephritis.

Clin Neurol Neurosurg, 2002 Jan, 104(1), 64 - 8
Bacterial meningoencephalitis in patients undergoing chronic hemodialysis: two case reports; Fujimoto C et al.; Two patients with bacterial meningoencephalitis (BME) undergoing chronic hemodialysis (HD) are reported . Patient 1 died of bacterial empyema caused by Streptococcus intermedius . Patient 2 was successfully treated by intravenous vancomycin (VCM), panipenem-betamipron and intrathecal VCM . Enterococcus avium from a sacral decubitus ulcer was suggested as a possible pathogen of BME in Patient 2 . Autopsy findings in Patient 1 and antimicrobial options in Patient 2 are discussed with a review of the literature . In the two BME patients presented here, sepsis played an important role in their pathogenesis during the chronic HD state.

An Esp Pediatr, 2002 Jan, 56(1), 5 - 9
{Prevalence pneumococcal meningitis in Spanish children}; Casado Flores J et al.; OBJECTIVE: To determine the prevalence of pneumococcal meningitis in the pediatric population in Spain.Material and methods Retrospective multicenter study performed in five autonomous communities (Catalonia, Galicia, Madrid, Navarre and the Basque Country) between January 1998 and December 2000 . All patients aged between 0 and 14 years old with a diagnosis of pneumococcal meningitis (Streptococcus pneumoniae isolation or presence of Gram-positive diplococcus in the cerebrospinal fluid (CSF) and CSF with more than 20 cells) in all the hospitals of the five autonomous communities were included in the study . The pediatric population in these communities aged between 0 and 14 years old was 2,327,079 . RESULTS: We detected 107 cases in 64 boys and 43 girls with a mean age of 1.19 years old (p 25-0.57; p 75-3.34) . The incidence was higher in the first 2 years of life {72/107 (67 %)} . The overall annual prevalence in the five autonomous communities in the first 24 months of life was 8.26 per 100,000 children aged under 2 years (95 % CI: 3.45-15.76) . The highest number of cases was detected in Catalonia and Madrid but the highest annual prevalence was found in the Basque Country with 15.52 cases per 100,000 children younger than 2 years old (95 % CI: 8.38-24.74) . In the first 12 months of life the prevalence was high in all the autonomous communities, especially in the Basque Country with 22.76 cases per 100,000 newborn infants aged under 12 months (95 % CI 14.58-34.5) . In the first 5 years of life the annual global adjusted prevalence per 100,000 children was as follows: Catalonia 3.21 (95 % CI: 1.31-5.11), Galicia 2.65 (95 % CI: 0.35-5.64), Madrid 3.49 (95 % CI: 1.36-5.61), Navarre 3.36 (95 % CI 5,08-11,81), the Basque Country 5.63 (95 % CI: 1.08-10.18) . CONCLUSION: The prevalence of pneumococcal meningitis in children from different autonomous communities is high and is greatest in the Basque Country and in children aged under 2 years . This prevalence is similar to that of other European countries and the USA.

Transfus Apheresis Sci, 2001 Jun, 24(3), 255 - 9
Current status of bacterial contamination of autologous blood for transfusion; Sugai Y et al.; Autologous transfusion, although not without risk, does decrease the risk of transmitted diseases via homologous transfusion . However, strict quality control is required for autologous transfusion . In Japan, a recent enactment requires that written informed consent be obtained prior to blood transfusion, which therefore requires that clinicians provide sufficient explanation of the risks involved with this procedure . To the best of our knowledge, this is the first study to comprehensively evaluate the manner in which the safety of autologous blood transfusion can be compromised by bacterial contamination . For a 24-month period, between April 1996 and March 1998, bacterial contamination of all kinds of autologous blood samples was tested by sampling the culture immediately prior to transfusion . Subculturing, identification and susceptibility testing of the isolates were performed . From the 287 units of all kinds of autologous blood transfused, 18 were culture positive (6.3%) . Positive blood cultures were obtained in two of the 59 units (3.4%) of autologous transfusion donated preoperatively (ATDP) that was infused intraoperatively, in three of the 117 units (2.6%) of hemodilution/autologous transfusion (HAT) and in three of the 81 (3.7%) of ATDP infused postoperatively . There was a high percentage (33.3%) of positive blood cultures in the cases of intraoperative blood salvage (IOBS) . The total rate of positive blood cultures was 6.3% including IOBS and 3.1% excluding IOBS . The most common microorganism isolated from autologous blood was coagulase-negative Staphylococci in 12 of 18 culture-positive units (66.7%) . Alpha Streptococcus uiridans was isolated in 2 units (11%) and Staphylococcus aureus was isolated in 1 unit (5.5%) . However, none of the patients who received the culture-positive autotransfusion blood showed clinical signs or laboratory findings of bacteremia . Safe ATDP is threatened by bacterial contamination that can be introduced by numerous sources, such as the donors' blood, the skin at the site of venipuncture, the environment and the phlebotomist's finger . In the cases of IOBS, protection against bacterial contamination at the surgical site is crucial . Here we discuss the relevance of our findings to the efforts to minimize the risks of contamination associated with autologous blood transfusion; risks that must be communicated to the patient in the process of informed consent . Continued research is required to identify the safest method of autologous blood transfusion.

Microbiol Immunol, 2001, 45(11), 777 - 86
Delayed onset of systemic bacterial dissemination and subsequent death in mice injected intramuscularly with Streptococcus pyogenes strains; Saito M et al.; Streptococcus pyogenes causes severe invasive diseases in humans, including necrotizing fasciitis, sepsis, and streptococcal toxic shock syndrome (STSS) . We found that mice infected intramuscularly (i.m.) with S . pyogenes strains developed bacteremia and subsequent sudden death after at least 10 days of a convalescent period . Mostly, it occurred more than 21 days after muscle infection . We provisionally designate this phenomenon as "delayed death." Just after muscle infection, all the mice lost weight and activity, but recovered completely within 3 days . They had kept good activity and a fine coat of fur till one or two days before their death . Some of the dead mice were found to have soft-tissue necrosis . There was no correlation between the virulence leading to the delayed death and the severity of diseases from which strains were isolated . It was also found that the production of neither streptococcal pyrogenic exotoxin (SPE) A nor B correlated to the virulence leading to delayed death . The bacteria obtained from the organs of the mice with delayed death expressed capsule . We suggest that the mice with delayed onset of systemic bacterial dissemination and subsequent death after muscle infection with S . pyogenes are the animal models of STSS, because the pathophysiology is extremely similar to that of human STSS.

Pharmacotherapy, 2002 Jan, 22(1 Pt 2), 2S - 11S; discussion 30S-32S
The emerging role of atypical pathogens in community-acquired pneumonia; Gleason PP; Community-acquired pneumonia (CAP) constitutes a major cause of morbidity and mortality . Although Streptococcus pneumoniae remains the bacterium most commonly implicated in CAP, the atypical respiratory pathogens Mycoplasma pneumoniae, Legionella species, and Chlamydia pneumoniae are being isolated with increasing frequency Contrary to previous beliefs, these agents are capable of causing severe as well as mild-to-moderate illness . Moreover, they can affect all age groups . Indeed, atypical pathogens are implicated in up to 40% of CAP cases and commonly occur as copathogens in mixed-infection CAP, an etiology associated with particularly high mortality (up to 25%) . Laboratory methods for detecting atypical pathogens are slow, and there is significant overlap between atypical and typical CAP manifestations . For these reasons, accurate prediction of etiology cannot be made purely on clinical or radiologic grounds . Consequently, empiric antimicrobial therapy for atypical pathogens (with agents such as macrolides, fluoroquinolones, in some cases tetracyclines, or the new ketolides) warrants careful consideration and now is recommended for the treatment of CAP.

Pharmacotherapy, 2002 Jan, 22(1 Pt 2), 18S - 29S; discussion 30S-32S
Antibiotic resistance: where do ketolides fit?
White RL.
Burgeoning resistance to antibiotics among common respiratory pathogens poses a very real risk to public health . A need therefore exists for new antibiotics that not only target all common respiratory pathogens, including problematic strains such as penicillin- and macrolide-resistant Streptococcus pneumoniae, but also resist resistance . The ketolides are a new class of antibiotics, of which telithromycin is the first to undergo clinical evaluation, designed to address such issues . These agents possess several innovative structural modifications that not only confer activity against common respiratory pathogens, irrespective of their beta-lactam or macrolide susceptibility, but also minimize the risk of emergent resistance . Ketolides such as telithromycin therefore represent important new options for the empiric treatment of community-acquired respiratory tract infections in an era of increasing resistance . They may be especially useful in areas where macrolide resistance among S . pneumoniae is common because current macrolide treatments against such pathogens are far from optimal.

Pediatr Infect Dis J, 2002 Jan, 21(1), 80 - 1
Recurrent purpura fulminans associated with drug-resistant Streptococcus pneumoniae infection in an asplenic girl; Pancharoen C et al.; We report a case of purpura fulminans associated with drug-resistant Streptococcus pneumoniae that responded to ceftriaxone therapy . Ultrasonography of the abdomen and splenic scan revealed the absence of a spleen.

Pediatr Infect Dis J, 2002 Jan, 21(1), 28 - 31
Role of Bartonella henselae in the etiology of Henoch-Schönlein purpura; Ayoub EM et al.; BACKGROUND: The etiology of Henoch-Schonlein purpura (HSP) has been ascribed to a variety of infectious and noninfectious agents . Because we encountered a patient with HSP who had evidence of Bartonella henselae infection and a prior report of a patient with systemic cat-scratch disease presenting as leukoclastic vasculitis, we investigated the association of B . henselae infection with HSP . METHODS: We determined the antibody titers to B . henselae on the sera of 18 patients with HSP and on 57 controls . All patients presented with the characteristic leukoclastic rash of HSP . About one-half of the patients had joint or abdominal symptoms, and four had hematuria at presentation . An indirect immunofluorescent assay was used to determine serum antibody titers to B . henselae . Sera that were reactive at a dilution of 1/64 were considered positive . RESULTS: Eight of the 57 (14%) control sera and 12 of the 18 (67%) patient sera were positive for B . henselae antibody (P < 0.0001) . CONCLUSION: The results of this study indicate a significant association of antecedent B . henselae infection with HSP . The frequency of this association (67%) exceeds that of previously ascribed etiologic agents for this disease, such as the group A Streptococcus.

Drugs, 2002, 62(1), 169 - 207
Gatifloxacin: a review of its use in the management of bacterial infections; Perry CM et al.; Gatifloxacin is an 8-methoxy fluoroquinolone antibacterial agent . The drug has a broader spectrum of antibacterial activity than the older fluoroquinolones (e.g . ciprofloxacin) and shows good activity against many Gram-positive and Gram-negative pathogens, atypical organisms and some anaerobes . Notably, gatifloxacin is highly active against both penicillin-susceptible and -resistant strains of Streptococcus pneumoniae, a common causative pathogen in community-acquired pneumonia (CAP), acute sinusitis and acute bacterial exacerbations of bronchitis . Gatifloxacin is absorbed well from the gastrointestinal tract (oral bioavailability is almost 100%) . Therefore, patients can be switched from intravenous to oral therapy without an adjustment in dosage . High concentrations of gatifloxacin are achieved in plasma and target tissues/fluids . Gatifloxacin has a long plasma elimination half-life, thus allowing once-daily administration . Few clinically significant interactions between gatifloxacin and other drugs have been reported . In patients with CAP, clinical response rates in recipients of intravenous/oral gatifloxacin 400 mg/day ranged from 86.8 to 98.0% and rates of bacterial eradication ranged from 83.1 to 100% (up to 28 days post-treatment) . Gatifloxacin showed efficacy similar to that of amoxicillin/clavulanic acid, ceftriaxone (with or without erythromycin) with or without stepdown to clarithromycin, levofloxacin or clarithromycin . Gatifloxacin was as effective as clarithromycin or amoxicillin/clavulanic acid, and was significantly more effective (in terms of clinical response; p < 0.035) than 7 to 10 days' treatment with cefuroxime axetil in the treatment of acute exacerbations of chronic bronchitis . In acute sinusitis, gatifloxacin showed clinical efficacy similar to that of clarithromycin, trovafloxacin or amoxicillin/clavulanic acid . Genitourinary infections were also successfully treated with gatifloxacin . Gatifloxacin is generally well tolerated . Its tolerability profile was broadly similar to those of comparator agents in comparative trials . The most common adverse events are gastrointestinal symptoms (oral formulation) and injection site reactions . CONCLUSIONS: Gatifloxacin has an extended spectrum of antibacterial activity and provides better coverage of Gram-positive organisms (e.g . S . pneumoniae) than some older fluoroquinolones . The drug has favourable pharmacokinetic properties, is administered once daily and is at least as well tolerated as other fluoroquinolones . Gatifloxacin is a useful addition to the fluoroquinolones currently available for use in the clinical setting and has an important role in the management of adult patients with various bacterial infections . As with other fluoroquinolones, careful control of gatifloxacin usage in the community is important in order to prevent the emergence of bacterial resistance and thus preserve the clinical value of this agent.

Drugs, 2002, 62(1), 13 - 59
A critical review of the fluoroquinolones: focus on respiratory infections; Zhanel GG et al.; The new fluoroquinolones (clinafloxacin, gatifloxacin, gemifloxacin, grepafloxacin, levofloxacin, moxifloxacin, sitafloxacin, sparfloxacin and trovafloxacin) offer excellent activity against Gram-negative bacilli and improved Gram-positive activity (e.g . against Streptococcus pneumoniae and Staphylococcus aureus) over ciprofloxacin . Ciprofloxacin still maintains the best in vitro activity against Pseudomonas aeruginosa . Clinafloxacin, gatifloxacin, moxifloxacin, sitafloxacin, sparfloxacin and trovafloxacin display improved activity against anaerobes (e.g . Bacteroides fragilis) versus ciprofloxacin . All of the new fluoroquinolones display excellent bioavailability and have longer serum half-lives than ciprofloxacin allowing for once daily dose administration . Clinical trials comparing the new fluoroquinolones to each other or to standard therapy have demonstrated good efficacy in a variety of community-acquired respiratory infections (e.g . pneumonia, acute exacerbations of chronic bronchitis and acute sinusitis) . Limited data suggest that the new fluoroquinolones as a class may lead to better outcomes in community-acquired pneumonia and acute exacerbations of chronic bronchitis versus comparators . Several of these agents have either been withdrawn from the market, had their use severely restricted because of adverse effects (clinafloxacin because of phototoxicity and hypoglycaemia; grepafloxacin because of prolongation of the QTc and resultant torsades de pointes; sparfloxacin because of phototoxicity; and trovafloxacin because of hepatotoxicity), or were discontinued during developmental phases . The remaining fluoroquinolones such as gatifloxacin, gemifloxacin, levofloxacin and moxifloxacin have adverse effect profiles similar to ciprofloxacin . Extensive post-marketing safety surveillance data (as are available with ciprofloxacin and levofloxacin) are required for all new fluoroquinolones before safety can be definitively established . Drug interactions are limited; however, all fluoroquinolones interact with metal ion containing drugs (eg . antacids) . The new fluoroquinolones (gatifloxacin, gemifloxacin, levofloxacin and moxifloxacin) offer several advantages over ciprofloxacin and are emerging as important therapeutic agents in the treatment of community-acquired respiratory infections . Their broad spectrum of activity which includes respiratory pathogens such as penicillin and macrolide resistant S . pneumoniae, favourable pharmacokinetic parameters, good bacteriological and clinical efficacy will lead to growing use of these agents in the treatment of community-acquired pneumonia, acute exacerbations of chronic bronchitis and acute sinusitis . These agents may result in cost savings especially in situations where, because of their potent broad-spectrum activity and excellent bioavailability, they may be used orally in place of intravenous antibacterials . Prudent use of the new fluoroquinolones will be required to minimise the development of resistance to these agents.

Int Immunopharmacol, 2002 Jan, 2(1), 129 - 37
Involvement of protein kinase C and tyrosin kinase in tumoricidal activation of macrophage induced by Streptococcus pneumoniae type II capsular polysaccharide; Um SH et al.; Capsular polysaccharide type 2 (PS) from Streptococcus pnemoniae induced the secretory and cellular macrophage response . However, the exact mechanism by which PS regulates the macrophage functions remains unclear . In this study, we examined signal molecules which may participate in PS-elicited responses by macrophages . Our data demonstrated that tumoricidal activation of macrophages induced by PS was inhibited by either protein kinase C (PKC) inhibitor, H7 or protein tyrosine kinase (PTK) inhibitor, genistein . In addition, these inhibitors blocked the production of TNF-alpha and NO in PS-stimulated macrophages . Furthermore, PS-induced cell activation is possibly mediated by Toll-like receptor 2 . These data suggest that PKC and PTK are involved in the activation of macrophages with PS.

Aust N Z J Obstet Gynaecol, 2001 Nov, 41(4), 457 - 8
Neonatal pneumococcal sepsis in association with fatal maternal pneumococcal sepsis; Hughes BR et al.; A live male infant was born at 37 weeks' gestation after a normal pregnancy to a 34-year-old mother . The baby developed bacteraemia with Streptococcus pneumoniae and recovered completely following treatment with antibiotics . The mother simultaneously developed bacteraemia with the same organism and died from septic shock . Blood culture isolates from mother and child were both serogroup 23F, and were shown to be identical by DNA fingerprinting . The literature reports rare cases of vaginal carriage and/or endometritis with this organism resulting in neonatal sepsis . Transmission to the neonate may have been ascending or haematogenous . A postmortem examination was refused.

Aust N Z J Obstet Gynaecol, 2001 Nov, 41(4), 420 - 3
Petrol sniffing in a pregnant Aboriginal population: a review of maternal and neonatal outcomes; Dodd J; The study's aim was to determine if petrol sniffing during pregnancy is associated with adverse maternal and neonatal outcomes at the Alice Springs Hospital . The study design was a retrospective case note review . The subjects were Aboriginal women who delivered at the Alice Springs Hospital between July 1991 and September 1999 where petrol sniffing was identified on the discharge coding; 14 women with 21 pregnancies were identified . One hundred and eleven nulliparous Aboriginal women who delivered at hospital between July 1998 and June 1999, with singleton gestation in cephalic presentation, were identified from the birth register and used as the control group . We found that women identified as petrol sniffers during pregnancy presented later for antenatal care, had fewer antenatal visits, lower booking haemoglobin and weighed less at booking when compared with non-petrol-sniffing women . Women who sniffed petrol during pregnancy were more likely to have one or more sexually transmitted diseases identified during the pregnancy; to use other substances during pregnancy; to be colonised with group B Streptococcus; to have meconium stained liquor prior to delivery; and to have a still-birth . Infants born to petrol-sniffing mothers were more likely to have birthweight less than 2,500 g; to have Apgar scores of less than 7 at 5 minutes; to require admission to the neonatal unit; and to be placed in foster care or for adoption . We concluded that the pregnancy complicated by petrol sniffing should be recognised as one at increased risk of adverse outcome, necessitating increased antenatal surveillance . However, as with other substances abused, it is extremely difficult to determine the role played by the substance per se, and that of the lifestyle associated with the abuse behaviour.

MMWR Morb Mortal Wkly Rep, 2001 Aug 24, 50(33), 707 - 10
Outbreak of pneumococcal pneumonia among unvaccinated residents of a nursing home--New Jersey, April 2001.
{Quantitative evaluation of Streptococcus mutans and Candida species and salivary factors in the oral cavity of patient undergoing radiotherapy}
Spolidorio DM, Spolidorio LC, Barbeiro RH, Hofling JF, Bernardo WL, Pavan S.

Disciplina de Patologia, Faculdade de Odontologia de Araraquara, UNESPThe aim of this study was to quantify the microorganisms Streptococcus mutans and Candida sp in the oral cavity of patients with oropharynx carcinoma, before, during and after radiotherapy, and to correlate the results with salivary factors such as pH, buffer capacity (CT) and flow rate (FS) . Saliva samples were collected, diluted and inoculated in SB-20 agar and in Sabouraud agar, for Streptococcus mutans and Candida sp, respectively . Previously to dilution, the concentrated saliva was analyzed, and the salivary factors were determined . After the growth of colonies, the number of microorganisms was determined in CFU/ml . The analysis of the results allowed to conclude that the salivary factors are related to the presence of microorganisms, and that the number of CFU/ml increased as salivary flow rate decreased . The effects of radiation compromised salivary homeostasis and favored the increase of infection by yeasts and bacteria.

Chemotherapy, 2001 Dec, 47(6), 409 - 14
Differences between two new quinolones (gemifloxacin and trovafloxacin) and ciprofloxacin in their concentration-dependent killing of Streptococcus pneumoniae; Joyanes P et al.; BACKGROUND: Ciprofloxacin resistance influences the in vitro effect of new quinolones on Streptococcus pneumoniae . METHODS: The early (over 3 h) in vitro bactericidal activity of gemifloxacin, trovafloxacin and ciprofloxacin was explored by time-kill tests against two ciprofloxacin-susceptible (MIC = 0.5 and 1 microg/ml) and two ciprofloxacin-resistant (MIC = 16 microg/ml) S . pneumoniae strains . RESULTS: At subinhibitory concentrations (0.5 x MIC) and inhibitory concentrations (1 x MIC), only gemifloxacin exhibited significant bactericidal activity with, respectively, approximately 85 and approximately 95% decrease in the initial inoculum of the two ciprofloxacin-resistant strains . At concentrations similar to peak serum concentrations (1.5, 3 and 2.5 microg/ml for gemifloxacin, trovafloxacin and ciprofloxacin, respectively) after standard doses, only gemifloxacin exhibited an approximately 99.9% (3 log(10)) reduction in the initial inoculum for the four strains tested, regardless of their susceptibility to ciprofloxacin . No bactericidal activity was exhibited for the other two quinolones against the ciprofloxacin-resistant strains . CONCLUSIONS: Gemifloxacin offers high early bactericidal activity at concentrations similar to peak and trough levels, theoretically preventing regrowth over the dosing interval, and thus dealing with the problem of ciprofloxacin resistance in S . pneumoniae .

Biochim Biophys Acta, 2001 Dec 30, 1534(2-3), 85 - 95
The CTP:phosphocholine cytidylyltransferase encoded by the licC gene of Streptococcus pneumoniae: cloning, expression, purification, and characterization; Campbell HA et al.; Streptococcus pneumoniae is a member of a small group of bacteria that display phosphocholine on the cell surface, covalently attached to the sugar groups of teichoic acid and lipoteichoic acid . The putative pathway for this phosphocholine decoration is, in its first two enzymes, functionally similar to the CDP-choline pathway used for phosphatidylcholine biosynthesis in eukaryotes . We show that the licC gene encodes a functional CTP:phosphocholine cytidylyltransferase (CCT) . The enzyme has been expressed and purified to homogeneity . Assay conditions were optimized, particularly with respect to linearity with time, pH, Mg(2+), and ammonium sulfate concentration . The pure enzyme has K(M) values of 890+/-240 microM for CTP, and 390+/-170 microM for phosphocholine . The k(cat) is 17.5+/-4.0 s(-1) . S . pneumoniae CTP:phosphocholine cytidylyltransferase (SpCCT) is specific for CTP or dCTP as the nucleotide substrate . SpCCT is strongly inhibited by Ca(2+) . The IC(50) values for recombinant and native SpCCT are 0.32+/-0.04 and 0.27+/-0.03 mM respectively . The enzyme is also inhibited by all other tested divalent cations, including Mg(2+) at high concentrations . The cloning and expression of this enzyme sets the stage for design of inhibitors as possible antipneumococcal drugs.

FEMS Microbiol Lett, 2002 Jan 2, 206(1), 81 - 6
The C-terminal portion of the fibrinogen-binding protein of Streptococcus equi subsp . equi contains extensive alpha-helical coiled-coil structure and contributes to thermal stability; Meehan M et al.; The major cell wall-associated protein of the equine pathogen Streptococcus equi subsp . equi is a fibrinogen-binding protein (FgBP) which binds horse fibrinogen and equine IgG-Fc avidly through residues located in the N-terminal half and central regions of the molecule, respectively . The molecule is a major virulence factor for the organism and displays protective potential . In the present study, we use circular dichroism spectroscopy to investigate the secondary structure of the protein and show through the analysis of a panel of recombinant FgBP truncates that the C-terminal portion of FgBP contains an extensive alpha-helical coiled-coil structure that contributes to the thermal stability of the molecule.

MMWR Morb Mortal Wkly Rep, 2001 Sep 21, 50(37), 800 - 4
Resistance of Streptococcus pneumoniae to fluoroquinolones--United States, 1995-1999.
{Microbiology of open surgical wounds after delivery--episiotomy and cesarean section}
Tsenov D, Shopova E, Chamova M, Garnizov T, Ganeva G, Diakova D.

The aim of the study is to assess the microbe find in the secretion of the open surgical wounds of the Cesarean Section and the perineal wounds . 81 young mothers have been examined--57 with open perineal wounds on 5th day after the delivery and 24 with open surgical wounds of Cesarean Section on the 7th day after the operation . RESULTS: The west frequent microbe find in the open perineal wounds is Streptococcus group "D" (enterococcus sp.)--53% of the cases and E . coli--26% of the cases . The most frequent microbe find in the open surgical wounds in the Cesarean Section is Enterococcus sp.--42% of the cases and St . aureus--21% of the cases . Considering the effectiveness of Penicillins (Ampicillin, Augmentin, Azlocillin, Karbencillin)--94%-99% against Enterococcus spp . and of Gentamycin against E . coli and St . aureus--90%-95% their application is recommended if is necessary.

Med Dosw Mikrobiol, 2001, 53(3), 227 - 32
{Biochemical typing as a method of differentiating group B streptococcus}; Dabrowska-Szponar M et al.; In epidemiological studies on the group B streptococcus the serological typing is used . The paper present the results of a study on usefulness of biochemical typing for differentiation of the group B streptococcus . For that purpose, 210 strains descended from colonized infants and pregnant women were put to typing with both of mentioned methods . We showed that each of the method distinguishes similar number of biotypes and serotypes . However, ought to be marked that significant number of strains (93.8%) belonged to the three out of eight biochemical types . Similar results were achieved in serological typing, three of the most numerous serotypes contained 81.4% strains . Analysis of the relationship between serological and biochemical types did not reveal statistical association because the strains belonged to various serotypes . Obtained results show that both methods of typing--biochemical and serological, have similar value in differentiation of the strains . The method of biochemical typing is quite simple and can be used in laboratory conditions.

Eur J Clin Microbiol Infect Dis, 2001 Nov, 20(11), 824 - 6
Penicillin-susceptible and erythromycin-resistant Streptococcus pneumoniae in children with acute mastoiditis; del Castillo F et al.; Resistance to erythromycin is usually associated with resistance to penicillin in Streptococcus pneumoniae isolates . Over the last few years, however, an increase has been detected in the number of Streptococcus pneumoniae isolates obtained from children with acute otitis media complicated by acute mastoiditis . These isolates are characterized by a penicillin-susceptible and erythromycin-resistant antibiotic profile . This observation prompted a review of the microbiology database and analysis of all Streptococcus pneumoniae isolates with this peculiar antibiotic profile at a university hospital in Madrid, Spain.

Eur J Clin Microbiol Infect Dis, 2001 Nov, 20(11), 770 - 8
Pre- and in-hospital management of community-acquired pneumonia in southern France, 1998-99; Laurichesse H et al.; A prospective, hospital-based, multicenter study was undertaken to identify the reasons for hospital admission, to describe antibiotic treatment before and during hospitalization, and to determine the outcome of community-acquired pneumonia (CAP) . Data collected included prehospital management of CAP, Pneumonia Outcome Research Team (PORT) classification on admission, in-hospital antibiotic treatment, and predictors of death within 30 days . Among the 215 patients (mean age, 66.7 years; M:F ratio, 1.1) recruited, 24 (11.2%) were living in nursing homes . CAP had been diagnosed prior to admission in 55 (25.6%) patients . At admission, 75 (34.9%) patients had a low risk of death (PORT classification I-II) . A pathogen was isolated for 55 (25.6%) patients, primarily Streptococcus pneumoniae (n=18), atypical agents (n=16), influenza virus (n=10), and respiratory syncytial virus (n=4) . Amoxicillin (with or without clavulanate), cefotaxime, or ceftriaxone monotherapy was prescribed to 121 (56.3%) patients . Dual combination therapy was prescribed to patients at higher risk of death (PORT classification III-V; OR, 3.09) . Mortality was 7% . Logistic-regression analysis identified nursing-home residency (OR, 8.36), serum creatinine > or =88 micromol/l (OR, 7.88), and Pneumonia Outcome Research Team classification (OR, 1.02) as independent predictors of death . CAP remains a serious disease for elderly persons living in nursing homes . This population should benefit from immunization with pneumococcal and influenza vaccines.

Microbiology, 2002 Jan, 148(Pt 1), 169 - 78
Immunological response mounted by Aboriginal Australians living in the Northern Territory of Australia against Streptococcus pyogenes serum opacity factor; Gillen CM et al.; Streptococcus pyogenes (Group A streptococcus) interacts with host fibronectin via a number of distinct surface components . The streptococcal serum opacity factor (SOF) is a cell-surface protein of S . pyogenes which causes opalescence of human serum and mediates bacterial binding to fibronectin . In this study, hexahistidyl-tagged fusion proteins encompassing full-length SOF, and domains of SOF encompassing opacity factor activity and fibronectin-binding regions, were used in the characterization of the Aboriginal immune response to SOF . Anti-SOF serum IgG responses were found to be significantly higher (P<0.0001) in Aboriginal adults and children when compared to a non-Aboriginal adult group . The Aboriginal immune response against the fibronectin-binding region of SOF was significantly reduced when compared to the response against the whole SOF protein and N-terminal domains examined in this study (P<0.001) . This pattern of immune response was also observed in rabbits immunized with recombinant SOF . Comparison of the deduced amino acid sequence of SOF from a number of common Australian isolates with other SOF sequences revealed that the N-terminus of SOF exhibits sequence similarity values ranging from 42.9% to 96.5% . The C-terminus containing the fibronectin-binding domain and membrane-spanning regions was more highly conserved, exhibiting sequence similarity values ranging from 84.6% to 100% within the fibronectin-binding repeats . These data suggest that the immune response against SOF is directed toward the variable N-terminus of the SOF protein . Phylogenetic analysis indicated that the sof genes of S . pyogenes do not exhibit geographical variation.

J Exp Med, 2002 Jan 7, 195(1), 1 - 13
Dendritic cells pulsed with intact Streptococcus pneumoniae elicit both protein- and polysaccharide-specific immunoglobulin isotype responses in vivo through distinct mechanisms; Colino J et al.; Immature bone marrow-derived myeloid dendritic cells (BMDCs) are induced to undergo phenotypic maturation and secretion of tumor necrosis factor (TNF)-alpha, interleukin (IL)-6, IL-12, and IL-10 when pulsed in vitro with intact Streptococcus pneumoniae . After transfer to naive mice, pulsed BMDCs induce immunoglobulin (Ig) isotype responses specific for both protein and polysaccharide pneumococcal antigens, having in common the requirement for viable BMDCs, T cells, and B7-dependent costimulation in the recipient mice . Whereas primary Ig isotype responses to bacterial proteins uniformly require BMDC expression of major histocompatibility complex class II, CD40, and B7, and the secretion of IL-6, but not IL-12, similar requirements for antipolysaccharide Ig responses were only observed for the IgG1 isotype.

Clin Microbiol Rev, 2002 Jan, 15(1), 95 - 110
Modulation of release of proinflammatory bacterial compounds by antibacterials: potential impact on course of inflammation and outcome in sepsis and meningitis; Nau R et al.; Several bacterial components (endotoxin, teichoic and lipoteichoic acids, peptidoglycan, DNA, and others) can induce or enhance inflammation and may be directly toxic for eukaryotic cells . Bactericidal antibiotics which inhibit bacterial protein synthesis release smaller quantities of proinflammatory/toxic bacterial compounds than B-lactams and other cell wall-active drugs . Among the B-lactams, compounds binding to penicillin-binding protein 2 (PBP-2) release smaller amounts of bacterial substances than antibacterials inhibiting PBP-3 . Generally, high antibiotic concentrations (more than 10 times the MIC) induce the release of fewer bacterial proinflammatory/toxic compounds than concentrations close to the MIC . In several in vitro and in vivo systems, bacteria treated with protein synthesis inhibitors or B-lactams inhibiting PBP-2 induce less inflammation than bacteria treated with PBP-3-active B-lactams . In mouse models of Escherichia coli peritonitis sepsis and of Streptococcus pneumoniae meningitis, lower release of proinflammatory bacterial compounds was associated with reduced mortality . In conclusion, sufficient evidence for the validity of the concept of modulating the release of proinflammatory bacterial compounds by antibacterials has been accumulated in vitro and in animal experiments to justify clinical trials in sepsis and meningitis . A properly conducted study addressing the potential benefit of bacterial protein synthesis inhibitors versus B-lactam antibiotics will require both strict selection and inclusion of a large number of patients . The benefit of this approach should be greatest in patients with a high bacterial load.

Zhonghua Kou Qiang Yi Xue Za Zhi, 2000 Nov, 35(6), 467 - 9
{The effect of immune bovine whey on cell-associated glucosyltransferase activity of Streptococcus mutans}; Chen W et al.; OBJECTIVE: To study the effect of immune bovine whey on cell-associated glucosyltransferase (GTF) activity of S . mutans MT8148 . METHODS: The immune milk was collected from cows immunized with cell-associated GTF overexpression strain B-29-33 of S . mutans MT8148 . The control milk was from non-immunized cows . The immune absorbed whey was gotten from immune bovine whey which was absorbed with lyophilized Formalin-killed B-29 whole cells . Three kinds of whey were subdivided into three groups: 50 microliters, 70 microliters, 90 microliters . The content of insoluble glucan was estimated colorimetrically by anthrone method . RESULTS: The control bovine whey had an enhancing GTF activity (407.00%-485.62%) . The immune absorbed whey inhibited partly the enhancing GTF activity (208.74%-273.00%) . The immune whey inhibited significantly the GTF activity (70.24%-38.62%) and the inhibition showed a tendency to depend on doses . CONCLUSIONS: The immune bovine whey inhibits significantly the cell-associated GTF activity of S . mutans MT8148.

Biochem Biophys Res Commun, 2002 Jan 11, 290(1), 585 - 8
Specificity role of the streptokinase C-terminal domain in plasminogen activation; Kim DM et al.; Several pathogenic bacteria secrete plasminogen activator proteins . Streptokinase (SKe) produced by Streptococcus equisimilis and staphylokinase secreted from Staphylococcus aureus are human plasminogen activators and streptokinase (SKu), produced by Streptococcus uberis, is a bovine plasminogen activator . Thus, the fusion proteins among these activators can explain the function of each domain of SKe . Replacement of the SKalpha domain with staphylokinase donated the staphylokinase-like activation activity to SKe, and the SKbetagamma domain played a role of nonproteolytic activation of plasminogen . Recombinant SKu also activated human plasminogen by staphylokinase-like activation mode . Because SKu has homology with SKe, the bovine plasminogen activation activities of SKe fragments were checked . SKebetagamma among them had activation activity with bovine plasminogen . This means that the C-terminal domain (gamma-domain) of streptokinase determines plasminogen species necessary for activation and converses the ability of substrate recognition to human species . (c)2002 Elsevier Science.

Mil Med, 2001 Dec, 166(12), 1087 - 90
Pneumococcal vaccine to counter emerging infectious disease threat in the military; McKeehan JA et al.; Streptococcus pneumoniae causes severe morbidity and mortality worldwide and poses a significant threat to the health and readiness of U.S . military personnel . Although a vaccine to prevent pneumococcal infections has been available for almost 25 years, its use has been limited . Recently, increasing antibiotic resistance among S . pneumoniae strains has emerged, prompting health care professionals to reevaluate the benefit of administering pneumococcal vaccine . The Naval Health Research Center, in collaboration with professionals from numerous civilian and military organizations, has initiated a rigorous double-blind, placebo-controlled trial investigating the operational value of vaccinating young adults as they enlist in the military.

Zhonghua Kou Qiang Yi Xue Za Zhi, 1999 May, 34(3), 172 - 4
{Regulation of adherence to serum-coated hydroxyapatite by Streptococcus sanguis}; Song X et al.; OBJECTIVE: To investigate the effects of pH and calcium iron on adhesion of Streptococcus sanguis to serum-coated hydroxyapatite . METHODS: The adhesion model in vitro established by Clark W . B . in 1977 was used to quantify adsorptive cells through {3H} thymidine labelling . RESULTS: The cpm values between different pH groups showed significant differences . Also, there were significant differences of cpm values between calcium groups and control group . CONCLUSION: Either pH or calcium iron has obvious effect on adherence of Stroptococcus sanguis to serum-coated hydroxyapatite . The findings suggest that regulating pH and concentration of calcium iron can help to change colonization on teeth surfaces by Streptococcus sanguis in periodontal circumstance.

Pathol Biol (Paris), 2001 Dec, 49(10), 840 - 5
{Streptococcus pneumoniae: lack of emergence of pristinamycin resistance}; Weber P; Since 1997, a few studies have been published suggesting the emergence of clinical isolates of Streptococcus pneumoniae resistant to pristinamycin . Such results were not confirmed by recent studies from different investigators using reference techniques for the determination of susceptibilities, which is in accordance with the low probability of emergence of resistance to this antibiotic in vitro . Discrepancies are encountered with macrolide-resistant strains and may be due to the type of method used for susceptibility testing (agar-diffusion test), the final inoculum used in this technique, or the recent lowering of breakpoint for susceptibility . On the contrary, correlation between reference techniques and commercial galleries using liquid medium is excellent . Despite 35 years of exerting selective pressure, the in vitro activity of pristinamycin remains constant against clinical isolates of S . pneumoniae.

Pathol Biol (Paris), 2001 Dec, 49(10), 824 - 9
{Implication and mode of action of infectious agents in the formation of atheromatous plaques . Infection and atherosclerosis}; Lizard G et al.; Different kinds of infectious agents seem to be implied in the atherosclerotic process . Indeed, some bacteria and viruses have been identified in atherosclerotic lesions: Chlamydia pneumoniae, Helicobacter pylori, Streptococcus sanguis, Porphyromonas gingivalis, herpes simplex viruses type 1 and 2, coxsakievirus B and hepatitis virus A . By their ability to induce antigenic and functional changes in the cells of the vascular wall (endothelial cells, smooth muscle cells, monocytes/macrophages, and fibroblasts) and to stimulate immune response as well as oxidative stress, it is more and more tempting to speculate that infectious agents probably play key roles in the initiation and in the formation of atherosclerotic plaques in certain patients.

Pathol Biol (Paris), 2001 Dec, 49(10), 789 - 93
{Bacterial epidemiological study of acute otitis media in children observed at home in the Nord Pas-de-Calais region}; Husson MO et al.; BACKGROUND: The aim of this work is the study of the bacteriologic epidemiology of acute otitis media in infants observed at home in Nord Pas-de-Calais area, and the analysis of bacteria associated to recurrent otitis and clinical failure . OBSERVATIONS: A total of 295 specimens of ear pus specimens were collected from children (mean age: 18 months; average: one month-12 years) . Pneumococcus strains were isolated from 52% of samples and 80% of these showed resistance to penicillin . H . influenzae was found in 35% of specimens and the half produced a beta lactamase . Pneumococcus is the predominant pathogen isolated in prolonged otitis media, while H . influenzae is preferentially found during recurrent otitis media . The main bacteriologic cause of failure traitement was penicillin-intermediate or -resistant pneumococci . The therapy administered 48 to 72 hours before collection of ear pus sample in therapeutic failure was ineffective (oral cephalosporins or macrolides), or administered to low dosage (50 mg/kg/j) . CONCLUSION: Our results demonstrate, in opposition to other studies, Streptococcus pneumoniae as the most frequent pathogen in acute otitis media . They also show the excellent correlation between antibiotic therapy and clinical failures.

Zhonghua Jie He He Hu Xi Za Zhi, 1999 Oct, 22(10), 623 - 5
{The isolation and drug susceptibility of penicillin resistant Streptococcus pneumoniae in Guangzhou}; Tang Y et al.; OBJECTIVE: To investigate the isolation rate and drug susceptibility of PRSP in Guangzhou and in vitro antimicrobial activities of 8 antimicrobial agents against PRSP . METHODS: MICs were tested by E-test . RESULTS: Of 102 strains of Streptococcus pneumoniae, 12 strains were low-level resistant against penicillin (isolation rate 11.8%) and the antimicrobial activites of 5 drugs (augmentin, cefaclor, ceftriaxone, cefuraxime, ofloxaxin) against them were within their MICs, augmentin and ceftriaxone being the most powerful . They were resistant to azithromicin, oxacillin and penicillin . CONCLUSIONS: The isolation rate of Penicillin resistant Streptococcus pneumoniae was not high in Guangzhou, but it may increase with the extensive use of antimicrobial agents, which deserves much attention.

Zhonghua Kou Qiang Yi Xue Za Zhi, 1999 Jan, 34(1), 19 - 21
{A study on the conjugation of Streptococcus mutans adhesins and its salivary receptors}; Zhan L et al.; OBJECTIVE: To investigate the conjugation specificity of Streptococcus mutans' adhesins and their salivary receptors . METHODS: Include purified salivary receptor or adhesin competitive bacteria adhesion inhibition test and enzyme linked immuno-receptor assay (ELIRA) on S . mutans WD9463A . RESULTS: Salivary amylases can both enhance and competitively inhibit the adhesion of the strain to HA, while IgA degraded fragments and MW = 13,000 protein only promote its adhesion . P1 and a 117,000 surface protein of WD9463A both inhibit adhesion of the strain to IgA degraded fragments and salivary amylases . An 127,000 protein of WD9463A and a kind of GTFase inhibit its adhesion to IgA degraded fragments and salivary amylases respectively . No conjugation was found between IgA degraded fragments and the adhesins, while reaction between amylases and the adhesins had basically accordance with adhesion inhibition test . CONCLUSION: The adhesion of S . mutans is a result of reaction between multireceptors and multiadhesins.

Chin Med J (Engl), 2000 Jul, 113(7), 628 - 31
E test for studying in vitro activity of seven antimicrobial agents against penicillin-susceptible and penicillin-resistant pneumococci; Li J et al.; OBJECTIVE: To evaluate the comparative activity of seven oral antimicrobial agents against 100 strains of Streptococcus pneumoniae (S . pneumoniae) . METHODS: Total 100 strains of S . pneumoniae were collected from general hospitals in Beijing from June 1996 to June 1997 . E test method was used to detect the minimum inhibitory concentration (MIC) values of the following seven drugs against S . pneumoniae: penicillin, amoxicillin/clavulanate, cefaclor, cefuroxime, ceftriaxone, azithromycin and ofloxacin . The breakpoint of susceptibility categories was defined according to NCCLS . RESULTS: 74% of isolates were susceptible (S, MIC 0.06 mg/L) to penicillin, and 5% were penicillin resistant (R, MIC 2 mg/L) . The intermediately resistant (I, MIC 0.1-1 mg/L) rate to penicillin was 21% . The total rates of R or I were 26% for penicillin, 6% for both amoxicillin/clavulanate and ceftriaxone, 9% for cefuroxime, 66% and 68% for azithromycin and ofloxacin respectively . Overall 94%, 94% and 91% of the pneumococcal isolates were susceptible to amoxicillin/clavulanate, ceftriaxone and cefuroxime respectively . S . pneumoniae was highly resistant to azithromycin tested as a representative of macrolides (MIC50 and MIC90 both > 256 mg/L, R rate 66%), and had a highly intermediately resistant rate to ofloxacin (I rate 62%) . CONCLUSIONS: Our data suggest that in vitro activity of oral amoxicillin/clavulanate was as good as ceftriaxone and cefuroxime . It can be considered as an alternative compound in the treatment of community acquired pneumoniae and other respiratory tract infections caused by multiresistant S . pneumoniae.

Zhonghua Kou Qiang Yi Xue Za Zhi, 1998 May, 33(3), 183 - 5
{Anti-cariogenicity of maceration extract of Momordica grosvenori: laboratory study}; Mu J; OBJECTIVE: To study the anti-cariogenicity of Momordica grosvenori a kind of natural sweet fruit . METHODS: The turbiding method in laboratory was used to test the influence of the maceration extract of Momordica grosvenori on the growth of Streptococcus mutans (S . mutans), glass rod adhering, and acid production . Sucrose, glocose, fructose, beet sugar were designed to compare with Momordica grosvenori . RESULTS: The growth and fermentation of S . mutans in Momordica grosvenori were significantly lower than these in the other groups includintg beet sugar group (P < 0.01) . S . mutans adhering glass rod in Momordica grosvenori was the lowest . CONCLUSION: Momordica grosvenori possesses many advantages: high sweetness and low adherence, and its anti-cariogenicity is better than beet sugar.

Zhonghua Kou Qiang Yi Xue Za Zhi, 1998 May, 33(3), 149 - 51
{The experimental study of immunization with purified surface protein antigen I/II from streptococcus mutans in BALB/c mice}; Fan M et al.; OBJECTIVE: To study the immunogenicity and immunoreactivity of purified surface protein antigen I/II from streptococcus mutans . METHODS: Purified antigen I/II was used to immune BALB/c mice by subcutaneous injection route, and S . mutans whole cells were used as comparison . RESULTS: ELISA showed immunization with antigen I/II highly induced both specific serum IgG antibody and specific salivary IgA antibody against antigen I/II (P < 0.01), but immunization with whole cells only induced specific serum IgG antibody (P < 0.05) . CONCLUSION: The study suggest purified antigen I/II is an effective candidate vaccine.

Zhonghua Yi Xue Yi Chuan Xue Za Zhi, 2001 Dec, 18(6), 435 - 40
{Cloning and analyzing of the conserved protein gene in Streptococcus sanguinis ATCC10556}; Wang H et al.; OBJECTIVE: To clone and analyze the conserved protein gene in Streptococcus sanguinis(S.s) ATCC10556 . METHODS: Southern blotting hybridization, molecular cloning techniques and dot blotting hybridization were employed to obtain the target clone which harbored the specific DNA fragment . The nucleotide sequence of the target clone was determined . The gene and its product were analyzed by Genework software and bioinformatics techniques . RESULTS: The conserved protein gene in Streptococcus sanguinis ATCC10556 was cloned for the first time and named as Streptococcus sanguinis conserved protein gene (Sscp gene) . The Genbank accession number for Sscp gene is AY032739 . The conserved protein gene in S.s ATCC10556 (named sscp163) was a transmembrane protein and contained two AAA domains . CONCLUSION: sscp163 protein might take part in the cell division in Streptococcus sanguinis; its function is similar to that of FtsK in E.coli.

Clin Infect Dis, 2002 Feb 1, 34(3), 330 - 9 Epub 2001 Dec 17.
The molecular epidemiology of penicillin-resistant Streptococcus pneumoniae in the United States, 1994-2000; Richter SS et al.; The genetic relatedness of 672 penicillin-resistant isolates of Streptococcus pneumoniae (PRSP) recovered during national surveillance studies conducted in the United States during the periods of 1994-1995, 1997-1998, and 1999-2000 was determined by use of pulsed-field gel electrophoresis (PFGE) . Overall, 104 different PFGE types were elucidated . For all study periods combined, the 12 most prevalent PFGE types included >75% of all isolates, and 5 types were closely related to widespread clones (Spain(23F)-1, France(9V)-3, Spain(6B)-2, Tennessee(23F)-4, and Taiwan(19F)-14) . From 1994-1995 to 1999-2000, 3 major PFGE types (not closely related to 16 recognized clones) increased in prevalence . Multidrug resistance was identified among 96%-100% of the isolates in 9 of 12 predominant PFGE types . The prevalence of erythromycin resistance increased within 4 major PFGE types . These observations support the hypothesis that the dominant factor in the emergence of PRSP in the United States during the 1990s has been human-to-human spread of relatively few clonal groups that harbor resistance determinants to multiple classes of antibiotics.

Pediatrics . 2002 Jan;109(1):E14.
Group a streptococcus spinal epidural abscess during varicella; Quach C et al.; Multiple complications of varicella have been described . Musculoskeletal complications (osteomyelitis, septic arthritis, and necrotizing fasciitis) as well as neurologic complications (ataxia, encephalitis, and transverse myelitis) are well-known . We describe the cases of 2 children, ages 18 months and 5 years, who were admitted recently to 2 pediatric hospitals in Montreal with a resolving varicella, abdominal and lumbar pain, and a refusal to walk and in whom a diagnosis of epidural abscess caused by group A streptococcus (GAS) was established . No previous case of epidural abscess caused by GAS in the context of varicella has been reported . Epidural abscesses are rare in pediatrics and are caused mainly by hematogenous spread of Staphylococcus aureus . The diagnosis in pediatrics is challenging because it is rare and does not present as classically as in adults . The prognosis is related to the presence of neurologic deficits before surgery and to the rapidity with which the diagnosis and the intervention are made . These cases highlight a new clinical association in children of epidural abscess caused by GAS and varicella . An early clinical diagnosis requires a high index of suspicion when back or abdominal pain with or without neurologic signs and symptoms occurs during or soon after varicella.

J Clin Microbiol, 2002 Jan, 40(1), 278 - 80
Molecular characterization of group A Streptococcus strains isolated during a scarlet fever outbreak; Perea-Mejia LM et al.; Forty group A streptococcus (GAS) isolates, recovered during a scarlet fever outbreak, were grouped based on their DdeI restriction profiles from emm amplicons . Twenty-seven isolates were identified by sequencing as emm2 . The emm2 isolates showed the speA1, speB1, and speC1 alleles . Isolation of this GAS type from scarlet fever outbreaks is uncommon.

J Clin Microbiol, 2002 Jan, 40(1), 275 - 7
Population-based survey of antimicrobial susceptibility and serotype distribution of Streptococcus pneumoniae from meningitis patients in Salvador, Brazil; Reis JN et al.; Penicillin-nonsusceptible strains were isolated from 15% of 303 individuals with pneumococcal meningitis identified during a 4-year surveillance study in Salvador, Brazil . The estimated rate of coverage of the seven-valent conjugate vaccine was 74% among patients <5 years of age and 94% among those infected with nonsusceptible isolates, indicating that the use of conjugate vaccines may be an approach to the control of emerging penicillin resistance in Brazil.

J Clin Microbiol, 2002 Jan, 40(1), 159 - 64
Importance of local variations in antibiotic consumption and geographical differences of erythromycin and penicillin resistance in Streptococcus pneumoniae; Garcia-Rey C et al.; A geographical analysis of how commonly prescribed oral antibiotics are quantitatively and qualitatively responsible for the different local rates of erythromycin and penicillin resistance in Streptococcus pneumoniae in Spain is presented . From 1998 to 1999 a multicenter surveillance study yielded 1,684 consecutive S . pneumoniae isolates from community-acquired respiratory infections . Data on antibiotic sales in the retail market for the same period were gathered, and the corresponding defined doses per 1,000 inhabitants per day were calculated . Macrolides and beta-lactams were considered separately . Macrolides were subdivided into thrice-, twice-, and once-a-day macrolides, and beta-lactams were split into aminopenicillins and cephalosporins . Univariate Spearman nonparametric coefficients (R) were calculated, and variables proving to be significantly associated (P < 0.1) were entered into several multiple lineal regression models . Ample variation in both resistance rates and antibiotic consumption was seen . Multivariate analyses showed that integrated consumption of both macrolides and beta-lactams accounted well for erythromycin (R(2) = 0.722; P = 0.002) and penicillin (R(2) = 0.706; P = 0.002) resistance . Macrolides were more important drivers for local differences in both erythromycin and penicillin resistance than beta-lactams were . Consumption of once-a-day macrolides was key for local erythromycin resistance variations . Cephalosporins were slightly more important penicillin resistance drivers than aminopenicillins were.

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