J Bacteriol, 1978 Oct, 136(1), 295 - 303 Enchancement of streptococcal transformation yield by proteolytic enzymes; Fuchs PG et al.; Trypsin and other proteolytic enzymes, added together with transforming DNA or during cell-DNA contact to competent cultures of several streptococcal strains, enchanced (10 to 600%) the yield of genetic transformation (stimulation) . With few exceptions, the level of stimulation was high (over 100%) when competence was low (below 2%) . Stimulation was caused by the action of an enzyme on competent cells and not on any other component of transformation mixture . The phenomenon occurred when the enzyme was added to the culture not earlier than 7 min before and not later than 5 min after the period of cell-DNA contact . The presence of trypsin during cell-DNA contact caused: (i) the alterations at cell surface, demonstrated by electron microscopy, increased release of 3H-amino acid-labeled material, and higher cell susceptibility to autolysis; (ii) the increase of both total and irreversible binding of DNA by the cells; and (iii) the decrease of early nucleolytic degradation of DNA by cells . These and other data point to the importance of a delicate balance of recipient cell's surface nuclease activities in the effectiveness of transformation process . It is also possible that trypsin eliminates an unknown cellular factor which obstructs DNA-cell receptors interaction. Sem Hop, 1978 Sep 8-15, 54(21-24), 738 - 42 {Extensive cellulitis during chicken-pox . Six causes (author's transl)}; Girouin D et al.; The authors report 6 cases of extensive cellulitis, in 6 children with chicken-pox . This is a rare complication during this disease . If streptococcal etiology is not always proved, clinical aspect and the dramatic reponse to treatment by penicillin G, characterize this kind of complication. Aust Fam Physician, 1978 Sep, 7(9), 1129 - 33 Group B streptococcal infection in the perinatal period . An increasing problem in newborn care; Campbell N; Group B streptococcal infections in newborn infants are increasing in frequency . Infection takes two forms--early-onset, developing in the first 24 hours, and late-onset, developing after the first week . Early-onset disease, a fulminating septicaemia, has a mortality of 40-70% . Late-onset disease, usually meningitis, has a mortality of 20-30%, with a high incidence of neurological damage in survivors . Early-onset disease is acquired during delivery from organisms colonizing the vagina . Up to 25% of women are colonized in late pregnancy . So far, no effective programmes for prevention have been developed. Vet Pathol, 1978 Sep, 15(5), 638 - 48 A freeze-etching study on experimental murine mastitis; Smith K et al.; Streptococcal mastitis was produced experimentally in mice inoculated by the intramammary route; freeze-etched preparations from the affected mammary glands were studied by electron microscopy . The inoculated cocci were seen free in the acinar lumen, within luminal phagocytes and within cells of the epithelium . No significant pathological changes were noted in the junctional complexes between secretory epithelial cells . The results were comparable to those obtained by ultrathin sectioning and indicated that, while cocci can transfer from the acinar lumen into the substance of the epithelium and towards a subepithelial location, the junctional complexes between epithelial cells present a potential barrier to movement through the intercellular spaces. Infect Immun, 1978 Aug, 21(2), 546 - 55 Extraction of streptococcal type 12 M protein by cyanogen bromide; Vosti KL et al.; Conditions for the release of streptococcal type 12 M protein from whole cells by cyanogen bromide are described; they demonstrated that methionine is not essential to the structural arrangements which account for some of its immunological and biological properties . The released M protein was separated from other proteins by column chromatography with hydroxylapatite . The type-specific molecules which reacted with precipitating antibodies were found only in the 0.3 M eluate, formed zones with mobilities less than 12% of that of the dye front on electrophoresis in the standard acrylamide disc gel system, formed at least four bands in sodium dodecyl sulfate-acrylamide disc gels with molecular weights ranging from 12,000 to 23,000, and stimulated the formation of opsonic antibodies in rabbits . Cyanogen bromide provides a highly specific method for the release of M proteins which should prove particularly useful in analyses of structural-functional relationships among different M proteins. Immunology, 1978 Aug, 35(2), 247 - 56 An investigation into the antigen-specificity of transfer factor in its stimulatory action on lymphocyte transformation; Salaman MR; Dialysable transfer factor (TF) was prepared from the buffy-coat cells of donors with known cell-mediated reactivity to tuberculin (PPD), streptococcal protein (SKSD) and diphtheria toxoid (DT) . The effect of such preparations on the transformation by these antigens of lymphocytes from tuberculin-negative donors was investigated . Transformation was determined as incorporation of tritiated thymidine . The concentrations of SKSD and DT were adjusted for different lymphocyte donors so as to give, in the absence of TF, a low index of transformation (less than 10-fold) comparable to that obtained with PPD . TF from tuberculin-positive donors stimulated antigen-induced transformation by on average approximately 2-fold whereas TF from tuberculin-negative donors generally had little effect . This was so not for PPD as antigen but also for SKSD and DT, and sensitivity of TF donor to SKSD of DT was not a determining factor . TF also frequently increased background transformation in the absence of antigen . Although a small effect, this ability tended to reflect the activity of TF in the presence of antigen . It is concluded that neither the whole nor any significant part of this enhancement of transformation can be ascribed to an antigen-specific factor . Tuberculin-positive donors apparently yield a higher level of non-specific factor and possible reasons for this are discussed . The factor active in transformation may be responsbile for the TF phenomenon in vivo. J Immunol, 1978 Aug, 121(2), 566 - 72 Subclass restriction of murine anti-carbohydrate antibodies; Perlmutter RM et al.; Examination of the subclass distribution of murine antibodies directed against groups A and C streptococcal carbohydrate, alpha-(1 leads to 3) dextran and phosphocholine yields the surprising observation that these carbohydrate antigens stimulate IgG responses largely restricted to the rare IgG3 subclass . This subclass restriction is particularly impressive in light of the low circulating levels of IgG3 in nonimmune mouse serum and the failure of a variety of other antigens including proteins and aromatic haptens to stimulate IgG3 antibody production . Attempts to alter the subclass restriction of antibodies with carbohydrate specificity by immunization with carbohydrate-coupled protein have been unsuccessful and indicate that immunoregulation of subclass expression probably occurs at the level of the antibody forming (B) cell . It is therefore conceivable that VH regions of murine immunoglobulins may be restricted to particular IgG subclasses . A similar type of subclass restriction has been reported in human and rat anti-carbohydrate antibodies . This recruitment of a minor immunoglobulin isotype by carbohydrate antigens in several species further supports the concept of immunoregulation at the level of subclass, and suggests that these and other mammals may share a structurally similar isotype with perhaps a common evolutionary origin. S Afr Med J, 1978 Jul 29, 54(5), 208 - 10 Complement consumption and progression to post-streptococcal nephrotic syndrome . A report of two cases; Diedericks R et al.; The immunopathogenesis of the nephrotic syndrome which occurs in about 0,3% of Black children with post-streptococcal glomerulonephritis has not been clearly defined . Findings in 2 out of 582 Black children with post-streptococcal glomerulonephritis who developed nephrotic syndrome suggest that minimal activation in the blood of complement components, particularly C3, early in the nephritic process may determine progression to nephrosis . Differences reported by other workers between normocomplementaemic and hypocomplementaemic patients with post-streptococcal glomerulonephritis support this interpretation. S Afr Med J, 1978 Jul 22, 54(4), 154 - 8 Group B streptococcal infections in neonates and infants . Report of 16 cases, with referrence to the fatal outcome in late-onset leucopenic cases; Jacobs MR et al.; Sixteen cases of group B streptococcal (GBS) infections in neonates and infants aged up to 3 months were detected from November 1973 to January 1977 . Three patients presented with pneumonia, 10 with meningitis and 3 with both pneumonia and meningitis . All diagnoses were confirmed by positive blood and/or cerebrospinal fluid cultures . The serotypes involved were type Ia (2 cases), type II (4 cases) and type III (10 cases) . Ten patients died (62.5%) . Early antibiotic treatment did not appear to affect the outcome, but low peripheral leucocyte count indicated a uniformly fatal outcome in 6 cases where leucopenia was documented, and this appeared to be associated with late-onset disease . The current status of GBS disease is presented, with particular reference to the control measures at present available and the possibility of immunotherapy and vaccination. Acta Pathol Microbiol Scand {A}, 1978 Jul, 86(4), 319 - 24 Post-streptococcal glomerulonephritis . A quantitative glomerular investigation; Ludwigsen E et al.; A light microscopical, quantitative glomerular examination was performed on renal biopsies from 14 patients with acute post-streptococcal glomerulonephritis . A significant increase of 58% (p less than 0.0025) in the total number of glomerular cells was found which was mainly due to an increase of endothelial cells (97%) . Mesangial cells were, however, also increased (61%) and mesangial area was increased by 34% (p less than 0.05) . Biopsies from patients with persisting proteinuria and/or hematuria revealed slight hypercellularity and an increase in mesangial area during the first six months of disease . The abnormalities in the acute phase of the disease could be so slight that they only would be disclosed by a quantitative investigation. Am J Ophthalmol, 1978 Jul, 86(1), 39 - 44 Clinical implications of aqueous humor studies in uveitis; Witmer R; We studied the serologic findings in serum and aqueous humor samples from 693 cases of uveitis . Specimens were tested for the presence of humoral antibodies against tuberculosis, toxoplasmosis, antistreptolysin-O, herpes simplex and herpes zoster viruses, mumps virus, and adenovirus . Serologic analyses rarely indicated tuberculous or streptococcal infections, but frequently showed toxoplasmosis and viral diseases. J Oral Surg, 1978 Jul, 36(7), 527 - 9 Antibiotic suseptibility of bacteria isolated from oral infections; Hunt DE et al.; Exudates from bacterial infections of oral soft tissues were cultured and tested for antiobiotic susceptibility . Of 74 specimens tested, 68 were cultivable on blood agar; 56 of the cultivable exudates were pure cultures and 12 were mixed cultures . Strepococci and staphylococci accounted for 57% and 34%, respectively, of the pure cultures . Anaerobic bacteria were found in nearly 15% of the pure culture exudates . Gramnegative organisms accounted for about 4% of the pure cultures . Virtually all of the pure and mixed streptococcal cultures were sensitive or moderately susceptible to ampicillin, cephalothin, and penicillin; however, approximately 50% of the streptococal and staphylocococcal isolates were resistant to demeclocycline hydrochloride and erythromycin. J Immunol, 1978 Jul, 121(1), 149 - 58 Light chain diversity of murine anti-streptococcal antibodies: IgCH-linked effects on L chain expression; Perlmutter RM et al.; L chains derived from anti-group A streptococcal carbohydrate antibodies raised in A/J, BALB/cJ, C57BL/6J, CB-20, BAB-14, and CAL-20 mice were examined by isoelectric focusing . Multiple strain-associated differences in the degree and frequency of expression of particular L chain spectrotypes were observed . Analysis of L chain-focusing patterns in allotype-congenic mice revealed that IgCH-linked genes can have profound effects on the L chain phenotypes expressed by strains with identical L chain genotypes . Lastly, the overall spectrotypic diversity of L chains from anti-GAC antibodies appears to be less extensive than the diversity of the antibodies from which these L chains derive, documented by similar techniques . These results are interpreted in light of the significance of combinatorial diversity in generating antibody heterogeneity. JAMA, 1978 Jun 2, 239(22), 2359 - 61 Disease control programs in the United States . Control of streptococcal and poststreptococcal disease; McCormick JB et al.; Programs administered by health departments and heart associations for control of streptococcal and poststreptococcal disease differ greatly from state to state . The year 1974 was used as a representative year when studying the variety of state policies and programs regarding surveillance of streptococcal disease, primary and secondary prevention of rheumatic fever, and prevention of poststreptococcal glomerulonephritis . A uniform national policy for streptococcal control is desirable but should be based on evidence not now available concerning the impact of various elements of control programs on morbidity and mortality. J Exp Med, 1978 Jun 1, 147(6), 1771 - 8 Streptococcal M protein extracted by nonionic detergent . III . Correlation between immunological cross-reactions and structural similarities with implications for antiphagocytosis; Fischetti VA; Three immunologically cross-reactive and non-cross-reactive streptococcal M proteins were analyzed by a chromatographic tryptic peptide mapping system . The results indicate that cross-reactions correlate with the extent of structural similarity among the M protein molecules analyzed . The data also reveal that free lysine is released by the action of trypsin from these three M proteins, suggesting a common lys-lys or arg-lys sequence . In addition, only one peptide has been found to be common within all three M types . This limited structural relatedness among the three M proteins examined indicates that sequence variation plays a major role in the immunological specificity of the M antigens . However, despite sequence variation, all M protein molecules have a common antiphagocytic activity . The fact that no common opsonic antibody has yet been found, even against limited M types, argues against this biological activity being solely the result of a common sequence . Based on these data, it is suggested that the antiphagocytic effect of M protein may be due to a conformationally created environment on the surface of the molecule which is selected by both immunological and biological pressure. Immunology, 1978 Jun, 34(6), 969 - 79 The induction of salivary antibodies by topical sensitization with particulate and soluble bacterial immunogens; Ebersole JL et al.; This investigation attempted to characterize systematically the secretory and serum immune responses following oral administration of soluble and particulate bacterial immunogens . Following oral sensitization of axenic mice with Escherichia coli lipopolysaccharide, Candidin, or streptococcal group H antigen, a substantially longer latent period was observed before all salivary samples exhibited specific agglutinins when compared to a similar immunization regimen with intact nonviable micro-organisms . Also, the peak titres of salivary agglutinins were significantly lower when the soluble antigenic counterparts of particulate E . coli or Candida albicans were utilized as immunogens . Examination of serum antibodies showed that following administration of E . coli LPS, similar titres of exocrine and serum agglutinins were noted . The serum titres were significantly greater (P less than 0.01) than those elicited by oral immunization with particulate E . coli . After termination of the topical immunization regimen, salivary agglutinins were found to decline rapidly whether immunization was via soluble or particulate antigens; however, immunization with particulate bacterial antigens appeared capable of stimulating and maintaining a higher rate of local antibody secretion than similar sensitization with soluble immunogen preparations. Z Immunitatsforsch Immunobiol, 1978 Jun, 154(3), 284 - 95 Genetics of the idiotype of strain AKR antibodies to group A streptococcal carbohydrate; further evidence for a low degree of homology in the VH chromosomal region; Krammer P et al.; A new VH gene is described which governs the expression of idiotypes associated with the antibody response of strain AKR mice to Group A streptococcal carbohydrate (A-CHO) . This VH gene, termed ACHd, is identified using guinea pig antisera to a pool of strain AKR antibodies to A-CHO . The genetic polymorphism is revealed by quantitative differences in idiotype expression between different inbred strains . In recombinant inbred strains linkage to the Ig-1d allotype allele of strain AKR is demonstrated . In a putative recombinant strain it appears that ACHd maps at a locus different from that of A5A+, another VH gene controlling idiotypes of anti-A-CHO antibodies . This represents a further example of pseudoallelism between related VH genes and lack of homology in the VH chromosomal region . Expression of the ACHd gene was independent of the Ly-2, 3 locus which is associated with kappa chain variants. Eur J Immunol, 1978 Jun, 8(6), 380 - 5 Variable region correlates of group b allotypes: amino acid sequence studies of b9 L chains from homogeneous antibodies; Fraser BA et al.; The amino acid sequence was determined for residues for residues 1 to 88 and residues 110 to 147 for a rabbit light chain (4153-I) with allotype b9 from a homogeneous anti-streptococcal antibody . The amino acid sequence of the L chain from a second antibody (4153-II) was also determined for residues 1 to 49 and 62 to 77 . In spite of the large differences in constant region sequence between b4 and b9 L chains, the variable regions of these antibodies are quite similar to those reported for b4 L chains . Both chains bear a b9-specific substitution (glutamic acid) at position 16 . The 4153-I chain also has substitutions at positions 70 and 81 that may be exclusive to variable regions of the L chains with the b9 allotype . These allotype-associated VL structural differences offer support to the notion that structural genes for the CL region are either linked to distinct VL gene complexes or that certain V regions are expressed only in concert with certain CL regions. Aust Fam Physician, 1978 May, 7(5), 521 - 31 Antibiotics: their true place in the treatment of viral disease; Vance JC; The use of antibiotics in viral diseases of childhood is discussed . If bacterial infection is likely, either as superinfection or as part of the differential diagnosis, then antibiotics should be given . The antibiotic of choice for each illness is considered . Respiratory infections are common . The diagnosis and treatment of streptococcal pharyngitis is compared with viral pharyngitis . Penicillin is indicated if the bacterial infection is possible . If there is difficulty in distinguishing between croup and epiglottitis, then chloramphenicol or ampicillin should be given . Otitis media and pneumonia caused by viruses are difficult to differentiate from their bacterial counterparts, and antibiotics are indicated . By contrast, antibiotics are not used in bronchiolitis or asthma . Antibiotics are contraindicated in gastroenteritis even if caused by bacteria . Prolongation of the carrier state or superinfection may then occur . Interpretation of the biochemical and bacteriological findings of the cerebrospinal fluid is important in distinguishing viral meningitis and encephalitis from bacterial meningitis . If bacterial meningitis is possible, then antibiotics should be used . The indications for antibiotics in viral diseases of the skin, eye, joints, heart and parotid are also discussed. Biull Eksp Biol Med, 1978 May, 85(5), 528 - 31 {Bioelectrical activity of the uterus of white rats with intrauterine streptococcal infection and exposed to the use of pulsing, local negative pressure with oxygen}; Korzhova VV et al.; Intrauterine streptococcal infection of albino rats hematogenically during pregnancy (implantation, placentation) leads to different disorders of the bioelectrical activity of the uterus, which become normalized after the institution of pulsating local negative pressure with periodic oxygen supply. Pediatrics, 1978 Apr, 61(4), 575 - 9 Hereditary late-onset lymphedema; Holmes LB et al.; Two different types of hereditary late-onset lymphedema are presented . In one family the father and one son had recurrent streptococcal lymphangitis beginning in childhood . In the son there was lymphatic hypoplasia in both legs with the infection having only occurred in one . Prophylaxis with penicillin prevented the recurrent lymphangitis . Because of 30 years of untreated lymphangitis, the father has chronic severe lymphedema . The second type, lymphedema associated with extra eyelashes (distichiasis) and a wide spinal canal, occurred in a woman whose lymphedema began at age 12 but in whom the hereditary nature of the disorder was not recognized until she was 29 . Both of these types of late-onset lymphedema, lymphedema with lymphangitis and lymphedema with distichiasis, are due to autosomal dominant genes . Both families would have benefited from early diagnosis of the cause of the lymphedema. Infect Immun, 1978 Apr, 20(1), 258 - 61 Inhibition of macrophage phagocytic activity by group A streptococcal cell walls; Smialowicz RJ et al.; Group A streptococcal cell walls inhibited phagocytosis of polystyrene latex particles by rat peritoneal macrophages in vitro . This inhibition was not accompanied by a measurable loss of cell viability . Group D streptococcal cell walls were relatively ineffective in altering phagocytosis . The effectiveness of group A variant streptococcal cell walls and peptidoglycan derived from group A cell walls was increased if cell wall preparations were added to macrophage cultures 12 h before, rather than simultaneously with, latex particles. Lancet, 1978 Mar 25, 1(8065), 636 - 8 Blood-transfusion in group-B streptococcal sepsis; Shigeoka AO et al.; Transfusion of fresh whole blood was evaluated as a means of supplying opsonins and lessening the high mortality of group-B streptococcal sepsis in neonates . Pre-transfusion and post-transfusion sera from 22 infants were examined for the presence of opsonins against group-B organisms . Opsonic activity rose only when donor blood containing heat-stable antibody was administered in high volume (greater than 40% of blood-volume) . 9 of 9 infants transfused with blood containing antibody to their infecting strain survived septic episodes . 3 of 6 who received blood lacking antibody to their infecting strain died. Am J Med, 1978 Mar, 64(3), 403 - 6 Pseudomonas maltophilia pseudosepticemia; Semel JD et al.; During a 17 month period, 25 hospitalized adult patients had blood cultures reported as positive for Pseudomonas maltophila . Review of the hospital records suggested that these were contaminants and that blood for coagulation studies and for cultures that were subsequently positive had been drawn simultaneously . The source of contamination appeared to be black-top evacuated collection tubes used for coagulation studies in adults . Cultures of the liquid anticoagulant tubes yielded a pure growth of greater than 10(5) colony forming units (CFU)/cc of Ps . maltophilia on blood agar . Mock trials demonstrated that following venipuncture by syringe, inoculation of contaminated black-top tubes prior to inoculation of blood culture bottles would yield false-positive blood cultures (pseudosepticemia) . One patient being treated for streptococcal prosthetic valve endocarditis and having frequent coagulation studies with blood obtained via direct venipuncture into evacuated collection tubes was found to have superinfection of his prosthetic valve with Ps . maltophilia at autopsy . Prosthetic valve infection may have occurred after reflux of contaminated anticoagulant from an evacuated collection tube directly into the vein . Contaminated evacuated collection tubes are a potential source of confusion in the diagnosis of infection as well as a potential source of true infection. AJR Am J Roentgenol, 1978 Mar, 130(3), 465 - 7 Streptococcal skeletal infections: observations in four infants; McCook TA et al.; The radiographic findings and clinical presentations of four patients with group B beta hemolytic streptococcal osteomyelitis and pyoarthritis are described . Radiographic features, though not specific, are similar in these patients and others reported in the literature . The combination of radiographic patterns and clinical presentations in children of this age group should alert clinicians and radiologists to the possibility of infection with this organism. Scand J Immunol, 1978 Mar, 7(3), 221 - 8 Activation of primed rabbit blood lymphocytes by antigen: early phase of triggering and the specificity of the response; Pawlita M et al.; The early phase of antigen-dependent triggering of rabbit blood lymphocytes (PBL) is described . Specific activation of PBL by streptococcal vaccines requires primed lymphocytes from high responder rabbits . B-cell memory is conferred by Ig receptors by both mu and gamma chains . Antigen-induced incorporation of leucine and thymidine reach peak values at day 5, with stimulation indices of 10 to greater than 100, closely followed by increases in the number of living cells . A second and less intensive phase of cell proliferation is seen on days 8--11 . A large fraction of cells (between 3 and 33%) participates in proliferation . A rough calculation of the average doubling time of cells during the exponential growth phase gives values of 8--16 h. Clin Nephrol, 1978 Mar, 9(3), 91 - 101 Observations on the evolution of idiopathic rapidly progressive glomerulonephritis; Davis CA et al.; Distinctive deposits of C3, C5 and properdin were identified in the minimally proliferative glomerular lesions of a patient with idiopathic rapidly progressive glomerulonephritis . Biopsies of her renal allograft at times of recurrences of her disease and of five other patients with progressive renal failure but less severe crescent formation showed deposits identical composition and position, giving evidence of a common pathogenesis . The deposits were subepithelial and located in that part of the basement membrane in apposition to the mesangium (capillary waist) . Breaks in the basement membrane were often exclusively in this area suggesting the deposits were causative . Ancillary observations suggest that the subepithelial deposits become unidentifiable after the scarring of severe extracapillary proliferation develops . Three of the patients had, in addition, intramembranous dense deposits but in other ways their disease was not characteristic of membranoproliferative glomerulonephritis Type II . Instead, the evidence indicated that all six patients were in early or lage stages of idiopathic (non-streptococcal) rapidly progressive glomerulonephritis. Arch Dermatol Res, 1978 Feb 15, 261(1), 17 - 26 {Erythema elevatum diutinum . II . Immunoelectronmicroscopical study of leukocytoclastic vasculitis within the intracutaneous test reaction induced by streptococcal antigen (author's transl)}; Wolff HH et al.; A leukocytoclastic vasculitis was induced by intracutaneous injection of streptococcal antigen in a patient with erythema elevatum diutinum (E.e.d.) . The immunoelectronmicroscopical demonstration of C3 was performed by use of the peroxidase-antiperoxidase multistep technique 24 h after the injection of the antigen . Deposits of C3 were found between endothelial cells, on the outer surface of endothelial cells, pericytes, and smooth muscle cells, as well as within the multilayered basal lamina of small vessels . Intact and disintegrating neutrophils accumulate within the vessel walls and in their surroundings . Necrosis and fibrin deposition are present in advanced stages . The findings demonstrate the sequence of events in leukocytoclastic vasculitis at the ultrastructural level . They also support the hypothesis that in E.e.d . an Arthus type reaction induced by bacterial antigens may be of pathogenetic significance. JAMA, 1978 Feb 13, 239(7), 626 - 7 Clindamycin in infective endocarditis; Cherubin CE et al.; Because of problems of penicillin allergy or lack of veins for intravenous administration of antibiotics, nine patients with endocarditis were treated with clindamycin, administered intramuscularly . Five patients were heroin addicts with staphylococcal endocarditis and four had alpha-streptococcal endocarditis . The only therapeutic failure occurred in a patient with a strain of Staphylococcus aureus that became resistant to clindamycin in vivo . Such resistance has been reported to occur in vitro, and testing for it should prove useful in proper selection of cases for treatment with clindamycin, an agent that appears to be effective in selected cases of endocarditis. Am J Med, 1978 Feb, 64(2), 199 - 206 Late prosthetic valve endocarditis: clinical features influencing therapy; Karchmer AW et al.; To assess the clinical features which might influence therapy, we studied 43 patients with late prosthetic valve endocarditis (LPVE) . Twenty patients (47 per cent) survived . Of patients with streptococcal LPVE 61 per cent (11 of 18) survived compared to 36 per cent (nine of 25) of the patients with nonstreptococcal LPVE (p less than 0.10) . Among patients with new regurgitant murmurs 33 per cent (nine of 27) survived versus 69 per cent (11 of 16) with such murmurs (p less than 0.03) . Of patients with moderate to severe congestive heart failure (CHF) 16 per cent (three of 19) survived compared to 71 per cent (17 of 24) with mild or no CHF (p less than 0.001) . The concurrence of two of these three features, i.e., nonstreptococcal etiology, a new regurgitant murmur or moderate to severe CHF, was associated with a mortality rate of 50 to 90 per cent . Persistent fever during therapy, a regurgitant murmur, atrioventricular conduction disturbances and relapse frequently reflected myocardial invasion . In view of the poor outcome with medical therapy and late reoperation, early surgical intervention should be considered when two of the three features noted are present or when myocardial invasion is suspected. Arch Mal Coeur Vaiss, 1978 Feb, 71(2), 222 - 6 {A case of subannular aneurysm of the left ventricle}; Chauvaud S et al.; The authors present a case of sub-annular aneurysm of the left ventricle in a child of 7 . It was associated with aortic incompetence, a ventricular septal defect, and coarctation of the aorta which were discovered during investigation of streptococcal septicaemia . As a first stage procedure, the aortic valve was repaired, the aneurysm was excised, and the ventricular septal defect closed . At a later stage, the coarctation was resected . The question of whether this lesion was congenital or acquired is discussed . After one year, the result remains satisfactory. Infect Immun, 1978 Feb, 19(2), 470 - 6 Suppression of antibody response by group A streptococcal pyrogenic exotoxin and characterization of the cells involved; Cunningham CM et al.; The effect of purified streptococcal pyrogenic exotoxins (SPE) on the antibody response to sheep erythrocytes was studied in cultures of mouse spleen cells . Purified SPE types A, B, and C shared the ability to suppress the day 4 direct plaque-forming cell response when added to cultures . SPE A and C were most suppressive at concentrations of 0.1 to 1 ng per culture, while SPE B was active at 1 microgram per culture . Pretreatment of mice with SPE A, 3 h before removal of their spleens for culture, also produced suppression . Cell populations were separated from spleens of normal and toxin-treated mice and recombined in culture to test the cellular site of action of SPE immunosuppression . When nonadherent cells (lymphocytes) and adherent cells (macrophages) from control and SPE-treated mice were separated and recombined, the plaque-forming cell response depended on the source of lymphocytes . Macrophages from toxin-treated mice functioned normally in the presence of control lymphocytes . In a further experiment, toxin pretreatment failed to suppress the plaque-forming cell response of spleen cells that were T-cell depleted and reconstituted with control thymocytes . When the T lymphocytes were removed from toxin-treated spleen cell suspensions, the remaining cells were able to respond normally to antigen if normal helper T cells were provided . The results suggest that the suppressive activity of SPE on antibody production is mediated by altered activity of T lymphocytes. J Fam Pract, 1978 Feb, 6(2), 251 - 6 Streptococal throat infections in family practice; Gillette RD; Beta hemolytic streptococcal throat infections occur often enough and cause sufficient morbidity that careful diagnosis and appropriate treatment are matters of concern to the family physician and others involved in primary patient care . Throat cultures aid the precision of diagnosis; a simple, inexpensive, and accurate method of performing cultures in the office is described . The risk of rheumatic fever secondary to untreated streptococcal infections appears to be less than it once was, and further work defining this risk in various population groups is needed . Penicillin remains the drug of choice for treatment, with blood levels maintained for at least ten days either by oral administration or by a single intramuscular dose of benzathine penicillin G . The results of a recent survey of US family practice programs and an equivalent number of practicing family physicians show that most physicians use a selective approach to diagnosis and treatment of throat infections based on symptoms, signs, and age of the patient. Nephron, 1978, 22(4-6), 301 - 5 Factor VIII procoagulant activity in children with nephrotic syndrome and post-streptococcal glomerulonephritis; Adhikari M et al.; Plasma factor VIII procoagulant activity has been shown to be significantly elevated in 32 children with the nephrotic syndrome . This increase is more marked in those with obvious glomerular lesions on histology than in patients with minimal change nephropathy . Fluctuations in factor VIII levels corresponded to changes in the clinical condition of the nephrotic syndrome . In 28 children with post-streptococcal glomerulonephritis, 4 patients with the highest factor VIII levels recovered between 7 and 60 days of onset of disease whereas the remainder did so in less than 7 days . Factor VIII levels may reflect the extent of immunopathological injury to glomerular capillaries and be useful in management of children with glomerular disease. Scand J Rheumatol, 1978, 7(3), 177 - 82 HLA antigens in females with ankylosing spondylitis and other forms of seronegative rheumatic diseases; Safwenberg J et al.; A total of 222 female patients with seronegative rheumatic diseases were investigated by sacroiliac joint X-ray and HLA-A, B and Ctyped . The frequency of the B27 antigen was significantly increased in the following groups: definite pelvospondylitis (26 patients and relative risk (RR) = 99), possible pelvospondylitis (20 patients, RR=4.5), definite sacroiliitis (14 patients, RR-20.1) and uroarthritis (8 patients) . When 24 B27 negative patients from these B27 associated diseases were analysed, significantly increased frequencies of the BW22 (RR=16.7) and CW1 (RR=14.4) antigens were found . There were no significantly deviating HLA frequencies in the following diagnostic groups: clinical sacroiliitis (20 patients), polyarthritis with clinically silent sacroiliitis (12 patients), polyarthritis without sacroiliitis (47 patients), arthralgia preceded by beta-streptococcal infection (17 patients), other arthralgia (33 patients), osteo-arthritis (13 patients) and other arthritis (12 patients). Ric Clin Lab, 1978 Jan-Jun, 8(1-2), 56 - 64 Evidence for the involvement of the IgE-basophil-mastocyte system in human acute post-streptococcal glomerulonephritis; Camussi G et al.; Several findings reveal the involvement of the IgE-basophil-mastocyte-platelet-activating-factor (PAF) system in human acute post-streptococcal glomerulonephritis . In the acute phases of the disease there is a transient, marked reduction in the circulating metachromatically staining basophils, indicating an in vivo basophil degranulation . The blood reservoirs of PAF are depleted . The number of metachromatic mastocytes in renal biopsy samples was very low and morphological aspects of degranulation were present . In vitro, we demonstrated basophil degranulation and PAF release in presence of exogenous streptococcal Ags after recovery . These findings suggest that the IgE-basophil-mastocyte-PAF system may play a role in human pathology, as has been shown in immune complex (Ic) deposition in acute serum sickness in rabbits. Arkh Patol, 1978, 40(6), 11 - 20 {Ultrastructure of activation of connective and lymphoid tissue cells during experimental infectious-allergic carditis}; Ptashekas RS et al.; As a result of multiple and long-term antigenic stimulation with streptococcal products in experimental infectious-allergic carditis (EIAC) in rabbits there occurs functional activation of young connective-tissue cells of the cardiac valve, endothelial and perithelial cells of myocardium vessels and cells of the lymphoid tissue . Enhanced secretion of tropocollagen is common for mesenchymal heart cells in EIAC . At that, the most marked fibrillogenesis is observed in the cardiac valve in which tropocollagen is aggregated into mature fibrillae . Fibrillogenesis is less marked around myocardial pericytes, and formation of thinner, incompletely formed pre-collagen (FLS) fibrillae is predominant . In EIAC, in lymphoid organs plasmatization of B-lymphocytes and increased immunoglobulin formation in plasma cells are observed which is most marked in cisterns of a rough ergastoplasmic reticulum of immature cells. Nephron, 1978, 21(4), 192 - 200 Studies of cell-mediated immunity in human glomerulonephritis by macrophage migration inhibition test; Matsumoto K et al.; Using the macrophage migration inhibition test (MIT), a total of 113 patients with various renal diseases, namely glomerulonephritis (GN), were studied for evidence of cell-mediated immunity to various soluble antigens prepared . The positive rate of MIT in the presence of streptococcal antigen, glomerular basement membrane antigen, renal tubular epithelial antigen and heat-aggregated IgG antigen was 15, 23, 16 and 15%, respectively . Out of 15 positive patients who were able to be evaluated with those four antigens, 9 cases exhibited cellular hypersensitivity to two or more antigens at the same time . These findings suggest that there is an abnormal cellular response to certain antigen or widespread cell-mediated hypersensitivity to a variety of antigens in certain forms of human GN. Jpn Circ J, 1978 Jan, 42(1), 39 - 42 Cellular immunity in rheumatic heart disease; Shiokawa Y et al.; Cellular immunity to non-specific antigens (PPD, Candida albicans, and streptococcal antigens) and mitogen (PHA) was investigated in patients with valvular heart disease of rheumatic origin . The result disclosed that lowered response in cellular immunity exists in these patients . The possible significance of this finding in occurrence of rheumatic activity was discussed. Arch Neurol, 1978 Jan, 35(1), 43 - 4 Acute encephalopathy, streptococcal infection, and cryoglobulinemia; Hodson AK et al.; A 9-year-old girl had an acute encephalopathic illness characterized by disordered consciousness, seizures, and multiple cortical deficits . The acute illness was associated with serologic evidence of an antecedent streptococcal infection and the presence of a mixed cryoglobulin with specific antistreptococcal antibody activity . Although the patient had no other evidence of a systemic or central nervous system vasculitis, computerized tomography demonstrated changes compatible with a vasculitic process . Treatment with corticosteroids was associated with resolution of the cryoglobulinemia and complete clinical recovery. Am Rev Respir Dis, 1978 Jan, 117(1), 55 - 62 Cell-mediated immune responses in sarcoidosis; Goldstein RA et al.; In an attempt to understand divergent observations regarding the in vitro lymphocyte responsiveness to antigens and mitogens, the frequency of cutaneous reactivity, and the relationship of these variables to clinical features of sarcoidosis, we examined cell-mediated immune responses in 75 untreated patients . In vitro lymphocyte responses to phytohemagglutinin and concanavalin A were significantly decreased among the group of patients with chronic active disease . In vitro lymphocyte responses to streptococcal antigen paralleled the patient's cutaneous reactivity; however, when compared to healthy persons, patients with sarcoidosis responded significantly less often to streptococcal skin tests . Twelve of 13 persons expected to be tuberculin positive by clinical history were found to be dermally reactive, and 11 these 12 exhibited positive in vitro lymphocyte responses to purified protein derivative . Among the remaining 62 patients, failure to respond to all stimuli in vivo and in vitro occurred in only 10 . No evidence was found to support the general view that sarcoidosis is characterized by anergy to specific antigens . The patterns of responses to mitogens were neither characteristic nor unique for sarcoidosis . In patients in whom diminished specific cellular immune reactivity was observed, no correlation was evident with specific clinical features of the disease. Infect Immun, 1978 Jan, 19(1), 296 - 303 Activation of the alternate complement pathway by peptidoglycan from streptococcal cell wall; Greenblatt J et al.; Activation of the alternate complement pathway in human serum by several bacterial components was compared . Peptidoglycan from group A streptococcal cell walls was the most active material, on a weight basis, followed by cell walls, protoplast membranes, and whole cells . The group-specific carbohydrate was inactive . Treatment of peptidoglycan with low concentrations of lysozyme or short periods of sonic treatment enhanced complement activation . High concentrations of lysozyme or extended sonic treatment of peptidoglycan destroyed or greatly reduced the capacity to activate complement . Lysozyme treatment of group A streptococcal cell walls or lipopolysaccharide had no measurable effect . Activation of the alternate complement pathway by group D streptococcal cell walls was destroyed by lysozyme . Activity of peptidoglycan was not inhibited by N-acetyl glucosamine, N-acetyl muramic acid, or D-alanine-D-alanine . Conversion of C3 and factored B by peptidoglycan was shown to occur by immunoelectrophoresis and crossed immunoelectrophoresis. Vox Sang, 1978, 34(3), 136 - 42 Serological inhibition of blast transformation to purified streptococcal antigens by planned immunization in HLA (A,B) compatible unrelated individuals; Greenberg LJ et al.; Sera obtained from planned immunizations between unrelated donors and recipients, identical or compatible at HLA-A and B, were assessed for their capacity to alter the in vitro response of a test panel of lymphocytes to PHA and a purified streptococcal antigen (PAS) . In the case of PHA, no serum effects were apparent . The response to PAS, however, significantly inhibited by two sera . When tested for their complement-dependent cytotoxicity on enriched populations of T and B lymphocytes, none of the sera manifested cytotoxicity against T cells nor did serological inhibition correlate with the capacity to lyze B cells . The data suggest that inhibition of the PSA response is mediated by blocking antibodies specific for a subset of lymphocytes, possibly T cells . While the precise mechanism governing the response to PSA is not known, the data are compatible with the idea that an HLA-linked Ir gene, expressed on a subset of T lymphocytes, controls immune responsiveness to PSA. Arch Immunol Ther Exp (Warsz), 1978, 26(1-6), 965 - 8 Lymphokine-supressing cells in patients after kidney transplantation; Gorski A et al.; Streptococcal antigens elicit Leukocyte Migration Inhibitory Factor (LMIF) production by sensitive human lymphocytes in vitro leading to an inhibition of leukocyte migration in agarose plates . When mononuclear cells isolated from peripheral blood of healthy donors are added to the assay system, no significant alteration of LMIF generation occurs . Likewise, cells from patients with kidney allografts obtained during an uneventful postoperative course did not influence lymphokine synthesis . Conversely, cells isolated from patients undergoing acute graft rejection abolished SKSD-induced LMIF production by normal lymphocytes . These results support our earlier report of the existence of lymphokine-suppressing cells in man and suggest that they may play yet poorly defined role in certain immunopathologic situations. Arch Immunol Ther Exp (Warsz), 1978, 26(1-6), 577 - 81 Detection of circulating immune complexes in patients with glomerulonephritis; Szewczyk Z et al.; 143 patients were evaluated clinically on the basis of the renal biopsy . Three methods for detecting circulating immune complexes (CIC) were employed: complement consumption test, inhibition of erythrocyte antibody IgG-EA rosette forming test and optical density of 4% PEG precipitated sera . CIC were present in the sera of all patients with acute poststreptococcal glomerulonephritis (2 weeks after streptococcal infection of the throat) . In a group of patients with chronic glomerulonephritis the highest values in positive results were observed in lupus nephritis, chronic proliferative glomerulonephritis and chronic submicroscopic glomerulonephritis . These results were compared with levels of total hemolytic complement, C3, C4 components and serum immunoglobulins (IgA, IgG, IgM). Ann Rech Vet, 1978, 9(1), 63 - 88 {Effectiveness of antibiotics in bovine staphylococcal and streptococcal mastitis}; Le Louedec C; The present knowledge of the efficiency of antibiotics against bovine mastitis has been reviewed . Criteria for the choice of papers are given, together with tabulated results of treatments with one antibiotic or two . Results are discussed in relation to the time of treatment and the pathogenic agent involved, and a classification of the antibiotics into three groups is proposed: recommended; not advised; not sufficiently studied. Zentralbl Gynakol, 1978, 100(11), 689 - 95 {Lymphocyte transformation test with streptococcal antigens in newborn infants and their mothers}; Knoll H et al.; Following streptococcal mitogens and antigens were tested in the lymphocyte transformation test with human cord blood and maternal blood: streptococcal M1- and M19-proteins, mucopeptide, erythrogenic toxins and additional phytohemagglutinin . There are no significant differences in the blastogenic response with the different mitogens and antigens in maternal and cord blood . The cord blood lymphocytes show the same degree of blastogenic reaction to the mitogens and antigens as the maternal lymphocytes, that may reflect the state of readiness for cellular immunological defence . The spontaneous incorporation of 3H-labelled thymidine into cord blood lymphoblasts is significant higher than in lymphoblasts of maternal blood.--The results of specific and unspecific stimulation by means of steptococcal antigens are discussed. Prog Clin Biol Res, 1978, 23, 601 - 12 Immunochemistry of streptococcal group C polysaccharide and the nature of its crossreaction with the Forssman glycolipid; Coligan JE et al.; Acid hydrolysis of streptococal Group C polysaccharide yields a disaccharide, 3-O-alpha-N-acetylgalactosaminosyl-N-acetylgalactosamine (3-O-alpha-GalNAc-GalNAc) which expresses Group C antigenic activity . This disaccharide, which exists as a side chain in the intact polysaccharide, can completely inhibit the binding between Group C polysaccharide and most Group C antibodies, indicating that this unit is the immunodominant feature of the intact polysaccharide . The alpha anomeric configuration and N-acetylation are required for the expression of the antigenic activity by the haptenic disaccharide . Also obtained from the acid hydrolysis of the Group C polysaccharide are rhamnose oligosaccharides with structural identity to the Group A-variant polysaccharide and with Group A-variant antigenic activity . It is inferred from these data that the Group A-varient polysaccharide structure is the core unit of the Group C polysaccharide . The nature of the immunologic crossreactivity between the Forssman glycolipid and Group C polysaccharide, which possess identical nonreducing terminal digalactosamine units, was investigated . Rabbit anti-Group C antibodies bound the Forssman glycolipid with approximately the same affinity as 3-O-alpha-GalNAc-GalNAc and were capable of mediating lysis of sheep red blood cells (SRBC) . Antibody fractions isolated from anti-sheep hemolysin were likewise able to bind Group C polysaccharide . The heterologous reactions were in most assay systems weaker than reactions with the immunizing antigen. Infect Immun, 1978 Jan, 19(1), 51 - 7 Alteration of clearance function by group A streptococcal pyrogenic exotoxin and its relation to suppression of the antibody response; Cunningham CM et al.; The effect of purified group A streptococcal pyrogenic exotoxin (SPE) type A on the processing of and antibody response to sheep erythrocytes (SRBC) was studied in BALB/cWat mice . The rate of clearance of 51Cr-labeled SRBC from the bloodstream was decreased 3 or 24 h following a single intravenous injection of 1 or 10 microgram of SPE . Delayed uptake of label was observed in both the livers and spleens of SPE-treated mice, suggesting an inhibitory effect of the toxin on phagocytic cells of the reticuloendothelial system . Three daily intravenous injections of 0.1 or 1 microgram of purified SPE type A suppressed the early immunoglobulin response to SRBC . The role of altered macrophage function in producing the immunosuppression was tested in macrophage transfer experiments . SPE treatment suppressed the antibody response to SRBC transferred by normal macrophages, indicating that the immunosuppressive effect of the toxin was not due solely to altered antigen processing by macrophages. Exp Cell Biol, 1978, 46(1-2), 71 - 81 Specific and cross-reactive activation of rabbit peripheral blood lymphocytes by streptococcal vaccines; Pawlita M et al.; The ability of primed rabbit blood lymphocytes to respond in vitro to the homologous streptococcal group antigen depends on its presence in culture in the form of vaccine or cell walls thereof . These lymphocytes can also be stimulated in vitro by streptococcal vaccines with chemically related group antigens . The basis for this cross-stimulation apparently resides in shared rhamnose moieties . Activation of these lymphocytes was not achieved by vaccines from unrelated bacteria . There is also the suggestion that rabbits of different genetic origin differentiate between cross-stimulating antigens, probably at the level of antigenic determinants . The data support the view that recognition and response pattern of the immune system rely heavily on a network of antigens. Ann Anesthesiol Fr, 1978, 19(11-12), 895 - 7 {Bacteriological studies of peritonitis}; Peloux Y; Bacterial infections of the peritoneum may be primary (pneumococcal peritonitis of childhood) . These are rare, as are Streptococcal and Staphylococcal peritonitis in the neonate, following umbilical or tegumental infections . The great majority of cases of peritonitis are secondary to an adjacent inflammation, a perforation of the gastro-intestinal tract, or trauma, which may be surgical in origin . The microbial flora involved is generally mixed, with a high proportion of anaerobic organisms, reflecting the composition of the intestinal flora, and in particular, that of the colon . Infections due to a single organisms are less common, and are seen principally in superinfected ascites, high perforations, or following preoperative antibiotic therapy . The treatment of peritonitis is thus dependent upon the microbial flora present . In mixed infections, broad spectrum antibiotic therapy (amino-glycosides + beta lactamines) is necessary, combined with a b-nitro-ionidazole derivative in view of the frequent presence of Bacteroides fragilis . When the infection is due to one or a limited number of organisms, only the antibiotic sensitivy will provide useful indications . The dangers of preoperative "sterilization", which leads only to the selection of multiresistant strains, is emphasized . Such sterilization is thus to be proscribed in the prevention of peritonitis . Antibiotic cover, on the other hand, is still indicated. Aust N Z J Med, 1977 Dec, 7(6), 616 - 24 Histocompatibility antigens (HLA): associations with immunopathic diseases and with responses to microbial antigens; Morris PJ et al.; Described is the experience from a single histocompatibility typing laboratory sampling, firstly, Australian patients with various immunopathic diseases and, secondly, subjects previously classified as "responders" or "non-responders" to various microbial antigens . The diseases considered included chronic active hepatitis (CAH) and various cirrhoses, "thyrogastric" autoimmune diseases, systemic lupus erythematosus (SLE), rheumatoid arthritis, dermatitis herpetiformis (DH) with intestinal villous atrophy, and multiple sclerosis (MS) . The immune responses considered included those to flagellin, candidin, mumps, trichophyton, tuberculin and streptococcal enzymes . The HLA specificities particularly associated with disease included B8 (CAH, thyrotoxicosis SLE, DH, and miscellaneous immunopathic diseases) and B7 (thyrotoxicosis, SLE, DH, and MS) . The same specificities were present in excess, although not impressively so, among responders to certain of the microbial antigens, i.e . B7 with high responders to flagellin and B8 (and A1) with responders to trichophyton. Infect Immun, 1977 Dec, 18(3), 624 - 8 Autoantibodies detected in rabbits hyperimmunized with group A, C, and G streptococcal vaccines; Onica D et al.; Rabbits hyperimmunized with group A, C, and G streptococcal vaccines developed autoantibodies with affinities for different tissues (smooth muscle, cytoplasmic, and myocardial antibodies) and for autologous proteins (anti-albumin and anti-immunoglobulin antibodies) . The presence of anti-albumin and smooth muscle antibodies, associated with a high level of immunoglobulin, suggests the development of hepatic disorders in the hyperimmunized rabbits. Am J Dis Child, 1977 Dec, 131(12), 1366 - 71 Group a beta-hemolytic streptococcal pneumonia: clinical course and complications of management; Molteni RA; Three childhood cases of beta-hemolytic streptococcal pneumonia are presented with a review of the literature . The disease, though uncommon in childhood, results in severe local and systemic effects . Hematologic fluid and electrolyte problems are frequent . Pericardial disease and secondary bacterial invasion are added dangers encountered in management . Early and vigorous drainage of the pleural cavity is essential to successful outcome . It appears that predisposing viral disease, including influenza, is essential for acquisition of this form of bacterial pneumonia. J Exp Med, 1977 Nov 1, 146(5), 1195 - 205 Antibody response to the streptococcal group A-variant polysaccharide in BASILEA rabbits lacking kappa-polypeptide chains; Weiss S et al.; Rabbits from a variant strain called BASILEA, in which homozygotes express only lambda-type chains and heterozygotes have normal kappa/lambda ratios, were hyperimmunized with a streptococcal group A variant vaccine . Homozygotes (bas/bas) produced antibodies with lambda-chains, heterozygotes, however, produced predominantly antibodies with kappa-chains . The incidence of restricted high responders in the BASILEA strain was high; it was probably introduced by the original mutant rather than by the loss of kappa-chains (founder effect) . The degree of heterogeneity of homozygotes is similar to the heterogeneity of heterozygotes, and to that of rabbits expressing kappa-chains . This suggests that in the rabbit, the repertoire of lambda-chain genes is of similar size to that of kappa-chain genes. Br J Dermatol, 1977 Nov, 97(5), 529 - 36 Lymphocyte activation by streptococcal antigens in psoriasis; Gross WL et al.; Cell-mediated immune responses in 28 hospitalized patients with psoriasis and in 36 healthy controls were studied using the two-step leukocyte migration agarose test . Specific cell-mediated immunity to A-streptococcal cell wall and cell membrane antigens occurred significantly more often in patients with psoriasis than in the control group . A statistically significant correlation between psoriasis-associated antigens of the HLA-B locus and cellular immune reactivity to A-streptococcal antigens or clinical course was not found . When patients with guttate psoriasis were compared separately with the control group, leukocyte migration inhibition induced by cell-free supernatants of A-streptococcal antigen-exposed mononuclear cell cultures was found to be more frequent than in other forms of psoriasis. J Exp Med, 1977 Nov 1, 146(5), 1436 - 49 Absolute frequencies of lipopolysaccharide-reactive B cells producing A5A idiotype in unprimed, streptococcal A carbohydrate-primed, anti-A5A idiotype-sensitized and anti-A5A idiotype-suppressed A/J mice; Eichmann K et al.; The absolute frequencies of B cells-producing A5A idiotype have been determined in vitro by limiting dilution analysis in a culture system in which every LPS-reactive B cell grows into a clone of IgM-secreting cells . Spleen cells from normal A/J mice contain 1 A5A-idiotype-producing B-cell precursor in 2.5 X 10(3) LPS-reactive B cells . Approximately a 10-20-fold increase in frequencies of precursor cells from antigen priming with Strep A-CHO (1 in 2.8 X 10(2)) or from sensitization with IgG1 anti-A5A idiotype (1 in 1.3 X 10(2)) . Injection of IgG2 anti-A5A idiotype which has been shown to suppress A5A idiotype in vivo results in only a marginal and maybe insignificant decrease in precursor frequencies (1 in 6.7 X 10(3)) . On the other hand, priming does not result in a detectable qualitative difference in the specific precursor cells, since each clone of B cells secretes 30 ng of A5A-bearing Ig within 8 days of culture, regardless of being unprimed or primed . Nearly half of all A5A idiotype-producing clones, both from unprimed as well as from primed mice, show antigen specificity in binding A-CHO . Priming by antigen, therefore, also results in a 10-fold increase in the frequency of idiotype positive B cells without antigen specificity . This result is a prediction of the network hypothesis. J Clin Microbiol . 1977 Nov;6(5):533. Evaluation of the Wampole Streptonase B test; Klein GC; The Streptonase B test was compared with the Center for Disease Control streptococcal anti-deoxyribonuclease B test . A total of 96% of anti-deoxyribonuclease B titers obtained with the Streptonase B test were within +/- 1 dilution step of those obtained with the Center for Disease Control anti-deoxyribonuclease B test. Gann, 1977 Oct, 68(5), 703 - 8 Antitumor effect of combined use of OK-432 and yeast cell wall with mitomycin-C in mice; Mashiba H et al.; Tumor-inhibitory effect of combined use of mitomycin-C and streptococcal preparation (OK-432) or yeast cell wall (YCW) was examined . Twenty-four hours after intraperitoneal inoculation of Ehrlich carcinoma cells, combination therapy was carried out and tumor growth was observed for 40 days . About one-half of mice treated with yeast cell wall at a single dose of 1 mg survived free of tumor . Mitomycin-C at a single dose of 2 microgram was not effective . However, in combination with yeast cell wall, tumor suppression was observed in 70% of the mice . This tumor-inhibitory effect was enhanced by subsequent treatment with OK-432 or yeast cell wall . When these materials were injected separately or in combination with mitomycin-C, the number of peritoneal exudate cells increased about 3 to 6 times after 3 days and these cells exhibited cytotoxic effect on tumor cells . Hemagglutinating antibody to sheep erythrocytes was hardly affected by the combination therapy. Health Lab Sci, 1977 Oct, 14(4), 284 - 90 Comparative study of antistreptolysin O, antideoxyribonuclease B and multienzyme tests in streptococcal infections; Golubjatnikov R et al.; The results of antistreptolysin O (ASO), antideoxyribonuclease B (ADB), and a multienzyme test, Streptozyme, with 162 sera from a stratified random sample of Wisconsin school children, and specimens routinely submitted for serodiagnosis of Group A streptococcal infections are described . A review of the results of Streptozyme tests of laboratories participating in the State Division of Health Proficiency Testing Program, is also presented . The results of these various tests have revealed both false positive and false negative results with the Streptozyme procedure . Although there was good correlation of the Streptozyme findings with the ASO and ADB tests results with sera from young children, false positive Streptozyme test results increased with age of the study subjects . Our results with the ADB test on sera from apparently normal Wisconsin children and young adults suggest that the upper limits of normal ADB values, suggested by the manufacturers of commercial ADB test kits, may be too low. J Pediatr, 1977 Oct, 91(4), 632 - 7 The differential leukocyte count in the assessment and outcome of early-onset neonatal group B streptococcal disease; Manroe BL et al.; The usefulness of the differential white blood cell count in distinguishing early-onset group B streptococcal disease from other causes of neonatal respiratory distress was studied in 45 infants with culture-proved infection . The initial diagnosis was hyaline membrane disease in 19 infants, wet lung syndrome 13, and other causes of respiratory distress in 13 . Thirty-nine (87%) had abnormal absolute neutrophil counts, 25 with neutropenia and 14 with neutrophilia . The absolute immature neutrophil count was elevated in 19 infants (42%) . Forty-one infants (91%) had an abnormal immature neutrophil to total neutrophil ratio . All infected infants were identified when both the absolute total neutrophil count and ratio were used . The differential white cell count appears to be a useful tool for screening infants presenting with respiratory distress in the first 48 hours of life and for separating early-onset group B streptococcal disease from other causes of neonatal respiratory distress. J Dent Res, 1977 Oct, 56(10), 1179 - 83 Effect of SnF2 mouthrinse on initial bacterial colonization of tooth enamel; Gross A et al.; Microbiologic quantitative methods and scanning electron microscopy were used to observe the effect of stannous fluoride (100 ppm F-) mouthrinse on early plaque formation . An in vivo plaque model system was used on two individuals to test this experimental agent . Following SnF2 mouthrinsing, the total bacterial counts of two-day-old plaque on enamel cylinders were reduced up to 50.8 times or 98% and the streptococcal counts were decreased up to 48.4 times or 97.9% . Scanning electron microscopy confirmed a marked decrease of bacteria on enamel with use of SnF2 mouthrinse . It appears that, in addition to reducing enamel solubility and other properties, SnF2 may also alter bacterial accumulations on teeth. J Exp Med, 1977 Oct 1, 146(4), 1108 - 23 Streptococcal M protein extracted by nonionic detergent . II . Analysis of the antibody response to the multiple antigenic determinants of the M-protein molecule; Fischetti VA; Purified streptococcal M protein extracted by nonionic detergent was used in an RIA and a solid-phase radiocompetitive inhibition assay to determine the nature of the immune response in both human beings and hyperimmunized rabbits to this complex antiphagocytic antigen . Results indicate that a type-specific response to an M antigen with the development of opsonic antibodies is the result of antibodies directed against the majority of the antigenic determinants of the molecule . Cross-reactions between certain M types on the other hand, are represented by antibodies directed against only a small percentage of these antigenic determinants . Results also suggest that avidity may play a role in the action of opsonic antibodies . However, the data indicate that factors besides avidity (i.e . sites bound by the antibodies) also seem essential for opsonization. J Fam Pract, 1977 Sep, 5(3), 385 - 9 The content of family practice: a family medicine resident's 2 1/2-year experience with the E-book; Shank JC; The purpose of this paper is to present the content of office family practice problems seen over a 2 1/2-year residency period and to afford comparison with the well-known Virginia Study . It illustrates the usefulness of the diagnostic E-Book, with which all the data were collected and preserved . Over a 2 1/2-year period, the author cared for 592 patients in the family practice office . The ratio of one physician to 592 patients compares to the Virginia Study's one physician to approximately 745 patients . A total of 1,640 problems were coded in the E-Book . In this study 55 problems/physician/month were seen, whereas in the Virginia Study approximately 177 problems/physician/month were noted . Respiratory illnesses were the most common diagnostic category in both studies . Among specific problems, obesity ranked first at Hershey, with afebrile colds second, hypertension and Beta streptococcal pharyngitis third, and smoking fourth . Obesity and smoking were ranked considerably lower in the Virginia Study, whereas "health maintenance examinations" were ranked number one . Finally, for age-sex practice profiles, the present data revealed two peak age groups for both sexes, whereas the Virginia work noted only one peak age range. Radiology, 1977 Sep, 124(3), 771 - 7 The radiographic features of early onset Group B streptococcal neonatal sepsis; Ablow RC et al.; The clinical and radiographic features of 27 newborn infants with early onset Group B streptococcal infection as documented by blood culture have been reviewed . Initial chest radiographs revealed a wide spectrum of patterns . These included changes usually associated with the respiratory distress syndrome, extensive pneumonia, and small infiltrates as well as a normal appearance . Premature birth and a fatal outcome were associated with extensive radiographic changes . At autopsy some of the infants with a radiographic appearance of respiratory distress syndrome had pathologic features of Group B streptococcal infection with no apparent evidence of coexisting respiratory distress syndrome. Ann Sclavo, 1977 Sep-Oct, 19(5), 1002 - 5 {Effects of streptococcal toxin on hepatic regeneration in the rat}; Rossolini A et al.; The liver regeneration percentage, mytotic activity and protein content were used to demonstrate the effects of streptococcal toxin on regenerating rat liver . No statistically significant difference was showed between controls and toxin treated animals . Serum level of C, resulted on the contrary, considerably reduced in the animals treated with streptococcal toxin. Am J Med Sci, 1977 Sep-Oct, 274(2), 163 - 7 Idiopathic hypertrophic subaortic stenosis in the elderly; Albin EL et al.; In a 24-month period, 27 patients with idiopathic hypertrophic subaortic stenosis (IHSS), ages 65-80 years, were observed . Diagnoses were made by echocardiography (24 patients), cardiac catheterization (one patient), and both methods (two patients) . The most common symptoms were angina (17 patients), dyspnea (13 patients), and syncope (11 patients) . Two patients were asymptomatic, while another complained only of vague retrosternal chest discomfort with exertion . One asymptomatic patient had a completely normal physical examination, but electrocardiography (ECG) demonstrated a pattern of left ventricular hypertrophy . Another patient had an inconsistent apical holosystolic murmur . Two patients had alpha streptococcal endocarditis; neither was known to have pre-existing valvular disease . Fourteen patients had ECG criteria for left ventricular hypertrophy (LVH) . Three patients were known to have associated aortic valve disease . The symptoms of IHSS may be nonspecific; asymptomatic patients with and without cardiac murmurs may be observed . Coexisting valvular disease, coronary artery disease, and bacterial endocarditis were documented . Patterns of myocardial infarction on ECG were not seen in these 27 patients. Infect Immun, 1977 Sep, 17(3), 599 - 606 Cytotoxicity of rat macrophages activated by persistent or biodegradable bacterial cell walls; Smialowicz RJ et al.; Peritoneal macrophages from Fischer 344 rats were cytotoxic for mouse fibroblasts after in vitro phagocytosis of non-biodegradable group A streptococcal cell walls . In contrast, macrophages from Buffalo rats were not activated to cytotoxicity by bacterial cell walls . Activation to cytotoxicity was only achieved by the macrophages after an interval of at least 3 days in culture after ingestion of group A cell walls . If macrophages were cultured only 24 h after ingestion of cell walls, a cytostatic effect on target cells was observed . Phagocytosis of biodegradable group D streptococcal cell walls did not activate macrophages from either rat strain to become cytotoxic . No direct toxicity of cell walls for macrophages or mouse L-cells was observed . The cytotoxicity of Fischer 344 macrophages appears to require direct cell contact with target cells. Infect Immun, 1977 Sep, 17(3), 591 - 8 Processing of streptococcal cell walls by rat macrophages and human monocytes in vitro; Smialowicz RJ et al.; Phagocytosis and degradation of cell walls by peritoneal macrophages obtained from Fischer 344 or Buffalo rats was measured in tissue culture . Group A cell wall antigen, detected by immunofluorescence, persisted in cultured rat macrophages for at least 40 days, whereas group D cell wall material was eliminated by 6 to 8 days . This same pattern of persistence of group A cell walls and elimination of group D cell walls was observed in cultures of human monocytes followed for 24 days in culture . Group A streptococcal cell walls labeled with either {14C}alanine or {14C}glucose were handled in a similar manner by macrophages from either Fischer 344 or Buffalo rats . In contrast, {14C}glucose-labeled group D cell walls were degraded at a much faster rate . Buffalo macrophages were more efficient than Fischer 344 macrophages in degrading group D cell walls . The inability of macrophages to degrade group A cell walls was not due to a failure of lysosomes to fuse with phagosomes . Neither serum lysozyme in the culture medium nor cell wall-associated autolysin contributed to the degradation of group D cell walls by macrophages . Neither immune serum nor macrophages obtained from specifically immunized rats influenced phagocytosis or persistence of group A cell walls. Arch Intern Med, 1977 Sep, 137(9), 1196 - 7 Renal cortical necrosis following Streptococcal infection; Moss SW et al.; Streptococcal infection frequently leads to proliferative glomerulonephritis, and, on rare occasions, to renal cortical necrosis . We report a case in which poststreptococcal proliferative glomerulonephritis and renal cortical necrosis occurred concomitantly. Am J Dis Child, 1977 Sep, 131(9), 1005 - 8 Staphylococcal and streptococcal colonization of the newborn infant: effect of antiseptic cord care; 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 three regimens studied included castile soap, triple dye, and silver sulfadiazine . The triple dye and silver sulfadiazine application inhibited bacterial colonization . Staphylococcal colonization was inhibited by both treatment regimens but most effectively by triple dye . Group B streptococcal colonization was inhibited most effectively by silver sulfadiazine while triple dye application to the umbilicus promoted colonization with this microorganism . Silver sulfadiazine was more effective in controlling colonization with Gram-negative microorganisms. Am J Med, 1977 Sep, 63(3), 449 - 52 Bacteremic hemophilus influenzae type B cellulitis in the adult; Drapkin MS et al.; Described herein are three patients over the age of 50 years who had cellulitis of the neck and the upper portion of the chest, associated with Hemophilus influenzae type B bacteremia and respiratory tract infection--particularly that of the upper airway . Only one of the patients with cellulitis had the classic bluish-purple hue commonly seen in children affected with this syndrome . In the other two, the H . influenzae type B cellulitis could not be distinguished clinically from the more common group A streptococcal or staphylococcal cellulitis . Since the antibiotics employed in treating patients with infection due to the latter two organisms differ significantly from those used to treat patients with H . influenzae type B infection, the possibility of disease due to H . influenzae type B must be considered in any adult or child in whom cellulitis of the neck, chest and possibly face is associated with a respiratory tract infection, especially of the upper airway. Br Med J, 1977 Aug 27, 2(6086), 552 - 4 Amoxycillin and co-trimoxazole in presumed viral respiratory infections of childhood: placebo-controlled trial; Taylor B et al.; A double-blind randomized controlled trial of amoxycillin, co-trimoxazole, and placebo was conducted on 197 children presenting with presumed viral respiratory infections . Routine throat swabs were taken to exclude streptococcal diseases . The three disease categories studied--nasopharyngitis, pharyngotonsillitis, and bronchitis (including laryngotracheobronchitis)--showed a generally similar pattern of resolution irrespective of treatment . Nevertheless, seven out of 66 children receiving placebo were withdrawn from the trial with unremitting symptoms or complications thought to require antimicrobial treatment . Only two of 56 children receiving amoxycillin and none of 75 receiving co-trimoxazole were withdrawn . Three other children receiving amoxycillin and three receiving placebo were seen during the trial but further treatment was not thought to be necessary . Thus the return consultation rate in children receiving placebo therapy was 15% compared with 4% for those receiving antimicrobial treatment . Antimicrobial treatment was associated with less nasal discharge on the eighth day of treatment . Placebo treatment allowed an earlier return to normal activity . There was a high incidence of possible side effects on all regimens including placebo . It is concluded that the benefits of antimicrobial treatment in presumed viral respiratory infections are marginal, and they should not be routinely prescribed for these conditions. Br Med J, 1977 Aug 13, 2(6084), 422 - 4 Cellular reaction to group A beta-haemolytic streptococcal membrane antigen and its relation to complement levels in patients with rheumatic heart disease; Sapru RP et al.; Cell-mediated immunity and blood complement activities were studied in 35 patients with chronic rheumatic heart disease (RHD) and 17 normal subjects . The T-cell population in patients with RHD was reduced, as were the CH50 and C3 complement levels . The response to phytohaemagglutinin stimulation was deficient, but the lymphocytes of patients with RHD showed increased avidity for 3H-thymidine when stimulated with specific streptococcal membrane antigen . No differences were found between patients with acute rheumatic activity and those without such activity . The susceptibility of individual patients may be related to the specific sensitisation of lymphocytes, while the fact that this persisted even when T-cell numbers had returned to normal may account for the well-known recrudescenses after streptococcal infections in these patients. Rheumatol Rehabil, 1977 Aug, 16(3), 141 - 9 Can chronic and self-perpetuating arthritis in the human be caused by arthrotropic undegraded microbial cell wall constituants? A working hypothesis; Ginsburg I; Although the aetiological agents responsible for the initiation of rheumatoid arthritis in the human are not known, the possibility that the disease is of bacterial origin has been considered . The bacterial factors involved may be small fragments of undegraded wall components which persist for long periods within macrophages and trigger the active release of lysosomal enzymes which cause tissue destruction . The failure to identify such wall components in diseases tissues may be due to the lack of adequate sensitive techniques to detect minute amounts of these wall components, shown to trigger chronic destructive arthritis in laboratory animals . Two models of arthritis caused by mycobacterial and streptococcal wall components are described and the possible role played by immune responses, to the persisting bacterial factors, in the pathogenesis of human arthritis is discussed. Intensive Care Med, 1977 Aug, 3(2), 93 - 6 Haemolytic streptococcal septicaemia; Stoddart JC; Two cases of haemolytic streptococcal septicaemia are reported, in one of which DIC was identified . The clinical presentation and the appearance of the patients is described. Am J Epidemiol, 1977 Aug, 106(2), 139 - 44 An evaluation of penicillin prophylaxis during an outbreak of foodborne streptococcal pharyngitis; Ryder RW et al.; Between August 16 and 21, 1974, an outbreak of beta-hemolytic group A M-9 T-9 streptococcal pharyngitis affected 49% of a randomly selected group of inmates at a jail in southern Florida . Food-specific attack rates incriminated improperly stored egg salad served at lunch on August 16 as the vehicle of transmission . By August 20, 290 symptomatic inmates had been placed on penicillin or erythromycin; on that day fewer than 5% of throat cultures from 400 allegedly non-penicillin-allergic largely asymptomatic inmates, cultured just before penicillin prophylaxis, were positive for the epidemic strain . At the time prophylaxis was given, secondary transmission had accounted for only 3% of cases . No non-suppurative sequelae were observed but 5% of inmates who received penicillin prophylaxis experienced an adverse reaction to the drug . Although widespread penicillin prophylaxis during outbreaks of group A beta-hemolytic streptococcal pharyngitis will likely prevent transmission of these organisms, prompt treatment of all symptomatic cases may be equally as effective in controlling adult institutional foodborne outbreaks of streptococcal pharyngitis and will likely minimize the number of adverse reactions to penicillin which may be seen. South Med J, 1977 Aug, 70(8), 1005 - 7 Fatal myocarditis associated with acute tonsillitis; Bender BL et al.; A case of myocarditis, hepatic necrosis, and acute anuria associated with acute tonsillitis was described . The previously reported relation between myocarditis and tonsillitis not of diphtheritic or beta-hemolytic streptococcal origin was discussed, as well as the implications for management. J Infect Dis, 1977 Aug, 136 Suppl, S222 - 33 Streptococcal M protein: an antiphagocytic molecule assembled on the cell wall; Fischetti VA et al.; After extraction with nonionic detergent, type 6 streptococcal M protein was found to be composed of multiple proteins ranging in molecular weight from 35,000 to 6,000 daltons . The antiphagocytic proteins, however, were found to be limited to three species having molecular weights of 28,000, 31,000, and 35,000 daltons . These molecules which removed opsonic antibodies from immune serum could be separated from those proteins that had only type specificity . Pulse chase experiments supported by chemical and immunological data suggest that the smaller, type-specific molecules are used to assemble the larger, antiphagocytic proteins . Type 6 M protein was radialabeled and used in a binding assay for the measurement of opsonic antibodies in human serum . Good correlation was observed between binding and the presence of opsonic antibodies in both systems . However, certain sera did exhibit binding but lacked type-specific opsonic activity . Results of competitive inhibition experiments demonstrated that the nonopsonic serum was deficient in certain antibodies that were present in opsonics serum and that the anitphagocytic molecules contained the sites necessary to bind these antibodies. South Med J, 1977 Aug, 70(8), 978 - 9 Group B streptococcal colonization in a newborn nursery: effects of iodophor and triple dye cord care; Wong P et al.; Control of nosocomial group B streptococcal (GBS) colonization of newborn infants was attempted in a four-cycle study alternately employing single applications of povidone-iodine (iodophor) and triple dye to the umbilical cord stump and periumbilical area . GBS colonization rates were 49% and 34% following iodophor cord care (cycles II and III) and 11% and 50% following triple dye cord care (cycles II and IV) . The apparent significant reduction of GBS colonization during triple dye cycle II could not be reproduced in a subsequent follow-up culture survey and remains unexplained. J Exp Med, 1977 Aug 1, 146(2), 344 - 60 Streptococcal-induced cell-mediated-immune destruction of cardiac myofibers in vitro; Yang LC et al.; We have demonstrated that T lymphocytes from the spleens of adult guinea pigs sensitized to group A streptococcal antigens are cytotoxic for cultured fetal guinea pig heart cells . Lymphocyte cytotoxicity, measured by 51Cr release from target cells, was stimulated by sensitization in vivo with group A whole cells, cell walls, and purified protoplast membranes emulsified with complete Freund's adjuvant (CFA) . Sensitization with group C streptococcal antigens in CFA or CFA alone produced lymphocytes with little or no specific cytotoxic activity . Target cells of cultured fetal skeletal muscle, liver, or skin were relatively refractory to effector cell cytotoxicity . The presence of antigenic determinants on the membranes of cultured myofibers, cross-reacting with group A streptococcal cellular antigens, was confirmed by immunofluorescence . These data are discussed in terms of a model for poststreptococcal rheumatic myocarditis in which cell-mediated autoimmune mechanisms may participate. Pediatrics, 1977 Aug, 60(2), 227 - 34 Polyarteritis nodosa in older children; Blau EB et al.; Polyarteritis in the older child is thought to be a rare disease . This study describes 11 children, 3 to 12 years of age, with polyarteritis seen over a five-year period . Fever, abdominal pain, hypertension, and leukocytosis were found in almost all . Renal disease occurred in eight . Examination of muscle, gut, or kidney tissue was an effective means of diagnosis . The pathological changes were the same as those seen in adults . There seemed to be an association between polyarteritis and group A streptococcal infection . Ten patients had a salutary response to high-dose prednisone administration. J Pediatr, 1977 Aug, 91(2), 228 - 32 Necrotizing arteritis in acute poststreptococcal glomerulonephritis: report of a recovered case; Ingelfinger JR et al.; A patient with biopsy documented acute poststreptococcal glomerulonephritis and arteritis recovered completely with supportive therapy . Illness was preceded by group A streptococcal pharyngitis . At the time of presentation, serum creatinine concentration was 11.5 mg/dl . Serum cryoglobulins containing IgG and C3 were present . The first biopsy, performed during the acute illness, contained glomeruli with typical features of acute PSGN . Medium-sized arteries had extensive necrosis and leukocytic infiltration, and contained IgG, C3, and fibrin . Glomerular filtration rate returned to normal within three weeks; proteinuria cleared by three months, and microscopic hematuria by 11 months . Renal biopsy one year later showed minimal mesangial hypercellularity and no arteritis. Z Gesamte Inn Med, 1977 Jul 15, 32(14), 347 - 51 {Therapy of rheumatic fever}; Seidel K; After making the diagnosis the rheumatic fever as a secondary disease after streptococcal infection is immediately to be treated with penicillin G . Parallel to this or overlapping the rheumatic inflammatory mesenchymal tissue reactions are treated with prednisolone or derivatives, aminophenazone or salicylic acid preparations, in which cases in children prednisolone and aminophenazone are preferred . The combat against the streptococcal infection by means of penicillin transgresses into a recidivation prophylaxis with benzathin-penicillin, which is to be performed up to an age of 5 years . Substitutes for the recidivation treatment with benzathin-penicillin are V-tablopen or erythromycin, perhaps also sulfaclomide . The treatment is to be performed in a hospital up to the time that the patient is free from signs of inflammation and at least 4 weeks without fever, then a gradual rehabilitation begins. Vet Pathol, 1977 Jul, 14(4), 325 - 31 Anaphylactoid purpura in a horse; Gunson DE et al.; An 8-year-old gelding with a long-standing, streptococcal respiratory infection developed dyspnoea and colic . Laparotomy disclosed numerous, discrete, hemorrhagic, thick areas of necrosis throughout the intestinal tract . At postmortem examination similar lesions were seen in the laryngeal mucosa and in many skeletal muscles . Microscopically these lesions had massive necrosis and hemorrhage with a leucocytoclastic vasculitis in adjacent tissue . This condition resembled anaphylactoid purpura (Henoch-Schonlein disease) in man . Fungal infection was ruled out by special stains which failed to show fungal elements. Johns Hopkins Med J, 1977 Jul, 141(1), 9 - 13 Fever in the first eight weeks of life; Roberts KB et al.; Sixty-one febrile infants in the first eight weeks of life were evaluated for serious, treatable illness . Infants with bacteremia could not be distinguished from non-bacteremic infants by height of fever, white blood cell count, absolute number of juvenile or mature polymorphonuclear leukocytes, or the presence of a focus of infection (meningitis excluded) . The examiners' overall assessment ("clinical judgment") correctly identified eight of the nine infants with bacteremia as not being "well"; one 2-week-old with group B streptococcal bacteremia was "missed" clinically, This points up the limitation of clinical judgment in assessing febrile infants in the age group studied and supports an aggressive approach in the management of very young febrile infants. Am Heart J, 1977 Jul, 94(1), 37 - 43 The value and limitations of echocardiography in recording mitral valve vegetations; Boucher CA et al.; The echocardiographic findings and case reports of three patients with active Streptococcal endocarditis and severe congestive heart failure are presented . All three had pathologically proven vegetations on the mitral valve; however, only the two with calcification of the vegetations were successfully demonstrated on echocardiography . Clinical and pathological differences are highlighted and prior case reports in the literature are reviewed . The nonspecific nature of echoes recorded from valvular vegetation is stressed and factors in their echocardiographic detection are discussed. Indian J Physiol Pharmacol, 1977 Jul-Sep, 21(3), 199 - 202 Studies on the toxic effects of streptolysin 'O': electrocardiographic changes in mammals; Gupta S et al.; The effect of streptolysin 'O' (a streptococcal exotoxin) on ECG in rabbits and mongrel puppys has been investigated . The intravenous administration of streptolysin 'O' (SLO) in doses of 0.5 to 2 U/kg in rabbits and 0.5 to 4 U/kg in puppys immediately caused transient sinus bradycardia, which was dose dependent . Intense sinus bradycardia followed by ST elevation and progressively increasing atrioventricular blocks in rabbits and nodal rhythm and intraventricular conduction defects in puppys, terminating in cardiac standstill were observed after a dose of 4 and 8 U/kg respectively . Pretreatment of rabbits with antistreptolysin 'O' completely protected them against the cardiotoxic and lethal effects of challenging doses of SLO . It is suggested that this streptococcal component may be involved in the causation of derangements of cardiac activity during acute rheumatic fever in man. Arch Pathol Lab Med, 1977 Jul, 101(7), 357 - 61 Hemolytic uremic syndrome with hypocomplementemia, serum C3NeF, and glomerular deposits of C3; Barre P et al.; A 4-year-old boy had hemolytic uremic syndrome (HUS) associated with depression of serum C3 level, a B-hemolytic streptococcal throat infection, and an elevated level of antistreptolysin O titer . In addition to the characteristic histologic changes associated with this syndrome, substantial infiltration of polymorphonuclear leukocytes and nodular deposits of C3 globulin were seen in the glomeruli of the first biopsy specimen . Two months after clinical remission, he had a recurrence of hemolytic anemia, thrombocytopenia, and acute renal failure . The serum C3 concentration had decreased again, and serum C3NeF was detected in the serum . The typical changes associated with HUS were still present on electron microscopy . Bilateral nephrectomy and renal transplantation were done because of the development of uncontrollable severe hypertension and increasing azotemia . This patient had three manifestations of HUS, but because of several differences, such as hypocomplementemia, serum C3NeF, a recurrence, and persistent glomerular deposits of C3 globulin, he appears to have had a different form of the syndrome. Arch Sci Med (Torino), 1977 Jul-Sep, 134(3), 253 - 74 {Erythema nodosum in childhood . Nosographical classification and case studies}; Chiappo GF et al.; A survey of the relevant literature, with particular attention to clinical and immunological studies propounding pathogenetic theories, is followed by the presentation of 32 cases of erythema nodosum observed in infants examined at the Turin Paediatrics Clinic and Regina Margherita Hospital . The clinical laboratory data showed that streptococcal infection was hardly less significant than T . B . as the cause of this condition. J Immunol, 1977 Jun, 118(6), 2161 - 6 Complete sharing of light chain spectrotypes by murine IgM and IgG anti-streptococcal antibodies; Perlmutter RM et al.; In order to examine the diversity of antibody light chains, we have developed an analytic isoelectric focusing procedure which permits the routine analysis of L chains from antibodies raised in individual mice . We have used this technique to demonstrate that the light chains of IgM and IgG anti-group A streptococcal antibodies raised in SWR mice are probably shared . Interestingly, numerous light chain spectrotypes are shared between individual mice whose 7S antibody focusing patterns differ. Lab Invest, 1977 Jun, 36(6), 607 - 17 Membranoproliferative glomerulonephritis with dense intramembranous alterations . A clinicopathologic study; Lamb V et al.; Two major categories of membranoproliferative glomerulonephritis (MPGN) designated type 1 and 2 MPGN are currently recognized, largely on the basis of characteristic morphologic and immunofluorescence features . In contrast to experience reported from outside the United States, type 2 MPGN has been observed rather infrequently in this country . In a retrospective clinicopathologic study, 24 kidney specimens obtained from 10 children and young adults including seven females and three males (mean age: 13 years) with type 2 MPGN were identified using light, immunofluorescence, and electron microscopy . The histopathologic findings were related to the clinical course of each patient . When initially seen all patients had hematuria and proteinuria, three were nephrotic, and five were mildly hypertensive . A single patient was mildly azotemic . Eight patients had experienced an upper respiratory ifnection preceding their illness, although only one patient had evidence of a streptococcal pharyngitis . During a period of follow-up averaging 10 years, eight patients were nephrotic at some time during their illness and seven were persistently so . Hypertension was a major problem in eight patients and renal function declined markedly within a year of its onset in five . Persistence of the nephrotic syndrome from early onset of the disease, especially when associated with hypertension, was an additional sign of poor prognosis . Four patients developed chronic renal failure and three received one or more renal allografts . Histologic evidence of recurrent disease was found in allografts from the three patients as early as 7 months after transplantation in the absence of clinical features indicative of recurrent glomerulonephritis . It is concluded that type 2 MPGN is a chronic progressive renal disease of unknown etiology and pathogenesis which chiefly afflicts children and young adults . Hypertension and the early and persistent presence of the nephrotic syndrome suggest a poor prognosis . The disease appears to be largely unresponsive to conventional forms of therapy . The disease recurs with great frequency in allografts, often in the absence of clinical evidence of recurrent glomerulonephritis. Clin Orthop, 1977 Jun, (125), 214 - 20 The role of prostaglandins in experimental arthritis in the rat; Floman Y et al.; In the experimental model of streptococcal CFE-induced arthritis, PGE and PGF concentrations rise significantly . This is due to an increase both in the substrate concentration and the enzyme activity for PG biosynthesis . Indomethacin therapy inhibited PG synthesis and diminished some of the gross, but not the histological, features of the inflammatory response . These results lend further support to the contention that the beneficial effect of indomethacin in arthritis is due to inhibition of PG biosynthesis. Urology, 1977 May, 9(5), 549 - 51 Idiopathic scrotal edema; Evans JP et al.; An eight-year experience consisting of 30 cases of idiopathic scrotal edema has been analyzed . The condition is characterized by a minimally painful scrotal swelling produced by subcutaneous edema . A normal testis and cord enable one to differentiate it from some other causes of scrotal swelling such as torsion of the testis and epididymo-orchitis . A connection with trauma, periurethral disease, or streptococcal disease appears unlikely . A localized allergic phenomenon, perhaps a local form of angioneurotic edema appears to be the most likely etiologic factor. J Lab Clin Med, 1977 May, 89(5), 1120 - 4 Preparation of type-specific anti-M streptococcal sera by ummunization with acid-hydrolyzed cells; Beck A et al.; The present study describes a method which simplifies the preparation of type-specific anti-M streptococcal sera . The procedure is based on vaccination with acid-hydrolyzed cells . The method makes possible the preparation of antisera from M strains which are problematic by conventional vaccination and is very useful for preparing all anti-M sera . The antisera obtained by the above method are devoid or almost devoid of cross-reactive antibodies. Infect Immun, 1977 May, 16(2), 673 - 9 Purification and characterization of group A streptococcal pyrogenic exotoxin type C; Schlievert PM et al.; Group A streptococcal pyrogenic exotoxin (SPE) type C was partially purified by differential solubility in ethanol and acetate-buffered saline . Toxin prepared in this way consisted of protein and hyaluronic acid . After removal of hyaluronic acid, the toxin remained pyrogenic, enhanced susceptibility of rabbits to letahl endotoxin shock, was stable when treated with acid, base, or pepsin, but was inactivated by heat . Toxin further purified by thin-layer isoelectric focusing was pyrogenic and enhanced the susceptibility of rabbits to lethal endotoxin shock . Purified type C toxin appeared homogeneous when tested by Ouchterlony immunodiffusion and migrated as a single protein band in isoelectric focusing polyacrylamide gels (isoelectric point, 6.7) and sodium dodecyl sulfate-polyacrylamide gels (molecular weight, 13,200) . The purified toxin was antigenically distinct from A and B SPE, and antisera raised against the purified toxin neutralized pyrogenic activity . The amino acid composition was determined. S Afr Med J, 1977 Apr 23, 51(17), 577 - 80 Evaluation of 125I-DNA for detecting anti-DNA antibodies in the diagnosis of systemic lupus erythematosus; Kaye V et al.; A 125I-DNA preparation for the detection of human anti-DNA antibodies (ADA) was evaluated as a diagnostic test for systemic lupus erythematosus (SLE) . A normal range of 0-25 U/ml was established . Serum ADA level greater than 110 U/ml were diagnostic in clinically active SLE and levels greater than 45 U/ml were found in 75% of patients with inactive disease . This value was significantly greater than that found in rheumatoid arthritis, renal disease caused by non-immune mechanisms, post-streptococcal glomerulonephritis and a miscellaneous group of disorders comprising connective tissue diseases, auto-immune disorders and chronic active hepatitis . Anti-nuclear factor (ANF) titres greater than 1/160 and LE cells were found in 85% of these patients . In inactive disease the ADA levels ranged between 25 and 98 U/ml, ANF titres varied from 1/40 to 1/640, and LE cells were detected in only 20% of the cases . In 3 patients investigated during the course of the disease, the ADA levels correlated best with clinical improvement . Two patients with apparent active lupus nephritis showed intermediate ADA levels, which were probably caused by antigen-antibody formation and immune complex deposition in the kidneys. Scand J Haematol, 1977 Apr, 18(4), 348 - 52 Streptokinase resistance in medical patients in Oslo; Arnesen H et al.; The streptokinase titrated initial dose (TID) was estimated in 31 2 patients consecutively admitted to a medical department in Oslo . 93% had a TID below 250,000 IU, 97% below 425,000 IU and 98.5% below 650,000 IU . No differences were found between the two sexes . The highest values were found in patients 50--60 years old . Otherwise, no differences were found between different age groups from 10 to 90 years of age . Two patients with extremely high TID values were both anamnestically prone to streptococcal infections . It is concluded that our standard initial dose of 250,000 IU of streptokinase is sufcient for the great majority of our patients . Pre-treatment test for TID is recommended only when recent streptococcal infections are suspected. J Clin Pathol, 1977 Apr, 30(4), 308 - 11 Circulating immune complexes in subacute infective endocarditis and post-streptococcal glomerulonephritis; Mohammed I et al.; Two out of five patients with subacute infective endocarditis and two patients with post-streptococcal glomerulonephritis had large amounts of soluble circulating immune complexes in their sera . The three others with endocarditis had less severe disease and minimal evidence of circulating immune complexes . Low serum complement was also found in two of the cases. Monatsschr Kinderheilkd, 1977 Apr, 125(4), 185 - 9 {Changing of clinical symptoms in glomerulonephritis (author's transl)}; Huttig G et al.; 76 children with glomerulonephritis (biopsy diagnosed) were studied for evidence of preceeding streptococcal infection, morphological and clinical symptoms . Glomerulonephritis often shows minimal symptoms; only 11% had acute, but 80% subclinical symptoms . Heading symptom was hematuria (95%), in 55% there was additional proteinuria . No correlation could be found between the clinical symptoms and glomerular lesions . Antistreptolysin 0 titers were elevated in only 39% of the children, but in all with acute clinical symptoms . The aetiology of glomerulonephritis in the remainder is uncertain, probably virus infections . The reason for decreased nephritis and increased subclinical nephritis is due to penicillin therapy and the improved renal diagnosis (renal biopsy). J Am Osteopath Assoc, 1977 Apr, 76(8), 617 - 24 Insuring effective antimicrobial therapy: laboratory evaluation; Tubbs RR; Specialized tests for the susceptibility of pathogenic microorganisms are not indicated for most clinical infections . Primary attention should be focused on proper collection of representative culture material and subsequent accurate identification of the offending organism . Specific antimicrobial therapy can then be empirically instituted based upon previously known susceptibility patterns . An overview of the broth dilution, agar dilution, and agar (disk) diffusion techniques is presented . The absolute indications for these tests are as follows: (1) infections with gram-negative bacilli; (2) staphylococcal infections; and (3) enterococcal and other group D beta hemolytic streptococcal infections . The following situations are relative indications for susceptibility testing: (1) infections occurring in immunosuppressed hosts; (2) infections that by their location are more susceptible to certain types of antibiotics; and (3) infections that should be treated with a bactericidal rather than a bacteriostatic drug . The rationale and indications for the serum bactericidal test (SBT or Schlichter test) and antibiotic assay techniques are described . The cases reported illustrate appropriate application of the specialized tests for susceptibility. J Exp Med, 1977 Apr 1, 145(4), 916 - 30 The inheritance of antibody V regions in the rabbit: linkage of an H-chain-specific idiotype to immunoglobulin allotypes; Yarmush ML et al.; Anti-idiotype antibodies specific for the H chain of an homogeneous antistreptococcal antibody (4135 Ab) were prepared by injection of recombinant molecules consisting of the H chains from 4135 Ab and L chains isolated from the injected rabbit . The antibodies prepared in this fashion (anti-HId) were specific for the VH region of 4135 Ab . Using this preparation in an inhibition of binding assay, sera from rabbits related and unrelated to 4135 were screened for the presence of the 4135 HId . It was found that about 45% of the related rabbits, when immunized with streptococcal Group C vaccine, produced antibodies with a cross-reactive idiotype, while less than 10% of similarly immunized unrelated rabbits produced molecules bearing HId . The expression of HId was linked to the a3 allotype present in the H chain allogroup J . Antibody molecules bearing the HId determinant were isolated from heterozygous (a1a3 and a2a3) rabbits and shown to express the a3 allotype . One rabbit lacking the a3 allotype produced significant amounts of antibodies expressing HId . These antibodies were found to express both VH and CH allo-types characteristic of the J allogroup, although neither allotype was found in a preimmune IgG sample from this rabbit. Klin Wochenschr, 1977 Mar 15, 55(6), 259 - 64 {Transformation of a poststreptococcal type glomerulonephritis into a rapidly progessive glomerulonephritis (author's transl)}; Fischbach H et al.; In the morphological course of a poststreptococcal type glomerulonephritis in a 37-year old patient without evidence of streptococcal infection crescents of Bowman's capsule developed after 4 months . The clinical course was rapidly progessive (the patient was uremic 5 months after onset) in contrast to the normal fair prognosis of the poststreptococcal type glomerulonephritis . Two renal biopsies were examined at an interval of 4 months . Both showed closely packed immunecomplex deposits (humps) on the glomerular immunecomplex deposits in the poststreptococcal type glomerulonephritis is a prognostically unfavourable sign. Southeast Asian J Trop Med Public Health, 1977 Mar, 8(1), 121 - 5 The association between thalassaemic diseases and traits and post-streptococcal acute glomerulonephritis; Tanphaichitr P et al.; This prospective study showed that thalassaemic patients, though susceptible to streptococcal infection, as evident from their elevated A.S.O . titres, are not, as has been suggested, more likely to develop acute glomerulonephritis than the rest of the population . The incidence of thalassaemic trait found among typical cases of acute glomerulonephritis does not exceed that of the general Thai population . There were 5 out of 56 cases of thalassaemic patients having transient microscopic haematuria. Am J Trop Med Hyg, 1977 Mar, 26(2), 266 - 72 Glomerular pathology in leprosy . An electron microscopic study; Date A et al.; Electron microscopic examination of renal biopsies from 19 patients with leprosy who had edema, proteinuria, or hematuria showed a proliferative glomerulonephritis in 12, amyloidosis in 2, and no lesion in 5 . The proliferative glomerulonephritis was of different patterns: diffuse with or without exudation, focal, or mesangial . Subendothelial and/or subepithelial deposits were seen in five biopsies . Of the patients with glomerulonephritis, 3 had a reduced total serum complement level, 5 had erythema nodosum leprosum, 5 had evidence of recent streptococcal infection, and 2 had microfilariae in the peripheral blood . The significance of these findings is discussed. Arthritis Rheum, 1977 Mar, 20(2 Suppl), 369 - 74 The changing picture of rheumatic fever; Markowitz M; Rheumatic fever has decreased in frequency and severity, but the disease has not been eradicated in this country, especially in low socioeconomic populations . Carditis is less common, and changes in the frequency of other rheumatic manifestations such as chorea has made the clinical diagnosis more difficult . Streptococcal antibody tests are still the most useful laboratory aid, but care must be taken against overinterpretation . The search for the answer to the pathogenesis puzzle continues . Until the nature of the disease is better understood, it is unlikely that rheumatic fever will be eradicated . In the meantime, however, the incidence of the disease can be reduced further by improved medical care for deprived populations. Arch Fr Pediatr, 1977 Feb, 34(2), 130 - 42 {Adrenal cysts in the newborn . Apropos of 2 cases}; Babin JP et al.; Cysts of the adrenal gland are very rare in the neonatal period and are always diagnosed either at surgery or at autopsy . Two patients are reported . One is an infant born at term in whom a mass in the left loin was discovered on the 3rd day of life . At surgery a suprarenal tumour was discovered and a polycystic adrenal was removed: recovery was uneventful . Histology showed a cystic haemangioma in the adrenocortical tissue . The diagnosis made was that of a cystic haemangioma . The other patient is an infant born at 38 weeks gestation who became jaundiced and developed a haemolytic streptococcal septicaemia . A mass was found in the right lumbar region on the 3rd day . The calcified egg-shell appearance, renal arteriography and an intravenous pyelogram demonstrated the cystic appearance of the adrenal . The cystic mass and the adrenal gland were removed and the patient recovered . Histological examination suggested that a pseudocyst had arisen secondary to a haemorrhagic infarct caused by a septic embolus . Adrenal cysts are classified as true cysts and pseudocysts (which must be distinguished from unilateral haematomas) . The histological appearances are reviewed . These patients may be added to the 11 neonatal case reports in the literature (9 haemorrhagic pseudocysts, only 2 true cysts) . To our knowledge cystic haemangioma has not previously been reported. Infect Immun, 1977 Feb, 15(2), 621 - 7 Novel bacterial structures in human blood: cultural isolation; Domingue GJ et al.; Evidence for the existence of a novel bacteriological system has been obtained from osmotically lysed and filtered human blood (membrane filters with a pore size of 0.22 micronm) placed in special culture media . These blood filtrates gave rise to ordinary bacteria for 71% of the blood specimens processed from diseased humans and for 7% of those from supposedly normal humans . Morphologically, the bacteria resembled streptococcal, staphylococcal, and gram-positive filamentous (cocco-bacillary) forms . Prior to the appearance of bacteria in the media, large and small "dense bodies" were microscopically observed but disappeared when ordinary bacteria were apparent, Cultures of of unlysed blood as conventionally performed were negative . These organisms may represent an adaptation of certain bacteria to life in the blood. Monatsschr Kinderheilkd, 1977 Feb, 125(2), 65 - 8 {Modern serology of rheumatic fever and glomerulonephritis (author's transl)}; Pilars de Pilar CE et al.; For the assessment of the situation after streptococcal infection and thus for prevention of rheumatic fever and glomerulonephritis more simple and rapid serological tests are needed . The principle of indirect haemagglutination seems particularly suited fo