Prim Care, 1990 Dec, 17(4), 793 - 809 Upper respiratory tract infections; Rabinowitz HK; Upper respiratory tract infections are among the most common acute infections in humans . This review discusses the clinically important aspects of the epidemiology, etiology, clinical presentation, diagnosis, management, complications, and prevention of the common cold, pharyngitis, otitis media, and sinusitis . Most episodes of the common cold and pharyngitis are of viral origin, and curative therapy is not available . Streptococcal pharyngitis, acute otitis media, and sinusitis are secondary to bacterial infections, and antibiotic therapy is important. Nippon Kyobu Geka Gakkai Zasshi, 1990 Dec, 38(12), 2421 - 5 {A case of recanalization of LV-RA communication associated with tricuspid regurgitation complicating active endocarditis in chronic renal failure}; Hata H et al.; Open heart surgery (patch closure of the defect and tricuspid valvuloplasty with DeVega's annuloplasty) has been successfully performed on 35-year-old woman who has had a history of VSD closure and was undergoing hemodialysis . The patient has also been under treatment for active endocarditis due to streptococcal infection . Hemofiltration method was used during cardiopulmonary bypass . We describe our experience and discuss the management of the problems in this case. Pediatr Infect Dis J, 1990 Dec, 9(12), 886 - 9 Changes in the differential white blood cell count in screening for group B streptococcal sepsis; Greenberg DN et al.; We compared several previously defined scoring systems using white blood cell indices as part of a retrospective evaluation of infants with early onset Group B streptococcal (GBS) sepsis . Nineteen newborns were diagnosed with GBS sepsis between January, 1988, and April, 1990 . Case controls (n = 33) were selected from patients admitted to the Neonatal Intensive Care Unit for suspected sepsis . Complete blood counts obtained at admission and between 12 and 24 hours of age were reviewed . There was a significant change in the ratio of immature to total neutrophils in the GBS group over time . Scoring systems for neonatal sepsis by Manroe et al., Rodwell et al . and Spector et al . had poor sensitivity, specificity, positive predictive value and negative predictive value when initial white blood cell count criteria were used, but scoring systems by Manroe and Rodwell were 100% sensitive and had 100% negative predictive value when applied to the repeat white blood cell count . We conclude that a single early complete blood count may not be an adequate screening tool for early onset GBS sepsis and should not be used to rule out infection . Optimal screening for GBS sepsis requires a repeat complete blood count within the first 24 hours of age. Infect Dis Clin North Am, 1990 Dec, 4(4), 623 - 44 Bacterial meningitis in neonates and children; Saez-Llorens X et al.; A high index of suspicion of meningitis is needed when evaluating neonates and young infants because clinical findings can be minimal and are often subtle and nonspecific . Analysis of the CSF constitutes the most effective method to document meningeal bacterial infection, although overlap with normal CSF values can occur, especially in newborns and very young infants . The introduction of highly active third-generation cephalosporins (ceftriaxone, cefotaxime) and their safety and efficacy in treating a broad array of bacterial pathogens that cause meningitis in all age groups has simplified selection of initial antibiotic therapy . In neonates, however, conventional antibiotic therapy with ampicillin and an aminoglycoside is appropriate because of its proven record of safety and efficacy, and because routine use of cephalosporins in the hospital nursery could lead to selection of resistant strains among gram-negative enteric bacilli . Despite the availability of modern intensive care management of infants and children with bacterial meningitis and the advent of potent antibiotics, case fatality rates and morbidity remain high . Because of this, recent research has focused on the complex interaction between bacteria and the host and on means to attenuate the meningeal inflammatory response . The clinical benefits demonstrated recently with the use of dexamethasone therapy in infants and children with bacterial meningitis underscore the importance of anti-inflammatory therapy to reduce audiologic and neurologic sequelae . Future studies of new methods to modulate meningeal inflammation such as the use of monoclonal antibodies directed against cytokines or of agents that interfere with leukocyte-endothelial interactions are indicated . The implication of routine H . influenzae type b immunization in young infants with the conjugated vaccines and optimal intrapartum prophylaxis against group B streptococcal disease in newborns will have an important impact on the incidence of meningitis in infants and children. Am Surg, 1990 Dec, 56(12), 774 - 7 Partial splenic embolization . An effective alternative to splenectomy for hypersplenism; Shah R et al.; Splenectomy for massive splenomegaly and hypersplenism carries a significant morbidity and mortality . We have used partial splenic embolization (PSE) as an effective alternative to splenectomy . Ten PSE procedures were performed on nine patients without mortality and with minimal morbidity . The age of the patients ranged from 8 months to 32 years (mean 14 years) . The causes of splenomegaly and hypersplenism included cystic fibrosis with cirrhosis (2), tyrosinemia and cirrhosis (1); thalassemia (1), hemophilia with Human Immune Deficiency Virus infection (2), chronic hepatitis with portal hypertension (1), malignant histiocytosis (1), and Wiskott-Aldrich Syndrome (1) . All procedures were performed under local anesthesia with sedation . A percutaneous femoral artery approach to the splenic artery was used to deliver Ivalon sponge particles (280-800 microns) into the spleen . Splenic infarction was assessed by postembolization angiograms . All of the patients except one demonstrated improvement of hematologic parameters . In one patient, however, cytopenia improved only after a second embolization . In the total series, there was an early mean rise of 8,600/mm3 in the leukocyte count (range 2,900-14,900) and 212,000/mm3 in the platelet count (range 30,000-718,000) . Follow-up ranged from 4 months to 7 years . Improvement of the blood picture has been persistent in seven of the eight patients who showed initial improvement . Transient procedural complications included fever (5), pleural effusion (2), pneumonia (1), and splenic abscess (1) . One patient had paralytic ileus lasting for 10 days and one patient developed a streptococcal peritonitis 3 weeks after embolization . No patient developed pancreatitis or vascular compromise of other abdominal viscera.(ABSTRACT TRUNCATED AT 250 WORDS) Br J Rheumatol, 1990 Dec, 29(6), 468 - 70 Streptococcal antibody cross-reactivity with HLA-DR4+VE B-lymphocytes . Basis of the DR4 associated genetic predisposition to rheumatic fever and rheumatic heart disease? Rajapakse C, al Balla S, al-Dallan A, Halim K. B-lymphocytes obtained from patients with either rheumatic fever or rheumatic heart disease and from normal subjects were reacted with serum obtained from rabbits immunized with streptococcal cell wall antigen . The presence of cytotoxicity was sought using an inverted phase microscope after differential uptake of eosin dye . The serum was found to be significantly more cytotoxic to HLA-DR4 containing cells of both patients and normals compared with DR4 negative cells (P less than 0.0001). South Med J, 1990 Dec, 83(12), 1418 - 20 A resurgence of acute rheumatic fever in a mid-South children's hospital; Leggiadro RJ et al.; A resurgence of acute rheumatic fever (ARF) has been reported in many areas of the United States in recent years . We retrospectively reviewed the medical records of inpatients with a new diagnosis of ARF from 1982 through 1988 at a children's hospital that serves a six-state referral area in the mid-South . Thirty patients were identified, 21 of whom were seen in 1987 (13) and 1988 (8) . The rate of new cases of ARF per 1000 hospital discharges (0.7) was significantly greater for 1987 and 1988 than it was (0.15) from 1982 through 1986 . Patients with recently diagnosed ARF were predominantly from nonurban areas, and polyarthritis was the most common recent major manifestation . Reasons for the resurgence of ARF in the US, including the mid-South, are unclear, but our experience serves to support recently published guidelines for the diagnosis and management of streptococcal pharyngitis in light of this resurgence of ARF. Br J Haematol, 1990 Dec, 76 Suppl 2, 19 - 23 Teicoplanin in the treatment of gram-positive bacteraemia in neutropenic patients; Micozzi A et al.; The increasing incidence of bacteraemia caused by Gram-positive bacteria in neutropenic patients prompted the authors to evaluate, in a prospective trial, the role of teicoplanin in the treatment of this infection . Over a 15-month period, 76 cases of bacteraemia (out of 265 evaluable episodes of fever) were observed at the Division of Haematology, University La Sapienza, Rome . Of the 76 cases studied, 46 (60%) were caused by Gram-positive bacteria and 28 (37%) were caused by Gram-negative bacilli . All febrile episodes were treated randomly and empirically with piperacillin plus amikacin with or without teicoplanin . Overall, 41 (54%) of the 76 cases of bacteraemia responded to the initial antibiotic regimen; with subsequent modifications the response rate rose to 96% . In the treatment of Gram-positive bacteraemia, first-line administration of teicoplanin was found to be associated with early defervescence and with a significantly higher rate of success without modification of treatment (P less than 0.01) . Addition of teicoplanin as second-line therapy produced a favourable outcome in 12 (70%) out of 17 cases of bacteraemia unresponsive to the initial piperacillin + amikacin regimen . No cases of Gram-positive bacteraemia associated with septic shock or adult respiratory distress syndrome were observed in either treatment group . Only two late deaths were observed, and these occurred in patients with streptococcal septicaemia who were not receiving early teicoplanin . The above data do not endorse the use of glycopeptide antibiotics in the early treatment of fever in neutropenic patients: rather, these compounds should be reserved for proven or presumed Gram-positive infections which do not respond to initial beta-lactam/aminoglycoside treatment. J Pediatr, 1990 Dec, 117(6), 853 - 8 Lack of impact of early antibiotic therapy for streptococcal pharyngitis on recurrence rates; Gerber MA et al.; To determine whether recurrence rates for group A beta-hemolytic streptococcal (GABHS) pharyngitis are related to the time of initiation of antibiotic therapy, we randomly assigned 113 patients with GABHS pharyngitis either to a group that began a 10-day course of penicillin V at the time of diagnosis or to a group that began the same antibiotic regimen after a dealy of 48 hours . Follow-up throat culture specimens were obtained 4 days, 2 months, and 4 months after the completion of antibiotic therapy, as well as during any interim episodes of acute pharyngitis . Serotyping of all GABHS isolates was performed to distinguish between recurrences with homologous serotypes and new acquisitions with heterologous serotypes . There was no significant difference between the two treatment groups in age, gender, duration of illness before enrollment in the study, initial clinical presentation, or compliance . Of the 50 patients in the immediate-treatment group, 6 (12%) had homologous serotypes of GABHS isolated on one of the follow-up throat cultures . Of the 63 patients in the delayed-treatment group, 9 (14%) had homologous serotypes of GABHS isolated on one of the follow-up throat cultures . These data indicate that a 48-hour delay in the initiation of penicillin therapy for GABHS pharyngitis does not reduce the recurrence rate. Kansenshogaku Zasshi, 1990 Dec, 64(12), 1535 - 41 {Tonsillitis associated with Chlamydia trachomatis and antimicrobial therapy with rokitamycin}; Ogawa H et al.; Tonsillitis is the most common disease in the otorhinolaryngeal location . For most patients, tonsillitis is attributed to a group A streptococcal infection if the throat culture is positive for that organism or to a viral infection if the throat culture is negative . However, recent studies have shown that Chlamydia trachomatis can produce tonsillar infection . In this study, we evaluated the efficacy of Rokitamycin, a 16-membered ring macrolide antibiotic agent, in the treatment of tonsillitis associated with C . trachomatis . In 26 of 28 (92.9%) patients from whom C . trachomatis was isolated, the organism was eradicated by antimicrobial treatment with Rokitamycin of five days to three weeks' duration . In 25 of the 26 patients, they were totally free of tonsillar symptoms. J Immunol, 1990 Nov 15, 145(10), 3170 - 6 Activation of murine T cells by streptococcal pyrogenic exotoxin type A . Requirement for MHC class II molecules on accessory cells and identification of V beta elements in T cell receptor of toxin-reactive T cells; Imanishi K et al.; We investigated the mechanisms of murine T cell activation by streptococcal pyrogenic exotoxin type A (SPE A), focusing on the role of MHC class II molecules on accessory cells (AC) and V beta usage in alpha beta TCR of SPE A-reactive T cells in comparison with staphylococcal enterotoxin B-reactive T cells . L cells transfected with I-Ab genes functioned as effective AC for SPE A-induced responses by C57BL/6 T cells, proliferation, and IL-2 production, but control L cells were not effective AC . Anti-I-Ab mAb inhibited the SPE A-induced responses . Staphylococcal enterotoxin B-induced C57BL/6 T cell blasts were composed of cells bearing V beta 3, members of the V beta 8 family, and V beta 11 . Most of the SPE A-induced T cell blasts (about 80%) bore V beta 8.2 . mAb reactive to V beta 8.2 markedly inhibited SPE A-induced T cell responses . Apparently, SPE A activates mainly T cells bearing V beta 8.2 in physical association with MHC class II molecules expressed on AC . We also discuss the pathogenic activities of SPE A in relation to toxic shock syndrome. Lancet, 1990 Nov 10, 336(8724), 1167 - 71 Changing epidemiology of group A streptococcal infection in the USA; Schwartz B et al.; To see whether changes in the epidemiology of group A streptococcal disease in the USA have been accompanied by a corresponding change in serotype distribution, epidemiological and M-typing and T-typing data for 5193 strains sent to the Centers for Disease Control, Atlanta, between 1972 and 1988 were analysed . The proportions of M-types 1, 3, and 18 increased significantly during the study period . These M-types were more likely to be invasive, to cause fatal infection, and to occur in a cluster of infections than were other types . By contrast, the proportions of M-types 4 and 12 decreased; they were less invasive and were less likely to be found in clusters than were other types . These data suggest that changes in the epidemiology of group A streptococcal disease may be related to changes in the distribution of M-types causing infection. Monatsschr Kinderheilkd, 1990 Nov, 138(11), 730 - 4 {IgA nephritis: a frequent form of glomerulonephritis in childhood}; Lettgen B et al.; Since the introduction of immunohistological techniques in the evaluation of renal biopsies, IGA-nephropathy as first described by Berger in 1968 is diagnosed frequently . The diagnosis of IGA-nephropathy is based upon the demonstration of mesangial IGA deposits . IGA-nephropathy has to be differentiate from post-streptococcal glomerulonephritis, Schonlein-Henoch-nephritis and Lupus-nephritis . With increasing observation periods the prognosis has not been confirmed to be benign, as previously assumed . Every physician interested in paediatrics should be aware of this kind of nephritis, because early renal biopsy is essential for the diagnosis and the estimation of the degree of histological alteration . Furthermore renal biopsy is important for the decision for an aggressive immunosuppressive therapy and therefore for the prognosis. Klin Padiatr, 1990 Nov-Dec, 202(6), 379 - 82 {Listeriosis in newborn infants}; Hanssler L et al.; Listeriosis of the newborn is a relatively rare disease, presenting with clinical signs of septicemia . Early onset disease, resembling group B streptococcal septicemia, is already transmitted from the mother to the fetus and is associated with high morbidity and mortality . Late onset septicemia occurs as sporadic or as epidemic disease, usually beyond the fifth day of life . Epidemics can be caused by consumption of contaminated food or by nosocomial infections in neonatal units . Phage typing offers an opportunity to elucidate the route of transmission . During a 7 years period, 5 neonates ware diagnosed to have early onset, 1 newborn to have late onset Listeriosis . They all showed signs of bacterial septicemia with typical changes of white blood cell count, elevated CRP, hepatomegaly, and severe pneumonia . In all patients Listeria monocytogenes could be isolated from blood cultures . Serological tests were negative in all cases . 3 patients died . Nosocomial transmission of Listeria monocytogenes from one infant to another was proven by phage typing. Vojnosanit Pregl, 1990 Nov-Dec, 47(6), 426 - 8 {The significance of determination of streptococcal deoxyribonuclease B antibody titers}; Saric A et al.; Results obtained by testing 266 sera using antistreptolysin O (ASTO) and antideoxyribonuclease B (ADNB) tests were compared . Upper limit of the normal ADNB titer was determined for population by analysing titer levels in 258 samples taken from healthy subjects (blood donors) and it was 225 IU/ml . Increased titer of one or both antibodies was found in 76 (29%) sera-ASTO and (or ADNB-positive sera being the much larger number than the positive sera number obtained by ASTO test) 40-15% 7 . This confirms necessity of the ADNS test application in all patients with normal ASTO titer. Eur J Biochem, 1990 Oct 5, 193(1), 143 - 8 Species-dependent binding of serum albumins to the streptococcal receptor protein G; Nygren PA et al.; The interaction of the serum albumin binding domain from streptococcal protein G to serum albumins isolated from different species was investigated . The highest affinity to protein G was found for serum albumins from rat, man and mouse . A medium binding was found for serum albumin from rabbit, cow, hen and horse, while little or no binding was found for ovalbumin and serum albumin from sheep . The interaction between human serum albumin and protein G showed rapid binding kinetics at the temperatures 7, 22 and 37 degrees C . Furthermore, the ability of different serum albumins to function as affinity ligands when covalently coupled to a solid support was tested . The results show that protein G derivatives could be eluted at different pH depending on the origin of the serum albumin . It was also possible to elute the streptococcal receptor efficiently from the mouse serum albumin matrix with human serum albumin . Based on these results, a gene fusion system for recovery of sensitive proteins by affinity purification is described, where high yields are obtained under mild elution conditions. Am J Reprod Immunol, 1990 Oct, 24(2), 45 - 50 Danazol suppresses the production of interleukin-1 beta and tumor necrosis factor by human monocytes; Mori H et al.; The effects of estradiol (E2), progesterone (P), and danazol on the production of interleukin-1 beta (IL-1 beta) and tumor necrosis factor (TNF) by OK-432 (a streptococcal preparation)-stimulated monocytes were examined . E2 and P at physiologic concentrations enhanced IL-1 beta and TNF production by monocytes from donors with lower control levels (without steroids added) of IL-1 beta and TNF . However, E2 and P at physiologic concentrations did not affect IL-1 beta and TNF production by monocytes from donors with higher control levels of IL-1 beta and TNF . Danazol inhibited IL-1 beta and TNF production by monocytes in a dose-dependent manner from not only donors with lower control levels of IL-1 beta and TNF but also donors with higher control levels of IL-1 beta and TNF . Danazol at a concentration of 10(-6) M significantly suppressed IL-1 beta and TNF production in the presence of E2 and/or P at concentrations giving peak responses of IL-1 beta production . These findings suggest possible new mechanisms of action for danazol in the treatment of endometriosis and infertility associated with immune abnormalities. Mikrobiyol Bul, 1990 Oct, 24(4), 357 - 60 {Group B streptococcal endocarditis}; Akan O et al.; In this article, a case of group B streptococcal endocarditis in a diabetic patient, taking immunosuppressive therapy because of dermatomyositis is reported. FEMS Microbiol Lett, 1990 Oct, 60(1-2), 147 - 51 Plasmid transformation and replica filter plating of Acholeplasma laidlawii; Sundstrom TK et al.; The restriction deficient mutant 8195 of Acholeplasma laidlawii strain JA1 was transformed by the promiscuous streptococcal plasmid vector pNZ18 at a frequency of 4 x 10(-4)/cfu . The plasmid was maintained without structural rearrangements but was lost in the absence of a selection pressure, i.e . kanamycin or neomycin . Transformed primary colonies were easily recognized due to a different colony morphology . Replica filter plating, previously not obtained with mycoplasmas, was achieved using pNZ18 as a marker by incubating the replica filters with the cell side down on the new agar plates . These findings should greatly facilitate the genetic and functional analysis of A . laidlawii. Singapore Med J, 1990 Oct, 31(5), 451 - 3 Group G streptococcal endocarditis and bacteraemia--a report of 3 cases; Yap JC et al.; Three patients with Group G Streptococcal infection presenting with endocarditis and septicaemia are reported . All had underlying cardiac disease, and one had diabetes mellitus and a colonic carcinoma . Our three patients responded to intravenous crystalline penicillin. Clin Chem, 1990 Oct, 36(10), 1747 - 9 Colorimetric liposome lysis for assay of anti-streptolysin O antibody; Kubotsu K et al.; We developed an automated colorimetric assay based on liposome lysis for measurement of the titer of anti-streptolysin O antibodies (ASO) in human sera by using liposomes in which alkaline phosphatase (EC 3.1.3.1) was entrapped . The assay involved the inhibition by ASO of liposome lysis caused by streptolysin O . The procedure was fully automated for use with a routine clinical automated analyzer . The inter- and intra-assay precision showed that results were reproducible . Potential interfering substances such as bilirubin, hemoglobin, and triglycerides did not affect the results . With this assay, results correlated well with those by the Rantz-Randall method and the latex agglutination method (r = 0.900 and 0.890, respectively) . This automated colorimetric assay for ASO should be of use for diagnosing streptococcal infections. J Immunol Methods, 1990 Sep 14, 132(2), 165 - 72 An investigation of the T cell requirements of in vitro antibody forming B cells detected by the ELISPOT assay and a comparison with antibody synthesis; Fellowes R et al.; We have studied the primate cellular requirements in the antibody forming cell (AFC) assay, using a 185,000 molecular mass streptococcal antigen . Cultures of B cells alone stimulated with the antigen were unable to develop into AFC . Reconstitution of B cells with T cells resulted in a significant increase in the number of AFC . However, CD4 cells were more efficient than T cells in helping the antibody response and CD8 cells failed to induce B cells to synthesise antibody . A comparison between the specific IgG antibody synthesis and the number of AFC detected by the ELISPOT method showed a highly significant correlation between the number of AFC and the amount of specific IgG antibody . We suggest that the AFC (ELISPOT) assay can be readily used to investigate B cell interactions with T cell subsets. J Immunol, 1990 Sep 1, 145(5), 1395 - 9 Inhibition of type 1 diabetes in BB rats with recombinant human tumor necrosis factor-alpha; Satoh J et al.; We previously reported that streptococcal preparation (OK-432), which is a TNF inducer, inhibits insulitis and development of autoimmune diabetes in nonobese diabetic (NOD) mice and Bio-Breeding (BB) rats, as animal models of insulin-dependent diabetes mellitus . We have recently shown that recombinant human (h)TNF-alpha also suppresses development of diabetes in NOD mice . In this study we have extended our observation on TNF to BB rats in order to see whether TNF generally inhibits autoimmune diabetes . A total of 5 x 10(4) U of rhTNF-alpha was administered i.p., twice a week to male and female BB rats from 4 to 27 wk of age . The cumulative incidence of diabetes by 27 wk of age in nontreated rats was 36.4% (8/22), whereas that in hTNF-alpha-treated rats was 0% (0/21) (p less than 0.001) . The hTNF-alpha-treated rats did not lose body weight and maintained normal blood glucose concentrations . Immunologic and histologic examinations were performed at the end of the experiment . Spleen cell cytotoxicities for NK-sensitive YAC-1 and rat insulinoma (RINm5F) cells in hTNF-alpha-treated rats significantly decreased in comparison with nontreated and nondiabetic BB rats . Intensity of insulitis was also inhibited in hTNF-alpha-treated rats . Interestingly, a huge hepatomegaly and splenomegaly was found in two of the 21 hTNF-alpha-treated rats . The latter consisted of W3/13dull+ and W3/25dull+ cells, which did not exhibit cytotoxicity for either YAC-1 or RINm5F cells . These results indicate that the chronic and systemic administration of TNF has a regulatory role in autoimmune diabetes in BB rats as well as in NOD mice, and that these animals may have a defect in TNF-mediated immunoregulation. Zhonghua Min Guo Xiao Er Ke Yi Xue Hui Za Zhi, 1990 Sep-Oct, 31(5), 328 - 31 {Neonatal group B streptococcal pneumonia and right-sided diaphragmatic hernia: report of one case}; Chang YC et al.; The symptoms of right-sided diaphragmatic hernia (RDH) rarely occur in the newborn period . The present report described a two-day-old neonate who presented with symptoms of respiratory distress and sepsis . Early onset group B beta-hemolytic streptococcal (GBBS) infection was diagnosed and RDH was found subsequently . A defect with smooth margin, sized 3 x 5 cm, located in posterior-lateral aspect of right diaphragm was observed during operation . After having been given antibiotics and surgical treatment, the infant recovered and was discharged in good condition . He has normal development at the age of one year . Possible pathogenesis is discussed in this report. J Am Soc Echocardiogr, 1990 Sep-Oct, 3(5), 424 - 7 Streptococcal endocarditis temporally related to transesophageal echocardiography; Foster E et al.; A case of streptococcal sanguis endocarditis temporally related to a transesophageal echocardiogram is reported; and the literature on the incidence of bacteremia occurring during transesophageal echocardiography is reviewed . On the basis of this case and review of the literature, a reevaluation of the current guidelines for endocarditis prophylaxis during this procedure is recommended. Pediatr Nephrol, 1990 Sep, 4(5), 482 - 4 Acute glomerulonephritis--changing patterns in Singapore children; Yap HK et al.; This study compared the pattern of acute glomerulonephritis (AGN), a disease known to be influenced by socioeconomic and environmental factors, in children 12 years and under, for the years 1971 and 1985 . All children admitted to the four major paediatric departments with haematuria and at least two of the following (oedema, hypertension or oliguria) had an initial diagnosis of AGN . A sample population from one unit from 1980 to 1984 showed that over 70% of these children had evidence of a post-streptococcal aetiology . In 1971, 411 children were admitted with AGN, as compared with only 58 in 1985 . The age-sex-race standardized rates for 1971 and 1985 were 0.632 and 0.023/1,000 children 12 years and under, respectively (P less than 0.001) . The mean age of presentation was lower in 1971 . Over this period, Singapore saw a threefold rise in the gross national product, accompanied by rapid urbanization . On analysis of the housing pattern, only 31% of the children lived in high-rise apartments in 1971, in contrast with 86% in 1985 (P less than 0.001) . The majority of non-apartment dwellers had homes in rural districts . From an epidemiological perspective, factors which could have led to the highly significant decline in prevalence of AGN in Singapore children included improvement in the socioeconomic status and health care system, and urbanization of the country. J Am Acad Dermatol, 1990 Sep, 23(3 Pt 1), 503 - 7 Sweet's syndrome: a clinicopathologic review of twenty-nine cases; Kemmett D et al.; Twenty-nine patients with Sweet's syndrome were studied . Not all of Sweet's original criteria were necessarily present and diagnosis was dependent on the recognition of the typical, acute, tender, erythematous plaques and the characteristic histologic features of a neutrophilic infiltrate with leukocytoclasis . Women are affected much more frequently than men . The origin of Sweet's syndrome is still unclear, but an underlying disease was found in more than 50% of our cases . A streptococcal infection was evident in six cases, inflammatory bowel disease in three cases, malignancy in four cases, and pregnancy in two others . Treatment with oral prednisolone for an average of 6 weeks was the usual treatment, although in four patients the disease cleared spontaneously . Resolution of the eruption is occasionally followed by milia and scarring . Recurrences are common and affect up to one third of patients. J Infect Dis, 1990 Sep, 162(3), 672 - 7 Population-based risk factors for neonatal group B streptococcal disease: results of a cohort study in metropolitan Atlanta; Schuchat A et al.; To determine risk factors for neonatal group B streptococcal (GBS) disease, a cohort study was conducted in Atlanta of infants with invasive GBS disease during 1982 and 1983 . Laboratory review detected 71 infants with early-onset disease (1.09 cases/1000 live births) and 37 infants with late-onset disease (0.57 cases/1000 live births) . Compared with the 64,858 births in Atlanta in the same period, infants with early-onset GBS disease were more often black, less than 2500 g, and born to teenage mothers . A history of miscarriage increased a woman's risk of delivering an infant with early-onset disease . Black infants had 35 times the risk of late-onset disease that nonblack infants had . Thirty percent of early-onset disease and 92% of late-onset disease could be attributed to black race, independent of other risk factors . Most case-mothers (96%) received prenatal care, suggesting that prevention strategies such as prenatal screening or maternal immunization could reach nearly all the population at risk. J Immunol, 1990 Sep 1, 145(5), 1332 - 6 Accessory cell-independent stimulation of human T cells by streptococcal M protein superantigen; Kotb M et al.; Stimulation of T cells by superantigens has been reported to be dependent on the presence of APC where binding to class II molecules is a prerequisite to recognition by the TCR . We examined the response of human T cells and a leukemic T cell line, Jurkat to the superantigen, streptococcal M protein . We show that immobilized or cross-linked streptococcal M protein stimulates Jurkat cells (V beta 8), but not normal purified human T cells, to produce IL-2 . Activation of purified T cells by this superantigen required costimulatory signals provided by PMA, IL-1, and IL-6 . These cytokines and growth factors alone can induce IL-2 production by T cells; however, proliferation occurred only in the presence of superantigen, which together with PMA, IL-1, and IL-6 induced the expression of IL-2R alpha on T cells . Similar results were obtained when the response of purified T cells to another known superantigen, staphylococcal enterotoxin B were examined, indicating that this phenomenon is not unique to M protein . Superantigens interact with a large number of T cells with particular V beta, and thus provide excellent models for studies of the role of biochemical events and signal transduction in T cell activation . Understanding these events may also explain the pathogenesis of autoimmune diseases associated with certain superantigens, such as streptococcal M protein that is thought to be involved in rheumatic fever and rheumatic heart disease. Indian J Pediatr, 1990 Sep-Oct, 57(5), 693 - 700 Immunologic and immunogenetic studies in rheumatic fever and rheumatic heart disease; Reddy KS et al.; In order to evaluate all the important limbs of the immune system in the same patient population with rheumatic fever (RF) and rheumatic heart disease (RHD) cellular and humoral immune parameters as well as the immunogenetic profile in 265 North Indian patients with RHD were evaluated . They were studied for class in HLA antigens and 165 of them were also evaluated for the class II (DR locus) antigen profile . Data obtained was compared with 400 and 134 healthy controls respectively of the same ethnicity . Humoral immune parameters (Serum immunoglobulins IgG, IgA; Serum complement fractions C3, C4, C3d; circulating immune complexes and B lymphocyte numbers) and cellular immune parameters (total leucocyte and lymphocyte counts; T lymphocyte sub-populations--CD4, CD8 counts; lymphocyte migration inhibition to an extracellular streptococcal antigen, streptolysin 'O') were studied in 23 patients with RF, 21 patients with "inactive" RHD and 20 normal controls . Patients of RHD were noted to have an increased frequency of DR3 (P less than 0.001; Relative risk = 2.3) and a decreased frequency of DR2 (P less than 0.001; Relative risk = 0.3) as compared to the controls . Patients of RF had evidence of an altered regulatory T cell function (increased CD4/CD8 ratio) and decreased cell mediated immunity to streptolysin 'O' . An increased humoral immune response (increased B cell counts, elevated serum IgG, circulating immune complexes and C3d) was noted in patients of RF as well as "inactive" RHD . An integrated pathogenetic model with immune response associated antigens of the DR locus influencing selection of cardiac cross-reactive antigens by the antigen processing macrophages, an altered regulatory T cell function with decreased suppressor T cell activity leading to an abnormal immune response is proposed to explain the pathogenesis of RF. Pediatr Med Chir, 1990 Sep-Oct, 12(5), 433 - 40 {Rheumatic fever}; Gerloni V et al.; While rheumatic fever (RF) remains a major problem in underdeveloped countries, in continental United States and Western Europe the incidence of this disease declined markedly in the sixties and reached a nadir during the seventies . However in the last eighties a resurgence of RF has been documented in some areas of the United States with an eightfold increase of incidence over the prior 15 year average . Although a true outbreak of RF has not been documented in Italy, a trend towards an increased number of new cases per year has been observed at the Centre for Rheumatic Children at the Gaetano Pini Institute in Milan . Most of these children presented a mild disease with clinical features rather different from those described in classical textbooks . Most of them satisfied the revised Jones' criteria, in some cases the objective signs of arthritis could not be noticed, but the joint involvement presented as marked arthralgia while other features supported the diagnosis of RF . Rheumatic carditis was observed in more than 1/3 of cases with a high rate of residual valvular heart disease of a mild degree of severity in most cases . In conclusion RF has not completely disappeared in Italy and remains as a possible cause of permanent valvular heart damage in children . It is possible that the increasing morbidity observed in the last eighties may be related to the reduced primary prophylaxis against streptococcal infections due to the wrong conviction that RF is no more a risk in developed countries. J Dairy Res, 1990 Aug, 57(3), 307 - 18 The effect of udder preparation before milking and contamination from the milking plant on bacterial numbers in bulk milk of eight dairy herds; McKinnon CH et al.; The effect of teat washing and drying on bacterial numbers in bulk milk was compared with that of no teat preparation in eight commercial herds over one year . Using in-line milk samplers, milk was collected at various points during its passage through the milking plant and the samples were used to establish the relative significance of the sources of contamination of raw milk . Teat washing and drying of cows housed during winter reduced the total counts by 40% and streptococcal and coliform counts by 50% . Bacterial counts were significantly lower in cows at pasture during the summer and there was no reduction in count due to teat washing and drying . Bacteriological counts increased at each stage as the milk passed through the milking machine . The milking equipment significantly increased the total colony count by between 2000 and 3000/ml, and the bulk tank added a further 1500 to 2000/ml . The mean rinse bacterial counts of the milking equipment were higher in summer than winter, averaging 4.4 X 10(7) bacteria/m2 compared with 3.5 X 10(7)/m2 respectively . Although this level of bacterial contamination of the equipment is high by current standards, very low bulk milk bacterial counts were nevertheless achieved, particularly in the summer . This confirms that organisms from this source are not a major contaminant of the bulk milk . There was a very poor correlation between rinse counts and the bulk milk bacterial count, but a strong correlation (0.98) between total and streptococcal counts of the bulk milk . The unreliability of the use of rinse techniques to assess the contribution of milking equipment to bacterial counts of raw milk is emphasized. Cancer Res, 1990 Aug 1, 50(15), 4630 - 4 Mechanism of tumoricidal activity of OK-432-specific L3T4+ Lyt2- T-cells; Ozaki S et al.; OK-432, a streptococcal preparation, has been used in the treatment of malignant diseases . We have found that OK-432 can act as an antigen and have established an OK-432-specific L3T4+ Lyt2- T-cell line (OK2) and a clone (OK2.21) from OK-432-immunized BALB/c mice (Iad) as antitumor effector cells . OK2 proliferated and secreted interleukin 2, but only when OK-432 was presented by Iad-positive antigen-presenting cells . Despite its helper phenotype and function, OK2 could kill OK-432-pulsed Iad-positive B-lymphoma cells . This killing was inhibited only by cold specific target cells (cold-target inhibition) . OK-432 induced the cytotoxicity of OK2 as a specific antigen, not as a nonspecific immunostimulator . OK2 and OK2.21 also killed Ia-negative bystander target cells only in the presence of OK-432-pulsed Iad-positive cells (bystander killing) . Double-chamber experiments suggested that the bystander killing was mediated by a short-acting soluble cytolytic factor . Finally, the OK-432-specific T-cells selectively killed tumor cells, suggesting that these T-cells play an important role in the immune surveillance against malignancy. Arch Intern Med, 1990 Aug, 150(8), 1696 - 700 Effects of a rapid antigen test for group A streptococcal pharyngitis on physician prescribing and antibiotic costs; Meier FA et al.; Decision analysis and opinion survey suggest that introduction of rapid antigen detection tests should decrease the number of patients with negative test results for group A streptococcal pharyngitis treated by antibiotics . We reviewed all cases in which a test for group A streptococcal pharyngitis was performed during the last 7 months of culture diagnosis and the first 7 months of antigen test diagnosis at an inner city community health center, recording culture or antigen test results, whether antibiotics were prescribed, and patient status (as regular health center patients or patients referred to the center) . Positive rates for culture and antigen-test periods were similar (10% and 12%), but 53% of patients with negative culture were treated, where only 32% of patients with negative antigen-test results received prescriptions . Significant reductions in the treatment of patients with negative test results were found in both patient-status subpopulations: health center patients, 43% to 29%; referred patients, 91% to 52% . Among health center patients reductions were consistent for both adult (30% to 21%) and child and adolescent (55% to 45%) age groups . For all patients with negative test results, direct costs of diagnostic reagents and antibiotic prescriptions fell from $3.58 per patient with culture to $3.45 with antigen testing; the $0.13 savings per patient was due to less treatment of referred patients . Thus, rapid antigen testing led to (1) significantly fewer patients with negative test results receiving antibiotic prescriptions; and, (2) savings in antibiotic costs offsetting reagent cost of antigen detection diagnosis. J Bacteriol, 1990 Aug, 172(8), 4536 - 42 Nucleotide sequence of the streptococcal pyrogenic exotoxin type B gene and relationship between the toxin and the streptococcal proteinase precursor; Hauser AR et al.; The streptococcal pyrogenic exotoxin (SPE) type B-encoding structural gene, speB, was subcloned from a 4.5-kilobase streptococcal DNA insert onto a 2.4-kilobase insert, which was then sequenced . Studies indicated that a 1,194-base-pair open reading frame encoded a 398-amino-acid protein . Removal of the putative signal peptide resulted in a mature protein with 371 residues (molecular weight, 40,314), which was subsequently proteolyzed to yield a 253-residue breakdown product (molecular weight, 27,588) . This processing was confirmed by amino-terminal sequencing of both the 40,314-molecular-weight protein and the breakdown product . Monte Carlo analysis indicated that SPE B was relatively dissimilar to other members of the pyrogenic toxin family that also includes SPEs A and C, toxic shock syndrome toxin 1, and the staphylococcal enterotoxins . Comparison with the published amino acid sequence of streptococcal proteinase precursor as well as DNA hybridization experiments indicated that SPE B is a variant of this protein even though the particular gene sequenced did not encode a proteolytically active molecule. Proc Natl Acad Sci U S A, 1990 Aug, 87(15), 5608 - 12 Cytologic assessment of nuclear and cytoplasmic O-linked N-acetylglucosamine distribution by using anti-streptococcal monoclonal antibodies; Turner JR et al.; Recent studies have demonstrated the existence of single O-linked N-acetylglucosamine (O-GlcNAc) residues on cytoplasmic and nuclear glycoproteins . Labeled lectin and enzymatic techniques have been used to identify O-GlcNAc-bearing proteins, but no antibodies generally reactive with such O-linked GlcNAc moieties have been described . We have previously characterized monoclonal antibodies (mAbs) specific for the GlcNAc residues of streptococcal group A carbohydrate, which is composed of a polyrhamnose backbone with GlcNAc side chains . We now report that these mAbs recognize O-GlcNAc-bearing proteins . By immunofluorescence, the mAbs reacted strongly with the nuclear periphery and nucleoplasm of mammalian cells and stained the cytoplasm less intensely . The distribution was not consistent with labeling of the endoplasmic reticulum, Golgi complex, or plasma membrane . Furthermore, the staining pattern of a mutant cell line, which retains terminal GlcNAc residues on many N-linked glycans, was indistinguishable from that of wild-type cells . Nuclear and cytoplasmic staining were inhibited by free GlcNAc and were completely abolished by galactosylation of terminal GlcNAc residues . Indirect ELISA demonstrated GlcNAc- and galactosylation-inhibitable binding of the mAbs to a 65-kDa human erythrocyte cytosolic protein known to contain O-GlcNAc . Thus, these mAbs react with O-GlcNAc without apparent influence of peptide determinants, do not show detectable binding to N- or O-glycans, and, therefore, represent a valuable tool for the study of O-GlcNAc moieties . In addition, these mAbs provide the first cytologic analysis of the distribution of O-GlcNAc residues throughout the nucleus and the cytoplasm of mammalian cells. J Immunol, 1990 Aug 1, 145(3), 915 - 24 Idiotope structure and genetic diversity in anti-streptococcal group A carbohydrate antibodies; Phillips NJ et al.; Three cross-reactive idiotopes(Id), termed IdX, IdI-1, and Id5, that are present on free L chains from murine anti-group A streptococcal carbohydrate antibodies have been mapped; these Id distinguish between products of three homologous V kappa genes . For each determinant, sequence analysis of anti-streptococcal group A carbohydrate antibody V domains yielded small numbers of amino acids invariably associated with Id expression . Flow micro-fluorimetry was used to isolate three IdI-1- spontaneous mutants of the IdI-1+ hybridoma GAC 39; all had single amino acid changes in the L chain at position 60 and 77, all retained other Id, and all bound group A carbohydrate . Computer modeling was used to examine spatial relationships between Id . A number of the conserved Id5 and IdX residues cluster in the L chain framework region 1 around the first back loop connecting strands of the beta pleated sheets, and overlap at residue 15 (Id5, proline; IdX, leucine) . This overlap accords with the mutually exclusive expression of Id5 and IdX . The IdI-1 loss variants have mutations of residues 60 or 77 on adjacent back loops, approximately 7.5 and 14 A from residue 15 . Competitive inhibition of anti-IdX and anti-IdI-1 binding to antibodies expressing both Id can be attributed to steric hindrance . The framework back loops may be favored sites for cross-reactive Id expressed by products of a single V region gene . IdI-3a, an individual Id not associated with use of a particular gene segment, has been localized in part to residue 31 (hypervariable region 1) of the H chain. Am J Epidemiol, 1990 Aug, 132(2), 336 - 42 Serum sickness in children after antibiotic exposure: estimates of occurrence and morbidity in a health maintenance organization population; Heckbert SR et al.; The computerized outpatient records of the Harvard Community Health Plan, a 230,000-member health maintenance organization, were used to determine the frequency with which serum sickness is recognized in the practice setting after exposure to antibiotics . The medical records of 3,487 children who had been prescribed cefaclor or amoxicillin were searched in December 1986 for coded diagnoses of serum sickness and related conditions . Diagnoses were validated by blinded review of dictated and written office notes . There were 12 cases of serum sickness in 11,523 child-years . During this time, these children were prescribed 13,487 courses of amoxicillin, 5,597 courses of trimethoprim-sulfamethoxazole (TMP-SMZ), 3,553 courses of cefaclor, and 2,325 courses of penicillin V . Serum sickness was considered to be antibiotic-related if it occurred within 20 days of initiation of antibiotic therapy . Five cases were temporally associated with cefaclor, one with both amoxicillin and TMP-SMZ, four with TMP-SMZ alone, and one with penicillin V alone . One case was not associated with any antibiotic exposure . All antibiotic-related cases occurred in children under age 6 years who were treated for otitis media or streptococcal pharyngitis, and most cases began 7-11 days after initiation of antibiotic . All but one of the antibiotic-related cases occurred in children who had relatively heavy lifetime antibiotic exposure . The risk of serum sickness was significantly elevated after cefaclor compared with amoxicillin, even among the most heavily exposed children (relative risk = 14.8, p = 0.01, 95% confidence interval 2.0-352.0) . Most cases prompted several physician visits, but none required hospitalization. Zh Mikrobiol Epidemiol Immunobiol, 1990 Aug, (8), 9 - 11 {The detection of streptococcal cell-wall proteins that form complexes with human macroglobulins}; Zorin NA et al.; The composition of the extracts of the cultures of individual streptococcal strains, studied by immunoblotting techniques, has been shown to contain proteins with a molecular weight of 70-80 KD . These proteins have pronounced affinity to human macroglobulins: alpha-macroglobulin, alpha-glycoprotein associated with pregnancy and protein A . The significance of this phenomenon on the cellular and somatic levels is discussed. Clin Exp Immunol, 1990 Aug, 81(2), 286 - 92 Evidence that the Fc region of autologous rabbit IgG isolated before and after hyperimmunization is structurally different: recognition by rheumatoid factor and monoclonal antibodies; Murray JS et al.; Autologous hyperimmune (HI) and pre-inoculation (PI) rabbit Fc gamma populations were found to be conformationally different by spectroscopic measurements, and antigenically different by measurements which examined rheumatoid factor (RF) and monoclonal antibody (MoAb) binding specificity for both populations in ELISA . Circular dichroism spectra of HI rabbit Fc gamma (prepared from animals after hyperimmunization with streptococcal vaccine) were both qualitatively and quantitatively different, particularly in the 225-228 nm range, in comparison to both homologous normal and autologous PI Fc gamma . Binding studies in ELISA showed that affinity constants obtained for reactions of both rabbit RF and various murine MoAb with HI IgG and Fc were approximately 10-fold higher relative to those observed for PI IgG and Fc . Enzymatic deglycosylation of HI and PI Fc gamma led to elimination of CD spectral differences . Further, association constants obtained for RF and MoAb reactions with deglycosylated (sialic acid and galactose removed) PI Fc gamma were equivalent to those obtained in the presence of untreated HI Fc gamma . Together, these results suggest the complex oligosaccharide structure of rabbit IgG may play a significant role in the expression of Fc gamma determinants, and alteration of this structure under hyperimmune or other conditions may be related to induction of an RF response. Dev Med Child Neurol, 1990 Jul, 32(7), 642 - 4 A possible post-streptococcal movement disorder with chorea and tics; Kerbeshian J et al.; A 14-year-old girl developed a movement disorder after a streptococcal infection . In the acute phase of the illness she exhibited simple and complex motor tics and chorea, but all abnormal movements ceased over the following eight months, without recurrence . This case raises questions about the relationship between tics, chorea and auto-immune reactivity. J Immunol, 1990 Jul 1, 145(1), 353 - 60 Expression of the human MHC, HLA-DQW6 genes alters the immune response in C57BL/6 mice; Nishimura Y et al.; In an attempt to obtain direct evidence for the critical role of HLA class II molecules in regulating the immune response, genomic genes for alpha- and beta-chains of HLA-DQw6 from HLA-Dw12 haplotype were introduced into the C57BL/6 (B6) strain of mouse and a line of HLA-DQw6 transgenic mouse was obtained . Tissue specificity of the expression of the transgenes was much the same as that of murine I-Ab genes . DQw6 molecules were expressed on B cells and macrophages in spleen cells and about 30 to 40% of the I-Ab+ spleen cells were positive for DQw6 . The HLA-DQw6 transgenic B6 mouse became tolerant to the DQw6 molecules, as evidenced by the MLR and antibody production specific to the DQw6 molecules . The HLA-DQw6 transgenic B6 mouse showed a strong immune response to streptococcal cell wall antigen (SCW), whereas the B6 mouse was a low responder to SCW . The SCW-specific T cell line was established from the transgenic mouse and this T cell line recognized SCW in the context of HLA-DQw6 molecules expressed on the mouse L cell transfectant or on human monocytes . The proliferative response to SCW of primed lymph node T cells and the SCW-specific T cell line derived from the transgenic mice was inhibited by anti-HLA-DQ mAb . Thus, it is clear that the HLA-DQw6 genes acted as major histocompatibility genes in these transgenic mice. Zh Mikrobiol Epidemiol Immunobiol, 1990 Jul, (7), 37 - 43 {An explosive outbreak of respiratory streptococcal infection with a droplet transmission mechanism}; Zhukov VV et al.; The data obtained in the study of an explosive outbreak of acute respiratory diseases, tonsillitis and scarlet fever in one of schools in Moscow have made it possible to exclude the alimentary mechanism of its development and to demonstrate the role of the droplet mechanism of transmission in the appearance of its outbreak . The epidemiological analysis of the outbreak has permitted the formulation of the hypothesis on the conditions of the formation and spread of the epidemic variant of the infective agent; this hypothesis corresponds to the available data in literature on the qualitative changes of the infective agent in the course of the epidemic process . The study has shown that the prophylaxis of the explosive outbreaks of respiratory streptococcal infections must be ensured by the system of epidemiological surveillance with timely intervention into the epidemiological process at its early stages. J Dairy Sci, 1990 Jul, 73(7), 1756 - 61 Bacterial counts associated with recycled newspaper bedding; Hogan JS et al.; Bacterial counts associated with recycled newspaper, wood shavings, and pelleted corn cobs used as bedding for lactating dairy cows were compared . Chopped newspaper and pelleted corn cobs had similar gram-negative bacterial, coliform, and streptococcal bedding counts . Staphylococcal counts in pelleted corn cobs were greater than in chopped newspaper . Conversely, gram-negative bacterial, coliform, and staphylococcal counts in chopped newspaper were greater than in wood shavings . Coliform and streptococcal counts did not differ between chopped newspaper and wood shavings bedding materials . Teat swab counts from cows bedded on pelleted corn cobs were greater than those from cows bedded on chopped newspaper for gram-negative bacterial, coliform, Klebsiella species, and staphylococci . Streptococcal teat swab counts did not differ between cows bedded on chopped newspaper and pelleted corn cobs . Cows bedded on chopped newspaper and wood shavings had similar gram-negative bacterial, coliform, and Klebsiella species teat swab counts . Streptococcal and staphylococcal teat swab counts were greater from cows bedded on chopped newspaper than those from cows bedded on wood shavings . Teat swab and bedding counts were correlated . In general, bacterial counts in bedding suggest no advantage in using chopped newspaper over pelleted corn cobs or wood shavings in reducing exposure of teats to environmental mastitis pathogens. Eur J Immunol, 1990 Jul, 20(7), 1513 - 7 Ontogeny of the humoral response to group A streptococcal carbohydrate: class and IgG subclass composition of antibodies in children; Morell A et al.; We determined isotypes of natural antibodies to streptococcal group A carbohydrate (A-CHO) in sera from 101 children between 1 and 16 years of age, using a calibrated enzyme-linked immunosorbent assay system . Anti-A-CHO IgM could be detected in all but one sera . Median levels increased with age and were highest between 8 and 12 years . IgG antibodies were present at low concentrations up to the age of 4 years, and consisted predominantly of the IgG1 subclass . Between 4 and 8 years, concentrations of anti-A-CHO IgG markedly increased and median levels continued to increase through age 12-16 . Anti-A-CHO IgG1 levels closely followed the pattern of IgG antibody concentrations . The number of IgG2 antibody positive sera was low in young children, as expected . In the 8-12 year age group and later, anti-A-CHO IgG2 was present in more than half of the samples, and in children between 12 and 16, medians of IgG2 and IgG1 antibodies were similar . Sera containing anti-A-CHO IgG3 were rare in children up to 4 years of age, but in the group of 4-8-year-old children, this subclass was detectable in 36% and later in up to 77% of the sera . Thus, the IgG response to A-CHO showed a clear maturation during childhood, involving the subclasses IgG1, IgG2 and IgG3 . There were no significant differences in A-CHO levels between boys and girls. Eur J Obstet Gynecol Reprod Biol, 1990 Jul-Aug, 36(1-2), 59 - 67 Chorioamnionitis in relation to gestational outcome in a Swedish population; Nordenvall M et al.; In a histopathological study, from a homogeneous Swedish population with a better than average socio-economic standard, placentas from 161 singleton infants small for gestational age (SGA) and 322 singleton infants appropriate for gestational age (AGA) were examined for the presence of inflammation in the placental parenchymal membranes, cord and decidua . Acute chorioamnionitis including funiculitis was found in 13.4% of the total material, in 17% of term AGA-infants (GA, greater than or equal to 38 weeks), in 13% of preterm AGA-infants (less than or equal to 37 weeks) and in 6.8% of SGA-infants (p less than 0.001, compared to term AGA) . Acute chorioamnionitis was correlated to vaginal delivery (p less than 0.01), rupture of the membranes greater than 24 hours (p less than 0.01), nulliparity (p less than 0.05) and amniocentesis (RR = 1.7) . In nulliparous, chorioamnionitis was related to duration of labor greater than 16 hours (p less than 0.01) . Streptococcal (p less than 0.01) and anaerobic vaginal infections (p less than 0.05) were also related to chorioamnionitis . Of 17 infants with sepsis, 6 had chorioamnionitis (p less than 0.05) . Decidual inflammation was chronic in type and found in 4.5% of the placentas and was not related to chorioamnionitis, but to parity (p less than 0.05) and term AGA-infants (p less than 0.001). Zhonghua Kou Qiang Yi Xue Za Zhi, 1990 Jul, 25(4), 213 - 5, 252 {Sapylin immunotherapy in oral squamous cancer}; Lu CY; A streptococcal preparation, Sapylin, was employed for 27 cases of oral squamous cancer without treatment that was injected into normal submucosa or sub-skin around the tumor . The recent clinical efficacy is as follows: 3 cases specially effective, 10 cases marked effective, 6 cases effective and 8 cases not effective . Effective percent 70% . A delayed SK-SD skin reaction were found to enhance, but NK activity and T-Rosette were not . A middle grade fever was present as a side effect of this preparation . The result suggested Sapylin that may be a useful to biological response modifier (BRM) agent for oral squamous cancer. Am J Vet Res, 1990 Jul, 51(7), 1026 - 31 Methods for detection of immune-mediated neutropenia in horses, using antineutrophil serum of rabbit origin; Jain NC et al.; Equine neutrophil antibody was raised in rabbits inoculated with equine neutrophils isolated to purity greater than 99.0%, using Percoll density-gradient sedimentation . Neutrophil antibody was detected by use of agar gel diffusion, leukoagglutination, indirect immunofluorescence, staphylococcal protein A and streptococcal protein G binding, and phagocytic inhibition techniques . Precipitin lines and leukoagglutination were seen in antiserum dilutions of 1:4 and 1:64, respectively . The specific nature of leukoagglutination was characterized by the formation of rosette-like clumps of neutrophils . Specific bright membranous fluorescence was seen in neutrophils treated with the antiserum and exposed to fluorescein-conjugated goat anti-rabbit immunoglobulin, and staphylococcal protein A and streptococcal protein G . Whereas the indirect immunofluorescence and protein G-binding tests were equally sensitive and resulted in titer of 1:256, the protein A-binding test was less sensitive and resulted in titer of only 1:32 . Nonspecific binding of protein A and protein G was noticed as uniform or patchy cellular fluorescence in a small number of neutrophils . Treatment of neutrophils with antiserum up to dilution of 1:8 resulted in a significant (P less than 0.05) suppression of phagocytosis of opsonized zymosan particles . Thus, protein G-binding and indirect immunofluorescence tests are highly sensitive to detect neutrophil antibody and may be used to diagnose immune-mediated neutropenias in horses and, possibly, in other animal species. Am J Med Sci, 1990 Jul, 300(1), 29 - 32 Dimethylthiourea reverses sepsis-induced pulmonary hypertension in piglets; Shook LA et al.; Dimethylthiourea (DMTU), a putative hydroxyl radical scavenger, attenuates thromboxane generation and pulmonary hypertension in the piglet model of group B streptococcal (GBS) sepsis . This study tested the hypothesis that DMTU reverses ongoing GBS-induced pulmonary hypertension coincident with decreased thromboxane production . Piglets (n = 15) received a 60 min infusion of GBS (10(-8) cfu/kg/min) . Mean pulmonary artery pressure (Ppa), arterial blood gases (ABGs), and thromboxane B2 (TXB) levels were measured at 10 min intervals throughout the study . GBS infusion resulted in a marked increase in pulmonary artery pressure (mean delta Ppa = 31 mm Hg) and a significant decline in PaO2 (mean = -80 torr) within 10 min of beginning the infusion . pH decreased from a mean of 7.47 to 7.37 . DMTU, 750 mg/kg, or normal saline vehicle was infused over 10-15 min beginning 10 min after initiating GBS . Ppa decreased significantly within 10 min of DMTU infusion . Piglets receiving vehicle had a slow decline in Ppa . Piglets receiving DMTU also had an improvement in PaO2 and showed no further drop in pH . Piglets receiving vehicle had no improvement in PaO2 and demonstrated a continued decline in pH . TXB levels did not differ between the groups at any time interval . We conclude that DMTU can partially reverse GBS-induced pulmonary hypertension, but may function through mechanisms independent of thromboxane generation. J Gastroenterol Hepatol, 1990 Jul-Aug, 5(4), 395 - 401 Protective effect of OK-432 (streptococcal preparation) on murine fulminant hepatitis following mouse hepatitis virus infection; Shirai M et al.; The effects of OK-432 (streptococcal preparation) on murine fulminant hepatitis were investigated . Hepatitis was induced by injection of mouse hepatitis virus type 2 (MHV-2) at a strength of either 1 x 10(3) or 1 x 10(4) plaque-forming units (PFU) . Mice without OK-432 treatment died within 5 days, whereas mice preinoculated with OK-432 showed survival rates of 50% (1 x 10(3) PFU) or 10% (1 x 10(4) PFU) after 60 days . Survival time was not prolonged if OK-432 was injected after MHV-2 . Examined histologically, mice not treated with OK-432 showed severe haemorrhagic necrosis of the liver, often panlobular . Treated mice showed less necrosis; the least necrosis was observed in those injected with OK-432 before MHV-3 . In those mice injected first with OK-432 and then with 1 x 10(3) PFU of MHV-2 that survived 7 days, autopsy showed a very slight and focal hepatic necrosis, with follicular infiltration by lymphocytes and macrophages . Mitogenic reaction of spleen cells was remarkably less than normal in mice with MHV-2 injection . However, mice injected with OK-432 before MHV-2 (same treatment as mice showing high survival rates) showed relatively high reactivity in comparison with mice not treated with OK-432. Z Naturforsch {C}, 1990 Jul-Aug, 45(7-8), 873 - 80 Hyaluronic acid-like substance from mouse ovaries with angiogenic activity; Sato E et al.; Glycosaminoglycans prepared from extracts of non-luteal mouse ovaries (JCL-ICR strain) were assayed for neovascularization by implanting Elvax films, impregnated with test samples, on the lateral wall of the sheath of m . rectus abdominis in adult mice of the same strain . Neovascularization occurred in a dose-dependent manner . When purified by chromatography on Dowex 1-x2 and DEAE Sephadex columns, fractions eluted with 0.5 M NaCl showed strong neovascularizing activity . On further purification by high performance liquid chromatography using TSK gel DEAE 2 SW column, the fraction with a retention time nearly coincident with that of hyaluronic acid possessed high neovascularizing activity . The activity of this fraction was markedly reduced when treated with streptococcal hyaluronidase . The present results suggest that glycosaminoglycans, especially a hyaluronic acid-like substance, are involved in ovarian neovascularization. Zentralbl Bakteriol, 1990 Jun, 273(2), 173 - 8 Typing of Actinomyces pyogenes by its production and susceptibility to bacteriocin-like inhibitors; Lammler C; A scheme for "fingerprinting" of Actinomyces pyogenes strains based on their production of (P-typing) and the sensitivity to (S-typing) bacteriocin-like substances has been developed . P-typing and S-typing of 42 A . pyogenes cultures with a set of 9 micrococcal and staphylococcal species as indicator strains and 9 streptococcal species as bacteriocin producer strains revealed 10 P types and 7 S types, respectively . The bacteriocin "fingerprinting" procedure might provide a means for subdividing A . pyogenes and may find application in epidemiological studies. Pediatr Dermatol, 1990 Jun, 7(2), 97 - 100 Perianal streptococcal dermatitis; Krol AL; Eight patients were treated for perianal streptococcal dermatitis . The condition previously was described as perianal cellulitis, a term that is confusing in light of the clinical features and distinctive appearance of the disorder. J Pediatr, 1990 Jun, 116(6), 882 - 7 Acute rheumatic fever in New York City (1969 to 1988): a comparative study of two decades; Griffiths SP et al.; One hundred fifteen attacks of acute rheumatic fever were observed during the past two decades (1969 to 1988) at the Columbia-Presbyterian Medical Center; 104 were initial attacks and 11 were recurrences . The maximum number of cases (18) occurred during the first year of this period, 1969; thereafter the annual incidence decreased until a resurgence was apparent in 1985 to 1986, with 25 cases . There were no differences in the frequency of major manifestations nor the severity of carditis in the 1970s compared with the 1980s . Polyarthritis alone was present in 51 cases, carditis alone in 31, and combined carditis and polyarthritis in 28; chorea was diagnosed in 5 . Congestive heart failure occurred in 17 attacks of carditis, including one death from fulminant disease in 1982 . In contrast to recent reports, the majority of the affected population was urban, low income, and from crowded communities: more than half were Hispanic, predominantly from Dominican Republic families . The prevalence of acute rheumatic fever underscores the need for early detection and treatment of streptococcal pharyngitis . The observation that 9.5% of the attacks were recurrent reflects failure to comply with antimicrobial prophylaxis and reaffirms the need for more effective secondary prevention programs. J Mol Cell Cardiol, 1990 Jun, 22(6), 645 - 51 Role of oxygen free radicals generated by blood monocytes and neutrophils in the pathogenesis of rheumatic fever and rheumatic heart disease; Kumar V et al.; The generation of oxygen free radicals by peripheral blood monocytes and neutrophils of patients with rheumatic fever and rheumatic heart disease has been studied using luminol enhanced chemiluminescence technique . Five groups of patients; acute rheumatic fever, recurrence of rheumatic activity, chronic rheumatic heart disease, acute pharyngitis and normal controls were studied . In all groups except the controls, measurements were made on 0, 15, 90 and 180 days . The chemiluminescence was measured in response to streptococcal membrane antigen, carbohydrate antigen and latex as triggering agents . Chemiluminescent response of monocytes, as well as, neutrophils was significantly higher (P less than 0.01) in acute rheumatic fever and recurrence of rheumatic heart disease as compared to patients with acute pharyngitis and chronic rheumatic heart disease through the study period and with all the triggering agents . A significant decline (P less than 0.001) in chemiluminescence was observed from day 0 to day 180 in the acute rheumatic fever, recurrence of rheumatic heart disease and pharyngitis patients while no such change, was observed in the chronic rheumatic heart disease group . This study raises the possibility that these phagocytic cells, which infiltrate the myocardium, may have a role in the pathogenesis of cardiac disease seen in patients with rheumatic heart disease, through the generation of oxygen free radicals. Nippon Jinzo Gakkai Shi, 1990 Jun, 32(6), 631 - 41 {Monoclonal antibody analysis of glomerular, tubulo-interstitial infiltrating immune cells in various glomerulonephritis}; Oda T et al.; To investigate the role of cell-mediated immunity (CMI) in glomerulonephritis (GN), we identified the infiltrating immune cells both within the glomerulus and in the interstitium . Frozen sections from 103 patients with various forms of GN: 10 with minor glomerular abnormality (MGA) as control, 10 with minimal change nephrotic syndrome (MCNS), 10 with membranous nephropathy (MN), 9 with focal glomerulosclerosis (FGS), 30 with IgA nephropathy (IgAN), 22 with acute post streptococcal glomerulonephritis (APSGN), and 2 with rapidly progressive glomerulonephritis (RPGN) were examined using monoclonal antibodies (MoAb) by indirect immunoalkaline-phosphatase labelling . In most glomerulonephritis, monocyte/M phi and helper/inducer T cells were predominantly infiltrating in the interstitium, but intraglomerular infiltration was rare, except for APSGN . This interstitial infiltration increased proportionally to the level of serum creatinine, and was most prominent in RPGN . Apparently different distribution was seen in APSGN, that is, prominent increase in total number of intra-glomerular monocyte/M phi infiltration with slightly increased T cells . The change was correlated with time after onset; namely the more leucocytic infiltration was observed when the tissue was taken earlier . These data suggest that in APSGN, monocyte/M phi accumulate in glomeruli via cell mediated immunity in addition to humoral immune mechanism resulting in glomerular hypercellularity, whereas in most chronic glomerulonephritis interstitial leucocyte infiltration, particularly helper T cells and monocyte/M phi may play an important role in the progression of glomerulonephritis. Mol Immunol, 1990 Jun, 27(6), 523 - 31 Protein H--a novel IgG binding bacterial protein; Akesson P et al.; Forty-eight group A streptococcal strains of different M types were screened for binding of human radiolabeled IgG . Three of the strains bound more than 80% of the added radioactivity and one of them, an M protein type 1 strain designated AP1, was selected for further analysis . Attempts were made to solubilize the IgG binding bacterial molecule, and small amounts of an IgG binding protein with a mol . wt of 40 kDa could be solubilized with mutanolysin, a muramolytic agent . The gene encoding this streptococcal protein was cloned and expressed in E . coli, and the E . coli-produced protein was purified in a single step by affinity chromatography on IgG-Sepharose . When tested with IgGs from different species, the molecule was found to bind human IgG almost exclusively . The N-terminal amino acid sequence was determined and showed no homology with previously isolated Ig binding proteins, and the name protein H (as in human IgG) is suggested for this novel Ig binding bacterial protein . Protein H showed preferential affinity for heavy chains and Fc fragments of human IgG, and did not bind Ig light chains . The affinity constant, determined by Scatchard plots, between protein H and human polyclonal IgG was 1.6 x 10(9) . No binding was observed between protein H and IgM, IgA, IgD, or IgE . Finally, when tested against several additional proteins and human plasma, protein H only showed weak binding to alpha 2-macroglobulin, a proteinase inhibitor. Pediatr Emerg Care, 1990 Jun, 6(2), 93 - 5 Latex agglutination for the rapid diagnosis of streptococcal pharyngitis: use by house staff in a pediatric emergency service; Tunik MG et al.; A rapid latex agglutination (LA) method was evaluated in 2401 consecutive pediatric patients presenting to an emergency service with suspected group A beta-hemolytic streptococcal pharyngitis . LA tests were performed by the treating physicians, who were not blinded to the clinical condition of the children and who made therapeutic decisions based on the results of the tests . When compared with anaerobic culture, the LA method had a sensitivity of 91%, a specificity of 82%, and a positive predictive value of 43% . There was a marked seasonal variation in the positive predictive value: 62% in winter and 16% in summer . However, even in peak streptococcal pharyngitis season (January to March), basing therapy on a positive LA test leads to the unnecessary treatment of a large number of patients . Therefore, we cannot recommend the routine performance of this test by all practitioners in all clinical settings. FEMS Microbiol Lett, 1990 Jun 1, 57(3), 201 - 4 Effect of streptococcal pyrogenic exotoxin on rabbit macrophage functions in vitro: mediation by splenic lymphocytes; Murai T et al.; Streptococcal pyrogenic exotoxin (SPE) showed no direct effect on rabbit macrophage functions in vitro . However, when splenic lymphocytes were added to macrophage cultures, SPE caused marked augmentation of glucose consumption and superoxide anion production, and concomitant inhibition of phagocytosis without loss of cell viability . The SPE effects were demonstrated to be mediated by a soluble factor(s) released from the splenic lymphocytes in response to SPE stimulus. Med J Malaysia, 1990 Jun, 45(2), 123 - 30 Acute glomerulonephritis in Kelantan--a prospective study; D'Cruz F et al.; A prospective study of acute nephritis in children was conducted at the Universiti Sains Malaysia Hospital, Kubang Kerian between July 1987 and June 1988 . One hundred and twenty four children were admitted with acute glomerulonephritis . The aim of the study was to determine the clinical pattern of the nephritis as well as its aetiology . The majority of our patients came from the lower socio-economic group and 54% of the families had incomes below the poverty line . Preceding skin infection was much more common than throat infection . The children showed a high incidence of complications: severe hypertension (43.6%), hypertensive encephalopathy (11.3%), clinical pulmonary oedema (36.3%), severe azotaemia (10.5%), and prolonged gross haematuria (13.7%) . By using immunologic indices such as ASOT, anti-DNase B and complement 3, it was concluded that 121 of the 124 patients had post-streptococcal nephritis. Nippon Gan Chiryo Gakkai Shi, 1990 May 20, 25(5), 1027 - 31 {Intraperitoneal administration of OK-432 and rIL-2 in a case of peritonitis carcinomatosa with chronic renal failure}; Kanaoka Y et al.; Recombinant interleukin-2 (rIL-2) was administered intraperitoneally for 15 days, 2 days after intraperitoneal administration of Streptococcal preparation OK-432 to a patient of peritonitis carcinomatosa occurred eight months after second look operation, in which residual tumor could not be removed completely . The patient had been maintained by hemodialysis three times a week for over ten years . Combination chemotherapy using CDDP and Ifosfamide, or CDDP and THP-Adriamycin had not been effective to control rapidly increasing ascites . Negative cytological exam, was achieved on day 7 and ascites disappeared by day 15 . No severe side effects including fluid retention were observed . Fever up was controllable by Indomethacin . Flow cytometric analysis revealed dominant (73%) CD4+, CD29+ helper inducer subset, while CD4+, CD45RA+ was 6%, in the lymphocytes in ascites on day 8 . It was suggested that intraperitoneal administration of rIL-2 after OK-432 was safe and effective for peritonitis carcinomatosa with chronic renal failure. J Mol Biol, 1990 May 20, 213(2), 247 - 62 Initiation of replication of plasmid pLS1 . The initiator protein RepB acts on two distant DNA regions; de la Campa AG et al.; The broad host range streptococcal plasmid pLS1 encodes the 24.2 kDa protein RepB, which is involved in the initiation of plasmid replication by an asymmetric rolling circle . RepB was overproduced in an Escherichia coli expression system and the protein was purified and characterized . Determination of the amino-terminal sequence of RepB protein showed that translation starts from the first AUG codon, which is preceded by an atypical ribosome-binding site sequence . RepB protein has in vitro-specific endonuclease and topoisomerase-like activities on the plasmid ori(+) . Footprinting experiments showed that RepB protein binds to a DNA region that includes three direct repeats of 11 base-pairs . Initiation of replication of pLS1 could start by a RepB-generated specific nick introduced on the plasmid coding strand . However, as a striking difference with other Gram-positive replicons, the nick generated by RepB lies 86 base-pairs upstream from its binding region . To explain the action of RepB at a distance, complex structures of the pLS1 ori(+) are proposed. Biol Chem Hoppe Seyler, 1990 May, 371 Suppl, 137 - 44 Synthesis of cysteine proteinase inhibitors structurally based on the proteinase interacting N-terminal region of human cystatin C; Grubb A et al.; Peptides spanning the entire, or part of, the Gly4-Glu21 segment of the human cysteine proteinase inhibitor cystatin C have been synthesized . Peptides containing residues on the N-terminal side of Gly11 were rapidly cleaved by papain at the bond Gly11-Gly12 whereas a peptide starting at residue Gly11 was not, thus demonstrating 1 . that the N-terminal segment of cystatin C has an amino acid sequence that would allow rapid interaction between this segment and the substrate pocket of papain and, if this interaction takes place, that 2 . the cystatin C residue Gly11 would be in the P1 position, and 3 . the major interaction would be between residues Arg8-Val10 and the papain substrate pocket subsites S4, S3 and S2, respectively . Several modified peptide derivatives containing either diazomethane groups or peptide bond isosters were synthesized based on the structure of the Leu9-Gly11 segment of cystatin C and tested for their cysteine proteinase inhibiting capacity . The peptidyl derivatives, t-butyloxycarbonyl-valyl-glycyl-diazomethane and benzyloxycarbonyl-leucyl-valyl-glycyl-diazomethane irreversible inhibited the cysteine proteinases papain, bovine cathepsin B and streptococcal proteinase, but did not influence the activity of serine, aspartic or metallo-proteinases. Jpn J Surg, 1990 May, 20(3), 316 - 26 Anti-tumor effects of the oral administration of the streptococcal preparation OK-432 (PICIBANIL)--the inhibition of carcinogenesis and growth in rats with ENNG-induced gastrointestinal tumors; Takeshita M et al.; We examined whether the Streptococcal preparation OK-432, an immunopotentiating agent, increases immunocompetence of the gut-associated lymphoid system (GALS), inhibits gastrointestinal carcinogenesis, and has an anti-tumor effect . 14C-labelled OK-432 was orally and intraperitoneally administered to rats, and the distribution of the agent in various organs then serially evaluated . The concentration of OK-432 in Peyer's patches and mesenteric lymph nodes was higher after oral administration than after intraperitoneal administration, and showed a biphasic pattern peaking at 30 minutes and 5 hours following administration, in the Peyer's patches . With regard to immunocompetence, PHA- and PWM-stimulated blastogenesis of lymphocytes derived from the mesenteric lymph nodes and peripheral blood enhanced, and the helper/suppressor T-cell ratio was elevated after the oral administration of OK-432 . Moreover, chemotactic activity of peritoneal macrophages was also increased . ENNG-induced gastrointestinal carcinogenesis was observed in 60 per cent of the rats orally administered OK-432 as compared with 88 per cent of the controls . The 13-month survival rate of the rats with gastrointestinal cancer was 50 per cent in those administered OK-432 as compared with 25 per cent in those administered OK-432 as compared with 25 per cent in the controls . When administered orally, the agent prevented reduction in immuno-competence in the course of carcinogenesis, suppressed carcinogenesis, and prolonged the survival of animals with cancer without any of the side effects associated with injection . The oral administration of OK-432 is thus considered to be an effective non-specific immunotherapy against gastro-intestinal malignancies. Clin Orthop, 1990 May, (254), 247 - 50 Streptococcal toxic shocklike syndrome leading to bilateral lower extremity compartment syndrome and renal failure . Report of a case; Knezevich S et al.; Compartment syndrome is considered a true emergency in orthopedic practice . To reduce morbidity and mortality from this condition, prompt diagnosis and appropriate treatment are absolutely essential . An unusual bilateral lower extremity compartment syndrome leading to renal failure and crush syndrome occurred in a 13-year-old girl with Streptococcal toxic shocklike syndrome . This situation seems not to have been previously reported . Early diagnosis and expeditious treatment produced minimal sequelae of the condition. Zhonghua Min Guo Xiao Er Ke Yi Xue Hui Za Zhi, 1990 May-Jun, 31(3), 151 - 7 Rapid diagnosis of streptococcal pharyngitis with enzyme immunoassay; Chu JM et al.; From June 1988 to May 1989, 444 throat swab specimens were tested with an enzyme immunoassay kit for rapid diagnosis of group A streptococcal pharyngitis . The results were compared with those of throat culture method . The rapid test was positive in 37 of 42 culture-positive specimens and negative in 379 of 402 culture-negative specimens, thus yielding a total agreement of 93.7%, sensitivity 88.1%, specificity 94.7%, positive predictive value 61.7%, negative predictive value 98.7% . According to this practical application, we suggest that enzyme immunoassay test can be applied in outpatient clinics by busy pediatricians for rapid diagnosis of group A streptococcal pharyngitis. Zhonghua Min Guo Xiao Er Ke Yi Xue Hui Za Zhi, 1990 May-Jun, 31(3), 144 - 50 Reevaluation of streptococcal infection in the pathogenesis of Kawasaki disease; Shen CT et al.; Twenty-five sera from forty-nine children with Kawasaki disease (KD) in the convalescent stage, and 191 sera from controls did not disclose a higher anti-streptolysin O titer; 23 bacterial cultures from the throat swab of KD patients during the acute stage did not show a higher rate of streptococcal isolation . It was therefore concluded that there was no relation between the genesis of KD and direct immediate streptococcal infection. J Med Assoc Thai, 1990 May, 73(5), 269 - 73 Cutaneous leukocytoclastic vasculitis: clinical and laboratory features of 45 patients seen in Ramathibodi Hospital; Puavilai S et al.; Forty-five patients with histologically proved cutaneous leukocytoclastic vasculitis were studied with regard to the clinical features, laboratory findings and etiology . There were 12 males and 33 females, with an age range of 13 to 64 years . The most common skin lesions were palpable purpura which appeared mostly on the lower part of the legs . Renal involvement was the most common systemic manifestation, which occurred in 45 per cent of the patients . Abdominal pain occurred in 42 per cent of the male patients while none of the female patients had this symptom . Arthralgia occurred in 20 per cent of the patients . The most common laboratory abnormalities were elevation of ESR, which was significantly more common in females than in males (P = 0.047) . The possible etiology of leukocytoclastic vasculitis was identified in 5 patients, these included streptococcal infection in 2 patients, in the other patients the possible causes were penicillin hypersensitivity, systemic lupus erythematosus and livedoid vasculitis, respectively. Rev Infect Dis, 1990 May-Jun, 12 Suppl 4, S476 - 82 Potential use of intravenous immune globulin for group B streptococcal infection; Baker CJ et al.; Several lines of evidence suggest that passive immunization as adjunctive therapy for or prevention of group B streptococcal (GBS) sepsis in neonates will require the use of preparations of human intravenous immune globulin (IVIG) that are hyperimmune for protective antibodies to GBS . Results from both in vitro and in vivo experiments utilizing commercially available IVIG preparations suggest that the doses necessary for achieving levels of pathogen-specific antibody capable of promoting efficient opsonization and phagocytosis of GBS may be prohibitive . Several laboratories have reported that standard IVIG preparations contain only modest levels of antibodies to the four capsular polysaccharides of GBS (the protective moieties), are variable in their effect on in vitro opsonophagocytosis by dose and method of preparation, and are significantly less protective in animal models than is IVIG prepared from adults immunized with GBS polysaccharide vaccines . Further, when we gave a single infusion of standard IVIG at a dose of either 500 or 750 mg/kg to 10 premature neonates during the first week of life, opsonophagocytosis of type III GBS by their sera and adult neutrophils was observed only when high levels of specific antibody were achieved, levels only transiently achieved in nonimmune infants . Commercial preparation of human immune globulin hyperimmune for GBS will be required for optimal adjunctive therapy in patients with sepsis due to GBS and for the possible prevention of late-onset infant disease. Rev Infect Dis, 1990 May-Jun, 12(3), 537 - 42 Varied presentations of sporadic group A streptococcal bacteremia: clinical experience and attempt at classification; Dan M et al.; The epidemiologic, clinical, and laboratory aspects of group A streptococcal bacteremia were studied in 33 patients seen at two urban hospitals in the Tel Aviv (Israel) area, over an 8-year period . Most patients (two-thirds) were female . Clinically significant bacteremia was observed in 26 patients, two of whom acquired their infection (puerperal sepsis) during hospitalization . A portal of entry, mainly cutaneous, was recognized in 61% of the patients, and a chronic underlying condition was observed in 69% . The case-fatality rate was 27%, with death occurring predominantly in patients admitted with shock or cryptogenic bacteremia . Our clinical experience and literature review show that the presentation of group A streptococcal bacteremia is diverse, with transient bacteremia of uncertain clinical significance on one end of the spectrum and overwhelming sepsis on the other . A practical classification of the various clinical forms of group A streptococcal bacteremia is proposed. Infect Immun, 1990 May, 58(5), 1217 - 22 Protein L, a bacterial immunoglobulin-binding protein and possible virulence determinant; Kastern W et al.; Protein L, an immunoglobulin kappa light chain-binding protein, is expressed on the surfaces of certain strains of Peptostreptococcus magnus . Thirty strains of P . magnus were isolated from clinical specimens, and four of them were found to express protein L . Among the 30 strains, 7 were isolated from the vaginas of patients with bacterial vaginosis, and the 4 immunoglobulin-binding strains all belonged to this group, results demonstrating that expression of protein L is correlated to peptostreptococcal virulence (P less than 0.001 in the chi-square test) and indicating that the molecule could be a virulence determinant . Similar amounts of protein L were expressed by the four strains, and when protein L was isolated from three of them and analyzed in Western blots, the same immunoglobulin-binding patterns were obtained . The N-terminal amino acid sequences of tryptic fragments of protein L were determined, and on the basis of these sequence data, oligonucleotides were synthesized and used to screen a genomic library of peptostreptococcal DNA in the lambda ZAP vector . The nucleotide sequence was determined for one of the clones detected in this way . In dot blots and Southern blots of peptostreptococcal DNA, another synthetic oligonucleotide probe based on this sequence showed no hybridization with DNA samples from the nonexpressing strains, whereas similar Southern blot patterns were seen when DNA samples from protein L-expressing strains were analyzed . These results suggest that the protein L gene is missing rather than being down regulated in protein L-negative strains of P . magnus . Finally, the probe did not hybridize with DNA purified from immunoglobulin-binding streptococcal and staphylococcal strains or with Escherichia coli DNA, suggesting that the protein L gene is unique to protein L-expressing strains of P . magnus. Nippon Shokakibyo Gakkai Zasshi, 1990 Apr, 87(4), 1020 - 7 {Effect of peri-operatively administrated OK-432 on immunopotency in primary liver cancer--immunological and histological study in cases receiving intrahepatic arterial administration}; Taniwaki S; OK-432 purified from streptococcal preparations was administrated via either hepatic artery or peripheral vein to the patients with primary liver cancer to prevent the decrease of immunopotency in the peri-operative periods . In "OK-432 administration" group, the immunological parameters such Su-PS skin reactions, number of lymphocytes, NK activity, and Leu 11 positive cells of peripheral blood showed more increased levels than those in "untreated" group . Histologically, the resected specimens showed varying degrees of lymphocyte infiltration throughout the cancerous tissue in five out of nine patients who received OK-432 via hepatic artery . In patients received OK-432 via the hepatic artery which was feeding cancer lesion, there were formation of lymph follicles in the cancerous tissues and destruction of the cancer nests by infiltrating lymphocytes . Together with the immunological and histological findings, the intraarterial administration of OK-432 seemed to be useful as a multidisciplinary treatment. Am J Pathol, 1990 Apr, 136(4), 909 - 21 Sequential events in the pathogenesis of streptococcal cell wall-induced arthritis and their modulation by bis(5-amidino-2-benzimidazolyl)methane (BABIM); Geratz JD et al.; This report builds on the authors' earlier discovery of bis(5-amidino-2-benzimidazolyl)methane (BABIM) as a strong suppressive agent for streptococcal cell wall fragment-induced arthritis in the Lewis rat . As a synthetic inhibitor of trypsinlike proteases, BABIM opens up a new route to the control of inflammatory joint disease . To gain a deeper insight into the function of the compound, the authors have now studied its influence on the sequential development of the joint changes and the associated lesions in spleen and liver . Bis(5-amidino-2-benzimidazolyl)methane is shown to block acute synovitis, to retard and reduce granuloma formation in spleen and liver, to decrease neutrophilic leukocytosis, and to diminish hemopoietic hyperplasia in the bone, and thus also to mitigate the distinctive osteoclastic and chondroclastic events . The compound does not interfere with the splenic immune response, the temporary rise in hepatocytic mitotic activity, or the organ deposition of streptococcal cell walls. Eur J Clin Microbiol Infect Dis, 1990 Apr, 9(4), 276 - 8 Incidence of early onset group B streptococcal septicemia in Sweden 1973 to 1985; Sjoberg I et al.; A retrospective investigation was made to determine the incidence of early onset group B streptococcal (GBS) septicemia in Sweden in relation to perinatal data . During the period 1973-1985 the yearly incidence of GBS septicemia increased from 0.1 to around 0.5 cases per 1,000 live births . In 416 cases verified by blood culture, the overall mortality was 15% 62/416) . In babies with a birth weight of greater than 2,500 g this figure was 9.6% (29/303) . In babies with a birth weight of less than 2,500 g the mortality was 29.2% (33/113) . Males had a worse prognosis than females and were also more often affected . Thirty-six percent of the verified cases were premature, the gestational age being 36 weeks or less . An increased incidence among twins was also noted. Infect Immun, 1990 Apr, 58(4), 854 - 9 Immunogenicity and antigenicity in rabbits of a repeated sequence of Plasmodium falciparum antigen Pf155/RESA fused to two immunoglobulin G-binding domains of staphylococcal protein A; Sjolander A et al.; A synthetic gene encoding a tetramer of the repeated subunit EENVEHDA of the Plasmodium falciparum antigen Pf155/RESA was expressed in a dual-expression system . The resulting fusion proteins, designated ZZ-M1 and BB-M1, comprised the EENVEHDA repeats and either two immunoglobulin G-binding domains from staphylococcal protein A or the human serum albumin-binding domains from streptococcal protein G, respectively . The soluble fusion proteins were affinity purified to homogeneity in one-step procedures . ZZ-M1 was used for immunization of rabbits . The rabbit antisera reacted with BB-M1 in an enzyme-linked immunosorbent assay and with Pf155/RESA in immunofluorescence of infected erythrocytes and immunoblotting . Inhibition studies revealed that the antibodies mainly recognized epitopes formed by two or more EENVEHDA subunits and were remarkably specific for Pf155/RESA . Importantly, the antibodies also inhibited P . falciparum merozoite reinvasion in vitro efficiently, indicating that they reacted with biologically important epitopes exposed on the native antigen . Immunization with Freund complete adjuvant resulted in high levels of specific immunoglobulin G antibodies over a 1-year period, whereas the antibody response obtained after immunization without adjuvant was generally weaker, immunoglobulin G and M mediated, and not sustained for longer periods . However, these titers were restored after booster injection . Taken together, the results support the usefulness of recombinant gene constructs of this type as immunogens for malaria vaccines. Clin Immunol Immunopathol, 1990 Apr, 55(1), 120 - 8 T lymphocyte subsets, suppressor and contrasuppressor cell functions, and production of interleukin-2 in the peripheral blood of rheumatic fever patients and their apparently healthy siblings; Alarcon-Riquelme ME et al.; We studied CD4 and CD8 T cell subsets, suppressor cell function, production of IL-2, and immune contrasuppressor cell activity in 21 patients with rheumatic fever (RF), both at the time of their first acute episode and 3 months later (recovery phase) . As controls we studied their healthy sibling nearest in age, as well as age- and sex-matched unrelated normal subjects . In the acute phase we found CD4+ T cells to be high, concanavalin A-induced suppression to be low, and production of IL-2 to be significantly decreased, as compared to the normal unrelated controls . The addition of contrasuppressor cells (VV+) to cell cocultures resulted in an increase in proliferation by mononuclear cells (MNC) in response to streptococcal M antigen but not to C carbohydrate antigen . In the recovery phase, CD4+ T cells became normal, CD8+ T cells rose above normal, and the suppressor cell functions (concanavalin-A-induced and spontaneously expanded), as well as the production of IL-2, fell further . Siblings were found to have increased CD8+ T cells and decreased production of IL-2, as compared to the unrelated controls . These findings indicate that important immunoregulatory disturbances occur during the acute phase of rheumatic fever, some of which persist, accentuate, or change during the recovery phase . The findings in siblings could be related either to streptococcal infection or to a familial immunoregulatory aberration. Rev Med Chir Soc Med Nat Iasi, 1990 Apr-Jun, 94(2), 351 - 2 {The present-day epidemiological process in streptococcal infection}; Oana C et al.; The changes in the epidemiological process of streptococcal infection in various periods are presented . From the great epidemics, extremely severe and with multi-annual evolution reported in the past, the last decades are characterized by a permanent decrease in incidence of scarlet fever and a progressive increase of streptococcal anginas . These aspects required a more careful surveillance of the agglomeration at epidemiological risk and an estimation of the late complications frequency . The role of some factors in making scarlet fever a benign affection with a diminished epidemic character, in lowering the incidence of streptococcal infections and of their complications, among which the social-economic conditions, the standardized treatment with Penicillin G and oral penicillin, the contacts' prophylaxis with oral penicillin is underlined . In conclusion it is mentioned that, as part of primary care, the surveillance--detection, isolation, adequate treatment should be improved. J Cell Biol, 1990 Apr, 110(4), 1417 - 26 Detection of high levels of heparin binding growth factor-1 (acidic fibroblast growth factor) in inflammatory arthritic joints; Sano H et al.; The synovium from patients with rheumatoid arthritis (RA) and LEW/N rats with streptococcal cell wall (SCW) arthritis, an experimental model resembling RA, is characterized by massive proliferation of synovial connective tissues and invasive destruction of periarticular bone and cartilage . Since heparin binding growth factor (HBGF)-1, the precursor of acidic fibroblast growth factor (FGF), is a potent angiogenic polypeptide and mitogen for mesenchymal cells, we sought evidence that it was involved in the synovial pathology of RA and SCW arthritis . HBGF-1 mRNA was detected in RA synovium using the polymerase chain reaction technique, and its product was immunolocalized intracellularly in both RA and osteoarthritis (OA) synovium . HBGF-1 staining was more extensive and intense in synovium of RA patients than OA and correlated with the extent and intensity of synovial mononuclear cell infiltration . HBGF-1 staining also correlated with c-Fos protein staining . In SCW arthritis, HBGF-1 immunostaining was noted in bone marrow, bone, cartilage, synovium, ligamentous and tendinous structures, as well as various dermal structures and developed early in both T-cell competent and incompetent rats . Persistent high level immunostaining of HBGF-1 was only noted in T-cell competent rats like the disease process in general . These observations implicate HBGF-1 in a multitude of biological functions in inflammatory joint diseases. Trans R Soc Trop Med Hyg, 1990 Mar-Apr, 84(2), 298 - 300 Epidemic scabies in four Caribbean islands, 1981-1988; Reid HF et al.; Scabies infestation has been reported to the PAHO/WHO Caribbean Epidemiology Centre (CAREC) from Trinidad and Tobago (T&T), Grenada, Dominica, the Turks and Caicos Islands (T&CI) and, more recently, St Lucia . Epidemic scabies was being reported from T&CI in 1981 (1200/100,000 population), but there were no reports from T&T until 1982 (8/100,000) . The first phase of the bimodal epidemic in Grenada occurred between 1982 and 1984 (132/100,000) and the explosive second phase from 1985 to 1987 (474-699/100,000) . In T&T there was a low incidence of scabies until 1985 (0-59/100,000) and in Dominica the rate fluctuated (67-14/100,000) during the same period . From 1986 to 1988, scabies infestation reached epidemic proportions in T&T (410-709/100,000) and fluctuated in Dominica (108-117/100,000) . In Tobago alone, scabies was not reported until March 1986, and by December the incidence rate was 105/100,000; by 1988 it had increased to 1124/100,000 population . Although no secondary infections have been reported from Grenada, Dominica, T&CI or St Lucia, T&T has reported increased streptococcal skin infections and epidemic post-streptococcal acute glomerulonephritis (PSAGN) . The observed trend of increasing scabies infestation, increasing streptococcal isolates from skin lesions, and increasing PSAGN in T&T is noteworthy. Anticancer Res, 1990 Mar-Apr, 10(2A), 441 - 6 Augmentation of cytotoxicity of lymphokine activated killer cells on ovarian tumor cells by various biological response modifiers; Nio Y et al.; The effect of combining lymphokine activated killer (LAK) cells with either recombinant interleukin-2 (rlL-2), recombinant interferon-alpha (rIFN-alpha), recombinant tumor necrosis factor (rTNF) or streptococcal preparation OK-432 were assessed, using Raji, 2 kinds of cultured ovarian lines (PA-1 and SKOV-3), and 7 fresh ovarian tumor lines . LAK cells were generated by culturing peripheral blood lymphocytes (PBL) with rIL-2 for 3-5 days . The simultaneous combination of LAK cells with rIFN alpha or OK-432 augmented the cytotoxicity of LAK cells . The susceptibility of tumor cells to LAK cells also increased after the pretreatment of tumor cells with OK-432 . These results suggest that the simultaneous injection of LAK cells with rIFN-alpha or OK-432 and the intralesional injection of OK-432 prior to the adoptive transfer of LAK cells may be a beneficial combination treatment for LAK treatment. Rev Esp Cardiol, 1990 Mar, 43(3), 142 - 52 {Infective endocarditis . Medicosurgical experience in a series of 137 patients}; Mesa JM et al.; We have reviewed our 1978 to 1987 experience in the treatment of 137 patients with 145 episodes of Infective Endocarditis . In 55 episodes the infection involved a valvular prosthesis . Positive blood cultures were obtained in 72.7%, with clear preeminence for staphylococcal organisms . Renal disfunction was associated in 41.8% of the cases and periprosthetic-leak in 40% of them . Eight patients died without surgery, five cases were cured by medical treatment alone, and 42 cases were operated, most of them because refractory heart failure . Surgical mortality was 15 cases (35.7%), with statistical significance within the early prosthetic valve endocarditis group, in which in turn was significantly greater the incidence of non-streptococcal germs, renal disfunction and periannular abscesses . The mean late follow-up was 47.6 months, including 88.8% of the surgical survivors, with a survival rate of 64.1%, being most of patients in a good functional status . In 90 episodes the infection involved a native valve, with about 40% of the cases in drug abusers . Positive blood cultures were obtained in 77.7% of the cases, with slight preeminence of staphylococcal germs . Renal dysfunction was associated in 16.6% of the cases . In 41 episodes were used only medical therapy, involving 30 of them the right side, with a death in this group . The treatment was surgical in 49 episodes, 45% of them in order to correct residual valve lesions. J Infect, 1990 Mar, 20(2), 155 - 8 Reactive arthritis complicating group G streptococcal septicaemia; Rogerson SJ et al.; We describe a case of group G streptococcal septicaemia complicated by sterile polyarthritis and pericarditis . We suggest that this organism may cause a 'reactive arthritis' type of illness, and that this is in keeping with known properties of the organism . We note that our patient's clinical features fit the modified Jones criteria for the diagnosis of rheumatic fever. FEMS Microbiol Lett, 1990 Mar 1, 56(1-2), 61 - 4 Macrophage hyperreactivity to endotoxin induced by streptococcal pyrogenic exotoxin in rabbits; Murai T et al.; Pretreatment of rabbits with streptococcal pyrogenic exotoxin (SPE) resulted in an enhancement of their febrile response to subsequent endotoxin challenge . This suggested that SPE may enhance the macrophage capacity to respond to endotoxin in vivo to produce an endogenous pyrogen . It was also demonstrated that peritoneal macrophages derived from SPE-treated rabbits exhibited hyperreactivity to endotoxin in vitro as assessed by endotoxin-induced increase in glucose consumption . These data indicate that SPE has the ability to enhance macrophage reactivity to endotoxin. FEMS Microbiol Lett, 1990 Mar 1, 56(1-2), 159 - 62 Increased vascular permeability, erythema, and leukocyte emigration induced in rabbit skin by streptococcal erythrogenic toxin type A; Kamezawa Y et al.; A highly purified streptococcal erythrogenic toxin type-A (SET-A) caused increased vascular permeability, erythema, and leukocyte emigration when injected into the skin of rabbits . A blueing reaction indicating increased vascular permeability appeared at 1 h, reaching the highest intensity between 4 and 5 h, decreasing thereafter and completely disappearing at 12 h after toxin injection . The intensity of the increase in permeability was found to be dose dependent . The erythematous reaction began later and persisted longer than the blueing . The time course of leukocyte emigration was found roughly to parallel that of the blueing reaction . The skin reaction to SET-A in rabbits can be characterized as having an acute non-specific exudative inflammatory nature. Rev Infect Dis, 1990 Mar-Apr, 12(2), 273 - 6 Postpartum maternal group B streptococcal meningitis; Aharoni A et al.; Maternal group B streptococcal (GBS) meningitis is rare, with only four cases previously reported in the literature . In this review a fifth case of postpartum GBS meningitis is presented . The five cases are compared with 34 cases of GBS meningitis in nonparturient adults . All cases of maternal GBS meningitis followed a vaginal delivery . The mean age of patients who had GBS meningitis outside the perinatal setting was 55 years, and most of these individuals had associated illnesses or frank immunosuppression; the mortality rate in this group was 23% . In contrast, all five patients with maternal GBS meningitis recovered . The case presented herein, like the four previous cases, illustrates the point that when patients with maternal GBS meningitis are treated immediately and have been healthy before the infection, the prognosis is good. J Clin Microbiol, 1990 Mar, 28(3), 413 - 5 Evaluation of a new latex agglutination test for detection of streptolysin O antibodies; Gerber MA et al.; Acute- and convalescent-phase serum specimens were collected from 50 patients with group A streptococcal pharyngitis . The anti-streptolysin O (ASO) titer for each serum specimen was determined by using both the standard neutralization assay and the latex agglutination (LA) test (Rheumagen ASO; Biokit Inc., New Britain, Conn.) . When the ASO titers derived by the two methods were compared, the correlation coefficient was 0.93 . When the ability of the LA test to demonstrate a significant ASO titer rise (greater than or equal to 2 dilutions) was compared with that of the standard neutralization assay, the LA test had a sensitivity of 91%, a specificity of 86%, a positive predictive value of 83%, and a negative predictive value of 92% . Triplicate LA test determinations were performed on a subset of 31 serum specimens, and for 29 (94%), the repeated ASO titers were all within 1 dilution of each other; the width of the 95% confidence interval for the triplicate measurements of each serum specimen was +/- 32.8 IU . We found the Rheumagen ASO to be a simple, rapid LA procedure for measuring ASO titers that produces results that are highly reproducible, show little lot-to-lot variability, and are comparable to the ASO titers obtained with the standard neutralization assay. Jinrui Idengaku Zasshi, 1990 Mar, 35(1), 1 - 13 HLA-linked immune suppression genes; Sasazuki T; Genetic control of immune response was investigated by family and population analyses in humans . It was first recognized that there are high responders and low or non responders to natural antigens in human population . Family analysis revealed that low responsiveness to streptococcal cell wall antigen (SCW) was inherited as an HLA-linked dominant trait . CD8+ suppressor T cells existed in low responders and depletion of the CD8+ T cells from low responders could restore the strong immune response to SCW . Therefore the gene controlling the low response to SCW was designated as an immune suppression gene for SCW . Immune suppression gene for SCW was in strong linkage disequilibrium with particular alleles of HLA-DQ locus . The association between HLA-DQ alleles and low responsiveness mediated by CD8+ suppressor T cell was also observed for schistosomal antigen, Mycobacterium leprae antigen, tetanus toxoid, cryptomeria pollen antigen and hepatitis B virus surface antigen suggesting that low responsiveness to those antigens was also controlled by immune suppression genes . Anti-HLA-DR monoclonal antibodies inhibited the immune response to those antigens of high responders in vitro, but anti-HLA-DQ monoclonal antibodies did not . On the other hand, anti-HLA-DQ monoclonal antibodies restored the immune response in low responders . Therefore, it is suggested that HLA-DR upregulates immune response and that HLA-DQ downregulates it and that HLA-DQ is epistatic to HLA-DR in the regulation of immune response in humans . Furthermore, direct evidence for the differential in immune regulation between HLA-DR and DQ was obtained by analyzing the SCW specific T cell lines from low responders . SCW specific and HLA-DQ restricted CD4+ T cell lines could activate CD8+ suppressor T cells which in turn downregulate SCW specific CD4+ T cells whereas SCW specific and HLA-DR restricted CD4+ T cell lines could not activate CD8+ suppressor T cells . All these observation clearly demonstrated that the HLA-linked immune suppression genes exist in humans to control low response to natural antigens. Keio J Med, 1990 Mar, 39(1), 21 - 5 Combination therapy for renal cell carcinoma using IFN-gamma and OK-432: in vitro study; Muraki J; Synergistic effect of recombinant IFN-gamma (IFN-gamma) and OK-432, a streptococcal preparation, using chromium release assay was studied in vitro on killer cell induction . The target cells utilized for assay were a human leukemia cell line K562, a human renal carcinoma cell line KU-2, autologous normal kidney tissues and autologous renal cell carcinomas . Culture supernatant of peripheral blood lymphocytes (PBL) and OK-432 (designated as OK conditioned medium or OK-CM) demonstrated enhanced cytotoxicity of fresh PBL against these target cells . Killer cell activity against autologous cancer cells could be also induced from PBL of renal cell carcinoma patients . Pretreatment of PBL with IFN-gamma revealed synergistic effect of OK-CM on killer cell induction . OK-CM deri