Pediatr Res, 1987 Mar, 21(3), 289 - 92 Efficacy of human immunoglobulin and penicillin G in treatment of experimental group B streptococcal infection; Kim KS; In an effort to develop more effective therapy for neonatal group B streptococcal infections, penicillin G and human immune serum globulin (ISG), alone and in combination, were evaluated for their therapeutic efficacy against experimental group B streptococcal bacteremia and meningitis in newborn rats . Infected rats received either penicillin G (200 mg/kg/day), ISG (2 g/kg) or penicillin G (200 mg/kg/day) + varying doses of ISG (0.25 to 2 g/kg) . All animals receiving ISG alone died; otherwise, mortality rates did not differ significantly (17-30%) . Therapy with penicillin G alone and in combination with ISG was equally effective in completely eradicating group B streptococcal from blood and cerebrospinal fluid . However, combinations of penicillin G and ISG were significantly more beneficial than penicillin G alone, as shown by a significantly lower incidence of bacteremia at the end of 1 day of therapy and by greater opsonophagocytic activity in sera of animals receiving penicillin G + ISG . These findings indicate that administration of ISG in conjunction with penicillin G rapidly clears bacteria from blood, suggesting that ISG may be a useful adjunct to antimicrobial therapy of neonatal group B streptococcal disease. Am J Obstet Gynecol, 1987 Mar, 156(3), 666 - 9 Type-specific streptococcal antibodies in amniotic fluid; Gray BM et al.; Type-specific antibodies against group B streptococcal and pneumococcal capsular antigens were measured in 68 amniotic fluid samples from healthy women between 16 and 20 weeks of pregnancy . Mean antibody levels ranged from 0.13 to 0.61 microgram/ml, with few samples having greater than 1 microgram/ml against any antigen . The role of antibodies in protection against intrauterine infection is discussed. Infect Immun, 1987 Mar, 55(3), 674 - 9 Variable severity and Ia antigen expression in streptococcal-cell-wall-induced hepatic granulomas in rats; Allen JB et al.; We have previously reported that a single intraperitoneal injection of an aqueous suspension of group A streptococcal cell wall (SCW) fragments induces extensive hepatic granulomas in LEW/N female rats, but not in F344/N female rats . To further understand the mechanisms underlying these differences, we compared granuloma development and class II major histocompatibility complex antigen (Ia) expression in histocompatible LEW/N, F344/N, and CAR/N female rats in response to SCW fragments of four different average molecular sizes . In LEW/N female rats, the smallest fragments (less than 5 megadaltons) induced the most severe hepatic inflammatory disease, with development of widespread granulomas composed of macrophages, lymphocytes, and a peripheral rim of fibroblasts . The largest fragments (greater than 500 megadaltons) induced equivocal disease . Fragments of intermediate size induced granulomas of intermediate severity . The extent of granuloma development, the intensity of Ia antigen expression, and the amount of SCW antigen deposited in the liver qualitatively paralleled each other . In contrast, injection of the most granulomagenic SCW fragments into F344/N and CAR/N rats did not induce granulomas . Although these rat strains are histocompatible with the LEW/N (i.e., RTL.1) strain, hepatic Ia antigen expression in these strains was not increased significantly above basal levels . The amount of SCW antigen in the livers of the resistant rat strains appeared similar to the amount in the susceptible LEW/N strain . These data indicate that granuloma development is dependent on the size of the SCW fragment and host genetic background and that Ia expression directly parallels the severity of the hepatic disease . In addition, the data suggest that non-major histocompatibility complex genetic loci play a major role in regulating the development of the hepatic disease. Mol Gen Genet, 1987 Mar, 206(3), 428 - 35 Replication of the streptococcal plasmid pMV158 and derivatives in cell-free extracts of Escherichia coli; del Solar G et al.; pMV158 is a 5.4 kb broad host range multicopy plasmid specifying tetracycline resistance . This plasmid and two of its derivatives, pLS1 and pLS5, are stably maintained and express their genetic information in gram-positive and gram-negative hosts . The in vitro replication of plasmid pMV158 and its derivatives was studied in extracts prepared from plasmid-free Escherichia coli cells and the replicative characteristics of the streptococcal plasmids were compared to those of the E . coli replicons, ColE1 and the mini-R1 derivative pKN182 . The optimal replicative activity of the E . coli extracts was found at a cellular phase of growth that corresponded to 2 g wet weight of cells per litre . Maximal synthesis of streptococcal plasmid DNA occurred after 90 min of incubation and at a temperature of 30 degrees C . The optimal concentration of template DNA was 40 micrograms/ml . Higher plasmid DNA concentrations resulted in a decrease in the incorporation of dTMP, indicating that competition of specific replication factor(s) for functional plasmid origins may occur . In vitro replication of plasmid pMV158 and its derivatives required the host RNA polymerase and de novo protein synthesis . The final products of the streptococcal plasmid DNAs replicated in the E . coli in vitro system were monomeric supercoiled DNA forms that had completed at least one round of replication, although a set of putative replicative intermediates could also be found . The results suggest that a specific plasmid-encoded factor is needed for the replication of the streptococcal plasmids. N Engl J Med, 1987 Feb 19, 316(8), 421 - 7 Resurgence of acute rheumatic fever in the intermountain area of the United States; Veasy LG et al.; We describe an outbreak of acute rheumatic fever that occurred in the intermountain area centered in Salt Lake City, Utah . Seventy-four children meeting the modified Jones criteria for the diagnosis of acute rheumatic fever were evaluated by the staff at Primary Children's Medical Center, Salt Lake City, from January 1985 through June 1986 . This represents an eightfold increase over the average annual incidence at this hospital during the past decade . Carditis, a dominant feature of the outbreak, was confirmed by auscultation in 53 of the patients (72 percent) . An additional 14 patients were found to have mitral regurgitation by Doppler ultrasound examination, raising the total incidence of carditis to 91 percent . The children were predominantly from white (96 percent) middle-class families with above-average incomes and with ready access to medical care . There was no apparent increase in the incidence of streptococcal disease or other explanation for the marked increase in acute rheumatic fever . However, mucoid M type 18 and M type 3 group A streptococcal strains were isolated from several siblings of the patients and from schoolchildren (chosen at random) in the area . We conclude that acute rheumatic fever remains an important health problem in the United States. Biochem Biophys Res Commun, 1987 Feb 13, 142(3), 813 - 8 Relation of streptococcal M protein with human and rabbit tropomyosin: the complete amino acid sequence of human cardiac alpha tropomyosin, a highly conserved contractile protein; Mische SM et al.; Partial sequences of group A streptococcal M proteins exhibit up to 50% sequence identity with segments of rabbit skeletal tropomyosin . It is well recognized that rheumatic fever and rheumatic heart disease in humans are sequelae of group A streptococcal infection . To examine whether the human cardiac tropomyosin would exhibit greater homology with the streptococcal M proteins, we have now determined its complete amino acid sequence . The amino acid sequence of human cardiac tropomyosin was established from sequence analyses of its peptides derived by enzymic and chemical cleavages, and comparison of these sequences to the reported sequence of rabbit skeletal tropomyosin . These studies have revealed that the amino acid sequence of human cardiac alpha tropomyosin is identical to that of the rabbit skeletal alpha tropomyosin, but for a single conservative substitution of Arg/Lys at position 220 . This observation increases the significance of the previously observed sequence homology between streptococcal M protein and rabbit skeletal tropomyosin and may have relevance to the pathogenesis of rheumatic fever . Furthermore, these results rank tropomyosin as one of the most highly conserved contractile proteins between vertebrate species reported thus far. Pediatr Res, 1987 Feb, 21(2), 159 - 65 The role of granulocytes in the pulmonary response to group B streptococcal toxin in young lambs; Engelhardt B et al.; Marked leukopenia and sequestration of granulocytes in the lung are consistently seen in severe early onset group B streptococcal (GBS) disease in human infants . To investigate the role of granulocytes as potential mediators in the pulmonary pathophysiology of this disease, the effects of intravenously administered GBS type III toxin were studied in young lambs before and after granulocyte depletion with hydroxyurea . Granulocyte depletion markedly reduced the 4-fold increase in total lung resistance and the decrease in dynamic compliance observed after GBS toxin . Granulocyte depletion significantly attenuated the pulmonary hypertension, hypoxemia and increased minute ventilation present during the first phase of the response (0.5-1 h after GBS toxin) . It did not significantly alter the increase in body temperature, the marked increase in lung lymph thromboxane B2 concentrations during the first phase or the increase in lung lymph flow and protein clearance during the second phase of the response (3.5-5 h after GBS toxin) . The results indicate that granulocytes are involved as mediators of the changes in lung mechanics seen after GBS toxin infusion in young lambs . Granulocytes contribute to the pulmonary hypertension and decrease in arterial oxygenation, but other mediators appear to be responsible for the injury of the vascular endothelium. J Infect Dis, 1987 Feb, 155(2), 247 - 52 Compartmentalization of cells bearing "rheumatic" cell surface antigens in peripheral blood and tonsils in rheumatic heart disease; Gray ED et al.; Monoclonal antibodies that recognize "rheumatic" antigens of peripheral blood non-T cells were used to study the compartmentalization of such cells in peripheral blood and tonsils of individuals with rheumatic heart disease (RHD) and suitable control subjects . The peripheral blood of most (71%) of the 42 individuals with RHD contained cells reacting with monoclonal antibody 83S19.23 or 256S.10, whereas these cells were present in only 17% of the 41 control subjects (P less than .02) . However, none of 21 individuals with RHD had such cells in their tonsils, although they were present in the tonsils of 50% of the 40 control subjects (P less than .03) . These results may reflect a failure in RHD or organ-specific homing of cells with the epitopes recognized by the antibodies . The presence of these cells in tonsils may be important in the immune response to streptococcal pharyngeal infection, and their absence in RHD may be involved in the unusual immune responses characteristic of this disease. Clin Orthop, 1987 Feb, (215), 206 - 11 Streptococcal necrotizing myositis: a rare entity . A report of two cases; Nather A et al.; Deep muscle abscess or bacterial myositis is not an uncommon disease in the tropics . The commonest pathogen involved is Staphylococcus aureus . However, streptococcal myositis is rare . Only a few cases have been reported in literature . Furthermore, streptococcal myositis with extensive necrosis of muscles has not been reported . In two cases of streptococcal myositis with extensive muscle necrosis, both developed severe acute infection with septicaemia . Histologic observations revealed massive necrosis of muscle tissue with acute inflammatory infiltration . This condition, which we designate streptococcal necrotizing myositis should be treated as a separate disease entity . It requires not just incision and drainage, as in bacterial myositis, but radical excision of all the necrotic muscles in addition to appropriate antibiotics . Unless it is recognized, the treatment will be inadequate and un-necessarily prolonged . Intramuscular pressure may contribute to the pathogenesis of muscle necrosis and may stimulate compartmental syndrome. Hybridoma, 1987 Feb, 6(1), 61 - 9 The isolation of cross-reactive monoclonal antibodies: hybridomas to streptococcal antigens cross-reactive with mammalian basement membrane; Fitzsimons EJ Jr et al.; Based upon the assumption that post-streptococcal sequelae are the result of cross-reactive antibodies, hybridomas were prepared from the spleens of mice immunized with Group A type 12 streptococcal cell membranes (SCM) specifically to screen for such cross-reactive antibodies . One fusion produced a cell population displaying antibodies reactive to both SCM and glomerular basement membrane (GBM) antigens as demonstrated by ELISA technique . Ascites produced by this cell population also showed reactivity to lung basement membrane (LBM) . Limiting dilution procedures have produced 15 monoclonal hybrids with both anti-SCM and anti-GBM activity . Confirmation of the cross-reactive and monoclonal nature of the antibody was accomplished by both direct and indirect competitive ELISA . These observations have established that unique cross-reactive antibody-secreting hybrid cells with reactivity to both SCM and basement membrane (BM) antigens can be isolated by standard cloning procedures. Nippon Sanka Fujinka Gakkai Zasshi, 1987 Feb, 39(2), 181 - 8 {Detection of type-specific group B streptococcal antibody by indirect immunofluorescence and prevention of vertical transmission by antibiotic therapy}; Sugiyama M et al.; Seventy-six (13.6%) of 558 third trimester pregnant women had positive vaginal Group B Streptococcal (GBS) colonization . Among these colonizing GBS, 17 (22.4%) of 76 reacted positively to type Ia serum, 6 (7.9%) to type Ib serum, 2 (2.6%) to type II serum, and 23 (30.3%) to type III serum respectively, whereas 22 (28.9%) lacked these heat stable antigens when examined by the agglutination method . Persistence of the colonization of GBS was observed only in 4 (9.9%) out of 44 ampicillin-treated women whereas 65 (86.7%) out of 75 cases in the non-treated group . The colonization rates of GBS in infants born to carrier mothers were 37.5% in the non-treated group and 7.4% in the ampicillin treated group . The levels of ampicillin concentration in cord sera and amniotic fluids were maintained over the MIC of GBS for 7 hours after the drug administration . Type-specific antibodies were assayed by indirect immunofluorescence in both maternal and cord sera . In 58(87%) of 67 cases antibodies to type Ia, in 15(27%) of 55 cases to type II, and in 28(42%) of 67 cases to type III were detected in the maternal sera . No antibody to type Ia was detected in a mother who had an affected infant with the same type of GBS . In cord sera, antibody titres of a premature infant and a low-birth-weight infant were lower than those of their mothers. Am J Infect Control, 1987 Feb, 15(1), 20 - 5 Role of rapid tests for streptococcal pharyngitis in hospital infection control; DeNeef P; Rapid streptococcal antigen detection tests are now an alternative to throat cultures for diagnosing group A streptococcal pharyngitis . Used alone, they are not suitable for hospital infection control applications because of the risk that individuals with streptococcal pharyngitis and a falsely negative test will spread the infection within the institution . However, a rapid test may be an economical method for screening employees with pharyngitis, provided that a throat culture is performed for everyone with a negative test . Compared with the use of throat cultures alone, this strategy reduces the number of missed diagnoses and the number of work days lost . Cost-benefit analysis shows that over a wide range of streptococcal prevalence and carrier rate the total cost is also less with the use of rapid tests first . If the prevalence of streptococcal pharyngitis is very low, the use of cultures alone is more cost-effective. J Exp Med, 1987 Feb 1, 165(2), 531 - 45 Molecular dissection of the murine antibody response to streptococcal group A carbohydrate; Lutz CT et al.; Monoclonal antibodies (mAb) to streptococcal group A carbohydrate (GAC) are encoded by a minimum of two VH, four JH, four V kappa, three J kappa, one V lambda, and one J lambda gene segments . The IdX, IdI-1, and Id5 idiotypic determinants are expressed by anti-GAC mAb and are found on free kappa chains . Each pattern of these determinants is encoded by a distinct V kappa gene segment, apparently without the requirement for a particular J kappa, VH, or JH gene segment, or somatic mutation . In contrast, the binding site-associated idiotypic determinant IdI-3a does not correlate with any single V or J gene segment. Am J Dis Child, 1987 Feb, 141(2), 224 - 7 Five vs ten days of penicillin V therapy for streptococcal pharyngitis; Gerber MA et al.; To determine the effectiveness of a short (five-day) course of penicillin V potassium therapy, 172 patients with group A beta-hemolytic streptococcal (GABHS) pharyngitis were randomly assigned to receive 250 mg of penicillin V potassium three times daily for either five or ten days . The patients in the two treatment groups were comparable with respect to clinical findings, compliance, and serologic response to GABHS . A bacteriologic treatment failure was defined as the presence of the same serotype of GABHS in the follow-up as in the initial throat culture and occurred in 13 (18%) of the 73 patients in the five-day treatment group and in six (6%) of the 99 patients in the ten-day treatment group . These findings support the current recommendation for a full ten days of oral penicillin V therapy for the treatment of GABHS pharyngitis. Antimicrob Agents Chemother, 1987 Feb, 31(2), 340 - 2 In vitro activity of LY146032, a new lipopeptide antibiotic, against gram-positive cocci; Verbist L; The activity of LY146032, a new lipopeptide antibiotic, was compared in vitro with those of vancomycin, oxacillin, and ampicillin against 261 staphylococcal and 154 streptococcal isolates . The MICs of LY146032 and vancomycin were similar, but the bactericidal activity and killing kinetics of LY146032 were more pronounced. Clin Exp Immunol, 1987 Feb, 67(2), 398 - 405 Antigen presentation by a subset of T8+ Ia+ cells to T4+ helper cells; Brines R et al.; The helper function of human T4+ cells acting on autologous peripheral blood B cells was elicited by the hapten-carrier conjugate DNP-streptococcal antigen (DNP-SA), in the presence of monocyte-enriched cells . The antigen presenting function of monocyte-enriched cells can be replaced by a subset of autologous T8+ Vicia villosa lectin adherent (T8VV+) cells . Cell depletion studies confirmed that the T8VV+ cell presentation was mediated by a T cell since killing with anti-T3 antibody and complement removed the antigen presenting capacity of T8VV+ cells but not of monocyte-enriched cells . Furthermore, killing with anti-Ia specific monoclonal antibody and complement abrogates antigen presentation by the T8VV+ cells, suggesting that the latter express an Ia gene product . The antigen presentation is specific to DNP-SA which elicits anti-DNP IgM antibodies, as the latter are not produced in response to tetanus toxoid . We suggest that interactions between T cells may occur not only by T4+ cells inducing T8+ suppressor cell functions but also the reverse activity of T8+ cell presenting antigen to T4+ cells to induce helper function in the absence of other accessory cells. J Rheumatol, 1987 Feb, 14(1), 23 - 7 Lymphocyte subpopulations in rheumatic heart disease; Regelmann WE et al.; Monoclonal antibodies and indirect immunofluorescence techniques were used to compare the distribution of lymphocyte subpopulations of tonsil and peripheral blood from patients with rheumatic heart disease and age and socioeconomically matched patients undergoing tonsillectomy for chronic recurrent tonsillitis, but who had no evidence of rheumatic fever or rheumatic heart disease . The proportions of B cells (BA-1+), total T cells (Lyt-3), inducer/helper T cells (T4+) and cytotoxic/suppressor T cells (T8) were determined . No significant differences were apparent between rheumatic heart disease and control groups in resting cells from tonsils or blood . Cells undergoing proliferation in response to streptococcal blastogen A were identified by similar techniques . These tonsillar preparations from patients with rheumatic heart disease generated a smaller proportion of T8+ cultured cells and a greater T4/T8 ratio of cultured cells in response to group A streptococcal blastogen A than did nonrheumatic subjects. Eur J Immunol, 1987 Feb, 17(2), 269 - 73 A synthetic vaccine constructed by copolymerization of B and T cell determinants; Leclerc C et al.; Synthetic vaccines are based on the identification of short peptide sequences responsible for inducing a protective immune response . These sequences could contain B and/or T cell determinants . In this study, we have examined the recognition by B and T mouse lymphocytes of several synthetic peptides corresponding to regions of a bacterial and two viral proteins . These include a streptococcal S-34 peptide, H(99-121) and two other synthetic hepatitis B virus surface peptides . A lymph node proliferation assay was employed to detect T cell determinants . Limiting dilution analysis was used to estimate the frequency of clonal precursor B cells specific for an antigenic determinant . This study indicates that the synthetic hepatitis B virus surface peptides are recognized by B cells but not by T cells, whereas the S-34 peptide possesses both B and T epitopes . The copolymerization of the B determinant H(99-121) with S-34 has conferred immunogenicity to the H(99-121) peptide . After copolymerization, the synthetic hybrid molecule retained the S-34 T epitope and acquired a new determinant recognized by T cells . These results demonstrate that synthetic vaccines could be constructed by appropriate selection and organization of B and T determinants. Cancer Immunol Immunother, 1987, 24(2), 172 - 7 Antitumor effect of the streptococcal preparation OK-432 in a murine model of ovarian cancer; Lichtenstein A; The antitumor effects of the streptococcal preparation OK-432 were analyzed in a murine ovarian teratocarcinoma (MOT) model . Administration of OK-432 i.p . prevented tumor outgrowth in 75% of mice challenged with 10(3) MOT cells i.p . 24 h previously . Treatment was less successful in mice challenged with 10(4) or 10(5) cells, preventing tumor growth in 25% of the former and only 5% of the latter group . Tumor-challenged mice cured by injections of OK-432 were not rendered resistant to a subsequent challenge with 10(3) MOT cells 75 days after initial treatment . Only the i.p . route of administration was effective as i.v . OK-432 did not prolong survival of tumor-challenged mice . An antitumor response was detected as early as 24 h after i.p . treatment . This correlated temporally with an influx of neutrophils into the peritoneal cavity . Peritoneal cells obtained between 6 and 24 h after treatment were capable of lysing MOT targets in vitro . A single cell cytotoxicity assay demonstrated that peritoneal neutrophils, elicited by i.p . injection of OK-432, could bind to and lyse MOT targets . These data indicate that OK-432 is effective against small tumor cell inocula in this murine model of ovarian cancer and, furthermore, that the neutrophilic response into the peritoneal cavity plays a role in tumor rejection. Nahrung, 1987, 31(5-6), 585 - 90 {Microflora in a controlled caries model study in rats}; Stosser L et al.; Changes of dental plaque were investigated in Osborne-Mendel-rats under the influence of a sucrose-containing diet as well as the inhibition of it by antibiotics (streptomycin, erythromycin, penicillin) in order to find out the optimal conditions of animal association with Str . mutans (OMZ 176) . The cariogenic diet did not alter the isolated total germ numbers, but modified the flora to a streptococcal one . The application of an erythromycin/penicillin mixture caused a 100 fold decrease of the germ number and streptococcal elimination so that an association of the germ Str . mutans detectable by microbiological methods could take place at this moment . The obtained caries scores differed from the non-contaminated group . Mono-associated gnotobiotic Wistar rats developed more carious lesions than conventional animals of the same strain; therefore Str . mutans OMZ 176 was classified as high cariogenic. Arkh Patol, 1987, 49(5), 3 - 11 {Streptococcal infection: variants and morphological manifestations}; Tsinzerling AV et al.; 82 cases of streptococcal infection (SI) in children who died in 1977-1985 are studied . Higher incidence of SI in children particularly in those who died at home is emphasized . As a rule, the proper diagnosis was not established clinically . By manifestations the observations were divided into two groups: 1) SI with a pronounced generalization including a pharyngeal one (31 cases), 4 of them with a rash (scarlet fever); extrapharyngeal (7 cases), 6 of them with a rash (scarlet fever); 2) SI without pronounced generalization (localized) including 33 cases with the involvement of the lungs and tonsilla and having an ordinary course and 11 cases of a sudden death . SI structural manifestations involved development of necrotic or purulent-necrotic inflammation of a various degree in the area of the primary focus, regional lymph nodes as well as in the foci resulting from lymphohaematogenic and intracanalicular dissemination . The first symptoms of the septic process could be found even in case of death during the first day of the disease . The role of viral respiratory infection being the background for the SI development, especially for its pharyngeal variant and lung affection, is shown . The significance of thymomegaly and adrenal hypoplasia in the development of a sudden death is revealed. Sex Transm Dis, 1987 Jan-Mar, 14(1), 52 - 3 Painful red leg nodules and syphilis: a consideration in patients with erythema nodosum-like illness; Silber TJ et al.; An adolescent girl presented with the classical physical findings of painful red nodules on the legs; the lesions were suggestive of erythema nodosum . The usual underlying causes were explored and found to be absent . Because she was sexually active, the patient was also routinely screened for sexually transmitted diseases . A rapid plasma reagin test was performed and found to be strongly positive . The confirmatory fluorescent treponemal antibody test was also positive . A diagnosis of syphilis was made, and she was treated with benzathine penicillin G (2.4 X 10(6) units) . This report is a reminder that when a patient is suspected of having erythema nodosum, the physician should check for syphilis as well as for tuberculosis, sarcoidosis, reaction to a drug, and streptococcal disease . Panniculitis can be an important clinical sign of secondary syphilis that should never be overlooked. Arch Fr Pediatr, 1987 Jan, 44(1), 45 - 6 {Submaxillary streptococcal B cellulitis in young infants}; Abrouk S et al.; The authors report 3 cases of young infants with B streptococcal cellulitis revealed by submandibular inflammatory induration . The clinical findings, similar to the cases reported in literature, were characteristic, due to the infants' ages, the aspect and localization of the cellulitis . Bacteriologic diagnosis relies on blood cultures and aspiration of the lesion. Pediatr Infect Dis J, 1987 Jan, 6(1), 36 - 40 Streptozyme test for antibodies to group A streptococcal antigens; Gerber MA et al.; The ability of the Streptozyme test to identify significant antibody rises in 46 patients with streptococcal pharyngitis was comparable to, but no greater than, that of the antistreptolysin O or antideoxyribonuclease B test and inferior to that of the combined use of both the antistreptolysin O and antideoxyribonuclease B tests . Serum specimens were also simultaneously analyzed with three different lots of Streptozyme reagent . Lot-to-lot variation in the reagent resulted in a significant difference in antibody titer for 18 (19%) of the 92 sera tested . Differences among the three lots also produced variation in determining whether a significant rise in titer had occurred from the acute phase to the convalescent phase serum for a given patient . These observations raise concerns about the standardization of the Streptozyme reagent and document the need for precise identification and quantitation of the streptococcal antigens used in this product. J Pediatr, 1987 Jan, 110(1), 31 - 6 Group B streptococcal carriage and disease: a 6-year prospective study; Dillon HC Jr et al.; A prospective study of group B streptococcal (GBS) carriage and disease was conducted over 6 years . Carriage rates at delivery for mothers and infants were 20% and 12%, respectively . Forty-five cases of GBS disease occurred in infants, 24 "early-onset" disease and 21 "late-onset" disease . The combined attack rate for early and late disease was 3.3 per 1000 live births over the 6 years . The rate of early-onset disease was highest in infants found to be heavily colonized at birth: 50 per 1000 live births . Twenty-three of 24 had evidence of intrauterine-acquired infection . All GBS serotypes were represented . Preterm delivery, prolonged labor, premature rupture of membranes, and maternal infection enhanced the risk of early disease . Septicemia was the predominant form of late-onset disease (15 of 21 cases); GBS type III accounted for 19 of 21 cases . Ten of 21 infants with late infections were colonized at birth with the GBS type that subsequently caused disease . Thus a maternal source of infection was identified in 34 of the 45 infants . These data reveal consistent year-to-year carriage and disease rates in the study population. Infect Immun, 1987 Jan, 55(1), 16 - 23 Effect of acetylation on arthropathic activity of group A streptococcal peptidoglycan-polysaccharide fragments; Stimpson SA et al.; Purified group A streptococcal peptidoglycan-polysaccharide (PG-PS) fragments were either de-O-acylated, or acetylated and then de-O-acylated to yield N-acetylated PG-PS . Native PG-PS was poorly degraded, N-acetylated PG-PS was extensively degraded, and de-O-acylated PG-PS was only slightly degraded by hen egg white lysozyme . N-acetylated PG-PS was also extensively degraded by human lysozyme and partially degraded by rat serum or rat liver extract . After a single intraperitoneal injection of rats with a sterile, aqueous suspension, all PG-PS preparations induced acute arthritis . The acute arthritis induced by N-acetylated PG-PS was significantly more severe than that induced by native PG-PS; that induced by de-O-acylated PG-PS was of intermediate severity . After the acute reaction, rats injected with native PG-PS developed chronic relapsing erosive synovitis which remained severe for the duration of the experiment (83 days) . In contrast, joint inflammation induced by N-acetylated PG-PS resolved within 6 weeks with little evidence of recurrent disease . Chronic arthritis induced by de-O-acylated PG-PS was of intermediate severity . In another assay of arthropathic activity, the arthritis in all rat ankle joints, which had been injected directly with native PG-PS, could be reactivated 3 weeks later by the intravenous injection of a small dose of PG . In contrast, only 50% of the joints initially injected with de-O-acylated PG-PS and none of the joints injected with N-acetylated PG-PS could be reactivated . These studies support the concepts that the resistance of PG-PS to muralytic digestion is crucial for chronic arthropathic activity and that the nature and degree of PG acetylation are important molecular determinants of the phlogistic activities of PG-PS polymers. J Perinatol, 1987 Spring, 7(2), 90 - 2 Sudden death following white cell transfusion in a premature infant; Zylberberg R et al.; A 1,700-g, 31 weeks' gestational age infant developed early onset Group B streptococcal septicemia associated with shock and respiratory distress . The infant was treated with antibiotics, exchange transfusion, and white cell transfusion . The infant improved, and then acutely deteriorated following the third white cell transfusion . Cause of death was presumed to be pulmonary sequestration of white cells or anaphylaxis. Scand J Urol Nephrol, 1987, 21(4), 301 - 6 Age at onset, sex distribution and HLA antigen frequency in patients with primary glomerulonephritis progressing to terminal uraemia . An epidemiological survey; Forsberg B et al.; In a retrospective study of 138 HLA-typed patients with primary glomerulonephritis progressing to terminal uraemia, a bimodal curve of age at onset of disease was observed among males . An initial peak occurred between 16 and 25 years of age, and a second peak between the ages of 46 and 55 . The prevalence of HLA B40 was found to be high among males in the first group, and a relationship was found to exist between the presence of HLA B40 and increased titres of ASO (antistreptolysin O) . No such findings were made either in the second group of males or in the female group . Among females, a single peak for age of onset occurred between 6 and 15 years . The frequency of HLA B40 did not differ significantly from that of the controls . The results of this study suggest a relationship to exist, predominantly in younger males, between primary glomerulonephritis with fatal outcome and HLA B40-related alterations in the immunological response to beta-streptococcal infection. Drugs, 1987, 33 Suppl 3, 298 - 311 An interim report of the efficacy and safety of anisoylated plasminogen streptokinase activator complex (APSAC); Johnson ES et al.; Anisoylated plasminogen streptokinase activator complex (APSAC) is a thrombolytic agent which can be administered to patients with acute myocardial infarction by intravenous injection rather than prolonged infusion, and which has sustained fibrinolytic activity, inducing thrombolysis with a low risk of early rethrombosis . In clinical trials, APSAC 30U intravenously produced angiographically confirmed reperfusion in 86/156 patients (55%) and coronary patency (in the absence of pretreatment angiography) in 131/161 patients (81%) up to 90 minutes after treatment . These figures compared with a reperfusion rate of 65% (71/110 patients) for intracoronary streptokinase, and a patency rate of 53% (27/51 patients) with intravenous streptokinase . Reperfusion occurred at a mean of about 45 minutes after either APSAC or streptokinase, and APSAC was more effective when administered within 4 hours, than between 4 and 6 hours, after the onset of symptoms of infarction . Reocclusion occurred in 4% (3/80) of infarct-related arteries assessed angiographically 1 to 3 days after APSAC, compared with 10% (7/74) after streptokinase . Preliminary analysis of mortality data from studies involving APSAC suggests a trend towards improved survival with APSAC in comparison with conventional therapy . Among 1855 patients treated with APSAC, and observed for periods of 1 month to 1 year, there have been 115 deaths (6.2%) . This compares with a mortality of 12.3% among patients receiving non-thrombolytic therapy (n = 708) . The results of large controlled mortality studies are awaited before evaluation of the precise extent of improvement with APSAC can be made . APSAC has been associated with relatively few serious side effects . Analysis of case records for 834 patients who received APSAC 30U intravenously revealed at least 1 suspected side effect in 44%, compared with in 33% of placebo-treated patients (n = 138) . Cardiovascular (e.g . arrhythmias and reduction in blood pressure) and haemorrhagic events (mostly associated with puncture sites) were reported most frequently . Cerebrovascular accidents occurred in 15/1598 patients (0.9%) treated with APSAC, of which 10 cases could possibly have been related to treatment . Allergic-type reactions (e.g . anaphylaxis, bronchoconstriction, skin rashes) occurred in 61/1152 patients (5%) after APSAC and may have resulted from previous exposure to streptococcal infection . APSAC induces systemic fibrinogenolysis and a 'lytic' state characterised by reductions in fibrinogen, plasminogen, Factors II, V and VIII and alpha 2-antiplasmin, and an increase in fibrin degradation products, which return to normal over a period of 2 days.(ABSTRACT TRUNCATED AT 400 WORDS) Cancer Immunol Immunother, 1987, 25(3), 169 - 74 Induction of activated natural killer cells from murine spleen cells primed in vivo and subsequently challenged in vitro with the streptococcal preparation 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 Thy 1+ and asialo GM1+, suggesting the activated natural killer cell . Next, mice were transplanted with syngeneic colon adenocarcinoma cells, and primed in vivo with OK432 . These spleen cells were subsequently challenged in vitro with OK432 . These spleen cells displayed a strong cytotoxic activity not only to the transplanted adenocarcinoma cells but also to other syngeneic tumor cells. Acta Cardiol, 1987, 42(3), 223 - 8 Group B streptococcal endocarditis mimicking mitral valve myxoma; von Kemp K et al.; A patient with group B streptococcal endocarditis and large vegetations resembling mitral valve myxoma is described . Group B streptococcal endocarditis and the differential diagnosis of vegetations and cardiac tumors are briefly reviewed. Arch Oral Biol, 1987, 32(2), 117 - 22 Antibodies to a streptococcal antigen in gingival capillary and crevicular fluid washings, collected from man and non-human primates; Lehner T et al.; The local gingival antibody response was examined in actively-immunized rhesus monkeys and in human natural immunization to the cell-surface streptococcal antigen (SA I/II) . A technique was developed to collect gingival capillary and crevicular fluid washings (GCCFW) from monkeys and human subjects with clinically normal gingiva . The thin crevicular epithelium and the adjacent capillary plexus are pierced with a probe and the resulting mixture of capillary blood, tissue fluid and crevicular fluid are collected by repeated washing of the gingival crevice . Antibodies measured by a solid-phase radioimmunoassay revealed that the IgG class of anti-SA I/II antibodies in GCCFW from the entire gingiva were positively correlated with the corresponding serum antibodies . Antibody levels from six defined dento-gingival units showed a progressive increase in the anti-SA I/II antibody level from the incisor to the premolar and molar units . A significant negative correlation was found between the antibody level of the total GCCFW and past caries experience . A similar negative correlation was found between antibodies from the GCCFW and the DMFS index of the molar teeth . The results are consistent with the hypothesis that there is an independent local immune response in the dento-gingival unit, which is superimposed on the common circulating serum antibodies and sensitized lymphocytes. Pediatr Hematol Oncol, 1987, 4(4), 329 - 36 High-dose cisplatin and etoposide in advanced malignancies of childhood; Perin G et al.; Thirty-two children with poor-prognosis solid tumors were treated with a combination of high-dose cisplatin (CDDP) (200 mg/m2 over 5 days) and VP16 . In the 30 children evaluable for antitumor effect, there were 7 complete, 12 partial, and 3 minor tumor responses . Wilms' tumor and rhabdomyosarcoma responded best . There were no therapy-related deaths . Severe neutropenia (PMN less than 500/mmc) developed after 29 out of the 45 evaluable courses and lasted a median of 8 days; during periods of neutropenia 8 episodes of fever occurred, 1 of which was caused by streptococcal sepsis . Platelet levels were depressed to less than 50,000/mmc after 17/45 cycles and this thrombocytopenia lasted a median of 8 days . No neurological toxicity occurred . One case developed acute renal failure . A hearing deficit for high frequencies was documented in 14/22 patients evaluated after the first cycle and in all cases after the subsequent cycles; the deficits correlated with the total dose of CDDP administered . High-dose cisplatin and VP16 is an effective association in children with advanced cancer, but cumulative dosage is limited by ototoxicity. Clin Ther, 1987, 9(6), 670 - 7 Cefuroxime axetil and penicillin V compared in the treatment of group A beta-hemolytic streptococcal pharyngitis; Gooch WM 3rd et al.; Patients with the signs and symptoms of acute tonsillopharyngitis were treated with cefuroxime axetil, an orally administered, beta-lactamase stable cephalosporin, or penicillin V for ten days . Group A beta-hemolytic streptococcal (GABHS) infection was confirmed bacteriologically in 115 patients . Patients aged 13 to 18 years received 250 mg of cefuroxime or 500 mg of penicillin V twice daily . Bacteriologic cure was found in 33 (94%) of 35 patients treated with the cefuroxime and in 12 (67%) of 18 treated with penicillin (P less than 0.05) . Patients aged 4 to 12 years who received 125 mg of cefuroxime axetil twice daily also experienced a greater rate of bacteriologic cure than patients who received 250 mg of penicillin V three times daily, but the difference was not statistically significant . Cefuroxime axetil is at least as effective as penicillin V in the management of streptococcal pharyngitis and may be more effective in preventing the carrier state. Pediatr Infect Dis J, 1987 Jan, 6(1), 123 - 30 Streptococcal pharyngitis in the 1980s; Dillon HC Jr; Streptococcal pharyngitis remains a common problem in children and adolescents . However, the incidence of acute rheumatic fever is now quite low except in developing countries . Proper management of streptococcal pharyngitis has contributed significantly to the decline in ARF . Penicillin treatment has clearly altered the natural history of streptococcal infection; the acute illness is shortened, risk of spread of infection is reduced, suppurative complications are prevented and ARF is prevented . Some cases of acute glomerulonephritis may be prevented . The decline in rheumatic fever has probably contributed to a greater interest in clinical benefits of therapy . Antigen detection tests appear promising for providing a more rapid bacteriologic diagnosis of streptococcal infection, which in turn permits prompt treatment . While penicillin has been the treatment of choice for four decades, a disturbing trend of increasing numbers of clinical relapses or recurrent infections has been noted in recent years . Alternative antibiotics, such as the oral cephalosporins, may now be superior to oral penicillin in terms of lessening the risk of relapse . This advantage must be weighed against other factors including cost effectiveness . The most pressing dilemma for the clinician is management of the patient with repeated episodes of acute streptococcal pharyngitis . Certain of these problem patients may benefit from a period of penicillin prophylaxis during the seasons when streptococcal infections are most prevalent . There is now agreement that posttreatment throat cultures need not be done in the child who remains asymptomatic following therapy . However, it is incumbent on the clinician to make certain that appropriate therapy is prescribed and that compliance with oral regimens of therapy is satisfactory in the management of the patient with acute streptococcal pharyngitis. Exp Clin Immunogenet, 1987, 4(3), 163 - 6 Interactive effect of Gm and Km allotypes on cellular immune responses to streptococcal cell wall antigen; Wachsmuth RR et al.; Serum samples from 121 unrelated, healthy Japanese individuals were typed for several Gm and Km(1) allotypes . Peripheral blood lymphocytes from these subjects were cultured with streptococcal cell wall (SCW) antigen and the incorporation of 3H-thymidine into T lymphoblasts was measured . Log-linear analysis showed a significant interactive effect of Gm1,17;13,16,21 and Km(1) on the cellular immune response to group A SCW antigen. Drugs, 1987, 33 Suppl 3, 1 - 12 Thrombolytic therapy in acute myocardial infarction . A perspective; Sherry S; This paper deals with the history of thrombolytic therapy from its inception to its application in acute myocardial infarction . It describes the discovery of streptococcal fibrinolysin, followed by the elucidation of the plasma proteolytic enzyme system concerned with fibrinolysis . An outline is given of the therapeutic basis for the decision to concentrate on the development of activators of the enzyme, rather than the enzyme itself . Early attempts to demonstrate the value of streptokinase and urokinase in the treatment of myocardial infarction are examined . Finally, the more encouraging approaches in current use, especially the early application of thrombolytic therapy after the onset of the morbid event, are discussed. Chemotherapy, 1987, 33(3), 177 - 82 Efficacy of teicoplanin in experimental group B streptococcal bacteremia and meningitis; Kim KS et al.; We evaluated the activity of teicoplanin against a type-III group B streptococcal strain in vitro and in vivo and compared the results with those of penicillin G . In vitro, the minimal inhibitory and minimal bactericidal concentrations of teicoplanin were 2- to 4-fold greater than those of penicillin G . In vivo studies were carried out with an experimental bacteremia and meningitis model in newborn rats . Eighty-one infected animals were randomized to receive teicoplanin 5, 10 or 20 mg/kg, twice daily, or penicillin G 50 or 200 mg/kg, twice daily, or saline (0.05 ml), twice daily . The mean serum levels of teicoplanin were maintained above 100 X the minimal bactericidal concentration for 7-8 h even with a dose of 5 mg/kg . The mean penetration of teicoplanin into the cerebrospinal fluid was estimated as 2.4-8.2% of those of concomitant levels in serum . The overall efficacy of teicoplanin was similar to that of penicillin G as judged by mortality rates . However, two bacteremic animals which were free of meningitis at the beginning of therapy developed this complication during 4 days of teicoplanin therapy, in contrast with none in the penicillin group . Further studies are needed to understand the reason(s) for these failures with teicoplanin therapy. Int J Immunopharmacol, 1987, 9(8), 875 - 9 Reduction of suppressor cell activities of human peripheral blood lymphocytes by a streptococcal preparation, OK-432; Toge T et al.; The effect of a streptococcal preparation, OK-432 on suppressor cell activities of peripheral blood lymphocytes was investigated . Suppressor cell activities were significantly reduced when they were generated in vitro by concanavalin A (Con A) in the presence of OK-432 . However, the reduction of suppressor cell activities was not observed when OK-432 was added in the effector phase . Similarly, a significant reduction of prostaglandin E2 (PGE2)-induced suppressor cell activities by OK-432 was observed . No increases of either T-cells with Fc receptors for IgG or OKT8 reactive T-cells were observed after Con A stimulation in the presence of OK-432 . The suppressive effect of the soluble suppressor factors (SSF) was not abrogated by OK-432 and the release of SSF from cells activated by Con A was not found in the presence of OK-432 . Thus, it is suggested that OK-432 might interfere with the induction of suppressor cells, but not with the expression of their activities. Gene, 1987, 58(2-3), 283 - 95 Nucleotide sequence analysis of the gene for protein A from Staphylococcus aureus Cowan 1 (NCTC8530) and its enhanced expression in Escherichia coli; Shuttleworth HL et al.; Nucleotide sequence analysis of the gene (spa) for staphylococcal protein A (SPA) from Staphylococcus aureus strain Cowan 1 (NCTC8530) shows that the sequence differs from previously reported SPA nucleotide sequences, especially in the number of repeat units in the cell-wall-binding region of the gene . Dot matrix comparison with streptococcal protein G and the macrophage receptor for the constant fragment (Fc) of immunoglobulins shows a limited but significant homology . The homology to the latter probably identifies the Fc-binding region in the immunoglobulin-binding domains of SPA . Enhanced production of SPA in Escherichia coli was achieved using the lac promoter immediately upstream from the spa gene. J Immunol, 1987 Jan 1, 138(1), 285 - 92 Interaction of IgG3 anti-streptococcal group A carbohydrate (GAC) antibody with streptococcal group A vaccine: enhancing and inhibiting effects of anti-GAC, anti-isotypic, and anti-idiotypic antibodies; Greenspan NS et al.; Enhancement of binding of one monoclonal antibody to an antigen in the presence of a second monoclonal antibody (specific for an independent epitope on the same antigen) has been observed for several antigen-antibody systems involving primarily protein, or glycoprotein, antigens . We have analyzed the interaction between radiolabeled IgG3 kappa anti-streptococcal group A carbohydrate (GAC) antibody (125I-HGAC 39) and streptococcal group A vaccine (GAV; traditionally used to elicit anti-GAC antibody) in the absence and presence of unlabeled anti-GAC antibodies, anti-isotypic antibodies, or anti-idiotypic antibodies, respectively . A variety of significant enhancing or inhibiting effects on the binding of 125I-HGAC 39 to solid-phase GAV (GAVsp) were noted . First, high concentrations of IgG3 anti-GAC antibodies specifically inhibit binding of 125I-HGAC 39 to GAVsp, but the presence of lower concentrations of IgG3 anti-GAC antibodies is associated with markedly increased (up to 300 to 400%) binding of 125I-HGAC 39 to GAVsp . In contrast, with the concentrations used, IgM anti-GAC antibodies only inhibit binding of 125I-HGAC 39 to GAVsp . A monoclonal anti-gamma 3 antibody (2E.6) also enhances binding (up to 700%) of 125I-HGAC 39 to GAVsp, whereas another high-affinity anti-isotypic antibody, anti-C kappa (187.1), only inhibits binding of 125I-HGAC 39 to GAVsp . In a similar manner, an antiidiotypic antibody (anti-IdX) specific for a framework idiotope located near the C kappa domain inhibits the interaction between 125I-HGAC 39 and GAVsp . Evidence is presented to suggest that neither anti-C kappa nor anti-IdX blocks the HGAC 39 paratope, and therefore, the inhibition of binding mediated by these antibodies must be on some other basis . An alternative explanation for this effect, on the basis of the impairment of functional bivalency of 125I-HGAC 39, is discussed . Finally, anti-idiotypic antibodies (anti-IdI-3a and anti-IdI-1) that bind closer to the antigen-binding site of HGAC 39 inhibit binding of 125I-HGAC 39 to GAVsp in a manner that is most readily interpreted as competition for the GAC-binding site (or nearby sites) on the HGAC 39 variable domain . These effects are shown to require specific immunologic recognition of either GAVsp or 125I-HGAC 39. JAMA, 1986 Dec 26, 256(24), 3353 - 7 The comparative cost-effectiveness of statistical decision rules and experienced physicians in pharyngitis management; Cebul RD et al.; We examined whether probability-based decisions for streptococcal pharyngitis, using probabilities derived from predictive models along with Tompkins' decision rules, could be more cost-effective than the actual decisions of ten physicians . We retrospectively calculated the probability of a positive throat culture ("disease") for each of 310 patients using four different models based on discriminant analysis (1), a branching algorithm (2), and logistic regression (3 and 4) . "Projected decisions" were based on these probabilities and Tompkins' rules . We calculated direct medical and indirect costs per correct action taken (diseased patient-treated or nondiseased patient-not-treated) . Two models' projected decisions were more cost-effective than the physicians' . Model 1 primarily would have reduced treatment costs (leaving no diseased patient untreated); model 4 primarily would have reduced throat culture costs (with 15% projected undertreatment) . While using statistical decision rules may be cost-effective in this setting, their adoption should be consistent with physician and patient priorities. S Afr Med J, 1986 Dec 6, 70(12), 762 - 3 Occult life-threatening streptococcal septicaemia in the elderly . A report of 2 cases; Gordon GD et al.; Streptococcal septicaemia may occur as a fulminant illness, which has a reported mortality rate in excess of 80% . The organism is, however, usually highly sensitive to penicillin and prompt diagnosis and initiation of therapy should reduce this . Two patients with streptococcal septicaemia who presented in shock, initially thought to have a primary vascular cause, are reported . The course of the disease illustrates the importance of recognizing the protean modes of presentation of this condition and of starting appropriate therapy before laboratory confirmation of the diagnosis. Am J Cardiol, 1986 Dec 1, 58(13), 1213 - 7 Cardiac conduction abnormalities complicating native valve active infective endocarditis; DiNubile MJ et al.; Two hundred eleven episodes of native valve active infective endocarditis treated at the Massachusetts General Hospital between 1975 and 1983 were reviewed . The aortic (36%) and mitral (33%) valves were most frequently involved, but in 21% of the cases the site of infection could not be localized . Streptococcal (50%) and staphylococcal (35%) species were the most frequently isolated pathogens . New or changing ("unstable") conduction abnormalities developed in 9% of the patients, while an additional 7% had conduction abnormalities of "indeterminate" age . Unstable conduction block was more likely to develop in patients with aortic valve infective endocarditis than in those with mitral infection . Surgery was performed in 23% of the patients . Unstable conduction abnormalities were significantly associated with valve replacement, but in a multivariate analysis, this effect could be explained by the site of valvular infection . The mortality rate was 20% . Patients with unstable conduction abnormalities had a significantly higher mortality rate, even after other significant predictors of death (age, type of causative organism) were taken into account . Patients whose conduction changes persisted had a worse prognosis than those with transient conduction abnormalities . Although more hemodynamically compromised, patients with unstable conduction block who underwent valve replacement did at least as well as those given medical therapy alone . Patients with native valve active infective endocarditis in whom persistent, unstable conduction abnormalities develop without other identifiable cause, especially in the presence of aortic valve infection, should be considered for valve replacement. J Infect Dis, 1986 Dec, 154(6), 1012 - 7 Detection of antibodies to muramyl dipeptide, the adjuvant moiety of streptococcal cell wall, in patients with rheumatic fever; Bahr GM et al.; The presence of antibodies to muramyl dipeptide (MDP), an adjuvant structure of streptococcal peptidoglycan, was investigated in patients with acute rheumatic fever (ARF) . The detection of these antibodies was done by an enzyme-linked immunosorbent assay with a synthetic multivalent MDP conjugate as an antigen . Sera from 33 of 54 children with ARF had detectable levels of antibodies to MDP at the time of diagnosis . Such antibodies could only be detected in sera from two of 52 healthy children and one of 21 children with acute poststreptococcal glomerulonephritis . The specificity of the antibodies to MDP was demonstrated by inhibition, with free MDP, of binding of the sera to the MDP conjugate . The possible use of these antibodies in the diagnosis of ARF and in screening for safe synthetic muramyl peptides in immunization of humans is discussed. J Clin Lab Immunol, 1986 Dec, 21(4), 169 - 71 Induction of tumor necrosis factor by administration of OK-432 in cancer patients; Kokunai I et al.; We examined whether OK-432, a streptococcal preparation, could induce tumor necrosis factor in cancer patients . OK-432 was administered at a dose of 100 KE intratumorally to 4 advanced gastric cancer patients and 10KE intracavitary to 8 patients with malignant pleuroperitoneal effusion . The cytostatic activity of the sera and malignant effusions was assayed by the growth inhibition of L929 cells . OK-432 induced significant cytostatic activity in the sera and malignant effusions . The activity was partially neutralized by the monoclonal antibody against human recombinant tumor necrosis factor . These data suggest that OK-432 induces tumor necrosis factor in the sera and malignant effusions of cancer patients. Int J Zoonoses, 1986 Dec, 13(4), 262 - 5 Emerging zoonoses in Africa . 1: Swine encephalitis in man; Ayanwale FO; Some cases of human cerebro-spinal meningitis associated with swine streptococcal infections were reported . Five piggery workers were involved . A 23 year old nursing mother and four male attendants suffered persistent headaches followed by stiffneck and what a physician diagnosed as meningitis and was treated in a hospital . Typical clinical signs of cold, mucopurulent catarrh with diarrhea and other symptoms were seen . Precautionary measures to be taken when swine encephalitis is suspected were also discussed. Helv Paediatr Acta, 1986 Dec, 41(5), 399 - 407 Neonatal periventricular leukomalacia: diagnosis and evolution evaluated by real-time ultrasound; Tamisari L et al.; Recent advances in imaging techniques have provided the opportunity to obtain prompt diagnosis and to study the natural evolution of periventricular leukomalacia (PVL) . Three premature neonates were followed up by brain sonograms from birth to six, four and three months of age, respectively . Sequential ultrasound examinations confirmed previous observations which identified four stages of PVL; 1 . increased echogenicity in the periventricular white matter, 2 . apparent normalization, 3 . cystic cavitation, 4 . resolution of cysts and development of ventriculomegaly . Decreased perfusion of the periventricular end-arterial zone is responsible for the development of PVL; this selective hypoperfusion has been documented in infants with a significant history of cardiorespiratory disturbances and group-B streptococcal sepsis . Two of our patients and other cases described in the literature, however, did not exhibit these clinical features . The present study suggests the involvement of chronic hypoxia and toxic insults in the pathogenesis of this condition and confirms the value and accuracy of sequential sonography in the diagnosis of PVL. Prim Care, 1986 Dec, 13(4), 657 - 65 Rapid testing for streptococcal pharyngitis; Fischer PM; Within the past 2 years, new technology has become available to office laboratories that permits a 10-minute laboratory diagnosis of a group A streptococcal infection in patients who present with sore throats . The availability of the test result while the patient is in the office can be a great improvement compared with waiting 1 to 2 days for a throat culture report . In addition, these rapid tests may be easier for office staff to read than traditional agar plates . A physician who incorporates rapid testing for streptococcal infection in the office laboratory should perform appropriate quality controls to be confident that the test method is working . The rapid streptococcal tests are the first of a new generation of microbiology immunoassays available to office laboratories. J Fam Pract, 1986 Dec, 23(6), 551 - 5 Comparison of tests for streptococcal pharyngitis; DeNeef P; Rapid streptococcal antigen detection tests are now an alternative to throat cultures for diagnosing group A streptococcal pharyngitis . By applying existing knowledge to 1,000 theoretical patients, this study compares the diagnostic accuracy, costs, and benefits of "gold standard" throat cultures, less specific office cultures, and rapid streptococcal tests . With the new rapid tests, appropriate treatment for streptococcal pharyngitis can be started promptly without waiting for a culture result . Benefit-cost analysis of existing data shows that rapid tests have the potential to be more efficient than throat cultures in minimizing medical costs and time lost because of illness . These conclusions remained true over widely ranging assumptions about streptococcal prevalence, carrier rate, rheumatic fever attack rate, test cost, and test accuracy. Mol Immunol, 1986 Dec, 23(12), 1391 - 5 Influence of CONH2 or COOH as C-terminus groups on the antigenic characters of immunogenic peptides; Gras-Masse HS et al.; The influence of the presence of a terminal COOH or CONH2 on the antigenic characters of synthetic immunogenic peptides has been studied on a streptococcal synthetic vaccine model . The obtained results show that when a peptide amide is used, the antibodies raised specifically against the amide group recognize neither free COOH nor the parent protein . The carboxamide group is thus unsuitable as was postulated for raising antibodies which recognize the peptide bond. J Biol Chem, 1986 Nov 25, 261(33), 15783 - 6 The nucleotide and partial amino acid sequence of toxic shock syndrome toxin-1; Blomster-Hautamaa DA et al.; The nucleotide sequence of toxic shock syndrome toxin-1 (TSST-1) has been determined . In addition, one-third of the predicted amino acid sequence was confirmed by amino acid sequence analysis of cyanogen bromide-generated TSST-1 protein fragments . The DNA sequencing results identified a 708-base pair open reading frame starting with an ATG, 7 base pairs downstream from a Shine-Dalgarno sequence, and terminating at a UAA stop codon . Amino acid analysis of the intact protein defined the NH2 terminus of the mature protein and located the cleavage point for the signal peptide (Ala/Ser) . The signal peptide contained the first 40 amino acids and had characteristic structural similarities with other bacterial signal peptides . The coding sequence of the mature protein was 585 base pairs (194 amino acids) in length, and the molecular weight of the predicted protein was 22,049 . This is in good agreement with the previously reported molecular weight of TSST-1 (22,000), as determined by sodium dodecyl sulfate-polyacrylamide gel electrophoresis . NH2-terminal amino acid sequence analysis performed on isolated TSST-1 CNBr fragments determined the position of the peptides in the TSST-1 sequence and verified the predicted amino acid sequence in those positions . Computer analyses of the amino acid sequence showed that TSST-1 has little or no sequence homology with biologically related toxins, streptococcal pyrogenic exotoxin A, and staphylococcal enterotoxins B and C. J Immunol, 1986 Nov 15, 137(10), 3158 - 61 Phenotypic and functional characteristics of active suppressor cells against IFN-gamma production in PHA-stimulated cord blood lymphocytes; Seki H et al.; Cord blood mononuclear cells (MNC) were defective in their ability to produce interferon-gamma (IFN-gamma) on stimulation with phytohemagglutinin (PHA) or recombinant interleukin 2, whereas cord MNC could induce comparable amounts of IFN-gamma with adult controls on stimulation with a streptococcal preparation, OK-432 . Moreover, irradiation of cord MNC with 1,500 rad before PHA stimulation could restore the IFN-gamma production . Kinetic studies indicated that such augmentation of IFN-gamma production by irradiation was evident when cord MNC were irradiated before or by 12 hr of PHA-stimulated culture . But irradiation after 18 hr or more of PHA stimulation did not exert any significant augmentation on IFN-gamma production by cord MNC . It seemed most likely that the ability of IFN-gamma production is already mature at birth, but radiosensitive suppressor effectors on IFN-gamma production are activated within cord MNC at an early stage of PHA stimulation, resulting in poor IFN-gamma production by cord MNC . PHA-induced IFN-gamma production by OKT3+, OKT4+, and OKT8- cord cells were markedly enhanced by irradiation with 1,500 rad before the culture . Coculture experiments disclosed that cord OKT4+ cells, but not OKT4- cells, when prestimulated with PHA for 24 hr, exerted active suppression on PHA-induced IFN-gamma production by adult MNC in a dose-dependent manner . These results suggested that radiosensitive suppressor effectors on IFN-gamma production were induced within the OKT4+ T cell subset of cord MNC on PHA stimulation. Zentralbl Bakteriol Mikrobiol Hyg {A}, 1986 Nov, 262(4), 448 - 54 Semi-quantitative determination of IgG-binding structures on bacteria by direct fluorescence technique; Schmidt KH et al.; A simple semiquantitative method for determination of IgG-binding structures on bacteria by direct fluorescence technique is described . The fluorescence of bacterial bound IgG-FITC-conjugate was measured in a paste-like bacterial sediment by using a fluorescence microscope photometer unit . For this purpose sharply centrifuged IgG-FITC conjugate treated bacteria, from which the washing fluid was carefully removed, were transferred to a glass slide and fluorescence was measured at the contact layer of the adhered drop on the inverted slide . The measured fluorescence intensity area was found to be correlated with the amount of bound IgG-FITC/cell, if bacteria had been incubated with an excess of fluorescein labeled IgG . The IgG-binding of different streptococcal strains was compared with the average IgG-binding of strain Cowan I resulting from 13 different cultivations . For strain Cowan I 9.4 X 10(4) IgG-molecules were estimated to bind on one staphylococcal cell . For a screening of IgG-binding bacterial strains the method did not demand a standardization of bacteria by cell counting. Br Heart J, 1986 Nov, 56(5), 483 - 5 Crescentic glomerulonephritis: a possible complication of streptokinase treatment for myocardial infarction; Murray N et al.; Twenty days after a streptokinase infusion given for myocardial infarction, a patient developed a group G streptococcal throat infection . Thirteen days later he presented with a serum sickness type illness and progressive renal failure . Renal biopsy showed crescentic glomerulonephritis. Am J Vet Res, 1986 Nov, 47(11), 2380 - 4 Effect of the injection site on the pharmacokinetics of procaine penicillin G in horses; Firth EC et al.; The plasma penicillin concentrations were determined in 5 horses given an IV injection of sodium penicillin G; plasma penicillin concentrations were also determined in a crossover experiment, where animals were given procaine penicillin G subcutaneously at 1 site and IM at 4 sites . The mean penicillin plasma peak concentration and bioavailability were highest after the drug was injected in the neck and biceps musculature . Injections in the gluteal muscle and in the subcutaneous sites resulted in similar, but lower, more persistent penicillin plasma concentrations and a lower bioavailability than were obtained with injection in the neck and biceps musculature . The pharmacokinetic data obtained after penicillin was administered via the pectoral muscle route exhibited an intermediate position . Therapeutic implications of the routes of administration with respect to hemolytic streptococcal infections are discussed. Clin Nephrol, 1986 Nov, 26(5), 227 - 34 Glomerular binding sites for peanut agglutinin in acute poststreptococcal glomerulonephritis; Mosquera JA et al.; Streptococcal neuraminidase may be responsible for the development of auto-immune reactivity in acute poststreptococcal glomerulonephritis (APSGN) . Neuraminidase may react with immunoglobulins in the circulation and with sialic acid-rich sites in the endothelial and epithelial glomerular capillary, therefore, extrinsic or intrinsic sialic acid-depleted substrate may be localized in the glomeruli . We studied renal biopsies from 17 patients with APSGN, 48 patients with other renal pathologies and 2 normal kidneys for the capacity to bind fluorescein-labelled peanut agglutinin (PNA) lectin . PNA has specificity for galactosyl radicals which are exposed after sialic acid removal . We similarly studied the kidneys of rats at intervals ranging from hours to 32 days after an intravenous injection of 0.02 units of neuraminidase per g of body weight . Five biopsies of APSGN patients and 2 biopsies from patients with renal pathologies different from APSGN showed glomerular PNA binding . Of APSGN patients, 4 corresponded to the 5 patients biopsied within 30 days of the beginning of the disease and only 1 biopsy was positive in the 12 patients who were biopsied later . The PNA binding predominated in the mesangium and the pattern was irregular and speckled . These findings suggest that sialic-acid depleted material is present in the glomeruli, early in the course of APSGN. Pediatr Infect Dis, 1986 Nov-Dec, 5(6 Suppl), S338 - 40 TetM tetracycline-resistant determinants in Ureaplasma urealyticum; Roberts MC et al.; Ureaplasma urealyticum is an organism usually considered susceptible to tetracycline, with a minimal inhibitory concentration of 1 microgram/ml or less . Sixty-three clinical strains of U . urealyticum and serovars 1 through 9 were screened for resistance to tetracycline . Thirteen clinical isolates of U . urealyticum and one serovar (9) were resistant to high levels of tetracycline . They differed from each other on sodium dodecyl sulfate-polyacrylamide gel electrophoresis gels and immunoblotting . All 14 strains contained DNA sequences homologous to the streptococcal determinant tetM which suggests the spread of this gene to the genus Ureaplasma. J Pediatr Surg, 1986 Nov, 21(11), 975 - 6 Streptococcal sepsis presenting as acute abdomen in a child with transient hypogammaglobulinemia of infancy; Kosnik EF et al.; Group A streptococcal sepsis was documented in a child who presented with an acute abdomen . Massive retroperitoneal edema was observed at laparotomy with no focus of infection . Immunologic evaluation revealed low serum immunoglobulins and deficient in vitro IgG synthesis consistent with transient hypogammaglobulinemia of infancy . Unusual or severe infections in infancy should be evaluated for congenital immunologic disease. Monatsschr Kinderheilkd, 1986 Nov, 134(11), 794 - 8 {Infection and neonatal meningitis: epidemiology, pathogen spectrum, therapy}; Speer CP et al.; Data from 196 infants were analyzed who had been treated for neonatal septicemia and/or meningitis between 1962-1974 (n = 88) and 1975-1985 (n = 108) . In addition to an increase in the incidence of septicemia (1962-1974: 0.88 cases/1000 live births/year; 1975-1985: 1.8 cases/1000 live births/year) there was also a change in the pattern of infection . Group B streptococcal infections were first observed in 1975 . Infections with Escherichia coli increased (1962-1974: 0.25 cases/1000 live births/year; 1975-1985: 0.65 cases/1000 live births/year) . Although the incidence of meningitis was similar in both periods (1962-1985: 0.45 cases/1000 live births/year) the relative number of cases declined (1962-1974: 51 of 88 patients; 1975-1985 25 of 108) . Mortality also decreased during the second period (1962-1974: 53%; 1975-1985: 29%) . All infants were primarily treated with a combination of ampicillin and gentamicin . The decision to discontinue this therapy was based on the clinical course of the patient and the results of culture and susceptibility studies . Ampicillin and/or gentamicin were effective in vitro against all microorganisms which caused septicemia and/or meningitis within the first four days of life . In contrast this antimicrobial combination was only active in vitro against 77% of the pathogens isolated after this time period. Prev Med, 1986 Nov, 15(6), 632 - 42 Evaluation of an Alaskan streptococcal control program: importance of the program's intensity and duration; Brant LJ et al.; Prospective follow-up information from the throat culturing results of 1,653 Eskimo children in 12 Alaskan villages was used to evaluate the effect of duration and intensity of a streptococcal control program begun in 1971 while controlling for several other risk factors related to streptococcal colonization . Relative risks of colonization for each of the subsequent study years relative to the first year indicate that the risk of colonization decreased over the duration of the study by 42% in Year 2 to 55% in Year 4 (P less than 0.0001) . Cost-cutting measures such as lengthening the time interval between routine throat cultures led to a 37% increase in the risk of colonization (P = 0.0002) . A comparison of the number of cases of acute rheumatic fever during the 5-year period before the streptococcal control program with the number of cases during the 5-year program period showed that cases in villages with the program decreased from 11 to 0 . In a similar group of comparison villages without the program, the number of cases decreased from 7 to 4 . A benefit-cost study of the program indicates that benefit exceeds cost . These findings and the changes in the carriage of streptococcal organisms during the control program underscore the importance of such long-term programs with regularly scheduled culturing in high-risk populations of children. J Clin Oncol, 1986 Nov, 4(11), 1645 - 51 Immunochemotherapy in human hepatocellular carcinoma using the streptococcal agent OK-432; Imaoka S et al.; Twenty-one patients with nonresectable hepatocellular carcinoma (HCC) received intraarterial infusion chemotherapy of Adriamycin (Adria Laboratories, Columbus, Ohio) via an indwelling catheter in the hepatic artery . Additional intratumoral injection therapy of OK-432 (50 KE) was administered to ten of these 21 patients . Nine of the ten patients showed a remarkable decrease in lymphocyte count on the first day after therapy . In all of the patients with a decreased lymphocyte count, computed tomograms (CTs) demonstrated evidence of necrosis associated with a rapid decrease in alpha fetoprotein (alpha-FP) . Blastogenesis of lymphocytes in peripheral blood induced by phytohemagglutinin (PHA) increased by 3.99 +/- 1.9 (mean +/- SE) times 4 weeks after therapy . On the basis of these results, we concluded that intratumoral injection therapy of OK-432 apparently produced initiation of necrosis in HCC by cell-damaging activity as well as by improvement of cell-mediated immunity. J Exp Med, 1986 Nov 1, 164(5), 1785 - 90 Sequence of myosin-crossreactive epitopes of streptococcal M protein; Dale JB et al.; Group A streptococcal M proteins contain epitopes that crossreact with sarcolemmal membrane proteins of human myocardium and myosin . In the present study, synthetic peptide copies spanning the entire 197-residue pepsin extracted fragment of type 5 M protein were used to localize the myosin-crossreactive epitopes of the molecule . Peptide 84-116 inhibited by 75% the binding of myosin-crossreactive antibodies evoked by pep M5, as determined by ELISA . Immunoblot inhibition studies confirmed that peptide 84-116 almost totally inhibited the binding of pep M5 antibodies to the heavy chain of human cardiac myosin . None of the remaining synthetic peptides, including peptide 1-35, which contains protective epitopes, inhibited antibodies binding to myosin . Two of three rabbits immunized with peptide 84-116 developed low but significant levels of antibodies crossreactive with myosin . Identification of the primary structures containing tissue-crossreactive as opposed to protective epitopes should not only allow the development of safe and effective M protein vaccines, but may also provide insights into the pathogenesis of rheumatic heart disease. Biochem Biophys Res Commun, 1986 Oct 30, 140(2), 557 - 64 Production of antibodies recognizing a hepatitis B virus (HBV) surface antigen by administration of murabutide associated to a synthetic pre-S HBV peptide conjugated to a toxoid carrier; Przewlocki G et al.; The influence of Murabutide, a muramyl peptide analog, on the response of mice to two synthetic hepatitis B virus antigens was compared with the activity of Al (OH)3 and of FCA . The synthetic peptides represented fragments either of the major component of the hepatitis B surface antigen (HBsAg) or of the pre-S region . They were used either conjugated to toxoid carrier or as a totally synthetic preparation, i.e . copolymerized with a streptococcal peptide . Our results demonstrated that treatment with Murabutide increased the levels of antibodies, modulated their specificity and allowed a better recognition of the natural antigens. Cancer Lett, 1986 Oct, 33(1), 11 - 8 Inhibition and augmentation of lymphoma metastasis by adoptively transferred peritoneal macrophages in hamster; Mashiba H et al.; The effect of adoptively transferred peritoneal exudate cells on the metastasis of hamster lymphoma was studied . Metastatic spread occurring after the surgical removal of a primary tumor was considerably inhibited by the adoptive transfer of the peritoneal exudate cells (PEC) stimulated by immunostimulants, using a streptococcal preparation (OK-432) or a purified beta (1-3) glucan (SPG) . However, the inhibitory effect on metastasis was abrogated by the in vitro treatment of the peritoneal adherent cells with silica . PEC stimulated with lymphokines in vitro was also effective in inhibiting metastasis . However, the adoptive transfer of peritoneal adherent cells treated in vitro with 12-O-tetradecanoylphorbol acetate (TPA) in vitro, augmented metastatic spread in tumor-bearing hamsters which usually exhibit concomitant immunity . The relation of the state of the functional activity of macrophages to metastasis is discussed. Postgrad Med J, 1986 Oct, 62(732), 933 - 4 Group B streptococcal meningitis in a diabetic adult; Lakhani M et al.; A rare case of adult group B streptococcal meningitis is presented . The association with diabetes mellitus is emphasized and attention is drawn to microscopic and serological confusion that may arise in differentiating it from pneumococcal meningitis. Pediatr Res, 1986 Oct, 20(10), 1004 - 8 Effects of a leukotriene antagonist on the early hemodynamic manifestations of group B streptococcal sepsis in piglets; Goldberg RN et al.; In order to evaluate the influence of leukotrienes on group B streptococcal (GBS) sepsis we studied the effect of a leukotriene antagonist, FPL 57231, on the early hemodynamic changes occurring secondary to an infusion of live GBS . Paralyzed, mechanically ventilated piglets received a continuous intravenous infusion of bacteria (5 X 10(8) org/kg/min) while systemic arterial pressure and pulmonary artery pressure were measured continuously . Cardiac output was measured by thermodilution; and plasma samples for determination of thromboxane B2 and 6-keto-PGF1 alpha were taken at preset intervals . In addition to GBS, treatment animals received a continuous infusion of FPL 57231 starting 15 min after the bacterial infusion was begun . Study animals as a whole responded to bacteria within 15 min with a marked elevation in pulmonary artery pressure from 13.6 +/- 4 to 44.6 +/- 6 mm Hg (p less than 0.001), and a decline in PaO2 (79 +/- 9 to 44 +/- 5 mm Hg) (p less than 0.001) and a cardiac output (0.27 +/- 0.07 to 0.15 +/- 0.06 liter/min/kg) (p less than 0.0001) . In animals treated with FPL 57231 these changes were reversed or significantly attenuated by 60 min . In the control group pH deteriorated significantly to 7.17 +/- 0.1 compared to baseline values (p less than 0.01) by 60 min, while treatment group animals maintained a pH of 7.3 +/- 0.23 . Thromboxane B2 and 6-keto PGF1 alpha were similar in both groups and did not change during the study period . In addition, survival was significantly longer in treatment (191 +/- 44 min) compared to control animals (100 +/- 32 min) (p less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS) Ann Intern Med, 1986 Oct, 105(4), 586 - 91 The importance of disease prevalence in transporting clinical prediction rules . The case of streptococcal pharyngitis; Poses RM et al.; Because clinical prediction rules often are applied in new settings to calculate the probability of a disease, we evaluated the accuracy of three rules for predicting streptococcal pharyngitis in 310 patients . Use of the rules led to overestimations of disease probability in 47%, 82%, and 93% of the patients . When we used receiver-operating characteristic curve analysis, no rule lost power to discriminate streptococcal from nonstreptococcal causes of pharyngitis . The overestimations in disease probability likely were caused by differences in disease prevalence between our setting (5%) and the settings in which they were developed (15% to 17%) . All rules led to accurate predictions when they were adjusted for the disease prevalence found in our setting using a likelihood ratio formulation of Bayes' theorem . The value of prediction rules, like that of other diagnostic tests, is affected by differences in disease prevalence in different settings . Failure to recognize and adjust for these differences may cause poor decision making or the premature dismissal of valid rules. J Clin Microbiol, 1986 Oct, 24(4), 639 - 41 High production of the acquired immunodeficiency syndrome virus (lymphadenopathy-associated virus) by human T lymphocytes stimulated by streptococcal mitogenic toxins; Alouf JE et al.; Purified streptococcal mitogens (SMs) including erythrogenic exotoxin were compared with phytohemagglutinin (PHA) for their ability to sustain lymphadenopathy-associated virus (LAV) replication after the stimulation of normal human peripheral blood mononuclear cells and purified CD4+ and CD8+ T cells infected with LAV . Both SM and PHA supported LAV production in peripheral blood mononuclear and CD4+ cells but not in CD8+ cells . LAV production assessed by the assay of reverse transcriptase in cell supernatants appeared earlier after stimulation with SM and was 6- to 10-fold greater than after stimulation by PHA. J Immunol, 1986 Oct 1, 137(7), 2199 - 209 T lymphocyte-dependent evolution of bacterial cell wall-induced hepatic granulomas; Wahl SM et al.; Injection of streptococcal cell walls (SCW) i.p . into susceptible rats results in dissemination of SCW primarily to the liver, spleen, bone marrow, and peripheral joints . Within the liver, the SCW are phagocytized by the Kupffer cells, initiating a sequence of events leading to the formation of hepatic granulomas . The granulomas are characterized by large numbers of W3/13+, W3/25+ T lymphocytes and Ia+, esterase-positive macrophages . The generation of inflammatory mediators by these mononuclear cells appears to be central to the evolution of the granulomas and the subsequent fibrotic sequelae evoked by the SCW . In the absence of functional T lymphocytes (athymic rats), injection of SCW does not trigger lymphokine production, and organized granulomas do not develop in the livers . Furthermore, inhibition of T lymphocyte proliferation and lymphokine synthesis pharmacologically by cyclosporin A administration in euthymic animals inhibits SCW-induced hepatic granuloma development . Although macrophage function is apparently not impaired as evidenced by IL 1 and PGE2 production, a chronic inflammatory response to SCW cannot be sustained in the absence of T lymphocyte participation . These studies provide insight into the cellular and molecular mechanisms leading to formation and maintenance of chronic granulomatous lesions. J Immunol, 1986 Oct 1, 137(7), 2173 - 9 Detection of C-reactive protein, streptolysin O, and anti-streptolysin O antibodies in immune complexes isolated from the sera of patients with acute rheumatic fever; Gupta RC et al.; Circulating immune complexes (IC) of 42 patients with acute rheumatic fever from Santiago, Chile, were studied . The complexes were isolated by polyethylene glycol precipitation and were analyzed for antibodies, antigens, and C-reactive protein . We found the complexes to be enriched in antibody to streptolysin O, particularly in the group of patients with elevated levels of IC . IgM was the predominant class of Ig present in the complexes . Western blots from 12 patients to detect antigens in the complexes showed proteins of m.w . 50,000, 60,000, and 69,000, consistent with the polypeptides of streptolysin O . Such antigens were absent in the complexes from patients with post-streptococcal glomerulonephritis and pharyngitis . Eluted antibodies from these protein bands on the nitrocellulose sheets reacted with the streptolysin O in Western blots and neutralized the hemolytic activity of streptolysin O in a microhemolysin assay . In addition, isolated complexes from several sera showed the presence of C-reactive protein bound to complexes . In vitro experiments demonstrated that {125I}C-reactive protein was not precipitated by polyethylene glycol either alone or when added to monomeric IgG, whereas it precipitated significantly when added to aggregated IgG . The detectable C-reactive protein in isolated complexes and sera samples increased after treatment with sodium dodecyl sulfate . These data suggest that circulating immune complexes in acute rheumatic fever contain streptolysin O and its antibody and raise interesting questions regarding the pathogenetic significance of C-reactive protein in the complexes. J Rheumatol, 1986 Oct, 13(5), 895 - 8 Studies on the effect of D-penicillamine, gold thioglucose and methotrexate on streptococcal cell wall arthritis; Ridge SC et al.; Intraperitoneal administration of group A streptococcal cell walls to rats induces an acute arthritis that resolves and is followed by a chronic lesion . The effect of low dose methotrexate, D-penicillamine and gold thioglucose has been investigated in this model . Whereas D-penicillamine and gold thioglucose had no effect on the hind paw inflammation and joint destruction (radiological assessment) associated with the lesion, methotrexate treatment suppressed both of these variables . Spleen cells derived from cell wall treated arthritic rats were hyporesponsive to concanavalin A (Con-A) and were deficient in the synthesis of interleukin 2 (IL-2) . Spleen cells derived from methotrexate treated rats exhibited an improved response to Con-A and their ability to synthesize IL-2 was significantly enhanced. J Exp Med, 1986 Oct 1, 164(4), 1226 - 38 Immunochemical localization and amino acid sequences of crossreactive epitopes within the group A streptococcal M6 protein; Jones KF et al.; mAbs 10A11, 10B6, and 10F5, raised against the native group A streptococcal M6 protein, were examined for their crossreactivity with non-laboratory passaged clinical isolates, representing 58 M serotypes, by bacterial dot blot immunoassay . mAb 10A11 crossreacted with 9, mAb 10B6 with 30, and mAb 10F5 with 30 different non-M6 serotypes . To identify the epitopes for these antibodies, the native M6 protein was cleaved with pepsin or staphylococcal V8 protease . Resultant peptides were purified by HPLC, examined for binding to crossreactive mAbs in ELISA, and reactive peptides were subjected to amino acid sequence analysis . Peptides were aligned with the amino acid sequence of the entire M6 protein predicted by the DNA sequence of the M6 gene . Competitive inhibition studies using peptides synthesized on the basis of peptide and DNA sequences, in concert with selective blocking of amino acid residues, allowed for the further identification and placement of these crossreactive epitopes within the M6 molecule . The 10A11 epitope was located within the six amino acid residues at position 134-139, which repeat at positions 159-164 and 184-189 within the variable amino terminal half of the native molecule . The conserved 10B6 and 10F5 epitopes were positioned within a 15-amino-acid span at position 275-289, with the possibility that either epitope could have been repeated at residues 239-247 . Chemical modification of amino acids within this sequence aided in the differentiation of these two epitopes . Such studies should aid in the recognition of a sequence(s) common to a greater number of M serotypes, which may be useful for future vaccine development or group A streptococcal identification. Vopr Med Khim, 1986 Sep-Oct, 32(5), 41 - 4 {Lipid peroxidation and anti-oxidative systems of an organism in experimental streptococcal myocarditis and rheumocarditis}; Kozlov GS et al.; Lipid peroxidation rate and activity of glutathione and tocopherol antioxidant systems were studied in rats with experimental streptococcal myocarditis and in patients with rheumatic carditis . During the acute period of inflammation content of diene conjugates and activity of glutathione reductase were increased in myocardium and erythrocytes of rats simultaneously with a decrease in tocopherol concentration in blood plasma . In the patients with rheumatic carditis activation of lipid peroxidation and the glutathione reductase was found in erythrocytes as well as a decrease of the tocopherol content--in blood plasma . Interrelationship between alterations in these patterns and their functions in rheumatic carditis pathogenesis are discussed. Biol Chem Hoppe Seyler, 1986 Sep, 367(9), 843 - 51 Combinatorial diversity in the generation of antibody molecules . The complete amino-acid sequence of the variable domain of a monoclonal anti-streptococcal group A polysaccharide antibody; Herbst H et al.; The first complete amino-acid sequence of the variable region of the gamma 3 heavy chain from a murine anti-streptococcal group A polysaccharide (A-CHO) immunoglobulin (monoclonal antibody 2S1.3) is described . Therefore, in conjunction with the previously published 2S1.3 light chain sequence, a V kappa 25 structure, the entire variable domain of this antibody has been determined . In addition, four partial amino-terminal heavy chain sequences of other antibodies with the same specificity are reported . These heavy chains share a high degree of homology with heavy chains from fructosan-binding murine myeloma proteins with the exception of those positions known to be encoded by the D (diversity) segment in germ line DNA . The light chains associated with the heavy chains reported here are products of the V kappa 25, V kappa 27, and J kappa 5 genes . Up to date three VH and four V kappa subgroups have been shown to contribute genetic material to the assembly of antibodies specific for the A-CHO . Unlike other experimental systems employing structurally completely resolved full antigens the antistreptococcal immune response uses V genes previously shown to be involved in the formation of antibodies with different specificities . This provides further experimental evidence for the physiological relevance of heavy/light chain association as a posttranscriptional diversification mechanism in the generation of the antibody repertoire in addition to those somatic diversifiers acting directly upon the genes encoding the variable regions of individual chains. Zh Mikrobiol Epidemiol Immunobiol, 1986 Sep, (9), 61 - 6 {Distribution of type-specific antibodies to streptococcal lipoproteinase based on population screening data}; Benevolenskaia LI et al.; In the serum samples obtained from residents of the Todzhinsky district in the Tuva Autonomous Soviet Socialist Republic antibodies to 12 out of 15 studied types of group A streptococcal lipoproteinases (OF-factor) were detected, with the prevalence of types 2, 4, 22, 25, 48, and 60, their incidence in the population constituting 34% . Antibodies to OF-antigens 58, 62, and 63 were not detected . The distribution of OF-antibodies was found to vary with sex, occurring in females 1.5 times more frequently than in males, and with age, accumulating in subjects aged 21-30 and 31-40 . The distribution of antibodies to different OF serotypes did not depend on the blood serum streptolysin O titers. Pediatr Res, 1986 Sep, 20(9), 864 - 6 Prostaglandin synthetase inhibition in group B streptococcal shock: hematologic and hemodynamic effects; Peevy KJ et al.; A rabbit model of group B Streptococcal (GBS) shock was used to study the effects of prostaglandin synthetase inhibition on the hemodynamic and hematologic response to GBS shock . The infusion of heat-killed GBS in groups I and II produced significant decreases in mean arterial pressure, neutrophil counts, and platelet counts (p less than 0.05), and significant rises in concentrations of thromboxane B2 and 6-Keto-PGF1 alpha, the stable metabolites of thromboxane A2 and prostacyclin (p less than 0.05) . Administration of indomethacin (4 mg/kg) after GBS infusion (group II) was associated with a significant rise in mean arterial pressure and a significant decline in thromboxane B2 and 6-Keto-PGF1 alpha concentrations (p less than 0.05) but had no effect on GBS-induced hematologic alterations . Indomethacin administration before GBS infusion (group III) prevented alterations in mean arterial pressure and was associated with a decrease in thromboxane B2 and 6-Keto-PGF1 alpha concentrations . Indomethacin in group III did not prevent neutropenia and thrombocytopenia and may have exacerbated neutropenia . Alteration of experimental GBS shock with prostaglandin synthetase inhibition produces disparate hemodynamic and hematologic response. J Pediatr, 1986 Sep, 109(3), 531 - 7 Once daily therapy for streptococcal pharyngitis with cefadroxil; Gerber MA et al.; To determine if a single daily dose of cefadroxil would be effective in the treatment of group A beta-hemolytic streptococcal (GABHS) pharyngitis, 196 patients with GABHS pharyngitis were randomly assigned to receive either penicillin V 250 mg three times daily or cefadroxil 30 mg/kg once daily, for 10 days . Outcome was measured by the ability to isolate GABHS from the upper respiratory tract 18 to 24 hours after the onset of therapy, the impact on the clinical course, and the bacteriologic treatment failure rate . There was no significant difference in the number of patients in the cefadroxil and penicillin V treatment groups with throat cultures positive for GABHS at the 18 to 24-hour follow-up visit (0% and 2%, respectively), and the clinical responses of the patients in the two treatment groups were similar . Of the 99 patients in the three times daily penicillin V group, six (6%) had strains of GABHS isolated on one of the follow-up cultures that were identical to the strains isolated from their initial throat cultures and were considered to have bacteriologic treatment failures . Of the 96 patients in the once daily cefadroxil group, two (2%) were considered to have bacteriologic treatment failures . A single daily dose of cefadroxil appears to be as effective in the treatment of GABHS pharyngitis in this population as penicillin V given three times daily. Ann Trop Paediatr, 1986 Sep, 6(3), 219 - 20 Delayed recurrence of group B streptococcal infection in a newborn infant: a case report; Haque KN et al.; Recurrence of neonatal group B streptococcal (GBS) sepsis in an infant aged 63 days is reported . Recurrence of GBS should be considered in an infant who "goes off" after apparent eradication of the initial infection even after the neonatal period. JAMA, 1986 Aug 8, 256(6), 740 - 3 Treatment of streptococcal pharyngitis revisited; Bass JW; Penicillin has remained the drug of choice for treatment of patients with streptococcal pharyngitis for the past four decades . From the early 1950s into the 1970s, a single injection of intramuscular penicillin G benzathine, alone or in combination with penicillin G procaine, was the preferred treatment . Because this regimen consistently produced the highest cure rate and because compliance was assured, it evolved as the gold standard with which other treatment regimens were compared . In the late 1960s and the 1970s, studies showed that in private practice settings with counseling as to the need to take oral penicillin for a full ten days to prevent rheumatic fever, good compliance with results equal to intramuscular penicillin G benzathine could be achieved . By the early 1980s, oral treatment was preferred by most primary physicians in the United States . Oral penicillin V in a dosage of 250 mg, twice daily for ten days, affords optimal treatment for children . In areas where rheumatic fever is still prevalent, particularly in poor and crowded inner-city populations where medical care is episodic, follow-up may be lacking, and compliance in taking oral penicillin cannot be relied on, treatment with intramuscular penicillin G benzathine remains preferred . Studies now confirm that early treatment of streptococcal pharyngitis can reduce the duration of symptoms to less than 24 hours in most cases, decrease the incidence of suppurative complications, limit spread of the disease in the family and community, and permit earlier return of the child to school . Recently developed tests that permit rapid, laboratory-confirmed diagnosis of streptococcal pharyngitis directly on the throat swab at the initial clinic visit may soon guide early treatment with these inherent benefits. J Biol Chem, 1986 Aug 5, 261(22), 10240 - 7 A physicochemical study of protein G, a molecule with unique immunoglobulin G-binding properties; Akerstrom B et al.; Protein G, an IgG-binding molecule, was prepared from the cell walls of a group G streptococcal strain, G-148 . The protein could be extracted from the cells by papain digestion and purified by the sequential use of ion-exchange chromatography on DEAE-Sephadex, affinity chromatography on Sepharose-coupled human IgG, and gel chromatography on Sephadex G-200 . Two protein bands with similar molecular weight, 34,000 and 36,000, were obtained when analyzing the pure protein G on sodium dodecyl sulfate-polyacrylamide gel electrophoresis . The yield using this purification scheme was 27% of the protein G solubilized from the cells or 70 micrograms/ml packed bacteria . The Stokes radius and frictional ratio of protein G were determined to 3.53 nm and 1.64, respectively, suggesting an elongated fibrous molecule . The protein did not contain any intrachain disulfide bonds . The amino acid composition of protein G was determined and was found to be different from that of protein A, the well known staphylococcal IgG-binding protein . The equilibrium constants of the reactions between protein G and human, rabbit, mouse, and goat polyclonal IgG, determined by Scatchard plots, ranged between 1 X 10(10) and 7 X 10(10), for rat polyclonal IgG 1.4 X 10(9), and human monoclonal IgG1, IgG2, IgG3, and IgG4 between 2 X 10(9) and 6 X 10(9) . These affinity constants were always greater than the corresponding values for protein A . The binding between protein G and various polyclonal and monoclonal IgG was pH dependent between 2.8 and 10, strongest at pH 4 and 5, and weakest at pH 10. Zh Mikrobiol Epidemiol Immunobiol, 1986 Aug, (8), 21 - 4 {Effect of metronidazole on the course of experimental anaerobic streptococcal pneumonia}; Shroit IG et al.; The effect of metronidazole in experimental anaerobic pneumonia in guinea pigs infected with peptostreptococci has been studied . In the untreated animals the prolonged pathological process in the lungs is mainly associated with the suppression of the functional state of the thymus-dependent link of the immune system . Metronidazole suppresses anaerobic flora, stimulates local immune reaction and arrests the development of inflammatory changes in the lungs . The drug eliminates the unbalance in some subpopulations of immunocompetent cells and restores the number of cells regulating immune response to the normal level . The results obtained in this investigation make it possible to recommend the trial of metronidazole in the complex therapy of peptostreptococcal pneumonia. J Immunogenet, 1986 Aug, 13(4), 309 - 14 Maternal immunoglobulin allotype (Gm and Km) and neonatal group B streptococcal infection; Thom H et al.; Gm and Km(1) allotypes in 37 mothers of neonates with severe Group B streptococcal (GBS) infection were compared with 115 mothers of non-infected infants, 36 of whom were known to be colonized with GBS . Deficits in G1m(1) and Km(1), and an increased incidence of G2m(23), were found in mothers of infected infants . Km(1) was associated mainly with the phenotype Gm(1, (2), 3, 17; 23; 5, 10, 11, 21) in mothers of infected infants while being uniformly distributed in mothers of non-infected infants . This study would seem, therefore, to support reports of Gm and Km(1) allotype involvement in maternal response to GBS infection and immunity in the new-born. Clin Nephrol, 1986 Aug, 26(2), 61 - 5 Incidence of circulating immune complexes in patients with acute poststreptococcal glomerulonephritis and in patients with streptococcal impetigo; Mezzano S et al.; In an attempt to further study the possible contribution of circulating immune complexes (CIC) in the pathogenesis of acute poststreptococcal glomerulonephritis, 61 patients with APSGN were studied during the first three weeks of the disease, and 13 patients with noncomplicated streptococcal impetigo as a control group . C1q solid phase ELISA and Conglutinin (K) solid phase ELISA were used to measure the levels of immune complexes . The incidence of CIC in a single serum sample from patients with APSGN was 48% . Elevated levels of immune complexes were found in 46% of the patients with streptococcal impetigo . The absolute levels of CIC were comparable in both groups of patients . No correlation was found among the presence of CIC and the clinical, immunoserological or pathological findings of the disease . Our results do not support the hypothesis that trapping of the circulating immune complexes play an important role on the renal injury poststreptococcal infection . Instead, we suggest that CIC are an epiphenomena present in APSGN, and may represent rather a systemic inflammatory immune response in patients with group A streptococcal infection. J Sch Health, 1986 Aug, 56(6), 218 - 21 Prediction of streptococcal pharyngitis: an option for school nurses? Squires RL, Ellison GC. In this article the authors address the dilemma confronting school nurses in determining whether or not to counsel parents about seeking medical care for a child with a sore throat . The use of a clinical scorecard in the school setting as an aid in predicting streptococcal pharyngitis is investigated . The authors conclude that the only valid solution to the dilemma is the availability of the throat culture to schools . Using the culture as an additional assessment tool augments those already proven over time--the stethoscope, scoliosis and vision screening, and the otoscope. Infect Immun, 1986 Aug, 53(2), 324 - 30 Arthropathic group A streptococcal cell walls require specific antibody for activation of human complement by both the classical and alternative pathways; Eisenberg RA et al.; The induction of acute arthritis in rats by a single intraperitoneal injection of group A streptococcal cell wall is associated with the activation of complement . We have therefore investigated the interaction of arthropathic peptidoglycan-polysaccharide complex of streptococcal cell walls and human complement . The incubation of cell wall in normal human serum results in the formation of complexes of cell wall and the C3 and C4 components of complement . Using agammaglobulinemic serum, we have further shown that the activation of complement and formation of complement-cell wall complexes absolutely requires the presence of a small quantity of specific antibody . This antibody is present in normal human immunoglobulin G and is effective as the Fab fragment (alternative pathway) . Although antibodies specific for three cell wall epitopes were capable of inducing complement-cell wall complex formation by the classical complement pathway, only anti-A polysaccharide antibody (N-acetyl-D-glucosamine epitope) was effective by the alternative complement pathway . A complement consumption assay showed that anti-cell wall antibody was required not only for complement-cell wall complex formation, but also for activation of complement by streptococcal cell wall in human serum . These studies suggest that a minimal level of anti-cell wall antibody may be required for the induction of arthritis in rats by streptococcal cell wall. Eur J Pediatr, 1986 Aug, 145(3), 204 - 6 C-reactive protein in the differentiation of adenoviral, Epstein-Barr viral and streptococcal tonsillitis in children; Putto A et al.; Sixty-two children with febrile exudative tonsillitis were studied to explore whether quantitative measurements of serum C-reactive protein (CRP) are useful in differentiating viral from streptococcal tonsillitis . There were 23 cases of adenoviral tonsillitis, 21 of EB viral tonsillitis and 18 of streptococcal tonsillitis . Measurements of CRP, WBC counts and erythrocyte sedimentation rates (ESR) were not useful in distinguishing viral from streptococcal tonsillitis . Seventy-four percent of patients with adenoviral tonsillitis were under the age of 3 years and 71% of the patients with Epstein-Barr (EB) viral tonsillitis were under the age of 6 years whereas 72% of the patients with streptococcal tonsillitis were over the age of 6 years . Age was clearly the most important factor in distinguishing between viral and bacterial tonsillitis in children. J Bacteriol, 1986 Aug, 167(2), 711 - 2 Transposition of the gram-positive transposon Tn917 in Escherichia coli; Kuramitsu HK et al.; The streptococcal transposon Tn917 was demonstrated to transpose in Escherichia coli from the Bacillus subtilis-E . coli shuttle plasmid pHK1207 into an F' plasmid derivative . Subsequently, a second round of transposition from the F' plasmid into pACYC184 could be readily demonstrated . These results represent the initial demonstration of the transposition of a gram-positive transposon in a gram-negative bacterium at a relatively high frequency. J Immunol, 1986 Aug 1, 137(3), 924 - 33 Functional and molecular analysis of three distinct HLA-DR4 beta-chains responsible for the MLR between HLA-Dw4, Dw15, and DKT2; Hirayama K et al.; Differences in structure and function of HLA-class II molecules between HLA-DR4-related HLA-D specificities HLA-Dw4, Dw15, and DKT2 were investigated . Anti-HLA-DR framework monoclonal antibody HU-4 completely inhibited the one-way mixed lymphocyte reaction (MLR) between these specificities . HU-4 precipitated a monomorphic alpha-chain and a polymorphic beta-chain of human class II molecules from each B lymphoblastoid cell line (BLCL) homozygous for these three HLA-D specificities . We established IL 2-dependent T cell lines specific for streptococcal cell wall (SCW) antigen from peripheral blood lymphocytes (PBL) from four DR4-positive donors: an HLA-Dw4/DKT2 heterozygote, an HLA-Dw4/Dw12 heterozygote, an HLA-DKT2/D-blank heterozygote, and an HLA-Dw15/D-blank heterozygote . These T cell lines showed a proliferative response to SCW antigen in the presence of autologous or allogeneic antigen-presenting cells (APC) when T cell donors and APC donors shared at least one of the HLA-D specificities . This cooperation between the T cell line and APC was completely blocked by HU-4 . We conclude from these data that the T cells could distinguish three distinct DR4 molecules expressed on APC of HLA-Dw4, Dw15, and DKT2 as restriction molecules at the presentation of SCW antigen. J Immunol Methods, 1986 Jul 24, 91(2), 275 - 81 Detection and purification of rat and goat immunoglobulin G antibodies using protein G-based solid-phase radioimmunoassays; Nilson B et al.; Using the newly described streptococcal surface protein, protein G, which has powerful immunoglobulin G binding properties, solid-phase radioimmunoassays were developed for the quantitation of goat and rat immunoglobulin G bound to the plastic surface of microtiter plates . The binding of goat immunoglobulin G to the surface via a specific antigen (guinea pig alpha 1-microglobulin) permitted the determination of antigen-specific antibodies with a detection limit of 50-100 ng . Optimum assay conditions were established and the whole assay procedure could be brought to completion at room temperature in less than a working day . The value of the assays was illustrated by monitoring rat and goat immunoglobulin G antibodies during their purification from whole sera by classical chrom