Streptococcal

JAMA, 1982 May 21, 247(19), 2680 - 2
Streptococcal wound infections caused by a vaginal carrier; Berkelman RL et al.; During a four-month period, ten cases of group A streptococcal (GAS) postoperative wound infection occurred among patients in a community hospital . Bacteremia developed in two patients, and one patient died . Group A streptococcal surgical wound infections were associated with exposure to a circulating nurse and duration of surgery . Prophylactic antibiotic reduced the risk of infection . Vaginal, perineal, and anal cultures from nurse A yielded GAS, serotype M-4, T-4, as did the blood of two infected patients . Penicillin eradicated GAS colonization of nurse A, and she returned to work . Five months later, two additional cases of GAS postoperative wound infections occurred and were associated with recolonization of the same nurse with GAS, serotype M-nontypeable, T-12 . She was relieved of patient-care duties, and no further cases have occurred.

Zh Mikrobiol Epidemiol Immunobiol, 1982 May, (5), 79 - 83
{Effect of proteolysis inhibitors on the phagocytic activity and leukocyte cytoplasmic enzyme activity of white mice with streptococcal peritonitis}; Shpak SI et al.; The functional and metabolic properties of neutrophils in white mice were studied in the course of streptococcal peritonitis and after treatment by the intraperitoneal injection of normal rabbit serum, antitryptic and antikallikrein immune sera and inhitryl . Protease inhibitors were shown to activate the bactericidal and phagocytic activity of neutrophils, to normalize oxidation processes and to enhance the metabolism of glycogen.

Arch Surg, 1982 May, 117(5), 561 - 7
The changing pattern of hemolytic streptococcal gangrene; Aitken DR et al.; We reviewed nine cases in which either limg-threatening or life-threatening complications developed due to streptococcal infection . Our findings indicate important changes in the pattern of this fulminating illness since its original description in 1924 . A higher mortality reflects increased longevity with a greater frequency of impaired host resistance and degenerative diseases involving vital organs . Initial symptoms and signs often mimic acute thrombophlebitis, acute arthritis, deep soft-tissue trauma, or acute vascular occlusion . The emergence of multiple organ failure and serious coagulation disorders are a challenge to current therapy . A diagnostic algorithm was developed to aid in the early diagnosis and management of this life-threatening infection.

Clin Exp Immunol, 1982 May, 48(2), 458 - 68
The assessment of anti-idiopathic antibodies as effective immunoregulatory probes in vivo; Olson JC et al.; In order to increase our understanding of the potential to use anti-idiotypic antibodies as immune modulators in vivo, we extensively analysed influences induced by one such antibody (anti-Id-l) following its administration to animals of different ages, genetic backgrounds, and immunological histories . Id-l is an inter-strain idiotype associated with rat anti-Group A streptococcal carbohydrate antibodies . The intraperitoneal (i.p.) injection of anti-Id-l antibodies, prepared against Id-l+ antibodies from an HPR rat could effectively induce long-term idiotype suppression in all tested strains of rats, regardless of the age at the time of treatment, the RTl haplotype or IgG2c or k-chain allotype . Total anti-streptococcal antibodies were not suppressed by this treatment . Although long-term suppression could be induced at any age, the percentage of animals suppressed following neonatal injections was consistently less than that following adult injections of anti-idiotypic antibodies . In addition, neonatal injections of anti-Id-l or Id-l with anti-Id-l appeared to enhance Id-l production in a minority of the animals . Similar treatment of adult animals never increased Id-l synthesis, suggesting that cells associated with enhanced Id-l production in older animals are either refractory to activation-differentiation signals and/or are sequestered and no longer accessible by i.v . or i.p . routes of administration of the probe . Auto-anti-Id-l immunity induced by immunizing adult rats with heavy, light, F(ab')2 fragments or whole IgG molecules could also induce an Id-l suppressed state . We were not able to induce significant Id-l suppression if animals were immunized with antigen prior to the injection of anti-Id-l . There was evidence, however, that such treatment might lead in time to the development of some idiotype specific suppression.

Immunology, 1982 May, 46(1), 83 - 8
Relationship of complement to experimental arthritis induced in rats with streptococcal cell walls; Schwab JH et al.; Experimental arthritis developed in rats injected intraperitoneally with aqueous suspensions of peptidoglycan-polysaccharide complexes (PG-APS) isolated from group A streptococcal cell walls . Reduction of serum complement by pretreatment with cobra venom factor (COV) reduced acute joint inflammation over the first 3 days following injection of PG-APs . Thereafter, the course of the disease was not different in the COV-treated rats . The serum levels of complement were depressed below detectable levels by 24 hr in rats injected only with cell walls, but rebounded to normal levels or above 3 days after injection . In rats injected with COV before cell walls, the complement levels also increased 3 days after injection of cell walls, in contrast to sustained depressed levels in rat injected only with COV . The correlation between severity of joint inflammation and serum complement levels at day 3 was positive in COV-treated rats . The quantity of cell wall per joint at day 3 correlated with the severity of joint disease . However, COV treatment did not alter the amount of cell wall localized in joint tissue . Therefore, although complement does appear to have a role in early joint inflammation, its effect is not upon the transport of cell wall into joint tissue.

J Immunol, 1982 May, 128(5), 2032 - 5
Streptococcal group A carbohydrate has properties of both a thymus-independent (TI-2) and a thymus-dependent antigen; Briles DE et al.; Streptococcal group A carbohydrate, which elicits mouse antibody of primarily the IgM and IgG3 isotypes, is relatively nonimmunogenic in nu/nu or xid mice, and thus appears to be a type of TD-2 antigen . The TD-2 antigens described previously have been proteins that elicit IgG antibody primarily of the IgG1 and IgG2 isotypes . Our findings indicate that TD-2 properties may also be a characteristic of at least some carbohydrate antigens that can elicit IgG antibody predominantly of the IgG3 class.

N Z Med J, 1982 Apr 28, 95(706), 262 - 4
A comparative study of the clinical patterns of acute glomerulonephritis from a high and a low incidence area of New Zealand; Dawson KP; Prompted by the marked regional differences in the incidence of acute nephritis in childhood, a comparative clinical study is reported . The features of the disease in a high incidence area, Tauranga, are contrasted with those in a low incidence area, Christchurch . The relative infrequency of the disease in Christchurch has been confirmed . The clinical features and the severity of the disease showed a similar pattern in the two centres . Serological evidence of recent streptococcal infection occurred in the majority of patients from both areas . Prior skin infection was more frequently reported from Tauranga and the significance of this is discussed.

Eur J Clin Microbiol, 1982 Apr, 1(2), 102 - 6
Antimicrobial susceptibility of Gemella haemolysans isolated from patients with subacute endocarditis; Buu-Hoi A et al.; Gemella haemolysans, a member of the family Streptococcacae, was isolated from patients with subacute endocarditis . The minimal inhibitory concentrations of 21 antimicrobial agents for five strains of the organism were determined . All strains were highly sensitive to penicillin G and ampicillin . Cefotaxime was the most active cephalosporin tested . All strains were sensitive to vancomycin, chloramphenicol and rifampin . Four strains were sensitive to tetracycline and erythromycin . All strains demonstrated a low level of resistance to aminoglycosides and were highly resistant to sulfonamides and trimethoprim . Killing curves and checker-board titration demonstrated synergism between penicillin G and streptomycin or gentamicin, and also between vancomycin and streptomycin or gentamicin . The results suggest that penicillin G combined with an aminoglycoside can be recommended for the treatment of subacute endocarditis caused by Gemella haemolysans.

Pediatrics, 1982 Apr, 69(4), 452 - 4
Serum penicillin concentrations after intramuscular administration of benzathine penicillin G in children; Ginsburg CM et al.; Concentrations of penicillin were measured in serum samples of 26 children who received benzathine penicillin G (BPG) alone or in combination with procaine penicillin (PBPG) . Both preparations were well absorbed; peak concentrations of penicillin after PBPG administration were 25-fold larger than those after BPG . One third and one half of serum samples from BPG and PBPG patients, respectively, contained no measurable penicillin activity at 18 days . At 30 days, there was no penicillin activity in any of the samples . These data raise questions regarding the use of BPG and PBPG for prophylaxis of group A streptococcal and pneumococcal infections.

J Immunol, 1982 Apr, 128(4), 1631 - 6
Characterization of the human cellular immune response to purified group A streptococcal blastogen A1; Regelmann WE et al.; The human mononuclear cell response to purified extracellular streptococcal protein, blastogen A, was compared to the response of these cells to PHA and tetanus antigen . Blastogen A induced peak uptake of thymidine during day 6 of tissue culture whereas PHA induced peak uptake during day 5 and tetanus during day 8 . Like PHA, blastogen A transformed human umbilical cord lymphocytes and those of nonimmune animals . Also like PHA, blastogen A transformed primarily T lymphocytes . However, unlike PHA, the ability of T lymphocytes to respond to blastogen A was almost completely dependent on the presence of viable non-T lymphocytes . Monocytes were not as effective in facilitating the response to blastogen A as they were for PHA . Thus, blastogen A behaves most like a polyclonal T lymphocyte mitogen, although the degree of dependence of the transformation response on the presence of non-T lymphocytes is much greater than that of PHA.

Mol Immunol, 1982 Mar, 19(3), 457 - 65
Properties of cold agglutinin and group carbohydrate-specific antibodies isolated from group C streptococcal antisera; Brown JC et al.; The relationship between erythrocyte autoreactive cold agglutinin (CA) antibodies and group carbohydrate-specific antibodies in hyperimmune rabbit Group C streptococcal antisera was investigated . The different antibody preparations examined were isolated from autologous erythrocyte, Group C carbohydrate, and alpha-GalNAc immunoabsorbents . Each population was subsequently tested for SRBC reactivity, RRBC autoreactivity, and carbohydrate and ligand reactivity, in hemagglutination assay, direct biphasic hemolytic and hemolytic inhibition assays, and radioimmunoassay . In absorption experiments, CA antibodies present in unfractionated serum and represented as purified IgG and IgM preparations, were reactive with Group C carbohydrate, but poorly reactive with alpha-GalNAc immunoabsorbent . In addition, CA antibody activity present in carbohydrate-eluted material, was absent in alpha-GalNAc-eluted material as determined by hemagglutination and direct hemolytic assay . By radioimmunoassay, carbohydrate-eluted and alpha-GalNAc-eluted streptococcal antibodies, and alpha-GalNAc-eluted BSA-alpha-GalNAc antibodies, exhibited similar reactivity with 125I-BSA-alpha-GalNAc antigen, and with GalNAc in radioimmunoassay inhibition experiments . In contrast to these results, both IgG and IgM CA antibodies exhibited a relatively low avidity toward 125I-BSA-alpha-GalNAc . Yet relative to the other antibody populations tested in radioimmunoassay inhibition experiments, CA antibodies did not exhibit a particularly significant difference in reactivity with GalNAc . However, recognition of other Gal-containing ligands, e.g . Mel and Lac, was restricted to the CA antibody preparations . These data suggest that CA antibodies present in Group C streptococcal antisera do not represent a higher affinity cross-reactive anticarbohydrate population, but instead perhaps represent cross-reactive carbohydrate-specific antibodies produced in response to nonimmunodominant Group C carbohydrate determinants.

Zh Mikrobiol Epidemiol Immunobiol, 1982 Mar, (3), 30 - 2
{Fibroblast ultrastructural cytopathology in a streptococcal infection}; Korinteli VI et al.; The study of the dynamics of streptococcal infection in fibroblast cell culture by electron microscopic analysis has revealed the intracellular development of bacteria . The degree of ultrastructural cytopathology of homologous bacteriophages in the model system have been studied.

Eur J Respir Dis, 1982 Mar, 63(2), 140 - 50
Viral respiratory infections in asthmatic children staying in a mountain resort; Roldaan AC et al.; In 32 mainly atopic children (aged 9-16 years) staying in a mountain resort the effects of viral infections on the course of asthma were studied . Daily surveillance was made of respiratory infection symptoms and clinical parameters for asthma, including forced expiratory volume in 1s (FEV1) . Serology for several respiratory viruses . Mycoplasma pneumoniae and Chlamydia psittaci was done . In 58 symptomatic respiratory infections (SRI) 39 asthmatic exacerbations occurred (67%) . Eighteen SRIs of viral origin caused 16 exacerbations (89%) . Twenty-one seroconversions with mild or absent symptoms of infection gave six exacerbations (29%) . Five flare-ups of asthma in eight episodes of seroconversion (63%) during which patients were not under observation were reported . Streptococcal pharyngitis did not cause asthmatic reactions . Thirteen SRIs due to influenza A all caused asthmatic exacerbations . The similarity of these data to those in children with "intrinsic" asthma suggests that the development of viral excerbations in asthmatics is not determined by whether the patient is allergic or not.

J Clin Microbiol, 1982 Mar, 15(3), 481 - 3
Diagnosis of group A streptococcal infections directly from throat secretions; Edwards EA et al.; The diagnosis of group A streptococcal disease still relies on isolation of group A streptococcal strains on sheep blood agar followed by presumptive identification based on bacitracin sensitivity or the results of the more precise serogrouping methods such as the Lancefield precipitin test . A technique that would permit rapid identification of streptococcal infections directly from throat secretions would allow immediate appropriate antimicrobial therapy for the management of streptococcal infections to be started . We have been able to identify soluble group A antigen directly from throat secretions by using a latex agglutination test . In a clinical trial in which latex (Streptex group A) and conventional culturing techniques were used, 53 throat secretion cultures were tested: 26 were positive by both procedures, 5 were positive by culture only, 3 were positive by the latex agglutination test only, and 19 were negative by both tests.

Jpn J Antibiot, 1982 Mar, 35(3), 754 - 60
{Clinical studies of 9, 3"-diacetylmidecamycin (author's transl)}; Sugaya N et al.; 1 . We had a chance to administer the "MOM dry syrup' (MOM fine granules) to 22 patients: 6 patients with streptococcal infections and 16 patients with other respiratory tract infections . The clinical efficacy was good in 16 cases and its rate was 80% . 2 . The causative organisms were isolated from 9 cases: 6 cases with S . pyogenes, 2 with S . pneumoniae and 1 case with B . pertussis . All of the clinical isolates were eradicated except for the S . pyogenes strains . 3 . Any remarked side effects were not observed but only eosinophilia in 2 cases . 4 . Because of no bitterness of the MOM dry syrup, all the children take it easily . 5 . MOM was effective in all the cases of pertussis and Mycoplasma pneumoniae pneumonia . As for streptococcal and pneumococcal infections, it is necessary to administer MOM under the control of bacterial sensitivity.

Clin Pediatr (Phila), 1982 Feb, 21(2), 83 - 8
Treatment of Group A streptococcal pharyngitis in children . Results of a prospective, randomized study of four antimicrobial agents; Ginsburg CM et al.; Penicillin V, benzathine/procaine penicillin G, cefadroxil monohydrate, and erythromycin estolate were randomly assigned for therapy of group A streptococcal pharyngitis in 198 children . All patients improved with in 24 hours of initiating therapy . Reinfection with a new group A streptococcal serotype occurred in 13 patients, 12 developing 7 to 12 days after stopping therapy and 11 becoming symptomatic . Relapse with the same organism occurred in 16 patients, only 5 (31%) of whom were symptomatic . Antibody titer rises, antibiotic resistance of group A organisms, presence of penicillinase-producing staphylococci, and lack of compliance were not related to recurrent infections . There were no significant differences between the failure rates of the four test drugs: penicillin V, 12%; benzathine/procaine penicillin G, 12%; cefadroxil monohydrate, 5%; and erythromycin, 2%.

Eur J Immunol, 1982 Feb, 12(2), 170 - 3
Allotypes in Basilea rabbits; Weiss S et al.; Basilea rabbits produce immunoglobulin molecules, practically all of which have lambda light chains rather than kappa chains . This variant strain was derived form a homozygous (b9/b9) male . Sensitive serological methods revealed that at least some homozygous bas/bas individuals possess traces (about 100 ng/ml) of b9 molecules . This level usually increases to almost 1 microgram/ml upon hyperimmunization with pneumococcal or streptococcal vaccines . One exceptional rabbit, with 50 micrograms/ml of b9 molecules, was found . In spite of the presence of b9 molecules in early pre-immune bleeds, homozygous bas/bas rabbits produce strong anti-b9 antibodies; i.e., they are capable of making autoantibodies . These anti-b9 allotypic antisera were not distinguishable by our methods from routinely produced anti-b9.

Int Urol Nephrol, 1982, 14(1), 75 - 87
Humoral immunity to streptococcal antigen in acute and chronic glomerulonephritis; Krzymanski M et al.; A study was carried out to verify the clinical usefulness of the elaborated method for the measurement of antistreptococcal antibody in revealing the streptococcal etiology of glomerulonephritis . In 158 patients with glomerulonephritis antistreptococcal antibody (ASA), circulating immune complexes (CIC) and haemolytic activity of the complement were measured . On the basis of immune complex formation it has been concluded that streptococcal infection may cause glomerulonephritis . Serial determinations of ASA and CIC are helpful in establishing the streptococcal etiology of glomerulonephritis and in monitoring the course of the disease.

Jpn J Surg, 1982, 12(2), 143 - 7
Survival time of tumor-bearing rats as related to operative stress and immunopotentiators; Hattori T et al.; To investigate the mechanism of tumor growth enhancement induced by operative stress in rats, laparo-thoracotomy was performed on day 2 after tumor cell inoculation associated with administrations of various kinds of immunopotentiators . OK-432 (Streptococcal preparation), PS-K (extract from mycelium of Coriolus Versicolor), Lentinan (extract from Lentinus Edodus) and C . parvum were administered intravenously or intraperitoneally in the fractionated form prior to or after inoculation . In general, administration of each immunopotentiator, except for Lentinan, resulted in a recovery from the reduction in survival days after laparo-thoracotomy . In particular, OK-432 administration prior to inoculation showed a significant improvement.

Ann Acad Med Singapore, 1982 Jan, 11(1), 36 - 41
Prognosis of post-streptococcal glomerulonephritis: Chandigarh study; Singhal PC et al.; 144 patients (107 adults and 37 children) belonging to a homogenous North Indian population who were hospitalised for acute post-streptococcal glomerulonephritis have been followed up for a period of ten years . The majority of these belonged to the lower socio-economic group . Varying degrees of proteinuria was present in 88.2%, hypertension in 62.5%, renal insufficiency in 61% and hematuria in 51.4% of the patients at the onset of the disease . By the end of the two years, 25 patients were dead because of rapid progression to end stage renal failure and 6 patients had mild to moderate renal insufficiency . Of the 119 patients who were alive at the end of the two years, 32 patients (who had shown a clinical recovery) were not available for further regular follow up and were excluded from the long term study, 87 patients were followed up beyond 2 years . In addition to 6 patients who were already in renal insufficiency at two years, 6 more developed renal failure on further follow up . 3 out of these 12 patients progressed to end stage renal failure 5 to 10.5 years after the onset of the disease . Persistence of nephrotic state, hypertension and renal insufficiency following an acute attack, and the presence of glomerular crescents on renal histology were associated with a poor outcome . Whereas only 2 out of 37 children died of end-stage renal failure, the majority of the deaths were in the adults (26 out of 107) . Thus, 17% of the patients of acute post-streptococcal glomerulonephritis progressed to end stage renal failure within 2 weeks to 2 years, another 2% within 10 years and more than 6% will ultimately progress failure beyond 10 years.

Biochem J, 1982 Jan 1, 201(1), 189 - 98
L-trans-Epoxysuccinyl-leucylamido(4-guanidino)butane (E-64) and its analogues as inhibitors of cysteine proteinases including cathepsins B, H and L; Barrett AJ et al.; 1 . L-trans-Epoxysuccinyl-leucylamido(4-guanidino)butane (E-64) at a concentration of 0.5 mM had no effect on the serine proteinases plasma kallikrein and leucocyte elastase or the metalloproteinases thermolysin and clostridial collagenase . In contrast, 10 muM-E-64 rapidly inactivated the cysteine proteinases cathepsins B, H and L and papain (t0.5 = 0.1-17.3s) . The streptococcal cysteine proteinase reacted much more slowly, and there was no irreversible inactivation of clostripain . The cysteine-dependent exopeptidase dipeptidyl peptidase I was very slowly inactivated by E-64 . 2 . the active-site-directed nature of the interaction of cathepsin B and papain with E-64 was established by protection of the enzyme in the presence of the reversible competitive inhibitor leupeptin and by the stereospecificity for inhibition by the L as opposed to the D compound . 3 . It was shown that the rapid stoichiometric reaction of the cysteine proteinases related to papain can be used to determine the operational molarity of solutions of the enzymes and thus to calibrate rate assays . 4 . The apparent second-order rate constants for the inactivation of human cathepsins B and H and rat cathepsin L by a series of structural analogues of E-64 are reported, and compared with those for some other active-site-directed inhibitors of cysteine proteinases . 5 . L-trans-Epoxysuccinyl-leucylamido(3-methyl)butane (Ep-475) was found to inhibit cathepsins B and L more rapidly than E-64 . 6 . Fumaryl-leucylamido(3-methyl)butane (Dc-11) was 100-fold less reactive than the corresponding epoxide, but was nevertheless about as effective as iodoacetate.

Zh Mikrobiol Epidemiol Immunobiol, 1982 Jan, (1), 37 - 9
{Dynamics of lysosomal cationic proteins in experimental streptococcal infection in monkeys}; Voskanian NA et al.; The study of the time course of nonenzymatic lysosomal cation proteins in monkeys (rhesus macaques) revealed its correlation with the clinical manifestations of the developing disease . At the period of pronounced clinical manifestations of the disease the cation protein indices decreased . They returned to the initial level when the general state of the animals improved, the erythrocyte sedimentation rate decreased and the leukocyte formula became normal . The determination of the cation protein level can serve as an additional test for the evaluation of the natural resistance of the body.

Int Arch Allergy Appl Immunol, 1982, 67(4), 322 - 8
In vitro augmentation of human natural killer (NK) cell activity by a streptococcal preparation OK-432 and its extracts, protein M and polysaccharides; Wakasugi H et al.; Effect of a streptococcal preparation OK-432 and its derivatives on the augmentation of human natural killer cell activity in vitro was examined . The strong augmentation was found by the OK-432 stimulation . Cell separation procedures revealed that cytotoxic activity augmented by the stimulant was considered to be mediated mainly by nonadherent, nonphagocytic, IgG-Fc receptor positive, non-T cells, i.e . NK cells . In addition, supernates cultured with OK-432 augmented NK activity, suggesting some kinds of soluble factors released in the supernates may be participating on the augmentation of human NK activity by OK-432.

Arch Dis Child, 1982 Jan, 57(1), 75 - 6
Gallbladder distension in septic neonates; Peevy KJ et al.; Eight cases of neonatal gallbladder distension are described . Group B streptococcal sepsis (5 infants) of suspected sepsis (3 infants) was present and probably played an aetiological role in the development of a distended gallbladder . Two infants required surgery because of persistent gallbladder enlargement and rising levels of bilirubin . Five responded to vigorous medical management and one died from sepsis and pneumonia . The need for conservative early management is stressed.

Infect Immun, 1982 Jan, 35(1), 377 - 80
In vivo changes in complement induced with peptidoglycan-polysaccharide polymers from streptococcal cell walls; Lambris JD et al.; In rats injected with an arthropathogenic dose of streptococcal cell wall fragments, serum hemolytic activity decreased over the first 24 h and was then elevated from days 2 through 6 after injection . Hemolytic activity was again elevated at days 16 and 40 . Levels of activity of alternative complement pathway, C3, and factor D were also altered.

Infect Immun, 1982 Jan, 35(1), 20 - 4
Lactoperoxidase and thiocyanate protect bacteria from hydrogen peroxide; Adamson M et al.; Lactoperoxidase and thiocyanate were shown to protect Escherichia coli and three oral streptococcal species from the bactericidal effect of hydrogen peroxide under aerobic conditions . Lactoperoxidase in the absence of thiocyanate was also protective for two of the bacterial species in a dilution medium but potentiated hydrogen peroxide toxicity for the other two under the same conditions . The products of the reaction between hydrogen peroxide and thiocyanate in the presence of lactoperoxidase were not bactericidal except in the case of E . coli, and then only under special conditions . The results demonstrate the effectiveness of lactoperoxidase and thiocyanate in protecting living cells from hydrogen peroxide toxicity . Although the effect on human cells was not examined in this study, extrapolation of these results to the cells of the oral mucosa would suggest an important protective role of lactoperoxidase and thiocyanate against the toxic effects of hydrogen peroxide in the oral cavity.

Transplantation, 1982 Jan, 33(1), 80 - 6
Acquisition of graft-versus-host reactivity by immature thymocytes in the coexistence of activated macrophages; Yamashita A et al.; The collaborative role of macrophages in the acquisition of the rat graft-versus-host (GVH) reactivity by parental thymocytes was investigated by the popliteal lymph node enlargement assay . The addition of peritoneal macrophages activated by streptococcal bacteria injection resulted in significantly increased GVH reactivity of parental thymocytes, when assayed both in normal F1 hybrid hosts and in those depleted of effective macrophages and lymphocytes . The thymocytes that acquire that alloantigen reactivity in the presence of activated macrophages were shown to be cortisone sensitive and of high density . Hence, the cortisone-resistant and less dense population of thymocytes did not exhibit further reactivity even in the presence of macrophages; however, this subpopulation showed an enriched activity on its own . Moreover, the simultaneous injection of activated macrophages induced a further augmenting effect on the graft-versus-host reaction (GVHR) of freshly peripheralized thymocytes, but did not affect the reactivity of lymph lymphocytes from parental rats thymectomized 15 months previously . These data suggest that activated macrophages play an essential role in the acquisition of alloantigen reactivity by immature thymocytes, and also that the macrophage-dependent thymocytes in the reaction may reside among the subpopulation that is cortisone sensitive, highly dense, short-lived, and freshly peripheralized . The possible nature of immunological maturation of immature thymocytes in the periphery is discussed in relation to cellular interactions with activated macrophages.

Scand J Infect Dis Suppl, 1982, 31, 68 - 77
Gram-positive microorganisms in sepsis; Holm SE; The significance of various microorganisms as pathogens in septicemia has been changing over the years . This has been amply demonstrated by several authors especially in the interesting survey from Boston by Maxwell Finland covering a 30 years' period from 1935-1965 . Dramatic changes were noted among the Gram-positives and this seemed to coincide with the introduction of antibiotics . However, since that time a continuous variation of microflora isolated from patients with bacteremia has been reported, which indicates the significance of a through analysis of isolated pathogens presently and in the future . The difference in etiology in various age groups has been strengthened and microorganisms, which were seldom found ten years ago, are now of major clinical importance in septicemia . There is no simple explanation to this phenomenon but rather reflects a summary of influences including changes of the host-microorganism interaction induced by different treatment procedures, survival of patients with diseases with a negative effect on the infectious response, new and better microbiological diagnostic procedures, etc . The possibility that the increased frequency of e.g . group B streptococcal infections reflects a change in 'Status epidemicus' must also be born in mind . The clinical significance of changes in the etiology of septicemia is obvious since the microorganisms have different virulence factors, influencing in various ways upon the host . These microorganisms may also have a different or changing antibiotic sensitivity pattern . It should be added, however, that the changes in antibiotic sensitivity pattern is a multifacetted problem involving factors like types of patients in a hospital, treatment regime, antibiotic use.

Dev Comp Immunol, 1982 Spring, 6(2), 263 - 9
Phylogeny of immunoglobulin structure and function . XIV . Peptide map and amino acid composition studies of shark antibody light chains; Clem LW et al.; Light chains from antibodies to the streptococcal A-variant carbohydrate from individual nurse sharks were compared by peptide maps of tryptic digests and amino acid compositions . Although the amino acid compositions of the different chains were quite similar, considerable differences as well as similarities were demonstrable on peptide maps . The peptide maps were interpreted as indicating that shark L chains likely have constant and variable regions as seen in the immunoglobulins of higher animals . Furthermore the unique peptides characteristic of different L chains support the hypothesis that nurse sharks, as a species, possess a relatively large number of different L chain amino acid sequences which are compatible with antibody binding sites to the streptococcal antigen . Hence the repetoire of nurse shark antibody combining sites to this antigen appears to be quite extensive.

Med Decis Making, 1982 Winter, 2(4), 463 - 9
Treating sore throats in the emergency room . The importance of follow-up in decision making; Centor RM et al.; Evaluation and treatment of emergency room patients complaining of sore throats are complicated by an unknown probability of follow-up . Tompkins' analysis of cost-effective sore throat management strategies was modified by adding an expression for variable follow-up rate . The original analysis specified a culture range when the probability of streptococcal infection was between 0.05 and 0.20, while the expanded analysis demonstrates that this range decreases with decreasing follow-up . For follow-up rates of 0.70 or less, all patients would be in either the treatment or no treatment group . This analysis demonstrates the importance of follow-up in out-patient decision making, and illustrates the methodology for including follow-up (and similar factors) in our analyses.

J Perinat Med, 1982, 10(6), 279 - 85
The influence of group B streptococcal-carriership on pregnancy outcome; Gerards LJ et al.; 762 women were screened for GBS-carriership in the first trimester of pregnancy . The mean age of carriers was 27.2 years . Follow-up was performed in 64 initially positive and 97 negative cases . Persistent carriership was the most important determinant for neonatal GBS-acquisition . Race, birth-weight, gestational-age, interval between rupture of the membranes and birth could not be associated with GBS-carriership or neonatal acquisition . The number of neonates with fetal distress was significantly higher amongst those born to all GBS-carriers; the number of S.G.A.-infants was significantly elevated amongst those born to permanently positive women . Vertical transmission was found in 86% of the mother-infant pairs . GBS serotype III and Ib were predominant . Serotype III was significantly more isolated from non-caucasian women . The transmission frequency of all types was equal (46%), except for type IIc (22%) . None of the serotypes was especially associated with fetal distress or smallness for gestational age.

Int Arch Allergy Appl Immunol, 1982, 67(3), 245 - 53
Dissociation of immune complexes in tissue sections by excess of antigen; Penner E et al.; Immune complexes (IC) present in the glomeruli of rabbits with chronic serum sickness (CSS) and in patients with systemic lupus erythematosus (SLE), idiopathic membranous nephropathy (IMN), and acute poststreptococcal glomerulonephritis (PSGN) were analyzed by incubation with antigenic preparations . The efficacy of these preparations to dissolve IC was assayed by comparison of results of direct immunofluorescence tests performed with the kidney tissues before and after incubation with antigenic preparations . The FITC-conjugated antisera used in these tests were specific for IgG, C3, and-in the case of CSS-for the eliciting antigen, bovine serum albumin (BSA) . During the acute proteinuric phase of CSS in rabbits, incubation of tissue sections with BSA alone led to complete dissolution of IC . In many rabbits with late phase proteinuria, however, tissues had to be incubated with both BSA and aggregated fraction II of rabbit serum . In all biopsy specimens from patients with IMN, and in some specimens from patients with PSGN and SLE, aggregated fraction II of human serum resulted in complete or incomplete dissolution of IC . On the other hand, incubation of tissues with excess DNA in SLE or with streptococcal antigens PSGN did not lead to dissolution of IC . These studies suggest significant participation of antibodies to aggregated immunoglobulins (i.e., rheumatoid factors or rheumatoid-like factors) in IC found in the above-mentioned diseases . Other antigen -antibody systems, however, may also contribute to the deposits in the glomerulonephritides studied.

Trans R Soc Trop Med Hyg, 1982, 76(3), 304 - 6
Circulating factor from a kala-azar patient suppresses in vitro antileishmanial T cell proliferation; Wyler DJ; In vitro lymphocyte blastogenesis stimulated by phytohaemagglutinin (PHA), streptococcal antigens (SKSD) and leishmanial antigens were used to assess T cell responsiveness in one patient with kala-azar before and after therapy . During the illness, responses to PHA and SKSD but not to leishmanial antigens could be detected . After treatment lymphocytes responded to all three stimuli when cells were cultured in convalescent plasma, but failed to respond to leishmanial antigens when cultured in plasma obtained before treatment . These observations suggest the presence of a circulating inhibitor of anti-leishmanial T cell responsiveness in kala-azar, and warrant further investigation.

Microbiol Immunol, 1982, 26(1), 59 - 66
Changes in prostaglandin levels in cultures of SV40 -transformed macrophage cell lines in relation to their phenotypic expression; Tanigawa T et al.; A radioimmunoassay was performed to determine the total amounts of the A, B, and E series prostaglandins (prostaglandins) in culture fluids of simian virus 40 (SV40)-transformed mouse clonal macrophages, line 28-12, and its subline, 28-12 (Ara) . When the proportion of phagocytic cells in confluent 28-12 cell cultures increased, the prostaglandin levels in the culture fluids decreased . On the other hand, stably phagocytic 28-12 (Ara) cells, which were derived from 28-12 cells and which had a reduced growth rate, did not release prostaglandins under the usual culture conditions; however, when they were treated with lipopolysaccharide or streptococcal preparation OK-432, large amounts of prostaglandins were released . In contrast, nonphagocytic cell populations in the cultures of 28-12 cells were not responsive to the drug treatment . These results suggest that there is a correlation between the phenotypic change from the nonphagocytic to the phagocytic state and a decrease in prostaglandin levels in culture fluids, and indicate that phagocytic cells are responsive to prostaglandin inducers, whereas nonphagocytic cells are not.

Dev Comp Immunol, 1982 Summer, 6(3), 463 - 72
Phylogeny of immunoglobulin structure and function XV . Idiotypic analysis of shark antibodies; Clem LW et al.; Nurse shark antibodies to the streptococcal A-variant carbohydrate were specifically purified from the sera of four individual animals and used as immunogens in guinea pigs . The resultant guinea pig antisera contained antibodies with apparent idiotypic specificities for the homologous shark proteins . The shark idiotypic sites were located on the Fab fragments and appeared to require the participation of H and L chains for full expression . Tests for cross reactivity employing the four guinea pig anti-idiotypic sera and antibodies from 13 immunized sharks were positive in only two cases (heterologous inhibition) . These findings indicate that the idiotypic library (and by inference the antibody combining site repertoire) of nurse sharks to the streptococcal A-variant antigen is probably quite extensive.

Acta Derm Venereol, 1982, 62(3), 265 - 6
Suppression of erythema nodosum by indomethacin; Ubogy Z et al.; Erythema nodosum (EN) can be a debilitating illness . Many treatment modalities have been suggested but none is universally effective . We describe three patients with severe EN secondary to streptococcal pharyngitis who were unresponsive to large doses of aspirin . Following the administration of indomethacin in doses of 100 to 150 mg per day, all three showed a dramatic response, with prompt resolution both of systemic symptoms and of local signs of inflammation . The lesions of EN involve the lower cutis, with inflammation of septae and fat lobules . It is likely, therefore, that the local liberation of fatty acids leads to increased prostaglandin synthesis which, in turn, is responsible for the intense inflammation . The impressive suppression of EN by indomethacin could be related to the inhibition of prostaglandin synthetase in the subcutaneous fatty tissues.

Clin Exp Immunol, 1981 Dec, 46(3), 557 - 64
Complement-mediated solubilization in patients with systemic lupus erythematosus, nephritis or vasculitis; Schifferli JA et al.; Solubilization of an immune precipitate by serum is a complement function mediated by the alternative pathway and enhanced by the classical pathway--it therefore provides the basis of a simple quantitative assessment of the integrity of complement function . Using a preformed radiolabelled precipitate of BSA-alpha BSA Ab, the solubilization capacity of serial sera from 75 patients with various immune complex diseases or diseases associated with hypocomplementaemia was investigated to correlate this assay of complement function prospectively with disease activity and with measurements of circulating immune complexes (CIC) . Reduction in solubilization, defined by more than 25% of values in a given patient being below the normal range, was found in 11 of 12 patients with active SLE, two of 19 patients with active systemic vasculitis, three of three patients with post-streptococcal glomerulonephritis and in three of six patients with nephrotic syndrome due to other types of nephritis . In serial studies, solubilization correlated with disease activity in patients with SLE (P less than 0.005), systemic vasculitis (P less than 0.05) and post-streptococcal glomerulonephritis (P less than 0.05) . CIC were found more frequently than abnormalities in solubilization; however, the solubilization assay identified a population of patients with CIC more likely to have active disease . This simple assay of complement function provides data on an aspect of immune complex disease not readily apparent from standard estimations of circulating immune complexes, and appears to be a better measure of their potential phlogistic effects.

Jpn Circ J, 1981 Dec, 45(12), 1382 - 3
Diagnosis of streptococcal infection: previous or recent; Fujikawa S et al.; For the determination of streptococcal infection, it is necessary to test 3 antibodies, i.e., ASO, ASK and ADN-B at a time, and if 2 of the 3 titers are positive one can make diagnosis of fairly recent streptococcal infection, but if only one of the 3 titers are positive, previous or non-specific causes should be considered.

Jpn Circ J, 1981 Dec, 45(12), 1374 - 8
Clinical appraisal of the antideoxyribonuclease-B (ADNB) by means of streptonase-B test (Wampole); Oda T et al.; Titers of antideoxyribonuclease-B (ADNB, by Streptonase-B test), antistreptolysin-O (ASO, by Rantz-Randall's micromethod) and Kinase test (antivaridase agglutination test) were performed on 118 sera of patients with suspected streptococcal infection and compared . Between ASO and ADNB, a fairly significant correlation was seen (r = 0.69), but many cases in which ADNB exceeded ASO were observed . Between Kinase and ADNB, no significant correlation was seen (r = 0.49) . Successive determination of antibody titers were made in 14 consecutive patients with acute glomerulonephritis, anaphylactoid purpura nephritis, rheumatic fever and chronic rheumatic heart disease . In general, ADNB titer was significantly higher than ASO with few exceptions . The duration of high titer of ADNB was much longer than ASO Kinase titers were sometimes unstable . Throughout this study it has been noted that the result of ADNB was very easily to read and was highly reproducible . There were no nonspecific or pseudopositive reactions . Therefore, ADNB is useful for the diagnosis of streptococcal infection and its complication especially when other antibody titers give negative or doubtful results.

Rev Rhum Mal Osteoartic, 1981 Dec, 48(12), 781 - 6
{Experimental study of the inducing action of streptococcal pathogenic factors on immunity and cellular autoimmunity}; Voicoulesco C et al.; Rabbits issued from a closed colony which was genetically homogenous were used to investigate the capacity of streptolysin O and streptococcal M-protein to induce both cellular immune and autoimmune responses with respect to autologous cardiac tissue . The presence of immune response was indicated by positive responses of two tests of cellular immunity: blastogenesis of splenic T lymphocytes and inhibition of splenic macrophage migration . By thing into account that a nonspecific direct effect is produced by certain components of the streptococcal cell wall (lipoteichoic acid) but not by streptolysin O or M-protein on splenic lymphocytes, and according to the data on the modifications of lymphocyte populations during the autoimmune processes, it was possible to presume that anti-cardiac autoimmunity was as much due to a modification of cardiac tissue towards "non-self" status caused by experimental inductive factors as to he presence of a functional imbalance of the immunomodulatory lymphocyte system due to a predominance of auxiliary T lymphocytes.

J Clin Microbiol, 1981 Dec, 14(6), 678 - 80
Quantitative evaluation of variation in composition of the streptozyme agglutination reagent for detection of antibodies to group A streptococcal extracellular antigens; Kaplan EL et al.; The antibody titers of 90 acute- and convalescent-phase sera from 30 patients (mean age, 15.0 years) were studied with five different lots of Streptozyme reagent to determine whether variation exists among lots of reagent and whether this can affect clinical interpretation of antibody titers . Each serum was tested simultaneously with each of the five lots of reagent . Lot-to-lot variation in the reagent resulted in a significant difference (greater than 2 dilution increments) in antibody titer for 61 (68%) of the 90 sera tested . In addition, differences among the five lots also resulted in variation in determining whether a significant rise in titer occurred from the acute-phase to the convalescent serum for a given patient . These data indicate a need for precise identification and quantitation of the streptococcal antigens coated onto erythrocytes used for the Streptozyme test reagent.

Am J Clin Pathol, 1981 Dec, 76(6), 823 - 6
Fatal group B streptococcal pneumonia in neonates . Effects of antibiotics; Hamoudi AC et al.; Prophylactic penicillin has been suggested to prevent neonatal group B streptococcal infections (GBS) . However, there is a concern that the antibiotics may conceal significant bacteremia if post-treatment blood cultures were used to recover the etiologic agent . To clarify this point, the autopsy records of 111 cases of fatal neonatal pneumonias is infants less than one week of age for the period 1974-1978 were reviewed . Nineteen documented cases of group B streptococcal infections were uncovered . Review of antibiotic therapy in these infants indicate that such therapy can indeed conceal the etiologic agent of pneumonia if one uses post treatment blood (or other normally sterile body fluids) cultures as the basis of diagnosis . On the other hand, review of 41 cases with morphologic evidence of pneumonia and no identifiable etiologic agent reveal that the majority of these were referral cases from outlying hospitals who received antibiotics prior to any diagnostic work-up.

Ann Trop Paediatr, 1981 Dec, 1(4), 229 - 35
Pneumococcal bacteraemia--a study of 75 black children; Berkowitz FE; Seventy-five black children from 0 to ten years old with pneumococcal bacteraemia, who were hospitalized during a one-year period, were studied retrospectively from case records . Half the children were under one year and 68% under two years of age . Sixty-seven per cent were malnourished, 34% severely so . The overall case-fatality-rate was 26.7% being highest in children presenting in autumn (52.4%) and in those with meningitis (54.5%), severe protein-calorie malnutrition (42.8%) or associated infections (61.5%) . Host defences against the pneumococcus are discussed, especially in relation to their deficiencies in malnourished and young children . Special mention is made of early-onset neonatal sepsis due to the pneumococcus and of the association between pneumococcal bacteraemia and acute post-streptococcal glomerulonephritis . This study indicates that pneumococcal bacteraemia is a serious infection in children, especially in those with malnutrition and other infections . In view of the emergence of penicillin-resistant strains, its treatment may become more difficult in the future.

Infect Immun, 1981 Dec, 34(3), 828 - 34
Reactivity with rabbit immunoglobulin G of cold agglutinins isolated from group C streptococcal antisera; Colling RG et al.; Cold agglutinin antibodies were isolated from group C streptococcal antisera by thermal elution from rabbit erythrocytes . These antibodies reacted with bovine submaxillary mucin, fetuin, immunoglobulin G, and the Fc fragment of immunoglobulin G in hemolytic inhibition assays . Further, in radioimmunoassay these antibodies reacted with the major glycopeptide fragment of rabbit immunoglobulin G . Affinity-purified group carbohydrate-specific antibodies reacted weakly with glycopeptide . These data suggest that certain populations of antibody in group C streptococcal antisera may participate in tissue reactivity via interaction with cell surface glycoproteins, including immunoglobulin G.

S Afr Med J, 1981 Nov 21, 60(21), 829 - 32
Rapidly progressive glomerulonephritis in black children . A report of 4 cases; Dilima MG et al.; Rapidly progressive glomerulonephritis in children in rare, and we have therefore described 4 cases in Black children . All had evidence of a preceding streptococcal infection and there were crescents in more than 80% of the glomeruli seen on histological examination . The dominant clinical features were oliguria or anuria in a setting of nephritis or nephrotic syndrome, with a relentless progression to chronic renal failure and death . Quadruple therapy with cyclophosphamide, steroids, heparin and dipyridamole in 3 of the patients was of no lasting benefit and was attended by severe complications . Guidelines to the monitoring of children with post-streptococcal glomerulonephritis for the early detection of this uncommon complication are given.

Clin Exp Immunol, 1981 Nov, 46(2), 397 - 405
Lymphocyte cell subpopulations during acute post-streptococcal glomerulonephritis: cell surface antigens and binding of streptococcal membrane antigens and C-reactive protein; Williams RC Jr et al.; T lymphocyte surface markers were examined in 23 patients with acute post-streptococcal glomerulonephritis (AGN) in parallel with normal controls and individuals without nephritis who showed evidence of pharyngeal or skin-sore beta-haemolytic streptococcal infection . Numbers of T gamma cells were similar in AGN and normal controls but were significantly lower (P less than 0.05) than those in skin-sore culture-positive streptococcal infection controls . Numbers of T mu cells were similar in AGN and normal controls but were lower (P less than 0.05) than those observed in streptococcal controls . Percentages of T mu cells were similar in AGN and normal controls but were lower (P less than 0.05) than those recorded in streptococcal infection control groups . Proportions of T cells were reduced during AGN (P less than 0.05) . Lymphocytes capable of binding type 12 group A streptococcal membranes were increased (30.4%) in patients with AGN as compared to normal controls (4.1%) . Subjects with streptococcal infection alone showed elevated but intermediate relative numbers (10.5%) of lymphocytes binding group A membranes . Increased relative numbers of both B and T lymphocytes binding group A streptococcal membranes were present in both AGN and non-nephritogenic streptococcal infection controls.

J Clin Lab Immunol, 1981 Nov, 6(3), 233 - 6
Lymphocytotoxic activity in primary glomerulonephritis: evidence for immune complex-mediated cytotoxicity; Charlesworth JA et al.; Sera from 84 patients with primary glomerulonephritis (GN) were tested for lymphocytotoxic activity (LCA) against panels of (a) normal peripheral lymphocytes and (b) B-lymphocytes obtained from patients with chronic lymphatic leukaemia (CLL) . Significant LCA was found particularly in minimal change GN, acute post-streptococcal GN (AGN-PS) and mesangiocapillary GN (MCGN) where 62%, 75% and 45% respectively of samples were positive . No correlation was observed between LCA and levels of C3 or immune complexes . All but three positive sera showed reactivity against T and B cells; these three showed only T cell cytotoxicity . Fractionation of 6 sera (2 minimal change GN; 2 AGN-PS; 2 MCGN) on Sephadex G200 showed cell killing to reside in the exclusion peak . When samples were separated under dissociating conditions at pH 3.0, there was significant reduction in LCA (P less than 0.001) compared to that of fractions collected at pH 7.2 . The same protocol did not affect the lymphocytotoxicity of anti-human lymphocyte globulin . The data suggest that lymphocyte killing in GN is mediated at least in part by antigen/antibody complex activity . The reaction is immunochemically similar to that seen in systemic lupus erythematosus and may have comparable implications for antibody regulation in GN.

Scand J Immunol, 1981 Oct, 14(4), 335 - 42
The four subclasses of IgG can be isolated from mouse serum by using Protein A-Sepharose; Seppala I et al.; We confirmed the findings of Ey and colleagues that mouse IgG is absorbed by protein A-Sepharose at pH 8.0 . Also confirmed was their finding that IgG1 mainly elutes from such a column by means of a buffer with pH 6.0 and that the corresponding pH values for IgG2a and IgG2b were 4.5 and 3.5 . We made the new finding that the bulk of IgG2a bearing allotypes a or j eluted already at pH 5, in contrast to IgG2a bearing allotype b . Another new finding was that IgG3 was mainly eluted at pH 4.5 regardless of the allotype . All four subclasses of IgG could thus be physically separated if the allotype was a or j (the only known exception is allotype b) . Separation of IgG2a and IgG3 was achieved even when the allotype was b by using a pH gradient for elution . IgG2a came out at a slightly higher pH than IgG3 . Mouse IgG antibodies against group A streptococcal polysaccharide belonged mostly to IgG3 and, to a lesser extent, to IgG2a and IgG2b.

Am Fam Physician, 1981 Sep, 24(3), 181 - 5
The common cold; Ellenbogen C; The clinical distinction between a patient who has a common cold with pharyngitis and a patient at risk for streptococcal pharyngitis is based on the symptoms that are present and those that are absent . Many other diagnostic distinctions in patients with a common cold or similar acute respiratory illnesses can be made, using readily available information . Management can be cost-effective and of low toxicity when the relative merits and risks of each preparation and its constituents are understood.

N Z Med J, 1981 Aug 26, 94(690), 139 - 40
With what was rheumatic fever confused?
Stanhope JM, Chilvers CD, Aitchison WR.
Follow-up of 427 cases initially diagnosed in Wairoa county during 1962-76 as rheumatic fever and/or rheumatic heart disease showed that 40 had neither condition and 51 had chronic rheumatic heart disease only . Sources of misdiagnosis were cardiac (e.g . congenital heart disease, onset of atrial fibrillation), joint (e.g . rheumatoid arthritis, gout), streptococcal infections not proceeding to rheumatic activity and febrile conditions of childhood . Awareness of the problems, some strengthening of the diagnostic criteria, and the evolution of the illness with time would serve to correct misdiagnosis.

N Z Med J, 1981 Aug 26, 94(690), 134 - 7
Acute glomerulonephritis in childhood: a prospective study of hospital admissions; Wallace MR; Eighty-four children with acute post-infectious glomerulonephritis were admitted to the Waikato Hospital in 1976-1980 . The rate of admission, sex difference, and seasonal variation in admission numbers were similar to the pattern of the previous ten years . Only 11 children (13 percent) showed evidence of antecedent streptococcal infection, but there was evidence for a variety of other infections before admission . Clinical abnormalities had disappeared in the majority of 31 children reviewed at 48 months, although 20 percent had proteinuria . The long-term prognosis is yet to be determined for these children.

An Esp Pediatr, 1981 Aug, 15(2), 139 - 50
{Streptococcal infection and rheumatic fever (author's transl)}; Hernandez Rodriguez M; Author reviews relations between streptococcal infections and rheumatic fever, particularly biological characteristics of streptococo, genetic and pathogenic factors . Special emphasis is placed on diagnostic criteria to avoid overdiagnosis . Finally, the basis for a program directed to eradicate the disease: screening of susceptible, individuals selection of rheumatogenic serotypes and vaccine preparation against this antigenic strains are reviewed.

Clin Exp Immunol, 1981 Aug, 45(2), 253 - 60
Infective endocarditis-associated glomerulonephritis in rabbits: evidence of a pathogenetic role for antiglobulins; Sindrey M et al.; Serial studies of circulating immune complexes, serum complement, proteinuria and renal histology and immunofluorescence have been undertaken in infective endocarditis glomerulonephritis in rabbits . Eighteen of 24 rabbits developed evidence of glomerulonephritis and 13 of 18 had circulating immune complexes . Gel filtration studies showed the immune complexes to have a size range of ca 4.10(6)--3.10(5) daltons . Direct immunofluorescence staining of glomeruli showed that IgM was the predominant immunoglobulin present and that antiglobulin activity was associated with IgM deposition . Intraglomerular localization of antiglobulin was closely associated with evidence of glomerulonephritis . Streptococcal antigen(s) were not demonstrable in glomeruli, even after acid elution of sections.

Postgrad Med, 1981 Aug, 70(2), 193 - 200
Allergic vasculitis: most common of the necrotizing vasculitides; Sams WM Jr; Allergic vasculitis presents with purpuric lesions that are distinguishable by their palpability and by their distribution primarily on the lower extremities . The disease can affect any organ system but most often involves the kidneys, joints, gastrointestinal tract, lungs, or nervous system . Histopathologic examination shows characteristic destruction of the vessel wall by polymorphonuclear leukocytes . Numerous etiologic agents have been implicated, but streptococcal infection and drug ingestion are the most common . Presumptive evidence suggests that the disease is due to immune complexes . The workup is aimed at establishing the cause and extent of systemic involvement, and treatment is tailored accordingly.

Cancer Res, 1981 Jul, 41(7), 2954 - 8
Effect of a streptococcal preparation, OK-432, on hematopoietic spleen colony formation in irradiated mice; Hiraoka A et al.; In vivo effect of an immunostimulant, OK-432, on hematopoietic spleen colonies (CFU-S) was investigated in irradiated JCL/ICR mice . Administration of OK-432 i.p . at various times before and/or after irradiation resulted in a significant increase in endogenous CFU-S . This increase was further characterized microscopically by an increase in the number of megakaryocytic colonies . Transplantable exogenous CFU-S also increased when normal bone marrow cells were transplanted into irradiated recipient mice previously given OK-432 i.p . Treatment with OK-432 gave rise to an earlier recovery of granulocyte and, particularly, platelet counts in the peripheral blood after irradiation . All these findings indicate that an increase in CFU-S is associated with activated hematopoietic microenvironment by OK-432.

J Clin Immunol, 1981 Jul, 1(3), 154 - 62
Augmentation of natural killer (NK) cell activity by a streptococcal preparation, OK-432, in patients with malignant tumors; Wakasugi H et al.; Recently, a streptococcal preparation, OK-432 has been used successfully as an immunopotentiator for immunotherapy in patients with malignant tumors in Japan . In this paper, we report that the administration of OK-432 augments the cytotoxic activity of peripheral blood lymphoid cells against a natural killer (NK) cell-sensitive erythroleukemic cell line, K562, in tumor patients . In patients before or after surgery, sufficient amounts of OK-432 strongly augmented the cytotoxic activity within 3 days after the initial administration of OK-432 . Thereafter the levels of cytotoxicity declined rapidly . The administration of a lower dose of OK-432 gave a lower increase in cytotoxicity . Enhanced cytotoxicity occurred with the reintroduction of OK-432 but remained at lower levels of activity . Characterization and fractionation of OK-432-induced effector cells revealed that the augmented cytotoxicity seemed to be carried mainly by NK cells . A low titer of interferon was detected in 3 of 10 patients within 72 hr after the first inoculation of the agent . Furthermore, we discuss the potency of OK-432 for the induction of interferon in detail.

Minerva Med, 1981 Jun 30, 72(26), 1703 - 6
{The value of the basophil degranulation test on the study of hypersensitivity reactions to iodinated contrast media}; Stratta P et al.; The ability of basophils and tissue mastocytes activated by sensitised IgE antibodies to release mediators in the presence of the specific antigen underlies immediate hypersensitivity reactions . This phenomenon can be explored by the in vitro basophil degranulation test adopted not only in experimental pathology, but in human allergological pathology and in the study of post-streptococcal and lupus glomerulonephritis . The test has been carried out to analyse sensitisation to iodate contrast media in 71 patients already submitted to contrastography, 37 of whom had given evidence of allergic reactions . All patients with a previous history of sensitisation presented, in vitro, a positive reaction (56 + 15.3% degranulation) in the presence of the contrast medium . Against this, none of the patients with negative test presented an allergic reaction during contrastography . Stress is laid on the practical importance of the test prior to performance of contrastography so as to predict possible sensitisation and select the most suitable medium.

Med Clin (Barc), 1981 Jun 10, 77(1), 33 - 6
{Rapidly progressive glomerular disease treated with plasmapheresis (author's transl)}; Praga M et al.; A case of rapidly progressive glomerular disease with 100% of epithelial crescents completely enveloping each glomerulus, prolonged anuria and renal failure requiring dialysis . There were no indications of either streptococcal etiology or systemic disease . Improvement in renal function in response to plasmapheresis and immunosuppressants was spectacular . During two subsequent episodes of renal failure with diminished diuresis response to plasmapheresis was again striking . Assay for circulating immune-complex was always negative . No anti-basement membrane antibodies were found . Due to the lack of an adequate vascular access plasmapheresis was discontinued and the patient died 7 months after onset . Tendency to interstitial glomerular sclerosis was established with three renal biopsy specimens taken during progression of the disease . Intense metabolic acidosis suggestive of tubular acidosis, disproportionate to renal insufficiency presented during the last months . Pathologic and prognostic aspects as well as possible access for plasmapheresis are discussed.

Int Dent J, 1981 Jun, 31(2), 145 - 51
Diagnosis and antibiotic treatment of alveolar infections in dentistry; Woods R; A scheme for differential diagnosis of dental alveolar infections has been presented . It depends on relating clinical symptoms with bacteria causing these infections and then coupling this information with established antibiotic sensitivity patterns of these bacteria . Approaching this problem by first assessing the likely pathogen then relating it to its antibiotic sensitivity would seem to be a sound therapeutic principle . This is because antibiotic sensitivity patterns change from time to time; there are also regional and geographic differences . By first establishing whether or not the infection is streptococcal, the predominant cause of alveolar infections, the opportunity for correct use of the penicillin, in particular amoxycillin, can be introduced . It is fortunate that erythromycin has such a wide application to the pathogens of alveolar infections as where there is doubt regarding diagnosis it can in most cases be utilized effectively . It should be recognized by all practitioners treating acute infections that antibiotics can be of great benefit . They augment, but they cannot replace, sound treatment of infection using established therapeutic principles.

Proc Natl Acad Sci U S A, 1981 Jun, 78(6), 3824 - 8
Prediction of protein antigenic determinants from amino acid sequences; Hopp TP et al.; A method is presented for locating protein antigenic determinants by analyzing amino acid sequences in order to find the point of greatest local hydrophilicity . This is accomplished by assigning each amino acid a numerical value (hydrophilicity value) and then repetitively averaging these values along the peptide chain . The point of highest local average hydrophilicity is invariably located in, or immediately adjacent to, an antigenic determinant . It was found that the prediction success rate depended on averaging group length, with hexapeptide averages yielding optimal results . The method was developed using 12 proteins for which extensive immunochemical analysis has been carried out and subsequently was used to predict antigenic determinants for the following proteins: hepatitis B surface antigen, influenza hemagglutinins, fowl plague virus hemagglutinin, human histocompatibility antigen HLA-B7, human interferons, Escherichia coli and cholera enterotoxins, ragweed allergens Ra3 and Ra5, and streptococcal M protein . The hepatitis B surface antigen sequence was synthesized by chemical means and was shown to have antigenic activity by radioimmunoassay.

JAMA, 1981 May 22-29, 245(20), 2044 - 6
Increased risk of group B streptococcal disease in twins; Edwards MS et al.; Infants who are the product of multiple births comprise a newly defined group of patients at increased risk for the development of invasive, group B streptococcal infection . This report summarizes the clinical and bacteriological features of 11 sets of twins and one set of triplets in which one (nine sets) or more (three sets) infants had proved early- or late-onset group B streptococcal infection . Reasons for the enhanced susceptability of index patients and their siblings are discussed . On the basis of these observations, an emperical approach is proposed for the treatment of the apparently noninvolved sibling of a twin with invasive group B streptococcal infection.

Dig Dis Sci, 1981 May, 26(5), 470 - 3
Severe penicillin-induced cholestasis in a 91-year-old woman; Williams CN et al.; An elderly woman was admitted for treatment of severe stasis ulceration, associated with varicose veins . One course of cloxacillin was given orally followed by a second course of penicillin-G to eradicate persistant hemolytic streptococcal skin infection . Deep progressive jaundice subsequently developed due to intrahepatic cholestasis and persisted for several weeks before resolution . Having excluded a progressive extrahepatic malignant lesion by appropriate investigations, the diagnosis was substantiated by classical changes present in a percutaneous liver biopsy.

Radiology, 1981 May, 139(2), 385 - 9
Delayed appearance of right diaphragmatic hernia associated with group B streptococcal infection in newborns; McCarten KM et al.; Right diaphragmatic hernia should be considered when an infant with Group B streptococcal infection shows deterioration . Although the diaphragm appears normal at first, increased density is seen in the right lower lobe shortly thereafter, indicating pneumonia and/or irregular aeration . Pleural effusion may develop over the next few days . Characteristically, the bowel gas on the right and the liver shadow gradually become elevated and the heart and mediastinal structures shift into the left hemithorax; loops of bowel may be seen in the right hemithorax as well . Static plain views should confirm hernia or eventration, necessitating immediate surgery.

Ann Otol Rhinol Laryngol Suppl, 1981 May-Jun, 90(3 Pt 3), 75 - 8
Etiology, diagnosis, and antimicrobial treatment of pharyngitis and pharyngotonsillitis; Paradise JL; This review focuses on clinically important aspects of the etiology, diagnosis, and antimicrobial treatment of pharyngitis and pharyngotonsillitis . Most episodes of throat infection are of viral etiology, and accordingly are not susceptible to antimicrobial drugs currently available . By contrast, streptococcal and other varieties of bacterial pharyngitis do call for appropriate antimicrobial treatment . The review encompasses a discussion of clinical, bacteriological, and serological diagnosis; an algorithm for decision-making about antimicrobial treatment that is based on both clinical findings and culture results; and a summary of treatment regimens, emphasizing the management of streptococcal throat infection.

Blood, 1981 May, 57(5), 888 - 93
Hereditary myeloperoxidase deficiency; Kitahara M et al.; Subjects with neutrophil myeloperoxidase (MPO) deficiency have been rarely reported . In part this may be due to the lack of a simple screening technique that would detect them . With the routine use of a cytochemical leukocyte differential counter that employs MPO stains, over a 40-mo a period 8 unrelated probands with partial MPO-deficiency and one with complete deficiency were identified . Family studies have identified 23 additional, partially deficient subjects . The largest pedigrees demonstrate that the carrier state or partial MPO deficiency is inherited in an autosomal dominant pattern . Leukocytes from a subject with complete MPO deficiency and from some subjects with partial deficiency have impaired bactericidal activity against S . aureus . Superoxide generation was increased and chemiluminescence decreased in MPO-deficient leukocytes . Eleven subjects were prospectively followed for 18-30 mo . Only two partially deficient subjects have had serious infections consisting of recurrent streptococcal cellulitis and aseptic meningitis . These data suggest that leukocyte MPO deficiency is a common inherited defect that results in minimal clinical problems, supporting the concept of multiple leukocyte bacterial killing systems.

Res Commun Chem Pathol Pharmacol, 1981 Apr, 32(1), 155 - 66
Antistreptococcal cell membrane antisera and the antigenicity of glomerular basement membrane; Lange CF et al.; Antigenic cross-reactivity between mouse or human glomerular basement membrane (GBM) and group A type 12 beta-hemolytic streptococcal cell membranes (SCM) was evaluated by immunofluorescent techniques . Neonatal tissue proved to be more reactive than adult tissue with anti-SCM and anti-GBM antisera whose specificity was toward protein epitopes . Removal of carbohydrate moieties by enzymes (CHOase), converted adult tissue antigenicity to that of the neonate . Partial removal of some CHO, especially sialic acid, gave a partial enhancement of antigenicity . Contrariwise, antisera directed toward CHO epitopes while showing some reactivity in adult tissue gave variable results in the neonatal or young tissue . Anti-CHO sera of SCM were negative while anti-CHO sera of GBM immunogens did react slightly . None of the antisera used in these studies gave positive reactivity to heart, lung or liver tissue from any mice.

J Periodontol, 1981 Apr, 52(4), 197 - 205
Penetration of dental plaque components into gingiva: sequential topical treatments with hyaluronidase and streptococcal polysaccharide in rats; Gaffar A et al.; EIGHTY-FIVE Sprague-Dawley rats were used in two experiments to determine the conditions necessary to permit transepithelial penetration by deleterious macromolecules in murine oral mucosa . In experiment one, Group I was a water and diet control; Group II mucosa was treated with hyaluronidase; Group III with streptococcal polysaccharide; and Group IV with hyaluronidase, followed by treatment with the polysaccharide . In the second experiment, the histological effects of the streptococcal polysaccharide were quantified by administering a series of concentrations, from 10 mg/ml to 100 microgram/ml . The results suggest that tissue-damaging plaque components, such as hyaluronidase and polysaccharide, act in combination to pass through the epithelial structures into the subjacent connective tissues to cause destructive changes in rat gingiva . Such changes may possibly be related to those seen in the periodontium when it is adjacent to dental plaque.

Med Trop (Mars), 1981 Mar-Apr, 41(2), 201 - 5
{Child scabies in Nouvelle-Calédonie: its complications in general, and renal in particular (author's transl)}; Thevenieau D; Child scabies in Nouvelle-Caledonie, is: -- frequent nowadays; -- sometimes difficult to diagnose because of secondary infection or eczematisation; -- most often of favorable evolution with a one-day treatment applied to both children and their close relatives; -- sometimes complicated by surinfection, either of staphylococcic origin with various but osseous foci or streptococcic with severe glomerulonephritis.

Acta Paediatr Scand, 1981 Mar, 70(2), 207 - 10
Increasing incidence of neonatal septicemia: causative organism and predisposing risk factors; Bennet R et al.; The incidence of neonatal septicemia in the referral area of St . Goran's Children's Hospital in Stockholm has been studied during a ten-year period (1969-1978) . An increase was noticed during the period 1974-1978 in comparison with the preceding five-year period . The incidence per 1 000 live births was 1.4 and 3.1, respectively . The incidence of osteoarthritis increased from 0.21 to 0.41 per 1 000 . Mortality rate from neonatal septicemia remained unchanged . Gram-negative organisms as an etiologic factor seemed to be decreasing while staphylococcal infections have increased . Group B streptococcal infection occurred with the same frequency during the whole period . The low incidence of enteric organisms might be related to the common practice of feeding the babies with milk from their own mothers . Perinatal risk factors were equally common in both five-year periods . The observed increase of the prevalence of neonatal septicemia caused by Staphylococcus aureus may be explained by a higher rate of survival of highly susceptible low-birthweight infants and other sick neonates treated in the neonatal intensive care unit.

Jpn Heart J, 1981 Mar, 22(2), 167 - 72
Rheumatic fever in children . A follow-up study with emphasis on cardiac sequelae; Chen SC et al.; Eighty-nine children with rheumatic fever between 1964 and 1978 were reviewed . There were 40 males and 49 females . The first attack occurred mostly between 6 and 12 years . Arthritis was present in 62.9%; carditis, 55.1%; chorea, 19.1% . Children were followed from 20 months to 15 years (mean 61 months) . Seventeen developed current attacks (19.1%) . On final examination, 40 had no heart disease, 30 had mild heart disease, 6 required valve surgery, 4 had died, and 9 had moderate heart disease but not operated . Chorea was present in 20 children . Six of them also had mitral insufficiency, 3 had recurrence after episode of chorea . Prompt diagnosis and treatment of streptococcal infection and penicillin prophylaxis need to be stressed . Service carditis on initial attack and recurrence predispose to the development of severe heart disease.

J Pediatr, 1981 Mar, 98(3), 403 - 10
Poststreptococcal crescenteric glomerulonephritis in children: comparison of quintuple therapy versus supportive care; Roy S 3rd et al.; Crescenteric glomerulonephritis preceded by a streptococcal infection with creatinine clearance CCr of less than 30 ml/minute/1.73 m2 was treated by supportive care plus three months of quintuple therapy (prednisone, azathioprine, cyclophosphamide, dipyridamole, and heparin followed by warfarin) in five children (Group A) or by supportive care alone in five others (Group B) . Of the glomeruli examined, 69.8 +/- 11.7% (mean +/- SE) in Group A and 64.4 +/- 10.6% in Group B had crescents which involved 54.0 +/- 10.8% and 60.0 +/- 10.5% of glomerular circumference, respectively . Clinical and histologic findings supported a recent streptococcal infection in every patient . Two patients from Group A had mild proteinuria and normal CCr at 12 months; one died abruptly of pulmonary hemorrhage after maintaining a normal CCr for 25 months . Following a second episode of poststreptococcal acute glomerulonephritis seven months after the first, one patient from Group B had persistent mild proteinuria for 41 months and hypertension through 56 months of follow-up . Nine surviving patients have maintained normal CCr for eight to 60 months (mean 29.5 months) . The findings of this study suggest that this quintuple therapy offers no advantage over supportive care in the clinical management and outcome of children with severe crescenteric glomerulonephritis when an antecedent streptococcal infection is confirmed by serologic and histopathologic criteria.

Pediatrics, 1981 Mar, 67(3), 376 - 7
Facial cellulitis: an early indicator of group B streptococcal bacteremia; Hauger SB; Epithelial manifestations as indicators of group B streptococcal (GBS) bacteremia have been infrequently reported in the literature . This report describes three infants, ranging in age from 2 1/2 weeks to 7 weeks, who were seen with facial cellulitis as the only sign of GBS bacteremia . Only one of these infants had fever on presentation; otherwise, there were no signs of systemic illness . "Spontaneous cellulitis" should be viewed as an indicator of underlying bacteremia; in an infant less than 3 months of age, GBS should be considered a prime etiologic agent.

Vopr Pitan, 1981 Mar-Apr, (2), 47 - 50
{Specific and nonspecific cytolysis reactions in rheumatic patients with a low degree of activity in the process of combined treatment by a high-protein diet and drug preparations}; Samsonov MA et al.; Effect of therapy including high-protein diet and hormones on specific and nonspecific cytolysis was studied in patients with torpid and latent-running recurrent rheumatic carditis . The number of HeLa cells on which specific antigens (cardiac tissue extract, collagen, group C streptococcal nucleoproteid) were adsorbed significantly decreased on addition to the test target sensitized lymphocytes from the patients examined . As a result of therapy most patients showed the reduced activity of supernatants obtained from peripheral blood lymphocyte cultures that were incubated with specific antigens.

Infect Immun, 1981 Feb, 31(2), 732 - 6
Staphylococcal scarlet fever: role of pyrogenic exotoxins; Schlievert PM; Staphylococcal pyrogenic exotoxin (PE) types A and B were tested for their role in production of a scarlatiniform rash . The PEs elicited minimal skin reactions after intracutaneous injection into animals not presensitized to the toxins . In contrast, erythematous injection into animals not presensitized to the toxins . In contrast, erythematous and edematous rashes were produced after administration of either PE to animals presensitized to homologous toxin . After 3 to 4 days, the erythematous areas showed membranous desquamation . Staphylococcal PEs also enhanced delayed and Arthus hypersensitivity skin reactions developed against unrelated proteins; the reactions subsequently desquamated . In addition, animals previously sensitized to either staphylococcal PE type developed scarlatiniform rashes after challenged with heterologous staphylococcal or any group A streptococcal PE . The data suggest that staphylococcal PEs produce scarlet fever-like rashes comparable to group A streptococcal PEs and that all PE types contain a common core moiety against which delayed hypersensitivity may be developed.

J Clin Periodontol, 1981 Feb, 8(1), 45 - 56
The predominant cultivable dental plaque flora of beagle dogs with periodontitis; Syed SA et al.; The predominant cultivable dental plaque flora was studied in 10 adult female beagle dogs with advanced periodontitis . Supragingival and subgingival plaque from a maxillary third premolar (P3) was removed and cultured anaerobically on various growth media and all colonies were subcultured and partially characterized . Histopathological specimens of the plaque sampling sites showed significant loss of connective tissue attachment . Spirochetes were found in all samples . Anaerobic gram-negative organisms were predominant in both types of plaque accounting for about 55% of the cultivable organisms in the supragingival plaque and almost 75% in the subgingival plaque . Bacteroides asaccharolyticus was the most predominant organism in the supragingival plaque, whereas Fusobacterium nucleatum predominated in the subgingival flora . Streptococcal and actinomycotic species were common in the supragingival plaque, but their proportions, especially those of the actinomycetes, were decreased in the subgingival flora . In many respects the bacterial profile associated with disease resembled that reported in human periodontal disease.

Arch Dermatol, 1981 Jan, 117(1), 47 - 9
Facial erysipelas in the immunocompromised host . Report of two cases; Cupps TR et al.; Two cases of facial erysipelas in immunologically altered hosts are reported herein . The unusual presentation with absence of erythema in the skin lesion is emphasized . Atypical fever patterns were also noted . In one patient, the facial lesion followed the onset of fever by 48 hours, and, in the other, the facial swelling preceded the fever . Various aspects of the patient's altered host status are discussed in light of the atypical clinical presentation . Recognition of facial erysipelas as a potential source of group A beta-hemolytic streptococcemia in immune-altered hosts is important to ensure rapid and appropriate therapeutic intervention.

J Exp Med, 1981 Jan 1, 153(1), 196 - 206
Role of immune recognition in latent allotype induction and clearance . Evidence for an allotypic network; Yarmush ML et al.; The role of allotype recognition in the regulation of the expression of latent allotypes has been investigated in two series of experiments . The first experiments were designed to investigate the apparent instability of latent allotypes in circulation . In these experiments, clearance rates of IgG preparations bearing allotypes matched and unmatched to the recipient were examined . In all cases, iodinated IgG matched in allotype to the recipient was cleared at a normal rate from the serum . However, in several cases, iodinated IgG of an unmatched allotype was cleared at a rate and in a manner suggesting prior sensitization of the recipient to IgG of that allotype . Such apparent sensitization correlated with the presence of the foreign allotypes as a latent allotype in several bleedings taken both before and after the clearance experiment . In the second series of experiments, designed to test the ability of antiallotype antibodies to affect the expression of latent allotypes, five rabbits were immunized first with purified antiallotype antibodies and then after 3-4 mo, with streptococcal vaccine . Examination of the antistreptococcal antibodies for latent allotype revealed, in all cases, that the allotype against which the antiallotype antibodies were directed was present in levels 8- to 20-fold greater than were observed before the antiallotype injections . These results indicate that recognition of allotypic determinants is an important element in the control of latent allotype expression and suggest the existence of a regulatory network involving antiallotype antibodies.

Helv Paediatr Acta, 1981, 36(6), 567 - 72
Mycoplasma pneumoniae infection presenting as acute rheumatic fever; Berant M et al.; We describe five children in whom symptoms and signs fully consistent with a diagnosis of acute rheumatic fever arose in association with infection by Mycoplasma pneumoniae . With the decline of streptococcal disease as a causative agent of acute rheumatic fever, other etiologic possibilities capable of reproducing the clinical syndrome - especially Mycoplasma pneumoniae - should be considered, as this may have therapeutic and prognostic implications.

Cor Vasa, 1981, 23(1), 4 - 7
Pediatric cardiology in Asia; Vongprateep C; The problems of pediatric cardiology in Asia can be summarized as follows . In the countries like India, Indonesia, Malaysia, Pakistan and some other countries especially with government support like Thailand, the priority is primary health care . Except in Japan, cardiac care for children is not well supported financially . Training in pediatric cardiology is not readily available . Consequently small numbers of pediatric cardiologists, pediatric cardiac surgeons and active centres are available even in Japan . It is importannt to reduce the incidence of rheumatic fever and rheumatic heart disease by prevention of streptococcal infections and to increase the standard of living and environment . Transportation and referral system diagnosis, and treatment and follow-up is a special problem in neonatal care in relation to heart disease . Concentration of physicians, medical schools and cardiac centers in urban areas, old customs and poor understanding of people about the treatability and preventability of heart diseases in children complicate the improvement in the management of children with heart diseases.

Arch Exp Veterinarmed, 1981, 35(1), 1 - 18
{Origin and behavior of macrophages in the milk of cows with healthy and pathological udders}; Mielke H et al.; Macrophages of cow milk are part of the mononucleic phagocyte system . Most of them are histiocytes which are transferred from udder tissue into milk at various stages of activity . They are variable in shape, size, and number and have certain defence and purification functions in the milk . Transformation in milk of lymphocytes to macrophages are considered possible . No hard evidence has been produced, as yet, to the repeatedly produced by means of optical light microscopy to close conglomeration of macrophages and lymphocytes in milk, which is interpreted as macrophage-lymphocyte interaction, as in immunoreactive processes . Cows with clinically intact udders were found to have in their milk between 17 and 20 per cent of macrophages, 37 or 38 per cent of polymorphonucleic leucocytes, between 13 and 20 per cent of lymphocytes as well as between 26 and 32 per cent of non-differentiable cells and cell fragments . The repair phase of acute mastitis was found to be associated with drastic decrease of milk cell counts, along with percentual rise in macrophages, caused mainly by reduction in polymorphonucleic leucocytes in the milk . With subclinical and chronic mastitis, the percentage of macrophages was found to be increased, particularly due to streptococcal infection.

Perspect Pediatr Pathol, 1981, 6, 139 - 51
Group B beta hemolytic streptococcal sepsis in the newborn; Craig JM; Group B Beta Hemolytic streptococcal infection among newborn infants has recently grown in importance . The pathological changes in the early onset cases appear to be confined to the lung . In our patients, hyaline membranes with peripheral atelectasis was unusual, although fibrin deposited in areas without accompanying atelectasis may lead to confusion with hyaline membrane disease . The clinical features and pathologic changes caused by GBS had some differences from those due to other organisms giving rise to fatal pneumonia in the newborn . The lungs of GBS-infected babies in our autopsy series were not as heavy, had more alveolar fibrin deposition, but not more hyaline membrane disease than in nonstreptococcal cases . Alveolar inflammation was more marked in nonstreptococcal cases, but the GBS cases had more interstitial inflammation . Massive alveolar bacterial growth was more common in the GBS cases . Chronic thymic involution was less marked in the GBS cases, while acute splenitis was more common . Meningitis was present in four of our nonstreptococcal cases, but in none of the GBS cases . The clinical courses of GBS and nonstreptococcal fatal pneumonias differed . The mothers of infants with GBS infection were less febrile and ahd an increased frequency of prolonged rupture of the membranes, while the infants had a decreased duration of life, compared to those with nonstreptococcal sepsis.

Ann Acad Med Singapore, 1981 Jan, 10(1), 79 - 83
A prospective study of group B streptococcal colonization in parturient mothers and their infants; Chow KK et al.; The objective of this study was to investigate the rates of group B streptococcal colonization among parturients within the 24 hours prior to delivery and colonization of their newborns . It was also to identify high risk factors . 204 parturients were randomly selected in the Alexandra Hospital, Singapore . Swabs for culture were taken from the maternal vagina and throat and the neonate's ears, throat and umbilicus . In this study it was found that vaginal colonization in the mother is significantly associated with neonatal colonization . Among the various ethnic groups, Malays and Indians/Pakistanis are at a higher risk of having vaginal colonization . All other factors studied, however, failed to show any influence on neonatal colonization and thus appear to have had no forewarning value.

Ann Immunol (Paris), 1981 Jan-Feb, 132C(1), 87 - 100
Antistreptococcal group A antibodies: production after in vitro activation and hybridization of mouse spleen cells; Herbst H et al.; Streptococcal group A polysaccharide-specific antibodies were raised by the method of somatic cell hybridization . Spleen cells of experimentally unprimed BALB/c and C57BL/6 mice were activated in vitro by the streptococcal vaccine and fused with the Sp2/0-Ag14 line at times o, 35, 70, and 105 h thereafter . Hybridomas were obtained at all times independent of the addition of thymocyte-conditioned medium . Occurrence of specific hybridomas for the T cell-dependent A-CHO, however, required activation for greater than 35 h . Low responder C57BL/6 splenocytes fused at considerably higher fusion efficiency to yield specific hybridomas than high responder spleen cells 105 h after activation by antigen . The isotypes of A-CHO-specific antibodies comprised predominantly mu and kappa polypeptides; however, gamma 3, alpha, and gamma polypeptide chains were also identified . All specific antibodies were agglutinating the group A streptococcal cells; this agglutination was fully inhibited by the addition of 1% N-acetyl-D-glucosamine, the immune determinant sugar of the A-CHO . Three hybridomas obtained by fusion of BALB/c splenocytes 105 h after activation were cloned and grown as tumours in the peritoneal cavity of BALB/c mice . The monoclonal antibodies in the ascites did not precipitate the A-CHO but continued to agglutinate group A streptococcal cells in a hapten inhibitable fashion with different specificity profiles . Antibody from clone 21S36.1 was coprecipitable upon addition of A-CHO with a gamma G3 monoclonal hybridoma-derived antibody in a ratio of 1/7 while the other two monoclonal gamma M antibodies and the S117 myeloma protein were not . The result suggests that antibody 21S36.1 recognizes one chain terminal determinant of the A-CHO.

Padiatr Padol, 1981, 16(1), 35 - 46
{Local manifestations of neonatal group B streptococcal disease (author's transl)}; Mravlag G et al.; In the case of neonatal group B streptococcal disease, two distinct types of illness have been described in the past few years . The early onset type occurs in the first hours of days of life and emerges as septicemia . The late onset type occurs after the first week and emerges as meningitis . Other frequent local manifestations are pneumonia and pleural effusions, but there are few reports on localized inflammation of other organs . This paper gives a brief survey of the local manifestations of the disease . In addition, a case of a 1120 g premature of 29 gestational week is reported . After ten uneventful weeks, the patient developed acute fulminating group B streptococcal septicemia . The initial signs of apnea, respiratory insufficiency and shock were followed by meningitis, cellulitis of the tongue and skin and severe coagulopathy . After seven days the baby died of an intracranial hemorrhage.

Vopr Pitan, 1981 Jan-Feb, (1), 8 - 11
{Evaluation of the effect of a high-protein diet in combination with hormone and drug preparations on immunological homeostasis indices in rheumatism patients with a low degree of activity of the disease process}; Samsonov MA et al.; High protein diet coupled with drugs was used for the treatment of patients with protracted and latent recurrent rheumocarditis . The mean daily doses of the drugs administered were as follows: 2 g of aspirin and 15 mg of prednisolone . With clinical improvement most patients showed a decrease in the amount of blast transformed lymphocytes in stained smears of the cultures of peripheral leukocytes incubated in the presence of cardial antigen, collagen and group C streptococcal nucleoprotein . They also manifested the diminished ability on in vitro sensitized lymphocytes to produce the leukocyte migration inhibition factor.

Acta Med Scand, 1981, 209(1-2), 103 - 10
Glomerulonephritis in infections with Yersinia enterocolitica O-serotype 3 . II . The incidence and immunological features of Yersinia infection in a consecutive glomerulonephritis population; Friedberg M et al.; In a consecutive series of 38 patients with acute glomerulonephritis (GN), 17 showed serological or immunological signs of current or previous yersiniosis . None of these 17 patients had raised antistreptolysin-o titres . Only half of these patients had had clinical symptoms of Yersinia infection . Light microscopic examination revealed that 12 of the 17 patients had proliferative and 4 epimembranous GN . In 8 out of 14 biopsy specimens, Yersinia antigen could be demonstrated by immunoglobulins and complement . Immunofluorescence microscopy examination of all biopsy specimens containing sufficient tissue for a valid analysis showed deposits of complement and immunoglobulin G, most specimens also immunoglobulins A and M . It is considered highly likely that Y . ent . O:3 may be, and frequently is, an etiological factor for development of acute GN . It would be advisable not only to investigate all patients with acute GN for streptococcal infections, but also to carry out serological and bacteriological tests for Y . eng . O:3 infection and to institute an active therapeutic approach to acute infections caused by this bacterium.

J Bacteriol, 1981 Jan, 145(1), 129 - 37
Naturally occurring macrolide-lincosamide-streptogramin B resistance in Bacillus licheniformis; Docherty A et al.; Resistance to the macrolide-lincosamide-streptogramin B (MLS) group of antibiotics is widespread and of clinical importance . B . Weisblum and his coworkers have demonstrated that this resistance is associated with methylation of the 23S ribosomal ribonucleic acid of the large ribosomal subunit which results in a diminished affinity of this organelle for these antibiotics (Lai et al, J . Mol . Biol . 74:67-72, 1973) . We report that 10 of 15 natural isolates of Bacillus licheniformis, a common soil organism, are resistant to the MLS antibiotics . The properties of this resistance (high level of tolerance for erythromycin, broad cross-resistance spectrum, and inducibility) suggest that resistance is conferred as described above . The resistance determinant from one of these strains was cloned onto a B . subtilis plasmid vector, and the resulting hybrid plasmid (pBD90) was used to prepare radioactive probe deoxyribonucleic acid for hybridization studies . All of the resistance B . licheniformis strains studied exhibited homology with the pBD90 insert . Plasmid pBD90 showed no homology to the following staphylococcal and streptococcal MLS-resistance plasmids: pE194, pE5, pAM77, pI258 . Plasmids pE194 and pE5, on the other hand, carry homologous MLS genes but showed no detectable homology to one another in their replication genes . pBD90 specified a 35,000-dalton erythromycin-inducible protein, detectable in minicells, which therefore appears different from the 29,000-dalton inducible resistance protein specified by pE194 . We conclude that there are at least three distinct MLS resistance determinants to be found among gram-positive bacteria.

Rev Chir Orthop Reparatrice Appar Mot, 1981, 67(7), 639 - 45
{Streptococcal gangrene . A report on 9 cases (author's transl)}; Lortat-Jacob A et al.; The authors have treated 9 cases of streptococcal gangrene of the limbs . They describe the clinical features:local oedema, erythema, and cyanotic spots . In 7 of the cases the infected general condition was very severe . At operation, the subcutaneous soft tissues were grey-green without pus . The authors have reviewed the literature and consider that treatment should be based on early excision of the skin and subcutaneous tissues . Antibiotics are of great help but are not sufficient by themselves . Nine patients reached a stable state but sequelae have been severe with one disarticulation of the shoulder, one ankylosis of the wrist, one ankylosis of the knee and one generalised stiffness of the hand . Only five patients have been completely cured.

Am Fam Physician, 1981 Jan, 23(1), 121 - 5
Topical antibiotics and minor skin trauma; Leyden JJ et al.; Recent double-blind controlled studies show that the application of a neomycin-bacitracin-polymyxin preparation reduces the incidence of staphylococcal and streptococcal infection of minor skin trauma . Allergic sensitization to neomycin is rare . Systemic side effects occur only with improper massive exposure . Resistant strains have appeared only in "closed populations." It is concluded that topical antibiotic combinations are safe and effective.

Int J Immunopharmacol, 1981, 3(4), 365 - 75
In vitro augmentation of natural killing activity by OK-432; Uchida A et al.; OK-432, a streptococcal preparation, augmented the natural killing (NK) activity of peripheral blood lymphocytes of normal donors and cancer patients against both NK sensitive and resistant human target cells in vitro . The enhancement of NK activity was evident after 4 h pretreatment and maximum by 16-24 h . The manifestation of OK-432 induced augmentation required active cell metabolism, RNA and protein synthesis but no DNA synthesis of lymphocytes . The supernatants produced by OK-432 stimulated lymphocyte cultures had no enhancing substance nor interferon . Anti-interferon antibodies did not inhibit boosting activity of OK-432 . Large granular lymphocytes were involved in both spontaneous and OK-432 induced cytotoxic activity . The proportion of lymphocytes conjugating to target cells was not changed by OK-432 . These results suggest that OK-432 augments cytotoxic activity of large granular lymphocytes having ability to recognize target cells independent of interferon induction.

Microbiol Immunol, 1981, 25(7), 683 - 92
Production of interferon by an SV40-transformed macrophage line, BB-W-531-2; Takayama H et al.; A simian virus 40-transformed mouse macrophage line, BB-W-531-2, was examined for its ability to produce interferon . BB-W-531-2 cells showed a phenotypic change between the macrophage and the nonmacrophage states . A viral inhibitor (interferon) was produced by the cells during the phenotypic change from the nonmacrophage to the macrophage state . Cells having macrophage properties were well capable of producing interferon when they were stimulated with ultraviolet-inactivated vaccinia virus, lipopolysaccharide, a streptococcal preparation (OK-432) or polyinosinate . polycytidylate . In contrast, cells that had lost their macrophage properties did not produce interferon even when they were given the same treatments as the cells having macrophage properties . The results suggest that the ability of BB-W-531-2 cells to produce interferon is associated with the expression of several macrophage properties.

Crit Rev Clin Lab Sci, 1981, 14(2), 75 - 108
Whipple's disease: a review emphasizing immunology and microbiology; Keren DF; Whipple's disease is an important and fascinating problem of local immunity in the gastrointestinal tract . Does the disease occur when an organism that is rare in nature infects an individual or do patients with Whipple's disease have a definable defect in their immune response that permits infection by a more common agent? Data in recent years indicate that there is only one type of microorganism that causes Whipple's disease . It is rod-shaped by electron microscopy and has a definable antigenic pattern by immunofluorescence . Paradoxically (considering its geometry), it reacts most strongly with antisera directed to streptococcal antigens . Patients with Whipple's disease do not have a disorder of immunoglobulin synthesis and do not have immune complexes present in their gut walls . Further, although earlier studies indicated that a defective response of T-lymphocytes to PHA is consistently present in these patients even years after therapy, more recent studies have found no consistent defect in mitogenic responses to PHA, CON A, or PWM . Also, recent studies indicate that mononuclear cells from patients with Whipple's disease usually mediate antibody-dependent cell-mediated cytotoxicity as well as controls, although spontaneous cell-mediated killing may be decreased . All these studies suggest that the defect is not primarily of lymphocytes, rather it is more likely that a defect exists in monocytes and macrophages . Future studies on Whipple's disease should add to existing knowledge of how the immune processes intracellular microorganisms.

Clin Exp Immunol, 1980 Dec, 42(3), 450 - 7
Antibody response to streptococcal cell wall antigens associated with experimental arthritis in rats; Greenblatt JJ et al.; The antibody response to group A streptococcal cell wall components was measured in rats during the development of chronic, remittent experimental arthritis . The arthritis was induced by a single intraperitoneal injection of an aqueous suspension of group A streptococcal cell wall fragments and antibodies were measured by a radioactive antigen-binding assay . Antibodies in serum against both peptidoglycan and A polysaccharide reached maximum levels at 1 or 2 weeks and declined to preimmunization levels by day 63 . The kinetics and magnitude of the antibody responses were similar in neonatally thymectomized and non-thymectomized rats . A relationship between chronic joint lesions and anti-peptidoglycan concentration in serum was indicated, since all rats which produced high levels of antibody developed severe chronic arthritis . However, 46% of the rats which produced very low levels of antibody also developed moderate to severe arthritis . There was no correlation between anti-A polysaccharide antibodies and joint disease, although the concentration of this antibody was 10- to 100-fold greater than the anti-peptidoglycan . We conclude that antibody can be a component in the pathogenesis of this experimental model of arthritis, but its role requires further elucidation.

J Natl Cancer Inst, 1980 Dec, 65(6), 1265 - 9
Augmentation of mouse natural killer cell activity by a streptococcal preparation, OK-432; Oshimi K et al.; Streptococcal immunopotentiator OK-432 (NSC-B116209) augmented the natural killer (NK) cell activity of peritoneal exudate cells (PEC) in inbred C57BL/6 mice given ip injections of 0.1 mg OK-432 per mouse . The cytotoxic activity of PEC increased as early as 1 day after inoculation, reached its peak on day 3, and gradually declined thereafter, YAC-1, K562, and MOLT-4 target cells were more sensitive to PEC than were EL 4 and P815 target cells . The elimination of adherent cells by a nylon wool column enriched the proportion of cytotoxic cells among PEC . Nylon wool column-passed PEC were resistant to treatment with anti-Thy 1.2 antibody plus complement and sensitive to anti-asialo GM1 serum plus complement . Because 1:40-diluted rabbit antiserum against glycosphingolipid asialo GM1 is capable of eliminating mouse NK cell activity and is not cytotoxic to killer T-cells, the above results strongly suggest that OK-432 augments the NK cell activity in mice.

Antimicrob Agents Chemother, 1980 Dec, 18(6), 969 - 75
Morphological expressions of antibiotic synergism against Pseudomonas aeruginosa as observed by scanning electron microscopy; Waisbren SJ et al.; Antibiotic-induced changes in Pseudomonas aeruginosa were observed by means of a scanning electron microscope . Seven frequent and five less frequent morphological changes were noted . The frequent changes were: (i) elongation; (ii) chain formation; (iii) nub formation; (iv) spheroplasts; (v) surface holes or pits; (vi) super-elongation; and (vii) increased filamentation . The less frequent changes were: (i) rounded ends; (ii) streptococcal forms; (ii) stalked nubs; (iv) surface bulges; and (v) convoluted surfaces . A morphological equivalent of antibiotic synergism was found in which changes were noted due to synergistic combinations of antibiotics that were not observed when the antibiotics were used alone or when a nonsynergistic combination of antibiotics was used.

Acta Med Okayama, 1980 Dec, 34(6), 401 - 8
Effect of streptococcal preparation (picibanil) on the postoperative rise in serum alanine aminotransferase activity in patients with urogenital cancer; Taketa K et al.; The effect of Picibanil, a streptococcal agent, on the development of liver injury after operations for urogenital cancer was studied retrospectively in the light of serum alanine aminotransferase (ALT) activity . The series comprised 32 cases receiving Picibanil and 33 controls with otherwise comparable clinical backgrounds . Picibanil reduced the incidence of postoperative ALT rise over 50 U/l within 6 weeks but increased it thereafter . The increase in ALT activity after 6 weeks was relatively small and was seen more often in patients given blood transfusions . It was interpreted as retardation and suppression of ALT rise and as being related to the induction of interferon or to immunopotentiation . Other antihepatotoxic effects of Picibanil, due to its antioxidant activity, for example, may also account for the prevention of the early postoperative rise in ALT activity.

Vet Rec, 1980 Nov 15, 107(20), 467 - 9
Streptococcal meningitis in pigs: results of a five-year survey; Lamont MH et al.; Information about new outbreaks of streptococcal meningitis in pigs has been collected since the disease was first recognised in the United Kingdom in late 1973 . The apparent spread of the disease across the country is illustrated . Factors affecting the age distribution of the disease and the dissemination of the infection are also discussed.

Bol Med Hosp Infant Mex, 1980 Nov-Dec, 37(6), 1123 - 34
{Glomerulonephritis with mesangial IgA deposit (IgA mesangiopathy?)}; Mota F et al.; Clinical correlations and evolution were studied in 34 biopsies from patients with the following diagnosis: Henoch-Schonlein purpura in 17, monosymptomatic hematuria in 11, idiopathic nephrotic syndrome in 3, and Fanconi Syndrome, Systemic lupus erythematosus and tubulointerstitial nephritis, one for each diagnosis respectively . All these biopsies showed anti-IgA mesangial deposits, by immunofluorescence techniques with variable morphology by light microscopy . Endo and extracapillary proliferation was the most frequent lesions . Twenty cases had follow-up observation for over 2 years: 7 cases were in remission, hematuria and/or proteinuria persisted in 10 and 3 cases progressed to chronic renal failure . In conclusion, mesangial IgA deposits are not an infrequent finding in renal biopsies performed in the Hospital Infantil de Mexico . Although the predominant clinical diagnosis was either Henoch-Schonlein purpura or monosymptomatic hematuria, other diagnosis were also found . Some cases with this mesangiopathy presented as idiopathic nephrotic syndrome or post-streptococcal glomerulonephritis, but with serum complement within normal levels . Long-term prognosis was related to glomerular morphology as in other glomerulopathies.

Acta Pathol Jpn, 1980 Nov, 30(6), 995 - 1007
The significance of in vitro activation of guinea pig complement in glomeruli of human renal biopsy materials from varied subtypes of glomerulonephritis; Masugi Y et al.; To measure the potential ability of complement activation by glomerular-bound immune complex or C3 convertase, the in vitro fixation of guinea pig complement (GPC) components to glomeruli was examined by immunofluorescence on the frozen sections of human renal biopsy materials, from the varied subtypes of glomerulonephritis (GN) . Study for the pathway of complement activation in each subtype was also done . The extent of GPC activation fairly well paralleled with those of the autologous immunoreactants depositions and further with the morphological alterations of glomeruli in the cases of proliferative GN, advanced membranoproliferative GN (MPGN), lupus nephritis, purpura nephritis of non-IgA nephritis type and advanced focal segmental glomerular sclerosis . The ability of GPC activation was present but generally weak in the cases of post-streptococcal acute GN (post-str . AGN) and subsiding MPGN . The rate of positivity was further reduced in the cases of membranous nephropathy (MN), IgA nephritis and related purpura nephritis . The dominant alternative pathway of GPC activation was found in MPGN, post-str . AGN, IgA nephritis, and related purpura nephritis, the only classical pathway was noted in MN.

J Lab Clin Med, 1980 Nov, 96(5), 803 - 14
Lymphocytes binding C-reactive protein and streptococcal membranes in acute rheumatic fever; Williams RC Jr et al.; Peripheral blood lymphocytes binding CRP and streptococcal membrane antigens were studied in 19 patients with ARF with the use of a number of paired analyses for cell surface markers . A small fraction (6.9%) of T cells showed binding to streptococcal membrane . A large degree of overlap (38% to 46%) occurred in membrane-binding T cells and those with identifiable CRP . One third of T gamma cells showed CRP bindings, and approximately one quarter to T gamma cells in both ARF patients and normal controls showed membrane la antigen . A considerable concordance (50% to 75%) was noted between T cells binding streptococcal membrane and cells positive for la antigen . In contrast to T cells, B cells bearing CRP showed less overlap (mean 11%) with cells binding streptococcal membrane . Since B cells with concomitant surface immunoglobulin and la antigen constituted the major lymphocyte subpopulation binding streptococcal membrane antigens, relative exclusion of streptococcal membrane binding by B cells with surface CRP may represent natural protective modulation whereby proportions of potential antigen-binding B cells are defused by lymphocyte membrane CRP.

Vopr Med Khim, 1980 Nov-Dec, 26(6), 727 - 30
{Serum creatine phosphokinase, GOT, and GPT activity in different types of infectious diseases in monkeys}; Lemondzhava NI et al.; An increase in creatine phosphokinase (CPK) activity as well as a decrease in activities of aspartate aminotransferase (AAT) and alanine aminotransferase (ALT) were observed in monkey blood serum under conditions of experimental infection of the animals with dysentery . Contrary to the non-immunized animals, the activity of CPK was increased but the activities of AAT and ALT were unaltered in blood serum of the immunized monkeys . Estimation of the enzymatic activity might be used for diagnosis of experimental dysentery and streptococcal infection.

Biull Eksp Biol Med, 1980 Nov, 90(11), 575 - 7
{Distribution of a cross-reacting antigen common to group A streptococcal polysaccharide and multilayer squamous epithelium in different human organs}; Silagadze DG et al.; Indirect immunofluorescence with the use of antibodies) to group A streptococcal polysaccharide (A-polysaccharide has shown cross-reacting antigen (CRA) common for A-polysaccharide and the squamous epithelium to be localized, apart from the skin and thymus, in basal layer cells of oral mucosa epithelium, esophagus, inferior portion of the rectum, in salivary and mammary ducts . These tissue carriers of CRA are united by common ectodermal origin . The evidence obtained may be of use in the devising of a method for differential diagnosis of tumors of different genesis . In the course of organogenesis CRA appears early in the monolayer embryonic epithelium . The data presented correlate with those obtained before during study of animal tissues.

Int J Cancer, 1980 Oct 15, 26(4), 401 - 4
Reduction of suppressor cells in cancer patients treated with OK-432 immunotherapy; Uchida A et al.; OK-432, a streptococcal preparation, was intradermally injected daily into patients with advanced cancer of the stomach or lung for 4 weeks and the effects of OK-432 on the mitogenic responses of cancer patients were followed . The cells involved in the depression of the response of untreated cancer patients were characterized . The cells responsible for impaired responses were nylon wool non-adherent and suppressed the mitogen responses of autologous and allogeneic lymphocytes . These cells lost their suppressive activity during 7 days' culture in vitro . Following OK-432 immunotherapy, mononuclear cells from cancer patients showed increased responses to PHA and Con A, and nylon wool non-adherent cells did not inhibit the mitogen responses . These results suggest that the cells suppressing non-specific mitogen responses are sensitive to in vitro culture, belong to nylon wool non-adherent cells and are lost during 4 weeks of OK-432 therapy.

N Engl J Med, 1980 Oct 2, 303(14), 769 - 75
Single-dose penicillin prophylaxis against neonatal group B streptococcal infections . A controlled trial in 18,738 newborn infants; Siegel JD et al.; Neonatal Group B streptococcal infections may not respond to antimicrobial therapy and have been associated with case fatality rates of 50 per cent or greater . We evaluated the effect on colonization and disease rates of a single intramuscular dose of aqueous penicillin G given at birth in a prospectively controlled study of 18,738 neonates during a 25-month period . The colonization rate in the mothers was 26.6 per cent, with 50 per cent concordance in the untreated infants and 12.2 per cent in the penicillin-treated infants (P < 0.001) . There was a significant decrease in the incidence of disease caused by all penicillin-susceptible organisms in the penicillin group (0.64 vs . 2.26 cases per thousand live births, P = 0.005) . Disease caused by penicillin-resistant pathogens was increased in the penicillin-treated group during the first year of the study but was unaffected during the second year . Routine administration of parenteral penicillin at birth cannot be recommended until the effect on the incidence of disease caused by penicillin-resistant pathogens is fully defined.

Antibiotiki, 1980 Oct, 25(10), 743 - 7
{Antibiotic sensitivity of the bacteria persisting in the gastric and duodenal mucosa of peptic ulcer patients}; Sytnik SI; Sensitivity of 210 strains of aerobic microbes isolated from the deep layers of the gastric and duodenal mucosa of 80 patients with peptic ulcers was studied with respect to benzylpenicillin, ampicillin, ampiox, methicillin, dicloxacillin, tetracycline, streptomycin, monomycin, neomycin and gentamicin . All strains of 6 streptococcal species, 2 staphylococcal species and pseudodiphtheria bacilli proved to be highly sensitive to ampicillin, ampiox, methicillin and dicloxacillin . Ampicillin had the most pronounced bacteriostatic and bactericidal effects on all cutures, except 7 strains of pseudodiphtheria bacilli . It is recommended to carry out clinical trials of ampicillin with respect to its antimicrobial effect in preoperative sanation of the gastric and duodenal mucosa of patients with peptic ulcers for prevention of postresection gastritis and anastomositis.

J Pediatr, 1980 Oct, 97(4), 540 - 4
Use of monoclonal antibodies in an enzyme-linked inhibition assay for rapid detection of streptococcal antigen; Polin RA et al.; We have developed an enzyme-linked monoclonal antibody inhibition assay to detect bacterial antigens in cerebrospinal fluid . The monoclonal antibody used in this immunodiagnostic test was produced by continuous cultures of hybrid myeloma cell lines . Using this assay, type III GBS antigen was detected in CSF specimens from 11 culture-proven cases of GBS meningitis and in the knee aspirate from an infant with GBS septic arthritis . Five spinal fluid specimens from meningitis due to other bacterial pathogens and ten other control samples were negative . The ELMIA detected streptococcal antigen at a concentration of 10 ng/ml, and is more sensitive and specific than currently used immunodiagnostic tests.

Ann Neurol, 1980 Oct, 8(4), 445 - 7
Sydenham's chorea: a possible presynaptic dopaminergic dysfunction initially; Naidu S et al.; A 10-year-old white girl showed chorea with elevated antibody titers indicative of an earlier group A streptococcal infection . Prior to treatment, cerebrospinal fluid homovanillic acid levels were markedly elevated . Haloperidol caused minimal improvement . She was then treated with reserpine alone, which resulted in remarkable improvement within one week . A repeat lumbar puncture one month after reserpine was started showed moderate reduction of homovanillic acid levels . When reserpine was discontinued, symptoms recurred . The data suggest presynaptic dopaminergic overactivity.

J Immunol, 1980 Oct, 125(4), 1551 - 7
A comparative analysis of the cell surface properties of activated vs endogenous mouse natural killer cells; Kiessling R et al.; Mouse natural killer (NK) cells can be activated by interferon and by interferon inducers, such as viruses . In the present report we compared the cell surface properties of the nonactivated "endogenous" NK cells from normal mice with NK cells activated in vivo by acute infection with lymphocytic choriomeningitis virus (LCMV) or in vitro by interferon . Several striking differences were found: 1) in vivo LCMV-activated as well as in vitro interferon-activated NK cells were more adherent to nylon wool columns than the endogenous NK cells; 2) activated NK cells were more EA-monolayer adherent than endogenous NK cells; this adherence could be blocked by streptococcal A protein, indicating that activated NK cells expressed greater Fc receptor mediated adherence; 3) LCMV-activated NK cells that passed through nylon wool columns expressed relatively low EA adherence properties; 4) the sensitivity of NK cells to anti-theta serum + complement treatment was increased in spleen cells late after LCMV infection (day 6 to 7) but not in spleen cells early after infection (day 2 to 3); 5) as shown by centrifugal elutriation, LCMV-activated spleens contained a population of large NK cells that were not present among endogenous spleen cells . In contrast to previous reports, these findings show that there are several distinct changes as a result of both long-term in vivo activation or of short-term in vitro activation of NK cells . These changes might functionally be involved in the increased lytic ability of activated NK cells.

JAMA, 1980 Sep 26, 244(13), 1456 - 9
Hereditary polymorphic light eruption in American Indians . Photoprotection and prevention of streptococcal pyoderma and glomerulonephritis; Fusaro RM et al.; Hereditary polymorphic light eruption (HPLE) occurs in Indians of North and South America . Affected persons are sensitive to long ultraviolet radiation and therefore receive no substantial benefit from conventional sunscreens . We have treated 46 patients with HPLE at the Red Lake Reservation, Minn, with topically administered dihydroxyacetone and lawsone, orally given beta carotene, or both . Oral beta carotene afforded adequate photoprotection to 33 patients, and four additional patients were protected with the combined use of oral and topical agents . Epidemiologic studies support our proposals that HPLE is a causative factor in streptococcal pyoderma in the American Indian and may be associated with epidemics of streptococcal glomerulonephritis.

Plasmid, 1980 Sep, 4(2), 139 - 47
Electron microscopic mapping of deletions on a streptococcal plasmid carrying extraordinarily long inverted repeats; Behnke D et al.; Deletions delta 101, delta 102, and delta 103 which occurred within the extraordinarily long inverted repeats of the self-ligated large EcoRI fragment of the streptococcal MLS (macrolides, lincosamides, streptogramin B)-resistance plasmid pSM19035 led to the formation of plasmids pDB101, pDB102, and pDB103 . Their molecular lengths were determined by contour length measurements to be 17.8, 17.4, and 13.9 kb, respectively . Electron microscopic examination of self-annealed molecules revealed stem-loop structures with inverted repeats comprising 41 to 91% of the mass of plasmids . Two unique sequences (US1 and US2) separated the inverted repeats in the case of pDB101 and pDB103, while in pDB102 the repeats were joined at one end and separated at the other by a unique sequence (US2) . The size of the unique sequence US2 was identical for all three plasmids, and the location of the resistance determinant was determined by electron microscopic examination of self-annealed molecules of the recombinant plasmid pDB201 . Mapping of the deletion termini, accomplished by combining electron microscopic and HindIII restriction data, suggested that deletions may occur at preferential sites.

Acta Pathol Microbiol Scand {C}, 1980 Aug, 88(4), 219 - 25
An immunoelectrophoretic analysis of the Strep . sanguis and adult human oral mucosa antigen extracts used for immunological investigations of recurrent aphthous stomatitis; Donatsky O; Water-soluble antigens of Strep . sanguis strain 2A, ATCC 10556, and adult human oral mucosa (AHOM) were analysed by four immunoelectrophoretic methods . Crossed immunoelectrophoresis (CIE), using rabbit antibodies raised against the soluble antigens, revealed 26 antigens in the standard Strep . sanguis antigen extract and 16 antigens in the standard adult human oral mucosa extract . All 26 Strep . 2A antigen-antibody precipitates observed in the CIE were identified as streptococcal components . Eleven of the AHOM antigen-antibody precipitates in the CIE were derived from human serum proteins and hemoglobin present in the crude AHOM-Ag extract . Five of the latter precipitates possibly were caused by oral mucosal antigens . The AHOM-Ag extract contained four bacterial contaminants . None of them influenced the crossed immunoelectrophoretic AHOM antigen-antibody reference pattern in the present study.

Cardiovasc Res, 1980 Aug, 14(8), 482 - 89
Fibrinolytic therapy in subacute bacterial endocarditis: an experimental study; Johnson CE et al.; The effect of adding fibrinolytic to penicillin therapy in experimentally induced streptococcal bacterial endocarditis has been studied in the rabbit . In 9 day old infected lesions, the vegetations could be substantially reduced in size after a 3 day course of intravenous streptokinase . Quantitative microbiological techniques demonstrated that the addition of streptokinase to standard intravenous penicillin treatment led to more rapid sterilisation of the vegetations . Embolism to lungs and kidneys was assessed in treated and untreated rabbits . Penicillin reduced the rate of embolism but the addition of streptokinase reversed this effect and gave values similar to those recorded in untreated animals.

Infect Immun, 1980 Aug, 29(2), 526 - 31
Muramic acid detection in mammalian tissues by gas-liquid chromatography-mass spectrometry; Fox A et al.; Muramic acid is a component of the peptidoglycan moiety of cell walls of all bacteria and blue-green algae and is not found elsewhere in nature . A gas-liquid chromatography-mass spectrometry assay for muramic acid in tissue is described . The application of the method to the detection of muramic acid in tissues of rats with streptococcal cell wall-induced polyarthritis is demonstrated . Because the method has the potential to measure total bacterial biomass in tissue, it should prove to be an important assay in elucidating the etiological role of bacterial debris in chronic inflammatory diseases in humans.

Med Care, 1980 Aug, 18(8), 862 - 71
The contributions of consumer health education to primary care practice: a review; Bartlett EE; The inclusion of health education in high quality primary care has been suggested on the basis of 1) definitions and descriptions and descriptions of the content of primary care practice; 2) observational studies which have found that about 25 per cent of the direct patient-care time of the primary care physician is devoted to health education and counseling; and 3) surveys of physicians, who identified the most important "critical incidents" contributing to desired medical outcomes . This article reviews empirical studies of the role of health education in improving behavioral and medical outcomes for such conditions as hypertension, diabetes, congestive heart disease, streptococcal infections and others . Other contributions of health education in primary care in schools and other community settings are cited . Finally, the possible role of health education in medical education programs is described.

Biull Eksp Biol Med, 1980 Aug, 90(8), 195 - 7
{Morphological studies in delayed hypersensitivity to streptococcal antigens using film preparations of the mesentery}; Smirnova MN et al.; Film preparations of the mesentery were used for morphological study of cell reactions, connected with the delayed type hypersensitivity (DTH) . Twenty-four hours after intraperitoneal injection of small doses of the streptococcal thermostable fraction (TST fraction) the guinea-pigs sensitized with streptococcal culture developed a more intensive, as compared with control animals, diffuse infiltration of the peritoneum with mixed type cells (lymphocytes, monocytes and polynuclear leukocytes) abundant in mononuclear elements . With TST fraction dose build up the infiltration demonstrated an abrupt increase in polynuclear leukocytes completely masking the monocytic reaction in some cases . Large aggregations of lymphocytes were seen in the prelymph sinuses accompanying blood capillaries and nervous stemlets . Detection in the peritoneum of cell reactions characteristic of DTH following the injection of certain doses of specific antigens and comparative simplicity of obtaining film preparations allow recommending the technique described for disclosing and experimental study of DTH to microbial antigens.

Acta Pathol Microbiol Scand {B}, 1980 Aug, 88(4), 199 - 205
Changes in virulence, M protein and IgG Fc receptor activity in a type 12 group A streptococcal strain during mouse passages; Burova LA et al.; A type 12 group A strain (1800) was passaged serially through mice 25 times . The ability to servive in normal human blood dropped from a growth index of 52 after the first passage to 1 after four passages . After 14 passages the growth index increased again and stabilized above 30 . The virulence for mice increased from a LD100 of 10(8) colony forming units (CFU) to 10-100 CFU after 7 passages and then remained constant . The Mqw antigen disappeared after 4 passages as tested by immunodiffusion, electroimmunoassay and indirect bactericidal tests . Three antisera, raised in rabbits against strains originally belonging to types M3, M12 and M46 but devoid of type antigens after mouse passages showed high bactericidal indices against the 1800 strain after 14 or more passages on mice . Anti-type M1 serum was also found bactericidal for the passaged strains . The IgG Fc-receptor activity of the strain isolated after each mouse passage was tested in hemagglutination experiments with human red blood cells coated with "incomplete" anti-Rh and hot hydrochloric acid extracts of the strains . The capacity to agglutinate "Ripley"-coated cells increased gradually during the first 12 passages and subsequently the titres of the extracts stabilized between 1:160 and 1:320 . The HUN coat, useful for detection of the G3m (5) maraker gave titraes increasing with the number of passages while the titres for IgG1 coats kept at 1:4 or below . On background of these results, the possible role of the IgG Fc-receptor as a virulence factor is discussed.

J Exp Med, 1980 Aug 1, 152(2 Pt 2), 297s - 313s
An HLA-linked immune suppression gene in man; Sasazuki T et al.; Genetic control of immune response in man was investigated with the system of antigen-specific T cell proliferation in vitro against streptococcal cell wall (SCW) antigen . Family analysis by Morton's maximum likelihood scoring method revealed that the low response to SCW antigen was controlled by a single dominant gene . Furthermore, this gene was shown to be closely linked to HLA (lod score was 3,209 at theta = 0) . This is the first description of the HLA-linked immune suppression gene in man . The possible mechanism for this gene action was discussed.

Am J Obstet Gynecol, 1980 Aug 1, 137(7), 773 - 80
Treatment of premature labor with beta sympathomimetics: results with isoxsuprine; Schenken RS et al.; This prospective study presents a protocol for the treatment of premature labor with beta sympathomimetics and the results when isoxsuprine was used . Seventy-two patients from 25 to 36 weeks' gestation were treated . All patients were placed at bed rest, hydrated, and given parenteral sedation prior to the intravenous use of isoxsuprine . Treatment was continued via the intramuscular and oral routes until the thirty-seventh week of gestation . Three patients (4.2%) were delivered of infants during the initial infusion, and 15 (20.2%) were delivered of infants within 2 weeks after the onset of therapy . Forty-nine (68%) were delivered of infants after 37 weeks' gestation, and their infants weighed more than 2,500 grams . Maternal side effects were common, but none necessitated termination of therapy . There were six neonatal deaths, the causes of which were respiratory distress syndrome in two infants, necrotizing enterocolitis in one, group B streptococcal sepsis in one, congenital anomalies with sepsis in one, and multiple congenital anomalies in one.

N Z Med J, 1980 Jul 23, 92(664), 41 - 4
Control programmes for streptococcal disease among rural school children; Stanhope JM; Rheumatic fever remains important in New Zealand, and rheumatic heart disease is common . In a high risk area, a study of primary preventive strategies was undertaken among primary school children . The principal aim was to reduce beta-haemolytic streptococcal throat carriage . Subordinate aims were to reduce sickness-related absenteeism and the clinical incidence of streptococcal disease . The strategies compared included (1) identification and treatment of asymptomatic carriers at three-monthly surveys; (2) between-survey home visits of a nurse to identify infections and encourage prompt referral to the family doctor; (3) an exercise programme intended to increase general and respiratory fitness . Some benefit resulted from each strategy but the exercise programme was the least costly . The benefits of treatment of carriers and home visiting are probably insufficient to make them worthwhile.

Infect Immun, 1980 Jul, 29(1), 50 - 8
Complement activation induced by rabbit rheumatoid factor; Meyer RR et al.; Rabbit rheumatoid factor produced in animals by hyperimmunized with group C streptococcal vaccine activated guinea pig complement . Anti-streptococcal serum was fractionated by Sephacryl S-200 chromatography into excluded (19S) and included (7S) material and examined for hemolytic activity in a sensitive homologous hemolytic assay system . In the presence of complement, both 19S and 7S antistreptococcal serum fractions induced lysis of bovine (ox) erythrocytes coated with mildly reduced and carboxymethylated rabbit anti-erythrocyte immunoglobulin G . That rabbit rheumatoid factor was responsible for the observed hemolytic activity was substantiated by hemolytic inhibition assays . Significant inhibition of hemolysis was effected when antistreptococcal serum fractions were incubated in the presence of human immunoglobulin G, rabbit immunoglobulin G, and Fc, whereas, no inhibition was detected when the same fractions were tested in the presence of rabbit Fab or F(ab')2 fragments . Deaggregation of inhibitor preparations revealed a preferential reactivity of rheumatoid factor for rabbit immunoglobulin G . In addition to the rheumatoid factor-dependent hemolytic activity observed in humoral preparations, immunoglobulin G-specific antibody-forming cells in spleen and peripheral blood lymphocyte isolates were enumerated by plaque-forming cell assay.

Klin Padiatr, 1980 Jul, 192(4), 351 - 7
{Streptococcal infection in the newborn (author's transl)}; Staudt F et al.; 28 newborn infants, only 3 of which were female, were treated for early-onset streptococcal septicaemia in the years 1970-1978 at the University Children's Hospital, Freiburg . Overall mortality was 60%, that for premature infants 80% . Almost all infants who died developed D.i.C . 60% had X-ray findings consistent with HMD, even among the mature newborns . 90% showed white blood-cell count changes such as Leucocytopenia, Granulocytopenia, rise in percentage of immature granulocytes, Thrombocytopenia . With the help of these signs and using Gram-stain on stomach aspirates early diagnosis and differentiation from HMD seems feasible.

Infect Immun, 1980 Jul, 29(1), 119 - 22
Fatty acid binding sites of serum albumin as membrane receptor analogs for streptococcal lipoteichoic acid; Simpson WA et al.; The ability of bovine serum albumin to inhibit the binding of group A streptococcal lipoteichoic acid (LTA) to human cells was investigated . Albumin blocked the ability of LTA to sensitize erythrocytes to agglutinate in the presence of anti-LTA in a dose-dependent manner . The inhibition of LTA binding to erythrocytes was demonstrated directly with radiolabeled LTA . At an albumin/LTA molar ratio of 1.5:1, albumin binding of the radiolabeled LTA at erythrocytes was inhibited by 45% . Analysis of the binding of radiolabeled LTA to erythrocytes in the presence of albumin indicated that albumin competitively inhibited the binding of LTA to putative cell membrane receptors, indicating that albumin and erythrocytes both bind to the same moiety on the LTA molecule.

J Thorac Cardiovasc Surg, 1980 Jul, 80(1), 31 - 7
Prosthetic valve endocarditis; Masur H et al.; The diagnosis, therapy, and complications of prosthetic valve endocarditis (PVE) in 48 patients seen between 1962 and 1978 are reviewed . Staphylococcus epidermidis and diphtheroids were the most common causes of both early and late PVE . These microorganisms were frequently resistant to the penicillins and cephalosporins but were uniformly sensitive to vancomycin . The mortality rate in this series was 69%, with 20% of the deaths attributed to central nervous system emboli and the remainder to cardiac causes . The mortality rate exceeded 75% in patients with any of the following findings: aortic valve infection, nonstreptococcal infecting microorganism, new or increased regurgitant murmurs, or significant congestive heart failure (CHF) . The mortality rate was lowest in streptococcal PVE (29%) and in mitral valve PVE (49%) . The unacceptably high mortality rate suggests that early replacement of infected prostheses should be considered in all patients except those with uncomplicated streptoccal or mitral valve PVE.

Cornell Vet, 1980 Jul, 70(3), 213 - 7
Vegetative endocarditis with generalized bacterial embolism in association with phlegmon induced by Dracunculus insignis in a raccoon; Diters RW et al.; Lesions of streptococcal vegetative endocarditis and subsequent embolic disease are described in a raccoon (Procyon lotor) . A phlegmon of the animal's forelimb associated with Dracunculus insignis infestation was believed to be the primary site of bacterial invasion.

J Am Acad Dermatol, 1980 Jul, 3(1), 1 - 13
Necrotizing vasculitis; Sams WM Jr; Necrotizing vasculitis is a term used to describe vessel wall necrosis due to neutrophil infiltration . Current evidence strongly suggests that these cells are responding to elaboration of chemotactic factors of the complement cascade released at the site of deposition of immune complexes in the vessel wall . The antibody is usually IgG or IgM (and rarely IgA), but the only antigens identified with even a minimum certainty are the streptococcal M protein, the hepatitis B surface antigen, and Mycobacterium tuberculosis . Vessels may be involved, leading to specific signs or symptoms, in a wide range of organs, but with those of the skin, kidney, joints, and gastrointestinal tract leading the list . Why vessels of different sizes or location become involved in individual patients is unknown . Therapy with nontoxic drugs, such as antihistamines or salicylates, is indicated when the disease is mild, but vital organ involvement may necessitate therapy with systemic corticosteroids and/or cyclophosphamide.

Infect Immun, 1980 Jun, 28(3), 876 - 80
Activation of murine T-suppressor lymphocytes by group A streptococcal and staphylococcal pyurogenic exotoxins; Schlievert PM; The effect of group A streptococcal pyrogenic exotoxin (PE) type C and staphylococcal PE on the in vitro antibody response to sheep erythrocytes was studied in cultures of mouse spleen cells . Both exotoxins suppressed the day 4 direct plaque-forming cell response when added to the cultures . The maximum suppression was obtained with 1.0 or 0.1 ng of toxin per culture, and the suppressive effect was reversed by addition of gangliosides to the cultures at the same time as the exotoxins . Preincubation of T lymphocytes for 4 days with either exotoxin resulted in the generation of a suppressor cell population, which produced dose-dependent suppression of the direct plaque-forming cell response when added to fresh sheep eyrthrocyte-activated splenocytes . The suppression obtained was not reversed by gangliosides indicating toxin carry-over was not responsible for the effect . B cells, preincubated with exotoxin, failed to suppress the direct plaque-forming cell response of fresh erythrocyte-activated spleen cells.

Pediatr Res, 1980 Jun, 14(6), 788 - 92
Protective value of gamma globulin preparations against group B streptococcal infections in chick embryos and mice; Vogel LC et al.; The protective value of pooled human gamma globulin (GG) and a group B streptococcal immune globulin (GBSIG) was studiedf in a chick embryo and a murine model of group B streptococcal (GBS) infection . Chick embryos were protected by the IV administration of 0.4 to 0.8 mg of GG from three manufacturers against IV challenge with type Ia GBS . Two of three GG preparations at doses of 0.4 to 1.65 mg protected chick embryos against type III, but 1.65 mg of all three preparations failed to protect against GBS types Ib and II . MIce were protected from lethal IP challenges with types Ia and Ib by the prior IM inoculation of three and two of the three GG preparations at doses of 0.5 to 1.0 mg, respectively . Administration IM of 1 mg of GG failed to protect mice against types II and III . The IV administration of 0.2 mg of GBSIG protected chick embryos against IV inoculation with GBS types Ia, Ib, II, and III . Administration IM of 0.5 mg of GBSIG protected mice against IP challenges with types Ia, Ib, and II, but not with type III . The IP administration of 0.25 mg of GBSIG simultaneously with type III GBS protected mice, whereas GG was not protective . GBSIG should undergo clinical trials for the prevention of GBS infections and their recurrences and as a possible adjunct to antibiotic and supportive therapy of severe GBS infections.

J Infect Dis, 1980 May, 141(5), 680 - 5
Activation of human neutrophil metabolism by streptolysin O; Andersen BR et al.; The effect of streptolysin O on the metabolic activity of human neutrophils was examined . Streptolysin O, within the range of 3 to 75 hemolytic units, stimulated neutrophils to emit light . This chemiluminescence was the result of metabolic activation, as confirmed by oxygen uptake studies and the suppression of chemiluminescence by the metabolic inhibitor, 2-deoxyglucose . Free cholesterol, which prevents streptolysin O from binding to membrane cholesterol, blocked the neutrophil chemiluminescent response to streptolysin O . Extracellular calcium ions were necessary for the streptolysin O-stimulated chemiluminescent response of neutrophils . Some cell viability was lost, as measured by trypan blue uptake and neutrophil lysis within the range of streptolysin O concentration that caused metabolic stimulation . These observations suggest a possible role for streptolysin O as a pathogenic factor in streptococcal infections.

Biull Eksp Biol Med, 1980 May, 89(5), 582 - 4
{Study of cross reactions between group A streptococcal antigens and cardiac interstitial connective tissue fibroblasts of different species of mammals}; Kochetkova EV et al.; It has been revealed by indirect immunofluorescence that sera of rabbits immunized with group A streptococcal non-type-specific antigens and F (ab')2 fragments of IgG obtained from these sera intensively react with fibroblasts of interstitial connective tissue (ICT) of the myocardium of humans and different mammalian species with the exception of rabbits . Negative or weak reactions with the same sera and F (ab')2 fragments were observed with fibroblasts of ICT of nonimmunized rabbits . Myocardial ICT of immunized animals showed bound immunoglobulins . This model can be used for making clear the reason for presence in sera of rheumatic patients circulating antibodies only to heterologous but not to homologous ICT of the myocardium regardless of the revealing bound immunoglobulins in the ICT of these patients.

J Med Microbiol, 1980 May, 13(2), 323 - 7
The role of glycoprotein carbohydrate in the immunological reactivity of antistreptococcal cell-membrane and antiglomerular basement-membrane antisera; Blue WT et al.; Rabbit antisera to "carbohydrate-rich" antigens prepared from group-A, type-12 streptococcal cell-membrane and human glomerular basement-membrane were found to react by an indirect fluorescent-antibody test with the glomerular basement membrane of adult human kidney . This activity was absent or diminished in neonatal tissue . Removal of the carbohydrate epitopes from the adult tissue by means of carbohydrases removed the immunological activity . Antisera against the "carbohydrate-rich" antigens showed immunological reactivities distinctly different from those against the parent native immunogens--streptococcal cell membrane or glomerular basement membrane--which proved to be directed towards the portein epitopes.

Br J Exp Pathol, 1980 Apr, 61(2), 164 - 71
Scanning electron microscopic observations of the surface of the initial lesion in experimental streptococcal endocarditis in the rabbit; McGowan DA et al.; The surfaces of vegetations in the first 24 h after initiation of experimental streptococcal endocarditis in rabbits were examined systematically using the scanning electron microscope (SEM) . Most of the observed fields were occupied by amorphous material but with the SEM very small features of interest could be identified . Erythrocytes were more frequent before 6 h and leukocytes were rarely seen . Bacteria were significantly more frequent at 10/15 min and at 20 h . It is suggested that bacteria lodge on the vegetation surface following inoculation and that after a lag phase colonies are formed within the vegetation which reach the surface again at about 20 h.

J Med Chem, 1980 Apr, 23(4), 405 - 12
Orally active cephalosporins and penicillins; Bohme EH et al.; A number of orally active cephalosporins and penicillins with interesting biological activity were synthesized . Two of these, 7-{{{3,4-(methylenedioxy)phenyl}glycyl}amino}deacetoxycephalosporanic acid and 7-{{2-(2,3-dihydro-5-benzofuranyl)glycyl}amino}deacetoxycephalosporanic acid were considerably more active than cephalexin both in vitro and in vivo against staphylococcal and streptococcal infections.

Infect Immun, 1980 Apr, 28(1), 254 - 7
Transfer of group A streptococcal pyrogenic exotoxin production to nontoxigenic strains of lysogenic conversion; Johnson LP et al.; Production of group A streptococcal pyrogenic exotoxins (SPE) type A and C was transferred from toxigenic streptococcal strains to nontoxigenic strains by lysogeny . Lysogens were tested for SPE with Ouchterlony immunodiffusion on Todd-Hewitt agar plates; toxin diffusing from isolated colonies reacted with specific hyperimmune antisera to SPE . Phage prepared from strains T25(3) (T12gl) and 3GL16, both yielding SPE type A, formed plaques on T25(3) (NONLYSOGENIC) lawns . Over 90% of the colonies picked from the plaque centers yielded A toxin, suggesting SPE type A was transferred by lysogenic conversion . SPE type C formation was transferred to nontoxigenic strains T25(3) and K56 with supernatant fluids from mitomycin C-induced cultures of CS112, producing SPE types B and C . All lysogens tested were positive for SPE type C, indicating that C toxin induction also was transferred by lysogenic conversion . SPE type B formation was not transferable by lysogeny with the strains tested.

Hautarzt, 1980 Apr, 31(4), 209 - 12
{Erythromelanoderma in pemphigus herpetiformis associated with eosinophilic spongiosis}; Weidner F et al.; A 62 year old female was treated for several years with DDS because of Duhring-disease like symptoms . She developed erythro-melanoderma, generalized lymphadenitis and pachyderma . Histologically there were eosinophilic spongiosis and intraepidermal vesiculation, blood eosinophilia up to 42%, and intercurrent streptococcal septicemia, immunohistologically in vivo bound pemphigus antibody, but no papillary or linear IgA . Indirect immunofluorescence was negative . Paraproteinemia was excluded.

Vopr Pitan, 1980 Mar-Apr, (2), 21 - 3
{Parameters of polynuclear cell activity in torpid and latent recurrent rheumocarditis in the process of treatment with a high-protein diet and drug preparations}; Samsonov MA et al.; The in vitro test of direct granulation of basophils affected by specific antigens (cardial tissue, acid-soluble fraction of collagen, streptococcal allergens) was investigated in the course of treating 41 patients (29 women and 12 men aged from 20 to 50 years) suffering from a little active rheumatic fever . The patients received a complex of therapeutic measures including high-protein diet (130-140 g protein) and drugs (1.5-2.0 g acetylsalicylic acid and 15 mg of prednisolone a day) . As a result of the treatment all the patients improved and demonstrated pain relief in the heart region, reduced palpitation, abatement of general weakness and fatigue . At the same time there was a decrease in the reactivity of basophilic leukocytes, shown by less number of degranulated cells in vitro, activated with specific antigens.

Am J Obstet Gynecol, 1980 Mar 1, 136(5), 575 - 8
Determinants of postpartum morbidity in laboring monitored patients: a reassessment of the bacteriology of the amniotic fluid during labor; D'Angelo LJ et al.; Identification of the type and concentration of bacterial organisms in the amniotic fluid (AF) during labor might allow for earlier and more effective treatment of postpartum infections . Previous studies have identified organisms typically associated with postpartum endometritis, but the relationship to intrapartum findings has been disappointing . The purpose of this prospective study was to reassess any relationships between the bacteriology of the AF during labor and the postpartum course in the high-risk, noninfected, monitored gravid patient . The intrapartum AF bacterial flora was similar in 70 patients delivered vaginally and 80 patients delivered abdominally . In patients who did not receive prophylactic antibiotics, a total AF organism count of greater than or equal to 10(4) colonies/ml and the presence of any streptococcal or Bacteroides organism, gram-negative bacillus, or Staphylococcus aureus were significantly related to postpartum morbidity . Under these conditions, cesarean section considerably increased the risk of clinical endometritis . These results suggest that semiquantitative culture of AF obtained through the intrauterine pressure catheter prior to delivery may be of value in the postpartum management of patients delivered by cesarean section.

Int J Pediatr Nephrol, 1980 Mar, 1(1), 4 - 9
Value of antistreptolysin "O" titers for differential diagnosis of renal diseases; Heymann W et al.; A.S.O . titers were determined in 93 children with various kidney diseases . In addition, 52 children without renal disorders were investigated as controls . In the children with renal disease, 38 suffered from the "idiopathic", "primary" nephrotic syndrome of childhood . Thirteen had acute, post-infectious glomerulonephritis, 16 had "primary" chronic glomerulonephritis, 3 had pyelonephritis, and 1 had disseminated lupus nephritis . In acute glomerulonephritis, with or without N.S., the titers were higher than in the controls, which is known and consistent with the frequency of preceding streptococcal infections . Children with chronic glomerulonephritis, with and without associated N.S., did not show a similar tendency to increased values . All patients but one with "primary", , "idiopathic" N.S . of childhood had titers of less than 100 . They were between 50 and 12 Todd units . These titers were observed early during the course of the disease and persisted for years in spite of remissions . They were not related to concomitant antimicrobial therapy, nor to corticosteroid administration . In "idiopathic" nephrotic syndrome of childhood a titer of less than 100 does not, in itself, lead to the diagnosis of a N.S . of childhood . However, a greater than 100 titer speaks against it and may well serve as a valid indication for a renal biopsy, in order to differentiate this disease from acute glomerulonephritis, and also from R.P.G.N . whenever they are associated with a N.S . The low titers are only of value in differentiating the "primary" form of the N.S . from the "secondary" forms which are preceded by chronic renal disease or which are due to another underlying, systemic disease . In nephrotic children less than 6 years of age, the less than 100 A.S.O . titers may also be due to their age.

Southeast Asian J Trop Med Public Health, 1980 Mar, 11(1), 28 - 31
The value of an indirect hemagglutination test for streptococcal antibodies in children with acute rheumatic fever; Pongpanich B et al.; This study was made to evaluate the value of the IHA test for streptococcal antibodies in children with acute rheumatic fever in comparison with the conventional ASO titer . The upper limit titers of ASO and IHA in control group were 170 and 640 respectively . All sera from 37 patients with rheumatic fever had IHA titers over 640 . In contrast, the level of ASO titer above upper normal limits was found in only 62% of these cases . This report present data which favours the use of IHA test . Its sensitivity is very similar to that of the commercial Anti Streptozyme test . In addition, the test is simple and could be performed economically . More studies are needed to evaluate the test further . If the results proved as favourable as this report a negative test would be of a considerable value in excluding the diagnosis of acute, rheumatic fever especially in questionable cases.

Hosp Pract, 1980 Mar, 15(3), 115 - 25
Penicillin prophylaxis and neonatal streptococcal disease; Hodes HL; Despite a number of efforts no means of preventing neonatal group B beta-hemolytic strep (GBS) infection by maternal treatment or immunization has proved effective . But impetus to a direct approach to the infant has been provided by the serendipitous discovery that routine penicillin prophylaxis for gonococcal ophthalmia may also protect against GBS . Large-scale controlled studies are now under way.

Infect Immun, 1980 Mar, 27(3), 1023 - 32
Production of bacteremia and meningitis in infant rats with group B streptococcal serotypes; Ferrieri P et al.; Group B streptococcal strains, representing the five major serotypes, were inoculated into infant rats by intranasal, oral, and intraperitoneal routes . Bacteremia regularly followed injection by the intraperitoneal route . Four strains (three of type III) isolated from human cerebrospinal fluid appeared more virulent for 5-day-old rats . Injection of fewer than 10 colony-forming units of one strain, a type III, led to bacteremia and death in 27% of animals . The cumulative bacteremia and mortality rate with this strain was 66% in animals given inocula of less than 10 to 10(3) colony-forming units . Bacteremia developed by 24 to 48 h with concentrations of greater than 10(5) colony-forming units per ml of blood, and death occurred soon afterward . Among bacteremic animals, positive cerebrospinal fluid cultures were found in 97%, and cerebrospinal fluid bacterial concentrations were equal to or exceeded bacterial counts in blood . The susceptibility of infant rats to infection with type Ia, Ic, or III strains was age dependent . Histopathological studies of the brain and meninges in 34 bacteremic animals with culture-positive cerebrospinal fluid revealed that 5- to 10-day-old animals had numerous bacteria distributed in a perivascular pattern but, with one exception, no leukocytic infiltration . In contrast, three of the 11- to 12-day-old and two 15-day-old animals had very thickened meninges infiltrated with polymorphonuclear leukocytes, macrophages, and bacteria.

Pediatrics, 1980 Mar, 65(3), 592 - 6
Acute urticaria associated with streptococcal infection; Schuller DE et al.; Eighty-one cases of acute urticaria were treated in our institution over a two-year period . In 13 of 32 cases screened for streptococcal pharyngitis, either positive throat culture, significant streptococcal exoenzyme antibodies (Streptozyme test), or both were found . Other causative factors for the acute urticaria had been excluded . It is our feeling that beta-hemolytic streptococcal infection may be a causative agent in many cases of acute urticaria, and that the infection may not always be clinically apparent . We therefore recommend a throat culture and determination of streptococcal enzyme level as routine procedures in evaluating acute urticaria . We also suggest, based on the findings in one case, that discontinuing therapy for a streptococcal infection when urticaria develops, even though necessary, might be inappropriate.

J Exp Med, 1980 Mar 1, 151(3), 695 - 708
Tropomyosin-like seven residue periodicity in three immunologically distinct streptococal M proteins and its implications for the antiphagocytic property of the molecule; Manjula BN et al.; Partial sequences of three immunologically distinct group A streptococcal M proteins (M5, M6, and M24) revealed significant homology with each other, certain amino acid residues being conserved within the three molecules . In addition, a common feature of the sequenced regions of these M proteins was their high alpha-helical potential and the presence of a repeating seven residue periodicity that is characteristic of the double helical coiled-coil molecule, tropomyosin . The existence of a tropomyosin-like seven residue periodicity strongly suggests that regions of these three M proteins may participate in intra- and/or intermolecular coiled-coil interactions . Because of the constraints imposed by such a repeating periodicity, certain conserved residues within the M proteins would occupy spatially equivalent positions in the tertiary structure of these molecules . This common characteristic could play an important role in the common antiphagocytic property of the immunologically diverse M molecules . In addition to similarities in the secondary structure of M proteins and tropomyosin, significant sequence homology has also been observed between certain regions of these molecules with up to 50% identical residues . As a result of the striking structural similarity with tropomyosin, M proteins may play a regulatory role in the contractile mechanisms involved in phagocytosis.

Ann Intern Med, 1980 Mar, 92(3), 390 - 5
Combination antibiotic therapy of bacterial endocarditis; Sande MA et al.; A penicillin-aminoglycoside regimen is accepted therapy for enterococcal endocarditis, but use of combinations of antibiotics in other forms of bacterial endocarditis is controversial . This review analyzes in-vitro, experimental animal model, and clinical studies of combination "synergistic" antibiotic treatment for enterococcal, viridans streptococcal, staphylococcal, and gram-negative aerobic bacillary endocarditis . Current recommendations for treatment of these entities are discussed.

Infect Immun, 1980 Mar, 27(3), 953 - 9
Heterogeneity of group A type-specific antibodies; El Kholy AM et al.; Extracting type 6 group A streptococcai with dilute nitrous acid releases an antigen that exhibits type-specific precipitating properties with anti-M6 serum but fails to neutralize the type-specific bactericidal reaction or to absorb the bactericidal antibody from anti-M6 serum . These studies suggest that the precipitating and antiphagocytic properties of the M protein are attributable to different antigenic determinants . The antigenic determinant responsible for bactericidal antibody is more sensitive to the deleterious effect of nitrous acid than is the moiety responsible for the precipitin reaction . Use of the indirect fluorescent technique with anti-M sera absorbed with lyophilized nitrous acid extracts permits the possible differentiation of the two M-protein determinants in situ on the surface of streptococcal cells.

Pediatr Res, 1980 Feb, 14(2), 128 - 32
Rapidly progressive glomerulonephritis in children: a report of thirteen cases and a review of the literature; Cunningham RJ 3rd et al.; The clinical course and outcome of rapidly progressive glomerulonephritis (RPGN) of variable etiology are not well defined in children . The present investigation reports on the clinical characteristics, the course and outcome, as well as the results of treatment of 13 children with apparent postinfectious RPGN . Three of 7 patients with documented streptococcal RPGN and 3 of 6 patients with RPGN of nonstreptococcal etiology progressed to chronic renal failure . In some patients, anticoagulant and antiplatelet therapy appear to have improved survival . The severity of crescent formation, not the presumable etiology, appears to be a reliable prognosticator.

Infect Immun, 1980 Feb, 27(2), 519 - 24
Comparative stimulation of granulocyte adherence and chemotaxis by bacterial products; Spagnuolo PJ et al.; Many inflammatory stimuli increase both in vitro granulocyte adhesiveness and motility . The present investigation compared the effects of bacterial products on in vitro granulocyte adherence to nylon fiber and granulocyte motility . Escherichia coli endotoxin and Staphylococcus aureus and E . coli culture filtrates enhanced both motility and granulocyte adherence to nylon . Column chromatography of S . aureus culture filtrate demonstrated that similar molecular weight components stimulated both motility and granulocyte adherence . In contrast, endotoxin stimulated granulocyte adherence but not chemotaxis in plasma-free medium . In addition, a group D streptococcal culture filtrate enhanced motility but not adhesiveness of plasma-free granulocytes . These studies indicate that inflammatory stimuli may interact with granulocytes in concert to enhance both adhesiveness and motility, or they may interact independently to stimulate one in vitro function preferentially.

Gann, 1980 Feb, 71(1), 73 - 9
Cytostatic activity of in vitro activated human adherent cells against human tumor cell lines; Matsunaga K et al.; Human adherent cells from peripheral blood were cultured with immunostimulant, BCG, yeast wall, or streptococcal preparation (OK-432), for 3 days, and the cytostatic activity of the adherent cells on human tumor cells was examined . The cells cultured in the presence of an immunostimulant exhibited increased phagocytic activity and the number of phagocytosed sheep red blood cells (sRBC) per cell increased . Adherent cells cultured without the immunostimulant showed slight cytostatic activity of 8 approximately 20% . HD-10 cells, derived from Hodgkin's disease, and QG-K and QG-U cells derived from uterine cervical cancer were more susceptible than HeLa cells to the adherent cells activated by OK-432 or yeast cell wall . Relationship between population doubling time and susceptibility to the cytostatic effect mediated by the activated adherent cells was not observed . The supernatant from the activated adherent cells was also effective in inhibiting DNA synthesis of the rapidly proliferating target cells, HD-10 cells and HeLa cells . However, the proliferation of the other two cell lines was enhanced . The effect of activated adherent cells on tumor cell proliferation and its relation to cytostasis were examined and discussed.

J Lab Clin Med, 1980 Feb, 95(2), 258 - 65
Enzyme-linked immunosorbent assay of antibodies in human sera to streptococcal DNase B; Gerber MA et al.; An ELISA method for determining the streptococcal anti--DNase B titers in human sera is presented . The details of this technique, a method for converting A493 readings into titers, and a standardization procedure are discussed . Anti--DNase B titers of 20 sera determined by ELISA were compared with titers determined by the microtechnique . A correlation coefficient of 0.96 between the two methods was obtained . The reproducibility of the ELISA method was established by comparing titers obtained from two separate determinations on the 20 sera . Twenty-four pairs of acute and convalescent sera were assayed for anti--DNase B titers by both ELISA and microtechnique to compare the ability of the two techniques to identify significant titer rises . The ELISA was as specific and possibly more sensitive than the microtechnique in identifying significant anti--DNase B titer rises . This ELISA method is simple and rapid and has the potential for automation.

Infect Immun, 1980 Feb, 27(2), 542 - 8
Inhibition of ribonucleic acid synthesis by group A streptococcal pyrogenic exotoxin; Schlievert PM et al.; Group A streptococcal pyrogenic exotoxins (SPEs) A, B, and C and alpha-amanitin enhance host susceptibility to lethal endotoxin shock . The capacity of SPE C and alpha-amanitin to prepare rabbits for the enhancement phenomenon required pretreatment of the animals 1 to 2 h before giving endotoxin . Endotoxin clearance from the circulation of rabbits pretreated with either SPE C or alpha-amanitin was reduced . Even at the time of death, significant amounts of endotoxin remained in the circulation . It is proposed that the SPE and alpha-amanitin inhibit ribonucleic acid synthesis in Kupffer cells with concomitant alteration in reticuloendothelial clearnace function, allowing endotoxin to persist in the circulation and produce host injury . All three SPE types and alpha-amanitin inhibited ribonucleic acid synthesis by 50% or greater in whole liver cells . Kupffer cells, liver cell nuclei, and liver nuclear extracts; inhibition was observed liver cells from both mice and rabbits . The inhibitory effect by SPEs was dose dependent and was observed after as little as 15 min of preincubation with liver cells . The content of ribonucleic acid in liver nuclei of mice pretreated with either SPE C or alpha-amanitan was reduced, whereas total deoxyribonucleic acid and protein content remained unaltered.

Eur J Immunol, 1980 Feb, 10(2), 105 - 12
Correlated expression of VH framework and VH idiotypic determinants on T helper cells and on functionally undefined T cells binding group A streptococcal carbohydrate; Eichmann K et al.; Antibodies to framework determinants of the VH and V lambda fragments of MOPC 315 and antisera to the VH idiotype determinants of the A 5 A antibody were used to analyze the antigen receptors of mouse T (and B) cells . This was done by using the antibodies as inhibitors in (a) an assay in which the binding of radiolabeled streptococcal carbohydrate (A-CHO) antigen by primed and unprimed T and B cells is determined and (b) an assay in which the helper activity of group A streptococcal vaccine-primed T cells is determined . The results suggest that the major proportion of primed and unprimed T cells binding A-CHO (70-90%) exhibit VH framework and VH idiotypic determinants . This population appears to include the helper T cells . A minor proportion of T cells (10-30%) express V lambda-related framework determinants and lack VH framework and VH idiotypic determinants . This population does not include T helper cells . Taken together, the data suggest that a subpopulation of T cells, including the helper cells, uses entire Ig VH regions as part of their antigen receptor system.

J Bacteriol, 1980 Feb, 141(2), 584 - 92
Isolation and characterization of cell-associated nucleases related to streptococcal extracellular deoxyribonuclease D; Citak BP et al.; A group of at least four distinct nucleases designated DcI through DcIV were isolated from cellular extracts of group A streptococcal strain S43 and shown to be antigenically similar to streptococcal extracellular deoxyribonuclease (DNase) D . These cellular endonucleases degraded single- and double-stranded deoxyribonucleic acid (DNA) as well as ribonucleic acid (RNA) to acid-soluble oligonucleotides . The products of digestion of DNA bore 5'-terminal phosphates, and in partial digests pdX-pdG linkages were most susceptible and pdA-pdX linkages were most resistant to nuclease action . The enzymes had pH optima of 8.0 to 8.5, were inhibited by NaCl, were unaffected by sulfhydryl modifying reagents, and absolutely required a divalent cation . Nucleases DcIII and DcIV were apparently hydrophobic in nature since they required the presence of detergents for migration on nondenaturing polyacrylamide gels . All four nucleases were electrophoretically distinct on such gels, from each other, and from DNase D . Molecular weights of DcI and DcII were similar to that of DNase D, suggesting that the mobility differences of these enzymes at least are reflections of differing net charges . It is suggested that the cellular nucleases represent a group of processing intermediates in the maturation and excretion of DNase D.

Int J Cancer, 1980 Jan 15, 25(1), 131 - 6
Suppression of Friend leukemia virus by Bacillus Calmette-Guérin and a streptococcal preparation, OK-432; Tsuruo T et al.; OK-432, a streptococcal preparation, and BCG effectively inhibited splenomegaly in Friend leukemia virus (FLV)-infected mice . Divided drug dosage resulted in stronger inhibition than single administration . When the second dose was fixed at the 3rd pre-infection day, the best timing for the first dose was approximately 30 days before infection . The optimal dosages were 100--600 KE/kg for OK-432 and 25--100 mg/kg for BCG . Transfer of peritoneal exudate cells (PEC) from immunomodulator-treated mice, but not PEC from untreated mice, conferred resistance against FLV which was highest when PEC were transferred 1 day before FLV infection . The transfer of PEC on the day of or one day after infection had no protective effect . Inactivation also occurred when FLV was incubated in the presence of PEC from immunomodulator-treated mice, however, no significant effect was observed for PEC from untreated mice.

J Mal Vasc, 1980, 5(2), 92 - 5
{Acute inflammatory exacerbations in lower limbs suffering from primary lymphoedema . Epidemiological and preventive considérations (author's transl)}; Brunner U; The most frequent complication of primary lymphoedema is streptococcal infection, and in particular erysipelas, and plantar fungal infections . The fungal infection is a portal of entry for erysipelas . Disinfiltration is the basis of treatment of erysipelas.

Clin Ther, 1980, 3(1), 49 - 61
Benzathine penicillin G after thirty years; Markowitz M; Many new antibiotics and countless formulations of old ones have been introduced during the past three decades . None has supplanted BPG . It remains the only drug that can provide antibiotic blood levels for several weeks following a single intramuscular injection . This property makes BPG the ideal preparation for treponematoses and group A streptococcal infections in patients who are not allergic to penicillin and for whom single-session therapy is desirable or necessary . Sensitivity reactions from BPG are less frequent and less severe than those from aqueous or procaine penicillin G . In certain situations, such as the prevention of rheumatic fever and rheumatic heart disease, the fear of a reaction in a patient with a negative past history of penicillin allergy is no justification for withholding BPG when it is clearly the drug of choice.

Dermatologica, 1980, 161(2), 112 - 5
Generalized familial benign chronic pemphigus; Friedman-Birnbaum R et al.; This is a report of generalized familial benign chronic pemphigus in a Negro male . The rich staphylococcal and streptococcal flora detected on the skin of this patient may have been a factor in the generalization of the process.

Clin Nephrol, 1980 Jan, 13(1), 1 - 4
Circulating immune complexes and serum immunoglobulins in acute poststreptococcal glomerulonephritis; Rodriguez-Iturbe B et al.; Acute poststreptococcal glomerulonephritis (APSGN) is a disease thought to be induced by the renal deposition of circulating immune complexes . In order to test this possibility, serum samples from 119 patients with APSGN were studied for Clq binding activity (ClqBA), levels of IgG, IgM, IgA, C3 and antibody titers to streptococcal enzymes . These parameters were analyzed in relation to the clinical and laboratory data of the acute nephritic syndrome and with respect to the time elapsed from streptococcal infection and from the onset of nephritis . Elevated ClqBA was found in 66.7% of the patients in the first week of the disease and this frequency decreased progressively to 17.6% after the second week . Normal ClqBA was found in patients after the third week of nephritis . Serum levels of IgG and IgM were elevated in over 95% of the patients . Levels of IgG in excess of 2400 mg/dl were detected in 71.1% of the cases . No correlation could be found between the ClqBA and the clinical or immunoserological findings of the disease . The data support the hypothesis that circulating immune complexes are responsible for the nephritis that follows streptococcal infection.

J Rheumatol, 1980 Jan-Feb, 7(1), 65 - 70
Articular complications of jejunoileal bypass surgery; Clegg DO et al.; Articular complications are now frequently recognized with jejunoileal-bypass surgery for morbid obesity . We have evaluated 6 referred patients with these problems and 50 consecutive patients who had this procedure . The arthritis is variable but usually affects multiple joints . Four patients were seen during acute attacks of arthritis and all had cryoprecipitable material in their sera and plasma . Three of these 4 patients had evidence of Group D streptococcal antigen present while their joint disease was active, suggesting a possible role for bacterial antigens in the pathogenesis of the arthritis of jejunoileal bypass.

Public Health Rep, 1980 Jan-Feb, 95(1), 62 - 8
Acute rheumatic fever and rheumatic heart disease on the Navajo reservation, 1962-77; Coulehan J et al.; The occurrence of acute rheumatic fever (ARF) and rheumatic heart disease (RHD) among Navajos was ascertained for the period from 1962 through 1977 by means of hospital discharge diagnoses and patients' charts . The annualized attack rate for ARF was 12.4 per 100,000 population, with no clear evidence of an overall secular trend . The proportion of recurrences (19.6 percent) and clinical features were similar to those reported elsewhere, but no seasonal variation in attack rates was noted . Between 1962-71 and 1972-77, the age of RHD patients increased, suggesting few newly diagnosed cases and the aging of known patients . A streptococcal disease control program was instituted in many Navajo elementary schools before 1975 . In the program, throat cultures were performed routinely for some asymptomatic children and for all symptomatic children . During the subsequent 3 years, ARF rates declined from 13.5 to 8.2 per 100,000 in areas covered by the program, while in the noncovered areas the rates showed little change-9.5 to 10.1 per 100,000.

Chemotherapy, 1980, 26(5), 372 - 6
Effect of antiseptic cord care on bacterial colonization in the newborn infant; Speck WT et al.; A randomized controlled study was undertaken to compare the effectiveness of three umbilical cord treatment regimens in controlling neonatal bacterial colonization . The regimens studied included daily application of castile soap, triple dye and silver sulfadiazine . The triple dye and silver sulfadiazine regimens inhibited bacterial colonization . Staphylococcal colonization was inhibited most effectively by triple dye treatment . Group B streptococcal colonization was equally inhibited by triple dye and silver sulfadiazine . Silver sulfadiazine was more effective in controlling colonization with gram-negative microorganisms.

Infect Immun, 1980 Jan, 27(1), 276 - 9
Ganglioside and monosaccharide inhibition of nonspecific lymphocyte mitogenicity by group A streptococcal pyrogenic exotoxins; Schlievert PM et al.; Group A streptococcal pyrogenic exotoxins (SPE) types A, B, and C are potent nonspecific lymphocyte mitogens . The mitogenicity of these exotoxins was inhibited by gangliosides and sialic acid, whereas concanavalin A was unaffected . The capacity of both concanavalin A and SPE-A to stimulate lymphocytes was suppressed by alpha-methyl-D-mannopyranoside . Galactose reduced the activity of SPE-C . The sugars, glucose, N-acetylglucosamine, alpha-methyl-D-glucopyranoside, and fucose, did not affect SPE mitogenicity.

Ann Intern Med, 1980 Jan, 92(1), 99 - 106
Quality of care in episodes of respiratory illness among Medicaid patients in New Mexico; Lohr KN et al.; As part of ambulatory-care review, the New Mexico Experimental Medical Care Review Organization (EMCRO) developed medical guidelines for the use of injections and informed physicians about them through written communications and personal visits . After their adoption, the EMCRO denied payment for Medicaid claims not meeting the guidelines . To study the effect of these activities, we compared quality of care in entire episodes of respiratory infections before and after guidelines were promulgated . Quality as judged by minimal criteria for antibiotic use improved . Percentages of episodes with appropriate therapy rose from 36% to 42% for streptococcal sore throat, from 42% to 81% for bronchitis, and from 36% to 51% for acute upper respiratory infection . Quality improved most among physicians with the poorest records initially; "outliers" still gave inadequate care . Assessment of episodes of care derived from claims data thus appears to be a feasible and nonintrusive mechanism for detecting deficiencies in quality and evaluating quality-assurance activities.

J Med, 1980, 11(4), 303 - 15
Therapy of nosocomial infections: past, present and future trends; Pasko M et al.; There has been a significant increase in the number of bacteremias sustained by hospitalized patients over the past 45 years . Responsible bacterial flora has shifted from streptococcal to staphylococcal to gram-negative . Simultaneously, the patient population has become significantly older . Two types of nosocomial infection are reviewed in this clinical setting . Pneumococcal disease still accounts for 10% of nosocomial pneumonias and 5-10% of nosocomial bacteremias . Antimicrobial therapy, although effective, has not eliminated mortality, particularly among older patients with one or more underlying diseases . Vaccination with pneumonococcal polysaccharide vaccine may reduce the morbidity and mortality associated with this infectious process . Several Pseudomonas vaccines have been evaluated, but none has proven both efficacious and non-toxic . Further development of a gram-negative vaccine, preferably one which protects against several types of bacteria, is required.

Agents Actions Suppl, 1980, 7, 33 - 40
Influence of indomethacin on various immunopharmacological effects of muramyl dipeptide (MDP); Parant M et al.; Muramyl dipeptide (MDP) is a low molecular (less than 500 daltons) synthetic analogue of a streptococcal peptidoglycan subunit . It was demonstrated to be the minimal structure essential for eliciting the adjuvant effect ascribed to Freund's complete adjuvant (FCA) . MDP was likewise shown to represent the minimal requirement for peptidoglycan-induced changes in temperature and it was at first concluded that there was an almost perfect correlation between pyrogenicity and adjuvant activity . However, other experiments showed that certain MDP derivatives were as adjuvant active without eliciting a febrile response in the rabbit . Moreover an anti-inflammatory substance such as indomethacin completely inhibits the pyrogenic effect of MDP but does not affect or even enhance various of its immunostimulant properties . Inhibition of MDP-induced fever is not associated with modification of leucopenia or production of circulating endogenous pyrogens observed after MDP injection . Indomethacin incubated with peritoneal macrophage cultures at a dose which blocks prostaglandin synthesis, does not decrease the production by MDP of endogenous pyrogens.

Folia Microbiol (Praha), 1980, 25(1), 40 - 9
Streptococcal extracellular NAD+ nucleosidase . Characterization of changes occurring during purification; Zahradnik FJ; Purification of streptococcal extracellular NAD+ nucleosidase is associated with changes of kinetic properties . A high-molecular weight component is required for a full activity of the enzyme . The component is not produced by bacteria and is present in the Todd-Hewitt cultivation medium, the beef-heart extract serving primarily as its source . In its effect on the enzyme this component can be replaced with bovine albumin . It follows from the time relationship of the NAD decomposition that the mechanism of the studied enzymic reaction is not hydrolytic . In addition to nicotinamide, a product of polymeric character is formed.

Acta Derm Venereol, 1980, 60(6), 485 - 90
Antideoxyribonuclease B titers in psoriasis; Quimby SR et al.; Psoriatic patients were examined for serologic evidence of streptococcal infections by using antideoxyribonuclease B (ADB), which has been shown to be a more sensitive screening tool than antistreptolysin O (ASO) for detecting such evidence in other clinical circumstances . Antistreptococcal antibody titers (ASO and ADB) of 71 patients with psoriasis vulgaris, 7 with guttate psoriasis, and 6 with erythrodermic psoriasis were compared with ASO and ADB antibody titers of 25 non-psoriatic dermatologic patients hospitalized at the same time and of an adult group that was used as a control for the test itself . Thirty-six of 71 patients with psoriasis vulgaris had elevated titers of ADB or ASO (41% vs . 15%) . Compared with control values the ADB titers were significantly higher in patients with psoriasis vulgaris (P less than 0.02) and patients with guttate psoriasis (P less than 0.05) . The ASO titers were significantly higher in patients with psoriasis vulgaris than in controls (P less than 0.04) . Within the group with psoriasis vulgaris, ADB titers were significantly higher than ASO titers (P less than 0.01) . Among patients with psoriasis vulgaris, histories of sudden flares of psoriasis and early recurrences of psoriasis after previous successful hospital treatment, family histories of psoriasis, and histories of potential streptococcal infections were more frequent in those with elevated antistreptococcal antibodies.

Anat Embryol (Berl), 1980, 160(3), 361 - 7
Alcian blue staining during the formation of mesoblast in the primitive streak stage chick blastoderm; Vanroelen C et al.; The distribution of alcian blue (AB) positivity, and its sensitivity to streptococcal and testicular hyaluronidase, were studied in primitive streak stage chick blastoderms . Accumulation of hyaluronate was observed in deep layer (DL) cells and on laterally migrating middle layer (ML) cells . During the formation of the middle layer, a first stage, namely de-epithelialization of the upper layer cells, is recognized and correlated with the absence of hyaluronate . A second stage, namely migration of the de-epithelialized upper layer cells laterally to the edge of the area pellucida, is correlated with the accumulation of AB-positivity . The AB-staining also demonstrated the accumulation of both sulphated and not-sulphated mucopolysaccharides, where a basal lamina is present.

Infection, 1980, 8(4), 132 - 41
Attachment of bacteria to mammalian surfaces; Sugarman B; Much attention has been devoted to the study of bacterial adherence to mammalian surfaces in vitro during the past several years . Some in vivo evidence also suggests that this process may indeed be an integral part of the pathogenesis of colonization and certain infections . The biochemical basis of attachment and definition of the actual receptor sites involved are just starting to become known and seem to be different amongst individual bacteria genera . However, pili may mediate attachment of a variety of gram-negative organisms to receptor cells, and streptococcal lipoteichoic acids probably serve a similar function . Some recent study methods and results in this field are reviewed.

Am J Obstet Gynecol, 1979 Dec 15, 135(8), 1062 - 5
Failure of penicillin to eradicate group B streptococcal colonization in the pregnant woman . A couple study; Gardner SE et al.; Prophylactic treatment of couples with oral penicillin has been recommended as a means of eradicating GBS from the parturient female . In 1977 and 1978 this hypothesis was tested in an investigation of couples from a middle and upper socioeconomic group in Houston, Texas . A group of 40 women, known to be colonized with GBS during the third trimester of pregnancy, and their husbands were treated simultaneously with oral penicillin . Patients were recultured 3 weeks following completion of therapy and at the time of delivery . At the time of delivery 67% of the women remained colonized with GBS . This percentage does not differ substantially from that obtained in a series of untreated colonized women . This study demonstrates that oral penicillin treatment of couples is not an effective means of reducing maternal colonization at the time of delivery.

Biull Eksp Biol Med, 1979 Dec, 88(12), 700 - 2
{Role of T- and B-lymphocytes in the heterogeneity of human cell-mediated reactions to bacterial antigens}; Novikov DK et al.; Leucocytes from 30 patients with allergy to tuberculin and bacterial antigens were treated with antithymus (ATS) and anti-immune globulin (AIGS) sera . The leucocyte migration inhibition test (LMIT) was performed with these antigens . ATS abolished the LMIT induced by tuberculin and sometimes by bacterial antigens (staphylococcal, streptococcal etc.) . AIGS frequently abolished the LMIT induced by bacterial antigens, but not by tuberculin . In some cases the treatment with any serum abolished the LMIT induced by the antigens, or, on the contrary, it was abolished only by a successive treatment with both sera . The lymphocyte types (T or B) determining the secondary immune response to the same antigen are different in various patients, as well as they differ in the same patients in relation to diverse antigens . Five types of lymphocyte - antigen interrelation in the LMIT have been distinguished.

J Clin Microbiol, 1979 Dec, 10(6), 805 - 14
Center for Disease Control Diagnostic Immunology Proficiency Testing Program results for 1978; Taylor RN et al.; Data from about 1,000 laboratories participating in the Diagnostic Immunology portion of the 1978 Center for Disease Control Proficiency Testing Program provided information dealing with laboratory performance and trends in testing protocols . Ninety specimens were distributed in scheduled quarterly and semiannual shipments, and five additional specimens were provided in a special survey . The specimens offered both qualitative and quantitative challenges for a wide variety of analytes which included syphilis serology, rheumatoid factor, bacterial agglutinins, hepatitis B surface antigen, immunoglobulins and other serum proteins, infectious mononucleosis, rubella, toxoplasma, antinuclear antibodies, and streptococcal exoenzymes . This paper summarizes the results of the 1978 program.

Acta Med Okayama, 1979 Dec, 33(6), 471 - 8
Immuno-chemotherapy of malignant lymphoma using OK-432, a streptococcal agent; Kimura I et al.; Clinical trials of immuno-chemotherapy were conducted on malignant lymphoma patients . Patients during the period from 1972 through 1977 were allocated to two groups retrospectively according to the mode of treatment, i.e., chemotherapy alone (historical control group, 35 patients) and chemotherapy with OK-432 (treated group, 15 patients) . Comparisons were made of the two groups, which were homogeneous with regard to induction chemotherapy, maintenance chemotherapy, stage and histologic type of disease . The treated group had a higher remission rate, and a longer remission duration and survival than the control groups, especially in patients with Hodgkin's disease but the difference was not statistically significant owing to the limited number of cases.

Infect Immun, 1979 Nov, 26(2), 779 - 82
Enhanced hydrogen peroxide release from macrophages stimulated with streptococcal preparation OK-432; Saito H et al.; Wheat germ lectin was found to be a potent triggering agent for hydrogen peroxide release from mouse peritoneal macrophages . Macrophages stimulated by intraperitoneal injection of OK-432, a lyophilized attenuated streptococcal preparation, were highly responsive to wheat germ lectin.

Ann Sclavo, 1979 Nov-Dec, 21(6), 816 - 22
{Co-agglutination as an alternative to precipitin testing in streptococcal grouping (author's transl)}; Visintin G et al.; Grouping of beta-hemolytic streptococcal strains was performed over a six months period on a total of 102 isolates . The purpose was to compare the Lancefield method with three different possibilities offered by the Co-agglutination technique . The results show that the Co-agglutination is as reliable as precipitin testing but it can be much more sensitive and rapid than any other method.

Rev Infect Dis, 1979 Nov-Dec, 1(6), 904 - 11
Antibodies to streptococcal carbohydrate: substitutes for the myeloma proteins; Krause RM et al.; Antibodies to streptococcal carbohydrates have been employed in a number of ways as substitutes for the myeloma proteins in studies of the structures of antibody molecules and the development of the immune response . This review concentrates on the chemical nature of the streptococcal polysaccharides and on structural studies of the variable regions of the light chains of rabbit anitbodies to the group A-variant polysaccharide produced by hyperimmunization . The chemistry of the group A-variant polysaccharide has now been clarified, and this information has explained the frequently reported difficulty in the preparation of precipitating antisera to this antigen . The group A-variant vaccine is a potent antigen, but the bulk of the antibody is nonprecipitating because it is directed against the noreducing terminal sugar of the nonbranched rhamnose polymer . Chemical studies of the light chains of homogeneous rabbit antibodies reveal two hypervariable regions and a J sequence that joins the variable region to the constant region . Although the precise topographic highlights of the antigen-binding site hae yet to be determined, these structural studies have extended our knowledge of the structure and diversity of antibody molecules.

Am J Dis Child, 1979 Nov, 133(11), 1146 - 8
Streptococcal pharyngitis therapy . A comparison of two erythromycin formulations; Derrick CW et al.; The recommended dosage of erythromycin, without regard to the formulation prescribed, for children with streptococcal pharyngitis is 30 to 40 mg/kg/day . We previously reported an acceptable streptococcal eradication rate among patients with pharyngitis treated with erythromycin estolate, 20 mg/kg/day . In this study, an extension of the earlier one, the efficacy of this same dosage of erythromycin estolate was compared with a 40 mg/kg/day dosage of erythromycin ethylsuccinate . Streptococcal eradication rates were nearly identical in the two groups of patients . The efficacy of erythromycin estolate at a dosage lower than that recommended for children is most likely explained on pharmacologic grounds: better absorption and higher levels in serum and tissue than those achieved with other erythromycin formulations . It seems rational to calculate required dosages of erythromycin on the basis of the formulation being administered.

Ann Intern Med, 1979 Nov, 91(5), 697 - 702
Asymptomatic glomerulonephritis after nonstreptococcal upper respiratory infections; Smith MC et al.; Two hundred forty previously healthy military personnel with nonstreptococcal upper respiratory infections were prospectively studied to define the incidence and clinicopathologic characteristics of possible virus-associated glomerulonephritis . Nine patients without preceding streptococcal infection had erythrocyte casts on urinalysis and glomerulonephritis on biopsy . Of these nine, four had a reduction in total hemolytic complement and five had serologic evidence of infection with adenovirus, influenza A, or influenza B . Initial renal biopsy showed either focal or diffuse mesangial proliferation in all nine, with mesangial C3 deposits in six specimens . Repeat biopsy in three showed histologic improvement or loss of immunofluorescent staining, or both . Sequential creatinine clearances were reduced to 74 to 90 mL/min.1.73 m2 in five patients for the duration of follow-up . We conclude that nonstreptococcal upper respiratory infection is frequently associated with glomerulonephritis and that abnormal glomerular structure and decreased creatinine clearances may persist for at least 2 to 8 months.

Infect Immun, 1979 Nov, 26(2), 467 - 72
Reinterpretation of the Dick test: role of group A streptococcal pyrogenic exotoxin; Schlievert PM et al.; Because of the association of the group A streptococcal pyrogenic exotoxins (SPEs) with erythrogenic toxin used in the classical Dick test, the involvement of the SPEs in production of erythematous skin reactions was assessed . Unless they had been presensitized, young adult rabbits failed to show skin reactions after intracutaneous challenged with SPEs . Rabbits presensitized to purified protein derivative exhibited enhanced skin reactivity when given purified protein derivative plus SPE C; the enhancement was neutralized by antiserum to SPE C . Rabbits sensitized to bovine serum albumin showed extensive red rash development resembling scarlet fever rashes when given bovine serum albumin containing SPE C . Desquamation occurred 5 to 10 days after injection . Animals sensitized to one SPE type showed enhanced skin reactivity to challenge with homologous or heterologous SPE types, indicating the presence of a cross-reactive determinant within the SPE molecules . Repeated challenge of SPE-sensitized animals with homologous toxin resulted in concomitant antitoxin production with reduction of the enhanced skin reactivities, until typical delayed-hypersensitivity skin reactions remained . The data indicate that, in addition to the toxic reaction previously described, SPEs enhance Arthus and delayed-hypersensitivity skin reactions . It follows that erythrogenic toxin represents the enhancement of acquired skin reactivity to streptococcal antigens by one or more SPE types . Therefore, the Dick test measures SPE-enhanced hypersensitivity to streptococcal products.

Infect Immun, 1979 Nov, 26(2), 585 - 9
Natural phosphorylation of group A streptococcal pyrogenic exotoxin type C; Schlievert PM et al.; Group A streptococcal pyrogenic exotoxin (SPE) type C, produced by strain T18P grown in the presence of 32P, was separated from culture supernatant fluids by using alcohol precipitation . The resulting toxin (EtOH-1) contained 3 X 10(6) to 5 X 10(6) cpm of 32P per milligram of protein . The radiolabel migrated with SPE C during isoelectric focusing in polyacrylamide gels (pI 6.7) and double immunodiffusion, in which the toxin formed a line of identity with highly purified SPE C when reacted with hyperimmune antisera raised against SPE C . The EtOH-1 radiolabeled toxin was pyrogenic and had the capacity to enhance host susceptibility to lethal endotoxin shock . EtOH-1 toxin lost both radiolabel and biological activity after being treated with alkaline phosphatase . The nonspecific lymphocyte mitogenicity of purified unlabeled SPE C was stimulated by adenosine monophosphate but not adenosine, adenosine diphosphate, or adenosine triphosphate . Adenosine monophosphate may function as a cofactor of SPE C and contribute the phosphate group required for biological activity.

Jpn J Exp Med, 1979 Oct, 49(5), 343 - 50
Effect of a streptococcal preparation on the complement system; Kato H et al.; Streptococcal preparation OK-432 (Picibanil), clinically being used as an immunopotentiator, has been shown to activate the complement system either through the classical or the alternative pathway in vitro {15} . In this experiment, OK-432 was found to increase serum complement level in guinea pigs, and in human without malignancy, when investigated by hemolytic assay using sensitized sheep erythrocytes (EA) for the classical pathway activity and unsensitized rabbit erythrocytes (RaE) for the alternative pathway activity . Assay of complement components revealed a significant increase in C3, but decrease in Clq, while no specific tendency was observed in C4, C5, C9, properdin, C3 activator and Cl-inhibitor . These evidences suggested that OK-432 might potentiate immune response of the host by elevating serum complement level, in addition to activate the complement system.

Gann, 1979 Oct, 70(5), 699 - 703
Correlation between lymphocyte responsiveness to mitogens and results of chemo-immunotherapy in patients with advanced cancer; Toge T et al.; The effect of chemo-immunotherapy on lymphocyte responsiveness to phytohemagglutinin (PHA) and pokeweed mitogen (PWM) was investigated in patients with advanced cancer . Patients received OK-432, a streptococcal preparation, intratumorally and additional systemic MFC (mitomycin-C, 5-fluorouracil, and cytosine arabinoside) chemotherapy intravenously . Patients with high lymphocyte responsiveness to mitogens at the beginning of treatment were more responsive to chemo-immunotherapy than those with low responsiveness . Furthermore, lymphocyte responsiveness to PHA was maintained at a high level throughout the treatment . In contrast, patients with initially depressed lymphocyte responsiveness maintained low responsiveness throughout the treatment . A significant increase of inhibitory activity of the serum was observed in patients with poor results of treatment . From these results, it seems reasonable to conclude that the response to chemo-immunotherapy might be predicted by in-vitro lymphocyte responsiveness.

Br J Obstet Gynaecol, 1979 Oct, 86(10), 819 - 22
Acute proliferative glomerulonephritis with crescents and renal failure in pregnancy successfully managed by intermittent haemodialysis . Case report; Naik RB et al.; A 26-year-old patient with no previous history of renal disease developed acute non-streptococcal crescentile glomerulonephritis with severe renal failure in the 17th week of her second pregnancy . It became necessary to treat her with haemodialysis to maintain the blood urea around 25 mmol/l . The haemoglobin was maintained above 9 g/dl with regular blood transfusion and the blood pressure was controlled with hypotensive drugs . Measurement of fetal biparietal diameter and human placental lactogen indicated normal fetal growth and placental function . The patient spontaneously delivered a healthy infant at 32 weeks . Haemodialysis requirements decreased post partum and the patient even managed without dialysis for 12 weeks . Renal function, however, remained severely impaired and maintenance haemodilysis was again necessary at nine months post partum . Glomerulonephritis complicating pregnancy is reviewed and the management of acute and chronic renal failure in pregnancy is discussed.

South Med J, 1979 Oct, 72(10), 1262 - 4
Incidence of sepsis in neonates with clinical respiratory distress; Dorand RD et al.; Respiratory distress is the most frequent symptom initiating referral to neonatal intensive care centers . Previous reports have indicated that 40% of infants with sepsis proved by blood culture had respiratory symptoms as their clinical presentation . In this prospective study there were 145 consecutive infants referred because of respiratory distress . Two-site blood cultures were collated with all other clinical and laboratory data to confirm a diagnosis of septicemia . There was a 4.8% incidence of bacteremia, and clinical and laboratory parameters confirmed septicemia in 3.5% of infants studied . Sixty percent of these infants had group B streptococcal sepsis, and 80% had leukopenia . The low incidence of confirmed septicemia in infants referred because of respiratory distress suggests that antibiotic therapy should not be routine.

J Urol, 1979 Oct, 122(4), 467 - 70
Immunological evaluation of a streptococcal preparation (OK-432) in treatment of bladder carcinoma; Kagawa S et al.; When 21 patients with bladder cancer (transitional cell carcinoma) were given local and systemic injections of a streptococcal preparation, OK-432, tumor regression was observed in 3 cases (14.3%) . The marked infiltration of lymphocytes observed on histological examination of regressed tumors suggested that a host-mediated action was involved in the antitumor effect of OK-432.

Isr J Med Sci, 1979 Oct, 15(10), 840 - 3
Staphylococcal lung abscess and acute glomerulonephritis; Danovitch GM et al.; A patient with a staphylococcal lung abscess developed acute glomerulonephritis with clinical and pathological features typical of postinfectious glomerulonephritis . There was no evidence of streptococcal infection and the nephritis resolved following treatment of the abscess.

Southeast Asian J Trop Med Public Health, 1979 Sep, 10(3), 338 - 41
Acute massive intravascular hemolysis and disseminated intravascular coagulation; Atichartakarn V et al.; Two cases of acute intravascular hemolysis complicating acute disseminated intravascular coagulation were presented, one after normal delivery and the other after group A beta hemolytic streptococcal septicemia complicating acute myelomonoblastic leukemia . Neither case received heparin therapy . The first one survived while the latter succumbed . Intravascular hemolysis may not be a bad prognostic sign in such a condition.

J Clin Microbiol, 1979 Sep, 10(3), 334 - 8
Quantitative assay of soluble beta-hemolytic streptococcal antigens via an immunochemical turbidimetric method with a spectrophotometer; Levinson SS; Soluble, group A, B, C, and G beta-hemolytic streptococcal antigens were successfully identified in a prototype spectrophotometric system by an immunochemical turbidimetric assay . Any spectrophotometic system which can take a zero reading followed by a second reading 2 or more min later can be used for the assay . Maximum absorbance was obtained near a wavelength of 340 nm . A wide range of linearity between antigen concentration and absorbance was observed at some antibody dilutions, resulting in a simple assay which can be used to quantitate amounts of antigen in solution . Minimal cross-reactions that present no problem in interpretation was observed . Simulated emergency samples were solubilized and assayed for group A and B bacteria within 3 h of colony recognition . Reproducibility of the absorbance resulting from the antibody-antigen reaction was great, with low coefficients of variation over a period of 50 days . The simplicity of the assay solutions, requiring only antisera and a buffer, and the accessibility to high levels of quality control are among the greatest assets of the technique to clinical laboratories.

Am J Dis Child, 1979 Sep, 133(9), 921 - 3
Group B streptococcal osteomyelitis and septic arthritis . Its occurrence in infants less than 2 months old; Memon IA et al.; Nine infants less than 2 months of age with group B streptococcal (GBS) osteomyelitis or septic arthritis, or both, were seen from January 1975 through January 1978 . The infants had local joint signs, usually in the absence of systemic signs . The bones and joints involved were equally distributed between proximal humerus and proximal and distal femur . An infant had involvement of the talus . Treatment consisted of two to three weeks of parenteral antibiotics, arthrotomy in infants with arthritis, and bone decompression in infants with osteomyelitis . Clinical follow-up showed normal growth and function of the affected joint . Of the organisms, five were typed: four were type III and one was type Ib . Group B streptococcal osteomyelitis and/or septic arthritis was the second most common late-onset GSB infection, being surpassed only by meningitis.

J Infect Dis, 1979 Sep, 140(3), 415 - 8
Occurrence of infection with group B coxsackievirus in rheumatic and nonrheumatic Filipino children; Limson BM et al.; The pathogenesis of rheumatic fever has been linked to various immune mechanisms involving streptococcal antibodies and heart tissue antigens . Latent myocarditis due to group B coxsackievirus has also been considered as a possible conditioning factor . The validity of the role of infection with group B coxsackievirus in rheumatic fever was tested by determining the incidence of type-specific neutralizing antibodies in sera of Filipino children . Analysis of the results by means of a normal Z-test showed that the incidence in rheumatic children was not statistically significant in comparison to the incidence in asymptomatic children.

Clin Exp Immunol, 1979 Aug, 37(2), 247 - 58
Predominance of immunoglobulin G sub-class 3 among the complement-fixing antibodies to streptococcal M-associated protein; Mortimer GE et al.; During investigation of the absorption of group-A streptococcal antibodies from human sera by a protein A-positive Staphylococcus aureus strain, we found that the complement-fixing antibodies to M-associated protein (MAP) were only partially absorbed from the majority of sera tested, although they were shown to belong to the immunoglobulin G (IgG) class by density gradient centrifugation . In contrast, other streptococcal antibodies: anti-streptolysin O (ASO), anti-deoxyribonuclease B (anti-DNAase B), 'bactericidal' M antibody and anti-opacity factor (anti-OF), were completely absorbed from all but a minority of sera . We suggest that the complement-fixing antibodies to MAP may be of restricted heterogeneity and have an abnormal IgG sub-class distribution, with a marked predominance of IgG3 (the only sub-class that does not interact with protein A) over the IgG1 and IgG2 sub-class; IgG4 does not participate in complement fixation . The concentration and relative porportions of IgG sub-classes are believed to be genetically influenced, so our findings may have some bearing on the immune responsiveness of different individuals to streptococcal infection, and possibly have important implications in the development of the secondary sequelae.

Chest, 1979 Aug, 76(2), 223 - 5
Development of aortic valvular vegetations during appropriate antibiotic therapy . Demonstration through serial echocardiograms; Assey ME et al.; The development of echocardiographically demonstrable vegetations on cardiac valves while the patient is receiving appropriate antibiotic therapy has not been previously reported . We report a case of alpha-hemolytic streptococcal endocarditis involving the aortic valve . Echocardiographically visualized vegetations were noted to occur on the 11th day of hospitalization . We discuss the role of serial echocardiograms in the management of patients with bacteremias and suspected endocarditis but absence of vegetations on the initial echocardiogram.

Immunobiology, 1979 Aug, 156(1-2), 41 - 7
Establishment of a human lymphoblastoid cell line with specific antibody production against group A streptococcal carbohydrate; Steinitz M et al.; A human lymphoblastoid cell line, secreting specific antibody against Group A carbohydrate (A-CHO) was established by pre-selection of antigen binding normal human lymphocytes, followed by Epsetin Barr virus (EBV) induced immortalization . Culture supernatants were assayed for anti A-CHO antibodies by radioimmunoassay, N-acetyl-glucosamine-coupled T4-phage plaque inhibition tests and passive hemagglutination . As a rule, the supernatants contained about 10 micrograms/ml anti-A-CHO antibodies of the IgM-kappa type . The antibody was fractionated and partially purified on an N-acetyl glucosamine Sepharose 4B column with a recovery of about 3 micrograms/ml of supernatant.

Clin Exp Immunol, 1979 Aug, 37(2), 239 - 46
Experimental immune glomerulonephritis induced in the rabbit with streptococcal vaccine; Bellon B et al.; Heavy C3 glomerular deposits were observed in rabbits injected intravenously with C5 streptococcal vaccine . Immunoglobulin deposits appeared later in a few rabbits . Although some data favour the presence of circulating immune complexes during the course of this glomerulonephritis, no evidence for their initiating role could be demonstrated . Streptococcal components are known to activate the alternative pathway of complement . It is suggested that complexes made of streptococcal components and activated C3 might deposit in glomerular tufts.

An Esp Pediatr, 1979 Aug-Sep, 12(8-9), 607 - 16
{Early onset group B streptococcal neonatal sepsis (author's transl)}; Omenaca F et al.; Seventy one per cent of neonates had a gestational age longer than 37 weeks . Sixteen showed respiratory distress, and shock occured in twelve cases . The onset of illness happened within the first 12 hours of life, in 15 cases . No differences were observed among preterm and term infants . Differential leukocyte count were altered in all infants, being particularly relevant the fact that the relation between immature neutrophil/total neutrophil, was elevated in 50 per cent of cases . Mortality rate was 52 per cent . Clinical alert and early treatment with penicillin, together with the use of fresh blood exchange transfusion, can be considered useful methods in the treatment of these cases.

Am J Clin Pathol, 1979 Aug, 72(2), 218 - 21
Comparison of two slide tests for detection of group A streptococcal antibodies; Tolliver PR et al.; Screening sera for streptococcal antibodies is a useful clinical procedure when recent streptococcal infection requires verification . Presently there are two test kits available that detect five (or more) of the antibodies that may be present . These two screening tests were compared using antistreptolysin O (ASO) and antideoxyribonuclease B (ADB) titers as the reference for true streptococcal infection . All four procedures were performed on 69 sera collected from a pediatric population . Both screening tests were found to be sensitive, specific, economical, and easy to perform; however, both were more sensitive to elevated ASO titers than to elevated ADB titers . In certain clinical situations, therefore, antibody titrations may be necessary to document completely recent streptococcal infection.

J Pediatr, 1979 Aug, 95(2), 202 - 5
Rapid diagnosis of type III group B streptococcal meningitis by latex particle agglutination; Edwards MS et al.; A latex particle agglutination assay was developed to detect type III group B streptococcal antigen in cerebrospinal fluid . Agglutination was observed in each of 12 initial and 54% of 26 subsequent CSF specimens obtained a mean of 53 hours after the institution of antimicrobial therapy . Latex agglutination was more sensitive than countercurrent immunoelectrophoresis for the detection of type III group B streptococcal antigen in CSF from neonates and young infants with meningitis.

Immunobiology, 1979 Aug, 156(1-2), 35 - 40
Light chain heterogeneity of type lambda anti-streptococcal group A-variant polysaccharide antibodies in rabbits; Weiss S et al.; BASILEA rabbits lack the expression of chi-polypeptide chains and compensate for this lack with expression of lambda polypeptide light chains . These rabbits were immunized with streptococcal group A-variant vaccines . The heterogeneity of the lambda polypeptide chains of specific antibodies was analyzed and compared with that of chi light chains . No significant difference was found by SDS-PAGE and IEF in the number of light chain bands of high affinity antibody expressed . This suggests that in the rabbit the size of the variable region repertoire is similar for lambda and chi light chains.

N Z Med J, 1979 Jul 25, 90(640), 55 - 7
Sequential complement changes after childhood acute nephritis; Hammond N et al.; A group of 29 children with acute nephritis have been studied in relation to complement changes during and after their illness . Eighty-two percent had evidence of a streptococcal aetiology . C3 levels were initially depressed in 96.5 percent, but by 12 months all children were normal clinically and had normal complement status . The role of complement is discussed in relation to acute nephritis.

Rev Ig Bacteriol Virusol Parazitol Epidemiol Pneumoftiziol Bacteriol Virusol Parazitol Epidemiol, 1979 Jul-Sep, 24(3), 173 - 80
{Diagnosis of primary chronic rheumatic carditis in adults}; Radivoievici A et al.; The authors maintain that in some cases one can note the so-called primar chronic rheumatic carditis, or apparently primary rheumatic carditis . Streptococcal infections can be held responsible for the eventuality of a sub-clinical evolution of rheumatism, and there which develops as a clinical form of latent rheumatism, and there is the possibility of ulterior development of valvular cardiopathy without a clear history of acute rheumatic fever in the antecedents . One of the groups subjects with maximal exposure to repeated streptococcic infection is represented by the teaching personnel working permanently in school or pre-school children collectivities or with teen-agers, which are both carriers and disseminators of the rheumatogenic streptococcal infection . Of a total of 50 cases of apparently primary chronic valvular cardiopathies that have been followed by the ASCAR personnel, 48 had tonsillary infections in their antecedents, 8 had arthralgia and 4 cases were detected by chance . In school collectivities at high risk prophylaxis with penicillin should be mandatory, both for the students and for the teaching personnel.

Rev Ig Bacteriol Virusol Parazitol Epidemiol Pneumoftiziol Bacteriol Virusol Parazitol Epidemiol, 1979 Jul-Sep, 24(3), 167 - 72
{Streptococcal infections in adults}; Elias A et al.; The paper presents the morbidity through streptococcal angina, acute rheumatic fever and acute glomerulonephritis in two industrial enterprises with different working conditions . This study was performed between 1968 and 1977 . In enterprise A, where rheumatogenic conditions were present, streptococcal angina had an yearly attacks vaeried between 0,13 and 0,7 percent, and acute glomerulonephritis between 2,3 and 5,4 percent . In enterprise B, with usual working conditions, angina showed an yearly variation between 2,3 and 5,8 percent, acute rheumatic fever varied between 0,0 and 0,84 percent and there were no cases of acute glomerulonephritis . In two units (collectivities of students) where angina was detected by active methods and prophylactic measures were applied rigurously no post-streptococcal complications were recorded . The authors stress the effects of morbidity through streptococcal infections in adults and recommend an extension of targeted prophylactic programs in high-risk units.

Rev Ig Bacteriol Virusol Parazitol Epidemiol Pneumoftiziol Bacteriol Virusol Parazitol Epidemiol, 1979 Jul-Sep, 24(3), 141 - 51
{Prevention of streptococcal infections and post-streptococcal complications}; Elias A; Starting from the particularities of the streptococcal infections, and the possibilities for fighting acute forms and the immediate and late complications, multiple aspects are discussed that should be implied by the prophylaxis of this infection in the present stage . Aspects of primary prophylaxis are treated separately, that are related to the limiting of the circulation of the etiologic agent, especially in view of preventing the epidemic forms of the disease . Also aspects of secondary prophylaxis are discussed, aimed at preventing streptococcal re-infections in subjects in whom complications such as rheumatic fever or acute glomerulonephritis have occured . "Primary prophylaxis" represents the key to the limitation of the streptococcal infection on the one hand, and of the transformation of acute articular rheumatic fever, of rheumatic carditis and of acute glomerulonephritis in "rarely encountered" diseases, on the other.

Rev Ig Bacteriol Virusol Parazitol Epidemiol Pneumoftiziol Bacteriol Virusol Parazitol Epidemiol, 1979 Jul-Sep, 24(3), 129 - 40
{Current status and prospects in the diagnosis and epidemiology of streptococcal infections}; Mihalcu F; In the first part of the paper the author stresses the importance, and the necessity of laboratory investigation of streptococcal infections, in view of the establishment of the clinical and of the etiologic diagnosis, for assessing the efficiency of the treatment applied, for monitoring the recovery of patients, as well as of chronic patients, and for the prevention, and detection of late complications . The complex methodology of laboratory methods of diagnosis in streptococcal infections is presented, stressing the use, and the efficiency of micromethods and of rapid techniques for diagnosis . In the second part of the paper are presented a series of data concerning the epidemiology of streptococcal infecstions in our country, as well as in other countries, with reference to various forms of the acute disease, and of late complications, stressing some particular aspects of the streptococcal infection . Morbidity indexes are presented, as well as death rates for scarlet fever, acute rheumatic fever and rheumatic cardiopathies, as well as the incidence of different serologic groups of the haemolytic type, and the fluctuation of group A serotypes, which have been prevalent over the last years in our country . In view of lowering the morbidity the author recommends an extensive surveillance, organized along the lines of a primary prophylaxis program, as well as of a secondary program of streptococcal infections in high-risk collectivities.

Clin Exp Immunol, 1979 Jul, 37(1), 98 - 105
Studies on the immunopotentiating effects of a streptococcal preparation, OK-432 . I . Enhancement of T cell-mediated immune responses of mice; Kai S et al.; The effects of the anti-tumour agent OK-432 on the immune response to hamster erythrocytes (HRBC) and nucleated chicken erythrocytes (CRBC) were studied in inbred SL mice . Mice were treated repeatedly with OK-432 before immunization with erythrocytes in saline . The cytotoxicity of CRBC-primed spleen cells, as demonstrated by 51Cr release from labelled CRBC, was markedly increased by treatment with OD-432 . The delayed footpad reaction to CRBC was significantly augmented by treatment with OK-432 . These results in mice indicate that OK-432 can enhance the cellular immune responses which require the contribution of T cells . Such an activation of T cells by OK-432 was observed in the humoral immune response to a trinitrophenyl group . Augmentation of anti-hapten antibody production, suggesting the enhancement of helper T cell activity by OK-432, was noticed after immunization with trinitrophenyl conjugated to erythrocytes . Furthermore, this enhancement of helper T cell activity by OK-432 was confirmed by utilizing an adoptive transfer system . These results support the possibility that T cell activation may be one of the important effects of OK-432 as an immunopotentiator.

Ann Rheum Dis, 1979 Jun, 38(3), 232 - 6
Myelotoxicity of D-penicillamine; Kay AG; Information has been collected on 10 patients, 9 with marrow depression and 1 in whom the diagnosis was presumed . Six of the 10 patients died . The sequentially recorded blood counts on at least 5 of the patients showed a downward trend of the white cell and platelet counts while D-penicillamine was still being administered . One patient suddenly developed leucopenia and thrombocytopenia with a streptococcal septicaemia.

Ann Rheum Dis, 1979 Jun, 38(3), 257 - 61
Acute poststreptococcal glomerulonephritis in Maracaibo . II: Studies on the incidence, nature, and significance of circulating anti-immunoglobulins; McIntosh RM et al.; Antiglobulins were measured in the sera of 82 patients with acute poststreptococcal glomerulonephritis and correlated with C1q binding activity, serum levels of immunoglobulins and C3, site of infection, antibody titres to streptococcal enzymes, and the duration of the nephritis and interval from infection . Raised serum antiglobulins were found in 89.2% of the patients . In addition, raised titres were detected at any time during the course of the disease and very early after streptococcal infection . The finding of antiglobulins soon after the infection suggests the possibility that they appear as a primary event in the disease.

Medicine (Baltimore), 1979 May, 58(3), 219 - 28
Membranous glomerulonephritis with extra-renal disorders in children; Kleinknecht C et al.; Thirty of 85 children with membranous glomerulonephritis (MGN) had associated extraglomerular disorders . The relation of these associations to membranous glomerulonephritis (MGN) is discussed . The causal relationship of acute hepatitis (5 cases), persistent hepatitis B antigenemia (6 cases), systemic lupus erythematosus (2 cases) and syphilis (1 case) may be ascertained; in similar conditions a definite antigen (Ag) has been found in MGN deposits . The association with SS or SA hemoglobinopathy (3 cases) ans with a preceding streptococcal infection (4 cases) raises the possible responsibility of renal tubular epithelium (RTE) Ag and of a streptococcal Ag . D-penicillamine therapy (1 case) is a well-known cause of MGN although the acting Ag remains unknown . Four children had serum sickness-like symptoms, two had hematologic disorders and two had proximal tubular dysfunction, one of them with proven anti-tubular and anti-alveolar basement membrane antibodies . A decrease in plasma C4, Clq, and factor B with normal C3 was frequently observed . The multiple Ag previously described as causative of MGN are recalled . The prevalent incidence of HBsAg is stressed, and the necessity for further investigations in patients with MGN in order to find an underlying disease is emphasized.

Acta Paediatr Scand, 1979 May, 68(3), 337 - 9
Neonatal septicemia and perinatal risk factors; Bergqvist G et al.; Many methods for screening and prediction of neonatal septicemia have been tried . In this study a score, related to both perinatal risk factors and neonatal diseases, was tested upon healthy newborn infants, infants with septicemia and infants with other diseases . Statistical differences were found between infants with neonatal septicemia and infants with other neonatal diseases as well as normal newborns . It was also possible to find a relationship between certain predisposing factors and predominance of certain pathogens . Complications during pregnancy and delivery were most often found in the group B streptococcal, combinations of invasive procedures and neonatal diseases in the staphylococcal group and surgical procedures in the gram-negative group.

Klin Padiatr, 1979 May, 191(3), 305 - 10
{Radiologic findings in newborns with group B streptococcal septicemia: clinical importance of heart size and lung manifestations (author's transl)}; Roos R et al.; Chest radiographs of thirteen neonates with group B streptococcal septicemia were evaluated for signs of early diagnosis . Six of the neonates had chest radiographs as seen in idiopathic respiratory distress syndrome (RDS) . Seven patients had radiologic findings consistent with neonatal pneumonia . The children with RDS were in general smaller and born prematurelly, but three neonates with x-rays resembling RDS had normal birth weights and thus were mature . Cardiomegaly was observed in a high percentage with a prevalence in children with RDS . Heart size increased in two of the three children who died, but became normal in patients recovering from infection . Three patients had pleural effusions.

Eur J Immunol, 1979 May, 9(5), 379 - 84
Rabbit allotype a locus subspecificities of homogeneous anti-streptococcal antibodies; Rodkey LS et al.; Rabbits were immunized with group A-variant (Av) streptococcal vaccine to elicit antisera containing antibodies of "restricted heterogeneity" specific for Av polysaccharide . Antibodies that migrated as single bands in polyacrylamide gel isoelectric focusing were isolated on agarose block electrophoresis and preparative isoelectric focusing . These homogeneous antibodies were analyzed for content of the a locus markers by inhibition of allotype-anti-allotype radioimmunoassays . Both single-band preparations and preparations containing 2--5 bands were deficient in content of the a locus markers . These analyses were strongly influenced by the different anti-allotype antisera used . Single-band preparations, deficient in a 2 or a 3 markers, were further used to produce anti-allotype antisera, and these sera were assayed for reaction with pooled a2 or a3 molecules . The results, in contrast to the a1 allotype, failed to demonstrate common determinants on either a 2 or a 3 molecules indicating that each a allotype consists of a set of different Ig molecules . The data suggest different evolutionary pathways of the a 1, as opposed to the a 2 and a 3 molecules.

Hoppe Seylers Z Physiol Chem, 1979 May, 360(5), 663 - 7
Amino acid sequences of antibody light chain variable regions of pedigreed rabbits: kappa light chain K49-501 (allotype b4 anti-streptococcal group A-variant polysaccharide antibody); Braun DG et al.; The amino acid sequence of positions 1--150 of a light chain, isolated from another monoclonal rabbit anti-streptococcal group A-variant polysaccharide antibody, was determined . The analysis was performed with 2 mumol of polypeptide chain, using a grossly modified Beckman 890B sequenator . This sequence stretch accounts for the whole variable region and a considerable part of the constant region at a total length of 218 amino acids . This allotype b4 light chain was isolated from a non-precipitating, end-group-specific antibody with a KD = 1.3 X 10(-5)M . This brings the present number of totally known rabbit VL sequences of antigen elicited antibodies to 21 . A comparison of these 21 sequences reveals a building plan of ribbit VL homologous to that of human and murine VL regions . The observed variability does follow a pattern of linked amino acid substitutions, indicating that this information must be contained in the germ-line of the rabbit in the form of multiple VL region genes . This conclusion, however, does not rule out the occasional variant being due to somatic rearrangement . Finally, this comparison reveals that the joining peptide between positions 96--110 is also a separate entity in rabbit VL region sequences.

JAMA, 1979 Apr 27, 241(17), 1807 - 10
Streptococcal endocarditis (nonenterococcal, non-group A): single vs combination therapy; Malacoff RF et al.; A 14-year experience with streptococcal endocarditis was reviewed . The effect of single vs combination antibiotic therapy on the relapse rate was found to be comparable . Of 68 patients treated, four patients died during therapy . Two of 46 patients receiving single-agent and none of 18 patients receiving combination therapy experienced a relapse . Duration of symptoms before diagnosis was the main risk factor predisposing to relapse, which occurred in two of 13 patients with symptoms for longer than three months and in none of 51 patients with symptoms for three months or less before diagnosis . Combination therapy offered no advantage over a single agent in the latter group . Optimal therapy for patients with symptoms for longer than three months could not be determined in this study . However, no relapses were observed in this high-risk group when a single agent was given for longer than 21 days.

JAMA, 1979 Apr 13, 241(15), 1589 - 94
Prophylaxis of streptococcal infections and rheumatic fever: a comparison of orally administered clindamycin and penicillin; Massell BF; Orally administered clindamycin and penicillin were compared for effectiveness in preventing streptococcal infections in 202 randomly assigned patients with previous rheumatic fever (RF) . Among 143 patients aged 21 years or younger observed for 537 patient-years, the number of streptococcal infections (and number per patient-year) was 23 (0.084) in the penicillin group and 12 (0.045) in the clindamycin group . Excluding uncooperative patients, the rate of streptococcal infection remained less, though not statistically significant, in the clindamycin group than in the penicillin group . Two RF recurrences occurred in the penicillin group, and no recurrence occurred in the clindamycin group . Clindamycin was well tolerated except for possible mild gastrointestinal symptoms in six patients . Clindamycin can be substituted for penicillin for RF prophylaxis when there is allergy to penicillin or concern about the development of penicillin-resistant mouth organisms.

Br J Vener Dis, 1979 Apr, 55(2), 118 - 20
Group B streptococcal infection: a review and update; Knox JM; The problems posed by the sudden increase in serious group B streptococcal disease among infants since the early 1970s are described and discussed . Virtually all offspring of colonised mothers harbour the organism and infection develops in about 1% of these infants . The mortality rate, even with immediate antibiotic treatment of early onset disease, is 30%; delay in treatment leads to much higher mortality . Late onset disease starting around the seventh to ninth day of life, but sometimes as late as the second month, is less frequently fatal . Preventive measures include active and passive immunisation or intravenous ampicillin during labour . Experimental evidence indicates that each of these methods gives protection.

Pediatrics, 1979 Apr, 63(4), 557 - 61
Immunofluorescence in group B streptococcal infection and idiopathic respiratory distress syndrome; Pinnas JL et al.; Immunofluorescence was performed on lung tissue obtained at necropsy from 18 newborn infants, including five with group B streptococcal (GBS) sepsis, seven with idiopathic respiratory distress syndrome (IRDS), and six control infants who died from other causes . Deposits of C3, IgG, and fibrin were found within hyaline membranes of infants who died with GBS sepsis or IRDS within 48 hours after birth . In some cases C4, factor B, and IgM were also observed . In five infants with IRDS who died more than five days after birth, immunofluorescent lung findings were less common and less intense . Hyaline membranes, attributed to mechanical ventilators and oxygen therapy in two infants who did not have GBS infection or IRDS, were negative for complement and immunoglobulins although fibrin was detected in one specimen . These data suggest that immunologic processes may contribute to the pathogenesis of certain types of acute lung injury, particularly in infants who die from GBS infection or IRDS during the early neonatal period.

J Exp Med, 1979 Apr 1, 149(4), 923 - 37
Distinct functions of monoclonal IgG antibody depend on antigen-site specificities; Schalch W et al.; Intraveneous hyperimmunization of selectivity bred rabbits with streptococcal group A-variant vaccines elicits antibody responses of restricted heterogeneity at high antibody levels . All antisera contain two functionally distinct antibody populations, which can be isolated in single-band purity upon analytical isoelectric focusing . Typical examples of these two kinds of single-band antibodies were investigated in great detail for several parameters by a variety of methods . 85--99% of the streptococcal group A-variant polysaccharide (Av-CHO)-specific antibody in the antisera does not precipitate the isolated 5,000 daltons poly-L-rhamnose antigen, neither agglutinates nor lyses in the presence of complement Av-CHO-coated sheep erythrocytes (SRBC), binds the radio-labeled Av-CHO with an association constant in the ragne of 10(5)--10(6) M-1, and is of terminal specificity (nonreducing end) for the linear Av-CHO . In contrast, the minor fraction of Av-CHO-specific antibody (1--15%) does precipitate the linear Av-CHO, both agglutinates and lyses Av-CHO-coated SRBC in the presence of complement, has an affinity range of 10(8)--10(9) M-1, and is of internal specificity for the Av-CHO . The antigenic determinants of the Av-CHO for the antibodies are nonoverlapping, only one Fab of the low affinity antibody can be bound whereas four Fab of the high affinity antibody are accommodated . Hence, the determinant specificity explains the functional differences observed, for there is no indication of subclass differences . A mechanistic model of the A-variant carbohydrate presentation on the vaccine appears to account best for the unbalanced levels of low and high affinity antibody.

Hautarzt, 1979 Mar, 30(3), 144 - 8
{Acute generalized pustular bacterid: a variety of pustular Andrew's bacterid}; Ishikawa H et al.; Eight cases of acute pustular bacterid preceded by angina of beta-streptococcal origin are summarized . Although this disease appears to be an acute type of pustular bacterid Andrews, the elevated antistreptolysin titers and the histological features of vasculitis with perivascular deposits of C3 and IgM seem to be remarkable findings . One of the patients' skin symptoms were complicated by a glomerulonephritis . The skin lesions improved rapidly after systemic administration of glucocorticosteroids.

Acta Paediatr Scand, 1979 Mar, 68(2), 173 - 80
Renal functional changes in acute glomerulonephritis in children . A one-year follow-up; Aperia A et al.; Renal function was studied in three patients with post-streptococcal, four patients with IgA and one patient with non-streptococcal proliferative glomerulonephritis (GN) at the onset of the disease and two, six and 12 months later . Renal biopsies were performed at the onset of the disease and 12 months later . Standard clearance techniques were used for the functional studies . The latter were performed during hydropenia and continuous isotonic saline infusion . During hydropenia, the GFR was uniformly depressed shortly after the onset of the disease, but it normalized during the following two months . The filtration fraction was depressed in poststreptococcal GN at the onset and it normalized with the GFR . In IgA GN, the filtration fraction remained within normal limits during the entire course of the illness . The natriuretic response to isotonic saline volume expansion was low in all patients at the onset of the disease, but normalized in post-streptococcal and IgA GN during the one-year follow-up . In spite of normalized renal function, biopsy findings in IgA GN were unchanged 12 months later . An episode of macroscopic hematuria in one patient with IgA GN at the six-month investigation had no apparent effect on renal function.

Antibiotiki, 1979 Mar, 24(3), 202 - 7
{Plasmid-determined streptococcal resistance to antibiotics}; Totolian AA et al.; The analysis of the genetic organization of the determinant ERLI by means of obtaining and studying the antibiotic sensitive mutants from the strain resistant to erythromycin and lincomycin provided experiment data in favour of the fact that inducable resistance to erythromycin and lincomycin determined by the plasmid might be defined by the same or closely linked genes.

Prim Care, 1979 Mar, 6(1), 3 - 12
Use of antibiotics in the outpatient setting; Levin S et al.; Antibiotics with small but definable mortality, such as chloramphenicol, should not be used when safer drugs will suffice . Antibiotics with a low (1 to 5 per cent) morbidity should not be used when safer drugs are available . Therefore, cleocin, minocycline, or oral erythromycin estolate should rarely be used and regular erythromycin base is almost always preferable . Fever should not be treated with antibiotics since they are not antipyretics . "Colds" should not be treated with antibiotics, but antibiotics should be administered to patients with a history of chronic bronchitis, sinusitis, and recurrent otitis as soon as any symptoms begin . Intramuscular antibiotics should not be given except for benzathine penicillin . Use placebos instead of antibiotics when the patient's psyche demands an intramuscular injection . Make certain that the needle, syringe, and solution are sterile . Agents other than penicillin or cephalosporins should be used in patients with a definite history of penicillin allergy . Combination antibiotics or broad spectrum antibiotics like cephelosporins or tetracyclines should not be used when narrow spectrum antibiotics of known efficacy are available for specific syndromes such as streptococcal pharyngitis.

Eur J Immunol, 1979 Mar, 9(3), 243 - 50
Induction and characterization of isogeneic anti-idiotypic antibodies to BALB/c myeloma S117: lack of reactivity with major idiotypic determinants; Seppala IJ et al.; Isogeneic anti-idiotypic antibodies were induced by immunization of BALB/c mice with the BALB/c-derived myeloma protein S117 which binds N-acetylglucosamine-containing antigens including Group A streptococcal carbohydrate (A-CHO) . Most BALB/c mice produced anti-S 117 idiotypic antibodies, as shown by various different immunization protocols . The antibodies of individual mice were of intermediate to high affinity (2.8 x 10(6) M-1 to 1.4 x 10(8) M-1) . In isoelectric focusing, most individual antibodies were shown to consist of a small number of clonotypes, but each mouse produced its own unique set of clones so that the potential clonal repertoire of strain BALB/c is rather large . Most importantly, all isogeneic anti-idiotypic antibodies were directed against idiotypic determinants of S117 that are not shared with induced anti-A-CHO antibodies, whereas it has been shown previously that allogeneic and xenogeneic anti-S 117 idiotypic antibodies react with idiotypic determinants unique to S 117 as well as with those that are shared with anti-A-CHO antibodies . The data suggest that the expression of S 117 idiotypic determinants in strain BALB/c is not under antibody-mediated, anti-idiotypic feedback control.

Obstet Gynecol, 1979 Mar, 53(3 Suppl), 13S - 15S
Intramembranous localization of bacteria in beta-hemolytic group B streptococcal chorioamnionitis; Vigorita VJ et al.; An unusual pathologic finding consisting of large colonies of bacteria, localized immediately beneath the epithelial layer of the amnion, has been observed in association with an example of group B beta-hemolytic streptococcal chorioamnionitis . Postpartum endometritis as well as neonatal sepsis and meningitis occurred . Histologic examination of the umbilical cord and placenta revealed routine features of intraamniotic inflammation, but the membranes were characterized by the presence of unusual darkly staining deposits of material immediately beneath the amniotic epithelium . Subsequent special stains revealed these to be colonies of gram-positive cocci . We have been unable to find a previous description of this observation in association with streptococcal or with other types of chorioamnionitis.

Monatsschr Kinderheilkd, 1979 Feb, 127(2), 64 - 7
{Hypertensive emergencies in children with renal hypertension (author's transl)}; Bachmann HJ et al.; Hypertensive emergencies of 10 children with renal hypertension were analysed . Cause of renal disease are chronic renal failure in three, acute renal failure in three, hemolytic uremic syndrome in two, acute post streptococcal glomerulonephritis in one, and renal arterial stenosis in a further patient . Therapy should be started early in the course of the hypertensive emergency, first symptoms are headache and vomiting . Drug of first choice is diazoxide (3-5-(8)mg/kg i.v.) . Three patients developed transitory hyperglycemia after repeated injections of diazoxide.

J Clin Microbiol, 1979 Feb, 9(2), 167 - 9
Evaluation of colistin and nalidixic acid in Todd-Hewitt broth for selective isolation of group B streptocci; Fenton LJ et al.; Todd-Hewitt broth (THB) containing colistin and nalidixic acid was compared with four other media with respect to efficacy of isolation of group B streptocci . It was effective as plain THB, THB with gentamicin and nalidixic acid and blood, and THB with colistin, nalidixic acid, and blood . THB with gentamicin and nalidixic acid, but without blood, was inhibitory to group B streptocci . The value of THB with colistin and nalidixic acid lies in its ability to successfully inhibit gram-negative organisms and still promote group B streptococcal growth without the addition of blood . This greatly reduces the time and expense of media preparation and permits early determination of bacterial growth, so that other means of rapidly identifying group B streptocci can be applied at the earliest possible time.

Acta Pathol Microbiol Scand {C}, 1979 Feb, 87C(1), 37 - 40
Precipitation of streptococcal peptidoglycan by human sera: influence of anti-immunoglobulins; Schalen C et al.; Antibodies to streptococcal peptidoglycan (PG) were detected by gel-precipitation in 38% of sera from blood donors and in 71% of sera with a Waaler-Rose test titre of greater than or equal to 1:64 . Twenty-six rheumatoid arthritis sera revealed patterns of interference with complete or partial fusion between PG and aggregated human IgG while none of the sera precipitating both these preparations showed non-interference . The reactions were interpreted as denoting interference between the PG-antibody complexes and aggregated IgG . Conversion of some non-precipitating blood donor sera to PG precipitation was obtained by addition of isolated rheumatoid factor, in itself not precipitating PG, to the sera . Thus, the high frequency of PG precipitation among rheumatoid arthritis sera could--at least in part--be attributed to the participation of anti-IgG in the reaction.

Eur J Immunol, 1979 Feb, 9(2), 145 - 9
Clonal dominance of low-affinity antibodies in rabbit hyperimmune anti-streptococcal group A-variant polysaccharide antisera; Schalch W et al.; Intraveneous hyperimmunization of selectively bred rabbits with streptococcal group A-variant vaccines elicits antibody responses of restricted heterogeneity at high antibody levels . In these antisera, IgG with dissociation constants Kd = 10(-6) M constitutes 90% and IgG with Kp = 10(-9) M accounts for only 10% of the group A-variant polysaccharide-specific antibodies . The low affinity antibody fraction represents the dominant clonotypes . Preparative isoelectric focusing in granulated (Ultrodex G-75) gels was used to successfully purify single-band material belonging to dominant spectrotypes . Affinity studies with these antibody fractions with the highest reported degree of purity yielded Kd = 10(-6) M values, thus confirming that clonal dominance is exclusively associated with low-affinity antibodies . Since it is known from previous work (M . Cramer and D . G . Braun, Scand . J . Immunol . 1975 . 4:63) and from the rabbit antisera used here that clonal dominance of this sort is long-lived, this work fails to support the argument of immune maturation . The data more logically relate to antibodies that emerge with different subspecificities -- recognized in the antigen as a function of time in immunization procedures -- rather than to an inherent property of the immune system.

Postgrad Med J, 1979, 55 Suppl 4, 35 - 8
Cefaclor in the treatment of susceptible infections in infants and children; Rodriguez WJ et al.; Cefaclor is a new oral cephalosporin with in vitro activity against a wide variety of organisms including S . aureus, S . pneumoniae, S . pyogenes and H . influenzae (including ampicillin-resistant strains) . Seventy-nine patients ranging in age from 2 months to 14 years with soft tissue infections (17 cases), otitis media (17), and streptococcal pharyngitis (45) were studied . They received cefaclor orally at a dose of 40 mg/kg per day in three or four divided doses for a minimum of five days . Results were generally good with favourable clinical and bacteriological responses obtained in 90% of cases . Most patients became afebrile within 48 hours after starting cefaclor . Two patients with H . influenzae cellulitis and bacteraemia defervesced within 24 hours and their blood cultures became negative promptly . Hepatic, renal and haematopoietic studies showed no adverse reactions except for an occasional increase in the eosinophil count with no clinical counterpart of hypersensitivity . Pharmacokinetic studies revealed that following a 10 mg/kg oral dose, peak serum levels of 8 micrograms/ml were observed at one hour, followed by a rather rapid tapering off so that at the end of four hours, virtually no cefaclor was detectable in serum.

J Surg Oncol, 1979, 12(3), 275 - 9
Effect of immunochemotherapy on lymphocyte response of patients with gastrointestinal cancer; Mashiba H et al.; Patients with gastrointestinal cancer were treated with 5-fluorouracil (5-FU) in combination with a streptococcal preparation, OK-432, or without OK-432 before operation, and lymphocyte response to PHA was examined . Oral administration of 5-FU with or without intramuscular injection of OK-432 did not affect the response . However, treatment with cytostatic drugs in combination with OK-432 markedly augmented the lymphocyte response to PHA, but the cytotoxic activity of lymphocytes was not elevated.

Ann Med Interne (Paris), 1979, 130(6-7), 359 - 64
{Sydenham's chorea in Tunisia: a report on 65 cases (author's transl)}; Ben Hamida M et al.; Sydenham's chorea was observed in 65 patients in Tunisia during the period 1971-1976 . The average age of onset was 10.8 years, and girls were affected twice as often as boys . Sydenham's chorea is a seasonal disorder; it usually develops between the months of november and march, and its frequency is closely related to that of Bouillaud's disease . A study of the past history of infections disease or rheumatic disorder (ARF), and biological tests for inflammation (sedimentation rate, blood fibrin levels, antistreptolysins O, and culture of throat swabs), showed that it is possible to distinguish cases of true chorea occurring alone from those in which it is associated with a rheumatic affection . These facts are discussed in the light of the data published in the literature . The authors conclude that sydenham's chorea and acute rheumatic fever are but two unrelated expressions of a streptococcal infection . Anti-inlammatory treatment with corticoids, therefore, is only indicated in the presence of signs of rheumatic affection.

Q J Med, 1979 Jan, 48(189), 99 - 111
Acute post-streptococcal glomerulonephritis in adults: a long-term study; Lien JW et al.; The long-term outcome after acute post-streptococcal glomerulonephritis was studied in 57 patients (52 aged 16 or over) followed for a period of one to 14 years (mean seven years) . All patients presented with hypertension, haematuria and proteinuria . The antistreptolysin-0 titre was raised or the serum complement was low in all cases at the initial episode . All patients had histological evidence of a diffuse proliferative and exudative glomerulonephritis at onset . Follow-up renal biopsy was performed in 33 patients; in 18 patients this was carried out five years or more after the initial illness . Five patients died beyond two years, only two having had abnormal renal function at the time or death . Four patients were found to be mildly hypertensive without other clinical abnormalities . Eleven patients had proteinuria, haematuria or abnormal renal function; in three of these repeat renal biopsy was normal, incomplete resolution was reported in five, obsolescent glomeruli in one, and two others were not biopsied . No patient who had normal renal function at the time of follow-up had abnormal renal histology on biopsy . Obsolescent glomeruli were present in two other biopsies in association with evidence of incomplete resolution . It was concluded that the majority of patients with acute PSGN have a good prognosis . Histological resolution of the renal lesion may not occur for nine years.

Scand J Immunol, 1979, 9(6), 563 - 7
Clonotype patterns of antibodies released by single lymph nodes; Frost H et al.; Experimental primary, secondary and tertiary stimulation with streptococcal vaccine of isolated lymph nodes in vivo in the sheep model induces largely persistence of anti-group polysaccharide antibody clonotype patterns with the rare occurrence of additional clonotypes demonstrable after secondary stimulation persisting during the tertiary stimulus . It is not clear whether these additional clonotypes are the products of mutants or whether they pre-existed and were demonstrable only after a secondary stimulus, because of threshold concentrations required for identification . Further, isolated contralateral popliteal and prescapular lymph nodes of individual sheep share completely overlapping clonotype patterns during experimental primary anti-polysaccharide antibody responses indicating an identical repertoire of specific clonotypes under this condition of responsiveness.

Scand J Infect Dis, 1979, 11(1), 93 - 5
Fatal group G streptococcal sepsis in a neonate; Nieburg PI; A full-term infant became ill at 16--24 h of age following an uncomplicated pregnancy, labor, and delivery . The clinical course (absence of prenatal warning, rapidly progressive respiratory distress, apnea, shock, and coagulopathy) terminated fatally and resembled that seen in neonatal 'early onset' group B streptococcal sepsis . Previous cases of neonatal group G streptococcal disease are briefly reviewed.

Postgrad Med J, 1979, 55 Suppl 4, 50 - 2
The use of cefaclor in the treatment of beta-haemolytic streptococcal throat infections in children; Disney FA et al.; Cefaclor was used as a therapeutic agent in beta-haemolytic streptococcal throat infections in children in 3 separate studies . Although the numbers of patients in these ongoing studies are too small for valid statistical analysis, cefaclor was found to be (1) an effective agent in a dose of 20 mg/kg/day, (2) as effective as phenoxymethyl penicillin at identical dosages, and (3) equally effective at doses administered twice daily or thrice daily . It was well accepted by the patients, had minimal side effects, and produced no adverse effects in the peripheral blood.

Int Arch Allergy Appl Immunol, 1979, 60(3), 310 - 4
Persistent clonotypes associated with group A streptococcal polysaccharide antibody response in man; Braun DG et al.; Elevated anti-streptococcal group A polysaccharide antibodies are present in the sera of acute rheumatic fever patients . Analytical isoelectric focusing of sera taken in the acute phase of the disease and sequentially for up to 2 years later reveals a stable clonotype pattern of anti-group A polysaccharide antibodies . In addition, with reinfection and recurrence of the rheumatic fever, the same clonotype pattern of antibodies is present . This finding indicates that naturally acquired immunity is associated with persistence of clonotype expression.

J Infect Dis, 1979 Jan, 139(1), 93 - 6
Interaction of group A streptococcal lipoteichoic acid with bovine myelin basic protein; Ofek I et al.; Group A streptococcal lipoteichoic acid (LTA), a polyglycerol phosphate ester linked with fatty acids, formed precipitin lines in agar gels with the positively charged myelin basic protein (MBP) isolated from bovine brain . The LTA-MBP complexes were formed with deacylated teichoic acid and were not inhibited by monomeric glycerol phosphate, a finding indicating the participation of the polyglycerol phosphate (PGP) backbone of LTA in the reaction . Following interaction with PGP, MBP inhibited the agglutination of LTA-sensitized erythrocytes by induction of antibodies to LTA, directed against the PGP antigenic determinant . The amplification of the humoral immune response to the insoluble complex of LTA and MBP was of particular interest in view of the lack of immunogenicity of either LTA or MBP alone.

Scand J Immunol, 1979, 9(1), 61 - 7
Detection of antibodies in human sera to streptococcal groups A and C carbohydrates by a radioimmunoassay; Aasted B et al.; Human antibodies to streptococcal groups A and C carbohydrates were measured quantitatively with a radioimmunoassay using tyrosylated 125I carbohydrate . Analysis of acute and convalescent sera from people with groups A or C streptococcal pharyngeal infection or persistent carriage revealed a significant rise in antibodies . Inhibition reactions with the cold carbohydrate indicated the specificity of the elicited antibodies . In some instances, group C as well as group A antibodies occurred after group A pharyngeal infections . Further clinical and epidemiological studies are required to determine the significance of group-specific antibodies . Antistreptolysin-O (ASO) rises were observed in individuals with group C antibody responses after persistent group C pharyngeal carriage . For this reason, epidemiological surveys that rely primarily on ASO surveys to determine the incidence of group A streptococcal infections must be interpreted with caution, at least in the developing countries, where group C pharyngeal carriage is common.

Medicine (Baltimore), 1979 Jan, 58(1), 65 - 79
The effect of age on the character of immune complex disease: a comparison of the incidence and relative size of materials reactive with Clq in sera of patients with glomerulonephritis and cancer; Rossen RD et al.; The impact of aging on the severity of chronic immune-complex glomerulonephritis was studied in 144 patients from whom diagnostic renal biopsies were obtained over a 3-year period . Glomerulonephritis was related to an antecedent streptococcal infection in nine of these patients . In 58, glomerulonephritis occurred in association with a systemic disease; 27 of these had lupus erythematosus . At the time of the renal biopsy, serum creatinines were more frequently abnormal in men over 40 years of age . Similarly, histological evidence of irreversible glomerular injury was more evident in men over 40 . Histological indices of renal glomerular injury correlated with the presence of intense fluorescent antibody reactions specific for C3 and C4 and IgG in the glomeruli . High serum Clq binding activities (Clq BA), an indication of the presence of circulating immune complexes, also were found significantly more often in males over 40 . High serum Clq BA correlated with renal functional and biopsy evidence of severe glomerulonephritis . The renal biopsies in 89 cases were tested with fluorescein-conjugated heat-aggregated IgG (FAIgG) to determine how many contained focal immunoglobulin deposits with antiglobulin activity . Antiglobulins were detected in glomeruli of 24 patients and were found significantly more often in biopsies which revealed histological evidence of severe and irreversible histological injury . Binding of FAIgG was not selectively associated with any sex or age groups . Thus, detection of circulating immune complex-like materials in sera and the presence of glomerular deposits with antiglobulin activity were both features associated with severe glomerular injury . Both correlated with the quantity of complement deposited in the glomeruli . But only serum Clq binding activity was age and sex related . Similarly, in cancer patients, abnormal Clq BA were found more frequently in sera of older men with cancer but not in age- and sex-matched controls . Examination of selected sera by sucrose density gradient ultracentrifugation revealed that the complexes from cancer patients were relatively small (less than 19S greater than 7S) whereas those in most nephritis patients were heterogeneous in size . Sera with relatively high Clq binding activity from patients with chronic glomerulonephritis tended to contain relatively greater quantities of Clq binding materials sedimenting more rapidly than 19S.

Scand J Immunol, 1979, 9(2), 105 - 14
The VkVI subgroup of rabbit light chains: complete amino acid sequence of a third variable region (K29-213); Huser H et al.; The amino acid sequence of the variable region of a rabbit anti-streptococcal A-variant antibody light chain was determined . By using a combination of different cleavage methods, the sequence was established . Large peptides were sequenced in an extensively modified Beckman sequentor . Light chain K29-213 belongs to a rare subgroup (kVI) . Several of these light chains of antibodies with different specificities have been totally or partially sequenced . Comparison of these light chains reveals at least four germ-line-encoded variants within this subgroup.

JAMA, 1978 Dec 8, 240(24), 2651 - 2
Inaccuracy of house staff in reading throat cultures; Glass R et al.; The low prevalence of streptococcal pharyngitis in our pediatric clinic during a normally high-prevalence period encouraged us to examine the accuracy of throat culture readings made by the house staff . Six pediatric residents processed 256 cultures, which were then reinterpreted by a microbiologist . The residents consistently underread the cultures, failing to identify 68 (60%) of 112 with beta-hemolysis and 23 (58%) of 40 with a zone of bacitracin inhibition . This inaccuracy in interpretation of throat cultures emphasizes the physician's need to periodically reassess these skills.

J Urol, 1978 Dec, 120(6), 708 - 11
Novel bacterial structures in human blood . II . Bacterial variants as etiologic agents in idiopathic hematuria; Domingue GJ et al.; Novel bacterial structures have been demonstrated in lysed blood filtrates placed in special culture media from patients with idiopathic hematuria . These structures converted rapidly to gram-positive coccal (streptococcal and staphylococcal-like), coccobacillary and filamentous, bacterial forms in vitro from 96 per cent of the patients studied . Blood cultured conventionally yielded negative findings . Although structures (dense bodies) were demonstrated in normal control blood specimens (albeit in lesser numbers) few converted to classical bacteria in vitro (7 per cent) . Erythromycin therapy appeared to correlate with disappearance of hematuria and inability to revert rapidly the variant forms to classical bacteria in vitro . It is suggested that continual bombardment of the blood by bacteria entering from the mouth or other sites may lead to the development of variant bacterial parasitism . In an effort to survive the deleterious host effects the organisms may convert to persisting osmotically stable variant bacterial forms (dense bodies) . Development of a disease state may be conditioned by some existing or developing abnormality in the host (immunologic, physiologic and/or biochemical) . Furthermore, changes (genetic?) that might take place in the organisms per se during their transition to variant forms and adaptation to life in vivo may not allow certain host environments to adapt to these new forms, possibly leading to a pathogenetic role in renal diseases whose etiologies have long been enigmas.

Infect Immun, 1978 Dec, 22(3), 681 - 8
Nonspecific and specific immunological mitogenicity by group A streptococcal pyrogenic exotoxins; Barsumian EL et al.; Group A streptococcal pyrogenic exotoxin (SPE) types A, B, and C induced lymphocyte proliferation both specifically and nonspecifically, and the responses showed characteristics associated with both types of stimulation . Guinea pig lymphocytes from animals presensitized to SPE A displayed immunologically specific proliferation in response to SPE A; control lymphocytes showed little activity in the presence of SPE A . Lymphocytes from guinea pigs not presensitized to SPE responded nonspecifically to SPE types B and C . Guinea pig lymphocytes from SPE A-presensitized animals showed enhanced proliferation over controls when treated with SPE B, suggesting that a degree of cross-reactivity between SPE types may exist, though they are serologically distinct . Mouse splenic lymphocytes exhibited low-level responsiveness to all SPE types, as would be expected for an antigen-specific proliferative response . Unlike mouse splenic lymphocytes, rabbit spleen cells and human cord blood, lymphocytes responded nonspecifically to all SPE types . Although rabbit spleen cells and human cord blood lymphocytes responded nonspecifically, the maximum response occurred at day 4 or 5, comparable to an antigen-specific system rather than a day 2 or 3 such as that with the nonspecific thymus-derived cell mitogen, concanavalin A.

Eur J Immunol, 1978 Dec, 8(12), 853 - 7
Recognition of idiotypes in lymphocyte interactions . II . Antigen-independent cooperation between T and B lymphocytes that possess similar and complementary idiotypes; Eichmann K et al.; Antigen-independent cooperation between T and B lymphocytes is demonstrated in vitro in two different experimental protocols: (a) B cells from A/J mice immunized in vivo either with Group A streptococcal vaccine (Strep A) or with the IgG1 fraction of guinea pig anti-idiotypic antibody to the A5A idiotype, mature into plaque-forming cells (PFC) with specificity for Group A streptococcal carbohydrate (A-CHO) during a 4-day culture together with T cells from A/J mice immunized in vivo with A5A idiotypic antibody . (b) B cells from A/J mice immunized in vivo with Strep.A generate PFC specific for A-CHO when cultured in the presence of small concentrations of anti-A5A idiotypic antibody and of T cells primed with Strep.A . In both cases, antigen-independent cooperation is idiotypically selective, such that only those B cells respond that secrete antibody with the A5A idiotype . The data are interpreted to suggest that, in addition to antigen-specific helper cells, idiotype-specific may participate in antibody responses, and that the latter type of help may be responsible for the idiotypic selectivity in T-B cooperation observed previously . Furthermore, idiotype-specific cooperation may be a means to generate and maintain B cell diversity during the evolution and ontogeny of the immune system.

Eur J Immunol, 1978 Dec, 8(12), 846 - 52
Recognition of idiotypes in lymphocyte interactions . I . Idiotypic selectivity in the cooperation between T and B lymphocytes; Hetzelberger D et al.; Idiotypic restrictions are demonstrated in vitro for the cooperation between T and B lymphocytes with specificity for Group A streptococcal carbohydrate . T helper cells which have been primed in vivo with anti-idiotypic antibodies to the A5A idiotype and which are therefore essentially A5A idiotype-positive, cooperate only with A5A idiotype-positive B cells, even when mixtures of A5A idiotype-positive and A5A idiotype-negative B cells are present . Essentially A5A idiotype-negative T helper cells that have been primed in vivo with Group A streptococcal vaccine after in vivo suppression with anti-A5A idiotypic antibody are unable to cooperate with B cells which have been primed with anti-A5A idiotype antibody and which are therefore essentially A5A idiotype-positive . Mixtures of A5A idiotype-negative and A5A idiotype-positive T cells cooperate with both A5A idiotype-negative and A5A idiotype-positive B cells . Idiotypic restrictions could not be demonstrated for T and B cells recognizing carrier and hapten determinants, respectively, in experiments in which the cooperation of genetically VH-identical T and B cells was compared to the cooperation of genetically VH-different T and B cells . The data are discussed with respect to various models for the communication between T and B cells . It is proposed that for successful T-B cooperation, ordinarily two types of T helper cells are required, one recognizing the antigen and the other recognizing the idiotype of the B cell.

Kidney Int, 1978 Nov, 14(5), 501 - 10
Evidence of an autologous immune complex pathogenic mechanism in acute poststreptococcal glomerulonephritis; McIntosh RM et al.; Clinical and experimental studies have suggested a role for antiimmunoglobulins in the pathogenesis of glomerulonephritis associated with streptococcal infection . We attempted to localize anti-IgG in the kidneys of 22 patients who had renal biopsies performed 7 to 66 days after the onset of acute poststreptococcal glomerulonephritis (APSGN) . In addition to routine localization of immunoglobulins and C3, specimens were stained with neuraminidase-treated, heat-aggregated, and unmodified IgG . Twelve biopsies showed staining with fluorescein-labeled human neuraminidase-treated IgG . A lesser number gave positive staining with the other IgG preparations . Following treatment of slides with 0.01 M citrate buffer, seven previously negative biopsies showed positive staining with neuraminidase-treated IgG . The demonstration of anti-IgG by these methods was possible in 19 out of 22 biopsies . It correlated best with the presence of C3 and IgG, and to a lesser extent with IgM, in the renal glomerulus . These results and our previous finding of elevated levels of serum anti-IgG early in the course of APSGN, and as early as 8 days following the antecedent streptococcal infection, support a role for anti-IgG in the immune pathogenesis of APSGN . Although our series of studies support the hypothesis that anti-IgG is formed to an IgG modified enzymatically by streptococcal product, the formation of this autoantibody to IgG incorporated in an exogenous (streptococcal antigen-antibody) complex can not be ruled out.

J Clin Microbiol, 1978 Nov, 8(5), 534 - 44
Laboratory identification and epidemiology of streptococcal hospital isolates; Hardy MA et al.; A total of 343 streptococcal strains were identified to species on the basis of the progressive method of bacterial identification as advocated by Cowan & Steel's Manual for the Identification of Medical Bacteria . Comparative studies were also performed with these strains to determine the accuracy and feasibility of using various types of blood, differential media, and biochemical tests in conjunction with the progressive method of identification . The streptococcal species were then correlated with the type of specimen, sex, and age of hospitalized patients to obtain some insight into the epidemiology of hospital streptococcal isolates.

South Med J, 1978 Nov, 71(11), 1421 - 3
An unusual cutaneous manifestation of group A streptococcal bacteremia; Ortbals DW et al.; A case of streptococcal bacteremia presenting with disseminated nodular lesions is presented . Although the incidence of group A streptococcal bacteremia has declined, the disease may affect both normal and immunologically compromised children . Early recognition and prompt antibiotic therapy are required to ensure a favorable outcome.

Arthritis Rheum, 1978 Nov-Dec, 21(8), 904 - 8
Humoral immune stimulation and antiepithelial antibodies in Yersinia infection; Gripenberg M et al.; Results consistent with a general humoral immune stimulation were found when 127 sera from 89 patients with Yersinia enterocolitica infection were studied . Significantly increased gammaglobulin concentrations and elevated isohemagglutinin titers were seen in these sera as compared to sera from normal blood donors and patients with streptococcal infection . Antinuclear and anti-smooth muscle antibodies were demonstrated in both yersinia and streptococcal infection . The prevalence of non-organ specific antiepithelial antibodies reacting with gastrointestinal and thyroid epithelial cells was significantly increased in yersinia infection.

Hoppe Seylers Z Physiol Chem, 1978 Nov, 359(11), 1473 - 80
Rabbit variable kappa light chain regions: subgroups contain polypeptides encoded by multiple genes; Huser H et al.; Two identical light chain variable regions were identified in anti-streptococcal Group A-variant antibodies elicited in litter-mate rabbits by hyperimmunization with vaccine . In addition, one rabbit produced two additional clonally restricted antibodies to this polysaccharide antigen . The partial amino acid sequence of the light chain of one of these antibodies was identical with the dominant antibody light chain sequence, while the light chain of the other antibody, also partially established, showed significant variations in the framework-associated regions with identical CDRI and II . Since all of these light chains were from a small subset of rabbit kappa light chain pools (b4 allotype) the data suggest, together with other light chains reported in the literature, that more than one copy of variable region genes are present in the germ-line per subgroup . Furthermore, framework associated amino acid substitutions are not random; this suggests the existence of some "ordered" mechanism for linked amino acid substitutions (presumably recombination) . Furthermore one light chain can pair with more than one heavy chain to yield functional antibodies.

Arch Sci Med (Torino), 1978 Oct-Dec, 135(4), 589 - 94
{Changes in fibrinogen values in children with acute articular rheumatism and streptococcal disease}; Chiappo GF et al.; A study was made of changes in body fluid parameters of rheumatism following treatment with sulphoadenosine-methionine and classic forms of management . Particular attention is drawn to improvement of the serum electrophoretic picture (especially in the case of alpha 2 and gamma-globulins) with respect to untreated control group . Note is also taken of the drug's positive influence on liver function, particularly with regard to lactate hydrogenase, compared with the variations in such parameters in the control group.

J Gen Microbiol, 1978 Oct, 108(2), 283 - 94
An electron microscopic study of the location of peptidoglycan in group A and C streptococcal cell walls; Wagner M et al.; The morphological appearance of deproteinized Group A and C streptococcal walls after treatment by different procedures extracting teichoic acids and polysaccharides (formamide, hydrochloric acid, nitrous acid, trichloroacetic acid, sulphuric acid, sodium hydroxide and sodium deoxycholate) was compared with the content of teichoic acids and polysaccharides remaining in the treated walls . All procedures extracted teichoic acids almost completely, but polysaccharides were extracted to various degrees . The ultrastructural appearance of walls after these extractions still exhibited the triple-layered wall profile; only a reduction of thickness of the wall and of electron density of the layers occurred . There was no direct correlation between the reduction of rhamnose content and thickness of walls . The ultrastructural localization of peptidoglycan in the streptococcal walls was explored by means of the indirect immunoferritin technique using anti-peptidoglycan antibodies isolated from anti-Group A-variant antisera . Ferritin particles were bound predominantly to filamentous structures which protruded from both surfaces of peptidoglycan fragments and isolated walls . Peptidoglycan was also detected on the filamentous protrusions of whole cocci . These results contradict models of the streptococcal wall in which peptidoglycan forms the innermost layer and support a mosaic structure in which peptidoglycan forms a network of the peptidoglycan-polysaccharide complex.

J Pediatr Surg, 1978 Oct, 13(6), 527 - 8
Overwhelming postoperative streptococcal infection; Pollack MM et al.; Fulminant postoperative group A beta-hemolytic streptococcal infections present a serious and potentially lethal threat to children . Three children with severe postoperative streptococcal wound infections are presented . Each child developed high fever within the first 24 hr after surgery, followed shortly by signs of septic shock . In all patients, the clinical appreciation of wound infection became apparent late in the course of the illness . All three children had white blood cell counts below 6000/cu mm . One child developed crepitus in the incision; another showed radiographic evidence of free air in the soft tissues . The only survivor received antibiotics immediately following the initial fever along with re-exploration and drainage of the operative wound.

J Infect Dis, 1978 Oct, 138(4), 506 - 11
Inhibition of mitogen- and antigen-induced lymphocyte blastogenesis by herpes simplex virus; Plaeger-Marshall S et al.; Lymphocytes were separated from peripheral blood of adult human donors by Ficoll-Hypaque gradient centrifugation and cultured in the presence of nonspecific mitogens (phytohemagglutinin{PHA} and concanavalin A) or specific microbial anatigens (herpes simplex virus {HSV}, mumps virus, streptococcal enzymes, and Candida albicans) . Exposure of lymphocyte cultures to infectious HSV resulted in almost complete inhibition of blastogenesis ({3/H}thymidine uptake) induced by each of the mitogens and antigens, a finding which suggests that a common mechanism may underlie the inhibitory effect . Several characteristics of the effect of virus on blastogenesis were noted: (1) virus inactivated by heat or ultraviolet irradiation was ineffective; (2) inhibition (is greater than 90%) was greatest in cultures exposed to HSV on or before the addition of PHA; (3) lymphocyte preparations washed free of HSV continued to be refractory to stimulation, an observation indicating that the presence of unabsorbed virions or viral products was not essential; and (4) inhibition was independent of the cell donor's state of humoral immunity to HSV.

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