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