Streptococcal

Jpn J Ophthalmol, 1998 Jul-Aug, 42(4), 304 - 7
Group B streptococcal metastatic endophthalmitis in an elderly man without predisposing illness; Matsuo K et al.; Our patient, an 83-year-old man, suddenly experienced acute lumbago and was prescribed bed rest . Later, pneumonia was diagnosed, even though he had no predisposing illness, and endophthalmitis developed in both eyes . Cultures of anterior chamber and vitreous specimens were positive for group B streptococcus . Treatment with systemic antibiotics, to which this bacteria is sensitive, was begun and his condition gradually improved . Nevertheless, the patient became blind in his right eye and the eye was enucleated . Histopathologic examination showed metastatic endophthalmitis with retinal detachment . Multiple microabscesses were found in the thickened choroid . We speculated that organisms disseminating from the microabscesses had caused the metastatic endophthalmitis.

Ann Otol Rhinol Laryngol, 1998 Sep, 107(9 Pt 1), 761 - 4
Effect of penicillin on formation of fibrous adhesions in acute otitis media; Caye-Thomasen P et al.; Fibrous middle ear adhesions are occasionally encountered in middle ear surgery and may cause a hearing impairment . Although usually associated with chronic otitis media, adhesions are also found following a single episode of experimental acute suppurative otitis media, suggesting a pathogenesis based on the inflammatory process engaging acute infection . In a well-established rat model of pneumococcal acute otitis media, we report on the effect of penicillin V on formation of fibrous middle ear adhesions . Previous studies have shown marked impact of penicillin on mucosal goblet cell density and other histopathologic features . Number, anatomic localization, and histopathologic morphology of adhesions were assessed in a longitudinal study of 25 normal, 25 untreated, and 25 treated rats . Although penicillin administration induced a slight tendency toward fewer ears with adhesions and fewer adhesions per ear, these changes were nonsignificant . Histomorphology and the general pattern of anatomic localization of adhesions were unaffected by penicillin administration . We conclude that administration of penicillin has an inconspicuous effect on the formation of fibrous adhesions in experimental acute otitis media caused by Streptococcus pneumoniae.

J Dairy Sci, 1998 Aug, 81(8), 2293 - 8
Germicidal activity of a chlorous acid-chlorine dioxide teat dip and a sodium chlorite teat dip during experimental challenge with Staphylococcus aureus and Streptococcus agalactiae; Boddie RL et al.; Three postmilking teat dips were tested for efficacy against Staphylococcus aureus and Streptococcus agalactiae in two separate studies using experimental challenge procedures that were recommended by the National Mastitis Council . The first study evaluated a barrier teat dip product containing chlorous acid-chlorine dioxide as the germicidal agent, and the second study evaluated a sodium chlorite product with a barrier component as well as a sodium chlorite product without a barrier component . The chlorous acid-chlorine dioxide teat dip reduced new intramammary infections (IMI) caused by Staph . aureus by 91.5% and reduced new IMI caused by Strep . agalactiae by 71.7% . The barrier dip containing sodium chlorite reduced new IMI caused by Staph . aureus and Strep . agalactiae by 41.0 and 0%, respectively . The nonbarrier dip containing sodium chlorite reduced new IMI caused by Staph . aureus by 65.6% and reduced new IMI caused by Strep . agalactiae by 39.1% . Teat skin and teat end conditions were evaluated before and after the second study; no deleterious effects among dipped quarters compared with control quarters were noted for the two sodium chlorite products.

J Dairy Sci, 1998 Aug, 81(8), 2280 - 92
Partial budget of the discounted annual benefit of mastitis control strategies; Allore HG et al.; The objective of this study was to rank the benefits associated with various mastitis control strategies in simulated herds with intramammary infections caused by Streptococcus agalactiae, Streptococcus spp . other than Strep . agalactiae, Staphylococcus aureus, coagulase-negative staphylococci, and Escherichia coli . The control strategies tested were prevention, vaccination for E . coli, lactation therapy, and dry cow antibiotic therapy . Partial budgets were based on changes caused by mastitis control strategies from the mean values for milk, fat, and protein yields of the control herd and the number of cows that were culled under a fixed mastitis culling criterion . Each annual benefit (dollars per cow per year) of a mastitis control strategy was compared with the revenue for the control herd and was calculated under two different milk pricing plans (3.5% milk fat and multiple-component pricing), three net replacement costs, and three prevalences of pathogen-specific intramammary infection . Twenty replicates of each control strategy were run with SIMMAST (a dynamic discrete event stochastic simulation model) for 5 simulated yr . Rankings of discounted annual benefits differed only slightly according to milk pricing plans within a pathogen group but differed among the pathogen groups . Differences in net replacement costs for cows culled because of mastitis did not change the ranking of control strategies within a pathogen group . Both prevention and dry cow therapy were important mastitis control strategies . For herds primarily infected with environmental pathogens, strategies that included vaccination for mastitis caused by E . coli dominated strategies that did not include vaccination against this microorganism.

J Bacteriol, 1998 Oct, 180(19), 5273 - 8
Molecular characterization of the complete 23F capsular polysaccharide locus of Streptococcus pneumoniae; Ramirez M et al.; The complete DNA sequence of the capsular locus 23F of Streptococcus pneumoniae is presented . The 18.6-kb cps23f locus is composed of 18 open reading frames flanked at the 5' and 3' ends by the genes dexB and aliA, an arrangement similar to those of some of the other identified cps loci.

J Biol Chem, 1998 Oct 2, 273(40), 26100 - 9
The active streptococcal hyaluronan synthases (HASs) contain a single HAS monomer and multiple cardiolipin molecules; Tlapak-Simmons VL et al.; The functional sizes of the two streptococcal hyaluronan synthases (HASs) were determined by radiation inactivation analysis of isolated membranes . The native enzymes in membranes from Group A Streptococcus pyogenes HAS and Group C Streptococcus equisimilis HAS were compared with the recombinant proteins expressed in Escherichia coli membranes . Based on their amino acid sequences, the masses of these four proteins as monomers are approximately 48 kDa . In all cases, loss of enzyme activity was a simple single exponential function with increasing radiation dose . The functional sizes calculated from these data were identical for the four HASs at approximately 64 kDa . In contrast, the sizes of the proteins estimated by the loss of antibody reactivity on Western blots were essentially identical at 41 kDa for the four HAS species, consistently lower than the functional size by approximately 23 kDa . Matrix-assisted laser desorption time of flight mass spectrometry analysis of purified S . pyogenes HAS-H6 and S . equisimilis HAS-H6 gave masses that differed by <0.07% from the predicted monomer sizes, which confirms that neither protein is posttranslationally modified or covalently attached to another protein . Ongoing studies indicate that the purified HAS enzymes require cardiolipin (CL) for maximal activity and stability . When irradiated membranes were detergent solubilized and the extracts were incubated with exogenous CL, the residual level of HAS activity increased . Consequently, the calculated functional size decreased by approximately 23 kDa to the expected size of the HAS monomer . The approximately 23-kDa larger size of the functional HAS enzyme, compared with the HAS monomer, is due, therefore, to CL molecules . We propose that the active streptococcal HA synthases are monomers in complex with approximately 16 CL molecules.

J Biomater Sci Polym Ed, 1998, 9(9), 915 - 29
Adhesion of different bacterial strains to low-temperature plasma treated biomedical PVC catheter surfaces; Yousefi Rad A et al.; In this study, firstly five different bacteria (i.e . Coagulase positive and negative staphylococcus, Streptococcus pyogenes, Escherichia coli, Pseudomonas aeruginosa) with their different strains were isolated and used . The contact angle, surface free energy, p-xylene adhesion, and zeta potential of these bacteria were in the range of 43-69 deg, 45.4-61.8 erg cm(-2), 2.3-80.3%, and from -650.2 to + 17.5 mV, respectively . Most of the bacteria were negatively charged . Attachment of these bacteria to PVC catheter and its DMAEMA- and AAc-plasma treated forms were investigated . Bacterial attachment to the hydrophobic PVC catheter was high . Both plasma treatments caused significant drops in bacterial attachment in most of the cases . The effects of AAc-plasma treatment was more significant.

Epidemiol Infect, 1998 Aug, 121(1), 77 - 84
M genotyping and DNA fingerprinting of Streptococcus pyogenes isolates from an area of central Italy; Mencarelli M et al.; M protein gene typing was used to analyse Streptococcus pyogenes clinical isolates collected between 1983 and 1995 in an area of central Italy from patients presenting different types of infections; the same isolates were also characterized by means of DNA fingerprinting . M type 1 was the most common (50% of study strains), followed by M types 4, 12 and 6 . The proportion of M type 12 decreased with time, whereas M type 1 increased, in agreement with data obtained in many different areas . Most invasive strains belonged to types M1 (30%) and M12 (30%); on the other hand, the M1 type did frequently occur also among non-invasive isolates . DNA fingerprinting showed a correlation between M types and DNA patterns . This report provides epidemiological information from a geographic area not sampled recently, and further shows the usefulness of the M genotyping technique, which offers potential advantages over conventional serological typing methods.

Ann Dermatol Venereol, 1998 Aug, 125(8), 522 - 4
{Cutaneous malacoplakia: a pediatric case}; Enjolras O et al.; INTRODUCTION: Cutaneous malakoplakia is an inflammatory disease characterized by granulomatous accumulation of distinctive phagocytic macrophages . It occurs mainly in visceral or orificial areas; the condition is rarely purely cutaneous, and appears to be extremely rare in childhood . CASE REPORT: A facial cutaneous crusted lesion was diagnosed as cutaneous malakoplakia in an immunocompetent child . The lesion had been excised twice and it had recurred, and the diagnosis was made possible only with a third biopsy, after a 2-year chronic expansion . This third biopsy revealed a dense granulomatous inflammation with numerous phagocytic histiocytes containing abundant fine granules and round Michaelis-Gutmann bodies, both staining with PAS, Perls and von Kossa . Biopsy cultures revealed only growth of two different streptococcus (group B) strains . The lesion resolved after a 4-month period of antibiotic therapy, including roxithromycin, ampicillin and trimethoprim-sulfamethoxasole . DISCUSSION: Diagnosis of malakoplakia is mainly made by histopathologic examination of tissue excision or biopsies . There are no specific clinical features . Most reported cases of this uncommon phagocytic reaction to common bacteria have developed in the genitourinary areas (71 p . 100); purely cutaneous localisation, as in our patient, are rare (4 p . 100) . Intracytoplasmic granules may result from phagolysosomes and incomplete bacterial killing, with subsequent deposit of iron and calcium in the phagocytic macrophages . A number of reported cases have affected immunocompromised patients with either congenital immunodeficiency or secondary immunodeficiency . The most effective treatment option is based on a protracted antibiotherapy, using drugs that easily permeate the macrophages, e.g . quinolones and trimethoprim-sulfamethoxasole . Lesion may recur after surgical excision.

Caries Res, 1998, 32(6), 447 - 55
Composition of pellicles formed in vivo on tooth surfaces in different parts of the dentition, and in vitro on hydroxyapatite; Carlen A et al.; Saliva from the major salivary glands dominates different areas of the mouth . The parotid (PS) and submandibular/sublingual (SMS) saliva differ in their protein composition, and thus, the composition of pellicles formed in various parts of the dentition might vary . In this study, proteins incorporated in 60-min pellicles from the premolar and front regions of the mouths of 4 subjects were examined using sodium dodecyl sulphate-polyacrylamide gel electrophoresis and immunoblotting using antibodies to amylase, albumin, IgA, parotid saliva agglutinin, low molecular weight SMS mucin (MG2) and proline-rich proteins . Pellicles formed in vitro on hydroxyapatite using PS, SMS and whole saliva from the subjects were examined in a similar manner . The pellicles formed in vitro and in vivo showed a major difference in the appearance of albumin . Bands of albumin were clearly stained in the samples of in vivo pellicles but were not observed or hardly visible in Western blots from the experimental, in vitro pellicles . The sites in the dentition from which a specific protein was recovered could differ between the 4 individuals . The overall protein pattern of the pellicles showed, however, characteristics typical of the saliva which may prevail in the part of the mouth where the pellicles were formed . Thus, parotid saliva agglutinin, a receptor for Streptococcus mutans, was primarily found in the premolar part of the dentition . The mucin MG2, which may mediate the adherence of Streptococcus sanguis and Streptococcus oralis, was in no case clearly seen in pellicles from the premolar region of the upper jaw . The observed variations might be important to the establishment of microflora and tooth-related disease patterns in various parts of the dentition.

Medscape Womens Health . 1996 Mar;1(3):2.
A Revised Strategy for the Prevention of Group B Streptococcal Infection in Pregnant Women and Their Newborns; Steele RW; Group B beta-hemolytic Streptococcus (GBS) is the leading cause of life-threatening perinatal infection of newborns in developed countries . Because a vaccine is not yet available, selective intrapartum chemoprophylaxis is the best current strategy for preventing disease . Joint recommendations of the Centers for Disease Control and Prevention (CDC), the American College of Obstetricians and Gynecologists (ACOG), and the American Academy of Pediatrics (AAP) are that all pregnant women be screened for GBS at 35 to 37 weeks of gestation . Pregnant women who are colonized with GBS should be treated with intravenous penicillin during labor . Women who have not been screened but exhibit risk factors known to be associated with GBS disease, such as preterm labor and/or membrane rupture at fewer than 37 weeks' gestation, intrapartum fever, and prolonged rupture of membranes > 18 hours, should also receive intrapartum antibiotics if they begin labor . Women with a history of GBS disease, such as a prior episode of GBS bacteriuria or a previous newborn with invasive GBS disease, are at high risk for recurrent GBS infection . The latter 2 categories in particular warrant chemoprophylaxis regardless of colonization status.

Infect Immun, 1998 Oct, 66(10), 4797 - 803
Functional analyses of a conserved region in glucosyltransferases of Streptococcus mutans; Chia JS et al.; Streptococcus mutans glucosyltransferases (GTFs; GtfB, -C, and -D) synthesize water-soluble and -insoluble glucan polymers from sucrose . We have identified previously a conserved region of 19 amino acids (aa) (Gtf-P1; aa 409 to 427 of GtfB and aa 435 to 453 of GtfC) which is functionally important for both enzymatic activity and bacterial adherence . Monoclonal antibodies directed against Gtf-P1 selectively inhibited insoluble glucan synthesis by GtfB and -C but had no effect on soluble glucan synthesis by GtfD, suggesting that despite an apparent near identity of sequence, corresponding residues may function differently in these enzymes . To test this hypothesis, we used different strategies of mutagenesis to analyze amino acid residues of GtfB and GtfC in Gtf-P1 . In-frame insertion of 6 amino acids preceding, or deletion of 14 amino acids within, this conserved region abolished the enzymatic activities of both GtfB and GtfC . Substitution of several residues in combination by random mutagenesis resulted in GtfB, but not GtfC, enzymes exhibiting decreased glucan synthesis and reduced rates of sucrose hydrolysis . Amino acid substitutions of Asp residues in GtfB or GtfC were found to be more critical for enzymatic activity than at other positions of this region . Interestingly, single mutation at Asp411 or Asp413 of GtfB resulted in enzymes retaining about 20% of wild-type activity, whereas mutagenesis of the corresponding Asp at position 437 or 439 in GtfC resulted in complete loss of enzymatic activity . Furthermore, single amino acid substitution of a Val residue between the two Asp residues enhanced the sucrase- and glucan-synthesizing activities of GtfB and GtfC . These results confirmed the report from another laboratory that Asp residues in the Gtf-P1 region are essential for enzymatic catalysis and provide new evidence that identical residues may function differently in closely related Gtf enzymes.

Infect Immun, 1998 Oct, 66(10), 4748 - 54
Comparison of the PspA sequence from Streptococcus pneumoniae EF5668 to the previously identified PspA sequence from strain Rx1 and ability of PspA from EF5668 to elicit protection against pneumococci of different capsular types; McDaniel LS et al.; PspA (pneumococcal surface protein A) is a serologically varied virulence factor of Streptococcus pneumoniae . In mice, PspA has been shown to elicit an antibody response that protects against fatal challenge with encapsulated S . pneumoniae, and the protection-eliciting residues have been mapped to the alpha-helical N-terminal half of the protein . To date, a published DNA sequence for pspA is available only for S . pneumoniae Rx1, a laboratory strain . PspA/EF5668 (EF5668 indicates the strain of origin of the PspA) is serologically distinct from PspA/Rx1 . Sequencing of the gene encoding PspA/EF5668 revealed 71% identity with that of PspA/Rx1 . The greatest amount of divergence between the two proteins was seen in their alpha-helical portions, which are surface exposed and probably under selective pressure to diversify serologically . In spite of the diversity within the alpha-helical regions of PspAs, we have observed that recombinant PspA (rPspA)/EF5668, like rPspA/Rx1, can elicit cross-protection against pneumococci of different capsular and PspA serological types.

Roum Arch Microbiol Immunol, 1997 Jul-Dec, 56(3-4), 147 - 53
Streptococcal erythrogenic toxin spe A gene detection by polymerase chain reaction in strains isolated in Albania; Shundi L et al.; The presence of gene encoding erythrogenic toxin type A (spe A) was determined by the polymerase chain reaction (PCR) to target specific sequences in 72 strains of Streptococcus pyogenes representative T type strains, which were associated with scarlet fever, impetigo, tonsillitis, isolated between the years 1980-1982 and in 1995 by carriers . Isolates showed statistically significant differences in the presence of spe A . With scarlet fever the strains had a 22.22% association, with impetigo had a 8.33% association . With tonsillitis' and with carriers had a low association, 5.55% and 6.9% respectively . The analysis of the data indicated that strains with certain T type surface antigens showed a higher (such as T-1, T-2, T-5) or lower (such as T-4, T-13, T-27) tendency to contain the spe A gene were more likely to be associated with scarlet fever and impetigo than with other types of diseases.

Nippon Jibiinkoka Gakkai Kaiho, 1998 Jul, 101(7), 924 - 30
{Identification of penicillin-resistant Streptococcus pneumoniae in nasopharynx of patient with acute otitis media by PCR}; Hotomi M et al.; Streptococcus Pneumoniae is a leading cause of acute otitis media (AOM) . For most AOM caused by S . pneumoniae, penicillin is the antibiotic of choice . However, there are some recent reports of clinical resistance to penicillin by S . pneumoniae . The sequences of penicillin binding protein, pbpla, pbp2b and pbp2x, genes of penicillin-resistant S . pneumoniae (PRSP) were more highly divergent than those of penicillin-succeptible S . pneumoniae (PSSP) . The polymerase chain reaction (PCR) can easily determine whether an S . pheumoniae isolate is susceptible or resistant to penicillin by amplifying the target gene by using a combination of primers . In this study, clinical isolates (n = 12) were obtained from the nasopharynx of patients with AOM . PCR was used to confirm the identification of an isolate as S . pneumoniae by amplifying the autolysin gene and to detect three PBP genes by amplifying parts of pbp1a, pbp2x and pbp2b . The resistance of S . pneumoniae to penicillin and other beta-lactams has been shown to be associated with mosaic mutations in the pbp1a, pbp2b and pbp2x genes . These findings suggest that rapid identification of PSSP and PISP/PRSP by PCR is possible and very useful for proper treatment of acute otitis media.

Cell Immunol . 1998 Aug 25;188(1):80.
Papers to appear in forthcoming issues
{The beta-hemolytic Streptococcus group A carrier state}
Colombo M, Magni LA.

Divisione di Pediatria, Ospedale di Rho, MI, ItaliaIn this study we describe the group A streptococcal upper respiratory tract carrier state, following a clinical method based on two main elements: the presence or the absence of symptoms and the result of throat swab . Through this method we are able to decide how to face each individual clinical case.

Biol Neonate, 1998 Nov, 74(5), 351 - 62
Adaptation in neonatology of the once-daily concept of aminoglycoside administration: evaluation of a dosing chart for amikacin in an intensive care unit; Langhendries JP et al.; BACKGROUND: The bactericidal efficacy of aminoglycosides is directly related to peak serum concentration (Cmax), particularly the first one . Transitory high concentrations of aminoglycosides do not result in such a high drug uptake by renal and cochlear tissues because of the saturation of cell binding sites . These observations have led to the concept that less frequent administration of relatively larger doses of aminoglycosides would be of interest in treating infectious diseases . OBJECTIVE: Prospective evaluation of a dosing chart of amikacin (Ak) in high-risk neonates suspected of infection within the first 2 days of life . This dosing chart was based on a previous pharmacokinetic population study published elsewhere, treated accordingly to the new once-daily concept of aminoglycoside administration . STUDY DESIGN: One hundred and seventy-seven neonates (69 females and 108 males; mean gestational age (GA +/-SD: 33.6 +/- 4.1 weeks (W) received Ak regimen dosage according to the following dosing chart: Group (Gr) 1a GA <28 W: 20 mg/kg/42 h; Gr 1b GA 28 </= 31 W: 20 mg/kg/36 h; Gr 2 GA 31 </= 34 W: 18.5 mg/kg/30 h; Gr 3 GA 34 </= 37 W: 17 mg/kg/24 h; Gr 4 GA >/= 37 W: 15.5 mg/kg/24 h . In case of asphyxia, hypoxic episode and intercourse treatment with indomethacin, the interval was systemically increased by 6 h whatever the GA groups . The mean duration time of Ak treatment (+/- 1 SD) was 5.00 +/- 2.01 days (range 2-13) . Ak serum concentrations 1 h after completion of 30 min infusion (C1h), and successive Ak serum concentrations just before next administration depending on the difference of interval between each group (so defined minimum serum concentration (Cmin)), were determined in each neonate . Creatininemia during the fist postnatal weeks was used as an index of glomerular filtration rate; brainstem auditory evoked potentials (BEAPs) were used in 139 babies when reaching a postconceptional age of >/= 36 weeks to assess possible ototoxicity, and were compared to values from a group of term and a group of preterm babies, previously defined as our reference control groups . RESULTS: At day 1 of treatment, there was no correlation between the Ak C1hS and the GA at birth (mean 27.8 +/- 5.21 microgram/ml (+/- 1 SD); median 28; r = -0.003; range 10-40) . In the same way, there was no correlation between the first Ak CminS and the GA at birth (mean 3.7 +/- 2.0 microgram/ml (+/- 1 SD); median 3.0; r = -0.33; range 0-10) . The lack of correlation between these first observed C1hS and CminS and the GA at birth suggests the validity of our previous established dose regimen recommendations . Analyzing the data between groups, the mean value +/- 1 SD of Ak C1hS at day 1 of treatment was not significantly different (p > 0.05) . Concerning the first Ak CminS, a significant difference (p < 0.01) was only observed when comparing groups 1a, 1b and 2 to group 4 . However, this significant difference disappeared when comparing the successive next Ak CminS between groups while each interval remained the same, suggesting a positive postnatal maturation of the renal clearance . In the same way, creatininemia showed a significant and normal decrease (p < 0.01) in each group during the first postnatal weeks . Threshold values of BEAPs at 30 dB showed no significant difference (p > 0.05) between the treated groups (preterm group and term group) and the corresponding control groups . While the primary aim of the study was not to test the bactericidal efficacy of this new regimen, the recovery was excellent in 37 babies with proven or highly suspected infectious disease, except in 1 of them who died from septic shock (group B Streptococcus) . After 5 years of using this kind of Ak administration in the unit, minimal inhibitory concentration profiles tested in 43 successive bacterial strains collected from inborn patients remained adequate . (ABSTRACT TRUNCATED)

Carbohydr Res, 1998 Jul, 309(3), 297 - 301
Oligosaccharide fragments of the type III group B streptococcal polysaccharide derived from S . pneumoniae type 14 capsular polysaccharide by a chemoenzymatic method; Zou W et al.; Partial N-deacetylation fo the GlcNAc residues in S . pneumoniae type 14 capsular polysaccharide (Pn14-PS) backbone was achieved by treatment with base, and the product was subsequently enzymatically sialylated at the 3-O-positions of the terminal galactose residues . The resultant, partially N-deacetylated type III Group B streptococcus capsular polysaccharide (GBSIII-PS) was subjected to nitrous acid deamination, which resulted in the degradation of GBSIII-PS polysaccharide into oligosaccharides containing increasing numbers of the identical repeating units . The oligosaccharides were then separated by passage through a Superdex 30 column and characterized by ESIMS and NMR spectroscopic analysis.

FEMS Microbiol Lett, 1998 Sep 1, 166(1), 127 - 33
Human transferrin as a source of iron for Streptococcus intermedius; Brochu V et al.; Streptococcus intermedius is well known to produce severe infections in various areas of the body . In this study, we evaluated the ability of S . intermedius to utilise human transferrin as a source of iron and investigated the mechanism by which iron can be obtained from this plasma protein . Adding either ferrous sulfate or holotransferrin to an iron-deficient culture medium allowed growth of S . intermedius . Cultivation of S . intermedius under an iron-poor condition was associated with the over expression of a 58 kDa cell surface protein . Neither siderophore activity nor reductase activity could be detected . Moreover, cells of S . intermedius did not show transferrin-binding activity or proteolytic activity toward transferrin . It was found that S . intermedius could rapidly decrease the pH of the medium during cell growth, resulting in a release of iron from holotransferrin . When the buffering capacity of the culture medium was significantly increased, the holotransferrin could not support growth of S . intermedius . It is suggested that under certain circumstances, S . intermedius may migrate from its normal niche (oral cavity), reach a particular site and create a localised environment where the pH can be lowered with the subsequent release of iron from transferrin . This would allow bacterial growth and initiation of the infectious process.

Am J Rhinol, 1998 Jul-Aug, 12(4), 233 - 41
Endoscopically guided cultures in chronic sinusitis; Nadel DM et al.; In chronic sinusitis, culture-directed antibiotics are often recommended as a cornerstone of treatment . The significance of Gram-negative rods (GNRs), coagulase-negative Staphylococci (SCN), and Staphylococcus aureus has been controversial . In an effort to determine host factors which correlate with culture results, 507 endoscopically-guided cultures are reviewed from 265 patients . A history of asthma, allergic rhinitis, prior sinus surgery, and the concurrent use of antibiotics, steroids, and irrigations were some of the host factors compared by X2 . The results were compared to a control group of 50 cultures from healthy volunteers . SCN, S . aureus, P . aeruginosa, and Streptococcus were the most common isolates . GNRs were present in 27% of cultures and were more common in patients who had prior sinus surgery or were using irrigations . P . aeruginosa was more common in patients taking systemic steroids . SCN occurred with the same incidence in patients and control subjects but was more prevalent in cultures obtained intraoperatively and in patients taking systemic steroids . No identifiable host factor was associated with S . aureus . S . aureus occurred at similar rates in patients and control subjects but grew heavily in patients and exhibited only light growth in controls . Topical nasal steroids appear to have no statistically significant effect on bacterial cultures . Findings from this study further our understanding of chronic sinusitis and may help guide practitioners in the treatment of this disease.

Ann Oncol, 1998 Jul, 9(7), 767 - 73
Totally implantable central venous access ports for long-term chemotherapy . A prospective study analyzing complications and costs of 333 devices with a minimum follow-up of 180 days; Biffi R et al.; BACKGROUND: A few data are available from analyses of the complications and costs of central venous access ports for chemotherapy . This prospective study deals with the complications and global costs of central venous ports connected to a Groshong catheter for deliverance of long-term chemotherapy . PATIENTS AND METHODS: Patients with a variety of solid neoplastic diseases requiring chemotherapy who were undergoing placement of implantable ports over a 30-month period (1 October 1994 to 31 March 1997) have been prospectively studied . Follow-up continued until the device was removed or the study was closed (30 September 1997); patients with uneventful implant experience and subsequent follow-ups of less than 180 days were not considered for this study . A single port, constructed of titanium and silicone rubber (Dome Port, Bard Inc., Salt Lake City, USA), was used, connected to an 8 F silastic Groshong catheter tubing (Bard Inc., Salt Lake City, USA) . Two-hundred ninety-six devices were placed in the operating room under fluoroscopic control even in the patients treated and monitored in a day-hospital setting: 37 of them were in an angiographic suite . A central venous access form was filled in by the operator after the procedure and all ports were followed prospectively for device-related and overall complications . The average purchase cost of the device was obtained from the hospital charges, based on the costs applied during the 30-month period of the study . Insertion and maintenance costs were estimated by obtaining the charges for an average TIAP implant and its subsequent use; the costs of complication management were assessed analytically . The total cost of each device was defined as the purchase cost plus the insertion cost plus the maintenance cost plus the cost of treatment of the complications, if any . The cost of removing the TIAP was also included in the economic analysis when required by the treatment of the complication . RESULTS: Three hundred thirty-three devices, for a total of 79,178 days in situ, were placed in 328 patients . Five patients received second devices after removal of the first . In all cases the follow-up was appropriate (median 237 days, range 180-732) . Early complications included 10 pneumothoraxes (3.4%; six tube-thoracostomies were applied, 1.8%) and six revisions for port and/or catheter malfunction (overall early complications = 16, 4.48%) . Late complications comprised five instances of catheter rupture and embolization (1.5%, 0.063 episodes/1000 days of use), five of venous thrombosis (1.5%, 0.063 episodes/1000 days of use), one of pocket infection (0.3%, 0.012 episodes/1000 days of use), and eight of port-related bacteremia (2.4%, 0.101 episodes/1000 days of use) . The infections were caused by coagulase-negative Staphylococcus aureus (five cases), Bacillus subtilis (one case), Streptococcus lactaceae (one case) and an unknown agent (one case); port removal was necessary in six of eight cases . The total cost per patient treated for a six-month period, consisting of the costs of purchase and implantation, treatment of early and late complications, and of maintenance of the device, is US$1,970 . CONCLUSIONS: This study represents the largest published series of patients with totally implantable access ports connected to a Groshong catheter . We have shown that US$2,000 are sufficient to cover six months of chemotherapy in one patient using the most expensive commercially available implantable port . According to the present study, totally implantable access ports connected to a Groshong catheter are associated with high purchase and insertion costs, a low complication rate and low maintenance costs . These data support their increasing use in current oncologic medical practice.

Pediatrics, 1998 Sep, 102(3 Pt 1), 538 - 45
Three-year multicenter surveillance of systemic pneumococcal infections in children; Kaplan SL et al.; OBJECTIVE: To track antibiotic susceptibility of Streptococcus pneumoniae isolates obtained from children with systemic infections and determine outcome of treatment . DESIGN: A 3-year (September 1993 through August 1996) prospective surveillance study of all invasive pneumococcal infections in children . PATIENTS: Infants and children cared for at eight children's hospitals in the United States with culture-proven systemic pneumococcal infection . RESULTS: One thousand two hundred ninety-one episodes of systemic pneumococcal infection were identified in 1255 children . An underlying illness was present in the children for 27% of the episodes . The proportion of isolates that were nonsusceptible to penicillin or ceftriaxone increased annually and nearly doubled throughout the 3-year period; for the last year the percentages of isolates nonsusceptible to penicillin and ceftriaxone were 21% and 9.3%, respectively . There was no difference in mortality between patients with penicillin-susceptible or nonsusceptible isolates . Only 1 of 742 patients with bacteremia had a repeat blood culture that was positive > 1 day after therapy was started . All 24 normal children with bacteremia attributable to isolates resistant to penicillin had resolution of their infection; the most common treatment regimen was a single dose of ceftriaxone followed by an oral antibiotic . CONCLUSIONS: The percentage of pneumococcal isolates nonsusceptible to penicillin and ceftriaxone increased yearly among strains recovered from children with systemic infection . Because empiric antibiotic therapy already has changed for suspected pneumococcal infections, antibiotic resistance has not been associated with increased mortality . Careful monitoring of antibiotic susceptibility and outcome of therapy is necessary to continually reassess current recommendations for treatment.

Semin Perinatol, 1998 Aug, 22(4), 267 - 76
Group B streptococcal infections; McKenna DS et al.; Group B streptococcal infection is the most common cause of neonatal sepsis and is responsible for significant neonatal morbidity and mortality . Group B streptococcus is also the causative agent in 50,000 maternal infections per year . Approximately 30% of women have asymptomatic group B streptococcal colonization at some time during pregnancy, but the neonatal attack rate is only about 2 per 1,000 deliveries . Maternal and neonatal risk factors contribute to the rates of vertical transmission and symptomatic neonatal disease . Options that have been investigated for prevention of neonatal group B streptococcal disease include identification of at-risk pregnancies as well as antenatal, intrapartum, and neonatal treatment . The intrapartum treatment of women at risk for vertical transmission of group B streptococcus to their neonates unequivocally has been shown to decrease the rate of neonatal colonization . Practitioners should implement one of two strategies that incorporate intrapartum prophylaxis for prevention of perinatal group B disease.

Eur J Biochem, 1998 Aug 1, 255(3), 734 - 8
Isolation, cDNA cloning and gene expression of an antibacterial protein from larvae of the coconut rhinoceros beetle, Oryctes rhinoceros; Yang J et al.; An antibacterial protein, designated rhinocerosin, was purified to homogeneity from larvae of the coconut rhinoceros beetle, Oryctes rhinoceros immunized with Escherichia coli . Based on the amino acid sequence of the N-terminal region, a degenerate primer was synthesized and reverse-transcriptase PCR was performed to clone rhinocerosin cDNA . As a result, a 279-bp fragment was obtained . The complete nucleotide sequence was determined by sequencing the extended rhinocerosin cDNA clone by 5' rapid amplification of cDNA ends . The deduced amino acid sequence of the mature portion of rhinocerosin was composed of 72 amino acids without cystein residues and was shown to be rich in glycine (11.1%) and proline (11.1%) residues . Comparison of the deduced amino acid sequence of rhinocerosin with those of other antibacterial proteins indicated that it has 77.8% and 44.6% identity with holotricin 2 and coleoptrecin, respectively . Rhinocerosin had strong antibacterial activity against E . coli, Streptococcus pyogenes, Staphylococcus aureus but not against Pseudomonas aeruginosa . Results of reverse-transcriptase PCR analysis of gene expression in different tissues indicated that the rhinocerosin gene is strongly expressed in the fat body and the Malpighian tubule, and weakly expressed in hemocytes and midgut . In addition, gene expression was inducible by bacteria in the fat body, the Malpighian tubule and hemocyte but constitutive expression was observed in the midgut.

J Antimicrob Chemother, 1998 Aug, 42(2), 257 - 60
Comparison of four antibiotics in a murine model of necrotizing cutaneous infections caused by toxigenic Streptococcus pyogenes and Staphylococcus aureus; Barg N; The ability of azithromycin, erythromycin, clarithromycin, or cefuroxime to modify the course of group A streptococcus (GAS) or Staphylococcus aureus soft-tissue infection was compared in a mouse model . In GAS-infected mice given azithromycin, fewer demonstrated dermonecrosis (P = 0.0004); the average weight gain was greater (P < 0.05) and the latency to sustained weight gain was shorter (P < 0.05) than for animals given other antibiotics . All antibiotics were effective against S . aureus infections, with no significant differences among treatments in parameters evaluated . The effectiveness of azithromycin in GAS-infected mice may be related to the high and sustained tissue concentrations achieved with this antibiotic.

J Leukoc Biol, 1998 Sep, 64(3), 291 - 7
Combinatorial requirements for adhesion molecules in mediating neutrophil emigration during bacterial peritonitis in mice; Mizgerd JP et al.; To investigate the requirements for adhesion molecules in neutrophil emigration during peritonitis, mice received intraperitoneal injections of Streptococcus pneumoniae while the functions of multiple adhesion molecules were blocked . Emigration after 4 h was compromised by antibodies against ICAM-1 or genetic deficiency of ICAM-1 . Anti-CD11a/CD18 antibodies decreased emigration in ICAM-1 mutant mice, suggesting that ICAM-1 independent emigration requires CD11/CD18 complexes . In contrast, mice mutant in ICAM-1 plus E-selectin showed no defect in emigration, suggesting that E-selectin commits neutrophils to an ICAM-1-dependent pathway during streptococcal peritonitis . However, in mutant mice lacking the three endothelial adhesion molecules E-selectin, P-selectin, and ICAM-1, emigration after 4 h was significantly compromised . Thus, P-selectin is essential to ICAM-1- and E-selectin-independent acute peritoneal inflammation . After 24 h of peritonitis, there were no differences between WT and E-selectin/P-selectin/ICAM-1 mutant mice, demonstrating that these endothelial adhesion molecules are not essential to neutrophil emigration during later stages of peritonitis.

J Clin Microbiol, 1998 Oct, 36(10), 2944 - 9
Molecular epidemiology of penicillin-resistant Streptococcus pneumoniae isolates recovered in Italy from 1993 to 1996; Marchese A et al.; Thirty-nine penicillin-resistant Streptococcus pneumoniae isolates recovered among the approximately 700 pneumococcal strains collected from 1993 to 1996 in central and northern Italy were analyzed for several characteristics, including serotype, antibiotic susceptibility profile, chromosomal relatedness (by using pulsed-field gel electrophoresis {PFGE}), restriction fragment length polymorphism (RFLP) of the penicillin-binding protein (PBP) genes 1A, 2X, and 2B, and the presence of a variety of antibiotic resistance genes (determined by hybridization with appropriate DNA probes) . The MICs of penicillin for most of the isolates (30 of 39) were high, in the range of 1 microgram/ml or higher, and these 30 isolates carried additional resistance traits to two or more drugs (erythromycin, chloramphenicol, co-trimoxazole, and tetracycline) and expressed serotypes 9, 19, and 23 and three distinct PFGE patterns . More than half (22 of 30) of the isolates for which MICs were high were identified as representatives of two widespread international epidemic clones of S . pneumoniae . The first one of these clones (seven isolates) expressed serotype 23F and possessed all properties characteristic of the widespread Spanish/USA international clone . Seven additional strains with serotype 19 also had the same PFGE pattern, PBP gene, and RFLP polymorphisms, and other properties typical of the serotype 23 Spanish/USA clone, suggesting that these strains were the products of a capsular transformation event (from serotype 23F to serotype 19) in which the Spanish/USA clone was the recipient . The second international clone was represented by eight serotype 9 isolates which were resistant to penicillin and trimethoprim-sulfamethoxazole and had the molecular properties of the French/Spanish epidemic clone . The remaining eight isolates for which penicillin MICs were high appeared to represent a hitherto-undescribed "Italian" clone; they had a novel PFGE type, unique RFLPs for the PBP genes, and resistance to tetracycline, trimethoprim-sulfamethoxazole, and erythromycin, and the penicillin MICs for these isolates were 2 to 4 microgram/ml.

Antimicrob Agents Chemother, 1998 Sep, 42(9), 2425 - 6
Prevalence and characterization of the mechanisms of macrolide, lincosamide, and streptogramin resistance in isolates of Streptococcus pneumoniae; Johnston NJ et al.; Of a total of 147 erythromycin-resistant Streptococcus pneumoniae isolates, 64 (43.5%) were resistant to erythromycin, clindamycin, and streptogramin B (MLSB phenotype), 57 of which possessed the ermB gene . Eighty-two (55.8%) were resistant to erythromycin alone (M phenotype), 81 of which possessed the mefE gene . One was erythromycin and streptogramin B resistant but susceptible to clindamycin (MS phenotype) and possessed neither the erm gene nor the mefE gene.

Antimicrob Agents Chemother, 1998 Sep, 42(9), 2375 - 9
In vivo activities of amoxicillin and amoxicillin-clavulanate against Streptococcus pneumoniae: application to breakpoint determinations; Andes D et al.; The in vivo activities of amoxicillin and amoxicillin-clavulanate against 17 strains of Streptococcus pneumoniae with penicillin MICs of 0.12-8.0 mg/liter were assessed in a cyclophosphamide-induced neutropenic murine thigh infection model . Renal impairment was produced by administration of uranyl nitrate to prolong the amoxicillin half-life in the mice from 21 to 65 min, simulating human pharmacokinetics . Two hours after thigh infection with 10(5) to 10(6) CFU, groups of mice were treated with 7 mg of amoxicillin per kg of body weight alone or combined with clavulanate (ratio, 4:1) every 8 h for 1 and 4 days . There was an excellent correlation between the MIC of amoxicillin (0.03 to 5.6 mg/liter) and (i) the change in log10 CFU/thigh at 24 h and (ii) survival after 4 days of therapy . Organisms for which MICs were 2 mg/liter or less were killed at 1.4 to 4.2 and 1.6 to 4.1 log10 CFU/thigh at 24 h by amoxicillin and amoxicillin-clavulanate, respectively . The four strains for which MICs were >4 mg/liter grew 0.2 to 2.6 and 0.6 to 2 . 3 logs at 24 h despite therapy with amoxicillin and amoxicillin-clavulanate, respectively . Infection was uniformly fatal by 72 h in untreated mice . Amoxicillin therapy resulted in no mortality with organisms for which MICs were 1 mg/liter or less, 20 to 40% mortality with organisms for which MICs were 2 mg/liter, and 80 to 100% mortality with organisms for which MICs were 4.0-5.6 mg/liter . Lower and higher doses (0.5, 2, and 20 mg/kg) of amoxicillin were studied against organisms for which MICs were near the breakpoint . These studies demonstrate that a reduction of 1 log10 or greater in CFU/thigh at 24 h is consistently observed when amoxicillin levels exceed the MIC for 25 to 30% of the dosing interval . These studies would support amoxicillin (and amoxicillin-clavulanate) MIC breakpoints of 1 mg/liter for susceptible, 2 mg/liter for intermediate, and 4 mg/liter for resistant strains of S . pneumoniae.

Antimicrob Agents Chemother, 1998 Sep, 42(9), 2312 - 8
Detection of Tn917-like sequences within a Tn916-like conjugative transposon (Tn3872) in erythromycin-resistant isolates of Streptococcus pneumoniae; McDougal LK et al.; A series of macrolide-lincosamide-streptogramin B (MLS)-resistant pneumococcal isolates of a variety of serotypes was examined and was found to contain Tn917-like elements by DNA-DNA hybridization . Like Tn1545, Tn917 also encodes an ermAM gene but does not mediate resistance to other antimicrobial agents . Furthermore, nucleotide sequence analyses of the DNAs flanking three of the Tn917-like elements revealed that they were inserted into orf9 of a Tn916-like element in a composite transposon-like structure (Tn3872) . Other MLS-resistant strains appeared to contain Tn1545-like elements that had suffered a deletion of sequences including the aphA-3 sequences responsible for kanamycin resistance . Thus, the MLS resistance phenotype in pneumococci appears to be mediated by the ermAM present on a much wider variety of genetic elements than was previously appreciated.

Antimicrob Agents Chemother, 1998 Sep, 42(9), 2267 - 73
Association of a thr-371 substitution in a conserved amino acid motif of penicillin-binding protein 1A with penicillin resistance of Streptococcus pneumoniae; Asahi Y et al.; We determined the nucleotide sequence between 1,903 and 3,097 bp of pbp1a, which encodes the transpeptidase domain of PBP 1A, from clinical isolates of penicillin-resistant Streptococcus pneumoniae (PRSP) serotypes 19 (n = 8), 6 (n = 9), 23 (n = 6), and 14 (n = 2) and two penicillin-susceptible S . pneumoniae (PSSP) isolates . These serotyped PRSP strains were isolated predominantly in Japan from 1993 through 1997 . The 25 resistant strains were classified into five groups on the basis of the extent of sequence differences . Strains in groups I (n = 5; serotype 6), II (n = 3; serotype 19), and III (n = 12; different serotypes) had sequences highly homologous to the sequence of pbp1a of PRSP strains from South Africa, Spain, and the United States . The group IV strain (n = 1; serotype 14) had unique deletions from or insertions in the sequences . The sequences of group V strains (n = 4; serotypes 6 and 23) had relatively few differences from the sequences of the PSSP strains . For strains (n = 18) for which the threonine at codon 371 (Thr-371) in a conserved STMK motif of PBP 1A was substituted with an alanine or a serine (in addition to having altered pbp2x and pbp2b genes), penicillin MICs were >/= 1.0 microgram/ml . The PBPs 1A of these strains showed decreased affinities for {3H}benzylpenicillin and slightly faster mobilities on sodium dodecyl sulfate-polyacrylamide gels . In contrast, for strains (n = 4) without a substitution at Thr-371 in PBP 1A but with mutations in both pbp2x and pbp2b, penicillin MICs were 0.125 to 0.25 microgram/ml, and the affinities of their PBPs 1A were similar to that of PSSP PBPs 1A . Furthermore, for the Thr-371-substituted strains (n = 3) with altered pbp2x genes but native pbp2b genes, penicillin MICs were 0.125 to 0.25 microgram/ml . These results suggest that amino acid substitution of Thr-371 contributes to the development of penicillin resistance in PRSP strains with altered pbp2x and pbp2b genes.

Antimicrob Agents Chemother, 1998 Sep, 42(9), 2193 - 6
Sparfloxacin resistance in clinical isolates of Streptococcus pneumoniae: involvement of multiple mutations in gyrA and parC genes; Taba H et al.; Antimicrobial susceptibility testing revealed among 150 clinical isolates of Streptococcus pneumoniae 4 pneumococcal isolates with resistance to fluoroquinolones (MIC of ciprofloxacin, >/=32 microgram/ml; MIC of sparfloxacin, >/=16 microgram/ml) . Gene amplification and sequencing analysis of gyrA and parC revealed nucleotide changes leading to amino acid substitutions in both GyrA and ParC of all four fluoroquinolone-resistant isolates . In the case of strains 182 and 674 for which sparfloxacin MICs were 16 and 64 microgram/ml, respectively, nucleotide changes were detected at codon 81 in gyrA and codon 79 in parC; these changes led to an Ser-->Phe substitution in GyrA and an Ser-->Phe substitution in ParC . Strains 354 and 252, for which sparfloxacin MICs were 128 microgram/ml, revealed multiple mutations in both gyrA and parC . These strains exhibited nucleotide changes at codon 85 leading to a Glu-->Lys substitution in GyrA, in addition to Ser-79-->Tyr and Lys-137-->Asn substitutions in ParC . Moreover, strain 252 showed additional nucleotide changes at codon 93, which led to a Trp-->Arg substitution in GyrA . These results suggest that sparfloxacin resistance could be due to the multiple mutations in GyrA and ParC . However, it is possible that other yet unidentified mutations may also be involved in the high-level resistance to fluoroquinolones in S . pneumoniae.

Am J Vet Res, 1998 Sep, 59(9), 1129 - 33
Molecular basis of variation in protective SzP proteins of Streptococcus zooepidemicus; Walker JA et al.; OBJECTIVES: To characterize, on a molecular basis, variable regions of the SzP proteins of the Moore and Bryans serovars of Streptococcus zooepidemicus and specificity of opsonic responses . SAMPLE POPULATION: 14 Moore and Bryans serovars of S zooepidemicus . PROCEDURE: Using polymerase chain reaction analysis and primers from the 5' and 3' sequences of the prototype gene SzPW60, the SzP genes of each Moore and Bryans serovar were sequenced and translated, then the amino acid sequences were compared . RESULTS: Comparison of the amino acid sequences revealed 2 variations at the N terminus; a hypervariable (HV) region from residue 106 to 166, approximately; and proline-glutamic acid-proline-lysine repeats in the carboxy terminus that ranged in number from 7 to 12 . Five distinct motifs, HV 1 to 5, which varied independently of the N termini were found in the internal HV region . All serovars were opsonized by antiserum to the prototype SzPW60 protein, indicating that opsonogenic epitopes are on the conserved regions of the protein . CONCLUSION AND CLINICAL RELEVANCE: Variant motifs may be valuable in epizootiologic and pathogenesis studies of S zooepidemicus infections of the respiratory tract of young horses and in determining whether there are populations of S zooepidemicus unique to specific animal hosts . It is also clear from the opsonic responses to SzP that at least a portion of the protective responses are probably not serovar specific.

J Am Geriatr Soc, 1998 Sep, 46(9), 1112 - 7
Outbreak of pneumonia in a long-term care facility: antecedent human parainfluenza virus 1 infection may predispose to bacterial pneumonia; Fiore AE et al.; OBJECTIVES: To determine the causes of an outbreak of lobar pneumonia . DESIGN: Matched (1:2) case-control study . SETTING: A 70-bed chronic care facility for older people . PARTICIPANTS: Residents of the facility . RESULTS: Ten residents developed pneumonia over a 10-day period . Two residents died . One case-patient had Streptococcus pneumoniae bacteremia; another had polymerase chain reaction evidence of S . pneumoniae infection . No other etiologic agent was identified . Only four of 10 case-patients had received routine diagnostic cultures of blood or sputum before the administration of antibiotics . Symptoms of upper respiratory illness (URI) among residents before the pneumonia outbreak corresponded with elevation of antibodies to human parainfluenza virus 1 (HPIV1) . In a matched case-control study, six of 10 case-patients, compared with five of 20 controls, had symptoms of URI during the preceding month (matched odds ratio (MOR) = 4.5, 95% CI = 0.8-33) . Nine case-patients had serum available, and five of these had both serologic evidence of recent HPIV1 infection and recent URI, compared with two of 18 controls (MOR = 9.0, 95% CI = 1.2-208) . Only three residents had documentation of pneumococcal vaccination . CONCLUSIONS: Noninfluenza viral infections may play a role in the pathogenesis of some bacterial pneumonias . S . pneumoniae was the cause of at least two pneumonias; lack of preantibiotic cultures may have interfered with isolation of S . pneumoniae in others . Recent HPIV1 infection was epidemiologically linked to subsequently developing pneumonia . Spread of HPIV1 in the facility may have contributed to increased susceptibility to S . pneumoniae and, potentially, to other bacterial pathogens.

Int J Syst Bacteriol, 1998 Jul, 48 Pt 3, 1063 - 5
16S rDNA sequence variations of some Streptococcus suis serotypes; Rasmussen SR et al.; Streptococcus suis 16S rDNA from selected serotypes has been sequenced and compared with the 16S rDNA sequences from serotypes 1 and 2 present in Genbank . After alignment the sequenced serotypes show clusters of variation . Based on these clusters, a limited phylogenetic tree showing the relationships of all of the serotypes was constructed.

Clin Chem, 1998 Sep, 44(9), 2031 - 5
Fixed polarizer ellipsometry for simple and sensitive detection of thin films generated by specific molecular interactions: applications in immunoassays and DNA sequence detection; Ostroff RM et al.; Biological thin films may form on a surface by specific molecular interactions . The fixed polarizer ellipsometer (FPE) is a sensitive instrument that detects biological thin films either qualitatively or quantitatively . The design is simple and inexpensive . The assays are formatted on an optical surface, and the FPE detection is based on the phase shift of linearly polarized light after reflection through a thin film . We have constructed mathematical models of the FPE response to reflection through single-layer and two-layer films that agree closely with experimental data . Several biological assays have been measured with the FPE to demonstrate the application of this technology to clinical targets, including ultrasensitive immunoassays for hepatitis B surface antigen (0.1 ng/mL) and alpha-fetoprotein (0.01 ng/ mL) and DNA hybridization (0.5 fmol/microL target probe) . A clinical study for detection of group A streptococcus from patient throat swabs demonstrated the qualitative application of the FPE to infectious disease targets . The flexibility and sensitivity of the FPE makes this technology suitable for numerous target analytes and applications.

Chemotherapy, 1998 Sep-Oct, 44(5), 328 - 30
In vitro activities of E1101, a novel oral cephalosporin, against bacteria causing infections in obstetric and gynecological patients; Mikamo H et al.; E1101 is a new oral cephalosporin with a broad spectrum of antibacterial activity . It inhibited more than 90% of clinical isolates of Streptococcus agalactiae, Escherichia coli and Peptostreptococcus magnus at the concentration of 3.13 mg/l . E1101 was the most active agent against S . agalactiae and E . coli . Since none of the compounds was sufficiently active against the Bacteroides fragilis and Prevotella bivia isolates, they are not appropriate in the treatment of patients with infections caused by these organisms . The results of this study suggest that, subject to confirmation by clinical trials, E1101, in combination with an agent with reliable activity against anaerobic bacteria, is suitable as empirical therapy of patients with obstetric and gynecological infections.

Int J Syst Bacteriol, 1998 Apr, 48 Pt 2, 581 - 9
Phylogenetic diversity of Streptococcus suis strains of various serotypes as revealed by 16S rRNA gene sequence comparison; Chatellier S et al.; The 16S rRNA gene sequences of reference strains of Streptococcus suis serotypes 1-34 and 1/2 were determined . A comparative sequence analysis showed that the degree of sequence similarity between S . suis reference strains ranged from 93.94 to 100% . A dendrogram was constructed from the similarity matrix . Thirty-two strains representing 32 serotypes fell into a major group divided into three clusters . The other strains, S . suis serotypes 32, 33 and 34, were more distant . Biochemical characterization of the six more distant strains, including S . suis serotypes 20, 22, 26, 32, 33 and 34, revealed a profile similar to that of other S . suis serotypes . Comparison of the 16S rRNA gene sequences of S . suis reference strains with sequences of other members of the genus Streptococcus indicated that, with the exception of S . suis serotypes 32, 33 and 34, reference strains did not cluster with any other species in the genus . In conclusion, 16S rRNA gene sequence analysis defined a major group of S . suis reference strains which were very closely related and a higher divergence for S . suis serotypes 32, 33 and 34 . However, to date, there is no strong evidence to reclassify strains of these serotypes in another species.

J Am Vet Med Assoc, 1998 Sep 1, 213(5), 676 - 84
Comparison of antibiotic administration in conjunction with supportive measures versus supportive measures alone for treatment of dairy cows with clinical mastitis; Morin DE et al.; OBJECTIVE: To determine whether antibiotic and supportive treatment would improve outcome for dairy cows with naturally developing clinical mastitis, compared with supportive treatment alone . DESIGN: Randomized controlled trial . ANIMALS: 124 cows in one herd with 172 episodes of clinical mastitis . PROCEDURE: Cows were examined at the onset of clinical mastitis, assigned a severity score, and randomly assigned to receive antibiotic (intramammary administration of cephapirin, i.v . administration of oxytetracycline, or both) and supportive treatment (administration of oxytocin, stripping of affected glands, and, in severely affected cows, administration of flunixin meglumine or fluids) or supportive treatment alone . Treatment was continued until 24 hours after signs of clinical mastitis resolved (clinical cure) . Milk samples from affected glands were submitted for bacterial culture before initial treatment and every 2 weeks thereafter until the causative organism was no longer isolated (bacteriologic cure) . RESULTS: When mastitis was caused by Streptococcus spp or coliform bacteria, clinical cure rate by the tenth milking was significantly higher if antibiotics were used . Bacteriologic cure rate at 14 days was significantly higher when antibiotics were used, particularly if mastitis was caused by Streptococcus spp . Cows receiving antibiotics developed fewer subsequent episodes of clinical mastitis during the 60 days after the initial episode of mastitis and had less severe clinical disease than cows that did not . CLINICAL IMPLICATIONS: Results suggest that, in herds in which mastitis is often caused by environmental bacteria, antibiotic and supportive treatment may result in a better outcome for cows with clinical mastitis than supportive treatment alone.

Am J Respir Cell Mol Biol, 1998 Sep, 19(3), 462 - 9
Altered alveolar macrophage function in calorie-restricted rats; Dong W et al.; Alveolar macrophage functions associated with clearance of bacteria from the lung were assessed in male Fischer 344 rats maintained on a 25% calorie-restricted diet . Calorie-restricted and ad libitum-fed (control) rats were exposed to concentrations of ozone known to compromise phagocytic function of alveolar macrophages . Ozone suppressed alveolar macrophage phagocytosis of latex beads in vitro in ad libitum-fed rats, but not in calorie-restricted rats . In fact, caloric restriction enhanced phagocytic function in both control and ozone-exposed animals . Ad libitum-fed rats exposed to ozone and challenged with Streptococcus zooepidemicus experienced a prolonged infection and influx of polymorphonuclear leukocytes (PMN), whereas calorie-restricted rats exposed to ozone cleared the bacteria in 24 h without an inflammatory response . Bacterial endotoxin-stimulated in vitro production of nitric oxide and tumor necrosis factor (TNF)-alpha as well as expression of TNF-alpha and interleukin-6 messenger RNAs were all lower in alveolar macrophages isolated from calorie-restricted rats . Together, the data suggest that caloric restriction enhances resistance to gram-positive bacteria, while lowering the production of proinflammatory mediators elicited by endotoxin, a component of gram-negative bacteria . Although increased bacterial resistance is considered beneficial, reduction in the lung's ability to induce inflammatory mediators can have both positive and pathophysiologic consequences.

J Matern Fetal Med, 1998 Jul-Aug, 7(4), 172 - 6
Detection of group B streptococcus: comparison of an optical immunoassay with direct plating and broth-enhanced culture methods; Nguyen TM et al.; The aim of this study was to compare the diagnostic accuracy of an optical immunoassay (STREP B OIA, Biostar) to direct plating and broth-enhanced culture for the detection of group B streptococcus (GBS) colonization of the lower genital tract in pregnant women . GBS cultures from the lower genital tract were obtained in a prospective fashion using a dual swab transport system from patients with risk factors for perinatal GBS infection . One swab was used to inoculate a trypticase soy agar plate with 5% sheep blood (TSA) and then placed in Lim broth . The other swab was used to perform the Strep B OIA . Growth of GBS by either direct plating or broth-enhanced culture was used as the gold standard for determining GBS colonization . Of the 524 women in the study, 90 women had positive cultures (either TSA or Lim broth) . The sensitivity, specificity, positive predictive value, and negative predictive value of the Strep B OIA were 47% (42/90), 96% (416/434), 70% (42/60), 90% (416/464) . The sensitivity, specificity, positive predictive value, and negative predictive value of the TSA were 61% (55/90), 100% (434/434), 100% (55/55), 93% (434/469) . The sensitivity, specificity, positive predictive value, and negative predictive value of Lim broth were 97% (87/90), 100% (434/434), 100% (87/87), and 97% (434/437) . The sensitivity of the Strep B OIA to detect light GBS colonization and heavy GBS colonization, as determined by the TSA, was 53% (19/36) and 90% (17/19), respectively . The Strep B OIA and direct agar plate culture appear to be of limited clinical value due to their poor sensitivities . This study also demonstrates the need to use a selective medium such as Lim broth when assessing for GBS colonization of the lower genital tract.

Scand J Infect Dis, 1998, 30(2), 147 - 51
Vertebral osteomyelitis at a Norwegian university hospital 1987-97: clinical features, laboratory findings and outcome; Chelsom J et al.; Altogether 40 patients aged 13-91 y (average 58 y) with vertebral osteomyelitis were treated at the Bergen University Hospital between July 1987 and June 1997 . All patients presented with back pain, 33 (83%) had vertebral tenderness, and 26 (65%) patients were febrile . The duration of symptoms before diagnosis was < 3 weeks in 13 patients, and from 3 to 16 weeks in the remaining 27 patients . C-reactive protein (CRP) level and erythrocyte sedimentation rate (ESR) were elevated in 39 and 38 patients, respectively . Staphylococcus aureus was the most frequent cause of osteomyelitis followed by Streptococcus spp., Escherichia coli and Mycobacterium tuberculosis . Magnetic resonance imaging was superior to other radiological methods and demonstrated changes consistent with osteomyelitis in all 23 patients examined with this method . 35 patients survived . 18/35 surviving patients had pareses and 17 underwent surgery with drainage of abscesses or laminectomy . All 35 patients made a good recovery and only 3 patients experienced permanent pareses . The diagnosis of vertebral osteomyelitis is easily missed, and treatment is often delayed, particularly in the elderly in whom signs of sepsis may not manifest . However, persisting localized pain and tenderness over the spine together with elevated CRP and ESR should prompt the physician to consider vertebral osteomyelitis . Fever and leukocytosis may support the diagnosis, but may not always be present.

Clin Diagn Lab Immunol, 1998 Sep, 5(5), 703 - 10
Use of highly encapsulated Streptococcus pneumoniae strains in a flow-cytometric assay for assessment of the phagocytic capacity of serotype-specific antibodies; Jansen WT et al.; A phagocytosis assay for Streptococcus pneumoniae based on flow cytometry (FACS) with human polymorphonuclear cells and human complement was developed for the study of human vaccination antisera . Human prevaccination sera already contain high levels of C-polysaccharide (C-PS) antibodies, which are not protective in humans but which might give false positive results in a flow-cytometry-based assay . Cultures of S . pneumoniae grown to log phase on three consecutive days, followed by heat inactivation, yielded stable and highly encapsulated strains for serotypes 6A, 6B, 14, 19F, and 23F . As a result, only serotype-specific antibodies were able to facilitate phagocytosis of these strains, whereas no phagocytosis was observed with antibodies against C-PS or pneumococcal surface proteins . No, or weak, phagocytosis was observed with human prevaccination sera, whereas in general, postvaccination antisera facilitated phagocytosis . A highly significant correlation was observed between enzyme-linked immunosorbent assay titers and FACS phagocytosis titers (r = 0.98, P < 0.001) for serotype 23F pneumococci with human vaccination antisera . For all serotypes, interassay variation was below 10% . Major advantages of this assay over the classical killing assay are that (i) limited amounts of sera are required (10 microliter per titration curve), (ii) 600 samples can be processed in one day by one person, and (iii) cells can be fixed and measurement of the samples can be performed up to 1 week later.

MMWR Morb Mortal Wkly Rep, 1998 Aug 21, 47(32), 665 - 70
Adoption of hospital policies for prevention of perinatal group B streptococcal disease--United States, 1997; Anticapsular polysaccharide antibodies and nasopharyngeal colonization with Streptococcus pneumoniae in infant rats; Department of Medicine, Children's Hospital, Boston, Massachusetts 02115, USA . malley@a1.tch.harvard.edu

To evaluate the effect of passive immunization with anticapsular antibodies on nasopharyngeal carriage, two models of Streptococcus pneumoniae colonization were developed in infant rats . In a direct inoculation model, 3- to 4-day-old infant rats were intranasally inoculated with 2 x 10(5) cfu of S . pneumoniae type 3 or 6 x 10(3) cfu of S . pneumoniae type 23F . In an intralitter transmission model, 2 infant rats were intranasally inoculated with 10(3) cfu of pneumococcus type 3 or type 19F and placed in a cage containing 10 infant rats . Pretreatment with bacterial polysaccharide immune globulin led to a significant reduction in colonization of contact animals with S . pneumoniae type 3 or 19F in the intralitter transmission model (P < .05) . No effect of immune globulin could be demonstrated in the direct inoculation model . These results indicate that systemic anticapsular antibodies conferred significant protection against nasopharyngeal acquisition by intralitter spread of S . pneumoniae type 3 and 19F.

J Infect Dis, 1998 Sep, 178(3), 700 - 6
A conservative amino acid mutation in the chromosome-encoded dihydrofolate reductase confers trimethoprim resistance in Streptococcus pneumoniae; Pikis A et al.; Multidrug-resistant Streptococcus pneumoniae strains have emerged over the past decade at an alarming rate . The molecular mechanism of trimethoprim resistance was investigated in 5 pneumococcal strains isolated in the Washington, DC, area from patients with invasive infections . Cloning and sequencing of the trimethoprim resistance determinant from these pneumococci indicated that an altered chromosome-encoded dihydrofolate reductase (DHFR) was responsible for the observed resistance . Comparison of DHFR sequences from pneumococcal strains with various susceptibilities to trimethoprim, together with site-directed mutagenesis, revealed that substitution of isoleucine-100 with a leucine residue resulted in trimethoprim resistance . Hydrogen bonding between the carbonyl oxygen of isoleucine-100 and the 4-amino group of trimethoprim is proposed to play a critical role in the inhibition of DHFR by trimethoprim . This enzyme-substrate model should facilitate the design of new antibacterial agents with improved activity against S . pneumoniae.

Eur Respir J, 1998 Aug, 12(2), 357 - 62
Thoracic infection caused by Streptococcus milleri; Porta G et al.; The objective of this study was to increase our understanding of the importance of members of the Streptococcus milleri (SM) group as respiratory pathogens, by studying the epidemiological and clinical features of thoracic infections caused by this group and comparing the epidemiology and prognosis of empyema caused by SM with cases of pneumococcal aetiology . The clinical histories and microbiology reports were reviewed in 27 cases of thoracic infection caused by SM over a period of 8 yrs . Cases of pneumococcal empyema that occurred during the same period were also analysed . Diagnoses were made of cases of empyema, including six with pneumonia and one with pulmonary abscess, three cases of pneumonia and two of mediastinitis . In 17 cases, SM was the only pathogen isolated . There was a history of instrument or surgical procedures on the digestive or respiratory tract in 59% . Secondary bacteraemia was documented in three cases . The treatment administered, a combination of antibiotics and surgery, was successful in 22 of 27 (81%) of cases . All strains were susceptible to penicillin . When the characteristics of the empyemas caused by monomicrobial SM infection were compared with those of pneumococcal aetiology from the same period of study, significant differences were found with respect to age, origin of the infection and the need for surgery . In conclusion, thoracic infections caused by Streptococcus milleri are largely pleural . They are polymicrobial in one-third of cases, commonly acquired in hospital and, in most patients, associated with major surgery and/or surgical procedures of the respiratory or digestive tract . The empyema frequently requires thoracotomy for complete resolution.

J Paediatr Child Health, 1998 Aug, 34(4), 314 - 7
Prevention of serious bacterial infection in children with nephrotic syndrome; McIntyre P et al.; Although nephrotic syndrome is well known as a predisposing factor to bacterial infection in children, especially peritonitis due to Streptococcus pneumoniae, data on the incidence of infection and the effectiveness of preventative measures are limited . With particular reference to pneumococcal disease, this review summarises the available data on the pattern and incidence of invasive bacterial infection in children with nephrotic syndrome, and the level of evidence for the use of penicillin chemoprophylaxis and pneumococcal immunisation . Although data on the effectiveness of pneumococcal immunization in children with nephrotic syndrome are limited, the safety profile of this vaccine makes the risk-benefit ratio favourable to use of the current polysaccharide vaccine in those over 2 years of age . Conjugate pneumococcal vaccines are likely to be more effective, particularly in children under 2 years of age and should be available by the year 2000 . Although penicillin prophylaxis against pneumococcal infection is not of proven benefit for nephrotic syndrome, it is beneficial in sickle cell disease without appreciable risk . Subgroups of patients with nephrotic syndrome most likely to benefit from twice daily phenoxymethyl penicillin prophylaxis include children under 2 years of age, with unresponsive or frequently relapsing disease, or who have had a previous episode of pneumococcal infection.

Pediatr Infect Dis J, 1998 Aug, 17(8), 685 - 91
Response to a heptavalent conjugate Streptococcus pneumoniae vaccine in children with recurrent infections who are unresponsive to the polysaccharide vaccine; Sorensen RU et al.; OBJECTIVE: To determine whether children with recurrent respiratory infections who failed to respond to the conventional polysaccharide vaccine would respond to a pneumococcal conjugate vaccine . METHODS: Children referred to our clinic for recurrent respiratory infections who had no known primary or secondary immunodeficiencies were immunized with a 23-valent pneumococcal polysaccharide vaccine . IgG antibodies to pneumococcal serotypes 1, 3, 4, 6B, 9V, 14, 18C, 19F and 23F were determined by enzyme-linked immunosorbent assay before and 4 to 6 weeks after immunization . An adequate IgG antibody response to an individual serotype was arbitrarily defined as a postimmunization antibody titer > or =1.3 microg/ml or at least 4 times the preimmunization value . Immunization with an experimental CRM197-heptavalent pneumococcal conjugate vaccine was offered to patients without an adequate response to 4 or more vaccine serotypes (nonresponders) . Post-conjugate immunization antibody concentrations were measured 4 to 6 weeks later . RESULTS: In nonresponder patients (n = 17) geometric mean post-conjugate immunization (C) serum antibody concentrations (microg/ml) compared with post-polysaccharide (PS) concentrations were: (serotype, C vs . PS) 4, 1.11 vs . 0.30 (P = 0.000227); 6B, 0.46 vs . 0.20 (P = 0.017267); 9V, 0.82 vs . 0.29 (P = 0.002163); 14, 1.88 vs . 0.27 (P = 0.000615); 18C, 0.98 vs . 0.32 (P = 0.021962); 19F, 1.24 vs . 0.34 (P = 0.002844); and 23F, 0.87 vs . 0.16 (P = 0.000194) . In responder patients (n = 67), after 1 dose of the polysaccharide vaccine, geometric mean antibody concentrations were: 4, 1.05; 6B, 0.96; 9V, 1.55; 14, 1.65; 18C, 1.62; 19F, 1.30; and 23F, 1.02 . CONCLUSIONS: Our results show that a pneumococcal conjugate vaccine is capable of inducing an IgG response in patients with recurrent infections who had failed to mount an adequate response to the polysaccharide vaccine . Conjugate vaccines may be of value in the management of children with recurrent pneumococcal respiratory infections.

J Allergy Clin Immunol, 1998 Aug, 102(2), 215 - 21
Influence of age on the response to Streptococcus pneumoniae vaccine in patients with recurrent infections and normal immunoglobulin concentrations; Sorensen RU et al.; BACKGROUND: A deficient antibody response to polysaccharide antigens is determined by measuring the response to the 23-valent pneumococcal polysaccharide vaccine . However, the diagnosis of this specific antibody deficiency is hampered by the lack of sufficient data and standardized testing of the response to pneumococcal polysaccharides . METHODS: All patients evaluated in our allergy/immunology clinic for recurrent respiratory infections between 1995 and 1997 without immunoglobulin, IgG subclass, or other known primary or secondary immunodeficiency were included in this analysis . IgG antipneumococcal serotypes 1, 3, 4, 6B, 9V, 14, 18C, 19F, and 23F were determined by a modified ELISA protocol . An adequate IgG antibody response to an individual serotype was arbitrarily defined as a postimmunization antibody titer of 1.3 microg/ml or greater or at least four times the baseline value . RESULTS: A total of 113 patients fulfilling the criteria for inclusion in this analysis were divided into five age groups . The geometric means for preimmunization and postimmunization pneumococcal antibody titers for all serotypes increased with age . For post-immunization antibody concentrations, there was a sharp increase in the specific antibody concentrations in adults in comparison with all pediatric age groups ranging in age from 7 months to 16 years . Similarly, the number of serotypes to which there was an adequate response also increased with age . CONCLUSION: We conclude that the definition of what constitutes an adequate response to pneumococcal immunization needs further definition . It is clear, however, that age has an important influence on the intensity of the response to most pneumococcal polysaccharides . Correlation studies between antibody concentrations in different IgG subclasses, functional studies, and protection studies against mucosal and invasive pneumococcal infections are in progress, and these should contribute to a refined definition of a normal response . The availability of a standardized method for the measurement of IgG antibodies against relevant pneumococcal serotypes is an important step toward this goal.

J Electron Microsc (Tokyo), 1998, 47(2), 169 - 74
Binding of influenza and paramyxoviruses to Group B Streptococcus with the terminal sialyl-galactose linkage; Hosaka Y et al.; Using the virus-binding assay and scanning electron microscopy (SEM), influenza A and B type viruses and two paramyxoviruses, parainfluenza (Sendai) and mumps viruses, were found to bind to Group B Streptococcus (GBS), type Ia and II, with the terminal sialyl-galactose linkage, although some viruses detached during the sample processing for SEM, and mumps virus did not bind to GBSIa . Binding of viruses eluted from GBS at 37 degrees C depended on combination of virus and GBS . The biological significance of these findings is discussed.

Ann Periodontol, 1998 Jul, 3(1), 151 - 60
Dental plaque, platelets, and cardiovascular diseases; Herzberg MC et al.; Cardiovascular diseases, including atherosclerosis and myocardial ischemia, occur as a result of a complex set of genetic and environmental factors . During periodontitis, dental plaque microorganisms may disseminate through the blood to infect the vascular endothelium and contribute to the occurrence of atherosclerosis and risk of myocardial ischemia and infarction . Myocardial ischemia and infarction are often preceded by acute thromboembolic events . In an in vitro model of thrombosis, certain dental plaque bacteria induce platelets to aggregate . Aggregation of platelets is induced by the platelet aggregation-associated protein {PAAPJ expressed on plaque bacteria, including Streptococcus sanguis and Porphyromonas gingivalis . Intravenous infusion of S . sanguis into rabbits has been shown previously to cause changes in the electrocardiogram (ECG), heart rate, blood pressure, and cardiac contractility . These changes are consistent with the occurrence of myocardial infarction . The ECG changes are now shown to begin within 30 seconds after infusion of PAAP+ S . sanguis, followed by alterations in blood pressure and respiratory rate . These changes occurred intermittently over a 30-minute period and changed within one heartbeat to a normal pattern and suddenly back to abnormal . Intermittent ECG abnormalities were seen in 13 of 15 rabbits, including left axis deviation, ST-segment depression, preventricular contractions, alternans, and bigemnia . Dose-dependent thrombocytopenia, accumulation of 111Indium-labeled platelets in the lungs, and tachypnea also occurred . No changes occurred with the PAAp- strain . The data indicated that PAPP+ S . sanguis interacts with circulating platelets, inducing thromboemboli to cause the pulmonary and cardiac abnormalities . During periodontitis, therefore, PAAP+ S . sanguis and P . gingivalis bacteremia may contribute to the chance of acute thromboembolic events.

J Oral Rehabil, 1998 Jul, 25(7), 485 - 9
Antibacterial temporary filling materials: the effect of adding various ratios of Ag-Zn-Zeolite; Hotta M et al.; The effect of a new type of antibacterial temporary filling material was evaluated . Ag-Zn-Zeolite (Bactekiller, Kanebo, Japan) and SiO2 filler were incorporated into urethane acrylate monomer paste in amounts of 5/55, 10/50, 20/40 and 30/30 wt%, respectively . The present study was designed to use a dye penetration test to measure direct inhibition of bacterial growth of four oral bacteria (Streptococcus mutans, Streptococcus mitis, Streptococcus salivarius, Streptococcus sanguis) . The amounts of silver and zinc ions released from these materials were measured by atomic absorption spectrophotometry . The results indicated that the occurrence of marginal leakage was low in all of these materials . These materials exhibited prominent in-vitro antibacterial activity against S . mutans and S . mitis . The Ag-Zn-Zeolite in these materials was able to release very small but detectable amounts of Ag and Zn even 4 weeks after the immersion started . The larger the amounts of Ag-Zn-Zeolite that were incorporated, the greater the release of silver and zinc . However, it appears that increasing antibacterial activity is not promoted by the higher ratio of Ag-Zn-Zeolite.

Microbios, 1998, 93(376), 139 - 46
Cellular heterogeneity in non-immune IgG-binding in a strain of Streptococcus mitis; Linder LE et al.; Electron microscopy revealed that Streptococcus mitis ATCC 903 bound gold probes conjugated with goat IgG by non-immune mechanisms . Only a few of the cells and the cell wall fragments could bind IgG, in contrast to Staphylococcus aureus and Streptococcus group G which showed a more homogeneous binding to nearly all cells or cell wall fragments.

Am J Infect Control, 1998 Aug, 26(4), 442 - 5
Potential for cross-contamination from use of a needleless injector; Weintraub AM et al.; BACKGROUND: Medical devices that are used on patients in fields containing potentially infectious body fluids can become contaminated and transmit infectious agents to other sites on the patient or to other patients if the devices are not properly cleaned and decontaminated after use on each patient treatment site . One such device is the needleless or jet injector, which is widely used in medicine and dentistry to deliver local anesthetic in procedures such as bone marrow aspirations, lumbar punctures, and cutaneous and intraoral injections . This study was conducted to determine whether cross-contamination can occur on in vitro reuse of a needleless injector and whether a manufacturer's recommended method of injector decontamination (ie, immersion sterilization) is effective in the prevention of cross-contamination . METHODS: The study was performed with new autoclaved injectors, fluorescein dye, and Streptococcus crista (the bacteria commonly found in saliva) in the field of use to determine whether these devices can become contaminated during use and carry over the contamination to other sites during immediate reuse . RESULTS: Fluorescein dye and bacteria tests with the needleless injectors showed that contamination or carryover does occur . It appeared to reduced to a minimum when a autoclaved, sterile rubber cap used over the head of the device during injection was replaced between each use, although replacement of the rubber cap alone did not prevent carryover . Immersion of the head of the injector in a 2% glutaraldehyde solution for 30 minutes followed by a sterile water rinse and the replacement of the rubber cap with a sterile cap between uses was shown to curtail bacterial growth and prevent cross-contamination on immediate reuse of the device . CONCLUSION: This study demonstrated that needleless injectors become contaminated during in vitro use and direct contact with contaminated surfaces and that needless injectors carry over the contamination to subsequent sites of release . The replacement of the injector's rubber cap with a new one after initial discharge or the removal of an exposed rubber cap and immersion of the head of the injector in 2% glutaraldehyde followed by a rinse of the head in sterile water, as recommended by one injector manufacturer, can minimize or eliminate the carryover.

J Bacteriol, 1998 Sep, 180(17), 4711 - 7
Intracellular alpha-amylase of Streptococcus mutans; Simpson CL et al.; Sequencing upstream of the Streptococcus mutans gene for a CcpA gene homolog, regM, revealed an open reading frame, named amy, with homology to genes encoding alpha-amylases . The deduced amino acid sequence showed a strong similarity (60% amino acid identity) to the intracellular alpha-amylase of Streptococcus bovis and, in common with this enzyme, lacked a signal sequence . Amylase activity was found only in S . mutans cell extracts, with no activity detected in culture supernatants . Inactivation of amy by insertion of an antibiotic resistance marker confirmed that S . mutans has a single alpha-amylase activity . The amylase activity was induced by maltose but not by starch, and no acid was produced from starch . S . mutans can, however, transport limit dextrins and maltooligosaccharides generated by salivary amylase, but inactivation of amy did not affect growth on these substrates or acid production . The amylase digested the glycogen-like intracellular polysaccharide (IPS) purified from S . mutans, but the amy mutant was able to digest and produce acid from IPS; thus, amylase does not appear to be essential for IPS breakdown . However, when grown on excess maltose, the amy mutant produced nearly threefold the amount of IPS produced by the parent strain . The role of Amy has not been established, but Amy appears to be important in the accumulation of IPS in S . mutans grown on maltose.

Microbiol Immunol, 1998, 42(7), 503 - 8
Effect of IgA1 protease on the ability of secretory IgA1 antibodies to inhibit the adherence of Streptococcus mutans; Tyler BM et al.; Secretory IgA (SIgA) is the principal immunoglobulin isotype present in the mucosal secretions of humans . SIgA is thought to play a major role in host defense at these surfaces by inhibiting the colonization of potentially pathogenic microorganisms . A number of bacteria that are mucosal pathogens of humans produce a protease that specifically cleaves the IgA1 subclass of humans and great apes at the hinge region to produce Fab and Fc fragments . In order to study the effect of IgA1 protease on the ability of SIgA1 antibodies to inhibit bacterial adherence, an in vitro assay that quantifies the adsorption of radiolabeled Streptococcus mutans to hydroxyapatite (HA) beads was employed . High titer S . mutans-specific SIgA1 and SIgA2 antibodies were induced in chimpanzee milk for use in the assay . Fab alpha1 fragments had significantly reduced ability to inhibit adherence of S . mutans to saliva-coated HA compared to intact SIgA1 or SIgA2 anti-S . mutans antibodies . These data support the potential importance of IgA1 proteases as an ecological determinant in the oral cavity and their role as a determinant of pathogenesis of pathogenic bacteria whose portal of entry is the mucosal surface.

Commun Dis Public Health, 1998 Mar, 1(1), 22 - 7
Pneumococcal bacteraemia and meningitis in England and Wales, 1993 to 1995; Laurichesse H et al.; A total of 10,346 blood and 682 cerebrospinal fluid (CSF) isolates of Streptococcus pneumoniae were reported to the PHLS Communicable Disease Surveillance Centre from laboratories in England and Wales from 1 January 1993 to 31 December 1995 . This corresponds to a mean annual incidence of 6.7 per 100,000 episodes of bacteraemia and 0.44/100,000 of meningitis . Absolute numbers of pneumococcal bacteraemia were similar to levels reported between 1990 and 1992, but fewer isolates of pneumococci were made from CSF . There was no discernible overall trend between 1993 and 1995, but age specific incidence suggested a slight increase in bacteraemia in older age groups . Estimated case fatality rates were 20% for pneumococcal bacteraemia and 22% for meningitis . The proportion of pneumococcal strains resistant to penicillin and erythromycin rose between 1989 and 1995 from 0.3% to 2.9% and 3.3% to 10.9%, respectively . The persistent threat of invasive pneumococcal infections highlights the need for continuing laboratory surveillance (including serotyping), appropriate use of antibiotics, and immunisation of groups at risk . The development of conjugate vaccines offers new prospects for prevention.

J Int Med Res, 1998 Jun-Jul, 26(3), 152 - 8
Azithromycin compared with clarithromycin for the treatment of streptococcal pharyngitis in children; Venuta A et al.; The treatment of streptococcal pharyngitis with azithromycin (10 mg/kg orally once daily for 3 days) or clarithromycin (7.5 mg/kg orally twice daily for 10 days) was compared in a randomized observer-blind study carried out in 174 children with documented Streptococcus pyogenes infection . The observed cure rate 10 days after the beginning of treatment was 61/63 (96.8%) in the clarithromycin group and 71/74 (95.9%) in the azithromycin group . At days 17-20 the bacteriological eradication rate was 95.2% for clarithromycin and 94.6% for azithromycin . When children who did not complete treatment were included in the analysis the eradication rate was higher for azithromycin (93.6% compared with 82.9%; P < 0.05); the difference was due to better compliance with the azithromycin regimen.

Md Med J, 1998 Aug, 47(4), 188 - 90
Flush resuscitation for group A streptococcus toxic shock: a possible role for continuous renal replacement therapy and plasmapheresis; Wiles CE 3rd et al.; Group A streptococcus has emerged as a major cause of aggressive life-threatening deep-seated infections . In addition, toxic shock syndrome caused by Group A streptococcus was recognized in 1983 . Group A streptococcus produces several potent exotoxins which explain the pathophysiology of these invasive infections . Other virulence factors such as M protein, which can impede phagocytosis, are associated with some Group A streptococcus . M protein and streptococcal pyrogenic exotoxins may act as super antigens . Host factors may influence the severity of infection . Blood purification techniques such as continuous renal replacement therapy and plasmapheresis can remove streptococcal exotoxins as well as inflammatory mediators . Replacement with fresh-frozen plasma corrects coagulopathy and may provide some antibody protection . Four patients with Group A streptococcus-toxic shock syndrome treated with continuous renal replacement therapy, plasmapheresis, or both showed dramatic, rapid improvement in cardiovascular dynamics and respiratory parameters . Two patients died . The mainstay of treatment for Group A streptococcus-toxic shock syndrome remains early diagnosis, aggressive surgical control of the infection, and appropriate antibiotics (i.e., penicillin and clindamycin) . Flush resuscitation may rescue some patients from profound toxic shock . The mechanisms of action need to be delineated.

FEMS Immunol Med Microbiol, 1998 Jul, 21(3), 189 - 95
Streptococcus suis and group B Streptococcus differ in their interactions with murine macrophages; Segura MA et al.; Streptococcus suis type 2 and group B Streptococcus type III (GBS) are important encapsulated bacterial species causing meningitis . In the present study we compared quantitatively the uptake and intracellular survival of S . suis type 2 and GBS type III with murine macrophages in non-opsonic conditions . The role of the capsule of both pathogens was also studied using previously obtained unencapsulated isogenic mutants . Encapsulated S . suis wild-type strain was practically not phagocytosed, while the unencapsulated mutant was easily ingested by macrophages . On the other hand, the well encapsulated GBS strain and its unencapsulated mutant were both phagocytosed in large numbers . Even if S . suis unencapsulated mutant showed a higher uptake rate than the parental strain, this value was always markedly lower than the numbers of ingested GBS strains . In addition, the intracellular survival of encapsulated and unencapsulated GBS strains was significantly higher than that of S . suis strains . These results suggest that interactions between GBS type III and S . suis type 2 with murine macrophages as well as the role of the capsule as an antiphagocytic factor are different for the two bacterial pathogens.

J Appl Microbiol, 1998 Jun, 84(6), 1104 - 10
Characterization of the interaction of bovine plasmin with Streptococcus uberis; Lincoln RA et al.; The binding of plasmin to Streptococcus uberis strain 0140 J was optimal in the pH range 5.0-5.5 . Plasmin binding decreased exponentially with increasing NaCl concentration (0-0.8 mol l-1), reaching a minimum at NaCl concentrations exceeding 0.55 mol l-1 . Neither K+, Mg2+ nor the metal chelator EDTA had any effect on the interaction . Plasmin binding was prevented, in a concentration-dependent manner, by the amino acids lysine, arginine and epsilon-aminocaproic acid . Bound plasmin was also eluted from the bacterial cell using the same amino acids . Bound plasmin was lost from the bacterium in a time- and temperature-dependent fashion, the rate of plasmin loss increased with increasing temperature over the range 4-55 degrees C, and the elution of plasmin from live and heat-killed bacteria was similar . Cell-bound plasmin was only partially inhibited by the physiological inhibitor alpha 2-antiplasmin whereas the serine protease inhibitor aprotinin, and the active site titrant p-nitrophenyl-p-guanidiniobenzoate, inhibited the activity of the cell-bound plasmin by more than 95%.

J Biol Chem, 1998 Aug 28, 273(35), 22466 - 70
HYAL2, a human gene expressed in many cells, encodes a lysosomal hyaluronidase with a novel type of specificity; Lepperdinger G et al.; Using Expressed Sequence Tags (ESTs) deposited in the data banks, a cDNA has been assembled that encodes a protein related to the hyaluronidases from bee venom and mammalian sperm . Expression of this cDNA yielded a polypeptide termed HYAL2, which is located in lysosomes . The HYAL2 protein was shown to have hyaluronidase activity below pH 4 . However, it only hydrolyzed hyaluronan of high molecular mass from umbilical cord, rooster comb, and a Streptococcus strain . The reaction product was a polysaccharide of about 20 kDa, which was further hydrolyzed to small oligosaccharides by the sperm hyaluronidase . Conversely, hyaluronan fragments from vitreous humor, which had a molecular mass of about 20 kDa, were not cleaved by the HYAL2 enzyme to any detectable extent . These results provide evidence for the existence of structural domains in hyaluronan, which are resistant to the action of this enzyme . The structural and functional implications of these findings are discussed.

Infect Immun, 1998 Sep, 66(9), 4403 - 10
Actinomyces naeslundii displays variant fimP and fimA fimbrial subunit genes corresponding to different types of acidic proline-rich protein and beta-linked galactosamine binding specificity; Hallberg K et al.; Actinomyces naeslundii genospecies 1 and 2 bind to acidic proline-rich proteins (APRPs) and statherin via type 1 fimbriae and to beta-linked galactosamine (GalNAcbeta) structures via type 2 fimbriae . In addition, A . naeslundii displays two types of binding specificity for both APRPs-statherin and GalNAcbeta, while Actinomyces odontolyticus binds to unknown structures . To study the molecular basis for these binding specificities, DNA fragments spanning the entire or central portions of fimP (type 1) and fimA (type 2) fimbrial subunit genes were amplified by PCR from strains of genospecies 1 and 2 and hybridized with DNA from two independent collections of oral Actinomyces isolates . Isolates of genospecies 1 and 2 and A . odontolyticus, but no other Actinomyces species, were positive for hybridization with fimP and fimA full-length probes irrespective of binding to APRPs and statherin, GalNAcbeta, or unknown structures . Isolates of genospecies 1 and 2, with deviating patterns of GalNAcbeta1-3Galalpha-O-ethyl-inhibitable coaggregation with Streptococcus oralis Ss34 and MPB1, were distinguished by a fimA central probe from genospecies 1 and 2, respectively . Furthermore, isolates of genospecies 1 and 2 displaying preferential binding to APRPs over statherin were positive with a fimP central probe, while a genospecies 2 strain with the opposite binding preference was not . The sequences of fimP and fimA central gene segments were highly conserved among isolates with the same, but diversified between those with a variant, binding specificity . In conclusion, A . naeslundii exhibits variant fimP and fimA genes corresponding to diverse APRP and GalNAcbeta specificities, respectively, while A . odontolyticus has a genetically related but distinct adhesin binding specificity.

Infect Immun, 1998 Sep, 66(9), 4299 - 304
Effectiveness of liposomes possessing surface-linked recombinant B subunit of cholera toxin as an oral antigen delivery system; Harokopakis E et al.; Liposomes appear to be a promising oral antigen delivery system for the development of vaccines against infectious diseases, although their uptake efficiency by Peyer's patches in the gut and the subsequent induction of mucosal immunoglobulin A (IgA) responses remain a major concern . Aiming at targeted delivery of liposomal immunogens, we have previously reported the conjugation via a thioether bond of the GM1 ganglioside-binding subunit of cholera toxin (CTB) to the liposomal outer surface . In the present study, we have investigated the effectiveness of liposomes containing the saliva-binding region (SBR) of Streptococcus mutans AgI/II adhesin and possessing surface-linked recombinant CTB (rCTB) in generating mucosal (salivary, vaginal, and intestinal) IgA as well as serum IgG responses to the parent molecule, AgI/II . Responses in mice given a single oral dose of the rCTB-conjugated liposomes were compared to those in mice given one of the following unconjugated liposome preparations: (i) empty liposomes, (ii) liposomes containing SBR, (iii) liposomes containing SBR and coadministered with rCTB, and (iv) liposomes containing SBR plus rCTB . Three weeks after the primary immunization, significantly higher levels of mucosal IgA and serum IgG antibodies to AgI/II were observed in the rCTB-conjugated group than in mice given the unconjugated liposome preparations, although the latter mice received a booster dose at week 9 . The antibody responses in mice immunized with rCTB-conjugated liposomes persisted at high levels for at least 6 months, at which time (week 26) a recall immunization significantly augmented the responses . In general, mice given unconjugated liposome preparations required one or two booster immunizations to develop a substantial anti-AgI/II antibody response, which was more prominent in the group given coencapsulated SBR and rCTB . These data indicate that conjugation of rCTB to liposomes greatly enhances their effectiveness as an antigen delivery system . This oral immunization strategy should be applicable for the development of vaccines against oral, intestinal, or sexually transmitted diseases.

Infect Immun, 1998 Sep, 66(9), 4163 - 8
The specificity patterns of human immunoglobulin G antibodies in serum differ from those in autologous secretions; Berneman A et al.; The specificity patterns of immunoglobulin G (IgG) antibodies to streptococcal antigens in serum and autologous secretions were compared in order to determine whether IgG found in human secretions is exclusively of serum origin or can also be locally produced irrespective of the systemic immune system . Surface antigens from a type 6 M-protein strain of Streptococcus pyogenes were extracted by cell wall digestion and subjected to sodium lauryl sulfate-polyacrylamide gel electrophoresis under reducing conditions . After being blotted onto nitrocellulose, the antigens were incubated with purified IgG from various body fluids: saliva, cervicovaginal secretions, seminal fluid, and colostrum . Binding was then revealed with labeled antibodies to human Fcgamma fragments . The antibody specificity patterns obtained by computer-assisted analysis were compared with those of paired sera . Major variations were observed between serum and secretions, as well as between different secretions from the same subject . These results are in favor of IgG-associated local immunity within different tissue compartments . This IgG response to mucosal antigens can complement that of secretory IgA in the defense against pathogens and should be taken into account during topical vaccinations.

FEMS Microbiol Lett, 1998 Aug 1, 165(1), 129 - 37
The expression and characterization of a putative adhesin B from H . influenzae; Lu D et al.; In the H . influenzae type b (Hib) genome, two putative adhesin B genes, HI0119 and HI0362, have been identified on the basis of homology to the adhesin B (FimA) of Streptococcus parasanguis . We expressed and characterized one of them, HI0119, from a non-typeable H . influenzae strain (NTHI) . This 37 kDa protein was selectively isolated from an H . influenzae surface protein (water) extract by elution from a celite matrix with EDTA . The adhesin B protein is 97.7% identical to that of H . influenzae, strain Rd, has 23.7% identity and 47.8% similarity to FimA of Streptococcus parasanguis but is distinguished from the FimA family by the absence of the N-terminal lipid anchor consensus sequence LXXC, the presence of a C-terminal disulfide-bonded domain, and a central histidine-rich domain . Recombinant fusion protein bound specifically to celite . Antisera raised against fusion protein recognized a 37 kDa protein from whole cell extracts of H . influenzae on Western blots . A truncated mutant lacking the C-terminal disulfide-bonded domain and a Cys308 to Ser mutant were constructed and expressed as fusion proteins . Both mutants retained celite binding . However, purified fusion proteins could not, unlike H . influenzae, bind Hep2 cells, suggesting that HI0119 may not be an adhesin in this organism.

J Otolaryngol, 1998 Aug, 27(4), 206 - 12
Peritonsillar abscess or cellulitis? A clinical comparative paediatric study; Szuhay G et al.; OBJECTIVE: Peritonsillar sepsis (PTS) can be divided into abscess and cellulitis . It is the most common deep neck infection in the paediatric age group . In this article we discuss the clinical issues related to peritonsillar sepsis in children . METHOD: This study involves 185 cases of peritonsillar that were treated at the Montreal Children's Hospital in the last 10 years . The symptoms, signs, laboratory and radiological data as well as the medical and surgical therapies are included . RESULTS: Seventy-five cases were peritonsillar cellulitis (PTC) and the rest were abscesses . The age at presentation varied between 2.5 months and 18 years . The majority of the cases diagnosed as peritonsillar abscess (PTA) occurred from age 12 to 18 years . Trismus was the only complaint that was statistically associated with PTA . Uvular deviation combined with trismus was also important in differentiating PTA from PTC . Our data revealed a lower percentage of anaerobic bacteria and the majority of cultures grew Streptococcus pyogenes group A . CONCLUSIONS: Clinical picture is important in differentiating PTA from PTC . Recurrence of peritonsillar sepsis was higher in children with a history of recurrent tonsillitis . Needle aspiration of PTA resulted in a higher incidence of recurrence compared to incision and drainage . A management algorithm is suggested for the child presenting with peritonsillar sepsis.

J Burn Care Rehabil, 1998 Jul-Aug, 19(4), 292 - 5
Melting graft-wound syndrome; Matsumura H et al.; Progressive epithelial loss (melting) from a previously well-taken graft, healed burn wound, or healed donor site is a significant problem in the treatment of patients with burn injuries . For many years, such epithelial loss was attributed to the growth of Streptococcus spp; however, we recently have encountered progressive epithelial melting without significant colonization or infection with Streptococcus spp . We retrospectively reviewed 1035 cases admitted from January 1994 to July 1996 and then collected data prospectively from 324 patients admitted to the University of Washington Burn Center from August 1996 to May 1997 . Melting graft-wound syndrome developed in 29 patients . Swab wound cultures from these patients mainly grew Staphylococcus aureus, and none grew Streptococcus spp . All patients were treated with systemic antibiotics and local wound care . Twenty-seven patients healed spontaneously, but two underwent debridement and re-autografting to close the wounds . The melting graft-wound is a significant clinical problem, and its incidence appears to be increasing . The pathophysiology, clinical course, and treatment of the melting graft-wound syndrome are not well understood, and there is no description of it in the literature . This study describes the clinical features of the syndrome.

Clin Infect Dis, 1998 Aug, 27 Suppl 1, S87 - 92
Resistance of Streptococcus pyogenes to erythromycin and related antibiotics in Italy . The Italian Surveillance Group for Antimicrobial Resistance; Cornaglia G et al.; A survey of antimicrobial resistance in Streptococcus pyogenes, performed within the framework of a national surveillance program, has revealed a dramatic increase in resistance of S . pyogenes to erythromycin in most areas of Italy . In virtually all the centers that provided data for 3 consecutive years, the incidence of erythromycin-resistant strains increased twofold to 20-fold from 1993 to 1995 and was greater than 30% in five of the 14 centers participating in the study . The clonality of erythromycin-resistant isolates was studied in 15 strains isolated from different patients at the Institute of Microbiology of Verona University (Verona) . The features of the Verona isolates and the substantially different rates of erythromycin and clindamycin resistance observed in most centers suggest that the spread of different resistance genes in multiple clones might be occurring throughout the country.

Clin Infect Dis, 1998 Aug, 27(2), 385 - 7
Clinical significance of bacteremia involving the "Streptococcus milleri" group: 51 cases and review; Bert F et al.; Fifty-one cases of bacteremia due to the "Streptococcus milleri" group were analyzed . Among these were 40 patients with underlying diseases, and associated local infections were present in 27 patients . The most frequent sites of infection were the thoracic cavity and the digestive and hepatobiliary tracts . A probable portal of entry related to mucosal-barrier trauma was identified for an additional 16 patients . The origin of bacteremia was unknown for the remaining eight patients . Abscess formation was evident for only six patients, and there were no cases of endocarditis . Multiple positive blood cultures and polymicrobial bacteremia were associated significantly with the presence of local sites of infection . The most common causative species were Streptococcus anginosus and Streptococcus constellatus . Two patients died of bacteremia.

Am J Kidney Dis, 1998 Aug, 32(2), 309 - 13
Infective endocarditis-induced crescentic glomerulonephritis dramatically improved by plasmapheresis; Daimon S et al.; A 50-year-old woman was referred to our hospital because of skin purpura, anemia, high fever, and acute renal insufficiency . Five years ago, she had been diagnosed as having ventricular septal defect without any complications . A blood culture drawn during the hospitalization grew Streptococcus viridans . She was diagnosed as having infective endocarditis-induced crescentic glomerulonephritis (GN) according to echocardiography and renal biopsy results . Although antibiotic treatment alone showed no apparent efficacy, after the initiation of plasmapheresis, the high fever and acute renal insufficiency were dramatically improved . After clinical stability was achieved, closure of the ventricular septal defect was performed . This result suggests that plasmapheresis may be beneficial in the treatment of infective endocarditis-induced crescentic GN . The possible mechanisms of this therapy are discussed.

J Clin Pathol, 1998 May, 51(5), 399 - 400
The Splendore-Hoeppli phenomenon in hepatic botryomycosis; Schlossberg D et al.; A 68 year old diabetic man developed septicaemia and multiple liver abscesses due to Streptococcus intermedius . Liver biopsy revealed streptococcal botryomycosis which showed the Splendore-Hoeppli phenomenon . Diabetes mellitus is an example of the immunosuppressed states that have been associated with botryomycosis.

Eur J Clin Microbiol Infect Dis, 1998 Apr, 17(4), 290 - 1
Septicemia and meningitis due to Streptococcus zooepidemicus; Ferrandiere M et al.; A case of septicemia and meningitis due to Streptococcus zooepidemicus in an immunocompetent patient is reported . This organism is an uncommon human pathogen that sometimes causes severe infection, usually in immunocompromised patients . In the reported case, the patient required to be mechanically ventilated for one week and was treated with intravenous ampicillin and gentamicin . He recovered and was discharged from hospital three weeks after the initial presentation . Streptococcus zooepidemicus sensitive to all penicillins, was isolated from all blood cultures and the cerebrospinal fluid.

Eur J Clin Microbiol Infect Dis, 1998 Apr, 17(4), 265 - 8
Current usefulness of procaine penicillin in the treatment of pneumococcal pneumonia; Cabellos C et al.; The aim of this study was to determine whether procaine penicillin could be used in the treatment of suspected pneumococcal pneumonia of mild to moderate severity in an area with a high prevalence of penicillin resistance . Forty-nine patients were treated with 1.2 x 10(6) U of i.m . procaine penicillin every 12 h . By intent-to-treat analysis, 40 of 49 patients were cured and no patient died . Streptococcus pneumoniae could be demonstrated in 17 patients; 5 of 17 isolates were resistant to penicillin (MICs 0.25-4 microg/ml) . Fifteen of 17 patients were cured with procaine penicillin, one presented allergy, and one was a therapeutic failure . Mean penicillin serum levels were 2.39 +/- 1.16 microg/ml (peak) and 0.61 +/- 0.38 microg/ml (trough) . The results suggest that procaine penicillin may still be useful in the empirical therapy of suspected pneumococcal pneumonia.

J Clin Microbiol, 1998 Sep, 36(9), 2778 - 81
Development of specific nested oligonucleotide PCR primers for the Streptococcus iniae 16S-23S ribosomal DNA intergenic spacer; Berridge BR et al.; Streptococcus iniae is a cause of septicemia, meningoencephalitis, and death in farmed fish and of cellulitis in human beings . A set of nested oligonucleotide PCR primers that specifically amplified a 373-bp subunit from a variety of clinical isolates from farmed fish and human patients were constructed from a 524-bp consensus sequence of the S . iniae 16S-23S ribosomal DNA intergenic spacer.

J Clin Microbiol, 1998 Sep, 36(9), 2703 - 7
Molecular analysis by pulsed-field gel electrophoresis and antibiogram of Streptococcus pneumoniae serotype 6B isolates from selected areas within the United States; Rudolph KM et al.; Fifty-eight clinical isolates of Streptococcus pneumoniae serotype 6B, including 16 from Alaska, 14 from Arizona, 11 from Washington, and 17 from seven additional states, were analyzed . The antibiograms of these isolates were assigned to 10 antibiotic profiles based on their susceptibilities to penicillin, erythromycin, tetracycline, and trimethoprim-sulfamethoxazole . Thirty-two (55%) of these isolates were penicillin nonsusceptible, while 21 (36%) were intermediate or resistant to three or more antibiotics . The restriction endonucleases ApaI and SmaI were used to digest intact chromosomes, and the fragments were resolved by pulsed-field gel electrophoresis (PFGE) . The ApaI and SmaI PFGE patterns were combined, and 13 of the 16 Alaskan isolates showed indistinguishable PFGE patterns . One other isolate exhibited highly related ApaI and SmaI PFGE patterns, differing by only one band after restriction with ApaI . Among the 14 isolates from Arizona, 1 was indistinguishable from the predominant ApaI and SmaI PFGE patterns seen in the Alaskan isolates; 5 others were highly related (+/-1 band after cutting with either enzyme) to the Alaskan isolates, suggesting a common ancestral origin . Of the remaining eight isolates, six additional ApaI plus SmaI PFGE patterns were observed . The 28 isolates from the various contiguous states had 22 ApaI plus SmaI PFGE patterns . No correlations were found between specific PFGE patterns, antibiograms, dates of isolation, or geography . The serotype 6B isolates across the contiguous United States were genetically diverse, while the 6B isolates from Alaska appeared to be much less diverse.

Arch Biochem Biophys, 1998 Aug 15, 356(2), 197 - 206
Bactericidal activity and poly-L-proline II conformation of the tandem repeat sequence of human salivary mucin glycoprotein (MG2); Antonyraj KJ et al.; The tandem repeat 23-residue sequence {TRS23 (145-167): T-T-A-A-P-P-T-P-S-A-T-T-P-A-P-P-S-S-S-A-P-P-E} of human salivary mucin glycoprotein MG2 was examined for its in vitro bactericidal activity against four oral microorganisms, Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis, Streptococcus gordonii, and Streptococcus mutans . The conformational features of the proline-rich peptide were determined by circular dichroism (CD) and 600 MHz two-dimensional (2D) nuclear magnetic resonance (NMR) in aqueous solution . The strains of P . gingivalis (W50 and 381), A . actinomycetemcomitans (Y4 and 67), S . gordonii (DL1), and S . mutans (GS5) are highly sensitive to this peptide at 1.5-3.0 microM concentrations, suggesting that the proline-rich repeat sequence is a potent bactericidal agent for oral pathogens . The assignment of backbone and side-chain proton resonances was accomplished by the combined analysis of 2D total correlated spectroscopy and nuclear Overhauser effect spectroscopy . The temperature dependence of amide NH chemical shifts and the 1H-2H exchange effect on amide NH resonances suggest the absence of intramolecularly hydrogen-bonded NH groups . The coupling constant (JNH-CalphaH) values, conformational restriction offered by the proline residues (phi = -60 degrees +/- 15 degrees), the set of medium- and short-range nuclear Overhauser effects observed for this sequence, and the results of restrained structure calculation using DIANA, the distance geometry algorithm for NMR applications, provide evidence for the existence of a significant population of poly-L-proline II-type helices in aqueous solution . The CD spectra of the peptide in phosphate buffer (pH 7.2) and in methanol are reminiscent of the CD spectrum of the poly-L-proline II helical conformation and are consistent with the NMR data . The bactericidal activity of the proline-rich repeat sequence suggests that bacterial colonization, facilitated by the adsorbed salivary mucins on tooth surface, could be partly controlled and cleared by proteolytically degraded proline-rich peptides of MG2 in saliva before the colonized organisms turn into pathogens . It appears that the poly-L-proline II helix is the biologically active backbone conformation for bactericidal activity of the tandem repeat sequences of salivary MG2 .

Ann N Y Acad Sci, 1997 Dec 15, 832, 383 - 93
Influence of heat inactivation of human serum on the opsonization of Streptococcus mutans; Moore MA et al.; Phagocytosis of bacteria, such as Streptococcus mutans, is important to host defense . One mechanism by which phagocytosis can be enhanced is by antibody or complement-mediated opsonization of bacteria . Many studies utilize opsonization of bacteria to enhance a cellular response, but little information has been found examining methodology or validity of the opsonization process following the denaturization of the serum . Human serum was inactivated by heat in order to disrupt the classical and alternative pathways of the complement cascade . S . mutans isolated from human subjects were opsonized with heat-inactivated human serum before exposing them to viable neutrophils in vitro . Luminol-dependent chemiluminescence (CL) was used to measure neutrophil activation . Human serum used to opsonize the bacteria was denatured by incubation at 57 degrees C for intervals of 30 and 60 min to inactivate complement . The results from the opsonization data indicated that there was significantly increased CL with 60-min inactivation of the serum (34% increase in mean integration mV.min; p < or = 0.05) over the nonopsonized control . This indicated a successful opsonization of the bacteria . In addition, the data demonstrate that the inactivation of serum requires a minimum of 60 min at 57 degrees C to disrupt the complement cascade, while 30- and 15-min inactivations produced no significant increase in CL activity over the control . Standard sandwich ELISA assays, detecting complement binding to S . mutans, confirmed successful heat inactivation of serum showing a significant decrease (p < or = 0.001) in complement binding to S . mutans after 30 min, but could not explain the increased CL response after 60-min heat deactivation of the serum.

Mol Microbiol, 1998 Jul, 29(1), 75 - 83
Development of competence in Streptococcus pneumonaie: pheromone autoinduction and control of quorum sensing by the oligopeptide permease; Alloing G et al.; Competence for genetic transformation in the human pathogen Streptococcus pneumoniae is a transient physiological property . A competence-stimulating peptide, CSP, was recently identified as the processed product of the comC gene . As conflicting results have been reported regarding CSP autoinduction, we monitored the CSP-induced expression of comCDE in derivatives of strain R6 using comC::lacZ fusions . Autoinduction was demonstrated in this genetic background . The kinetics of CSP-induced transcription of comCDE and of a late competence-induced (cin) operon were compared . While the comCDE mRNA level was highest 5 min after CSP addition then decreased, maximal cin expression required 10 min exposure to CSP . Transformation frequencies paralleled cin expression . After 20 min exposure to CSP, both mRNAs disappeared almost completely, providing evidence for an intrinsic mechanism for shutting off CSP signal transduction . Investigation of spontaneous competence development in mixed cultures indicated that transformation of wild-type cells was delayed in the presence of CSP non-producers, consistent with a direct role of CSP in quorum sensing . The effect of varying inoculum size on the timing of competence development was investigated . While competence developed in wild-type cultures at a similar critical density, about OD550 = 0.15, a mutant lacking the three oligopeptide-binding lipoproteins transformed at a 50-fold reduced cell density . The latter effect was mimicked in a strain harbouring a duplication of comC . Altogether, these results suggest that CSP does not accumulate passively in pneumoccal cultures, but that comCDE basal expression can be modulated.

Mol Microbiol, 1998 Jul, 29(1), 39 - 48
The A and the extended V N-terminal regions of streptococcal protein I/IIf mediate the production of tumour necrosis factor alpha in the monocyte cell line THP-1; Chatenay-Rivauday C et al.; The induction of tumour necrosis factor (TNF)-alpha from the monocytic cell line THP-1 by the streptococcal antigen I/II from Streptococcus mutans serotype f (protein I/IIf) was studied by use of recombinant polypeptides containing the discrete domains of the protein . The derivatives carrying the N-terminal alanine-rich region (A region) and the adjacent variable region (extended V region) of the protein bound to THP-1 cell extracts in a saturable fashion, and one derivative lacking both the A and the extended V regions was not able to bind monocyte cell extracts, suggesting that the domains responsible for the binding of protein I/IIf to monocytes were the A and the extended V regions . Sodium metaperiodate pretreatment of THP-1 cell extracts, tunicamycin pretreatment of monocyte cells or competition with N-acetyl neuraminic acid (NANA) and fucose resulted in a 45-70% reduction in binding activity of the derivatives carrying the extended V region, demonstrating the lectin-like mode of recognition of the monocytic receptor by the extended V region and the role of NANA and fucose in this recognition process . Besides, the stimulation of monocytes to release TNF-alpha by the derivatives containing the A region and the extended V region was effective and was not affected by the addition of polymyxin B or vitamin D3, suggesting that CD14 does not play the role of receptor in stimulation of monocytes by protein I/IIf to release TNF-alpha.

Zh Mikrobiol Epidemiol Immunobiol, 1998 May-Jun, (3), 35 - 9
{Features of humoral antibacterial immunity in patients with HIV infections and AIDS}; Kulakov AV et al.; The level of antibodies to some bacterial antigens, their affinity and relationship to the level of CD4+ T-lymphocytes in persons at different stages of HIV infection was studied . The study revealed that at early stages of the development of HIV infection a decrease in the levels of antibodies to Streptococcus pneumoniae protein somatic antigen in comparison with those in HIV-negative donors occurred . In the process of the development of HIV infection an increase in the level of Staphylococcus aureus peptidoglycan and some S.aureus antigenic determinants, as well as to S.pneumoniae protein somatic antigen, took place . Patients with HIV infection who had non-specific pulmonary diseases exhibited an increased level of antibodies to Branhamella catarrhalis complex ultrasonic antigen . In patients with HIV infection having an amount of CD4+ T-lymphocytes below 200/1 the level of antibodies to bacterial antigen was higher than in patients with an amount of CD4+ T-lymphocytes varying within 200-400/1 . In addition, at all stages of HIV infection and in all kinds of its complications an increase in the titer of antibodies to N-acetylglycosoaminylmuramyl dipeptide, an antigenic determinant of peptidoglycan with immunostimulating and adjuvant activity.

Ophthal Plast Reconstr Surg, 1998 Jul, 14(4), 281 - 5
Streptococcal necrotizing fasciitis complicating a conjunctival dacryocystorhinostomy; Hirschbein MJ et al.; Necrotizing fasciitis is a rare infection of the deep and subcutaneous tissue layers most commonly caused by group A beta-hemolytic Streptococcus . The disease begins as a typical cellulitis . Necrosis of the deeper tissues progresses rapidly, accompanied by a dusky, gray-blue skin discoloration with erythematous margins . Even with appropriate treatment, mortality rates remain as high as 36% . Most cases of necrotizing fasciitis have been reported in the general surgical literature, associated with trauma or as a postoperative wound infection after abdominal and gynecologic procedures . Of the 50 cases involving the eyelids reported in the literature, only three were reported to have occurred as a "postoperative" complication . This report is of the first known case of streptococcal necrotizing fasciitis complicating a conjunctival dacryocystorhinostomy.

Am J Respir Crit Care Med, 1998 Aug, 158(2), 620 - 8
Pulmonary fibrosis correlates with duration of tissue neutrophil activation; Jones HA et al.; The role of inflammatory cells such as neutrophil granulocytes in the pathogenesis of pulmonary scarring is unclear . We determined the metabolic activity of neutrophils with positron emission tomography (PET) to measure regional uptake of (18F)-2-fluoro-2-deoxy-D-glucose (18FDG) following its intravenous injection . Fibrogenic or nonfibrogenic substances were instilled into the right upper lobe of rabbit lungs . Time course and intensity of the 18FDG signal in the affected region varied markedly, depending on the stimulus . Time to peak signal (Tmax) and rate constant for its decline (k) for the test substances were, respectively: C5a 10 h (Tmax), 0.045 +/- 0.030 h-1 (k); Streptococcus pneumoniae 15 h, 0.068 +/- 0.012 h-1; bleomycin 28 h, 0.002 +/- 0.001 h-1; microcrystalline silica (microXSiO2), 90 h, 0.0012 +/- 0.0007 h-1; amorphous silica (aSiO2), no response . Response to the nonfibrogenic agents C5a, S . pneumoniae and aSiO2 was brief or nonexistent, falling to baseline values within 3 d, whereas that to the fibrogenic agents bleomycin and microXSiO2 persisted for up to 4 wk . Neutrophil numbers in the lung were proportional to the 18FDG signal following C5a and S . pneumoniae, but not bleomycin and microXSiO2 . Autoradiography of lungs following administration of (3H)-deoxyglucose {(3H)-DG} showed specific localization to neutrophils in all models . Thus, 18FDG uptake provides a remarkably specific measure of neutrophil activity in situ, and the development of pulmonary fibrosis may be related to persistence of this activity.

Am J Physiol, 1998 Aug, 275(2 Pt 1), L255 - 61
Pulmonary sequestration of polymorphonuclear leukocytes released from bone marrow in bacteremic infection; Sato Y et al.; We examined the bone marrow response and the sequestration of polymorphonuclear leukocytes (PMNs) in lung using a bacteremic infection model in rabbits . PMNs were labeled with the thymidine analog 5-bromo-2'-deoxyuridine (BrdU) in the bone marrow, and the bone marrow release and the sequestration of BrdU-labeled PMNs were measured using immunohistochemistry . A focal subcutaneous infection (S) was induced, and the bacteremia (B) was produced 4 h later with Streptococcus pneumoniae (S+B) . This S+B group was compared with other groups with only subcutaneous infection or only bacteremia . The S+B group developed a profound leukopenia after the bacteremia that was associated with an increase in circulating BrdU-labeled PMNs . Morphometric studies showed more PMN sequestration in the lung of the S+B group compared with the others (P < 0.05) . Compared with unlabeled PMNs, BrdU-labeled PMNs, which represent newly released PMNs, preferentially sequestered in lung (P < 0.05) and were slow to migrate into the infected tissues (P < 0.05) . We conclude that bacteremic infection is associated with an accelerated release of PMNs from the bone marrow and that these newly released PMNs preferentially sequester in lung and are slow to migrate into infected tissues.

J Dent, 1998 Jul-Aug, 26(5-6), 443 - 5
Detection of Streptococcus mutans by PCR amplification of the spaP gene in teeth rendered caries free; Allaker RP et al.; OBJECTIVES: To investigate the degree of association between tactile and optical criteria as used to assess the carious status of the enamel-dentine junction (EDJ) during cavity preparation, assessment with a caries detector dye and detection of Streptococcus mutans using culture and polymerase chain reaction (PCR) techniques . METHODS: Twenty-nine teeth, extracted within the previous 30 min, and 15 teeth prepared under rubber dam in vivo, were clinically assessed at the EDJ after the removal of evident carious tissue . Demineralisation was then assessed using a caries detector dye (1% acid red in propylene glycol; Cavex) . A rosehead bur was used to remove tissue at the EDJ for culture and PCR analysis . Culture was carried out on a tryptone yeast cystine sucrose bacitracin selective medium, and PCR used to amplify a sequence (192 bp) of the spaP gene, which encodes the surface protein antigen I/II of S . mutans . RESULTS: Demineralised tissue at the EDJ, as shown using the dye, was found in 52% of teeth . Removed tissue was culture and PCR positive for S . mutans in 2 and 47% of teeth, respectively . A highly significant association (77% of cases; P < 0.001) was shown between dye and PCR assessment methods . No association was found between any other combination of assessment methods . CONCLUSIONS: Culture methods may underestimate the presence of S . mutans . Removal of sufficient dye-stained tissue is therefore recommended to prevent further carious assault from residual S . mutans.

Can J Microbiol, 1998 May, 44(5), 448 - 55
The nonrandom binding distribution of Streptococcus pneumoniae to type II pneumocytes in culture is dependent on the relative distribution of cells among the phases of the cell cycle; Berube LR et al.; The adherence of Streptococcus pneumoniae to epithelial (A549) lung cells was studied and the bacterial binding distribution was found to be nonrandom (non-Gaussian) . Analysis of the dependency of bacterial binding on the cell cycle of A549 cells revealed that approximately 1.8 times more bacteria bind to G2 cells than to G0-G1 phase cells . Furthermore, bacterial binding curves exhibited a plateau of binding to G2 cells at a normalized bacteria to cell ratio approximately 1.8 times larger than that at which the plateau of binding to G0-G1 cell was observed . Since G2 cells are on average 1.4-1.8 times larger than G0-G1 cells, the results indicate that bacterial binding is proportional to cell size and not to the preferential binding (higher affinity) of bacteria to A549 cells in the G2 phase . Finally, the non-Gaussian distribution of bacterial binding could be mathematically modeled by a linear combination of three Gaussian distributions each representing bacterial binding to cells in a particular phase of the cell cycle (G0-G1, S, and G2-M) . Because the Gaussian function contains a term that takes into account the relative number of cells in each of the phases, this last result implies that the overall (non-Gaussian) binding distribution (and hence the median of bacterial binding) can be highly sensitive to the relative proportion of cells in the various phases of the cell cycle.

New Microbiol, 1998 Jul, 21(3), 289 - 92
Effect of sucrose and glucose on the susceptibility of Streptococcus mutans to cephalosporins; Petti S et al.; The effect of the type of sugar used as substrate on the susceptibility of Streptococcus mutans to antibiotics was evaluated . Thirty strains, grown in excess of sucrose (s-MIC) and in excess of glucose (g-MIC), were tested for susceptibility to four cephalosporins . About 21% of the strains were sensitive in the presence of sucrose and resistant in the presence of glucose, whereas only 3% of the strains showed the opposite situation . The mean values of the s-MICs of the four cephalosporins were significantly lower than those of the g-MICs . These findings may also be explained by the synthesis, in excess of sucrose, of insoluble glucan by Streptococcus mutans which increases the interbacterial distance and promotes antibiotic diffusion . Given the susceptibility of Streptococcus mutans grown in excess of sucrose to cefotaxime and cefepime, these antibiotics may be used in the primary prevention of infective endocarditis, when subjects predisposed to endocarditis need invasive dental therapy.

J Surg Res, 1998 May, 76(2), 192 - 9
Aspiration pneumonia-induced sepsis increases cardiac dysfunction after burn trauma; Sheeran PW et al.; Pneumonia occurs in approximately 50% of incubated patients in burn intensive care units and carries a mortality as high as 40% . A model was developed to study altered cardiopulmonary function in burn complicated by pneumococcal pneumonia . Sprague-Dawley rats were given a 43% total body surface area scald burn or sham burn; 24 h later they were transtracheally inoculated with either 10(7) Streptococcus pneumoniae in 0.5 ml phosphate buffer solution (PBS) or 0.5 ml PBS alone . The four groups were: Sham (N = 7), Burn alone (N = 10), Pneumonia alone (N = 11), and Burn and Pneumonia ( N = 12) . A fifth group of burned rats (N = 10), given an identical fluid resuscitation regimen, was sacrificed 24 h postburn to examine the early cardiac responses to burn injury alone . Shams and burned animals had normal lung histology, negative bronchoalveolar lavage (BAL) cultures, and negative blood cultures . Pneumonia and burn plus pneumonia animals had abnormal lung histology, positive BAL cultures, and positive blood cultures . Cardiac function was assessed 24 h after S.pneumoniae challenge (48 h after burn) (Langendorff preparation) . Compared to the Sham group, Pneumonia group, and Burn group, the Burn plus Pneumonia group had the lowest left ventricular pressure (LVP: 94 +/- 4, 71 +/- 3, and 87 +/- 3 mm Hg vs 63 +/- 4 mm Hg, P < 0.05), the lowest maximal rate of LVP rise (+dP/dt{max}:1932 +/- 115, 1419 +/- 71, and 1772 +/- 96 mm Hg vs 1309 +/- 59 mm Hg/s, P < 0.05), and the lowest maximal rate of LVP fall (-dP/dt{max}:1704 +/- 120, 1263 +/- 73, and 1591 +/- 83 mm Hg vs 1025 +/- 98 mm Hg/s, P < 0.05) . Cardiac contraction and relaxation deficits were confirmed in animals 24 h postburn (group 5), as indicated by a significantly lower LVP and +/-dP/dt(max) (62 +/- 3 mm Hg 1210 +/- 60, and 909 +/- 50 mm Hg/s, respectively, P < 0.05 compared to Sham group) . Tumor necrosis factor-alpha (TNF-alpha) concentrations in serum, but not bronchoalveolar lavage, were greater in burned animals with aspiration pneumonia-induced sepsis than in animals with either burn alone or aspiration pneumonia-induced sepsis alone . While our data suggest that elevated circulating TNF-alpha levels may contribute, in part, to depressed cardiac function, further studies are needed to fully define the mechanisms underlying cardiac contractile deficits in this model . We speculate that depressed cardiopulmonary function due to burn complicated by pneumonia and sepsis contributes to the high mortality of this patient population.

Dev Med Child Neurol, 1998 Jul, 40(7), 496 - 9
Acquired brachial-plexus neuropathy in the neonate: a rare presentation of late-onset group-B streptococcal osteomyelitis; Sadleir LG et al.; Acquired brachial-plexus neuropathy outside the immediate neonatal period is uncommon . Pseudopalsy of a limb, associated with osteomyelitis, is well recognized . Acquired brachial-plexus neuropathy as the initial presentation of osteomyelitis of the humerus in the neonatal period is described . Three infants presented at 3, 15, and 21 days respectively, with acute monoplegia consistent with brachial-plexus neuropathy . The infants were afebrile and generally well . Initial radiographs of the humerus were normal and blood cultures grew group-B streptococcus in all infants . Nerve conduction studies were consistent with brachial-plexus neuropathy . Following intravenous antibiotics, there was complete recovery in all infants . Osteomyelitis of the humerus should be considered in infants in whom there are no overt signs of sepsis and who present with brachial-plexus neuropathy . Early diagnosis and appropriate treatment should result in a complete neurological recovery.

J Bone Joint Surg Am, 1998 Jul, 80(7), 961 - 8
Direct-exchange arthroplasty for the treatment of infection after total hip replacement . An average ten-year follow-up; Ure KJ et al.; Twenty consecutive patients who had a direct-exchange total hip arthroplasty, performed by one surgeon between October 1979 and July 1990, were prospectively followed and data were collected . The most common infecting organism was Staphylococcus epidermidis (nine patients), followed by Streptococcus species and Staphylococcus aureus (five patients each) . Three patients (15 per cent) had a draining sinus tract at the time of the operation . The operation and the postoperative management included meticulous debridement, administration of appropriate systemic antibiotic therapy, and use of antibiotic-loaded cement . By an average of 9.9 years (range, 3.5 to 17.1 years) postoperatively, no patient had had recurrence of the infection . Two patients had a revision for aseptic loosening nine and seventeen years after the direct exchange . Although the present series is relatively small, our experience has shown that direct exchange, which is associated with less morbidity and is less expensive than delayed exchange, can be successful in carefully selected patients.

J Infect Dis, 1998 Aug, 178(2), 569 - 72
Antibody responses in invasive group B streptococcal infection in adults; Wessels MR et al.; Nonpregnant adults with group B streptococcus bacteremia were identified by active surveillance in three hospitals . Serum samples collected within 2 days of the time of blood culture were assayed for IgG antibodies to the capsular polysaccharide of the infecting strain: serotype Ia (3 isolates), III (5 isolates), or V (4 isolates) . In 7 of 12 bacteremia episodes, the serum level of IgG to the infecting isolate was > or = 3.5 microg/mL, higher than the 1-2 microg/mL level thought to be protective in neonates . Among selected acute-phase sera, 4 of 5 that contained > or = 3.5 microg/mL specific IgG mediated efficient opsonophagocytic killing of the corresponding group B streptococcus isolate in vitro . High levels of specific antibodies during the acute phase of invasive group B streptococcus infection in nonpregnant adults may reflect a rapid antibody response to infection or, in some cases, may indicate that susceptibility is due to defects in other immune effectors.

J Mol Evol, 1998 Aug, 47(2), 222 - 9
The IS1167 insertion sequence is a phylogenetically informative marker among isolates of serotype 6B Streptococcus pneumoniae; Robinson DA et al.; The phylogenetic utility of the IS1167 insertion sequence was examined with restriction fragment length polymorphism (RFLP) analyses of a sample of 50, predominantly invasive, capsular serotype 6B Streptococcus pneumoniae isolates previously characterized by multilocus enzyme electrophoresis (MLEE) . The strains represented a genetically diverse assemblage of 34 distinct clonotypes composed of 26 restriction fragment types and 23 multilocus enzyme types . All isolates carried the IS1167 insertion sequence, with an average of 9.5 copies . The cross-classification of isolates based on RFLP and MLEE typing schemes was 81% concordant . Phylogenetic analyses demonstrated a significant (P < 0.0001) association between strains of a given RFLP lineage with those of a given MLEE lineage . A significant correlation (P < 0.00004) was also found between the proportion of restriction fragments shared by any given pair of isolates and their genetic distances estimated from the MLEE data . Parity between the two genetic markers implied that the sampled isolates were in linkage disequilibrium . The existence of nonrandom associations among genetic loci was confirmed by Monte Carlo analyses of the MLEE data . These studies, thus, demonstrated that invasive pneumococcal isolates of a single capsule type recovered on a regional scale can retain a largely clonal population structure over a period of 8 years . The ability to detect linkage disequilibrium and generate relatively congruent dendrograms based on distance and parsimony methods suggested that the restriction fragment data were robust to phylogenetic analysis.

Gen Dent, 1998 May-Jun, 46(3), 286 - 8
Antimicrobial activity produced by six dentifrices; Settembrini L et al.; The antimicrobial activity of six commercially available dentifrices and positive and negative controls as they come into contact with Streptococcus mutans, S . sanguis, and Actinomyces viscosus commonly found in the oral cavity . Sterile discs treated with the dentifrices were placed on agar plates with the controls . Zones of microbial inhibition were measured in millimeters after 48 hours . All of the test dentifrices demonstrated antimicrobial activity against the bacteria.

Eur J Biochem, 1998 Jul 1, 255(1), 296 - 302
The chemical structures of the capsular polysaccharides from Streptococcus pneumoniae types 32F and 32A; Karlsson C et al.; The structures of the capsular polysaccharides from Streptococcus pneumoniae types 32F and 32A have been determined by means of NMR spectroscopy as the principal method . It is concluded that both polysaccharides are composed of tetrasaccharide repeating units with a phosphorylcholine (PCho) group linked to the 3-position of the 4-substituted beta-L-rhamnose (Rha) residue . Both polysaccharides are substituted with one O-acetyl group at the 2-position of the same beta-L-rhamnose residue . In addition, the type-32A polysaccharide is substituted with another O-acetyl group at the 4-position of the 2,3-disubstituted alpha-D-glucose residue, i.e . the branch-point residue . An unusual detail in the structure is that the side chain is composed of a rhamnosyl phosphate . {chemical structure: see text} In the type-32F polysaccharide R=H, and in the type-32A polysaccharide R=Ac . The structure of C-polysaccharide found in our preparations of type-32F and type-32A capsular polysaccharides is in agreement with that published previously for the pneumococcal common antigen C-polysaccharide {Fischer, W., Behr, T., Hartmann, R., Peter-Katalinic, J . & Egge, H . (1993) Eur . J . Biochem . 215, 851-857; Kulakowska, M., Brisson, J.-R., Griffith, D . W., Young, N . M . & Jennings, H . J . (1993) Can . J . Chem . 71, 644-648}.

Respirology, 1998 Jun, 3(2), 113 - 7
The pattern of micro-organisms and the efficacy of new macrolide in acute lower respiratory tract infections; Soepandi P et al.; Lower respiratory tract infection (LRTI) is one of the major health problems in developing countries such as Indonesia . According to the National Household Health Survey conducted by the Ministry of Health in 1992, LRTIs still rank fourth as the main cause of death in Indonesia . The problem of LRTIs could be simply managed as long as the causative organism can be identified and the proper antibiotic known . In some occasions, it is not quite so easy to identify the causative micro-organism, especially in lower tract infections . There are several methods of obtaining specimens from LRTIs for cultures . The easiest, most simple way is to collect expectorated sputum . Unfortunately, because of the high rate of contamination by upper respiratory tract flora, this method is not reliable . Recognizing the difficulties with routine expectorated sputum cultures, two alternative approaches have been suggested . One approach is to bypass potential expectorated sputum 'contaminants' in the oropharynx by transtracheal aspiration or transthoracic aspiration . The second approach is to modify the usual technique of processing expectorated sputum by either washing techniques or by quantitative cultures . Azithromycin and clarithromycin are chemically related to macrolide erithromycin . Both antibiotics retain the traditional macrolide spectrum of activity against gram-positive and atypical pneumonia pathogens, while demonstrating improved activity against gram-negative bacteria . The American Thoracic Society (ATS) recommended the use of macrolide for outpatients with community-acquired pneumonia, without comorbidity and 60 years of age or younger . A total of 34 outpatients with acute LRTIs were open-comparative, randomly allocated to treatment with the new macrolide in Persahabatan Hospital, Jakarta, 1996 . The purposes of this study were: (i) to identify the causative micro-organisms; and (ii) to evaluate the clinical efficacy of the new macrolide in these infections . Azithromycin 500 mg was given orally once a day for 3 days and was administered 1 h before or 2 h after every meal . Clarithromycin 500 mg was given orally every 12 h for 10 days . The diagnosis of the patients were: 16 with pneumonia, 10 with acute bronchitis and 8 with acute exacerbation of chronic bronchitis . In this study of 34 patients, the sputum specimens were washed with N acetylcysteine before culture and we could only detect micro-organisms in one patient . Before treatment, we found 47 strains in 33 (97.05%) patients and after treatment we found five strains . From serological examination, only four (11.76%) atypical bacterial were detected . The most frequently found microorganisms were 23 strains of Klebsiella pneumoniae (40.42%), 10 of Streptococcus alpha haemolyticus (21.26%), five of Streptococcus pneumoniae (10.63%) and five of Staphylococcus aureus (10.63%) . The atypical bacterial were: two Legionella pneumophila, one Mycoplasma pneumoniae and one Chlamydia pneumoniae . The clinical efficacy of new macrolides were 100% and the bacteriological responses with eradication of 94.12% vs 70.59% of isolates in the azithromycin and clarithromycin groups are shown in Table 1 . There were no adverse reactions detected in the two treatment groups until the end of the study.

Ann Thorac Surg, 1998 Jul, 66(1), 267 - 8
Combined mitral and aortic homograft valve replacement for acute bacterial endocarditis; Amado-Cattaneo R; Homograft replacement of the aortic valve in cases of acute bacterial endocarditis is considered the ideal choice because of the resistance of the homograft to reinfection . We report a case of aortic and mitral valve bacterial endocarditis, secondary to Streptococcus viridans, with severe aortic and mitral valve regurgitation and hemodynamic instability requiring surgical interventions with the use of aortic and mitral valve homografts.

Clin Exp Dermatol, 1998 Mar, 23(2), 87 - 8
Necrotizing fasciitis complicating disseminated cutaneous herpes zoster; Jarrett P et al.; The association of necrotizing fasciitis, often due to group A streptococcus and primary varicella (chicken pox), is unusual but recognized in children . The association in adults is rare but one report in the literature describes a previously healthy man with the two disorders . We now describe a case of disseminated cutaneous herpes zoster complicated by subacute necrotizing fasciitis in an elderly woman taking low dose methotrexate and prednisone for rheumatoid arthritis . Staphylococcus aureus was isolated . Localized debridement and split skin grafting were required.

Carbohydr Res, 1998 Jan, 306(1-2), 111 - 25
Synthesis of four spacer-containing 'tetrasaccharides' that represent four possible repeating units of the capsular polysaccharide of Streptococcus pneumoniae type 6B; Thijssen MJ et al.; In the framework of studies towards oligosaccharide-conjugate based vaccines against Streptococcus pneumoniae, the synthesis is reported of four spacer-containing tetrasaccharides that each can be conceived as representing a repeating unit of the capsular polysaccharide of S . pneumoniae serotype 6B, namely, 3-aminopropyl D-ribityl-(5-->hydrogen phosphate-->2)-alpha-D-galactopyranosyl-(1-->3) -alpha-D-glucopyranosyl-(1-->3)-alpha-L-rhamnopyranoside, 3-aminopropyl alpha-L-rhamnopyranosyl-(1-->4)-D-ribityl-5(-->hydrogen phosphate-->2)-alpha-D-galactopyranosyl-(1-->3)-alpha-D-glucopyranoside, 3-aminopropyl alpha-D-glucopyranosyl-(1-->3)-alpha-L-rhamnopyranosyl-(1-->4) -D-ribityl-(5-->hydrogen phosphate-->2) -alpha-D-galactopyranoside, and alpha-D-galactopyranosyl-(1-->3)-alpha-D-glucopyranosyl-(1-->3)-alpha-L -rhamnopyranosyl-(1-->4)-5-O-(3-aminopropyl hydrogen phosphate)-D-ribitol . Phosphorylations were carried out using the H-phosphonate method.

Carbohydr Res, 1998 Jan, 306(1-2), 93 - 109
Synthesis of spacer-containing di- and tri-saccharides that represent parts of the capsular polysaccharide of Streptococcus pneumoniae type 6B; Thijssen MJ et al.; In the framework of studies towards oligosaccharide-conjugate-based vaccines against Streptococcus pneumoniae, the synthesis is reported of several spacer-containing oligosaccharides that represent parts of the capsular polysaccharide of S . pneumoniae serotype 6B, namely alpha-L-rhamnopyranosyl-(1-->4)-5-O-(3-aminopropyl hydrogen phosphate)-D-ribitol, 3-aminopropyl D-ribitol-(5-->hydrogen phosphate-->2)-alpha-D-galactopyranoside, 3-aminopropyl alpha-L-rhamnopyranosyl-(1-->4)-D-ribityl-(5-->hydrogen phosphate-->2) -alpha-D-galactopyranoside, and 3-aminopropyl D-ribityl-(5-->hydrogen phosphate-->2) -alpha-D-galactopyranosyl-(1-->3)-alpha-D-glucopyranoside . Phosphorylations were carried out using the H-phosphonate method.

Schweiz Med Wochenschr, 1998 Jul 7, 128(27-28), 1096 - 103
{Pneumococcal vaccination--yes or no?}; Hess T; Invasive pneumococcal infections, defined as demonstration of Streptococcus pneumoniae in blood cultures or CSF, are frequent and associated with high mortality in risk groups . Risk groups are the over-65s, individuals with anatomic or functional asplenia, immunosuppressed patients, patients with haemotological neoplasias and HIV-infected subjects, as well as, in general, al sufferers from chronic cardiopulmonary disease, diabetics and patients with severe renal failure or nephrotic syndrome . The 23valent polysaccharide vaccine produces a reliable immune response in children aged over 2 years and adults . The immune response is diminished in severely immunocompromised subjects and in the elderly . Numerous clinical studies provide evidence of the effectiveness of pneumococcal vaccination in the he prevention of invasive pneumococcal infection . Pneumococcal vaccination is recommended for the above mentioned risk groups . It should be observed that for the group at most risk, i.e . heavily immunosuppressed and HIV-infected subjects, there are no convincing data on clinical effectiveness . Regarding non-bacteriaemic pneumococcal pneumonias there are only pointers to the possible usefulness of polysaccharide vaccines . Booster vaccination is not recommended by the manufacturers in view of the reportedly increased incidence of side effects . Studies show that side effects are not more frequent than with primary vaccination . A single revaccination is particularly indicated in status post splenectomy . The conjugate vaccines now under development will improve the efficacy of pneumococcal vaccination and will also be usable in children aged under 2 years.

J Clin Invest, 1998 Aug 1, 102(3), 633 - 8
Mobilization of potent plasma bactericidal activity during systemic bacterial challenge . Role of group IIA phospholipase A2; Weinrauch Y et al.; Extracellular mobilization of Group IIA 14-kD phospholipase A2 (PLA2) in glycogen-induced rabbit inflammatory peritoneal exudates is responsible for the potent bactericidal activity of the inflammatory fluid toward Staphylococcus aureus (1996 . J . Clin . Invest . 97:250-257) . Because similar levels of PLA2 are induced in plasma during systemic inflammation, we have tested whether this gives rise to plasma bactericidal activity not present in resting animals . Baboons were injected intravenously (i.v.) with a lethal dose of Escherichia coli and plasma or serum was collected before and at hourly intervals after injection . After infusion of bacteria, PLA2 levels in plasma and serum rose > 100-fold over 24 h to approximately 1 microg PLA2/ml . Serum collected at 24 h possessed potent bactericidal activity toward S . aureus, Streptococcus pyogenes, and encapsulated E . coli not exhibited by serum collected from unchallenged animals . Bactericidal activity toward S . aureus and S . pyogenes was nearly completely blocked by a monoclonal antibody to human Group IIA PLA2 and addition of purified human Group IIA PLA2 to prechallenge serum conferred potent antistaphylococcal and antistreptococcal activity equal to that of the 24 h post-challenge serum . PLA2-dependent bactericidal activity was enhanced approximately 10x by factor(s) present constitutively in serum or plasma . Bactericidal activity toward encapsulated E . coli was accompanied by extensive bacterial phospholipid degradation mediated, at least in part, by the mobilized Group IIA PLA2 but depended on the action of other bactericidal factors in the 24-h serum . These findings further demonstrate the contribution of Group IIA PLA2 to the antibacterial potency of biological fluids and suggest that mobilization of this enzyme during inflammation may play an important role in host defense against invading bacteria.

J Clin Invest, 1998 Aug 1, 102(3), 550 - 60
Molecular analysis of the role of the group A streptococcal cysteine protease, hyaluronic acid capsule, and M protein in a murine model of human invasive soft-tissue infection; Ashbaugh CD et al.; Human invasive soft-tissue infections caused by group A Streptococcus are associated with significant morbidity and mortality . To investigate the pathogenesis of these serious infections, we characterized the host response to bacterial challenge with an M-type 3 isolate recovered from a patient with necrotizing fasciitis, or with isogenic gene replacement mutants deficient in cysteine protease, hyaluronic acid capsule, or M protein in a murine model of human invasive soft-tissue infection . Animals challenged with the wild-type or cysteine protease-deficient strain developed spreading tissue necrosis at the site of inoculation, became bacteremic, and subsequently died . Histopathologic examination of the necrotic lesion revealed bacteria throughout inflamed subcutaneous tissue . Arterioles and venules in the subcutaneous layer were thrombosed and the overlying tissue was infarcted . In contrast, animals challenged with either an acapsular or M protein-deficient mutant developed a focal area of tissue swelling at the site of inoculation without necrosis or subsequent systemic disease . Histopathologic examination of the soft-tissue lesion demonstrated bacteria confined within a well-formed subcutaneous abscess . We conclude that the group A streptococcal hyaluronic acid capsule and M protein, but not the cysteine protease, are critical for the development of tissue necrosis, secondary bacteremia, and lethal infection in a murine model of human necrotizing fasciitis.

J Anim Sci, 1998 Jul, 76(7), 1955 - 63
Strategies that ruminal bacteria use to handle excess carbohydrate; Russell JB; When ruminal bacteria have insufficient nitrogen and other nutrients, excess carbohydrate can be toxic . Pure cultures that are nitrogen-limited can convert only some of the excess carbohydrate to intracellular polysaccharide, but this pool can be quickly saturated . Fibrobacter succinogenes cultures that have excess cellobiose secrete glucose and cellotriose into the culture medium, and Prevotella ruminicola produces methylglyoxal, a highly toxic substance that causes a dramatic decrease in viability . Some ruminal bacteria (e.g., Streptococcus bovis and Selenomonas ruminantium) have mechanisms to decrease ATP production or spill the ATP that has already been produced . These mechanisms of decreasing intracellular ATP seem to protect the cell . Most ruminal bacteria can use ammonia as a nitrogen source, but amino nitrogen increases the growth efficiency of mixed ruminal bacteria . Amino nitrogen-dependent improvements in growth efficiency can be explained by an increase in growth rate and a decrease in energy spilling . Amino nitrogen is only beneficial if the rate of carbohydrate fermentation is rapid and carbohydrate is in excess.

J Card Surg, 1997 Nov-Dec, 12(6), 406 - 11
Active infective endocarditis in infants and childhood: ten-year review of surgical therapy; Picarelli D et al.; We review our 10-year (June 1987-June 1997) experience in 26 children requiring early surgery due to active infective endocarditis (AIE) refractory to medical therapy . Mean age at operation was 5.0 (SD 3.5) years . Nineteen patients (73%) had predisposing factors: congenital heart disease (CHD) was the most common (10/19, 53%); endocavitary foreign materials (6/19); and previous cardiac surgery (3/19) . Vegetations or valve dysfunction was detected by transthoracic echocardiography in all cases but one . Valvular location (17/26, 65%) was the most common; others locations included cardiac chambers (8/26) and intravascular thoracic aorta (1/26) . Bacterial isolation was achieved in 19 patients (73%): Staphylococcus (10 patients); Streptococcus (6 patients); and Candida albicans (3 patients) . The indication for surgery was progressive or persistent cardiac failure (2 patients) or infection (9 patients), or a combination of these (7 patients), despite adequate medical therapy; major embolic accident with a mobile vegetation (4 patients), recurrent pulmonary embolism with a mobile vegetation (3 patients), and mobile vegetation (> 10 mm) in left cardiac chambers (1 patient) . All the patients required surgery before 6 weeks of antibiotic therapy had been completed . The hospital mortality was 19% (5/26, 70% confidential limits{CL}: 2-35%) . Deaths were due to infective causes in all cases but one . No late deaths occurred in 18 patients followed up for a mean of 4.2 years (SD 2.4) . Three patients needed four reoperations . We conclude that improvement in the treatment of children with AIE can be obtained with an early and accurate diagnosis, an adequate antibiotic treatment, and a more aggressive surgical approach.

Acta Odontol Scand, 1998 Jun, 56(3), 161 - 5
Antibacterial effects of a bioactive glass paste on oral microorganisms; Stoor P et al.; Bioactive glasses contain oxides of calcium, sodium, phosphorus, and silicon in a proportion that provides the material with surface activity and concomitantly with the property of forming a strong bond with bone . Bioactive glasses have been tested as bone substitutes in different clinical situations . In an aqueous environment, Ca2+, Na+, PO4(3-) , and Si4+ are released from the glass, resulting in a rise in pH and in osmotic pressure in its vicinity . Since these are factors that potentially influence the viability of oral microorganisms at the dentogingival margin, we studied the effects of bioactive glass S53P4 on the oral microorganisms Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis, Actinomyces naeslundii, Streptococcus mutans, and Streptococcus sanguis . This was done by incubating each microbe in a suspension, in the presence of bioactive glass S53P4 in powder form . A . naeslundii was found to lose its viability within 10 min under the experimental conditions . A . actinomycetemcomitans, P . gingivalis, and S . mutans lost their viability within 60 min . Also for S . sanguis a significant loss of viability was seen within 60 min, but it was the only microbe that had any viable cells left after 60 min . Thus, in aqueous solutions the powdered bioactive glass S53P4 appears to have a broad antimicrobial effect on microorganisms of both supra- and subgingival plaque . Consequently, it could be useful as an ingredient in tooth-care products that may have beneficial effects on oral health both from a cariologic and a periodontal point of view.

Microbiol Immunol, 1998, 42(6), 467 - 9
Plasmid maintenance renders bacteria more susceptible to heat stress; Sato T et al.; The presence of shuttle plasmid pTS749 in the oral bacterium Streptococcus mutans resulted in growth inhibition under heat stress conditions . This effect was dependent upon the growth stage of the inoculum used to initiate growth . Likewise, the introduction of plasmids containing distinct ori sequences into Escherichia coli also resulted in growth inhibition at elevated temperatures and could be correlated with the plasmid levels within the cells . These results suggest that these plasmids in bacteria render the cells to be more susceptible to heat stress conditions.

Appl Environ Microbiol, 1998 Aug, 64(8), 2836 - 43
De novo synthesis of amino acids by the ruminal bacteria Prevotella bryantii B14, Selenomonas ruminantium HD4, and Streptococcus bovis ES1; Atasoglu C et al.; The influence of peptides and amino acids on ammonia assimilation and de novo synthesis of amino acids by three predominant noncellulolytic species of ruminal bacteria, Prevotella bryantii B14, Selenomonas ruminantium HD4, and Streptococcus bovis ES1, was determined by growing these bacteria in media containing 15NH4Cl and various additions of pancreatic hydrolysates of casein (peptides) or amino acids . The proportion of cell N and amino acids formed de novo decreased as the concentration of peptides increased . At high concentrations of peptides (10 and 30 g/liter), the incorporation of ammonia accounted for less than 0.16 of bacterial amino acid N and less than 0.30 of total N . At 1 g/liter, which is more similar to peptide concentrations found in the rumen, 0.68, 0.87, and 0.46 of bacterial amino acid N and 0.83, 0.89, and 0.64 of total N were derived from ammonia by P . bryantii, S . ruminantium, and S . bovis, respectively . Concentration-dependent responses were also obtained with amino acids . No individual amino acid was exhausted in any incubation medium . For cultures of P . bryantii, peptides were incorporated and stimulated growth more effectively than amino acids, while cultures of the other species showed no preference for peptides or amino acids . Apparent growth yields increased by between 8 and 57%, depending on the species, when 1 g of peptides or amino acids per liter was added to the medium . Proline synthesis was greatly decreased when peptides or amino acids were added to the medium, while glutamate and aspartate were enriched to a greater extent than other amino acids under all conditions . Thus, the proportion of bacterial protein formed de novo in noncellulolytic ruminal bacteria varies according to species and the form and identity of the amino acid and in a concentration-dependent manner.

Antimicrob Agents Chemother, 1998 Aug, 42(8), 2084 - 8
Correlation between quinolone susceptibility patterns and sequences in the A and B subunits of DNA gyrase in mycobacteria; Guillemin I et al.; The in vitro activities of seven quinolones and the sequences of the quinolone resistance-determining regions (QRDR) in the A and B subunits of DNA gyrase were determined for 14 mycobacterial species . On the basis of quinolone activity, quinolones were arranged from that with the greatest to that with the least activity as follows: sparfloxacin, levofloxacin, ciprofloxacin, ofloxacin, pefloxacin, flumequine, and nalidixic acid . Based on MICs, the species could be organized into three groups: resistant (Mycobacterium avium, M . intracellulare, M . marinum, M . chelonae, M . abscessus {ofloxacin MICs, >/=8 microg/ml}), moderately susceptible (M . tuberculosis, M . bovis BCG, M . kansasii, M . leprae, M . fortuitum third biovariant, M . smegmatis {ofloxacin MICs, 0.5 to 1 microg/ml}), and susceptible (M . fortuitum, M . peregrinum, M . aurum {ofloxacin MICs, </=0.25 microg/ml}) . Peptide sequences of the QRDR of GyrB were identical in all the species, including the amino acids at the three positions known to be involved in acquired resistance to quinolone, i.e., 426 (Asp), 447 (Arg), and 464 (Asn) (numbering system used for Escherichia coli) . The last two residues could be involved in the overall low level of susceptibility of mycobacteria to quinolones since they differ from those found in the very susceptible E . coli (Lys-447 and Ser-464) but are identical to those found in the less susceptible Staphylococcus aureus and Streptococcus pneumoniae . Peptide sequences of the QRDR of GyrA were identical in all the species, except for the amino acid at position 83, which was an alanine in the two less susceptible groups and a serine in the most susceptible one, as in E . coli, suggesting that this amino acid is involved in the observed differences of quinolone susceptibility within the Mycobacterium genus.

Antimicrob Agents Chemother, 1998 Aug, 42(8), 2032 - 5
Prevalence of a putative efflux mechanism among fluoroquinolone-resistant clinical isolates of Streptococcus pneumoniae; Brenwald NP et al.; Twenty-three norfloxacin-selected first-step mutants of Streptococcus pneumoniae showed low-level fluoroquinolone resistance . Their susceptibility to norfloxacin in the presence or absence of reserpine and known efflux pump substrates was determined by an agar dilution method . Five mutants showed four- to eightfold increases in their susceptibility to norfloxacin in the presence of reserpine and four- to eightfold decreases in their susceptibility to acriflavine and ethidium bromide . This phenotype is suggestive of an efflux mechanism of resistance . A representative of these mutants, 1N27, accumulated significantly less ethidium bromide than the parent strain; reserpine abolished these differences . No changes in the quinolone resistance-determining regions of parC, parE, gyrA, or gyrB were found in this mutant . By our validated agar dilution method, the efflux phenotype was sought in clinical isolates of S . pneumoniae . Of 1,037 clinical isolates examined from the United Kingdom, 273 showed reduced susceptibility to norfloxacin or ciprofloxacin . Of these, 45.4% showed the efflux phenotype . Our findings suggest that an efflux mechanism may be a frequent cause of clinically significant fluoroquinolone resistance in pneumococci.

Antimicrob Agents Chemother, 1998 Aug, 42(8), 2024 - 31
Cloning and nucleotide sequences of the topoisomerase IV parC and parE genes of Mycoplasma hominis; Bebear CM et al.; The topoisomerase IV parC and parE genes from the wall-less organism Mycoplasma hominis PG21 were cloned and sequenced . The coupled genes are located far from the DNA gyrase genes gyrA and gyrB . They encode proteins of 639 and 866 amino acids, respectively . As expected, the encoded ParE and ParC proteins exhibit higher homologies with the topoisomerase IV subunits of the gram-positive bacteria Staphylococcus aureus and Streptococcus pneumoniae than with their Escherichia coli counterparts . The conserved regions include the Tyr residue of the active site and the region involved in quinolone resistance (quinolone resistance-determining region {QRDR}) in ParC and the ATP-binding site and the QRDR in ParE.

Antimicrob Agents Chemother, 1998 Aug, 42(8), 1973 - 9
In vitro activities of oral beta-lactams at concentrations achieved in humans against penicillin-susceptible and -resistant pneumococci and potential to select resistance; Thorburn CE et al.; The beta-lactam susceptibilities of 65 strains of Streptococcus pneumoniae for which penicillin MICs covered a broad range were assessed . The order of potency was amoxicillin (AMX) = amoxicillin-clavulanate (AMC) > penicillin G > cefpodoxime (CPO) > cefuroxime (CXM) > cefprozil > cefaclor > loracarbef > cefixime . No decrease in susceptibility was seen following repeated subculture of two penicillin-susceptible strains of S . pneumoniae in AMX, AMC, cefaclor, or loracarbef, whereas repeated exposure to CPO and CXM resulted in 4- to 32-fold decreases in susceptibility for both strains . When one of these strains was exposed to concentrations of CPO, CXM, AMX, and AMC achieved in the serum of humans following the administration of an oral dose, all agents were rapidly bactericidal, with no decrease in susceptibility up to 72 h . This was consistent with antibiotic concentrations exceeding the MICs for 100% of the dosing interval . For a penicillin-resistant strain, MICs were exceeded for 29% of the 12-h dosing interval for 500 mg of AMX, 42% of the interval for AMC with 875 mg of AMX and 125 mg of clavulanate (875/125 mg of AMC) 21% of the interval for 500 mg of CXM, and 0% of the interval for 200 mg of CPO . Consequently, only 875/125 mg of AMC produced a sustained bactericidal effect . A four- to eightfold reduction in susceptibility to CPO and CXM and cross-resistance with cefotaxime, but not penicillin or AMC, were selected following exposure to simulated serum CPO and CXM concentrations . In addition, AMX and AMC were the only agents which consistently produced a >99% reduction in bacterial numbers in time-kill studies using concentrations of antibiotic achieved in middle ear fluid for all three strains of penicillin-resistant S . pneumoniae tested.

Antimicrob Agents Chemother, 1998 Aug, 42(8), 1906 - 10
Generation of bioluminescent Streptococcus mutans and its usage in rapid analysis of the efficacy of antimicrobial compounds; Loimaranta V et al.; The oral bacterium Streptococcus mutans was transformed by electroporation with a shuttle vector (pCSS945) containing insect luciferase gene from a click beetle (Pyrophorus plagiophthalamus) resulting in a bioluminescent phenotype . This S . mutans strain was used in experiments in which light emission was used as a rapid and, compared to conventional CFU counting, more convenient means of estimating the effects of various antimicrobial treatments . The basic parameters affecting in vivo light production by the strain were studied . It was found that pH 6.0 was optimal for incorporation of the substrate D-luciferin for the luciferase reaction . The optimum concentration of D-luciferin was approximately 150 microM at room temperature . Under optimum conditions the light emission in vivo increased rapidly to a constant level and thereafter had a decay of 0.6%/min when logarithmic-growth-phase cells were used . The light emission closely paralleled the numbers of CFU, giving a detectable signal from 30,000 cells and having a dynamic measurement range over 4 log CFU/relative light unit . The cells were treated with various antimicrobial agents, and the emitted bioluminescence was measured . With the bioluminescent measurements, the results were obtained within hours compared to the days required for agar plates, and also, the kinetics of the antibacterial actions could be followed . Thus, the light emission was found to be a reliable, sensitive, and real-time indicator of the bacteriostatic actions of the antimicrobial agents tested.

J Oral Rehabil, 1998 Jun, 25(6), 416 - 23
Effectiveness of two methods of denture sterilization; Webb BC et al.; Species of Candida and in particular Candida albicans may be involved in the aetiology of denture stomatitis . Studies have shown that Candida and other oral micro-organisms including Streptococcus gordonii are associated with denture plaque; hence denture hygiene is an important factor in the prevention and treatment of the disease . The aim of this investigation was to test in vitro the efficacy of two methods of denture sterilization: (1) microwave irradiation and (2) sodium hypochlorite soak . Twenty upper acrylic dentures were prepared for microbiological assay; 10 were inoculated with C . albicans H1 and 10 with S . gordonii LGR2 . Within each group, five dentures were tested in a domestic microwave oven for optimal exposure time and temperature to ensure sterilization; the five control dentures were not microwaved . Microbiological analyses showed that the inoculated dentures became sterile after six min of irradiation at medium setting (2450 MHz, 350 W) . Damage to the microorganisms after microwave irradiation was clearly visible by scanning electron microscopy (SEM) . Following the same protocol as above, experimental dentures were soaked for 8 h in either 0.02%, or 0.0125% sodium hypochlorite solution and control dentures soaked in distilled water . Microbiological analyses showed that the experimental dentures inoculated with C . albicans H1 became sterile . By contrast, those inoculated with S . gordonii LGR2 did not become sterile, and the SEM procedures confirmed these findings . The results of this study indicate that microwaving may be a more effective method of denture sterilization than denture soaking in sodium hypochlorite . However, compared with microwaving, hypochlorite reduces the levels of residual non-viable micro-organisms attached to the denture surface.

J Antimicrob Chemother, 1998 Jun, 41(6), 629 - 34
In-vitro, in-vivo and ex-vivo studies with oral beta-lactams against Streptococcus pneumoniae; Perez-Trallero E et al.; In-vitro killing curves, a protection model in immunocompetent mice and an ex-vivo model in volunteers were used to evaluate the efficacy of amoxycillin, cefuroxime axetil and cefpodoxime proxetil against a penicillin-intermediate-resistant Streptococcus pneumoniae (MIC = 1 mg/L) (PRP) and a penicillin-susceptible S . pneumoniae (MIC = 0.01 mg/L) (PSP) . In vitro, the maximal bactericidal activity was obtained with amoxycillin (1 x MIC versus 2 x MIC cefpodoxime and 4 x MIC cefuroxime) . Mice were challenged by intraperitoneal inoculation and treated orally every 8 h for 48 h with 2.5, 5, 7.5 and 10 mg/kg doses of these three beta-lactams . The rate of survival for the PSP strain was 100% with any dose of the three tested antibiotics . For the PRP strain only amoxycillin showed 100% survival with 5, 7.5 or 10 mg/kg doses . Twelve healthy volunteers were randomized in three groups and each received two doses of the oral antibiotic . Blood samples were collected from each subject 0.5 h and 2 h after drug administration and serum inhibitory and bactericidal titres were measured . Similar values were obtained with the three beta-lactams against PSP but against PRP only the serum of volunteers that had taken amoxycillin exhibited serum bactericidal titres of > or = 8 . This study suggests a more predictable therapeutic efficacy against pneumococcal infection with amoxycillin than with available oral cephalosporins.

Pediatr Nephrol, 1998 Jun, 12(5), 392 - 6
Serum and glomerular IgG in poststreptococcal glomerulonephritis are correlated; West CD et al.; Among 75 patients hospitalized for poststreptococcal acute glomerulonephritis, 33 (44%) had an elevated serum level of IgG . The IgA level was elevated in 11 of 39 patients (28%) . Paradoxically, of 20 biopsied patients with elevated IgG levels, IgG was absent from the glomerular deposits in 11, while of 23 with normal IgG levels, IgG was absent from the glomerular deposits in only 2 (P <0.001) . Also, patients with an elevated level more frequently had antistreptolysin O titers > or =833 Todd units (P < 0.001) . Elevated IgG did not correlate with severity of disease, with age of the patient, or with the serum albumin or C3 level . There appears to be a subset of patients with elevated serum IgG levels who with high frequency have IgG absent from their glomerular deposits . Thus, failure to form antibody to a glomerular-bound protein produced by the nephritogenic streptococcus, widely assumed to be the origin of the IgG in the glomerular deposits, is in some way significantly associated with elevated serum levels of IgG and of antibody to streptolysin O.

Eur J Pediatr, 1998 Jul, 157(7), 564 - 6
Cardiac tamponade after varicella infection; Shefler A et al.; Infection with varicella zoster virus is common in childhood and generally associated with few complications . Myopericarditis following varicella infection is rare but may result in severe rhythm disturbances and congestive cardiac failure . The case is presented of a 4-month-old infant presenting with a large pericardial effusion and cardiac tamponade 2 weeks after the onset of a varicella exanthem . Although Streptococcus was noted in the pericardial fluid, it could not be grown on bacterial culture and the subsequent clinical course was in keeping with a viral myopericarditis . CONCLUSION: Varicella infection in children may be complicated by myopericardial disease ranging from subclinical ECG changes to fulminant cardiac failure and/or cardiac tamponade . The clinical spectrum of this unusual complication is reviewed and the importance of early recognition emphasised.

Proc Assoc Am Physicians, 1998 Jul-Aug, 110(4), 297 - 305
The role of cytokines in bacterial pneumonia: an inflammatory balancing act; Moore TA et al.; Bacterial pneumonia is a leading cause of morbidity and mortality in both developed and developing countries . While tremendous advances have been made in the treatment of pneumonia using broad-spectrum antibiotic regimens, these approaches have resulted in the recent emergence of multidrug resistant bacteria . To understand better the role of the host immune response to pulmonary bacterial infections, several in vivo animal models have been developed using different bacterial agents: two acute infection models using Klebsiella pneumoniae and Streptococcus pneumoniae and one model of chronic infection using Pseudomonas aeruginosa . To summarize, the resolution of pulmonary bacterial infections involves a finely orchestrated balancing act of proinflammatory and antiinflammatory cytokines . On initial encounter with deposited bacteria, resident alveolar macrophages become activated and secrete proinflammatory cytokines and chemokines, resulting in the eventual generation of a proinflammatory amplification loop between resident or recruited macrophages or polymorphonuclear neutrophils and lymphocytes . As the infection is cleared, a second wave of antiinflammatory cytokines is produced to localize the inflammatory response to within the lung microenvironment and eventually to downmodulate this response . Experimental perturbation of the host inflammatory "cycle" can have either beneficial or detrimental effects on bacterial clearance . With this in mind, a cautionary approach needs to be used in proposing immunoadjuvant therapies for pneumonia treatment.

Braz J Med Biol Res, 1997 Dec, 30(12), 1427 - 30
Cloning, expression and purification of recombinant streptokinase: partial characterization of the protein expressed in Escherichia coli; Avilan L et al.; We cloned the streptokinase (STK) gene of Streptococcus equisimilis in an expression vector of Escherichia coli to overexpress the profibrinolytic protein under the control of a tac promoter . Almost all the recombinant STK was exported to the periplasmic space and recovered after gentle lysozyme digestion of induced cells . The periplasmic fraction was chromatographed on DEAE Sepharose followed by chromatography on phenyl-agarose . Active proteins eluted between 4.5 and 0% ammonium sulfate, when a linear gradient was applied . Three major STK derivatives of 47.5 kDa, 45 kDa and 32 kDa were detected by Western blot analysis with a polyclonal antibody . The 32-kDa protein formed a complex with human plasminogen but did not exhibit Glu-plasminogen activator activity, as revealed by a zymographic assay, whereas the 45-kDa protein showed a K(m) = 0.70 microM and kcat = 0.82 s-1, when assayed with a chromogen-coupled substrate . These results suggest that these proteins are putative fragments of STK, possibly derived from partial degradation during the export pathway or the purification steps . The 47.5-kDa band corresponded to the native STK, as revealed by peptide sequencing.

Ann Fr Anesth Reanim, 1997, 16(1), 47 - 9
{Acute Streptococcus salivarius meningitis after spinal anesthesia}; Kaiser E et al.; The case of a 50-year-old woman who experienced an acute Streptococcus salivarius meningitis after a spinal anaesthesia for hysteroscopy is reported . The contamination of the cerebrospinal fluid may occur from a puncture during a bacteriaemia . Contamination from the patient's skin and from the upper airway's flora of the operator seems to be a more plausible cause . Spinal anaesthesia is contra-indicated in the febrile patient . Asepsis is essential during spinal puncture, including wearing a surgical face mask.

Am J Med, 1998 May 29, 104(5A), 3S - 6S
The specter of glycopeptide resistance: current trends and future considerations; Moellering RC Jr; Two glycopeptide antibiotics, vancomycin and teicoplanin, are currently available for clinical use in various parts of the world, whereas a third, avoparcin, is available for use in agricultural applications and in veterinary medicine in some countries . Because of their outstanding activity against a broad spectrum of gram-positive bacteria, vancomycin and teicoplanin have often been considered the drugs of "last resort" for serious infections due to drug-resistant gram-positive pathogens . Glycopeptides had been in clinical use for almost 30 years before high-level resistance, first reported in enterococcal species, emerged . More recently, there have been disturbing reports of low- and intermediate-level resistance to vancomycin in strains of Staphylococcus aureus . A review of earlier reports reveals, however, that S . aureus strains with reduced susceptibility to glycopeptides were first identified >40 years ago . Such strains may occur in nature or may have developed low-level mutational resistance in response to the selection pressure of glycopeptide therapy . Of considerably greater concern is the possibility that vancomycin resistance genes found in enterococci may be transferred to more virulent organisms such as staphylococci or Streptococcus pneumoniae.

J Vasc Interv Radiol, 1998 Jul-Aug, 9(4), 572 - 8
Clinical factors associated with positive bile cultures during primary percutaneous biliary drainage; Brody LA et al.; PURPOSE: To evaluate the utility of routine bile cultures and to determine the risk factors for bacterial colonization of the bile as well as the biliary flora in patients with biliary obstruction undergoing primary percutaneous biliary drainage . MATERIALS AND METHODS: Between October 1995 and January 1997, bile cultures were prospectively obtained in all patients undergoing percutaneous biliary drainage . Seventy-six patients underwent 86 procedures . Culture results were correlated with clinical, laboratory, and demographic variables . The antibiotic sensitivities of cultured organisms were examined . RESULTS: Fever, previous endoscopic or percutaneous biliary instrumentation, and bilioenteric anastomosis were significant predictors of a positive bile culture . In the absence of any of these indicators, bile cultures were unlikely to be positive . Enterococcus species was the organism isolated most commonly . Yeast, gram-negative aerobic bacilli, and Streptococcus viridans followed in frequency . CONCLUSION: Bile cultures provide valuable information that was useful for planning antibiotic prophylaxis and treatment . The likelihood of positive bile cultures can be predicted based on certain clinical variables . Continued investigation is needed to better predict bacterial flora in individual patients . Given the association between previous instrumentation and biliary colonization, noninvasive imaging modalities should be exhausted before invasive procedures are performed for solely diagnostic purposes in patients with biliary obstruction.

Am J Med, 1998 May 29, 104(5A), 34S - 42S
Evaluation of in vitro activity of quinupristin/dalfopristin and comparator antimicrobial agents against worldwide clinical trial and other laboratory isolates; Dowzicky M et al.; This report summarizes the activities of quinupristin/dalfopristin (Q/D) and appropriate comparator antibiotics, including ciprofloxacin, erythromycin, gentamicin, rifampin, teicoplanin, and vancomycin, against selected gram-positive pathogens, including Enterococcus faecium, Staphylococcus aureus, Staphylococcus epidermidis, Streptococcus pneumoniae, Streptococcus agalactiae, and Streptococcus pyogenes . The study pathogens were obtained from 2 sources: (1) clinical isolates taken from patients participating in Q/D worldwide Phase III comparative and noncomparative (emergency-use program) clinical trials; and (2) other isolates collected from the laboratories of 45 geographically distinct medical centers around the world . Q/D was highly active, with minimum inhibitory concentrations (MICs) < or = 1.0 microg/mL against most isolates, including those known to be resistant to methicillin, vancomycin, or erythromycin . Q/D was active (MICs < or = 1 microg/mL) against 95% of the vancomycin-resistant E . faecium strains, for example, whereas ciprofloxacin was active against 6% . Q/D was equally active against methicillin-susceptible or -resistant S . aureus strains (MIC90=1 microg/mL), as was vancomycin (MIC90=2 microg/mL), whereas ciprofloxacin was much less active against methicillin-resistant strains than against methicillin-susceptible strains (MIC90=32 vs 1 microg/mL) . Given its spectrum of activity, Q/D may provide a viable option for the treatment of severe respiratory and skin and skin-structure infections caused by gram-positive bacteria, especially when strains with known or suspected resistance to other commonly used antibiotics are present.

Int J Clin Pract, 1998 Apr-May, 52(3), 206 - 7
Septic sacroiliitis: an unusual causative organism in a rare condition; O'Brien CM et al.; Streptococcus pneumoniae is a relatively uncommon cause of septic arthritis, and Infection of the sacroiliac joint by this organism has been rarely described . We present such a case.

Vet Q, 1998 Jul, 20(3), 111 - 4
Wasps are the cause of an increasing mastitis problem in dairy cattle in Israel; Yeruham I et al.; The German wasp Vespula germanica (Fabr.) (Hymenoptera: Vespidae) has been observed to injure dairy cows teats, causing lesions which can lead to mastitis . The number of dairy herds in Israel reported to be affected in this way has increased from five prior to 1989 to 32 from 1989 to 1993 . Likewise, the geographical distribution of the colonies of these wasps has expanded from the Galilee to the northern Negev . Most cases of mastitis appeared during August and September when the wasps were most active; the predominant organism isolated was Streptococcus dysgalactiae . Apparently the wasps served as a vector in spreading S . dysgalactiae infection in the herds . More adult cows than first-calving cows were affected . The teats of the front quarters were more affected than those of the hind quarters.

Chemotherapy, 1998 Jul-Aug, 44(4), 265 - 71
Therapeutic efficacy of cefozopran in a murine model of haematogenous pneumococcal meningitis; Iizawa Y et al.; Antimicrobial regimens for the treatment of pneumococcal meningitis are not established . We have produced a murine model of haematogenous pneumococcal meningitis and have examined its usefulness for determining the required dosage and term of antimicrobial agents . Streptococcus pneumoniae serotype 6 was injected intraperitoneally (inoculum: about 1 x 10(4) CFU) into mice . Although half of the mice died within 2 days, the surviving mice showed positive bacterial cultures, increase of the protein level, decrease of the glucose level and infiltration of polymorphonuclear leucocytes into cerebrospinal fluids (CSF) . When cefozopran was administered subcutaneously twice a day for 1-3 days starting 2 days after infection, dose- and duration-dependent effects were observed and all mice treated with 20 mg/kg of cefozopran for 3 days survived . The penetration rate of cefozopran from blood to CSF in infected mice was 44.7%, which was 6 times higher than that obtained in uninfected mice . This model may be useful for investigating the pathogenesis of haematogenous pneumococcal meningitis and its therapy.

Chemotherapy, 1998 Jul-Aug, 44(4), 238 - 42
In vitro and in vivo antibacterial activities of AM-1155 in the fields of obstetrics and gynecology; Mikamo H et al.; AM-1155 is a new 8-methoxyquinolonecarboxylic acid with a broad spectrum of antibacterial activity . It inhibited more than 90% of clinical isolates of Streptococcus agalactiae, Escherichia coli, Peptostreptococcus magnus, Bacteroides fragilis and Prevotella bivia at the concentration of 3.13 mg/l . The antibacterial activity of AM-1155 was almost equal to that of sparfloxacin . The in vivo efficacy of AM-1155 was evaluated using a polymicrobial pyometra (E . coli and B . fragilis) model of rats . The accumulation of neutrophils to the uterus in the AM-1155-treated group was less marked than that of the nontreated group, as well as the bacteriological response . These results suggest that the new antimicrobial agent AM-1155 might be useful for the treatment of polymicrobial infections in the fields of obstetrics and gynecology.

Cancer Res, 1998 Jul 15, 58(14), 2991 - 5
Presence of Streptococcus anginosus DNA in esophageal cancer, dysplasia of esophagus, and gastric cancer; Sasaki H et al.; We recently reported cloning of Streptococcus anginosus (S . anginosus) DNA fragments containing the 16S ribosomal gene from DNA samples of surgical specimens of gastric cancers . To investigate the specificity of S . anginosus infection, Southern blot analysis with S . anginosus 16S ribosomal DNA probe and PCR analysis with S . anginosus-specific primers were performed in DNA samples prepared from 15 esophageal cancers, 43 gastric cancers, 16 lung cancers, 10 cervical cancers, 14 renal cell carcinomas, 10 colorectal cancers, and 19 bladder cancers . We frequently found S . anginosus DNA sequences in DNA samples from esophageal cancer and gastric cancer tissues, as well as in those from dysplasia of the esophagus of esophageal cancer patients . No S . anginosus DNA bands were detected by Southern blot analysis on DNAs from the noncancerous portions of the esophagus or the stomach . By PCR analysis with 35 cycles, only 7% of the noncancerous portion of the esophagus was shown to contain S . anginosus sequences . No S . anginosus sequences were found in DNAs from cancers in lung, cervix, and kidney, but they were found in 1 of 10 colon cancers.

Int J Dermatol, 1998 Jul, 37(7), 524 - 31
Autoantibodies to autologous skin in guttate and plaque forms of psoriasis and cross-reaction of skin antigens with streptococcal antigens; Perez-Lorenzo R et al.; BACKGROUND: Psoriasis is a chronic disease of the skin that appears to be of autoimmune nature . It has a strong association with throat streptococcal infections, as well as with stressful events . Although many groups consider psoriasis to be a T-cell-mediated autoimmune disease, autoantibodies could also play a role in the development of this process . METHODS: In this work, we looked for autoantibodies to psoriatic skin in 21 psoriatic patients and four healthy donors (controls) . The immunoperoxidase technique was used to look for autoantibodies in autologous sera in skin sections obtained from lesions or from healthy areas of the same patient, before and after immunoadsorption with a Streptococcus pyogenes extract . The skin biopsies were also analyzed with a pool of sera from mice immunized with the streptococcal extract . RESULTS: We found that all psoriatic patients had autoantibodies to antigens present in keratinocytes, whereas healthy subjects did not . These antibodies did not recognize epitopes on healthy skin from the same psoriatic patients or controls . Immunoadsorption of autologous sera removed the reactivity to antigens in skin lesions in all cases . Mouse anti-streptococcal sera recognized epidermal antigens present in lesional psoriatic skin, but not in healthy skin from psoriatic patients or controls . Deposits of immunoglobulin G (IgG) were not detected in the lesions . CONCLUSIONS: It seems that autoantibodies, although they do not appear to participate in the pathogenesis of psoriasis, are an important feature, and that skin antigens, which appear in lesional immature keratinocytes, cross-react with S . pyogenes and contribute to the autoimmune process in psoriasis.

Infect Dis Obstet Gynecol, 1998, 6(1), 25 - 9
Intrapartum management relating to the risk of perinatal transmission of group B streptococcus; Levine EM et al.; OBJECTIVE: To review the incidence of neonatal group B streptococcal (GBS) sepsis and its associated risk factors in our obstetrical population . METHODS: A computerized perinatal database of over 17,000 births (from 1992 to 1996) was queried for the incidence of neonatal GBS sepsis . A more detailed review of 895 births (from the first quarter of 1997) was undertaken to identify the incidence of risk factors known to be associated with neonatal GBS sepsis . RESULTS: In our institution, 30 cases of neonatal early-onset GBS sepsis were identified in over 17,000 births (or 1.7/1,000 deliveries) . Risk factors were identified in 17 of those cases (56%) . There were two neonatal fatalities . Chemoprophylaxis was provided in 15% of the total deliveries . CONCLUSIONS: In spite of the lack of a uniform policy for identifying patients suitable for GBS chemoprophylaxis, we found only a 43% incidence of neonatal GBS sepsis occurring without risk factors present . Identification of antepartum or intrapartum risk factors in our series, therefore, would have identified the majority of cases resulting in neonatal GBS sepsis, which may have benefited from intrapartum therapy . Some negative potential consequences of chemoprophylaxis are discussed, raising questions regarding the recent recommendations of the Centers for Disease Control and Prevention.

Br J Theatre Nurs, 1998 May, 8(2), 14 - 8
Highly virulent pathogens--a post antibiotic era?
Domin MA.
The spectrum of infectious diseases is changing rapidly . Emerging infectious agents present an intriguing constellation of nosocomial challenges . Antimicrobial resistance results in increased morbidity, mortality and costs of health care . Resistance to antimicrobial agents has been recorded since 1940 with penicillin resistant Escherichia coli (E coli) (Abraham and Chain 1940) . A similar pencillin resistance was reported in 1944 in Staphylococus aureus (S . aureus) (Kirby 1944) Even before the widespread global use of penicillin, resistance had already been detected in both gram-positive and gram-negative organisms . The 1990s herald the era of multiple drug resistance . To grasp further the enormity and complexity of our modern antimicrobial resistance problem, one only needs to think about how many--how fast--and in how many settings (hospitals, clinics, outpatients nursing and long term facilities, etc), these pathogens have developed antimicrobial resistance: Multiple drug-resistant Mycobacterium tuberculosis, penicillin-resistant Streptococcus pneumonia, fluconzole-resistant Candida, methicillin-resistant S . aureus (MRSA), vancomycin-resistant Enterococci (VRE) and now S . aureus with reduced susceptibility to vancomycin . Given the dramatic increase in the incidence of multiple drug-resistant organisms--and now--the mounting evidence of resistance transfer from one organism to another, we will certainly witness a combined growth of nosocomial pathogens, for which there are no antibiotic solutions . Appropriate infection control measures for such resistant strains depend, in part, on the mechanisms of genetic information exchanged among micro-organisms . Clearly we need to strengthen the basic tenets of infection prevention and control; hygiene, engineering and microbial barriers, to prevent transinfection . We need to control horizontal nosocomial transmission of organisms . Contaminated environmental surfaces are a reservoir for resistant organisms such as MRSA (Boyce et al 1997) and VRE (Karanfil et al 1992) . Stringent infection control policies need to be developed and implemented . A comprehensively applied infection control programme will reduce the dissemination of resistant strains . Each patient care setting must examine its current practices and review the outcome efficacy . A consensus development conference to develop centres for disease control (CDC) formal guidelines against vancomycin intermediate-level resistant staphylococcus aureus (VISA) and vancomycin-resistant staphylococcus aureus (VRSA) may take a year or more to convene . This paper will examine the basic considerations currently offered by the CDC which may be valuable starting points for the enhancement of current infection control practices . Perspectives of the Society for Healthcare Epidemiology of America (SHEA) will also be included.

FEMS Microbiol Lett, 1998 Jul 1, 164(1), 207 - 14
Molecular characterization of PcpA: a novel choline-binding protein of Streptococcus pneumoniae; Sanchez-Beato AR et al.; The gene pcpA that encodes a novel pneumococcal choline-binding protein has been cloned and characterized . Northern blot analysis revealed that pcpA is expressed during the exponential phase of growth of pneumococci as a monocistronic transcript of about 2.3 kb . The transcription start site has been located 132 bp upstream of the start codon and the proposed -35 and -10 boxes that are highly similar to those of the typical sigma 70 promoters from Escherichia coli . This gene encodes a putative 79 kDa protein that contains a typical C-terminal choline-binding domain (ChBD) . The ChBD of PcpA is built up by 11 identical motifs of 20 amino acids plus a tail of 19 amino acids, which represents the longest ChBD that has been characterized so far . Interestingly, two tandem arrays of five characteristic amphipathic leucine reach repeats (LRRs) of 22-26 amino acids in length have been found in the N-terminal region of PcpA . Since LRRs have been proposed to be involved in protein-protein and protein-lipid interactions our findings suggests a role for PcpA in pneumococcal adhesion.

Clin Infect Dis, 1998 Jul, 27(1), 176 - 80
Favorable prognosis of purulent meningitis in patients infected with human immunodeficiency virus; Almirante B et al.; We prospectively reviewed all cases of purulent meningitis among human immunodeficiency virus (HIV) type 1-infected patients > 14 years old that occurred at the Hospital General Vall d'Hebron (Barcelona) during the period 1 January 1985 through 31 March 1997 . There were 12 episodes of purulent meningitis in nine of 2,150 HIV-1-infected patients . The annual rate of purulent meningitis was 0.465 cases per 1,000 patients, a rate that is 150 times higher than that for the general population . During 10 episodes, CD4+ lymphocyte counts were < 200/mm3 . The etiologic organism was Streptococcus pneumoniae in nine episodes (seven episodes occurred in four splenectomized patients), and Escherichia coli, Streptococcus agalactiae, and Enterococcus faecium each caused one episode . Clinical features and cerebrospinal fluid abnormalities were similar to those observed among patients without HIV-1 infection . All patients had bacteremia . The overall mortality was 8.3% . We conclude that purulent meningitis, particularly pneumococcal meningitis, is more frequent among HIV-1-infected patients than in the general population . The prognosis for HIV-1-infected patients is better than for HIV-1-negative patients.

Infect Immun, 1998 Aug, 66(8), 3931 - 5
Role of streptococcal pyrogenic exotoxin B in the mouse model of group A streptococcal infection; Kuo CF et al.; Streptococcal pyrogenic exotoxin B (SPE B) is a cysteine protease produced by Streptococcus pyogenes . In this study, the differences in virulence between protease-positive clinical isolates and their protease-negative mutants were examined in a mouse model . Isogenic protease-negative mutants were constructed by homologous recombination, using integrational plasmids to disrupt the speB gene . These mutants caused less mortality and tissue damage than protease-positive strains when inoculated into BALB/c mice via air pouch, suggesting that SPE B cysteine protease plays an important role in the pathogenesis of S . pyogenes infection . Reconstitution of SPE B in the air pouches increased the mortality of mice receiving the speB mutant strain . Infiltrated cell numbers in the exudates from the air pouches of mice infected with SPE B-producing S . pyogenes were higher than those from mice infected with protease-negative mutants at 12 h . However, despite pretreatment with vinblastine to deplete neutrophils, injection of protease-positive bacteria still resulted in severe tissue injury, indicating that neutrophil infiltration may not be the major factor involved in SPE B-enhanced tissue damage . The role of SPE B was further confirmed by demonstrating that SPE B immunization of mice conferred protection from challenge with a lethal dose of protease-positive bacteria.

Infect Immun, 1998 Aug, 66(8), 3767 - 74
Molecular cloning of a 32-kilodalton lipoprotein component of a novel iron-regulated Staphylococcus epidermidis ABC transporter; Cockayne A et al.; Our previous studies identified two iron-regulated cytoplasmic membrane proteins of 32 and 36 kDa expressed by both Staphylococcus epidermidis and Staphylococcus aureus . In this study we show by Triton X-114 phase partitioning and tritiated palmitic acid labelling that these proteins are lipoproteins which are anchored into the cytoplasmic membrane by their lipid-modified N termini . In common with those of some other gram-positive bacteria, these highly immunogenic lipoproteins were released from the bacterial cell into the culture supernatants, with release being promoted by growth of the bacteria under iron-restricted conditions . Immunoelectron microscopy with a monospecific rabbit antiserum to the 32-kDa S . epidermidis lipoprotein showed that the majority of the antigen was distributed throughout the staphylococcal cell wall . Only minor quantities were detected in the cytoplasmic membrane, and exposure of the lipoprotein on the bacterial surface was minimal . A monoclonal antibody raised to the 32-kDa lipoprotein of S . aureus was used in immunoblotting studies to investigate the conservation of this antigen among a variety of staphylococci . The monoclonal antibody reacted with polypeptides of 32 kDa in S . epidermidis and S . aureus and of 40 kDa in Staphylococcus hominis . No reactivity was detected with Staphylococcus lugdunensis, Staphylococcus cohni, or Staphylococcus haemolyticus . The gene encoding the 32-kDa lipoprotein from S . epidermidis has been isolated from a Lambda Zap II genomic DNA library and found to be a component of an iron-regulated operon encoding a novel ABC-type transporter . The operon contains three genes, designated sitA, -B, and -C, encoding an ATPase, a cytoplasmic membrane protein, and the 32-kDa lipoprotein, respectively . SitC shows significant homology both with a number of bacterial adhesins, including FimA of Streptococcus parasanguis and ScaA of Streptococcus gordonii, and with lipoproteins of a recently described family of ABC transporters with proven or putative metal ion transport functions . Although the solute specificity of this novel transporter has not yet been determined, we speculate that it may be involved in either siderophore- or transferrin-mediated iron uptake in S . epidermidis.

Infect Immun, 1998 Aug, 66(8), 3736 - 43
Regulation of sucrose-6-phosphate hydrolase activity in Streptococcus mutans: characterization of the scrR gene; Hiratsuka K et al.; Previous results have implicated an important role for the enzyme IIScr, the sucrose-specific permease, in the transport of sucrose by cariogenic Streptococcus mutans . The product of the scrB gene, sucrose-6-phosphate hydrolase (Suc-6PH), is required for the metabolism of phosphorylated sucrose . The results from the utilization of scrB::lacZ fusions in S . mutans GS-5 have suggested that sucrose-grown cells have higher levels of scrB gene expression than do cells grown with glucose or fructose . Northern blot analysis of scrB transcripts has also confirmed the relative strengths of expression as sucrose>glucose>fructose . Immediately downstream from the scrB gene, an open reading frame with homology to regulatory proteins of the GalR-LacI family as well as to ScrR proteins from several other bacteria has been identified . In addition, this gene appears to be transcribed in the same operon as scrB . Inactivation of this gene, scrR, did not alter the relative expression of the scrB gene in the presence of sucrose or fructose but did increase SUC-6PH levels in the presence of glucose to that observed with sucrose . Furthermore, the S . mutans ScrR homolog appears to bind to the scrB promoter region as determined from the results of gel shift assays . These results suggest that the scrR gene is involved in the regulation of scrB, and likely scrA, expression . However, it is not clear whether sucrose acts as an inducer of expression of these genes or, alternatively, whether glucose and fructose act as repressors.

Infect Immun, 1998 Aug, 66(8), 3705 - 10
Antibody responses to capsular polysaccharide backbone and O-acetate side groups of Streptococcus pneumoniae type 9V in humans and rhesus macaques; McNeely TB et al.; Streptococcus pneumoniae is responsible for high rates of pneumococcal bacteremia, meningitis, pneumonia, and acute otitis media worldwide . Protection from disease is conferred by antibodies specific for the polysaccharide (Ps) capsule of the bacteria . Of the four types of group 9 pneumococci, types 9N and 9V cause the most disease, and both types are included in the polyvalent pneumococcal vaccine . The type 9V capsule consists of repeating pentasaccharide units linearly arranged, with an average of 1 to 2 mol of O-acetate side chains per mol of repeat units, added in a complex pattern in which not all repeat units are alike . alpha-GlcA residues may be O-acetylated in the 2 (17%) or 3 (25%) position and beta-ManNAc residues may be O-acetylated in the 4 (6%) or 6 (55%) position . Under certain conditions, the O-acetate side chains are subject to oxidation, which results in subsequent de-O-acetylation of a significant number of the repeat units . This de-O-acetylation could adversely affect the efficacy of a vaccine containing the 9V Ps . A study was undertaken to compare the relative contributions of O-acetate and Ps backbone epitopes in the immune response to S . pneumoniae 9V type-specific Ps . In both an infant rhesus monkey model and humans, antibodies against the non-O-acetylated 9V backbone as well as against O-acetylated 9V Ps were detected . Functional (opsonophagocytic) activity was observed in antisera in which the predominant species of antibody recognized de-O-acetylated 9V Ps . We concluded that the O-acetate side groups, while recognized, are not essential to the ability of the 9V Ps to induce functional antibody responses.

Pediatr Pulmonol, 1998 Jun, 25(6), 390 - 2
Fatal pneumococcal sepsis following flexible bronchoscopy in an immunocompromised infant; Picard E et al.; A 5-month-old boy who suffered from a leukocyte chemotactic defect underwent flexible bronchoscopy for persistent right upper lobe atelectasis and tachypnea . Ten hours after the procedure he developed fulminant sepsis, and he died 16 hrs after bronchoscopy . Streptococcus pneumoniae (serotype 23) grew from the bronchoalveolar lavage fluid and from the blood culture taken during the sepsis work-up . We, therefore, suggest administering prophylactic antimicrobial therapy immediately following bronchoscopy to immunosuppressed children, even when an acute respiratory infection is not suspected, in order to prevent bacteremia and sepsis.

South Med J, 1998 Jul, 91(7), 660 - 2
Bilateral vocal cord paralysis after meningitis due to Streptococcus pneumoniae; Clack ZA et al.; We report the clinical course of a 15-month-old boy who had fever, decreased activity, and weakness, with severe respiratory distress during transport to the hospital . Laboratory evaluation confirmed the diagnosis of meningitis due to Streptococcus pneumoniae . He was intubated on arrival and required 4 days of ventilatory support . Soon after extubation, he had marked stridor and dyspnea that were unresponsive to standard therapy with nebulized racemic epinephrine and intravenous dexamethasone . Magnetic resonance imaging of the brain revealed nonspecific findings, and airway endoscopy showed bilateral vocal cord paralysis . Repeated endoscopy showed no improvement in vocal cord function and a deficient swallowing mechanism . Tracheostomy was done to facilitate airway management before discharge from the pediatric intensive care unit . We propose that the diagnosis of vocal cord paralysis must be considered in patients with meningitis and respiratory compromise.

Acta Odontol Scand, 1998 Apr, 56(2), 116 - 21
Growth of xylitol-resistant versus xylitol-sensitive Streptococcus mutans strains in saliva; Soderling E et al.; Five Streptococcus mutans pairs (serotype c S . mutans 10449 and four clinical isolates of S . mutans: 123.1, LG1, OMFA, T10B) were used to find out if the xylitol-resistant (XR) natural mutants of the corresponding xylitol-sensitive (XS) S . mutans parental strains differ in their growth patterns in saliva . The isogenic X natural mutants of the parental S . mutans strains were selected after sequential cultivations in the presence of xylitol and glucose . The XR/XS strains pairs were grown in individual and pooled glucose-supplemented filter-sterilized salivas (one to five sequential cultivations) . The two salivas used represented subjects with good or poor support of the growth of S . mutans in vivo . Protease and peptidase activities were determined from the saliva growth media and cell suspensions . Salivary protein profiles were analyzed using SDS-PAGE and native IEF before and after the cultivations . The growth properties of the XR/XS S . mutans pairs were similar in both individual and pooled salivas . Sequential cultivation of all strains did not show any differences in growth patterns . XS strains were inhibited by the presence of xylitol (2% w/v) in pooled saliva, as shown for other glucose-supplemented media . Protease and peptidase activities of the XR/XS S . mutans pairs were low and of similar magnitude . Also, the general hydrolytic properties of most XR/XS S . mutans pairs appeared similar as judged by the small growth-induced changes in salivary protein profiles . In conclusion, saliva, the source of nutrients for salivary microorganisms in vivo, favored neither the XR nor the XS strains of S . mutans.

Clin Exp Dermatol, 1998 Jan, 23(1), 35 - 7
Persistent infection of the chin with an unusual skin pathogen (Streptococcus milleri): a sign of intraoral carcinoma; Buckley DA et al.; Streptococcus milleri is a commensal of the oropharynx and gastrointestinal tract which is not generally associated with skin disease . We now report a patient who presented with a pustular mass of the chin with lower lip anaesthesia . He was initially thought to have sycosis barbae, but response to treatment was poor and lesional swabs repeatedly cultured S . milleri . After some delay, squamous cell carcinoma of the mouth, involving the mandible and overlying skin, was detected . We consider that the S . milleri either invaded through the tumour from the mouth or root canal or colonized the skin from saliva dribbled over the numb lower lip . Isolation of an unusual organism and numbness of the chin are features that should suggest the need for early radiography.

Nihon Rinsho Meneki Gakkai Kaishi, 1998 Apr, 21(2), 70 - 9
{Intravenous immunoglobulin (GB-0998) for prophylaxis of recurrent acute otitis media and lower respiratory tract infection in infancy with IgG 2 deficiency}; Sakiyama Y et al.; The prophylactic effect of intravenous immunoglobulin (GB-0998) on the recurrent acute otitis media, bronchitis and bronchopneumonia in IgG 2 deficient infants was investigated in a multicenter trial . GB-0998 was administered 6 times every 4 weeks . The doses were 300 mg/kg wt . during the first treatment, followed by 5 doses of 200 mg/kg wt . The results indicated that GB-0998 was effective in the prophylaxis of the recurrent infection of acute otitis media, bronchitis and bronchopneumonia in infancy with IgG 2 deficiency and/or IgG 2 antibody deficiency specific for Streptococcus pneumoniae.

Kyobu Geka, 1998 Jul, 51(7), 583 - 5
{A case report of successful mitral valve replacement for infective endocarditis during pregnancy}; Iwakura A et al.; Infective endocarditis is an important but uncommon complication in obstetric or gynecologic practice . A 32 weeks' pregnant woman exhibited endocarditis due to Streptococcus oralis . The present case was successfully managed by means of aggressive antibiotic and diuretic treatments appropriate for endocarditis . The patient entered spontaneous labor at the estimated date of confinement and delivered of healthy 2.8 kg boy . After four weeks later scheduled mitral valve replacement with SJM valve was performed at the chronic stage of endocarditis . Her postoperative recovery was uneventful and she was discharged 40 days after the operation.

J Clin Microbiol, 1998 Aug, 36(8), 2346 - 8
Enzyme immunoassay detecting teichoic and lipoteichoic acids versus cerebrospinal fluid culture and latex agglutination for diagnosis of Streptococcus pneumoniae meningitis; Stuertz K et al.; A newly developed enzyme immunoassay (EIA) was used to detect the presence of pneumococcal teichoic and lipoteichoic acids in cerebrospinal fluid (CSF) from patients with Streptococcus pneumoniae meningitis who were being treated with antibiotics . All initial CSF samples, which on culture grew S . pneumoniae, were positive in the EIA . A total of 14 subsequent culture-negative samples gave clear signals in the EIA up to day 15 after the onset of antibiotic treatment . For 11 CSF specimens, culture, microscopy, and latex agglutination were negative while the EIA detected pneumococcal antigens . The EIA did not react either with CSF of patients with meningitis caused by bacteria other than S . pneumoniae or by viral pathogens . In conclusion, this EIA can be a valuable tool for the diagnosis of S . pneumoniae meningitis from CSF samples in cases in which prior antimicrobial therapy minimizes the usefulness of culture or other antigen detection tests.

Clin Microbiol Rev, 1998 Jul, 11(3), 497 - 513
Epidemiology of group B streptococcal disease in the United States: shifting paradigms; Schuchat A; Since its emergence 25 years ago, group B streptococcus has become recognized as a cause of serious illness in newborns, pregnant women, and adults with chronic medical conditions . Heavy colonization of the genital tract with group B streptococcus also increases the risk that a woman will deliver a preterm low-birthweight infant . Early-onset infections (occurring at < 7 days of age) are associated with much lower fatality than when they were first described, and their incidence is finally decreasing as the use of preventive antibiotics during childbirth increases among women at risk . New serotypes of group B streptococcus have emerged as important pathogens in adults and newborns . Clinical and laboratory practices--in obstetrics, pediatrics, and clinical microbiology--have an impact on disease and/or its prevention, and protocols established at the institutional level appear to be critical tools for the reduction of perinatal disease due to group B streptococcus . Since intrapartum antibiotics will prevent at best only a portion of the full burden of group B streptococcal disease, critical developments in vaccine evaluation, including study of polysaccharide-protein conjugate vaccines, offer the potential for enhanced prevention in the relatively near future.

J Clin Invest, 1998 Jul 15, 102(2), 347 - 60
Pneumococcal trafficking across the blood-brain barrier . Molecular analysis of a novel bidirectional pathway; Ring A et al.; Although Streptococcus pneumoniae is a major cause of meningitis in humans, the mechanisms underlying its traversal from the circulation across the blood-brain barrier (BBB) into the subarachnoid space are poorly understood . One mechanism might involve transcytosis through microvascular endothelial cells . In this study we investigated the ability of pneumococci to invade and transmigrate through monolayers of rat and human brain microvascular endothelial cells (BMEC) . Significant variability was found in the invasive capacity of clinical isolates . Phase variation to the transparent phenotype increased invasion as much as 6-fold and loss of capsule approximately 200-fold . Invasion of transparent pneumococci required choline in the pneumococcal cell wall, and invasion was partially inhibited by antagonists of the platelet-activating factor (PAF) receptor on the BMEC . Pneumococci that gained access to an intracellular vesicle from the apical side of the monolayer subsequently were subject to three fates . Most opaque variants were killed . In contrast, the transparent phase variants were able to transcytose to the basal surface of rat and human BMEC in a manner dependent on the PAF receptor and the presence of pneumococcal choline-binding protein A . The remaining transparent bacteria entering the cell underwent a previously unrecognized recycling to the apical surface . Transcytosis eventually becomes a dominating process accounting for up to 80% of intracellular bacteria . Our data suggest that interaction of pneumococci with the PAF receptor results in sorting so as to transcytose bacteria across the cell while non-PAF receptor entry shunts bacteria for exit and reentry on the apical surface in a novel recycling pathway.

Bull Tokyo Dent Coll, 1998 Feb, 39(1), 7 - 14
The efficacy of antimicrobial mouth rinses in oral health care; Okuda K et al.; There is growing public recognition of the importance of oral health, as symbolized by the theme . "Oral Health for a Healthy Life" proposed for the 1994 World Health Day . In this report, the efficacy of antimicrobial mouth rinses, mainly Listerine, was reviewed by three investigators who are working as a microbiologist, a microbiologist, a dentist, and a dental hygienist participating in oral health care . Listerine, an antimicrobial mouth rinse, completely killed microorganisms in 10 to 30 seconds; the microbes includes methicillin-resistant Staphylococcus aureus, Streptococcus pyogenes, Helicobacter pylori, Candida albicans, Streptococcus mutans, Actinomyces viscosus, Porphyromonas gingivalis, Prevotella intermedia, and Actinobacillus actinomycetemcomitans . Listerine was also weakly effective in inactivating human immunodeficiency viruses . Bacteria in samples collected from human dental plaque and saliva were completely killed within 30 seconds when exposed to Listerine . When saliva samples were collected from subjects who had rinsed their mouths with 20 ml of Listerine or 1:50 diluted povidone-iodine, levels of viable anaerobic bacteria in the samples were reduced to 1% . When Listerine was used for oral surgery such as tooth extraction and periodontal surgery, the agent was effective in relieving toothache . This was probably due to a decrease in oral bacteria by the antimicrobial action of Listerine, leading to lowering the inflammatory response of the host . The use of antimicrobial mouth rinse during dental treatments such as endodontic treatment proved effective for more reliable infection control . In Japan, there are an increasing number of elderly and medically compromised hosts who are potentially at risk for developing pneumonia due to silent aspiration of microbes in the oral cavity and throat . For the aged with such potential risk, using of antimicrobial mouth rinse may be effective in preventing dental plaque accumulation when used in addition to the mechanical control of plaque, since they tend to have difficulty in brushing teeth by themselves . Indeed, the use of antimicrobial mouth rinse in these elderly people proved useful not only in preventing bacterial pneumonia, but also in improving their quality of life by preserving their oral health.

Curr Microbiol, 1998 Aug, 37(2), 77 - 9
Nucleotide sequence and chromosomal location of L-lactate dehydrogenase gene from Streptococcus pneumoniae; Jado I et al.; We report here the 1244-bp sequence of a Streptococcus pneumoniae chromosomal fragment that contains the putative promoter and protein-coding region of the lactate dehydrogenase gene (ldh) . The nucleotide sequence predicts a protein of 327 aa with a molecular weight of 35,202 daltons, after removal of the N-terminal methionine residue . The ldh gene is located on the ApaI fragment 1 and SmaI fragment 2 of the previously reported physical map of S . pneumoniae chromosome.

Antimicrob Agents Chemother, 1998 Jul, 42(7), 1858 - 61
In vivo antibacterial activities of sanfetrinem cilexetil, a new oral tricyclic antibiotic; Tamura S et al.; The in vivo antibacterial activities of a new oral trinem, sanfetrinem cilexetil (a prodrug of sanfetrinem), were evaluated in comparison with those of cefdinir and amoxicillin . Sanfetrinem cilexetil showed potent efficacy against experimental murine septicemia caused by Staphylococcus aureus, Streptococcus pyogenes, and Escherichia coli and against murine respiratory infections caused by Streptococcus pneumoniae . Likewise, in murine models of respiratory infection by penicillin-susceptible and penicillin-resistant S . pneumoniae, sanfetrinem cilexetil was more effective than amoxicillin in reducing the number of bacteria in infected lungs . These results were reflected in its potent in vitro activity and high levels in plasma.

Antimicrob Agents Chemother, 1998 Jul, 42(7), 1706 - 12
Evaluation of moxifloxacin, a new 8-methoxyquinolone, for treatment of meningitis caused by a penicillin-resistant pneumococcus in rabbits; Ostergaard C et al.; Moxifloxacin is a new 8-methoxyquinolone with high activity against gram-positive bacteria, including penicillin-resistant pneumococci . In an experimental meningitis model, we studied the pharmacokinetics of moxifloxacin in infected and uninfected rabbits and evaluated the antibiotic efficacies of moxifloxacin, ceftriaxone, and vancomycin against a penicillin-resistant Streptococcus pneumoniae strain (penicillin, ceftriaxone, vancomycin, and moxifloxacin MICs were 1, 0.5, 0.5, and 0.125 microgram/ml, respectively) . Moxifloxacin entered cerebrospinal fluid (CSF) readily, with peak values within 15 to 30 min after bolus intravenous infusion and with a mean percent penetration into normal and purulent CSF of approximately 50 and 80%, respectively . The bactericidal effect of moxifloxacin was concentration dependent, and regrowth was seen only when the concentration of moxifloxacin in CSF was below the minimal bactericidal concentration . All antibiotic-treated groups (moxifloxacin given in two doses of 40 mg/kg of body weight, moxifloxacin in two 20-mg/kg doses, ceftriaxone in one 125-mg/kg dose, and vancomycin in two 20-mg/kg doses) had significantly higher reductions in CSF bacterial concentration than the untreated group (P < 0.05) . Moxifloxacin was as effective as vancomycin and ceftriaxone in reducing bacterial counts at all time points tested (3, 5, 10, and 24 h) . Moreover, moxifloxacin given in two 40-mg/kg doses resulted in a significantly higher reduction in CSF bacterial concentration (in log10 CFU per milliliter) than vancomycin within 3 h after the start of antibiotic treatment (3.49 {2.94 to 4.78} versus 2.50 {0.30 to 3.05}; P < 0.05) . These results indicate that moxifloxacin could be useful in the treatment of meningitis, including penicillin-resistant pneumococcal meningitis.

Antimicrob Agents Chemother, 1998 Jul, 42(7), 1605 - 9
Erythromycin inhibits tumor necrosis factor alpha and interleukin 6 production induced by heat-killed Streptococcus pneumoniae in whole blood; Schultz MJ et al.; To determine the effects of penicillin and erythromycin on cytokine production induced by heat-killed Streptococcus pneumoniae (HKSP), we studied the effects of those drugs on cytokine production induced by S . pneumoniae in human whole blood in vitro and ex vivo . In whole blood in vitro, erythromycin, but not penicillin, caused a dose-dependent decrease in HKSP-induced production of tumor necrosis factor alpha (TNF) and interleukin 6 (IL-6), while the production of IL-10, IL-12, and gamma interferon was inhibited only at the highest erythromycin concentration tested (10(-3) M) . The production of TNF and IL-6 in whole blood obtained from healthy subjects after a 30-min infusion of erythromycin (1,000 mg) was lower after ex vivo stimulation with HKSP than that in blood drawn before the infusion . Inhibition of TNF contributed to erythromycin-induced inhibition of IL-6 synthesis . Inhibition of TNF and IL-6 production by erythromycin may have a negative impact on host defense mechanisms during pneumococcal pneumonia.

Acad Emerg Med, 1998 Jun, 5(6), 599 - 606
Parenteral vs oral antibiotics in the prevention of serious bacterial infections in children with Streptococcus pneumoniae occult bacteremia: a meta-analysis; Rothrock SG et al.; OBJECTIVE: To determine whether parenteral antibiotics are superior to oral antibiotics in preventing serious bacterial infections in children with Streptococcus pneumoniae occult bacteremia . METHODS: Using the MEDLINE database, the English language literature was searched for all publications concerning bacteremia, fever, or Streptococcus pneumoniae from 1966 to January 1, 1997 . All nonduplicative studies with a series of children with S . pneumoniae occult bacteremia having both orally treated and parenterally treated groups were reviewed . Children were excluded from individual studies if at the time of their initial evaluation they were immunocompromised, had a serious bacterial infection, underwent a lumbar puncture, or did not receive antibiotics . RESULTS: Only 4 studies met study criteria . From these studies, 511 total cases of S . pneumoniae occult bacteremia were identified . Ten of 290 (3.4%) in the oral group and 5 of 221 (2.3%) in the parenteral antibiotic group developed serious bacterial infections (pooled p-value = 0.467, pooled OR = 1.48; 95% CI, 0.5-4.3) . Two patients in the oral group (0.7%) and 2 patients in the parenteral group (0.9%) developed meningitis (pooled p-value = 0.699, pooled OR = 0.67; 95% CI, 0.1-5.1) . CONCLUSION: The rates of serious bacterial infections and meningitis did not differ between children who were treated with oral and parenteral antibiotics . The extremely low rate of complications observed in both groups suggests no clinically significant difference between therapies . A study with >7,500 bacteremic children (or >300,000 febrile children) would be needed to have 80% power to prove parenteral antibiotics are superior to oral antibiotics in preventing serious bacterial infections.

Acad Emerg Med, 1998 Jun, 5(6), 567 - 72
The role of betamethasone in the treatment of acute exudative pharyngitis; Marvez-Valls EG et al.; OBJECTIVE: To compare betamethasone with placebo as an adjuvant to antibiotic therapy in the treatment of acute exudative pharyngitis . METHODS: The study was a randomized, doubled-blind, placebo-controlled, single-center, parallel, outpatient clinical trial . After consent was obtained, each patient was asked to rate his or her pain on a 10-cm numbered visual analog scale (VAS; 0-10) . All of the patients received injectable benzathine penicillin . If allergic to penicillin, they were started on a 10-day course of polyenteric-coated erythromycin (PCE) . Each patient was randomized to receive either i.m . betamethasone or i.m . placebo . All patients were contacted by telephone at 24 and 48 hours by one of the study investigators and asked to rate their pain based on another VAS . If their pain was not resolved by 48 hours, they were called again daily between the third and seventh days after the initial visit to determine the time of pain resolution . RESULTS: A total of 92 patients were enrolled in the study, with 46 randomized to receive placebo and 46 to receive betamethasone . Eight patients were excluded from the statistical analysis because of inability to obtain follow-up . Demographic comparison showed that gender distributions, ages, mean initial pain scores, mean times to the first and second follow-up calls, and treatment regimens were similar in the 2 groups . There were significantly better pain scores for the betamethasone group at first follow-up (p = 0.0005), at second follow-up (p = 0.004), and in number of hours until relief of pain (p = 0.004) . When only those patients with a positive culture for a streptococcus species were analyzed, there also were significant reductions in pain score at the first (p = 0.006) and second (p = 0.02) follow-up visits . CONCLUSION: Pain relief was greater and more rapid in patients treated with betamethasone as an adjuvant therapy in acute exudative pharyngitis.

Respir Med, 1998 Apr, 92(4), 664 - 7
Value of C-reactive protein measurements in exacerbations of chronic obstructive pulmonary disease; Dev D et al.; C-reactive protein (CRP) has been shown to be a useful and sensitive indicator of pyogenic infections in many clinical situations, including acute pneumonia and infective pulmonary exacerbations in cystic fibrosis patients . Exacerbations of COPD are often, but not always, associated with demonstrable infection . The value of CRP measurement in this situation has not been assessed . We have evaluated CRP measurement in 50 patients {age 71 +/- 8 (SD) years} who were admitted to hospital with clinical evidence of exacerbation {PaO2 = 7.3 +/- 1.3 (SD) kPa, baseline FEV1 = 0.8 +/- 0.4 (SD) l} . These patients all had serial measurement of CRP {polarizing immunofluorescence (Abbot, TDx)}, peripheral white cell count (WCC), body temperature, peak expiratory flow rate, Karnofsky performance status and chest X-ray, in addition to serial sputum bacteriological analysis carried out in a specialized laboratory . CRP was elevated (> 10 mg l-1) in all patients (n = 29) with proven infection {103 +/- 98 (SD) mg l-1} . Levels were markedly elevated in patients infected with Streptococcus pneumoniae (mean 156 mg l-1); there was also a rapid fall in the CRP with therapy . WCC fell with therapy, giving a correlation with CRP level (r = 0.44, P < 0.01) . Since CRP elevation was observed in patients having exacerbation with proven infections and also in those where infection was not proven, it is possible that, while it is a marker for COPD exacerbation, it is not necessarily a marker of bacterial infection per se . However, it is evident from our study that it is of value in the assessment of exacerbations of COPD, where routine bacterial culture of sputum is often unreliable, and thus the measurement of serum CRP may provide an additional objective indicator of infection.

J Clin Pathol, 1998 Apr, 51(4), 270 - 4
Application of molecular typing to the epidemiology of Streptococcus pneumoniae; Hall LM; The spread of antibiotic resistance and the development of new vaccines have focused attention on the epidemiology of Streptococcus pneumoniae over recent years . While serotyping and the determination of antibiotic resistance remain primary methods for characterising pneumococci, molecular typing can add greater discrimination and complementary information . Methods based on restriction fragment length polymorphism within total DNA or non-specific polymerase chain reaction provide information representative of the whole genome and can be used to recognise closely related isolates from different sources, whether in the investigation of possible cross infection at the local level or in the investigation of national or international spread of antibiotic resistant strains . Fingerprinting of penicillin binding protein genes adds further information in the analysis of penicillin resistant isolates . The use of a combination of typing methods to analyse both the genome as a whole and specific loci has led to the realisation that pneumococci undergo horizontal gene transfer much more often than most other bacterial species . In particular the spread of penicillin resistance has been characterised by a combination of the spread of epidemic strains, transfer of chromosomal resistance genes from such strains into other genetic backgrounds, and transfer of capsule genes resulting in the switch of serotypes within strains . In the future molecular typing will have an important role in discovering whether widespread vaccination leads to genetic modification of the pneumococcal population causing invasive disease.

Schweiz Rundsch Med Prax, 1998 Jun 10, 87(24), 839 - 44
{Otogenic meningitis}; Friedl A et al.; We present three patients with otogenic meningitis, whose illness varied in extent and clinical course . Meningitis and otitis media are associated in 19-22% of all meningitis-patients . Streptococcus pneumoniae is the predominant microorganism with hemophilus influenzae being the second most important . We discuss the importance and problems of spinal puncture, early CT-scan as well as further, more extensive and sophisticated examinations to exclude late complications or predisposing factors . We emphasize an early start of antibiotic treatment, which should not be delayed for diagnostic reasons . With the appearance of highly penicillin-resistant pneumococci antibiotic therapy may become more difficult in the future, but for the moment pneumococcal infections in Switzerland can initially still be treated with cephalosporins or high dose penicillin . The use of steroids, although of unproven efficacy, may be considered in some cases . An otolaryngologist should initially be consulted for diagnostic reasons as well as for possibly indicated early surgery.

Rev Esp Cardiol, 1998, 51 Suppl 2, 4 - 10
{Experimental endocarditis . Pathological anatomy of human endocarditis}; Alonso Pulpon L et al.; Experimental reproduction of human endocarditis in animal models has been based on the induction of structural lesions in valve endocardium using different methods . The primary lesion caused in this way is the so called non-bacterial thrombotic endocarditis . Its colonization is then induced by inoculation of microorganisms in the bloodstream . Freedman's modified method has been the most widespread model of this type . It has mainly been performed in rabbits with inoculation of Staphylococcus aureus or alpha-hemolitic Streptococcus . Experimental models of endocarditis have contributed to our knowledge of the pathogenic mechanisms, causative agents and predisposing factors of endocarditis . They have also allowed us to develop appropriate diagnostic, therapeutic and prophylactic measures for its management.

Ann Otol Rhinol Laryngol, 1998 Jun, 107(6), 501 - 7
Upregulation of messenger RNA for inflammatory cytokines in middle ear mucosa in a rat model of acute otitis media; Hebda PA et al.; A rat model for acute otitis media has been established and was used to delineate the temporal expression of messenger RNA for key inflammatory cytokines . Inoculation with live Streptococcus pneumoniae induced a rapid expression of tumor necrosis factor alpha (within 6 hours) followed by upregulation of message for interleukin (IL)-6 (peak at 12 to 24 hours, remaining elevated through 120 hours) and IL-10 (peak at 24 hours) . Inducible nitric oxide synthase message was also selectively increased following live bacterial inoculation (peak at 12 to 24 hours) . Although there was a detectable inflammatory response to killed bacteria, it was minimal, was of short duration, and preceded the peak for live bacteria; only expression of IL-6 was significantly increased in this group (peak at 12 hours, remaining elevated through 72 hours) . We interpret this to be due to an inflammatory response to bacterial products (such as lipopolysaccharide) in the heat-killed bacterial inoculum . The phosphate-buffered saline (PBS)-inoculated group exhibited a transient increase of IL-6 message, which indicates that this cytokine is a sensitive marker of the acute response to trauma . Otherwise, PBS invoked only a slight reaction in the mucosa with respect to the other inflammatory mediators being measured.

J Pharmacol Exp Ther, 1998 Jul, 286(1), 29 - 35
Pharmacodynamic activities of ciprofloxacin and sparfloxacin in a murine pneumococcal pneumonia model: relevance for drug efficacy; Bedos JP et al.; We looked for associations between pharmacokinetic (Pk) and pharmacodynamic (Pd) parameters of ciprofloxacin (CPFX) and sparfloxacin (SPFX) and the in vivo efficacy of these antimicrobials in an immunocompetent mouse model of severe Streptococcus pneumoniae pneumonia . Bacterial killing curves recorded in the lungs during the 24 h after single subcutaneous injections of the fluoroquinolones (FQs) in doses ranging from 6.25 to 200 mg/kg were compared with mean Pk/Pd parameters in the serum of the same mice . The impact of the dosing interval on the antimicrobial dose response was evaluated based on the survival of mice treated for 3 days with CPFX (25-200 mg/kg) or SPFX (6.25-50 mg/kg) administered at various intervals from 3 to 24 h . Bacterial killing curves showed that the maximal bacterial decrease achieved in the lungs was correlated, similarly for both FQs, with the area under the curve (AUC) above the minimal inhibitory concentration (MIC) (overall correlation: r = 0.968, P < 10(-4)) . CPX attained higher maximal bactericidal effect values, a steeper killing slope and a shorter time to maximal bactericidal effect in comparison with SPX for the highest doses tested . The lower MIC of SPFX compared with CPFX (0.25 vs . 0.75 microgram/ml) and its higher AUC/dose ratio (resulting from a lower serum peak but a longer half-life) translated into a greater area under the bactericidal curve . In the dose fractionation experiments, the Pk/Pd parameter most closely correlated with the survival rate for both FQs was the daily AUC/MIC ratio (r = 0.976, P < 10(-4)) . When the AUC/MIC ratio was greater than 160, the probability of a clinical cure was 100%, independently of the dosage schedule.

Pediatr Emerg Care, 1998 Jun, 14(3), 194 - 7
Streptococcus pneumoniae bacteremia in children infected with HIV: presentation, course, and outcome; Dayan PS et al.; OBJECTIVE: To examine the presentation, course, and outcome of pneumococcal bacteremia in children infected with human immunodeficiency virus (HIV) . METHODS: A retrospective series of HIV-infected children less than 18 years of age with Streptococcus pneumoniae bacteremia from four urban, tertiary care hospitals was evaluated . The main outcome measures included persistent bacteremia, the development of a focal infection, and death . RESULTS: Seventy-two episodes of pneumococcal bacteremia were identified in 59 patients . Fifty-four first episodes were included; 26/54 were occult . Mean temperature was 39.8 degrees C . In patients with bacteremia, white blood cells (WBCs) > or = 15,000 and > or = 10,000 had sensitivities of 40% and 75%, respectively . At the time of bacteremia, age >3 years old was associated with a lower mean WBC count compared with episodes occurring in patients <3 years old (11.2 vs 16.1, P < 0.05) . Patients with occult bacteremia who were discharged with antibiotics (12 i.m., 7 p.o.) were less likely than patients without antibiotic treatment to have persistent bacteremia at a return visit within 72 hours (0/19 vs 2/5, P < 0.05) . No patient with occult bacteremia died, progressed to clinical meningitis, or had other sequelae . Two of fifty-four patients died as a result of their first episode of invasive pneumococcal disease . Both patients who died had meningitis and appeared ill on initial presentation . CONCLUSIONS: Neither a WBC count > or = 15,000 nor > or = 10,000 is a sensitive indicator of pneumococcal bacteremia in HIV-infected children . Empiric antibiotics are useful to decrease the risk of persistent bacteremia . Children infected with HIV who have occult pneumococcal bacteremia appear to do well with appropriate antibiotics . Patients who are afebrile and well appearing on reevaluation may be safely treated as outpatients.

Pediatr Infect Dis J, 1998 Jun, 17(6), 470 - 3
Erythromycin resistance of Streptococcus pyogenes in Madrid; Orden B et al.; BACKGROUND: Erythromycin is considered to be an adequate alternative to penicillin for patients who are allergic to penicillin . Erythromycin-resistant Streptococcus pyogenes strains have been reported in some parts of the world . METHOD: The in vitro activity of erythromycin and other antimicrobial agents was determined in a total of 1310 clinical Streptococcus pyogenes isolates collected in the city of Madrid from January, 1993, through December, 1996 . RESULTS: All strains showed susceptibility to penicillin, rifampin, vancomycin and chloramphenicol . Tetracycline resistance was 8.5% . In 36 of the strains (2.7%) MIC was 4 microg/ml for ofloxacin . Clindamycin resistance was observed in only 18 strains (1.4%); this resistance was constitutive in 15 and inducible in 3 strains . Resistance to erythromycin was observed in 14.3% of the strains, showing an increase during the study period (2.0% in 1993 vs . 22.4% in 1996; chi square for linear trend 68.8, P < 0,0001); >90% of them showed the novel resistance phenotype described by Seppala et al . and 32 of 32 of these strains showed by PCR the 1.4-kb fragment of the mefA gene recently described as the novel macrolide efflux resistance determinant . The erythromycin-resistant strains were isolated more often in pediatric patients (144 of 872) than in adults (44 of 438) (chi square 9.9, P = 0.0016) . CONCLUSION: The study emphasizes the need to screen for resistance to macrolides in S . pyogenes and indicates that resistance to erythromycin in S . pyogenes has increased significantly in Madrid.

New Horiz, 1998 May, 6(2 Suppl), S72 - 9
Infections complicating pancreatitis: diagnosing, treating, preventing; Uhl W et al.; The most important risk factor in patients suffering from acute necrotizing pancreatitis is pancreatic infection, a factor that determines the course of the disease, its therapeutic management, and its outcome . The bacterial infection route is very likely via the colon . In patients with acute pancreatitis, the infection rate is about 40 to 70% within the first 3 wks . Bacteria most frequently found are those from the gastrointestinal tract: Escherichia coli, Pseudomonas species, Streptococcus fecalis, Enterococcus, and Staphylococcus aureus . Screening methods for infected necrotizing pancreatitis include fine needle puncture by ultrasonography or computed tomographic guidance with Gram staining and culture of the aspirate . We previously investigated different broad-spectrum antibiotics with regard to their efficacy at preventing infection . This analysis indicated that antibiotics have different efficacy factors based on pharmacodynamic properties . Imipenem and quinolones, in combination with metronidazole, are the drugs of choice for treating or preventing pancreatic infection, whereas aminoglycosides do not enter the pancreas and therefore are not indicated . Based on increasing evidence that patients with acute necrotizing pancreatitis will benefit by early and appropriate antibiotic therapy, we altered the approach in such patients with an immediate start of antibiotic therapy continued for at least 14 days . We have found a reduction of the infection rate to 33% (11/32) in the third week after the onset of the disease . This treatment of the infection and the possibility of delaying operative intervention resulted in optimal surgical conditions . However, further prospective, controlled, and randomized studies are necessary to determine which antibiotics and antimycotic therapeutic regimens should be chosen.

New Horiz, 1998 May, 6(2 Suppl), S3 - 10
A microbiologist's view of factors contributing to infection; Emmerson M; Why some patients develop postoperative surgical wound infection and others do not remains a mystery . There are many risk factors for infection, and mathematical scoring systems are often good predictors of infection; yet, some patients with a plethora of risk factors fail to develop surgical site infections . Even patients with established abdominal infection do not automatically develop wound infection . Early experimental work, now confirmed in the clinical setting, dictates that bacteria must be in the wound to cause infection; the minimal infecting dose will depend on the environmental conditions in the wound . The presence of foreign bodies, trauma, hematoma, etc., will enhance the effect of the inoculum; therefore, surgical debridement and careful surgery are necessary to reinforce the host defenses . Some bacteria, e.g., Staphylococcus aureus and Streptococcus pyogenes, have a greater propensity to cause infection, so extensive infection-control practices are necessary to prevent or contain these pathogens . To minimize the risk of surgical site infection, individual patient risk factors must be identified and modified whenever possible . The patient should be prepared for the operation and appropriate skin antiseptics should be used on the operative site . The patient should be considered for perioperative antibiotic prophylaxis and, if appropriate, bowel preparation should be carried out . Care and attention to the theater operating environment is important, especially for cases in which airborne transmission of bacteria should be controlled, e.g., ultraclean air systems for implant surgery . In elective surgery, the source of bacteria that cause infection is either the patient's normal flora (e.g., skin or bowel), i.e., endogenous, or the surgical staff or environment, i.e., exogenous . Surgical expertise and theater discipline are essential components in the fight against surgical sepsis.

J Infect Dis, 1998 Jul, 178(1), 147 - 58
Protein F1 is required for efficient entry of Streptococcus pyogenes into epithelial cells; Jadoun J et al.; It was recently reported that strains of Streptococcus pyogenes are capable of inducing entry of the bacterium into epithelial cells; however, nothing is known regarding the gene(s) and the underlying mechanism(s) involved . Using isogenic mutants of S . pyogenes JRS4 strain that are defective in the expression of each of the surface proteins F1 and M6, it was demonstrated that both are required for efficient internalization . Expression of F1 on the surface of a poorly invading S . pyogenes strain significantly enhances its internalization efficiency . Protein F1-mediated internalization is inhibited by UR, the nonrepetitive fibronectin-binding domain of this protein, and to a lesser extent, by the repetitive fibronectin-binding domain, RD2 . Polyclonal anti-human fibronectin antibodies completely abolish F1-mediated internalization; increasing fibronectin concentrations result in a significant enhancement of bacterial uptake . The findings shown here suggest that protein F1 mediates streptococcal internalization and that the M6 protein is required for more efficient entry of the bacterium.

Jpn J Antibiot, 1997 Nov, 50(11), 887 - 96
{Studies on penetration of cefepime into respiratory tract using broncho-alveolar lavage and sputum}; Arai C et al.; We investigated broncho-alveolar distribution of cefepime (CFPM), a fourth generation cephem, using 38 BALF specimens from 19 serious pneumonia patients who underwent artificial respiratory system control . The mean broncho-alveolar CFPM level was 3.44 microgram/ml (5.34% of the mean peak blood level) . We thus observed that the BALF level after a single dose of 1 g of CFPM exceeds the MIC90 of the drug against RTI causing bacteria such as Streptococcus pneumoniae, Klebsiella pneumoniae, Haemophillus influenzae, Branhamella catarrhalis, coagulase-negative Staphylococcus, Pseudomonas aeruginosa and Staphylococcus aureus.

Jpn J Antibiot, 1997 Nov, 50(11), 878 - 86
{Antimicrobial activities of clindamycin against clinical isolated Streptococcus pneumoniae}; Suzuki Y et al.; We investigated antimicrobial activity of clindamycin (CLDM) against clinically isolated Streptococcus pneumoniae in 1996 . The results are summarized as follows; 1 . The detection frequencies of macrolides (MLs)-resistance against penicillin (PC)-susceptible S . pneumoniae (PSSP) was 48.0% and those against PC-intermediate S . pneumoniae (PISP)/ PC-resistant S . pneumoniae (PRSP) was 92.0% . 2 . It was found that the ratio of MLs-inducible resistant strains of PSSP was 24.6% and that of PISP/PRSP was 66.0% . MLs-constitutive resistant strains of PSSP accounted for 24.0% and that of PISP/PRSP for 26.0% . MLs-constitutive resistant strains was relatively frequent in PSSP and MLs-inducible resistant strains was frequent in PISP/PRSP . 3 . CLDM showed strong antimicrobial activity against MLs-inducible resistant strains . The MIC70 of CLDM against PSSP was < or = 0.025 microgram/ml and that against PISP/PRSP was 0.1 microgram/ml . From these results, it was suggested that CLDM is effective against the infection of PISP/PRSP where the detection frequency of MLs-inducible strains was high . 4 . Antimicrobial activity of CLDM was found to be strong against MLs-inducible resistant strains, but to be weak against MLs-constitutive resistant strains . When S . pneumoniae is detected, susceptibility of the strain to CLDM should be examined.

Microb Drug Resist, 1998 Summer, 4(2), 99 - 105
Limiting the spread of penicillin-resistant Streptococcus pneumoniae: experiences from the South Swedish Pneumococcal Intervention Project; Ekdahl K et al.; In an attempt to limit the spread of penicillin-resistant pneumococci (PRP), an intervention project was initiated in the Malmohus County, southern Sweden in January 1995 . The ongoing project combines traditional communicable disease control measures and actions aiming at reducing antibiotics consumption . All patients in the county with a nasopharyngeal culture positive for PRP with MIC of Penicillin G > or =0.5 mg/L are followed with nasopharyngeal cultures until PRP-negative . Nasopharyngeal cultures are obtained from family members and close contacts of the index cases . Preschool children carrying PRP are denied attendance at group day-care . From January 1995 to March 1997, 1,038 PRP-carriers (429 index cases and 609 contact cases) were identified . Children aged 1-6 years dominated (83%) . Antibiotics sales decreased during the study period, and epidemiologic data indicate that the intervention may have limited the dissemination of PRP in the county, but further evaluation is needed.

J Clin Periodontol, 1998 May, 25(5), 346 - 53
Subgingival microbiota in healthy, well-maintained elder and periodontitis subjects; Haffajee AD et al.; This investigation compared the site prevalence of 40 subgingival species in 30 periodontally healthy (mean age 36+/-9 years), 35 elders with a well-maintained periodontium (mean age 77+/-5) and 138 adult periodontitis subjects (mean age 46+/-11) . Subgingival plaque samples were taken from the mesial aspect of each tooth (up to 28 samples) in the 203 subjects at baseline . The presence and levels of 40 subgingival taxa were determined in 5003 plaque samples using whole genomic DNA probes and checkerboard DNA-DNA hybridization . Clinical assessments including dichotomous measures of gingival redness, bleeding on probing, plaque accumulation and suppuration, as well as duplicate measures of pocket depth and attachment level, were made at 6 sites per tooth . The % of sites colonized by each species (prevalence) was computed for each subject . Differences in prevalence and levels among groups were sought using the Kruskal-Wallis test . Commonly detected species, such as Actinomyces naeslundii genospecies 2, Streptococcus sanguis and Streptococcus oralis did not differ significantly among subject groups . After adjusting for multiple comparisons, 4 species were significantly elevated and at greater prevalence in the periodontitis group . Mean % of sites (+/-SEM) colonized by Bacteroides forsythus was 10+/-3, 12+/-2 and 40+/-2 (p<0.001) for healthy, elder and periodontitis groups respectively . The odds ratio was 14.4:1 that a subject had periodontitis when B . forsythus was detected at > or = 5% of sampled sites . Mean prevalence for Porphyromonas gingivalis in healthy, elder and periodontitis subjects was 4+/-2, 5+/-2 and 23+/-2 respectively (p<0.001); for Treponema denticola 12+/-4, 10+/-3 and 30+/-2 (p<0.001) and for Selenomonas noxia 6+/-2, 7+/-2 and 19+/-2 (p<0.01) . Similar differences among subject groups were observed when only sites with PD 0-4 mm were analyzed . The data suggest an etiologic role for B . forsythus, P . gingivalis, T . denticola and S . noxia in adult periodontitis.

J Clin Microbiol, 1998 Jul, 36(7), 2164 - 6
Streptococcus iniae, a human and animal pathogen: specific identification by the chaperonin 60 gene identification method; Goh SH et al.; It was recently reported that Streptococcus iniae, a bacterial pathogen of aquatic animals, can cause serious disease in humans . Using the chaperonin 60 (Cpn60) gene identification method with reverse checkerboard hybridization and chemiluminescent detection, we identified correctly each of 12 S . iniae samples among 34 aerobic gram-positive isolates from animal and clinical human sources.

J Clin Microbiol, 1998 Jul, 36(7), 1933 - 7
Extremely high prevalence of nasopharyngeal carriage of penicillin-resistant Streptococcus pneumoniae among children in Kaohsiung, Taiwan; Chiou CC et al.; Resistance (intermediate and high) to penicillin among Streptococcus pneumoniae strains is an emerging problem worldwide . From 1995 to 1997, isolates of S . pneumoniae not susceptible to penicillin were seen with increasing frequency from blood, cerebrospinal fluid, pleural fluid, and middle ear fluid from pediatric patients at the Veterans General Hospital-Kaohsiung . To determine the prevalence of carriage of these penicillin-nonsusceptible S . pneumoniae isolates, we obtained nasopharyngeal swab specimens from 2,905 children (ages, 2 months to 7 years) attending day-care centers or kindergartens or seen in our outpatient clinic . S . pneumoniae was isolated from 611 children, and 584 strains were available for analysis . The oxacillin disc test was used as a screening test to evaluate penicillin susceptibility . The MICs of 11 antibiotics (penicillin, cefaclor, cefuroxime, ceftriaxone, cefotaxime, imipenem, chloramphenicol, clarithromycin, rifampin, vancomycin, and teicoplanin) were determined by the E-test . Only 169 (29%) of the strains were susceptible to penicillin; 175 (30%) strains were intermediately resistant and 240 (41%) were highly resistant . The isolates also demonstrated high rates of resistance to other beta-lactams (46% were resistant to cefaclor, 45% were resistant to cefuroxime, 45% were resistant to ceftriaxone, 31% were resistant to cefotaxime, and 46% were resistant to imipenem) . The rate of resistance to macrolide antimicrobial agents was strikingly high; 95% of the isolates were not susceptible to clarithromycin . However, 97% were susceptible to rifampin and 100% were susceptible to the two glycopeptides (vancomycin and teicoplanin) . While reports of penicillin-resistant S . pneumoniae increased worldwide through the 1980s, the high prevalence (71%) of resistance reported here is astonishing . Surveillance of nasopharyngeal swab specimen cultures may provide useful information on the prevalence of nonsusceptible strains causing invasive disease . Such information could be used to guide therapy of pneumococcal infections.

Rev Alerg Mex, 1998 Mar-Apr, 45(2), 31 - 5
{Oropharyngeal bacterial flora in asthmatic and health subjects}; Vazquez Nava F et al.; MATERIAL AND METHODS: It was carried out cultivation of oozing pharyngeal to 248 fellows, 128 of them were asthmatic and 120 seemingly healthy . From group of asthmatic 55.46% they correspond to the masculine sex and 44.54% to the feminine; 72.97% they present more than two sharp squares of asthma per month . RESULTS: In the cultivation of 107 asthmatic the presence of germs is reported like: Staphylococcus aureus positive 43.56% (p = NS), the Streptococcus betahemolytic 72.97% (p = 0.001), Candida albicans 70.58% (p = 0.004), Streptococcus alpha haemolyticus 61.42% (p = 0.008) . CONCLUSIONS: When they exist more than two germs in a same individual frequently the Staphylococcus aureus is detected with the Streptococcus beta hemolytic 42.10% or with the Candida albicans 31.57% . We proposes to magnify the problem to which the patients face in order to order a medication or examine of laboratory with opportunity and when we hoped to obtain the good benefit for the health of the population.

Arch Med Res, 1998 Summer, 29(2), 143 - 8
Recognition of Streptococcus pyogenes and skin autoantigens in guttate psoriasis; Villeda-Gabriel G et al.; BACKGROUND: Guttate psoriasis is associated with infections by Streptococcus pyogenes and cross-reactions between skin and streptococcal antigens have been reported, suggesting an autoimmune component in the disease . METHODS: In this work, the authors looked for antibodies against S . pyogenes M-5 antigens by immunoblot in 52 sera of psoriasis patients and in 52 sera of normal individuals . Histological and immunohistochemical analysis in skin biopsies from lesions of another group of 16 clinically diagnosed guttate psoriasis patients and four healthy controls were also carried out . RESULTS: All guttate psoriasis patients studied (11) had IgG antibodies that intensively recognized three different proteins of 70, 60 and 14 kDa, as compared to sera from patients with other forms of psoriasis or from healthy controls . The diagnosis of psoriasis was confirmed in 14 of the patients by hematoxylineosin staining . Of the other two patients, one was diagnosed as parapsoriasis and the other as liquen . By indirect immunofluorescence (IFI), all 14 psoriatic patients had autoantibodies against their own lesional skin that did not recognize normal skin from control subjects or from the two non-psoriatic patients . The parapsoriatic and the liquen patients did not have autoantibodies . A rabbit immune serum against S . pyogenes antigens reacted with lesional skin from the 14 guttate psoriatic patients, but not with normal skin from controls or with lesional skin from the 2 non-psoriatic patients . CONCLUSIONS: The recognition by immunoblot of streptococcal antigens by serum of guttate psoriasis patients, the presence of autoantibodies against their own skin, and recognition of the same skin antigens by anti-streptococcal rabbit antibodies confirm the participation of the immune system and of streptococcal infections in guttate psoriasis.

Appl Microbiol Biotechnol, 1998 May, 49(5), 600 - 5
The diversion of lactose carbon through the tagatose pathway reduces the intracellular fructose 1,6-bisphosphate and growth rate of Streptococcus bovis; Bond DR et al.; Twenty strains of Streptococcus bovis grew more slowly on lactose (1.21 +/- 0.12 h-1) then than on glucose (1.67 +/- 0.12 h-1), and repeated transfers or prolonged growth in continuous culture (more than 200 generations each) did not enhance the growth rate on lactose . Lactose transport activity was poorly correlated with growth rate, and slow growth could not be explained by the ATP production rate (catabolic rate) . Batch cultures growing on lactose always had less intracellular fructose 1,6-bisphosphate (Frul,6P2) than cells growing on glucose (6.6 mM compared to 16.7 mM), and this difference could be explained by the pathway of carbon metabolism . Glucose and the glucose moiety of lactose were metabolized by the Embden-Meyerhoff-Parnas (EMP) pathway, but the galactose moiety of lactose was catabolized by the tagatose pathway, a scheme that by-passed Frul,6P2 . A mutant capable of co-metabolizing lactose and glucose grew more rapidly when glucose was added, even though the total rate of hexose fermentation did not change . Wild-type S . bovis grew rapidly with galactose and melibiose, but these galactose-containing sugars were activated by galactokinase and catabolized via EMP . On the basis of these results, rapid glycolytic flux through the EMP pathway is needed for the rapid growth (more than 1.2 h-1) of S . bovis.

Obstet Gynecol, 1998 Jul, 92(1), 28 - 30
Oral quinolone in the treatment of experimental polymicrobial puerperal infection in rabbits; McDuffie RS Jr et al.; OBJECTIVE: To evaluate the efficacy of oral levofloxacin in the treatment of experimental polymicrobial puerperal infection in the rabbit . METHODS: Timed pregnant rabbits were anesthetized on day 29 or 30 of a 31-day gestation and 106 colony-forming units each of Escherichia coli, group B streptococcus, and Staphylococcus saccharolyticus were inoculated endoscopically in the cervices . Labor was induced with intramuscular oxytocin 16 hours later if it had not occurred spontaneously . The animals then were observed every 3 hours for fever; when a temperature of 104F was reached, treatment was begun . Animals were assigned randomly in a blinded, placebo-controlled manner to received oral levofloxacin (10 mg/kg/day) or placebo and were treated twice daily for 4-5 days . The animals were killed and necropsy was performed 4-6 hours after the last dose . Specimens for culture were taken from uterine horns, peritoneum, and blood . Levofloxacin concentrations were determined from blood samples at necropsy . Clinical cure of fever, eradication of microbes, and presence of uterine abscesses at necropsy were assessed . RESULTS: Compared with placebo-treated rabbits, levofloxacin-treated animals had a significantly greater number of clinical cures (nine of 11 versus four of 12, P=.027) and significantly more eradication of E coli (ten of 11 versus five of 12, P=.022) . Four uterine abscesses were seen in 12 placebo-tested animals, compared with none of 11 levofloxacin-tested animals (P=.093) . There was no difference in eradication of group B streptococcus between the two groups . No blood cultures were positive for organisms in any animal . Levofloxacin was detected in all treated animals, but at low levels (less than 1 microg/mL) . CONCLUSION: Treatment of experimental puerperal infection with oral levofloxacin in rabbits resulted in significantly more clinical cures and eradication of E coli compared with treatment with placebo.

Mol Gen Genet, 1998 May, 258(4), 326 - 33
Effect of signal peptide changes on the extracellular processing of streptokinase from Escherichia coli: requirement for secondary structure at the cleavage junction; Pratap J et al.; Streptokinase (SK), an extracellular protein from Streptococcus equisimilis, is secreted post-translationally by Escherichia coli using both its native and E . coli-derived transport signals . In this communication we report that cleavage specificity of signal peptidase I, and thus efficiency of secretion, varies in E . coli when SK export is directed by different transport signals . The native (+1) N-terminus of mature SK was retained when it was transported under the control of its own, PelB or LamB signal peptide . However, when translocation of SK was controlled by the OmpA or MalE signal peptide, Ala2 of mature SK was preferred as a cleavage site for the pre-SK processing . Our results indicate that compatibility of the leader peptide with the mature sequences of SK, which fulfills the requirement for a given secondary structure within the cleavage region, is essential for maintaining the correct processing of pre-SK . An OmpA-SK fusion, which results in the deletion of two N-terminal amino acid residues of mature SK, was further studied with respect to the recognition of alternative cleavage site in E . coli . The alanine at +2 in mature SK was changed to glycine or its relative position was changed to +3 by introducing a methionine residue at the +1 position . Both alterations resulted in the correct cleavage of pre-SK at the original OmpA fusion site . In contrast, introduction of an additional alanine at +4, creating three probable cleavage sites (Ala-x-Ala-x-Ala-x-Ala), resulted in the recognition of all three target sites for cleavage, with varying efficiency . The results indicate that the nature of the secondary structure generated at the cleavage junction of pre-SK, resulting from the fusion of different signal peptides, modulates the cleavage specificity of signal peptidase I during extracellular processing of SK . Based on these findings it is proposed that flexibility in the interaction of the active site of signal peptidase I with the cleavage sites of signal peptides may occur when it encounters two or more juxtaposed cleavage sites . Preference for one cleavage site over another, then, may depend on fulfillment of secondary structure requirements in the vicinity of the pre-protein cleavage junction.

Carbohydr Res, 1998 Jan, 306(3), 335 - 9
Measurement of long-range carbon-carbon coupling constants in a uniformly enriched complex polysaccharide; Xu Q et al.; A quantitative coherence transfer scheme for 1H-detected measurement of long-range carbon-carbon coupling constants in NMR spectra of complex carbohydrates is described . It is applied to a uniformly highly 13C-enriched monosaccharide and to a complex cell wall polysaccharide from Streptococcus mitis J22 having seven distinct sugars in the repeating subunit . Coupling values within the ring were compared to published values for monosaccharides to demonstrate the validity of the method . An attempt was made to relate coupling constants between carbon atoms across the glycosidic linkage to the dihedral angles of a recently published flexible model for the polysaccharide which is based on 3JCH data . The experimental coupling constants do not agree with any single conformation demonstrating that the repeating subunit of the polysaccharide must be flexible . This conclusion is in accord with results of molecular modeling nuclear Overhauser effect and 3JCH data.

Appl Environ Microbiol, 1998 Jul, 64(7), 2335 - 40
Structure-activity study of the lantibiotic mutacin II from Streptococcus mutans T8 by a gene replacement strategy; Chen P et al.; Mutacin II, elaborated by group II Streptococcus mutans, is a ribosomally synthesized and posttranslationally modified polypeptide antibiotic containing unusual thioether and didehydro amino acids . To ascertain the role of specific amino acid residues in mutacin II antimicrobial activity, we developed a streptococcal expression system that facilitates the replacement of the mutA gene with a single copy of a mutated variant gene . As a result, variants of mutacin II can be designed and expressed . The system was tested by constructing the following mutant peptides: delta N1, V7A, P9A, T10A, T10S, C15A, C26A, and C27A . All of these mutacin II variants except delta N1 and T10A, which were not secreted, were isolated, and their identities were verified by mass spectrometry . Variants P9A, C15A, C26A, and C27A failed to exert antimicrobial activity . Because the P9A and T10A variants comprise the "hinge" region of mutacin II, these observations suggest that in addition to the thioether and didehydro amino acids, the hinge region is essential for biological activity and biosynthesis or export of the peptide . Tandem mass spectrometry of the N-terminal part of the wild-type molecule and its C15A variant confirmed that the threonine at position 10 is dehydrated and present as a didehydrobutyrine residue . This analysis of the active T10S variant further suggested that a didehydro amino acid at this position is specific for antimicrobial activity and that the biosynthetic machinery does not discriminate between threonine and serine . In contrast, the lack of production of mutacin variants with alanine substituted for threonine at position 10, as well as the deletion of asparagine at the N terminus (delta N1), indicates that specific residues in the propeptide may be crucial for certain steps in the biosynthetic pathway of this lantibiotic.

Ned Tijdschr Geneeskd, 1998 Apr 4, 142(14), 793 - 6
{Primary peritonitis due to Streptococcus pneumoniae in childhood}; van Houten MA et al.; Three patients, two boys of 5 months and 6 years and one girl aged 4 years, presented with acute abdominal pain, vomiting and fever, suggesting peritonitis . Imaging examinations (abdominal survey roentgenogram and (or) echography), exploratory laparotomy (in two patients) and blood cultures with growth of Streptococcus pneumoniae led to the diagnosis of primary peritonitis . Intravenous antibiotics led to recovery, in one patient complicated by paralytic ileus, which was treated surgically . Primary peritonitis is a rare condition which should be considered in the differential diagnosis of children with an acute abdominal syndrome . Conditions requiring surgery should be excluded by imaging examinations or laparotomy . When the diagnosis is confirmed by paracentesis or laparotomy, antibiotic treatment has to be started.

Vet Microbiol, 1998 Mar 15, 61(1-2), 93 - 110
Potential virulence factors of Streptococcus dysgalactiae associated with bovine mastitis; Calvinho LF et al.; Mastitis caused by environmental pathogens is a major problem that affects many well-managed dairy herds . Among the environmental pathogens, Streptococcus dysgalactiae is isolated frequently from intramammary infections during lactation and during the nonlactating period . In spite of its high prevalence, little is known about factors that contribute to the virulence of S . dysgalactiae . During the last decade, several cell-associated and extracellular factors of S . dysgalactiae have been identified; yet, the relative importance of these factors in the transmission and pathogenesis of mastitis caused by S . dysgalactiae has not been defined . Streptococcus dysgalactiae can interact with several plasma and extracellular host-derived proteins such as immunoglobulin G, albumin, fibronectin, fibrinogen, collagen, vitronectin, plasminogen, and alpha 2-macroglobulin . These interactions are mediated by bacterial surface proteins . This organism also produces hyaluronidase and fibrinolysin which may be involved in promoting dissemination of the organism into host tissue . Streptococcus dysgalactiae adheres to and is internalized by bovine mammary epithelial cells in vitro . Involvement of host cell kinases, intact microfilaments and de novo eukaryotic protein synthesis are required for internalization of S . dysgalactiae into bovine mammary epithelial cells; a process that appeared to occur by a receptor-mediated endocytosis mechanism . However, de novo bacterial protein synthesis was not required for epithelial cell internalization . Furthermore, S . dysgalactiae survived within mammary epithelial cells for extended periods of time without losing viability or damaging the eukaryotic cell . Further research on characterization of host-pathogen interactions that take place during the early stages of mammary gland infection will enhance our understanding of pathogenesis of intramammary infection which may contribute to development of methods to minimize production losses due to mastitis.

J Nat Prod, 1998 Jun 26, 61(6), 817 - 20
Binaphthalenone glycosides from African chewing sticks, Diospyros lycioides; Li XC et al.; Our laboratory has engaged in the exploration of active antimicrobial principles present in chewing sticks commonly used by the African and Middle Eastern countries as a mechanical oral hygiene aid in place of tooth brushing . During this investigation, a methanol extract from the twigs of Diospyros lycioides, a Namibia tooth cleaning stick, demonstrated antimicrobial activity against common oral pathogens including Streptococcus mutans and Porphyromonas gingivalis (MICs 2.5 and 0.156 mg/mL) . Subsequent fractionation and purification of this extract led to the identification of two novel binaphathalenone glycosides: 1', 2-binaphthalen-4-one-2',3-dimethyl-1,8'-epoxy-1,4',5,5',8, 8'-hexahydroxy-8-O-beta-glucopyranosyl-5'-O-beta-xylopyranosyl(1-- >6) -beta-glucopyranoside (1) and 1',2-binaphthalen-4-one-2', 3-dimethyl-1,8'-epoxy-1,4',5,5',8,8'-hexahydroxy-5', 8-di-O-beta-xylopyranosyl(1-->6)-beta-glucopyranoside (2) . Their structures were established using spectroscopic techniques . Examination of the antimicrobial activity of these two compounds revealed positive but only marginal growth inhibition against the test cariogenic pathogens, S . sanguis and Streptococcus mutans.

West Afr J Med, 1998 Jan-Mar, 17(1), 19 - 24
Screening of potential semen donors for sexual transmitted diseases; Olatunbosun OA et al.; BACKGROUND AND OBJECTIVES: The risk of infection with sexually transmitted diseases (STDs) is of great concern to couples undergoing therapeutic donor insemination . GOAL OF STUDY: We sought to determine the prevalence of STDs in potential semen donors and assess the rate of acquisition of new infection during the follow-up period . STUDY DESIGN: 29 potential semen donors were screened for common STDs . RESULTS: The study population had a prevalence of the following STDs: 27.5% ureaplasma, 13.8% mycoplasma, 6.9% cytomegalovirus 6.9% group B streptococcus, and 3.4% human papillomavirus infection . No participant tested positive for gonoccoccal or HIV infection . Over all, evidence of STD was present in 10 of 29 (34.5%) prospective donors . A follow-up infection rate of 22.2% (6 of 27 enrolled donors) was found and 3 (11.1%) of these were excluded from semen donation . CONCLUSION: A high prevalence of sexually transmissible infections is present in potential semen donors . New infections are also common during the follow-up period.

Kansenshogaku Zasshi, 1998 May, 72(5), 526 - 35
{Experimental studies of polymorphonuclear leukocyte on mandibular bone infection model in rabbit}; Abe A et al.; Polymorphonuclear leukocytes (PMN) play important roles in the prevention of infection at an early stage . We studied the function of these leukocytes using rabbit models of mandibular bone infection to evaluate the conditions which could not be reproduced in human beings Streptococcus milleri NCTC7331 and Bacteroides fragillis NCTC9343 were inoculated into the mandibular bone of rabbits using the Satoh-Heimdahl method, to produce supposed multiple infection models . Rabbits inoculated with these bacteria were used as a test group, and animals with surgically induced inflammation were used as a control group . We compared the number of leukocytes, the function of PMN, and histopathologic findings . 1) The number of leukocytes increased after treatment, reached a perk on day 3, gradually diminished later, but remained slightly higher than the baseline level on day 7, with persistence of inflammation in both groups . 2) Adhesiveness, ability to migrate and NBT reduction, were accelerated in both groups . 3) These functions of PMN accelerated more in the test group because the bacteria inoculated induced stronger inflammatory reactions and activated a series of infection defense mechanisms in the hosts . 4) Histopathologic examination after treatment showed invasion of inflammatory cells, predominantly leukocytes, in both groups, but heavier and more extensive infiltration in the group treated with the bacteria . All measurements were higher in the test group than the control group . These results showed that in the test group, causative or accompanied microorganisms activated the host's infection defense mechanisms and accelerated the functioning of PMN at an acute stage of infection.

Kansenshogaku Zasshi, 1998 May, 72(5), 475 - 81
{Epidemiological study on penicillin-resistant Streptococcus pneumoniae}; Yamasaki S et al.; We studied the differences among clinical isolates of Penicillin-resistant Streptococcus pneumoniae by polymerase chain reaction (PCR) of pbp2b gene, followed by serotyping and pulsed field gel electrophoresis (PFGE) analysis . Clinical isolates were recovered from sputum samples from patients with respiratory infection in Tottori University Hospital between June 1986 and May 1996 . By PCR, altered pbp2b genes of the resistant isolates were detected in 76.5% . The percentages of the isolates that had altered pbp2b genes increased concomitantly with the minimum inhibitory concentration (MIC) . By serotyping the percentage of 19F, 23F, 6B and 14 was 54.5%, 18.2%, 9.1% and 9.1% respectively . The frequency of isolates resistant to penicillin increased rapidly from 1991 in this hospital and most isolates belonged to serotype 19F . The resistant isolates in this hospital and 4 clinical resistant isolates of S . pneumoniae 19F in a second hospital were studied by PFGE . 14 of 18 resistant 19F isolates in this hospital and all 19F isolates from the second hospital presented an identical pattern . The remaining 4 samples were similar though not completely identical . These results indicate that the penicillin resistant 19F isolates have a common clonal origin and have spread rapidly from 1991 in this hospital.

J Endod, 1998 Feb, 24(2), 86 - 90
Endodontic pathogens stimulate monocyte chemoattractant protein-1 and interleukin-8 in mononuclear cells; Jiang Y et al.; Microbial infection of the dental pulp leads to the recruitment of leukocytes and the formation of lesions of endodontic origin . The chemokines interleukin-8 (IL-8) and monocyte chemoattractant protein-1 (MCP-1) are relatively specific chemoattractants for neutrophils and monocytes, respectively . In the present studies, peripheral blood mononuclear cells were stimulated by Streptococcus mutants, Porphyromonas endodontalis, and Peptostreptococcus anaerobius, which are associated with lesions of endodontic origin . Each of these bacteria induced a dose-dependent increase in IL-8 and MCP-1, determined by ELISA . The levels induced are physiologically relevant . However, low doses of P . endodontalis were less effective in inducing IL-8 or MCP-1 expression, compared with S . mutants or P . anaerobius . Thus, these bacteria can induce significant levels of the chemokines IL-8 and MCP-1, which could contribute to the recruitment of neutrophils or monocytes in vivo . The expression of these mediators may contribute to the development of endodontic infections, particularly with regard to inflammatory leukocyte recruitment.

Zentralbl Bakteriol, 1998 May, 287(4), 449 - 60
Cloning and sequencing of BeS-1 gene encoding the immunogenic antigen of Streptococcus sanguis KTH-1 isolated from the patients with Behçet's disease; Yoshikawa K et al.; In order to analyze the immunopathologic mechanisms of Behcet's disease, the gene (bes-1) encoding a streptococcal antigen correlated with the disease was cloned and sequenced, and protein produced by this clone was identified by Western immunoblotting using serum antibody from the patient . Cellular DNA of Streptococcus (S.) sanguis serotype KTH-1 (uncommon serotype 1, strain 113-20) from the patient was extracted and digested with EcoRI . The digested fragments were cloned into the cloning vector lambda gt11, and then the resulting DNA library was immunoscreened using the patient's serum antibody to serotype KTH-1 . The immunopositive clone of the 1.5 kbp fragment was subcloned into pUC 118 plasmid (pU8BeS1-1) and sequenced . The sequence showed that the 3'-terminal half side region of this insert contained 962bp of open-reading frame (ORF) discontinued at the EcoRI restriction site, and the stop codon was not found . The nucleotide sequence of the remaining additional 3'-terminal region of this gene encoding whole BES-1 was determined by genome walking . The whole ORF of bes-1 consisted of 849 amino acid residues with a calculated molecular mass of 95 kDa . The residues in a portion of the amino acid sequence showed a 60% correspondence to those of the human intraocular peptide Brn-3b.

J Cardiovasc Surg (Torino), 1998 Apr, 39(2), 227 - 8
Myocardial abscess at a distant zone from the active valvular infection; Romero-Menor C et al.; A case of an infective endocarditis with myocardial abscess due to Streptococcus anginosus at a distant location from the active valvular infection is reported . We conclude that local cardiac suppurative complications can appear in the evolution of endocarditis caused by this virulent organism.

Kyobu Geka, 1998 Jun, 51(6), 488 - 91
{A case report of mycotic aneurysms of descending thoracic aorta}; Doi K et al.; A rare case of mycotic aneurysms of descending thoracic aorta is presented . A 63-year-old man was admitted with history of persistent high fever and loss of consciousness to our hospital . On admission, there were elevated WBC and CRP . Blood and spinal fluid cultures revealed growth of Streptococcus pneumonia . Despite of antibiotic therapy for meningitis and bacteremia, inflammatory sign continued, and new abnormal shadow appeared on chest X-ray . Chest CT and aortography showed two aneurysms of descending thoracic aorta . In an emergency operation, there was no abscess formation around the aneurysms . Aneurysms were excised en bloc without opening aneurysms followed by in situ Dacron tube graft replacement . The patient has been doing well without infection.

N Engl J Med, 1998 Jun 25, 338(26), 1861 - 8
An outbreak of multidrug-resistant pneumococcal pneumonia and bacteremia among unvaccinated nursing home residents; Nuorti JP et al.; BACKGROUND: Outbreaks of pneumococcal disease are uncommon and have occurred mainly in institutional settings . Epidemic, invasive, drug-resistant pneumococcal disease has not been seen among adults in the United States . In February 1996, there was an outbreak of multidrug-resistant pneumococcal pneumonia among the residents of a nursing home in rural Oklahoma . METHODS: We obtained nasopharyngeal swabs for culture from residents and employees . Streptococcus pneumoniae isolates were serotyped and compared by pulsed-field gel electrophoresis . A retrospective cohort study was conducted to identify factors associated with colonization and disease . RESULTS: Pneumonia developed in 11 of 84 residents (13 percent), 3 of whom died . Multidrug-resistant S . pneumoniae, serotype 23F, was isolated from blood and sputum from 7 of the 11 residents with pneumonia (64 percent) and from nasopharygeal specimens from 17 of the 74 residents tested (23 percent) and 2 of the 69 employees tested (3 percent) . All the serotype 23F isolates were identical according to pulsed-field gel electrophoresis . Recent use of antibiotics was associated with both colonization (relative risk, 2.3; 95 percent confidence interval, 1.3 to 4.2) and disease (relative risk, 3.6; 95 percent confidence interval, 1.2 to 10.8) . Only three residents (4 percent) had undergone pneumococcal vaccination . After residents received pneumococcal vaccine and prophylactic antibiotics, there were no additional cases of pneumonia, and the rates of carriage decreased substantially . CONCLUSIONS: In this outbreak a single pneumococcal strain was disseminated among the residents and employees of a nursing home . The high prevalence of colonization with a virulent organism in an unvaccinated population contributed to the high attack rate . Clusters of pneumococcal disease may be underrecognized in nursing homes, and wider use of pneumococcal vaccine is important to prevent institutional outbreaks of drug-resistant S . pneumoniae infection.

Infect Immun, 1998 Jul, 66(7), 3449 - 53
Identification of an insertion sequence located in a region encoding virulence factors of Streptococcus pyogenes; Berge A et al.; An insertion sequence, IS1562, was identified in a Streptococcus pyogenes strain of the clinically important M1 serotype . IS1562 is located in the mga regulon between the genes coding for the M protein and the C5a peptidase, both important virulence factors . The same or similar insertion sequences were found in most S . pyogenes strains, but the chromosomal location differed among isolates.

Infect Immun, 1998 Jul, 66(7), 3337 - 48
Identification and characterization of staphylococcal enterotoxin types G and I from Staphylococcus aureus; Munson SH et al.; Staphylococcal enterotoxins are exotoxins produced by Staphylococcus aureus that possess emetic and superantigenic properties . Prior to this research there were six characterized enterotoxins, staphylococcal enterotoxin types A to E and H (referred to as SEA to SEE and SEH) . Two new staphylococcal enterotoxin genes have been identified and designated seg and sei (staphylococcal enterotoxin types G and I, respectively) . seg and sei consist of 777 and 729 nucleotides, respectively, encoding precursor proteins of 258 (SEG) and 242 (SEI) deduced amino acids . SEG and SEI have typical bacterial signal sequences that are cleaved to form toxins with 233 (SEG) and 218 (SEI, predicted) amino acids, corresponding to mature proteins of 27,043 Da (SEG) and 24,928 Da (SEI) . Biological activities for SEG and SEI were determined with recombinant S . aureus strains . SEG and SEI elicited emetic responses in rhesus monkeys upon nasogastric administration and stimulated murine T-cell proliferation with the concomitant production of interleukin 2 (IL-2) and gamma interferon (IFN-gamma), as measured by cytokine enzyme-linked immunoassays . SEG and SEI are related to other enterotoxins of S . aureus and to streptococcal pyrogenic exotoxin A (SpeA) and streptococcal superantigen (SSA) of Streptococcus pyogenes . Phylogenetic analysis and comparisons of amino acid and nucleotide sequence identities were performed on related staphylococcal and streptococcal protein toxins to group SEG and SEI among the characterized toxins . SEG is most similar to SpeA, SEB, SEC, and SSA (38 to 42% amino acid identity), while SEI is most similar to SEA, SEE, and SED (26 to 28% amino acid identity) . Polyclonal antiserum was generated against purified histidine-tagged SEG and SEI (HisSEG and HisSEI) . Immunoblot analysis of the enterotoxins, toxic-shock syndrome toxin 1, and SpeA with antiserum prepared against HisSEG and HisSEI revealed that SEG shares some epitopes with SEC1 while SEI does not.

Am J Physiol, 1998 Jun, 274(6 Pt 1), L958 - 69
Pulmonary surfactant proteins A and D enhance neutrophil uptake of bacteria; Hartshorn KL et al.; The collectins are a class of collagenous lectin proteins present in serum and pulmonary secretions {pulmonary surfactant protein (SP) A and SP-D} that are believed to participate in innate immune responses to various pathogens . With the use of flow cytometric and fluorescent-microscopic assays, SP-A and SP-D were shown to increase calcium-dependent neutrophil uptake of Escherichia coli, Streptococcus pneumoniae, and Staphylococcus aureus . Evidence is provided that the collectins enhanced bacterial uptake through a mechanism that involved both bacterial aggregation and direct actions on neutrophils . The degree of multimerization of SP-D preparations was a critical determinant of both aggregating activity and potency in enhancing bacterial uptake . The mechanisms of opsonizing activity of SP-D and SP-A differed in important respects from those of opsonizing antibodies . These results provide the first evidence that surfactant collectins may promote neutrophil-mediated clearance of bacteria in the lung independently of opsonizing antibody.

Clin Infect Dis, 1998 Jun, 26(6), 1312 - 20
Once-daily sparfloxacin versus high-dosage amoxicillin in the treatment of community-acquired, suspected pneumococcal pneumonia in adults . Sparfloxacin European Study Group; Aubier M et al.; The objective of this randomized, double-blind, multicenter study of 329 adult patients requiring hospitalization was to compare the safety and efficacy of sparfloxacin at a dosage of 200 mg once daily (following a 400-mg loading dose on day 1) with those of amoxicillin given as a 1-g oral dose three times daily for treatment of community-acquired pneumonia suspected to be due to Streptococcus pneumoniae . Success of treatment was determined by a combination of clinical assessment and chest radiography . Pneumococcal pneumonia was the confirmed diagnosis for 177 patients (54%) . Overall rates of success among evaluable patients were equivalent between drugs, both at the end of treatment (sparfloxacin, 92%; amoxicillin, 87%) and at follow-up (sparfloxacin, 89%; amoxicillin, 84%) . Sparfloxacin was well-tolerated and produced fewer gastrointestinal effects than amoxicillin . In conclusion, sparfloxacin is a safe and effective alternative to high-dose amoxicillin for the treatment of suspected pneumococcal community-acquired pneumonia.

Clin Infect Dis, 1998 Jun, 26(6), 1355 - 61
Invasive Streptococcus pneumoniae infection in Latin American children: results of the Pan American Health Organization Surveillance Study; Kertesz DA et al.; Protein-polysaccharide conjugate vaccines against Streptococcus pneumoniae promise to be an effective public health intervention for children, especially in an era of increasing antimicrobial resistance . To characterize the distribution of capsular types in Latin America, surveillance for invasive pneumococcal infection in children < or = 5 years of age was done in six countries between February 1993 and April 1996 . Fifty percent of 1,649 sterile-site isolates were from children with pneumonia, and 52% were isolated from blood . The 15 most common of the capsular types prevalent throughout the region accounted for 87.7% of all isolates . Overall, 24.9% of isolates had diminished susceptibility to penicillin: 16.7% had intermediate resistance and 8.3% had high-level resistance . Three customized vaccine formulas containing 7, 12, and 15 capsular types were found to have regional coverages of 72%, 85%, and 88%, respectively . This study emphasizes the need for local surveillance for invasive pneumococcal disease prior to the development and evaluation of protein-polysaccharide conjugate vaccines for children.

Clin Infect Dis, 1998 Jun, 26(6), 1346 - 54
Clinical outcome of invasive infections by penicillin-resistant Streptococcus pneumoniae in Korean children; Choi EH et al.; One hundred six cases of invasive pneumococcal infections diagnosed from 1985 to 1996 were analyzed retrospectively . The types of infection were bacteremia without focus (45%), meningitis (19%), peritonitis (17%), pneumonia (bacteremic) (16%), and others (3%) . Penicillin-nonsusceptible Streptococcus pneumoniae was first detected in 1989, and its incidence increased rapidly thereafter, reaching 89% in 1995 . Initial empirical regimens were of parenteral beta-lactam antimicrobials with or without an aminoglycoside, but these were modified subsequently . Among the 72 nonmeningeal infections analyzed, a favorable response at 72 hours and death were observed in 83% and 2.5%, respectively, of 40 penicillin-susceptible infections, as compared with 86% (P = 1.0) and 7.1% (P = .45) of 14 infections due to intermediate strains and 61% (P = .07) and 11% (P = .22) of 18 due to resistant strains . The favorable-response rate and mortality among 49 patients not in initially critical condition were 92% and zero, respectively, as compared with 52% (P = .00027) and 17% (P = .008) of 23 in critical condition . The data suggest that clinical outcome of penicillin-nonsusceptible pneumococcal infection outside the CNS may be more closely related to clinical condition at presentation than to the level of resistance of the causative strain when such infection is treated with parenteral beta-lactams.

Ann Dermatol Venereol, 1996, 123(12), 804 - 6
{Acute necrotizing cutaneous streptococcal infection following bites or scratch by dog or cat}; Tanasescu S et al.; INTRODUCTION: Domestic animal bites or scratches are quite frequent . Among banal bacteria isolated from infected bites or scratches, group A streptococcus seems to be frequently associated with severe infections . CASE REPORTS: Three cases of acute necrotizing cutaneous streptococcal infections, following cat or dog bite or scratch are reported . Twice, group A streptococcus was isolated from cutaneous swabs . In the third case, previous antibiotic therapy had sterilised bacteriological samples . Diagnosis was ascertained on the basis of clinical presentation and significant antistreptococcal antibodies elevation . Skin necrosis around the inoculation area was observed in the 3 cases . Cicatrisation required an average of two months under appropriate treatment . DISCUSSION: An evolution towards cutaneous necrosis localized to the initially injured area is common to these three cases . This peculiar evolution is worth to be known in order to choose an effective anti streptococcal antibiotherapy whenever domestic animals bites and scratches are to be treated.

Diagn Microbiol Infect Dis, 1998 Jun, 31(2), 373 - 6
Combinations of orally administered beta-lactams to maximize spectrum and activity against drug-resistant respiratory tract pathogens: I . Synergy studies of amoxicillin and cefixime with Streptococcus pneumoniae; Jones RN et al.; Streptococcus pneumoniae strains have emerged that are resistant to penicillin (MICs >0.06 microg/mL) and many other beta-lactams . However, some older compounds such as amoxicillin have potency against these pneumococci with altered penicillin-binding proteins, but are labile to beta-lactamases produced by other prevalent respiratory tract pathogens . The interactions of amoxicillin with an enzyme-stable cephalosporin (cefixime) with a long elimination half-life were examined by the checkerboard dilution method versus 39 S . pneumoniae strains (13 resistant, 15 intermediate, and 11 susceptible to penicillin) . Among 24 strains with evaluable drug interaction tests, 17 (71%) demonstrated partial or complete synergy . This favorable interaction produces a cefixime susceptibility category change from resistant or intermediate to susceptible for 16 of 28 strains (57%), when combined with < or = 1 microg/mL amoxicillin . Thus, the use of two currently available oral beta-lactams (amoxicillin twice a day + cefixime once a day; three total doses) appears to be a potential alternative treatment with greater spectrum for community-acquired respiratory tract infections pending clinical trial results.

Microb Pathog, 1998 Jun, 24(6), 341 - 9
Interaction of a group A Streptococcus within human plasma results in assembly of a surface plasminogen activator that contributes to occupancy of surface plasmin-binding structures; D'Costa SS et al.; Group A streptococcal isolate 187061 incubated in human plasma or serum reconstituted with fibrinogen but not plasminogen-depleted plasma or serum alone acquired a surface plasminogen activator activity . Assembly of the surface plasminogen activator was inhibited by the presence of neutralizing antibodies to streptokinase . Once assembled, the bacterial-associated plasminogen activator could generate plasmin when incubated in human plasminogen, plasmin or serum which could bind to bacterial surface plasmin-binding structures despite the presence of host physiological inhibitors . These studies provide evidence that the pathways by which group A isolates interact with human plasmin(ogen) are potentially linked and may provide a mechanism for bacteria to acquire host enzymatic activity efficiently in the infected host .

Mol Microbiol, 1998 May, 28(3), 487 - 500
Isolation and characterization of Fap1, a fimbriae-associated adhesin of Streptococcus parasanguis FW213; Wu H et al.; An adhesin of Streptococcus parasanguis FW213, a primary colonizer of the tooth surface, has been purified from the culture medium by immunoaffinity chromatography . The purified protein has a molecular mass of 200 kDa and stains positively for carbohydrate . The amino-terminal sequence indicated that this protein represented a unique streptococcal surface protein . Immunogold labelling of the bacterium indicated that this protein was associated with fimbriae and designated Fap1 (fimbriae-associated protein) . A polymerase chain reaction (PCR) product based on the amino terminus of Fap1 was used to probe an FW213 genomic library . A 9 kb fragment containing the fap1 gene was isolated and 2.5 kb have been sequenced . Generation of fap1 mutants by a single cross-over (Campbell insertion) or a non-polar allelic exchange abolished the expression of Fap1 . The inactivation of fap1 resulted in a dramatic reduction in the expression of the long peritrichous fimbriae and adhesion to saliva-coated hydroxylapatite (SHA) . Northern blots probed with an internal gene fragment of fap1 hybridized to a 9 kb transcript, which suggests that fap1 is transcribed as a polycistronic message . These data demonstrate that Fap1 is a unique streptococcal adhesin that is involved in the assembly of S . parasanguis FW213 fimbriae and adhesion to SHA.

FEMS Microbiol Lett, 1998 Jun 1, 163(1), 73 - 7
Zoocin A immunity factor: a femA-like gene found in a group C streptococcus; Beatson SA et al.; A 6.8-kb fragment of Streptococcus equi subsp . zooepidemicus 4881 DNA containing the zoocin A gene (zooA) was cloned in Escherichia coli and sequenced . We have identified a gene we call zoocin A immunity factor (zif), which protects the producer cell from the otherwise lethal action of its own product . Transformation of Streptococcus gordonii DL1 with zooA and zif changed its phenotypic character from a non-zoocin A producing-zoocin A sensitive cell to a zoocin A producing-zoocin A resistant cell . zif has sequence homology to femA (factor essential for methicillin resistance) and lif (lysostaphin immunity factor) . No differences were observed in amino acid or amino sugar compositions of peptidoglycan purified from zoocin A sensitive vs . zoocin A immune cells.

Protein Expr Purif, 1998 Jun, 13(1), 83 - 9
Expression and purification of Streptococcus pneumoniae hyaluronate lyase from Escherichia coli; Jedrzejas MJ et al.; Pneumococcal hyaluronate lyase enzyme breaks down hyaluronan of the extracellular matrix of tissues and possibly contributes to the invasion of host tissue and to the penetration of host defenses by this bacterial pathogen . In light of the emergence of increasing numbers of antibiotic-resistant strains, the understanding of the mechanism of action of hyaluronate lyase enzyme may lead to a better understanding of interactions between a host and bacterial pathogens and may contribute to more efficient treatment of bacterial infections . The native Streptococcus pneumoniae hyaluronate lyase enzyme has a molecular mass of 107 kDa but undergoes conversion to smaller enzymatically active forms . The truncated 83-kDa functional form of the enzyme has been cloned into the pET-21d vector, expressed in Escherichia coli, and purified to homogeneity using a nickel affinity column with chelating Sepharose fast flow media . The recombinant enzyme is active and stable and the availability of large quantities of the enzyme will help in its biochemical and biophysical characterization . As a number of other Gram-positive surface proteins, it appears that the enzyme is anchored via its carboxy-terminal part to the pneumococcal cell wall by a covalent linkage with peptidoglycan structures.

J Biochem (Tokyo), 1998 May, 123(5), 937 - 45
Diversity of capsular polysaccharide synthesis gene clusters in Streptococcus pneumoniae; Kolkman MA et al.; Streptococcus pneumoniae comprises 90 serotypes, each one having its own specific polysaccharide capsule . In order to explore the diversity of capsular polysaccharide synthesis (cps) gene clusters in S . pneumoniae, we performed cross-hybridizations between the 12 cps genes of S . pneumoniae serotype 14 and chromosomal DNA of 26 strains comprising 26 different capsule types . Large variations in the hybridization patterns were observed . The genes cps14A to cps14D are conserved in most serotypes . Sequences homologous to cps14I to cps14L were only observed in the four types of serogroup 15, which all have a capsule structure similar to that of type 14 . By using a cps14E knock-out construct, cpsE mutants of the pneumococcal types 9N, 13, and 15B were obtained . These mutants were unencapsulated and showed reduced glycosyltransferase activity, indicating that the pneumococcal types 9N, 13, and 15B express a glucosyl-1-phosphate transferase which is homologous to Cps14E . Glycosyltransferase assays showed that among 21 pneumococcal types which contain glucose in the core of their capsule polysaccharide, 19 types express glucosyl-1-phosphate transferase activity . However, not all of these types hybridized strongly with Cps14E, the type 14 glucosyl-1-phosphate transferase gene . Thus, pneumococci possess glucosyltransferase genes distinct from cps14E, but encoding enzymes with identical activity . All serotypes which synthesized lipid-linked lactose intermediates in glycosyltransferase activity assays (type 11B, 13, 15F, 15A, 15B, 15C) hybridized with cps14G . This gene encodes a galactosyltransferase which catalyzes the addition of 1,4-linked beta-galactose to lipid-linked glucose . The cps14G homologues in type 11B, 13, 15F, 15A, 15B, and 15C may encode a similar beta-galactosyltransferase activity as cps14G in type 14.

Arq Neuropsiquiatr, 1997 Jun, 55(2), 231 - 6
{Postoperative mortality in infective endocarditis: determinant factors}; Andre C et al.; The factors leading to high postoperative mortality in active infectious endocarditis (IE) are poorly defined . We studied patients operated at an University Hospital between March 1978 and April 1992 . We hypothesized that the summation of potential adverse factors would strongly increase mortality after surgery . We studied 39 patients (28 men), age range 13-70 years (mean +/- SD = 32 +/- 16) operated during active IE (time from onset 52 +/- 48 days) . Predisposing factor: rheumatic valvar disease in 14 cases, intravenous drug use in 5 . Affected valves: aortic in 14, mitral in 10, tricuspid in 8, multiple structures in 7 . In most cases, S aureus (12) or Streptococcus sp (10) was isolated in blood cultures . Surgery was indicated in most patients because of heart failure (30), multiple embolic complications (17) or treatment failure (14) . The possible adverse influence of specific demographic characteristics, clinical features and surgical variables was assessed by the Student t test or the chi 2 test . Also, multiple regression analysis was performed in order to identify independent adverse factors for increased mortality . Positive correlations were further investigated with the chi 2 test to assess whether an increasing number of adverse factors could identify a special subset of patients with markedly elevated death risk . Fourteen patients (36%) died after surgery . Emergency surgery (p = 0.001), the presence of coma 6 hours after surgery (p = 0.0015) and S . aureus infection (p = 0.023) were all associated with increased mortality . The presence of neurological complications was correlated with a high mortality (54% vs . 27%) . However this increase was of dubious statistical significance (p = 0.097) . Multiple regression analysis confirmed S . aureus and emergency surgery as independent adverse factors for increased mortality . When put together, an increasing number of adverse factors was highly predictive of a fatal outcome, even after exclusion of that evaluated after surgery (level of consciousness) . Patients with two or three adverse factors had a very high mortality rate (> 76.9%) . Mortality following surgery for active IE is increased in patients operated on an emergency basis especially if the infection is caused by S . aureus . The presence of neurological complications may also be associated with worse outcome . Early consideration of surgery should reduce the high mortality in patients with active IE.

Biol Chem, 1998 Apr-May, 379(4-5), 573 - 4
Actinobacillus and Streptococcus: producers of isoschizomers of the restriction endonucleases R.HphI, R.SauI, R.NheI, R.MboI and R.SwaI; Dedkov VS et al.; New restriction endonucleases have been found in microorganisms isolated from the microflora of human teeth . The strain-producers are Actinobacillus suis and Streptococcus milleri . The new enzymes are isoschizomers of the prototypes as follows: AsuHPI - HphI; AsuSAI - SauI; AsuNHI - NheI; AsuMBI and SmiMBI - MboI; SmiI - rare-cutter SwaI.

J Dairy Res, 1998 May, 65(2), 187 - 98
Changes in electrical conductivity and somatic cell count between milk fractions from quarters subclinically infected with particular mastitis pathogens; Woolford MW et al.; Cows with subclinical intramammary infections were identified by milk bacteriology . The mastitis pathogens included Staphylococcus aureus (n = 9), Streptococcus uberis (n = 10) and coagulase-negative staphylococci (n = 10) . Samples of first fore milk, main flow milk and strippings milk fractions were collected from each quarter and laboratory measurements were made of electrical conductivity, milk fat concentration and somatic cell count . Conductivity measurements were corrected for milk fat concentration and within-cow inter-quarter conductivity ratios calculated . Repeatability estimates of all measurements between days were calculated . In the case of infected quarters, all conductivity values decreased markedly (P < 0.05) from first fore milk to main flow milk fractions . Conductivity differences between quarters of infected cows were substantially lower during the main milk flow phase . For quarters infected with Staph . aureus an increase in conductivity was observed (P < 0.05) from main flow to strippings fractions . For uninfected quarters, conductivity declined as milk fat concentration increased with successive milk fractions . Variation, both within and between milk fractions, was greater for somatic cell count than for conductivity . Differences in conductivity between milk fractions from individual infected quarters were not accounted for by changes in fat concentration and may result from the mixing of milk from infected and uninfected regions of the gland . Localized infection may produce a decrease in conductivity between fore milk and mid-flow fractions while differential drainage from an infection site in the secretory tissue may additionally produce an increase in conductivity from mid-flow to strippings fractions . Such changes may thus provide information on the location and magnitude of an infection . The results clearly demonstrate the importance of the milk fraction when using conductivity as a diagnostic of intramammary infection, the highest diagnostic sensitivity being achieved by using first fore milk samples.

FEMS Immunol Med Microbiol, 1998 Apr, 20(4), 249 - 55
Monoclonal antibodies with specificities for Streptococcus pneumoniae group 9 capsular polysaccharides; Kolberg J et al.; Streptococcus pneumoniae group 9 includes four capsular polysaccharide types: 9A, 9L, 9N and 9V . We have generated four mouse monoclonal antibodies against group 9 polysaccharide using heat-treated S . pneumoniae strains of different capsular polysaccharides types as immunogens . The specificities of the monoclonal antibodies were determined by ELISA using capsular polysaccharide directly coated to the wells as antigens and by dot blotting with heat-treated bacteria . Two groups of monoclonal antibodies were found . The first group included two monoclonal antibodies which were found to be capsular type specific . The second group was monoclonal antibodies that bound to epitopes shared by two or three pneumococcal group 9 types . The monoclonal antibody 204,A-4 (IgM) was found to be specific for S . pneumoniae type 9N . The binding of the type 9V specific monoclonal antibody 206,F-5 (IgG1) was found to be dependent upon O-acetyl groups . Monoclonal antibody 205,F-3 (IgM) reacted also with type 9V, but was found to cross-react with types 9A and 9L . The binding of this monoclonal antibody to polysaccharide 9V was not dependent upon O-acetyl moieties . The fourth monoclonal antibody (214,G-5, isotype IgM) did not show any correlation between reactivity with isolated polysaccharides and dot blotting with relevant bacteria . The monoclonal antibody reacted with polysaccharides 9A and 9L in ELISA, but not with the homologous bacteria.

Proc Natl Acad Sci U S A, 1998 Jun 9, 95(12), 6584 - 9
Ozonolysis for selectively depolymerizing polysaccharides containing beta-D-aldosidic linkages; Wang Y et al.; The depolymerization of polysaccharides, particularly those containing acid-sensitive components, into intact constituent repeating units can be very difficult . We describe a method using ozonolysis for depolymerizing polysaccharides containing beta-D-aldosidic linkages into short-chain polysaccharides and oligosaccharides . This method is carried out on polysaccharides that have been fully acetylated whereby beta-D-aldosidic linkages are selectively oxidized by ozone to form esters, from which the polysaccharides are subsequently cleaved with a nucleophile . Ozone oxidation of aldosidic linkages proceeds under strong stereoelectronic control, and reaction rates depend on the conformations of glycosidic linkages . Thus, beta-D-aldosidic linkages with different conformations can have very different reaction rates even in the absence of substantial chemical differences . These rate differences allowed for very high selectivity in cleaving beta-D-linkages of polysaccharides . Several polysaccharides from group B Streptococcus and other bacterial species were selectively depolymerized with this method . The repeating units of the group B Streptococcus polysaccharides all contain an acid-sensitive sialic acid residue in a terminal position on a side chain and several beta-D-residues including galactose, glucose, and N-acetylglucosamine; however, with each polysaccharide, one type of linkage was more reactive than others . Selective cleavage of the most sensitive linkage occurs randomly throughout the polymer chain, yielding fragments of controllable and narrowly distributed sizes and the same repeating-unit structure . The average size of the molecules decreases exponentially, and desired sizes can be obtained by stopping the reaction at appropriate time points . With this method the labile sialic acid residue was not affected.

Am J Ophthalmol, 1998 May, 125(5), 723 - 5
Infectious crystalline keratopathy caused by Candida guilliermondii; Ainbinder DJ et al.; PURPOSE: To describe the manifestations of infectious crystalline keratopathy caused by Candida guilliermondii in a corneal transplant performed for pseudophakic bullous keratopathy . METHOD: Case report . RESULTS: Candida guilliermondii was identified as the causative organism of an indolent infectious crystalline keratopathy . Incisional lamellar biopsy provided diagnostic culture and histopathologic results . Histopathology showed aggregates of yeast elements between corneal stromal lamellae, without inflammation . The infection progressed despite a 6-week course of topical amphotericin B and an additional 6-week course of topical and oral fluconazole . Repeat penetrating keratoplasty resulted in clear graft, with no recurrent infection . CONCLUSIONS: Fungal keratopathy should be included in the differential diagnosis of infectious crystalline keratopathy . Numerous Candida species have been isolated in addition to the most common causative bacterial organism, Streptococcus viridans . Candida guilliermondii is yet one more causative agent of infectious crystalline keratopathy . Candida guilliermondii, a rare human pathogen, was resistant to medical therapy in this case.

Int J Clin Pract, 1998 Mar, 52(2), 69 - 74
A multicentre, double-blind, randomised study comparing the efficacy and safety of oral levofloxacin versus ciprofloxacin in the treatment of uncomplicated skin and skin structure infections; Nicodemo AC et al.; A multicentre, randomised, double-blind trial in Latin America compared oral levofloxacin 500 mg once daily for 7 days with oral ciprofloxacin 500 mg twice daily for 10 days in 272 patients with uncomplicated skin and skin structure infections . Among 253 subjects evaluable for clinical efficacy (129 levofloxacin, 124 ciprofloxacin), clinical success (cure and improvement) was observed in 96.1% of levofloxacin-treated patients and in 93.5% of ciprofloxacin-treated patients . Overall, bacteriological eradication rates by pathogen were 93.2% and 91.7%, respectively . Levofloxacin eradicated 94% (66/70) of Staphylococcus aureus and 94% (17/18) of Streptococcus pyogenes isolates, compared with 93% (70/75) and 92% (12/13) for ciprofloxacin . Microbiological eradication rates by subject were approximately 93% and 90% for the levofloxacin and ciprofloxacin groups, respectively . Drug-related adverse events were reported by 8.9% of those receiving levofloxacin and 8.2% of those administered ciprofloxacin . Findings support the efficacy of oral levofloxacin for uncomplicated skin and skin structure infections due to S . aureus and S . pyogenes.

Br J Gen Pract, 1998 Feb, 48(427), 959 - 62
Towards a better diagnosis of throat infections (with group A beta-haemolytic streptococcus) in general practice; Dagnelie CF et al.; BACKGROUND: Sore throat is a common complaint in general practice . However, management strategies are not very clear . A better diagnostic procedure is needed to prevent the overuse of antibiotics . AIM: To assess the diagnostic value of a rapid streptococcal antigen detection test in addition to four clinical features in patients with sore throat, using throat culture and antibody titres as reference tests . METHOD: Four clinical features {fever (history) > or = 38.0 degrees C, lack of cough, tonsillar exudate, and anterior cervical lymphadenopathy} were registered in 558 patients aged 4 to 60 years presenting with sore throat of no more than 14 days' duration . A rapid diagnostic test was performed, as well as a throat culture and antibody titres {fourfold increase in anti-streptolysin-O (ASO) and/or anti-deoxyribonuclease B (anti-DNAase B)} in patients aged 11 years and older . RESULTS: Throat cultures were positive for group A beta-haemolytic streptococcus (GABHS) in 33% of the patients . Rapid tests were positive in 24% . Compared with the throat culture, the sensitivity of the rapid test was 65%, the specificity 96%, the positive predictive value 88%, and the negative predictive value 85% . However, for patients with three or four clinical features, the sensitivity of the rapid test was considerably higher at 75% . Children (< or = 14 years) had a slightly raised specificity and raised positive predictive value and prevalence . With the antibody titres as a reference, the rapid test performed as well as the throat culture with regard to its predictive value . CONCLUSION: For the management of patients with sore throat in general practice, a rapid test may have an additional value, especially in patients with a high chance of having GABHS infection . However, as the sensitivity of the test studied is low, tests with a higher sensitivity are needed.

Antimicrob Agents Chemother, 1998 Jun, 42(6), 1509 - 11
In vitro activities of the new ketolide antibiotics HMR 3004 and HMR 3647 against Streptococcus pneumoniae in Germany; Reinert RR et al.; The comparative in vitro activity of HMR 3004 and HMR 3647, new ketolide antibiotics, was tested by a standard agar dilution technique against 221 pneumococcal strains, including isolates with intermediate levels of resistance to penicillin and erythromycin-resistant isolates . The ketolides were more active than other macrolides and showed excellent activity against erythromycin-resistant strains . All the strains were inhibited by < or = 2 micrograms of HMR 3004/ml or by < or = 0.5 microgram of HMR 3647/ml.

Antimicrob Agents Chemother, 1998 Jun, 42(6), 1397 - 407
Moxifloxacin in the therapy of experimental pneumococcal meningitis; Schmidt H et al.; The activity of moxifloxacin (BAY 12-8039) against a Streptococcus pneumoniae type 3 strain (MIC and minimum bactericidal concentration {MBC} of moxifloxacin, 0.06 and 0.25 microgram/ml, respectively; MIC and MBC of ceftriaxone, 0.03 and 0.06 microgram/ml, respectively) was determined in vitro and in a rabbit model of meningitis . Despite comparable bactericidal activity, 10 micrograms of moxifloxacin per ml released lipoteichoic and teichoic acids less rapidly than 10 micrograms of ceftriaxone per ml in vitro . Against experimental meningitis, 10 mg of moxifloxacin per kg of body weight per ml reduced the bacterial titers in cerebrospinal fluid (CSF) almost as rapidly as ceftriaxone did (mean +/- standard deviation, -0.32 +/- 0.14 versus -0.39 +/- 0.11 delta log CFU/ml/h) . The activity of moxifloxacin could be described by a sigmoid dose-response curve with a maximum effect of -0.33 delta log CFU/ml/h and with a dosage of 1.4 mg/kg/h producing a half-maximal effect . Maximum tumor necrosis factor activity in CSF was observed later with moxifloxacin than with ceftriaxone (5 versus 2 h after the initiation of treatment) . At 10 mg/kg/h, the concentrations of moxifloxacin in CSF were 3.8 +/- 1.2 micrograms/ml . Adjunctive treatment with dexamethasone at 1 mg/kg prior to the initiation of antibiotic treatment only marginally reduced the concentrations of moxifloxacin in CSF (3.3 +/- 0.6 micrograms/ml) . In conclusion, moxifloxacin may qualify for use in the treatment of S . pneumoniae meningitis.

Antimicrob Agents Chemother, 1998 Jun, 42(6), 1361 - 4
In vivo efficacies of amoxicillin and cefuroxime against penicillin-resistant Streptococcus pneumoniae in a gerbil model of acute otitis media; Cenjor C et al.; The comparative efficacies of amoxicillin and cefuroxime against acute otitis media caused by a penicillin-resistant (MIC, 2 micrograms/ml) Streptococcus pneumoniae strain were assessed in a gerbil model by challenging each ear with 10(7) bacteria through transbullar instillation . Each antibiotic was tested at two doses (5 and 20 mg/kg of body weight) administered at 2, 10, and 18 h postinoculation . Samples were obtained from the middle ear (ME) on days 3 and 7 postinoculation for determination of bacterial counts . Only amoxicillin, at both doses, was able to significantly halt the weight loss in animals, reducing both the number of culture-positive animals and the bacterial concentration in ME samples versus the values for untreated animals . Comparison of the efficacies between the antibiotics, determined by their ability to achieve culture-negative ME specimens, showed that amoxicillin at 5 mg/kg was significantly more active than cefuroxime at the same dose . The use of higher doses of either amoxicillin or cefuroxime did not produce significantly better results than those obtained with the lower dose but caused a greater inflammatory response . The more favorable results obtained with amoxicillin compared with those obtained with cefuroxime could be related to the antimicrobial susceptibility of the pneumococcal strain (MICs and minimum bactericidal concentrations of 1 and 1 microgram/ml and 4 and 4 micrograms/ml for amoxicillin and cefuroxime, respectively) as well as to the better pharmacokinetic parameters obtained with amoxicillin.

Antimicrob Agents Chemother, 1998 Jun, 42(6), 1329 - 33
Alterations in PBP 1A essential-for high-level penicillin resistance in Streptococcus pneumoniae; Smith AM et al.; High-level penicillin resistance in pneumococci is due to alterations in penicillin-binding proteins (PBPs) 2X, 2B, and 1A . We have sequenced the penicillin-binding domain of PBP 1A from penicillin-resistant South African pneumococcal isolates and have identified amino acid substitutions which are common to all the resistant isolates analyzed . Site-directed mutagenesis was then used to determine whether particular amino acid substitutions at specific positions in PBP 1A mediate penicillin resistance . PCR was used to isolate PBP 2X, 2B, and 1A genes from clinical isolate 8303 (penicillin MIC, 4 micrograms/ml) . These wild-type PBP genes were cloned into pGEM-3Zf and were used as the transforming DNA . Susceptible strain R6 (MIC, 0.015 microgram/ml) was first transformed with PBP 2X and 2B DNA, resulting in PBP 2X/2B-R6 transformants for which MICs were 0.25 microgram/ml . When further transformed with PBP 1A DNA, 2X/2B/1A-R6 transformants for which MICs were 1.5 micrograms/ml were obtained . Site-directed mutagenesis of the PBP 1A gene from isolate 8303 was then used to reverse particular amino acid substitutions, followed by transformation of PBP 2X/2B-R6 transformants with the mutagenized PBP 1A DNA . For PBP 2X/2B/1A-R6 transformants, the introduction of the reversal of Thr-371 by Ser or Ala in PBP 1A decreased the MIC from 1.5 to 0.5 micrograms/ml, whereas the reversal of four consecutive amino acid substitutions (Thr-574 by Asn, Ser-575 by Thr, Gln-576 by Gly, and Phe-577 by Tyr) decreased the MIC from 1.5 to 0.375 micrograms/ml . These data reveal that amino acid residue 371 and residues 574 to 577 of PBP 1A are important positions in PBP 1A with respect to the interaction with penicillin and the development of resistance.

Nat Med, 1998 Jun, 4(6), 705 - 9
Neonatal mouse immunity against group B streptococcal infection by maternal vaccination with recombinant anti-idiotypes; Magliani W et al.; We investigated whether immunization with recombinant anti-idiotypic antibody fragments mimicking the conformation of the capsular antigen can protect against infection by group B streptococcus, an important neonatal pathogen . Single-chain fragment-variable anti-idiotypes competed with the type III carbohydrate for binding to type-specific antibodies and elicited, in mice, the production of protective immunoglobulins reacting against the type III polysaccharide . Moreover, maternal immunization with soluble or phage-displayed fragments protected neonatal mice against streptococcal infection . These data indicate that recombinant anti-idiotypic antibodies may be useful in developing protein images of relevant carbohydrate epitopes and, ultimately, in preventing infections by encapsulated bacteria.

J Periodontol, 1998 May, 69(5), 571 - 7
Periodontal status and serum antibody responses to oral microorganisms in Sjögren's syndrome; Celenligil H et al.; Sjogren's syndrome is an autoimmune disease characterized by keratoconjunctivitis sicca and xerostomia . Rapid bacterial plaque accumulation occurs in Sjogren's syndrome patients due to decreases in salivary flow rate . The purpose of this study was to evaluate the periodontal status of patients with Sjogren's syndrome and evaluate serum antibody responses to selected oral microorganisms, including major periodontopathogens, compared to healthy controls . Seventeen Sjogren's syndrome patients and 14 healthy subjects were included in the study . Plaque (PL), sulcular bleeding (SBI), periodontal index scores (PI), probing depths (PD), and total number of teeth were recorded . An ELISA was used to determine the serum IgG antibody level to a panel of 13 oral microorganisms . Significantly higher PL, SBI, PD, and PI scores, as well as an increased number of lost teeth were observed in patients with Sjogren's syndrome compared to healthy subjects (P <0.0001) . Antibody levels to Streptococcus oralis were significantly lower in Sjogren's syndrome patients than controls (P <0.0002) . These patients exhibited significantly elevated antibody levels to Actinobacillus actinomycetemcomitans and Porphyromonas gingivalis compared to controls (P <0.006 to 0.0004) . Our findings indicate that Sjogren's syndrome patients have established periodontal disease and serum antibody responses to oral microorganisms previously identified as periodontopathogens in systemically healthy subjects . These results suggest that Sjogren's syndrome may affect bacterial colonization in plaque and contribute to increased periodontal disease in this compromised population.

Biol Reprod, 1998 Jun, 58(6), 1385 - 93
Amniotic fluid prolactin is decreased by experimental intrauterine infection or interleukin-1beta infusion but not via prostaglandins in pregnant rhesus macaques; Bethea CL et al.; Amniotic fluid contains a high concentration of prolactin produced and secreted by the decidua . In vitro models have suggested that bacterial products inhibit prolactin secretion by decidual cells . To further examine this potentially important regulatory mechanism in the whole animal, chronically instrumented pregnant rhesus monkeys were prepared . Experimental infection was induced by intraamniotic or choriodecidual inoculation of 10(3)-10(6) group B streptococcus . Alternatively, interleukin (IL)-1beta was infused into the amniotic cavity . Finally, indomethacin was coadministered with IL-1beta to block the production of prostaglandins (PGs) . The average prolactin level prior to inoculation (0 h) equaled 34.0 +/- 6.4 microg/ml . There was a 40% decrease in prolactin by 37 h postinfection (n = 6) and a 71% decrease between 61 and 72 h postinfection (n = 3, p < 0.01 vs . before infection) . Infusion of IL-1beta also caused a decrease in amniotic fluid prolactin . There was a 42% decrease in prolactin between 0 and 24 h postinfusion (p < 0.05) and a 66% decrease between 25 and 72 h after IL-1beta infusion (p < 0.05; n = 6) . Coadministration of indomethacin with IL-1beta prevented the accompanying increase in PGs but did not prevent the decrease in prolactin (n = 5) . Amniotic fluid prolactin levels in untreated monkeys were stable and without a prepartum decline during the sampling period from 130 to 166 days of gestation . In summary, intrauterine bacterial infection decreases amniotic fluid prolactin, and IL-1beta mimics this effect . The effect of IL-1beta on amniotic fluid prolactin does not appear to be mediated by PGs and may involve a direct effect of IL-1beta on decidual cells.

Ned Tijdschr Geneeskd, 1998 Apr 25, 142(17), 952 - 6
{Optimization of the antibiotics policy in the Netherlands . II . SWAB guidelines for the antimicrobial therapy of pneumonia in patients at home and as nosocomial infections . The Netherlands Antibiotic Policy Foundation}; van Kasteren ME et al.; The Netherlands Antibiotic Policy Foundation issued guidelines for empirical antimicrobial therapy of adult pneumonia patients in hospitals . A distinction is made between pneumonia contracted at home or in hospital because of the differences in micro-organisms and resistance patterns . These two categories are subdivided further with an empirical antibiotic treatment being chosen on the basis of the causative agents to be expected . For instance, pneumonia contracted at home is mostly caused by Streptococcus pneumoniae, to be treated with benzylpenicillin or amoxicillin . With regard to nosocomial pneumonia, treatment varies according to whether a pneumonia has or has not been contracted in the intensive care unit . Combating development of resistance is alloted an important place . Emphasis is laid on 'streamlining' the therapy, i.e . its adjustment (including choosing an antibiotic with the narrowest possible spectrum) once the causative agent is known.

Med Vet Entomol, 1998 Apr, 12(2), 192 - 5
Increasing parasitism by the German yellow jacket wasp, Paravespula germanica, on dairy cattle in Israel; Braverman Y; During the past two decades, parasitism by the German yellow jacket wasp, Paravespula germanica, on lactating dairy cattle has occurred in Israel during August to October annually, affecting up to 65% of cows in certain herds . The nibbled and exposed tissues of teats and sometimes udders become infested by bacteria, especially Streptococcus dysgalactiae and Actinomyces pyogenes, causing clinical and subclinical mastitis . Normally, German wasps are primarily insect predators, but the urbanization around many dairy farms has reduced open space and associated standard food sources, i.e . insects, plants and carcasses . This has resulted in P . germanica nesting more often on dairy farms . In some instances, when high densities of P . germanica correspond with scarcity of prey, a segment of the wasp population preys primarily on the older and heavier cows with weak defensive behaviour . The teat feeding colonies of P . germanica may have an advantage, in that they are less dependent on fluctuations in the number of prey insects.

Mol Microbiol, 1998 Apr, 28(2), 343 - 53
Structure of the has operon promoter and regulation of hyaluronic acid capsule expression in group A Streptococcus; Alberti S et al.; Group A streptococcal strains vary widely in the amount of hyaluronic acid capsule they produce, although the has operon, which encodes the enzymes required for hyaluronic acid synthesis, is highly conserved . The three genes making up the has operon are transcribed from a single promoter located upstream of the first gene in the operon, hasA . To investigate transcriptional regulation of capsule synthesis, we studied the structure and function of the has operon promoter sequences from two strains of group A Streptococcus: a highly encapsulated M-type 18 strain and a poorly encapsulated M-type 3 strain . Transcriptional fusions of the has operon promoter to a promoterless chloramphenicol acetyltransferase gene were constructed in a temperature-sensitive shuttle vector . The influence of promoter structure on has operon transcription was reflected by chloramphenicol acetyl transferase activity in cell lysates of Escherichia coli harbouring the recombinant plasmids and in group A Streptococcus after integration of the promoter fusions into the streptococcal chromosome . Fusions including as few as 12 nucleotides upstream from the -35 site of the has promoter exhibited full activity, indicating that sequences further upstream do not affect has gene transcription . A transcriptional fusion of the has promoter from the highly encapsulated M-type 18 strain was threefold more active than a similar construct from the poorly encapsulated M-type 3 strain . Analysis of the promoter sequences for the two strains revealed differences in three nucleotides in the -35, -10 spacer region of the promoter and in four nucleotides in the +2 to +8 positions relative to the start site of hasA transcription . To determine the relative importance of the two groups of nucleotide substitutions, chimeric promoter sequences were constructed in which either of the two clusters of variant nucleotides from the M18 has promoter was substituted for the corresponding positions in the M3 has promoter . Analysis of these chimeric promoter fusions showed that sequence changes in both regions influenced promoter strength . These results define the limits of cis-acting chromosomal sequences that influence transcription of the has operon and indicate that the fine structure of the promoter is an important determinant of capsule gene expression in group A Streptococcus.

Lik Sprava, 1998 Jan-Feb, (1), 115 - 7
{The colonization resistance of the tonsils in healthy and frequently ill children}; Marushko IuV; State of colonization resistance was studied in healthy children and those presenting with recurring infectious and inflammatory diseases of the upper respiratory tract . Identification of representatives of tonsil anaerobic and aerobic floras was carried out . Lactic acid bacteria (LAB), alpha-Streptococcus, were present in tonsil flora of healthy children . Pathogenic microorganisms and opportunistic pathogens were recoverable from always ailing children with tonsillitis, with alpha-streptococcus being recoverable very seldom and no decrease in LAB levels being seen . In patients--candidates for tonsillectomy, pathogenic microorganisms were identifiable, with LAB levels decrease by a factor of 10(3-4) . The above findings suggest development of dysbacteriosis, decrement of tonsil colonization resistance in always ailing children, which fact is to be considered in designing and implementing therapeutic measures.

No To Shinkei, 1998 May, 50(5), 469 - 72
{An autopsied case of purulent meningitis associated with ocular flutter}; Orimo S et al.; We report a 72-year-old autopsied case of purulent meningitis associated with ocular flutter . She was admitted to our hospital because of disturbances of consciousness and fever . Physical examination revealed fever, tachycardia, and tachypnea . Neurological examination showed disturbance of consciousness (Japan Coma Scale 30), agitated state, anisocoria, sluggish and fixed reaction of pupils to light, and nuchal stiffness . Routine blood examination showed leukocytosis, thrombocytopenia, positive CRP, and elevated myocardial enzymes . Cerebrospinal fluid revealed pleocytosis with predominant leukocytes, elevated protein, and decreased glucose (22% of blood glucose), and Streptococcus pneumoniae was proved in culture . Brain CT scan revealed no abnormal findings . Electrocardiography showed tachycardia, left axis deviation, and elevated ST segment in aVF, and V3-V6 . Ultrasonic echocardiography revealed slight hypokinesis of the left anterior wall, septum, and apex . She was diagnosed as having purulent meningitis, myocarditis, probable encephalitis . Thus, antibiotics, acycrovir, glycerol, and aspirin were administrated . But her respiration deteriorated and ocular flutter was observed for 15 minutes . After that, She required artificial ventilation and eventually died after 29 hours the admission to our hospital . Pathological examination revealed leukocyte accumulation in the arachnoid space of the derebral surface, especially frontal and parietal lobes . Uncal herniation was not observed . The brainstem and cerebellum were histologically within normal limits . These findings suggest that ocular flutter observed in this patient was caused by functional damage of the brainstem.

J Dairy Sci, 1998 May, 81(5), 1205 - 13
Effects of milk somatic cell count on cottage cheese yield and quality; Klei L et al.; Eight Holstein cows in midlactation were selected for low milk somatic cell count (SCC) and the absence of the pathogens that cause mastitis . Milk collection and cottage cheese manufacture from low SCC milk were replicated on each of 4 d (control period) . Each cow was infused with 1000 cfu of Streptococcus agalactiae . One week after infusion, milk from the same eight cows was collected and commingled . On each of 4 d, cottage cheese was made from milk with high SCC (treatment period) . A mass-balance protocol, accounting for protein and total solids, was used to determine recoveries in whey, wash water, and uncreamed curd . Actual yields, yields adjusted for composition, and theoretical yields of uncreamed curd were calculated . Mean milk SCC for the periods with the low SCC (control) and the high SCC (treatment) were 83 x 10(3) and 872 x 10(3) cells/ml, respectively . The recovery of protein in the uncreamed curd was higher during the low SCC period than during the high SCC period (75.85% vs . 74.35%) . High SCC and the associated higher proteolytic activity caused higher protein loss in the whey and wash water and more curd fines . The percentage of total solids recovery in uncreamed curd was higher for high SCC milk because the lactose content of the high SCC milk was 0.27% lower than that of the low SCC milk . The moisture content of the curd was higher for the high SCC milk (82.75% vs . 83.81%) . Proteolysis during refrigerated storage was faster in cottage cheese made from high SCC milk . The yield efficiency of uncreamed curd, adjusted for composition based on 81% moisture, was 4.34% lower for the cottage cheese curd made from high SCC milk.

J Clin Microbiol, 1998 Jun, 36(6), 1805 - 7
Conservation of restriction sites in isolates of Streptococcus pneumoniae with diverse restriction fragment patterns; Hall LM et al.; Separation of large restriction fragments by pulsed-field gel electrophoresis is a commonly used method for epidemiological typing of Streptococcus pneumoniae and many other bacterial species . Information on the genetic changes underlying the restriction fragment polymorphisms that allow discrimination between isolates is scarce . In this study fragments adjacent to ApaI sites in a clinical isolate of S . pneumoniae were cloned and used to probe HindIII and HindIII-plus-ApaI genomic DNA digests from other isolates with very different ApaI fragment patterns . If for a given isolate the HindIII fragment detected by the probe was reduced in size on digestion with ApaI, it was deduced that the ApaI site was conserved in that isolate . The results demonstrate that of six ApaI sites in PN93/908 examined, five were retained in 11 genetically different isolates and one was retained in 2 isolates but lost in 9 others . It was concluded that point mutations at restriction sites are unlikely to account for the restriction fragment length polymorphism observed and that much of the polymorphism may be due to DNA rearrangements, possibly resulting from the insertion or deletion of mobile DNA elements.

J Clin Microbiol, 1998 Jun, 36(6), 1769 - 71
Diagnosis of group A streptococcal necrotizing fasciitis by using PCR to amplify the streptococcal pyrogenic exotoxin B gene; Louie L et al.; This study evaluated a PCR assay for detection of the streptococcal pyrogenic exotoxin B (speB) gene from tissue biopsy specimens of patients with necrotizing fasciitis . speB was detected in specimens from all 10 patients with necrotizing fasciitis due to group A streptococcus . The assay was negative for all 11 patients without culture or serologic evidence of streptococcal infection . These results suggest that the detection of speB by PCR may be useful for confirming group A streptococcal infection when cultures are negative or not available.

J Clin Microbiol, 1998 Jun, 36(6), 1601 - 3
Multicenter comparison of BACTEC 9050 and BACTEC 9240 blood culture systems; Murray PR et al.; The overall recovery of organisms and time to detection with the BACTEC 9050 and BACTEC 9240 systems were compared in a multicenter evaluation . In the first phase of the study, a total of 4,383 compliant aerobic (Plus Aerobic/F) blood culture sets were processed . There was no significant difference in the recovery of individual groups of organisms with the two systems, with the exception of Streptococcus pneumoniae which was isolated more frequently with BACTEC 9050 . False-positive signals occurred more often with BACTEC 9240 (58 cultures) than with BACTEC 9050 (43 cultures), but false-negative cultures were uncommon with both systems (3 cultures for each system) . Time to detection of positive cultures of clinically significant organisms was essentially the same with both instruments . In the second phase of the study, 2,431 compliant anaerobic (Plus Anaerobic/F) blood culture sets were processed . There was no significant difference in the recovery of organisms with BACTEC 9050 compared with BACTEC 9240 . Significantly (P < 0.03) more false-positive signals occurred with BACTEC 9240 (15 cultures) than with BACTEC 9050 (4 cultures) . Likewise, more false-negative cultures occurred with BACTEC 9240 (11 cultures) than with BACTEC 9050 (8 cultures) . Time to detection of positive cultures of clinically significant organisms was essentially the same with both systems with the exception of anaerobes (N = 10), which were recovered earlier (P < 0.01) with BACTEC 9240 (35.0 h) than with BACTEC 9050 (61.4 h).

Pharmacotherapy, 1998 May-Jun, 18(3), 612 - 9
Nitric oxide concentrations and cerebrospinal fluid parameters in an experimental animal model of Streptococcus pneumoniae meningitis; Destache CJ et al.; Streptococcus pneumoniae is a common cause of meningitis . Nitric oxide (NO) has been implicated in causing cerebral edema . Modulating NO production in cerebrospinal fluid (CSF) may have a role in the treatment of bacterial meningitis . Experimental S . pneumoniae meningitis was induced in a rabbit model to determine CSF parameters and NO concentrations . An electrochemical probe in the CSF throughout the 7-hour experiment monitored NO concentrations . The animals had S . pneumoniae (10(5)) injected intracisternally and incubated for 1 hour . Cerebrospinal fluid 200-300 microl was obtained by intracisternal puncture at zero, 2, 4, and 7 hours after drug administration to measure glucose, protein, and lactic acid by standard chemical methods . White blood cell count was measured by hemocytometry . Three groups of five animals were used-control (C), ceftriaxone (CTX), and ceftriaxone plus dexamethasone (CTX+D) . Ceftriaxone concentrations in CSF were obtained by microdialysis and analyzed by high-performance liquid chromatography . Mean (+/- SEM) CSF white blood cell count was significantly higher at 2 hours in the C group than in the other two groups (C 7307 +/- 1302, CTX 605 +/- 345, CTX+D 730 +/- 43/mm3, p<0.002) . Ceftriaxone induced a significant rise in protein at 4 hours compared with the other groups (C 364 +/- 107, CTX 1158 +/- 797, CTX+D 365 +/- 100 mg/dl, p<0.02) . Cerebrospinal fluid lactic acid was significantly different at 4 and 7 hours between C and CTX+D groups (4-hr C 8.0 +/- 2.2, CTX+D 2.0 +/- 0.4 mmol/L, p<0.05; 7-hr C 10.2 +/- 2.4, CTX+D 2.8 +/- 0.8 mmol/L, p<0.01) . Median NO concentrations were significantly elevated in the control group compared with the other two groups (C 11.7, CTX 6.8, CTX+D 6.5 micro, p<0.02 C vs CTX, p<0.01 C vs CTX+D) . Average (+/- SEM) NO concentrations were significantly higher in the C group at 4 hours (18.1 +/- 0.4, CTX 5.8 +/- 1.8 microM, p<0.05; CTX+D 11.5 +/- 4.0 microM, p>0.05), whereas they did not rise significantly until 7 hours in the CTX group (CTX 18.7 +/- 0.7, C 8.9 +/- 0.4 microM, p=0.055; CTX+D 8.1 +/- 2.2 microM, p<0.05) . These results indicate that ceftriaxone with or without dexamethasone significantly decreases lactic acid concentrations and white cell penetration into the CSF in an experimental model of S . pneumoniae meningitis . In addition, ceftriaxone induced a significant elevation in CSF protein . Median NO production in the CSF was significantly attenuated by ceftriaxone.

Pharmacotherapy, 1998 May-Jun, 18(3), 456 - 62
The pharmacologic and bacteriologic properties of oxazolidinones, a new class of synthetic antimicrobials; Dresser LD et al.; The oxazolidinones are a new synthetic class of antimicrobials structurally unrelated to any agent presently marketed . Data pertaining to these compounds, with respect to their pharmacology, pharmacokinetics, pharmacodynamics, mechanism of action, and bacteriologic activity, focusing on the analogs linezolid (PNU 100766) and eperezolid (PNU 100592), were retrieved by MEDLINE search and review of relevant abstracts presented at recent clinical conferences . Since the drugs are still investigational, we obtained in vitro and animal data as well as available human studies . The oxazolidinones have bacteriostatic activity against a number of important pathogens including methicillin-resistant Staphylococcus aureus, penicillin-resistant Streptococcus pneumoniae, and vancomycin-resistant enterococci . They appear to be efficacious and well tolerated both orally and parenterally . Their role remains to be elucidated by clinical trials.

Tokai J Exp Clin Med, 1997 Sep, 22(3), 99 - 102
Comparison of in vitro activity of azithromycin and ampicillin against 31 isolates of Streptococcus milleri; Kaneko A et al.; Antibacterial action of azithromycin against 31 strains of dental infection-derived Streptococcus milleri and tissue transfer of the agent were compared with ampicillin, the drug of first choice for dental infections . Concentrations required to inhibit 50% of isolates(MIC50) and Concentrations required to kill 50% of isolates(MBC50) were 0.10 and 0.2 microgram/ml, respectively, for azithromycin . The antibacterial action of azithromycin was 4 times more potent in than ampicillin . The MBC90 for azithromycin was 0.39 microgram/ml, for amplicill 3.13 micrograms/ml . Bactericidally, azithromycin was 8 times more active than ampicillin . The peak value of concentrations (Cmax) of azithromycin was 0.45 microgram/ml, about 1/10 that of ampicillin . The half-life of azithromycin was 10 hours, about 5 times longer than that of ampicillin . The contact time of MIC90 concentrations for azithromycin was 12 hours, distinctly longer than the 8 hours calculated for ampicillin . Azithromycin showed excellent tissue transfer concentrations: the gingival transfer concentration following oral administration of 500 mg/day ranged from 0.7-23.5 micrograms/ml.

Dtsch Med Wochenschr, 1998 May 8, 123(19), 588 - 93
{Puerperal sepsis caused by streptococcus group A with a severe form of progression like "toxic shock-like syndrome"}; Susset MA et al.; HISTORY AND CLINICAL FINDINGS: A previously healthy 32-year-old woman was admitted with shock symptoms 5 days after an uneventful home delivery . She developed a fever up to 39.5 degrees C during the days after delivery with sore throat, diarrhoea and muscle aches in all limbs . On physical examination there were swellings of the arms and lower legs as well as macular and vesicular erythrodermia, especially of the trunk . INVESTIGATIONS: Abnormal laboratory findings were thrombocytopenia (20,000/microliters), increased serum concentrations of fibrin breakdown products (102 mg/dl) and of C-reactive protein (> 200 mg/dl), increased creatine kinase (5700 U/l), transaminases (GOT 220 U/l, GPT 52 U/l), creatinine (2.0 mg/dl) and urea (114 mg/dl) . Streptococcus pyogenes was grown on blood culture and from vaginal smear . Sonography, echocardiography and radiological examinations failed to demonstrate a septic focus . TREATMENT AND COURSE: Mechanical ventilation was required for 7 days because of respiratory failure and shock symptoms (toxic shock-like syndrome, TSLS) . Penicillin G and tobramycin were given after the bacteriological diagnosis . Severe consumption coagulopathy was successfully treated with antithrombin III and platelet concentrates . After extubation she was found to have a flaccid tetraparesis, especially of the right and of the legs, due to soft-tissue necrosis and damage to peripheral nerves . An embolic occlusion of the right brachial artery 4 weeks after onset of the disease required upper-arm amputation . CONCLUSION: One of the decisive factors for the prognosis of TSLS is early antibiotic treatment . The prodromal symptoms in this case underline the necessity of early recognition and treatment to prevent a full-blown picture of the syndrome.

J Immunol Methods, 1998 Feb 1, 211(1-2), 147 - 58
Development of a novel in vitro co-culture system for studying host response to native bacterial antigens; Mason KM et al.; We have developed a novel co-culture system in which murine splenocytes are cultured with live bacteria in the presence of a bacteriostatic antibiotic . Superantigens, like staphylococcal enterotoxin B (SEB) are important factors in bacterial pathogenicity . Research has shown that superantigens affect numerous immune cell types, either directly or indirectly, yet their involvement in pathogenic mechanisms remains poorly defined . In these studies, we utilize the co-culture system to study how superantigen pretreatment affects interferon-gamma (IFN-gamma) production by splenocytes co-cultured with gram-positive bacteria . Streptococcus mutans, S . sanguis and Bacillus subtilis were tested for susceptibility to a panel of antibiotics . Spectinomycin was found to maintain a bacteriostatic state of approximately 10(5) bacteria ml(-1) at optimal concentrations for each bacterial strain . Co-culturing splenocytes with bacteria did not affect splenocyte viability and cultured splenocytes responded to mitogenic stimulation as expected . Two days after SEB pretreatment, isolated splenocytes cultured with either Streptococcus species produced 10-15 times more IFN-gamma than splenocytes from sham-injected controls; however, no differences in CD4+ or CD8+ T cell populations appeared in cultures with or without bacteria . Splenocytes isolated four days after SEB treatment did not produce significant amounts of IFN-gamma in co-culture . Co-cultures containing live bacteria produced four times more IFN-gamma than cultures containing heat-killed bacteria . Splenocytes depleted of natural killer (NK) cells prior to SEB treatment produced 25% less IFN-gamma after 20 h co-culturing with S . mutans . T lymphocytes were identified to be the major producer of IFN-gamma at this time point by intracellular cytokine staining . Apparently SEB exposure primes a response to live bacteria and the response is evident two days after initial exposure . The in vitro co-culture system allows us to observe host responses to bacteria in the context of the multicellular interdependent immune response . With this assay we can more closely 'mimic' in vivo events, particularly immune cell interactions in microfloral environments, to study how the pathogenic effects of superantigens alter this response.

J Hosp Infect, 1998 May, 39(1), 27 - 37
Infections and bacteriological data after laparoscopic and open gallbladder surgery; den Hoed PT et al.; In two hospitals 637 patients undergoing cholecystectomy between June 1989 and June 1993 were entered into a prospective audit . The aim of this study was to determine the incidence of postoperative infections, especially wound infections, after open and laparoscopic biliary surgery and to assess the bacteriological data on these patients . The incidence of minor wound infection was 10.4% (66/637), of major wound infection 3.6% (23/637) and the overall incidence was 14% (89/637) . The incidence of wound infection after laparoscopic cholecystectomy was 5.3% (10/189) and all were minor . Significant specific risk factors for developing a wound infection after laparoscopic cholecystectomy were emergency of the operation (P = 0.046) and acute cholecystitis (P = 0.014) . Overall, bile cultures were positive in 22% . There were 85 patients (13.3%) with positive bile from the gallbladder . From the laparoscopically operated patients 2.8% had a positive bile culture . The predominant micro-organisms from gallbladder bile were Escherichia coli (56 isolates), Klebsiella spp . (20 isolates) and Streptococcus spp . (16 isolates) . There was no relationship between positive gallbladder cultures and wound infection . The consequences of wound infections can be serious and this study showed a morbidity rate comparable with the literature . The incisions used in laparoscopic gallbladder surgery are less susceptible to major problems . This combined with the significantly lower incidence of wound infections after laparoscopic cholecystectomy suggests that routine antibiotic prophylaxis as recommended for biliary surgery in general is now questionable.

Drugs, 1998 Jun, 55(6), 779 - 90
Practical considerations when treating children with antimicrobials in the outpatient setting; Werk LN et al.; Over the past decade new antimicrobial agents have been introduced used to treat common paediatric infectious diseases such as acute otitis media and sinusitis . These agents vary with respect to their mechanism of action, dosage and duration of therapy, cost, taste and type of adverse effects . More recently, there has been concern about the overuse of antibiotics and increasing bacterial resistance, particularly Streptococcus pneumoniae, to these agents . Dosage and duration of therapy, cost, taste, and adverse effects play important roles in determining success or failure of antimicrobial medications in paediatric patients . Use of potential alternatives and adjuncts to antimicrobial treatment, such as vaccination, control of environmental risk factors, surgical techniques and alternative medical therapies may also be employed, and the practitioner must ascertain if their paediatric patients are being treated by any of these methods . Rather than listing the therapeutic challenges for all common outpatient paediatric infectious diseases, acute otitis media (accounting for over 50% of the antimicrobial prescriptions dispensed in childhood) is used to illustrate each issue . Clinicians are faced with a growing number of possible antimicrobial choices; concomitantly, there is increasing concern that these agents are overused . When prescribing antimicrobial agents, we need to be familiar with what we can do to optimise the care we provide . By avoiding inappropriate or trivial use of antimicrobials, we can preserve and even strengthen our armamentarium against disease . Simple strategies can improve compliance with therapeutic regimens and improve parental satisfaction.

Clin Immunol Immunopathol, 1998 May, 87(2), 184 - 92
Myosin-reactive autoantibodies in rheumatic carditis and normal fetus; Wu X et al.; EBV-transformed B cells from a 20-week human fetal spleen and from blood of patients with poststreptococcal rheumatic carditis were studied . Most antibodies from nine fetal and six patient myosin-reactive B cell clones were multireactive (reacting with cardiac myosin, Streptococcus pyogenes, and rat cardiac myocytes) which supports a role for molecular mimicry in stimulation of these autoantibodies . Sequence analysis revealed that fetal and patient anti-myosin repertoires were composed of unrelated clones with diverse V gene usages . Fetal and patient antibodies had reduced VH CDR3 length on average and reduced light chain N region addition with a low rate of somatic mutation in the variable region genes, characteristics generally associated with fetal B cells but also with some adult B cells . Five of six myosin-reactive patient clones used VH3, whereas only two of nine fetal clones used VH3, suggesting skewing from the average 50-60% VH3 gene usage found in randomly selected adult and fetal antibodies.

J Bacteriol, 1998 May, 180(10), 2701 - 10
Isolation and characterization of three Streptococcus pneumoniae transformation-specific loci by use of a lacZ reporter insertion vector; Pestova EV et al.; Although more than a dozen new proteins are produced when Streptococcus pneumoniae cells become competent for genetic transformation, only a few of the corresponding genes have been identified to date . To find genes responsible for the production of competence-specific proteins, a random lacZ transcriptional fusion library was constructed in S . pneumoniae by using the insertional lacZ reporter vector pEVP3 . Screening the library for clones with competence-specific beta-galactosidase (beta-Gal) production yielded three insertion mutants with induced beta-Gal levels of about 4, 10, and 40 Miller units . In all three clones, activation of the lacZ reporter correlated with competence and depended on competence-stimulating peptide . Chromosomal loci adjacent to the integrated vector were subcloned from the insertion mutants, and their nucleotide sequences were determined . Genes at two of the loci exhibited strong similarity to parts of Bacillus subtilis com operons . One locus contained open reading frames (ORFs) homologous to the comEA and comEC genes in B . subtilis but lacked a comEB homolog . A second locus contained four ORFs with homology to the B . subtilis comG gene ORFs 1 to 4, but comG gene ORFs 5 to 7 were replaced in S . pneumoniae with an ORF encoding a protein homologous to transport ATP-binding proteins . Genes at all three loci were confirmed to be required for transformation by mutagenesis using pEVP3 for insertion duplications or an erm cassette for gene disruptions.

Proc Natl Acad Sci U S A, 1998 Apr 28, 95(9), 5229 - 34
Bacteria-induced neo-biosynthesis, stabilization, and surface expression of functional class I molecules in mouse dendritic cells; Rescigno M et al.; Here, we show that bacteria induce de novo synthesis of both major histocompatability complex (MHC) class I and II molecules in a mouse dendritic cell culture system . The neo-biosynthesis of MHC class I molecules is delayed as compared with that of MHC class II . Furthermore, bacteria stabilize MHC class I molecules by a 3-fold increase of their half-life . This has important consequences for the capacity of dendritic cells to present bacterial antigens in the draining lymph nodes . In addition, a model antigen, ovalbumin, expressed on the surface of recombinant Streptococcus gordonii is processed and presented on MHC class I molecules . This presentation is 10(6) times more efficient than that of soluble OVA protein . This exogenous pathway of MHC class I presentation is transporter associated with antigen processing (TAP)-dependent, indicating that there is a transport from phagolysosome to cytosol in dendritic cells . Thus, bacteria are shown to be a potentially useful mean for the correct delivery of exogenous antigens to be presented efficiently on MHC class I molecules.

Pediatr Infect Dis J, 1998 May, 17(5), 381 - 5
Bacteremia in febrile human immunodeficiency virus-infected children presenting to ambulatory care settings; Lichenstein R et al.; BACKGROUND: Risk factors for bacteremia in febrile HIV-infected children are unknown . OBJECTIVE: To describe the frequency of bacteremia in febrile HIV-infected infants and young children in ambulatory settings and its association with clinical and laboratory factors . METHODS: In a birth cohort of 42 HIV-infected children, all febrile outpatient encounters at < or = 36 months of age were reviewed for HIV disease severity, presence of a central venous catheter (CVC) and the usage of antibiotics and/or intravenous immunoglobulin (IVIG) . Blood culture results, highest temperature and white blood cell count (WBC) were noted . RESULTS: There was a mean of 1.8 febrile visits (210 visits/116.5 subject years) per child year of observation . Rapid HIV-disease progressors (n=14) were 4 times more likely to have a febrile visit than 28 non-rapid HIV disease progressors (P < 0.01) . Blood cultures and WBCs were obtained for 87 and 89% of the febrile visits, respectively . Eleven of the 27 positive blood cultures grew Streptococcus pneumoniae and 16 grew CVC related organisms . The only pathogen identified (n=9) in 104 febrile visits in children without a CVC was S . pneumoniae, which was often (7 of 9) associated with mild illnesses . In children without a CVC temperature > or = 39 degrees C was significantly associated with S . pneumoniae bacteremia (P < 0.05) . In 79 febrile visits by subjects with a CVC, temperature > or = 39 degrees C and WBC > or = 15000 cells/mm3 were frequently observed in the 16 bacteremic compared with the 63 nonbacteremic episodes (P < or = 0.05) . There was a trend toward fewer S . pneumoniae bacteremias (3 of 11) in febrile subjects who were receiving antibiotics or IVIG . CONCLUSION: HIV-infected children younger than 36 months of age have a high incidence of S . pneumoniae and CVC-related bacteremias . Temperature > or = 39 degrees C, WBC > or = 15000 cells/mm3 and the presence of a CVC should be considered in the management of febrile HIV-infected children.

Anaesthesia, 1998 Mar, 53(3), 292 - 5
Bacterial meningitis following combined spinal-epidural analgesia for labour; Bouhemad B et al.; We report a case of Streptococcus salivarius meningitis following combined spinal-epidural analgesia for labour . Although rare, bacterial meningitis following combined spinal-epidural anaesthesia is being increasingly described . We review the previously reported cases and discuss the possible aetiological causes and the aseptic precautions likely to reduce the incidence of infectious complications.

Med Pregl, 1998 Mar-Apr, 51(3-4), 169 - 73
{Sensitivity of Streptococcus pneumoniae to antimicrobial drugs}; Mihajlovic-Ukropina M et al.; INTRODUCTION: Streptococcus pneumoniae is the leading cause of community acquired pneumonia and a frequent cause of otitis media, sinusitis and meningitis . Although most pneumococci remain susceptible to penicillin, relatively less susceptible and resistant strains have been recognized with increasing frequency throughout the world (1) . The aim of this study was to determine whether and to what degree pneumococci isolated in our laboratory were resistant to penicillin and other frequently used antimicrobial agents . MATERIAL AND METHODS: During the period from 1991 to 1995 1139 Streptococcus pneumoniae strains isolated from patients with different pneumococcal infections were tested for their susceptibility to antimicrobial agents at the Department of Bacteriology and Parasitology of the Institute of Public Health in Novi Sad . Antimicrobial agents tested included: penicillin, ampicillin, cephalexin, erythromycin, sulfamethoxazole-trimethoprim and clindamycin . Susceptibility test was performed by using Kirby-Bauer disc diffusion technique on Mueller-Hinton agar supplemented with 5% defibrinated bovine blood (5) . RESULTS: Susceptibility of Streptococcus pneumoniae to seven antimicrobial agents used in the study is shown in Table 2 . There was a resistance to all antimicrobial agents tested . It was the lowest to erythromycin (1.6%) and the highest to sulfamethoxazole+ trimethoprim (67.3%) . The rate of resistance of penicillin was 3.3% . In Table 3 and 4 we can also see that the lowest resistance was to erythromycin, and the highest to sulfamethoxazole+trimethoprim, both for isolates from nose and other sources . Strains of Streptococcus pneumoniae isolated from nasal swabs were more susceptible to penicillin than those isolated from blood, sputum and cerebrospinal fluid . DISCUSSION: For many years penicillin has been the mainstay of therapy for pneumococcal diseases . Clinical resistance to penicillin was first reported in 1960's . Since this early reported, penicillin resistance has been encountered with increasing frequency in strains of Streptococcus pneumoniae from around the world . In our study resistance to penicillin was low (3.3%) . This is in accordance with the authors from Italy, Great Britain, USA and Germany (7, 8, 9, 10) . Much higher prevalence of resistant pneumococci we found in the reports from Spain, France and Hungary (13, 14, 15, 17) . Many of these strains have been resistant to multiple drugs and have been isolated from patients with invasive infections (meningitis, pneumonia, bacteremia) . Percentage of penicillin resistant pneumococci isolated from blood, sputum and cerebrospinal fluid in our study was relatively low (7.7%), but it was higher than the percentage of resistant isolates from nasal swabs (2.0%) . These findings are in accordance with other reports (20, 21) . CONCLUSION: The increasing number of Streptococcus pneumoniae isolates resistant to penicillin and other antimicrobial agents indicates the need to perform susceptibility testing for every isolated strain in order to avoid possible therapeutic failure.

Enferm Infecc Microbiol Clin, 1998 Mar, 16(3), 132 - 4
{Recurrent infection by Streptococcus agalactiae}; Garcia MT et al.; BACKGROUND: To study the factors implicated in the infectious process (host, microorganism and antibiotic) of a newborn early sepsis by S . agalactiae that suffered a reactivation at day five from discharge . METHODS: Description of two episodes of newborn sepsis by S . agalactiae corresponding to the same patient and microbiologic study of the isolated strain: typing by "genomic macrorestriction" and antibiotic tolerance by "timed killing curves" . RESULTS: It was demonstrated that both strains of S . agalactiae type la/c belonged to the same clone as well as the tolerance to ampicillin of the strain . DISCUSSION: This sort of infections processes in the newborn are very serious and there is possibility of relapse . Thus, it is important to study the ethiologic agent and its relationship with antibiotics, in order to stablish the best treatment regimes, avoiding the possibility of relapses as the case we have described.

Microbiology, 1998 May, 144 ( Pt 5), 1235 - 45
Biological functions of UDP-glucose synthesis in Streptococcus mutans; Yamashita Y et al.; A gene encoding glucose-1-phosphate uridylyltransferase (EC 2.7.7.9) was isolated from Streptococcus mutans . A cell extract of Escherichia coli expressing the cloned gene exhibited glucose-1-phosphate uridylyltransferase activity . The enzyme catalyses the conversion of D-glucose 1-phosphate and UTP into UDP-D-glucose . Rabbit antiserum against the serotype-c-specific antigen did not react with autoclaved extracts from mutant cells in which the cloned gene was insertionally inactivated . The glucose content of the cell-wall preparation purified from the mutant was very much lowered, whereas there was no observable decrease in the content of rhamnose . When the mutant strain was grown in an acidic environment, its cell viability was much lower than that of the wild-type . These results suggest that UDP-D-glucose functions not only as an immediate precursor of the serotype-c-specific antigen of S . mutans (as a glucose donor for side-chain formation), but is also important for the organism's viability in environmental conditions of low pH.

Curr Microbiol, 1998 Jun, 36(6), 348 - 52
Effects of chlorhexidine diacetate on ruminal microorganisms; Attia-Ismail SA et al.; The objectives of this study were to examine the effects of chlorhexidine diacetate on growth and L-lactate production by Streptococcus bovis JB1 as well as the effects of this antimicrobial compound on the mixed ruminal microorganism fermentation . Addition of 1.8 microM chlorhexidine diacetate to glucose medium resulted in a lag in growth by S . bovis JB1, and growth was completely inhibited in the presence of 3.6, 9.0, and 18 microM chlorhexidine . When 6.2 microM chlorhexidine diacetate was added to glucose medium after 2 h of incubation, glucose utilization and L-lactate production by S . bovis JB1 were reduced . Phosphoenolpyruvate-dependent phosphorylation of 14C-glucose by toluene-treated cells of S . bovis JB1 was inhibited by increasing concentrations (1.8 to 18 microM) of chlorhexidine, whereas only the 18 microM concentration reduced the membrane potential (delta psi) . Chlorhexidine diacetate was a potent inhibitor of L-lactate and methane production from glucose fermentation by mixed ruminal microorganisms . However, because chlorhexidine also decreased acetate and propionate concentrations and increased ammonia concentrations in mixed-culture incubations, this antimicrobial compound may have limited application as a ruminant feed additive.

An Med Interna, 1998 Apr, 15(4), 211 - 3
{Non-tropical pyomyositis: review of a case}; Fernandez-Miera MF; The pyomyositis is still being a rare disease in our environment . A review of this illness is made as a result of a new case, which shows some peculiarities that differ it from others published previously: the patient showed a basic medullary carcynoma of thyroid with cerebral metastasis and the responsible germ was a Streptococcus pneumoniae . The immunodepressor factors which are presented at most patients who suffer a pyomyositis, the clinic picture so suggestive and the image methods we dispose nowadays, should serve to suspect its diagnostic in an earlier way, proceeding to its bacteriological confirmation before illness evolves to stages as advanced as in the shown case.

Vaccine, 1998 Jan-Feb, 16(2-3), 286 - 92
Induction of mucosal and systemic immune responses by intranasal immunization using recombinant cholera toxin B subunit as an adjuvant; Wu HY et al.; Intranasal (i.n.) immunization with Streptococcus mutans surface protein AgI/II mixed with cholera toxin B subunit (CTB) containing a trace amount of cholera toxin (CT) induces strong immune responses in mucosal and systemic sites, but whether pure CTB alone has an adjuvant effect has been questioned . To determine the adjuvant effect of recombinant (r) CTB, mice were immunized with 10 micrograms of AgI/II either mixed with or conjugated to 5 micrograms of rCTB, and antibody responses in saliva, nasal wash, gut wash, vaginal wash, and serum were assayed by ELISA . The results showed that AgI/II either mixed with or conjugated to rCTB could induce both mucosal IgA and systemic IgG antibodies to higher levels than in mice similarly immunized with AgI/II alone . Some responses, especially serum IgG antibodies, were enhanced by adding 5 micrograms CT to the immunogen, whereas overall mice immunized with AgI/II mixed with CTB contaminated with CT tended to generate the strongest mucosal IgA and serum IgG responses to AgI/II . However, rCTB used as an adjuvant induced lower antibody responses against itself than CTB intentionally or inadvertently mixed with CT . These results show that rCTB can serve as an adjuvant for protein immunogens administered by the i.n . route.

Vaccine, 1998 Jan-Feb, 16(2-3), 174 - 80
Effect of route of immunisation and adjuvant on T and B cell epitope recognition within a streptococcal antigen; Todryk SM et al.; Oral immunisation may elicit both systemic and mucosal immunity . Antibodies directed to a portion (residues 816-1213) of a cell surface adhesin termed streptococcal antigen I/II (SA I/II) of Streptococcus mutans prevent colonisation of this bacterium in vivo . This polypeptide is highly immunogenic in mice and is immunodominant in naturally sensitised humans . In this study, the effects of immunisation by different routes and of adjuvant on T and B cell epitope recognition were investigated . The recombinant polypeptide comprising residues 816-1213 of SA I/II was administered to groups of SJL mice intraperitoneally, subcutaneously or orally . For systemic immunisation, incomplete Freund's adjuvant was used, whereas for oral immunisation the antigen was coupled to the cholera toxin B subunit . The hierarchy of T and B cell epitope recognition differed significantly following different routes of immunisation . These differences in T and B cell responses may be accounted for by extracellular protease activity and processing by antigen presenting cells at the sites of immunisation . Furthermore, epitope recognition may be critical if the immune response elicited by a vaccine must be directed specifically to functional determinants within an antigen . This study emphasises the importance of route of immunisation in vaccine development.

Rheum Dis Clin North Am, 1998 May, 24(2), 237 - 59
Rheumatic fever . The relationships between host, microbe, and genetics; Gibofsky A et al.; Acute rheumatic fever is a delayed, nonsuppurative sequela of a pharyngeal infection with the group A streptococcus . The onset of the disease is usually characterized by an acute febrile illness; however, there may be chronic involvement of the heart and/or central nervous system . The article explores the relationship between the initial infection and host-microbial interactions that may be operative in disease pathogenesis.

J Trop Pediatr, 1998 Apr, 44(2), 84 - 6
Members of the throat microflora among infants with different feeding methods; Hokama T et al.; Normal throat microflora have an important role of antagonistic activity against pathogenic bacteria . We studied members of throat microflora of 30 exclusively breastfed, 15 mixed-fed and 15 exclusively formula-fed infants at the age of 1 month . All infants harboured alpha haemolytic Streptococcus . The incidence of gamma Streptococcus and coagulase negative Staphylococcus's isolation from breastfed infants was higher . We also found that coagulase negative Staphylococcus is one of three predominant bacterial species in breastfed infants.

Clin Diagn Lab Immunol, 1998 May, 5(3), 322 - 4
The polysaccharide fucoidin inhibits the antibiotic-induced inflammatory cascade in experimental pneumococcal meningitis; Granert C et al.; There is evidence that the treatment of bacterial meningitis with antibiotics liberates harmful bacterial products in the subarachnoid space (SAS) . This enhances meningeal inflammation and in particular the recruitment of leukocytes into the cerebrospinal fluid (CSF), which has been shown to be more harmful than beneficial in this disease . In this study, we used a rabbit meningitis model based on intracisternal injection of live Streptococcus pneumoniae . Ampicillin (40 mg/kg of body weight given intravenously {i.v.} 16 h after induction of meningitis) caused a fivefold increase in CSF leukocytes over a 4-h period . Inhibition of leukocyte rolling by treatment with the polysaccharide fucoidin (10 mg/kg, i.v.) prevented the enhanced leukocyte extravasation into the SAS and attenuated the leakage of plasma proteins over the blood-brain barrier . These results suggest that certain polysaccharides that block leukocyte rolling have the potential to reduce leukocyte-dependent central nervous system damage in bacterial meningitis.

J Med Chem, 1998 May 7, 41(10), 1660 - 70
Anhydrolide macrolides . 2 . Synthesis and antibacterial activity of 2,3-anhydro-6-O-methyl 11,12-carbazate erythromycin A analogues; Griesgraber G et al.; A series of 3-descladinosyl-2,3-anhydro-6-O-methylerythromycin A 11, 12-cyclic carbazate analogues was prepared and evaluated for antibacterial activity . These 2,3-anhydro macrolides were found to be potent antibacterial agents in vitro against macrolide-susceptible organisms including Staphylococcus aureus 6538P, Streptococcus pyogenes EES61, and Streptococcuspneumoniae ATCC6303 . These compounds were also very active against some organisms that show macrolide resistance (S . aureus A5177, S . pyogenes PIU2584, and S . pneumoniae 5649) . The compounds generally showed poor activity against organisms with constitutive MLS resistance . Selected compounds were evaluated in vivo in mouse protection studies . Although most of the compounds tested in vivo showed poor efficacy, two compounds, 38 and 57, were more active than clarithromycin against S . pneumoniae ATCC6303.

J Med Chem, 1998 May 7, 41(10), 1651 - 9
Anhydrolide macrolides . 1 . Synthesis and antibacterial activity of 2,3-anhydro-6-O-methyl 11,12-carbamate erythromycin A analogues; Elliott RL et al.; A series of 3-descladinosyl-2,3-anhydro-6-O-methylerythromycin A 11, 12-carbamate analogues have been synthesized and evaluated for antibacterial activity . These compounds were found to be potent antibacterial agents against Gram-positive organisms in vitro, many having MIC values below 1 microg/mL for the macrolide-susceptible Staphylococcus aureus, Streptococcus pyogenes, and Streptococcus pneumoniae, as well as improved activity compared to erythromycin A against the inducibly MLS (macrolide, lincosamide, and streptogramin B)-resistant organisms . Structure-activity studies revealed that arylalkyl carbamates with two and four carbon atoms between the aromatic moiety and carbamate nitrogen have the best in vitro activity . All of the C-10 epi analogues evaluated were found to have substantially less activity than the corresponding natural C-10 isomer . Several analogues demonstrated moderate antibacterial activity against the constitutively resistant S.aureus A-5278, S . pneumoniae5979, and S.pyogenes 930 . However, despite potent in vitro activity, these analogues showed only moderate in vivo activity in mouse protection studies.

Microb Pathog, 1998 Mar, 24(3), 167 - 74
Amino acid changes affecting the activity of pneumolysin alter the behaviour of pneumococci in pneumonia; Alexander JE et al.; Pneumolysin is a multi-functional toxin produced by Streptococcus pneumoniae . The toxin has distinct cytotoxic activity and complement-activating activity mediated by different parts of the toxin molecule . Mice challenged intranasally with a type 2 pneumococcal strain contract bronchopneumonia and bacteremia {1} . Mice were infected intranasally with isogenic mutants of this strain in which the chromosomal pneumolysin gene carried point mutations affecting either or both properties of pneumolysin . Reduction in either cytotoxic activity or complement activation by pneumolysin decreased the virulence of the mutant pneumococci . However, it was the ability to activate complement that most affected the behaviour of pneumococci in the lungs and associated bacteremia in the first 24 h following infection . Copyright 1998 Academic Press Limited.

What Is Dna?, What Is Anthrax?, What Is Protein?, What Is Bioengineering?, What Is Cell Biology?, r, Microorganism, c, Microbiology, n, Bacteria, r, Microbe, o, Microbes, i, Corynebacter, r, Biodegradation, i, Microbial, c, Culture medium, i, Corynebacter, r, Corynebacterium, c, Escherichia coli, o, Microbial, n, S. cerevisiae, a, Staphylococcus, a, Listeriosis, o, Erwinia, i, Rhizobacter, o, Yeasts, o, Cell cultures, i, Escherichia coli, i, Botulism, s, Yeasts, r, Gram negative, a, Petri dish, a, Microbiological

Scientific Publications - Work Done by Microbiology Reader Bioscreen C
Agricultural Microbiology Anaerobic Microbiology Antimicrobial Susceptibility Artificial Atmosphere Bioassay of Antibiotics Biofilm Microbiology Bioreactor Technology Biotechnology Cell Biology Clinical Microbiology Environmental Microbiology Experiments with Yeast	Fermentation Food Microbiology Functional Genomics Gene Technology Growth Media Development Growth Rate and Lag Time Industrial Microbiology Medical/Pharmaceutical Field Microbiological Assay Microbiological Research Microbiology of Cosmetics go to a specific theme...	Military Microbiology Molecular Microbiology Mutagenicity and Genotoxicity Oral Microbiology Patents Postantibiotic Studies Soil Microbiology Spore Microbiology Veterinary Microbiology Waste/Wastewater Treatment Water Microbiology Wine Microbiology

� 2005 Transgalactic Ltd (manufacturer of Bioscreen C software) | Privacy Statement | P.O. Box 1393, 00101 Helsinki, Finland, phone: +358 9 85172920, fax: +358 9 8749481, e-mail: microbiology@bionewsonline.com

Last modified: May 25, 2005