Int J Syst Evol Microbiol, 2005 Jan, 55(Pt 1), 271 - 4 Streptococcus marimammalium sp . nov., isolated from seals; Lawson PA et al.; Two strains of an unidentified, Gram-positive, catalase-negative, chain-forming, coccus-shaped organism recovered from seals were characterized using phenotypic and molecular taxonomic methods . Based on morphological and biochemical criteria the strains were tentatively identified as streptococci but they did not appear to correspond to any recognized species of the genus Streptococcus . Comparative 16S rRNA gene sequencing studies showed that the strains were closely related to each other and confirmed their placement in the genus Streptococcus . Sequence divergence values of >5 % with reference streptococcal species demonstrated the organisms from seals represent a novel species . SDS-PAGE analysis of whole-cell proteins confirmed that the two organisms were closely related to each other but were different from all currently defined streptococcal species . Based on biochemical criteria, molecular chemical and molecular genetic evidence, it is proposed that the unknown isolates from seals be assigned to a novel species of the genus Streptococcus, Streptococcus marimammalium sp . nov . The type strain is M54/01/1(T) (=CCUG 48494(T)=CIP 108309(T)). J Dairy Sci, 2005 Feb, 88(2), 604 - 14 Factors affecting cure and somatic cell count after pirlimycin treatment of subclinical mastitis in lactating cows; Deluyker HA et al.; This study investigated the associations of both bacteriological cure and quarter somatic cell count (SCC) after intramammary antibiotic treatment with treatment duration, cow characteristics, and pretreatment bacteriology and SCC . For the purpose of this paper, data from 2 treatment groups in each of 2 multi-location studies were selected . These studies were conducted to evaluate the efficacy of daily intramammary infusions with 50 mg of pirlimycin hydrochloride for the treatment of subclinical mastitis . Data from study 1 allowed for comparison of a group of cows that received pirlimycin intramammarily for 2 d with a group that received no treatment, and study 2 provided data for comparison of pirlimycin for 2 d with pirlimycin for 8 d . Quarter milk samples from cows with a high monthly SCC were tested for bacteriology and SCC . If one or more quarters had both a positive bacteriology and an SCC >/=300,000 cells/mL, the cow was enrolled and randomly allocated to a treatment group . Enrolled cows were monitored for clinical mastitis and other disease for 4 wk after treatment initiation . At 3 and 4 wk after treatment initiation, milk samples were taken from each enrolled quarter to determine the SCC and conduct a bacteriological culture . Bacteriological culture results were interpreted such that quarters where the same bacterial species was cultured before treatment and found in at least 1 of the 2 posttreatment samples were considered a failure . The analysis of SCC used a mixed linear model (SAS proc mixed) and the analysis of bacteriological cure used a mixed logistic model (SAS glimmix macro) . Bacteriological cure rate was significantly higher for lower parity, lower number of colonies in the pretreatment culture, longer treatment duration, and for streptococci compared with Staphylococcus aureus . However, treatment regimen affected bacteriological cure differently in major than in minor pathogens and there was a significant interaction of treatment regimen with stage of lactation . Posttreatment SCC was significantly higher with increasing parity, in rear quarters, and with shorter duration of treatment . In the group of second and third parity animals, post-treatment SCC was more reduced in front quarters than in rear quarters . Also, the difference in posttreatment SCC between younger and older cows increased with higher pretreatment SCC . In conclusion, when predicting bacteriological cure following treatment of subclinical mastitis during lactation both treatment regimen and other risk factors need to be considered . The other risk factors may vary with treatment regimen . Posttreatment SCC was associated with treatment regimen, other risk factors, and interactions among the other risk factors; but these other risk factors did not vary significantly with treatment regimen. Microb Drug Resist, 2004 Winter, 10(4), 300 - 5 Antibiotic resistance and genotypic characteristics of group a streptococci associated with acute pharyngitis in Korea; Kim S et al.; Group A streptococci (GAS) is the most common pathogen of bacterial pharyngitis . GAS were isolated from pediatric outpatients with symptomatic acute pharyngitis . T typing and emm genotyping were performed for an epidemiologic study . The phenotypes of erythromycin (EM) resistance were evaluated, and the frequencies of ermB, ermTR(A), and mefA genes were determined by polymerase chain reaction . A total of 125 (50.8%) of 246 children yielded GAS . The two most frequent T types were T12 (35.2%) and T nontypeable (30.4%) . The most frequent emm type was emm 12 (28.5%), followed by emm75 (18.7%), emm22 (13.0%), emm2 (12.2%), and emm8 (8.1%) . The resistance rates to erythromycin and clindamycin were 44.8% and 19.2%, respectively . Among the EM-resistant strains, constitutive resistance, inducible resistance, and the M phenotype were observed in 42.1%, 0%, and 57.9%, respectively . The ermB, ermA, and mefA genes were present in 39.3%, 0%, and 58.9%, respectively . Most of the emm12 strains showed constitutive resistance, while emm18 and emm75 demonstrated the M phenotype . The organisms with other emm genotypes were susceptible to both EM and clindamycin . These results indicate that some emm genotypes might be associated with a specific mechanism of EM resistance. J Antimicrob Chemother . 2005 Jan 13; {Epub ahead of print} Culture results of heart valves resected because of streptococcal endocarditis: insights into duration of treatment to achieve valve sterilization; Upton A et al.; To analyse the culture results of heart valves removed following streptococcal endocarditis in order to gain insight into the duration of treatment required for valve sterilization . Retrospective review of 131 episodes of streptococcal endocarditis: 94 due to alpha-haemolytic streptococci; 15 due to beta-haemolytic streptococci; 10 due to nutritionally deficient streptococci; eight due to the Streptococcus anginosus group and four due to Streptococcus pneumoniae . Patients had their valves removed during antimicrobial treatment . Culture results were analysed with respect to duration of treatment before surgery . For alpha-haemolytic streptococci, 17 (18%) valves were culture-positive and 77 (82%) culture-negative after a median (range) of 4 (1-20) and 16 (4-58) days of treatment, respectively, P < 0.001 . For beta-haemolytic streptococci, two valves (13%) were culture-positive; both patients had received </=4 days of treatment . Four patients (40%) with nutritionally deficient streptococci were culture-positive, and had received </=8 days of treatment . For the S . anginosus group, two valves (25%) were culture-positive; both patients had received </=4 days of treatment before operation . Overall, only one of 131 (0.8%) valves was culture-positive after 14 days of treatment . All valves infected with beta-haemolytic streptococci, nutritionally deficient streptococci and the S . anginosus group, who were treated for more than 8 days before surgery, were culture-negative . Our findings support current treatment guidelines for endocarditis caused by alpha-haemolytic streptococci . We suggest that the recommended duration of treatment for endocarditis resulting from other streptococci may be excessive and treatment trials evaluating 2 and 4 week regimens are justified. Oral Health Prev Dent, 2003, 1(1), 53 - 7 Effect of maternal use of chewing gums containing xylitol, chlorhexidine or fluoride on mutans streptococci colonization in the mothers' infant children; Thorild I et al.; PURPOSE: The aim was to evaluate the effect of maternal use of chewing gums containing xylitol, chlorhexidine/xylitol or fluoride on the prevalence of mutans streptococci (MS) in the mothers' 18-month-old offsprings . MATERIALS AND METHODS: After screening 416 women with newborn babies, 173 mothers with high counts of salivary MS were randomly assigned into three experimental chewing gum groups containing A) xylitol, B) chlorhexidine/xylitol and C) sodium fluoride . Mothers with low or medium MS counts formed a reference group D without any intervention . The participants in the experimental groups were instructed to chew one gum for 5 minutes, three times a day . The chewing was initiated when the child was 6 months old and terminated one year later . The outcome measure was MS colonization in mothers' 18-month-old infants . Bacterial sampling and cultivation was carried out with the Strip mutans technique . RESULTS: The MS prevalence was 10%, 16%, and 28% in groups A, B, and C respectively . In the reference group D, 10% of the infants harbored MS . The difference between group C and groups A and B was statistically significant (p<0.05) . The colonization levels in groups A and B were similar to those obtained in children of mothers with low MS counts (group D) . CONCLUSION: Maternal consumption of xylitol- and chlorhexidine/xylitol-containing chewing gums significantly reduced the mother-child transmission of salivary mutans streptococci. Arthritis Res Ther, 2005, 7(1), R118 - 26 Epub 2004 Nov 24. MMP-3 expression and release by rheumatoid arthritis fibroblast-like synoviocytes induced with a bacterial ligand of integrin alpha5beta1; Zeisel MB et al.; Fibroblast-like synoviocytes (FLSs) play a major role in the pathogenesis of rheumatoid arthritis (RA) by secreting effector molecules that promote inflammation and joint destruction . How these cells become and remain activated is still elusive . Both genetic and environmental factors probably play a role in transforming FLSs into inflammatory matrix-degrading cells . As bacterial products have been detected in the joint and shown to trigger joint inflammation, this study was undertaken to investigate whether a bacterial ligand of integrin alpha5beta1, protein I/II, could contribute to the aggressive behavior of RA FLSs . Protein I/II is a pathogen-associated molecular pattern (PAMP) isolated from oral streptococci that have been identified in the joints of RA patients . The response of RA and osteoarthritis FLSs to protein I/II was analyzed using human cancer cDNA expression arrays . RT-PCR and pro-MMP-3 (pro-matrix metalloproteinase) assays were then performed to confirm the up-regulation of gene expression . Protein I/II modulated about 6% of all profiled genes . Three of these, those encoding IL-6, leukemia inhibitory factor, and MMP-3, showed a high expression level in all RA FLSs tested, whereas the expression of genes encoding other members of the cytokine or MMP-family was not affected . Furthermore, the up-regulation of MMP-3 gene expression was followed by an increase of pro-MMP-3 release . The expression of interferon regulatory factor 1 and fibroblast growth factor-5 was also up-regulated, although the expression levels were lower . Only one gene, that for insulin-like growth factor binding protein-4, was down-regulated in all RA FLSs . In contrast, in osteoarthritis FLSs only one gene, that for IL-6, was modulated . These results suggest that a bacterial ligand of integrin alpha5beta1 may contribute to the aggressive behavior of RA FLSs by inducing the release of pro-inflammatory cytokines and a cartilage-degrading enzyme, such as IL-6 and MMP-3, respectively. Oral Health Prev Dent, 2003, 1(3), 195 - 9 Effect of xylitol-containing chewing gums on lactic acid production in dental plaque from caries active pre-school children; Twetman S et al.; PURPOSE: The aim of this study was to evaluate the lactic acid concentration in supragingival plaque from caries-active pre-school children after a short-term use of either xylitol- or sorbitol-containing chewing gums . MATERIAL AND METHODS: The investigation consisted of a prospective crossover design with 10 healthy children aged 2-4 years each with at least two caries lesions within the dentine (ds > or = 2) . The children were instructed to chew 6 pieces of a test or a control gum every day for a 14-day period . The test gum contained 65% xylitol and the control gum was sweetened with sorbitol . At baseline and after 14 days, salivary mutans streptococci were enumerated with a chair-side test (Strip mutans) and dental plaque was collected from the upper maxillary incisors . After a washout period of 6 weeks, the same procedure was repeated with the corresponding test or control gum . Lactic acid was determined enzymatically in glucose-challenged plaque suspensions . RESULTS: The lactic acid concentration was significantly reduced (p<0.05) by 22% compared with baseline following the xylitol gum regimen but was unaltered after the control gum . The levels of salivary mutans streptococci were mainly unaffected by both chewing gums . CONCLUSION: A 14-day use of xylitol-containing chewing gums, corresponding to a daily amount of 5 grams of xylitol, could diminish glucose-initiated lactic acid formation in supragingival plaque in caries-active pre-school children. Appl Environ Microbiol, 2005 Jan, 71(1), 587 - 90 Use of glnQ as a Counterselectable Marker for Creation of Allelic Exchange Mutations in Group B Streptococci; Tamura GS et al.; Efficient allelic exchange mutagenesis in group B streptococci (GBS) has been hampered by the lack of a counterselectable marker system . Growth inhibition of GBS by the glutamine analog gamma-glutamyl hydrazide requires glnQ . We have used this phenomenon to create a counterselectable marker system for efficient selection of allelic exchange mutants in GBS. Immunobiology, 2004, 209(8), 609 - 17 Influence of modified natural and synthetic surfactant preparations on bacterial killing by polymorphonuclear leucocytes; Rauprich P et al.; In addition to its biophysical functions, surfactant plays an important role in pulmonary host defense . In this investigation we studied the influence of various commercially available surfactants on the phagocytosis of bacteria that are common pathogens in the neonatal period . Group B streptococci (GBS), Escherichia coli and Staphylococcus aureus were cultured with isolated human polymorphonuclear leucocytes (PMN) and non-specific serum in the presence or absence of different modified natural (Curosurf, Alveofact, Survanta) or totally synthetic, protein-free surfactant preparations (Exosurf, Pumactant) . Prior to and after 30 and 60 min of incubation with PMN at different surfactant concentrations (1, 10 or 20 mg/ml), the number of viable bacteria was determined by colony counting . Killing of S . aureus by PMN was not influenced by any of the surfactants . Alveofact and Curosurf had no significant negative impact on phagocytosis . At 20 mg/ml, Curosurf even reduced the number of viable E . coli . Survanta at 10 and 20 mg/ml and Exosurf at all concentrations impaired the killing of non-encapsulated GBS and E . coli . Pumactant at 1-20 mg/ml interfered with the phagocytosis of E . coli . In further experiments we demonstrated that Curosurf did not interfere with the phagocytosis of an encapsulated GBS-strain opsonised by a specific antiserum either . In additional experiments we analysed the influence of the different surfactants on the release of reactive oxygen metabolite by PMN and found that the changes in nitroblue tetrazolium reduction did not necessarily correlate with the findings of the studies on killing . In conclusion, we found that killing by PMN was influenced by the bacterial species and the composition and concentration of the different surfactant preparations . The strongest impairment in phagocytic function of PMN was observed with the protein-free synthetic surfactant Exosurf, a phospholipid preparation that contains the alcohols hexadecanol and tyloxapol as spreading agents. Int J Obstet Anesth, 1993 Oct, 2(4), 202 - 3 A potential complication of early blood patching following inadvertent dural puncture; Allen DL et al.; Early blood patching following inadvertent dural puncture has been recommended by some workers . We describe a case in which this resulted in the injection of blood contaminated with group B haemolytic streptococci . Although no complications ensued, the potential for injecting bacteraemic blood following parturition limits the application of this technique in obstetric patients. Pediatr Res . 2005 Jan 5; {Epub ahead of print} Group B Streptococci Exposed to Rifampin or Clindamycin (versus Ampicillin or Cefotaxime) Stimulate Reduced Production of Inflammatory Mediators by Murine Macrophages; Brinkmann KC et al.; Streptococcus agalactiae (group B Streptococcus, GBS) is an important cause of sepsis and meningitis in neonates, and excessive production of the inflammatory mediators tumor necrosis factor (TNF) and nitric oxide (NO) causes tissue injury during severe infections . We hypothesized that exposure of GBS to different antimicrobial agents would affect the magnitude of the macrophage inflammatory response to this organism . We stimulated RAW 264.7 murine macrophages with a type-Ia GBS isolate in the presence of ampicillin, cefotaxime, rifampin, clindamycin, or gentamicin, singly or in combination . We found that GBS exposed to rifampin or clindamycin (versus beta-lactam antibiotics) stimulated less TNF secretion and inducible nitric oxide synthase (iNOS) protein accumulation in RAW 264.7 cells . Furthermore, GBS exposed to combinations of antibiotics that included a protein synthesis inhibitor stimulated less macrophage TNF and iNOS production than did organisms exposed to beta-lactam antibiotics singly or in combination . We conclude that exposure of GBS to rifampin or clindamycin leads to a less pronounced macrophage inflammatory mediator response than does exposure of the organism to cell wall-active antibiotics. J Clin Microbiol, 2005 Jan, 43(1), 163 - 7 PCR detection of bacteria on cardiac valves of patients with treated bacterial endocarditis; Rovery C et al.; We used broad-range PCR amplification and sequencing to detect and identify bacterial DNA in 156 valves of patients treated for infective endocarditis (IE) . Bacterial DNA was found more frequently in patients who underwent valve replacement while on antibiotic treatment for IE (60%) than in patients who had completed antibiotic treatment for IE (37%; P = 0.02) . We found specific bacterial DNA in valves removed from 11 of 30 patients who had completed antibiotic treatment for IE . Six had no histological evidence of IE . The presence of DNA was significantly correlated with the presence of histologic lesions (P = 0.001) and with the presence of bacteria detected by Gram staining (P < 0.001) . Bartonella and streptococci were detected for much longer after antibiotic treatment by PCR than other species (P = 0.047 and 0.04, respectively), and coagulase-negative staphylococci were detected for much shorter periods (P = 0.02) . The finding that bacterial DNA was more likely to be detected in valves of patients with active IE than in patients who had completed antibiotic treatment for IE shows that bacterial DNA is cleared slowly . There was no significant correlation between the duration of antibiotic therapy and the presence of bacterial DNA in valves . Since the persistence of bacterial DNA in valves does not necessarily indicate the persistence of viable bacteria, the detection of bacterial DNA in valves from IE patients should be interpreted with caution, in particular in those patients with a past history of treated IE. J Food Prot, 2004 Dec, 67(12), 2644 - 50 Mastitis-causing streptococci are important contributors to bacterial counts in raw bulk tank milk; Zadoks RN et al.; The objective of this study was to probe the contribution of streptococci to the microbial quality of raw milk . Over a 5-month period, bulk tank milk samples from 48 New York State dairy farms were analyzed qualitatively for bacterial ecology and quantitatively for total bacterial, streptococcal, staphylococcal, and gram-negative bacterial counts . Linear regression analysis was used to determine the contribution of differential counts to total bacterial counts . Streptococci, staphylococci, and gram-negative bacteria accounted for 69, 3, and 3% of total bacterial count variability, respectively . Randomly selected Streptococcus isolates from each bulk tank milk sample were identified to species by means of the API 20 STREP identification system . The most commonly identified streptococcal species were Streptococcus uberis, Aerococcus viridans, and Streptococcus agalactiae, which were detected in 81, 50, and 31% of 48 bulk tank samples, respectively . For five herds, S . uberis isolates from bulk tank milk and individual cows were characterized by PvuII ribotyping . A farm-specific dominant ribotype was found in each bulk tank sample, and that ribotype was isolated from at least one cow within each herd of origin . Bacteriological and strain typing data indicate that control of streptococci, specifically mastitis-causing species, is important for improvement of the microbial quality of raw milk in New York State. Epidemiol Mikrobiol Imunol, 2004 Nov, 53(4), 192 - 5 {Multilocus sequence typing of group A streptococci isolated from invasive diseases in the Czech Republic in 2003}; Strakova L et al.; First results of multilocus sequence typing (MLST) for characterization of 29 invasive Streptococcus pyogenes strains isolated in the Czech Republic in the first half of 2003 are presented . None of 16 emm types detected among the study strains showed sequence type (ST) variability . The MLST results are indicative of differences between the strains causing serious diseases in the Czech Republic and those isolated in other countries . In seven strains, four new STs with known alleles in new combinations, ST134, ST308, ST336, ST340, and one new ST with three as yet undescribed alleles (gki 91, murI 65 and yqiL 60), ST341, were described . These newly described STs were submitted to the web-based reference MLST database for S . pyogenes. Diagn Microbiol Infect Dis, 2005 Jan, 51(1), 9 - 12 Comparison of selective and nonselective enrichment broth media for the detection of vaginal and anorectal colonization with group B streptococcus; Rauen NC et al.; The use of a selective enrichment broth medium has been widely recommended to optimize the recovery of group B streptococci (GBS) from genital and anorectal samples . Because selective antibiotic-containing versions of broth media are significantly more expensive than their nonselective parent formulations, we sought to examine whether the use of the nonselective Todd-Hewitt broth (THB) could accomplish comparable recovery of GBS to the recommended, selective version of this medium (Lim broth) . During the study, vaginal and anorectal swab samples submitted to our laboratory for GBS culture were all inoculated onto Columbia colistin-nalidixic acid agar (CNA) and into either THB or Lim broth (alternated on a weekly basis) . During the 45-week study period, 1200 samples (600 in each study arm) were evaluated . GBS were recovered from 164 samples (27.3%) in the Lim arm of the study, of which 60 (36.7%) were positive only on subculture of broths . In the THB study arm, 161 samples (26.8%) yielded GBS, of which 58 (36.0%) were positive only in broths . This study conclusively demonstrates that a nonselective enrichment broth media provides comparable sensitivity to the recommended selective broth for detection of GBS colonization during pregnancy. Biochim Biophys Acta, 2005 Jan 11, 1681(2-3), 134 - 49 Epub 2004 Nov 30. Molecular characterization of NADase-streptolysin O operon of hemolytic streptococci; Kimoto H et al.; Whether slo, the gene encoding streptolysin O (SLO), a streptococcal cytolysin, has its own promoter or not is unsettled as yet . Present analyses demonstrate that slo is a member of an operon covering the upper-stream nusG and nga (NADase) genes, from which transcription of slo proceeds polycistronically, and major transcript is produced by readthrough from nga promoter . Mutational conversion of the sixth nucleotide T at the putative -10 region of chromosomal nga gene into C caused a drastic decrease in both NADase and SLO activities and the disappearance of the two corresponding mRNA bands from the Northern blot profile . The initiation site of the transcription was determined at 56 bp upstream (NusG gene) and 25 bp upstream (NADase gene) of each initiation codon . Although the promoter region of slo gene is highly conserved between group A and C streptococci, the proper slo promoter is nonfunctional in group C strain H46A . Moreover, commonly conserved arrangement was limited to the nusG-nga-orf1-slo region . These results indicate an intimate relationship between NADase and SLO in the regulation of their biosynthesis . Additional results suggest that NADase, synthesized as precursor with feeble activity, is activated by removing the carboxyl terminal region during or after secretion into culture medium. Int J Pediatr Otorhinolaryngol, 2005 Jan, 69(1), 9 - 19 The role of anaerobic bacteria in tonsillitis; Brook I; This review summarizes the information that supports the potential importance of anaerobic bacteria in tonsillitis . Some anaerobic bacteria possess interfering capability with Group A beta-hemolytic streptococci (GABHS) and other pathogens . The possible role of anaerobes in the acute inflammatory process in the tonsils is supported by several observations: anaerobes have been isolated from the cores of tonsils of patients with recurrent GABHS and non-GABHS tonsillitis (NST); the recovery of anaerobes as predominant pathogens in abscesses of tonsils, in many cases without any aerobic bacteria; their recovery as pathogens in well-established anaerobic infections of the tonsils (Vincent's angina); the increased recovery rate of encapsulated pigmented Prevotella and Porphyromonas spp . in acutely inflamed tonsils; their isolation from the cores of recurrently inflamed NST; and the response to antibiotics in patients with NST . Furthermore, immune response against Prevotella intermedia is present in patients with recurrent NST, and an immune response can also be detected against P . intermedia and Fusobacterium nucleatum in patients who recovered from peritonsillar cellulitis or abscesses, infectious mononucleosis and acute non-streptococcal and GABHS tonsillitis . Although more studies are needed, these findings support the possible pathogenicity of Gram-negative anaerobic bacilli in tonsillitis. Jpn J Infect Dis, 2004 Dec, 57(6), 271 - 2 The Rate of Asymptomatic Throat Carriage of Group A Streptococcus in School Children and Associated ASO Titers in Duzce, Turkey; Ozturk CE et al.; A prospective study was conducted to investigate the rate of group A streptococci (GAS) carriers and associated anti-streptolysin O (ASO) titers in serum samples in asymptomatic school children in spring in Duzce, Turkey . Pharyngeal swabs were obtained to detect the presence of GAS and blood samples were collected to determine elevated ASO titers in serum . A total of 351 asymptomatic primary school children were included in the study, and 91 (25.9%) of these were found to be GAS carriers . Of the 91 carrier students, ASO titers were elevated (>/=200 IU/ml) in 34 students (37%) . Of the 260 non-carrier children, ASO titers were found as elevated (>/=200 IU/ml) only in 27 (10.3%) students . The difference between the ASO-positivity rate of the GAS carrier group (34 in 91 students) and that of the non-carrier group (27 in 260 students) was found to be statistically significant (P < 0.05) . The finding of the significant relationship between ASO positivity and GAS carriage indicated that ASO measurement might be used together with throat culture to identify of GAS carriers. Antimicrob Agents Chemother, 2005 Jan, 49(1), 111 - 7 Removal of group B streptococci colonizing the vagina and oropharynx of mice with a bacteriophage lytic enzyme; Cheng Q et al.; Group B streptococci (GBS) are the leading cause of neonatal meningitis and sepsis worldwide . The current treatment strategy is limited to intrapartum antibiotic prophylaxis in pregnant women to prevent early-onset neonatal diseases, but considering the potential for antibiotic resistance, the risk of losing control over the disease is high . To approach this problem, we have developed a bacteriophage (phage) lytic enzyme to remove colonizing GBS . Bacteriophage muralytic enzymes, termed lysins, are highly evolved molecules designed to degrade the cell wall of host bacteria to release phage particles from the bacterial cytoplasm . Several different lysins have been developed to specifically kill bacterial pathogens both on mucosal surfaces and in blood and represent a novel approach to control infection . A lysin cloned from a phage infecting GBS was found to contain two putative catalytic domains and one putative binding domain, which is similar to the domain organization of some staphylococcal phage lysins . The lysin (named PlyGBS) was recombinantly expressed in Escherichia coli, and purified PlyGBS efficiently killed all tested GBS serotypes in vitro . In a mouse model, a single dose of PlyGBS significantly reduced bacterial colonization in both the vagina and oropharynx . As an alternative strategy for intrapartum antibiotic prophylaxis, this approach may be used to reduce vaginal GBS colonization in pregnant women before delivery or to decontaminate newborns, thus reducing the incidence of GBS-associated neonatal meningitis and sepsis. Antimicrob Agents Chemother, 2005 Jan, 49(1), 97 - 103 Distribution of antimicrobial resistance and virulence-related genes among Brazilian group B streptococci recovered from bovine and human sources; Duarte RS et al.; In the present report we describe the characteristics of 189 antimicrobial-resistant Streptococcus agalactiae isolates from bovine (38 isolates) and human (151 isolates) sources . All the strains were resistant to tetracycline (TET), and 16 (8.5%) were also resistant to erythromycin, corresponding to 23.7% of the TET-resistant bovine isolates and 4.6% of the TET-resistant human isolates . The tet(O), erm(B), and mreA resistance-related genes, as well as the bca and scpB virulence-related genes, were the most frequent among the bovine isolates, while the tet(M), erm(A), mreA, bca, lmb, and scpB genes were the most prevalent among the isolates from humans . Although a few major clusters were observed, pulsed-field gel electrophoresis results revealed a variety of profiles, reflecting the substantial genetic diversity among strains of this species isolated from either humans or bovines. Antimicrob Agents Chemother, 2005 Jan, 49(1), 88 - 96 Effect of antibiotics on group A Streptococcus exoprotein production analyzed by two-dimensional gel electrophoresis; Tanaka M et al.; High-dose clindamycin (CLDM) and benzylpenicillin (PCG) are the recommended chemotherapeutic remedies for toxic shock-like syndrome caused by group A streptococci . One reason for this is that it has been shown that CLDM suppresses the expression of some exoproteins, e.g., SpeB, SpeA, and streptolysin O (Slo) . We analyzed the effects of antibiotics on the production of whole exoproteins by two-dimensional gel electrophoresis . Unexpectedly, we found that the levels of several exoproteins, Slo, NAD(+)-glycohydrolase (Nga), M protein, and Sic, were increased by CLDM treatment, although we also confirmed previous findings that the levels of various exoproteins, including SpeB, were decreased . The increases in exoprotein levels were also detected by using other protein synthesis inhibitor antibiotics: erythromycin, kanamycin, tetracycline, chloramphenicol, and linezolid . Peptidoglycan synthesis inhibitors (such as PCG, cefazolin, and imipenem), DNA replication inhibitors (such as gatifloxacin), and an RNA polymerase inhibitor (rifampin) did not have significant effects on exoprotein production . The combination of CLDM and PCG had no advantageous effects with regard to exoprotein production compared to the effect achieved with CLDM alone . We also analyzed the transcriptional levels of slo and nga by reverse transcription-PCR and found that this change was also detected at the transcriptional level . Furthermore, the phenomenon was seen not only in strains of the M1 serotype but also in strains of the other M serotypes . Our study suggests that the clinical effectiveness of CLDM might be due to the inhibition of the production of a limited number of exoproteins. Srp Arh Celok Lek, 2004 Oct, 132 Suppl 1, 39 - 41 {Value of rapid test for identification of beta hemolytic streptococcus antigens in children with Streptococcal pharyngitis}; In vitro activity of telithromycin against mefA and ermB erythromycin-resistant viridans streptococci isolated from bacteremia of oral origin in Spain; Department of Special Needs, School of Medicine and Dentistry, Santiago de Compostela University, Santiago de Compostela, SpainTomas I, Alvarez M, Lopez-Melendez C, Limeres J, Tomas M, Diz P . In vitro activity of telithromycin against mefA and ermB erythromycin-resistant viridans streptococci isolated from bacteremia of oral origin in Spain . Oral Microbiol Immunol 2005: 20: 35-38 . (c) Blackwell Munksgaard, 2005 . Erythromycin-resistant viridans streptococci are often responsible of bacteremias following dental manipulations . The aim of this study was to evaluate the in vitro activity of telithromycin against erythromycin-susceptible and erythromycin-resistant viridans streptococci . Venous blood samples were collected from 84 patients, 30 s after dental extractions . Viridans streptococci were identified by conventional microbiological techniques . A set of 36 viridans streptococci were selected to investigate the in vitro activity of telithromycin by the agar dilution method . Macrolide resistance genes were amplified with specific primers for the mefA and ermB genes and visualized by electrophoresis . For erythromycin-susceptible viridans streptococci, telithromycin minimal inhibitory concentration(90) (MIC(90)) was <0.008 mug/ml . For erythromycin-resistant viridans streptococci, telithromycin MIC(90) was 1 mug/ml . The MIC(90) to telithromycin of the mefA-positive and ermB-negative viridans streptococci was lower than that of the mefA-negative and ermB-positive viridans streptococci (0.128 mug/ml versus 1 mug/ml) . The in vitro activity of telithromycin was high, irrespective of the erythromycin susceptibility and the mechanism of erythromycin resistance identified. Oral Microbiol Immunol, 2005 Feb, 20(1), 31 - 4 Comparative analysis of the antibacterial effects of combined mouthrinses on Streptococcus mutans; Menendez A et al.; Menendez A, Li F, Michalek SM, Kirk K, Makhija SK, Childers NK . Comparative analysis of the antibacterial effects of combined mouthrinses on Streptococcus mutans . Oral Microbiol Immunol 2005: 20: 31-34 . (c) Blackwell Munksgaard, 2005 . Background/aims: Chlorhexidine has been proposed as a potent chemotherapeutic agent against oral bacteria . However, there are some inconsistent results regarding the usefulness of chlorhexidine mouthrinse as an antimicrobial for Streptococcus mutans . The purpose of this study was to investigate the effectiveness of combining oral rinses to reduce S . mutans levels in human saliva . Methods: Sixteen healthy adult subjects were randomly assigned to one of four rinse groups using a 4-cell crossover design . The groups rinsed twice a day for 7 days with one of the following: 0.12% chlorhexidine (PerioGard( ((R)) )), 1.5% hydrogen peroxide (Peroxyl( ((R)) )), a combined chlorhexidine + hydrogen peroxide, or water (control) . Every 5 weeks, each group initiated a different rinse . Saline wash samples were collected on days 7 and 21 for assessment of S . mutans and total streptococci . Results: No significant differences were seen in S . mutans levels among the groups; however, the levels of total streptococci on day 7 samples were significantly lower in the chlorhexidine and chlorhexidine + hydrogen peroxide groups than in the hydrogen peroxide and control groups . There was no additional decrease seen in S . mutans or total streptococci levels in the group receiving chlorhexidine + hydrogen peroxide compared to chlorhexidine alone . Conclusions: Sample variation was high throughout the study, with a significant trend toward lower counts as the study progressed . Adding hydrogen peroxide to the chlorhexidine mouthrinse did not result in a further decrease in S . mutans levels. Paediatr Drugs, 2004, 6(6), 363 - 73 Acute rheumatic Fever in children : recognition and treatment; Lennon D; Acute rheumatic fever (ARF) is an inflammatory disease of the heart, joints, CNS, and subcutaneous tissue that develops after a pharyngeal infection by one of the group A beta-hemolytic streptococci (Streptococcus pyogenes) . The pathogenesis of the disease remains an enigma and specific treatment is not available, yet prevention of initial and recurrent attacks is possible by penicillin treatment . Rheumatic fever is especially important because of the heart disease that usually ensues; as succinctly stated by Lasegue many years ago, rheumatic fever "licks the joints and bites the heart", a statement that holds true today . Rheumatic fever is no longer a significant health problem in most socioeconomically advanced countries but it still causes 25-40% of all cardiovascular disease in the world, including tropical countries where it was once believed to be rare . In many countries it causes more hospital admissions than congenital heart conditions.ARF and rheumatic heart disease - with high associated morbidity, cost, and mortality - are largely preventable . Importantly, recurrences of rheumatic fever with their increased likelihood of more severe carditis are inexpensively preventable . Primary prevention has been achieved innovatively in some countries, for example, Costa Rica, and more conventionally in some developed countries . Treatment of the acute episode controls symptoms and may limit cardiac damage. Prescrire Int, 2004 Dec, 13(74), 227 - 32 Antibiotics for acute group A streptococcal pharyngitis; Role of L-ficolin/mannose-binding lectin-associated serine protease complexes in the opsonophagocytosis of type III group B streptococci; Division of Microbiology, Joshi-Eiyoh (Kagawa Nutrition) University, Sakado, Saitama 350-0288, JapanSerotype III group B streptococci (GBS) are a common cause of neonatal sepsis and meningitis . Although deficiency in maternal capsular polysaccharide (CPS)-specific IgG correlates with susceptibility of neonates to the GBS infection, serum deficient in CPS-specific IgG mediates significant opsonophagocytosis . This IgG-independent opsonophagocytosis requires activation of the complement pathway, a process requiring the presence of both Ca(2+) and Mg(2+), and is significantly reduced by chelating Ca(2+) with EGTA . In these studies, we defined a role of L-ficolin/mannose-binding lectin-associated serine protease (MASP) complexes in Ca(2+)-dependent, Ab-independent opsonophagocytosis of serotype III GBS . Incubation of GBS with affinity-purified L-ficolin/MASP complexes and C1q-depleted serum deficient in CPS-specific Ab supported opsonophagocytic killing, and this killing was inhibited by fluid-phase N-acetylglucosamine, the ligand for L-ficolin . Binding of L-ficolin was proportional to the CPS content of individual strains, and opsonophagocytic killing and C4 activation were inhibited by fluid-phase CPS, suggesting that L-ficolin binds to CPS . Sialic acid is known to inhibit alternative complement pathway activation, and, as expected, the bactericidal index (percentage of bacteria killed) for individual strains was inversely proportional to the sialic acid content of the CPS, and L-ficolin-initiated opsonophagocytic killing was significantly increased by addition of CPS-specific IgG2, which increased activation of the alternative pathway . We conclude that binding of L-ficolin/MASP complexes to the CPS generates C3 convertase C4b2a, which deposits C3b on GBS . C3b deposited by this lectin pathway forms alternative pathway C3 convertase C3bBb whose activity is enhanced by CPS-specific IgG2, leading to increased opsonophagocytic killing by further deposition of C3b on the GBS. Tidsskr Nor Laegeforen, 2004 Dec 16, 124(24), 3187 - 90 {Do colostrum tablets have a symptomatic effect on sore throat?}; Lindbaek M et al.; BACKGROUND: Throat infections are common conditions in general practice . Pain and discomfort can be considerable in all kinds of throat infections and it would be of great clinical relevance to find out if either of the two types of colostrum tablets sold over the counter in Norway shortens the duration of symptoms in throat infections not caused by group A streptococci . MATERIALS AND METHODS: The study was prospective, double-blinded, randomised and placebo-controlled . 148 adult patients with sore throat were recruited in five Norwegian military camps during the winters 1999-2001 . The main outcome measures were the degree of sore throat and malaise as experienced by the patients, measured by visual analogue scale, and the number of days until recovery . The patients were divided in three groups who received either one of the two brands of tablets or placebo which they would use more or less continuously until recovery . RESULTS: 148 patients completed the study . Patients in all three groups reported a reduction of pain on the visual analogue scale of approximately 50% after 6 days . There were no significant differences in pain reduction between the groups . As to malaise, the Curamed group had a somewhat lower, non-significant start value and also experienced less reduction in symptoms . The differences between the groups were not significant . There was no significant difference between the groups as to the duration of pain until recovery . INTERPRETATION: In this study we found no symptomatic effect of neither of the colostrum tablets used by patients with sore throat. Am Fam Physician, 2004 Dec 1, 70(11), 2113 - 20 A practical guide to infant oral health; Douglass JM et al.; Early childhood caries is the most common chronic disease in young children and may develop as soon as teeth erupt . Bacteria, predominately mutans streptococci, metabolize simple sugars to produce acid that demineralizes teeth, resulting in cavities . Physicians should examine children's teeth for defects and cavities at every well-child visit . Any child with significant risk factors for caries (e.g., inadequate home dental care and poor oral hygiene, a mother with a high number of cavities, a high sugar intake, enamel defects, premature birth, special health care needs, low socioeconomic status) should be referred to a dentist by 12 months of age . Promoting appropriate use of topical and systemic fluoride and providing early oral hygiene instruction can help reduce caries in young patients, as can regularly counseling parents to limit their child's consumption of sugar. Eur J Clin Microbiol Infect Dis . 2004 Dec 17; {Epub ahead of print} Emergence of endocarditis due to group D streptococci: findings derived from the merged database of the International Collaboration on Endocarditis; Hoen B et al.; The aim of the present study was to compare the epidemiological and clinical characteristics of Streptococcus bovis endocarditis with those of endocarditis caused by oral streptococci, using data obtained from a large international database of uniformly defined cases of infective endocarditis . S . bovis, a well-known cause of infective endocarditis, remains the common name used to designate group D nonenterococcal streptococci . In some countries, the frequency of S . bovis endocarditis has increased significantly in recent years . Data from the International Collaboration on Endocarditis merged database was used to identify the main characteristics of S . bovis endocarditis and compared them with those of infective endocarditis (IE) due to oral streptococci . The database contained 136 cases of S . bovis IE and 511 cases of IE due to oral streptococci . Patients with S . bovis IE were significantly older those with IE due to oral streptococci (63+/-16 vs . 55+/-18 years, P<0.00001) . The proportion of streptococcal IE due to S . bovis increased from 10.9% before 1989 to 23.3% after 1989 (P=0.0007) and was 56.7% in France as compared with 9.4% in the rest of Europe and 6.0% in the USA (P<0.00001) . Patients with S . bovis IE had more comorbidity and never used intravenous drugs . Complication rates, rates of valve replacement, and mortality rates were similar in the two groups . In conclusion, this study confirmed that S . bovis IE has unique characteristics when compared to endocarditis due to oral streptococci and that it emerged in the 1990s, mainly in France, a finding that is yet unexplained. J Infect, 2005 Jan, 50(1), 34 - 40 Klebsiella pneumoniae fascial space infections of the head and neck in Taiwan: emphasis on diabetic patients and repetitive infections; Chang CM et al.; Objectives . To assess the epidemiological features, clinical characteristics, treatment, and outcome of head and neck infections caused by Klebsiella pneumoniae . Methods . We reviewed records of four common aerobic pathogens isolated by the microbiological laboratory of a teaching hospital in Taiwan from July 1995 to December 1999 . Patients aged 14 or older with community-acquired fascial space infections of head and neck were identified by review of medical records and included in the study . Results . A total of 100 cases were identified, and K . pneumoniae was the most common pathogen of monomicrobial infections (48%), followed by viridans streptococci (15%) . Polymicrobial infections were noted in 35 cases . In comparison with patients with infections not caused by K . pneumoniae, those with monomicrobial K . pneumoniae infections were older {Formula: see text} and had a higher prevalence of diabetes mellitus {Formula: see text} a longer duration of antimicrobial therapy {Formula: see text} a longer hospital stay {Formula: see text} and more repetitive infections {Formula: see text} All but one of K . pneumoniae isolates were susceptible to first generation cephalosporins and aminoglycosides . Conclusions . K . pneumoniae is an important endemic pathogen of fascial space infections of head and neck in Taiwan, especially among diabetics . Physicians should be aware of the tendency of this organism to cause repetitive infection. Vestn Otorinolaringol, 2004, (5), 4 - 8 {Microbial view and optimal antibiotic therapy in acute purulent ENT diseases}; Behcet's disease; Department of Immunology, St . Marianna University School of Medicine, 2-16-1, Sugao, Miyamae-ku, Kawasaki, Kanagawa 216-8511, Japan . n3suzuki@marianna-u.ac.jp Behcet's disease (BD) is a systemic disorder of recurrent acute inflammation, characterized by major symptoms of oral aphthous ulcers, uveitis, skin lesions and genital ulcers . Involvement of intestines, vessels, and central nervous system (CNS) sometimes leads to a poor prognosis . Patients with BD are known to distribute along the ancient Silk Road . The incidence is relatively higher from eastern Asia to the Mediterranean area as roughly 1-10 patients in 10,000 people, whereas only 1-2 patients in 1,000,000 people in UK and North America . Although etiology of the disease is still unknown, high prevalence of HLA-B51, increased expression of heat shock protein 60 and Th1 dominant immune responses in the patients are considered important in its pathogenesis . Non-infectious neutrophil activation and infection with Streptococcus sanguis and herpes simplex virus would also be associated . Because BD lacks any pathognomonic symptoms and laboratory findings, the diagnosis relies largely upon the criteria proposed by the International Study Group for Behcet's disease in 1990 . In Japan, the diagnosis was also made according to the Japanese criteria revised in 1987 . Recently, the Behcet's Disease Research Committee of Japan again revised the Japanese criteria in 2003 to avoid overdiagnosis . The new Japanese criteria are introduced in this review . Differential diagnosis excluding Sweet's disease, pemphigus, erythema nodosum and Crohn's disease is important, and positive laboratory data for pathergy test, prick test for dead Streptococci and HLA-B51 are emphasized to make appropriate diagnosis in these criteria . Pathological findings of the disease-affected site such as erythematous nodosum is also stressed . Treatment for the disease has been chosen according to the clinical symptoms . Non-steroidal anti-inflammatory drugs, immunosuppressants, corticosteroids and colchicine are basically introduced . Recently, effects of interferon-alpha/beta, anti-tumor necrosis factor antibody and thalidomide are encouraging, specifically in treatment for the cases with poor prognosis including eye, intestine, vessel and CNS involvement . Low dose weekly administration of methotraxate looks effective for the cases with CNS involvement . Further studies for elucidation of the etiology, improvement of the diagnostic criteria and development of new therapy are needed to conquer the disease. J Esthet Restor Dent, 2004, 16(3), 176 - 82; discussion 183-4 Growth-inhibitory effect of antibacterial self-etching primer on mutans streptococci obtained from arrested carious lesions; Kitasako Y et al.; BACKGROUND: An antibacterial self-etching primer has been developed to inhibit bacterial attachment and plaque accumulation on the tooth surfaces . The purpose of this study was to evaluate the growth-inhibitory effect of an antibacterial self-etching primer on mutans streptococci obtained from arrested carious lesions . MATERIALS AND METHODS: Softened dentin specimens were obtained from arrested carious lesions with an excavator or a round steel bur . The effect of a commercial antibacterial self-etching primer and a commercial self-etching primer on the total streptococci on Mitis-Salivarius (MS) agar plates and on Streptococcus mutans on MS agar plates containing 0.02 M bacitracin (MSB) was evaluated . Specimens with no primer were used as controls . The number of colonies of both total streptococci and S . mutans were compared statistically with two-way analysis of variance and Fisher's Protected Least Squares Differences (PLSD) test (p < .05) . RESULTS: The number of colonies of total streptococci (CFU/mL) for the two methods (excavator and round steel bur) were as follows: for the control, 5.0 x 10(6) and 5.0 x 10(6); for the self-etching primer, 1.0 x 10(5) and 1.0 x 10(5); and for the antibacterial self-etching primer, 0 and 0 . The number of colonies of S . mutans for the two methods (excavator and round steel bur) were as follows: for the control, 5.0 x 10(6) and 1.8 x 10(5); for the self-etching primer, 3.5 x 10(4) and 5.0 x 10(3); and for the antibacterial self-etching primer, 0 and 0 . Regardless of the method of softened dentin removal, the antibacterial effect was significantly higher for the group that had antibacterial self-etching primer compared with that of the control group and the group that had commercial self-etching primer (p < .05) . CLINICAL SIGNIFICANCE: The antibacterial self-etching primer showed a high level of antibacterial activity against mutans streptococci obtained from the arrested carious lesions. J Infect Dis, 2005 Jan 1, 191(1), 40 - 5 Epub 2004 Dec 01. Brain-derived neurotrophic factor protects against multiple forms of brain injury in bacterial meningitis; Bifrare YD et al.; BACKGROUND: Brain-derived neurotrophic factor (BDNF) blocks activation of caspase-3, reduces translocation of apoptosis-inducing factor (AIF), attenuates excitotoxicity of glutamate, and increases antioxidant enzyme activities . The mechanisms of neuroprotection suggest that BDNF may be beneficial in bacterial meningitis . METHODS: To assess a potentially beneficial effect of adjuvant treatment with BDNF in bacterial meningitis, 11-day-old infant rats with experimental meningitis due to Streptococcus pneumoniae or group B streptococci (GBS) were randomly assigned to receive intracisternal injections with either BDNF (3 mg/kg) or equal volumes (10 mu L) of saline . Twenty-two hours after infection, brains were analyzed, by histomorphometrical examination, for the extent of cortical and hippocampal neuronal injury . RESULTS: Compared with treatment with saline, treatment with BDNF significantly reduced the extent of 3 distinct forms of brain cell injury in this disease model: cortical necrosis in meningitis due to GBS (median, 0.0% {range, 0.0%-33.7%} vs . 21.3% {range, 0.0%-55.3%}; P<.03), caspase-3-dependent cell death in meningitis due to S . pneumoniae (median score, 0.33 {range, 0.0-1.0} vs . 1.10 {0.10-1.56}; P<.05), and caspase-3-independent hippocampal cell death in meningitis due to GBS (median score, 0 {range, 0-2} vs . 0.88 {range, 0-3.25}; P<.02) . The last form of injury was associated with nuclear translocation of AIF . CONCLUSION: BDNF efficiently reduces multiple forms of neuronal injury in bacterial meningitis and may hold promise as adjunctive therapy for this disease. Caries Res, 2005 Jan-Feb, 39(1), 78 - 84 The microflora of the erupting first permanent molar; Brailsford SR et al.; The relationship between microflora, eruption status and caries status in the first permanent molar of young children was investigated in 177 children aged 6-7 years . A significantly greater proportion of fully erupted teeth were classified as sound and plaque-free compared to partially erupted teeth . Fully erupted teeth yielded greater numbers and proportions of mutans streptococci compared with significantly greater numbers and proportions of Actinomyces israelii in partially erupted teeth . Logistical regression analysis showed significant associations between white spot lesions in partially erupted teeth and increased numbers of Streptococcus oralis, mutans streptococci and Streptococcus salivarius whereas the presence of Actinomyces naeslundii was associated with health . Significantly greater numbers and proportions of S . oralis and S . salivarius were isolated from partially erupted teeth with white spot lesions whereas Streptococcus mutans was isolated in significantly greater numbers and proportions from fully erupted molars with white spots . This study suggests that organisms other than mutans streptococci are associated with caries development in erupting permanent molar teeth . J Clin Microbiol, 2004 Dec, 42(12), 5609 - 13 Direct identification of gram-positive cocci from routine blood cultures by using AccuProbe tests; Lindholm L et al.; Rapid and reliable identification of bacteria directly from blood cultures is important in clinical practice to guide appropriate antibiotic therapy . In this study, the performance of the AccuProbe (Gen-Probe, Inc., San Diego, Calif.) in direct identification of Staphylococcus aureus, Streptococcus pneumoniae, enterococci, and group A and B streptococci from positive blood culture bottles was evaluated by using 6-year routine clinical laboratory blood culture material from Paijat-Hame Central Hospital, Lahti, Finland . With the enterococcal and group A and B streptococcal probes, the diagnostic performance of the test was excellent at a cutoff value of 50,000 relative light units (RLU) as recommended by the manufacturer . However, with the S . aureus probe, although the specificity was very high (99.8%), the sensitivity was low (72.4%) . To improve the clinical usability of the direct AccuProbe identification, optimal cutoff values for the individual AccuProbe tests were defined by using receiver-operating characteristic analysis . Consequently, cutoff values for S . aureus and S . pneumoniae tests were adjusted to 30,000 RLU and for enterococci and to 55,000 RLU for group A and B streptococci . With these adjustments, the performance of the AccuProbe tests, especially that for S . aureus, was significantly improved. Microbiology, 2004 Dec, 150(Pt 12), 4211 - 21 Protein FOG--a streptococcal inhibitor of neutrophil function; Johansson HM et al.; Several strains of group G streptococci (GGS) form aggregates when grown in vitro . Aggregating strains interact with fibrinogen, and this study reports the isolation of a novel self-associating and fibrinogen-binding protein of GGS, denoted protein FOG . Sequencing of the fog gene revealed structural similarity with M proteins of both GGS and group A streptococci (GAS) . Analogous to GAS, GGS were found to multiply in human blood . All strains of GGS express protein G, a protein known to interact with the constant region of immunoglobulin G and albumin . Surprisingly, a clinical isolate expressing protein G, but lacking protein FOG, was killed in human whole blood; however, the addition of intact soluble protein FOG restored the ability of the bacteria to survive and multiply in human blood . This is believed to be the first report of a soluble M-like protein salvaging an M-negative strain from being killed . The antibactericidal property of protein FOG is dependent on its fibrinogen-binding activity . Thus, in plasma, FOG precipitates fibrinogen, and when added to whole blood, protein FOG triggers the formation of visible aggregates comprising fibrinogen and neutrophils that are disabled in their killing of the bacteria . Moreover, the results emphasize the importance of an intact FOG molecule, as presented on the bacterial surface, for full protective effect. Clin Infect Dis, 2004 Dec 15, 39(12), 1794 - 801 Epub 2004 Dec 15. Community-based surveillance in the united states of macrolide-resistant pediatric pharyngeal group A streptococci during 3 respiratory disease seasons; Tanz RR et al.; BACKGROUND: In 2001, a total of 48% of pharyngeal group A streptococci (GAS) from Pittsburgh children were macrolide resistant . We assessed macrolide resistance, resistance genes, and emm types among GAS in the United States . METHODS: In prospective, multicenter, community-based surveillance of pharyngeal GAS recovered from children 3-18 years old during 3 respiratory seasons (the 2000-2001 season, the 2001-2002 season, and the 2002-2003 season), GAS were tested for macrolide resistance and underwent emm gene sequencing . Macrolide-resistant GAS were tested for resistance to clindamycin, and resistance genes were determined . RESULTS: Erythromycin resistance was observed in 4.4% of isolates from the 2000-2001 season, 4.3% from the 2001-2002 season, and 3.8% from the 2002-2003 season (P=.80) . Clindamycin resistance was found in 1.04% of isolates; annual rates of clindamycin resistance were stable (P=.75) . The predominant resistance genotype each year was mef A (65%-76.9%; overall, 70.3%) . Resistant isolates included strains representing 8-11 different emm types each year . Heterogeneity of emm subtypes, resistance genes, and clindamycin resistance was evident among resistant isolates within some emm types . Geographic variability in resistance rates was present each year . CONCLUSIONS: The macrolide resistance rate among pharyngeal GAS was <5% and was stable over the 3 seasons . However, rates varied among sites each year . There was no evidence of spread of a specific resistant clone, increasing clindamycin resistance, or escalation in median erythromycin MICs. Acad Emerg Med, 2004 Dec, 11(12), 1297 - 301 A low peripheral blood white blood cell count in infants younger than 90 days increases the odds of acute bacterial meningitis relative to bacteremia; Bonsu BK et al.; In relying on the peripheral blood white blood cell (WBC) count to identify infants at high risk for acute bacterial meningitis and bacteremia, to the best of the authors' knowledge, it has not been reported previously whether high and low values of the test have similar implications for predicting these separate infections . OBJECTIVE: To analyze the relationship between the peripheral WBC count and the odds of acute bacterial meningitis relative to bacteremia among sick infants aged 3 to 89 days . METHODS: Areas under the receiver operating characteristic curve (AUCs) and likelihood ratios at various intervals of the total peripheral blood WBC count were computed . RESULTS: A pathogen was isolated from blood or cerebrospinal fluid (CSF) from 72 infants aged 3 to 89 days . Fifty-two infants had growth of a pathogen from the blood only, and 20 had growth from the CSF . The most common bacteria isolated were Escherichia coli (32) and group B streptococci (32) . The AUC for the peripheral WBC count when differentiating between acute bacterial meningitis and bacteremia was 0.75 (95% CI = 0.63 to 0.88) . The odds of acute bacterial meningitis relative to bacteremia were sevenfold higher for a peripheral WBC cutoff below 5,000 cells/mm(3) and threefold lower for a peripheral WBC cutoff at or above 15,000 cells/mm(3) . CONCLUSIONS: In young infants, the peripheral blood WBC count is useful for estimating the odds of acute bacterial meningitis relative to isolated bacteremia . A low peripheral blood WBC count should be considered a much more worrisome laboratory finding because it is associated with a relatively high risk for acute bacterial meningitis relative to the potential for bacteremia. Sichuan Da Xue Xue Bao Yi Xue Ban, 2004 Nov, 35(6), 818 - 20 {Acquisition of Mutans streptococci by children of 3-4 years with possible source of the pathogen from their mothers}; Li S et al.; OBJECTIVE: The aim of this study was to investigate the prevalence of Mutans streptococci (MS) in children of 3-4 years and thus reveal the relationship between the children's acquisition of MS and their mothers' pathogen . METHODS: Fifty mother-child pairs were selected, examined and divided into three groups according to the children's caries . MS in plaque and mothers' salivary samples were detected by MSB medium . Then 200 MS strains from 20 mothers-children were analyzed by AP-PCR . RESULTS: Acquisition of MS was identified in 37 of 50 children (74%), including 11 of 24 caries-free children and all 26 children with caries . The difference was significant (P<0.01) . Genotypes showed that 16 of 37 children (43.2%) had the same fingerprint as their mothers' . The level of MS identified in mothers' salivary sample was lower than that in mothers' plaque sample (32% and 56%) . CONCLUSION: These results suggested that caries in children of 3-4 years are closely related with MS acquisition . Mothers are still their important source of MS . The sensitivity of mothers' salivery samples is much lower than that of plaque samples in studying the transmission of MS. J Coll Physicians Surg Pak, 2003 Dec, 13(12), 711 - 4 Necrotizing fasciitis: management and outcome; Muqim R; OBJECTIVE: To observe the various clinical presentations of necrotizing fasciitis and evaluate their management and outcome . DESIGN: An observational descriptive study . PLACE AND DURATION OF STUDY: Surgical-c unit of Khyber Teaching Hospital, Peshawar, from July 2001 to June 2002 . SUBJECTS AND METHODS: The study included 20 patients of necrotizing fasciitis treated during this period . Age, gender, clinical presentation and predisposing factors were recorded . Pus was cultured and the isolated organism and their sensitivity identified . Management included broad-spectrum antibiotics, extensive and frequent debridements along with supportive measures . RESULTS: Common age group was 21-40 years with a male predominance . eight patients had necrotizing fasciitis of inguinoscrotal and perineal region, while 6 each had abdomen and 6 with necrotizing fasciitis of the limbs involvement . Factors predisposing to infection were diabetes in 5 patients, abscess in 6, trauma in 3 and surgery in 3 patients, while no specific cause was found in 3 cases . Escherichia (E . coli), Bacteroids, Enterococci and Streptococci were the commonest organisms isolated . All were sensitive to a combination of piperacillin and ampicillin . Debridements were done 1-5 times in most cases . Fifteen patients (75%) had complete recovery, 2 (10%) went to other hospitals on their own, 2 (10%) patients expired while one patient was referred to the plastic surgery unit . CONCLUSION: Necrotizing fasciitis has multiple etiology and predisposing factors . The bacteriology is poly microbial . Early presentation and diagnosis, supportive measures, broad-spectrum antibiotics, prompt and aggressive surgical debridements remains the cornerstone of management. East Mediterr Health J, 2003 Jan-Mar, 9(1-2), 172 - 7 Beta-haemolytic streptococci in acute pharyngitis; Boukadida J et al.; To determine the role and importance of beta-haemolytic streptococci in acute pharyngitis and its relative susceptibility to antibiotics, we cultured samples from 143 patients (age range: 3-72 years) who presented over a 5-month period in 2001 at three primary health care centres in Sousse, Tunisia . The cultures yielded 80 beta-haemolytic streptococci (59 group A streptococci and 21 non-group A streptococci) . All strains were susceptible to benzylpenicillin, amoxicillin, chloramphenicol, rifampicin and pristinamycin . Susceptibility was variable in erythromycin, tetracycline, fosfomycin, telithromycin and levofloxacin . Minimum inhibitory concentrations were determined by E-test for penicillin, erythromycin and levofloxacin . Our results confirm that penicillin is still the reference treatment for acute pharyngitis . However, to minimize the potential for complications arising from its use, continued vigilance is required. Braz J Med Biol Res, 2004 Dec, 37(12), 1889 - 94 Epub 2004 Dec. Analysis of five streptokinase formulations using the euglobulin lysis test and the plasminogen activation assay; Couto LT et al.; Streptokinase, a 47-kDa protein isolated and secreted by most group A, C and G ss-hemolytic streptococci, interacts with and activates human protein plasminogen to form an active complex capable of converting other plasminogen molecules to plasmin . Our objective was to compare five streptokinase formulations commercially available in Brazil in terms of their activity in the in vitro tests of euglobulin clot formation and of the hydrolysis of the plasmin-specific substrate S-2251 . Euglobulin lysis time was determined using a 96-well microtiter plate . Initially, human thrombin (10 IU/ml) and streptokinase were placed in individual wells, clot formation was initiated by the addition of plasma euglobulin, and turbidity was measured at 340 nm every 30 s . In the second assay, plasminogen activation was measured using the plasmin-specific substrate S-2251 . Streptase was used as the reference formulation because it presented the strongest fibrinolytic activity in the euglobulin lysis test . The Unitinase and Solustrep formulations were the weakest, showing about 50% activity compared to the reference formulation . All streptokinases tested activated plasminogen but significant differences were observed . In terms of total S-2251 activity per vial, Streptase (75.7 +/- 5.0 units) and Streptonase (94.7 +/- 4.6 units) had the highest activity, while Unitinase (31.0 +/- 2.4 units) and Strek (32.9 +/- 3.3 units) had the weakest activity . Solustrep (53.3 +/- 2.7 units) presented intermediate activity . The variations among the different formulations for both euglobulin lysis test and chromogenic substrate hydrolysis correlated with the SDS-PAGE densitometric results for the amount of 47-kDa protein . These data show that the commercially available clinical streptokinase formulations vary significantly in their in vitro activity . Whether these differences have clinical implications needs to be investigated. Mov Disord . 2004 Nov 18; {Epub ahead of print} Nerve conduction study in Sydenham's chorea; Cardoso F et al.; Sydenham's chorea (SC) is a late complication of group A beta-hemolytic streptococci infection presumably caused by an abnormal autoimmune reaction . Despite rare case reports of peripheral neuropathy associated with streptococcal infection, there is no investigation of peripheral nerve in SC . We performed nerve conduction studies in a cohort of patients with SC . The neurophysiology investigation comprised measurement of amplitude and sensory conduction velocity of median, ulnar, and sural nerves; amplitude and motor conduction velocity; and F-wave latency of median, ulnar, fibular, and tibial nerves . Twenty-six patients entered the study (12 females, 14 males; mean age 12.8 +/- 3.6 years) . Thirteen subjects had absent or decreased deep reflexes . All investigated neurophysiological parameters fell within the normal range for our population . We failed to find neurophysiological evidence of peripheral nerve involvement in patients with a history of SC . Our findings suggest that the possible autoimmune dysfunction in SC patients is not targeted against epitopes present in peripheral nerves . (c) 2004 Movement Disorder Society. J Antimicrob Chemother, 2004 Dec, 54(6), 971 - 981 Epub 2004 Nov 16. Guidelines for the antibiotic treatment of endocarditis in adults: report of the Working Party of the British Society for Antimicrobial Chemotherapy; Elliott TS et al.; The BSAC Guidelines on Endocarditis were last published in 1998 . The Guidelines presented here have been updated and extended to reflect changes in both the antibiotic resistance characteristics of causative organisms and the availability of new antibiotics . Randomized, controlled trials suitable for the development of evidenced-based guidelines in this area are still lacking, and therefore a consensus approach has again been adopted . The Guidelines cover diagnosis and laboratory testing, suitable antibiotic regimens and causative organisms . Special emphasis is placed on common causes of endocarditis, such as streptococci and staphylococci, however, other bacterial causes (such as enterococci, HACEK organisms, Coxiella and Bartonella) and fungi are considered . The special circumstances of prosthetic endocarditis are discussed. Clin Infect Dis, 2004 Nov 15, 39(10), 1527 - 30 Epub 2004 Oct 27. Native valve endocarditis due to coagulase-negative staphylococci: report of 99 episodes from the International Collaboration on Endocarditis Merged Database; Chu VH et al.; Using a large cohort of patients from the International Collaboration on Endocarditis Merged Database, we compared coagulase-negative staphylococcal (CoNS) native-valve endocarditis (NVE) to NVE caused by more common pathogens . Rates of heart failure and mortality were similar between patients with CoNS NVE and patients with Staphylococcus aureus NVE, but rates for both groups were significantly higher than rates for patients with NVE due to viridans streptococci . These results emphasize the importance of CoNS as a cause of NVE and the potential for serious complications with this infection. Int J Med Microbiol, 2004 Oct, 294(4), 247 - 54 ISSag1 in streptococcal strains of human and animal origin; Franken C et al.; The chromosomal region of Streptococcus agalactiae harboring the C5a peptidase and the lmb genes displays the structure of a composite transposon . Its presence in a streptococcal strain is associated with the origin of this strain from a human host . In S . agalactiae it is flanked by two copies of the insertion element ISSag2, and the nucleotide sequence for a third IS element (ISSag1) can be found in this region . Based on amino acid sequence similarity of the deduced transposase ISSag1 belongs to the IS3 family . It is 1251 bp long and flanked by 37 bp imperfect inverted repeats . Horizontal gene transfer among different bacterial species is facilitated by mobile genetic elements . To investigate if ISSag1 homologues are also present in other streptococcal species, various species of pyogenic streptococci from animal and human origin were analyzed by Southern blot hybridization and PCR . Among the different streptococcal species, multiple copies of an ISSag1 homologue could only be detected in S . dysgalactiae subsp . dysgalactiae strains of animal origin . All of the S . agalactiae strains harbored only a single copy, that was always found in strains with the scpB-lmb composite transposon . A single copy of an ISSag1 homologue could also be detected in some of the S . pyogenes and S . dysgalactiae subsp . equisimilis strains . Nucleotide sequencing of the IS element in S . dysgalactiae subsp . dysgalactiae strains revealed several different variants . One of the variants showed the features of a regular IS3 element . The other two variants that were observed displayed a 500-bp deletion and a mosaic structure composed of ISSag1 and ISSag2 homologues . This mosaic structure suggests that recombination and horizontal gene transfer events in S . dysgalactiae strains of bovine origin could have played a role in the assembly of the scpB-lmb composite transposon structure. Indian J Pediatr, 2004 Oct, 71(10), 915 - 9 Group A beta-hemolytic streptococcal bacteremia; Abuhammour W et al.; OBJECTIVE: The aim of this study was to review the clinical features, laboratory findings and the risk factors associated with invasive group A streptococcal infections in children admitted to our institution over a 9-year period (January 1, 1990 through December 31, 1999) . METHODS: Medical records of children who had a positive blood culture for group A beta-hemolytic streptococci and children who had this organism isolated from any other sterile site were identified and retrospectively reviewed . RESULTS: Forty-one children with invasive GAS were identified, of whom 15 (36%) were diagnosed between 1990 and 1994, while the balance (26 patients, 63%) were diagnosed between 1995 and 1999 (p< 0.05) . The mean age was 4.3 +/- 2.5 years (age range: 2 months to 16 years) . Thirteen (32%) patients were infants . Sixteen patients had only bacteremia, while 25 patients had in addition to bacteremia the following: cellulitis (n: 13), osteomyelitis (n: 6), pneumonia (n: 3), meningitis (n: 1), pharyngitis (n:3) and Toxic Shock Syndrome (n: 2) . Primary varicella infection constituted the most common predisposing factor for invasive GAS infections and occurred in 11 (27%) patients . Leukocytosis (A white blood cell count > 15,000/mm3) occurred in 21 (51 %) patients, while leukopenia (A white blood cell count < 5000/mm3) occurred in 2 patients . Parenteral crystalline penicillin G followed by oral penicillin or amoxicillin were the most common antibiotics administered . The mean hospital length of stay was 8 days (range: 6 -32 days) . All, but one patient survived . The one patient who died had malnutrition and died from streptococcal toxic shock syndrome . CONCLUSION: More cases of invasive GAS were diagnosed during the second half of the study period, however, the overall rate of occurrence of bacteremia during the study period was consistent with previous reports . Primary varicella infection was the most common predisposing factor for invasive GAS infections . The low occurrence of toxic shock syndrome and fatalities among children with invasive GAS infections are consistent with other pediatric but not with adult series. J Vet Med Sci, 2004 Oct, 66(10), 1267 - 9 Susceptibilities against bovine lactoferrin with microorganisms isolated from mastitic milk; Lee NY et al.; Antibacterial effects of bovine lactoferrin were studied in vitro against microorganisms isolated from mastitic milk in Tokachi area, Hokkaido, Japan . Microorganisms isolated were Escherichia coli (11 isolates), Klebsiella pneumoniae (5 isolates), enterococci (8 isolates), Staphylococcus aureus (10 isolates), coagulase negative staphylococci (CNS, 13 isolates), streptococci (11 isolates), Prototheca zopfii (7 isolates) and yeast-like fungi (9 isolates) . Lactoferrin has been known as a multifunctional protein and its antimicrobial effect is one of the most essential function of it . In order to compare their susceptibilities against lactoferrin, the minimal inhibitory concentration values were estimated by a microplate assay method using 96-well microplate, which involved measuring the optical density of the cultures . Prototheca zopfii was highly sensitive to bovine lactoferrin and complete inhibition of this microorganism was observed even at the low concentration of 7 mug/ml . On the other hand, E . coli and enterococci showed resistance against lactoferrin action and staphylococci showed strain-dependent resistance. J Clin Microbiol, 2004 Nov, 42(11), 5385 - 7 Effect of transport time, temperature, and concentration on the survival of group B streptococci in amies transport medium; Stoner KA et al.; The impact of transport time and temperature on survival of group B streptococci (GBS) in Amies transport medium was evaluated . Viability of 10 or more CFU of GBS was maintained for 4 days at 24 or 3 degrees C . However, there was a significant decrease in viability for GBS held at 30 degrees C for 4 days. J Clin Microbiol, 2004 Nov, 42(11), 5357 - 61 Fibronectin-binding protein gene recombination and horizontal transfer between group A and G streptococci; Towers RJ et al.; We report evidence of interspecies gene transfer between the important virulence factor genes sfbI and gfbA . Because the identified group G streptococcus gfbA types possess DNA cassettes that can be identified in a number of group A streptococcus strains, it appears that homologous recombination is occurring between these species. Epidemiol Mikrobiol Imunol, 2004 Aug, 53(3), 106 - 11 {Surveillance of serious diseases caused by group A streptococci in the Czech Republic in 2003--the Strep-EURO project}; Strakova L et al.; Results obtained in the first year of active surveillance of serious diseases caused by group A streptococci in the Czech Republic carried out within the Strep-EURO project are summarized . From January to December 2003, 28 Czech laboratories referred to the National Institute of Public Health 59 group A streptococcal strains isolated from invasive diseases meeting the Strep-EURO definition . At the same time, clinical-epidemiological data and information on the catchment area population were provided . For 2003, the total morbidity and case fatality rates were calculated to be 1.3/100,000 population and 13.5%, respectively . A high proportion (23.7%) of the 59 strains were of type emm 1, initially labeled M1 . As many as 24.1%, 17.2% and 20.7% of the strains tested were resistant to erythromycin, clindamycin and tetracycline, respectively . The seemingly lower morbidity rate and higher case fatality rate from serious diseases caused by group A streptococci reported in the Czech Republic for 1994-1996, i.e . 0.4/100,000 and 46.5%, respectively, in comparison with the latest data can be explained by the use of softer international criteria for the Strep-EURO definition of invasive disease. Ann Trop Med Parasitol, 2004 Oct, 98(7), 685 - 96 The efficacies of affected-limb care with penicillin diethylcarbamazine, the combination of both drugs or antibiotic ointment, in the prevention of acute adenolymphangitis during bancroftian filariasis; Joseph A et al.; Repeated attacks of adenolymphangitis (ADL) contribute significantly to the progression of chronic lymphoedema in lymphatic filariasis . They are a cause of stigma and, since they may prevent work and require treatment for which payment must be made, of economic loss . The aim of the present study was to improve the treatment of ADL attacks, which is currently mostly empirical . In a double-blind, placebo-controlled, clinical study, 150 subjects who had each suffered at least two ADL attacks in the preceding year were enrolled and randomly allocated to a programme of self-care of the affected limb (after an intensive training programme) and one of five treatments for 12 months . The subjects were supplied with tablets and ointment so that they could take oral penicillin (800 mg/day), oral diethylcarbamazine (DEC; 1 mg/kg.day) or both of these drugs (at the same doses), or apply framycetin ointment to the affected limb, or just take placebo tablets and apply placebo (zinc-oxide) ointment . Placebo tablets and placebo ointment were used so that neither the subjects nor those assessing the responses to treatment were aware of the treatment arm to which each subject had been assigned . The subjects were requested to continue with the affected-limb care after they had stopped taking the tablets and applying the cream, and were followed-up for 24 months from the first treatment.Overall, the mean incidence of ADL attacks decreased from 2.7 episodes/person-year in the pre-treatment year to just 0.38 episode/person-year during the treatment year (P< 0.01) . The greatest reduction in incidence was seen in the 58 subjects who received penicillin (with or without DEC) . Even in the placebo group, however, the incidence of ADL in the treatment year was significantly lower than that seen in the pre-treatment year, indicating that affected-limb care on its own helps to prevent some attacks . In all groups except the placebo, the incidence of ADL attacks in the year post-treatment exceeded that seen in the treatment year, indicating that chemoprophylaxis needs to be continued for more than a year if such attacks are to be prevented . In most (84%) of the attacks recorded, titres of anti-streptococcal antibodies were seen to be elevated (compared with those recorded during convalescence),indicating that streptococci have a role in the aetiology of ADL.It is recommended that a combination of penicillin prophylaxis and affected-limb care be incorporated into filariasis-control programmes, to decrease morbidity. Pediatrics, 2004 Nov, 114(5), 1212 - 9 Group A streptococci among school-aged children: clinical characteristics and the carrier state; Martin JM et al.; OBJECTIVE: A 4-year longitudinal study of school-aged children was conducted to describe the clinical characteristics and epidemiologic features of infections with group A streptococci (GAS) . METHODS: Between 1998 and 2002, surveillance throat cultures were performed twice per month (October to May) for a cohort of elementary school children in Pittsburgh, Pennsylvania . In addition, throat cultures were obtained during any respiratory illness . Erythromycin and clindamycin susceptibility testing was performed for all isolates . Molecular typing was performed with field-inversion gel electrophoresis . Representative isolates from each field-inversion gel electrophoresis group were emm typed . Strict definitions were used to characterize each GAS infection . Children were classified into 4 categories each year, ie, single episode, recurrent episodes, carriers of GAS, and no infections . RESULTS: A total of 48 to 100 children per year were studied for 4 years; 61 (49%) were male . The mean age was 9.6 years (range: 5-15 years) . A total of 5658 throat cultures were performed; 878 (15.5%) were positive for GAS . Antimicrobial agents were used to treat 209 episodes of infection . Thirteen emm types were observed during the 4-year period . GAS were isolated most often from children who were carriers; isolates from single episodes were next most common . Children carried a single emm type for a mean of 10.8 weeks (range: 3-34 weeks) . Carriers were likely to be classified again as carriers in subsequent years and frequently switched emm types . Sixty-two percent of the children had > or =1 year with no infections . CONCLUSIONS: GAS infections are common among school-aged children . The majority of positive throat cultures observed in this longitudinal study were obtained from children who were carriers of GAS . Carriers switched emm types but tended to become carriers repeatedly during the study . Practitioners should consider treating children known to be GAS carriers when they develop a new illness that is consistent with streptococcal pharyngitis, because they may acquire new emm types and be at risk for rheumatic heart disease. Obstet Gynecol, 2004 Nov, 104(5 Pt 1), 1062 - 76 Perinatal infections due to group B streptococci; Gibbs RS et al.; Group B streptococci (GBS) emerged dramatically in the 1970s as the leading cause of neonatal infection and as an important cause of maternal uterine infection . We review the epidemiology, diagnosis, and therapy of GBS perinatal infection . In 1996, the first national consensus guidelines were released . Since then, there has been a 70% reduction in early-onset neonatal GBS infection, but no decrease in late-onset neonatal GBS disease . In 2002, new national guidelines were released recommending 1) solely a screen-based prevention strategy, 2) a new algorithm for patients with penicillin allergy, and 3) more specific practices in certain clinical scenarios . Yet many clinical issues remain, including implementation of new diagnostic techniques, management of preterm rupture of membranes, use of alternative antibiotic approaches, improvement of compliance, prevention of low birth weight infants, emergence of resistant organisms, and vaccine development. Obstet Gynecol, 2004 Nov, 104(5 Pt 1), 1058 - 61 Vaginal-perianal compared with vaginal-rectal cultures for identification of group B streptococci; Jamie WE et al.; OBJECTIVE: To estimate whether the rates of recovery of group B streptococci from combined vaginal and perianal cultures and combined vaginal and rectal cultures are equivalent . METHODS: We performed a prospective cohort study of vaginal-perianal versus vaginal-rectal culture for group B streptococci . Two hundred pregnant women in the third trimester were enrolled . Three specimens were collected from each patient in the following order: lower third of the vagina, perianal skin, and rectum . Each specimen was cultured serially in selective broth media, then on sheep's blood agar . Suspicious colonies were confirmed by latex agglutination . Culture positivity rates from the combined sites of vagina and perianal skin were compared with vagina and rectum . Laboratory personnel were blinded to the collection site of each individual swab . RESULTS: Of the 200 subjects, 71 (36%) had a positive culture from at least 1 site . Vaginal culture was positive in 55 patients (28%), compared with 48 patients (24%) with positive perianal cultures and 50 patients (25%) with positive rectal cultures . Results of combined vaginal and perianal cultures were positive in 68 patients (34%); results of combined vaginal and rectal cultures were positive in 67 patients (34%) (P = 1.0) . CONCLUSION: The group B streptococci detection rate from vaginal-perianal specimens is not significantly different from the detection rate from vaginal-rectal specimens . Therefore, pregnant women do not need to be subjected to the discomfort of collection of a rectal specimen . LEVEL OF EVIDENCE: II-2. J Oral Sci, 2004 Sep, 46(3), 179 - 83 Feasibility of eradication of mutans streptococci from oral cavities; Nomura Y et al.; OBJECTIVES: Dental caries prevention programs using chlorhexidine (CHX) have been proposed, but CHX's effect in reducing levels of mutans streptococci (S . mutans and S . sobrinus) appears to last for only a few months . The aim of this study was to attempt to eradicate mutans streptococci from the oral cavity using intensive professional mechanical tooth cleaning (PMTC) and topical application of CHX in custom-made trays . METHODS: Seven adult dentate subjects participated in this study (mean age 53.7+/-5.6, age range 46 to 62, mean DMFT, 9.1+/-4.2) . For each subject, PMTC was carried out eight times within ten days . After each PMTC, 1% CHX was applied twice to the tooth surface using custom-made trays . In addition, as home treatment, subjects were required to carry out tooth brushing three times a day, and apply 0.2% CHX in custom trays after brushing in the morning and evening . In addition, subjects rinsed with 0.2% CHX solution after lunch . Salivary levels of mutans streptococci were evaluated using Dentocult-SM at baseline and on days 9, 20, 70, 120 . RESULTS: Mutans streptococci were eradicated by day 120 from 4 of the 7 seven subjects participating in this study . Those 3 subjects still harboring mutans streptococci exhibited deep periodontal pocketing . CONCLUSIONS: Eradication of mutans streptococci from the oral cavity is feasible using a combination of CHX application in custom-made trays and intensive PMTC. Antimicrob Agents Chemother, 2004 Nov, 48(11), 4463 - 5 Antimicrobial susceptibility patterns among viridans group streptococcal isolates from infective endocarditis patients from 1971 to 1986 and 1994 to 2002; Prabhu RM et al.; To determine whether changes in antimicrobial resistance have occurred among viridans group streptococci, we retrospectively examined 50 viridans group streptococcal isolates recovered from patients with infective endocarditis over 3 decades . Resistance rates (percent resistant isolates 1971 to 1986 and 1994 to 2002) were as follows: levofloxacin, 0 and 9; penicillin and clindamycin, 0 and 4; and erythromycin and azithromycin, 11 and 26, respectively. Emerg Infect Dis, 2004 Oct, 10(10), 1751 - 9 Fluoroquinolone resistance in penicillin-resistant Streptococcus pneumoniae clones, Spain; de la Campa AG et al.; Among 2,882 Streptococcus pneumoniae sent to the Spanish Reference Laboratory during 2002, 75 (2.6%) were ciprofloxacin-resistant . Resistance was associated with older patients (3.9% in adults and 7.2% in patients > or =65 years of age), with isolation from noninvasive sites (4.3% vs . 1.0%), and with penicillin and macrolide resistance . Among 14 low-level resistant (MIC 4-8 microg/mL) strains, 1 had a fluoroquinolone efflux phenotype, and 13 showed single ParC changes . The 61 high-level ciprofloxacin-resistant (MIC > or =16 microg/mL) strains showed either two or three changes at ParC, ParE, and GyrA . Resistance was acquired either by point mutation (70 strains) or by recombination with viridans streptococci (4 strains) at the topoisomerase II genes . Although 36 pulsed-field gel electrophoresis patterns were observed, 5 international multiresistant clones (Spain23F-1, Spain6B-2, Spain9V-3, Spain14-5 and Sweden15A-25) accounted for 35 (46.7%) of the ciprofloxacin-resistant strains . Continuous surveillance is needed to prevent the dissemination of these clones. Int Dent J, 2004 Oct, 54(5), 279 - 83 An in vivo study of the plaque control efficacy of Persica: a commercially available herbal mouthwash containing extracts of Salvadora persica; Khalessi AM et al.; AIM: This study compared the oral health efficacy of Persica mouthwash (containing an extract of Salvadora persica) with that of a placebo . DESIGN: In a double-blind, cross-over trial, participants were randomly allocated to use either the Persica mouthwash or a placebo for a three-week period . Plaque accumulation, gingival bleeding and the salivary concentrations of mutans streptococci (MS) were measured before and immediately following the experimental period . After an eight-week 'washout' period, the study was repeated with participants using the alternative mouthwash . PARTICIPANTS: Twenty-eight healthy students (aged between 18 and 42 years) volunteered to take part in this investigation . RESULTS: Compared with the pre-treatment values, both placebo and experimental groups demonstrated significantly reduced gingival bleeding (p < 0.01) . Plaque scores were not significantly reduced following use of either Persica or the placebo . However, the use of Persica, but not the placebo, resulted in significant reduction in the carriage of MS (p < 0.05) . CONCLUSION: Use of Persica mouthwash resulted in improved gingival health and lower carriage rate of cariogenic bacteria when compared with the pre-treatment values . The placebo (vehicle control) also improved gingival health significantly . Neither the Persica nor the placebo reduced the accumulation of dental plaque. Dtsch Tierarztl Wochenschr, 2004 Sep, 111(9), 355 - 8 {Relationship between morphological characteristics of the teat duct and prevalence of intramammary infections with Streptococcus agalactiae in dairy cows}; Falkenberg U et al.; The objective of the study was to determine the relationship between morphological findings of the surface of teat duct particularly the level of ceratosis and the prevalence of intramammary infections (IMI) . The study was conducted on a commercial dairy herd housing about 3000 lactating dairy cows . We examined 891 quarters in the middle of lactation . Duplicate samples of quarter foremilk were collected monthly . The bacteriological status of quarters was determined according to the recommendations of IDF . At the same time teats were evaluated by clinical examinations . The appearance of teat skin lesions and the status of the teat duct especially the existence of hyperceratosis (HC) was documented . Four classes of teat duct hyperceratosis were defined: without, slight, medium and severe HC . The rate of IMI in different classes of hyperceratosis of teat duct was compared by Chi-square analysis . Prevalences of intramammary infections were determined three times (P1, P2 and P3) during the study period . Prevalence of infection was high for S . aureus (P1: 5.6% vs . P2: 4.5% vs . P3: 4.3%), Sc . agalactiae (P1: 2.7% vs . P2: 2.6% vs . P3: 2.8%) and CNS (P1: 10.7% vs . P2: 8.8% vs . P3: 9.6%) . Furthermore we detected IMI caused by other streptococci, yeast, E . coli and mixed infections . A positive correlation between status of HC and prevalence of IMI for Sc . agalactiae was found . At the second and third sampling time the rate of intramammary infection with Sc . agalactiae in quarters with medium HC (P2: 9.21% and P3: 13.73%) differed significantly (p < 0.05) compared to groups without (P2: 1.56% and P3: 1.91%) and slight hyperceratosis (P2: 2.33% and P3: 2.56%) . The results of our study indicate a correlation between morphology of teat duct surface, especially regarding to Sc . agalactiae . On one hand HC can cause high intramammary infection rate with Sc . agalactiae . On the other hand it is possible that HC is the consequence of a quarter infection with Sc . agalactiae . Further research is required. Expert Opin Pharmacother, 2004 Nov, 5(11), 2321 - 31 Daptomycin - a novel antibiotic against Gram-positive pathogens; LaPlante KL et al.; Daptomycin is a novel member of a new class of antimicrobial agents used in treating resistant Gram-positive infections . These infections are becoming more commonplace and treatment options are limited . At present, daptomycin is approved for use in the US for complicated skin and skin-structure infections that are a common complication of surgery, diabetic foot ulcers, and burns . The most common causative organisms in these types of infections are Staphylococcus aureus, Streptococcus pyogenes, Streptococcus agalactiae, and Group C and G streptococci . Traditionally, these infections have been treated with penicillin and cephalosporins, but resistance to these agents is widespread and increasing . Of particular concern is the rapid increase in methicillin-resistant S . aureus (MRSA) . The SENTRY Antimicrobial Surveillance Programme reported that approximately 30% of S . aureus isolates from skin and skin-structure infections were MRSA . The standard treatment for MRSA infections is vancomycin but resistance to this agent is also developing . There is a continuing need for the development of new antibiotics with Gram-positive activity, to combat multi-drug-resistant Gram-positive infections. J Med Microbiol, 2004 Nov, 53(Pt 11), 1083 - 8 Streptococcus sinensis may react with Lancefield group F antiserum; Woo PC et al.; Lancefield group F streptococci have been found almost exclusively as members of the 'Streptococcus milleri' group, although they have been reported very occasionally in some other streptococcal species . Among 302 patients with bacteraemia caused by viridans streptococci over a 6-year period, three cases were caused by Streptococcus sinensis (type strain HKU4T, HKU5 and HKU6) . All three patients had infective endocarditis complicating their underlying chronic rheumatic heart diseases . Gene sequencing showed no base differences between the 16S rRNA gene sequences of HKU5 and HKU6 and that of HKU4T . All three strains were Gram-positive, non-spore-forming cocci arranged in chains . All grew on sheep blood agar as alpha-haemolytic, grey colonies of 0.5-1 mm in diameter after 24 h incubation at 37 degrees C in ambient air . Lancefield grouping revealed that HKU5 and HKU6 were Lancefield group F, but HKU4T was non-groupable with Lancefield groups A, B, C, D, F or G antisera . HKU4T was identified by the Vitek system (GPI), API system (20 STREP) and ATB system (ID32 STREP) as 99 % Streptococcus intermedius, 51.3 % S . intermedius and 99.9 % Streptococcus anginosus, respectively . Using the same tests, HKU5 was identified as 87 % Streptococcus sanguinis/Streptococcus gordonii, 59 % Streptococcus salivarius and 99.6 % S . anginosus, respectively, and HKU6 as 87 % S . sanguinis/S . gordonii, 77 % Streptococcus pneumoniae and 98.3 % S . anginosus, respectively . The present data revealed that a proportion of Lancefield group F streptococci could be S . sinensis . Lancefield group F streptococci should not be automatically reported as 'S . milleri'. Drugs Aging, 2004, 21(13), 833 - 50 Optimal treatment of infected diabetic foot ulcers; Jude EB et al.; Foot ulceration can lead to devastating consequences in diabetic patients . They are not only associated with increased morbidity but also mortality . Foot infections result as a consequence of foot ulceration, which can occasionally lead to deep tissue infections and osteomyelitis; both of which can result in loss of limb . To prevent amputations prompt diagnosis and treatment is required . Understanding the pathology of the diabetic foot will help in the planning of appropriate investigations and treatment . Clinical diagnosis of infection is based on the presence of discharge from the ulcer, cellulitis, warmth and signs of toxicity; though the latter is uncommon . Deep tissue samples from the ulcer and/or blood cultures should be taken before, but without delaying the start of antibacterial treatment in limb and life-threatening infections . In milder infections wound sampling may direct appropriate antibacterial treatment . Staphylococcus aureus, followed by streptococci are the most common organisms causing infection and antibacterial treatment should be targeted against these organisms in mild infection possibly with monotherapy . But in serious infections combination therapy is required because these are usually caused by multiple organisms including anaerobes . Drug-resistant organisms are becoming more prevalent and methicillin-resistant infections can be treated effectively with a number of oral antibacterials either as monotherapy or in combination . Surgical treatment with debridement, for example, callus removal or drainage of pus form an important part of diabetic foot ulcer management especially in the presence of infection . Occasionally limited surgery including dead infected bone removal may be necessary for resolution of infection . Amputation is sometimes required as a last resort for limb or life preservation. Int J Med Microbiol, 2004 Sep, 294(2-3), 177 - 88 The intracellular status of Streptococcus pyogenes: role of extracellular matrix-binding proteins and their regulation; Kreikemeyer B et al.; Streptococcus pyogenes (group A streptococci, GAS) is an important and exclusively human pathogen . Adherence to and internalization into host cells significantly contributes to the pathogenesis of GAS infections . The adherence mechanism is a two-step process in which host extracellular matrix (ECM) proteins act as prime targets . GAS may express more than a dozen different microbial surface components recognizing adhesive matrix molecules (MSCRAMMs) that attach to fibronectin or collagen . One of them, protein F1/SfbI binds fibronectin and mediates adherence of GAS to host cells . Bound fibronectin acts as a bridging molecule towards host cell integrins, which in turn initialize the uptake process that leads to GAS internalization . In their safe intracellular niche GAS can persist protected from antibiotics and host defense, a scenario currently discussed in the context of treatment failure, asymptomatic GAS carriers and recurrent GAS infections . Patients with such low grade infections represent the main GAS reservoir from which the bacteria are spread in the general population . Due to their important function, expression of GAS MSCRAMMs is under control of several "stand alone" transcriptional regulators and two-component signal transduction systems . Several regulator genes are organized together with MSCRAMM genes on one of two potential pathogenicity islands, act together in a growth phase-dependent regulatory network and are expressed in a strain-specific manner . A detailed understanding of these mechanisms is crucial, since interference with MSCRAMM function alone or in conjunction with specific manipulations of regulators is an attractive goal for novel anti-infective strategies. Int J Med Microbiol, 2004 Sep, 294(2-3), 169 - 75 Surface proteins of Streptococcus agalactiae and horizontal gene transfer; Broker G et al.; Streptococcus agalactiae is responsible for serious infectious diseases in neonates, immuno-compromised adult patients and causes bovine mastitis in animal hosts . Genome sequencing projects revealed strong indications for horizontal gene transfer events leading to virulence acquisition and genetic diversity in this species . Bacterial surface proteins establish the first contact with host tissues and represent interesting targets for the exchange of virulence properties among different streptococci . This review will focus on horizontal gene transfer events in characterized S . agalactiae surface proteins, mobile genetic elements adjacent to the corresponding genes and will discuss potential mechanisms of transfer. J Formos Med Assoc, 2004 Oct, 103(10), 784 - 6 Primary pulmonary botryomycosis with parietal pleura involvement; Ke YC et al.; Botryomycosis is a rare chronic suppurative disease characterized by the presence of eosinophilic granules containing the causative bacteria on histological study of an abscess specimen . The majority of cases involve the skin and visceral involvement is rare . A 54-year-old man with primary pulmonary botryomycosis which involved parietal pleura presented with exertional dyspnea for 2 weeks . Echo-guided aspiration of lung mass yielded viridans streptococci and positive Gram stain of the surgical specimen indicated viridians streptococci was the causative pathogen . There was no recurrence during 2 years of follow-up after surgery and antibiotic treatment . Early differentiation of botryomycosis from lung cancer, pulmonary tuberculosis, and actinomycosis is essential. J Formos Med Assoc, 2004 Oct, 103(10), 754 - 60 Clinical characteristics and prognostic determinants of infective endocarditis in adult intravenous drug users; Chao TH et al.; BACKGROUND AND PURPOSE: Infective endocarditis (IE), one of the most serious complications of intravenous (IV) drug use, has been increasing in incidence in the past decade in Taiwan . The difference in prognostic determinants for IE between patients with and without IV drug use is poorly understood . This study investigated the clinical profile and prognostic determinants of IE in IV drug users . METHODS: The medical records for 157 episodes (30 episodes in IV drug users and 127 episodes in non-drug users) of IE in 143 consecutively hospitalized patients were retrospectively evaluated . Independent prognostic determinants were identified by multiple Cox proportional hazards regression analysis . RESULTS: IV drug users were younger with a predominance of males . They also had a higher frequency of right-sided IE, underlying disease, and had a larger area of vegetation than non-drug users . Staphylococci were the most common causative microorganisms in IV drug users while streptococci were more common in non-drug users . Septic pulmonary embolism and septic complications were more frequent in IV drug users . In-hospital mortality was similar between the 2 groups . Non-cardiac shock was the only significant prognostic determinant in IV drug users (odds ratio {OR} 15.5; 95% confidence interval {CI} 3.0 to 81.5); however, in non-drug users, non-cardiac shock (OR, 4.4; 95% CI, 2.0 to 9.8), older age (> or = 50 years), and neurological complications were independent predictors of in-hospital mortality . CONCLUSIONS: The clinical characteristics and prognostic determinants of IE in IV drug users were significantly different from those of non-drug users . IV drug users were less likely to have a benign clinical course and had a higher frequency of septic complications . These findings indicate the importance of risk stratification and modified treatment strategy in IV drug users who develop IE. Indian J Med Res, 2004 Sep, 120(3), 141 - 50 Neonatal & maternal group B streptococcal infections: a comprehensive review; Shet A et al.; Group B Streptococcus is an important cause of maternal and neonatal morbidity and mortality in many parts of the world . The last two decades have seen intensified efforts in the Western hemisphere in the prevention of this devastating infection by identifying and treating pregnant women who carry group B streptococci or who are at highest risk of transmitting the organism to newborns . The intrapartum use of antibiotics in these women has led unequivocally to a decrease in the rate of neonatal group B streptococcal disease . Although studies in India show a predominance of Gram negative bacterial sepsis among infants, contributing to infant mortality, it is possible that the role of group B Streptococcus has been underestimated . This review discusses its epidemiology in India, and summarizes current concepts of microbiology, pathogenesis, clinical management and preventative issues regarding group B streptococcal disease. Microbes Infect, 2004 Nov, 6(13), 1163 - 70 Oral streptococcal glyceraldehyde-3-phosphate dehydrogenase mediates interaction with Porphyromonas gingivalis fimbriae; Maeda K et al.; Interaction of Porphyromonas gingivalis with plaque-forming bacteria is necessary for its colonization in periodontal pockets . Participation of Streptococcus oralis glyceraldehyde-3-phosphate dehydrogenase (GAPDH) and P . gingivalis fimbriae in this interaction has been reported . In this investigation, the contribution of various oral streptococcal GAPDHs to interaction with P . gingivalis fimbriae was examined . Streptococcal cell surface GAPDH activity was measured by incubation of a constant number of streptococci with glyceraldehyde-3-phosphate and analysis for the conversion of NAD+ to NADH based on the absorbance at 340 nm . Coaggregation activity was measured by a turbidimetric assay . Cell surface GAPDH activity was correlated with coaggregation activity (r = 0.854, P < 0.01) with Spearman's rank correlation coefficient . S . oralis ATCC 9811 and ATCC 10557, Streptococcus gordonii G9B, Streptococcus sanguinis ATCC 10556, and Streptococcus parasanguinis ATCC 15909 exhibited high cell surface GAPDH activity and coaggregation activity; consequently, their cell surface GAPDHs were extracted with mutanolysin and purified on a Cibacron Blue Sepharose column . Subsequently, their DNA sequences were elucidated . Purified GAPDHs bound P . gingivalis recombinant fimbrillin by Western blot assay, furthermore, their DNA sequences displayed a high degree of homology with one another . Moreover, S . oralis recombinant GAPDH inhibited coaggregation between P . gingivalis and the aforementioned five streptococcal strains in a dose-dependent manner . These results suggest that GAPDHs of various plaque-forming streptococci may be involved in their attachment to P . gingivalis fimbriae and that they may contribute to P . gingivalis colonization. J Eur Acad Dermatol Venereol, 2004 Nov, 18(6), 687 - 90 The importance of serum creatine phosphokinase level in the early diagnosis and microbiological evaluation of necrotizing fasciitis; Simonart T et al.; BACKGROUND: Necrotizing fasciitis (NF) due to group A beta-haemolytic streptococci (GAS) is a rare but still life-threatening soft-tissue infection characterized by rapidly spreading necrosis of the muscle fascia and of the surroundin