Cornea, 1998 May, 17(3), 282 - 7 Comparison of ciprofloxacin and ofloxacin using human corneal susceptibility levels; Kowalski RP et al.; PURPOSE: We compared the in vitro susceptibility of gram-positive bacteria to ciprofloxacin and ofloxacin using human corneal susceptibility levels . METHODS: The concentrations of ciprofloxacin and ofloxacin that can be attained in 99% of human corneas (Cornea99) after topical administration were calculated statistically from reported data . The minimal inhibitory concentrations (MICs) were determined for 95 corneal isolates of gram-positive bacteria (51 Staphylococcus aureus, 16 Streptococcus pneumoniae, 16 Streptococcus viridans group, and 12 coagulase-negative staphylococci) . Susceptibility was interpreted by comparing the MICs with the respective Cornea99 for each antibiotic . Time-kill studies of representative gram-positive bacteria were tested using the Cornea99 and the maximal corneal concentrations reported for ciprofloxacin and ofloxacin . RESULTS: The Cornea99 of ciprofloxacin and ofloxacin were calculated to be 3.57 microg/ml (n = 22) and 2.22 microg/ml (n = 20), respectively . The reported mean corneal concentrations of ciprofloxacin (6.90 +/- 6.20 microg/ml) and ofloxacin (5.71 +/- 6.15 microg/ml) were comparable (p = 0.54) . All gram-positive bacteria were equally susceptible to ciprofloxacin and ofloxacin (p = 0.54) based on the Cornea99 . The time-kill studies determined that 8-24 h were required for both ciprofloxacin and ofloxacin to reach bactericidal levels . CONCLUSION: Ciprofloxacin and ofloxacin demonstrated comparable penetration into the cornea and provided equivalent in vitro efficacy against representative gram-positive bacteria . Time-kill studies indicated that 8-24 h of continual corneal concentrations of ciprofloxacin and ofloxacin were necessary in this study to reduce susceptible gram-positive bacteria by 99.9%. Biochim Biophys Acta, 1998 Apr 23, 1384(1), 112 - 20 Circular dichroism analysis of the glucan binding domain of Streptococcus mutans glucan binding protein-A; Haas W et al.; The glucan binding domain (GBD) of the glucan binding protein-A (GBP-A) from the cariogenic bacterium Streptococcus mutans was studied using circular dichroism (CD) analysis, Chou-Fasman-Rose secondary structure prediction, and absorption and fluorescence spectroscopy . Our data show that the binding domain undergoes a conformational shift upon binding to the ligand dextran . The CD spectrum shows two positive bands at 280 nm and 230 nm which were assigned to aromatic residues . The 230-nm band was seen at 20 degrees C and 30 degrees C, lost intensity at 40 degrees C, and was eliminated at 45 degrees C coinciding with complete denaturation . The protein was stable at physiological pH, but precipitated at pH 5 . A pH of 10 changed the secondary structure but had no effect on the 230-nm band . Analysis of the CD data in the far UV using the SELCON computer program revealed a high content of beta-sheets and a lack of alpha-helical structures . Secondary structure prediction based on the amino acid sequence of GBD agreed with the CD analysis . The fluorescence emission maximum at 339 nm suggested that the majority of the tryptophans were located in the interior of the protein . This maximum shifted to higher energy upon binding to the ligand dextran. Biochim Biophys Acta, 1998 May 29, 1398(1), 86 - 98 The Streptococcus agalactiae hylB gene encoding hyaluronate lyase: completion of the sequence and expression analysis; Gase K et al.; We report the cloning, sequencing and expression analysis of the Streptococcus agalactiae strain 4755 hylB4755 allele, the first chromosomally-encoded streptococcal hyaluronate lyase gene to be cloned and sequenced completely . This gene lies in a region homologous to that found in S . mutans, between the mutX and rmlB genes, a region involved in the synthesis of the serotype c-specific polysaccharide antigen of this organism . Sequencing of hylB4755 revealed a 3216-bp open reading frame that encodes a 121.2-kDa polypeptide possessing a 30-amino acid signal sequence which was theoretically predicted and experimentally confirmed . A recombinant plasmid, pHYB100, containing hylB4755 together with its promoter and terminator was constructed and used to analyze the expression of the gene in Escherichia coli . In Northern hybridization experiments, hylB4755 was found to be transcribed as 3.3-kb monocistronic mRNA from its own promoter which exhibits an extended, sigma70-like 10 consensus sequence . Transcript mapping by primer extension analysis placed the major transcription initiation site leading to the longest transcript 38 bp upstream of the translational initiation codon, ATG . E . coli TG1(pHYB100) efficiently synthesized hyaluronan-cleaving enzyme activity at approximately 7000 working units/109 cells, with lyase activity detectable in all principle cellular locations . Zymography and Western analysis identified functional activity in TG1(pHYB100) to be associated with approximately 118, 110 and 94-kDa polypeptides, with the two low molecular weight species constituting the major components of the enzyme purified from the culture supernatant fluid of S . agalactiae 4755 . The 118-kDa form was shown to represent the undegraded mature enzyme, whereas the smaller species are likely to arise from proteolytic cleavage in the N-terminal part of the mature protein . The HylB4755 protein showed extensive sequence identity to the homologous enzymes from S . agalactiae 3502 and S . pneumoniae characterized by others but sequence comparisons clearly show that incomplete genes truncated at their 5' ends had been isolated from these two organisms . Infect Immun, 1998 Jun, 66(6), 2866 - 70 Isotypes and opsonophagocytosis of pneumococcus type 6B antibodies elicited in infants and adults by an experimental pneumococcus type 6B-tetanus toxoid vaccine; Vidarsson G et al.; Streptococcus pneumoniae is a major respiratory pathogen of infants, children, and the elderly . Polysaccharide vaccines have been useful in adult populations but do not elicit protective immunity in infants and young children . To enhance their immunogenicity, vaccines of pneumococcal polysaccharides conjugated to proteins are being developed . In this study antibody levels and opsonic activities were compared in sera of infants and adults injected with pneumococcal polysaccharide type 6B (Pn6B) conjugated to tetanus toxoid (TT) (Pn6B-TT) . Healthy infants were injected with Pn6B-TT; group A was injected at 3, 4, and 6 months of age, and group B was injected at 7 and 9 months of age . A booster injection was given at 18 months . Adults were injected once . Antibodies were measured by enzyme-linked immunosorbent assay and radioimmunoassay, and their functional activities were measured by opsonophagocytosis of radiolabelled pneumococci . In adults, increases in immunoglobulin M (IgM), IgG, IgA, IgG1, and IgG2 to Pn6B were observed . Infants reached adult levels of IgG1 anti-Pn6B after the primary injections . After the booster injection the infant groups had total IgG- and IgM-Pn6B antibody levels similar to those of adults . After the booster injection, IgG1 was the dominant infant anti-Pn6B isotype and at a level higher than in vaccinated adults, but IgA and IgG2 antibodies remained at very low levels . Opsonic activity increased significantly after Pn6B-TT injections; the highest infant sera showed opsonic activity comparable to that of vaccinated adults . Overall, opsonic activity correlated best with total and IgG anti-Pn6B antibodies (r = 0.741, r = 0.653, respectively; n = 35) and was highest in sera with high levels of all Pn6B antibody isotypes . The results indicate the protective potential of a pneumococcal 6B polysaccharide protein conjugate vaccine for young infants. Infect Immun, 1998 Jun, 66(6), 2743 - 9 Genetic and biochemical analysis of mutacin 1140, a lantibiotic from Streptococcus mutans; Hillman JD et al.; Streptococcus mutans JH1000 and its derivatives were previously shown (J . D . Hillman, K . P . Johnson, and B . I . Yaphe, Infect . Immun . 44:141-144, 1984) to produce a low-molecular-weight, broad-spectrum bacteriocin-like inhibitory substance (BLIS) . The thermosensitive vector pTV1-OK harboring Tn917 was used to isolate a BLIS-deficient mutant, DM25, and the mutated gene was recovered by shotgun cloning in Escherichia coli . Sequence analysis of insert DNA adjacent to Tn917 led to the identification of four open reading frames including two (lanA and lanB) which have substantial homology to the Staphylococcus epidermidis structural gene (epiA) and a modifying enzyme gene (epiB) for biosynthesis of the lantibiotic epidermin, respectively . Although the BLIS activity could not be recovered from broth cultures, high yields were obtained from a solid medium consisting of Todd-Hewitt broth containing 0.5% agarose that was stab inoculated with JH1140 (a spontaneous mutant of JH1000 that produces threefold-elevated amounts of activity) . Agar could not substitute for agarose . Chloroform extraction of the spent medium produced a fraction which yielded two major bands on sodium dodecyl sulfate-polyacrylamide gel electrophoresis . The faster-migrating band was absent in chloroform extracts of the mutant, DM25 . The amino acid sequence of this band was determined by Edman sequencing and mass spectroscopy . The results showed that it is a lantibiotic, which we have named mutacin 1140, and that the sequence corresponded to that deduced from the lanA sequence . We observed a number of similarities of mutacin 1140 to epidermin and an S . mutans lantibiotic, B-Ny266, but it appears to have significant differences in the positions of its thioether bridges . It also has other unique features with regard to its leader sequence and posttranslational modification . A proposed structure for mutacin 1140 is presented. Infect Immun, 1998 Jun, 66(6), 2529 - 34 In vitro expression of adhesion receptors and diapedesis by polymorphonuclear neutrophils during experimentally induced Streptococcus uberis mastitis; Smits E et al.; The expression of adhesion receptors and diapedesis by polymorphonuclear neutrophils (PMN) were studied before and during experimentally induced Streptococcus uberis mastitis . Both quarters of the left half of the udders of five midlactation cows were inoculated with a suspension containing approximately 500 CFU of S . uberis 0140J . Clinical signs of an inflammatory reaction and leukocyte influx were observed 24 h after challenge . The expression of CD11b/CD18 adhesion receptors, determined by flow cytometry, was upregulated 24 h after challenge . A confluent monolayer of bovine secretory mammary epithelial cells on collagen-coated inserts was used to study PMN diapedesis . Bovine C5a was used as the chemoattractant . An 80% decrease in PMN diapedesis was observed 24 h after challenge . The decrease in diapedesis continued for 3 weeks after challenge. Infect Immun, 1998 Jun, 66(6), 2441 - 6 Streptococcus pneumoniae type 14 polysaccharide-conjugate vaccines: length stabilization of opsonophagocytic conformational polysaccharide epitopes; Laferriere CA et al.; A simple and convenient method was developed for the preparation of Streptococcus pneumoniae type 14 polysaccharide (Pn14PS)-tetanus toxoid (TT) conjugate vaccines, using terminally linked Pn14PS fragments of different lengths . Native Pn14PS was simultaneously depolymerized and activated for conjugation by partial N-deacetylation followed by nitrous acid deamination which yielded fragments (1.4 to 150.0 kDa) having a free aldehyde at the reducing end . These were then conjugated to TT through their terminal aldehydic groups, using the reductive amination procedure . All of the above conjugates, when injected in rabbits, induced anti-Pn14PS antibodies, whereas the native Pn14PS did not . The amounts of anti-Pn14PS antibodies elicited by these conjugates, as determined by enzyme-linked immunosorbent assay, followed a trend with conjugates containing the highest-molecular-weight Pn14PS eliciting the highest titers . The same trend was also observed in the ability of the antibodies to opsonize and kill live type 14 pneumococci, although the increase in opsonophagocytic activity was more pronounced and did not correlate linearly with increases in antibody titer . Competitive inhibition of the binding of different conjugate antisera to the native Pn14PS, using Pn14PS fragments as inhibitors, established that the conjugates induced antibodies with specificities for different lengths of Pn14PS beginning at 2 repeating units (RU) . It was also established, both immunologically and antigenically, that at least 4 RU of Pn14PS were required to form an extended conformational epitope and that approximately 22 RU of Pn14PS were required to duplicate the same epitope on the same saccharide chain . The conformational epitope was found to be essential for the induction of antibodies with high opsonophagocytic activity and that augmentation of opsonophagocytic activity was also dependent on further chain extension. Clin Infect Dis, 1998 May, 26(5), 1188 - 95 Drug-resistant Streptococcus pneumoniae; Campbell GD Jr et al.; Streptococcus pneumoniae remains a major cause of infection in both children and adults, annually resulting in significant morbidity and mortality . The past two decades have seen an alarming worldwide increase in the incidence of drug-resistant S . pneumoniae (DRSP) . DRSP is now common throughout the United States, and physicians are questioning how best to approach this epidemic . With the introduction of a number of newer antimicrobial agents, the potential for improved preventive measures, and a better understanding of DRSP, the approach to the management of DRSP infections may change greatly in the next few years . In this article we will review the development of DRSP, identify populations at increased risk of exposure to DRSP, address what approaches might be used to limit its spread, and suggest initial empirical therapy when treating patients with pneumonia due to DRSP. J Antimicrob Chemother, 1998 Apr, 41(4), 451 - 9 Pharmacodynamics of penicillin are unaffected by bacterial growth phases of Streptococcus pneumoniae in the mouse peritonitis model; Knudsen JD et al.; The correlation between pharmacokinetic parameters and the in-vivo effect of antibiotics in relation to bacterial growth phases was evaluated using the mouse peritonitis model with a penicillin-resistant pneumococcus . Different 8 h dosing regimens were applied, with different total doses and initiated at different times during the bacterial growth phase . The effect was measured as the decline in bacterial counts in the peritoneal cavity . The pharmacokinetic parameters showed major changes during the phases of growth, as the serum elimination of penicillin decreased during the infection . The same effect of dosing regimens was observed in the exponential and stationary phases . In two regimens where T(>MIC) (the time the serum concentration exceeded the MIC) was 50% of the treatment period, a significantly better effect was achieved with a 2 hourly regimen than with a regimen with treatments every 20 min . The T(>MIC) of each dose was shown to be a critical parameter for achieving an effect in all growth phases . The maximum effect of penicillin, a 5-6 x log10 decline in bacterial counts in the peritoneum of the mice, was achieved when T(>MIC) was >50% of the treatment time or longer than approximately 40 min of each dose . The 50% effective dose for protection after a single injection, ED50, was measured in the different phases of the infection and found to increase with the duration of the pneumococcal infection, while mice treated 24 h after challenge were beyond therapeutic range . The correlation between the effect of penicillin and pharmacokinetic parameters appears to follow the same rules during the different in-vivo growth phases of pneumococci. Clin Otolaryngol, 1998 Apr, 23(2), 164 - 8 Microbiology and antibiotic treatment of head and neck abscesses in children; Simo R et al.; The clinical data, microbiological results and antibiotic treatment of 65 children who have required incision and drainage of suppurative head and neck abscesses was retrospectively investigated with the aim of developing a more effective clinical protocol of treatment, improving speed of resolution and rationalizing the need for surgical intervention . A positive culture grew in 78% of children and of these 45% were Staphylococcus aureus, 9% Streptococcus pyogenes, and 8% atypical mycobacteria . Only 3% of the samples grew anaerobes . All isolates of S . aureus were sensitive to Flucloxacillin and all isolates of S . pyogenes were sensitive to penicillin . All anaerobes were Metronidazole sensitive . In 40% of the children there were no localizing symptoms which could guide the treatment, therefore we recommend Flucloxacillin and Metronidazole as the antibiotic regimen of choice in acute suppurative lymphadenitis . The increasing incidence of atypical mycobacterial lymphadenitis is noteworthy. Pediatrics, 1998 May, 101(5), 813 - 6 Accuracy of a polymerase chain reaction-based assay for detection of pneumococcal bacteremia in children; Isaacman DJ et al.; OBJECTIVE: To evaluate the utility of a polymerase chain reaction (PCR)-based assay for identifying pneumococcal DNA in the blood of pediatric patients with suspected bacteremia . METHODS: Children evaluated at the Children's Hospital of Pittsburgh who were having blood drawn for culture had an additional 2 to 3 mL of blood (from the same sampling) obtained and placed in a sodium citrate tube for PCR processing (study group) . The control group for this study consisted of children having blood drawn for biochemical analysis who were afebrile, well-appearing, and had no recent illnesses . Specimens were frozen at -70 degrees C and then batch-processed for PCR-based analyses with the JM201/202-204 primer/probe set . Amplified products were detected after liquid hybridization format wherein a 32P end-labeled probe was annealed to the amplified DNA and visualized by autoradiographic analysis after gel retardation . RESULTS: Four hundred eighty study group patients and 103 controls had specimens tested by both PCR and blood culture . Twenty-six (5%) patients had a positive blood culture for a pathogenic organism (21 of which were Streptococcus pneumoniae) . Twelve (57%) of the 21 patients with blood cultures positive for S pneumoniae also were positive by PCR . In addition, 206 study group patients and 16 controls with negative blood cultures had positive PCR results . A greater proportion of study group patients were PCR-positive/culture-negative than were controls (206/459 vs 16/103) . CONCLUSION: Although this assay currently lacks adequate sensitivity and specificity for clinical use, the high frequency of PCR-positive cases in patients with suspected bacteremia may indicate a greater role for S pneumoniae than had previously been appreciated . Further refinement of this assay as well as the development of a rapid PCR-based assay appears warranted. J Clin Microbiol, 1998 Apr, 36(4), 1139 - 40 Long-term survival of Streptococcus pneumoniae at room temperature on Dorset egg medium; Wasas AD et al.; Forty-five isolates of Streptococcus pneumoniae were inoculated on Dorset egg and supplemented Columbia agar base media, incubated overnight at 37 degrees C, and then kept at room temperature (RT; 21 degrees C) or 4 degrees C . Long-term viability was best at RT for both media, with all isolates remaining viable on Dorset egg medium for 44 days; viability was 90 and 57% on Columbia agar base medium after 7 and 30 days . We recommend the use of Dorset egg medium for the maintenance of pneumococci at RT. J Clin Microbiol, 1998 Apr, 36(4), 902 - 7 Group A streptococcal Vir types are M-protein gene (emm) sequence type specific; Gardiner DL et al.; The M-protein genes (emm genes) of 103 separate impetiginous Streptococcus pyogenes isolates were sequenced and the sequence types were compared to the types obtained by Vir typing . Vir typing is based on restriction fragment length polymorphism (RFLP) analysis of a 4- to 7-kb pathogenicity island encoding emm and other virulence genes . By using both HaeIII and HinfI to generate RFLP profiles, complete concordance between Vir type and emm sequence type was found . Comparison of the emm sequences with those in GenBank revealed new sequence types sharing less than 90% identity with known types . Diversity in the emm sequence was generated by corrected frameshift mutations, point mutations, and small in-frame mutations. Int J Pediatr Otorhinolaryngol, 1998 Feb, 43(1), 33 - 9 Tonsillar lymphocyte subsets in recurrent acute tonsillitis and tonsillar hypertrophy; Lopez-Gonzalez MA et al.; Recurrent acute tonsillitis is usually produced directly by micro-organisms, mainly beta-hemolytic streptococcus . Idiopathic tonsillar hypertrophy is presented without infection history and usually leads to obstructive sleep apnea . We have measured lymphocyte subsets in tonsillar cellular suspensions of infectious and obstructive tonsillar pathology by flow cytometry . Comparing with peripheral blood, the CD4+/CD8+ ratio for tonsillar pathology varies from 4.0 to 5.0 while in peripheral blood the ratio was 1.3 . In tonsils the ratio of B lymphocytes/T lymphocytes is 1.6, being 0.3 in peripheral blood, cytotoxic T lymphocytes represent 8% in tonsils and 29% in peripheral blood, virgin or nonstimulated T lymphocytes (CD4+ CD62L+) consist of 3% in tonsils and 16% in peripheral blood . The immature B lymphocytes (CD20+ CD5+) represent 23% in tonsils and 12% in peripheral blood . In regards to NK cells (CD3- CD16+), 1% was found in tonsils and 11% in peripheral blood . In tonsils B lymphocytes and a low proportion of cytotoxic T lymphocytes predominate, in comparison to peripheral blood, with a CD4+/CD8+ ratio four times greater than tonsils . We have found in tonsils a significant increase of T cells (CD3+ and TCR alpha+ beta+) in infectious processes in comparison to obstructive pathology. Vet Microbiol, 1998 Feb 15, 60(1), 59 - 66 Serological characterization and antimicrobial susceptibility of Streptococcus suis isolates from diagnostic samples in Denmark during 1995 and 1996; Aarestrup FM et al.; At the Danish Veterinary Laboratory Streptococcus suis infections in pigs were diagnosed in 114 cases in 1995 and in 151 cases in 1996 . Isolates were serotyped using specific antisera against type 1 through 28 and a total of 67 cases from 1995 and 113 cases in 1996 were tested for resistance to 11 antimicrobial agents . The majority of cases were lung diseases (57%), followed by septicaemia (16%), meningitis (15%) and endocarditis (8%) . Almost 96% of the isolates could be typed using the 28 antisera . The most common serotype was serotype 2 (29%), followed by serotype 7 (17%), and serotypes 3, 4 and 8 (9-10%) . The remaining serotypes were observed in frequencies of less than 5% . Serotype 7 was more commonly isolated from septicaemia than the other serotypes . Serotype 2 was more commonly isolated from pigs older than 4 weeks compared to the other serotypes . Most isolates were susceptible to amoxycillin + clavulanate, ampicillin, ceftiofur, enrofloxacin, penicillin, spectinomycin, tiamulin and trimethoprim + sulphadiazine . A high frequency (> 30%) of resistance to tetracycline was observed . Among isolates of serotype 2, 9.7% were resistant to lincomycin and 12.9% to spiramycin . Among other serotypes 56.8% were resistant to lincomycin and spiramycin . The differences in susceptibility between isolates of serotype 2 and the other serotypes were statistically significant . Compared to a previous Danish study the distribution of serotypes of S . suis causing infections among pigs in Denmark has changed during the last 15 years. J Endod, 1997 Apr, 23(4), 229 - 31 Residual antimicrobial activity after canal irrigation with chlorhexidine; White RR et al.; We previously reported that the in vitro antimicrobial activity of a 2.0% chlorhexidine endodontic irrigant was equivalent to that of 5.25% sodium hypochlorite . The purpose of this study was to determine if chlorhexidine irrigants could instill substantive antimicrobial activity in instrumented root canals in vitro . Human teeth were instrumented using 2.0% or 0.12% chlorhexidine as irrigants . After instrumentation, the root canals were filled with sterile water, and samples of the root canal fluid were absorbed with paper points at 6, 12, 24, 48, and 72 h after treatment . The paper points were assayed for antimicrobial activity by placing them on agar plate surfaces inoculated with Streptococcus mutans and measuring zones of inhibition . Antimicrobial activity was present in all 2.0% chlorhexidine-treated teeth throughout the 72-h testing period and in most teeth, in relatively lower concentrations, for 6 to 24 h after irrigation with 0.12% chlorhexidine . These results indicate that chlorhexidine instills substantive antimicrobial activity when used as an endodontic irrigant. NDA J, 1995 Dec, 46(2), 8 - 11 Salivary count of Streptococcus mutans in elementary school children; Richardson L et al.; Previous studies have documented that persons with high levels of Streptococcus mutans are "at risk" for dental caries . The objective of this study was to identify children at an early age who were "at risk" for caries . The sample consisted of 77 school children aged 9-13 years old . The majority of the sample was African-Americans (55.8%) . Approximately 51% were females . The Dentocult SM Strip Mutans Test was used to estimate the S . mutans count in saliva . The method is based on the use of a selected culture broth and the adhere S . mutans count of < 1,000,000 bacteria ml saliva and children with S . mutans count of < 1,000,000 were classified as "low risk" for caries . The DMF-T was used to estimate the number of decayed, missing and filled teeth . The decayed mean score = 1.85; range = 0-9 . Only two children had teeth missing (one in each) . The number of filled teeth was low; mean = .88; range = 0-6 . The DMF-T mean score was 2.75; range = 0-9 . Correlations were sought between levels of S . mutans rates and decayed teeth . Low, but nonsignificant, correlations were found between S . mutans and decayed teeth (r = .20) . This trend continued for S . mutans levels and the DMF-T (r = .16) . Analysis of Variance Test (ANOVA) indicated a significant effect by sex on the levels of S . mutans P < .05 (females had higher S . mutans levels than males) . There was no significant difference or interaction noted in DMF-T scores by sex or race . In addition no significant difference was noted in the number of decayed teeth by sex or race . Our results indicate that females in this age group are potentially at greater risk for dental caries than their male counterparts due to the observed higher levels of S . mutans . This observation deserves further study. Antimicrob Agents Chemother, 1998 May, 42(5), 1266 - 8 In vitro antimicrobial effects of various combinations of penicillin and clindamycin against four strains of Streptococcus pyogenes; Stevens DL et al.; Previous studies using mouse models of Streptococcus pyogenes necrotizing fasciitis demonstrated that clindamycin had greater efficacy than penicillin . Frequently both agents are used concurrently in the treatment of severe S . pyogenes infections . This study investigated interactions between penicillin and clindamycin . E-test and broth microdilution assays suggested additivity or indifference, while timed-killing assays demonstrated concentration-dependent variable effects . Timed-kill studies utilizing clinical concentrations suggest that there is no antagonism with the combination of drugs but that the combination does not have a bactericidal advantage over either penicillin or clindamycin alone. J Infect Dis, 1998 May, 177(5), 1308 - 13 Genomic diversity among Streptococcus agalactiae isolates detected by a degenerate oligonucleotide-primed amplification assay; Limansky AS et al.; A random-amplified polymorphic DNA assay using partially degenerate oligonucleotides as primers was used for the characterization of 78 epidemiologically related and unrelated clinical isolates of Streptococcus agalactiae belonging to different serotypes . Thirty distinct amplification profiles were obtained among 52 unrelated S . agalactiae isolates assigned to nine groups by serotyping (including 3 nontypeable strains), uncovering the extent of genomic heterogeneity existent within serotypes . This method was particularly useful in providing evidence for or against vertical transmission of a given clone of this microorganism, as well as for relapsing or reinfection in related cases, and suggested clonal relatedness between unrelated S . agalactiae isolates associated with some invasive infections . Thus, this simple methodology represents a suitable tool for the epidemiologic study of S . agalactiae infections. Eur Arch Otorhinolaryngol, 1998, 255(4), 195 - 201 The anti-inflammatory effect of fusafungine during experimentally induced rhinosinusitis in the rabbit; Otori N et al.; The short-term effects of local intranasal administration of fusafungine were studied for its anti-inflammatory and antimicrobial properties against experimentally induced bacterial rhinosinusitis . The maxillary sinuses of 20 rabbits were infected with encapsulated Streptococcus pneumoniae after mechanical occlusion of each animal's anatomic ostium . Either fusafungine solution or placebo was administered as a nasal spray through the nostrils twice daily for 10 days . Histopathological grading of inflammation, biochemical assay of inflammatory mediators, and the number of bacterial species isolated from the nasal cavities all showed significant recovery from inflammation after fusafungine treatment . The beneficial effects of fusafungine on inflamed sinus mucosa may possibly also be attributable to an initial alleviation of inflammation in the nasal cavity, which permitted entry of the drug to the sinus cavity through a partially reopened ostium . A reciprocal relationship between nasal and sinus reactivity involving generalization of inflammation and recovery was also thought to be of importance . The present findings indicate that local applications of fusafungine may effectively improve clinical conditions producing rhinitis and sinusitis. Zhonghua Kou Qiang Yi Xue Za Zhi, 1996 Nov, 31(6), 344 - 7 {The characterization of Streptococcus mutans MT8148 and its glucosyltransferase deficient mutants}; Bian Z et al.; The characterization of GTase-deficient mutants of S . mutans MT8148 was analysed to understand the possible virulence of GTase . In the presence of 1% sucrose, these mutants lost the ability to adhere to glass wall and the insoluble glucan synthesis was dramatically decreased . The GTase enzyme activity for insoluble glucan synthesis of these mutants was also decreased . Western blot using anti-CAGTase polyclonal antibody and anti-GTFI or anti-GTFSI monoclonal antibody showed the lack of the corresponding GTase which further confirmed the mutation of specific GTase gene. Am J Dent, 1997 Dec, 10(6), 272 - 4 Effect of enamel microabrasion on bacterial colonization; Segura A et al.; PURPOSE: To determine if microabraded surfaces inhibit Streptococcus mutans colonization . MATERIALS AND METHODS: Ten extracted molars were obtained and sectioned in half mesio-distally . The mesial side was treated with microabrasion (PREMA Compound) . The distal surface was designated as the control site . A plastic tube was secured on each surface with resin composite, exposing a surface of 13.2 mm 2 . S . mutans 10,499 was cultured in TSB-YE supplemented with 5% sucrose and 2.5% glucose was added to each secured site in addition to 50 microliters of cell suspension . Samples were incubated in a 5% CO2 chamber for 7 days at 37 degrees C . Samples were taken from each site, incubated with dextranase (75 micrograms 1 ml), sonicated, and vortexed to disrupt cellular aggregates as much as possible . Samples were then plated on Mitis-Salivarius agar using a spiral plating system . Enumeration of numbers of colonizing bacteria was achieved following standard spiral plating system methodology . RESULTS: The mean for the microabraded group was 1.12 x 10(2) cfu/tooth and for the control it was 1.15 x 10(4) . Analyzing the data revealed a significant difference (P = 0.0188). Afr Dent J, 1993, 7, 1 - 5 The influence of dietary sugars and starch on the establishment of Streptococcus mutans and Actinomyces viscosus in dental plaque of specific pathogen-free rats; Matee MI et al.; The establishment of S . mutans together with A . viscosus was investigated in dental plaque of specific pathogen-free (SPF) rats fed different carbohydrate diets . Two Tanzanian S.mutans strains MM3 and MM24 and one Tanzanian A . viscosus strain MM13 were used for this purpose . The basic diet consisting of 32% skim-milk, 7% yeast extract and 1% soy bean oil was supplemented with either 10% lactose and 50% corn flour, or 10% glucose and 50% corn flour, or 60% amylum or 60% wheat flour . S . mutans and A . viscosus were enumerated twenty days after inoculation . S . mutans counts were high irrespective of the dietary regime . A . viscosus counts in the glucose, lactose and amylum groups were of the same magnitude and significantly higher than those of the wheat flour group . The hypothesis that the establishment of S . mutans in sucrose free diets could be facilitated by the extracellular polysaccharides produced by A . viscosus was not supported by the present data . The finding that S . mutans can establish in high number in dental plaque of SPF rats in the absence of sucrose corroborates previous reports indicating high S . mutans counts in African populations with a low sucrose intake. J Paediatr Child Health, 1998 Apr, 34(2), 192 - 5 Streptococcus pneumoniae-induced haemolytic uraemic syndrome; McTaggart SJ et al.; Haemolytic uraemic syndrome secondary to infection with neuraminidase producing Streptococcus pneumoniae is well recognised, but was previously considered to be rare . This case report describes the course of a 9-month-old male with pneumococcal pneumonia, T activation and haemolytic uraemic syndrome . The clinical features of three other cases treated in Southeast Queensland in the past 2 years and 12 previously reported cases are summarised . The widespread availability of rapid diagnostic testing for this entity should allow for increased recognition, enabling appropriate use of low plasma volume blood products with improved patient outcome. J Toxicol Environ Health A, 1998 May 8, 54(1), 1 - 20 Immunotoxicological assessment of methyl parathion in female B6C3F1 mice; Crittenden PL et al.; Methyl parathion is a widely used agricultural insecticide, and the recent unlicensed use of this compound in homes has led to the evacuation of approximately 1100 persons in Mississippi . Although the primary concern in such cases of acute exposure is neurotoxicity, a few organophosphorus compounds apparently have immunotoxic effects at dosages that do not produce neurotoxic symptoms . The purpose of the present study was to determine if this is the case for methyl parathion . Female B6C3F1 mice were exposed to methyl parathion by gavage, daily for 7, 14, 2 1, or 28 d (at 6 mg/kg/d) . Exposure for 14-28 d produced significant, dose-responsive inhibition of acetylcholin-esterase (the target molecule for methyl parathion-induced neurotoxicity) in brain or plasma, indicating that the compound was active . The following immunological parameters were evaluated: white blood cell counts and differentials, spleen and thymus weight and cellularity, splenic natural killer cell activity, nitrite production by peritoneal macrophages following activation in vitro, antibody response to sheep erythrocytes in vitro and in vivo, the cytotoxic T lymphocyte response to allogeneic tumor cells, and resistance to Streptococcus agalactiae and B16F10 melanoma cells . Methylparathion at 1 or 3 mg/kg/d significantly increased splenic natural killer cell activity . Nitrite production by macrophages was increased in mice treated with 1, 3, or 6 mg/kg/d . The antibody response to sheep erythrocytes in vitro was significantly suppressed, but the humoral response to sheep erythrocytes in vivo was not affected . The cytotoxic T-lymphocyte response to allogeneic tumor cells was not significantly affected . Host resistance was not significantly decreased . Although it remains possible that immunological parameters not tested here may be affected by methyl parathion, the present results do not suggest substantial immunotoxic potential for this compound. Egypt Dent J, 1993 Oct, 39(4), 533 - 9 Dental, oral and bacteriological aspects in patients at risk of subacute bacterial endocarditis; Darhous MS et al.; The present investigation was performed on 100 patients, at the Cardiac Institute in Imbaba suffering from either rheumatic heart disease or congenital heart disease . In all the patients, the cardiac, dental and periodontal conditions as well as any other oral manifestations were evaluated . Bacterial samples of plaque and throat were taken in cases receiving long-acting penicillin . In most of the cases, the caries, plaque and periodontal indices were very high and in cases of congenital heart disease, there was atrophy of the tongue coating . The bacterial ecology of dental plaque changed in most of the patients taking long-acting penicillins with supervening Streptococcus viridans, E . coli and Staphylococcus aureus . The results stress on the importance of proper antibiotic prophylaxis before any dental intervention as well as through oral hygiene procedures. Zentralbl Veterinarmed B, 1998 Apr, 45(3), 161 - 70 Factors influencing adherence of Streptococcus dysgalactiae to bovine mammary epithelial cell monolayers; Calvinho LF et al.; Factors that affected adherence of Streptococcus dysgalactiae to monolayers of primary bovine mammary epithelial cells and to a bovine mammary epithelial transformed cell line were evaluated . Cell culture medium inhibited more than 99% of binding of S . dysgalactiae to plastic and was as effective as several blocking agents in decreasing adventitious adherence of this organism to plastic . Adherence of two strains of S . dysgalactiae (UT516 and UT519) was higher to a transformed mammary epithelial cell line (2.85% and 0.83%, respectively) than to primary bovine mammary epithelial cells (0.45% and 0.52%, respectively) . Measurement of the extent of bacterial adherence to cell monolayers showed that adherence was affected by inoculum size . This indicated that the process was mediated by saturable cell receptors and allowed selection of bacteria:epithelial cell ratios not approaching saturating conditions (< 1500:1) . In addition, reduction of bacterial adherence by more than 90% following cell fixation indicated that cell surface proteins played a major role in this process . Delineation of bacterial and epithelial cell factors influencing adherence of S . dysgalactiae to mammary epithelial cell monolayers resulted in the development of an in vitro method for quantifying bacterial adherence to cell monolayers. J Endod, 1997 Jul, 23(7), 433 - 8 The use of a 16s rDNA directed PCR for the detection of endodontopathogenic bacteria; Conrads G et al.; The study evaluates a 16S rDNA directed polymerase chain reaction (PCR) to detect and differentiate bacteria in necrotic root canal samples . The examination focused on species that are fastidious concerning culture or are difficult to differentiate after culturing by biochemical methods . In the described PCR assay, a universal 16S rDNA directed forward primer in combination with a highly specific reversed one was used to amplify taxon specific gene fragments of 230 to 950 bp length . A similar PCR reaction using a universal 16S rDNA reversed primer was also established to demonstrate bacteria in root canal specimens in general . A first application of this method revealed the presence of Actinomycetales-species, Fusobacterium nucleatum, "Streptococcus milleri," and, presumably for the first time described in infected root canals, Bacteroides forsythus . The identity of amplificons was confirmed by generating sequence information and comparison to gene databanks. J Endod, 1997 Sep, 23(9), 583 - 5 An evaluation of the bactericidal effect of the Nd:YAP laser; Blum JY et al.; The aim of this in vitro study was to compare the efficacy of a classical irrigant with that of a laser in disinfecting a contaminated root canal . Thirty canals of extracted single-root teeth were prepared with files to size #20 . The teeth were sterilized with Germispad (Spad, France) for 30 min and then inoculated with Streptococcus mitis ATCC 33399 . By randomization, the teeth were divided into six groups of five teeth each . In the first group, teeth were neither inoculated nor prepared . This was the sterility control group (1) . In the second group (2) teeth were inoculated without any preparation: as positive controls . The third group was inoculated and then hand-instrumented with files to size #30 with 5.25% NaOCl as irrigant . This was the hand instrumentation group . The other groups were prepared with hand instrumentation with files to size #30, using sterile water as an irrigant, and the canal was then lased with different frequencies as follows: group 4, frequency of 5 Hz and power of 260 mJ; group 5, frequency of 10 Hz and power of 310 mJ; and group 6, frequency of 30 Hz and power of 300 mJ . After experimentation, the residual colonies were counted . The results indicated that (i) the treatment with NaOCl and manual instrumentation effectively inhibited the growth of Streptococcus mitis ATCC 33399; and (ii) the antibacterial effect of the Nd:YAP laser depended on the frequency . Only a frequency of 30 Hz of the Nd:YAP laser inhibited the growth of Streptococcus mitis ATCC 333999. Kansenshogaku Zasshi, 1998 Mar, 72(3), 258 - 65 {Report of surveillance on streptococcal toxic shock syndrome in Japan and presentation of the criteria}; Shimizu Y et al.; A survey was made on the situation of Group A Streptococcal toxic shock syndrome (STSS) based on questionnaires . The survey was divided into two parts . The first survey was done by sending out an outline of the STSS inquiring if any STSS cases were observed by mail to university hospitals, residence training hospital and other major hospitals totaling 2512 institutes . The second survey was subsequently done to the institutes that had STSS cases asking for the clinical course, data and sampling of the bacteria . The diagnosis of STSS was confirmed based on the diagnostic criteria induced by the working group of the United States . We have found 97 cases of STSS which 48.5% had fatal outcomes . There was no significant sex difference in the onset or the mortality rate . It occurred more in the older population, and occurred through out Japan but was not found to be epidemic . The first case was backed in 1978 and it began to increase since 1993, reaching its peak in 1994 and now decreasing in number . Most of the isolated Group A streptococcus were of type M1 and M3 . We have modified the United States diagnostic criteria creating a new Japanese criteria, which includes the symptoms of the central nervous system in the term MOF . The aim for the Japanese criteria is to search for the etiology of the disease . The Japanese criteria requires that the disease progresses rapidly and that the patient be free from any conditions that might suppress the immunal system. Genome Res, 1998 May, 8(5), 557 - 61 Sequencing multimegabase-template DNA with BigDye terminator chemistry; Heiner CR et al.; Using the recently introduced BigDye terminators, large-template DNA can be directly sequenced with custom primers on automated instruments . Cycle sequencing conditions are presented to sequence DNA samples isolated from a number of microbial genomes including 750-kb Ureaplasma urealyticum, 1.2-Mb Mycoplasma fermentans, 2.3-Mb Streptococcus pneumoniae, and 4.6-Mb Escherichia coli . Average read lengths of >700 bp from unique primer annealing sites are often sufficient to fill final gaps in microbial genome sequencing projects without additional manipulations of template DNA . The technique can also be applied to sequence-targeted regions, thereby bypassing tedious subcloning steps. Nat Med, 1998 May, 4(5), 601 - 6 Characterization of a recombinant plant monoclonal secretory antibody and preventive immunotherapy in humans; Ma JK et al.; A functional comparison was made between a monoclonal secretory antibody generated in transgenic plants and its parent murine IgG antibody.The affinity constants of both antibodies for a Streptococcus mutans adhesion protein were similar . However the secretory antibody had a higher functional affinity due to its dimeric structure . In the human oral cavity, the secretory antibody survived for up to three days, compared with one day for the IgG antibody . The plant secretory antibody afforded specific protection in humans against oral streptococcal colonization for at least four months . We demonstrate that transgenic plants can be used to produce high affinity, monoclonal secretory antibodies that can prevent specific microbial colonization in humans . These findings could be extended to the immunotherapeutic prevention of other mucosal infections in humans and animals. Singapore Dent J, 1995 Jul, 20(1), 16 - 20 Correlating Streptococcus mutans counts in saliva with plaque amount, gingival inflammation and caries experience in school children; Jalil RA; Samples of stimulated whole saliva were obtained from ninety-four 12-14-year-old school children living in inner London to evaluate if there was a correlation between Streptococcus mutans counts in saliva with plaque amount, gingival inflammation and caries experience . S . mutans counts were obtained by a dip-slide method (Dentocult 'Strip Mutans') in which the count was expressed as 0, 1, 2, 3, or 4 based on visual estimation of the colony density . There was no association between counts' of S . mutans in saliva with plaque amount and gingival inflammation . However, there was a significant trend of increased decayed, missing, filled surfaces (DMFS) with increasing S . mutans counts. J Clin Invest, 1998 Apr 15, 101(8), 1708 - 16 Hyaluronic acid capsule modulates M protein-mediated adherence and acts as a ligand for attachment of group A Streptococcus to CD44 on human keratinocytes; Schrager HM et al.; We used wild-type and isogenic mutant strains of group A Streptococcus (GAS) that expressed M protein, capsule, or both to study the function of M protein and the hyaluronic acid capsular polysaccharide in attachment of GAS to human keratinocytes . Types 6 and 24, but not type 18, M protein were found to mediate attachment of GAS to soft palate or skin keratinocytes, but this interaction was prevented by the hyaluronic acid capsule on highly encapsulated, or mucoid, strains . Monoclonal antibody to CD44, the principal hyaluronic acid-binding receptor on keratinocytes, inhibited attachment of both highly encapsulated and poorly encapsulated wild type strains of GAS, but not the attachment of acapsular mutants . Transfection of K562 cells with cDNA encoding human CD44 conferred the capacity to bind each of six wild-type strains of GAS, but not to bind acapsular mutants . Because, in contrast to other potential adhesins, the group A streptococcal capsule is both highly conserved and surface-exposed, it may serve as a universal adhesin for attachment of diverse strains of GAS to keratinocytes of the pharyngeal mucosa and the skin. Med Clin (Barc), 1997 Oct 25, 109(14), 527 - 31 {Nosocomial infection over three years in a neonatal intensive care unit . Multivariate study}; Munoz Platon E et al.; BACKGROUND: The Neonate Intensive Care Units (NICU) present high frequencies of hospital infections (HI) as well as patients with high intrinsic and extrinsic infection risks . PATIENTS AND METHODS: A prospective study of 3 years in a NICU was carried out . Six-hundred and five neonates with stays longer than 48 hours were included . A descriptive study and a predictive equation, by non-conditional logistic regression, were performed, including the principal HI risk factors . RESULTS: The HI incidence was 25.8/1,000 patients-day, and it was most frequent in children with weight lower than 2,500 g . The main etiologic agents were Streptococcus epidermis and Pseudomonas aeruginosa . The risk factors for HI in NICU were assisted respiration (odds ratio {OR} = 5.1; 95% CI, 2.3-11.5), low weight at birth (OR = 3.2; 95% CI, 1-1.08), transfusion (OR = 3.8; 95% CI, 1.4-10.1) and central venous catheter . Validation by ROC curve was satisfactory . CONCLUSIONS: The incidence of HI in NICU is high, and depends on both disease features and instrumentation in NICU. J Mol Evol, 1998 Apr, 46(4), 432 - 6 Evidence for horizontal transfer from Streptococcus to Escherichia coli of the kfiD gene encoding the K5-specific UDP-glucose dehydrogenase; Munoz R et al.; Capsular polysaccharides are important virulence factors both in Gram-positive and Gram-negative bacteria . A similar cluster organization of the genes involved in the synthesis of bacterial exopolysaccharides has been postulated in both cases, suggesting that these clusters evolved by module assembly . Horizontal gene transfer has been postulated to explain the polymorphism found in these cellular polymers . The cap1 K and cap3A genes coding for the pneumococcal type 1 and type 3 UDP-glucose dehydrogenases, respectively, have been compared with other UDP-sugar dehydrogenases . We have observed that the evolutionary distance between Cap1K and Cap3A is approximately equal to that found between Cap1K (or Cap3A) and other UDP-GlcDH of families evolutionarily distant like KfiD, the dehydrogenase from Escherichia coli K5 . On the basis of comparisons of G + C content, patterns of synonymous and nonsynonymous substitutions, dinucleotide frequencies, and codon usage bias, we conclude that the kfiD gene has been introduced into E . coli from an exogenous source, probably from a streptococcal species. Microbiology, 1998 Apr, 144 ( Pt 4), 993 - 1003 Affinity purification and characterization of a fibrinogen-binding protein complex which protects mice against lethal challenge with Streptococcus equi subsp . equi; Meehan M et al.; Cell-wall-associated proteins from Streptococcus equi subsp . equi, the causative agent of strangles, were analysed with a view to identifying a potential protective antigen . Preparations of these proteins, isolated from mutanolysin extracts of cell walls, were shown to contain one major high-M(r) protein species (apparent M(r) 220,000 and 550,000 when analysed by SDS-PAGE and gel-filtration chromatography, respectively) . The high-M(r) protein bound horse fibrinogen and was purified under non-denaturing conditions using fibrinogen affinity chromatography . The fibrinogen-binding protein (FgBP) reacted with serum taken from horses recovering from strangles and protected mice against lethal challenge from S . equi subsp . equi . The sequence of the corresponding gene (fbp) was determined and shown to encode a mature protein (M(r) 54,597) with predicted coiled-coil structure . An FgBP truncate, lacking the C-terminal cell wall/membrane anchor domain, was overexpressed in and purified from Escherichia coli and was shown to behave in an analogous fashion to the wild-type product in terms of M(r) estimation, fibrinogen binding and seroreactivity. J Antimicrob Chemother, 1998 Mar, 41(3), 381 - 5 In-vitro activity of 21 beta-lactam antibiotics against penicillin-susceptible and penicillin-resistant Streptococcus pneumoniae; Verhaegen J et al.; MICs of 21 beta-lactams were determined by agar dilution against 283 penicillin-susceptible (pen-S), 122 intermediate (pen-I) and 23 fully penicillin-resistant (pen-R) pneumococci . MICs of all beta-lactams increased with increasing MICs of penicillin . Clometocillin was the most active penicillin against pen-I or pen-R pneumococci . All oral cephalosporins except cefuroxime and cefpodoxime were less active than penicillin and none was satisfactory against pen-I or pen-R pneumococci . The parenteral third- and fourth-generation cephalosporins (except ceftazidime) were similar in activity to penicillin against pen-S isolates . Cefpirome showed the lowest mean MICs against pen-I and pen-R strains. J Oral Rehabil, 1998 Feb, 25(2), 125 - 7 In vitro adherence of Streptococcus constellatus to dense hydroxyapatite and titanium; Ichikawa T et al.; Bacterial adherence to dense hydroxyapatite (HA) and titanium (Ti) rods was examined in vitro using Streptococcus constellatus ATCC27832 . Streptoccus constellatus is associated with dental abscess and was isolated from the peri-implantitis . The dense HA was etched with 5% hydrofluoric acid for 0, 10, 20, 30, 40, and 50 s Adherence to the untreated dense HA was twice as high as the adherence to the Ti . The adherence to saliva-treated Ti was 13% higher than that to untreated Ti . The adherence was increased by acid-treatment of the dense HA, following a sigmoid curve from 20 to 50 s of treatment time . The dense HA has the capacity to receive more bacterial adherence than Ti and furthermore, the etched dense HA becomes more adherent. Pediatr Infect Dis J, 1998 Apr, 17(4), 287 - 93 Epidemiology of invasive pneumococcal infections in infants and young children in Metropolitan Santiago, Chile, a newly industrializing country; Levine MM et al.; AIM: To study the epidemiology of invasive pneumococcal infections in infants and young children in Santiago, Chile, as a representative pediatric population in a newly industrializing country where pneumococcal conjugate vaccines may be used in the future . METHODS: A 5-year retrospective laboratory-based review (1989 to 1993) was followed by a 3-year prospective laboratory and hospital surveillance study in two of the six health administrative areas of Santiago to detect all hospitalized cases of invasive pneumococcal disease (defined as Streptococcus pneumoniae isolated from blood, cerebrospinal fluid or another normally sterile site) among infants and children (0 to 23 months of age in the retrospective and 0 to 59 months of age in the prospective study) . RESULTS: During the 5-year retrospective survey the incidence of invasive pneumococcal disease was 90.6 cases per 10(5) infants 0 to 11 months old and 18.5 cases per 10(5) toddlers 12 to 23 months old . Similar rates (60.2 per 10(5) infants and 18.1 per 10(5) toddlers) were recorded during the 3 years of prospective surveillance . Among the 110 cases in children 0 to 59 months of age detected during the 3-year prospective surveillance, 2 clinical forms, pneumonia and meningitis, accounted for 87.2% of all cases; 13 of the 49 pneumonia patients (26%) had empyema as a complication . Notably 40 of the 110 cases (36.4%) occurred before 6 months of age (63.4% of the 63 infant cases) . Serotypes 1, 14, 5 and 6B were the most prevalent . Overall 76 and 69%, respectively, of S . pneumoniae isolates were antigenic types that would be covered by the 11- or 9-valent conjugate vaccines under development . CONCLUSIONS: Invasive pneumococcal infections in Santiago, Chile, exhibit an epidemiologic pattern intermediate between that of developing and industrialized countries . The high burden of disease in early infancy dictates that an accelerated immunization schedule (beginning in the perinatal period) or maternal immunization with pneumococcal vaccines should be explored. Pediatr Infect Dis J, 1998 Apr, 17(4), 279 - 86 The use of Streptococcus pneumoniae nasopharyngeal isolates from healthy children to predict features of invasive disease; Kellner JD et al.; BACKGROUND: The role of sampling nasopharyngeal carriage isolates of Streptococcus pneumoniae to determine characteristics of isolates causing invasive disease has not been established . METHODS: Data were compared from two 1995 studies of S . pneumoniae in Metropolitan Toronto and Peel Region (population, 3.1 million) . The first was a prospective survey of nasopharyngeal (NP) carriage in child care centers . The second was a prospective surveillance for all cases of invasive disease . RESULTS: There were 545 NP S . pneumoniae isolates obtained from 532 children and 96 cases of invasive S . pneumoniae disease in children . The prevalences of reduced antibiotic susceptibility in the NP carriage and invasive studies, respectively, were: penicillin (16% vs . 11%, P=0.29); erythromycin (12% vs . 7%, P=0.25); and multiresistant (16% vs . 12%, P=0.34) . The power to rule out a difference between the groups was <30% for each comparison . Trimethoprim/sulfamethoxazole resistance was more common in NP carriage isolates than invasive isolates (38% vs . 23%, P=0.02) . Serotype 14 was more common in invasive isolates, whereas serogroup 6 was more common in NP carriage isolates . Antibiotic-resistant isolates were predominantly serogroups 6, 19 and 23 in both studies . CONCLUSIONS: Nasopharyngeal carriage isolates of S . pneumoniae reflect the antibiotic susceptibility rates of invasive isolates found in the same period for most antibiotics . However, even a large study like this may have limited power to detect a difference . The most common NP carriage serotypes are the same as the invasive isolates, although the rank order of specific serotypes is different . Routine surveys of S . pneumoniae NP carriage are not feasible because of the cost of serotyping and limited power of the observations, unless sample sizes are extremely large. Can J Surg, 1998 Apr, 41(2), 156 - 60 Necrotizing fasciitis of the retroperitoneum: an unusual presentation of group A Streptococcus infection; Devin B et al.; A 14-year-old girl presented with symptoms resembling acute appendicitis . Five days after appendectomy and continued fever and severe abdominal pain, blood cultures were found positive for Streptococcus pyogenes . Two days later a diagnosis of group A streptococcal peritonitis with necrotizing retroperitoneal fasciitis was confirmed by retroperitoneal cultures obtained at laparotomy . Although multiple organ systems showed impaired functioning, including hepatic, renal and respiratory changes, she did not meet the criteria for streptococcal toxic shock syndrome . She was treated with a combination of high-dose parenteral penicillin and clindamycin, followed by prolonged treatment with clindamycin orally . Recovery was complicated by persistent hydronephrosis, which was slow to resolve. J Clin Microbiol, 1998 May, 36(5), 1428 - 9 Simplification of a locus-specific DNA typing method (Vir typing) for Streptococcus pyogenes; Hartas J et al.; We describe a simplification of a highly discriminatory molecular typing method, called Vir typing, for Streptococcus pyogenes (D . Gardiner, J . Hartas, B . Currie, J . D . Mathews, D . J . Kemp, and K . S . Sriprakash, PCR Methods Appl . 4:288-293, 1995) . The procedure can be completed within a day, is reproducible, and can be applied directly to colonies growing on primary culture plates, allowing rapid establishment of strain identity in an outbreak. J Clin Microbiol, 1998 May, 36(5), 1388 - 91 Simultaneous detection and identification of human parainfluenza viruses 1, 2, and 3 from clinical samples by multiplex PCR; Echevarria JE et al.; Reverse transcription (RT)-PCR assays have been widely described for use in the diagnosis of human parainfluenza viruses (HPIVs) and other respiratory virus pathogens . However, these assays are mostly monospecific, requiring separate amplifications for each HPIV type . In the present work, we describe multiplex RT-PCR assays that detect and differentiate HPIV serotypes 1, 2, and 3 in a combined reaction . Specifically, a mixture of three pairs of primers to conserved regions of the hemagglutinin-neuraminidase gene of each HPIV serotype was used for primary amplification, yielding amplicons with similar sizes . For typing, a second amplification was performed with a mixture of nested primers, yielding amplicons with sizes easily differentiated by agarose gel electrophoresis . A modified single-amplification RT-PCR assay with fluorescence-labeled nested primers, followed by analysis of the labeled products on an automated sequencing gel, was also evaluated . Fifteen temporally and geographically diverse HPIV isolates from the Centers for Disease Control and Prevention archives and 26 of 30 (87%) previously positive nasopharyngeal specimens (8 of 10 positive for HPIV serotype 1 {HPIV1}, 9 of 10 positive for HPIV2, and 9 of 10 positive for HPIV3) were positive and were correctly typed by both assays . Negative results were obtained with naso- or oropharyngeal specimens and/or culture isolates of 33 unrelated respiratory tract pathogens, including HPIV4, enterovirus, rhinovirus, respiratory syncytial virus, adenovirus, influenza virus, and Streptococcus pneumoniae . Our multiplex RT-PCR assays provide sensitive, specific, and simplified tools for the rapid diagnosis of HPIV infections. Oral Microbiol Immunol, 1998 Feb, 13(1), 47 - 50 Characterization of a novel N-acetylneuraminic acid-specific Fusobacterium nucleatum PK1594 adhesin; Shaniztki B et al.; Fusobacterium nucleatum has been identified as significantly associated with sites with active periodontal disease and, as a group, the oral fusobacteria coaggregate with members of all oral bacteria genera tested . Monoclonal antibodies were prepared and used in conjunction with other potential inhibitors, such as simple sugars and amino acids, to characterize coaggregation interactions, of F . nucleatum PK1594 . Four unique monoclonal antibodies, 5H11, 14C7, 19F2 and 29C12, were obtained by their ability to inhibit coaggregation of F . nucleatum PK1594 with Actinomyces israelii PK16 . They were also capable of inhibiting other coaggregations including Streptococcus oralis H1, S . oralis J22, Capnocytophaga ochracea ATCC33596, Prevotella denticola PK1277 and Prevotella intermedia PK1511 . All of these interactions were completely inhibited by N-acetylneuraminic acid . Neither N-acetylneuraminic acid nor monoclonal antibody 5H11 had any inhibitory effect on other F . nucleatum PK1594 interactions, including all galactose-inhibitable coaggregations . The results indicate that F . nucleatum PK1594 expresses upon its surface a distinct type of adhesin that mediates coaggregation interactions that are inhibited by N-acetylneuraminic acid. Oral Microbiol Immunol, 1998 Feb, 13(1), 41 - 6 Differential activation of human neutrophils by Streptococcus mutans isolates from root surface lesions and caries-free and caries-active subjects; Moore MA et al.; Phagocytosis of bacterial pathogens is an important defense mechanism and may contribute to regulating Streptococcus mutans-induced dental caries, particularly at root surfaces . This study was undertaken to examine and compare differences in polymorphonuclear leukocyte or neutrophil activation by clinical isolates of S . mutans collected from the saliva of caries-free or caries-active individuals with S . mutans isolates from root surface lesions . S . mutans clinical isolates (5 caries-free, 5 caries-active, 5 root caries isolates and a laboratory strain) were incubated with neutrophils in the presence of normal human serum and the luminol dependent chemiluminescence was measured for 1 h at 37 degrees C . Results indicated that the caries active and laboratory strains activated neutrophils equally . The mean integration stimulated by caries-free strains, however, displayed a 25-30% enhanced neutrophil activation over the caries-active and laboratory strains . In contrast, neutrophil activation by root caries strains of S . mutans was 45-50% lower than all other S . mutans strains, possibly suggesting a natural selection for S . mutans strains that can evade neutrophil recognition and subsequent phagocytosis . Stimulation of neutrophils with the cell wall and membrane surface component preparations indicated that extracts from all four groups activated neutrophils significantly . Again, caries-free preparations activated neutrophils significantly more than caries active, laboratory strain and root caries isolates . This selection may become more important on root surfaces due to increased exposure to crevicular fluid and neutrophils . The data provide evidence for the presence or onset of mechanisms or biological alterations in S . mutans developed to circumvent neutrophil recognition and/or phagocytosis, thus increasing S . mutans survival and colonization on tooth surfaces, resulting in an enhanced risk of dental caries, particularly at root surfaces. Oral Microbiol Immunol, 1997 Dec, 12(6), 329 - 35 Nasal immunization of humans with dehydrated liposomes containing Streptococcus mutans antigen; Childers NK et al.; Five healthy female adult volunteers were intranasally immunized twice (7-day interval) with 250 micrograms of a crude glucosyltransferase (GTF) preparation from Streptococcus mutans in liposomes . Parotid saliva, nasal wash, and serum were collected prior to and at weekly intervals for 6 weeks following the first immunization for analysis of anti-GTF activity by enzyme-linked immunosorbent assay . The levels of IgA1 anti-GTF activity increased in the nasal wash from all five individuals after immunization . Increases in salivary IgA1 and IgA2 anti-GTF activities were observed to a lesser extent . Increased serum IgM and IgA (but not IgG) anti-GTF activities were seen in immunized subjects . Nasal immunization with a dehydrated liposome-protein vaccine was effective in inducing an apparent secretory IgA antibody response, which was primarily of the IgA1 subclass . These results provide the first evidence of the effective use of a nasal liposome-protein vaccine in humans. Neth J Med, 1998 Jan, 52(1), 16 - 21 Streptococcus pneumoniae, an emerging pathogen in mycotic aneurysms? Brouwer RE, van Bockel JH, van Dissel JT. Two patients are described with a mycotic aneurysm caused by streptococcus pneumoniae infection . The patients presented with back pain and fever, and had an antecedent history of lower respiratory tract infection; neither of them were suffering from endocarditis . Mycotic aneurysms are a rare disorder with, over the years, a changing spectrum of presentation, localisation and bacterial aetiology . S . pneumoniae infection has only very rarely been reported as a cause of mycotic aneurysms . Since 1986, 14 patients with a mycotic aneurysm were treated at the Leiden University Hospital . Of these patients, 5 had mycotic aneurysms caused by S . pneumoniae infection . The mortality in these patients was high . In this communication, we would like to draw attention to S . pneumoniae infections as an emerging cause of mycotic aneurysms. J Struct Biol, 1998 Jan, 121(1), 73 - 5 Crystallization and preliminary X-ray analysis of Streptococcus pneumoniae hyaluronate lyase; Jedrzejas MJ et al.; A fully active 83-kDa truncated form of recombinant hyaluronate lyase from Streptococcus pneumoniae was crystallized by the hanging drop vapor diffusion method using ammonium sulfate as a precipitating agent . Crystals grew at room temperature using a variety of buffers with pH around 6 . The crystals diffract X-rays beyond 2.0 A resolution using Cu K alpha radiation and a rotating-anode X-ray source . They belong to the orthorhombic space group P2(1)2(1)2(1) with unit cell dimensions, a = 84.2, b = 104.2, c = 104.6 A, and alpha = beta = gamma = 90.0 degrees . The VM value of 2.9 A3/Da is consistent with only one molecule of the enzyme in the asymmetric unit and the solvent content of 57% . Diffraction data 94.7% complete to 2.0 A resolution with Rsym of 5.4% were collected from one native crystal at room temperature . The search for heavy-atom derivatives to solve the structure is in progress. Int J Antimicrob Agents, 1998 Feb, 9(4), 215 - 8 Comparative in vitro activities of four new fluoroquinolones against Streptococcus pneumoniae determined by Etest; Waites K et al.; Clinafloxacin, levofloxacin, sparfloxacin and trovafloxacin were tested by Etest against 188 Streptococcus pneumoniae isolates . Clinafloxacin and trovafloxacin were 2-4-fold more potent than sparfloxacin and 8-fold more than levofloxacin . Two isolates, both serotype 6, with high-level quinolone resistance (> or = 8 micrograms/ml) were detected . The Etest is a practical means for determining S . pneumoniae susceptibilities to new fluoroquinolones. Infect Immun, 1998 May, 66(5), 2186 - 92 Structural properties of group B streptococcal type III polysaccharide conjugate vaccines that influence immunogenicity and efficacy; Wessels MR et al.; In this study, we tested the hypothesis that the immunogenicity and protective efficacy of polysaccharide-protein conjugate vaccines are influenced by three variables: (i) molecular size of the conjugate, (ii) molecular size of the polysaccharide used for conjugation, and (iii) extent of polysaccharide-to-protein cross-linking . Type III group B Streptococcus capsular polysaccharide was linked by reductive amination at multiple sites to tetanus toxoid to create a polysaccharide-protein conjugate (III-TT) . A single lot of III-TT was fractionated into small, medium, and large Mr pools . Whereas all three conferred protection in a maternal immunization-neonatal challenge model in mice, the smallest Mr conjugate evoked less polysaccharide-specific immunoglobulin G (IgG) than the two larger Mr conjugates . To test whether the molecular size of the polysaccharide used for conjugation also affected the immunogenicity of the conjugate, vaccines were synthesized using capsular polysaccharides with Mrs of 38,000, 105,000, and 349,000 . Polysaccharide-specific IgG responses in mice increased with the Mr of the polysaccharides, and protective efficacy was lower for the smallest polysaccharide conjugate compared to the other two vaccines . Immunogenicity testing of a series of vaccines prepared with different degrees of polysaccharide-to-protein cross-linking demonstrated higher polysaccharide-specific antibody responses as the extent of cross-linking increased . However, opsonic activity was greatest in mouse antiserum raised to a moderately cross-linked conjugate, suggesting that some antibodies evoked by highly cross-linked conjugates were directed to a nonprotective epitope . We conclude that conjugate size, polysaccharide size, and degree of polysaccharide-protein cross-linking influence the immunogenicity and protective efficacy of III-TT conjugate vaccines. Infect Immun, 1998 May, 66(5), 2180 - 5 Inactivation of the gbpA gene of Streptococcus mutans increases virulence and promotes in vivo accumulation of recombinations between the glucosyltransferase B and C genes; Hazlett KR et al.; Glucan-binding protein A (GbpA) of Streptococcus mutans has been hypothesized to promote sucrose-dependent adherence and the cohesiveness of plaque and therefore to contribute to caries formation . We have analyzed the adherence properties and virulence of isogenic gbpA mutants relative to those of wild-type S . mutans . Contrary to expectations, the gbpA mutant strains displayed enhanced sucrose-dependent adherence in vitro and enhanced cariogenicity in vivo . In vitro, S . mutans was grown in the presence of {3H} thymidine and sucrose within glass vials . When grown with constant rotation, significantly higher levels of gbpA mutant organisms than of wild type remained adherent to the vial walls . Postgrowth vortexing of rotated cultures significantly decreased adherence of wild-type organisms, whereas the adherence of gbpA mutant organisms was unaffected . In the gnotobiotic rat model, the gbpA mutant strain was hypercariogenic though the colonization levels were not significantly different from those of the wild type . The gbpA mutant strain became enriched in vivo with organisms that had undergone a recombination involving the gtfB and gtfC genes . The incidence of gtfBC recombinant organisms increased as a function of dietary sucrose availability and was inversely correlated with caries development . We propose that the absence of GbpA elevates the cariogenic potential of S . mutans by altering the structure of plaque . However, the hypercariogenic plaque generated by gbpA mutant organisms may be suboptimal for S . mutans, leading to the accumulation of gtfBC recombinants whose reduced glucosyltransferase activity restores a less cariogenic plaque structure. Infect Immun, 1998 May, 66(5), 2085 - 92 Identification of a homolog of CcpA catabolite repressor protein in Streptococcus mutans; Simpson CL et al.; A locus containing a gene with homology to ccpA of other bacteria has been cloned from Streptococcus mutans LT11, sequenced, and named regM . Upstream of the regM gene, on the opposite strand, is a gene encoding an X-Pro dipeptidase, pepQ . A 14-bp palindromic sequence with homology to the consensus catabolite-responsive element sequence lay in the promoter region between the two genes . To study the function of regM, the gene was inactivated by insertion of an antibiotic resistance marker . Diauxic growth of S . mutans on a number of sugars in the presence of glucose was not affected by disruption of regM . The loss of RegM increased glucose repression of alpha-galactosidase, mannitol-1-P dehydrogenase, and P-beta-galactosidase activities . These results suggest that while RegM can affect catabolite repression in S . mutans, it does not conform to the model proposed for CcpA in Bacillus subtilis. Med Hypotheses, 1998 Feb, 50(2), 135 - 7 Biological strategies expressed by different Streptococcus pyogenes strains: an explanation of the epidemiology; Osterlund A et al.; The numerous reports in the last ten years on the serious diseases caused by Streptococcus pyogenes indicate the continued significance of this pathogen . Furthermore, clinical studies and modern techniques have yielded new information on S . pyogenes and its pathogenic mechanisms . Although much still remains to be discovered about the biology of S . pyogenes, two different strategies--the 'epidemic' and the 'endemic' strategy--can be seen in the interaction of different S . pyogenes strains with the human host . The challenges posed by these two groups of bacteria are also outlined. Obstet Gynecol, 1998 May, 91(5 Pt 1), 741 - 5 Meconium: a marker for peripartum infection; Piper JM et al.; OBJECTIVE: To test the hypothesis that the presence of meconium-stained amniotic fluid (AF) is associated with maternal and neonatal infection, both before and after delivery . METHODS: Nine hundred thirty-six laboring women were analyzed for the presence of meconium in amniotic fluid and occurrence of peripartum infection . Meconium was assessed clinically as thin, moderate, or thick . Intra-amniotic infection and endometritis were diagnosed by standard definitions . All patients were tested for vaginal group B streptococcus, bacterial vaginosis, and other aerobic organisms . RESULTS: Meconium-stained AF was present in 28% of the study participants (9% thin, 12% moderate, 7% thick) . The presence of meconium was associated with increased intra-amniotic fluid (17% versus 9%, relative risk {RRI 1.98, 95% confidence interval {CI} 1.3, 3.1), endometritis (10% versus 5%, RR 2.38, 95% CI 1.3, 4.4), and total infection (25% versus 13%, RR 2.19, 95% CI 1.5, 3.2) . Thick meconium had higher infection rates than clear AF (44% versus 13%, RR 5.18, 95% CI 2.9, 9.3) . Meconium was associated independently with peripartum infection by multiple logistic regression (RR 1.28, 95% CI 1.1, 1.6) . CONCLUSION: Meconium-stained AF is associated with increased peripartum infection, independent of other risk factors for infection . Thick meconium, in particular, is associated with a marked increase in peripartum infectious morbidity. Biosci Biotechnol Biochem, 1998 Mar, 62(3), 491 - 5 Effects of synthetic hydroxy isothiocyanates on microbial systems; Tajima H et al.; Hydroxy isothiocyanates (ITCs), including some new derivatives of naturally occurring compounds, were synthesized and their minimum inhibitory, minimum fungicidal, and minimum bactericidal concentrations for Aspergillus niger, Aspergillus fumigatus, Staphylococcus aureus, and Escherichia coli were estimated . These compounds were strongly antimicrobial; for example, 2-(4-hydroxyphenyl) ethyl ITC inhibited growth of all strains examined at concentrations of 7.8 to 15.6 micrograms/ml . The ATP concentration in E . coli was markedly reduced when cells were treated with 2-(4-hydroxyphenyl)ethyl ITC . Inhibition of the growth of E . coli by 2-(4-hydroxyphenyl)ethyl ITC was decreased in the presence of cysteine . Streptolysin S production in washed cells of Streptococcus equisimilis was extremely sensitive to this ITC derivative and this inhibition also was counteracted by cysteine . The results showed that the ITC compounds had antimicrobial effects by blocking sulfhydryl groups. Anal Biochem, 1998 May 1, 258(2), 195 - 201 Synthesis of 5-azido-UDP-N-acetylhexosamine photoaffinity analogs and radiolabeled UDP-N-acetylhexosamines; Sunthankar P et al.; Nuleotide sugar photoaffinity analogs have proven to be useful in the identification and characterization of glycosyltransferases . A radioenzymatic synthesis of {32P}5-azido-UDP-N-acetylglucosamine has been accomplished using 5-azido-UTP, {gamma-32P}ATP, porcine N-acetylgalactosamine kinase, and Escherichia coli UDP-N-acetylglucosamine pyrophosphorylase, GlmU . This general enzymatic scheme was useful for the synthesis of {32P}5-azido-UDP-N-acetylgalactosamine and high-specific-activity {3H} or {32P}UDP-N-acetylhexosamines . A new chemical synthesis method for generating 5-azido-uridine compounds was also developed . {32P}5-Azido-UDP-N-acetylglucosamine was functionally characterized using different soluble and membrane-associated glycosyltransferases which utilize UDP-GlcNAc as a substrate . Site-specific photoincorporation was observed for partially purified GlmU and porcine UDP-GlcNAc pyrophosphorylase . The photoprobe also effectively photoincorporated into the alpha- and beta-subunits of purified bovine UDP-N-acetylglucosamine:lysosomal enzyme N-acetylglucosamine-1-phosphotransferase . Lastly, the photoprobe was also effective at photolabeling Streptococcus pyogenes hyaluronate synthase in membrane preparations. FEMS Microbiol Lett, 1998 Apr 15, 161(2), 331 - 6 Molecular analyses of glucosyltransferase genes among strains of Streptococcus mutans; Fujiwara T et al.; Three glucosyltransferase (GTase) genes (gtfB, gtfC and gtfD) were cloned and sequenced from clinically isolated strains of Streptococcus mutans MT8148 (serotype c), MT4239 (c), MT4245 (e), MT4467 (e) and MT4251 (f), respectively . Comparison of the gtf genes revealed that interstrain difference of gtfB and gtfD was limited, while gtfC showed significant interstrain variations . Similar to gtfB and gtfD, gtfC possessed five direct repeats composed of homologous unit in the carboxyl-terminal portion . The repeating unit consisted of 63-65 amino acid residues and is responsible for glucan binding . The gtfC gene from S . mutans MT4245 lacked the fourth unit . Multiple alignment with the gtf sequence of strain GS-5 (c) revealed several changes in these gtf genes due to frameshift mutations . The peptides encoded by the gtfB, gtfC and gtfD genes of GS-5 were 1, 80, and 32 amino acid residues shorter than those of the test strains except strain MT4245. FEMS Microbiol Lett, 1998 Apr 15, 161(2), 217 - 24 Molecular cloning, expression, and characterization of dnaK in Streptococcus pneumoniae; Kim SW et al.; DnaK is known to be highly conserved in all species and is a major immunogen in Streptococcus pneumoniae . To elucidate the role of dnaK in S . pneumoniae, dnaK was cloned in Escherichia coli using a homologous dnaK probe generated by PCR . The His-tagged DnaK was overexpressed in soluble form and purified from E . coli . Alignment of the deduced DnaK amino acid sequence from nucleotide sequences of the cloned dnaK revealed high homology with DnaK analogs in E . coli (53%) and Staphylococcus aureus (73%) . However, anti-pneumococcal DnaK antiserum did not crossreact with DnaK analogs in E . coli, S . aureus and human cells suggesting that pneumococcal DnaK might be a good candidate as a vaccine. J Marmara Univ Dent Fac, 1996 Sep, 2(2-3), 491 - 9 The relation of microbiologic data to aspartate aminotransferase enzyme activity in gingival crevicular fluid; Kuru B et al.; Gingival crevicular fluid (GCF), reflects the immune and inflammatory reactions and is itself a location for specific host-microbe interactions that lead to periodontal diseases . Aspartate aminotransferase (AST) is one of the components of GCF that is released as a result of cell death . In this study, 40 periodontal sites in 10 early onset periodontitis patients before and after nonsurgical periodontal therapy, with and without local metronidazole administration, were first examined for the AST enzyme levels in GCF and then evaluated for microbiological and clinical variables . In each patient, 4 sites (one site/quadrant) with a probing depth of > or = 5 mm were selected and treated with separate treatment protocols . Certain microbial species including Prevotella intermedia, Porphyromonas gingivalis, and Actinobacillus actinomycetemcomitans(A . a.) were found more often and/or in higher levels in AST active sites (36/40 first measurement--9/36 second measurement), while other species (Streptococcus and Actinomyces) were found more often and/or in higher levels in AST inactive sites (4/40 first measurement--8/36 second measurement) . Eight post-treatment AST active sites revealed 1.5 mm of attachment loss, whereas 8 post-treatment AST inactive sites showed 1.37 mm of attachment gain . AST activity and microbiological-clinical data presenting such an agreement suggests that, AST level assessment would be beneficial as an adjunctive method alongside other clinical criteria, in guiding the clinician in periodontal treatment. J Marmara Univ Dent Fac, 1997 Sep, 2(4), 605 - 8 Effect of Cervitec varnish on the salivary Streptococcus mutans levels in the patients with fixed orthodontic appliances; Eronat C et al.; The aim of the present study was to assess the efficiency of a 1% chlorhexidine-containing varnish (Cervitec, Vivadent, Liechtenstein) on the levels of Streptococcus mutans in saliva of patients with fixed orthodontic appliances using the Dentocult-SM (Vivadent, Liechtenstein) technique for the microbiological investigation . Eighty subjects participated in the study and, divided randomly into two equal groups in which one group was treated with the placebo varnish (Vivadent, Liechtenstein) for negative controls . Streptococcus mutans in saliva of the subject was sampled and enumerated by using the Dentocult-SM dip-slide technique for periods of one, two four and twelve weeks after a single varnish application . The results were evaluated statistically . After the chlorhexidine containing varnish treatment the levels of Streptococcus mutans in saliva were significantly reduced after one week (p < 0.01) and continued reduction for one month (p < 0.05) . After twelve weeks Streptococcus mutans levels in saliva were given a relative increase . No significant suppression was found in the placebo group (p > 0.05) . The results suggested that Cervitec varnish reduces salivary Streptococcus mutans levels and that the application should be repeated every 3 months to get antibacterial effect. Lett Appl Microbiol, 1998 Mar, 26(3), 215 - 8 Inhibition effect of enterocin CCM 4231 in the rumen fluid environment; Laukova A et al.; Enterocin CCM 4231 is a bacteriocin with a broad antimicrobial spectrum produced by the ruminal strain Enterococcus faecium CCM 4231 . Its inhibitory effect towards enterococci, Ent . faecium EF 26/42, staphylococci, Streptococcus bovis AO 24/85 and Escherichia coli, as well as towards Listeria monocytogenes OHIO strain, in the rumen fluid environment was studied during culture at 37 and 30 degrees C for 24 h and 20 days . Enterocin CCM 4231 was added to the samples at a concentration of 3200 AU ml-1 . The best inhibitory effect was noted against enterococci at both cultivation temperatures . A decrease in total cell count from 10(8) cfu ml-1/or 10(4) cfu ml-1 and from 10(5) cfu ml-1 to 10(1) cfu ml-1 was detected . Addition of enterocin to the rumen fluid also inhibited staphylococci (from 10(5) cfu ml-1 to 10(4) cfu ml-1 and/or 10(3) cfu ml-1) . Gram-negative E . coli cells were inhibited at both cultivation temperatures (decrease from 10(6) cfu ml-1 to 10(1) cfu ml-1 at 37 degrees C, and from 10(7) cfu ml-1 to 10(5) cfu ml-1 at 30 degrees C) . Enterococcus faecium EF 26/42 and Streptococcus bovis AO 24/85, the strains growing in the rumen fluid, were the most sensitive to the addition of enterocin during the first 24 h of fermentation (decrease from 10(10) cfu ml-1 and 10(8) cfu ml-1 to 10(6) cfu ml-1 and 10(4) cfu ml-1) . An antilisterial effect of the bacteriocin was also confirmed . Further application of bacteriocin in ruminal ecology was indicated. Folia Microbiol (Praha), 1998, 43(1), 35 - 8 Lack of surface receptors not restriction-modification system determines F4 phage resistance in Streptococcus bovis II/1; Styriak I et al.; The resistance of Streptococcus bovis strain II/1, the producer of SbvI restriction endonuclease, to F4 phage infection was demonstrated by the double-agar-layer method . Despite the presence of restriction endonuclease SbvI which can cleave F4 phage DNA to numerous fragments in vitro, the evidence that adsorption inhibition is the most important defence mechanism in phage resistance of S . bovis II/1 strain was obtained by adhesion experiments in vivo . Electron microscopy of phage-host mixtures showed many phage particles on the bacterial surface of phage-sensitive S . bovis 47/3 control strain in comparison with no phage particles seen on S . bovis II/1 (phage-resistant) strain surface. J Paediatr Child Health, 1998 Feb, 34(1), 74 - 8 The use of lumbar puncture and laboratory tests for sepsis by Australian neonatologists; Joshi P et al.; OBJECTIVE: To ascertain the current use of lumbar puncture (LP) and laboratory tests for possible or suspected sepsis by Australian neonatologists . METHODS: A self administered anonymous response questionnaire . RESULTS: Sixty-nine (73%) of 94 neonatologists responded . None performed LP routinely in preterm infants with respiratory distress syndrome (RDS) or asymptomatic term infants with maternal Group B streptococcus (GBS) colonisation . One (1.6%) performed LP in term infants with respiratory distress, and only 35 (51%) performed LP in preterm infants with suspected late-onset sepsis (LOS) . Twenty-one percent did not perform LP on all preterm infants with RDS and septicaemia and 24% did not perform LP on all preterm infants with late-onset septicaemia . Sixty-six percent and 85% did not perform LP for laboratory evidence suggestive of sepsis in preterm infants with RDS and preterm infants with LOS, respectively . Forty-nine percent investigated asymptomatic term infants with maternal GBS colonisation . CONCLUSIONS: Lumbar puncture and laboratory tests for possible or suspected sepsis are not used uniformly by Australian neonatologists . The presently available information in the scientific literature is ambiguous and systematic review and further scientific study are required to determine best practice guidelines. Int J Immunopharmacol, 1997 Jul, 19(7), 405 - 12 Evidence that eosinophil infiltration in the OK-432/fibrinogen-injected Meth-A tumor in mice is mediated by locally produced IL-5; Ishiko T et al.; It was previously demonstrated that a single injection of OK-432 (a penicillin-treated freeze-dried Streptococcus) mixed with fibrinogen into cancer tissues induces marked infiltration by eosinophils of the tumor stroma and leads to tumor necrosis . In the present study, we examined mechanisms regulating the local accumulation of eosinophils and the role of infiltrating eosinophils in tumor regression using the OK-432/fibrinogen injected Meth-A fibrosarcoma tumor . After injection of OK-432/fibrinogen into the tumor on the left flank of the BALB/c mice, eosinophil infiltration became obvious in the tumor stroma on day 3 following the accumulation of macrophages and neutrophils, was massive on day 5 and decreased by day 10 . After the decrease in the infiltration of eosinophils, the tumor injected with OK-432/fibrinogen diminished markedly in size with ulceration as compared with control . Northern blot analysis revealed that expression of IL-5 mRNA in the tumor tissue was not detected on day 0, was significantly on day 3, reached the maximum on day 5, and thereafter decreased by day 10 . Although intraperitoneal injection of rat anti-IL-5 monoclonal antibody in tumor bearing mice prior to OK-432 injection inhibited the infiltration of eosinophils, the antitumor effects of OK-432 persisted . In the blood, neither eosinophilia nor IL-5 activity was recognized during the course of the experiment . These results suggest that intratumoral injection of OK-432/fibrinogen induces local production of IL-5, which in turn recruits eosinophils into the tumor tissue, however, the infiltrating eosinophils do not play an important role in tumor regression. Minerva Stomatol, 1997 Dec, 46(12), 693 - 9 {Rokitamycin in odontostomatology . Controlled study of doses}; Fornaseri C et al.; BACKGROUND: Rokitamycin is a semisynthetic macrolide with a lactonic ring with 16 atoms, showing anti-bacterial action at concentrations near to MIC . A controlled clinical study is carried out, in parallel groups, whose aim was to assess the therapeutic action and safety of two dosage schemes of rokitamycin, in the short term treatment (5 days) of acute infective processes of odontostomatological origin . METHODS: Twenty patients (14 males, 6 females) were recruited for the trial, suffering from alveolitis, abscess, phlegmon, sialadenitis and suppurating cysts . The patients were divided in a randomized fashion into two groups: 10 patients were treated orally with 800 mg/day and 10 with 1200 mg/day . Rokitamycin was supplied in 400 mg tablets . RESULTS: The 5 days of treatment with rokitamycin determined the complete resolution of the infective process, with eradication of the germs originally isolated, all belonging to the Streptococcus genus . Clinical efficacy was evident by the third day of treatment, with a prompt improvement of symptoms (functional limitation, pain, tumefaction) and the return of body temperature to within normal limits, in a totally superimposable fashion between the two groups . Safety was excellent with both doses, with no side effects observed . CONCLUSIONS: The results of the study show that treatment with rokitamycin in the short term, at the usual dosage of 800 mg/day, is a valid therapeutic scheme in infective processes in odontostomatology. Indian J Public Health, 1997 Jan-Mar, 41(1), 6 - 10, 32 Epidemiology of group-A streptococcal infection amongst children of different ethnic groups in Darjeeling; Chakrabarti AK et al.; The carrier rate of Group A Streptococcus (GAS) was studied amongst 932 children from 1+ upto 12 years of age in three major racial groups in the foothills of the Darjeeling district of West Bengal . It was altogether 13 per cent and was found to be evenly distributed in the three ethnic groups as Gurkhas: 11 per cent, Rajbanshis: 15 per cent and Cosmopolitans: 13 per cent, but the incidence of Rheumatic fever and/or Rheumatic heart diseases were unnoticed among the Gurkha children who also had significant low ASO titres. Med Clin (Barc), 1998 Mar 7, 110(8), 290 - 4 {Site of care provision, etiology and treatment of community-acquired pneumonia in Palma de Mallorca}; Santos de Unamuno C et al.; BACKGROUND: It is not common that community-acquired pneumonias studies include patients non treated in hospital . The objectives were: to determine the cases managed in the ambulatory setting; to describe the clinical features; to identify the aetiological agents, and to describe the treatment, comparing inpatients with outpatients . PATIENTS AND METHODS: Observational prospective study . Population attended at three teaching primary care centers of Palma de Mallorca (60,450 habitants) . Patients (> 14 years) were investigated when diagnosticated of community-acquired pneumoniae, from November 1992 to December 1994 . Exclussions: HIV infection, patients living in a nursing home and tuberculosis . Data were collected in both Hospital and primary health care centers . Epidemiological, clinical, radiological and laboratory findings were recorded at the initial visit and 21 days after . RESULTS: 91 cases were investigated . 57% were managed at the primary care centers exclusively, 63.3% of the patients who went initially to the hospital were admitted in; but only 10.9% of those who went initially to the primary care centers (p < 0.005) . 24 patients were hospitalized . 56 microbiological agents were identified in 48 patients (52.7%): Mycoplasma pneumoniae (10); Streptococcus pneumoniae (9); Influenza B (8); Chlamydia psittacci (7); Influenza A (7); Coxiella burnetii (5); Chlamydia pneumoniae (4); Legionella (3); Adenovirus (2); and Parainfluenza 3 (1) . Mycoplasma was predominant in outpatients: 9 cases . S . pneumoniae in inpatients: 5 cases . Eritromycin was the most common treatment prescribed (76.9% of patients), alone or in combination with other antibiotics . Monotherapy was most common at primary care yield (96.7%) than at the hospital (45.2%) (p < 0.005) . CONCLUSIONS: Most of the patients with community-acquired pneumonias are managed at primary health care centers . M . pneumoniae is the predominant microbiological agent in outpatients and S . pneumoniae in inpatients . Erithromycin is the most used antibiotic in both groups of patients. Med Decis Making, 1998 Apr-Jun, 18(2), 220 - 8 Effect of an explicit decision-support tool on decisions to prescribe antibiotics for sore throat; McIsaac WJ et al.; Studies of scoring rules for sore throat have failed to show that they lower antibiotic prescription rates . The authors studied the effect of an explicit decision-support tool, incorporating a modified score, on antibiotic-prescription decisions . Four hundred and fifty family physicians received an information package, a score card, and a recording form to use during one sore-throat encounter . The physicians randomly received either a control form or an intervention form that required them to interact with the score during the clinical recording process . There was a trend towards a reduction in antibiotic prescriptions (21%, p=0.09) in the physicians using the intervention form . A greater reduction (45%, p=0.06) was observed for patients whose probabilities of infection with group A streptococcus were low . Sore-throat-scoring rules may reduce unnecessary antibiotic prescriptions if physicians are specifically cued to use them during clinical encounters and appropriate management responses are linked to score estimates for the likelihood of group A streptococcus infection. Bull Tokyo Dent Coll, 1997 Nov, 38(4), 297 - 302 Bactericidal effects of mouth rinses on oral bacteria; Kasuga Y et al.; The bactericidal efficacy of two types of Listerine; Listerine and Cool Mint Listerine, and povidone iodine on oral microorganisms, methicillin-resistant Staphylococcus aureus (MRSA), Streptococcus pyogenes, Helicobacter pylori and Candida albicans were examined . Most of the oral bacteria were killed completely by a 10-sec exposure to Listerine or Cool Mint Listerine . H . pylori, MRSA and C . albicans were also reduced by a 30-sec exposure to the Listerine mouth rinse . Bacteria in dental plaque were decreased by exposure to Listerine, Cool Mint Listerine, and povidone iodine for 30 seconds . Mouthwashing with Listerine for 30 seconds resulted in a decrease to approximately 1/100 of the viable bacterial counts in saliva . These bactericidal effects against bacteria in saliva and dental plaque indicated that Listerine and Cool Mint Listerine antiseptic are useful in oral cavity as antiseptic mouth rinses. J Dairy Sci, 1998 Mar, 81(3), 703 - 17 Design and validation of a dynamic discrete event stochastic simulation model of mastitis control in dairy herds; Allore HG et al.; A dynamic stochastic simulation model for discrete events, SIMMAST, was developed to simulate the effect of mastitis on the composition of the bulk tank milk of dairy herds . Intramammary infections caused by Streptococcus agalactiae, Streptococcus spp . other than Strep . agalactiae, Staphylococcus aureus, and coagulase-negative staphylococci were modeled as were the milk, fat, and protein test day solutions for individual cows, which accounted for the fixed effects of days in milk, age at calving, season of calving, somatic cell count (SCC), and random effects of test day, cow yield differences from herdmates, and autocorrelated errors . Probabilities for the transitions among various states of udder health (uninfected or subclinically or clinically infected) were calculated to account for exposure, heifer infection, spontaneous recovery, lactation cure, infection or cure during the dry period, month of lactation, parity, within-herd yields, and the number of quarters with clinical intramammary infection in the previous and current lactations . The stochastic simulation model was constructed using estimates from the literature and also using data from 164 herds enrolled with Quality Milk Promotion Services that each had bulk tank SCC between 500,000 and 750,000/ml . Model parameters and outputs were validated against a separate data file of 69 herds from the Northeast Dairy Herd Improvement Association, each with a bulk tank SCC that was > or = 500,000/ml . Sensitivity analysis was performed on all input parameters for control herds . Using the validated stochastic simulation model, the control herds had a stable time average bulk tank SCC between 500,000 and 750,000/ml. J Dairy Sci, 1998 Mar, 81(3), 678 - 86 Invasion and persistence of Streptococcus dysgalactiae within bovine mammary epithelial cells; Calvinho LF et al.; Little is known about bacterial and host factors that contribute to the establishment and persistence of intramammary infection by Streptococcus dysgalactiae . Streptococcus dysgalactiae adheres to epithelial cells from the bovine mammary gland and to extracellular matrix proteins in vitro and invades mammary epithelial cell cultures, all of which can be potentially important pathogenic mechanisms . In this study, mechanisms involved in the invasion of Strep . dysgalactiae into epithelial cells from the bovine mammary gland were characterized . Studies were conducted to determine whether Strep . dysgalactiae invaded mammary epithelial cell cultures in a dose-dependent manner and whether mammary epithelial cells that harbored different numbers of Strep . dysgalactiae for varying times were damaged . Bacterial invasion increased as inoculum size increased; however, the number of intracellular bacteria was not proportional to the inoculum size, increased; however, the number of intracellular bacteria was not proportional to the inoculum size, indicating that a finite number of organisms is capable of invading epithelial cells . No net increase in intracellular organisms was detected at any bacterial density evaluated; however, Strep . dysgalactiae remained viable throughout the evaluation . In addition, Strep . dysgalactiae did not appear to cause cell injury at any bacterial density or time point evaluated . These data suggest that Strep . dysgalactiae can survive within mammary epithelial cells for an extended time without losing viability or damaging the eukaryotic cell . This feature may be associated with the development of persistent infection and protection of organisms from antimicrobial drugs and host defense mechanisms and may provide a route for bacterial colonization of subepithelial tissues. Pediatr Surg Int, 1998 Mar, 13(2-3), 100 - 3 Septic complications after splenectomy for sickle cell sequestration crisis; Sorrells DL et al.; Patients with sickle cell disease (SCD) are predisposed to infections . There is a paucity of recent information on the incidence of post-splenectomy infectious complications in these patients . The purpose of this study was to determine whether splenectomy increases infectious complications in SCD . Twenty-nine patients with SCD had splenectomy for sequestration crises at our hospital between 1988 and 1992; 16 of them received all of their follow-up care at our institution . These 16 charts were reviewed for infectious-related admissions, hospital days, days of i.v . antibiotics, positive cultures, and episodes of sepsis . For each patient, these parameters in the pre- and postoperative period were compared and expressed as number per year . The mean age at time of splenectomy was 2.5 +/- 0.4 years and the mean follow-up was 4.5 +/- 0.4 years . There was no significant difference in the pre- and postoperative periods for admissions, hospital days, days of i.v . antibiotics, positive cultures, or episodes of sepsis per year . There were also no operative deaths . The incidence of pre-splenectomy sepsis was 0.04 +/- 0.03 episodes per year compared to 0.09 +/- 0.04 (P = ns) episodes/year after splenectomy . Sepsis occurred at an average of 20.8 (range 2-30) months postoperatively; Streptococcus pneumoniae was the most common causative organism . The total mortality after splenectomy in SCD patients was 3.4% (1/29) over a nearly 5-year period . Although infections are common in children with SCD, there was no increase in infections or episodes of sepsis in SCD patients who underwent splenectomy. J Neurol Sci, 1998 Feb 18, 155(1), 13 - 22 Glial cells production of inflammatory mediators induced by Streptococcus pneumoniae: inhibition by pentoxifylline, low-molecular-weight heparin and dexamethasone; Schwartz D et al.; Exposure of primary rat glial cells to heat inactivated Streptococcus pneumoniae, induced dose-dependent production of tumor necrosis factor alpha (TNF alpha), nitric oxide (NO) and prostaglandin E2 (PGE2) . Concomitant addition of the bacterium and the synthetic glucocorticoid dexamethasone resulted in complete suppression of TNF alpha, NO and PGE2 production . Pentoxifylline, a phosphodiesterase inhibitor completely blocked TNF alpha secretion, whereas NO and PGE2 were not affected . Low-molecular-weight heparin enoxaparin caused 25-64% inhibition in TNF alpha production, up to 30% inhibition of NO secretion and a 10% reduction in PGE2 . Thus, Streptococcus pneumoniae, the pathogen most commonly associated with meningitis in the Western world can be added to the list of agents causing direct stimulation of glial cells . Pentoxifylline and enoxaparin in addition to dexamethasone may limit the central nervous system local inflammatory responses and could improve the effort towards reducing the dismal outcome of patients with pneumococcal meningitis. Diagn Microbiol Infect Dis, 1998 Feb, 30(2), 89 - 92 In vitro activity of LY333328 against vancomycin-resistant enterococci, methicillin-resistant Staphylococcus aureus, and penicillin-resistant Streptococcus pneumoniae; Patel R et al.; We report the activity of LY333328 against 35 clinical isolates of vancomycin-resistant enterococci (including organisms carrying the vanA, vanB, vanC-1, and vanC-2/3 genes, as determined by PCR), 33 clinical isolates of methicillin-resistant S . aureus, and 29 clinical isolates of high-level penicillin-resistant S . pneumoniae . All isolates of vancomycin-resistant enterococci were inhibited by 2 micrograms/mL LY333328, and 8 micrograms/mL LY333328 was bactericidal against all isolates tested . All isolates of methicillin-resistant S . aureus were inhibited by 1 microgram/mL LY333328, and 4 micrograms/mL LY333328 was bactericidal against all methicillin-resistant S . aureus isolates tested . All isolates of penicillin-resistant S . pneumoniae were inhibited by < 0.125 microgram/mL LY333328, and 0.25 microgram/mL LY333328 was bactericidal against all S . pneumoniae isolates tested . LY333328 is a promising new glycopeptide antimicrobial agent. Chemotherapy, 1998 Mar-Apr, 44(2), 94 - 8 In vitro interaction between ofloxacin and cefotaxime against gram-positive and gram-negative bacteria involved in serious infections; Gimeno C et al.; The checkerboard method was used to determine the antimicrobial activity of the combination cefotaxime/ofloxacin against 217 bacterial isolates involved in serious infections . Synergy or partial synergy was observed against 19 of 34 (55.8%) Staphylococcus aureus methicillin-susceptible isolates, 4 of 47 (8.4%) Streptococcus pneumoniae isolates, 28 of 34 (82.2%) Escherichia coli isolates and 70 of 102 (68.5%) Pseudomonas aeruginosa isolates . Antagonism was not observed with any of the isolates examined. Eur J Immunol, 1998 Mar, 28(3), 1069 - 77 Fibronectin-binding protein I of Streptococcus pyogenes is a promising adjuvant for antigens delivered by mucosal route; Medina E et al.; A common problem in human vaccinology is the limited availability of efficient and non-toxic adjuvants capable of promoting mucosal responses . The potential usefulness of fibronectin-binding protein I (Sfbl) of Streptococcus pyogenes as immunological adjuvant was assessed using ovalbumin (OVA) as a model antigen . Mice were immunized by intranasal route, either with soluble OVA or OVA covalently coupled to Sfbl . Immunization with OVA-Sfbl resulted in the elicitation of about 100-fold higher titers of anti-OVA serum IgG than using OVA alone . The anti-OVA IgG subclass pattern was dominated in both groups of mice by IgG1, followed by IgG2b, IgG2a, and IgG3 . Immunization with OVA-Sfbl also resulted in the elicitation of OVA-specific IgA in lung washes (24% of the total IgA), which was absent in mice immunized with OVA alone . Spleen cells from OVA-Sfbl-immunized mice also gave a much stronger proliferative response to restimulation with soluble OVA in vitro . Phenotypic analysis of proliferating cells showed an enrichment in CD4+ T cells, producing a pattern of cytokines (IL-4, IL-5, IL-6 and IL-10) characteristic of Th2-type cells . In contrast to immunization with soluble OVA alone, OVA-Sfbl induced the generation of CD8+ OVA-specific cytotoxic cells . These results demonstrate that Sfbl represents a promising mucosal adjuvant able to substantially improve cellular, humoral and mucosal responses when coupled to an antigen administered by intranasal route. Am J Surg, 1998 Mar, 175(3), 213 - 7 Limb salvage for streptococcal gangrene of the extremity; Schurr M et al.; BACKGROUND: Extremity soft tissue infections from group A, beta-hemolytic streptococcus frequently culminate in amputation . This study compares our protocol for limb salvage with expected results . METHODS: Patients with extremity streptococcal gangrene treated from 1989 to 1995 were reviewed . The management protocol mandated immediate, radical excision of involved skin and subcutaneous tissue, with preservation of fascia . Patients were managed in the burn unit, and wounds were covered with split-thickness skin grafts . Amputation rate and mortality were measured . RESULTS: Fourteen cases of extremity streptococcal gangrene were identified . Delay to surgical referral was 5 days . Eleven (79%) patients were septic . Ten (71%) were managed with a single debridement before grafting . Limb salvage was 93% (13 of 14) . One patient (7%) died on day 150 from acute myelogenous leukemia . CONCLUSIONS: Delay in referral of extremity streptococcal gangrene is common, contributing to a high incidence of sepsis . Our management protocol of a single, radical debridement with preservation of fascia maximizes limb salvage and survival. Antimicrob Agents Chemother, 1998 Apr, 42(4), 945 - 6 Antipneumococcal activities of a ketolide (HMR 3647), a streptogramin (quinupristin-dalfopristin), a macrolide (erythromycin), and a lincosamide (clindamycin); Barry AL et al.; Four different compounds belonging to the macrolide-lincosamide-streptogramin B (MLSb) class of antimicrobial agents were tested against 611 Streptococcus pneumoniae strains . The ketolide (HMR 3647, previously RU66647) and the streptogramin (quinupristin-dalfopristin) were both active against pneumococci with high-level MLSb resistance (clindamycin-resistant strains) as well as those with low-level macrolide resistance (clindamycin-susceptible strains). Antimicrob Agents Chemother, 1998 Apr, 42(4), 942 - 4 Comparative in vitro killing activities of meropenem, imipenem, ceftriaxone, and ceftriaxone plus vancomycin at clinically achievable cerebrospinal fluid concentrations against penicillin-resistant Streptococcus pneumoniae isolates from children with meningitis; Fitoussi F et al.; The activities of meropenem, imipenem, ceftriaxone, and vancomycin were evaluated against 80 penicillin-susceptible and -resistant Streptococcus pneumoniae strains . Meropenem, imipenem, ceftriaxone, and vancomycin MICs at which 90% of the isolates are inhibited were 0.5, 0.25, 1, and 0.25 microg/ml, respectively . Against penicillin-resistant strains, the best killing activity at cerebrospinal fluid concentrations was obtained with imipenem and ceftriaxone-vancomycin . However, while the killing activity of imipenem was significantly greater than that of meropenem, no significant difference was observed between the activities of meropenem and ceftriaxone-vancomycin. Antimicrob Agents Chemother, 1998 Apr, 42(4), 862 - 7 Efficacy of trovafloxacin against penicillin-susceptible and multiresistant strains of Streptococcus pneumoniae in a mouse pneumonia model; Bedos JP et al.; The increasing emergence of penicillin-resistant and multidrug-resistant strains of Streptococcus pneumoniae will create a serious therapeutic problem in coming years . Trovafloxacin is a novel naphthyridone quinolone with promising activity against S . pneumoniae, including penicillin-resistant strains (MIC for 90% of the isolates tested, 0.25 microg/ml) . We compared its in vivo efficacy with that of other fluoroquinolones (ciprofloxacin, temafloxacin, and sparfloxacin) and a reference beta-lactam (amoxicillin) in a model of acute experimental pneumonia . Immunocompetent Swiss mice were infected by peroral tracheal delivery of a virulent, penicillin-susceptible strain (MIC, 0.03 microg/ml); leukopenic Swiss mice were infected with three poorly virulent, penicillin-resistant strains (MICs, 4 to 8 microg/ml) and a ciprofloxacin-resistant strain (MIC, 32 microg/ml) . Treatments were started 6 h (immunocompetent mice) or 3 h (leukopenic mice) after infection . Doses ranging from 12.5 to 300 mg/kg were given at 12- or 8-h intervals for 3 days . Trovafloxacin (25 mg/kg) was the most effective agent in vivo against penicillin-susceptible and -resistant strains . Corresponding survival rates were 2- to 4-fold higher than with 50-mg/kg sparfloxacin or temafloxacin and 8- to 16-fold higher than with 100-mg/kg ciprofloxacin . The ratios of the area under the concentration-time curve to the MIC in serum and lung tissue were more favorable with trovafloxacin than with the other quinolones