Streptococcal

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 derived from patients was shown to contain IL-2 activity as well as high titer of interferon . Neutralizing monoclonal antibody against IFN-gamma and IL-2 receptor demonstrated reduction of cytotoxicity . These results suggested potential benefit of sequential use of IFN-gamma and OK-432 for the treatment of metastatic renal cell carcinoma.

Infect Immun, 1990 Mar, 58(3), 774 - 8
Phosphorylase-cross-reactive antibodies evoked by streptococcal M protein; Dale JB et al.; Rabbit antisera evoked by type 5 streptococcal M protein (M5) were screened by enzyme-linked immunosorbent assay (ELISA) for immunological cross-reactivity with purified rabbit muscle phosphorylases a and b . Of 10 pep M5 antisera tested, 3 showed significant cross-reactivity with both forms of the enzyme . ELISA inhibition studies using one of the pep M5 antisera showed that all of the phosphorylase b antibodies were inhibited by pep M5, the immunogen, and phosphorylase b, the ELISA antigen . All of the antibodies were also inhibited by pep M6 and pep M19, but not by pep M24, indicating that the cross-reactive epitopes were shared by multiple serotypes of M protein . Western blot (immunoblot) analyses showed that pep M5 antisera reacted strongly with the subunit of phosphorylase b . In addition, purified phosphorylase partially inhibited the binding of pep M5 antibodies to a 95-kilodalton protein of human myocardium . One of the three cross-reactive pep M5 antisera inhibited the enzymatic activity of phosphorylase a in a dose-related fashion, reaching a maximum inhibition of 75% . The enzymatic activity in the presence of antibody was totally restored when the antiserum was first incubated with pep M5.

Pediatrics, 1990 Mar, 85(3), 246 - 56
Cost-effectiveness of rapid latex agglutination testing and throat culture for streptococcal pharyngitis; Lieu TA et al.; Decision analysis was used to evaluate the cost-effectiveness of four alternative strategies for management of pharyngitis in children ("treat all," "antigen test alone," "culture alone," "antigen test + culture") . In the model, estimates of test sensitivity and specificity, disease prevalence, treatment rates after positive test results, rates of complications for treated and untreated patient-cases, rates of antibiotic-induced complications, treatment effectiveness, and direct dollar costs of diagnosis and therapy were used . Results were expressed in terms of severe penicillin reactions per disease case prevented and dollars per complication prevented . Sensitivity analysis was performed to assess the impact of changes in parameter estimates on model outcomes . With treat all, 90% of streptococcal complications were prevented and there were low short-term direct dollar costs . However, treat all is associated with a high rate of penicillin allergy (70% of which occurs in uninfected children) and is the least cost-effective strategy when the costs of treating complications are included . The marginal cost of antigen test + culture is less than the cost of either one-test strategy . Antigen test + culture is the most cost-effective strategy when the costs of managing the complications of streptococcal infection are considered . Antigen test + culture is the most clinically effective strategy, and its benefits are obtained at a modest marginal cost relative to the one-test strategy.

Wien Klin Wochenschr, 1990 Feb 16, 102(4), 111 - 4
{Acute tonsillitis: clinical symptoms; bacteriologic culture and rapid test as deciding criteria for the use of antibiotics}; Raich T et al.; In order to prevent late sequelae from an untreated streptococcal pharyngitis all patients with streptococcal tonsillitis/pharyngitis have to be treated with antibiotics, preferably penicillin . A correct diagnosis by clinical criteria is only achievable in 72% of patients with streptococcal pharyngitis . Additional criteria such as diagnosis by culture are, therefore, mandatory . Time is a major disadvantage of traditional culture methods . Slide agglutination tests show an acceptable sensitivity of 92% and a specificity of 93% . Due to the possibility of false negative test results, with consequent withholding of adequate antimicrobial chemotherapy, these test results should be used only as a valuable guide . Decision to administer an antibiotic should still be based on clinical criteria.

South Med J, 1990 Feb, 83(2), 146 - 9
Group A beta-hemolytic streptococcal bacteremia and HIV infection; Johnson MP et al.; We describe a case of group A beta-hemolytic streptococcal bacteremia in an individual infected with the human immunodeficiency virus (HIV) . The organism was also recovered from the stool, but not from the throat . A review of 19 cases of group A beta-hemolytic streptococcal bacteremia shows an association between an underlying immunologic defect and the occurrence of serious group A beta-hemolytic streptococcal infection in adults . We review evidence in the literature suggesting that there is a predisposition to infection caused by pyogenic bacteria in HIV-infected individuals.

Fukuoka Igaku Zasshi, 1990 Feb, 81(2), 88 - 96
{CD4+T cells restricted by DQ not by DR support CD8+T cells to grow}; Kamikawaji N; Much attention has been paid whether there are any differences in regulating the human immune response between HLA-DR and -DQ molecules encoded by the genes within the HLA class II multigene family . Previous studies have suggested that HLA DQ molecules control low responsiveness through activating CD4 T cells which generate CD8 positive T cells, whereas HLA -DR molecules control high responsiveness through activating CD4 helper T cells . To examine this model we investigated the streptococcal cell wall antigen (SCW) specific T cell lines restricted by either DR or DQ molecule . To identify the restricting molecules, L cell transfectants expressing DQw1, DR2AB1 or DR2AB5 from Dw12 haplotype or DQw4, DR4 or DRw53 from DW15 haplotype were used . 1 . From individuals with Dw12 which is a low responder haplotype to SCW, T cell clones specific to SCW and restricted by HLA-DQw1 or DR2 were identified, whereas from individuals with Dw15 which is a high responder haplotype, only DR4 or DRw53 restricted T cell clones were identified and DQw4 restricted T cells were never observed . 2 . SCW specific CD4 T cells restricted by DQw1 were able to support the growth of CD8 positive cells, whereas those restricted by DR4 could not do so . 3 . The CD8 T cells also required autologous antigen presenting cells and SCW to grow, and they completely blocked the immune response to SCW in vitro . These observations clearly demonstrated the distinct function of HLA-DQ and -DR molecules in regulating the human immune response to SCW.

Clin Exp Immunol, 1990 Feb, 79(2), 297 - 306
Flare-up reaction of streptococcal cell wall induced arthritis in Lewis and F344 rats: the role of T lymphocytes; van den Broek MF et al.; One i.p . injection of a sterile suspension of streptococcal cell walls (SCW) induces chronic erosive polyarthritis in susceptible Lewis rats, but not in resistant F344 or nude Lewis rats . Because continuous exacerbations may be one possible mechanism underlying chronic disease, we studied the mechanism of these flare-up reactions in Lewis and F344 rats . Injection of SCW into the right knee joint of rats induced a transient monoarthritis in both strains . Reactivation of the subsided arthritis by i.v . administration of the same antigen could be evoked only in the Lewis rat . Even repeated i.v . challenges with SCW failed to induce a flare-up reaction in the F344 rat, while the Lewis rat went through an exacerbation after every challenge . Removal of T lymphocytes by monoclonal antibodies before induction of an exacerbation rendered Lewis rats refractory to flare-up reactions, thus indicating the T cell-dependence of this reaction . Furthermore, when cell walls from heterologous bacteria were tested for their capacity to induce exacerbations of SCW-induced monoarthritis and to induce proliferation of SCW-specific T lymphocytes in vitro, a strong correlation between both features was found, again pointing to a role for SCW-specific T cells in exacerbations . Together, these data support our hypothesis that chronic arthritis is the result from repeated reactivations of a waning arthritis which are dependent on antigen-specific T lymphocytes.

Med Hypotheses, 1990 Feb, 31(2), 161 - 4
Defective generalized extracellular matrix in the neoplasm bearing host: decreased inflammation, immunity and resistance; Stone OJ; Neoplasms have extensive qualitative and quantitative changes in their extracellular matrix . Lytic factors from neoplasms breakdown extracellular matrix of the areas adjacent to the neoplasms and fibroblasts in these areas produce increased extracellular matrix . Some of the extracellular matrix fractions are normally present in serum . Multiple fractions derived from extracellular matrix are present in the serum of tumor patients . Tumor patients often have decreased early cellular inflammation and immunity . These reactions depend on a normal extracellular matrix . A number of known facts about the tumor bearing host can be explained by the concept that the host's generalized extracellular matrix is altered by circulating fractions of extracellular matrix . These could be qualitative or quantitative defects as well as an abundance of depolymerized fractions . The beneficial effects of cytokines, streptococcal infections and pyridoxine deficiency on tumors can be explained by this concept.

Arerugi, 1990 Feb, 39(2 Pt 1), 118 - 23
{Serum gamma interferon levels in relation to tumor necrosis factor and interleukin 2 receptor in patients with Kawasaki disease involving coronary-artery lesions}; Matsubara T; Serum levels of gamma interferon (IFN-gamma) were determined by a sandwich radioimmunoassay in 45 patients with Kawasaki disease (KD), 14 with measles, 3 with streptococcal infection, 17 with anaphylactoid purpura, 6 with various vasculitis and also in 10 healthy children . Serum levels of IFN-gamma were seen to increase during the acute phase of KD and measles . In addition, serum levels of tumor necrosis factor (TNF) and interleukin 2 receptor (IL-2R) were measured simultaneously in 45 patients with KD . In KD patients with coronary-artery lesions (CAL), the percentage of positive cases for TNF (greater than or equal to 10 units/ml), IL-2R (greater than or equal to 1056 units/ml) and IFN-gamma (greater than or equal to 0.3 units/ml) was higher than that in patients without CAL . Several cytokines in association with activated monocytes/macrophages and T lymphocytes were detected in the serum during acute KD . These results suggest that aggressive activation of immuno-competent cells develops in KD involved CAL.

Acta Paediatr Scand, 1990 Feb, 79(2), 156 - 61
Effect of an intravenous gammaglobulin preparation on the opsonophagocytic activity of preterm serum against coagulase-negative staphylococci; Etzioni A et al.; Recent reports have described cases of septicaemia caused by coagulase-negative staphylococci in preterm neonates, mainly due to the use of artificial intravenous devices . It was of interest to examine if intravenous immunoglobulin therapy, known to be effective in group B streptococcal infections of neonates, had a similar beneficial effect in coagulase-negative staphylococcal infections . Opsonophagocytosis of coagulase-negative staphylococci by normal polymorphonuclear leukocytes in the presence of cord blood serum supplemented with the commercial IgG preparation 'Sandoglobulin' was investigated, using luminol-dependent chemiluminescence . It was found that with two different coagulase-negative staphylococcal strains, Sandoglobulin had a concentration-dependent enhancing effect on the chemiluminescent response . This effect was demonstrated in the presence of native as well as inactivated cord blood serum and in the presence of sera from preterm infants (28-33 weeks) . It is concluded that intravenous Sandoglobulin therapy may be effective in the treatment of preterm infants with severe coagulase-negative staphylococcal infections.

J Immunol Methods, 1990 Jan 24, 126(1), 103 - 8
Quantification of free alpha 2-macroglobulin and alpha 2-macroglobulin-protease complexes by a novel ELISA system based on streptococcal alpha 2-macroglobulin receptors; Justus CW et al.; An ELISA test system has been developed for the quantification of the two distinct forms of the proteinase inhibitor alpha 2-macroglobulin (alpha 2M): (i) free alpha 2M (functionally active), which is the electrophoretically slow form (alpha 2 MS), and (ii) the alpha 2 M-proteinase complex (functionally inactive), which is the electrophoretically fast form of alpha 2 M (alpha 2 MF) . Discrimination between the two types of alpha 2 M was achieved using extracts of the two independent streptococcal strains, M1 and Sc1, which express receptors for alpha 2 MS and alpha 2 MF, respectively, in combination with a monoclonal antibody specific for alpha 2 M . The assay system described is easy and reliable and permits quantitation of alpha 2 MS and alpha 2 MF in complex biological samples such as plasma and cutaneous suction blister fluid.

APMIS, 1990 Jan, 98(1), 1 - 8
Do carbohydrate antigens stimulate human T cells? Review article; Emmrich F; T cells fail to recognize free antigenic determinants . What the T-cell receptor recognizes is a complex consisting of a peptide fragment cleaved from antigen and self-MHC structures on the surface of antigen-presenting cells . While extensively investigated with protein antigens, only limited information is available on the capability of T cells to recognize carbohydrate antigens in a specific way . Therefore, we have investigated the specificity of human T-cell lines and clones reactive to streptococcal A (Strep A) vaccine . It was found that neither soluble streptococcal A carbohydrate (A-CHO) nor synthetic oligosaccharides deduced from bacterial carbohydrates could stimulate Strep A-reactive T cells, although A-CHO stimulates specific antibody production in B cells very effectively . In conclusion, Strep A-specific T cells seem to recognize other structures of the bacterial vaccine than A-CHO . This was confirmed by retained stimulation after removal of carbohydrate epitopes by periodate treatment . Such Strep A-reactive T cells are frequently (greater than 10(-3} found in CD4+ T cells of healthy donors . Implications of this finding with regard to anti-carbohydrate immune responses are discussed.

Arch Intern Med, 1990 Jan, 150(1), 89 - 93
Group A beta-hemolytic streptococcal bacteremia and intravenous substance abuse . A growing clinical problem?
Lentnek AL, Giger O, O'Rourke E.
Over an 18-month period, the incidence of group A beta-hemolytic streptococcal bacteremia rose from an average of 2.5 per 10,000 patient discharges to 17.9 . A retrospective analysis was performed comparing patients with group A beta-hemolytic streptococcal bacteremia during this 18-month period with those who presented over the preceding 36 months . Most of the increased incidence was attributable to individuals hospitalized with a diagnosis of drug addiction who had concomitant soft-tissue infection, although the absolute number of hospitalized drug addicts did not change during this interval . No common or distinctive group A streptococcal serotypic patterns were discovered . This experience suggests that group A beta-hemolytic streptococcal bacteremia and soft-tissue infection may present in epidemic fashion among parenteral drug addicts in the absence of a common source.

Surgery, 1990 Jan, 107(1), 74 - 84
New approach to management of malignant ascites with streptococcal preparation OK-432 . III . OK-432 attracts natural killer cells through a chemotactic factor released from activated neutrophils; Hayashi Y et al.; When a streptococcal preparation, OK-432, was administered intraperitoneally to patients with malignant ascites, lymphocytes with cytotoxic activity against tumor cells increased in number in the peritoneal cavity after 5 to 7 days . To investigate the underlying mechanisms of such lymphocyte accumulation, lymphocyte chemotactic activity (LCA) in ascitic fluid was measured by a modification of the Boyden method . High LCA was found on the third and fourth days after the OK-432 injection . This LCA was generated in the cell-free supernatant of the patients' abdominal neutrophils that accumulated in the peritoneal cavity 24 hours after the injection of OK-432 . A similar LCA was also found when normal peripheral neutrophils were incubated with OK-432 . Incubation of normal neutrophils without OK-432 failed to generate LCA, however, and OK-432 alone had no LCA . We tentatively named this factor "neutrophil-derived lymphocyte chemotactic factor" (NDLCF) . The NDLCF was heat stable and nondializable, and its molecular weight was approximately 45,000 daltons . It attracted mainly natural killer cells by immunoperoxidase assay of migrated lymphocytes in the chemotactic membrane . These characteristics were distinct from C5a, interleukin-1, and interleukin-2 . The results suggest that the newly found NDLCF may be responsible for the infiltration of cytotoxic lymphocytes, especially natural killer cells in the peritoneal cavity in patients with malignant ascites when treated by intraperitoneal injections of OK-432.

Pediatr Res, 1990 Jan, 27(1), 11 - 5
Detection of serum antibody by the antimitogen assay against streptococcal erythrogenic toxins . Age distribution in children and the relation to Kawasaki disease; Abe Y et al.; We describe a new method to measure human serum antibody against streptococcal erythrogenic toxins that uses inhibition of lymphocyte mitogenicity of the toxins as the indicator . Sera from 53% of 53 Kawasaki disease patients contained specific inhibitory activity against A toxin, whereas only 15% had serum inhibitory activity against B toxin . The specific anti-A toxin serum inhibitor was found in 10% of 118 age-matched control patients suffering from various infections and allergic diseases (p = 0.001, compared to Kawasaki disease patients) . Serum inhibitory activity was detected in a small number of patients with beta-hemolytic streptococcal infection (3/19) and in none of the age-matched healthy children (0/17) . However, four of seven cord blood sera samples and five of 13 sera samples from healthy neonates contained the inhibitor, a result suggesting passive transfer from mothers . Most of the antimitogen-positive sera were also positive by ELISA of IgG antibody against A toxin, and IgG fractions of the positive sera remained positive in both assays . Thus, it is possible that the specific serum inhibitor detected by the antimitogen assay represents anti-A toxin antibody . The role of toxin-producing bacteria in the pathogenesis of Kawasaki disease remains to be investigated.

J Infect Dis, 1990 Jan, 161(1), 65 - 70
Patterns of immune response among survivors of group B streptococcal meningitis; Edwards MS et al.; Serum samples from 10 infants surviving type III, group B streptococcal (GBS) meningitis were collected acutely and longitudinally for 6 months to determine patterns of antibody response to the capsular polysaccharide and their in vitro functional correlates . Five infants who failed to develop specific antibody at a mean of 3.8 weeks after diagnosis had an increase of greater than or equal to 1.0 microgram/ml after another 4-8 weeks . This IgM-predominant type-specific antibody declined to baseline 2-4 months later . Opsonophagocytosis of type III GBS increased from 0 to 88% in parallel with peak antibody response . Three infants developed increased antibody and opsonophagocytosis at 15-31 weeks after diagnosis, while two had no detectable response . Despite increasing complement levels, opsonophagocytosis of type III GBS was poor with low specific antibody levels These results suggest that survivors of GBS meningitis transiently develop specific antibody and associated efficient opsonophagocytosis, but functional competence does not persist despite maturation to adult levels of complement proteins.

Biotherapy, 1990, 2(1), 51 - 61
Successful adoptive immunotherapy with OK432-inducible activated natural killer cells in tumor-bearing mice; Yamaue H et al.; We had demonstrated that the NK cell mediated cytotoxicity of murine spleen cells could be augmented by in vivo priming and subsequent in vitro challenge with a streptococcal preparation OK432, and the cell surface phenotype of induced killer cells was Thy-1+, asialo GM1+, suggesting that the activated cells were of NK lineage (OK-NK cell) . We had also clarified that IL-2 played a major role in inducing the OK-NK cells via the production of IFN-gamma . In this study, we examined the effect of adoptive transfer of OK-NK cells on syngeneic tumors in mice . Mice were implanted with SP2 myeloma cells intraperitoneally (i.p.), or C26 colon adenocarcinoma cells subcutaneously to make the models of peritonitis carcinomatosa or solid tumor, and the OK-NK cells were transferred i.p . or intratumorally, adoptively . By the adoptive transfer of OK-NK cells, 92% of mice bearing SP2-tumor had be cured . The tumor growth of C26-solid tumor was inhibited, and the survival rate of mice bearing C26-tumor was significantly increased . The intratumoral remnants of 125I-labelled OK-NK cells were 61, 27 and 8% at 4, 12 and 36h after intratumoral transfer, respectively . By multiple transfer of OK-NK cells, the antitumor effect was more effectively augmented than that of a single transfer . Results in this study suggested that OK-NK cells could be useful for the therapy of cancer patients.

Int J Immunopharmacol, 1990, 12(4), 419 - 26
Combined effects of intraperitoneal administration of recombinant interleukin-2 and streptococcal preparation OK-432 in murine tumors; Fujioka T et al.; The combined effects of rIL-2 and OK-432 were investigated against a Meth-A tumor, a syngeneic tumor of inbred BALB/c mice . An analysis of the effector cells was also performed . The treatment resulted in an inhibition in vivo of tumor growth and increased survival of the Meth-A tumor-bearing mice . Splenic cells obtained from Meth-A inoculated mice which received combination therapy were not only NK-sensitive YAC-1 and LAK-sensitive EL-4 cells, but also NK-resistant Meth-A cells, as shown in a 4-h 51Cr-release assay . Syngeneic killer cell activity against Meth-A cells was abolished almost completely with anti-Thy 1.2 treatment and about 70% of the activity was abolished with anti-asialo GM1 treatment in a complement-dependent cytotoxic assay . It was not changed by the removal of macrophages and B cells from the splenic cells . Mice which survived for 60 days after the start of therapy rejected Meth-A inoculation when rechallenged, suggesting the establishment of a specific immunity . Combination therapy appeared to be beneficial against Meth-A cells and T-cells appeared to play a determining role in the treated Meth-A bearing mice . It was suggested that more than two populations of killer cells exist in the spleen treated with the combined therapy and they may have the same characteristics as activated T and NK cells with or without specific killer T-cells.

Minerva Urol Nefrol, 1990 Jan-Mar, 42(1), 47 - 9
{Acute renal failure . 3 years' activity of a pediatric dialysis unit}; Gaido M et al.; Acute renal failure is a frequent and dramatic clinical syndrome, producing a wide variety of serious and potentially lethal disorders in infancy . Review of 30 cases of severe acute renal failure occurred from 1985 in our unit reveals that the major causes are: acute tubular necrosis (33%), hemolytic uremic syndrome (16%), post-streptococcal glomerulonephritis (16%) . 16 patients aged from 7 days to 15 years weighing 2 to 59 kilos, underwent dialysis: 8 HD, 7 PD, 1 both . Functional recovery occurred in 13 patients (82%); 3 patients died for the condition that precipitated renal insufficiency.

Klin Khir, 1990, (3), 13 - 5
{The effect of the microflora in burn wounds on the survival of free skin flaps in autodermoplasty}; Le N; On the basis of studying the microflora of burn wounds in 112 patients, the dynamics of bacterial contamination of the wounds is shown, the microflora levels, which have the negative effect on survival of the free cutaneous flaps are defined . Gram-negative microflora and streptococcal infection conditioned a failure of the transferred cutaneous flaps in autodermoplasty.

J Perinat Med, 1990, 18(2), 125 - 9
Pneumococcal septicemia in the newborn . A report on seven cases and a review of the literature; Geelen SP et al.; This report summarizes the essential findings of seven cases of pneumococcal septicemia in the newborn and compares the data with those reported in the literature . It is emphasized that pneumococcal septicemia is a rare but highly lethal disease of the newborn . The clinical course strongly resembles early onset group B streptococcal disease . Epidemiological data suggest that the majority of infants are colonized near birth . Analogous to group B streptococcal sepsis, it seems rational to administer penicillin prophylaxis during labor to women with S . pneumoniae isolated from their genital tract to prevent vertical transmission and neonatal pneumococcal septicemia.

Jpn J Surg, 1990 Jan, 20(1), 76 - 82
The antitumor effects of locally injecting human peripheral blood mononuclear cells treated with OK-432 into the tumor site: the possible role of a tumor growth inhibitory factor (TGIF); Katano M et al.; The production of a tumor growth inhibitory factor (TGIF) was induced in human peripheral blood mononuclear cells (PBMC) by a streptococcal preparation, OK-432, in vitro . The antitumor effect of locally injecting PBMC treated with OK-432 into the tumor site was studied . PBMC were collected from patients with gastric cancer 5 to 12 days before their operation, and cultured with OK-432 for 24 hr in vitro . After the culture, the PBMC were washed thoroughly to eliminate the OK-432 . The washed PBMC went on producing TGIF for more than 72 hr in vitro in the absence of OK-432 . A small number of TGIF-producing PBMC, approximately 10(7) cells, were injected around the lesion under endoscopic observation . A remarkable antitumor effect was observed in 2 out of 10 cases of resectable gastric cancer . Histological examinations indicated that the antitumor effect is due to antitumor cytokines such as TGIF produced by PBMC rather than to the OK-432-activated PBMC themselves.

J Immunoassay, 1990, 11(4), 545 - 54
Use of solid-phase C1Q to remove soluble antigen/antibody complexes in an inhibition ELISA for streptococcal cell membrane antigens; Zelman ME et al.; Solid-phase C1q was used to remove antigen/antibody complexes in an inhibition ELISA for low molecular weight streptococcal cell membrane (SCM) polypeptide antigens . To selectively fix IgM monoclonal antibody bound to antigen, binding was carried out in C1q-coated ELISA plates; transfer of supernatants to SCM-coated plates for ELISA permitted measurement of residual antibody . When inhibition occurred in the presence of C1q, the maximal binding was 72-98% . In the absence of C1q the maximum apparent binding was only 45-50%, which we attribute to displacement of the initially bound SCM antigen by solid phase SCM antigen . Removal of antigen/antibody complexes by solid-phase Clq during inhibition assays may facilitate analysis of low affinity antigen/antibody interactions.

Acta Cardiol, 1990, 45(5), 403 - 10
Late endocarditis-associated obstructive dysfunction of a tricuspid ball-cage-type valve . Doppler echocardiographic findings and therapeutic implications; De Zuttere D et al.; Thrombotic obstruction is rare in bacterial endocarditis involving prosthetic heart valves . A 45-year-old man who had three intracardiac, ball-cage-type prosthetic valves, presented with streptococcal septicemia . Major obstruction of the tricuspid Smeloff-Cutter valve and normal function of the two other prostheses were documented by Doppler echocardiography . Emergency replacement of the tricuspid valve alone was decided on the one basis of this echocardiographic diagnosis, and successfully performed . Operative findings confirmed the noninvasive findings.

Biol Neonate, 1990, 58(3), 121 - 6
Surfactant replacement in spontaneously breathing babies with hyaline membrane disease--a pilot study; Victorin LH et al.; In a neonatal unit which, at that time, had no facilities for artificial ventilation, 14 newborn infants with birth weight greater than or equal to 1,500 g fulfilling the diagnostic criteria for severe hyaline membrane disease (HMD) were treated by tracheal instillation of bovine surfactant (200 mg/kg) . Twelve of these babies showed increased transcutaneous PO2/FiO2 ratio within 2 min, the average therapeutic response being sustained for at least 72 h . One of the two babies who did not respond to treatment was later diagnosed as a case of group B streptococcal pneumonia . One baby with favorable initial response died from sepsis at the age of 7 days; the other patients survived without sequelae . We conclude that treatment with exogenous surfactant might be considered as an alternative to ventilator treatment in babies with severe HMD.

Am J Cardiovasc Pathol, 1990, 3(2), 101 - 5
Postinflammatory scarring of cardiac valves of rheumatic and nonrheumatic etiology; Gallo P et al.; In rheumatic heart disease, cardiac valves often display only a nonspecific postinflammatory scarring, without specific features, such as the rheumatic granuloma . Fifty-five native valves excised from 47 patients, exhibiting postinflammatory scarring, were studied . Patients were subdivided into three groups according to their case histories: patients with both streptococcal infection and rheumatic fever (group I), with streptococdal infection without noncardiac major manifestations of rheumatic fever (group II), and without either of these features (group III) . Pathological examination alone was unable to differentiate among the three groups, all the valves showing the same general pathological features . Differences in terms of sex, age, and valvular involvement were detected among group III and the others, whereas patients belonging to the first two groups did not differ significantly . These results suggest that diagnostic criteria for rheumatic fever are too restrictive and that a postinflammatory valvular scarring of nonrheumatic etiology does exist.

Scand J Infect Dis, 1990, 22(4), 421 - 9
Streptococcal serogroup A epidemic in Norway 1987-1988; Martin PR et al.; A nationwide outbreak of Lancefield group A streptococcal (GAS) infections in Norway during the season 1987-88 is described . Data were collected from the Norwegian infectious disease notification system and supplemented by active search for cases of bacteraemia and other serious infections in addition to serotyping of selected clinical bacterial isolates . The number of reported cases of non-invasive GAS infections from week 29/1987 to week 28/1988 was 60% higher than expected . Between 1 Jan . and 30 June 1988, 84 cases of bacteraemia were notified, several with fulminant septicaemia and shock . The case fatality rate was 25% . Six cases of neonatal GAS septicaemia were seen . There was a nearly 3-fold total increase in occurrence of GAS bacteraemia compared with previous years, and the increase was marked particularly in cases among older children and adults 30-50 years old . Additional culture-confirmed diagnoses included unusual cases compared to recent decades such as pneumonia with empyema, necrotising fasciitis and primary peritonitis . Serotyping of strains collected consecutively from localized infections revealed a marked predominance of T-type 1, opacity factor negative strains (T-1 OF-), ranging from 41% in North Norway to 87% in Mid-Norway . M-typing confirmed that these strains were M-1, as were 87% of the preserved bacteraemia strains from the period described . Although most of the M-1 strains were distinctly mucoid only one case of acute rheumatic fever was reported during the first half of 1988 . We conclude that an epidemic of GAS infections caused by M-1 strains has occurred in Norway resulting in an increase in both incidence and seriousness of disease.

J Hyg Epidemiol Microbiol Immunol, 1990, 34(2), 219 - 26
The effect of sodium nucleinate on allergic and immunological reactions; Zemskov AM et al.; Experiments on immunized rabbits and guinea pigs indicated that sodium nucleinate (SN) was capable of weakening or entirely eliminating anaphylactic and skin reactions of delayed type hypersensitivity to repeated administration of staphyloanatoxin, APDT vaccine . The findings on patients with the infectious form of bronchial asthma and chronic rheumatism showed that sodium nucleinate attenuated reactions to the subcutaneous administration of staphylococcal and streptococcal allergens . The treatment of patients suffering from infectious-allergic bronchial asthma and rheumatism with SN resulted in the recovery of deficient T cells, T-suppressors, normalization of immunoglobulin concentrations . In children with acute glomerulonephritis sodium nucleinate normalized decreased T-suppressor cells and increased IgG and circulating immune complexes (CIC), resulting in a pronounced remission of disease . The mechanism of desensitization and elimination of CIC by SN has not been explored, however, the parameters of SN-induced immunomodulation are known rather completely . It is suggested that SN brings about accumulation in the cell of cyclic AMP which diminished membrane permeability, activates monoaminooxidase resulting in the degradation of histamine and other biogenic amines, enhances the synthesis of endogenous corticosteroids with their desensitizing properties . All these effects contribute to the elimination of delayed type hypersensitivity . The role of SN in the inhibition of delayed type hypersensitivity remains obscure.

Biotherapy, 1990, 2(3), 213 - 22
Orally administered streptococcal preparation, OK-432 augments the antitumor immunity of patients with gastric or colorectal cancer; Nio Y et al.; A streptococcal preparation, OK-432, was orally administered at a dose of 5 KE to patients with gastric or colorectal cancer for 7-14 days before their operations, and its immunomodulatory effects on peripheral blood lymphocytes (PBL), regional node lymphocytes (RNL) and tumor infiltrating lymphocytes (TIL) were assessed . The group treated with OK-432 included 8 gastric and 6 colorectal cancer patients, and the control group included 8 gastric and 8 colorectal cancer patients . The NK cell activity of PBL was significantly augmented by the oral administration of OK-432, and the proportions of Leu 7+ and Leu 11+ cells in PBL also increased . The responses of PBL and TIL to autologous tumor extracts in the presence of interleukin-2 were enhanced after the oral administration of OK-432 . The proportion of OKT8+ cells in PBL increased after treatment with oral OK-432, whereas the proportion in RNL significantly decreased . These results indicate that oral OK-432 affects NK and T cells and may augment the antitumor immunity of patients with gastrointestinal cancer.

Crit Rev Microbiol, 1990, 17(4), 251 - 72
Staphylococcal and streptococcal pyrogenic toxins involved in toxic shock syndrome and related illnesses; Bohach GA et al.; Toxic-shock syndrome (TSS) is an acute onset, multiorgan illness which resembles severe scarlet fever . The illness is caused by Staphylococcus aureus strains that express TSS toxin-1 (TSST-1), enterotoxin B, or enterotoxin C . TSST-1 is associated with menstrual TSS and approximately one-half of nonmenstrual cases; the other two toxins cause nonmenstrual cases, 47% and 3%, respectively . The three toxins are expressed in culture media under similar environmental conditions . These conditions may explain the association of certain tampons with menstrual TSS . Biochemically, the toxins are all relatively low molecular weight and fairly heat and protease stable . Enterotoxins B and C, share nearly 50% sequence homology with streptococcal scarlet fever toxin A; they share no homology with TSST-1 despite sharing numerous biological properties . Numerous animal models for development of TSS have suggested mechanisms of toxin action, though the exact molecular action is not known . The toxins are all potent pyrogens, induce T lymphocyte proliferation, requiring interleukin 1 release from macrophages, suppress immunoglobulin production, enhance endotoxin shock, and enhance hypersensitivity skin reactions . The genetic control of the toxins has been studied and suggests the exotoxins are variable traits . Some additional properties of TSS S . aureus which facilitate disease causation have been clarified.

Growth Factors, 1990, 2(2-3), 179 - 88
Cytokines and growth regulation of synoviocytes from patients with rheumatoid arthritis and rats with streptococcal cell wall arthritis; Remmers EF et al.; Paracrine growth factors probably stimulate the pathologic proliferation of synovial fibroblast-like cells (synoviocytes) in rheumatoid arthritis (RA), but the relative importance of various factors is highly controversial . To address this problem, we compared the effects of highly purified or recombinant cytokines, in serum-free medium, on the in vitro long-term growth of synoviocytes from patients with RA and rats with streptococcal cell wall (SCW) arthritis . Of the factors tested (PDGF, aFGF, bFGF, EGF, TGF-beta, IL-1-alpha, TNF-alpha and IFN-gamma), PDGF, was clearly the most potent stimulant of long-term growth of both rat and human synoviocytes . The strong mitogenic activity of rheumatoid synovial fluids was significantly inhibited by neutralizing anti-PDGF antibody, thus confirming the importance of PDGF . EGF, TGF-beta, IL-1-alpha, TNF-alpha, and IFN-gamma had minimal effects . Similar to the effects on anchorage-independent growth, TGF-beta 1 and 2, inhibited serum- or PDGF-stimulated anchorage-dependent growth . Considered in the context of other reports, these data support the view that cytokines such as PDGF, and possibly aFGF and bFGF, play major roles in stimulating synoviocyte hyperplasia in RA and SCW arthritis, whereas TGF-beta may inhibit synoviocyte growth.

Geburtshilfe Frauenheilkd, 1990 Jan, 50(1), 56 - 60
{Effect of the place of birth on mortality and morbidity of the early form of group B streptococcal infection in newborn infants of normal weight}; Beltinger C et al.; In a retrospective analysis, 23 newborns (birth weight more than 2000 g) with early-onset group B streptococcal disease were studied . 13 babies had been born in another hospital and were subsequently transferred; these were compared with 10 infants from an adjacent perinatal centre . A paediatrician was present at the birth of the last group of infants, but only once at the birth of a baby born in a hospital not attached to our centre . At admission, the infants transferred from outside, were significantly more distressed, 5 infants died, whereas all infants of the second group survived . Although maternal risks or early signs of sepsis were present in 4 of the 5 decreased cases were in a state of septic shock at admission . To improve the neonatal outcome, the obstetrician must recognise the maternal risk factors, know the clinical picture of neonatal sepsis, and judge the symptoms accordingly . After basic diagnostic studies have been performed, intravenous penicillin must be administered and a qualified transfer to a neonatal intensive care unit must be arranged . Prevention of neonatal group B streptococcal disease is discussed.

Drug Saf, 1990 Jan-Feb, 5(1), 7 - 27
The toxicity of cytarabine; Stentoft J; The principal toxicity of standard induction regimens for acute non-lymphocytic leukemia (ANLL) {including cytarabine (ARA-C) 100 mg/m2 for 7 days plus an anthracycline} is myelotoxicity, leading to death in at least 25% of cases during induction in non-selected patients . The complete remission rate is less than 35% in patients over 65 years of age, due in part to an age-related increase of myelotoxicity . The other important adverse effect of standard-dose cytarabine is gastrointestinal toxicity, especially oral mucositis, diarrhoea, intestinal ulceration, ileus and subsequent Gram-negative septicaemia . Idiosyncratic reactions like exanthema, fever and elevation of hepatic enzymes are relatively frequent, but do not represent therapeutic problems . Intermittent high-dose cytarabine (3 g/m2 in 8 to 12 doses) is extremely myelosuppressive . Similarly, the gastrointestinal toxicity is formidable and dose-limiting . Severe, and sometimes irreversible, cerebellar/cerebral toxicity in 5 to 15% of courses of treatment limits the peak dose of cytarabine . The pathogenesis, prophylactic and therapeutic measures are unknown . These major toxicities are age-related and prohibitive to the use of high-dose cytarabine therapy in patients older than 55 to 60 years . Subacute noncardiogenic pulmonary oedema occurs in some patients, with an incidence of about 20%, and seems to have an intriguing coincidence with precedent streptococcal septicaemia; high-dose systemic steroids may be beneficial . Corneal toxicity is very frequent in high-dose cytarabine therapy but is always reversible . It is largely preventable with prophylactic steroid or 2-deoxycytidine eyedrops . Fever, exanthema and hepatic toxicity have an incidence similar to that in standard dosage . The maximum tolerable cumulated dose of cytarabine is significantly lower when the agent is administered as a continuous infusion, due to myelosuppression and gastrointestinal toxicity . Conversely, continuous infusion may be less neurotoxic . The antileukaemic effect of continuous infusion high-dose cytarabine is less well established . The only significant toxicity of low-dose cytarabine is myelosuppression . Given the generally poor condition of leukaemia patients, low-dose cytarabine therapy is well tolerated, although occasional cases of diarrhoea, reversible cerebellar symptoms, peritoneal and pericardial reactions, and ocular toxicity have been reported . Continuous infusion may be more toxic than the usual intermittent dosage . It is concluded that the toxicity of the standard induction regimen for ANLL is acceptable in patients younger than 60 to 65 years with no concurrent disease . Low dose cytarabine is tolerable for virtually all ANLL patients, but the overall therapeutic efficacy still needs to be defined and compared to standard therapy in the relevant age groups.(ABSTRACT TRUNCATED AT 400 WORDS)

Clin Exp Rheumatol, 1990 Jan-Feb, 8(1), 5 - 9
Serological cross-reactions against Yersinia enterocolitica in patients infected with other arthritis-associated microbes; Lahesmaa-Rantala R et al.; In order to investigate arthritis-triggering, serologically cross-reactive antigens, sera from patients infected with arthritis-associated microbes, Salmonellae, Chlamydia trachomatis, and Sindbis-like alphavirus, were reacted against SDS-PAGE separated and immunoblotted Yersinia enterocolitica 0:3 antigens . These sera reacted with Yersinia to the same extent as did the control sera taken from patients with streptococcal, staphylococcal and Bordetella pertussis infections or from healthy blood donors . Moreover, the various sera produced different reactivity patterns, directed against several different antigens . Although sera from test subjects, as well as from controls including healthy individuals, recognized some Yersinia antigens, these patterns differed markedly from those recognized by sera taken from patients with Yersinia infection . Significantly, analysis of the reactivities against the different molecular weight antigen components of Yersinia revealed no dominant band or pattern which could thus have been defined as arthritis-associated.

Microbiol Immunol, 1990, 34(9), 755 - 64
Systemic group B streptococcal disease in the neonate: characterization of an oral colonization model using the suckling rat; Weisman LE et al.; Aspiration or ingestion of contaminated amniotic fluid or vaginal secretions has been suggested as a cause of systemic group B streptococcal (GBS) infection in the neonate . Suckling rat studies disagree on whether systemic disease will develop after an oral challenge of GBS . Our goal was to determine if systemic GBS disease would occur following oral colonization in the suckling rat and the effect of bacterial, host and environmental factors . Suckling rat littermates received oral inoculation on one of the first four days of life with varying doses and strains of GBS . Studies confirmed gastric inoculation without aspiration . Mortality and bacteremia decreased with age, increased with dose, varied with strain, and increased with asphyxia . Autopsy confirmed sepsis, intestinal colonization, meningitis, and pneumonia . Bacteremia was associated with an abnormal immature: total neutrophil ratio at 24 hr, thrombocytopenia at 48 hr, and neutropenia at 72 hr after inoculation . GBS can cause systemic infection in the host after oral colonization which appears age-, dose, strain-, and environment-dependent . Evaluation of GBS entry in the susceptible host may facilitate therapies directed toward preventing mucosal invasion.

Curr Med Res Opin, 1990, 12(1), 25 - 33
Comparison of the clinical and bacteriological efficacy of clarithromycin and erythromycin in the treatment of streptococcal pharyngitis; Scaglione F; The efficacy and tolerability of clarithromycin and erythromycin stearate in the treatment of documented Group A beta-haemolytic streptococcal pharyngitis were compared in a single-centre, open, out-patient study . One hundred and twenty patients were randomly assigned to each treatment group . Dosage of clarithromycin and erythromycin was 250 mg twice daily and 500 mg twice daily, respectively; each patient was given a 10-day supply of medication . Clinical success (cured or improved) was observed in 111 (96.5%) of 115 and in 108 (93.9%) of 115 clinically-evaluable patients treated with clarithromycin and erythromycin, respectively . Eradication of the pathogen occurred in 108 (97.3%) of 111 and in 98 (92.5%) of 106 bacteriologically-evaluable clarithromycin and erythromycin patients, respectively . Adverse events reported by 7 (5.8%) of the clarithromycin-treated and by 12 (10%) of the erythromycin-treated patients included epigastritis and nausea and vomiting . In general, the severity of adverse events was greater for the patients treated with erythromycin, necessitating the discontinuation of therapy in 8 (6.7%) patients treated with erythromycin as opposed to 1 (0.8%) patient treated with clarithromycin . Although clarithromycin and erythromycin were comparable in terms of efficacy, clarithromycin was better tolerated.

Zh Mikrobiol Epidemiol Immunobiol, 1990 Jan, (1), 37 - 42
{The epidemic process of an acute streptococcal respiratory infection in large organized collectives of children}; Zhukov VV et al.; The study of the specific features of the development of the epidemic process of scarlet fever, tonsillitis, and acute respiratory diseases (ARD) in two large organized groups of children revealed the presence of some differences which depended on the character of prophylactic measures taken in these groups . Thus, in the absence of prophylaxis with bicillin a pronounced increase in the level of carriership, accompanied by an increase in the infective capacity of carriers, was noted . This resulted in a high level and unfavorable dynamics of morbidity in scarlet fever, tonsillitis, and ARD . On the contrary, the use of prophylaxis with bicillin ensured the stability of the level of carriership, while the infective capacity of carriers was not pronounced . At the same time a rise in ARD morbidity was insignificant, and morbidity in scarlet fever and tonsillitis was reduced to nil.

Zh Mikrobiol Epidemiol Immunobiol, 1990 Jan, (1), 33 - 7
{The general characteristics of the epidemic process and of the circulating streptococcal strains during an upsurge in scarlatina morbidity in Leningrad}; Krasil'nikov IA et al.; The dynamics of scarlet fever morbidity in Leningrad for many years was studied and the absence of any effect produced by the existing system of preventive measures against this disease for the last 30 years was shown . On the basis of epidemiological and bacteriological data the authors came to the conclusion on the unity of the epidemic process of scarlet fever in the whole city and the relatively autonomous character of the process in individual districts . The necessity of the realization of epidemiological surveillance on streptococcal infection, with special emphasis on the multilevel social structure of the city and the wide use of the bacteriological diagnosis of streptococcal diseases, is substantiated.

Public Health Rev, 1990-91, 18(3), 239 - 49
The decline of acute rheumatic fever in Israel; Yarrow A et al.; INTRODUCTION AND METHODS . In Israel, as in most economically developed countries, rheumatic fever has become uncommon, although cases continue to be reported each year, particularly in the Arab population . In this observational survey, based on cases notified to, and investigated by, the Ministry of Health, we review the epidemiology of acute rheumatic fever in Israel in the decade 1981-90 . RESULTS AND RECOMMENDATIONS . Where it persists in Israel, acute rheumatic fever remains commoner in non-Jews than in Jews and in males rather than in females, in children aged 5-14, and in children from relatively overcrowded and deprived homes . Despite the steady decline in rheumatic fever incidence in the past decade, its continued occurrence in Israel, and reports of outbreaks of acute rheumatic fever and virulent streptococcal infection in North America and Europe, demand that clinicians continue to treat streptococcal sore throats with full curative antibiotic doses, that confirmed cases receive extended chemoprophylaxis, and that surveillance and notification of acute rheumatic fever be continued.

Scand J Infect Dis, 1990, 22(6), 681 - 90
Nonenterococcal group D streptococcal septicemia: association with unrecognized endocarditis; Wang LS et al.; 68 patients presented to the Veterans General Hospital, Taipei with nonenterococcal group D streptococcal septicemia in the years 1985-1987 . 36 patients (53%) had nonenterococci as part of a polymicrobial bacteremia . The large intestine was not examined in most patients . Five patients (7%) had associated colonic carcinoma, and 17 patients (25%) had colorectal diseases . Only 7/68 patients (10%) were clinically diagnosed as having infective endocarditis by the doctors in charge . The others were regarded as having septicemia . The charts of these patients were reviewed retrospectively to diagnose infective endocarditis based on strict definitions . One (1%) had definite endocarditis proved at autopsy . 16 patients (24%) had probable endocarditis due to the presence of either a new regurgitant murmur or both a predisposing heart disease and embolic phenomena; 39 (57%) had possible endocarditis based on evidence of having either a predisposing heart disease or embolic phenomena; and only 12 (18%) had no evidence of endocarditis . 27 patients (40%) had at least one predisposing heart disease associated with endocarditis . 51 patients (75%) had at least one lesion suggesting embolic phenomena . 30 patients (44%) had electrocardiographic abnormalities . This high incidence of arrhythmia in nonenterococcal septicemia is of particular interest and could be related to cardiac involvement in some patients . The overall mortality, 62% (42/68), was extremely high in our series, but in those who were clinically diagnosed and treated as infective endocarditis, the mortality was low, 14% (1/7) . We suggest all patients with nonenterococcal septicemia associated with either heart disease or lesions of CNS, lung, heart, kidney or limbs suggesting embolic phenomena should be regarded as having possible or probable endocarditis . Treating such patients as having infective endocarditis may reduce the mortality in nonenterococcal septicemia.

J Antimicrob Chemother, 1990 Jan, 25(1), 159 - 73
Does administration of an aminoglycoside in a single daily dose affect its efficacy and toxicity?
Nordstrom L, Ringberg H, Cronberg S, Tjernstrom O, Walder M.
Treatment efficacy, oto- and nephrotoxicity, and aminoglycoside pharmacokinetics were evaluated in a prospective, comparative, randomized clinical study of aminoglycosides given once a day or three times a day for severe infections . Sixty patients were treated with netilmicin or gentamicin 4.5 mg/kg bodyweight/day, either once a day or divided into three doses a day . The patients were allocated randomly to the different groups . The clinical effect was difficult to compare in the different groups, because of the small numbers of patients . Therapeutic failures were seen in seven patients (three after one and four after three doses per day) . Two patients, one with Staphylococcus aureus endocarditis and one with streptococcal endocarditis, on netilmicin once daily and conventional high-dose therapy with a penicillin had positive blood cultures after five and seven days of treatment, respectively . Vestibular function and hearing acuity were examined by serial audiograms and electronystagmograms . In spite of extensive diagnostic evaluation, only two cases of ototoxicity were detected . One patient treated with gentamicin three times a day developed vertigo and a severe abnormality of her electronystagmogram . One young patient treated with gentamicin once daily had a slight bilateral reduction of hearing . Nephrotoxicity was mild and did not differ in the four treatment groups . This was the first investigation of a once-daily dosing regimen conducted in seriously ill patients with systemic infections . We could not demonstrate any evidence that aminoglycoside treatment once daily has greater oto- or nephrotoxicity than the traditional three times daily regimen.

Ter Arkh, 1990, 62(11), 39 - 42
{The incidence of exacerbations in chronic diseases in patients hospitalized with influenza and para-influenza}; Bondarenko SS et al.; A retrospective analysis was made of the case reports of 829 patients admitted to the infectious department with a diagnosis of influenza (592) and parainfluenza (237) . In all the patients, the diagnosis was supported serologically with the aid of the hemagglutination inhibition test, with the antibody titer in the serum rising 4-fold and more . In part of the patients the indicated test was used in combination with the immunofluorescence test in studying nasopharyngeal smears, whereas in part of the patients, it was coupled with virological tests . It has been revealed that in addition to the most frequently occurring complications on the part of the bronchopulmonary system and ENT organs caused by the pneumococcal and streptococcal flora, there were complications on the part of the endocrine, urogenital, nervous and gastrointestinal systems, equally in patients with influenza and parainfluenza . In patients with postinfarction cardiosclerosis, influenza B and mixed influenza run the most unfavourable course, provoking deterioration of coronary heart disease in every other patient . In 66.6% of cases, exacerbation of coronary heart disease fell within the period of early convalescence of patients with influenza and parainfluenza.

Growth Factors, 1990, 4(1), 17 - 26
In situ expression of transforming growth factor beta in streptococcal cell wall-induced granulomatous inflammation and hepatic fibrosis; Manthey CL et al.; The expression of transforming growth factor beta (TGF-beta) was examined during the evolution of streptococcal cell wall (SCW)-induced hepatic granulomas in rats to evaluate the role of TGF-beta in chronic inflammation progressing to fibrosis . As determined by immunocytochemistry, Kupffer cells rapidly expressed TGF-beta 1 following intraperitoneal (i.p.) injection of SCW, and TGF-beta was expressed by mononuclear phagocytes in the earliest cell aggregates as well as by mononuclear phagocytes within the capsule of mature lesions . Interestingly, apparent extracellular TGF-beta was observed in mature lesions at the interface of the capsule and the cellular core, a region of active fibrogenesis . Granulomas isolated 3, 6, and 12 weeks post-SCW injection elaborated nanogram (ng) quantities of latent and active TGF-beta into culture supernatants, and expressed high levels of 2.4 and 1.9 kb TGF-beta 1 transcripts . Expression of procollagen type I and III mRNAs were observed in parallel with the expression of the TGF-beta 1 transcripts . Thus, TGF-beta is expressed throughout SCW-granuloma development, and, based on known bioactivities, it appears that TGF-beta mediates, in part, the recruitment and activation of monocytes and fibroblasts and deposition of collagen in SCW-granulomas and likely other chronic inflammatory lesions progressing to fibrosis.

Lab Delo, 1990, (8), 29 - 31
{Nuclear fragmentation of neutrophilic granulocytes in patients with angina}; Navrotskii SA et al.; The informative value of the neutrophilic segmentation index (NSI) was estimated in 77 patients with primary streptococcal tonsillitis and in 40 normal young subjects . This index was found reduced at the peak of the disease in all the patients, this decrease depending on the disease severity . During convalescence the sooner NSI recovered, the milder was the disease course . This permits recommending NSI as an objective laboratory criterion permitting assessment of the severity of bacterial tonsillitis and the efficacy of its treatment.

Annu Rev Immunol, 1990, 8, 65 - 82
The molecular basis of T-cell specificity; Matis LA; Studies of TCR expression in antigen-specific immune responses have provided a large body of information correlating the primary structure of the TCR with specificity . Much has been learned regarding the mechanisms for the generation of TCR diversity and the selection of TCR V elements in immune responses . However, the exact nature of the trimolecular complex found during the TCR/antigen/MHC interaction awaits the structural characterization of the TCR by crystallography . Just as describing the three-dimensional structure of MHC molecules and defining their putative antigen-binding site have made it possible to interpret with fresh insight the wealth of functional data regarding antigen/MHC binding and alloreactivity, similar characterization of the TCR structure will allow more definitive interpretation of all the current data with respect to TCR usage in antigen-specific immune responses . It should also facilitate the study of the molecular basis of positive and negative TCR selection during thymic ontogeny . Finally, the identification of T-cell superantigens and their ability to stimulate T cells on the basis of TCR V beta expression alone has defined a new and distinct type of TCR/ligand interaction . The fact that bacterial products such as staphylococcal and streptococcal toxins as well as the mitogenic moiety produced by some mycoplasma are included within this class of antigens suggests that TCR recognition of superantigens may have major clinical significance . It is important to determine the structural basis of T-cell activation by these antigens.

Int J Immunopharmacol, 1990, 12(1), 107 - 12
Interference of the induction of suppressor cells by a streptococcal preparation, OK-432 through the blocking of suppressor inducer T-cells; Toge T et al.; The effect of OK-432 on suppressor inducer T cells in the generation of suppressor cells was investigated to determine its mechanism of action as an immunopotentiating agent . Suppressor cell activities induced by sera from patients with advanced cancer (stage III, IV or recurrence) were found to be as high as those induced by Con-A . Suppressor activity induced by Con-A or serum from cancer patients resided in CD8+ T cells, although CD4+ T-cells were required for the induction of suppressor cells . Significant increases in the CD4+2H4+ T cell population after stimulation with either Con-A or sera from the advanced cancer patients were observed when compared with stimulation by normal serum . Stimulation with Con-A induced suppressor cells as well as a significant increase of CD4+2H4+ T-cells . The presence of OK-432 during the generation of suppressor cells, however, significantly reduced the suppressor activity and apparently blocked the increase of CD4+2H4+ T-cells . Thus, it is suggested that OK-432 may interfere with the induction of suppressor cells through the blocking of CD4+2H4+ suppressor inducer T-cells.

Nippon Gan Chiryo Gakkai Shi, 1989 Dec 20, 24(11), 2546 - 55
{Successful adoptive immunotherapy with OK432-inducible activated natural killer cells on tumor-bearing mice}; Yamaue H et al.; We had demonstrated that the NK cell mediated cytotoxicity of murine spleen cells could be augmented by in vivo prime and subsequent in vitro challenge with the streptococcal preparation OK432, and the cell surface phenotype of induced killer cells was Thy 1+, asialo GM1+, suggesting the activated NK cells (OK-NK cell) . The culture supernatants of spleen cells with OK432 possessed the activity of IL-2 and IFN-gamma, and the IL-2 played a major role to induce the OK-NK cells via the production of IFN-gamma . In this study, we examined the effect of adoptive transfer of OK-NK cells on tumor-bearing mice . The mice were implanted SP2 myeloma cells intraperitoneally (i.p.), or C26 colon adenocarcinoma cells subcutaneously (s.c.) to make the models of peritonitis carcinomatosa or solid tumor, and the OK-NK cells were transferred i.p . or i.t., adoptively . By the adoptive transfer of OK-NK cells, the 92% of mice bearing SP2-tumor had be cured . The tumor growth of C26-solid tumor was inhibited, and the survival rate of mice bearing C26-tumor was increased, significantly . The intratumoral remnants of 125I-labelled OK-NK cells were 61.27 and 8% after intratumoral transfer, respectively . By multiple transfer of OK-NK cells the anti-tumor effect was more augmented than that of a single transfer . Thus we recognized the anti-tumor effect of adoptive transfer of OK-NK cells on tumor-bearing mice, and suggested that OK-NK cells could be useful for the therapy of cancer patients.

Nippon Gan Chiryo Gakkai Shi, 1989 Dec 20, 24(11), 2504 - 12
{Role of interleukin 2 and interferon gamma in induction of activated natural killer cells by the streptococcal preparation OK432}; Yamaue H et al.; The natural killer (NK) cell mediated cytotoxicity to syngeneic tumor cells can be augmented by in vivo priming and subsequent in vitro challenge with the streptococcal preparation OK432 . Supernatants of coculture of spleen cells with OK432 contained Interleukin 2 (IL-2) and Interferon (IFN), mainly IFN-gamma . As the anti-mouse IFN-gamma monoclonal antibody but not anti-mouse IFN-alpha antibody inhibited the induction of activated NK cells with OK432, the IFN-gamma participated in this response . The incubated spleen cells with IL-2 receptors increased with OK432 treatment by flow cytometry, and the NK cell and IFN activities of supernatants were also abrogated by the treatment with anti-mouse IL-2 receptor monoclonal antibody to block the interaction between IL-2 and these receptors of effector cells . By panning method, it was clarified that the incubated spleen cells with IL-2 receptors were responsible for the production of IFN-r . These results suggest that IL-2 plays a major role to induce the activated NK cells from murine spleen cells primed in vivo and subsequently challenged in vitro with OK432, by the production of IFN-gamma.

J Biol Chem, 1989 Dec 15, 264(35), 21334 - 9
Induced bending of plasmid pLS1 DNA by the plasmid-encoded protein RepA; Perez-Martin J et al.; The broad host range streptococcal plasmid pLS1 encodes for a 5.1-kDa repressor protein, RepA . This protein has affinity for DNA (linear or supercoiled) and is translated from the same mRNA as the replication initiator protein RepB . By gel retardation assays, we observed that RepA shows specificity for binding to the plasmid HinfID fragment, which includes the target of the protein . The target of RepA within the plasmid DNA molecule has been located around the plasmid single site ApaLI . This site is included in a region that contains the promoter for the repA and repB genes and is contiguous to the plasmid ori(+) . A complex sequence-directed DNA curvature is observed in this region of pLS1 . Upon addition of RepA to plasmid linear DNA or to circularly permuted restriction fragments, this intrinsic curvature was greatly enhanced . Thus, a strong RepA-induced bending could be located in the vicinity of the ApaLI site . Visualization of the bent DNA was achieved by electron microscopy of complexes between RepA and plasmid DNA fragments containing the RepA target.

J Immunol, 1989 Dec 15, 143(12), 4213 - 20
Mouse antibody response to group A streptococcal carbohydrate; Jarvis CD et al.; In an attempt to more fully understand the generation of antibody diversity to carbohydrate (CHO) Ag, we produced and characterized a panel of hybridoma cell lines specific for group A streptococcal CHO from mice injected with the intact bacteria (minus the hyaluronic acid capsule and cell wall protein Ag) . We have analyzed the use of H and L chain V region genes in the early (day 7) and late response (hyperimmune) and have sequenced the dominant VH gene used in several of our hybridomas . Our data allowed us to assess the extent to which the recombination of various V, D, and J gene segments and somatic mutation contribute to antibody diversification in this system . In this report we confirm that a minimum of two VH and four VK gene segments are used to encode this response . We extend this analysis to show that multiple D and J gene segments are used and that a significant amount of junctional variability is tolerated in CDR 3 . Our results indicate that the level of somatic mutation in the hyperimmune response is generally low in comparison with the response to haptens and protein Ag . These data also suggest that there is a positive selection for mutation in CDR 1 during the hyperimmune response to group A streptococcal CHO.

Pediatr Emerg Care, 1989 Dec, 5(4), 259 - 61
Streptococcal pharyngitis in children; Klein MD; Children with suspected group A beta-hemolytic streptococcal pharyngitis are encountered daily in outpatient settings . Despite the ubiquity of this condition, important management issues still remain unresolved . This article will review selected epidemiologic, diagnostic, and therapeutic topics germane to clinical practice.

Pediatr Res, 1989 Dec, 26(6), 629 - 32
Transplacental or enteral transfer of maternal immunization-induced antibody protects suckling rats from type III group B streptococcal infection; Heiman HS et al.; Deficiency of maternal group B streptococcal (GBS) type-specific IgG increases neonatal susceptibility to GBS infection . We asked if immunization-induced maternal type III GBS opsonic antibody transferred prenatally (via placenta) or postnatally (via breast milk) would affect suckling rat survival after GBS infection . Pregnant immunized dams with type III GBS opsonic antibody (20 through 320 dil-1) and nonimmunized dams without GBS antibody were matched (n = 16) . Half of each litter was cross-suckled to a matching dam creating four pup groups with different exposure to maternal type III GBS opsonic antibody: none, postnatal, prenatal, and combined (pre- and postnatal) . After infection with type III GBS, group survival (n) was 41% (51), 66% (47), 98% (43), and 98% (47), respectively . Type III GBS opsonic antibody in surviving pups was directly related to their immunized dam's antibody either postnatally (R = 0.85), prenatally (R = 0.84), or combined (R = 0.81) . Pups exposed postnatally to high titers (80 to 320 dilution-1) of type III GBS opsonic antibody survived more often than those exposed to low titers (20 to 40 dil-1) (p less than 0.03) . Immunization-induced maternal type III GBS opsonic antibody is transferred pre- and postnatally and results in improved neonatal survival after GBS infection . Survival of pups exposed to postnatal antibody appears related to the concentration of maternal type III GBS opsonic antibody . Breast milk with high titers of GBS type-specific antibody may modify the course of GBS infection . GBS vaccines and strategies could be tested in this model.

Gynecol Oncol, 1989 Dec, 35(3), 367 - 72
Immunotherapy using the streptococcal preparation OK-432 for the treatment of uterine cervical cancer . Cervical Cancer Immunotherapy Study Group; Noda K et al.; The efficacy of immunotherapy using a streptococcal preparation, OK-432, was evaluated in each clinical stage of uterine cervical cancer . The 382 eligible patients were stratified by clinical stage and presence/absence of surgery . Within each stratum, patient's were randomly allocated to OK-432 treatment or to control treatment . OK-432 significantly inhibited recurrence in patients with stage II cervical cancer; the recurrence-free interval and survival time were remarkably prolonged in patients with stage II disease who underwent surgery . However, OK-432 did not significantly prolong these parameters in patients with stage III disease . Retrospective analyses revealed that in patients with or without lymph node metastases who underwent surgery, the recurrence-free interval and survival time were significantly prolonged by OK-432 treatment . These results indicate that OK-432 is an effective and useful postoperative immunotherapeutic agent for uterine cervical cancer.

J Clin Invest, 1989 Dec, 84(6), 1731 - 40
Transin/stromelysin expression in the synovium of rats with experimental erosive arthritis . In situ localization and kinetics of expression of the transformation-associated metalloproteinase in euthymic and athymic Lewis rats; Case JP et al.; Transin is a neutral metalloproteinase initially isolated from malignantly transformed rat fibroblasts and subsequently shown to be homologous to human stromelysin . We performed Northern blot analysis on synovial tissue specimens from Lewis rats with proliferative and invasive streptococcal cell wall (SCW) arthritis . Transin mRNA was present in abundance, as was the mRNA of the c-myc oncogene, which is associated with cellular proliferation . Immunohistochemical staining of synovia from rats with chronic SCW arthritis showed high-level transin expression in the cells of the lining layer and underlying stroma, as well as in chondrocytes and osteoclasts in subchondral bone . Intense nuclear staining for the Myc oncoprotein was also detected with a cross-reactive antibody to v-Myc . Transin stained similarly in the early, rapid-onset, thymus-independent, acute phase of SCW arthritis . In the T cell-dependent adjuvant arthritis, transin expression was noted by day 4, 6 d before the influx of mononuclear cells and the onset of clinical disease . Athymic rats did not express transin . We concluded that transin is a marker of proliferative, invasive arthritis in rats and appears early in the course of disease development, but requires a competent immune system to sustain its expression in these model arthropathies.

Hiroshima J Med Sci, 1989 Dec, 38(4), 213 - 9
Effect of OK-432 on the lymphnode metastasis of MCA-sarcoma cell lines: a new therapeutic approach; Inoh A et al.; The two unique highly metastatic MCA-sarcoma cell lines have been established by the present authors . The inoculation of 1153Ln, one of the cell lines, either into footpad or subcutaneously on the back of syngeneic mice resulted in the development of metastasis exclusively in almost all lymphnodes of the body . We evaluated the therapeutic effect of a streptococcal preparation, OK-432, on the lymphnode metastasis . Two KE per mouse of OK-432 were injected intratumorally (it) at 4, 7 or 10 days after the footpad inoculation of 1153Ln . OK-432 injected it at 7 days after tumor inoculation showed an inhibition of the lymphnode metastasis . Histological findings indicated that the proliferation of lymphoid cells in the drainage node was most prominent in mice treated with OK-432 at 7 days after the tumor inoculation . A combined treatment of it and intraperitoneal (ip) injections of OK-432 significantly reduced lymphnode metastasis as compared with that of ip injection alone . This can be attributed to the fact that the activated lymphocytes induced by it-injected OK-432 exhibited a potent antimetastatic activity together with general administration (ip) of OK-432 given after surgical removal of the tumor . Low dose of total-body irradiation (TBI), known to augment the antitumor potential of tumor-bearing animals together with general application of OK-432, showed synergistic action in inhibiting tumor growth . Overall results suggest that the better antitumor effect of OK-432 can be anticipated by combination of the agent itself and with other means.

Ophthalmology, 1989 Dec, 96(12), 1722 - 6
Rural endophthalmitis; Boldt HC et al.; The antibiotic regimens recommended for empiric use in posttraumatic endophthalmitis are based on data collected from medical centers in large metropolitan areas . In rural areas, trauma resulting in endophthalmitis frequently involves injuries with perforating objects that are contaminated with organic matter . These rural cases therefore may not be comparable with endophthalmitis occurring after nonrural injuries . A 10-year retrospective analysis was performed to investigate the incidence of rural endophthalmitis as well as determine the type of causative organisms . Endophthalmitis developed in 24 (30%) of 80 patients with rural penetrating trauma, compared with 23 (11%) of 204 patients with nonrural penetrating trauma . Of 24 patients, Bacillus spp were isolated in 11 (46%), followed by gram-negative rods in 7, Staphylococcus epidermidis in 6, and streptococcal species in 5 . In 10 (42%) of these 24 patients with rural trauma, more than one organism was isolated . Bacillus spp were involved in six (60%) of ten of these mixed infections . Based on these findings, the authors suggest an intravitreal regimen of gentamicin along with either vancomycin or clindamycin for the empiric therapy of rural endophthalmitis.

Q J Med, 1989 Dec, 73(272), 1135 - 42
Neurological presentations of native valve endocarditis; Gransden WR et al.; In a prospective study of 178 episodes of community-acquired native valve infective endocarditis seen at St Thomas' Hospital between 1969 and 1987, 59 patients (33 per cent) presented with neurological disorders that included meningitis, toxic confusion, major thromboembolic phenomena and headache . A neurological presentation occurred in 54 per cent of all cases of staphylococcal endocarditis, but in only 19 per cent of episodes of 'viridans' streptococcal and enterococcal endocarditis . Overall one-third of patients with staphylococcal endocarditis presented with clinical features of meningitis (40 per cent with no cardiac murmur) . The mortality rate for community-acquired native valve endocarditis was higher for those with a neurological presentation than without.

FEMS Microbiol Rev, 1989 Dec, 5(4), 301 - 25
Recent advances in the genetics of the clostridia; Young M et al.; Several laboratories around the world have started work on genetic analysis of clostridia . Interest in this diverse group of anaerobic organisms has grown with increasing awareness of the benefits that may accrue from their biotechnological exploitation . Research to date has focussed on construction of shuttle vectors containing replicons from clostridial and streptococcal plasmids, development of methods for transferring genes, and molecular cloning of genes--especially those involved in toxigenicity, fermentative metabolism and polysaccharide utilization . In selected species gene transfer by protoplast transformation, electroporation and conjugation has been accomplished and transposable elements have been introduced . It can be anticipated that our understanding of the molecular biology of these interesting organisms will grow rapidly in the future, bringing with it improved prospects for rational biotechnological exploitation.

J Biol Chem, 1989 Nov 25, 264(33), 19863 - 70
The streptococcal flavoprotein NADH oxidase . II . Interactions of pyridine nucleotides with reduced and oxidized enzyme forms; Ahmed SA et al.; Anaerobic addition of 0.5 eq of NADH/FAD to the streptococcal NADH oxidase produces a redox form spectrally similar to that obtained with 0.5 eq of dithionite/FAD . The second phase of the titration, however, in addition to reducing the flavin with 1 eq of NADH/FAD, leads to the appearance of a long-wavelength absorbance band centered at 725 nm . Reductive titrations of the enzyme with 3-acetylpyridine-adenine dinucleotide, which has a redox potential 72 mV more positive than that of NADH, yield a similar reduced enzyme species . Dithionite reduction of the NADH oxidase followed by titration with NAD+ partially mimics the long-wavelength absorbance of the NADH-reduced enzyme but also leads to the oxidation of 1 FADH2/dimer . NADH is not formed, however, and a similar result is obtained when the dithionite-reduced oxidase is titrated with the nonreducible substrate analog 3-aminopyridine-adenine dinucleotide . These data indicate that the FADH2 oxidation observed is intramolecular and suggest that the active centers of the two apparently identical subunits/dimer are not equivalent . These results also demonstrate that bound pyridine nucleotides can modulate the redox manifold of the NADH oxidase and, when taken together with the effects of these ligands on pre-steady-state behavior, suggest an important regulatory aspect of the catalytic redox function of this unique flavoprotein.

J Immunol Methods, 1989 Nov 13, 124(1), 43 - 52
A dual expression system for the generation, analysis and purification of antibodies to a repeated sequence of the Plasmodium falciparum antigen Pf155/RESA; Stahl S et al.; A novel dual expression system for the generation and analysis of immune responses to recombinant protein is described . The two expression systems are based on the IgG-binding domains (ZZ) of staphylococcal protein A (SpA) and the human serum albumin (HSA) binding domains (BB) of streptococcal protein G, respectively . Products of fusions with the ZZ region are used to generate an immune response against the recombinant peptide and the corresponding peptide fused to the BB region is used for analysis and purification of the specific antibodies . The protein A and protein G expression systems were used to produce fusion proteins with the repeated C terminal octapeptide subunit EENVEHDA of the Plasmodium falciparum merozoite derived protein Pf155/RESA . Rabbits were immunized with the protein A-derived fusion protein (designated ZZ-M1) and the antibody response was analyzed using the protein G-derived fusion protein (designated BB-M1) . The rabbit antisera reacted with BB-M1 in both ELISA and immunoblotting . In addition, BB-M1 proved to be an efficient ligand for affinity purification of antibodies specific for the malaria peptide . Furthermore, the rabbit antisera reacted with Pf155/RESA both in merozoite extracts and when deposited in the membrane of parasite infected erythrocytes.

J Pediatr Surg, 1989 Nov, 24(11), 1121 - 3
Aortic root replacement for complicated bacterial endocarditis in an infant; Perelman MJ et al.; We report the case of a 10-week-old girl with streptococcal aortic valve endocarditis that was resistant to medical management and complicated by aortic insufficiency, congestive heart failure, annular abscess, and a large periaortic pseudoaneurysm . She underwent successful aortic valve and root replacement (with coronary artery reimplantation) utilizing an aortic valve homograft (allograft) . The patient recovered completely and was discharged 3 weeks postoperatively . To our knowledge, this is the youngest patient to receive an aortic homograft for bacterial endocarditis and annular abscess.

J Rheumatol, 1989 Nov, 16(11), 1436 - 42
Cytokines and immunoglobulin in rheumatic heart disease: production by blood and tonsillar mononuclear cells; Miller LC et al.; Rheumatic fever and rheumatic heart disease are considered to result from abnormal immune responses after Group A streptococcal pharyngitis . Production of interleukin 1 (IL-1), tumor necrosis factor-alpha (TNF), interleukin 2 (IL-2) and immunoglobulin (Ig) by blood and tonsillar mononuclear cells from rheumatic or healthy children was measured after stimulation in vitro by pokeweed mitogen (PWM) or the streptococcal extracellular product, blastogen A (BLA) . Tonsillar cells from patients with rheumatic heart disease produced significantly less IL-1, TNF, IL-2, and Ig than control tonsillar cells . In contrast, blood mononuclear cell cultures from rheumatic children produced more TNF and IL-2 than controls . Our findings suggest that abnormal regulation of cytokine and Ig production may contribute to the pathogenesis of acute rheumatic fever and rheumatic heart disease.

Kansenshogaku Zasshi, 1989 Nov, 63(11), 1217 - 22
{A study on the examination of the incidences of streptococcal infectious diseases in the nationwide and the regional surveillance information of infectious diseases in Japan (1st report)}; Morita M; As the first step to examine the incidences of streptococcal infectious diseases for the nationwide and the regional surveillance information of infectious diseases in Japan, the number of patients with streptococcal infectious diseases per year or week and the hospitals in the surveillance systems in 47 prefectures from 1982 to 1987 were compared . It was found to have the tendency that the numbers of the patients were comparatively more in Hokkaido, Tohoku, partial areas of Kyushu and Shikoku than in other regions, and more in rural areas than in urban areas . Because of the deviation from the tendency, however, it was also suggested that the information of the disease in some prefectures might be poor . Although ratios of no . of the patients against no . of patients with exanthema subitum in 16 prefectures, respectively, were calculated and compared, it was be not enough to analyze the difference among the incidences of streptococcal infectious diseases in these prefectures.

Pediatr Infect Dis J, 1989 Nov, 8(11), 834 - 7
Evaluating the impact of a home screening test for streptococcal pharyngitis; Walker AM; Home screening tests must be evaluated as an aid to self-referral to a physician and should not be judged as if they were diagnostic procedures, i.e . the sole determinants of a therapeutic decision . The performance characteristics of a test are properly compared to those of the patient or parent, operating in the absence of the test . For streptococcal pharyngitis there would be a net increase in the number of cases correctly treated whenever the sensitivity of the home test (multiplied by the probability that the patient will act upon the test results) exceeds the a priori probability that the patient will be seen by a physician in the absence of the test . Use of home screening tests is likely to increase the number of patient-physician contacts among persons with sore throats and will do so proportionately more frequently among those with streptococcal pharyngitis.

Rev Chil Pediatr, 1989 Nov-Dec, 60(6), 333 - 7
{Streptococcal antibodies in a general population . Comparative study in 2 periods at a health service}; Berrios X et al.; Antibodies to streptococcal Estreptolysin O and DNAse B were sampled from 1986 through 1989 in 135 healthy individuals of both sexes, grouped by age, at a metropolitan area of Santiago, Chile, and their geometric mean titers (GMT) were calculated . GMT of 110 U (Todd) for Antiestreptolysin and 194 U for Anti-DNAse B were recorded in the whole sample . Antiestreptolysin O titers were 62 UT for age group 5 to 9 years, 127 UT for 10 to 14 year olds and 114 UT for ages 15 or older . Anti-DNAse B titers for the same age groups were 158 U, 240 U and 198 U respectively . No significant differences were detected between these results and those from an earlier (1978 to 1981) study, except for Anti-DNase B titers in 5 to 9 years olds, which were significantly lower (GMT 158 U vs . 270 U) in the most recent screening.

J Immunol, 1989 Nov 1, 143(9), 2948 - 54
Ig-binding bacterial proteins also bind proteinase inhibitors; Sjobring U et al.; Protein G is a streptococcal cell wall protein with separate binding sites for IgG and human serum albumin (HSA) . In the present work it was demonstrated that alpha 2-macroglobulin (alpha 2M) and kininogen, two proteinase inhibitors of human plasma, bound to protein G, whereas 23 other human proteins showed no affinity . alpha 2M was found to interact with the IgG-binding domains of protein G, and in excess alpha 2M inhibited IgG binding and vice versa . A synthetic peptide, corresponding to one of the homologous IgG-binding domains of protein G, blocked binding of protein G to alpha 2M . Protein G showed affinity for both native and proteinase complexed alpha 2M but did not bind to the reduced form of alpha 2M, or to the C-terminal domain of the protein known to interact with alpha 2M receptors on macrophages . Binding of protein G to alpha 2M and kininogen did not interfere with their inhibitory activity on proteinases, and the interaction between protein G and the two proteinase inhibitors was not due to proteolytic activity of protein G . The finding that protein G has affinity for proteinase inhibitors was generalized to comprise also other Ig binding bacterial proteins . Thus, alpha 2M and kininogen, were shown to bind both protein A of Staphylococcus aureus and protein L of Peptococcus magnus . The results described above suggest that Ig-binding proteins are involved in proteolytic events, which adds a new and perhaps functional aspect to these molecules.

J Immunol, 1989 Oct 15, 143(8), 2677 - 83
Human and murine antibodies cross-reactive with streptococcal M protein and myosin recognize the sequence GLN-LYS-SER-LYS-GLN in M protein; Cunningham MW et al.; Molecular mimicry or epitope similarity between group A streptococcal M proteins and myosin may contribute to the presence of heart reactive antibodies in acute rheumatic fever . In our study overlapping synthetic peptides copying the entire sequence of PepM5 protein were used to map the myosin cross-reactive epitopes of streptococcal M protein recognized by mouse and human mAb and affinity purified myosin-specific antibodies from acute rheumatic fever and rheumatic heart disease sera . Overlapping M protein peptides SM5(164-197)C and SM5(184-197)C inhibited the murine mAb reactions with PepM5 protein . The human mAb and affinity purified myosin-specific antibodies reacted exclusively with SM5(184-197)C . However, one of the five different purified myosin-specific antibodies not only reacted with SM5(184-197)C but also reacted with SM5(84-116)C . The synthetic subpeptides SM5(175-184)C and SM5(188-197C) did not react with any of the antibodies to PepM5 and myosin demonstrating a requirement of the 184-188 amino acid sequence for antibody recognition . A heptapeptide containing the sequence SM5(183-189) was also found to inhibit selected human myosin-specific antibodies and a human antimyosin mAb . Therefore, the majority of mouse and human myosin crossreactive antibodies recognized an epitope within the 14 residue carboxy terminus of PepM5 which appeared to involve the GLN-LYS-SER-LYS-GLN sequence.

Clin Exp Immunol, 1989 Oct, 78(1), 102 - 7
Autoimmune kidney disease in MRL/Mp-lpr/lpr mice inhibited by OK-432, a streptococcal preparation; Mihara M et al.; Autoimmune MRL/Mp-lpr/lpr (MRL/l) mice were treated with the immunostimulating anti-cancer drug OK-432 (a streptococcal preparation), a potent inducer of tumour necrosis factor . Treatment was initiated at 8 weeks of age, before the onset of the autoimmune disease . OK-432 prevented the development of immune complex-mediated glomerulonephritis in a dose-dependent manner, and prolonged the life in this strain of mice . At 36 weeks of age, the incidence of proteinuria was 90% in the controls, 60% in the 0.5-KE(1 KE = 0.1 mg) treatment group, and 33% in the 2.0-KE group . The 50% survival time was 23 weeks for the controls; 32 weeks for the 0.5-KE group; and greater than 36 weeks for the 2.0-KE group . Immune complex deposition in glomeruli was significantly reduced in the treated groups . The IgM class of serum autoantibody levels was significantly increased by OK-432 treatment but the IgG class was almost unchanged . Furthermore, lymphadenopathy and splenomegaly were not suppressed . The results indicate that OK-432 may be useful in the treatment of autoimmune disease in humans.

J Clin Invest, 1989 Oct, 84(4), 1345 - 8
Recombinant human tumor necrosis factor alpha suppresses autoimmune diabetes in nonobese diabetic mice; Satoh J et al.; We previously reported that administration of a streptococcal preparation (OK-432) inhibited insulitis and development of autoimmune diabetes in nonobese diabetic (NOD) mice and BB rats as animals models of insulin-dependent diabetes mellitus . In this study, we screened various cytokines that could be induced by OK-432 in vivo, for their preventive effect against diabetes in NOD mice . Among recombinant mouse IFN gamma, human IL1 alpha, human IL2, mouse granulocyte-macrophage colony-stimulating factor and human TNF alpha, only human TNF alpha suppressed insulitis and significantly (P less than 0.001) inhibited development of diabetes . NOD mice were the lowest producers of the mRNA of TNF and serum TNF on stimulation with OK-432 or with IFN gamma plus LPS, compared with C57BL/6, C3H/He, and Balb/c mice . The results imply a role for low productivity of TNF in the pathogenesis of autoimmune diabetes in NOD mice.

J Med Assoc Thai, 1989 Oct, 72(10), 545 - 7
Group A beta-hemolytic streptococcal meningitis in adults; Chotmongkol V et al.; Two cases of Group A beta-hemolytic streptococcal meningitis are reported . One patient presented with fever, coma, seizure and was associated with skull defect whilst the other had meningitis after surgical removal of an epidural cyst . The first died but the latter completely recovered . This organism should be considered in patients with skin wounds and bacterial meningitis due to Gram-positive cocci.

Zentralbl Bakteriol, 1989 Oct, 271(4), 475 - 80
Penicillin and clindamycin alter some group A streptococcal products; Figueiredo AM et al.; The effects of subMICs of penicillin and clindamycin on group A streptococcal products were analyzed . Penicillin caused an increase in the expression of the group carbohydrate for the three strains tested; in contrast, clindamycin inhibited the expression in two strains . The M and T proteins were not affected by the drugs . Clindamycin caused an increase in the hyaluronidase activity and both antimicrobial agents inhibited the activity of streptolysin at 1/2 MIC.

J Allergy Clin Immunol, 1989 Oct, 84(4 Pt 2), 579 - 86; discussion 586-8
High-dose intravenous immune globulin impairs antibacterial activity of antibiotics; Kim KS; In an effort to examine further whether passive immunotherapy is a useful adjunct to antimicrobial therapy for neonatal group B streptococcal disease, we evaluated human intravenous immune globulin and penicillin G, alone and in combination, for their therapeutic efficacy against experimental severe group B streptococcal infection in newborn rats . Infected rats received either immunoglobulin (2 gm/kg) intraperitoneally, penicillin G (dosage varied), or a combination of the two . All animals that received immunoglobulin alone died . The mortality rate of animals treated with penicillin G alone was 51% . In contrast, therapy with combined penicillin G and immunoglobulin resulted in a significantly greater mortality rate (88%) . Similar detrimental effects were also observed when human immunoglobulin (2 gm/kg) was given in conjunction with ceftriaxone (mortality rates of 95.7% for ceftriaxone and immunoglobulin versus 56.5% for ceftriaxone alone) . However, a smaller dose of immunoglobulin (0.5 gm/kg) did not result in the greater mortality rate . Moreover, antibiotic-mediated bacterial killing was impaired in vitro and in vivo by a large dose of immunoglobulin but not by a smaller dose . These findings suggest that large doses of human immunoglobulin may be disadvantageous to the bacterial activity of penicillin G and ceftriaxone against group B streptococcal disease . Additional studies are needed to elucidate further the mechanisms responsible for this dose-dependent adverse effect of human immunoglobulins.

East Afr Med J, 1989 Oct, 66(10), 636 - 40
Waning significance of anti-streptolysin O (ASO) titres in diagnosing streptococcal infections in Lagos, Nigeria; Anyiwo CE et al.; A total of 200 serum specimens comprising 100 specimens from patients with streptococcal disease conditions, 50 from patients with other diseases and another 50 specimens from apparently healthy individuals were collected from Lagos University Teaching Hospital and from various areas of Lagos metropolis and screened for the presence of anti-streptolysin O (ASO) . For streptococcal disease conditions, other diseases and for apparently healthy persons, anti-streptolysin O titres above 250 iu/ml recorded for each category of clinical conditions in terms of the number examined were 34%, 36% and 28% respectively . It is therefore suggested that high anti-streptolysin O (ASO) titres occur in apparently healthy individuals with no history of streptococcal infection and individuals with disease conditions other than those of streptococcal origin . Consequently the diagnosis of streptococcal diseases based on high titres of ASO in Lagos, is not pathognomonic, should be interpreted with caution and must not be definitive since healthy individuals and others without streptococcal infections develop high ASO titres.

J Biol Response Mod, 1989 Oct, 8(5), 488 - 500
Monoclonal antibody to a human salivary gland adenocarcinoma cell line: augmentation of antibody-dependent cell-mediated cytotoxicity activity by streptococcal preparation OK-432 in human salivary gland adenocarcinoma-bearing nude mice given the antibody; Kaji R et al.; An IgG2a mouse monoclonal antibody (MoAb) to the human salivary gland adenocarcinoma cell line HSG, 5B/10, has been generated in our laboratory . In the current study, the antitumor effects mediated by MoAb 5B/10 in human salivary gland adenocarcinoma (HSG)-bearing nude mice or the antibody-dependent cell-mediated cytotoxicity (ADCC) against HSG cells using human peripheral blood mononuclear cells (PBMC) as effector cells were examined . In addition, effects of the streptococcal preparation OK-432 on the growth of HSG tumors or on the MoAb 5B/10-mediated cellular cytotoxicity were studied . MoAb 5B/10 mediated an ADCC reaction against HSG cells that were insensitive to NK cells but not to the reaction of antibody and complement-mediated cytotoxicity . The coexistence of MoAb 5B/10 and OK-432 caused marked augmentation of cytotoxic effects . Treatment of OK-432-stimulated PBMC with antiasialo Gm1 antiserum plus complement but not with silica particles resulted in a significant decrease of cytotoxic effects as compared with relevant controls . the nude mice inoculated intraperitoneally with HSG cells and treated with MoAb 5B/10, OK-432, or (especially) a combination of the two had significantly prolonged survival times as compared with untreated controls . Moreover, spleen cells from the tumor-bearing mice treated with OK-432 alone or a combination of MoAb 5B/10 and OK-432 were found to carry high levels of effector cell activity in the MoAb 5B/10-mediated cytotoxicity assay using HSG cells as targets.

Zentralbl Bakteriol, 1989 Oct, 271(4), 532 - 42
Prospective study of pharyngitis: clinical diagnosis and microbiological profile; Rotta J et al.; A prospective study of pharyngitis was carried out in the general population of twenty-two thousand in a small country town, over a period of ten weeks in the fall of 1984 . It has been confirmed that, as in the past clinical diagnosis "streptococcal" and "nonstreptococcal" pharyngitis without microbiological examination is still highly inaccurate . From the clinical and microbiological parameters, the incidence in the period of follow-up was calculated as 7.2 and 12.0 cases per 100 population per year for streptococcal and nonstreptococcal pharyngitis, respectively . These data document the health importance of this disease which is frequently underestimated . The M (by M or OF antigens) typability accounted for 62% of group A strains isolated, the prevailing types being M 1 and M 12 . Comparison of M and OF typability of field strains immediately after isolation and three weeks later proved the superiority of an early typing . The accurate identification of prevailing types is essential for the prospect of streptococcal vaccine . In streptococcal pharyngitis cases treated with penicillin, the increase of antistreptolysin O and antideoxyribonuclease B titres was recorded in very few instances during a three week period after the onset of the disease . The examination of patients with nonstreptococcal pharyngitis aimed at detecting the role of some viruses or of M . pneumoniae proved that the etiology by these agents was practically nil in the cases concerned at this particular period of time . This finding suggests focusing interest on a possible role of other pathogens . The morbidity rates of pharyngitis, and the clinical as well as the microbiological data resulting from the study make it urgent to pay further attention to this infection and to attempt to elucidate the missing points in the etiology and diagnosis of this disease which belongs to the bacterial infections most frequently seen in man in economically developed countries.

J Bacteriol, 1989 Oct, 171(10), 5531 - 5
IS861, a group B streptococcal insertion sequence related to IS150 and IS3 of Escherichia coli; Rubens CE et al.; A 1,442-base-pair (bp) insertion sequence (IS861) was identified in the type III group B streptococcal (GBS) strain COH-1 . It is flanked by 26-bp imperfect inverted repeats and contains two open reading frames, 1 and 2, encoding 141- and 277-amino-acid proteins, respectively . A 3-bp target sequence, ACA, is duplicated and flanks each inverted repeat . IS861 shares greater than 30% homology with IS3 and IS150 of Escherichia coli, primarily in the region of their putative transposases . Northern (RNA) analysis revealed that RNA is actively transcribed in vivo by IS861 and 17- and 36-kilodalton proteins were synthesized in E . coli maxicell assays . Multiple copies of IS861 were observed throughout the chromosome of COH-1, and one of the copies is located near genes involved in GBS capsule synthesis . IS861 is the first insertion sequence identified in GBS . Its role in GBS and the significance of its relationship to the phylogenetically similar insertion sequences typified by IS150 and IS3 of E . coli are unknown.

J Bacteriol, 1989 Sep, 171(9), 4778 - 84
Region of the streptococcal plasmid pMV158 required for conjugative mobilization; Priebe SD et al.; The nonconjugative streptococcal plasmid pMV158 can be mobilized by the conjugative streptococcal plasmid pIP501 . We determined the sequence of the 1.1-kilobase EcoRI fragment of pMV158 to complete the DNA sequence of the plasmid . We showed that an open reading frame, mob (able to encode a polypeptide of 58,020 daltons), is required for mobilization of pMV158 . An intergenic region present in the EcoRI fragment contains four lengthy palindromes that are found also in one or more of the staphylococcal plasmids pT181, pE194, and pUB110 . One palindromic sequence, palD, which is common to all four plasmids, also appeared to be necessary for mobilization . Circumstantial evidence indicates that this sequence contains both an oriT site and the mob promoter . The Mob protein is homologous in its amino-terminal half to Pre proteins encoded by pT181 and pE194 that were shown by others to be essential for site-specific cointegrative plasmid recombination; their main biological function may be plasmid mobilization.

Respir Med, 1989 Sep, 83(5), 395 - 401
The place of lung 99mTc DTPA aerosol transfer in the investigation of lung infections in HIV positive patients; O'Doherty MJ et al.; Pneumocystis carinii pneumonia (PCP) is the most common cause of pneumonia in HIV antibody positive patients, but other pneumonias remain important, i.e . streptococcal and mycobacterial infections . A definitive diagnosis relies on obtaining samples from the lung either noninvasively (induced sputum), or invasively (bronchoalveolar lavage, transbronchial or open lung biopsy) . We have used the noninvasive technique of nebulized 99mTc DTPA transfer, to assess patients with PCP (n = 30) and other lung infections (n = 20) to see whether this test will distinguish between the various infections . The presence of a biphasic, rapid transfer curve indicates severe extensive alveolar damage and is seen in PCP or legionella pneumonia . The mean transfer time (T50 +/- SEM) for patients with PCP (whether smokers or nonsmokers) was 2.1 +/- 0.2 min, and for two of the patients with legionella 3.2 min . In PCP effective treatment causes the transfer to slow (mean T50 22.7 +/- 3.3 min, n = 24) and become monoexponential . Other causes of these changes in transfer are discussed . The other pneumonias (streptococcal, mycobacterial, and staphylococcal) did not result in biphasic curves or very rapid times, their T50 values are indistinguishable from cigarette smokers . In this patient group the DTPA transfer is a useful noninvasive investigation with a very rapid, biphasic curve indicating a high probability of PCP.

Clin Exp Rheumatol, 1989 Sep-Oct, 7 Suppl 3, S123 - 7
Mechanisms of bone and cartilage destruction in rheumatoid arthritis: lessons from the streptococcal cell wall arthritis model in LEW/N rats; Wilder RL et al.; Rheumatoid arthritis is a proliferative and erosive disease which has been described as tumor-like . Streptococcal cell wall-induced arthritis in the LEW/N rat is also tumor-like and closely simulates the features of joint destruction that develop in rheumatoid arthritis . This article discusses the mechanisms of bone and cartilage destruction in streptococcal cell wall arthritis with particular emphasis on the tumor-like behavior of synovial connective tissue cells and the role of cytokines, such as platelet-derived growth factor, transforming growth factor beta and interleukin 1, in regulating this abnormal behavior.

J Rheumatol, 1989 Sep, 16(9), 1225 - 8
The failure of intravenous cyclophosphamide therapy in refractory idiopathic inflammatory myopathy; Cronin ME et al.; Eleven patients with idiopathic inflammatory myopathy refractory to treatment with corticosteroids and other immunosuppressive agents were treated with monthly intravenous cyclophosphamide (0.75-1.357 g/m2) . Six patients completed a full course of 7 infusions at which point only one patient met predefined criteria for improvement in both strength and function . Five had modest improvement in strength but did not meet the criteria for improvement . All patients have subsequently required treatment with other medications . Major complications observed during therapy included serious infections in 2 patients (streptococcal endocarditis and disseminated Mycobacterium avium intracellulare) and death in one patient in which the contribution of cyclophosphamide cannot be excluded . We conclude that intravenous cyclophosphamide as used in our study cannot be recommended for the treatment of patients with refractory inflammatory myopathy.

No To Hattatsu, 1989 Sep, 21(5), 475 - 80
{Usefulness of ultrasonography and transcranial Doppler flowmetry in evaluation of infantile bacterial meningitis}; Hashimoto K et al.; A 40-day-old girl with B-group streptococcal meningitis was examined with ultrasonography (US) and transcranial Doppler flowmeter . Transfontanelle US with a 7.5 MHz probe showed a dilatation of the extracerebral space (ECS) . The flow velocity in the middle cerebral artery increased remarkably in the acute phase, and thereafter returned to normal . The superficial arterial velocity on the left side could not be recorded in the period of fluid collection in the left ECS . These two methods are useful procedures in the evaluation of infantile bacterial meningitis and its complications.

Ir J Med Sci . 1989 Sep;158(9):233.
Group B streptococcal infection as a pyrexia of unknown origin; O'Mahony D et al.; Group B Streptococcal bacteraemia seldom behaves as a pyrexia of unknown origin (PUO) except in the context of infective endocarditis . Scleroderma is not known to predispose to Group B streptococcal infection . We report a case of Group B streptococcal bacteraemia presenting as a PUO in a patient with probable scleroderma in whom there was no evidence of endocarditis.

Arch Surg, 1989 Sep, 124(9), 1083 - 6
Delayed presentation of a right-sided diaphragmatic hernia and group B streptococcal sepsis . Two case reports and a review of the literature; Rescorla FJ et al.; Group B streptococcal sepsis was associated with delayed presentation of an unsuspected right-sided diaphragmatic hernia in two neonates . These unusual clinical observations and a review of 24 similar cases from the literature form the basis of this report . Infants present with respiratory distress during the first few hours of life and have group B streptococcal sepsis confirmed by results of blood cultures . The right side of the diaphragm appears normal on the initial chest roentgenogram in the majority of cases . After initial improvement with antibiotic therapy and ventilatory support, sudden deterioration of respiratory status may occur . Subsequent chest roentgenograms often demonstrate herniated viscera in half of the cases, while ultrasound examination, isotopic liver scan, and peritoneography are useful in achieving a diagnosis in the other cases . If recognized, survival is 100% following hernia repair . Persistent respiratory symptoms in a neonate who is recovering from group B streptococcal sepsis should prompt a careful evaluation of the right side of the diaphragm for the presence of an unsuspected posterolateral hernia.

J Pediatr, 1989 Sep, 115(3), 445 - 50
High intravenous doses of human immune globulin suppress neonatal group B streptococcal immunity in rats; Weisman LE et al.; We evaluated the effect of intravenously administered immune globulin (IVIG) on neonatal group B streptococcal (GBS) infection in vivo and in vitro . A suckling rat model was used to compare the impact of penicillin (150 mg/kg) with albumin control, high-dose IVIG (2.7 gm/kg), or low-dose IVIG (0.68 gm/kg) on survival and bacteremia . Three lots of IVIG (two standard and one hyperimmune) with varying titers of GBS type III activity were used . An opsonophagocytic assay was then employed to evaluate in vitro the effect of concentrations of penicillin (none to 2.4 micrograms/ml), IVIG (none to 20 mg/ml), organism-specific (GBS type III-specific) activity (none to 1280(-1}, and quantity of organisms (10(4) to 10(6} on the killing of several strains of GBS type III . Low doses of IVIG enhanced suckling rat survival (p less than 0.0025) and bacterial clearance (p less than 0.01) . High doses of IVIG did not improve survival and in fact delayed bacterial clearance (p less than 0.05) when compared with low doses . Survival and bacterial clearance increased as the GBS type III activity of the IVIG lot increased . GBS opsonophagocytosis was suppressed at all penicillin concentrations (p less than 0.01) by high levels of IVIG (20 mg/ml) . High-dose IVIG suppression of GBS opsonophagocytosis decreased as type III activity of the lot increased . We speculate that high doses of nonspecific IVIG may cause blockade of neutrophil or bacterial receptors necessary for GBS immunity in neonates.

Obstet Gynecol, 1989 Sep, 74(3 Pt 2), 464 - 5
Group B streptococcal sepsis and death in utero following funipuncture; McColgin SW et al.; The technique of umbilical cord puncture for diagnosis and therapy, which has been shown to be feasible and relatively safe for both mother and fetus, is being used increasingly . The fetal loss rate with this technique has been estimated to be approximately 1% . A case is presented of fetal death from group B beta-streptococcal sepsis after funipuncture, the first report of this complication.

Nippon Geka Gakkai Zasshi, 1989 Sep, 90(9), 1432 - 5
{Immunotherapy for lung cancer by streptococcal preparation OK-432}; Watanabe Y et al.; To evaluate the clinical efficacy of OK-432 immunotherapy, patients admitted between 1975 and 1982 were randomized into two groups: An immunochemotherapy (IM-C) group and a chemotherapy (control) group . For each group, a fixed chemotherapy was administered using a combination of three drugs . The survival rates of cases with non-small cell carcinoma were evaluated at the end of 1987 . One hundred and fifty-seven cases in the IM-C group and 148 in the control group were eligible for evaluation of long-term survival rates . Statistically significant improvement of the survival rates in the IM-G group were noted in the following items: All cases, resected cases, non-resected cases, resected stage I + II cases, resected stage III cases, completely resected cases, incompletely resected cases, and cases with epidermoid carcinoma . However, in comparison of adenocarcinoma there was no significant difference between the two groups . SU-polysaccharide skin test and natural killer activity were the best immunological parameters during the OK-432 therapy . To intensify the effects of immunotherapy, a possibility of regional immunotherapy was studied following some experimental works . Regional infusion of LAK cells (induced by incubation of patient's lymphocytes with rIL-2) through bronchial artery after regional infusion of OK-432 and chemotherapeutics showed favorable effect for advanced lung cancer . Future prospect of these regional adoptive immunotherapy was discussed.

J Assoc Physicians India, 1989 Sep, 37(9), 582 - 5
Coxsackie virus and rheumatic fever . A correlative study; Suresh L et al.; Twenty-one patients of whom 13 had acute rheumatic fever and 8 had recurrence of rheumatic fever were studied for the evidence of coxsackie B viral infection using neutralisation test . A significant rise was noted in 17 cases (81%) and two cases had very high initial titre of neutralising antibodies to coxsackie B viruses type 1 to 6 . Mixed infection with more than one serotype was seen in 11 cases . Coxsackie B2 was the commonest type and 14 patients had antistreptolysin 'O' anti-bodies . The high incidence of coxsackie B viral infection in rheumatic fever and the coexistent streptococcal infection and their relationship are discussed.

In Vivo, 1989 Sep-Oct, 3(5), 307 - 13
Antitumor activity of orally administered streptococcal preparation, OK-432 on murine solid tumors and its absorption from the gut; Nio Y et al.; OK-432 is an immunopotentiator which is normally administered by injection . In the present study, the antitumor activity of orally administered OK-432 on various solid tumors and the absorption of OK-432 from the gut were studied . Orally administered OK-432 inhibited the growth of Meth-A and BAMC-1 fibrosarcomas which had been subcutaneously transplanted in BALB/c mice . Autoradiograms of mice which had been administered 14C-labelled OK-432 orally demonstrated the absorption of OK-432 from the gut, and about 6% of orally administered OK-432 was absorbed 24 hrs after its administration . Moreover, an immunofluorescent study using an anti-OK-432 antibody revealed specific fluorescence in the mesenteric lymph node of mice which had been orally administered with OK-432 . These results suggest that oral administration of OK-432 may be a beneficial immunotherapy.

Asia Oceania J Obstet Gynaecol, 1989 Sep, 15(3), 281 - 9
Induction of endogenous cytokines in ascites of patients with ovarian cancer by OK-432, a streptococcal preparation; Mori H et al.; To clarify the action mechanism of OK-432, OK-432 was intraperitoneally (i.p.) administered to 4 ovarian cancer patients with malignant ascites . In 2 of the 4 patients, 4 types of cytokines (tumor necrosis factor, interleukin 1 beta, interleukin 2, and interferon gamma) were induced in ascites after intraperitoneal injection of OK-432 (i.p . OK-432) . In one of these patients, the ascitic supernatant after i.p . OK-432 significantly inhibited colony formation of autologous ascitic tumor cells; the amount of ascites decreased markedly, and the ascitic cytology became negative . In the other 2 patients, only interferon gamma was induced in ascites after i.p . OK-432 . In these 2, ascitic supernatant did not inhibit colony formation of autologous ascitic tumor cells . These results indicated that i.p . OK-432 can induce various endogenous cytokines in malignant ascites and that these induced cytokines may contribute to the antitumor effect of i.p . OK-432.

Eur J Clin Microbiol Infect Dis, 1989 Sep, 8(9), 792 - 5
Age-related variations in anti-streptococcal antibody levels; Renneberg J et al.; The present study was undertaken to determine the upper 95% confidence limits (CL) for titres of antibodies to streptolysin O (ASO) and streptococcal DNase B (ADNB) using 741 sera from a general population . The ASO titres in sera from children increased abruptly with increasing age, from a mean of 21 (CL 67) in infants of 3 years or less to 211 (CL 462) in children 7 to 8 years old . In children 9 to 12 years of age titres exhibited a plateau with mean values of 168-258 (CL 436-611) . In individuals over 20 years the mean ASO titre diminished with increasing age, individuals of 70 years or more showing a mean titre of 83 (CL 169) . A similar variation was seen for ADNB . Infants 3 years of age or younger exhibited no detectable ADNB whereas individuals 70 years or more had a mean titre of 11 (CL 91) . A maximal mean ADNB titre of 184 (CL 706) was detected in 9-year-old-children . It was concluded that age-related reference values for anti-streptococcal antibodies increase the clinical relevance of the tests.

Rev Med Interne, 1989 Sep-Oct, 10(5), 429 - 33
{Systemic vasculitis associated with non-streptococcal infection . Report of 4 cases}; Frances C et al.; The responsibility of bacterial agents in the staring of systemic vasculitis is discussed on the basis of four cases: three men and one woman presenting with severe vasculitis which revealed or complicated a focus of infection without hematogenic dissemination . Two patients had gastrointestinal lesions and one had severe renal lesions . The vasculitis affected small caliber vessels, and in two out of four cases it involved arterioles of medium caliber with histological images resembling periarteritis nodosa . Antibiotic therapy alone was immediately effective against vasculitis . However, a purely cutaneous relapse occurred in three patients whose disease had regressed under an adjuvant treatment.

Mol Immunol, 1989 Sep, 26(9), 915 - 23
Isolation and partial characterization of antigens from basement membranes and streptococcal cell membrane (SCM) employing anti-SCM monoclonal antibody; Zelman ME et al.; Monoclonal antibodies (mAb) against streptococcal cell membrane (SCM) antigen were used to identify specific cross-reactive peptides prepared by trypsin digestion of purified glomerular basement membrane (GBM) and lung basement membrane (LBM) . Anti-SCM mAb-coupled HPLC columns were used to affinity isolate soluble LBM, GBM, and SCM antigens which then were sized by HPLC . Alternatively, SCM, GBM, and LBM digests were subjected to an initial separation by HPLC into component polypeptides, followed by affinity purification and ELISA of these fractions using anti-SCM mAb . Comparison of the antigenic reactivities by ELISA of the sized polypeptides on a nanomolar basis permitted the estimation of their individual relative epitope densities . The results for SCM antigens showed increasing epitope density with increasing molecular size, which suggests that intact SCM consists of repeating epitopes . Low mol . wt GBM polypeptides in nanogram amounts inhibited mAb binding to SCM, indicating that these small GBM polypeptides may similarly contain more than a single cross-reactive epitope . The identification of these cross-reactive epitopes in LBM and GBM has important implications for the etiology of post-streptococcal sequelae.

Prim Care, 1989 Sep, 16(3), 551 - 76
Scabies, lice, and fungal infections; Taplin D et al.; Scabies and pediculosis capitis are frequent and often unrecognized causes of multiple streptococcal and staphylococcal pyodermas . Permethrin 1 per cent creme rinse (NIX) for head lice, and permethrin 5 per cent topical cream for scabies are new, highly effective, safe, and cosmetically elegant treatments which have shown superiority over older remedies . In populations in which pediculosis and scabies have resisted traditional lindane therapy, patients promptly responded to these permethrin products . Scabies in nursing homes is a persistent and expanding problem which demands a high level of diagnostic suspicion and an integrated approach to management . For fungal infections, several new broad-spectrum oral and topical agents have been introduced . Their successful use is enhanced by appropriate diagnostic tests which can be performed in the office setting . Recommendations and references are given to assist the physician in diagnosis and choice of therapy.

Nippon Gan Chiryo Gakkai Shi, 1989 Aug 20, 24(8), 1607 - 15
{Oral administration of OK-432 (picibanil) . (8th report) clinical application: its immunomodulatory effects on the patients with gastrointestinal cancers}; Nio Y et al.; A streptococcal preparation, OK-432 at a dose of 5 KE was orally administered to the patients with gastric or colorectal cancer for 7 approximately 14 days before operation, and its immunomodulatory effects on peripheral blood lymphocytes (PBL), regional lymph node lymphocytes (RLNL) and tumor infiltrating lymphocytes (TIL) were assessed . OK-432 treated group included 5 gastric and 6 colorectal cancers, and control group included 6 gastric and 8 colorectal cancers . After oral administration of OK-432 the proportion of Leu 7+ and Leu 11+ cells in PBL increased, and NK cell activity of PBL also was augmented . The proportion of OKT8+ cells increased in PBL and those of OKT3+ cells and OKT8+ cells decreased in RLNL after oral administration of OK-432 . The responsiveness of TIL to autologous tumor extracts in the presence of interleukin-2 was enhanced in oral OK-432 group . These results indicate that oral OK-432 affects on NK and T cells and augments the antitumor immunity of the patients with gastrointestinal cancer.

J Immunol, 1989 Aug 15, 143(4), 1142 - 8
Transforming growth factor-beta production by synovial tissues from rheumatoid patients and streptococcal cell wall arthritic rats . Studies on secretion by synovial fibroblast-like cells and immunohistologic localization; Lafyatis R et al.; The growth of synovial fibroblast-like cells from patients with rheumatoid arthritis and rats with streptococcal cell wall (SCW)-induced arthritis in vitro under anchorage-independent conditions is inhibited by transforming growth factor-beta (TGF-beta) . Because this growth factor is present in rheumatoid synovial fluids, we studied whether this cytokine might be secreted by cells in rheumatoid synovial tissue . We show that synovial tissues from patients with rheumatoid arthritis and osteoarthritis, and rats with SCW-induced arthritis, contain TGF-beta-1 mRNA . TGF-beta, predominantly type 1, was spontaneously secreted in vitro by synovial tissue explants and synovial fibroblast-like cells . In addition, TGF-beta could be detected immunohistochemically in cells throughout rheumatoid and SCW-induced arthritic rat synovial tissues . Finally, exogenous TGF-beta induced collagen and inhibited collagenase mRNA levels by cultured synoviocytes . These data support an autocrine role for TGF-beta in the regulation of synoviocytes in rheumatoid arthritis and, in light of its demonstrated effects on the immune system, suggest that TGF-beta might also have important paracrine effects on infiltrating inflammatory cells.

Nippon Kyobu Geka Gakkai Zasshi, 1989 Aug, 37(8), 1608 - 13
{False aneurysm of the right pulmonary artery--a rare complication of aorto-pulmonary shunt in a patient with tricuspid atresia}; Tachibana H et al.; A 12-year-old girl with tricuspid atresia who underwent a side-to-end anastomosis between the ascending aorta and the right pulmonary artery at the age of two months, developed a false aneurysm of the right interlobar trunk artery . The diagnosis was established by angiography, computed tomography and bronchoscopy . Emergency surgical intervention was required because of impending aneurysmal rupture into the right interlobar bronchus . Creation of a left Blalock-Taussig shunt to tide over the anticipated postoperative hypoxemia and right middle and lower lobectomy were carried out successfully . The false aneurysm in this case occurred following an episode of a streptococcal infection and was probably mycotic in origin . But it is possible that the presence of aorto-pulmonary shunt itself might have affected as a predisposing factor for aneurysm formation in this case.

Int J Pept Protein Res, 1989 Aug, 34(2), 118 - 23
Influence of ions on cyclization of the amino terminal glutamine residues of tryptic peptides of streptococcal PepM49 protein . Resolution of cyclized peptides by HPLC and characterization by mass spectrometry; Khandke KM et al.; RPHPLC of the tryptic digest of lysine blocked group A streptococcal PepM49 protein (DHP-PepM49) consistently yielded, among others, two pairs of peptides which were well resolved, eluted in tandem, and had identical amino acid compositions . In each pair, the earlier eluting peptide was readily amenable to sequencing and yielded an amino-terminal glutamine whereas the later eluting peptide could not be sequenced . Mass spectral analysis revealed that each of these pairs of peptides differed in mass corresponding to the loss of ammonia . These data suggested that the later eluting peptide in each pair is a result of cyclization of the amino-terminal glutamine residue to pyroglutamic acid, which apparently leads to an increase in the hydrophobicity of the peptide . A kinetic analysis of the tryptic digestion of the DHP-PepM49 protein revealed that the cyclized form of the peptides were essentially absent during the initial time and increased with time of incubation, with a concomitant decrease in the uncyclized form . In 0.2 M ammonium bicarbonate at 37 degrees, nearly 44% conversion of the glutaminyl peptides to the pyroglutamyl peptides was observed in 24 h . This conversion was accelerated in sodium phosphate buffer relative to that in ammonium bicarbonate whereas it had a significantly lower rate in ammonium acetate buffer . The conversion was also temperature dependent, with essentially no cyclization at 0 degree, in all the three buffers . Thus, an extended digestion at 0 degree or a brief digestion at 37 degrees in ammonium acetate was found to be a suitable condition for limiting the cyclization of amino-terminal glutamine residues of PepM49 peptides.(ABSTRACT TRUNCATED AT 250 WORDS)

Immunol Invest, 1989 Aug, 18(7), 919 - 30
Comparison of the mitogenic activities of streptococcal protein-G and staphylococcal protein-A on human mononuclear cells; Lindhqvist V et al.; In the present work we report data from experiments comparing the proliferative stimuli demonstrated by Streptococcal Protein-G and Staphylococcal Protein A on human peripheral blood mononuclear cells . Protein-G and Protein-A are presented to the cells in solution as well as linked to plastic or Sepharose beads, or incorporated within the cell wall of whole bacteria . The cellular response is measured by incorporation of 3H-thymidine in 72 hr cultures . The soluble and the immobilized forms of Protein-A, but not those of Protein-G, displayed high mitogenicity . Possible explanations for the absence of Protein-G induced mitogenicity are discussed.

J Exp Med, 1989 Aug 1, 170(2), 449 - 66
Protection against streptococcal cell wall-induced arthritis by pretreatment with the 65-kD mycobacterial heat shock protein; van den Broek MF et al.; We report that streptococcal cell wall (SCW)-induced arthritis in rats, a T cell-dependent chronic, erosive polyarthritis, can be prevented by pretreatment of the rats with the mycobacterial 65-kD heat shock protein . This 65-kD protein shows extensive amino acid homology with prokaryotic and eukaryotic 65-kD heat shock proteins and is a ubiquitous bacterial common antigen . Both the clinical and histopathologic manifestations of the arthritis were prevented completely when rats were pretreated with 50 micrograms of 65-kD protein intraperitoneally at 35, 25, 15, or 5 d before administration of SCW . In such protected rats, SCW-specific T cell responses were suppressed, as compared with responses in arthritic rats . Pretreatment with 65-kD protein had no effect on the production of antibodies against SCW, on a nonspecific inflammatory reaction (zymosan-induced arthritis), or on general cellular immunity in vivo (delayed type hypersensitivity reaction to a nonrelated protein antigen) . Furthermore, the protection against SCW arthritis was transferable by splenic T cells to naive recipients . Our data show that pretreatment with the 65-kD mycobacterial heat shock protein protects rats against a subsequent bacterium-induced arthritis . This protection is immunologically specific and resides in the lymphoid cell population.

Invest Radiol, 1989 Aug, 24(8), 604 - 8
Streptococcal antigen-induced dislocation and dysplasia of the hip in newborn rats . Radiologic and histologic evaluation of a model of congenital dislocation of the hip; Parker MD et al.; Dislocation of the hip developed in 62% of newborn rats with streptococcal antigen-induced synovitis . Age at the time of the induction of synovitis is critical since dislocation is not observed in older rats . Synovitis with distention and laxity of the joint capsule is most likely responsible for the hip dislocation . Although congenital dislocation of the hip in children is not mediated by an inflammatory process, the current model of dislocation of the hip in rats is similar in being critically age-dependent, and associated with ligamentous laxity . Our model may be helpful in studying this important clinical entity.

Aust N Z J Obstet Gynaecol, 1989 Aug, 29(3 Pt 2), 291 - 3
Group B streptococcal colonization and preterm labour; McDonald H et al.; Recent publications have highlighted the controversy regarding the significance of Lancefield Group B Streptococcal (GBS) colonization in pregnancy and preterm delivery . In this prospective study vaginal swabs from 692 women at approximately 24 weeks' gestation were cultured for GBS . GBS was detected in 91 (13.2%) women . The rate of preterm labour (PTL) (less than 37 weeks) was significantly higher in GBS positive women than in GBS negative women (18.7% versus 5.5%; p less than 0.001) . This association remained significant even when patients with other recognized factors predisposing to PTL were excluded (11.5% versus 3.9%; p less than 0.001) . The rate of premature rupture of membranes (PROM) was also significantly higher in GBS positive women (9.9% versus 2.7%; p less than 0.005) and remained significantly higher when patients with other recognized risk factors were excluded (6.1% versus 1.8%; p less than 0.025) . These results unequivocably show that pregnant women who are vaginal carriers of GBS have a significantly increased risk of PROM and PTL.

Jpn J Exp Med, 1989 Aug, 59(4), 163 - 6
Enzyme immunoassay (ELISA) for the detection of anticarbohydrate antibodies in rheumatic fever and rheumatic heart disease; Wahi V et al.; Antibodies to group A streptococcal polysaccharide were estimated in the following groups of patients: (I) Patients with uncomplicated streptococcal pharyngitis: 10 patients, followed up for 3 months . (II) Patients with acute rheumatic fever: 8 patients with first attack followed up for one year . (III) Patients with reactivated rheumatic heart disease: 10 patients, followed up for one year . (IV) Patients with chronic rheumatic heart disease: followed up for one year . (V) normal controls without any history of sore throat/fever/vaccination/rheumatic disease: 10 patients followed up for one year . Group (I) patients did not show any significant elevation in anticarbohydrate antibodies by both ELISA and RIA . In the case of (III) and (IV), antibody levels were significantly higher as compared to group (V) and remained so till one year of follow up . In group (II) patients there was no significant rise in antibody levels . There was a good correlation between the ELISA and RIA used to detect the antibody levels . These findings suggest that the use of ELISA to detect anticarbohydrate antibody can be of help in diagnosing cases of rheumatic heart disease (both acute and chronic RHD).

Zhonghua Nei Ke Za Zhi, 1989 Aug, 28(8), 486 - 9, 511
{Clinical features and long-term outcome of 91 cases of adult onset post-streptococcal glomerulonephritis in Hong Kong}; Fang GX; The clinical features and long-term outcome of 91 cases of adult-onset PSGN in Hong Kong were reported . There were 46 male and 45 female with age ranging from 13 to 56 yrs (mean 18.6) . The diagnosis was based on clinical manifestations and renal biopsy was performed in 29 cases . The main manifestations were acute nephritic syndrome (72.5%) and acute nephritic-nephrotic syndrome (27.5%) . Serum creatinine was increased in 48.4% of the patients at presentation . Four cases presented with acute renal failure . Serial serum C3 levels were determined in 48 patients . It was decreased in all patients at presentation but returned to normal within 15 weeks . The follow-up duration of this series ranged from I to 19 yrs (mean 4.73 yr) 67.03% recovered early (within 3 mts); 14.29% recovered later (from 6 mts to 7 yrs): 16.48% had persistent or intermittent proteinuria and or haematuria . Two cases developed chronic renal insufficiency . Our results suggested that the prognosis of PSGN in adults is relatively good and the indications for renal biopsy in adult-onset PSGN were discussed.

J Rheumatol, 1989 Aug, 16(8), 1069 - 73
Antibody to streptococcal cell wall peptidoglycan-polysaccharide polymers in sera of patients with juvenile rheumatoid arthritis but absent in isolated immune complexes; Moore TL et al.; Sera of 88 children with juvenile rheumatoid arthritis (JRA) (10 seropositive, polyarticular onset, 29 seronegative, polyarticular onset, 32 pauciarticular onset, and 17 systemic onset) were evaluated for the presence of serum antibodies to streptococcal cell wall peptidoglycan-polysaccharide polymers (PG-PSP) . Immune complexes (IC) isolated by the antihuman IgM (HIgM) affinity column method were also evaluated for the presence of antibodies to PG-PSP . Forty-one of 88 patients with JRA (7 of 10 seropositive, polyarticular onset, 11 of 29 seronegative, polyarticular onset, 16 of 32 pauciarticular onset, and 7 of 17 systemic onset) showed elevated levels of antibodies to PG-PSP in their sera . IgM rheumatoid factors (RF) were demonstrated in 70/88 isolated IC fractions of patients with JRA and IgG RF in 7; however, none of the patients demonstrated the presence of antibodies to PG-PSP in their isolated IC fractions from the anti-HIgM affinity column . These data indicate that antibodies are produced to PG-PSP in all JRA onset types, but they are not constituents of isolated IC by the anti-HIgM affinity column method.

J R Coll Gen Pract, 1989 Aug, 39(325), 332 - 4
Sore throat in family practice: comparison of blood agar throat culture with a rapid enzyme immunoassay test for diagnostic purposes; Hasin M et al.; The Ventrescreen (Ventrex) rapid enzyme immunoassay test for detecting group A streptococcal antigen directly from a throat swab was compared with conventional blood agar throat culture in the diagnosis of beta haemolytic streptococcal infection among 311 patients with a sore throat attending a large suburban Jerusalem primary care clinic . Using the throat culture as the 'gold standard' the Ventrescreen test had a sensitivity of 82%, a specificity of 50%, a positive predictive value of 49%, and a negative predictive value of 82% for beta haemolytic streptococcal infection . These results are not good enough for the test to be considered a reliable substitute for throat culture in such a setting . The negative predictive value, however, supports the use of a negative test result to identify those patients in whom antibiotic therapy could be withheld until the result of their throat culture became available . These conclusions are at variance with recommendations from other studies of similar tests in different population groups, and stress the need for the careful evaluation, especially in primary care clinics, of any such rapid test which claims to be able to replace throat culture in the detection of beta haemolytic streptococcal infection.

Acta Paediatr Jpn, 1989 Aug, 31(4), 487 - 92
Concurrent poststreptococcal acute glomerulonephritis and Schönlein-Henoch purpura; Onisawa S et al.; A 5-year-old Japanese boy developed concurrent poststreptococcal acute glomerulonephritis (PSAGN) and Schonlein-Henoch purpura (SHP) . An elevated titer of ASK on admission confirmed the preceding streptococcal infection . Arthritis of the left knee and petechiae on admission were regarded as features of SHP . The presence of SHP was further confirmed by the pathological finding of leukocytoclastic vasculitis in the skin . PSAGN was strongly suspected due to the findings of microscopic hematuria and hypocomplementemia in the acute phase . The concurrence of SHP and PSAGN suggests similar underlying pathophysiological processes as poststreptococcal sequelae . At the height of the illness, peripheral blood lymphocyte subset analysis showed a marked increase in the suppressor inducer T subset and a reciprocal decrease in the helper T subset . This alteration in T lymphocyte subsets was regarded as indicative of the immunological derangement in this patient.

J Biol Chem, 1989 Jul 25, 264(21), 12330 - 8
The non-flavin redox center of the streptococcal NADH peroxidase . II . Evidence for a stabilized cysteine-sulfenic acid; Poole LB et al.; Incubation of the streptococcal NADH peroxidase with 5-thio-2-nitrobenzoate under anaerobic denaturing conditions leads to the rapid incorporation of 1 eq/FAD of the aromatic thiol . Addition of dithiothreitol to the resulting conjugate, following ultrafiltration, demonstrates that a mixed disulfide has been formed . Analysis of the denatured NADH peroxidase by iso-electric focusing reveals the presence of two predominant species differing in isoelectric point by approximately 0.1 units . Preincubation with 20 mM hydrogen peroxide gives essentially complete and irreversible conversion to the more acidic species . Treatment of the native peroxidase with low concentrations of hydrogen peroxide also leads to irreversible enzyme inactivation; the low extinction long wavelength absorbance associated with the enzyme as purified is lost in the process . Anaerobic dithionite and NADH titrations of the peroxide-inactivated enzyme indicate that, while the cysteinyl redox center is nonfunctional, the enzyme is still capable of forming a binary complex with NADH . We propose that the redox-active cysteinyl derivative which serves as the second redox center in the native peroxidase is a stabilized cysteine-sulfenic acid derivative of Cys42 . This determination is consistent with the covalent modifications observed with both 5-thio-2-nitrobenzoate and with H2O2 and is supported by mass spectrometric analysis of a chymotryptic cysteinyl peptide derived from the unmodified peroxidase.

J Biol Chem, 1989 Jul 25, 264(21), 12322 - 9
The non-flavin redox center of the streptococcal NADH peroxidase . I . Thiol reactivity and redox behavior in the presence of urea; Poole LB et al.; Unlike the 2-electron-reduced (EH2) forms of the flavoprotein disulfide reductases and mercuric reductase, the native EH2 form of the streptococcal NADH peroxidase is quite refractile toward chemical modification with thiol-specific reagents . In the presence of 1.3 M urea, however, the single thiol of the reduced enzyme reacts with phenylmercuric acetate with a t1/2 of 3 min . This modification abolishes the charge-transfer absorbance band at 540 nm and inactivates the enzyme; the latter effect is shown to be reversed with dithiothreitol . Alkylation of the streptococcal peroxidase with iodo{1-14C}acetamide under reducing conditions in the presence of 8 M guanidine hydrochloride allows the isolation of a single labeled tryptic peptide with the sequence: Gly-Asp-Phe-Ile-Ser-Phe-Leu-Ser-C*ys-Gly-Met-Gln-Leu-Tyr-Leu- Glu-Gly-Lys . This sequence is identical to that previously reported (Poole, L . B., and Claiborne, A . (1988) Biochem . Biophys . Res . Commun . 153, 261-266) for the cysteinyl peptide isolated from the NADH peroxidase labeled metabolically with {35S}cysteine . Careful examination of the physical properties of the streptococcal peroxidase in the presence of 1.3 M urea shows that, while catalytic activity and native structural features are largely retained, the relative potentials of flavin and non-flavin redox centers are dramatically affected . We propose that low concentrations of urea stabilize an intermediate state in the transition between native and denatured forms, which is responsible for the observed changes in both active-site thiol reactivity and in redox properties.

Nippon Gan Chiryo Gakkai Shi, 1989 Jul 20, 24(7), 1370 - 8
{Induction of activated natural killer cells by the streptococcal preparation OK432 (I) . Induction from spleen cells of normal or tumor-bearing mouse primed in vivo and subsequently challenged in vitro with OK432}; Yamaue H et al.; The present study shows that natural killer cell-mediated cytotoxicity of BALB/c mouse spleen cells to syngeneic tumor cells was augmented by in vivo priming or in vitro stimulation with the streptococcal preparation OK432 . The augmentation of spleen cell cytotoxicity to syngeneic tumor cells by in vivo priming alone with OK432 was lower than that obtained by in vitro stimulation alone with OK432 . When the murine spleen cells primed in vivo with OK432 were rechallenged in vitro with OK432 at various intervals, the natural cytotoxicity was more strongly enhanced than that seen with in vitro stimulation alone . The cell surface phenotype of killer cells activated with OK432 was Thy1+ and asialo GM1+, suggesting the activated natural killer cell . Mice were transplanted with syngeneic colon adenocarcinoma cells, and primed in vivo with OK432, and then their spleen cells were subsequently challenged in vitro with OK432 . These cells displayed a strong cytotoxic activity not only to the transplanted adenocarcinoma cells but also to other syngeneic tumor cells.

Cancer, 1989 Jul 15, 64(2), 434 - 41
Cytotoxic and cytostatic effects of the streptococcal preparation OK-432 and its subcellular fractions on human ovarian tumor cells; Nio Y et al.; Previous studies have indicated that OK-432 is a potent biologic response modifier (BRM) and that it augments immune responses to tumor cells . We studied the direct effect of OK-432 on tumor cells . Established and freshly derived human ovarian carcinoma lines were examined for their susceptibility to OK-432 or its subcellular fractions in direct cytotoxicity, cytostatic activity, and inhibition of metabolic activity . OK-432 was cytotoxic to 13 of 15 freshly derived ovarian carcinoma lines in a 24-hour chromium-51 (51Cr) release assay . The optimal effect was noticed at OK-432 concentrations between 0.1 and 1.0 Klinishe Einhert (KE) per milliliter . The cytostatic effect on two established lines and one fresh line correlated with the cytotoxic activity . In all three lines, however, the metabolic activities (DNA, RNA, and protein synthesis) were inhibited by OK-432, suggesting that cell lysis by OK-432 may not be directly correlated with the inhibition of metabolic activities . Several subcellular fractions were derived from OK-432 and only the cytoplasmic and protoplast membrane fractions showed cytotoxic activity against the OK-432-sensitive tumor cell lines, although the cytotoxicity obtained was greatly less than the whole microorganism OK-432 . The direct binding of 14C-OK-432 to tumor cells was examined . Binding took place rapidly after 1 hour of incubation and reached a maximum activity at 37 degrees C . Binding in all three lines ranged between 1.7 and 2.7 pg/cell . These results demonstrate the direct cytotoxic effect of OK-432 and some subcellular fractions on human ovarian carcinoma lines . These results also show that the BRM OK-432 may exert its effect by both potentiating the antitumor response and directly inhibiting tumor cell growth.

Endoscopy, 1989 Jul, 21(4), 168 - 71
The endoscopic intratumor administration of OK-432 in gastric cancer unsuitable for surgery; Nakazawa S et al.; In eleven patients with gastric cancer who could not be operated on because of advanced age, refusal of surgery, or the presence of complications, the streptococcal preparation OK-432 was administered, both intradermally and by direct injection into the tumor under endoscopic guidance . Via gastric x-ray and endoscopic examinations, the tumor was observed to disappear in two cases-one advanced cancer and one early gastric cancer endoscopically . Particularly in the latter case repeated biopsies revealed no evidence of cancer cells . All patients developed fever after intratumor injection, but in no case was it necessary to discontinue administration, and no other serious side effects were noted . The endoscopic injection of OK-432 appears to be a safe and useful form of therapy for gastric cancer unsuitable for surgery.

Am J Otolaryngol, 1989 Jul-Aug, 10(4), 227 - 33
Medical treatment of non-streptococcal recurrent tonsillitis; Brook I; Forty patients with a history of recurrent non-beta-hemolytic streptococcal tonsillitis (RNST) participated in a prospective randomized study comparing penicillin and clindamycin in the treatment of acute non-group A streptococcal infection . The efficiency of each antibiotic was evaluated according to its ability to alleviate acute infection and prevent recurrence . Surface tonsillar cultures were obtained both before and ten days after the termination of therapy, and specimens were processed for aerobic and anaerobic bacteria . Beta-lactamase-producing bacteria (BLPB) were present in 36 (90%) tonsillar cultures . Thirty-one BLPB were isolated in 17 patients before penicillin therapy and 42 BLPB were recovered from 19 after such treatment . Thirty-three BLPB were recovered in 19 patients before clindamycin therapy, after which four BLPB were isolated in three patients (P less than .05) . From the second day posttherapy onward, significantly fewer patients who received clindamycin had fever, pharyngeal injection, and sore throat . In a 1-year follow-up period, recurrent tonsillitis was noted in 13 of the patients who received penicillin and in two treated with clindamycin (P less than .001) . The data clearly demonstrate the superiority of clindamycin therapy over penicillin in patients with RNST.

J Bone Joint Surg Am, 1989 Jul, 71(6), 828 - 34
Two-stage reconstruction of a total hip arthroplasty because of infection; McDonald DJ et al.; From 1969 to 1985, eighty-one patients (eighty-two hips) who had an infection after a previous total hip arthroplasty were treated with a resection arthroplasty, followed by delayed reconstruction in the form of a repeat total hip arthroplasty . For all of the reconstructions, the femoral and acetabular components were fixed to bone with cement that did not contain antibiotics . An average of 5.5 years (range, 2.0 to 13.6 years) after reimplantation, infection had recurred in eleven hips (13 per cent) . The presence of retained cement at the time of the resection arthroplasty appeared to be associated with recurrent sepsis, as three of seven patients who had retained cement had a recurrent infection, compared with only eight (11 per cent) of seventy-five patients from whom the cement had been completely removed (p less than 0.01) . The twenty-six patients (twenty-six hips) who had the reimplantation less than one year after the resection arthroplasty had seven recurrent infections (27 per cent), while the fifty-six patients who had reimplantation more than one year after the resection arthroplasty had only four recurrences (7 per cent) (p less than 0.001) . Three of the seven patients in whom the infection was caused by gram-negative bacilli and group-D streptococcal organisms (which are considered highly virulent) and who received systemic antimicrobial therapy for less than twenty-eight days had a recurrence . In contrast, only one of the thirteen patients in whom the infection was caused by a virulent organism and who were treated for longer than twenty-eight days had a recurrence (p = 0.055) . The two-stage reconstruction is an effective, safe technique even when the infection is caused by a virulent organism.

Diagn Microbiol Infect Dis, 1989 Jul-Aug, 12(4), 357 - 9
Varicella associated intracerebral hemorrhage in the absence of thrombocytopenia; Fikrig E et al.; A young woman with varicella complicated by streptococcal cellulitis developed an intracerebral bleed in the absence of thrombocytopenia, serious coagulopathy, or a detectable vascular lesion . We postulate that during the acute infection with varicella, a cerebral endothelial lesion was produced which later caused the intracerebral bleed.

Hum Immunol, 1989 Jul, 25(3), 157 - 68
Activation of human CD8+ suppressor T cells by an antigen-specific CD4+ T-cell line in vitro; Fukunaga M et al.; We generated an antigen (streptococcal cell wall antigen)-specific T-cell line from peripheral blood mononuclear cells of a healthy donor with an intermediate response to streptococcal cell wall antigen . Proliferation of the T-cell line was completely blocked by a monoclonal antibody to HLA-DR . This line activated autologous CD8+ T cells in an antigen-specific manner in the presence of autologous monocytes . This activation was mediated by a factor derived from this line and was blocked by a monoclonal antibody against HLA class I molecules . The resultant CD8+ T blasts showed antigen-nonspecific suppression but no cytolytic activity . This antigen-specific generation of the CD8+ T-cell line in vitro by the antigen-specific CD4+ T-cell line is expected to contribute to analyses of functions of CD8+ T-cell subsets, particularly in the down-regulating system, at both cellular and molecular levels.

Infect Immun, 1989 Jul, 57(7), 2249 - 52
Conservation of the biologically active portions of staphylococcal enterotoxins C1 and C2; Bohach GA et al.; We determined the primary sequence of staphylococcal enterotoxin (SE) C2 by sequencing its cloned structural gene, entC2 . The entC2 structural gene contains an 801-base-pair open reading frame which encodes a 266-amino-acid precursor with a molecular weight of 30,608 . Mature SE C2, produced by removal of the signal peptide, contains 239 amino acids with a molecular weight of 27,531 . A sequence comparison between SE C2 and SE C1 showed that the 167 carboxyl amino acids in both toxins were 100% conserved . In contrast, the 72 N-terminal residues were 10% divergent . This provides additional evidence that carboxyl regions of staphylococcal and streptococcal pyrogenic toxins determine shared biological activities and cross-reactive epitopes.

Proc Natl Acad Sci U S A, 1989 Jun, 86(12), 4771 - 5
A central nervous system defect in biosynthesis of corticotropin-releasing hormone is associated with susceptibility to streptococcal cell wall-induced arthritis in Lewis rats; Sternberg EM et al.; We have recently found that susceptibility to streptococcal cell wall (SCW)-induced arthritis in Lewis (LEW/N) rats is due, in part, to defective inflammatory and stress mediator-induced activation of the hypothalamic-pituitary-adrenal (HPA) axis . Conversely, the relative arthritis resistance of histocompatible Fischer (F344/N) rats is related to their intact responses to the same stimuli . Specifically, LEW/N rats, in contrast to F344/N rats, have markedly impaired plasma corticotropin and corticosterone responses to SCW, recombinant human interleukin 1 alpha, the serotonin agonist quipazine, or synthetic rat/human corticotropin-releasing hormone (CRH) . To explore the mechanism of this defect, we examined the functional integrity of the hypothalamic CRH neuron in LEW/N rats compared to F344/N rats . LEW/N rats, in contrast to F344/N rats, showed profoundly deficient paraventricular nucleus CRH mRNA levels and hypothalamic CRH content in response to SCW . Compared to F344/N rats, there was no increase in LEW/N hypothalamic CRH content or CRH release from explanted LEW/N hypothalami in organ culture in response to recombinant interleukin 1 alpha . These data provide strong evidence that the defective LEW/N corticotropin and corticosterone responses to inflammatory and other stress mediators, and the LEW/N susceptibility to experimental arthritis, are due in part to a hypothalamic defect in the synthesis and secretion of CRH . The additional finding of deficient expression in LEW/N rats of the hypothalamic enkephalin gene, which is coordinately regulated with the CRH gene in response to stress, suggests that the primary defect is not in the CRH gene but is instead related to its inappropriate regulation.

J Biochem (Tokyo), 1989 Jun, 105(6), 1040 - 3
Binding of activated macrophages to tumor cells through a macrophage lectin and its role in macrophage tumoricidal activity; Oda S et al.; A 45-60 kDa Gal/GalNAc-specific macrophage lectin was found to participate in the interaction between tumor cells and tumoricidal macrophages activated by an antitumor streptococcal preparation, OK-432, and in the tumoricidal activity of the activated macrophages . The binding between OK-432-elicited activated macrophages and murine mastocytoma P-815 cells was inhibited on preincubation of the macrophages with a neoglycoprotein (Gal-BSA) or a complex-type glycopeptide (unit B) which was a specific inhibitor of the macrophage lectin . This binding of the macrophages to P-815 cells was also inhibited on the addition of anti-macrophage lectin antiserum . Contrary to the case of OK-432-elicited macrophages, the binding of thioglycolate-elicited (responsive) macrophages to P-815 cells was inhibited only a little by Gal-BSA and unit B, and not inhibited by the antiserum . Furthermore, the tumoricidal activity of the activated macrophages was inhibited by the addition of the anti-macrophage lectin antiserum . These results suggest that the binding of activated macrophages to tumor cells through the Gal/GalNAc-specific macrophage lectin is an important part of the tumor cell killing mechanism.

Clin Chem, 1989 Jun, 35(6), 1039 - 42
Nonenzymic glycation of human immunoglobulins does not impair their immunoreactivity; Morin LG et al.; Diabetic patients have an increased proportion of their immunoglobulins nonenzymically glycated . To investigate the possibility that this may contribute to increased susceptibility to infection, we compared the immunoreactivity of glycated and nonglycated human immunoglobulins against rubella and hepatitis; streptococcal exoenzyme and infectious mononucleosis; human lymphocytotoxic antigens (HLA); and Varicella zoster in terms of antigen-antibody binding, cell agglutination, cytotoxicity, and complement-fixation properties, respectively . We found no evidence to support the supposition that glycated immunoglobulins are functionally impaired.

Nippon Gan Chiryo Gakkai Shi, 1989 May 20, 24(5), 948 - 56
{Combined effect of intraperitoneally administered OK-432 and recombinant interleukin (rIL-2) against mouse tumors}; Fujioka T et al.; Combined effect of the streptococcal preparation, OK-432 and rIL-2, both administered intraperitoneally, was examined against Meth-A tumor, a syngeneic tumor of inbred BALB/c mice and an analysis of the effector cells also was performed . The combined treatment resulted in significant in vitro inhibition of tumor growth and increase in the length of survival of the Meth-A bearing mice . The spleen cells obtained from Meth-A bearing mice treated with both OK-432 and rIL-2 on the 12th day after the tumor transplantation were capable of lysing syngeneic Meth-A tumor cells in addition to NK-sensitive allogenic YAC-1 cells and LAK-sensitive EL-4 cells in vitro in a 4 hour 51Cr-release assay . Neither spleen cells obtained from the tumor bearing mice treated with OK-432 or rIL-2 alone, nor those obtained from normal mice treated with both agents, showed cytotoxic activity against Meth-A cells . The in vitro growth of NK-resistant allogenic P-388 was not inhibited by the spleen cells obtained from any treated mouse, with or without Meth-A tumor . In order to determine the effector subpopulation against Meth-A cells, the spleen cells obtained from the tumor-bearing mice treated with OK-432 and rIL-2 on the 12th day after tumor transplantation, were treated with either anti-Thy-1, 2 antibody plus complement, anti-asialo GM1 serum plus complement, or by adherence to a plastic plate or nylon wool column.(ABSTRACT TRUNCATED AT 250 WORDS)

Med J Aust, 1989 May 15, 150(10), 595 - 6
Agranulocytosis after ranitidine administration; Lane GP et al.; A patient who developed agranulocytosis and streptococcal septicaemia while taking ranitidine is reported . We believe this to be the first published Australian case, and in view of the wide clinical usage of this drug, clinicians should be alerted to this possible complication.

Immunol Lett, 1989 May, 21(2), 127 - 30
Production of interleukin 6 by human spleen cells stimulated with streptococcal preparation OK-432; Fukui H et al.; The streptococcal preparation OK-432 was tested for the ability to stimulate human spleen leukocytes (SPL) for generation of interleukin 6 (IL-6) . When SPL were cultured with OK-432 for 24 h in serum-free T medium, the cell-free supernatant induced production of IgM in the SKW6.CL-4 and IgG in the CESS human B cell line, while no such activity was detected in unstimulated SPL culture . The activity was neutralized by treatment with antiserum directed against B cell stimulatory factor 2 (BSF-2) . An optimum production of BSF-2 was observed when SPL were stimulated with 10 micrograms/ml of OK-432 . The culture supernatant also induced proliferation of IL-6-dependent murine hybridoma MH-60.BSF2 (hybridoma growth factor; HGF) . It is thus evident that the molecule produced by OK-432-activated human SPL is BSF-2/HGF/IL-6 . These results indicate that the antitumor agent OK-432 stimulates human spleen cells to produce IL-6.

Antibiot Khimioter, 1989 May, 34(5), 348 - 52
{Eremomycin--a new antibiotic of the polycyclic glycopeptide group}; Gauze GF et al.; Eremomycin is a novel antibacterial antibiotic . It was isolated at the Institute of New Antibiotics, the USSR Academy of Medical Sciences from the culture fluid of actinomycete INA-238 . By its physico-chemical and biological properties the antibiotic was classified as belonging to the group of polycyclic glycopeptides . Chemical structure of eremomycin was asserted and it was shown to be a new representative of the group close by its structure to vancomycin and differing from it by the carbohydrate composition and structure of tri-phenoxytriaminotricarboxylic acid . By its anti-bacterial spectrum eremomycin was found to be close to ristomycin and vancomycin . Still, its activity was 2-10 times higher . The antibiotic was several times less toxic than vancomycin . Unlike vancomycin and ristomycin, the novel antibiotic induced no tissue necrosis after its intramuscular administration . The chemotherapeutic indices of eremomycin in treatment of staphylococcal and streptococcal sepsis in albino mice exceeded 10 times those of vancomycin . At present eremomycin is under clinical trials.

South Med J, 1989 May, 82(5), 633 - 4
Group G streptococcal bacteremia in a healthy young man; Teel LD et al.; Group G streptococcal bacteremia was detected in a 20-year-old man in association with bilateral epididymitis and orchitis . This patient showed none of the predisposing risk factors for group G streptococcal bacteremia which have been documented previously.

J Bacteriol, 1989 May, 171(5), 2271 - 7
Plasmid structural instability associated with pC194 replication functions; Ballester S et al.; The hybrid plasmid pJS37 is composed of the streptococcal plasmid pLS1, which confers tetracycline resistance, and the staphylococcal plasmid pC194, which confers chloramphenicol resistance . When gram-positive bacteria containing pJS37 were grown in the presence of chloramphenicol, four different deleted derivatives accumulated . The deletions in the plasmid enhanced resistance to chloramphenicol by placing the cat gene of pC194 near promoters of pLS1 . All four deletions shared a common endpoint that corresponded to the putative target site for DNA strand nicking by the pC194 replication protein, RepH . At the other, variable endpoint, the DNA sequence was similar to the putative RepH target sequence . Alteration of the RepH protein, by in vitro modification of the gene encoding it, eliminated this class of deletions . By extending a previously proposed model for the generation of a different but related class of deletions (B . Michel and S.D . Ehrlich, EMBO J . 5:3691-3696, 1986), a comprehensive model that could generate both classes of deletions is suggested . It proposes that a nicking-closing activity of the plasmid replication protein at its normal target site and, aberrantly, at sites with similar sequence can generate deletions either proximal or distal to the aberrant site during rolling-circle replication of the plasmid.

Trans R Soc Trop Med Hyg, 1989 May-Jun, 83(3), 419 - 20
Changing pattern of primary glomerulonephritis in a south Indian hospital; Date A et al.; Data were reviewed on 2805 patients with primary glomerulonephritis admitted to a south Indian hospital in 1972-1987 . A decrease in the proportion of endocapillary proliferative, crescentic and mesangial proliferative types was noted . There was also a decrease in group A beta-haemolytic streptococcal isolates among the 24,657 throat swab cultures made during the same period . This suggests a decreasing prevalence of nephritogenic streptococcal infections in this tropical region.

Clin Exp Immunol, 1989 May, 76(2), 198 - 203
Endostreptosin: isolation of the probable immunogen of acute post-streptococcal glomerulonephritis (PSGN); Cronin W et al.; It is now generally accepted that acute post-streptococcal glomerulonephritis (PSGN) is the consequence of the formation of antigen-antibody-complement complexes on the basement membrane of the glomerulus and that the antigen is of streptococcal origin . In cases of acute PSGN a high titre of specific antibodies to a streptococcal cytoplasmic extract can be found at the very beginning of the disease . This cytoplasmic antigen which we called endostreptosin (ESS) is probably the pathogenetic antigen of glomerulonephritis . It is deposited on the subendothelial side of the basement membrane in the first few days of the disease and is rapidly covered by newly-formed and specific antibody and complement with resultant immune injury causing signs and symptoms of symptomatic but also frequently asymptomatic acute glomerulonephritis . To further characterize and isolate ESS we used immunoaffinity chromatography and Western blotting techniques . PAGE analysis of the affinity-isolated ESS revealed the major component to have a molecular weight of approximately 45 kD . Sera from patients with PSGN or sera of rabbits immunized with affinity-isolated ESS reacted by Western blotting with at least one antigenic component with a molecular weight of approximately 45 kD . Normal human sera or the sera of non-immunized rabbits failed to demonstrate activity against this antigen . The basement membranes of the glomeruli of patients with very early PSGN stain with fluorescein-labelled gammaglobulin of patients with glomerulonephritis . This staining can be prevented when these sera are pre-absorbed with ESS but not by pre-absorption with intact cells or cytoplasmic extracts of other bacteria.

Z Orthop Ihre Grenzgeb, 1989 May-Jun, 127(3), 367 - 70
{Pathogen spectrum and resistance status of infections following orthopedic operations--an evaluation of 5 years}; Carstens C et al.; This study reports of 191 infections that occurred after 14807 primary clean operations from 1982 to 1986 . The spectrum of organism and the resistancy of bacteria has been analysed . 5 groups of organisms (Staphylococcus aureus, Staphylococcus epidermidis, Streptococcen, Enterococcen and Pseudomonas aeruginosa) are responsible for 82% of the infections . 88% of the bacteria in monoinfections were sensitive to Cefazedon . The development of resistancy against this type of Cefalosporin could not be seen.

Am J Obstet Gynecol, 1989 May, 160(5 Pt 1), 1073 - 4
Toxic shock-like syndrome associated with Bartholin's gland abscess: case report; Shearin RS et al.; Herein is the first reported case of bartholinitis complicated by toxic shock-like syndrome . Streptococcal exotoxin is implicated in this case of nonmenstrual toxic shock-like syndrome, which is an increasingly recognized manifestation of streptococcal infection . Further surveillance, investigation, and reporting of streptococcal toxic shock-like syndrome are recommended.

Med Clin (Barc), 1989 Apr 29, 92(16), 608 - 11
{Histopathologic factors with prognostic significance in mesangial proliferative glomerulonephritis}; Garcia del Moral R et al.; To investigate the histopathological findings with prognostic significance in mesangial proliferative glomerulonephritis (MPGN), 52 patients with this disease were evaluated with sufficient clinical follow-up . A moderate but highly significant correlation was found between the final creatinine levels and the percentage of sclerosed glomeruli and number of atrophic tubuli per 10 high power fields (r = 0.530, p less than 0.001) . When the patients with idiopathic MPGN and those with MPGN secondary to systemic or streptococcal disease were separately considered, there was a remarkable increase in the correlation index for the primary cases (r = 0.912, p less than 0.001) . It was concluded that the finding with the highest predictive value in idiopathic forms is tubular atrophy . Three levels of disease were proposed, respectively defining patients with preserved renal function, established chronic renal failure and unpredictable outcome of renal function after a follow-up of five years.

Nucleic Acids Res, 1989 Apr 11, 17(7), 2405 - 20
Purification and characterization of RepA, a protein involved in the copy number control of plasmid pLS1; del Solar GH et al.; The promiscuous streptococcal plasmid pLS1 encodes for the 5.1 kDa RepA protein, involved in the regulation of the plasmid copy number . Synthesis of RepA was observed both in Bacillus subtilis minicells and in an Escherichia coli expression system . From this system, the protein has been purified and it appears to be a dimer of identical subunits . The amino acid sequence of RepA has been determined . RepA shows the alpha helix-turn-alpha helix motif typical of many DNA-binding proteins and it shares homology with a number of repressors, specially with the TrfB repressor encoded by the broad-host-range plasmid RK2 . DNase I footprinting revealed that the RepA target is located in the region of the promoter for the repA and repB genes . Trans-complementation analysis showed that in vivo, RepA behaves as a repressor by regulating the plasmid copy number . We propose that the regulatory role of RepA is by limitation of the synthesis of the initiator protein RepB.

J Clin Invest, 1989 Apr, 83(4), 1267 - 76
Anchorage-independent growth of synoviocytes from arthritic and normal joints . Stimulation by exogenous platelet-derived growth factor and inhibition by transforming growth factor-beta and retinoids; Lafyatis R et al.; Exuberant tumor-like synovial cell proliferation with invasion of periarticular bone is a feature of rheumatoid arthritis in humans and of streptococcal cell wall (SCW)-induced arthritis in rats . These histologic observations prompted us to examine synoviocytes from arthritic joints for phenotypic characteristics of transformed cells . The capacity to grow in vitro under anchorage-independent conditions is a characteristic that correlates closely with potential in vivo tumorigenicity . In medium supplemented with 20% serum or in basal media supplemented with platelet-derived growth factor (PDGF), early passage synoviocytes from both SCW-induced and rheumatoid arthritic joints formed colonies in soft agarose . Epidermal growth factor (EGF), interleukin 1 (IL-1), tumor necrosis factor-alpha (TNF-alpha), interferon-gamma (IFN-gamma), and transforming growth factor-beta (TGF-beta) did not support growth, although EGF enhanced PDGF-dependent growth . On the other hand, TGF-beta, as well as all-trans-retinoic acid, inhibited colony growth . Early passage normal rat and human synoviocytes also grew under the same conditions, but lung, skin, and late-gestation embryonic fibroblast-like cells did not . Considered in the context of other published data our findings provide cogent evidence that synoviocytes, but not other types of fibroblast-like cells, readily acquire phenotypic characteristics commonly associated with transformed cells . Expression of the transformed phenotype in the inflammatory site is likely regulated by paracrine growth factors, such as PDGF and TGF-beta.

J Bacteriol, 1989 Apr, 171(4), 2202 - 8
Streptokinase mutations relieving Escherichia coli K-12 (prlA4) of detriments caused by the wild-type skc gene; Muller J et al.; A novel phenotype is described for Escherichia coli K-12 carrying the prlA4 allele determining a membrane component of the protein export mechanism . It is manifest as transformation deficiency for plasmids containing the cloned group C streptococcal streptokinase gene, skc . Streptokinase plasmid mutations relieving the prlA4 strain of this deficiency fell into three classes . Class 1 included skc::IS5 insertions, with IS5 integrated in a region encoding the Skc signal sequence and inactivating skc . Class 2 included IS1 insertions leaving skc intact but reducing skc expression, presumably by altering the function of the skc promoter as judged by an insertion site close to the -35 region . The most interesting class, 3, included skc deletions removing the entire signal sequence or a tetrapeptide from its hydrophobic core . The tetrapeptide deletion reduced the size, hydrophobicity, and predicted alpha-helicity of the central region of the Skc signal sequence but facilitated the export of mature Skc in both the wild type and the prlA4 mutant . These findings indicate that the incompatibility between prlA4 and skc is related to deleterious effects of the Skc signal sequence . The tetrapeptide deletion may function by altering the conformation of the signal sequence so as to render interaction with both the PrlA wild-type protein and the PrlA4 mutant protein less detrimental to the export mechanism . These findings also provide an explanation for the difficulties encountered in cloning streptokinase genes in E . coli plasmids and maintaining their structural stability.

J Immunol, 1989 Apr 1, 142(7), 2495 - 500
Ig allotype-linked regulation of class and subclass composition of natural antibodies to group A streptococcal carbohydrate; Morell A et al.; To determine the importance of genes located in or near the Ig constant regions in regulating the human antibody response, we correlated Ig allotypic markers with total Ig concentrations and natural antibody concentrations to the streptococcal group A carbohydrate (A-CHO) in 193 healthy adult blood donors . The major correlations between Ig allotypes and total Ig and specific antibody concentrations were observed with the Gm(f;n;b) haplotype . When compared with Gm(f;n;b) negative individuals, Gm(f;n;b) positives had significantly higher concentrations of total IgG2 (p less than 0.001) and IgG2 anti A-CHO (p less than 0.05), lower concentrations of total IgG1 (p less than 0.001) and IgG1 anti A-CHO (p less than 0.001), and lower concentrations of total IgM (p less than 0.001) and IgM anti A-CHO (p less than 0.05) . We conclude that individuals with the Gm(f;n;b) haplotype respond preferentially with IgG2 rather than IgG1 subclass antibodies . This increased capacity to respond with IgG2 antibodies may be reflected in the magnitude of the total antibody response when the IgG2 subclass comprises a major proportion of the response, as occurs in the adult response to many polysaccharide Ag.

Proc Natl Acad Sci U S A, 1989 Apr, 86(7), 2374 - 8
Inflammatory mediator-induced hypothalamic-pituitary-adrenal axis activation is defective in streptococcal cell wall arthritis-susceptible Lewis rats; Sternberg EM et al.; Inbred Lewis (LEW/N) female rats develop an arthritis in response to group A streptococcal cell wall peptidoglycan polysaccharide (SCW), which mimics human rheumatoid arthritis . Histocompatible Fischer (F344/N) rats do not develop arthritis in response to the same SCW stimulus . To evaluate this difference in inflammatory reactivity, we examined the function of the hypothalamic-pituitary-adrenal (HPA) axis and its ability to modulate the development of the inflammatory response in LEW/N and F344/N rats . We have found that, in contrast to F344/N rats, LEW/N rats had markedly impaired plasma corticotropin and corticosterone responses to SCW, recombinant human interleukin 1 alpha, the serotonin agonist quipazine, and synthetic rat/human corticotropin-releasing hormone . LEW/N rats also had smaller adrenal glands and larger thymuses . Replacement doses of dexamethasone decreased the severity of LEW/N rats' SCW-induced arthritis . Conversely, treatment of F344/N rats with the glucocorticoid receptor antagonist RU 486 or the serotonin antagonist LY53857 was associated with development of severe inflammatory disease, including arthritis, in response to SCW . These findings support the concept that susceptibility of LEW/N rats to SCW arthritis is related to defective HPA axis responsiveness to inflammatory and other stress mediators and that resistance of F344/N rats to SCW arthritis is regulated by an intact HPA axis-immune system feedback loop.

Arch Mal Coeur Vaiss, 1989 Apr, 82(4), 509 - 15
{Infective endocarditis of a valve prosthesis . Multicenter study (179 cases)}; Hanania G et al.; Over a 5-year period (1982-1986) 176 cases of infective endocarditis on prosthesis (IEP) were recorded in 40 cardiology departments . 65 p . 100 of the patients were male, and the mean age of the population was 51 years . Mechanical prostheses were involved in 57 p . 100 of the cases and bioprosthesis in 43 p . 100 . There was a high proportion of initial indications for bacterial endocarditis (18 p . 100) and for reoperation on prosthesis (10 p . 100) . IEP developed early in 40 cases and late in 139 cases; 19 (48 p . 100) of the early IEPs were staphylococcal, while 31 p . 100 of late IEPs were streptococcal (p less than 0.01) . 143 patients were reoperated upon within less than 1 month in 41 p . 100 of the cases, with a pre-operative antibiotic therapy of less than 10 days in 39 p . 100 . Reoperation was performed in stage IV or as an emergency in 45 p . 100 of the cases . Abscesses were three times more frequent with aortic prostheses than with mitral prostheses (58 p . 100 vs 20 p . 100, p less than 0.001) . Vegetations were more frequent on mechanical prostheses than on bioprostheses (43 p . 100 vs 31 p . 100, NS) . The operative mortality rate was 25 p . 100; the mortality rate of unoperated patients was even higher (31 p . 100) . The survival rate in operated IEP was 51 p . 100 at 30 months, as against 46 p . 100 at 12 months in unoperated IEP.(ABSTRACT TRUNCATED AT 250 WORDS)

Nippon Juigaku Zasshi, 1989 Apr, 51(2), 380 - 8
Augmented production of gamma interferon in mice experimentally infected with Toxoplasma gondii; Shirahata T et al.; The gamma interferon (IFN-gamma) production and the cell populations participating to this production were examined in Toxoplasma-infected mice . When spleen cells from Toxoplasma-infected mice were cultured with Concanavalin A (Con A) or OK-432, a Streptococcal preparation, they produced significantly high levels of IFN-gamma as compared with that of noninfected mice . Such enhanced IFN titers were observed as early as at 5 days postinfection, reached at the maximum levels on 20 days around and declined gradually thereafter . Treatment of spleen cells from the infected mice with either monoclonal anti-Thy-1.2 antibody plus complement or macrophage-blocking agents virtually abolished the IFN production . The spleen cells producing IFN-gamma were more susceptible to the treatment with monoclonal anti-Lyt-1.2 than anti-Lyt-2.2 antibodies, suggesting that CD4+ T cells are main producers of this lymphokine . When mice infected with Toxoplasma 10 days previously were injected with lipopolysaccharide (LPS), a well-known inducer of IFN-alpha/beta, the sequential production of IFN-alpha/beta and IFN-gamma was induced in their circulation.

J Immunol, 1989 Apr 1, 142(7), 2475 - 81
Tropomyosin shares immunologic epitopes with group A streptococcal M proteins; Fenderson PG et al.; Tropomyosin is an alpha-helical coiled-coil protein with structural similarities to the streptococcal M protein . In order to show serologic cross-reactivity between streptococcal M proteins and tropomyosin, we selected from a panel of murine mAb those which reacted with M proteins and tropomyosins in the ELISA . Western blots were used to study the reactions of each mAb with human and rabbit cardiac and rabbit skeletal tropomyosins . The antibodies were further characterized for their reactions with the additional autoantigens myosin, actin, keratin, and DNA . Five mAb were found which reacted with either PepM5 or ColiM6 protein and tropomyosin in Western blots or ELISA . Two of the tropomyosin positive mAb were also antinuclear antibodies and were inhibited with DNA . In Western blots of cardiac tropomyosins, the mAb reacted with either the 70-kDa dimer of tropomyosin, the 35-kDa monomer, or both . Some differences were observed in the reactions of the mAb with the different tropomyosins in Western blots . The heart cross-reactive epitopes shared between M proteins and tropomyosin were in most instances shared with cardiac myosin . Differences were observed among the reactions of the mAb with the different tropomyosins . This report constitutes the first evidence of serologic cross-reactivity between streptococcal M proteins and tropomyosins.

Nippon Gan Chiryo Gakkai Shi, 1989 Mar 20, 24(3), 626 - 37
{Combined effect of cis-DDP (II), OK-432 and systemic hyperthermia in ascites tumor in mice}; Komatsu K et al.; Combined effect of cis-DDP (II) (CDDP), a streptococcal preparation (OK-432) and systemic hyperthermia on ascites tumor in mice was studied . Tumor cells were of a syngeneic cloned cell line FMA3 which was derived from Furth's mastocytoma . When number of cells transplanted into the abdominal cavity was at 10(5), a single i.p . injection of CDDP at a dose of 4 mg/kg was effective to increase the mean survival time by a factor of 1.6 . OK-432 given i.p . at a dose of 5 KE/kg on every two days between day 2 and day 10 after transplantation decreased the mean survival times . Even when it was used in combination with CDDP, enhancement of the effect of CDDP was not statistically significant . However, by the factorial analysis of the all data obtained in the experiments carried out with tumor cells of the number of 10(2), 10(3), 10(4) and 10(5), enhancement of the effect of CDDP by OK-432 was significant . Systemic hyperthermia of the core-body temperature of 40 degrees C was not effective when used alone, and did not enhance the effect of CDDP . However, combined use of it and OK-432 significantly enhanced the effect of CDDP.

Plasmid, 1989 Mar, 21(2), 155 - 60
Transformation of Acholeplasma laidlawii with streptococcal plasmids pVA868 and pVA920; Dybvig K; One limitation with studying mycoplasma genetics is the lack of cloning vectors . Studies were undertaken to determine whether streptococcal plasmids could replicate in Acholeplasma laidlawii, for the purpose of identifying potential vectors . Plasmids pVA868 and pVA920 contain the same origin of replication and tetracycline resistance determinant . pVA920 also contains an erythromycin resistance determinant not present in pVA868 . A . laidlawii was transformed with plasmids pVA868 (13.7 kb) and pVA920 (12.2 kb), and isolated from the transformants were deletion derivatives of the parent plasmids having sizes of 3.7 and 10.3 kb, respectively . The tetracycline and erythromycin resistance markers functioned in A . laidlawii, and the deletion derivatives may be useful for development of mycoplasma vectors . However, difficulties may arise due to plasmid instability.

J Clin Lab Immunol, 1989 Mar, 28(3), 129 - 36
Interleukin-1 inducing activity of a streptococcal preparation OK-432 and its fractions by human monocytes; Katsuta S et al.; Interleukin-1 (IL-1) inducing activity of a streptococcal preparation OK-432 and its fractions by monocytes were investigated in patients with lung cancer and healthy subjects . The results showed that cell free extracts and cell wall fractions of OK-432 were the strong IL-1 inducing fractions . IL-1 activity released by OK-432-stimulated monocytes of patients with lung cancer fell within normal range . OK-432 stimulated intracellular IL-1 synthesis as well as extracellular release by monocytes . These results, therefore, suggested that OK-432 immunotherapy in patients with malignant diseases might be effective by increasing IL-1 production of monocytes.

Ann Pediatr (Paris), 1989 Mar, 36(3), 187 - 92
{Hydrocholecystitis in children and newborn infants . Apropos of 3 cases}; Bernier V et al.; We report two cases of hydrocholecystitis in children and one in a neonate . One child had hepatitis A and the other had typhoid fever . A beta-hemolytic group B streptococcal infection was found in the neonate . In all three cases, the first manifestation was an abdominal mass and treatment of the causative disease ensured recovery . These three observations provided us with the opportunity for reviewing the literature . Isolated hydrocholecystitis is distinguished from hydrocholecystitis as a symptom . The clinical evaluation and diagnostic investigations are described in detail; special attention is given to abdominal ultrasonography . Etiology and pathophysiology, as well as management are discussed . Our three cases and the review of the literature confirm the benign prognosis of this condition.

Ophthalmic Surg, 1989 Mar, 20(3), 182 - 5
Massive pseudophakic pigment dispersion associated with an iris nevus; Kremer I et al.; A 67-year-old woman examined 12 months following extracapsular cataract extraction had a massive pseudophakic pigment dispersion associated with diffuse corneal epithelial edema, mild uveitis, and secondary glaucoma . She underwent penetrating keratoplasty following removal of a posterior chamber intraocular lens (IOL), anterior vitrectomy, capsulectomy, and iris biopsy . Histopathologic examination revealed a pigmented iris nevus and signs of iris erosion by the IOL loop . Because 3 months later the eye developed streptococcal endophthalmitis and had to be eviscerated, we had the opportunity to examine the eye contents; we found no evidence of phakoanaphylactic uveitis.

J Lab Clin Med, 1989 Mar, 113(3), 387 - 95
Neutrophil chemiluminescence induced by opsonized group A streptococcal particles: an effective probe of intravenous immunoglobulin preparations; Rufenacht R et al.; We compared the capacity of eight different intravenous immunoglobulin (IVIG) preparations to opsonize streptococcal group A particles and to induce luminol-enhanced chemiluminescence in neutrophil granulocytes . Antibodies to the streptococcal group A carbohydrate (A-CHO) antigen exposed on the particles were present in all preparations at high concentrations . In some preparations, anti-A-CHO consisted predominantly of either immunoglobulin G1 (IgG1) or IgG2, whereas in others, both IgG subclasses were equally represented . Dilutions of the IVIGs and of a normal IgG reference preparation were adjusted for their anti-A-CHO content, incubated with streptococcal particles, and exposed to neutrophil granulocytes isolated from normal blood . The various IVIGs differed in their capacity to elicit chemiluminescence signals . Some preparations, particularly those consisting of chemically modified IgG molecules, showed little activity, whereas others were comparable to the reference preparation . We concluded that to some extent such differences could be related to the IgG subclass composition of the antibody . However, of greater importance were the manufacturing procedures by which both the antigen-binding fragment and crystallizable fragment portions, and thus the functional integrity of the IgG molecules, were more or less severely affected.

Anal Biochem, 1989 Feb 15, 177(1), 78 - 84
A chromogenic assay for the detection of plasmin generated by plasminogen activator immobilized on nitrocellulose using a para-nitroanilide synthetic peptide substrate; Kulisek ES et al.; A direct solid phase chromogenic assay has been developed for the detection of plasmin (EC 3.4.21.7), generated by the interaction of a nitrocellulose-bound plasminogen activator, using the plasmin specific tripeptide substrate, H-D-valyl-leucyl-lysine - p-nitroaniline . para-Nitroaniline released by the cleavage of the lysine - p-nitroaniline bound by plasmin was derivatized to its diazonium salt and subsequently coupled to N-1-napthylethylenediamine in situ to form a diazoamino of an intense red color at the site of the plasminogen activator . This method was used to assay for the streptococcal plasminogen activator, streptokinase, not only in crude bacterial supernatants, but also to detect streptokinase secreted by individual bacterial colonies . In addition, this solid phase assay was used to identify monoclonal antibodies specific for streptokinase which could inhibit the activation of human plasminogen by streptokinase . This method also permitted simultaneous immunological and biochemical identification of the plasminogen activator, thus permitting unequivocal comparative observations . This assay is quantitative and sensitive to nanogram amounts of activator comparable to those obtained with soluble assays . This method may also be applicable for the detection of other plasminogen activators, such as tissue plasminogen activator, urokinase, and staphylokinase, and also for the detection of immobilized proteases which can cleave other substrates derivatized with p-nitroaniline . The reagents used in this assay are inexpensive and easy to prepare.

Lancet, 1989 Feb 11, 1(8633), 295 - 7
Effect of breast-feeding on immune response to BCG vaccination; Pabst HF et al.; The effect on BCG immunisation of feeding either formula or breast milk was assessed in Canadian Cree infants who were vaccinated either at birth or after 1 month of age . The response to BCG was measured in terms of lymphocyte blastogenesis stimulated by purified protein derivative of Mycobacterium tuberculosis . Breast-feeding significantly enhanced cell-mediated immune response to BCG vaccine given at birth, but had no significant effect if vaccine was given after 1 month . These findings were not related to maternal history of tuberculosis or BCG vaccination, and the feeding method did not influence lymphocyte stimulation by candida or streptococcal antigens.

J Clin Lab Immunol, 1989 Feb, 28(2), 91 - 6
Blastogenic responses of human lymphocytes to a streptococcal preparation OK-432 and its fractions; Tanaka T et al.; This study was undertaken to examine the blastogenic responses of PBL to Streptococcal preparation OK-432 and its fractions . The results showed that OK-432 and its fractions, Su-PR and PM, have the mitogenic activity against human lymphocytes . The demonstration that PBL which had been cultured with OK-432 expressed IL-2 receptors and the blastogenic responses of PBL to OK-432 were inhibited by anti-IL-2 antibody suggested that IL-2 and IL-2 receptors might play a central role in OK-432-induced proliferation of human lymphocytes.

Nippon Geka Gakkai Zasshi, 1989 Feb, 90(2), 280 - 4
{Surgical management of infective endocarditis}; Watanabe G et al.; We reviewed fourty-six patients who had undergone surgery for infective endocarditis in the past fifteen years and identified risk factors affecting the outcome . Twenty-nine patients had infection of the native valve only, 11 had infective endocarditis associated with congenital heart disease, and 6 had prosthetic valve endocarditis . Overall hospital mortality was 6.5% . Prosthetic valve endocarditis carried a higher mortality (33%) than native valve endocarditis (3.4% or congenital heart disease with infective endocarditis (0%) . For the patients with active endocarditis, the early mortality rate was higher (13%) than with inactive endocarditis (3.2%) . Staphylococcal infections were more likely to cause severe valve destruction and residual infection than streptococcal infection . Our results indicated that surgical management of infective endocarditis should be done after the completion of adequate antibiotic therapy . Early diagnosis should reduce the mortality, prevent fatal complications, and lead to qualitative improvement of infective endocarditis.

Hinyokika Kiyo, 1989 Feb, 35(2), 253 - 7
{Local immunotherapy with streptococcal preparation, OK-432 in superficial bladder tumors, and common antigens between OK-432 and the tumor}; Fujioka T et al.; In 38 patients with superficial bladder, local immunotherapy with streptococcal preparation OK-432 has been performed . We investigated whether OK-432 was an effective biological response modifier (BRM) against bladder tumors or not, and the relationship between the common antigens which OK-432 shared with the tumors, and antitumor effects of OK-432 . In six out of 28 patients treated by intravesical instillation, and three out of 10 cases treated by intratumor injection, tumors were eliminated endoscopically . In the other patients, the tumors did not change . The PAP study using an anti-OK-432 antibody, showed a positive reaction in 66.7% of the instillation cases and in 40.0% in the injection cases . In 66.7% of the patients with the common antigens treated by the instillation and in 75.0% of patients with the antigens treated by the injection, tumors were eliminated . However, the PAP study showed a positive reaction in 9.1% of the no-change cases treated by the instillation and in 14.3% out of the no-change cases treated by the injection . We concluded that OK-432 was a favorable BRM for topical immunotherapy against bladder tumor and the presence of the common antigens between OK-432 and tumor may enhance the immune response of patients and promote tumor regression.

Anal Chem, 1989 Feb 1, 61(3), 265 - 70
D-alanine as a chemical marker for the determination of streptococcal cell wall levels in mammalian tissues by gas chromatography/negative ion chemical ionization mass spectrometry; Ueda K et al.; A gas chromatography/mass spectrometry method using selected ion monitoring with negative ion detection and methane chemical ionization was employed to quantitate a marker for bacterial peptidoglycan, D-alanine, in mammalian tissues . D-Alanine originating from bacterial peptidoglycan was obscured by substantial amounts of D-alanine generated by racemization from L-alanine present in tissue protein . To overcome this problem, samples were enzymatically treated and hydrolyzed in deuterated hydrochloric acid . Newly formed D-alanine derived from protein was labeled with deuterium and bacterial D-alanine remained unlabeled, enabling differentiation by the molecular weight increase . Butyl heptafluorobutyryl derivatives of the D- and L-amino acids were separated on a fused silica capillary column coated with Chirasil-val . The amounts of bacterial D-alanine found in livers of arthritic rats were consistent with previously reported levels of other carbohydrate-derived markers for bacterial peptidoglycan-polysaccharide complexes.

Wis Med J, 1989 Feb, 88(2), 11 - 5
Acute rheumatic fever in Wisconsin; Tantengco MV et al.; Medical records of patients discharged from Children's Hospital of Wisconsin from January 1980 to May 1988 who fulfilled the revised Jones criteria for acute rheumatic fever were reviewed . A total of 13 patients were hospitalized with a first attack of acute rheumatic fever during this period . Migratory polyarthritis was present in 92% of the patients and carditis in 62% . Mitral regurgitation was present in all cases of carditis . Only six patients (46%) had a history of a preceding streptococcal infection, half of whom were treated with antibiotics . While there is no evidence to support a new outbreak of acute rheumatic fever in Wisconsin, our data demonstrate that the disease is still prevalent within the eastern region of the state . Patients with Group A streptococcal pharyngitis must be identified and treated to prevent this disease from increasing in incidence.

Infect Immun, 1989 Feb, 57(2), 351 - 8
Systemic injection of group A streptococcal peptidoglycan-polysaccharide complexes elicits persistent neutrophilia and monocytosis associated with polyarthritis in rats; Wells AF et al.; The perpetuation of inflammatory changes within joints elicited by persisting, poorly biodegradable group A streptococcal cell walls (peptidoglycan-polysaccharide complexes {PG-PS}) is well documented . Chronic changes in the bloodstream induced by PG-PS have not been described previously . We demonstrated that leukocytosis occurs within 3 days after intraperitoneal injection of PG-PS and remains elevated 20 weeks later . Chronic neutrophilia, monocytosis, and lymphocytosis were observed in all experiments . Chronic changes in platelet, erythrocyte, and reticulocyte counts were not seen . The newly documented leukocytosis, lasting for months after PG-PS administration, provided a circulating pool of leukocytes that may participate in chronic inflammatory events in the joint . Although the central role of the macrophage in PG-PS-mediated inflammation has been emphasized (F . G . Dalldorf, W . J . Cromartie, S . K . Anderle, R . L . Clark, and J . H . Schwab, Am . J . Pathol . 100:383-402, 1980), the polymorphonuclear cell may be involved in periods of exacerbation of streptococcal cell wall-mediated polyarthritis . This was supported by our observations that neutrophilia and monocytosis correlate well with the degree of chronic joint inflammation.

Offentl Gesundheitswes, 1989 Feb, 51(2), 71 - 4
{Communicable disease control measures in group A streptococcal diseases at community facilities}; Steinitz H et al.; Considering the fact that various epidemiological situations in Public Health departments arise everyday life, many different proposals are made for Public Health and sanitary measures, e.g . throat culture, antibiotic treatment and, in particular, readmission to community institutions.

J Med Chem, 1989 Feb, 32(2), 310 - 4
Deaminoteicoplanin and its derivatives . Synthesis, antibacterial activity, and binding strength to Ac-D-Ala-D-Ala; Trani A et al.; Teicoplanin and its acid hydrolysis products were deaminated with hydroxylamine-O-sulfonic acid (HOS) . A few amides of these deaminoteicoplanins were also prepared . The loss of the terminal amino group reduces in vitro activity against staphylococcal and streptococcal bacteria to one-half to one-third, while binding strength to Ac-D-Ala-D-Ala, measured by differential UV spectroscopy, is reduced to one-tenth that of teicoplanin . The in vitro activity is further reduced by the presence of serum, and this is attributable to the increased lipophilicity and total negative charge of the deamino compounds . Comparison of UV spectra of deaminoteicoplanins with those of parent compounds made it possible to single out the most acid phenol group of teicoplanin aglycon (OH-4; pK = 8.2).

Cell Immunol, 1989 Feb, 118(2), 239 - 49
The role of T cells in immunoglobulin class switching of specific antibody production system in vitro in humans; Shinomiya N et al.; Only antibodies of the IgM class were produced in vitro by peripheral blood mononuclear cells stimulated with streptococcal carbohydrate . B cells of the peripheral blood mononuclear cells, however, synthesized both IgM and IgG class antibodies when combined with tonsillar T cells, suggesting that T cells inducing immunoglobulin class switching are present in the tonsils . Peripheral blood T cells also became capable of inducing B cells to produce IgG class antibodies when the T cells were incubated with antigen-pulsed macrophages . Surface IgM-positive, IgG-negative high-density B cells produced IgG antibodies for streptococcal carbohydrate in the presence of these T cells or tonsillar T cells . The culture supernatant solutions from these T cells or tonsillar T cells, however, failed to cause the B cells to produce IgG, indicating that class switching is not mediated by factors released from T cells . Lymphokines such as interleukin-2, human B cell growth factor, helper T cell factor, or interferon-gamma were also incapable of inducing IgG production . These results suggest that the cognate interaction between T cells and B cells is necessary for the immunoglobulin class switching.

Am J Dis Child, 1989 Feb, 143(2), 153 - 5
Failure of once-daily penicillin V therapy for streptococcal pharyngitis; Gerber MA et al.; To determine if a single daily dose of penicillin V would be effective in the treatment of group A beta-hemolytic streptococcal (GABHS) pharyngitis, 154 patients with GABHS pharyngitis were randomly assigned to receive 750 mg of penicillin V once daily for ten days or 250 mg of penicillin V three times daily for ten days . The two regimens were comparable in their ability to eradicate GABHS from the upper respiratory tract in 18 to 24 hours and in their impact on the clinical course of the disease . However, a bacteriologic treatment failure occurred in six (8%) of the 76 patients in the three-times-daily group and in 16 (22%) of the 74 patients in the once-daily group . These findings support the current recommendation that penicillin V be given in two or more divided doses for a full ten days for the treatment of GABHS pharyngitis.

J Immunol, 1989 Jan 15, 142(2), 575 - 81
Differential IgG-binding characteristics of staphylococcal protein A, streptococcal protein G, and a chimeric protein AG; Eliasson M et al.; Various Gram-positive bacteria express different types of IgG-binding receptors, each of which displaying certain unique binding properties . To evaluate specificity and avidity aspects of the differential binding pattern, a set of competitive binding assays was employed, by using staphylococcal protein A (SPA), streptococcal protein G (SPG), and a chimeric protein AG . These receptors were analyzed, in a reciprocal fashion, for binding and inhibition of binding to a selected panel of polyclonal and monoclonal Ig . Results of the study reveal that a majority of the determinants on human and bovine IgG, recognized by SPA and SPG, are either coextensive or closely overlapping . Accordingly, a minor portion of the determinants appear to be unique in the sense that a particular determinant(s) is selectively identified by one of the two receptors . Binding assays involving purified Fc fragments from human IgG, suggest that SPG shows exclusive specificity for an Fab region determinant(s) not recognized by SPA, whereas the Fc determinants for SPA and SPG are identical or overlapping . Furthermore, one of the IgG subclasses of bovine origin appears to be seen by the SPG receptor only . The competition study also demonstrates that the novel chimeric protein AG receptor shows higher or equal avidity for variants of human IgG molecules compared to the best of its parental constituents . It can thus be deduced that chimeric receptors might be useful as optimized tools for immunologic applications.

Presse Med, 1989 Jan 7-14, 18(1), 21 - 4
{Prevention using pefloxacin of infections in cancer patients with granulocytopenia}; Leleux A et al.; The practical procedures of digestive tract decontamination and prophylaxis of bacterial infection in granulocytopenic patients are debated . Fluoroquinolones are active against Gram-negative bacilli and have few side-effects . Pefloxacin was administered prophylactically to patients with cancer and granulocytopenia . None of them developed Gram-negative septicaemia, but 2 cases of streptococcal septicaemia were observed . The drug was well tolerated by all patients except one . Studies are currently in progress to try to reduce the incidence of septicaemia caused by Gram-positive cocci, using pefloxacin combined with penicillin.

J Dairy Sci, 1989 Jan, 72(1), 250 - 8
Bacterial counts in bedding materials used on nine commercial dairies; Hogan JS et al.; Bacterial counts were monitored for 1 yr in bedding materials used on nine commercial dairies . Organic materials used to bed lactating cows had significantly higher moisture content and gram-negative bacterial, coliform, Klebsiella species, and streptococcal counts than did inorganic materials . Klebsiella species counts were higher in sawdust than in chopped straw . Streptococcal counts were higher in chopped straw than sawdust . Bacterial counts did not differ between sand and crushed limestone . Gram-negative bacterial and coliform counts were higher during summer and fall than in winter and spring months . Streptococcal counts did not differ among seasons of the year . Linear relationships were significant between total rates of clinical mastitis during lactation and both gram-negative bacterial and Klebsiella species counts in lactating cow bedding . These data indicate that bacterial populations differed between both types of bedding and among seasons of the year . Rates of clinical mastitis were related to bacterial counts in bedding.

Pediatr Infect Dis J, 1989 Jan, 8(1), 16 - 20
Serum cortisol responses in febrile children; Nickels DA et al.; Adrenocortical stress response in children with a variety of febrile illnesses was prospectively evaluated in 76 patients presenting to a general pediatric clinic with temperature greater than 101 degrees F (38.3 degrees C) . Serum cortisol concentrations at presentation and again after recovery from infection were determined . Overall mean magnitude change in cortisol concentrations was 3.6-fold . Cortisol response was unrelated to the height of temperature but significant differences depending on clinical diagnosis were identified . The largest response (5-fold) was observed in patients with pneumonia, bacterial meningitis and fever of undetermined etiology . Current recommendations to double or triple replacement hydrocortisone dosage during times of increased stress in children with adrenal insufficiency are adequate only for simple febrile illnesses such as upper respiratory infection and streptococcal pharyngitis but could be subtherapeutic for infections such as pneumonia, meningitis and fever of undetermined origin, which imply a greater systemic involvement . It is possible, but untested, that a 4- to 5-fold increase in dosage would be more appropriate in those conditions.

Clin Cardiol, 1989 Jan, 12(1), 34 - 8
Lymphocyte subsets in acute rheumatic fever and rheumatic heart disease; Bhatia R et al.; Lymphocyte subsets in 53 patients with acute rheumatic fever and 78 patients with chronic rheumatic heart disease were compared with 20 normal control subjects and 39 patients suffering from uncomplicated streptococcal pharyngitis to obtain information about the pathogenesis of the disease . Twenty patients with rheumatic fever were followed for 24 weeks to evaluate changes occurring over the course of the disease . Total leukocyte and lymphocyte counts were increased in patients with rheumatic fever and to a lesser extent in those with rheumatic heart disease, when compared with controls . The difference between the two groups was significant . Patients with acute rheumatic fever had an increased number of B cells and a smaller increase in total T and T-helper-inducer (CD-4) cells . The proportion of B cells increased, while that of T-suppressor-cytotoxic (CD-8) cells fell . An increased number and proportion of B cells was also seen in patients with rheumatic heart disease . Total T and T-helper lymphocyte percentages and numbers were significantly higher in patients with rheumatic fever compared with those of patients with rheumatic heart disease . Follow-up studies at 6, 12, and 24 weeks revealed no significant differences from the entry point studies, although there was a trend toward reduction in the degree of derangement from normal values . Patients with uncomplicated streptococcal pharyngitis, however, did not show perturbations in the T-cell and T-subset counts . Our study suggests that the immunoregulatory defect in acute rheumatic fever is characterized by a relative reduction of suppressor T cells with an absolute increase in helper T cells and B cells, resulting in an increased cellular as well as humoral immune response.(ABSTRACT TRUNCATED AT 250 WORDS)

Infect Immun, 1989 Jan, 57(1), 23 - 8
Biological and immunological properties of the carboxyl terminus of staphylococcal enterotoxin C1; Bohach GA et al.; Comparisons of recently published primary sequences of staphylococcal and streptococcal pyrogenic toxins prompted an evaluation of biological and immunological properties of the C terminus of staphylococcal enterotoxin C1 . The 59 N-terminal amino acids were deleted from the toxin by digestion with trypsin . The resulting fragment (Mr, 20,659) contained the remaining 180 C-terminal residues . This fragment (Trp F1) consisted of two polypeptide chains (Trp F1a and Trp F1b) linked by cysteine residues . Trp F1 was mitogenic, pyrogenic, and enhanced susceptibility of rabbits to lethal endotoxin shock . In addition, this fragment contained at least one antigenic epitope that cross-reacted with enterotoxin B.

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