Neisseria

Sex Transm Dis, 1994 Mar-Apr, 21(2), 107 - 11
Multicenter trial of single-dose azithromycin vs . ceftriaxone in the treatment of uncomplicated gonorrhea . Azithromycin Gonorrhea Study Group; Handsfield HH et al.; BACKGROUND AND OBJECTIVES: Azithromycin is a new, long-acting azalide antibiotic that is active against Neisseria gonorrhoeae . A single oral dose of 1.0 g is effective against uncomplicated genital infection with Chlamydia trachomatis . GOAL OF THIS STUDY: To compare the efficacy and tolerance of single-dose treatment of uncomplicated gonorrhea with azithromycin, 2.0 g orally, and ceftriaxone, 250 mg intramuscularly . STUDY DESIGN: Seven hundred twenty-four men and women with presumptive, uncomplicated gonorrhea were treated with azithromycin 2.0 g orally or ceftriaxone 250 mg intramuscularly in a 2:1 ratio in a multicenter, open, randomized control trial in 10 public sexually transmitted disease clinics in the United States . Patients were followed up in 5 to 9 days and, for a subset of patients, 12 to 18 days after treatment . The main outcome measures were the isolation of N . gonorrhoeae and C . trachomatis and patient-reported side effects . RESULTS: Among infected patients who returned for follow-up, N . gonorrhoeae was eradicated from all anatomic sites in 370 of 374 (98.9%; 95% confidence interval {95%CI} 97.9%-100%) treated with azithromycin and 171 of 175 (97.7%; 95%CI 95.5%-99.9%) given ceftriaxone . Treatment with either drug was effective in all 73 patients infected with beta-lactamase-producing N . gonorrhoeae . Chlamydial infection was eradicated in all 17 patients given azithromycin who returned and were recultured at follow-up and in two of seven patients given ceftriaxone (P < 0.001) . Gastrointestinal side effects occurred in 35.3% (95%CI 30.7%-39.8%) of patients given azithromycin; of those with symptoms, these were moderate in 10.1% and severe in 2.9% . CONCLUSIONS: Azithromycin 2.0 g and ceftriaxone 250 mg are equally effective in the treatment of uncomplicated gonorrhea . Azithromycin was associated with a relatively high frequency of gastrointestinal side effects and is expensive, but it has the advantages of oral administration and efficacy against concomitant chlamydial infection.

J Clin Microbiol, 1994 Mar, 32(3), 701 - 4
Enzyme electrophoresis, sero- and subtyping, and outer membrane protein characterization of two Neisseria meningitidis strains involved in laboratory-acquired infections; Guibourdenche M et al.; Two cases of laboratory-acquired infections due to Neisseria meningitidis were suspected to have occurred in two French hospitals . The first case occurred shortly, i.e., 3 days, after one strain had been handled by a laboratory technician, and the link between this strain and the strain causing meningitis was easily established . In the second case, infection occurred 3 weeks after 10 strains had been handled by a technician . In this case, it was necessary to use high-resolution markers in order to establish the link between the infecting strain and 1 of the 10 strains handled . The antigenic formulae of the two infecting strains (serogroup:serotype:subtype) were, respectively, C:NT:P1.12 and B:2a:P1.2 . Outer membrane protein profile analysis and multilocus enzyme electrophoresis unequivocally confirmed the identity of the respective strains.

J Am Board Fam Pract, 1994 Mar-Apr, 7(2), 110 - 23
Pelvic inflammatory disease: diagnosis and management; Quan M; BACKGROUND: Acute pelvic inflammatory disease (PID) is a major gynecologic health problem in the United States, afflicting more than 1 million women each year and generating annual direct and indirect costs estimated at $4.2 billion . Family physicians can play an important role in the prevention, as well as diagnosis and treatment, of PID . METHODS: A MEDLINE search for articles published from 1985 to the present was made using the key words "pelvic inflammatory disease," "endometritis," "salpingitis," "tubo-ovarian abscess," "adnexitis," "pelvic abscess," "parametritis," and "oophoritis." The bibliographies of these articles and the author's personal files were also sources of information . RESULTS AND CONCLUSIONS: A number of risk factors have been linked to PID, including young age, age at first intercourse, multiple sex partners, the presence of bacterial vaginosis, vaginal douching, the use of an intrauterine contraceptive device, and a history of a sexually transmitted disease . The diagnosis of PID represents a major clinical challenge that requires a careful history and physical examination coupled with selective and knowledgeable use of the diagnostic tests and procedures currently available . Broad-spectrum antibiotics, which represent the cornerstone of therapy, must adequately cover the polymicrobial spectrum of pathogens implicated in this infection, which includes Neisseria gonorrhoeae, Chlamydia trachomatis, and specific cervicovaginal anaerobic and aerobic bacteria . The numerous sequelae associated with PID, which include infertility, ectopic pregnancy, and chronic pelvic pain syndromes, underscore the need for effective measures for preventing pelvic inflammatory disease.

J Infect Dis, 1994 Mar, 169(3), 532 - 7
Human experimentation with Neisseria gonorrhoeae: rationale, methods, and implications for the biology of infection and vaccine development; Cohen MS et al.; Neisseria gonorrhoeae infection is limited to the human host . Experimental urethral infection in male volunteers was used to study different aspects of the infection . Urethral installation of a variety of gonococcal variants (10(4)-10(6)) led to infection in 27 subjects, who developed pyuria and shed bacteria in urine before urethritis developed 1-6 days after gonococcal inoculation . The incubation period was affected by the inoculation procedure and size of the inoculum . Subjects were treated with intramuscular ceftriaxone (250 mg) if urethritis developed or at 6 days after inoculation . Urine cultures became negative within several hours of therapy, and symptoms resolved within 1 day of therapy . Infected patients suffered no major complications . Experimental male urethral gonococcal infection provides a unique opportunity to understand the biology and immunology of gonococcal infection and is an efficient method to test gonococcal vaccine candidates.

Ann Thorac Surg, 1994 Mar, 57(3), 748 - 50
Neisseria gonorrhoeae mycotic ascending aortic aneurysm; Risher WH et al.; Mycotic aneurysms of the ascending aorta are rare . We report the case of a 38-year-old woman with systemic lupus erythematosus being treated with steroids who presented with a large Neisseria gonorrhoeae ascending aortic aneurysm . She was successfully treated with surgical resection of the aneurysm and prolonged postoperative antibiotic therapy.

J Bacteriol, 1994 Mar, 176(6), 1764 - 6
Identification of the iroA gene product of Neisseria meningitidis as a lactoferrin receptor; Pettersson A et al.; The iroA gene product is an iron limitation-inducible outer membrane protein of Neisseria meningitidis . A spontaneous mutant lacking the gene was unable to bind lactoferrin . Furthermore, Escherichia coli strains expressing the IroA protein were capable of binding lactoferrin . Apparently, the IroA protein functions as a lactoferrin receptor.

J Exp Med, 1994 Mar 1, 179(3), 911 - 20
Multiple gonococcal opacity proteins are expressed during experimental urethral infection in the male; Jerse AE et al.; The opacity (Opa) proteins of Neisseria gonorrhoeae are a family of outer membrane proteins demonstrating phase and antigenic variation . N . gonorrhoeae strain FA0190 has 11 opa loci that encode at least 8 antigenically distinct Opa proteins . To determine if expression of one Opa protein or a subset of them is favored during gonococcal infection, we inoculated Opa-negative variants of strain FA1090 intraurethrally into male volunteers . The Opa phenotype of gonococci isolated from urine and urethral swab cultures from nine infected subjects was determined . Opa proteins were expressed in a large proportion of the reisolates from the infected subjects . Gonococci cultured from urine or urethral swab samples from six of the subjects were uniformly Opa positive, with the predominant Opa variants differing among subjects . Three different Opa proteins were represented as the predominant type in at least one subject each . In three subjects, there was more heterogeneity in Opa phenotype of the reisolates, including the presence of Opa-negative variants . An increase in the proportion of isolates expressing multiple Opa proteins occurred over time in most subjects . Passage of the inoculum in vitro did not result in similar changes in Opa expression . There was no detectable difference in infectivity of an Opa-negative variant and one expressing an Opa protein (OpaF) that was highly represented in reisolates from the original nine subjects . Reisolates from three infected volunteers inoculated with the OpaF variant showed continued expression of OpaF alone or in conjunction with other Opa proteins . These results demonstrate that there is strong selection for expression of one or more Opa proteins by strain FA1090 in vivo, but that no single protein is preferentially expressed during early infection in the male urethra.

Am J Reprod Immunol, 1994 Mar-Apr, 31(2-3), 77 - 83
Antisperm antibodies (ASAs) in infertile males: subclass distribution of IgA antibodies and the effect of an IgA1 protease on sperm-bound antibodies; Kutteh WH et al.; PROBLEM: (1) To determine the IgA subclass distribution of antibodies in the serum and on the sperm of infertile male patients . (2) To determine the effect of an IgA1 protease on the binding of IgA antisperm antibodies (ASA) . METHOD: Fifteen infertile males with ASA in serum (10) or on sperm (5) were recruited for this study . Duration of infertility was at least one year . Monoclonal antibodies to human IgA1 and IgA2 were conjugated to immunobeads . The distribution of IgA1 and IgA2 subclass ASA was determined for positive serum and sperm samples . The effects of an IgA1 protease (isolated from Neisseria meningitidis strain HF13) on sperm-bound antibodies was evaluated by immunobead binding . RESULTS: In serum, the IgA1 subclass ASA was predominate (91%) when compared with IgA2 (9%) subclass . Direct sperm-bound antibodies displayed a distribution more characteristic of the secretory immune system with IgA1 accounting for 63% and IgA2 accounting for 37% of the total IgA ASA . Enzyme treatment dramatically reduced the amount of serum IgA antibodies bound to sperm (P < 0.05) . Similarly, a significant reduction in direct sperm-bound antibodies was observed after enzymatic treatment with no loss in sperm motility . CONCLUSIONS: (1) Although IgA1 direct sperm-bound antibodies were dominant, when compared with serum there was a higher proportion of IgA2 subclass, which suggests a local production of IgA . (2) Specific IgA1 protease treatment is capable of reducing the amount of immunobead-detectable IgA on sperm . Hamster oocyte sperm-penetration assays are ongoing to determine if this treatment might improve sperm penetration rates.

Sex Transm Dis, 1994 Mar-Apr, 21(2 Suppl), S81 - 3
Epidemiology of sexually transmitted diseases . What does it tell us?
Kohl PK.
Incidence numbers of Neisseria gonorrhoeae, Treponema pallidum and Chlamydia trachomatis differ substantially in different countries at different times . In European countries, the incidence of gonorrhea and of primary and secondary syphilis currently is extremely low . In North American countries gonorrhea incidence declined at a very slow annual rate and syphilis incidence increased . Chlamydial infections show a profile that seems to be delayed by two decades from infections with Neisseria gonorrhoeae . Our efforts in the future should be directed to prevent the resurgence of gonorrhea and syphilis and to achieve the same success with chlamydial infections . Poor populations in developed and developing countries, which have similar demographic, social and economic characteristics, represent one important target group for control programs . Education of young and poor people represent the challenge of the future for sexually transmitted diseases control strategies . Combined strategies also will have an effect on incurable viral STD.

J Pak Med Assoc, 1994 Mar, 44(3), 70 - 1
Beta-lactamase producing Neisseria gonorrhea strains in Karachi; Khanani R et al.; Urethral or cervical swab of 255 patients attending Skin and Social Hygiene Centre and found positive for gram negative intracellular diplococci on direct microscopy were inoculated on Modified New York City (MNYC) medium and chocolate (heated blood) agar for isolation of neisseria gonorrhea . Growth of N . gonorrhea was obtained in 134 (52.5%) cases . These strains were tested for penicillin susceptibility by disc diffusion method and for the production of beta-lactamase by rapid penicillinase paper strip test and rapid chromogenic cephalosporin method . Penicillin resistance was found in 31 (23%) strains, of which twelve (9%) were beta-lactamase producers (PPNG), the remaining 19 (14%) strains were penicillin resistant beta-lactamase negative (Pen RB Neg) . We conclude that PPNG as well as other penicillin resistant strains (Pen RB Neg) of neisseria gonorrhea are prevalent in our country and appropriate changes in the conventional therapeutic regime are desirable.

Diagn Microbiol Infect Dis, 1994 Mar, 18(3), 175 - 80
Evaluation of interpretive criteria of agar dilution and disk diffusion susceptibility tests for Neisseria gonorrhoeae; Altaie SS et al.; Using strains of Neisseria gonorrhoeae from Western New York, the National Committee for Clinical Laboratory Standards' (NCCLS) interpretive criteria for disk diffusion susceptibility testing was evaluated on chocolate-Mueller-Hinton agar (CMH) and GC agar . The reference method for comparison was the NCCLS agar dilution minimum inhibitory concentration (MIC) method . Even though the zone sizes were significantly smaller on the CMH agar, the interpretations were not significantly different on either GC or CMH agars except for tetracycline . On the CMH agar, the number of tetracycline-resistant strains was greater than on GC agar: 3% of the strains failed to grow on CMH agar and 4% did not produce interpretable zone sizes for ceftriaxone . Therefore, the use of CMH is not recommended . There was a significant difference between the interpretative criteria of the MIC and the disk diffusion method only for tetracycline . Therefore, the NCCLS zone-diameter interpretation criteria for tetracycline does not seem applicable for N . gonorrhoeae isolates in the Buffalo, New York, area.

Bratisl Lek Listy, 1994 Mar, 95(3), 122 - 4
{Quantification of Neisseria gonorrhoeae from the cervicovaginal area in nonpregnant women infected with gonorrhoea}; Pec J et al.; The authors studied quantification of Neisseria gonorrhoeae from the cervicovaginal area of 53 nonpregnant women with gonorrhoea . The variability of the amount of gonococci in cervicovaginal secretion was rather high from 1.0.10(1) to 1.1.10(8) cfu N . gonorrhoeae in 1 ml . Maximum values of N . gonorrhoeae have been found intra menses (from 1.0.10(2) to 3.0.10(8) cfu N . gonorrhoeae in 1 ml) . These findings allow the authors to make some, already more or less known, conclusions usable in clinical practice.

J Bacteriol, 1994 Mar, 176(5), 1323 - 31
Type IV prepilin peptidase gene of Neisseria gonorrhoeae MS11: presence of a related gene in other piliated and nonpiliated Neisseria strains; Dupuy B et al.; The assembly of type IV pili in Neisseria gonorrhoeae is a complex process likely to require the products of many genes . One of these is the enzyme prepilin peptidase, which cleaves and then N methylates the precursor pilin subunits prior to their assembly into pili . We have used a PCR amplification strategy to clone the N . gonorrhoeae prepilin peptidase gene, pilDNg . A single copy of the gene is shown to be present in the chromosome . Its product promotes correct cleavage of the gonococcal prepillin in Escherichia coli cells carrying both the prepilin peptidase gene and the pilin structural gene . PilDNg also cleaves prePulG, a type IV pilin-like protein of Klebsiella oxytoca . Moreover, PilDNg complements a mutation in the gene coding for the prepilin peptidase-like protein of K . oxytoca, pulO, partially restoring PulG-PulO-dependent extracellular secretion of the enzyme pullulanase . Finally, we show that genes homologous to pilDNg are present and expressed in a variety of species in the genus Neisseria, including some commensal strains.

J Histochem Cytochem, 1994 Mar, 42(3), 297 - 306
Digital confocal microscopy allows measurement and three-dimensional multiple spectral reconstruction of Neisseria gonorrhoeae/epithelial cell interactions in the human fallopian tube organ culture model; Gorby GL; A strategy for measuring Neisseria gonorrhoeae attachment and invasion in the human Fallopian tube organ culture (FTOC) model via computerized image analysis (CIA) combined with "digital" confocal microscopy (DCM) was tested . DCM on serial image stacks of fluorescent latex beads reduced out-of-focus light propagation in the Z-axis (p < 0.005) and improved the shape factor of lateral three-dimensional reconstructions of the beads (p < 0.001) . Sections of tissue infected for 44 hr with piliated, Opa+ gonococci were stained with fluorescein-labeled monoclonal anti-gonococcal antibodies, rhodamine-labeled phalloidin, and Hoechst 33342 . Serial images collected at identical focal planes for each fluorochrome were subjected to DCM . Epithelial cytoplasmic regions of interest defined by rhodamine-stained actin were superimposed on the corresponding fluorescein-stained and Hoechst-stained images . Fluorescent objects defined by gray-scale threshold were measured by computerized image analysis using different border treatments to differentiate attached from intracellular gonococci or count cell nuclei . Compared with raw images, measurement of DCM images was less dependent on threshold choice (p < 0.05) . DCM augments conventional microscopy in removing out-of-focus light from fluorescent images, in reconstructing three-dimensional images, and in quantitatively differentiating extracellular from intracellular gonococci in a natural target tissue.

Int J Cancer, 1994 Feb 1, 56(3), 358 - 63
Sexually transmitted agents and cervical neoplasia in Colombia and Spain; de Sanjose S et al.; Case-control studies of cervical intra-epithelial neoplasia grade III (CIN III) and of invasive cervical cancer were carried out in Spain and Colombia to assess the relationship between cervical cancer and 6 common sexually transmitted agents (STAs) . The CIN-III studies included 525 cases and 512 controls matched for age and for the place of recruitment; the invasive-cancer studies included 373 histologically confirmed cases of squamous-cell carcinoma and 387 age-stratified controls selected randomly from the populations that generated the cases . Antibodies to Chlamydia trachomatis, Neisseria gonorrhoeae, Treponema pallidum, herpes simplex virus type II (HSV-2) and cytomegalovirus (CMV) were tested in 88% of the women . Cervical scrapes were examined for HPV DNA in 63% of the women using a polymerase-chain-reaction assay (PCR) . Among controls, the highest antibody prevalence was to CMV (96.5%), followed by HSV-2 (31.4%) and C . trachomatis (23.3%) . For all STAs, the sero-prevalence was markedly higher in Colombia than in Spain both for cases and for controls . After adjustment for the presence of HPV DNA, C . trachomatis was the only STA associated with CIN III in both countries; Spain and Colombia . In both countries, the risk of CIN III increased with increasing of C . trachomatis antibody titers . Among Spanish women, an increase in risk of invasive carcinoma was found for those with antibodies to N . gonorrhoeae; those with antibodies to HSV-2 and those with antibodies to C . trachomatis . These associations were present only in HPV-DNA-negative women . Among HPV-DNA-positive women, none of the STAs considered were associated with cervical neoplasia . Our findings could be interpreted as indicating that past infections with HSV-2, N . gonorrhoeae and C . trachomatis are surrogate markers of HPV, but because HPV DNA may have escaped detection, we cannot exclude that these STAs are also of separate etiological significance.

Genitourin Med, 1994 Feb, 70(1), 3 - 6
Leukocyte esterase urine strips for the screening of men with urethritis--use in developing countries; Tyndall MW et al.; BACKGROUND AND OBJECTIVES--The leukocyte esterase (LE) strip is a useful tool for the screening of men with urethritis . In developing countries, where laboratory facilities are limited, and sexually transmitted diseases endemic, simple and inexpensive diagnostic tests which perform well, would be of great value . METHODS--Men presenting with urethritis to a referral clinic for sexually transmitted diseases in Nairobi, Kenya participated in this cohort analytical study . First-void urine was collected for LE dipstick testing as part of the diagnostic work-up . The results of the dipstick measurement were compared with the laboratory detection of Chlamydia trachomatis and Neisseria gonorrhoeae . RESULTS--Of 200 men with symptoms of urethritis, 33 (17%) had a pathogen detected from the urethra or the urine . Chlamydia was detected in urine by PCR in 22 (11%), and gonorrhoea was cultured from the urethra in 11 (6%) . Esterase activity (trace or greater) had a sensitivity of 76%, a specificity of 80%, a positive predictive value of 42% and a negative predictive value of 94% for the presence of chlamydia or gonorrhoea . CONCLUSIONS--The use of the LE dipstick for the screening of men with symptomatic urethritis can improve diagnostic accuracy and reduce the amount of empiric antimicrobial therapy . The low detection rate of chlamydia in these men with a clinical diagnosis of nongonococcal urethritis needs further study.

Obstet Gynecol, 1994 Feb, 83(2), 280 - 6
Piperacillin and tazobactam versus clindamycin and gentamicin in the treatment of hospitalized women with pelvic infection . The Piperacillin/tazobactam Study Group; Sweet RL et al.; OBJECTIVE: To compare the efficacy and safety of a combination of piperacillin and tazobactam with that of clindamycin and gentamicin in the treatment of hospitalized women with infections of the upper genital tract . METHODS: This was a randomized open-label trial in hospitalized women with infections of the upper genital tract . Patients were recruited at 12 hospitals in the United States and two hospitals in Canada and were randomly assigned to one of two regimens in a 2:1 ratio . One group received piperacillin, 3 g every 6 hours, and tazobactam, 375 mg every 6 hours; the other group received clindamycin, 900 mg every 8 hours, and gentamicin, 2.5-5.0 mg/kg/day in three divided doses . Therapy with the assigned regimen was to be administered for a minimum of 3 days . Cultures for aerobic and anaerobic bacteria were obtained from the site of infection before initiation of therapy . Cultures for Chlamydia trachomatis were also obtained from patients with endometritis or pelvic inflammatory disease . Subjects were evaluated for clinical and bacteriologic response at 24-72 hours and 2-4 weeks after completing therapy . RESULTS: Two hundred ninety-nine patients were enrolled; 196 were in the piperacillin-tazobactam group and 103 were in the clindamycin-gentamicin group . The most common diagnoses were endometritis (146) and pelvic inflammatory disease (115) . The most common microorganisms recovered included: Peptostreptococcus sp (99), Prevotella sp (87), black pigmented Bacteroides (29), B fragilis (11), enterococci (64), group B streptococcus (26), Escherichia coli (31), Neisseria gonorrhoeae (49), and C trachomatis (19) . A favorable clinical response occurred in 84.7% (166 of 196) of piperacillin-tazobactam patients and 87.3% (90 of 103) of clindamycin-gentamicin patients . Among those evaluable for bacteriologic response, 78% (67 of 86) and 82% (23 of 28), respectively, had a favorable response . Diarrhea occurred significantly more frequently in the piperacillin-tazobactam group (9.7 versus 2.9%; P = .04), but the majority of episodes were mild to moderate . None of the adverse experiences in either treatment group were considered life-threatening and drug-related . CONCLUSION: The combination of piperacillin and tazobactam is an effective and well-tolerated antibiotic regimen for the treatment of infections of the upper genital tract in women.

Nihon Kyobu Shikkan Gakkai Zasshi, 1994 Feb, 32(2), 146 - 51
{Bacterial flora of the respiratory tract in patients with long term tracheostomy--colonization of the lower respiratory tract by Pseudomonas aeruginosa}; Tano Y et al.; Throat secretions (TS) and bronchial secretions aspirated from tracheostomy sites (TSTA) from six subjects with long term tracheostomy were simultaneously collected and then cultured every two weeks from January, 1990, to December, 1992 . Isolated bacteria were mainly alpha-streptococci (96.2%) and Neisseria (69.6%) in TS, and Pseudomonas aeruginosa (75.7%) in TSTA . In all cases, P . aeruginosa was isolated from and colonization of the lower respiratory tract by this organism was apparent 24.4 months, on average, after tracheostomy . There were ten episodes of respiratory infection in five cases, eight of which occurred after colonization . P . aeruginosa was the causative organism in seven of these episodes . Findings in patients with long term tracheostomy indicated separate colonization of the upper and lower respiratory tracts and that P . aeruginosa colonized the lower respiratory tract . The colonization of the lower respiratory tract by P . aeruginosa would thus appear to be an important factor inducing respiratory infection.

Mol Chem Neuropathol, 1994 Feb-Apr, 21(2-3), 299 - 309
Ganglioside conjugate vaccines . Immunotherapy against tumors of neuroectodermal origin; Helling F et al.; Gangliosides are known to be suitable targets for immune attack against cancer but they are poorly immunogenic . Active immunization with ganglioside/BCG or liposome vaccines results in moderate titer IgM antibody responses of short duration . Covalent attachment of poorly immunogenic antigens to immunogenic proteins is a potent method for inducing an IgG antibody response . GD3, a dominant ganglioside on malignant melanoma, was modified by ozone cleavage of the double bond in the ceramide backbone, an aldehyde group introduced and used for coupling via reductive amination to epsilon-amino-lysyl groups of proteins . Utilizing this method, GD3 conjugates were constructed with: 1 . Synthetic multiple antigenic peptide (MAP) constructs expressing 4 repeats of a malaria T-cell epitope; 2 . Outer membrane proteins (OMP) of Neisseria meningitidis; 3 . Cationized bovine serum albumin; 4 . Keyhole limpet hemocyanin (KLH); and 5 . Polylysine . In addition, conjugates containing only the GD3 oligosaccharide were synthesized . All constructs were tested for antigenicity using anti-GD3 antibody R24, and for immunogenicity in mice . Serum antibody levels were analyzed by ELISA and immune thin-layer chromatography . Results in the mouse show a significant improvement in the IgM antibody response and a consistent IgG response against GD3 using GD3-KLH conjugates . Other carrier proteins and the use of GD3 oligosaccharide were significantly less effective . If improved immunogenicity and clinical benefit with conjugate vaccines can be demonstrated in patients with melanoma, this approach may be applicable to patients with other tumors of neuroectodermal origin, including gliomas, glioblastomas, astrocytomas, and neuroblastomas.

Mol Cell Probes, 1994 Feb, 8(1), 55 - 61
Design and characterization of PCR primers for detection of pathogenic Neisseriae; Muralidhar B et al.; Oligonucleotide polymerase chain reaction (PCR) primers directed at a group of closely related Neisserial species were designed from 16S rDNA sequences even though only a single such sequence from the targeted group was known . The amplifiable group included all Neisserial species considered pathogenic for man, including Neisseria gonorrhoea and Neisseria meningitidis . None of 43 other bacterial DNA specimens were amplified, including five non-Neisserial Neisseriaceae and three non-pathogenic Neisseriae . Another non-pathogenic Neisserial species gave a signal only at high DNA concentrations . DNA specimens from the pathogenic Neisseriae were detectable in amounts as low as 0.01 pg per PCR reaction, the approximate equivalent of a single organism, with equal sensitivity in buffer or in simple extracts of human inflammatory synovial fluids to which Neisserial DNA had been added . Simultaneously studied control specimens lacking added DNA were negative . The approach used to design these group-directed primers using only a single rDNA sequence from the targeted group by exploiting known patterns of sequence conservation among the 16S rDNA genes may prove useful for designing other similar group-directed primers . Polymerase chain reaction primers prepared in this way should prove of value in a number of areas, both investigational and clinical.

J Clin Microbiol, 1994 Feb, 32(2), 464 - 8
Nonrepresentative PCR amplification of variable gene sequences in clinical specimens containing dilute, complex mixtures of microorganisms; Wright CJ et al.; PCR amplification and DNA sequencing of the expression locus from Neisseria gonorrhoeae contained in urine sediments collected from experimentally infected human subjects produced two observations . First, different pilin sequences were obtained when separate aliquots of the same sample were amplified and sequenced . In contrast, the same pilin sequence was obtained when repeated amplifications were performed on individual colonies grown from the clinical samples . Second, mixed sequences (i.e., more than one nucleotide at variable positions in the pilin gene sequence) were observed in both the direct clinical isolates and individual cultures grown from the isolates . These results suggest that when clinical samples are directly examined by PCR amplification and sequencing, multiple amplifications may be required to detect sequence variants in the sample and minority variant sequences will not always be detected.

Gene, 1994 Jan 28, 138(1-2), 43 - 50
Cloning and constitutive expression of structural genes encoding gonococcal porin protein in Escherichia coli and attenuated Salmonella typhimurium vaccine strains; Elkins C et al.; Previous reports {Gotschlich et al., Proc . Natl . Acad . Sci . USA 84 (1987) 8135-8139; Carbonetti and Sparling, Proc . Natl . Acad . Sci . USA 84 (1987) 9084-9088; Carbonetti et al., Proc . Natl . Acad . Sci . USA 85 (1988) 6841-6845} concluded that synthesis of the porin protein (Por) from Neisseria gonorrhoeae in Escherichia coli was toxic to that organism, which limited studies of the biology of Por in foreign hosts . We assembled intact por genes from the gonococcal strains, FA19 (serogroup PIA) and FA6434 (a hybrid Por containing epitopes from serogroups PIA and PIB), and observed stable expression in E . coli without evident toxicity . Expression of por from strain MS11 (serogroup PIB) in E . coli was difficult, but por from MS11 was expressed without toxicity when the -35 region of the por promoter was removed . Encouraged by this, we moved por from E . coli into attenuated Salmonella typhimurium strains and expressed por either in single copy from the chromosome or in multiple copy from plasmids . Expression levels of por in S . typhimurium were higher from plasmids than from the chromosome, probably due to a gene dosage effect . This work will enable study of the immune response to Por in mice vaccinated orally with live S . typhimurium.

J Mol Biol, 1994 Jan 21, 235(3), 1154 - 5
Crystallization and preliminary X-ray investigation of a recombinant outer membrane protein from Neisseria meningitidis; de la Sierra IL et al.; A protein constituent of the outer membrane from Neisseria meningitidis (hereafter called P64K) has been crystallized using the hanging drop technique . Crystals are tetragonal with unit cell dimensions a = b = 136.84 A and c = 78.44 A, compatible with a single monomer of 64 kDa in the asymmetric unit . When exposed to high intensity synchrotron radiation, these crystals diffract X-rays to at least 2.9 A resolution, indicating that a high resolution structure analysis is feasible.

Schweiz Rundsch Med Prax, 1994 Jan 11, 83(2), 46 - 8
{Gonorrheal arthritis}; Weber M et al.; A 43-year-old female patient presented with migratory arthralgias, generalized exanthema and arthritis of the left elbow . She had a history of fever and chills three days earlier . Beside to a maculopapular and pustular rash and a joint involvement we found a swelling of the dorsal surface of her right hand without wrist effusion or synovitis . The clinical presentation was typical for the diagnosis of disseminated gonococcal infection (arthritis-dermatitis syndrome) . Arthrocentesis was performed, and the cultures of the synovial fluid on chocolate agar were positive for Neisseria gonorrhoeae . The serologic examination for gonococcus was negative, it became positive some weeks later . The therapy with intravenous penicillin G 6 x 10(6) units/day for ten days was successful; unfortunately, we could not treat the partner . The present case report is illustrated with colour prints and describes the typical clinical picture of a diagnosis which is nowadays rare or even forgotten.

Cancer Res, 1994 Jan 1, 54(1), 197 - 203
GD3 vaccines for melanoma: superior immunogenicity of keyhole limpet hemocyanin conjugate vaccines; Helling F et al.; Cell surface gangliosides show altered patterns of expression as a consequence of malignant transformation and have therefore been of interest as potential targets for immunotherapy, including vaccine construction . One obstacle has been that some of the gangliosides that are overexpressed in human cancers are poorly immunogenic in humans . A case in point is GD3, a prominent ganglioside of human malignant melanoma . Using an approach that has been effective in the construction of bacterial carbohydrate vaccines, we have succeeded in increasing the immunogenicity of GD3 in the mouse by conjugating the ganglioside with immunogenic carriers . Several conjugation methods were used . The optimal procedure involved ozone cleavage of the double bond of GD3 in the ceramide backbone, introducing an aldehyde group, and coupling to aminolysyl groups of proteins by reductive amination . Conjugates were constructed with a synthetic multiple antigenic peptide expressing repeats of a malarial T-cell epitope, outer membrane proteins of Neisseria meningitidis, cationized bovine serum albumin, keyhole limpet hemocyanin, and polylysine . Mice immunized with these conjugates showed a stronger antibody response to GD3 than mice immunized with unconjugated GD3 . The strongest response was observed in mice immunized with the keyhole limpet hemocyanin conjugate of the GD3 aldehyde derivative and the adjuvant QS-21 . These mice showed not only a long-lasting high-titer IgM response but also a consistent high-titer IgG response (predominantly IgG1), indicating recruitment of T-cell help, although the titers of IgM and IgG antibodies following booster immunizations were not as high as they are in the response to classical T-cell-dependent antigens . This method is applicable to other gangliosides, and it may be useful in the construction of immunogenic ganglioside vaccines for the immunotherapy of human cancers expressing gangliosides on their cell surface.

Antimicrob Agents Chemother, 1994 Jan, 38(1), 155 - 8
Antimicrobial susceptibilities of Neisseria gonorrhoeae strains representing five distinct resistance phenotypes; Rice RJ et al.; The susceptibilities of 109 strains of Neisseria gonorrhoeae to penicillin G, tetracycline, amoxicillin-clavulanic acid, cefotetan, cefoxitin, ceftriaxone, ciprofloxacin, and fleroxacin were determined . The activities of cefmetazole, cefuroxime, cefixime, and ofloxacin were also determined against 62 of these strains . Strains represented penicillin-susceptible (Pen(s)) N . gonorrhoeae; penicillinase-producing N . gonorrhoeae (PPNG) possessing 2.9-, 3.05-, 3.2-, or 4.4-MDa beta-lactamase plasmids; strains with high-level, plasmid-mediated tetracycline resistance (TRNG); strains with plasmid-mediated resistance to penicillin and tetracycline; and strains with chromosomally mediated resistance to penicillin and tetracycline (CMRNG) . Ceftriaxone, cefixime, and ciprofloxacin were the most active agents tested against all strains . Pen(s), TRNG, and PPNG strains possessing a 3.2-MDa beta-lactamase plasmid were more susceptible to amoxicillin-clavulanic acid, extended- and broad-spectrum cephalosporins, and quinolones than were either PPNG strains possessing a 2.9-, a 3.05-, or a 4.4-MDa beta-lactamase plasmid or CMRNG strains.

Sex Transm Dis, 1994 Jan-Feb, 21(1), 43 - 6
Single dose azithromycin treatment of gonorrhea and infections caused by C . trachomatis and U . urealyticum in men; Steingrimsson O et al.; BACKGROUND AND OBJECTIVES: Single dose regimens have advantages in the treatment of STD . Azithromycin has unique pharmacokinetics that may make single dose regimens feasible . Treatment with a single 1 g dose of azithromycin was compared to 100 mg doxycycline twice daily for seven days . STUDY DESIGN: This was a randomized third-party blinded study on 183 male patients, 176 of whom could be evaluated for efficacy . RESULTS: Chlamydia trachomatis was cultured from 148 patients, 79 receiving azithromycin and 69 receiving doxycycline . Six patients receiving azithromycin had positive cultures on follow-up, four were known to have had sexual intercourse with infected partners . Fifty-one patients had gonorrhea; 28 were treated with azithromycin and 23 with doxycycline . Neisseria gonorrhoeae was eradicated from all patients except one receiving azithromycin . He denied sexual exposure during follow-up . Sixty patients were infected with Ureaplasma urealyticum, 35 were treated with azithromycin and 25 with doxycycline . Five patients in each group had positive cultures on follow up . Three patients receiving azithromycin and two receiving doxycycline were known to have had sexual exposure during follow-up . CONCLUSION: A single dose of azithromycin showed similar effectiveness as a 7-day regimen of doxycycline.

FEMS Microbiol Lett, 1994 Jan 1, 115(1), 39 - 44
Neisseria gonorrhoeae possesses two nicotinamide adenine dinucleotide-independent lactate dehydrogenases; Fischer RS et al.; An important metabolic capability of Neisseria gonorrhoeae is the utilization of host-derived lactate . Two isoenzymes of the membrane-associated, pyridine dinucleotide-independent type of lactate dehydrogenase (iLDH) participate in lactate assimilation, but exhibit distinctive properties . Isoenzyme iLDH-I utilized lactate exclusively as substrate, exhibiting a preference for the D-isomer . In contrast, isoenzyme iLDH-II exhibited broad substrate specificity (lactate, phenyllactate, and 4-hydroxyphenyllactate), but was stereospecific for the L-isomers . These results explain the difficulty in isolating mutants unable to utilize lactate.

Rev Med Chil, 1994 Jan, 122(1), 42 - 7
{Detection of anti-gonococcal antibodies using a dot immunobinding assay in a high risk female population}; Soto L et al.; The bacteriological diagnosis of gonorrhea in women has a low efficiency . A dot immunobinding assay, using whole piliated Neisseria gonorrhoeae cells, was used to detect antigonococcal antibodies in 300 prostitutes in whom a parallel Thayer-Martin culture of endocervical secretion was performed . Twenty sera from men with bacteriologically confirmed gonorrhoea were used as positive controls and 20 sera from children without history of gonococcal infections, as negative controls . Antibodies were detected in 49.7% of women and culture was positive in only one . All men with gonorrhea has positive titers and all sera from children were negative, except one that had a cross-reaction . Test sensitivity in the female population was 1 and specificity 0.5 . There were no false negative reactions . Although the test detected antibodies in high risk women, there were cross-reactions . Therefore, the technique should be improved, using a more specific antigen.

Arch Med Res, 1994 Winter, 25(4), 455 - 61
Evaluation of the efficacy of human antimeningococcal immunoglobulin G in infant rats experimentally infected with Neisseria meningitidis group B; Infante JF et al.; Infants rats, a well known model for the experimental reproduction of bacterial meningitis, were used by us to test the protective potential of antibodies developed in humans who had been vaccinated with the Cuban antimeningitis vaccine (VA-MENGOCBC) . Newborn rats were inoculated by the intraperitoneal and intranasal routes with suspensions of Neisseria meningitidis group B bacteria . Bacteremia kinetics were evaluated from blood and brain-spinal fluid cultures . Samples of the central nervous system were taken and smears of backbone fluids prepared for histopathologic evaluations . Characterization of bacteremia evolution, as well as the mean lethal dose of germs and histopathologic features, were determined . After standardization of the model, therapeutic schemes were applied using passive immunization pre- and post-infection with N . meningitidis . A significant level of protection was obtained in relation to control animals that received the same challenge doses.

Scand J Infect Dis, 1994, 26(5), 605 - 9
Bacteremia in patients without known underlying disorders; Amit M et al.; Of 2030 consecutive patients with bacteremia, only 102 were free from underlying disorders . 43 were males, and the median age was 66 years . The sources of infection were the urinary tract (in 48%), lower respiratory tract (13%), endocarditis (7%), biliary tract (6%) and the meninges (5%) . The most common pathogens were Escherichia coli (in 45% of patients), Streptococcus pneumoniae (21%), Staphylococcus aureus (9%) and hemolytic streptococci (9%) . Overall mortality rate was 13%, 4% in patients with urinary tract infection and 19% in patients with other sources . Half of the deaths occurred within 2 days of hospitalization, and 75% of them within 4 days . All patients with septic shock and all patients with meningitis died . Other factors related to mortality were residence in a nursing home, low functional capacity, advanced age, high blood urea nitrogen and creatinine and low albumin, and infections caused by Staphylococcus aureus, Neisseria meningitidis and polymicrobial infections . A protective effect of appropriate antimicrobial antibiotic therapy could not be demonstrated . In conclusion, bacteremic patients with no known underlying disorder and source of their infection other than the urinary tract should be given maximum supportive treatment and should be closely watched.

Bull Soc Pathol Exot, 1994, 87(3), 148 - 51
{Rhinopharyngeal carriage of Neisseria meningitidis serogroup C in the collectivity around the patients of Mali . Apropos of 1,033 subjects sampled}; Koumare B et al.; This study showed that the carriage rate is nul or low in collectivity not in close contact, but high in collectivity in close contact (schools, particularly coranic schools) . In this later case, the duration of the carriage may reach several weeks (2 to 6 in our study) at variable rates (3.7 to 9.6%; 12.5 to 62.5%; 14.3 to 42.9% according to the coranic school visited) . For the strains of N . meningitidis serogroup C isolated, the rate of resistance to sulfamides and cotrimoxazole is 86.8% . These results explain why during epidemics, it is necessary to close schools and avoid to use for the chemoprophylaxis, sulfamids and their associations because of resistance.

Pediatr Neurosurg, 1994, 21(3), 189 - 91
Cerebrospinal fluid shunt infection by Neisseria sicca; Hornyik G et al.; Neisseria sicca is considered to be a nonpathogenic oral saprophyte . Presented here is an unusual case of cerebrospinal fluid (CSF) shunt infection by N . sicca . Although medical management of the common community-acquired meningitides, including infection by Neisseria meningitidis, is often successful in patients with CSF shunts, removal and replacement of the infected shunt was necessary in this case.

Acta Microbiol Immunol Hung, 1994, 41(3), 291 - 3
A comparative study for detection of Chlamydia trachomatis and Neisseria gonorrhoeae with DNA probe (a note); Szell A et al.; A newly developed DNA probe assay (Gen-Probe Pace 2 San Diego, USA) was compared with Chlamydia trachomatis direct immunofluorescence and Neisseria gonorrhoeae culture . Detection of C . trachomatis in cervical specimens from women and urethral specimens from men showed 23% positivity out of 313 cases . Out of the 69 positive cases 40 were positive with both examinations, in 29 cases only with DNA probe . Examinations of N . gonorrhoeae in 254 patients gave 98% positivity . Sensitivity of DNA probe assay was 100%, specificity was 97.8% . On the basis of preliminary data Gen-Probe is suitable for the detection of both causative agents.

Acta Microbiol Pol, 1994, 43(1), 103 - 5
Identification of a new restriction endonuclease R.NciII, from Neisseria cinerea; Piekarowicz A; Site-specific restriction endonuclease R . Nci II has been purified from Neisseria cinerea strain 32615 . The enzyme recognizes the sequence 5' GATC 3' and its activity is inhibited by the presence of methylated adenine residue within the recognition sequence.

Trop Geogr Med, 1994, 46(1), 44 - 5
Diagnosis of Trichomonas vaginalis in male urethritis; Pillay DG et al.; Trichomonas vaginalis was diagnosed in 42 (19%) of 227 adult males with urethral discharge . In 27 men (15%) T . vaginalis was isolated together with Neisseria gonorrhoeae . Non-gonococcal urethritis was diagnosed in 15 patients and T . vaginalis was isolated from 47% of such patients . Stained smear preparations, i.e . RapiDiff and acridine orange of modified Diamond's media, were superior to wet smear microscopy for the identification of T . vaginalis . RapiDiff stain was the most sensitive and identified 41 of 42 (98%) positive cultures . It is recommended that all turbid culture media should be stained for the optimal diagnosis of trichomoniasis.

Gene, 1993 Dec 31, 137(2), 233 - 6
Transcriptional control of gonococcal pilE expression: involvement of an alternate sigma factor; Boyle-Vavra S et al.; The pilE gene encoding Neisseria gonorrhoeae (Gc) pilin contains two putative promoter sequences 5' to the transcription start point (tsp), a Pribnow box and an RpoN-binding consensus sequence . Sequence analysis shows that the nucleotide (nt) sequence of the pilE promoter region is completely conserved among eight different Gc isolates . Using a pilE::lacZ transcriptional fusion, we demonstrate that the RpoN sigma factor can function in Escherichia coli to increase pilE transcription when the NifA activator from Klebsiella is present in trans . In addition, over-production of the native pilin protein using RpoN and NifA is lethal to E . coli . Finally, we show that the RpoN sigma factor decreases the basal expression of pilE when an activator is not present . These results suggest that, in Gc, pilE transcription may be regulated by RpoN in conjunction with an activator and that sigma 70 can also act to direct transcription of pilE.

Gene, 1993 Dec 31, 137(2), 153 - 62
A rapid and sensitive PCR strategy employed for amplification and sequencing of porA from a single colony-forming unit of Neisseria meningitidis; Saunders NB et al.; The predicted amino acid sequence was determined for the class-1 outer membrane protein, PorA, from a B:15:P1.7,3 strain of Neisseria meningitidis that is currently causing an epidemic of meningitis in Northern Chile . The P1.7,3 PorA showed a unique sequence in the exposed loop 4 of the putative porin structure that is different from all the reported PorA sequences . Based on the nucleotide (nt) sequence of the P1.7,3 porA, we designed two sets of PCR (polymerase chain reaction) primers that specifically amplified porA from any N . meningitidis strain, and a third set of primers that amplified porA only from the P1.7,3 strain . Using these primers, we developed a sensitive double hot-start nested PCR (HNPCR) strategy that could amplify porA and generate nt sequence from as low as a single colony-forming unit . This strategy consisted of three phases of PCR . The first two phases were designed to generate amplified target DNA that could be directly visualized by ethidium bromide staining starting from one to two molecules of Neisseria genome . The third phase was designed to generate a sequence of several hundred nt directly from the amplified DNA . A number of culture-negative cerebrospinal fluid samples from individuals suspected of meningitis during a vaccine trial were analyzed by this strategy to obtain more accurate information on the actual number of cases that occurred in the study and the non-study populations . The basic HNPCR strategy described here could be applied to amplify and sequence target DNAs from any low-copy-number biological sample.

Genitourin Med, 1993 Dec, 69(6), 434 - 8
Sexually transmitted diseases reported by STD services in The Netherlands, 1984-1990; Treurniet HF et al.; OBJECTIVE--To present general trends in sexually transmitted disease (STD) in the Netherlands during the period 1984-1990 and to describe characteristics of the patients in order to get insight into possible factors underlying these trends . METHODS--Since 1984 patients diagnosed with STD visiting STD clinics and local public health services in the Netherlands are reported by the nursing staffs . In addition to diagnosis and gender of the patient epidemiological background information is registered . The reported annual cases of gonorrhoea, syphilis and Chlamydia trachomatis infections are presented . Further, the epidemiological features of over 25,000 patients with infections due to Chlamydia trachomatis, gonorrhoea or syphilis infections were compared . RESULTS--During the period 1984-1990 an overall decrease in the total number of gonorrhoea infections was reported; among homosexual males; however, an increase in gonorrhoea rates and an increasing number of sexual partners after 1989 was reported . Furthermore, the percentage of gonorrhoea infections caused by penicillinase-producing Neisseria gonorrhoeae was found to be on the increase in various subgroups but not in homosexual males . Syphilis rates among females declined from 1984 to 1987 after which an increase was reported reaching a peak in 1989; syphilis rates among males peaked during 1989 . After 1988 Chlamydia trachomatis infections increased which, however, is largely due to the introduction of screening among all visitors of the Amsterdam STD service resulting in improved case-detection . Finally, it appeared that STDs are not randomly distributed over the population but are associated with certain patient characteristics . CONCLUSION--The data provided by STD services reveal an epidemiological pattern for STDs in the Netherlands . The increase in the reported number of gonorrhoea infections among homosexuals together with the increasing number of sexual partners among homosexual males suggest that a group of highly sexually active individuals switch or return to higher risk behaviours . Further research is needed to determine the causes of the described trends and behavioural changes in order to undertake preventive activities.

Genitourin Med, 1993 Dec, 69(6), 427 - 30
High prevalence of sexually transmitted diseases in a rural area in Mozambique; Vuylsteke B et al.; OBJECTIVE--To assess the extent of the sexually transmitted diseases (STDs) problem in a rural area of Mozambique . METHODS--A cross sectional study among pregnant women and patients presenting with genital complaints . Laboratory confirmation was done for gonorrhoea, chlamydial infection, active syphilis, trichomoniasis and HIV infection . SETTING--A primary health care setting in Vilanculos, Inhambane province, Mozambique . RESULTS--Evidence of one or more of the above STDs was found in 51% of 201 pregnant women, 56% of 85 women and 62% of 77 men with genital complaints . Neisseria gonorrhoea or Chlamydia trachomatis were found in 16% of pregnant women, 23% of female patients and 28% of male patients; genital ulcer disease was present in 6%, 28% and 36%, of respectively pregnant women, female and male patients . The prevalence of active syphilis was about the same in the three groups of study subjects, that is 15% . HIV infection was found in 4% of the male patients; no HIV infection could be detected in the female groups . CONCLUSION--STDs were a major health problem in this rural area in Mozambique . Though HIV infection was still low, the high prevalence of STDs indicates that the potential is there for an explosive spread of the HIV/AIDS epidemic.

J Bacteriol, 1993 Dec, 175(24), 8030 - 7
Characterization of the rho genes of Neisseria gonorrhoeae and Salmonella typhimurium; Miloso M et al.; We have cloned and sequenced the genomic regions encompassing the rho genes of Neisseria gonorrhoeae and Salmonella typhimurium . Rho factor of S . typhimurium has only three amino acid differences with respect to the Escherichia coli homolog . Northern (RNA) blots and primer extension experiments were used to characterize the N . gonorrhoeae rho transcript and to identify the transcription initiation and termination elements of this cistron . The function of the Rho factor of N . gonorrhoeae was investigated by complementation assays of rho mutants of E . coli and S . typhimurium and by in vivo transcription assays in polar mutants of S . typhimurium.

Pediatrics, 1993 Dec, 92(6), 755 - 60
Randomized trial of silver nitrate, erythromycin, and no eye prophylaxis for the prevention of conjunctivitis among newborns not at risk for gonococcal ophthalmitis . Eye Prophylaxis Study Group; Bell TA et al.; OBJECTIVE . To compare the efficacy of commonly used forms of eye prophylaxis for newborns with no prophylaxis in the prevention of nongonococcal conjunctivitis . DESIGN . Randomized doubly masked clinical trial . SETTING . University of Washington Hospital and affiliated clinics, Seattle, between 1985 and 1990 . SUBJECTS . The medical records of 8499 women were evaluated for possible participation; 2577 were eligible . Of the 758 enrolled, the infants of 630 were evaluable . INTERVENTION . Comparison of silver nitrate, erythromycin, and no eye prophylaxis given at birth for the prevention of conjunctivitis . MAIN OUTCOME MEASURES . Conjunctivitis during the first 60 days of life and nasolacrimal duct patency in the first 2 days of life . RESULTS . The frequency of impatent tear ducts at the 30- to 48-hour examination did not differ significantly by prophylaxis group . Among the 630 infants randomized and observed, 109 (17%) developed mild conjunctivitis . Sixty-nine (63%) of the cases appeared during the first 2 weeks of life . After 2 months of observation, infants allocated to silver nitrate eye prophylaxis at birth had a 39% lower rate of conjunctivitis (hazard ratio = 0.61, 95% confidence interval = 0.39 to 0.97), and those allocated to erythromycin had a 31% lower rate of conjunctivitis (hazard ratio = 0.69, 95% confidence interval = 0.44 to 1.07), than did those allocated to no prophylaxis . CONCLUSION . Silver nitrate eye prophylaxis caused no sustained deleterious effects and even provided some benefit to infants born to women without Neisseria gonorrhoeae . However, the effect was modest and against microorganisms of low virulence . The results suggest that parental choice of a prophylaxis agent including no prophylaxis is reasonable for women receiving prenatal care and who are screened for sexually transmitted diseases during pregnancy.

Br J Biomed Sci, 1993 Dec, 50(4), 301 - 4
Neisseria gonorrhoeae penicillin susceptibility: a comparison of three testing methods; Hitchcock PA; The 3-disc sensitivity method and the PDM Epsilometer (E-Test) were compared against the agar plate dilution reference method for the testing of N . gonorrhoeae penicillin susceptibility . Forty-six clinical isolates and five reference strains were examined . Both methods showed a high level of correlation in the detection of both high and moderate levels of resistance and both should be considered suitable for routine use . The E-Test had the advantage of producing a precise breakdown of the level of moderate resistance and may have a role to play in the diagnostic laboratory for this type of work.

Br J Biomed Sci, 1993 Dec, 50(4), 295 - 300
Typing of Neisseria gonorrhoeae by auxotype, serovar and lectin agglutination; Moyes A et al.; A total of 267 strains of Neisseria gonorrhoeae, comprising 129 serogroup IA and 138 serogroup IB, isolated in Edinburgh over a two-year period were analysed to assess the discrimination given by three typing methods: auxotyping; serotyping using the Genetic Systems (GS) and Pharmacia (PH) monoclonal antibody panels; and lectin agglutination . Each typing system was assessed individually and in combination . Serotyping subdivided the strains into 14 GS and 18PH serovars . Auxotyping (Aux) yielded 11 separate auxotypes while lectin agglutination yielded 22 different reaction patterns (LP) . The standard auxotype/GS serovar (A/S) classification system yielded 37 classes . Lectin agglutination allowed further subdivision of the main A/S classes . AHU/IA-2 strains,which accounted for 70% of IA strains, yielded nine different lectin patterns (A/S/LP classes) . Likewise, lectin agglutination allowed subdivision of the main IB A/S classes . NR/IB-1, NR/IB-2 and NR/IB-3, which accounted for 28%, 38% and 20% respectively of the IB strains, yielded 7, 7 and 6 A/S/LP classes respectively . It was concluded that lectin agglutination is a useful adjunct to the standard A/S classification system for studying the micro-epidemiology of gonococcal infection.

Ann Soc Belg Med Trop, 1993 Dec, 73(4), 267 - 78
{Management of sexually transmissible diseases in an urban environment in Cameroon in 1992}; Louis JP et al.; During the progress, in 1989, of a programme of social marketing of condoms in Cameroon, it was obvious that this approach should be supplemented by a similar programme for the management of STD's . Nine surveys were carried out in 1992 in Yaounde and Douala in the sexually most active male population (in the general community, at the workplace and in the leisure environment) in order to collect the basic data necessary for its implementation . Treatment essentially consists of mono-chemotherapy with drugs which are generally inefficient against the two principal etiologies of urethritis: Neisseria gonorrhoeae and Chlamydia trachomatis . The cost of treatment is considered excessive and leads to poor follow-up of the complete prescription . Simultaneous treatment of partners should be developed . All these data have been taken into account for the elaboration of a pilot programme which should be implemented in 1993.

Acta Virol, 1993 Dec, 37(6), 449 - 58
The complex formation of influenza virus envelope glycoproteins with outer membrane proteins of Neisseria meningitidis or Borrelia burgdorferi; Slavik I et al.; The isolation of influenza virus envelope glycoproteins was achieved by one-step procedure consisting of treatment of purified virus with zwitterionic detergent and separation of viral constituents by sucrose density gradient centrifugation . Viral glycoproteins and proteins of outer membrane of N . meningitidis or B . burgdorferi formed complexes after removal of the detergent by dialysis . Complexing of viral glycoproteins and bacterial proteins was monitored by gel chromatography on Sepharose 6B, polyacrylamide gel electrophoresis and electron microscopy . It was demonstrated by immunoblot analysis, that virus-spirochete complexes elicited formation of antibodies in mice directed against osp A and osp B of spirochete, as well as against viral glycoproteins, respectively.

Microb Pathog, 1993 Dec, 15(6), 433 - 45
The interaction between human transferrin and transferrin binding protein 2 from Moraxella (Branhamella) catarrhalis differs from that of other human pathogens; Yu RH et al.; The interaction between human transferrin and the transferrin binding proteins of Moraxella catarrhalis was studied by binding and affinity isolation experiments with transferrin and its derivatives . Competition binding experiments demonstrated that, compared to transferrin binding proteins in Neisseria meningitidis, the receptors in M . catarrhalis were more effectively blocked by iron-saturated transferrin than by the apo form of the protein . A combination of direct binding experiments and affinity isolation experiments demonstrated that this was due to a strong preference for binding of iron-saturated transferrin by transferrin binding protein 2 (Tbp2) . Binding and affinity isolation studies also demonstrated that the C-lobe of human transferrin was fully capable of binding to M . catarrhalis transferrin binding protein 1 (Tbp1) but not to Tbp2 . Neither the N-lobe nor a proteolytic derivative of human transferrin lacking only a portion of the C-terminus were capable of effectively binding to M . catarrhalis Tbp2, possibly implicating the involvement of several regions in the binding interaction.

Trends Biotechnol, 1993 Dec, 11(12), 506 - 10
Phase and antigenic variation--the impact on strategies for bacterial vaccine design; Maskell D et al.; Many pathogens have the ability to vary the antigenic composition of surface-associated antigens . Often, this variation is mediated by the regulation of gene expression . By varying its antigenicity, the pathogen is able to avoid host immune responses more efficiently; however, this makes the design of vaccines against pathogens that exhibit antigenic variation difficult . In this review, we use the pathogenic Neisseria as an example of antigenically variable bacteria and discuss some attempts to overcome the problems of vaccine design posed by such organisms.

Infect Immun, 1993 Nov, 61(11), 4662 - 8
Increased sensitivity of gonococcal pilA mutants to bactericidal activity of normal human serum; Taha MK; PilA is a pleiotropic transcriptional regulator in Neisseria gonorrhoeae, encoded by an essential gene, pilA . It regulates pilin gene expression and stress response and it is implicated in gonococcal adaptation to external signals . All these phenomena may participate in gonococcal virulence . In this report, I tested the role of PilA in another aspect of gonococcal virulence, resistance to the bactericidal effect of normal human serum . Gonococcal mutants with impaired PilA function were more susceptible to the bactericidal effect of normal human serum than the isogenic wild-type strain . However, the major outer membrane protein and the lipooligosaccharide, targets for complement-mediated killing by the serum, were unchanged in the mutants . I discuss the role of PilA in modulating gonococcal sensitivity and resistance to normal human serum.

Infect Immun, 1993 Nov, 61(11), 4599 - 606
Identification and cloning of a fur homolog from Neisseria gonorrhoeae; Berish SA et al.; The promoter region of the major iron-regulated protein of Neisseria gonorrhoeae, Fbp, has two regions that exhibit homology with the Escherichia coli consensus Fur-binding sequences . Gel retardation assays suggested that purified E . coli Fur bound to two sites within the Fbp promoter . The presence of a gonococcal Fur homolog was suggested by Southern hybridization under conditions of low stringency, which revealed a DNA locus that exhibited homology to the E . coli fur gene . Oligonucleotides derived from the conserved regions of fur genes of extremely diverse bacteria were used to amplify a 140-bp fragment of a putative gonococcal fur gene . This fragment was used to identify clones containing the entire gonococcal fur gene . After sequencing the gonococcal fur gene and its promoter region, we found that gonococcal Fur exhibited 50% identity with E . coli Fur at the amino acid level; however, it complemented two E . coli Fur- mutants . The presence of a Fur homolog in N . gonorrhoeae suggests that Fur-regulated genes are widely distributed among extremely diverse bacteria.

Int J STD AIDS, 1993 Nov-Dec, 4(6), 330 - 2
PPNG at St Thomas' Hospital--a changing provenance; Sherrard J et al.; Between 1986 and 1992, 15% of all cases of penicillinase-producing Neisseria gonorrhoeae (PPNG) notified in the UK were seen at our central London clinic . During this time the geographical provenance of PPNG has changed . Africa and SE Asia have been supplanted by the Caribbean as the predominant source, with 21.4% of all cases being directly imported from there in 1992 . If all gonococcal infections acquired outside the UK had been assumed to be PPNG, together with those occurring in patients with family origins in Africa or SE Asia, some 60% of cases of PPNG could have been predicted before laboratory confirmation of resistance . There is little evidence that PPNG has become endemic in the United Kingdom.

Int J Biochem, 1993 Nov, 25(11), 1517 - 27
Polysialic acids; Reglero A et al.; 1 . Polysialic acids are linear homopolymers of N-acetylneuraminic acid (Neu5Ac), N-glycolylneuraminic acid (Neu5Gc) and deaminated neuraminic acid (KDN) residues joined by alpha 2,8, alpha 2-9 or alpha 2,8/alpha 2,9 ketosidic linkages . 2 . They occur in glycoproteins of embryonic neural membranes (playing a role of neural cell adhesion molecules), in non-neural tissues (postnatal kidney), tumours, (neuroectodermal tumours), fish eggs and in the capsule of certain bacteria such as Neisseria meningitidis group B . 3 . These polymers are synthesized through reactions which involve (a) the synthesis of sialic acid; (b) its activation to a cytidine monophosphate sugar nucleotide and (c) the polymerization of the different residues by a polysialyl-transferase complex . 4 . Polysialic acids are involved in organogenesis and in cell growth . In several tissues they act as oncodevelopmental antigens, and in bacteria are also virulent determinants.

J Gen Microbiol, 1993 Nov, 139 ( Pt 11), 2603 - 11
Genetic structure of Neisseria gonorrhoeae populations: a non-clonal pathogen; O'Rourke M et al.; Reproduction by binary fission generates a clonal genetic structure in bacterial populations in the absence of a high rate of recombination . The extent of recombination in natural populations of Neisseria gonorrhoeae was determined from an analysis of electrophoretically demonstrable allelic variation at structural genes encoding nine enzyme loci in 227 worldwide isolates . No significant linkage disequilibrium was evident in the population, indicating that recombination must be frequent, relative to binary fission . The genetic structure of N . gonorrhoeae was compared with that of Bacillus subtilis from an earlier study . Linkage disequilibrium was less extreme in the N . gonorrhoeae population than in the local population of B . subtilis, in which only modest clonal structure was evident . Thus, N . gonorrhoeae, unlike pathogens so far examined, has a non-clonal population structure . As expected in a freely recombining population, no correlation was found between electrophoretic genotype and serovar or auxotype.

J Clin Microbiol, 1993 Nov, 31(11), 3053 - 5
Evaluation of Etest for testing antimicrobial susceptibilities of Neisseria gonorrhoeae isolates with different growth media; Yeung KH et al.; The MICs for 101 isolates of Neisseria gonorrhoeae obtained by Etest (AB-Biodisk, Solna, Sweden) and the agar dilution method on GC medium base supplemented with 1% Kellog's defined supplement (GCMB) were compared . The overall percent agreement (within 1 log2 dilution) between methods was greater than 97.9 . The Pearson's correlation coefficients for penicillin, tetracycline, erythromycin, and ceftriaxone for the two methods were 0.98, 0.97, 0.93, and 0.93 (P = 0.001), respectively, for comparisons on GCMB . The overall percent agreement was lower when hemoglobin-supplemented GCMB was used . Etest is an attractive alternative to the agar dilution method for gonococcal antimicrobial susceptibility testing and should be further analyzed in multicenter studies.

J Antimicrob Chemother, 1993 Nov, 32(5), 677 - 84
Penicillin-binding protein 2 genes of chromosomally-mediated penicillin-resistant Neisseria gonorrhoeae from Greece: screening for codon Asp-345A; Tirodimos I et al.; Low affinity of penicillin for altered penicillin-binding protein 2 (PBP 2) of Neisseria gonorrhoeae that are chromosomally resistant to penicillin (CMRNG) has been attributed, at least partly to the insertion of an additional aspartic acid (Asp-35A) codon in the penA gene . Oligonucleotide probes were used to detect the presence or absence of this extra amino-acid residue in 34 non-penicillinase producing N . gonorrhoeae with decreased susceptibility to penicillin (MICs 0.25-2 mg/L) and 11 strains sensitive to penicillin (MIC < or = 0.06 mg/L) isolated in Greece and previously characterized by auxotype and serovar . The Asp-345A codon was found in all CMRNG strains as well as in strains with intermediate resistance to penicillin, but was absent from all strains exhibiting an MIC of penicillin of < or = 0.03 mg/L . No association of the Asp-345A insertion to any particular auxotype or serovar was found . These results expand the previously reported correlation between the presence of the Asp-345A codon and reduced sensitivity to penicillin, and shows that this particular mutation is common among epidemiologically distinct CMRNG strains.

J Antimicrob Chemother, 1993 Nov, 32(5), 667 - 76
Nucleotide sequences of the tet(M) genes from the American and Dutch type tetracycline resistance plasmids of Neisseria gonorrhoeae; Gascoyne-Binzi DM et al.; High-level tetracycline-resistant Neisseria gonorrhoeae (TRNG) has been associated with the presence of a plasmid approximately 25.2 MDa in size which carries a Tet M tetracycline resistance determinant . Two different plasmid types, American and Dutch, have previously been described, based on the restriction endonuclease digestion pattern . In this study, the tet(M) genes from the two plasmid types have been amplified by the polymerase chain reaction (PCR) and then sequenced . The gene sequences from the two plasmids shared 96.8% identity, and showed similarities with different segments of the tet(M) gene sequences from Tn1545, Tn916 and Ureaplasma urealyticum . The data suggest that it is highly likely that the Tet M determinant found in the American type plasmid has a different origin from that present in the Dutch plasmid.

Sex Transm Dis, 1993 Nov-Dec, 20(6), 338 - 43
The epidemiology of Neisseria gonorrhoeae isolates in Greenland 1979-1990: the emergence, spread and disappearance of non-PPNG strains carrying the conjugative 38.9 kb plasmid; Reimann K et al.; BACKGROUND: In 1990, Greenland was one of the few areas in the world in which endemic occurrence of PPNG had not been reported . However, between 1982 and 1988 an increase in the prevalence of strains with chromosomally mediated resistance to penicillin had been noticed . The standard treatment regimen was changed early in 1983 . OBJECTIVE: To determine the prevalence of the 38.9 kb plasmid in gonococcal strains isolated in Greenland 1979-1990 . DESIGN: Retrospective (1979-1984) and prospective (1985-1990) studies of antimicrobial susceptibility and plasmid profile of consecutive N . gonorrhoeae isolates from patients attending the STD clinic in Nuuk, Greenland; selected strains from 1982-1984 were subjected to serotyping and auxotyping . RESULTS: Before 1982, N . gonorrhoeae strains harboring the 38.9 kb conjugative plasmid were rare; in 1982, a sudden increase in the prevalence of these strains was strongly associated with the emergence of streptomycin-resistant strains with high-level chromosomally mediated resistance to penicillin, 70% of which carried the 38.9 kb plasmid . Determination of antimicrobial susceptibility pattern, auxotype and serovar supported the assumption of an epidemic spread of a single clone . The predominance of this clone was transient, but the 38.9 kb plasmid spread to penicillin-susceptible as well as to other clones of penicillin-resistant strains . CONCLUSION: The emergence of the 38.9 kb plasmid in 1982 was linked to a single clone of strains, but the subsequent spread of the plasmid was independent of the presence of other plasmids, and its disappearance was not associated with a change in standard treatment regimen.

Sex Transm Dis, 1993 Nov-Dec, 20(6), 329 - 33
Detection of the tetM determinant in Neisseria gonorrhoeae; Ison CA et al.; BACKGROUND AND OBJECTIVES: Plasmid-mediated high level resistance to tetracycline in Neisseria gonorrhoeae has become a therapeutic problem in many parts of the world . Simple, fast and accurate screening tests are required to enable rapid detection . GOAL OF THE STUDY: To evaluate screening tests for high-level tetracycline resistance for their ability to predict the presence of the tetM determinant in Neisseria gonorrhoeae . STUDY DESIGN: Strains considered to exhibit plasmid-mediated (90) and chromosomal resistance (19) to tetracycline were used to compare the screening tests, growth on tetracycline agar, disc testing, MIC and plasmid content, with confirmation by hybridization to the tetM probe . A polymerase chain reaction to amplify tetM in N . gonorrhoeae was also evaluated . RESULTS: All strains defined as presumptive TRNG by the screening tests hybridized with the tetM probe . None of the low-level resistant strains were positive in the screening tests or hybridized with the probe . In addition, the polymerase chain reaction (PCR) on whole bacterial cells detected tetM in all TRNG tested . Restriction enzyme digests of the PCR product gave three patterns suggesting genetic diversity within the tetM determinant of N . gonorrhoeae . CONCLUSION: Simple screening tests were found to be reliable predictors of TRNG . tetM was detected by PCR in all strains tested and exhibited some genetic variation that may be of use for epidemiological typing.

Sex Transm Dis, 1993 Nov-Dec, 20(6), 314 - 20
Characterization of multiresistant strains of Neisseria gonorrhoeae isolated in Nicaragua; Castro I et al.; The extensive use of antibiotics in Nicaragua raises concerns about the resulting levels of susceptibility of pathogenic bacteria . This is the first study that characterizes 18 strains of N . gonorrhoeae isolated in Nicaragua (1989), for their antibiotic susceptibility . Strains were predominantly of the auxotype/serotype Proto/PIB . There was no difference in lipopolysaccharides profiles obtained after SDS-PAGE for all strains . Variable expression of the PII outer membrane protein was not associated to antimicrobial resistance . All strains were susceptible to ceftriaxone, spectinomycin, rifampin and cefoxitin . The strains were classified in five groups based on plasmid profiles . A total of 78% of the isolates were penicillinase-producing (PPNG) and 22% were tetracycline-resistant N . gonorrhoeae (TRNG) . One PPNG strain showed a concomitant decreased of penicillin binding to penicillin-binding protein 2 . These randomly chosen isolates of N . gonorrhoeae from Nicaragua possess high levels of resistance to multiple families of drugsPIP: In Nicaragua, in 1989, health workers obtained urethral or cervical samples from 18 people with gonorrhea attending public health clinics in Managua and sent them to the National Laboratory of Public Health in Managua for characterization of their antibiotic susceptibility . Of the 18 strains, 15 (83.3%) were of the auxotype/serotype Proto/PIB . Electrophoresis of lipopolysaccharides on SDS-polyacrylamide gels (15%) with 4 M urea revealed no difference in lipopolysaccharide profiles for all strains . The variable expression of the 31-kDa opacity outer membrane protein was not related to antimicrobial resistance . All isolates exhibited susceptibility to ceftriaxone, spectinomycin, cefazolin, cefoxitin, and rifampin . 78% of the strains produced beta-lactamase . 89% of the strains were resistant to penicillin and ampicillin, 44% were resistant to tetracycline, 28% were resistant to cefamandol, 22% were resistant to chloramphenicol, and 11% were resistant to erythromycin . There were 5 distinct groups of Neisseria gonorrhoeae isolated according to their plasmid profiles . The largest was plasmid profile group 1 (55.6%), defined as carrying the 24.5, 3.2, and 2.6 MDa plasmids . It produced beta-lactamase . Penicillinase-producing N . gonorrhoeae (PPNG) comprised 78% of the isolates, 22% of whom were tetracycline-resistant N . gonorrhoea . One PPNG strain exhibited a parallel decrease of penicillin binding to penicillin-binding protein 2 . These findings confirmed the presence of multiresistant N . gonorrhoeae strains in Managua, Nicaragua . Based on these findings, the researchers recommended that penicillin and tetracycline not be used to treat gonorrhea in Nicaragua; they recommended ceftriaxone and spectinomycin .

Mol Microbiol, 1993 Nov, 10(3), 567 - 74
Isolation of the periplasm of Neisseria gonorrhoeae; Judd RC et al.; The periplasm of Neisseria gonorrhoeae should be similar to other Gram-negative bacteria, but no published reports confirm this assumption . We used a periplasmic isolation procedure developed in Escherichia coli to release the periplasmic contents of N . gonorrhoeae . The resultant periplasmic extract lacked lipopolysaccharide, protein markers of inner or outer membranes, surface-radiolabelled protein components, or ribosomal proteins . The periplasmic extract contained a single haem protein believed to be a c-type cytochrome known to exist in the periplasm of other Gram-negative species, and retained significant alkaline phosphatase activity . The dominant protein species released in the periplasmic extract was the gonococcal homologue of elongation factor Tu, a major component released in similar periplasmic extracts of E . coli . These data showed that the extraction procedure selectively released periplasmic components and that the gonococcal periplasm was comparable to that of E . coli . Further analysis of the gonococcal periplasm may provide important insights into the physiology of this pathogen of humans.

Mol Microbiol, 1993 Nov, 10(4), 699 - 712
A novel determinant (comA) essential for natural transformation competence in Neisseria gonorrhoeae and the effect of a comA defect on pilin variation; Facius D et al.; A novel genetic determinant (comA) has been identified and found to be required for the transformation of piliated Neisseria gonorrhoeae . Mutants in comA of strain MS11 grow normally and are DNA-uptake proficient but blocked in the translocation of DNA into the cytoplasm . Here we show by site-specific mutagenesis and genetic complementation that only one of two open reading frames identified in comA is essential for competence: it encodes a protein (ComA) with a predicted size of 74 kDa . The comA gene maps upstream of the iga locus and is transcribed in the opposite orientation, probably under the control of a putative sigma 54-type promoter . While DNA probes specific for the N . gonorrhoeae iga locus reveal only a little cross-reactivity with commensal Neisseria species, the neighbouring comA gene appears to be present in most of them . ComA fusion proteins were obtained by in vitro translation . The synthesized gene products migrated atypically in SDS gels indicating its strong hydrophobicity . Several transmembrane alpha-helices were predicted from the amino acid sequence of ComA which, in the context of an observed sequence similarity with other inner membrane proteins, suggests a location for the protein in the inner membrane . Using piliated and non-piliated comA mutants the consequences of transformation deficiency on pilin phase variation were assessed . We show that the comA defect affects some but not all types of DNA rearrangements associated with pilE variation . The results are in agreement with previous observations supporting the notion that multiple recombination pathways contribute to the variability of pilE.

EMBO J, 1993 Nov, 12(11), 4043 - 51
Phase variation of lipopolysaccharide directs interconversion of invasive and immuno-resistant phenotypes of Neisseria gonorrhoeae; van Putten JP; Phase variation of Neisseria gonorrhoeae lipopolysaccharide (LPS) controls both bacterial entry into human mucosal cells, and bacterial susceptibility to killing by antibodies and complement . The basis for this function is a differential sialylation of the variable oligosaccharide moiety of the LPS . LPS variants that incorporate low amounts of sialic acid enter human mucosal epithelial cells very efficiently, but are susceptible to complement-mediated killing . Phase transition to a highly sialylated LPS phenotype results in equally adhesive but entry deficient bacteria which, however, resist killing by antibodies and complement because of dysfunctional complement activation . Phase variation of N . gonorrhoeae LPS thus functions as an adaptive mechanism enabling bacterial translocation across the mucosal barrier, and, at a later stage of infection, escape from the host immune defence.

Mol Microbiol, 1993 Nov, 10(3), 445 - 56
Immunophilins: structure-function relationship and possible role in microbial pathogenicity; Hacker J et al.; Immunophilins are housekeeping proteins present in a wide variety of organisms . Members of two protein superfamilies, cyclophilins (Cyps) and FK506-binding proteins (FKBPs) belong to this class of immunophilins . Despite the fact that the amino acid sequences of Cyp and FKBPs do not exhibit noticeable homology to each other, proteins of both classes are able to ligate immunosuppressive peptide derivatives . Cyps form complexes with the cyclic undercapeptide cyclosporin A and FKBPs are able to bind FK506 as well as rapamycin, both of which have a pipecolyl bond within their structure . In a ligand-bound form, immunophilins interfere with signal transduction in T cells . In addition, immunophilins have peptidyl prolyl cis-trans isomerase (PPlase) activity and are able to accelerate the rate of conformational events in proline-containing polypeptides . Microorganisms produce proteins that exhibit extensive sequence homologies to cyclophilins and FKBPs of higher organisms and which have considerable PPlase catalytic activity . While cyclophilins seem to be present in most if not all microbial species investigated, FKBPs are produced by yeasts as well as by a number of pathogenic bacteria, such as Legionella pneumophila, Chlamydia trachomatis and Neisseria meningitidis . The Mip protein of L . pneumophila is a virulence factor that plays an essential role in the ability of the bacteria to survive and multiply in phagocytic cells . Some results are summarized on the structure and putative functions of immunophilins and place special emphasis on the contribution of these polypeptides to the virulence of pathogenic microorganisms.

J Gen Microbiol, 1993 Nov, 139 ( Pt 11), 2613 - 20
Structural comparison and epitope analysis of outer-membrane protein PIA from strains of Neisseria gonorrhoeae with differing serovar specificities; Mee BJ et al.; The sequences of the por genes, encoding outer-membrane protein PI, have been obtained from a number of strains of Neisseria gonorrhoeae that express PIA molecules with differing serovar specificities . The inferred amino acid sequences of the mature proteins each comprise 308 residues and show considerable homology, with the degree of sequence variation between PIA molecules being considerably less than seen previously with PIB, but more evenly distributed throughout the molecule . The positions of sequence variation are largely confined to the regions predicted to form one of eight surface-exposed loops, suggesting a more widespread distribution of potential antigenic diversity . The deduced amino acid sequences were used to synthesize peptides for epitope mapping experiments . Some epitopes responsible for serovar specificity or recognized by bactericidal monoclonal antibodies could be identified on the basis of their reactivity with simple linear peptides, whilst others recognized conformational epitopes . By comparison of sequence differences with mAb reactivity it was possible to identify regions that appear to contribute to such determinants, including separated regions of the molecule which together were required for the formation of the conformational epitopes . All the epitopes identified lie at or close to the apices of the predicted surface-exposed loops 1, 3, 6, or 8, focusing attention on these regions as accessible targets for immune attack.

J Infect Dis, 1993 Oct, 168(4), 969 - 78
Pelvic inflammatory disease: metaanalysis of antimicrobial regimen efficacy; Walker CK et al.; An extensive body of literature has investigated the efficacy of antimicrobial regimens used to treat pelvic inflammatory disease (PID), leaving many clinicians confused about how to choose among them . This study provides a formal appraisal of these reports . Thirty-four treatment studies published between 1966 and 1992 were identified, using Medline and bibliographies, and evaluated qualitatively and quantitatively in a metaanalysis . Twenty-one studies met the criteria for inclusion in this evaluation: appropriate system for making the diagnosis of PID, standardized assessment of clinical outcome, and entry and follow-up evaluation for lower genital tract infection with Neisseria gonorrhoeae and Chlamydia trachomatis . This metaanalysis identifies a considerable range of quality in study methods and research design and underscores the limitations inherent in comparing such data . Despite this, a number of antimicrobial regimens appear to have very good short-term clinical and microbiologic efficacy . Pooled clinical cure rates range from 75% to 94% and pooled microbiologic cure rates range from 71% to 100% . A cost comparison is provided, and future research priorities are suggested.

Clin Pediatr (Phila), 1993 Oct, 32(10), 609 - 12
Early detection and treatment of sexually transmitted disease in pregnant adolescents of low socioeconomic status; Matson SC et al.; This study evaluated the prevalence of sexually transmitted disease (STD) in adolescents presenting to a primary pediatric care clinic (PPCC) for the diagnosis of pregnancy and our ability to eradicate identified infections . We followed 168 pregnant adolescents of low socioeconomic status from their original pregnancy diagnosis until their first prenatal clinic visit . We collected screening cervical cultures for Neisseria gonorrhoeae and Chlamydia trachomatis by completing a pelvic examination on 91 patients at our PPCC . At the PPCC visit, 29% were positive for gonorrhea, chlamydia, or both . Screening tests for these infections were collected on all patients at the initial prenatal clinic visit . The risk for presenting to the prenatal clinic with a STD was significantly greater in patients not screened and treated for STD at the PPCC . Average delay from diagnosis to first prenatal clinic visit was 35.7 days . Thus, in this adolescent population, primary care providers are missing an important therapeutic opportunity by failing to identify and treat STD at initial diagnosis of pregnancyPIP: Maternal sexually transmitted disease (STD) is an important and preventable cause of infant morbidity and mortality . The early identification and treatment of STDs could, however, reduce the number of premature deliveries, low-birthweight infants, and neonatal deaths . Sexually active adolescents of low socioeconomic status (SES) are at increased risk for perinatal morbidity and mortality due to their substantially higher STD rates compared to adult women . Despite these facts, many primary care providers simply diagnose pregnancies with urine tests, then refer adolescents to a prenatal program for a thorough evaluation, including a screen for STDs . This practice means that young women infected with STDs at the diagnosis of pregnancy will most likely remain infected until they return to begin prenatal care and are subsequently diagnosed and treated for the problem . This study followed a group of pregnant adolescents from the initial diagnosis of pregnancy at a primary pediatric care clinic (PPCC) until the initial prenatal clinic visit . The study was undertaken to document the frequency of STD in adolescents presenting at such a PPCC for pregnancy diagnosis and to evaluate the ability to treat the infections once they are identified . 235 pregnancies were identified at the PPCC serving urban adolescents of low SES in Milwaukee, Wisconsin, over the period August 1, 1988, to January 31, 1992 . 44 of these patients were seen at other prenatal programs, nine had miscarriages and nine had induced abortions before starting prenatal care, and five met the exclusion criteria, so the study findings pertain to only 168 subjects . 91 subjects were screened at the initial visit to the PPCC for gonorrhea and chlamydia with a pelvic exam and 77 were not . The screened group was of mean age 16.4 years compared to the unscreened group at 15.9 years, while the former also reported more STD-related symptoms than the unscreened group at the time of the initial PPCC visit . 29% of the 91 were positive for gonorrhea, chlamydia, or both . The average delay from pregnancy diagnosis to first prenatal clinic visit was 35.7 days . 53 of the 168 women presenting for prenatal care (32%) had STDs . Patients originally screened at the PPCC for STD, however, had a significantly lower prevalence of infection than the previously unscreened group . 22 of the group screened at the initial PPCC were infected, 12 of whom had been previously negative . The authors stress that primary care providers are missing an important therapeutic opportunity in this adolescent population by failing to identify and treat STDs at the initial diagnosis of pregnancy . The initial diagnosis of pregnancy in adolescents should always include screening for STD, with suspected infections treated immediately rather than waiting for definitive test results . Patients should also be given information on how to protect themselves from acquiring new STDs during pregnancy .

Antimicrob Agents Chemother, 1993 Oct, 37(10), 2244 - 6
Antibacterial activities of OPC-17116, ofloxacin, and ciprofloxacin against 200 isolates of Neisseria gonorrhoeae; Zenilman JM et al.; OPC-17116 is a new fluoroquinolone with potent activity against aerobic and anaerobic organisms . We evaluated the susceptibilities of 200 clinical gonococcal isolates including organisms with plasmid and chromosomally mediated resistance to beta-lactams and tetracycline . The antibiotics studied included OPC-17116, ofloxacin, ciprofloxacin, penicillin, tetracycline, erythromycin, azithromycin, and ceftriaxone . All isolates tested were susceptible to the quinolone class of antibiotics . The MICs of ciprofloxacin, ofloxacin, and OPC-17116 for 90% of isolates tested were 0.004, 0.03, and 0.004 micrograms/ml, respectively . For organisms with chromosomally mediated resistance to penicillin and tetracycline, geometric mean MICs of all antibiotics including the quinolones were increased.

J Clin Microbiol, 1993 Oct, 31(10), 2831 - 3
Discriminatory power of typing schemes based on Simpson's index of diversity for Neisseria gonorrhoeae; Dillon JA et al.; Simpson's index of diversity was used to produce a single numerical value to compare the abilities of single or combined typing schemes to discriminate between unrelated isolates . This calculation was used to compare the discriminating power of auxotype and serovar determination and plasmid content analysis, either singly or in combination, for Neisseria gonorrhoeae isolates having different antimicrobial susceptibilities (i.e., antibiotic-susceptible isolates and those that produce penicillinase, carry plasmid-mediated resistance to tetracycline, have chromosomally mediated penicillin resistance, or both produce penicillinase and carry plasmid-mediated resistance to tetracycline) . Plasmid content analysis and auxotype determination produced the lowest level of discrimination, while a combination of auxotype and serovar typing schemes generally provided higher levels of discrimination . Addition of plasmid content analysis to auxotype and serovar typing provided additional discrimination only with penicillinase-producing isolates . For isolates that carried plasmid-mediated resistance to tetracycline, isolates that were tetracycline resistant, isolates that both produced penicillinase and carried plasmid-mediated resistance to tetracycline, or isolates that had chromosomally mediated penicillin resistance, none of the typing methods produced high discriminatory indices, indicating that these isolates are probably derived from relatively few clones.

J Clin Microbiol, 1993 Oct, 31(10), 2783 - 5
Direct DNA probe assay for Neisseria gonorrhoeae in pharyngeal and rectal specimens; Lewis JS et al.; The direct detection of gonococcal DNA in rectal and pharyngeal specimens was evaluated by using a DNA probe-based assay (Gen-Probe, Inc., San Diego, Calif.) . Rectal (234) and pharyngeal (608) swab specimens were obtained from 249 men and 372 women attending sexually transmitted disease clinics in Las Vegas and Reno, Nevada . The prevalence of gonococcal infection by culture at the pharyngeal and rectal sites was 2.9% (16 of 548 specimens) in women and 2.7% (8 of 294 specimens) in men . No false-positive reactions were observed among the 234 rectal specimens tested . Two probe-positive, culture-negative specimens were detected among the 361 pharyngeal specimens obtained from women . Both of these samples were confirmed as Neisseria gonorrhoeae by a probe competition assay . The overall correlation of the DNA probe test with pharyngeal and rectal cultures was 99.4% (837 of 842 cultures), with a sensitivity of 87.5% (21 of 24 cultures) and specificity of 99.7% (816 of 818 cultures) . The positive and negative predictive values of the DNA assay were 91.3 and 99.8%, respectively . The direct DNA probe assay provides an alternative to culture screening for rectal and/or pharyngeal gonococcal infections.

Genitourin Med, 1993 Oct, 69(5), 361 - 3
Microbiology of acute epididymitis in a developing community; Hoosen AA et al.; OBJECTIVE--To investigate the aetiology of acute epididymitis in a developing community with a view of determining appropriate antimicrobial therapy . SETTING--City Health Sexually Transmitted Diseases Clinic, King Edward VIII Hospital, Durban, South Africa . PARTICIPANTS--144 adult men with clinically diagnosed acute epididymitis . METHOD--Endourethral swab and midstream urine (MSU) specimens were processed to detect sexually transmitted pathogens and urinary tract infections . RESULTS--The majority of patients (93%) were less than 35 years of age . Neisseria gonorrhoeae and/or Chlamydia trachomatis were detected in 78% of patients: N gonorrhoeae in 57%, C trachomatis in 34% and both in 13% . Escherichia coli was cultured more frequently from MSU specimens of older patients, 30% versus 3% . In 53% of patients urethritis was diagnosed by the presence of inflammatory cells in endourethral smears in the absence of a visible urethral discharge . CONCLUSION--In our setting of a busy clinic with limited facilities, we recommend the performance of a Gram stain on endourethral specimens from patients with acute epididymitis . If inflammatory cells and Gram negative diplococci are detected, treatment with antimicrobial agents to cover both penicillinase-producing N gonorrhoeae strains and C trachomatis is recommended . If Gram negative diplococci are not detected in the presence of microscopic evidence of urethritis, treatment for chlamydial infection alone is recommended.

Genitourin Med, 1993 Oct, 69(5), 357 - 60
The association between sexually transmitted pathogens and cervical intra-epithelial neoplasia in a developing community; Kharsany AB et al.; OBJECTIVE--To determine the association of sexually transmitted pathogens in women with cervical intra-epithelial neoplasia (CIN) . SETTING--An urban tertiary referral hospital serving a large indigent developing community . PARTICIPANTS--48 women attending a colposcopy clinic and 49 women attending a family planning clinic . METHODS--Vaginal, endocervical, rectal swab specimens and sera were collected for the detection of sexually transmitted pathogens . Cervical cytology was performed on all patients . Women attending the colposcopy clinic had confirmation of abnormal cervical cytology by colposcopic directed biopsy . RESULTS--The mean age of women with CIN (33 years) was significantly greater than that of the women without CIN (28 years) and that of the family planning group (26 years) . There was a high prevalence of sexually transmitted pathogens in all women . A significantly higher prevalence of bacterial vaginosis was found in women with CIN compared to those without (50% vs 20%; p = 0.034) . The human papilloma virus (HPV) was detected in 46% of women with CIN and 65% of those without CIN . Chlamydia trachomatis (21%) and Trichomonas vaginalis (39%) were detected frequently in women with CIN . C . trachomatis (14%-21%) was detected more frequently than Neisseria gonorrhoeae (3-5%) in all asymptomatic women studied . CONCLUSION--This study demonstrates a high prevalence of sexually transmitted pathogens in women with and without CIN as well as family planning clinic attenders . Bacterial vaginosis was a significant finding in women with CIN . C . trachomatis was detected in a high proportion of all women studied and found more commonly than N . gonorrhoeae . We therefore recommend that all women attending gynaecological services in a developing community be investigated and treated for sexually transmitted diseases.

Int J Syst Bacteriol, 1993 Oct, 43(4), 687 - 93
Neisseria weaveri sp . nov . (formerly CDC group M-5), from dog bite wounds of humans; Holmes B et al.; The taxonomic relationships of strains belonging to Centers for Disease Control group M-5 were examined . Previous studies of rRNA cistron similarities placed this organism on the Neisseriaceae rRNA branch of rRNA superfamily III; the closest neighbors included the genus Neisseria and groups EF-4a and EF-4b . The group M-5 strains were characterized by a range of phenotypic tests, and their G + C contents and DNA-DNA relatedness levels were determined . In addition, a numerical taxonomic analysis of the whole-cell protein patterns (obtained by sodium dodecyl sulfate-polyacrylamide gel electrophoresis) of group M-5 and related taxa was performed . The strains studied included 45 group M-5 strains, the type strains of six Neisseria species or subspecies, three group EF-4a reference strains, and three group EF-4b reference strains plus the type strain of the phenotypically similar organism Oligella urethralis . Our results showed that the group M-5 strains were members of a homogeneous taxon distinct from phylogenetically closely related taxa . The genomic divergence as revealed by levels of rRNA cistron similarity and phenotypic characteristics indicate that group M-5 can be considered a new species of the genus Neisseria . We therefore propose the new species Neisseria weaveri, with NCTC 12742 (= CCUG 4007 = ISL775/91 = LMG 5135) as the type strain . N . weaveri strains are strictly aerobic, gram-negative, nonmotile, rod-shaped organisms which are catalase and oxidase positive, nonsaccharolytic, and able to grow on MacConkey agar and do not reduce nitrate but generally reduce nitrite.(ABSTRACT TRUNCATED AT 250 WORDS)

Am J Obstet Gynecol, 1993 Oct, 169(4), 976 - 81
Randomized trial of prophylactic antibiotic therapy after preterm amnion rupture; Owen J et al.; OBJECTIVE: Our purpose was to determine whether maternal administration of prophylactic ampicillin or erythromycin after preterm amnion rupture is associated with maternal or neonatal benefits . STUDY DESIGN: Women with singleton pregnancies between 24 and 33 weeks 6 days of gestation were eligible if they had no immediate indication for delivery . After giving informed consent, patients were randomized either to receive ampicillin (erythromycin if penicillin allergic) until delivery or to enter a control group . Women whose cervical cultures were positive for either group B streptococci or Neisseria gonorrhoeae received treatment . Tocolytics and corticosteroids were not used . RESULTS: From January 1990 to February 1992 117 patients (antibiotics 59, control 58) were recruited and analyzed . Prophylactic antibiotics were associated with a longer latent phase (mean 12 vs 7.0 days, p = 0.004) and fewer maternal infectious complications (29% vs 60%, p = 0.001) . A higher incidence of neonatal necrotizing enterocolitis was observed in the treatment group (14% vs 3.5%, p = 0.05) . Other neonatal complications, including death, were lower in the treatment group, but none attained statistical significance (p = 0.09 to 0.33) . CONCLUSION: The use of prophylactic antibiotics in selected patients after preterm amnion rupture appears to have a demonstrable maternal benefit . Large, multicenter trials may demonstrate a significant neonatal benefit or confirm any adverse outcomes.

Am J Obstet Gynecol, 1993 Oct, 169(4), 1031 - 5
The risk of sexually transmitted diseases in human immunodeficiency virus-infected parturients; Lindsay MK et al.; OBJECTIVE: We assessed the prevalence of and defined the relationship between other sexually transmitted diseases and human immunodeficiency virus infection . STUDY DESIGN: We performed a case-control study among 121 human immunodeficiency virus-infected and 222 randomly selected seronegative parturient women . These women were identified from a prenatal population undergoing routine voluntary antibody screening in a large urban hospital in the southeastern United States . RESULTS: During the 24-month study period, 16,868 women consented to human immunodeficiency virus antibody screening; 121 (7.2/1000) were infected with human immunodeficiency virus . Cases were significantly more likely than controls to be infected with at least one sexually transmitted disease during pregnancy (48% vs 21%; odds ratio 3.4, 95% confidence interval 2.1 to 5.7) . The prevalence of Chlamydia trachomatis and hepatitis B infection did not differ significantly among the groups . Cases were significantly more likely than controls to be infected with Treponema pallidum (29% vs 4%; odds ratio 9.6, 95% confidence interval 4.2 to 22.4) . This relationship persisted after we controlled for confounding risk factors (odds ratio 9.2, 95% confidence interval 2.1 to 13.3) . In addition, cases were significantly more likely than controls to be infected with Neisseria gonorrhoeae (17.2% vs 4%; odds ratio 5.2, 95% confidence interval 2.1 to 13.3) . This relationship also persisted after we controlled for confounders (odds ratio 3.7, 95% confidence interval 1.4 to 10.0) . CONCLUSION: Human immunodeficiency virus-infected parturient women in our center are at substantial risk of having other sexually transmitted diseases.

Diagn Microbiol Infect Dis, 1993 Oct, 17(3), 243 - 5
Interpretive criteria for cefodizime in vitro susceptibility tests with Neisseria gonorrhoeae; Barrett MS et al.; Cefodizime was tested against 100 strains of Neisseria gonorrhoeae with varying susceptibility patterns to penicillin . Agar-dilution minimum inhibitory concentrations (MIC) and disk diffusion susceptibility testing were performed in triplicate for each strain according to National Committee for Clinical Laboratory Standards (NCCLS) guidelines to establish susceptibility interpretive criteria for this beta-lactamase-stable cephalosporin . Cefodizime was very active against these strains of N . gonorrhoeae, with a MIC50 of only 0.008 microgram/ml . Because no resistant strains were documented, a single susceptible criterion of < or = 0.05 microgram/ml (> or = 31 mm) was proposed to predict clinical success after a single intramuscular (i.m.) dose.

Diagn Microbiol Infect Dis, 1993 Oct, 17(3), 193 - 6
Assessment of gelatin supplementation of PEDS Plus BACTEC blood culture medium; McDonald JC et al.; Gelatin supplementation of blood culture media has been shown to neutralize the effects of sodium polyanetholesulfonate and enhance detection of Neisseria species . We evaluated the effect of 1.2% gelatin supplementation of nonradiometric Peds Plus Bactec blood culture medium on the rate and speed of recovery of pathogens from pediatric patients . From June 1991 to June 1992, a total of 6451 paired comparisons of blood cultures in Peds Plus medium and gelatin-supplemented Peds Plus medium were done: 465 organisms were isolated, of which 338 were significant . There were no significant differences in recovery of organisms or the speed of detection of microbial growth between the two media . In particular, the recovery of Neisseria meningitidis (eight isolates) was not improved with gelatin supplementation . In conclusion, gelatin supplementation of Peds Plus Bactec medium does not offer any advantage over the regular Peds Plus Bactec medium.

Mol Microbiol, 1993 Oct, 10(2), 311 - 8
The ferric iron-binding protein of pathogenic Neisseria spp . functions as a periplasmic transport protein in iron acquisition from human transferrin; Chen CY et al.; The ferric iron-binding protein (Fbp) expressed by pathogenic Neisseria spp . has been proposed to play a central role in the high-affinity acquisition of iron from human transferrin . The results of this investigation provide evidence that Fbp participates in this process as a functional analogue of a Gram-negative periplasmic-binding protein component, which operates as a part of a general active transport process for the receptor-mediated, high-affinity transport of iron from human transferrin . Known properties of Fbp are correlated with those of other well-characterized periplasmic-binding proteins, including structural features and the reversible binding of ligand . Predictive of a periplasmic-binding protein, which functions in the high-affinity acquisition of iron, is that Fbp is a transient participant in the process of iron acquisition from human transferrin . Evidence for this is demonstrated by results of pulse-chase experiments . Taken together, the data described here and elsewhere suggest that pathogenic Neisseria spp . use a periplasmic-binding protein-mediated active transport mechanism for the acquisition of iron from human transferrin.

Gene, 1993 Sep 30, 132(1), 15 - 20
Natural variation of the NgoII restriction-modification system of Neisseria gonorrhoeae; Gunn JS et al.; The NgoII restriction-modification (R-M) system of Neisseria gonorrhoeae recognizes the sequence 5'-GGCC-3' . This system is encoded by two separate genes, dcmB for the methyltransferase (MTase) and dcrB for the restriction endonuclease (ENase) . Three strains that vary in their NgoII phenotype were examined . Strain Pgh3-2 produced detectable levels of both enzymes, strain F62 lacked detectable levels of the dcrB gene product, and strain WR302 failed to produce either gene product . Strains that lacked either enzyme activity still possessed the genes that encode them . Transcriptional fusions of dcrB in strains F62 and Pgh3-2 indicate that this gene is transcribed at nearly identical levels in each strain . The DNA encoding the NgoII R-M system was cloned from the three strains, and the nucleotide sequence was determined . The dcrB genes of WR302 and F62 possess the same frameshift mutation (base position 1435) which would result in a truncated protein . The WR302 dcmB was found to have a point mutation that changed Arg288 (a residue that is conserved in all prokaryotic and phage cytosine MTases sequenced to date) to Trp.

FEMS Microbiol Lett, 1993 Sep 15, 112(3), 243 - 50
Population genetics of a transformable bacterium: the influence of horizontal genetic exchange on the biology of Neisseria meningitidis; Maiden MC; Information of the biochemistry and genetics of bacterial species, usually obtained by the study of single isolates, is enhanced by studies of populations of bacteria . Recent advances in molecular technology, particularly polymerase chain reaction-based nucleotide sequence analysis, provide powerful tools for the study of population genetics . Data obtained by such techniques indicate that, while some bacterial species have a clonal population structure, others are non-clonal or panmictic . Clonal populations are a consequence of asexual reproduction by binary fission; panmictic population structures result from 'horizontal' exchange of genetic material between clones . A consequence of horizontal genetic exchange is mosaic gene structures, recognisable by comparisons of nucleotide sequences . In transformable bacteria, for example the human pathogen Neisseria meningitidis, several different genes, including the gene encoding the class 1 outer membrane protein, a major surface antigen, are mosaics . This genetic process has implications both for vaccine design and in the interpretation of epidemiological data.

J Clin Microbiol, 1993 Sep, 31(9), 2535 - 7
Incidence of Neisseria gonorrhoeae isolates negative by Syva direct fluorescent-antibody test but positive by Gen-Probe accuprobe test in a sexually transmitted disease clinic population; Beebe JL et al.; To determine the accuracy of the Syva (Palo Alto, Calif.) direct fluorescent-antibody (DFA) test in comparison with the Gen-Probe (San Diego, Calif.) Accuprobe culture confirmation test, we tested 395 isolates of Neisseria gonorrhoeae from cultures obtained from patients attending a sexually transmitted disease clinic from 1 July 1991 through 30 June 1992 . All isolates were tested for DFA reactivity with a polyclonal reagent (Difco Laboratories, Detroit, Mich.) and a monoclonal reagent (Syva, Inc., direct specimen test) and for specific molecular probe reactivity by the Gen-Probe Accuprobe culture confirmation test for N . gonorrhoeae . The 395 isolates gave positive results for the Gen-Probe culture confirmation test and the Difco polyclonal direct specimen test . However, 18 (4.6%) of the isolates were negative for N . gonorrhoeae by the Syva DFA test . With the exception of six beta-lactamase-positive isolates, all isolates that were negative by Syva DFA were sensitive to penicillin, tetracycline, spectinomycin, and ceftriaxone by disk-diffusion susceptibility testing . Auxotyping and serotyping studies indicated that strains negative by Syva DFA consisted of several variants . The frequency of N . gonorrhoeae isolates showing negative results by Syva DFA in this patient population ranged from 0 to 11.5%/month . Laboratories using only the Syva DFA test for confirmation of N . gonorrhoeae may incur a significant risk of misidentification.

J Clin Microbiol, 1993 Sep, 31(9), 2531 - 2
Ceftizoxime interpretive criteria for in vitro susceptibility tests with Neisseria gonorrhoeae; Barrett MS et al.; Ceftizoxime was tested in triplicate against 100 clinical strains of Neisseria gonorrhoeae in accordance with National Committee for Clinical Laboratory Standards guidelines to establish susceptibility testing interpretive criteria . The MICs for 50 and 90% of the strains tested were 0.008 and 0.03 microgram/ml, respectively . These results confirm those of other studies reporting ceftizoxime's excellent activity against gonococci . Because no resistant strains were identified, a breakpoint MIC of < or = 0.5 microgram/ml was selected, with a correlate zone diameter of > or = 32 mm . Ceftizoxime appears to represent an alternative to other beta-lactamase-stable beta-lactams for cost-effective therapy of uncomplicated gonorrhea.

J Clin Microbiol, 1993 Sep, 31(9), 2456 - 66
Neisseria weaveri sp . nov., formerly CDC group M-5, a gram-negative bacterium associated with dog bite wounds; Andersen BM et al.; CDC group M-5 is a rod-shaped, gram-negative, nonmotile bacterium associated with dog bite wounds . DNA-DNA relatedness and biochemical and growth characteristics were studied for 54 strains from the collection at the Centers for Disease Control and Prevention . One typical M-5 strain, 8142, was further studied by 16S rRNA sequencing . DNA from 40 of 53 strains showed 82 to 100% relatedness (hydroxyapatite method) to labeled DNA from strain 8142 . The guanine-plus-cytosine (G + C) content in 8 of the 41 highly related M-5 strains was 50.5 to 52 mol% . These 41 strains were oxidase and catalase positive, nonfermentative, nitrite positive, nitrate negative, weakly phenylalanine deaminase positive, aerobic, and alpha-hemolytic (sheep blood) . DNA from the 13 remaining strains showed only 7 to 46% DNA relatedness to strain 8142 . These 13 non-M-5 strains differed from the M-5 strains in G + C content, growth characteristics, and biochemical profiles . DNA from M-5 strain 8142 was most closely related to DNA from groups EF-4b (47%) and EF-4a (45%) . 16S rRNA sequence analysis placed M-5 strain 8142 in the Neisseriaceae cluster of the beta-3 subgroup of the class Proteobacteria . It was most homologous (98.4 to 98.8%) to Neisseria animalis, Neisseria flavescens, Neisseria canis, and Neisseria elongata . All data are consistent with M-5 being a new species of Neisseria, for which we propose the name Neisseria weaveri.

FEMS Microbiol Lett, 1993 Sep 1, 112(2), 159 - 65
Characterization of the transferrin-iron uptake system in Neisseria meningitidis; Pintor M et al.; The transferrin-iron uptake system of six Neisseria meningitidis strains was characterized using 125I-transferrin in receptor assays and 55Fe-loaded transferrin in uptake assays . Receptors for transferrin varied among the strains both in number (from 700 to 4700 receptors per cell) and in their affinity constants for the protein (Ka ranged from 0.7 x 10(7) to 4.0 x 10(7) l mol-1) . Neither receptor numbers nor affinity constants were significantly different in carrier and invasive strains, although the Ka seem to be somewhat higher in the latter . Iron uptake from transferrin was also variable among the strains, but showed the same lack of correlation with their origin.

Infect Immun, 1993 Sep, 61(9), 3703 - 10
Purification and characterization of polyphosphate kinase from Neisseria meningitidis; Tinsley CR et al.; The important human pathogens Neisseria meningitidis and Neisseria gonorrhoeae accumulate phosphate in the form of polyphosphate (A . Noegel and E . C . Gotschlich, J . Exp . Med . 157:2049-2060, 1983), and the localization of more than half of this long-chain polymer on the exterior of the cells suggests a function as a protective, capsule-like coating . To enable further genetic investigation of the role of polyphosphate in Neisseria spp., the enzyme polyphosphate kinase (PPK), which catalyzes the synthesis of polyphosphate from ATP, was purified from N . meningitidis BNCV . The activity is dependent on Mg2+ and phosphate or polyphosphate and is inhibited by ADP . The Km for ATP is 1.5 mM, and the turnover number is 47 phosphate residues per polypeptide per s . Analysis of PPK labelled with {gamma-32P}ATP indicates that the enzyme is phosphorylated during the reaction, probably at an arginine residue . N-terminal and two internal amino acid sequences were derived from the purified protein and will allow the design of synthetic oligonucleotides for cloning and genetic manipulation of the ppk gene.

J Bacteriol, 1993 Sep, 175(18), 5839 - 50
The opsX locus of Xanthomonas campestris affects host range and biosynthesis of lipopolysaccharide and extracellular polysaccharide; Kingsley MT et al.; Xanthomonas campestris pv . citrumelo strain 3048 is the causal agent of citrus bacterial leaf spot disease and has a wide host range that includes rutaceous and leguminous plants . A spontaneous prototrophic mutant of strain 3048 (strain M28) that had lost virulence on citrus but retained virulence on bean plants was recovered . Growth studies in planta showed that M28 cells died rapidly in citrus leaves but grew normally in bean leaves . In addition to the loss of citrus-specific virulence, M28 displayed the following mutant phenotypes in culture: decreased growth rate, reduction of the amount of exopolysaccharide (to ca . 25% of the amount in 3048), loss of capsules, and significant alterations of the two 3048 lipopolysaccharide (LPS) bands visualized by silver stain on polyacrylamide gels, consistent with a defect(s) in LPS assembly . A 38-kb DNA fragment from a 3048 total DNA library that complemented the mutant phenotypes of M28 was identified . The 38-kb fragment did not hybridize to two similarly sized fragments carrying different hrp (hypersensitive response and pathogenicity) genes cloned from 3048 . Subcloning, DNA sequence analyses, and gene disruption experiments were used to identify a single gene, opsX (for outer-membrane polysaccharide), responsible for the mutant phenotypes of M28 . At least one other gene downstream from opsX also affected the same phenotypes and may be part of a gene cluster . We report here the DNA sequence and transcriptional start site of opsX . A search of protein sequence data bases with the predicted 31.3-kDa OpsX sequence found strong similarity to Lsi-1 of Neisseria gonorrhoeae and RfaQ of Escherichia coli (both are involved in LPS core assembly) . The host-specific virulence function of opsX appears to involve biosynthesis of the extracellular polysaccharide and a complete LPS . Both may be needed in normal amounts for protection from citrus, but not bean, defense compounds.

Am J Emerg Med, 1993 Sep, 11(5), 476 - 9
Acute suppurative salpingitis with concomitant intrauterine pregnancy; Yip L et al.; A 20-year-old woman presented to the emergency department with a history of lower abdominal pain and recent loss of consciousness . She was admitted with a primary diagnosis of abdominal pain; ectopic pregnancy was ruled out . The culture of the endocervix was positive for Neisseria gonorrhoeae . Surgical exploration of the pelvis was performed, and histological analysis of the specimen showed an acute suppurative salpingitis and an intrauterine pregnancy . The patient was placed on intravenous antibiotics . Postoperative course was unremarkable, and the patient was discharged on oral antibiotics . Although a rare entity acute suppurative salpingitis with concomitant intrauterine pregnancy are not mutually exclusive . Ectopic pregnancy should be the presumptive diagnosis when clinical presentation is consistent with pelvic inflammatory disease and pregnancy especially in the first trimester . Patients who are pregnant and exhibit clinical signs and symptoms that are consistent with salpingitis should be admitted for aggressive management of their high-risk pregnancy . Fetal wastage seems to be significant in spite of aggressive management . Endocervical culture for N gonorrhoeae should be obtained from all pregnant patients with follow-up treatment pending culture results . The following is a case presentation along with a review of the existing cases in the English literature and discussion of the possible pathogenesis and clinical outcome of this entity.

Hua Xi Yi Ke Da Xue Xue Bao, 1993 Sep, 24(3), 299 - 302
{The distribution of normal oral flora in 49 healthy children and juvenile}; Xiao X et al.; The frequencies and proportions of predominant cultiv ableoral bacteria associated with 49 healthy children and juvenile (6-25 yr old) were studied . A total of 72 bacterial species belonging to 28 genus were detected in 195 samples of saliva, fissure plaque, supragingival plaque, and subgingival plaque . The predominant bacteria were Oral streptococci, Neisseria, Actinomyces, Capnocytophaga, Bacteroides and Fusobacterium in the normal oral cavity of healthy children and juvenile . There were differences in the distribution of the predominant flora, e.g . Fusobacterium and Bacteroides had higher incidence and proportion in the subgingival plaque than in the fissure plaque.

Zentralbl Bakteriol, 1993 Sep, 280(1-2), 113 - 9
Siderophore production and iron-regulated envelope proteins of Helicobacter pylori; Illingworth DS et al.; All Helicobacter pylori strains tested produced extracellular siderophores, detected by a modified Universal Detection medium, but growth on this medium was poor . By using the iron chelating compound, 2,2'-dipyridyl, outer membrane proteins of 78 and 40 kDa were detected in some, but not all strains examined . No direct binding of lactoferrin or transferrin (the mechanism used by Neisseria to obtain iron) could be demonstrated for H . pylori . Some other techniques for the study of iron-limitation on bacteria were found to be unsuitable for H . pylori.

Trans R Soc Trop Med Hyg, 1993 Sep-Oct, 87(5), 560 - 3
Bacteraemia and meningitis among hospital patients with diarrhoea; Mitra AK et al.; To characterize bacteraemia and meningitis in diarrhoeal patients, the records of 3395 blood cultures and 120 cerebrospinal fluid (CSF) cultures from 6132 patients admitted with diarrhoea to the Clinical Research Centre of the International Centre for Diarrhoeal Disease Research, Bangladesh during 1989 were analysed . Microorganisms were isolated from 12% (417 of 3395) of blood cultures and 9% (11 of 120) of CSF cultures . Children below 5 years of age represented 80% of all patients who had blood cultures and 82% of those who had CSF cultures made . The nutritional status was significantly lower in patients who had positive blood cultures than in those who had negative cultures . 23% (97 of 417) of patients with positive blood cultures and 45% (5 of 11) with positive CSF cultures died . Deaths occurred twice as often among patients who had organisms isolated than among those who had no organisms isolated from blood cultures . The organisms isolated from blood cultures which predicted most deaths were Pseudomonas aeruginosa, Neisseria meningitidis, Escherichia coli and Klebsiella sp., and they were multiresistant . We conclude that bacteraemia and meningitis remain serious complications associated with diarrhoea, especially in malnourished children; the therapeutic problem is further complicated by multiple drug resistance of the isolates.

Vaccine, 1993 Sep, 11(12), 1214 - 20
Transferrin-binding proteins isolated from Neisseria meningitidis elicit protective and bactericidal antibodies in laboratory animals; Danve B et al.; Transferrin-binding proteins (Tbps) were affinity-isolated from group B Neisseria meningitidis strain B16B6 and used to raise specific antisera . Administration of the antisera to mice loaded with human transferrin before bacterial challenge significantly protected the animals from death . In active immunization studies, mice received three 25 micrograms injections of purified Tbps over a period of 28 days, 7 days after which they were challenged with N . meningitidis . The survival rate in immunized mice was much higher than in control groups . In both active and passive immunization experiments mice were protected against at least 100 LD50 . A specific Tbp antiserum was highly bactericidal against the parent strain and against approximately half of the strains tested.

Antimicrob Agents Chemother, 1993 Sep, 37(9), 2007 - 8
Ofloxacin susceptibilities of 5,667 Neisseria gonorrhoeae strains isolated in Hong Kong; Kam KM et al.; Of 5,667 strains of Neisseria gonorrhoeae isolated from the Government Social Hygiene (sexually transmitted disease) Clinics in Hong Kong from 1990 to 1992, there was a trend toward an increase in the percentage of strains resistant in vitro to 0.01 and 0.1 microgram of ofloxacin per ml, with 54.3 and 5.5% resistant strains, respectively, in January 1990, rising to 95.3 and 41.5%, respectively, in December 1992 . The percentage of strains for which the MIC is > 1 microgram/ml remains stable, and no clinical failure has yet been seen . This trend of decreasing susceptibility warrants close monitoring when ofloxacin is used as first-line treatment for gonorrhea.

Sex Transm Dis, 1993 Sep-Oct, 20(5), 290 - 3
Treatment of uncomplicated gonorrhea with single doses of 200 mg cefixime; Verdon MS et al.; BACKGROUND: Single-dose cefixime 400 mg orally is effective in the treatment of uncomplicated gonorrhea . However, lower doses of cefixime have not been studied, and the minimum effective single-dose regimen may risk selecting resistant strains of Neisseria gonorrhoeae . Therefore, we studied the efficacy of a lower dose of cefixime . OBJECTIVE: To assess the efficacy of 200 mg cefixime in the treatment of uncomplicated gonorrhea . METHODS: One hundred twenty-five patients (106 men, 19 women) with presumptive gonorrhea were treated with single doses of cefixime 200 mg orally in an open non-comparative study . Follow-up visits were scheduled for four to seven days after treatment . RESULTS: Genital and rectal gonorrhea were eradicated in 93 (95%, CI95 90.5-99.2%) of 98 patients who were culture-positive at enrollment and returned for follow-up . Treatment was effective in 78 (95%) of 82 men with urethral infection and 15 (94%) of 16 women with anogenital infection . Two of three pharyngeal infections also were eradicated . Persistent infection was not associated with resistance to cefixime, penicillin, or tetracycline . CONCLUSIONS: Cefixime 200 mg in a single dose has substantial efficacy in the treatment of uncomplicated gonorrhea, enhancing confidence that use of 400 mg cefixime for gonorrhea has a low risk of selecting gonococci with clinically significant antibiotic resistance . However, the 200 mg dose should not be used for routine treatment.

Sex Transm Dis, 1993 Sep-Oct, 20(5), 269 - 73
Multicenter, comparative study of cefotaxime and ceftriaxone for treatment of uncomplicated gonorrhea; McCormack WM et al.; BACKGROUND AND OBJECTIVES: Cefotaxime is a third-generation cephalosporin that has in vitro activity against Neisseria gonorrhoeae, including beta-lactamase-producing strains . A single 1-g intramuscular dose is effective and is recommended by the Centers for Disease Control and Prevention as an alternative treatment for uncomplicated gonorrhea . GOAL OF THIS STUDY: This study was conducted to evaluate the efficacy and safety of a lower 500-mg dose of cefotaxime in the treatment of uncomplicated gonococcal infections . STUDY DESIGN: In a randomized multicenter study, patients who had uncomplicated gonorrhea were treated with 500 mg of cefotaxime or 250 mg of ceftriaxone . Both antibiotics were given intramuscularly . Efficacy and safety were assessed four to seven days following treatment . RESULTS: Six hundred thirteen patients were enrolled . Bacteriologic eradication rates for anogenital infection were 97.7% of the patients (213/218) in the cefotaxime group and 99.1% of the patients (221/223) in the ceftriaxone group (P = 0.243) . Adverse events occurred in 4.2% and 7.5% of patients in the two groups, respectively . CONCLUSION: Cefotaxime 500 mg appears to be a safe and cost-effective alternative to ceftriaxone 250 mg for the treatment of uncomplicated gonorrhea.

Sex Transm Dis, 1993 Sep-Oct, 20(5), 243 - 7
Comparison of DNA-probe test and culture for the detection of Neisseria gonorrhoeae in genital samples; Stary A et al.; BACKGROUND AND OBJECTIVES: The nonisotopic DNA probe assay (PACE 2) was evaluated for the detection of Neisseria gonorrhoeae in urethral and endocervical specimens and compared quantitatively and qualitatively using recommended culture methods . GOAL OF THIS STUDY: To evaluate whether culture methods could be replaced by the DNA probe assay for the diagnosis of N . gonorrhoeae . STUDY DESIGN: A total of 502 men and women were studied, including 42 non-registered and 132 legally registered prostitutes and 115 male and 213 female STD patients . RESULTS: The overall concordance of culture and the PACE 2 assay was 98.4% . Of the tested persons, 9.6% were positive for N . gonorrhoeae by culture technique compared with 11.2% using the DNA probe assay . All samples that were positive in culture were positive in the Gen-Probe test . Of samples positive in Gen-Probe, 14.3% (8/56) were negative in culture . Three of these results were determined false-positives and five were true positives when evaluated by further analysis . The sensitivity and specificity were 90.6% and 100%, for the culture technique, and 100% and 99.3% for the DNA probe assay, respectively, when compared with true positive and negative results . CONCLUSION: The data indicate that the DNA probe assay serves as a suitable screening and diagnostic test for the diagnosis of N . gonorrhoeae in symptomatic and in asymptomatic men and women . When the performance of culture technique is not possible or unreliable, the DNA probe assay can be used for testing those at high risk for gonorrhea . In borderline cases with a low value of RLU, the DNA test should be confirmed to avoid false positive results, especially in women.

Mil Med, 1993 Sep, 158(9), 618 - 9
Prevalence of asymptomatic chlamydial cervical infection in active duty Army females; Catterson ML et al.; Four hundred seventy-six consecutive active duty Army females who presented for routine pap smears were screened for Chlamydia trachomatis and Neisseria gonorrhea . Thirty-nine of 476 (8.2%) tested positive for chlamydia using the Chlamydiazyme enzyme immunoassay . All patients with positive tests for chlamydia were asymptomatic and had normal pelvic exams . The average age of patients testing positive for chlamydia was 23.9 . Only 6 of the 39 patients with chlamydia were older than 30 . Tests for gonorrhea and pap smear results had little correlation with patients testing positive for chlamydia . The high prevalence of chlamydia in this population of asymptomatic women makes it probable that screening similar populations of patients would be more cost-effective than treating the complications of this disease.

Mt Sinai J Med, 1993 Sep, 60(4), 327 - 9
Screening for human immunodeficiency virus and sexually transmitted diseases in an inner-city colposcopy clinic; Dottino PR et al.; Among patients attending an inner-city colposcopy clinic, the prevalence of Chlamydia trachomatis was 22/375 (5.0%), Neisseria gonorrhoeae, 3/375 (0.8%), and seropositivity for syphilis, 10/375 (2.7%) . In addition, 13/261 (5.0%) of asymptomatic women agreeing to voluntary human immunodeficiency virus (HIV-1) antibody screening were HIV-1 seropositive . Our data support incorporating screening for and education on sexually transmitted diseases and HIV into the work of our colposcopy clinic.

Mol Microbiol, 1993 Sep, 9(6), 1203 - 11
Molecular cloning and characterization of a proline iminopeptidase gene from Neisseria gonorrhoeae; Albertson NH et al.; Proline iminopeptidase (Pip) is a hydrolase elaborated by virtually all strains of Neisseria gonorrhoeae that selectively removes N-terminal proline residues from peptides . Escherichia coli clones expressing the gonococcal gene coding for Pip were identified in a genomic cosmid library using a synthetic colorimetric substrate . Nucleotide sequence determination and analyses of polypeptides detected by coupled in vitro transcription/translation reactions revealed that Pip is a 311-amino-acid polypeptide with a M(r) of 35 kDa and a pI of 5.4 . Southern hybridization showed that the pip gene is present in a single copy on the chromosome of N . gonorrhoeae strain MS11 which maps immediately upstream of the previously identified opaA locus . The transcriptional start site of pip in E . coli, determined by primer extension analysis, was characteristic of an NtrA or sigma-54-dependent promotor . Complementation of an E . coli mutant deficient in both proline biosynthesis and dipeptide uptake confirmed that Pip is capable of releasing biologically active proline from peptides . Pip expression was found to be non-essential for in vitro growth of N . gonorrhoeae, based on the viability of a Pip- gonococcal mutant.

Gene, 1993 Aug 16, 130(1), 73 - 80
Cloning and characterization of Neisseria meningitidis genes encoding the transferrin-binding proteins Tbp1 and Tbp2; Legrain M et al.; Genes tbp1 and tbp2, encoding the transferrin-binding proteins Tbp1 and Tbp2, have been isolated from two strains of Neisseria meningitidis . The tbp2 and tbp1 open reading frames are tandemly arranged in the genome with an 87-bp intergenic region, and the DNA region upstream from the tbp2-coding sequence contains domains homologous to Escherichia coli promoter consensus motives . Nucleotide sequence analysis suggests the existence of a Tbp1 precursor carrying an N-terminal signal peptide with a peptidase I cleavage site and of a Tbp2 precursor with N-terminal homology to lipoproteins, including a peptidase II cleavage site . Comparison of the Tbp1 deduced amino acid (aa) sequences from both strains showed about 76% aa homology, while those of Tbp2 revealed only about 47% aa homology . These comparisons should be extended to other Neisseria strains in order to evaluate further this genetic divergence further.

MMWR CDC Surveill Summ, 1993 Aug 13, 42(3), 29 - 39
Sentinel surveillance for antimicrobial resistance in Neisseria gonorrhoeae--United States, 1988-1991 . The Gonococcal Isolate Surveillance Project Study Group; Gorwitz RJ et al.; PROBLEM/CONDITION: The prevalence of antimicrobial resistance in Neisseria gonorrhoeae in the United States has been increasing since the mid-1970s . DESCRIPTION OF SYSTEM: The Gonococcal Isolate Surveillance Project (GISP) was established in 1986 to monitor trends of antimicrobial resistance in N . gonorrhoeae . GISP is a sentinel surveillance system consisting of 26 publicly funded sexually transmitted disease clinics and five regional laboratories . At each clinic, urethral isolates are obtained from the first 20 men diagnosed with gonorrhea each month; these isolates are shipped to one of the regional laboratories, where the susceptibilities of the organisms to a panel of antibiotics are determined . REPORTING PERIOD COVERED: This report describes the results of surveillance for antimicrobial resistance in N . gonorrhoeae from January 1991 through December 1991 . These results are compared with data obtained from January 1988 through December 1990 . RESULTS AND INTERPRETATION: In the 1991 GISP sample, 32.4% of isolates were resistant to penicillin or tetracycline . The proportions of isolates with high-level, plasmid-mediated resistance to penicillin, tetracycline, or both drugs have increased significantly (p < 0.001) in the GISP sample during 1988-1991 . No documented clinical treatment failures have been related to decreased susceptibility of N . gonorrhoeae to either ceftriaxone or ciprofloxacin, which belong to the classes of antibiotics currently recommended for gonococcal therapy . ACTION TAKEN: Because of the demonstrated ability of N . gonorrhoeae to develop resistance to antimicrobial agents, surveillance to guide therapy recommendations will be continued.

MMWR Morb Mortal Wkly Rep, 1993 Aug 6, 42(30), 589 - 91, 597
Update: barrier protection against HIV infection and other sexually transmitted diseases; Clinical manifestations of infection with the human immunodeficiency virus in women in Louisiana; Section of HIV, Louisiana State University School of Medicine, New Orleans 70112To better understand the clinical manifestations of human immunodeficiency virus (HIV) infection in women in Louisiana, we conducted a retrospective review of the records of HIV-infected women who presented to the largest HIV outpatient clinic in Louisiana as well as to a tertiary care university hospital in New Orleans between January 1987 and December 1991 . A total of 224 women were evaluated . Gynecologic examinations revealed that 17.5% had cervical intraepithelial neoplasia and that 35% had evidence of candidal vulvovaginitis or colonization . The following conditions were diagnosed among indicated percentages of patients: syphilis, 22.2%; Neisseria gonorrhoeae infection, 7.2%; Chlamydia trachomatis infection, 12.3%; pelvic inflammatory disease, 5.3%; trichomonal vulvovaginitis, 26.9%; genital ulcers due to herpes simplex virus, 16.5%; and clinically evident genital human papillomavirus infections, 16.5% . Both trichomonal vulvovaginitis and syphilis were more common among intravenous drug users . A total of 82 opportunistic processes were observed in 55 women . Pneumocystis carinii pneumonia was the most frequent complication of AIDS, followed by candidal esophagitis and wasting syndrome . Over 85% of women had received a diagnosis of AIDS before death . Gynecologic diseases occurred often in this population; the frequency of AIDS-defining events was similar to that reported previously in the literature.

J Clin Microbiol, 1993 Aug, 31(8), 1996 - 9
Comparative evaluation of AccuProbe culture identification test for Neisseria gonorrhoeae and other rapid methods; Young H et al.; The AccuProbe chemiluminescent culture identification test for Neisseria gonorrhoeae (Gen-Probe Inc., San Diego, Calif.) was assessed in a comparative evaluation with other rapid methods by using 269 isolates of oxidase-positive, gram-negative diplococci . Chemiluminescence was read with a PAL luminometer, and results were expressed as PAL light units (PLUs): the cutoff value for a positive identification was 1,500 PLUs . All 200 isolates of gonococci confirmed by carbohydrate utilization and serotyped with monoclonal antibodies were identified correctly by AccuProbe on initial testing . The API Quadferm system (Bio Merieux, Marcy l'Etoile, France) identified 95% (n = 190) of the gonococci correctly on initial testing and 99.5% (n = 199) on repeat testing, while the Phadebact Monoclonal GC test (Kara Bio Diagnostics AB, Huddinge, Sweden) identified 95.5% (n = 191) of the gonococci on both initial and repeat testing; 8 of the Phadebact-negative isolates were all of the same rare serovar (serovar 1B-17) . The mean PLU for the gonococcal isolates was 9,014 (range 2,264 to 10,845) compared with a mean of 51 (range, 8 to 109) for the 69 nongonococcal isolates . We conclude that the AccuProbe culture confirmation test provides a rapid and accurate objective means of identifying cultured N . gonorrhoeae isolates.

Obstet Gynecol, 1993 Aug, 82(2), 216 - 8
Colchicine and post-inflammatory adhesions in a rabbit model: a dose-response study; Marcovici I et al.; OBJECTIVE: To determine the dose-response relationship of colchicine in reducing inflammatory adhesive disease secondary to Neisseria gonorrhoeae in the rabbit . METHODS: Following intrauterine inoculation of a suspension of N gonorrhoeae, the rabbits were divided into five groups of 11 rabbits each . The control group received no medications . The remaining four groups received 0.1, 0.5, 1, and 2 mg, respectively, of colchicine intramuscularly daily for 14 days . The day after the last injection of colchicine, the peritoneal cavity was explored and assessed for the presence, number, and grade of adhesions . RESULTS: With increasing doses of colchicine, the incidence of adhesions decreased . A linear model (log {dose + 0.5}) showed, however, that as the dose of colchicine increased, the response tended to plateau (P < .05) . CONCLUSION: In this model, colchicine was effective in preventing inflammatory adhesions in the rabbit . Increasing doses produced a greater effect in reducing adhesion formation . However, there was a plateau of the response at the 1-mg dose.

Infect Immun, 1993 Aug, 61(8), 3360 - 8
Cloning of a gonococcal DNA sequence that complements the lipooligosaccharide defects of Neisseria gonorrhoeae 1291d and 1291e; Sandlin RC et al.; An isogenic set of gonococcal lipooligosaccharide (LOS) mutants derived from pyocin treatment of Neisseria gonorrhoeae 1291 was used to identify cloned gonococcal DNA fragments . A gene bank from N . gonorrhoeae 1291c chromosomal DNA was made in pLEE10, a shuttle vector that replicates in the gonococcus and Escherichia coli . A plasmid (pSG30) that could transform the LOS mutants 1291d and 1291e to reactivity with monoclonal antibody 3F11 and to production of an LOS component with migration identical to that of the parent, 1291, was identified . pSG30 contains a 9-kb EcoRI fragment . Curing studies indicate that pSG30 encodes gene products that affect LOS biosynthesis in trans . Subcloning identified a 2.6-kb HincII fragment (pSG38) that retained the ability to modify the LOS of 1291d and 1291e . The DNA regions involved in modification of 1291d and 1291e were named lsi-4 and lsi-5, respectively . The region of pSG38 that was involved in LOS modification was further localized by the construction of exonuclease III deletion plasmids . Transformation of these constructs identified a 750-bp fragment that retains the ability to modify 1291e and a 540-bp fragment which retains the ability to modify 1291d.

An Esp Pediatr, 1993 Aug, 39(2), 99 - 101
{Prevalence of Neisseria meningitidis carriers in a school population in the metropolitan area of Madrid}; Calle Puron EM et al.; The prevalence of healthy carriers of Neisseriae meningitidis has been addressed by studying oropharynx samples of 1,172 schoolchildren in Madrid . The sample design took into consideration social status, age and sex . The total prevalence of healthy carriers was 2.30%, with 66% or these in the six year old age group (RR = 2.88, p < 0.005) . Serotype B was found in 74% of the carriers, again mainly in the six year old age group, and 18.5% were serotype A, with most of them being found in the fourteen year age group . Serotype A carriers were females in 80% of the cases (p = 0.04) . Serotype C was only found in six year old males . The prevalence of healthy carriers of Neisseriae meningitidis in our school-age population, in a non-epidemic situation, is in accord with results reported from other countries around us and agrees with previous reports of a higher prevalence among younger children and in males . In addition, the association between sex and some serotypes is confirmed.

Eur J Clin Microbiol Infect Dis, 1993 Aug, 12(8), 625 - 7
Endocarditis caused by Neisseria elongata subspecies nitroreducens: case report and literature review; Struillou L et al.; Neisseria elongata subsp . nitroreducens, an usual commensal of the nasopharynx, can cause serious infections, usually endocarditis . A case of Neisseria elongata endocarditis complicating mitral valve prolapse in a patient allergic to penicillin is reported . Cure was obtained with a combination of ceftriaxone and gentamicin, there being no requirement for surgery during the acute phase of the disease.

Antimicrob Agents Chemother, 1993 Aug, 37(8), 1670 - 3
Comparison of ciprofloxacin and ceftriaxone as single-dose therapy for uncomplicated gonorrhea in women; Hook EW 3rd et al.; Although women bear the brunt of gonococcal infection-related morbidity, few large studies of gonorrhea treatment in women have been conducted . In a multicenter, double-blind, placebo-controlled trial, 181 evaluable women with uncomplicated gonorrhea were treated with ciprofloxacin (250 mg orally; 94 women) or ceftriaxone (250 mg intramuscularly; 87 women) . Twenty-four percent of the participants were infected with antibiotic-resistant Neisseria gonorrhoeae . Cervical gonorrhea was cured in 100% (93 of 93) of the women treated with ciprofloxacin and 99% (83 of 84) receiving ceftriaxone . All pharyngeal (n = 5) or rectal (n = 20) infections treated with ciprofloxacin were cured, as were ceftriaxone-treated patients with pharyngeal (n = 6) or rectal (n = 21) infection . Geometric mean MICs (range) for 248 pretreatment isolates were: penicillin, 0.28 (0.015 to 8.0); tetracycline, 0.46 (0.06 to 4); ciprofloxacin, 0.003 (0.002 to 0.015); and ceftriaxone, 0.004 (0.001 to 0.125) microgram/ml . Both drugs were well tolerated . Despite the high prevalence of antibiotic-resistant gonococci in these populations, 250 mg of oral ciprofloxacin was as effective as an injection of ceftriaxone.

Genitourin Med, 1993 Aug, 69(4), 286 - 9
Neisseria gonorrhoeae isolated at St . Mary's Hospital London, 1980-91; Renton AM et al.; OBJECTIVE--To describe and discuss the trends in the isolation of Neisseria gonorrhoeae from patients attending the Genitourinary Medicine Clinic at St . Mary's Hospital, Paddington, London between 1980 and 1991 . DESIGN--A retrospective study of the total number of gonococci isolated over an eleven year period was performed . In addition, for the years 1988-1991 the number of isolates from homosexual men was analysed by age of the patient, site of infection and HIV antibody status of the patient . RESULTS--The total number of N . gonorrhoeae isolates identified declined markedly between 1980 and 1989 from 3670 to 750 isolates . Over the same time period the number of specimens screened for N . gonorrhoeae fell by 50% . In 1990 there was an increase in N . gonorrhoeae isolates but this was not maintained, and in 1991 the number of N . gonorrhoeae fell to its lowest level of 638 isolates . The decrease since 1980 occurred in both men and women although the number of rectal isolates from men showed a steeper decline reaching its lowest level of 24 isolates in 1988 . The number of rectal isolates from homosexual men has since increased with a peak in 1990 . Many of the infections among homosexual men occurred in older men and included insignificant number of patients who were HIV positive . CONCLUSION--Gonorrhoea among attenders at St . Mary's Hospital has declined dramatically since 1980 following trends reported from much of Europe . The increase in gonococcal isolates since 1989 and the peak in 1990 are unexplained but are coincident with a higher number of isolates from homosexual men.

Lancet, 1993 Jul 24, 342(8865), 206 - 10
Health gains from screening for infection of the lower genital tract in women attending for termination of pregnancy; Blackwell AL et al.; Infection of the upper genital tract after abortion is well recognised, but routine screening for infection before termination is rare, and few centres are aware of the prevalence of post-abortion complications in their population . We undertook a study to assess the prevalence and sequelae of genital-tract infection in patients undergoing termination of pregnancy and to estimate the costs and potential benefits of introducing screening and prophylaxis for the most commonly found organisms . The study in Swansea, UK, was of 401 consecutive patients attending for termination of pregnancy; only 1 patient refused to take part . Immediately before the termination procedure vaginal and cervical swabs were taken for microscopic examination and culture of Trichomonas vaginalis, Neisseria gonorrhoeae, and candida species . We sought Chlamydia trachomatis by enzyme-linked immunosorbent assay . 112 (28%) women had the typical bacterial flora of anaerobic (bacterial) vaginosis, 95 (24%) had candidal infection, 32 (8%) chlamydial infection, 3 (0.75%) trichomonas infection, and 1 (0.25%) gonorrhoea . Postoperative follow-up of 30 of the women with chlamydial infection showed that pelvic infection developed in 19 (63%), of whom 7 were readmitted to hospital . 9 male partners of women with chlamydial (plus gonococcal in 1 case) infection were examined; 8 were symptom-free, 3 had C trachomatis infection, and 1 N gonorrhoeae . Estimated costs of hospital admissions for complications of chlamydial infection were more than double the costs of providing a routine chlamydia screening programme and prophylactic treatment . Screening for chlamydial infection before termination of pregnancy is essential . Prophylactic treatment for both chlamydial infection and anaerobic vaginosis should also be considered . Male partners of women infected with chlamydia are often symptom-free, but they must be traced to avoid reinfectionsPIP: Between October 1990 and March 1991, 401 women at Hill House Hospital in Swansea, Wales, undergoing an abortion enrolled in a study to determine the prevalence and sequelae of lower genital tract infection and to assess the costs and potential benefits of screening and of prophylaxis for the most common pathogens . The physicians administered 500 mg oxytetracycline for 10 days for women with uncomplicated chlamydia infection and for 14=21 days for those with chlamydia-related pelvic inflammatory disease (PID) . A 5-day course of oral metronidazole (400 mg/2/times/day) treated anaerobic vaginosis and trichomonas infections . 51.7% had at least 1 lower genital tract infection, 28% had anaerobic vaginosis, 24% had candida infection and 32 women (8%) were infected with Chlamydia trachomatis . Some of these women also had anaerobic vaginosis, anaerobic vaginosis and candidosis, Escherichia coli infection, and candidosis (15, 1, 1, and 6 women, respectively) . Anaerobic vaginosis was more likely to be present in women with chlamydia infection than in those without chlamydia infection (53% vs . 26%; p .05) . 19 of 30 women (63%) with chlamydia infection who could be followed postoperatively developed PID . 7 women had to be readmitted to the hospital . 9 males partners of 26 women also attended the Genito-Urinary Medicine clinic . 8 had not symptoms, but 3 had C . trachomatis infection and 1 had Neisseria gonorrhoea infection . The physicians estimated the costs of hospital admissions for pelvic infection to be 2.4 times more costly than providing routine prophylactic screening and treatment (16,800 vs . 6960 UK pounds) . These results showed the need to be screen for chlamydia infection before termination of pregnancy and to provide prophylactic treatment for chlamydia infection and anaerobic vaginosis . The physicians also recommended tracing the male partners of chlamydia-infected women to prevent reinfections .

Ned Tijdschr Geneeskd, 1993 Jul 17, 137(29), 1457 - 61
{Trends in incidence of sexually transmissible disorders in The Netherlands}; Treurniet HF et al.; In 1983 the Chief Medical Inspectorate set up a national registration of sexually transmitted diseases (STD), beside the system of statutorily notifiable diseases in the Netherlands . Data for this registration are collected by the nursing staff in STD clinics . Besides diagnosis and sex of the patient epidemiological background information is registered . The data show a decrease in the total number for gonorrhoea and syphilis in the period 1984-1990 . Among homosexual men gonorrhoea increased after 1989 . A decrease in STD was demonstrated among prostitute women . Further, the share of penicillinase producing Neisseria gonorrhoeae was found to be increasing in various subgroups, but not in homosexual men . Comparison of age, sex, prostitution, and sexual inclination of over 25,000 patients with Chlamydia trachomatis, gonorrhoea or syphilis infections indicate that syphilis was significantly more frequent among older patients and women than gonorrhoea, but less frequent among prostitutes . Syphilis patients were significantly more often visitors of prostitutes than patients with gonorrhoea, and were more often homosexual or bisexual . Chlamydiosis patients were mostly women and younger than gonorrhoea patients, they were less often working as a prostitute and less often homosexual or bisexual.

Gene, 1993 Jul 15, 129(1), 51 - 7
Shuttle mutagenesis: two mini-transposons for gene mapping and for lacZ transcriptional fusions in Neisseria gonorrhoeae; Boyle-Vavra S et al.; Shuttle mutagenesis is a system we developed for producing stable transposon insertions in Saccharomyces cerevisiae {Seifert et al., Proc . Natl . Acad . Sci . USA 83 (1986) 735-739; Hoekstra et al., Methods Enzymol . 194 (1991) 329-342} and Neisseria gonorrhoeae (Gc) {Seifert et al., J . Bacteriol . 172 (1990) 40-46} by transposition in Escherichia coli and transformation into yeast or Gc . In developing the system for use in Gc, a series of mini-transposons (mTn) were derived from mTn3 which confer resistance to chloramphenicol in Gc (mTnCm) (Seifert et al., 1990) . Herein, we describe the creation of two mTnCm derivatives for use in Gc . One of these transposons, mTnCmNS, contains the infrequently occurring NheI and SpeI restriction sites to localize genes on the gonococcal macro-restriction map which was recently developed using these restriction sites {Bihlmaier et al., Mol . Microbiol . 5 (1991) 2529-2539; Dempsey et al., J . Bacteriol . 173 (1991) 5476-5486} . The mTnCmLac was developed to generate lacZ transcriptional fusions using transposition . It contains at its end a promoterless lacZ gene which is expressed once the element has transposed downstream from a promoter in a cloned gene . In adapting the use of mTnCmLac to the shuttle mutagenesis system, we have identified some factors which affect the transformation of Gc using cloned chromosomal fragments containing the large heterologous insertion, mTnCmLac . Using mTnCmLac, we have created Gc variants containing a pilE::mTnCmLac fusion to determine that pilE transcription in Gc is not auto-regulated.

Gene, 1993 Jul 15, 129(1), 123 - 8
Cloning and characterization of the Neisseria meningitidis asd gene; Hatten LA et al.; The asd mutants of Gram- and some Gram+ bacteria have an obligate requirement for diaminopimelic acid (DAP), an essential constituent of the cell wall of these organisms . In environments deprived of DAP, i.e., mammalian tissues, they will undergo lysis . This has previously been exploited to develop vaccine strains of Salmonella typhimurium and Streptococcus mutans . As a first step for the development of a biosafe Neisseria meningitidis laboratory strain, we have cloned the asd from wild-type strain B16B6 by complementation of an Escherichia coli asd mutant . By subcloning and insertion mutagenesis, the N . meningitidis asd was localized to a 1.5-kb DNA fragment . In a T7 RNA polymerase-T7 promoter expression system, a 38-kDa protein was strongly expressed from this DNA fragment . The N-terminal amino acid (aa) sequence was deduced from the nucleotide sequence, which was determined with the help of an in-frame Asd'::'LacZ protein fusion . A comparison of the N-terminal aa of the Asd proteins from N.meningitidis and E . coli revealed 70% identity, suggesting that the Asd protein may be highly conserved among Gram- bacteria.

Microb Pathog, 1993 Jul, 15(1), 51 - 63
Neisseria gonorrhoeae strain MS11 harbouring a mutation in gene aroA is attenuated and immunogenic; Chamberlain LM et al.; An aroA mutant of gonococcal strain MS11 was constructed (JKD298) and compared with the wild-type (JKD288) . The requirement of JKD298 for aromatic compounds, typical of an aroA mutant, was demonstrated using defined media . Other than the expected auxotrophy, no further differences could be demonstrated between the parent and the aroA mutant . SDS-PAGE analysis of protein and lipopolysaccharide (LPS) profiles showed no differences between the strains . Bactericidal assays using human and guinea-pig normal sera showed that both strains were serum sensitive and were similarly converted to serum resistance by in vitro sialylation using CMP-NANA . Infectivity experiments in guinea-pig subcutaneous chambers showed considerably reduced virulence of the aroA JKD298, which could only infect chambers at very high doses . Established infections by either strain elicited a strong PMN response in which similar proportions of each strain were seen intracellularly . Infections by JKD298 provoked a strong antibody response as detected by ELISA using whole sonicated gonococci . This is the first demonstration of attenuation of Neisseria gonorrhoeae by introduction of a defined mutation in a metabolic gene.

J Antimicrob Chemother, 1993 Jul, 32 Suppl A, 11 - 6
The domiciliary management of genital tract infection; Ridgway GL; Present treatment schedules for lower genital tract infections are far from ideal . Members of the 4-quinolone antibiotic class are highly active against Neisseria gonorrhoeae, and some of the newer agents are active against Chlamydia trachomatis . Clinical success has been reported with, for example, a single daily dose of ofloxacin for one week . New macrolides are active against C . trachomatis and N . gonorrhoeae . Azithromycin has been shown to be effective in a single oral dose . The role of newer agents in the therapy of bacterial vaginosis is largely unproven, but there are encouraging signs . The importance of attempting to make a firm diagnosis is emphasized.

Eur J Clin Microbiol Infect Dis, 1993 Jul, 12(7), 540 - 5
Asymptomatic Neisseria subflava biovar perflava bacteriuria in a child with obstructive uropathy; Janda WM et al.; A case of asymptomatic urinary tract infection with Neisseria subflava biovar perflava in a 10-year-old male patient with congenital structural abnormalities of the urinary bladder is presented . The organism was recovered from three catheter urine specimens collected over a seven-month period . A brief review of the role of saprophytic Neisseria species in infectious processes is presented and the likely source of this unusual urinary tract isolate is discussed.

J Adolesc Health, 1993 Jul, 14(5), 356 - 61
Screening for urethral infection in adolescent and young adult males; Johnson J et al.; We evaluated the urinary leukocyte esterase (LE) dipstick as a predictor of a positive urethral culture for Neisseria gonorrhoeae and/or Chlamydia trachomatis in adolescent and young adult males . Sexual and sexually transmitted disease (STD) histories were also analyzed to determine predictors of infection . Subjects were recruited from sexually active males attending an adolescent medicine clinic . Patients were interviewed regarding presence of symptoms of urethritis and a variety of clinical variables . First-voided urine for LE dipstick and urethral swabs for gonorrhea and C . trachomatis cultures were obtained . One hundred patients (mean age, 19.2 years) were asymptomatic; 50 patients (mean age, 19.0 years) had symptoms of urethritis . In asymptomatic patients, the sensitivity, specificity, predictive value positive (PVP), and predictive value negative (PVN) of the LE dipstick were 0.31, 0.92, 0.57, and 0.90, respectively . These values were 0.66, 0.71, 0.76, and 0.60, respectively, in symptomatic patients . In each patient group the dipstick was more sensitive in detecting, and a better predictor of, a positive culture for gonorrhea than Chlamydia . LE dipstick results and clinical variables were evaluated as correlates of infection using stepwise logistic regression . A positive LE dipstick and four additional variables increased the probability of obtaining a positive culture for one or both organisms from symptomatic patients . These variables were the following: sexual contact in the previous month with a partner diagnosed as having a sexually transmitted disease, having ever used a condom, five or more lifetime sexual partners, and more than one sexual partner in the past month . Only a positive LE dipstick entered the model as a predictor of infection in asymptomatic patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Clin Infect Dis, 1993 Jul, 17(1), 82 - 8
Clinical algorithms for the screening of women for gonococcal and chlamydial infection: evaluation of pregnant women and prostitutes in Zaire; Vuylsteke B et al.; A substantial proportion of women with gonococcal and/or chlamydial infection are asymptomatic . Thus active case detection is problematical, particularly in developing countries, where facilities and materials for laboratory testing are limited . We assessed the diagnostic validity of the hierarchical clinical algorithms recommended by the World Health Organization as well as that of a nonhierarchical scoring system, using data for 1,160 pregnant women (a low-prevalence group) and 1,222 prostitutes (a high-prevalence group) in Kinshasa, Zaire . Neisseria gonorrhoeae and/or Chlamydia trachomatis was detected in 6.5% and 31.0% of pregnant women and prostitutes, respectively . No single variable that was both sensitive (> 60%) and specific (> 60%) was associated with infection . A simple hierarchical algorithm based only on reported symptoms had a sensitivity of 48.0% and 54.9% and a specificity of 75.2% and 52.2% for the screening of pregnant women and prostitutes, respectively . A second algorithm that included a speculum examination had a sensitivity of only 29.3% but a specificity of 85.3% in pregnant women . When a nonhierarchical scoring system was used, the sensitivity was 72.0% and 71.0% and the specificity was 73.5% and 55.8% for pregnant women and prostitutes, respectively . Scoring systems that incorporate risk markers as well as symptoms and signs may represent affordable alternative methods of screening for gonococcal and/or chlamydial infections among women in resource-poor settings.

Int J Syst Bacteriol, 1993 Jul, 43(3), 474 - 81
Moraxella lincolnii sp . nov., isolated from the human respiratory tract, and reevaluation of the taxonomic position of Moraxella osloensis; Vandamme P et al.; A polyphasic taxonomic study was performed to determine the relationships of 10 Moraxella-like strains isolated mainly from the human respiratory tract in Sweden . Two of the strains formed a separate subgroup on the basis of both their protein contents and their fatty acid contents . However, the overall protein and fatty acid profiles revealed that all 10 strains were highly related . Representative strains of the two subgroups exhibited high DNA binding values (98%) with each other and had an identical DNA base ratio (44 mol% G+C) . DNA-rRNA hybridizations revealed that this taxon can be included in the genus Moraxella, which is only distantly related to phenotypically similar genera, such as the genera Neisseria and Kingella . The results of an extensive phenotypic analysis indicated that the general biochemical profile of the 10 strains conforms with the description of the genus Moraxella given in Bergey's Manual of Systematic Bacteriology . We therefore consider these organisms members of a new Moraxella species, for which the name Moraxella lincolnii is proposed . Furthermore, we also conclude that Moraxella osloensis belongs, genotypically as well as phenotypically, to the genus Moraxella.

J Bacteriol, 1993 Jul, 175(14), 4565 - 8
Neuraminic acid is alpha 2-->3 linked in the lipooligosaccharide of Neisseria meningitidis serogroup B strain 6275; Yamasaki R et al.; We have analyzed the sialylated lipooligosaccharide of Neisseria meningitidis 6275 . Sialylated oligosaccharide released from strain 6275 lipooligosaccharide by mild hydrolysis was determined to contain N-acetylneuraminic acid linked alpha 2-->3 to terminal galactose as shown below . {formula: see text}

Rev Med Chil, 1993 Jul, 121(7), 785 - 8
{Susceptibility of Neisseria gonorrhoea strains}; Vidal A et al.; The susceptibility of 45 strains of Neisseria gonorrhoea was studied measuring minimal inhibitory concentrations of five antimicrobials . Results show that 66.7% of strains are resistant to tetracycline and 11.2% to penicillin . All strains were susceptible to ciprofloxacin, ceftriaxone and cefotaxime . This results should prompt to perform surveillance in different areas of Santiago and to establish new therapeutic norms for the treatment of gonococcal infections.

Pathology, 1993 Jul, 25(3), 310 - 2
M-6 endocarditis: report of an Australian case; Kociuba K et al.; Neisseria elongata subsp . nitroreducens (formerly CDC group M-6) is a newly-recognized cause of particularly destructive endocarditis, frequently requiring valve replacement . We describe an Australian case of endocarditis caused by this organism, summarizing the clinical and microbiological features of this rarely isolated subspecies.

Med Microbiol Immunol (Berl), 1993 Jul, 182(3), 137 - 45
Polymerase chain reaction and direct sequencing of Neisseria gonorrhoeae protein IB gene: partial nucleotide and amino acid sequence analysis of strains S4, S11, S48 (serovar IB4) and S34 (serovar IB5); Lau QC et al.; A pair of primers were designed for the polymerase chain reaction (PCR) to amplify a 341-base pair fragment of the gene encoding the outer membrane protein IB (PIB) of Neisseria gonorrhoeae . This PCR technique is specific and sensitive, being able to detect gonococcal strains belonging to ten different PIB serovars, but not PIA gonococcus nor other negative control bacteria . PCR products of four representative PIB strains were directly sequenced . Of the three strains belonging to serovar IB4, two (S11 and S48) shared identical nucleotide and amino acid sequences in the PIB region examined . The third IB4 strain (S4) revealed sequences identical to the published IB26 strain (P9) . The sequences of strains P9, S4, S11 and S48 were found to differ from those of strain S34 (serovar IB5) . The PCR sequencing technique can further differentiate strains belonging to a common serovar and establish clonal relationships among strains . As a molecular epidemiological tool, the PCR-sequencing strategy can augment existing typing methods including serotyping.

Zhonghua Zheng Xing Shao Shang Wai Ke Za Zhi, 1993 Jul, 9(4), 249 - 51, 317
{Oro-pharyngeal flora in severely burned patients}; Zhang YP; Throat cultures were taken in thirty-seven cases of burned patients, and also, at the same time, from twenty-three healthy persons . The results showed that the essential oro-pharyngeal flora in healthy persons were Neisseria (65.7%) and Streptococcus viridans (14.3%), and Staphylococcus aureus was obtained occasionally . In twenty-five out of thirty-seven patients dominant growth of invaders was observed . The prominent aerobic bacteria in patients included Serratia (9.33%), Pseudomonas aeruginosa (8.44%) and Proteus (7.11%) . The positive rate of fungi was as high as 75.1%, of which Candida was the most commonly found organism . In 7 patients the number of bacteria in the throat was in excess of 108/cm2 . Of these 7 patients, 4 died . Quantitative bacterial count of lungs were taken in 3 non-survivors, and the bacterial count was over 10(5)/g . The bacteria in the lungs were as same as the predominantly colonized bacteria in the throat, and in a part of cases were the same as the systemically disseminated bacteria . The study of the throat flora is simple, its result might help the prediction of pulmonary infection.

Sex Transm Dis, 1993 Jul-Aug, 20(4), 227 - 9
Comparison of enoxacin and ceftriaxone in the treatment of uncomplicated gonorrhea; Covino JM et al.; BACKGROUND AND OBJECTIVES: The increasing prevalence of resistant strains of Neisseria gonorrhoeae has prompted investigation of new agents for the treatment of this sexually transmitted disease . GOAL OF THIS STUDY: This study compared the efficacy and safety of a single oral dose of enoxacin to intramuscular ceftriaxone in the treatment of uncomplicated anogenital infection with N . gonorrhoeae . STUDY DESIGN: A randomized open trial was conducted at a sexually transmitted diseases clinic in Brooklyn, New York . Adults with uncomplicated gonorrhea were randomly assigned to receive 400 mg of enoxacin or 250 mg of ceftriaxone . A follow-up examination was conducted 5 to 9 days later . RESULTS: 59 women and 23 men were enrolled; 40 women and 19 men were evaluable . Enoxacin eradicated 18 of 19 endocervical, 10 of 10 urethral, 5 of 5 anorectal, and 3 of 3 pharyngeal gonococcal infections . Ceftriaxone eradicated 20 of 21 pharyngeal gonococcal infections . Fifty-nine pretreatment isolates of N . gonorrhoeae were available for antimicrobial susceptibility testing . The geometric mean minimal inhibitory concentration was 0.03 mg/1 for enoxacin and 0.005 mg/l for ceftriaxone . There were few sides effects in either group, and both drugs were ineffective against concomitant infection with Chlamydia trachomatis . CONCLUSION: Oral enoxacin appears to be a safe and effective method of treatment for anogenital infections caused by N . gonorrhoeae.

Kansenshogaku Zasshi, 1993 Jul, 67(7), 648 - 53
{Effect of erythromycin on production of cytotoxin and attachment factors of bacteria}; Mikasa K et al.; We studied the effect of erythromycin (EM) on the attachment of Pseudomonas aeruginosa and Neisseria gonorrhoeae to HeLa and HT-177 cell and on cytotoxin production of P . aeruginosa . 1 . EM inhibited attachment of these bacteria . 2 . EM inhibited manifestation of the pili of these bacteria . 3 . EM inhibited production of protein II, the second attachment factor of N . gonorrhoeae . 4 . EM inhibited production of 66 K cytotoxin of P . aeruginosa . On the basis of these findings, it was suggested that EM might inhibit infection by repressing manifestation of the attachment factor and production of cytotoxin of the bacteria.

J Immunol, 1993 Jul 1, 151(1), 234 - 43
Idiotype and anti-anti-idiotype antibodies to Neisseria gonorrhoeae lipooligosaccharides with bactericidal activity but no cross-reactivity with red blood cell antigens; Brossay L et al.; A panel of murine mAb against three different epitopes of Neisseria gonorrhoeae lipooligosaccharides (LOS) was developed . Only one of these, 3G5, displays bactericidal activity against all in vitro serum-resistant strains of N . gonorrhoeae . Evidence suggests that sialylation, which could occur in vivo, modifies some LOS epitopes in such a way that the strains become resistant to bactericidal activity and are no longer recognized by specific antibodies . The epitope recognized by our bactericidal mAb is not affected by sialylation as shown by immunoblot analysis . We also provided evidence that the 3G5 epitope is different from RBC precursor Ag, since our mAb did not induce RBC agglutination . Since LOS induce an immune response in a T cell-independent fashion and are highly toxic, they cannot be used for immunization . Use of anti-idiotypic antibodies (aId) could be a way to bypass these difficulties . Therefore, in the present study, aId were produced in rabbits and rendered idiotype-specific by appropriate adsorption . These aId specifically bind to the relevant Id but not to LOS, and inhibit only the binding of anti-LOS mAb (3G5) to LOS preparations from N . gonorrhoeae in a dose-response fashion . The specificity of our aId for the binding site of anti-LOS mAb is suggested by the binding inhibition of affinity-purified aId to Id by LOS . In addition, the capacity of aId to inhibit bactericidal activity of this anti-LOS mAb and the idiotypic cross-reactivity between rat and mouse anti-LOS antibodies support this point . Finally, the elicitation of anti-LOS activity with bactericidal activity upon immunization of naive mice with aId confirms the internal image properties of the aId . These data suggest that a bactericidal mAb suitable for immunoprotection was obtained, and the production of aId opens the door for development of a vaccine.

Schweiz Med Wochenschr, 1993 Jun 19, 123(24), 1250 - 5
{Sexually transmissible diseases following travel in tropical countries}; Eichmann A; Travel to tropical countries is an important factor in the spread of sexually transmitted diseases . In spite of intensive anti-AIDS campaigns, some 30% of Swiss tourists have casual sexual contacts abroad . The prevalence of sexually transmitted diseases is higher in tropical countries than in western industrialized countries . More than 25% of cases of gonorrhea treated in Switzerland from 1989-1991 were imported from abroad . The penicillin producing Neisseria gonorrhoeae strains (PPNG) isolated in Switzerland from 1989-1991 are mainly imported from abroad (60%) . The typical "imported sexually transmitted diseases" in Switzerland are chancroid, lymphogranuloma venereum and donovanosis . The clinical manifestations, laboratory and special examinations, and treatment of these diseases are described . The most frequent sexually transmitted disease from the so-called "imported tropical STD's" is chancroid . Chancroid is also a major risk factor for HIV infection.

FEMS Microbiol Lett, 1993 Jun 15, 110(2), 139 - 45
Neisseria meningitidis transferrin-binding protein 1 expressed in Escherichia coli is surface exposed and binds human transferrin; Palmer HM et al.; A gene library of Neisseria meningitidis B15 P1.16 DNA was established in lambda Zap II and clones containing DNA encoding transferrin binding protein 1 (TBP-1) identified following hybridisation with a 63-bp DNA probe based on the codon assignment for the first 21 N-terminal amino acids of TBP-1 . Sequencing of the cloned DNA demonstrated that all of the intergenic DNA (i.e . upstream of tbp-1 running through to the 3' end of the transferrin-binding protein 2 gene) and approx . 15% of tbp-1 had been cloned . The complete gene was generated using a polymerase chain reaction, with the primer for the 3' end being based on tbp-A of N . gonorrhoeae, and the approx . 2.9-kb DNA product cloned into pGem-3Z . The expressed protein (approx . 100 kDa) reacted with antiserum to an N-terminal peptide of TBP-1 . In addition, the native product was surface-expressed by Escherichia coli and bound human transferrin.

South Med J, 1993 Jun, 86(6), 604 - 10
Multicenter randomized trial of ofloxacin versus cefoxitin and doxycycline in outpatient treatment of pelvic inflammatory disease . Ambulatory PID Research Group; Martens MG et al.; A multicenter randomized comparative trial was done to assess the safety and efficacy of oral ofloxacin (400 mg twice daily for 10 days) versus cefoxitin (2 g intramuscularly) followed by doxycycline (100 mg twice daily orally for 10 days) for the outpatient treatment of uncomplicated pelvic inflammatory disease (PID) . Neisseria gonorrhoeae (GC) grew on pretreatment endocervical cultures from 43 of 268 women (16%), and in 30 of 247 women (12%) cultures were positive for Chlamydia trachomatis (Ct) . Ninety-five percent (122/128) of the women treated with the ofloxacin regimen and 93% (112/121) of those treated with the cefoxitin/doxycycline regimen had cure or improvement on examination at a minimum of one follow-up visit . All GC species were eradicated by both ofloxacin and cefoxitin . Among women who returned for follow-up, the eradication of C trachomatis was 88% (15/17) for the cefoxitin/doxycycline group and 100% (18/18) for ofloxacin . Side effects were more prevalent in the cefoxitin/doxycycline group (15%) than in the ofloxacin group (7%), nausea/vomiting being the most frequent adverse effect . In this study, it appears that ofloxacin and cefoxitin/doxycycline have similar clinical effectiveness for the outpatient treatment of uncomplicated pelvic inflammatory disease.

Infect Immun, 1993 Jun, 61(6), 2390 - 5
Immunogenicity and efficacy of oral or intranasal Shigella flexneri 2a and Shigella sonnei proteosome-lipopolysaccharide vaccines in animal models; Orr N et al.; Immunity against shigellosis has been shown to correlate with the presence of antibodies specific for Shigella lipopolysaccharide (LPS) . We here propose a new candidate vaccine for shigellosis composed of purified Shigella flexneri 2a or Shigella sonnei LPS hydrophobically complexed with group C type 2b Neisseria meningitidis outer membrane protein proteosomes . Immunization of mice either orally or intranasally with this complex induced specific homologous anti-LPS antibodies in both intestinal and respiratory secretions as well as in sera . Strong anamnestic responses were found after two or three immunizations . LPS alone, alkaline-detoxified LPS, or alkaline-detoxified LPS complexed with proteosomes was not effective . Oral or intranasal immunization of guinea pigs with two or more doses of this proteosome-LPS vaccine elicited homologous protection against Shigella keratoconjunctivitis (Sereny test) . These data demonstrate that proteosomes can be used as an effective mucosal vaccine delivery system and that orally or intranasally administered acellular vaccines can protect against Shigella infections.

Obstet Gynecol, 1993 Jun, 81(6), 963 - 7
Efficacy of intravaginal 0.75% metronidazole gel for the treatment of bacterial vaginosis; Hillier SL et al.; OBJECTIVE: To assess the efficacy of 0.75% metronidazole vaginal gel, formulated at pH 4.0, for the treatment of bacterial vaginosis in a double-blind, placebo-controlled crossover trial . METHODS: Fifty-three women with bacterial vaginosis (clue cells of at least 20% plus vaginal pH of at least 4.7, amine odor, or homogeneous discharge) were enrolled . Women with concomitant infection by Candida, Trichomonas, Chlamydia trachomatis, or Neisseria gonorrhoeae were excluded . Five grams of metronidazole gel or placebo was inserted intravaginally twice daily for 5 days . Response to therapy was evaluated at 4-16 days and 1 month after treatment . RESULTS: Twenty-six of the 30 women (87%) who received metronidazole were free of bacterial vaginosis 9-21 days after enrollment, compared with only four (17%) of 23 placebo-treated women (P < .001) . Women who were cured were followed prospectively . Those who had persistent bacterial vaginosis were crossed over to metronidazole gel in an open trial; bacterial vaginosis was eradicated in 21 of 23 (91%) of these women at the 2-week follow-up . Recurrent bacterial vaginosis developed within 1 month in four (15%) of 26 women who were initially cured after receiving metronidazole gel . Response to therapy was accompanied by a decrease in vaginal Bacteroides, Gardnerella vaginalis, and Mycoplasma hominis . CONCLUSIONS: Treatment with intravaginal metronidazole gel resulted in a clinical cure in 87% (placebo-controlled trial) to 91% (crossover trial) of women with bacterial vaginosis . The recurrence rate of 15% at 1 month after treatment is similar to that reported with oral metronidazole.

Ann Intern Med, 1993 Jun 1, 118(11), 844 - 9
Clinical manifestations of trichomoniasis in men; Krieger JN et al.; OBJECTIVE: To determine the prevalence and clinical manifestations of trichomoniasis among sexually active men . DESIGN: Survey of two groups of men attending a sexually transmitted disease clinic . Subjects had a comprehensive sexual history and clinical examination plus cultures for Trichomonas vaginalis, Neisseria gonorrhoeae, and Chlamydia trachomatis . PARTICIPANTS: The study included 147 sexual partners of women with trichomoniasis and 300 subjects selected randomly from heterosexual men coming to the same clinic for evaluation of new problems . MAIN OUTCOME MEASURES: Isolation of T . vaginalis was compared with urogenital signs and symptoms . RESULTS: The prevalence of T . vaginalis was 33 of 147 (22% {95% CI, 16% to 29%}) among sexual contacts of women with trichomoniasis and 17 of 300 (6% {CI, 3% to 9%}) among heterosexual men attending the same clinic . Men with trichomoniasis alone were more likely to complain of urethral discharge (P < 0.01), to have discharge on examination (P < 0.03), and to have inflammatory cells in their urethral secretions (P < 0.01) than were men who did not have T . vaginalis, N . gonorrhoeae, or C . trachomatis . Trichomonas vaginalis remained associated with nongonococcal nonchlamydial urethritis (adjusted odds ratio 3.8; CI, 1.1 to 11.2) after adjustment for race, age, number of sex partners in the previous 6 months, exposure to a partner with trichomoniasis, and history of trichomoniasis, urethritis, or gonorrhea . CONCLUSIONS: Trichomoniasis was common among men at risk for sexually transmitted diseases and was associated with symptoms and signs of urethritis.

J Antimicrob Chemother, 1993 Jun, 31 Suppl E, 193 - 8
Open study of the safety and efficacy of a single oral dose of azithromycin for the treatment of uncomplicated gonorrhoea in men and women; Waugh MA; An open, non-comparative study was undertaken to assess the safety and efficacy of a single 1 g oral dose of azithromycin in patients with uncomplicated gonorrhoea . One hundred and eighteen patients (105 male, 13 female) took part in the study . Only patients culture-positive for Neisseria gonorrhoeae were evaluated . The majority of male patients (84) had urethral gonorrhoea, but four had rectal and two pharyngeal infections . Four patients had positive cultures at more than one site (two urethral and rectal; two urethral and pharyngeal) . All nine female patients had infection of the cervix only . Bacteriological eradication of N . gonorrhoeae was achieved in 76/82 (93%) patients with positive urethral cultures, 9/9 with positive cervical, 4/4 with positive rectal, and 2/2 with positive pharyngeal cultures . Twenty-two patients (18 males, four females) had concomitant chlamydial infection . Chlamydia trachomatis was eradicated in all patients who returned for follow-up assessment and in whom culture was done . Azithromycin was very well tolerated, with only two patients reporting mild-to-moderate side-effects . This study shows that single-dose azithromycin is effective in uncomplicated gonorrhoea and in mixed gonococcal and chlamydial infections.

Zentralbl Bakteriol, 1993 Jun, 279(1), 104 - 13
Characterization of the family Pasteurellaceae on the basis of cellular lipids and carbohydrates; Mutters R et al.; Selected strains representing established and newly described taxa in the family Pasteurellaceae were investigated for their cellular lipid and carbohydrate composition to clarify the taxonomic significance of such features . Methylated cellular fatty acids and acetylated derivatives of the cellular carbohydrates were determined by capillary gas chromatography using a flame ionization detector . In part the carbohydrates were identified by mass spectrometry . Phospholipids were determined by thin layer chromatography, the lipoquinones by high pressure liquid chromatography . The cellular fatty acid patterns proved to be uniform with minor variations, but the separation from the Neisseriaceae and from Moraxella was possible . Also the distribution of the phospholipids was uniform within the family . The lipoquinone contents were useful for the discrimination of groups within the family not necessarily reflecting the degree of genomic relatedness . The analysis of the cellular carbohydrates resulted in a common sugar pattern with all members of the family and characteristic carbohydrate profiles discriminating groups, often to the species level . All of the cytochemical features considered were useful for the characterization of the family Pasteurellaceae.

Mol Microbiol, 1993 Jun, 8(6), 1125 - 33
Preparation and analysis of isogenic mutants in the transferrin receptor protein genes, tbpA and tbpB, from Neisseria meningitidis; Irwin SW et al.; Isogenic mutants were constructed in the tbpA and tbpB genes from Neisseria meningitidis strain B16B6, which code for the transferrin receptor proteins, Tbp1 and Tbp2 . Insertion mutants of the tbpA and tbpB genes were obtained by shuttle mutagenesis and by in vitro cassette mutagenesis, respectively . The isogenic mutants were verified by Southern blot and Western blot analysis . Isogenic mutants deficient in Tbp1 or Tbp2 demonstrated a reduced transferrin binding activity in intact cells and total membranes but were incapable of utilizing transferrin iron for growth . Tbp1 could be isolated by affinity methods from the mutant lacking Tbp2 but isolation of Tbp2 from the mutant lacking Tbp1 required the presence of exogenous Tbp1.

Genitourin Med, 1993 Jun, 69(3), 222 - 3
A case of gonococcal mastitis in a male; Bodsworth NJ et al.; A case of a 42 year old homosexual man with mastitis of the left breast due to Neisseria gonorrhoeae is presented on account of its extreme rarity . It was probably acquired as a result of direct oral-nipple contact.

Genitourin Med, 1993 Jun, 69(3), 201 - 7
Penicillinase producing Neisseria gonorrhoeae from St Thomas' Hospital 1976-1990--the first fifteen years; Warren C et al.; OBJECTIVE--To examine the penicillinase producing N . gonorrhoeae (PPNG) collected at St Thomas' Hospital from 1976-1990 and, by determination of antibiotic susceptibility pattern and application of three typing methods, examine the prevalence of different gonococcal types . Also to determine whether there is any relationship between antibiotic sensitivity, plasmid profile, auxotype and serovar . MATERIALS AND METHODS--A total of 665 isolates of PPNG from patients attending the Department of Genitourinary Medicine at St Thomas' Hospital were characterised by antibiotic MIC, plasmid profile, auxotyping and serotyping . RESULTS--Penicillin MICs for 85% of all isolates were between 0.25 and 32 mg/l . The MIC of tetracycline for 60-80% of the isolates was < 1 mg/l . A small number of isolates had tetracycline MICs of 32 mg/l but MICs > 32 mg/l were not seen . Over 90% of the isolates were sensitive to the remaining three antibiotics tested, erythromycin, cefuroxime and spectinomycin . The 3.2 or 4.4 MDa plasmid with or without the 24.5 MDa conjugal plasmid was seen in all isolates until 1989/90 when a 2.9 MDa beta-lactamase encoding plasmid and the 25.2 MDa plasmid mediating tetracycline resistance were also recognised . Ninety-nine percent of all isolates belonged to one of four auxotypes, prototrophic, arginine, proline or proline/arginine requiring . An initial predominance of isolates with the 1A outer membrane protein was reversed in 1982 and 1B has remained predominant . Thirty two different serovars were identified among the 665 isolates, 14 belonged to serogroup 1A and 18 to 1B, and the eight most common accounted for 83.9% (554) of all isolates . Analysis of the results of combined typing methods showed there was an association between antibiotic resistance, plasmid profile and serogroup . The number of auxotypes and serovars detected in the collection, indicates the possibility that PPNG have been introduced from abroad or outside our local population . CONCLUSION--Temporal trends in the distribution of auxotype/serovar classes show that the total population of PPNG isolates is formed by a heterogenous mixture in which certain auxotype/serovar classes appear, disappear and may re-emerge . Others were present throughout in small numbers.

Genitourin Med, 1993 Jun, 69(3), 196 - 200
Effectiveness of norfloxacin and ofloxacin for treatment of gonorrhoea and decrease of in vitro susceptibility to quinolones over time in Rwanda; Bogaerts J et al.; OBJECTIVE--To study the effectiveness of single-dose norfloxacin and ofloxacin in the treatment of gonococcal urethritis in men, and to monitor in vitro antimicrobial susceptibility to these antibiotics over time . SETTING--Centre Medico-Social de Bilyogo, Kigali, Rwanda . The only clinic in Rwanda using quinolones for the treatment of gonorrhoea . METHODS--As part of a monitoring programme, men with gonococcal urethritis were evaluated after treatment with norfloxacin (800 mg) in 1986 and 1987, and after treatment with ofloxacin (400 mg) in 1989 . RESULTS--Neisseria gonorrhoeae was eradicated from the urethra from 96.0% (189/197) and from 97.1% (166/171) men treated with norfloxacin and ofloxacin, respectively . Overall 38.2% of the pretreatment isolates produced penicillinase (PPNG isolates) and 20.4% (44/216) of the tested non-PPNG isolates were chromosomally resistant to penicillin (MIC > or = 2.0 mg/l) . Resistance to tetracycline and thiamphenicol was common in both PPNG and non-PPNG and increased considerably in 1989 . All isolates were susceptible to kanamycin, spectinomycin, ceftiaxone, norfloxacin, ofloxacin and ciprofloxacin . However, a higher number of isolates recovered in 1989 showed decreased susceptibility to the quinolones . Treatment failure occurred more often in subjects with isolates having MIC values > or = 0.06 mg/L of norfloxacin (p = 0.006) . Seven out of 13 patients who did not respond to therapy had no signs nor symptoms of urethritis . CONCLUSION--Quinolone antibiotics are now indicated as a first line treatment of gonorrhoea in countries with a problem of antimicrobial multiresistance . However, antimicrobial susceptibility to the quinolones may decrease rapidly, and close monitoring of the in vitro susceptibility of N gonorrhoeae and the clinical effectiveness of the antibiotics is imperative.

Pathol Biol (Paris), 1993 Jun, 41(6), 555 - 61
{Clinical, diagnostic and therapeutic aspects of Moraxella catarrhalis infections}; Bourgeois F et al.; Moraxella catarrhalis is a Gram-negative diplococcus of the Neisseriaceae family now recognized as a cause of acute otitis media in pediatric patients and of lower respiratory tract infections in debilitated adults . The finding that 80% to 90% of strains produce beta-lactamases together with reports of cases of bacteremia and arthritis due to M . catarrhalis suggest an increasing pathogenic role for this organism . Antibiotic susceptibility testing suggests that the greatest bactericidal effect is provided by amoxicillin-clavulanic acid.

J Clin Microbiol, 1993 Jun, 31(6), 1555 - 61
Typing by serovar, antibiogram, plasmid content, riboprobing, and isoenzyme typing to determine whether Neisseria gonorrhoeae isolates requiring proline, citrulline, and uracil for growth are clonal; Ng LK et al.; Neisseria gonorrhoeae isolates requiring proline, citrulline, and uracil for growth (PCU-) have homogeneous phenotypes; most are plasmid-free, belong to few serovars, and are significantly associated with intermediate levels of susceptibility to penicillin, tetracycline, erythromycin, and cefoxitin . Because of their lack of variation by these criteria, molecular typing methods, ribotyping (restriction fragment length polymorphism {RFLP} of rRNA genes), and multilocus enzyme electrophoresis were explored as tools for further distinguishing PCU- isolates . By ribotyping, selected PCU- isolates could be separated into four groups on the basis of the hybridization patterns (RFLPs) of SmaI- and AvaII-digested DNA with probes containing rRNA sequences . Most of the isolates (18 of 23 isolates) belonged to a single RFLP (group I) . One isolate each was in groups II and IV, and three isolates were in group III . All isolates except one, isolate NS791, had similar multilocus enzyme electrophoresis patterns . Strain NS791 was unusual in that it contained a variant cryptic plasmid with an insert in the 0.46-kb MspI-HinfI fragment of the 4.2-kb plasmid, it was the only isolate belonging to RFLP group IV, and it differed in its multilocus enzyme electrophoresis pattern, having different mobilities for glyceraldehyde phosphate dehydrogenase, phosphoglucose isomerase, 6-phosphogluconate dehydrogenase, and glutamate dehydrogenase . Serovars of PCU- isolates appeared to be more indicative of strain divergence than RFLP or isoenzyme typing . Multilocus enzyme electrophoresis indicated that PCU- isolates are clonal.

J Bacteriol, 1993 Jun, 175(11), 3664 - 8
Characterization of a stress protein from group B Neisseria meningitidis; Arakere G et al.; Increased levels of a 65-kDa stress protein (Msp65) were observed in group B Neisseria meningitidis grown under stationary-growth conditions . Electron microscopy showed two apposing rings of seven subunits, a structure typical of Escherichia coli GroEL . Msp65 was not found in either the periplasmic space or the outer membrane . Several important differences between the GroEL analogs of N . meningitidis and Neisseria gonorrhoeae are discussed.

J Immunol, 1993 Jun 1, 150(11), 4943 - 7
Genetic basis of human complement C8 beta deficiency; Kaufmann T et al.; The eighth component of human complement (C8) is a serum protein consisting of three chains (alpha, beta, and gamma) and encoded by three different genes, C8A, C8B, and C8G . C8A and C8B are closely linked on chromosome 1p, whereas C8G is located on chromosome 9q . In the serum the beta subunit is non-covalently bound to the disulfide-linked alpha-gamma subunit . Patients with C8 beta deficiency suffer from recurrent neisserial infections such as meningitis . Exon-specific polymerase chain reaction (PCR) amplification with primer pairs from the flanking intron sequences was used to amplify all 12 C8B exons separately . No difference regarding the exon sizes was observed in a C8 beta-deficient patient compared with a normal person . Therefore, direct sequence analysis of all exon-specific PCR products from normal and C8 beta-deficient individuals was carried out . As a cause for C8 beta deficiency, we found a single C-T exchange in exon 9 leading to a stop codon . An allele-specific PCR system was designed to detect the normal and the deficiency allele simultaneously . Using this approach as well as PCR typing of the Taql polymorphism located in intron 11, five families with 7 C8 beta-deficient members were investigated . The mutation was not found to be restricted to one of the two Taql RFLP alleles . The mutant allele was observed in all families investigated and can therefore be regarded as a major cause of C8 beta deficiency in the Caucasian population . In addition, two C8 beta-deficient patients were found to be heterozygous for the C-T exchange . The molecular basis of the alleles without this point mutation also causing deficiency has not yet been defined.

J Assoc Physicians India, 1993 Jun, 41(6), 352 - 3
Serological characterisation of Neisseria gonorrhoeae by co-agglutination technique; Kulkarni MG et al.; Antibiotic susceptibility pattern in cases of acute gonococcal urethritis, was studied by single disc diffusion technique and minimum inhibitory concentration (MIC) by agar dilution technique were determined for 5 antibiotics, viz penicillin, ampicillin, tetracycline, gentamicin and norfloxacin . All the penicillinase producing Neisseria gonorrhoeae (PPNG) and non-PPNG strains were sensitive to norfloxacin . 72% of the isolates belonged to serogroup WII/WIII by co-agglutination technique.

Gene, 1993 May 30, 127(2), 273 - 4
Sequence determination of variable region genes of two human monoclonal antibodies against Neisseria meningitidis; Ayala Avila M et al.; Nucleotide sequences for the variable regions of both the heavy and light chains for two human monoclonal antibodies have been determined . Both antibodies are directed against an outer membrane protein of Neisseria meningitidis, and their genes show a low resemblance to germline sequences.

Proc Natl Acad Sci U S A, 1993 May 15, 90(10), 4384 - 8
How clonal are bacteria?
Smith JM, Smith NH, O'Rourke M, Spratt BG.
Data from multilocus enzyme electrophoresis of bacterial populations were analyzed using a statistical test designed to detect associations between genes at different loci . Some species (e.g., Salmonella) were found to be clonal at all levels of analysis . At the other extreme, Neisseria gonorrhoeae is panmictic, with random association between loci . Two intermediate types of population structure were also found . Neisseria meningitidis displays what we have called an "epidemic" structure . There is significant association between loci, but this arises only because of the recent, explosive, increase in particular electrophoretic types; when this effect is eliminated the population is found to be effectively panmictic . In contrast, linkage disequilibrium in a population of Rhizobium meliloti exists because the sample consisted of two genetically isolated divisions, often fixed for different alleles: within each division association between loci was almost random . The method of analysis is appropriate whenever there is doubt about the extent of genetic recombination between members of a population . To illustrate this we analyzed data on protozoan parasites and again found panmictic, epidemic, and clonal population structures.

FEMS Microbiol Lett, 1993 May 15, 109(2-3), 159 - 65
Purification of the Neisseria meningitidis transferrin binding protein-2 (TBP2) to homogeneity using column chromatography; Ferron L et al.; A method for purifying TBP2 from N . meningitidis has been developed using affinity chromatography on Tf-agarose followed by ion exchange chromatography; the Tf-binding activity of fractions was evaluated by a dot-blot technique . This method allowed the purification of the TBP2 in milder conditions than those used previously and to a high degree of homogeneity as was demonstrated by Coomassie brilliant blue or Silver staining after SDS-PAGE electrophoresis . The SDS-PAGE profile of the material obtained in the Tf-agarose affinity chromatography step shows only two detectable proteins, identified as the TBP1 and the TBP2, with a small amount of contamination . Passage through a MonoQ HR anion exchange column, allowed the isolation of TBP2 in the absence of TBP1 . Our results demonstrate the conservation of the antigenic reactivity of this protein, which produces monospecific serum with the antibodies elicited reacting exclusively with the TBP2 in whole outer membrane vesicles.

Sex Transm Dis, 1993 May-Jun, 20(3), 168 - 73
Chlamydia trachomatis, infertility, and population growth in sub-Saharan Africa; Brunham RC et al.; In sub-Saharan Africa, Neisseria gonorrhoeae and Chlamydia trachomatis are common infections . These pathogens are also the major causes of post-salpingitis tubal infertility, and infertility is a frequent problem in this region . A mathematical model, recently devised to estimate the effect of gonococcal infection on population growth, was used to estimate the potential effect of chlamydial infection on population growth . The model predictions for chlamydial infection were compared with those previously reported for gonococcal infection . The model predicts that both infections may be exerting severe effects on population growth at realistic prevalence rates of infection . The model also predicts that N . gonorrhoeae produces a steeper reduction in population growth than does C . trachomatis because its transmission dynamics result in a higher force of infection (incidence rate) at any given prevalence of infection . Large scale changes in the epidemiology of these infections can be expected to occur in sub-Saharan Africa because of improved sexually transmitted disease (STD) diagnosis and treatment services as a component of AIDS prevention . Changes in the epidemiology of gonococcal and chlamydial infection are predicted to result in accelerated population growth unless STD control programs are linked to effective contraception programsPIP: Researchers applied estimates of Chlamydia trachomatis transmission and disease parameters to a compartmental mathematical model of heterosexual, sexually transmitted disease (STD) transmission to determine the potential effect of chlamydia infection via its link to tubal infertility on population growth in sub-Saharan Africa . Epidemiologic parameters included transmission efficiency, salpingitis rate per cervical infection, tubal fertility rate per salpingitis episode, and average duration of infectivity . Sexual behavior parameters were sexual partner change and networks of sexual mixing . Demographic parameters consisted of a constant mortality rate (.02/year), a mean life expectancy (50 years), age of menarche (15 years), age of menopause (45 years), and maximum potential fertility rate . The mathematical model estimated that as the probability of infertility due to chlamydia infection increases, population growth falls almost linearly at various values of basic reproductive rates . In fact, 10% decline in population growth accompanies a 10% chlamydia prevalence . When the researchers applied estimates of gonorrhea transmission to the model, they learned that a 10% prevalence of gonorrhea results in a 30% reduction in population growth, indicating that gonorrhea has more of an effect on population growth than does chlamydia infection . Gonorrhea has higher transmissibility and shorter duration of infectivity than chlamydia infection, resulting in a higher incidence rate at any given prevalence of infection . Improved diagnosis and treatment of STDs as a result of AIDS prevention programs should result in considerable changes in the epidemiology of gonorrhea and chlamydia infection . These changes will likely speed up population growth unless STD control programs are integrated with effective family planning programs .

Sex Transm Dis, 1993 May-Jun, 20(3), 158 - 63
Etiology of acute pelvic inflammatory disease proven by laparoscopy; Dan M et al.; BACKGROUND: Only a few studies have investigated the etiology of acute pelvic inflammatory disease (PID) in laparoscopy-proven cases using pelvic samples for culture . Most of these studies were conducted in North America and Scandinavia . GOAL OF THE STUDY: To study the microbial etiology of laparoscopy-proven acute pelvic inflammatory disease in Israeli women . STUDY DESIGN: A prospective survey of women admitted to a hospital for treatment of acute pelvic inflammatory disease . All diagnoses were laparoscopy confirmed . Specimens for culture were obtained from the pelvic cavity via the laparoscope, and two serum samples were sent for serologic studies . RESULTS: Forty patients were studied . Their mean age was 34.4 years of age, and 27.5% had a history of PID . Chlamydia trachomatis infection was diagnosed in 14 (35%) patients (group A) . Facultative and/or anaerobic bacteria were isolated from pelvic specimens of 7 (17.5%) patients (group B), one of these patients also had positive chlamydial serology . Mycoplasma hominis was cultured from a pelvic specimen of one woman, and herpes simplex virus grew from a pelvic sample of another patient in whom C . trachomatis was also found . In 19 (47.5%) women, the microbial etiology could not be determined (group C) . In no case was Neisseria gonorrhoeae isolated . Stage I (mild) PID was diagnosed most often in group A (75% vs . 14% in group B {P < 0.02}), whereas the opposite was true for stage III (severe) PID (71.4% in group B vs 25% in group A {P = 0.07}) . Tubal abscess was mainly diagnosed in group B patients (57% vs 16.6% in group A {P = 0.09}) . CONCLUSION: In Israel, C . trachomatis is the most common cause of PID, while gonococci are rarely involved in this infection.

Sex Transm Dis, 1993 May-Jun, 20(3), 152 - 7
Screening urine with a leukocyte esterase strip and subsequent chlamydial testing of asymptomatic men attending primary care practitioners; Sellors JW et al.; BACKGROUND AND OBJECTIVES: The detection of asymptomatic urethritis using a leukocyte esterase (LE) strip may have a role in primary care screening to select men who need diagnostic testing for Chlamydia trachomatis and Neisseria gonorrhoeae . STUDY DESIGN: Eight-hundred and eighty-two men, 16 to 35 years of age were studied when they attended their family physician or university health clinic for nongenitourinary complaints . First void urine (FVU) was tested by an LE strip (Chemstrip 2 LN, Boehringer Mannheim Corp., Indianapolis, IN), Chlamydiazyme (Abbott Laboratories, N . Chicago, IL) enzyme immunoassay with confirmatory blocking and polymerase chain reaction (PCR) with chlamydial plasmid primers . RESULTS: Forty-five men (5.1%) were positive (> trace) by LE strip . Of the LE-positive urines, 9 (20.0%) were positive by EIA or PCR, and none of the LE-negatives were positive by EIA or PCR . Twenty-three LE positives (5 EIA/PCR-positive; 1 PCR-positive; 17 EIA/PCR-negative) were able to be followed with a second urine and 2 urethral swabs . All of the 6 chlamydia-positives who had follow-up tests were positive by both immunoassay and PCR on urine . Based on the FVU results, the prevalence of asymptomatic chlamydial infection was 1.0% (9/88) (95% CL, 0.5 to 1.9) for which the LE urine strip was 100% (9/9) sensitive and 95.9% (837/873) specific . Analyses based on screening 1,000 men, 16 to 25 years of age, showed that the cost per case detected was $192.00 using the LE strip (> 1+) to select urine specimens for EIA testing, compared to $1,326.00 using the EIA to test all urine specimens . CONCLUSION: In this low prevalence, primary care setting, the LE urine strip was an accurate screening test, which if used to preselect urine specimens for subsequent chlamydial testing, would be less costly per case detected than assaying each specimen for chlamydia.

Sex Transm Dis, 1993 May-Jun, 20(3), 143 - 6
Gonorrhea, genital chlamydial infection, and nonspecific urethritis in male partners of women hospitalized and treated for acute pelvic inflammatory disease; Kamwendo F et al.; BACKGROUND AND OBJECTIVES: Acute pelvic inflammatory disease (PID) is often a complication to a sexually transmitted disease (STD), the most important agents being Neisseria gonorrhoeae and Chlamydia trachomatis . However, very little is known of the genitourinary status of the male partners of women with acute pelvic inflammatory disease (PID) . GOAL OF THIS STUDY: To determine the presence of N . gonorrhoeae and/or C . trachomatis infection or nonspecific urethritis (NSU) in regular sexual male partners of women with acute PID . STUDY DESIGN: Two hundred regular sexual male partners to 196 women admitted to a hospital for treatment of acute PID were referred by contact tracing to the sexually transmitted disease outpatient clinic for clinical and laboratory examination regarding N . gonorrhoeae and/or C . trachomatis infection, or NSU defined as the presence of > 5 polymorphonuclear leukocytes per high-power field (x1,000) in > 4 fields and with negative laboratory tests for N . gonorrhoeae and C . trachomatis . RESULTS: The majority of the males was in the age group 20 to 29 years of age, female sexual partners in 15 to 24 years years of age . N . gonorrhoeae was demonstrated in 42.9% of the male partners to women with acute PID and concomitant gonorrhea . The corresponding figure for C . trachomatis was 43.7% . Nonspecific urethritis was diagnosed in 26 (33.8%) of the male partners to 77 women were diagnosed with N . gonorrhoeae and/or C . trachomatis infection, and in 45 (37.8%) partners of 119 women without such an infection . In all, N . gonorrhoeae, C . trachomatis or NSU were demonstrated in 117 (59.7%) of the 196 male partners, but only 32% of the males with N . gonorrhoeae or C . trachomatis and 8.5% of those with NSU presented subjective symptoms of urethritis . CONCLUSION: The findings of the study stress the need for routine clinical and laboratory examination and treatment of sexual male partners to women with acute PID.

Clin Infect Dis, 1993 May, 16(5), 667 - 70
Native-valve endocarditis due to Neisseria sicca: case report and review; Heiddal S et al.; Many species of the Neisseria, gram-negative diplococci that are frequent respiratory commensals in humans, have been regarded as being nonpathogenic or as causing disease in only immunocompromised hosts; in contrast, gram-negative diplococci such as Neisseria meningitidis and Neisseria gonorrhoeae are known pathogens . We report a case in which Neisseria sicca was the cause of serious infection (with catastrophic consequences) in an immunocompetent patient and review the world literature on endocarditis due to N . sicca.

BMJ, 1993 May 1, 306(6886), 1173 - 4
Prevalence of cervical pathogens in women with and without inflammatory changes on smear testing; Parsons WL et al.; OBJECTIVE--To assess correlation between nonspecific cervicitis, inflammation, or exudate on cervical smears tests and confirmed presence of known cervical pathogens . DESIGN--Investigation of women attending a family practice clinic for smear test by microbiological screening for Chlamydia trachomatis, Mycoplasma hominis, Ureaplasma urealyticum, Trichomonas vaginalis, Candida species, group B streptococcus, Gardnerella vaginalis, and Neisseria gonorrhoeae . SETTING--Family practice teaching clinic in a university hospital . PATIENTS--411 women presenting for a smear test . MAIN OUTCOME MEASURES--Prevalence of genital infections associated with presence or absence of inflammatory changes on cervical smear . RESULTS--Of the 132 women with inflammatory changes on cervical smear, 64 (48%) had positive cultures . Of the 248 without inflammatory changes, 117 (47%) had positive cultures . Subgroup analysis on individual organisms also showed no significant difference between the two groups . CONCLUSION--Reports of inflammatory changes on cervical smear testing are a poor indicator of infection.

Infect Immun, 1993 May, 61(5), 1909 - 16
Sequence divergence in two tandemly located pilin genes of Eikenella corrodens; Tonjum T et al.; Eikenella corrodens normally inhabits the human respiratory and gastrointestinal tracts but is frequently the cause of abscesses at various sites . Using the N-terminal portion of the Moraxella nonliquefaciens pilin gene as a hybridization probe, we cloned two tandemly located pilin genes of E . corrodens 31745, ecpC and ecpD, and expressed the two pilin genes separately in Escherichia coli . A comparison of the predicted amino acid sequences of E . corrodens 31745 EcpC and EcpD revealed considerable divergence between the sequences of these two pilins and even less similarity to EcpA and EcpB of E . corrodens type strain ATCC 23834 . EcpC from E . corrodens 31745 displayed high degrees of homology to the pilins of Neisseria gonorrhoeae and Pseudomonas aeruginosa . EcpD from E . corrodens 31745 showed the highest homologies with the pilin of one of the three P . aeruginosa classes, whereas EcpA and EcpB of strain ATCC 23834 most closely resemble Moraxella bovis pilins . These findings raise interesting questions about potential genetic transfer between different bacterial species, as opposed to convergent evolution.

Infect Immun, 1993 May, 61(5), 1657 - 66
Anaerobic growth and cytidine 5'-monophospho-N-acetylneuraminic acid act synergistically to induce high-level serum resistance in Neisseria gonorrhoeae; Frangipane JV et al.; In vivo, gonococci encounter a myriad of conditions not present in vitro . At some stages of infection and disease, gonococci may grow anaerobically, probably by using sodium nitrite as a terminal electron acceptor . Also, gonococci sialylate their lipooligosaccharide (LOS) in vivo, by using low concentrations of cytidine 5'-monophospho-N-acetylneuraminic acid (CMP-NANA) present in host tissue . This sialylation is responsible for the acquired resistance of gonococci to both normal and immune human serum . Given that gonococci grown in the absence of oxygen or in the presence of CMP-NANA probably more closely resemble gonococci grown inside a human host, we studied the serum resistance of gonococci cultivated under these conditions . In the absence of CMP-NANA, anaerobically grown (anaerobic) gonococci were somewhat less sensitive to serum killing than were aerobically grown (aerobic) gonococci . However, anaerobic gonococci grown with 6 micrograms of CMP-NANA per ml exhibited almost complete serum resistance, while aerobic gonococci required 16-fold-higher CMP-NANA concentrations to achieve significant serum resistance . Anaerobic gonococci incubated in CMP-NANA converted to serum resistance two to three times faster than did similarly treated aerobic gonococci and incorporated up to six times as much sialic acid into their LOS . Gonococci can express several different LOS molecules . Anaerobic gonococci expressed the LOS molecule that acts as an acceptor for sialic acid from CMP-NANA in greater quantity than aerobic gonococci did . Finally, Triton X-100 extracts of anaerobic gonococci contained about four times more sialyltransferase activity than did extracts of aerobic gonococci . Sialyltransferase activity in these extracts was not inhibited by oxygen or enhanced by anaerobiosis . These data indicate that anaerobic conditions lead to altered LOS biosynthesis and to induction of sialyltransferase activity in gonococci . In vivo, where decreased oxygen levels and relevant concentrations of CMP-NANA are found, gonococci could readily become resistant to killing by normal and immune human serum.

Pediatrics, 1993 May, 91(5), 873 - 9
Factors associated with condom use by sexually active male adolescents at risk for sexually transmitted disease; Orr DP et al.; OBJECTIVE . The purpose of this study was to identify the predictors of condom use in a population of male adolescents at risk for sexually transmitted diseases (STDs) . DESIGN . Cross-sectional cohort study . SETTING . Clinical sites (school-based, adolescent and STD clinics) providing reproductive health care to male adolescents in a midwestern city . PARTICIPANTS . One hundred sixteen male adolescents 15 to 19 years of age were enrolled consecutively . OUTCOME MEASURES . Subjects completed a multi-instrument questionnaire examining sexual behaviors, attitudes, and beliefs about STDs and condoms, cognitive maturity, and health risk behaviors; urethral specimens were cultured for Chlamydia trachomatis and Neisseria gonorrhoeae . RESULTS . The median age was 17; 31% were white and 69% were African-American . Thirty-seven percent had urethral infections: 21% were infected with C trachomatis, 11% with N gonorrhoeae, and 5% with both organisms . More than 60% reported some experience with condoms and 23% reported condom use at last coitus . Consistent with the Health Belief Model, condom use for STD prevention was less likely among those reporting other health risk behaviors (odds ratio {OR} = 0.53; 95% confidence interval {CI} = 0.36 to 0.78; P < .001) and more STD risk behaviors (OR = 0.65; CI = 0.45 to 0.96; P = .03) . Adolescents who were more highly motivated (OR = 1.58; CI = 1.09 to 2.30; P = .02) and who were more positive about condoms (OR = 1.83; CI = 1.25 to 2.68; P < .001) were more likely to report condom use for contraception . Adolescents using condoms for acquired immunodeficiency syndrome (AIDS) protection engaged in fewer behavioral (OR = .62; CI = 0.42 to 0.92; P = .02) and STD risks (OR = .67; CI = 0.45 to 0.99; P = .04) . Three specific reasons for condom use were highly predictive of condom use at last intercourse: STD prevention (OR = 8.9; CI = 3.13 to 25.4; P < .001), birth control (OR = 2.1; CI = 1.05 to 4.25; P = .03), and AIDS prevention (OR = 2.4; CI = 1.05 to 5.42; P = .03) . CONCLUSION . Condom use among adolescent males is influenced by perceived benefit, namely prevention of pregnancy & avoidance of STDs including AIDS . Nonuse is associated with other risk-taking behavior.

Microb Pathog, 1993 May, 14(5), 343 - 53
Regions located in both the N-lobe and C-lobe of human lactoferrin participate in the binding interaction with bacterial lactoferrin receptors; Yu RH et al.; As a first step in localizing the regions of human lactoferrin involved in binding to bacterial lactoferrin receptors, N-lobe and C-lobe fragments were assessed for binding to receptors on Neisseria meningitidis, Neisseria gonorrhoeae and Moraxella (Branhamella) catarrhalis . Preparations of N-lobe and C-lobe were obtained by tryptic digestion of iron-loaded human lactoferrin followed by separation of the two lobes by gel exclusion chromatography in 10% acetic acid . Solid phase binding studies demonstrated that the isolated C- and N-lobe preparations were capable of binding to membranes from iron-deficient N . meningitidis, N . gonorrhoeae and M . catarrhalis . The binding of the individual C- and N-lobes was confirmed by an analytical SDS-PAGE binding method in which the membrane-associated polypeptides were identified by prior biotinylation and subsequent binding of labelled streptavidin . This contrasts with bacterial transferrin receptors, which only bind to C-lobe fragment of human transferrin, indicating that the bacterial lactoferrin and transferrin receptors differ in their interaction with their respective glycoprotein ligands and may differ in the mechanism of iron removal.

J Med Microbiol, 1993 May, 38(5), 366 - 70
Subtyping of Neisseria gonorrhoeae auxotype-serovar groups by pulsed-field gel electrophoresis; Poh CL et al.; Genomic DNA from 48 Neisseria gonorrhoeae isolates was digested with low-frequency cleavage (LFC) endonucleases (SpeI and NheI) and analysed by contour-clamped homogeneous electric fields electrophoresis (CHEF) . The restriction patterns generated were reproducible, stable, easy to read and offer a more practical approach than restriction endonuclease analysis (REA) with high-frequency cleavage (HFC) endonucleases . Strains sharing common auxotypes and serovars could be differentiated and correlation with auxotype/serovar (A/S) classes was demonstrated for some, but not all strains . The strains were distributed into 18 A/S classes and 38 SpeI and 40 NheI restriction patterns . This greater discriminatory power of CHEF REA should allow subdivision of strains within common A/S classes.

Plasmid, 1993 May, 29(3), 206 - 21
Genetic organization and evolution of the cryptic plasmid of Neisseria gonorrhoeae; Sarandopoulos S et al.; Three promoters have been identified on the phenotypically cryptic plasmid of Neisseria gonorrhoeae that can direct transcription in Escherichia coli . These promoters do not seem to function at a detectable level when N . gonorrhoeae is grown in vitro under normal growth conditions . The T7 RNA polymerase expression system has been used to identify the proteins encoded by this plasmid, and a series of subclones were constructed and used to localize the gene encoding each protein . In a search of the sequence databases, we have discovered that the derived amino acid sequence of a 1.2-kb segment of the plasmid shows a high degree of sequence similarity to the Mob proteins encoded by the colicinogenic plasmids ColA, ColE1, and ColK of E . coli . The 1.2-kb segment contains part of a Col mobilization region that has subsequently been inactivated by a small duplication . During the recombination event that formed the cryptic plasmid one of the mobilization genes was fused to a cryptic plasmid open reading frame to form the cppB gene . Despite the manner in which it was formed, we have shown that the cppB gene can be expressed when N . gonorrhoeae is grown under the appropriate environmental conditions.

Gesundheitswesen, 1993 May, 55(5), 239 - 45
{Molecular epidemiology of Neisseria gonorrhoeae: typing with combined auxotype/serovar classification}; Kohl PK et al.; Auxotyping or determination of serovars of N . gonorrhoeae used separately can be for a limited differentiation of strains only . Combined auxotype/serovar (A/S)-classification was examined for its discriminatory ability on 360 gonococcal strains isolated over 9 years in the area of Heidelberg . The prototrophic, prolin requiring and (P)AH(U)-auxotype were the 3 most frequent auxotypes . 33 different serovars were identified . Protein-IB-serovars dominated by 75% . IB-3, IB-2 and IA-1/2 were the most frequent serovars . The (P)AH(U) auxotype is statistically significant associated with serovar IA-1/2, the PA(U) auxotype with serovar IB-2/16 and the prolin requiring auxotype with serovar IB-1 . Combined typing resulted in 68 different A/S classes . The 3 most frequent classes were Proto/IB-3, (P)AH(U)/IA-1/2 and Proto/IB-2/16 . The number of the A/S classes identified per year rose generally with the number of the isolated strains . Our data show the heterogeneity and dynamics of a gonococcal population . A/S classification permits the epidemiological differentiation of a gonococcal population in endemic, transient and microepidemic strains.

Mol Microbiol, 1993 May, 8(4), 719 - 25
Antigenic variation of pilin regulates adhesion of Neisseria meningitidis to human epithelial cells; Nassif X et al.; Pili have been shown to play an essential role in the adhesion of Neisseria meningitidis to epithelial cells . However, among piliated strains, both inter- and intrastrain variability exist with respect to their degree of adhesion to epithelial cells in vitro (Virji et al., 1992) . This suggests that factors other than the presence of pili per se are involved in this process . The N . meningitidis pilin subunit undergoes extensive antigenic variation . Piliated low- and high-adhesive derivatives of the same N . meningitidis strain were selected and the nucleotide sequence of the pilin gene expressed in each was determined . The highly adhesive derivatives had the same pilin sequence . The alleles encoding the pilin subunit of the low-adhesive derivatives were completely different from the one found in the high-adhesive isolates . Using polyclonal antibodies raised against one hyperadhesive variant, it was confirmed that the low-adhesive piliated derivatives expressed pilin variants antigenically different from the highly adhesive strains . The role of antigenic variation in the adhesive process of N . meningitidis was confirmed by performing allelic exchanges of the pilE locus between low- and high-adhesive isolates . Antigenic variation has been considered a means by which virulent bacteria evade the host immune system . This work provides genetic proof that a bacterial pathogen, N . meningitidis, can use antigenic variation to modulate their degree of virulence.

Monatsschr Kinderheilkd, 1993 May, 141(5), 412 - 5
{Homozygous C7 defect in a German family}; Pietsch H et al.; An 11 year old boy with recurrent meningitis/sepsis (once without positive bacterial culture, once with demonstration of Neisseria meningitidis in blood) was evaluated for suspected immunodeficiency . Absent activity of both the classical and alternative pathway of complement suggested a defect of the membrane attack complex . Immunochemical and functional analyses together with family studies revealed a homozygous defect of the seventh component of complement in the boy . This is the first description of C7 deficiency in a German family.

Mol Microbiol, 1993 May, 8(3), 483 - 93
Phospholipid substitution of capsular polysaccharides and mechanisms of capsule formation in Neisseria meningitidis; Frosch M et al.; Within the capsule gene complex (cps) of Neisseria meningitidis two functional regions B and C are involved in surface translocation of the cytoplasmically synthesized capsular polysaccharide, which is a homopolymer of alpha-2,8 polyneuraminic acid . The region-C gene products share characteristics with transporter proteins of the ABC (ATP-binding cassette) superfamily of active transporters . For analysis of the role of region B in surface translocation of the capsular polysaccharide we purified the polysaccharides of region B- and region C-defective Escherichia coli clones by affinity chromatography . The molecular weights of the polysaccharides were determined by gel filtration and the polysaccharides were analysed for phospholipid substitution by polyacrylamide gel electrophoresis and immunoblotting . The results indicate that the full-size capsular polysaccharide with a phospholipid anchor is synthesized intracellularly and that lipid modification is a strong requirement for translocation of the polysaccharide to the cell surface . Proteins encoded by region B are involved in phospholipid substitution of the capsular polysaccharide . Nucleotide sequence analysis of region B revealed two open reading frames, which encode proteins with molecular masses of 45.1 and 48.7 kDa.

Int J Pept Protein Res, 1993 May, 41(5), 455 - 66
Cyclic V3-loop-related HIV-1 conjugate vaccines . Synthesis, conformation and immunological properties; Tolman RL et al.; Branched undecapeptides with sequences related to the virus glycoprotein V3 domain sequences of the MN and IIIB variants of HIV-1 were synthesized and cyclized with a peptide (amide) closure to cyclic decapeptides . Two-dimensional NMR studies allowed protons for the MN variant-related cycle (L-697,250) to be assigned . Molecular modelling with distance geometry methods permitted a conformation to be identified which showed good agreement with ROESY and 2D NMR study data . A molecular dynamics simulation showed that the highly conserved loop tip sequence (Gly-Pro-Gly-Arg) was in a conventional beta-turn less than 50% of the time . For evaluation of immunogenicity and antibody characterization studies, covalent carrier conjugates were prepared . 3-Maleimidopropionylation of the Nle amino group of the cyclic peptides gave an electrophilic tether which captured a thiol group from a thiolated carrier protein, OMPC (outer membrane protein complex of Neisseria meningitidis) . Through the use of a novel co-conjugation procedure, soluble immunogen-carrier molecules were prepared which had suitable physical properties for use as a vaccine . These V3-loop-based vaccines could elicit neutralizing antibody, but not consistently in all animals . Characterization of sera showed that responses were broadly virus neutralizing.

FEMS Microbiol Lett, 1993 May 1, 109(1), 101 - 6
Demonstration of lectin-like activity for the common antigen of Neisseria gonorrhoeae by quantitative immunoelectrophoretic techniques; Benkirane R et al.; To overcome problems associated with Western blotting of denatured proteins, we have used quantitative immunoelectrophoretic techniques to perform functional analysis of the Neisseria gonorrhoeae common antigen . Using these techniques, we show (a) that Neisseria gonorrhoeae expresses an antigen that is cross-reactive with the common antigen of Pseudomonas aeruginosa and Legionella micdadei and with the GroEl-like protein of Chlamydia, and (b) that this N . gonorrhoeae common antigen has lectin-like activity and can be precipitated with three different sugars immobilized on agarose beads: alpha-D-glucosamine, maltose and fucose.

Clin Infect Dis, 1993 Apr, 16(4), 523 - 7
Variation in phenotypic expression of the Opa outer membrane protein and lipooligosaccharide of Neisseria meningitidis serogroup C causing periorbital cellulitis and bacteremia; Patrick CC et al.; Expression of the Opa outer membrane protein varies widely among isolates of Neisseria meningitidis; the clinical significance of this variation is unclear . A sialic-acid acceptor is present in the lipooligosaccharide of some strains of Neisseria and has been shown to render Neisseria gonorrhoeae serum-resistant . We report the case of a patient who had an unusual clinical manifestation of infection due to N . meningitidis serogroup C, periorbital cellulitis with concomitant bacteremia . Clinical isolates from the blood and aspirate of the periorbital cellulitis were identical except for the phenotypic expression of the Opa outer membrane protein in the isolate from the periorbital cellulitis and in the lipooligosaccharide phenotype of the sialic-acid acceptor as defined by monoclonal antibodies . We discuss the laboratory and clinical implications of these findings.

Genitourin Med, 1993 Apr, 69(2), 98 - 101
The association of gonorrhoea and syphilis with premature birth and low birthweight; Donders GG et al.; OBJECTIVE--Provide evidence from prospective data that Neisseria gonorrhoeae may be an important cause of premature delivery and low birth weight in areas with high prevalence of genital infections . SETTING--Department of Obstetrics and Gynaecology, Kalafong University Hospital, Pretoria, South Africa in collaboration with the Departments of Microbiology and of Gynaecology and Obstetrics, Katholieke Universiteit, Leuven, Belgium . SUBJECTS--Two hundred and fifty six consecutive black pregnant women were examined during the first antenatal visit, and one to four weeks later a second culture for N gonorrhoeae was taken at random in 67 of them . Hundred and sixty seven were analysable, 75 were lost to follow up . METHODS--After obtaining detailed clinical history, an endocervical specimen for N gonorrhoeae culture (Thayer-Martin) and C trachomatis antigen detection (Chlamydiazyme (R)) was taken . Syphilis was diagnosed when both reactive plasma protein (RPR) and T pallidum haemagglutination inhibition assay (TPHA) were positive . Prematurity was defined as delivery at less than 37 gestational weeks . RESULTS--Infection with N gonorrhoeae (n = 9) and untreated syphilis (n = 7) were both associated with prematurity and low birth weight . After multi-variate regression analysis, age-adjusted parity, late sexual debut, number of recent sexual partners, infection with N gonorrhoeae and infection with syphilis revealed significant associations with low birth weight . However, infection with C trachomatis, presence of abundant vaginal discharge, social class, Trichomonas vaginalis infection, gestational weeks at first antenatal visit and number of previous miscarriages did not reveal such an association . Attributable risk of untreated gonorrhoea for premature birth was 72% and routine cultures were cost-benefit efficient . CONCLUSIONS--At least in countries where the prevalence is high, genital infections as well as the risk factors for acquiring them (young age, late sexual debut, number of recent partners) play a major role in the aetiogenesis of prematurity and low birth weight . N . gonorrhoeae is a main contributor, and in high prevalence areas it should be routinely looked for and treated for during pregnancy.

Clin Pharmacokinet, 1993 Apr, 24(4), 289 - 300
Cephalosporin-probenecid drug interactions; Brown GR; The effect of concurrent probenecid administration on the pharmacokinetics of cephalosporin antibiotics varies with the available cephalosporins . Most cephalosporins are affected to some degree by concurrent probenecid administration, although ceforanide, ceftazidime, ceftriaxone and latamoxef (moxalactam) have no significant changes in pharmacokinetics . For those cephalosporins affected by probenecid, the predominant findings are impairment in renal clearance resulting in increased peak serum concentrations, an increased area under the concentration-time curve (AUC), and both delayed and prolonged recovery of the cephalosporin in the urine . The distribution of the cephalosporins is affected to varying degrees, with reports of increased penetration into ocular, central nervous system and blister fluids noted with some agents . The clinical relevance of the changes in cephalosporin distribution associated with probenecid administration has not been investigated . The dose and timing of probenecid administration appear to be major determinants in any possible interaction . Studies with ceftizoxime and cefoxitin suggest that larger probenecid doses result in greater changes in the pharmacokinetics of cephalosporins . Prolonged probenecid therapy before administration of a cephalosporin did not seem to be as relevant as the probenecid dosage in determining the magnitude of the interaction . Probenecid administration with or immediately before cephalosporin administration appears able to produce these documented changes in cephalosporin pharmacokinetics . The route of administration (oral versus parenteral) of either prolosporin pharmacokinetics . The route of administration (oral versus parenteral) of either probenecid or the cephalosporin does not appear to influence the characteristics of the interactions . The therapeutic efficacy of a combination of a cephalosporin with probenecid has been most thoroughly studied for single-dose treatment of gonorrhoea . The addition of probenecid to cephalosporin therapy results in sustained systemic concentrations adequate for eradication of Neisseria gonorrhoeae . Regimens involving either second or third generation cephalosporins demonstrate good success rates with single-dose therapy . However, the success of ceftriaxone administered alone for treatment of both penicillase-producing and non-penicillase-producing strains of N . gonorrhoeae suggests that the addition of probenecid is unnecessary . The use of probenecid, in combination with cephalosporins, to enhance the treatment of other venereal and systemic infections has preliminary, inconclusive support.

Epidemiol Infect, 1993 Apr, 110(2), 297 - 305
Antimicrobial susceptibilities and serotyping of Neisseria gonorrhoeae in southern Africa: influence of geographical source of infection; Ison CA et al.; One hundred and ninety-two strains of Neisseria gonorrhoeae isolated from migrant mine-workers were tested for their susceptibility to antibiotics, auxotyped and serotyped . Of the total, 93 (48%) were acquired locally and 64 (33%) from different geographical locations . Plasmid-mediated resistance to penicillin was found in 28 (14.6%) strains and was associated predominantly with the presence of 5.0 kb penicillinase encoding plasmid (18/28, 64%) . Chromosomal resistance to penicillin (MIC > or = 1 mg/l) was detected in 14 (7.3%) strains . Resistance to tetracycline was chromosomally and not plasmid-mediated . Antibiotic resistance was encountered most commonly among strains acquired in Natal . The overall gonococcal population was sensitive to ceftriaxone, ciprofloxacin, spectinomycin and azithromycin . Nine auxotype/serovar (A/S) classes were encountered among penicillinase-producing N . gonorrhoeae (PPNG) compared to 24 A/S classes among non-PPNG strains . The most common A/S class was NR/IA-6 which accounted for 38% of PPNG and 15% of non-PPNG.

Infect Immun, 1993 Apr, 61(4), 1232 - 8
Characterization of a catalase-deficient strain of Neisseria gonorrhoeae: evidence for the significance of catalase in the biology of N . gonorrhoeae; Johnson SR et al.; We obtained a catalase-deficient (Kat-) strain of Neisseria gonorrhoeae isolated from a patient who had been unsuccessfully treated with penicillin . Quantitative enzyme assays and electrophoresis of cell extracts on native polyacrylamide gels subsequently stained for catalase and peroxidase activities failed to detect both enzymes . The strain exhibited no growth anomalies or unusual requirements when grown under ordinary laboratory conditions . However, the Kat- strain proved extremely sensitive to exogenous hydrogen peroxide, and analysis of the bacterial DNA after such exposure showed extensive single-strand breakage in both chromosomal and plasmid DNAs . Partial characterization of the gonococcal catalase from a Kat+ laboratory strain revealed that the enzyme had the physical and chemical properties of both catalase and peroxidase.

Microb Pathog, 1993 Apr, 14(4), 307 - 13
Detection and some properties of the sialyltransferase implicated in the sialylation of lipopolysaccharide of Neisseria gonorrhoeae; Mandrell RE et al.; A sensitive assay for sialyltransferase (STase activity extracted from gonococci with 0.5% Triton X100 was developed . Enzyme activity was optimal in the pH range 5.8-8.0 and was strongly inhibited by CMP, CDP and CTP, but not by other nucleotides, 10 mM Mg2+, Zn2+, Ca2+ or Mn2+, or by 18 mM EDTA . More than 90% of the activity was lost after 30 s at 67 degrees C . The apparent Vmax and apparent Km of the STase for cytidine 5'-monophospho-N-acetylneuraminic acid were 1.7 nmol of NANA incorporated/min/mg protein and 5.3 microM, respectively.

Mol Microbiol, 1993 Apr, 8(2), 369 - 77
The NodL and NodJ proteins from Rhizobium and Bradyrhizobium strains are similar to capsular polysaccharide secretion proteins from gram-negative bacteria; Vazquez M et al.; The NodL and NodJ nodulation proteins have been described in different Rhizobium and Bradyrhizobium species . The nodLJ genes belong to the nod regulon . Other genes from this regulon are involved in the biosynthesis and modification of lipo-oligosaccharide molecule(s) which are morphogenic signals when acting on legume roots . It has been proposed that the NodL and NodJ proteins belong to a bacterial inner membrane transport system of small molecules . Nucleotide sequencing of Mudll PR13 insertions in the nodulation region of the symbiotic plasmid from a Rhizobium leguminosarum bv . phaseoli strain CE3 has revealed the presence of nodL and nodJ-related sequences downstream of nodC . Computer nucleotide sequence analysis of the entire NodL and NodJ sequences from R . leguminosarum bv . viciae and Bradyrhizobium japonicum strains show that both proteins are similar to the KpsT and KpsM proteins from Escherichia coli K1 and K5 strains, to the BexB and BexA proteins from Haemophilis influenzae and to the CtrD and CtrC proteins from Neisseria meningitidis, respectively . Except for the NodL and NodJ proteins, all of them have been involved in the mechanism of secretion of polysaccharides in each of their harbouring species . On the basis of the similarity found, we propose that the NodL and the NodJ proteins could be involved in the export of a lipo-oligosaccharide.

Mol Microbiol, 1993 Apr, 8(2), 357 - 68
Conservation of genes encoding components of a type IV pilus assembly/two-step protein export pathway in Neisseria gonorrhoeae; Lauer P et al.; Three gonococcal genes have been identified which encode proteins with substantial similarities to known components of the type IV pilus biogenesis pathway in Pseudomonas aeruginosa . Two of the genes were identified based on their hybridization with a DNA probe derived from the pilB gene of P . aeruginosa under conditions of reduced stringency . The product of the gonococcal pilF gene is most closely related to the pilus assembly protein PilB of P . aeruginosa while the product of the gonococcal pilT gene is most similar to the PilT protein of P . aeruginosa which is involved in pilus-associated twitching motility and colony morphology . The products of both of these genes display canonical nucleoside triphosphate binding sites and are predicted to be to cytoplasmically localized based on their overall hydrophilicity . The gonococcal pilD gene, identified by virtue of its linkage to the pilF gene, is homologous to a family of prepilin leader peptidase genes . When expressed in Escherichia coli, the gonococcal PilD protein functions to process gonococcal prepilin in a manner consistent with its being gonococcal prepilin peptidase . These results suggest that Neisseria gonorrhoeae is capable of expressing many of the essential elements of a highly conserved protein translocation system and that these gene products are probably involved in pilus biogenesis.

Eur J Epidemiol, 1993 Mar, 9(2), 195 - 8
Serotype patterns of gonococcal infection in contact pairs; Young H et al.; The use of gonococcal serovars in studying the epidemiology of Neisseria gonorrhoeae is well established . Most studies assume that the isolated serovar remains stable in vivo indefinitely . This study was designed to observe the correlation between serovars isolated in patients naming each other as sexual contacts . The overall rate of discordant transmission episodes was 12% (26/220) . There were however significantly more discordant transmission episodes for partners of patients infected with IB serovars than IA serovars: 19% (23/124) versus 3% (3/96) - p < 0.01 . The overall prevalence of serogroup IB isolates although significantly higher at 53% (p < 0.01) was thought insufficient to account for the correlation between discordant pairs and serogroup IB infection . Reasons considered for the discrepancies in contact pairs included: problems of partner reporting involving inaccurate or incomplete information; technical problems with reagents; culture induced phenotypic variation in antigenic expression or differences in the in vitro recognition of epitopes; and antigenic differences resulting from genetic mutation within the Protein I gene . It was concluded that carefully planned and controlled prospective studies involving duplicate parallel testing of isolates from patients and their well documented partners are needed to assess the extent to which these various factors contribute to discordancies in serovars isolated from contact pairs . Serotyping should be combined with other methods such as auxotyping for detailed microepidemiological studies involving partner notification.

Sex Transm Dis, 1993 Mar-Apr, 20(2), 105 - 9
Persistence of multiple serovars of Neisseria gonorrhoeae; Joyce CF et al.; Two simple mathematical models of gonococcal transmission dynamics that allow for heterogeneity within the pathogen were assessed . Models were compared for their ability to mirror the observed persistence of different gonococcal serovars over time and differential distribution within subgroups of the total population . Serotyping data collected between the periods of 1984-1988 and 1988-1990 were analyzed for differences in serovar distribution . The data show persistence of multiple serovars within both homosexual and heterosexual contact groups over time . The models provide a framework for the use of phenotypic markers to assess behavior change in sexually active populations.

Ceylon Med J, 1993 Mar, 38(1), 12 - 4
Sexually transmitted diseases in the age of AIDS; Wimalawansa SJ; Sexually transmitted diseases (STD) are common illnesses in the world . There is at least one new sexually transmitted disease consultation for every 100 persons a year in industrialised countries . Today the World Health Organisation estimates that there are 250 million new cases of STD every year world-wide, and over 20 distinct pathogens are currently recognised . While the overall incidence of STD have remained high in industrialised countries, the rates of increase of many bacterial STD such as syphilis and gonorrhoea were beginning to stabilise; but currently there is again a trend for these bacterial STD to rise in urban populationsPIP: WHO estimates 250 million new cases worldwide of sexually transmitted diseases (STDs) each year . STDs of growing concern are chlamydial infections responsible for pelvic inflammatory disease (PID) in women and pneumonia and ophthalmia in newborns, and incurable viral infections, including Herpes simplex virus, human papilloma virus (HPV), hepatitis B virus, and HIV infection . HPV types 16 and 18 are associated with cervical intraepithelial neoplasia, one of the most serious complication of STDs . PID is another serious STD complication because it tends to recur and causes chronic abdominal pain, eventually resulting in hysterectomy, infertility, ectopic pregnancy, or chronic backache . STDs adversely affect pregnancy, often leading to ectopic pregnancy, stillbirth, prematurity, congenital and perinatal infections, and puerperal maternal infections . Genital ulcer diseases, e.g., chancroid, facilitate HIV transmission . HIV infection boosts the virulence of STD pathogens, e.g., Herpes simplex virus . Many people with STDs are asymptomatic and the clinical profile of STDs is always in flux, thus resulting in less than optimal case detection . Obstacles of STD treatment include antibiotic resistance of betalactamase-producing Neisseria gonorrhoea strains and the immunocompromising effect of HIV infections . Tourists are responsible for introducing HIV infection into many countries . Some countries (e.g., Saudi Arabia) require a negative HIV test before foreigners can work in those countries . Health resources are not keeping up with the spread of STDs and HIV . Governments should embark on health education campaigns to stem the spread of HIV . They should also integrate AIDS prevention with the control of other STDs .

Biopharm Drug Dispos, 1993 Mar, 14(2), 161 - 9
Ceftriaxone pharmacokinetics in elderly subjects and penetration into epididymis; Geny F et al.; In a prospective study, the epididymal penetration of ceftriaxone was evaluated in order to use it in the treatment of orchi-epididymitis in men . A bolus intravenous dose of 1 g of ceftriaxone was administered to 15 patients hospitalized for surgery as part of treatment for prostatic adenoma or prostatic cancer . Nine successive blood samples were collected in the interval from 0 to 24 h after administration, and epididymis samples were taken 0.75 h after administration . Concentrations of drug in all samples were assayed by a reverse-phase-ion pairing high-performance liquid chromatography method with UV detection . The results showed that the pharmacokinetics of ceftriaxone in serum did not differ from those determined previously in healthy volunteers . The terminal half-life was 6.9 +/- 1.7 h, and the mean residence time 9.5 +/- 2.3 h . The volume of distribution was 0.144 +/- 0.018 1 kg-1 and the total body clearance 1.17 +/- 0.29 l h-1 . The concentrations in tissue reached 27.2 +/- 6 micrograms g-1 in righ epididymis, and 25.4 +/- 6.2 micrograms g-1 in left epididymis . The tissue-versus-serum concentration ratios ranged from 0.175 to 0.545 (mean value, 0.295 +/- 0.099) . The concentrations in serum and tissue observed in this study were in excess of the MICs for bacteria considered to be susceptible to ceftriaxone, particularly Neisseria gonorrhoeae and coliform bacteria.

J Acquir Immune Defic Syndr, 1993 Mar, 6(3), 313 - 8
HIV-1 and HTLV-I in sexually transmitted disease clinics in the Dominican Republic; Rodriguez EM et al.; A cross-sectional seroprevalence study of human immunodeficiency virus type 1 (HIV-1) and human T-cell lymphotropic virus type I (HTLV-I) was undertaken among 494 attendees in two Santo Domingo sexually transmitted disease clinics in 1989 . All participants were evaluated for Neisseria gonorrhoeae, Chlamydia trachomatis, syphilis, and genital ulcers . Of the 494 participants, 15 (3.0%) were positive for HIV-1 and 14 (2.8%) were positive for HTLV-I . Twelve of 371 (3.2%) men were HIV-1 seropositive: 0 of 68 homosexual/bisexual and 12 (4.0%) of 302 heterosexual men (one seronegative male could not be classified) . Three (2.4%) of 123 women were HIV-1 seropositive . One (1.5%) homosexual/bisexual man, five (1.7%) heterosexual men, and eight (6.5%) women were HTLV-I seropositive . Among heterosexual men, HIV-1 was associated with multiple lifetime sex partners (O.R . = 5.9; 95% C.I . = 1.4, 23; p = 0.007) . HIV-1 was associated with genital ulcer disease among women (p = 0.004) . Among women, HTLV-I was associated with professional sex work (O.R . = 18; 95% C.I . = 2.1, > 100; p = 0.001) . These findings suggest the need for control of sexually transmitted diseases and targeted educational programs for prevention of HIV-1 and HTLV-I among individuals with high-risk behaviors in the Dominican Republic.

Arch Fr Pediatr, 1993 Mar, 50(3), 231 - 3
{Neisseria mucosa endocarditis complicated by intracerebral aneurysm}; Epelbaum S et al.; BACKGROUND . Serious complications, such as emboli and mycotic aneurysms, are still frequent in documented cases of infective endocarditis . Infecting organisms other than Streptococcus viridans and Staphylococcus are becoming more common . CASE REPORT . A 8 year-old girl was admitted because of a sudden pain in the right calf followed by complete disability . She had low-grade fever and presented with a moderate heart murmur with no sign of congestive heart failure, a severe pain at palpation of her calf with no Homans sign; she had many dental caries . Laboratory data indicated leukocytosis with increased percentage of polymorphonuclear cells and increased sedimentation rate . Ultrasonography of the calf showed laceration of the muscle with blood suffusion . Echocardiography showed vegetations involving the mitral valve . Intravenous antibiotic therapy with penicillin G and netilmicin was instituted, but mitral insufficiency appeared 7 days later while the fever persisted . At that time, the brain CT scan showed ischemic lesions, while angiography showed several mycotic aneurysms . Neisseria mucosa was recovered from the 5 initial blood cultures 16 days after the onset, and penicillin G was replaced by ampicillin . A second vegetation involving the aortic valve was seen a few days later, and a recent arterial embolism to the right leg was suspected because fever and pain reappeared . The brain ischemic lesions gradually disappeared and a second angiography performed 3 months after the first showed that all but one large mycotic aneurysm had disappeared; this last aneurysm was excised . Four years later, the child is in good health without any neurological sequelae but having mitral insufficiency . CONCLUSION . This girl presented with classical complication of infective endocarditis due to Neisseria mucosa, a saprophytic organism of the oral cavity . This is the second report of such an infection in children.

Zh Mikrobiol Epidemiol Immunobiol, 1993 Mar-Apr, (2), 38 - 41
{The plasmid profile of Neisseria meningitidis strains}; Khetsuriani KG et al.; The distribution of plasmids in N . meningitidis strains according to their origin and serological groups has been studied . Plasmids have been discovered in N . meningitidis of all groups, plasmid-carrying strains constituting 55% of strains isolated from healthy carriers and 46.2% of strains isolated from patients . The molecular weight of N . meningitidis plasmid DNA varies from 2.9 MD to 95 MD.

Zh Mikrobiol Epidemiol Immunobiol, 1993 Mar-Apr, (2), 11 - 5
{The effect of detergents on the immunological activity of the antigens of Neisseria meningitidis serogroup B{}; Bugaev LV et al.; The complex study of the influence of detergents of different classes and aluminum hydroxide, a traditional adjuvant, on the immunological activity of individual N . meningitidis antigens (outer membrane proteins, polysaccharide B) and the complex preparation containing all these antigens revealed that changes in the antigenic and immunogenic properties of the antigens under study depended on the degree of their purification and the character of modifying substances . Aluminum hydroxide proved to be the most active adjuvant: it stimulated immune response to both outer membrane proteins and antigens of the protein-polysaccharide complex, while decreasing the antigenicity of outer membrane proteins and polysaccharide . Detergents increased the antigenicity of outer membrane proteins, both purified and, to a lesser extent, contained in the complex; still the immune response only to the purified preparation could be stimulated.

FEMS Microbiol Lett, 1993 Feb 15, 107(1), 59 - 66
Cloning and partial sequence of transferrin-binding protein 2 of Neisseria meningitidis using a novel method: twin N-terminal PCR; Wilton J et al.; The genes encoding transferrin-binding proteins (TBPs) 1 and 2 of Neisseria meningitidis and N . gonorrhoeae were used as model loci in a novel method of cloning (twin N-terminal polymerase chain reaction; TNT-PCR) involving amplification between the 5' ends of two genes . Primers were based on N-terminal amino-acid sequences . A 2.1-kb product amplified from N . meningitidis strain SD (B15 P1.16) was cloned into a plasmid vector and partially sequenced . Translated sequence immediately downstream of the primer at both ends of this product correlated to the additional known N-terminal amino acids of TBP-1 and 2 . The protein encoded by the cloned sequence reacted with TBP-2-specific antiserum . The size of products generated in TNT-PCR correlated exactly with the different sized TBP-2 produced by 10 strains of the Neisseria spp . examined, indicating successful cloning of the gene for TBP-2 and showing it to be adjacent to and preceding TBP-1 on the chromosome for both N . meningitidis and N . gonorrhoeae.

BMJ, 1993 Feb 13, 306(6875), 426 - 8
Sexually transmitted diseases and HIV-1 infection among homosexual men in England and Wales; Evans BG et al.; OBJECTIVE--To examine surveillance data for evidence of changing sexual behaviour and continuing transmission of HIV-1 among men who have sex with men . DESIGN--Analytic study of surveillance data on sexually transmitted diseases . SETTING--England and Wales . MAIN OUTCOME MEASURES--Number of cases of rectal gonorrhoea and newly diagnosed HIV infection in homosexual men . RESULTS--New cases of gonorrhoea among men attending genitourinary medicine clinics increased by 7.7% in 1989 and by 4.2% in 1990 . Reports of rectal isolates of Neisseria gonorrhoeae also rose and the male to female ratio for patients with rectal gonorrhoea changed from 0.3:1 during 1988-9 to 2.6:1 in 1990-1 . Although the overall number of cases of acute hepatitis B fell during 1988-91, 81 and 82 homosexual men were infected in 1990 and 1991 respectively compared with 50 and 42 in 1988 and 1989 . 1526 men had HIV-1 infection diagnosed in 1991, the largest number since 1987 . Twenty eight of the 97 (29%) men who seroconverted between January 1989 and December 1991 were aged less than 25 . The proportion of men aged 15-19 who were found to be infected with HIV-1 at their first test increased from an average of 2.4% up to 1990 to 4.7% in the first nine months of 1991 . The prevalence of HIV infection in men under 25 attending genitourinary medicine clinics in London was 17% compared with 7.8% outside London . CONCLUSION--Unsafe sexual behaviour and HIV transmissions have increased among homosexual men after a period of decline . Recent HIV transmissions may disproportionately affect younger men.

Presse Med, 1993 Feb 6, 22(4), 153 - 6
{C-reactive protein in bacterial meningitis in adults}; Nouira S et al.; In order to assess the benefits of serial assays of C-reactive protein in the course of bacterial meningitis in adults, daily blood samples were taken for CRP measurement during 10 days in 21 consecutive patients (mean age: 24 +/- 8 years) hospitalized for bacterial meningitis principally due to Neisseria meningitidis (n = 15) . The highest CRP level (178 +/- 38 mg/l) was present on admission, followed by a regular decrease occurring in uncomplicated meningitis until normal level was achieved on day 9 . The CRP kinetics was not influenced by the type of causative micro-organism . This study shows that CRP kinetics in adults is similar to that reported in children . The benefit of CRP assays in optimizing the duration of antibiotic treatment of meningitis needs to be more carefully assessed.

Bioorg Khim, 1993 Feb, 19(2), 228 - 35
{Biopolymer fragments, containing glycosylphosphate residues . 12 . Synthesis of glycosylphosphosugars, containing 2-acetamido-2-deoxy-alpha-D-mannopyranosylphosphate residues including a fragment of the Neisseria meningitidis A capsule antigen}; Utkina NS et al.; 2-Acetamido-3,4,6-tri-O-benzoyl-2-deoxy-alpha-D-mannopyranosyl hydrogen phosphonate was synthesised and used for the first syntheses of glycosyl phosphosugars containing N-acetylmannosamine residue . The phosphodiesters prepared include ManNAc(alpha)-P-6Man(alpha)Me, an analogue of the fragment of some lysosomal glycoproteins, and ManNAc(alpha)-P-6ManNAc(alpha)Np, a derivative of the fragment of the capsular antigen from Neisseria meningitidis A.

Diagn Microbiol Infect Dis, 1993 Feb, 16(2), 173 - 84
Use of molecular diagnostics in sexually transmitted diseases . Critical assessment; Chapin-Robertson K; This review describes and assesses the use of molecular assays for the diagnosis of sexually transmitted diseases (STDs) . Specifically, data from literature on currently available commercial systems as well as that of imminently to be released assay formats are presented . The focus is on evaluations of two molecular diagnostic techniques--hybridization and amplification for the direct detection of Chlamydia trachomatis and Neisseria gonorrhoeae (gonococci, GC)--the use of urine as a specimen for the diagnosis of these pathogens in humans, a confirmatory probe assay for GC, and finally the description of a hybridization assay for pathogens significant in vaginitis and bacterial vaginosis . Although viral pathogens are a significant part of the STD problem, and molecular techniques have been described for their identification, they are not being discussed here . With the exception of the Virapap DNA hybridization assay for human papillomavirus (Digene Diagnostic, Silver Spring, MD), suitable molecular clinical laboratory assays for viral detection have not been developed for genital samples.

Clin Invest Med, 1993 Feb, 16(1), 38 - 44
Bacteremic community-acquired pneumonia due to viridans group streptococci; Marrie TJ; We studied 1118 patients with community-acquired pneumonia who were admitted to our hospital over an 8-y period . Seventy-six of the 1118 patients were bacteremic and 7 (9.2%) of these had blood cultures positive for various viridans streptococci . Four had polymicrobial bacteremia (S . mitis, S . sanguis 1, S . sanguis II; S . mitis, S . sanguis II; S . MG; S . sanguis II, Neisseria sp; S . intermedius, S . aureus) . For 3 of the 7, viridans streptococci were the only agents implicated in the etiology of the pneumonia . These patients were classified as definite viridans streptococcal pneumonia; the remaining 2 were probably and 2 were possibly due to these micro-organisms . The 5 males and 2 females had a mean age of 61.8 y . The mortality rate was 28% . All were febrile and had elevated white blood cell counts . The 5 who had arterial blood gas measurements performed were hypoxemic pO2 34-68 torr . The chest radiographs were not distinctive--a segmental alveolar opacity was the most common abnormality . We conclude that viridans streptococci rarely cause bacteremic community-acquired pneumonia . There are no distinctive clinical or radiographic features of this type of pneumonia.

EMBO J, 1993 Feb, 12(2), 641 - 50
Variable opacity (Opa) outer membrane proteins account for the cell tropisms displayed by Neisseria gonorrhoeae for human leukocytes and epithelial cells; Kupsch EM et al.; Opacity proteins (Opa) of Neisseria gonorrhoeae, a family of variant outer membrane proteins implicated in pathogenesis, are subject to phase variation . In strain MS11, 11 different opa gene alleles have been identified, the expression of which can be turned on and off independently . Using a reverse genetic approach, we demonstrate that a single Opa protein variant of strain MS11, Opa50, enables gonococci to invade epithelial cells . The remaining variant Opa proteins show no, or very little, specificity for epithelial cells but instead confer interaction with human polymorphonuclear neutrophils (PMNs) . Thus, depending on the opa allele expressed, gonococci are capable of invading epithelial cells or of interacting with human leukocytes . The respective properties of Opa proteins are maintained independent of the gonococcal strain; thus, the specificity for epithelial cells or leukocytes is intrinsic to Opa proteins . Significant homology exists in the surface exposed variable regions of two invasion supporting Opa proteins from independent strains . Efficient epithelial cell invasion is favoured by high level Opa production, however, a 10-fold reduction still allows significant invasion by gonococci . In contrast, recombinant Escherichia coli expressing Opa proteins adhered or invaded poorly under similar experimental conditions, thus indicating that additional factors besides Opa are required in the Opa-mediated interaction with human cells.

Postgrad Med, 1993 Feb, 93(2), 85 - 6, 89-91
Pelvic inflammatory disease . Current diagnostic criteria and treatment guidelines; Ault KA et al.; Pelvic inflammatory disease (PID) is a common infection in women of reproductive age . PID is actually a spectrum of disease, beginning with cervicitis and progressing to endometritis and eventually salpingitis . Sequelae include ectopic pregnancy, infertility, chronic pelvic pain, hydrosalpinx, and tubo-ovarian abscess . Neisseria gonorrhoeae and Chlamydia trachomatis are the primary causes of PID . Chlamydial infection may be asymptomatic, and the resulting salpingitis is often referred to as "silent PID." Polymicrobial infection with other organisms (eg, anaerobes, facultative aerobes) may be initiated by gonorrhea, chlamydial infection, or both . Early recognition of infection, prompt institution of appropriate antibiotic therapy, and proper follow-up are important to prevent the sequelae of PID . Patient education is essential to reduce the incidence of PID.

J Clin Microbiol, 1993 Feb, 31(2), 451 - 3
Evaluation of the PACE 2 Neisseria gonorrhoeae assay by three public health laboratories; Hale YM et al.; The Gen-Probe PACE 2 DNA probe assay for Neisseria gonorrhoeae was compared with conventional culture techniques in three Florida public health laboratories with 436 patients (271 females and 165 males) . The prevalence rates based on culture were 19.9, 55.8, and 33.5% for females, for males, and overall, respectively . Twenty-seven probe-positive specimens gave negative culture results . Twenty of these specimens were resolved as true positives after retesting with a probe competition assay . The resolved sensitivity, specificity, positive predictive value, and negative predictive value were 99.4, 99.6, 99.4, and 99.6%, respectively.

J Bacteriol, 1993 Feb, 175(4), 1173 - 5
A dominant sulfhydryl-containing protein in the outer membrane of Neisseria gonorrhoeae; Norrod EP et al.; By using a method that labels sulfhydryl-containing proteins in situ, we have detected a major outer membrane protein of Neisseria gonorrhoeae at 41 kDa . A protein of this molecular mass has not previously been shown to be a major outer membrane protein in gonococci . In addition, a minor protein rich in cysteinyl residues was detected at 31.5 kDa.

MMWR Morb Mortal Wkly Rep, 1993 Jan 22, 42(2), 25 - 8
Gang-related outbreak of penicillinase-producing Neisseria gonorrhoeae and other sexually transmitted diseases--Colorado Springs, Colorado, 1989-1991.
{Complement analysis tests}
Mollnes TE, Nielsen EW, Hogasen K, Mellbye OJ.

Avdeling for immunologi og transfusjonsmedisin Nordland Sentralsykehus, BodoAlthough routine analysis of the complement system is rarely demanded, it is important from a diagnostical and therapeutical point of view to include the relevant tests when clinically required . Complement analysis should be performed when hereditary angioedema (C1 inhibitor deficiency) is suspected, and as part of investigation of patients with immunodeficiency (recurrent infections in childhood) . Furthermore, complement analysis may be required in cases of recurrent systemic neisserial infections at any age, and to follow up certain autoimmune diseases . Only a few tests are available for routine purposes . These are reviewed briefly, with emphasis on collection and storage of samples prior to analysis . It is important that these guidelines be followed, to avoid misinterpretation of the results.

Am J Epidemiol, 1993 Jan 15, 137(2), 166 - 70
Serum antibodies and subsequent cervical neoplasms: a prospective study with 12 years of follow-up; Hakama M et al.; Approximately 40,000 blood samples drawn in 1968-1972 by the Social Insurance Institution's mobile clinic in Finland have been stored . Linking cancer incidence data obtained from the Finnish Cancer Registry with this material yielded 32 cases of cervical cancer diagnosed after drawing of the blood sample . These 32 individuals and 64 matched controls were analyzed for serum antibodies indicative of past infection with Chlamydia trachomatis, Neisseria gonorrhoeae, cytomegalovirus, Epstein-Barr virus, and herpes simplex virus type 2 . After adjustment for smoking and other sexually transmitted diseases, antibodies to C . trachomatis showed the strongest association with cervical cancer (odds ratio = 5.0 (95% confidence interval 1.6-15.7)), but the numbers were too small for drawing conclusions as to the sexually transmitted diseases with which cervical cancer is most specifically associated.

Gene, 1993 Jan 15, 123(1), 45 - 50
Control of gonococcal pilin-encoding gene expression in Escherichia coli; Fyfe JA et al.; The pilE gene from Neisseria gonorrhoeae, unlike other type-4 pilin-encoding genes, is well expressed in Escherichia coli . Two putative promoters have been implicated in the transcription of this gene . Besides the -24/-12 promoter used to transcribe type-4 pilin-encoding genes in most species, the consensus sequence for a conventional promoter is also present . The two promoters overlap and would have almost identical transcription start points (tsp) . Transcription from a -24/-12 promoter should be abolished in an E . coli rpoN mutant . A recombinant plasmid carrying pilE could not be transformed into such a mutant, apparently because the synthesis of the N-terminal hydrophobic domain of pilin is lethal to the rpoN mutant . This suggests that pilE is expressed at a higher level in an rpoN mutant than it is in a wild-type (wt) strain of E . coli . This suggestion was confirmed by constructing fusions between the pilE promoter region and a promoter-less cat gene . We suggest that the conventional promoter is primarily responsible for the transcription of pilE, but that the binding of the RpoN sigma factor partially represses transcription of this gene in wt strains . In an rpoN mutant, the repression is removed and transcription occurs at a level that is lethal to the mutant host.

Eur J Clin Microbiol Infect Dis, 1993 Jan, 12(1), 45 - 8
Characterization of penicillinase-producing strains of Neisseria gonorrhoeae; Hermida M et al.; Twenty-three penicillinase-producing strains of Neisseria gonorrhoeae were characterized . All strains showed hybridization with a TEM-1 probe and production of a TEM-1 type beta-lactamase (pI 5.4) on isoelectric focusing . Eight strains also showed a beta-lactamase band of pI 5.5 . The penicillin MICs for the strains producing only TEM-1 were in the range 4-16 micrograms/ml; MICs of the strains with the additional pI 5.5 band were > or = 128 micrograms/ml for seven strains and 4 micrograms/ml for an arginine-hypoxanthine dependent strain . The association of the high MICs with the presence of the pI 5.5 band was statistically significant . The pI 5.5 band could represent a new beta-lactamase type or a TEM-1 mutant.

Clin Microbiol Rev, 1993 Jan, 6(1), 22 - 33
Antimicrobial susceptibility testing of Neisseria gonorrhoeae and implications for epidemiology and therapy; Fekete T; Antimicrobial susceptibility testing (AST) of Neisseria gonorrhoeae has been under development since the early days of antimicrobial agents . However, it is rarely applied to clinical isolates today . The history of the various in vitro tests to determine the susceptibility of N . gonorrhoeae to antibiotics is rich with evidence that these results predict response to therapy for almost all agents tested . Further, AST is a useful and important aspect of strain characterization and disease epidemiology in conjunction with the more specific but laborious techniques of auxotyping, serotyping, and plasmid analysis . Current technology has overcome many of the objections to AST for N . gonorrhoeae with standardization of test media and the development of an accurate disk diffusion AST method that is suited to most clinical laboratories regardless of volume or level of technical expertise . Ironically, the very low level of resistance to the current primary treatment strategy in the United States, ceftriaxone or another potent cephalosporin, makes the use of AST somewhat superfluous.

Plasmid, 1993 Jan, 29(1), 41 - 9
Lack of substantial sequence homology between the cryptic plasmid and chromosome of Neisseria gonorrhoeae; Sarandopoulos S et al.; Previous reports have suggested that either large segments of the 4.2-kb phenotypically cryptic plasmid or the entire plasmid are integrated into the chromosome of Neisseria gonorrhoeae, even in rare plasmid-free strains . A series of subclones of the cryptic plasmid have been used in Southern blotting experiments to map the extent of this hybridization with the chromosome . Hybridization could only be detected at low or medium stringency, and the data suggest the absence of entire plasmids, or even large contiguous sections of the cryptic plasmid, in the chromosome of N . gonorrhoeae . In confirmation of this, a chromosomal fragment that hybridizes to the cryptic plasmid was cloned and sequenced . The low stringency hybridization between the cryptic plasmid and chromosome seems to be the result of short repetitive sequences found in both DNA molecules, rather than full or partial plasmid integration.

Ann Rheum Dis, 1993 Jan, 52(1), 49 - 53
Arthritis in the highlands of Papua New Guinea; Pile KD et al.; Acute polyarthritis is an important cause of morbidity in many tropical countries . Classification has often been difficult, with the term tropical polyarthritis used for those in whom a diagnosis could not be made . The implication that this is a distinct entity is probably incorrect, with likely causes being septic arthritis or post-infective reactive arthritis . This study aimed to determine the types of arthritis found in 43 patients (30 men) presenting consecutively to the Goroka Base Hospital in the Eastern Highlands of Papua New Guinea . Gonococcal arthritis was diagnosed in eight patients (six men) on the basis of isolation of Neisseria gonorrhoeae from the joint aspirate . In all cases the N gonorrhoeae was identified by the closed culture system on chocolate agar, but not always by routine plating . There were no specific clinical features that identified patients with a gonococcal septic arthritis . The remaining 34 patients had an undifferentiated oligoarthritis . The pattern of arthritis in men and women was of a lower limb pauciarticular arthritis with a predilection for the knee and ankle joints . A total of 30% of male patients had a history of urethral discharge and 44% of all patients had preceding diarrhoea . Arthritis was the only feature in 59% of patients and in 32% there was an associated enthesitis . In this study most patients had an oligoarthritis consistent with a reactive arthritis or a septic arthritis due to N gonorrhoeae . Broth inoculation of synovial fluid was the best method to isolate N gonorrhoeae, with standard methods for gonococcal isolation failing in some patients . It is recommended that the term 'tropical polyarthritis' is no longer used as it does not refer to a specific entity but consists of several known arthritides.

J Clin Invest, 1993 Jan, 91(1), 339 - 43
Antibody to Rmp (outer membrane protein 3) increases susceptibility to gonococcal infection; Plummer FA et al.; The severe adverse effects of gonococcal infection on human fertility suggests that Neisseria gonorrhoeae would exert powerful selection for the development of a protective immune response in humans . N . gonorrhoeae is an obligate human pathogen and must persist in humans to survive . Since it is an ecologically successful organism, it must have evolved strategies to evade any human immune response it elicits . In a longitudinal study among 243 women working as prostitutes and experiencing frequent gonococcal infection, younger women, women with HIV infection, and women with antibody to the gonococcal outer membrane protein 3 (Rmp) were at increased risk of infection (adjusted odds ratio 3.4, CI95% 1.1-10.4, P < 0.05) . Rmp is highly conserved in N . gonorrhoeae and the blocking of mucosal defences may be one of its functions . As similar proteins occur in many gram negative mucosal pathogens, the enhancing effect of such proteins may be a general strategy whereby bacteria evade human immune responsesPIP: Between March 1985 and July 1986 researchers enrolled 243 female prostitutes in Pumwani community of Nairobi, Kenya, in a longitudinal study to examine the relationship between the antibody to the gonococcal outer membrane protein 3 (Rmp Ab) and gonococcal mucosal infection . Few women used condoms . 69% were HIV-1 seropositive . Just 9.5% (23) of the women had not had any gonococcal infections, despite probable exposure to them, indicating the possibility of some acquired protective immunity to Neisseria gonorrhoea . 90.5% had had at least 1 gonococcal infection . Women with Rmp Ab faced a greater risk of gonococcal infection than those who were Rmp Ab negative (OR = 3.4;l p .05), denoting that Rmp Ab increases susceptibility to gonococcal mucosal infections . Women older than 29 years were at lower risk of gonococcal infection than those younger than 29 years (odds ratio {OR} = 0.3; p .03) . Women who used oral contraceptives (OCs) were also likely to be infected with N . gonorrhoea (OR = 3; p = .062) . Further, 31% of OC users had cervical ectopy compared to just 14% of nonusers (OR = 2.8; p .005), suggesting that the effect of OCs on the cervix make it more susceptible to gonococcal infection . Rmp Ab also exists in many other gram-negative mucosal pathogens, often playing the same role as it does in N . gonorrhoea infection . Thus, Rmp Ab may be a common scheme bacteria used to elude human immune responses . These findings provide more understanding as to why N . gonorrhoea is an ecologically successful human pathogen .

J Clin Microbiol, 1993 Jan, 31(1), 107 - 10
Value of a DNA probe assay (Gen-Probe) compared with that of culture for diagnosis of gonococcal infection; Vlaspolder F et al.; The Gen-Probe PACE 2 system for Neisseria gonorrhoeae (GP), which uses a chemiluminescently labeled DNA probe, was compared with conventional culture as the method of reference . A total of 1,750 specimens were collected from 496 females and 623 males visiting the outpatient clinic of the Sexually Transmitted Diseases Department of the Westeinde Hospital, The Hague, The Netherlands, during the year 1991 . The prevalences of gonorrhea culture-positive men and women were 14.9 and 7.7%, respectively . The overall positive rate was 8.7% . Sensitivity, specificity, and positive and negative predictive values of GP were 97.1, 99.1, 90.6, and 99.8%, respectively . A total of 12 of 13 patients with positive GP results and negative cultures may have had a gonococcal infection, a conclusion based on clinical symptoms, positive methylene blue smears, and high relative light unit ratios . The DNA probe test can be useful as a suitable screening and diagnostic test for gonorrheal infection in men and women . An advantage of using this DNA probe technique is that simultaneous testing for Chlamydia trachomatis of the same specimen is possible . We also examined whether (all) rRNA had disappeared after adequate treatment for gonococcal and/or chlamydial infection in 30 patients . None of those positive patients showed a positive result in the DNA probe assay after treatment.

Obstet Gynecol, 1993 Jan, 81(1), 33 - 8
Treatment of gonorrhea in pregnancy; Cavenee MR et al.; OBJECTIVE: To evaluate prospectively the 1989 Centers for Disease Control recommendations for treatment of gonorrhea in pregnancy . METHODS: Two hundred fifty-two women referred with probable endocervical gonorrhea had pre-treatment endocervical, rectal, and oral cultures for Neisseria gonorrhoeae and direct fluorescent antibody testing for Chlamydia trachomatis . They were assigned randomly to receive ceftriaxone 250 mg intramuscularly (IM), spectinomycin 2 g IM, or amoxicillin 3 g orally plus probenecid 1 g orally . Treatment was unblinded and in a 1:1:1 distribution . RESULTS: Two hundred forty-five women (97%) had endocervical infection, 68 (27%) had rectal infection, and 17 (7%) had pharyngeal infection . One hundred two of 252 women (40%) had concomitant endocervical C trachomatis . The overall efficacy was 235 of 252 subjects (93%) (95% confidence interval {CI} 90.1-96.4%) . Ceftriaxone was effective in 80 of 84 cases (95%) (95% CI 90.6-99.9%), amoxicillin with probenecid was effective in 75 of 84 cases (89%) (95% CI 82.5-96%), and spectinomycin was effective in 80 of 84 cases (95%) (95% CI 90.6-99.9%) . No significant difference was noted in overall efficacy or by site of infection . There was no increased incidence of congenital malformations in the offspring spring of any treatment group . CONCLUSIONS: Ceftriaxone and spectinomycin are safe and effective for the treatment of gonorrhea in pregnancy . Amoxicillin with probenecid has lower efficacy and is not recommended for treatment of gonococcal infection in pregnancy.

Obstet Gynecol, 1993 Jan, 81(1), 118 - 21
Effects of colchicine on pelvic adhesions associated with the intrauterine inoculation of Neisseria gonorrhoeae in rabbits; Marcovici I et al.; OBJECTIVE: To determine whether colchicine, an anti-inflammatory drug, is effective in reducing adhesion formation in a rabbit model in which pelvic inflammation was produced by injection of a suspension of Neisseria gonorrhoeae into the uterine horn . METHODS: Following inoculation, the rabbits were divided into four groups of 11 animals each . The control group received 1 mL saline intramuscularly (IM) for 14 days . Another group received one 100-mg dose of ceftriaxone IM 2-4 hours after inoculation . The third group received one 100-mg dose of ceftriaxone IM 2-4 hours after inoculation and 1 mg colchicine IM daily for 14 days . The fourth group received 1 mg colchicine IM daily for 14 days . The day after the last injection of colchicine, the rabbits were sacrificed and the abdominal cavities were explored to determine the number and grade of adhesions . RESULTS: The incidence of adhesions in the control group was similar to that in the antibiotic-treated group, suggesting that antibiotics do not prevent adhesions in this model . Similarly, the incidence of adhesions in the colchicine and antibiotic group was not different from that in the group receiving colchicine alone . However, the colchicine-treated groups had significantly fewer adhesions than the groups not treated with colchicine (P < .0005) . CONCLUSIONS: In this model, antibiotics alone did not prevent the formation of adhesions . Colchicine, alone or in combination with antibiotics, was effective in preventing bacteria-induced pelvic adhesions . Therefore, colchicine may offer a novel approach to the prevention of adhesions associated with pelvic inflammatory disease in women.

Wien Klin Wochenschr, 1993, 105(12), 346 - 9
Antimicrobial susceptibility pattern of Neisseria gonorrhoeae in western Austria; Allerberger F et al.; From January to October 1992 24 Neisseria gonorrhoeae isolates from clinical specimens were collected at the Federal Public Health Laboratory in Innsbruck (Austria) and screened for resistance to penicillin G, erythromycin, tetracycline, spectinomycin, ceftriaxone, cefuroxime, ciprofloxacine, and silver nitrate . Patients originated from the Austrian provinces Salzburg, Tirol, and Vorarlberg, and presented with manifest gonorrhoea . Two of 24 isolates were penicillinase-producing N . gonorrhoeae . Both strains were isolated from men who had just returned from Thailand or Kenya . The isolate from Africa was also resistant to tetracycline . Five of 24 infections were acquired abroad, sex tourism being involved in four cases . The antimicrobial resistance pattern found in gonococci in western Austria revealed that topical silver nitrate and erythromycin are equally acceptable for use in prophylaxis of neonatal ophthalmia . Penicillin is still the drug of choice in the treatment of endemic infections . If gonorrhoea has been acquired abroad, especially in Asia or Africa, ceftriaxone, spectinomycin or ciprofloxazine are recommended for therapy.

Drugs Exp Clin Res, 1993, 19(1), 41 - 6
Treatment of gonococcal infections with a single 250 mg intramuscular injection of trospectomycin sulphate vs ceftriaxone sodium; Mroczkowski TF et al.; Trospectomycin sulphate is a new, more potent analog of spectinomycin, which is active in vitro against penicillin-sensitive and penicillin-resistant strains of Neisseria gonorrhoeae . This study was designed to determine the bacteriologic and clinical efficacy as well as safety of a single intramuscularly administered 250 mg dose of trospectomycin sulphate in the treatment of uncomplicated gonorrhoea (cervical, urethral, pharyngeal and anal) . Ceftriaxone sodium was used as a comparator antibiotic in a single 250 mg intramuscular dose . Seventy-four patients (36 women and 38 men) were evaluable in the trospectomycin treated group and 40 patients (22 women and 18 men) in the ceftriaxone treated group . The overall bacteriologic cure rate was 98.6% (73/74) for trospectomycin and 95% (38/40) for ceftriaxone . Bacteriologic failures were observed among women 1/36 (2.8%) treated with trospectomycin and 2/22 (9.1%) treated with ceftriaxone . The overall clinical success rate (clinically cured plus clinically improved) was 90.5% for trospectomycin and 100% for ceftriaxone . Adverse events were reported rarely in both groups . Less than 10% of patients complained of pain and/or tenderness at the injection site for both drugs; one patient developed a generalized, pruritic rash which occurred three days after administration of trospectomycin and resolved within six days . In conclusion, a single dose of 250 mg i.m . trospectomycin appears to be at least as effective and safe as a single dose of ceftriaxone in the treatment of uncomplicated gonorrhoea.

Acta Leprol, 1993, 8(3), 143 - 7
Characterization of microbial flora of leprous ulcers infested with maggots; Husain A et al.; Swabs from 64 maggot infested leprosy ulcers before and after treatment for maggots and 100 non-infested leprosy ulcers were studied for the bacterial flora . From maggot infested ulcers (before treatment), the cultures usually showed mixed growth . Among the Gram positive isolates, Staphylococcus aureus (37%), S . albus (18%) and Streptococcus pyogenes (36%) were frequently isolated . Gram negative bacteria isolated were Proteus spp . (21%) and Escherichia coli (7%) . Anaerobic bacteria isolated were Micrococcus (3%) and Bacteroides (4%) . After treatment of maggot infested ulcers, S . aureus (36%) continued to be isolated with almost the same frequency . The isolates of other Gram negative organisms were slightly reduced . Among the Gram negatives the Proteus spp . (10%) were also less in number . In few cases Neisseria (3%) was found . Anaerobic isolates were M . luteus (2%) and B . necrophorus (3%) . From the cases without maggot infestation, a single organism was isolated from 16 cases and 84 mixed cultures were obtained . Isolates included the aerobic Gram positives S . aureus (46%), S . albus (21%) and S . pyogenes (38%), and the Gram negative Proteus spp . (19%) and E . coli (7%) . The anaerobic isolate was M . luteus (3%) . From this study no apparent association between the type of bacterial flora and maggot infestation could be observed.

New Microbiol, 1993 Jan, 16(1), 51 - 6
In vitro adherence of Neisseria gonorrhoeae to human epithelial cells; Caprilli F et al.; Gonococcal adherence was studied in vitro using buccal epithelial cells (BEC) . In smears stained with the Gram method, a progressive decrease in gonococcal adherence to the BEC after some culture passages was observed . There was a parallel decrease to almost total disappearance in the number of fimbriated bacteria . An electron microscopy study showed that adherence to the epithelial cells was mediated by fimbriae and, in part, by a polysaccharide component of the bacterial cell wall which seems to guarantee persistent adherence ability, even after the loss of fimbriae.

Int J Clin Pharmacol Res, 1993, 13(6), 317 - 24
Penetration of cefpirome into renal and prostatic tissue; Saito I et al.; We have conducted a study on the antibacterial activity and penetration into prostatic and renal tissue of cefpirome (CPO), a new injectable cephalosporin drug, and have obtained the following results . In the target bacterium Neisseria gonorrhoeae stored in this Department (34 non-PPNG isolates, 20 PPNG isolates), the minimum inhibitory concentration (MIC) distribution of CPO was < or = 0.003-0.1 micrograms/ml for the non-PPNG isolates and 0.006-0.1 micrograms/ml for the PPNG (penicillinase-producing Neisseria gonorrhoeae) strains, with MIC90 values of 0.1 microgram/ml and 0.05 microgram/ml respectively . Concentrations in blood and in prostatic tissue were measured in 30 prostatectomy patients after intravenous injections of 1 g of CPO . The concentration in prostatic tissue reached a maximum of 52.9 micrograms/g 15 min after administration, and gradually decreased thereafter, with average values of 17.9 micrograms/g at 60 min, 10.3 micrograms/g at 180 min, 7.22 micrograms/g at 320 min (one patient) and 2.70 micrograms/g at 360 min (one patient) . There was a positive correlation between prostatic tissue concentration and blood concentration at the time of tissue collection, and it is considered that CPO penetrated into the prostatic tissue to an extent dependent on its concentration in the blood . In renal tissue, measured in 4 nephrectomy patients, the CPO concentrations found were 107-148 micrograms/g in the cortex and 80.6-88.6 micrograms/g in the medulla, which were higher than the blood concentration levels in all of the subjects . These findings indicate that CPO showed sufficient concentrations in the blood and tissues for it to be considered highly useful in the treatment of urological infections.

Ann Dermatol Venereol, 1993, 120(12), 889 - 91
{Necrotizing fasciitis, caused by Neisseria meningitidis, simultaneously involving an arm and a leg}; Mentec H et al.; INTRODUCTION . Necrotizing fasciitis is usually due to Streptococcus species but can be caused by a variety of organisms, among which Neisseria species are distinctly rare, as only four cases have been reported in the literature . CASE REPORT . We report the first case of Neisseria meningitidis necrotizing fasciitis in a non-immunocompromised man, with a possibly predisposing effect of non-steroidal anti-inflammatory drugs . Neisseria meningitidis group C was isolated from subcutaneous and bullae aspirates . The involvement of two distant sites strongly suggests hematogenous dissemination of the microorganism . Four previous cases of fasciitis caused by Neisseria species are reviewed . CONCLUSION . Although Streptococcus group A is the main cause of apparently primary necrotizing fasciitis, Neisseria meningitidis must be considered a possible etiologic agent of this severe soft tissue infection.

Drugs, 1993, 45 Suppl 3, 134 - 8
Quinolones in sexually transmitted diseases; Ridgway GL; The role of quinolones in the treatment of sexually transmitted diseases is assessed . Little is known of their activity against Treponema pallidum . These compounds are all highly active against Neisseria gonorrhoeae, and have produced good in vivo results with a single dose . Only the more recent compounds show useful antichlamydial activity in vitro . Clinical trials with ofloxacin demonstrate the efficacy of a single daily dose for 7 days for chlamydial genital infection in men and women . Results for treatment of bacterial vaginosis have so far been disappointing . Ciprofloxacin and fleroxacin are effective for chancroid . The potential for treating pelvic inflammatory disease with new quinolones is discussed.

Biochemistry, 1992 Dec 29, 31(51), 12760 - 8
Structural analysis of lipooligosaccharide produced by Neisseria gonorrhoeae, strain MS11mk (variant A): a precursor for a gonococcal lipooligosaccharide associated with virulence; Kerwood DE et al.; We studied the structure of the lipooligosaccharide (LOS) that is produced by a variant A of strain MS11mk . This variant produces a single LOS that is recognized by monoclonal antibody (MAb) 2-1-L8 . In a recent study of the pathogenesis of Neisseria gonorrhoeae in male volunteers, variant A gave rise to other phase variants that produce higher molecular weight LOSs, and these LOS were associated with virulence . Definition of the structure of the variant A LOS is important to understand the biosynthesis of LOS and its expression in vivo . The dephosphorylated oligosaccharide (OS) structure derived from the variant A LOS was analyzed by two-dimensional NMR and methylation analysis . The OS structure was found to be a truncated form of the LOS produced by strain F62 {Yamasaki et al . (1991) Biochemistry 30, 10566-10575}; the variant A OS is a hexamer, a beta-lactosyl residue linked to a tetrasaccharide: Gal beta 1-->4Glc beta 1-->4{GlcNAc alpha 1-->2Hep alpha 1-->3}Hep alpha 1-->KDO . We determined that the variant A LOS is a precursor for the synthesis of higher MW LOS . We also studied expression of the MAb 2-1-L8-defined epitope present on the variant A LOS . Our data indicate that the MAb-defined epitope is not a linear beta-lactosyl residue but its specificity is directed toward the phosphorylated GlcNAc-Hep-Hep residue . Since this MAb binds to gonococci, at least part of the phosphorylated diheptose area is exposed on the gonococcal surface.

FEMS Microbiol Lett, 1992 Dec 15, 79(1-3), 345 - 9
Transformation-mediated exchange of virulence determinants by co-cultivation of pathogenic Neisseriae; Frosch M et al.; The horizontal flow of genetic material between microbes utilizes three principal routes: conjugation, transduction and transformation . While the significance in nature of the first two pathways is generally accepted, the in vivo role of transformation remains uncertain, despite the early observations by Griffith in 1928 on the transformation of streptococci from an avirulent to a virulent state {1} . Recently, circumstantial evidence was collected suggesting a role for transformation-mediated horizontal exchange in the modulation of virulence determinants of pathogenic Neisseriae and the variation of surface structures . In order to further assess the significance of transformation-mediated exchange we performed simple co-cultivation experiments of different Neisseria strains . We observed an efficient intra- and interspecies transfer of essential virulence determinants; the process was sensitive to the presence of DNaseI in the culture and was blocked in transformation-deficient recipients.

Genitourin Med, 1992 Dec, 68(6), 361 - 5
The value of urine specimens in screening for male urethritis and its microbial aetiologies in Tanzania; Mayaud P et al.; OBJECTIVE--To evaluate the first void urine (FVU) specimen in screening for urethritis and its microbial aetiologies in a male African population in which urinary schistosomiasis is also prevalent . PATIENTS AND METHODS--Two hundred and forty eight males aged 15-54 years provided FVU specimens: 55 patients from a clinic for sexually transmitted diseases (STD), 151 patients from a medical outpatient clinic and 42 villagers from an area of high endemicity for S haematobium . Specimens were tested for leucocyte esterase (LE) using a dipstick (Nephur-Test+Leuco, Boehringer-Mannheim France SA) . Ova of S haematobium were sought in terminal urine samples from all subjects . For all STD patients, and all medical outpatients with a positive LE test, urine and urethral swabs were tested for Chlamydia trachomatis antigen, and urethral swabs were tested for Neisseria gonorrhoeae by gram stain and isolation . RESULTS--The prevalence of LE positivity was 38/41 in STD patients with urethral signs or symptoms (93%), 5/14 among other STD patients (36%), 21/151 among medical outpatients (15%) and 13/42 among villagers (31%) . As a screening test for urethral infection (detection of gonorrhoea or chlamydia and/or > or = 5 polymorphs per high power field on gram stain) the LE test had a sensitivity of 94% and a specificity of 53% among STD patients . Of 24 STD patients with gonococcal or chlamydial infection, 23 had a positive LE test (96%) . Among general medical outpatients, 12 of 22 with a positive LE test had either conventionally defined urethritis or gonococcal or chlamydial infection, giving a positive predictive value of 55% for the LE test in this group . Of 18 subjects in all groups with urinary schistosomiasis nine had a positive LE test (50%), although three of these also had gonorrhoea . Chlamydial antigen was detected in the FVU specimen of all six subjects in whom it was detected in a urethral swab, and in an additional three subjects in the outpatient group . CONCLUSIONS--The FVU, which is an easily collected and non-invasive specimen, can provide valuable information on the prevalence of urethritis and on its microbial aetiology among the general male population in African countries.

Genitourin Med, 1992 Dec, 68(6), 356 - 60
The dominance of a multiresistant strain of Neisseria gonorrhoeae among prostitutes and STD patients in The Gambia; Ison CA et al.; OBJECTIVE--To study the epidemiology of antibiotic resistant strains of Neisseria gonorrhoeae from sexually transmitted disease clinics in The Gambia . MATERIALS AND METHODS--One hundred and sixty five strains of N gonorrhoeae were tested for their antibiotic susceptibility, auxotype, serotype, and plasmid content . RESULTS--Of the total population 84 (51%) were non-penicillinase producing (nonPPNG) and 81 (49%) penicillinase-producing N gonorrhoeae (PPNG) . There were 16 serovars, five auxotypes and 33 auxotype/serovar (A/S) classes in the total population and the nonPPNG . Among PPNG only five serovars, two auxotypes and nine A/S classes were found . One A/S class predominated, NR/IB-7 (86 isolates), of which 66 (77%) were PPNG and the remainder were chromosomally-mediated resistant N gonorrhoeae (CMRNG) . These strains also showed reduced susceptibility to ciprofloxacin, ceftriaxone and tetracycline and were evenly distributed among patient groups . CONCLUSION--We have identified a relatively homogeneous gonococcal population with a core group of isolates exhibiting high levels of antibiotic resistance.

Br J Obstet Gynaecol, 1992 Dec, 99(12), 994 - 9
A longitudinal study of pelvic inflammatory disease; Stacey CM et al.; OBJECTIVE: To study the microbiology and long term prognosis of pelvic inflammatory disease (PID) . DESIGN: A prospective study of women with laparoscopically confirmed PID . SETTING: Teaching hospital in central London . SUBJECTS: 23 women with PID . OUTCOME MEASURES: Microbiological investigations at the time of diagnosis and at follow up; subsequent fertility and the occurrence of pelvic pain . RESULTS: PID diagnosed by laparoscopy was regarded as moderate to severe in 15 cases . Neisseria gonorrhoeae, Chlamydia trachomatis, Mycoplasma hominis and Ureaplasma urealyticum or a combination of these micro-organisms were detected most frequently in the cervix, less often in the endometrium and least in the tubes, C . trachomatis being the micro-organism found most commonly in the tubes . There was serological evidence of acute chlamydial infection in 13 of 20 cases in which paired sera were available and a serological response to M . hominis in 9 of 12 cases in which it was possible to evaluate the results . On the basis of microbiological and serological results, C . trachomatis appeared to be the most important aetiological agent in 10 cases, N . gonorrhoeae in four cases, M . hominis in three cases and U . urealyticum in none; in five cases, two of these micro-organisms appeared to be of equal importance . After 1 to 3 years, 33% of the women were having difficulty conceiving and 56% continued to complain of pelvic pain . CONCLUSION: It is difficult to be certain of the infectious cause of PID in any given case . However, the evidence that N . gonorrhoeae and C . trachomatis are pathogens is very strong . M . hominis may be responsible for a few cases on its own or together with other micro-organisms.

Nippon Hinyokika Gakkai Zasshi, 1992 Dec, 83(12), 2070 - 7
{Diagnosis of gonococcal urethritis and chlamydial urethritis by polymerase chain reaction}; Deguchi T et al.; A polymerase chain reaction (PCR) method was compared to standard methods (cultures for Neisseria gonorrhoeae and Chlamydia trachomatis and an enzyme-immunoassay for C . trachomatis) in diagnosis of gonococcal and chlamydial urethritis in 40 male patients with urethritis . Gonococcal urethritis was diagnosed by detection of a 206 bp DNA fragment amplified by PCR with N . gonorrhoeae-specific primers . Chlamydial urethritis was diagnosed by detection of a 242 bp DNA fragment amplified by PCR with C . trachomatis-specific primers . Gonococcal and chlamydial urethritis, gonococcal and non-chlamydial urethritis, non-gonococcal and chlamydial urethritis, and non-gonococcal and non-chlamydial urethritis were diagnosed in 8, 10, 14 and 8 patients, respectively, by the PCR method . In 9 patients with gonococcal and chlamydial urethritis, 10 with gonococcal and non-chlamydial urethritis, 12 with non-gonococcal and chlamydial urethritis, and 9 with non-gonococcal and non-chlamydial urethritis, diagnosed by the standard methods, the coincidence rates of the PCR to the standard methods were 78% (7/9), 90% (9/10), 100% (12/12), and 89% (8/9), respectively . The overall coincidence rate between the PCR and the standard methods in diagnosis of urethritis were high (90%) . In addition, N.gonorrhoeae and C.trachomatis could be simultaneously detected from one urethral sample in approximately 6 hours by means of the PCR . Thus, the PCR method could clinically be applied and would offer several advantages to diagnosis of urethritis, compared to the standard methods.

Am J Med Sci, 1992 Dec, 304(6), 379 - 91
Infections of the central nervous system; Luby JP; Infections of the central nervous system are common, serious medical conditions . One hundred consecutive adult cases with purulent meningitis of known etiology encountered by the Medical Service at Parkland Memorial Hospital were reviewed . Streptococcus pneumoniae was the most common pathogen (56 cases), followed by Neisseria meningitidis (16 cases) and Listeria monocytogenes (seven cases) . Hemophilus influenzae, Staphylococcus aureus, and streptococci each accounted for five cases . An additional 15 patients had purulent meningitis with a pathogen being isolated . Twenty five purulent meningitis cases of known etiology after trauma or neurosurgery were reviewed . Staphylococcus aureus (five cases), Staphylococcus epidermidis (four cases), and gram negative bacilli (14 cases) were the most common pathogens . Review of intracranial suppurative infections demonstrated advances in microbiology, antibiotic therapy, and imaging, leading to improvements in therapy . Subdural empyema continues to be a difficult diagnosis to make and apparently is related to the anatomic pathology of the infectious process . To illustrate salient features about granulomatous meningitis and encephalitis, cases of tuberculous meningitis, herpes simplex encephalitis, St . Louis encephalitis, and encephalitis of undetermined etiology are presented and discussed.

J Clin Microbiol, 1992 Dec, 30(12), 3089 - 94
Preliminary evaluation of the ligase chain reaction for specific detection of Neisseria gonorrhoeae; Birkenmeyer L et al.; Rapid identification of Neisseria gonorrhoeae in clinical specimens is essential for effective control . Traditional culture requires a minimum of 24 h, and for some specimens harboring gonococci, the gonococci fail to grow or are misidentified . The recently described ligase chain reaction (LCR) is a highly specific and sensitive DNA amplification technique which was evaluated as an alternative to routine culture . Three LCR probe sets were used . Two of the probe sets were directed against the multi-copy Opa genes (Omp-II), while the third set was targeted against the multicopy Pilin genes . Each LCR probe set was evaluated with 260 microorganisms including 136 global isolates of N . gonorrhoeae, 41 isolates of N . meningitidis, and 10 isolates of N . lactamica; 26 nonpathogenic Neisseria strains; and 47 isolates of non-Neisseria species that may reside in clinical specimens . Amplification products were detected by using the IMx LCR format (Abbott Laboratories, Abbott Park, Ill.) . Strains of N . gonorrhoeae were assayed at 270 cells per LCR (approximately 6.7 x 10(4) CFU/ml) with the Opa and Pilin probes, producing signals at least 21 and 15 times above background, respectively . In contrast, only background values were observed when testing the probe sets with 124 nongonococcal strains at 1.3 x 10(6) cells per LCR (approximately 3.2 x 10(8) CFU/ml) . One hundred urogenital specimens were assayed by LCR, and compared with culture, the three probes were 100% sensitive (8 of 8) and 97.8% specific (90 of 92), resulting in an agreement of 98% (98 of 100) . On the basis of the results of these preliminary studies, LCR has the potential to be an accurate and rapid DNA probe assay for the detection of N . gonorrhoeae in clinical specimens.

J Infect Dis, 1992 Dec, 166(6), 1329 - 34
Binding of plasminogen to Neisseria meningitidis and Neisseria gonorrhoeae and formation of surface-associated plasmin; Ullberg M et al.; Forty-two strains of Neisseria meningitidis and 17 of Neisseria gonorrhoeae were tested for their ability to interact with 125I-labeled Glu-plasminogen . All strains tested reacted substantially with plasminogen, resulting in uptake values of 20%-48% . Scatchard analysis with selected N . meningitidis strains demonstrated a dual-phase receptor interaction, one more avid receptor with a Kd of 50 nM and 3000-6000 receptors per bacterium and a second receptor with a Kd of 200 nM and 10,000-20,000 receptors per bacterium . Plasminogen uptake could be completely eliminated by low concentrations of epsilon-aminocaproic acid, suggesting that the lysine binding sites on the plasminogen molecule are involved in the receptor-ligand interaction . The binding of plasminogen to the bacterial receptor facilitates the tissue-type plasminogen activator-mediated conversion to Glu-plasmin, which also modifies itself to the Lys form . Receptor-associated plasmin is enzymatically active, monitored as a breakdown of the chromogenic substrate S-2251, and retains its activity in the presence of naturally occurring inhibitors in plasma.

J Infect Dis, 1992 Dec, 166(6), 1322 - 8
Human monoclonal antibodies against an epitope on the class 5c outer membrane protein common to many pathogenic strains of Neisseria meningitidis; Fernandez de Cossio ME et al.; Neisseria meningitidis is a causative agent of meningitis . Despite vaccination programs, it still causes a large number of deaths in young children . Early diagnosis followed by passive immunization with human monoclonal antibodies could be an approach to effective therapy . Peripheral blood lymphocytes from normal, healthy blood donors and from vaccinated individuals were immunized in vitro, using outer membrane proteins purified from N . meningitidis B:4:P1.15 . The immunized human B cells were Epstein-Barr virus transformed and fused to a heteromyeloma . Several stable human hybridoma cell lines were established and two, secreting antibodies against the 31-kDa class 5c outer membrane protein, were characterized further . The human antibodies were of IgG1 and IgG3 isotypes, with kappa light chains . The recognized epitope was commonly found among pathogenic strains of N . meningitidis; thus, these human monoclonal antibodies may be important in the evaluation of N . meningitidis infections.

Mol Microbiol, 1992 Dec, 6(23), 3493 - 9
Identification of variable region differences in Neisseria meningitidis class 3 protein sequences among five group B serotypes; Zapata GA et al.; Strains of Neisseria meningitidis express one of two porin proteins . These porins have been identified as the class 2 and class 3 proteins, and express serotype-specific epitopes . The gene for the class 3 protein was amplified by the polymerase chain reaction from the DNA of a serotype 4 strain as a 1025 bp fragment . The nucleotide sequence of this gene was determined and compared with two recently published sequences . On the basis of this comparison we have identified two major variable regions in the translated protein sequence, VR1 and VR2, that may be associated with serotype specificity . Three other variable regions were also identified . The sequences in the VR1 and VR2 regions from five additional group B N . meningitidis strains of serotypes 1, 4, 8, 12, and 15, all expressing class 3 proteins, were determined . The VR1 and VR2 regions were variable and were flanked by highly conserved regions among eight different class 3 sequences . These two variable regions of 15 and 9 amino acids are predicted to be in surface-exposed loops.

Pathol Biol (Paris), 1992 Dec, 40(10), 993 - 8
{Study of ninety strains of serogroup A Neisseria meningitidis isolated from cerebrospinal fluid (25) and rhinopharynx (65) in Morocco (December 1989-April 1990)}; Nejmi S et al.; Ninety strains of Neisseria meningitidis were recovered from cerebrospinal fluid and nasopharyngeal specimens during the outbreak which occurred in Morocco between December 1989 and April 1990 . All the strains recovered belonged to serogroup A . Serotype determination carried out using the "whole cell ELISA" method showed that all strains were serotype 4, subtype P1.9 . Antigenic formula of the strains was therefore A:4:P1.9 . Electrophoretic characterization of outer membrane proteins demonstrated proteins belonging to classes 1, 3, 4, 5 and 6, with a few rare exceptions which are discussed.

Hybridoma, 1992 Dec, 11(6), 677 - 87
Bactericidal activity of two IgG2a murine monoclonal antibodies with distinct fine specificities for group B Neisseria meningitidis capsular polysaccharide; Hurpin CM et al.; To analyze the fine specificity of the protective IgG response for the capsule of group B Neisseria meningitidis (Men B) induced after immunization with live bacteria, two specific IgG2a monoclonal antibodies (mAb) have been generated from hyperimmunized Balb/c and NZB mice (101C11 and 30H12) . They specifically recognize in direct and competitive binding assays the capsular polysaccharides of Men B and Escherichia coli k1 on condition that the length of the polysaccharidic chain is sufficient to make a conformational structure (more than 15 monomers of alpha (2-->8) linked N-acetyl neuraminic acid) . They do not interact with group A and group C Neisseria meningitidis polysaccharides in ELISA . A chemical derivative of the Men B polysaccharide, the N-propionylated Men B polysaccharide, considered as mimicking a unique bactericidal epitope on the surface of Men B is recognized by 101C11 but not by 30H12 . The two mAb have, in vitro, a specific bactericidal activity against live Men B which do not seem serotype specific . Moreover, the killing of Men B mediated by 30H12 can be neutralized by an anti-idiotypic mAb (216F11) generated from A/J mice, immunized with polymerized 30H12 . These data show that at least two distinct bactericidal epitopes exist on the surface of the Men B capsule.

Eur J Biochem, 1992 Nov 15, 210(1), 119 - 24
Nuclear-magnetic-resonance analysis of the capsular antigen of Actinobacillus pleuropneumoniae serotype 9 . Its identity with the capsular antigen of Escherichia coli K62 (K2ab), Neisseria meningitidis serogroup H and Pasteurella haemolytica serotype T15; Beynon LM et al.; The specific capsular antigen of Actinobacillus pleuropneumoniae serotype 9 was characterized by one-dimensional and two-dimensional high-field nuclear-magnetic-resonance methods, and by chemical analyses, as a teichoic-acid-type polymer of a repeating unit having the structure {formula: see text} The basic polymer structure is identical to capsular antigens of Neisseria meningitidis group H, Escherichia coli K62 (K2ab) and Pasteurella haemolytica serotype T15.

FEMS Microbiol Lett, 1992 Nov 15, 78(1), 23 - 9
Identification and characterization of a cross-reactive and a unique B-cell epitope on the hsp60 homologue from Neisseria gonorrhoeae; Pannekoek Y et al.; Two monoclonal antibodies (G6 and 7B), generated against a 63-kDa stress protein (GSP63) from Neisseria gonorrhoeae strain VP1, were used to investigate the antigenic heterogeneity of GSP63 among the Neisseriaceae and its antigenic relationship with the Hsp60 heat-shock protein family . Immunoblotting experiments demonstrated antibody reactivity with all pathogenic Neisseria tested and with some of the commensal strains . One of the antibodies (7B) cross-reacted with the 65-kDa M . bovis BCG heat-shock protein and with 14 out of the 21 similarly sized proteins in other bacterial species . The other antibody (G6) specifically recognized neisserial GSP63 homologues . These results demonstrate that GSP63 is a conserved neisserial antigen bearing both a unique neisserial B-cell epitope and a more widely distributed Hsp60 epitope.

Sex Transm Dis, 1992 Nov-Dec, 19(6), 351 - 4
Compliance with antibiotic therapy for Chlamydia trachomatis and Neisseria gonorrhoeae; Katz BP et al.; Control of bacterial sexually transmitted diseases (STD) depends on adequate antibiotic therapy . During a 4-week period, a survey concerning compliance was administered to all patients attending an STD clinic who were being treated with one of the standard antibiotic regimens for presumed gonococcal or chlamydial infections . Of the 497 eligible patients, 406 (81.7%) were surveyed between 24 hours and 72 hours after the end of treatment . Of those being treated with the standard 7-day regimen of tetracycline or erythromycin, 63.4% complied . Compliance was not associated with race, gender, symptoms, or antibiotic regimen . Those who were younger, were sexual contacts of an infected partner, or had gastrointestinal side effects were more likely not to comply with treatment.

Sex Transm Dis, 1992 Nov-Dec, 19(6), 341 - 5
Evaluation of treatment with single-dose ampicillin/sulbactam with probenecid or ceftriaxone in patients with uncomplicated gonorrhea; Baddour LM et al.; This study compared ampicillin/sulbactam plus probenecid with ceftriaxone for treatment of uncomplicated gonorrhea . Of the 297 men and women who were enrolled and randomized to receive either ampicillin/sulbactam (1.0 g/0.5 g) with probenecid (1 g) or ceftriaxone (0.25 g), 274 patients were evaluable . Both ampicillin/sulbactam and ceftriaxone were administered by intramuscular injections . Patients were gonococcal contacts, had positive culture results for Neisseria gonorrhoeae, or had clinical evidence of gonorrhea . Specimens for gonococcal cultures were collected from the cervix (female patients), urethra, rectum, and pharynx at pretreatment and test-of-cure visits . The presence of N . gonorrhoeae and a test-of-cure visit were required for drug efficacy analysis . Of the 274 evaluable patients, 195 (71.2%) had positive culture results for N . gonorrhoeae . Cure was achieved in 93 (94.9%) of 98 patients receiving ampicillin/sulbactam with probenecid and in 96 (99.0%) of 97 patients receiving ceftriaxone . Penicillinase-producing N . gonorrhoeae strains were found in 21 (10.8%) patients; these were eradicated by either ampicillin/sulbactam with probenecid (N = 9) or ceftriaxone (N = 12) . Overall, the two drug regimens were very well tolerated and no serious adverse effects were noted . Ampicillin/sulbactam with probenecid may be useful as single-dose therapy in patients with uncomplicated genitorectal gonorrhea.

Child Abuse Negl, 1992 Nov-Dec, 16(6), 847 - 53
Gardnerella vaginalis infection and sexual contact in female children; Ingram DL et al.; Gardnerella vaginalis (GV) infection has been reported as being acquired via sexual contact in adults and as an indicator of sexual contact in female children (DeJong, 1985) . The purpose of this study was to determine if GV infection was more commonly found in 191 female children who gave a history of sexual contact and/or were infected with Neisseria gonorrhoeae (GC) or Chlamydia trachomatis (CT) (Group 1), compared with 144 female children evaluated for possible sexual abuse and found to have no such history or infection with GC or CT (Group 2), or 31 female children (friends of the authors) without such a history or GC or CT infection (Group 3) . Vaginal GV was found in 5.3% of Group 1, 4.9% of Group 2 and 6.4% of Group 3 (p > .05) . Also, vaginal GV infection was not related to the type of sexual contact or race, but did increase with age in white female children . Because vaginal GV infection is not more commonly found in children with a history of sexual contact than those without such a history, the finding of GV in a vaginal culture in an individual case would not be a reliable marker of sexual contact . Routine culturing for GV is not recommended as part of a sexual abuse workup.

Diagn Microbiol Infect Dis, 1992 Nov-Dec, 15(8), 685 - 91
Susceptibility testing interpretive criteria and drug stability for cefdinir, cefetamet, and cefpodoxime against Neisseria gonorrhoeae; Barrett MS et al.; Cefdinir, cefetamet, and cefpodoxime, three orally administered cephalosporins, were tested against 100 strains of Neisseria gonorrhoeae having various antimicrobial susceptibility patterns . Triplicate testing of each organism strain was performed for all agar dilution and disk diffusion tests . Cefdinir was the most active compound (MIC90) micrograms/ml) especially against gonococci with chromosomal-mediated resistance to penicillin . The recommended susceptible interpretive criteria were as follows: for the 5-micrograms cefdinir disk, > or = 31 mm (MIC correlate, < or = 0.25 microgram/ml); for the 10-micrograms cefetament disk, > or = 29 mm (MIC correlate, < or = 0.5 microgram/ml; for the 30-micrograms cefetamet disk, > or = 31 mm (MIC correlate, < or = 0.5 microgram/ml); and for the 10-micrograms cefpodoxime disk, > or = 29 mm (MIC correlate, < or = 0.5 microgram/ml) . No organisms resistant to these new cephalosporins were detected . Cefdinir, cefetamet, and defpodoxime were stable in GC agar medium for at least 21 days when stored at 2 degrees-5 degrees C.

Clin Infect Dis, 1992 Nov, 15 Suppl 1, S53 - 61
Evaluation of new anti-infective drugs for the treatment of acute pelvic inflammatory disease . Infectious Diseases Society of America and the Food and Drug Administration; Sweet RL et al.; Pelvic inflammatory disease (PID) is a syndrome unrelated to pregnancy or surgery and characterized by lower abdominal pain and tenderness, cervical motion tenderness, and adnexal tenderness . Fever, leukocytosis, and the results of laboratory tests are used to support the diagnosis . Participants in clinical trials should be stratified into two groups: those with and those without tubo-ovarian abscess--i.e., those with complicated and those with uncomplicated PID . Diagnostic studies and treatment should be directed at four major groups of pathogens: Neisseria gonorrhoeae, Chlamydia trachomatis, anaerobic bacteria, and facultative bacteria such as Escherichia coli . Women requiring hospitalization should generally be treated as inpatients for at least 4-7 days; outpatient therapy should then be instituted to complete a 14- to 21-day course . Clinical and laboratory evaluations should be conducted daily during hospitalization and both 2-4 days and 2-4 weeks after the completion of therapy.

Clin Infect Dis, 1992 Nov, 15 Suppl 1, S167 - 71
Evaluation of new anti-infective drugs for the treatment of infectious arthritis in adults . Infectious Diseases Society of America and the Food and Drug Administration; Norden C et al.; This guideline describes clinical trials of new anti-infective drugs for the treatment of septic arthritis due to bacteria other than Neisseria gonorrhoeae in adults . Septic arthritis is associated with fever and with physical findings at the affected joint . Diagnosis is established by culture of synovial fluid . Treatment includes the administration of antimicrobial drugs and drainage of the joint by needle aspiration or surgery . Multicenter, randomized comparative clinical trials that are single-, double-, or evaluator-blinded should be performed . However, an open trial of a new antimicrobial agent with historical controls is acceptable . Patients should receive treatment for at least 2-3 weeks . After 5 days of antimicrobial therapy, synovial fluid should be sterile and clinical signs and symptoms should have diminished . Patients should be followed for 2-4 weeks after completion of therapy.

Bioconjug Chem, 1992 Nov-Dec, 3(6), 514 - 8
Acidic derivatives of homocysteine thiolactone: utility as anionic linkers; Leanza WJ et al.; Homocysteine thiolactone (2) derivatives in which the nitrogen is acylated with groups containing acidic functionalities have been synthesized . These include the succinyl (3), the carboxymethylglutaryl (4), the 3-phosphonopropionyl (7), and the 3-sulfopropionyl (8) derivatives . These thiolactones can be used to introduce a thiol functionality into proteins such as the outer membrane protein complex of Neisseria meningitidis (OMPC) allowing conjugation with electrophilic ligands . This chemistry is the same as with N-acetylhomocysteine thiolactone (1), but their pKa values are such that at pH 7 concomitant negative charge is introduced into the conjugate . Such negative charge should neutralize some excess positive charge introduced when arginine- and lysine-rich peptides are bonded as ligands . In the case of OMPC, introduction of such positive charge appears to effect irreversible precipitation . The system has been studied using the maleimidopropionyl and bromoacetyltriarginine (9 and 10) derivatives as models . In select instances anionic spacers reduce the degree of precipitation relative to N-acetyl-homocysteine thiolactone derivatives.

Pediatr Infect Dis J, 1992 Nov, 11(11), 945 - 50
Epidemiology of adult sexually transmitted disease agents in children being evaluated for sexual abuse; Ingram DL et al.; This prospective study describes the epidemiology of adult sexually transmitted disease agents in 1538 children ages 1 to 12 years being evaluated for possible sexual abuse . Infections with these agents were related to the presence or absence of a history of sexual contact . Neisseria gonorrhoeae (GC) was found in 2.8% (41 of 1469); human papillomavirus presenting as condyloma acuminata, 1.8%; Chlamydia trachomatis, 1.2% (17 of 1473); Treponema pallidum (syphilis), 0.1% (1 of 1263); and herpes simplex virus, 0.1% . Overall a history of sexual contact was present in 83% of children with N . gonorrhoeae; condyloma acuminata, 43%; Chlamydia trachomatis, 94%; syphilis, 0%; and herpes simplex virus, 50% . Selected vaginal discharges were examined for Trichomonas vaginalis and bacterial vaginosis . In children comprehending questions regarding sexual contact (i.e . were "verbal"), 89% with N . gonorrhoeae, 100% with Chlamydia trachomatis and 63% with condyloma acuminata had a history of sexual contact, indicating that in "verbal" children any infection with N . gonorrhoeae or C . trachomatis was highly associated with sexual contact.

J Bacteriol, 1992 Nov, 174(22), 7345 - 51
Kinetics and sequence specificity of processing of prepilin by PilD, the type IV leader peptidase of Pseudomonas aeruginosa; Strom MS et al.; PilD, originally isolated as an essential component for the biogenesis of the type IV pili of Pseudomonas aeruginosa, is a unique endopeptidase responsible for processing the precursors of the P . aeruginosa pilin subunits . It is also required for the cleavage of the leader peptides from the Pdd proteins, which are essential components of an extracellular secretion pathway specific for the export of a number of P . aeruginosa hydrolytic enzymes and toxins . Substrates for PilD are initially synthesized with short, i.e., 6- to 8-amino-acid-long, leader peptides with a net basic charge and share a high degree of amino acid homology through the first 16 to 30 residues at the amino terminus . In addition, they all have a phenylalanine residue at the +1 site relative to the cleavage site, which is N methylated prior to assembly into the oligomeric structures . In this study, the kinetics of leader peptide cleavage from the precursor of the P . aeruginosa pilin subunit by PilD was determined in vitro . The rates of cleavage were compared for purified enzyme and substrate as well as for enzyme and substrate contained within total membranes extracted from P . aeruginosa strains overexpressing the cloned pilD or pilA genes . Optimal conditions were obtained only when both PilD and substrate were contained within total membranes . PilD catalysis of P . aeruginosa prepilin followed normal Michaelis-Menten kinetics, with a measured apparent Km of approximately 650 microM, and a kcat of 180 min-1 . The kinetics of PilD processing of another type IV pilin precursor, that from Neisseria gonorrhoeae with a 7-amino-acid-long leader peptide, were essentially the same as that measured for wild-type P . aeruginosa prepilin . Quite different results were obtained for a number of prepilin substrates containing substitutions at the conserved phenylalanine at the +1 position relative to the cleavage site, which were previously shown to be well tolerated in vivo . Substitutions of methionine, serine, and cysteine for phenylalanine show that Km values remain close to that measured for wild-type substrate, while kcat and kcat/Km values were significantly decreased . This indicates that while the affinity of enzyme for substrate is relatively unaffected by the substitutions, the maximum rate of catalysis favors a phenylalanine at this position . Interesting, PilD cleavage of one mutated pillin (asparagine) resulted in a lower Km value of 52.5 microM, which indicates a higher affinity for the enzyme, as well as a lower kcat value of 6.1 min m(-1) . This suggests that it may be feasible to design peptide inhibitors of PilD.

J Bacteriol, 1992 Nov, 174(21), 6928 - 37
Identification and molecular analysis of a 63-kilodalton stress protein from Neisseria gonorrhoeae; Pannekoek Y et al.; Iron limitation, glucose deprivation, and growth under low oxygen supply (environmental stress) increased the expression of several proteins of Neisseria gonorrhoeae, including a 63-kilodalton protein identified by sodium dodecyl sulfate-polyacrylamide gel electrophoresis . This gonococcal stress protein (GSP63) was detected in the cytosol and copurified with lithium acetate-derived outer membranes . Successful purification of the protein was achieved by sucrose density gradient centrifugation and by chromatography on phenyl-Sepharose . Gel filtration of the purified protein revealed a molecular weight of approximately 450,000, suggesting that in its native state, the protein consists of a multimer of six to eight subunits . Isoelectric focusing indicated a pI of 5.2 . Immunoblotting experiments using a polyclonal antiserum raised against the purified protein demonstrated cross-reactivity with a protein of the same electrophoretic mobility as GSP63 in all eight gonococcal isolates tested . N-terminal amino acid sequencing of the protein revealed up to 65% homology with members of the Hsp60 heat shock protein family, suggesting that GSP63 is related to this group of proteins . This relationship was further substantiated by the immunological cross-reactivity of GSP63 with mycobacterial Hsp60 and the ATP-binding activity of the gonococcal stress protein.

Infect Immun, 1992 Nov, 60(11), 4704 - 8
The major anaerobically induced outer membrane protein of Neisseria gonorrhoeae, Pan 1, is a lipoprotein; Hoehn GT et al.; Pan 1 is an acidic outer membrane protein of Neisseria gonorrhoeae that is expressed only when gonococci are grown anaerobically . On silver-stained sodium dodecyl sulfate-polyacrylamide gels, Pan 1 migrates as an intense but diffuse 54-kDa protein . The deduced amino acid sequence of Pan 1 from the aniA (anaerobically induced protein) open reading frame reveals a lipoprotein consensus sequence, Ala-Leu-Ala-Ala-Cys, and a processed molecular mass of 39 kDa . Furthermore, there is strong homology at the N terminus and C terminus of Pan 1 to the termini of the gonococcal outer membrane lipoproteins Lip and Laz . {3H}palmitic acid labeling of gonococci grown under oxygen-limited conditions demonstrated specific incorporation of label into Pan 1, suggesting further that Pan 1 is a lipoprotein.

Infect Immun, 1992 Nov, 60(11), 4586 - 92
Molecular characterization of a genomic region associated with virulence in Dichelobacter nodosus; Katz ME et al.; The major pathogen implicated in footrot, a highly contagious disease of sheep, is the strict anaerobe Dichelobacter nodosus (formerly Bacteroides nodosus) . Sequence analysis of a 2,262-bp segment of the D . nodosus genome which is more prevalent in virulent isolates than in other isolates showed the presence of four open reading frames which appeared to have consensus transcriptional and translational start signals . These virulence-associated genes have been designated vapABCD . Two of the three copies of the vap region in the genome of the reference strain D . nodosus A198 were shown to carry all of the vap genes, whereas one copy contained only the vapD gene . The VapD protein was gel purified, shown to contain the predicted amino-terminal sequence, and used to raise rabbit antibodies . Western blots (immunoblots) showed that all of the D . nodosus strains tested that contained the vap region produced the VapD protein . The VapD protein had significant amino acid sequence identity with open reading frame 5 from the cryptic plasmid of Neisseria gonorrhoeae, and the vapBC operon had sequence similarity with the trbH region of the Escherichia coli F plasmid . It is proposed that these gene regions evolved from the integration of a conjugative plasmid from another bacterial species into the D . nodosus chromosome.

Infect Immun, 1992 Nov, 60(11), 4695 - 703
Isolation and nucleotide sequence of the gene (aniA) encoding the major anaerobically induced outer membrane protein of Neisseria gonorrhoeae; Hoehn GT et al.; When grown under anaerobic conditions, Neisseria gonorrhoeae, the etiologic agent of the sexually transmitted disease gonorrhea, expresses several novel outer membrane proteins . One of these, Pan 1, has an apparent molecular mass of 54 kDa in electrophoresis and is recognized by serum samples from patients with gonococcal infection . The presence of antibodies to this protein in patient sera suggests that Pan 1 is expressed during gonococcal infection and, more importantly, that N . gonorrhoeae grows anaerobically in vivo . We have cloned the Pan 1 structural gene, aniA, by screening a gonococcal lambda gt11 expression library with monospecific, polyclonal anti-Pan 1 antiserum . Three distinct immunoreactive recombinants, containing overlapping fragments of DNA, were isolated and confirmed to be coding for Pan 1 protein sequences . Northern (RNA blot) hybridization of an insert from an aniA recombinant to total gonococcal cellular RNA revealed the presence of a 1.5-kb transcript that was specific to RNA from anaerobically grown gonococci, indicating that the aniA gene is regulated at the transcriptional level and is monocistronic . To characterize the aniA gene, we have sequenced the entire 2-kb region spanned by the overlapping recombinants . We have also performed primer extension analysis on RNA isolated from aerobically and anaerobically grown gonococci in order to define the aniA promoter region . Two putative primer extension products specific to organisms grown anaerobically were identified by homology to known Escherichia coli promoter sequences, suggesting that the regulation of aniA expression involves multiple promoter regions.

Mol Microbiol, 1992 Nov, 6(22), 3439 - 50
Interaction of two variable proteins (PilE and PilC) required for pilus-mediated adherence of Neisseria gonorrhoeae to human epithelial cells; Rudel T et al.; Pili confer the initial ability of Neisseria gonorrhoeae to bind to epithelial cells . Pilin (PilE), the major pilus subunit, and a minor protein termed PilC, reportedly essential for pilus biogenesis, undergo intra-strain phase and structural variation . We demonstrate here that at least two different adherence properties are associated with the gonococcal pili: one is specific for erythrocytes, which is virtually unaffected by PilE variation, and another is specific for epithelial cells, and is modulated in response to the variation of PilE . Based on this finding, mutants of a recA- strain were selected that had lost the ability to bind to human cornea epithelial cells (A-) but retained the ability to form pili (P+) and to agglutinate human erythrocytes (H+) . The adherence-negative mutants failed to produce detectable levels of PilC1 or PilC2 proteins, representing piIC phase variants generated in the absence of RecA . The A- pilC phase variants were indistinguishable from their A+ parents and spontaneous A+ revertants with regard to the amount of PilE produced and its electrophoretic mobility, the degrees of piliation and haemagglutination, and the pilE nucleotide sequence . These data demonstrate a central role for PilC in pilus-mediated adherence of N . gonorrhoeae to human epithelial cells and further indicate that neither PilC1 nor PilC2 is obligatory for the assembly of gonococcal pili.

J Bacteriol, 1992 Nov, 174(22), 7321 - 7
Production of Neisseria gonorrhoeae pili (fimbriae) in Pseudomonas aeruginosa; Hoyne PA et al.; Pseudomonas aeruginosa K/2PfS, when transformed with an expression plasmid harboring the pilin gene (pilE1) of Neisseria gonorrhoeae MS11, was able to express and assemble gonococcal pilin monomers into surface-associated pili, as judged by sodium dodecyl sulfate-polyacrylamide gel electrophoresis, immunoblotting, and immunoelectron microscopy . Concomitant with the expression of gonococcal pili in P . aeruginosa was the virtual loss of production of P . aeruginosa K/2PfS pili normally associated with the host cell.

Can J Microbiol, 1992 Nov, 38(11), 1202 - 5
The N-linked oligosaccharides of human lactoferrin are not required for binding to bacterial lactoferrin receptors; Alcantara J et al.; The oligosaccharides of human lactoferrin were enzymatically removed with glycopeptidase F, resulting in a preparation containing partial and fully deglycosylated human lactoferrin . The derivatives were separated by Concanavalin A affinity chromatography and compared with native human lactoferrin with respect to their ability to bind to bacterial receptors . Competitive binding experiments demonstrated that the lactoferrin derivatives were equally capable as native lactoferrin in binding to receptors of Neisseria meningitidis, Neisseria gonorrhoeae, and Moraxella catarrhalis . This result indicates that the oligosaccharides on human lactoferrin are not essential for binding to the bacterial receptors.

Infection, 1992 Nov-Dec, 20(6), 339 - 41
Resistance of recent Neisseria gonorrhoeae isolates in Nigeria and outcome of single-dose treatment with ciprofloxacin; Otubu JA et al.; One hundred four patients (71 males, 33 females) with acute gonococcal urethritis or cervicitis were treated with a single oral 250 mg dose of ciprofloxacin at Jos University Teaching Hospital, Jos, Nigeria . All gonococcal strains were isolated from appropriate pre-treatment swabs . Penicillinase-producing Neisseria gonorrhoeae (PPNG) accounted for 72.8% of all isolates . In vitro sensitivity of gonococcal isolates to ciprofloxacin was 100%, while that to penicillin, ampicillin and co-trimoxazole was below 15% . Of the 104 patients treated with ciprofloxacin, 73 (70%) attended a follow-up visit . Seventy-three (100%) patients showed clinical cure and elimination of N . gonorrhoeae from the respective site of infection . Post-gonococcal urethritis or cervicitis believed to be due to concomitant chlamydial infection was found in 22 (30.1%) patients--18 males and four females . No adverse reactions were reported by any patient . Our findings show that a single oral dose of ciprofloxacin (250 mg) is well tolerated and effective in the treatment of uncomplicated gonorrhoea and is particularly useful in regions with a high prevalence of PPNG.

Int J STD AIDS, 1992 Nov-Dec, 3(6), 434 - 6
Prevalence of urogenital Chlamydia trachomatis infection in El Salvador . II . Gynaecology outpatients; Canas Posada AB et al.; The prevalence of urogenital infection caused by Chlamydia trachomatis was examined in 100 non-pregnant women with cervicitis, and 100 healthy women, in San Salvador City, El Salvador . Pharmacia Chlamydia EIA test was used for the detection of chlamydial antigen in urethral and cervical specimens from all the women . Direct immunofluorescence was used for confirmative tests on the EIA positive and the negative gray zone samples . C . trachomatis antigen was detected in 28% of the women with cervicitis compared with 5% in the group of healthy women (P < 0.001) . The cervicitis group were also screened for Neisseria gonorrhoeae which was isolated from 12% of them . One strain out of 12 was beta-lactamase producing (PPNG) . Five per cent of the women with cervicitis had simultaneous C . trachomatis and N . gonorrhoeae infections.

Int J STD AIDS, 1992 Nov-Dec, 3(6), 430 - 3
Gonorrhoea: signs, symptoms and serogroups; Horner PJ et al.; Over 19 weeks, 104 male patients attending a genitourinary medicine clinic with gonococcal urethritis were asked to complete a questionnaire detailing symptoms . Sixty-seven questionnaires were duly completed . The examining nurse documented signs . Ninety-one isolates of Neisseria gonorrhoeae were serogrouped and auxotyped, 55 of these were from patients who had completed a questionnaire . Patients presented earlier if they had a past history of gonorrhoea (p = 0.02) . The serogroup of N . gonorrhoeae did not influence the amount of discharge, the presence of meatal inflammation, dysuria or penile tip irritation or the delay in presentation after appearance of discharge . Auxotype AHU was not associated with asymptomatic gonorrhoea.

Int J STD AIDS, 1992 Nov-Dec, 3(6), 423 - 5
Urethritis due to Neisseria meningitidis in a London genitourinary medicine clinic population; Maini M et al.; A retrospective study was performed in a department of genitourinary medicine to determine the prevalence and clinical features of urethral and cervical infection with Neisseria meningitidis among patients being screened for sexually transmitted diseases . During the 28 month period of the study 11 isolates (from 10 patients) of N . meningitidis were identified from 5571 urethral cultures from homosexual men (0.2%) . This compares with an isolation rate of 4.7% for N . gonorrhoeae; 1.2% samples screened for chlamydial antigen were positive . There were no isolates from 8992 urethral cultures from heterosexual men or 15,976 cervical cultures . Eight of the cases identified had features of urethritis at diagnosis; 6 were diagnosed initially as non-specific urethritis (NSU) and 2 as gonorrhoea on the basis of microscopy of a urethral smear . Eight of the 10 patients were treated with amoxycillin and/or a tetracycline, and all but one had a clinical and microbiological cure . In the study population the prevalence of N . meningitidis infection was low and restricted to homosexual men; however, it may be associated with symptoms.

Diagn Microbiol Infect Dis, 1992 Nov-Dec, 15(8), 645 - 9
Evaluation of the Gen-Probe PACE II assay for the direct detection of Neisseria gonorrhoeae in endocervical specimens; Chapin-Robertson K et al.; Evaluation of a non-isotopic DNA-rRNA hybridization assay {Probe Assay-Chemiluminescence Enhanced System (PACE II, Gen-Probe, San Diego, CA)} for the direct detection of Neisseria gonorrhoeae from clinical specimens was compared with culture . Culture and probe tests were performed on 795 endocervical specimens . Results demonstrated that total positives by culture were 18 (2.3% of total); both culture and the DNA-rRNA assay agreed in all cases but four . The PACE II yielded four hybridization-positive results with negative companion cultures . The sensitivity, specificity, and positive and negative predictive values for PACE II were 100%, 99.5%, and 82%, and 100%, respectively . The four discrepant results were resolved using a competitive nucleic acid hybridization assay with recalculated sensitivity, specificity, and positive and negative predictive values of 100, 99.7, and 91.6 and 100%, respectively . Overall, the DNA-rRNA assay offered a number of advantages over culture . The assay was more rapid, able to be performed directly on clinical specimens, and provided superior transport stability.

Drugs, 1992 Nov, 44(5), 800 - 34
Cefodizime . A review of its antibacterial activity, pharmacokinetic properties and therapeutic use; Barradell LB et al.; Cefodizime is a third generation cephalosporin with a broad spectrum of antibacterial activity . Administered intravenously or intramuscularly, cefodizime 1 to 4 g daily for an average of 7 to 10 days produced clinical cure in 80 to 100% of patients (adults, elderly or children) with upper or lower respiratory tract infections or urinary tract infections, and in comparative trials cefodizime was as effective as other third generation cephalosporins . A single dose of cefodizime 1 or 2 g is also useful in treating lower urinary tract infections, particularly uncomplicated infections, with a rate of clinical success of 72 to 88% . Urogenital gonorrhoea, whether caused by beta-lactamase producing or non-beta-lactamase producing Neisseria gonorrhoeae, is very effectively treated by single dose therapy with intramuscular cefodizime 0.25 to 1 g (virtually 100% cured) . Preliminary data from a small number of patients indicate that cefodizime may also be useful in the treatment of otitis media, sinusitis and gynaecological infections, and for the prophylaxis or treatment of surgical infections . The clinical efficacy of cefodizime in comparison with other third generation cephalosporins is superior to that predicted from in vitro results . This superior activity of cefodizime may be related to the relatively long elimination half-life of the drug or its ability to modify some functions of the immune system--a potentially important finding awaiting further investigation . Cefodizime is well tolerated and has a tolerability profile similar to other members of its class with systemic adverse events being primarily gastrointestinal or dermatological . Thus, limited comparative studies indicate cefodizime has the potential to become a useful alternative to current antimicrobial therapy for the treatment of a variety of infections . Cefodizime may be more convenient to administer than some other agents of its class as it may be given once or twice daily . While there are no trials comparing cefodizime to other third generation cephalosporins in immunosuppressed populations, preliminary information indicates cefodizime may be useful in this group.

N Engl J Med, 1992 Oct 29, 327(18), 1272 - 8
A cohort study of the risk of cervical intraepithelial neoplasia grade 2 or 3 in relation to papillomavirus infection; Koutsky LA et al.; BACKGROUND . Human papillomavirus (HPV) has been associated with cervical intraepithelial neoplasia, but the temporal relation between the infection and the neoplasia remains unclear, as does the relative importance of the specific type of HPV, other sexually transmitted diseases, and other risk factors . METHODS . We studied prospectively a cohort of 241 women who presented for evaluation of sexually transmitted disease and had negative cervical cytologic tests . The women were followed every four months with cytologic and colposcopic examinations of the uterine cervix and tests for HPV DNA and other sexually transmitted diseases . RESULTS . Cervical intraepithelial neoplasia grade 2 or 3 was confirmed by biopsy in 28 women . On the basis of survival analysis, the cumulative incidence of cervical intraepithelial neoplasia at two years was 28 percent among women with a positive test for HPV and 3 percent among those without detectable HPV DNA . The risk was highest among those with HPV type 16 or 18 infection (adjusted relative risk as compared with that in women without HPV infection, 11; 95 percent confidence interval, 4.6 to 26; attributable risk, 52 percent) . All 24 cases of cervical intraepithelial neoplasia grade 2 or 3 among HPV-positive women were detected within 24 months after the first positive test for HPV . After adjustment for the presence of HPV infection, the development of cervical intraepithelial neoplasia was also associated with younger age at first intercourse, the presence of serum antibodies to Chlamydia trachomatis, the presence of serum antibodies to cytomegalovirus, and cervical infection with Neisseria gonorrhoeae . CONCLUSIONS . Cervical intraepithelial neoplasia is a common and apparently early manifestation of cervical infection by HPV, particularly types 16 and 18.

Ugeskr Laeger, 1992 Oct 26, 154(44), 3053 - 6
{Presence of genital Chlamydia trachomatis in abortion seekers--correlates with young age and nulliparity but not with previous genital infection}; Sorensen JL et al.; Out of 432 women applying for termination of pregnancy, 7.9% (34/428) had cervical Chlamydia trachomatis and 0.7% (3/431) genital Neisseria gonorrhoeae . The prevalence of Chlamydia was 19.2% among the women applying for termination who were under 20 years and 12.8% among those aged 21-25 years . The finding of Chlamydia among nulliparae was 14.5% . Only 2.8% of the women with Chlamydia had previously had pelvic infections . Women with Chlamydia did not have significantly greater frequency of previous venereal diseases . It is concluded that women under the age of 25 years and nulliparae who apply for termination of pregnancy should be examined for Chlamydia and should be treated in connection with the intervention . Previous pelvic infections are observed significantly more rarely in women with Chlamydia applying for termination and thus do not constitute an indication for examination for Chlamydia . It is not yet elucidated whether women with previous venereal diseases should be examined for Chlamydia . On account of the low prevalence, there are no indications for performing routine smears in women applying for termination of pregnancy for gonococci but, on the other hand it appears relevant to examine women with Chlamydia for gonococci as double infections are frequently present.

Ugeskr Laeger, 1992 Oct 26, 154(44), 3047 - 53
{Genital Chlamydia trachomatis infection in abortion seekers . Strategy of examination and treatment in order to reduce the sequelae of the infection}; Sorensen JL et al.; Among women applying for termination of pregnancy, 5-17% are infected with Chlamydia trachomatis . The prevalence is higher among women under 20 years of age (12-30%), in nulliparae and when Neisseria gonorrhoeae are found simultaneously . If women applying for termination of pregnancy with Chlamydia infection are not treated, 10-60% will develop pelvic infection after abortion . Salpingitis caused by Chlamydia runs a milder clinical course than salpingitis caused by gonococci or other etiology but salpingitis due to Chlamydia is regarded as one of the most important causes of tubal infertility and extrauterine pregnancy . The symptoms may be discharge and dysuria or objective findings such as cervicitis and pathological findings in wet smears of the cervical secretion . The majority of women applying for termination of pregnancy with Chlamydia infection have no symptoms . Only few investigations have analysed Chlamydia infection in connection with sexual behaviour and association between Chlamydia infection and the number of sexual partners has been demonstrated . Direct immune fluorescent microscopic examination or enzyme immune examination of material from the cervix and urethra may be employed in women applying for termination of pregnancy on account of the rapid results . Tetracyclines and erythromycin may be employed for treatment of demonstrated Chlamydia infection . Completion of treatment prior to abortion is probably not necessary . The sexual partners should be treated.

Curr Opin Obstet Gynecol, 1992 Oct, 4(5), 682 - 6
Pelvic inflammatory disease; McNeeley SG Jr; Pelvic inflammatory disease is a common serious complication of the sexually transmitted pathogens Neisseria gonorrhoeae and Chlamydia trachomatis . There are more than 800,000 cases of pelvic inflammatory disease annually accounting for approximately 200,000 hospital admissions for acute and chronic infections . Early accurate diagnosis and treatment are essential to prevent the serious sequelae including ectopic pregnancy, tubal disease infertility, chronic pain, and disability requiring multiple hospitalizations and surgery . Although clinical models to aid in the diagnosis and management of pelvic inflammatory disease have been developed by numerous investigators, all have lacked the sensitivity and specificity to be helpful to the clinician . Laparoscopy, considered by many to be the "gold standard" for diagnosis, is underutilized, and the definition of pelvic infection differs between investigators . Improved patient compliance and safety may be seen if single-agent therapy for acute pelvic inflammatory disease becomes a reality . In a small prospective randomized study, oral ofloxacin was as effective as cefoxitin plus doxycycline for outpatient treatment of chlamydial and gonococcal pelvic inflammatory disease . Treatment of tuboovarian abscess appears to be successful with single agent and combination therapy . Risk factors for developing postabortion endometritis continue to be identified, and the most efficacious prophylactic antibiotic regimen has not been determined to datePublication Types:

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