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 r