Lett Appl Microbiol, 2004, 38(5), 423 - 7 Modifications of hydrophobicity, in vitro adherence and cellular aggregation of Streptococcus mutans by Helichrysum italicum extract; Nostro A et al.; AIMS: The purpose of the present study was to examine whether sublethal concentrations of Helichrysum italicum extract could affect some of the cariogenic properties of Streptococcus mutans . METHODS AND RESULTS: We studied the antibacterial activity of H . italicum (ethanolic extract) against oral streptococci (Strep . mutans ATCC 35668, Strep . salivarius ATCC 13419 and Strep . sanguis ATCC 10556) and its influence on cell-surface hydrophobicity, in vitro sucrose-dependent adherence to glass surface and cellular aggregation of Strep . mutans . The results indicate that all streptococci were susceptible to ethanolic extract with minimum inhibitory concentration (MIC) values of 31.25-62.50 microg x ml(-1) . Sub-MIC concentrations of H . italicum (7.81-31.25 microg x ml(-1)) reduced the hydrophobicity and the adherence (almost 90%) to glass surface of Strep . mutans . The aggregation in the presence of dextran T2000 was also affected . CONCLUSION: The inhibitory activity of H . italicum extract on Strep . mutans is worthy of further study . SIGNIFICANCE AND IMPACT OF THE STUDY: There is considerable interest in the use of natural compounds as alternative methods to control undesirable micro-organisms. Clin Microbiol Infect, 2004 Apr, 10(4), 302 - 8 Causative organisms of infective endocarditis according to host status; Barrau K et al.; A prospective study of infective endocarditis (IE) was conducted between 1994 and 2000 in Marseilles, France, and included 170 definite cases diagnosed with the use of modified Duke criteria . Classification of IE based on the aetiological agent was related to epidemiological characteristics, including age, gender and the nature of the injured valve . Enterococci and Streptococcus bovis were identified more frequently in older subjects (p 0.02), and S . bovis was also associated with mitral valve infection (p 0.03) . Streptococcus spp . were found to be associated with native valves (p < 10(-3)), whereas coagulase-negative staphylococci and Coxiella burnetii were associated with intracardiac prosthetic material (p < 0.05) . S . bovis and Staphylococcus aureus were the predominant species associated with presumably healthy valves (p < 0.05), whereas oral streptococci caused IE exclusively in patients with previous valve damage . The basic host status of IE patients has been linked to specific microorganisms, and this may be of value when empirical treatment is needed in patients who have received previous antibiotic therapy and whose blood cultures are negative. Curr Microbiol, 2004 Feb, 48(2), 85 - 7 Oral streptococci exhibit diverse susceptibility to human beta-defensin-2: antimicrobial effects of hBD-2 on oral streptococci; Nishimura E et al.; We examined the antimicrobial effects of human beta-defensin-2 (hBD-2) on 17 species of oral streptococci to investigate the involvement of antimicrobial peptide activity in oral microflora development and the clinical use of the antimicrobial peptide for oral microflora control . Oral streptococci exhibit diverse levels of susceptibility to human beta-defensin-2 (hBD-2) . Two major cariogenic bacterial species, Streptococcus mutans ( S . mutans) and S . sobrinus, were found to be susceptible to the peptide, indicating that it is a potential therapeutic agent for preventing dental caries . S . mitis exhibited the lowest susceptibility to the peptide . S . mitis is a major indigenous bacterium in the oral microflora, and our results suggest that it might possess a certain resistance mechanism against hBD-2. Immunology, 2004 Apr, 111(4), 444 - 52 The interaction of streptococcal inhibitor of complement (SIC) and its proteolytic fragments with the human beta defensins; Fernie-King BA et al.; Streptococcal inhibitor of complement (SIC) is a 31 kDa extracellular protein produced by a few highly virulent strains of Streptococcus pyogenes (in particular the M1 strain) . It has been shown additionally to inhibit four further components of the mucosal innate response-lysozyme, secretory leucocyte proteinase inhibitor, human alpha-defensin 1 and the cathelicidin LL-37 which are all bactericidal against Group A Streptococci (GAS) . We now show that SIC also inhibits variably the antibacterial action of hBD-1, -2 and -3 . By enzyme-linked immunosorbent assay (ELISA), SIC binds strongly to hBD-2 and hBD-3, but not at all to hBD-1 . Investigation of the antimicrobial action of beta-defensins hBD-1, -2 and -3 against GAS in two different buffer systems shows that both the killing efficiencies of all three defensins, and the binding of SIC to them, occurs more efficiently in 10 mm Tris buffer than in 10 mm phosphate . The lower ionic strength of the Tris buffer may underlie this effect . hBD-1 kills the M1 strain of GAS only in 10 mm Tris, but is able to kill an M6 (SIC negative) strain in 10 mm phosphate . The inhibition of hBD-3 by SIC is clearly of physiological relevance, that of hBD-2 is likely to be so, but the inhibition of hBD-1 occurs only at lower ionic strength than is likely to be encountered in vivo . Elastase digestion of SIC yields three major fragments of MW 3.843 kDa comprising residues 1-33 (fragment A); 10.369 kDa comprising residues 34-126 (fragment B); and MW 16.487 kDa, comprising residues 127-273 (fragment C) . By ELISA, only fragment B binds to hBD-2 and hBD-3 and this may indicate the inhibitory portion of the SIC molecule. Bangladesh Med Res Counc Bull, 2003 Dec, 29(3), 113 - 7 Identification of serogroups of beta hemolytic streptococci in children with tonsillo-pharyngitis; Ahmed J et al.; Rheumatic fever and post streptococcal glomerulonephritis are common sequelae of beta hemolytic streptococci among Bangladeshi children . The occurrence of these serious complications of beta hemolytic streptococcal throat infections are related to the epidemiology of group A beta hemolytic streptococci . Little is known about the epidemiology of beta hemolytic streptococci in Bangladesh . We have studied 6890 school boys and girls of Narayangonj to find out the prevalence of beta hemolytic streptococcal infections of throat . From them we selected 2175 children, who were suffering from tonsillo-pharyngitis . This cross sectional study was conducted during March-December 1999 . All statistical analysis was done by using statistical package SPSS windows version 8 . The mean (SD) age of the children was 11.1 (3.3) years . Four hundred and twenty eight isolates of beta hemolytic streptococci were recovered from tonsillo-pharyngeal swab cultures obtained from 428 children . Among the isolated beta hemolytic streptococci, 92 (21.5%) belonged to group A, 5 (1.2%) to group B, 14 (3.3%) to group C and 317 (74.0%) to group G . These findings demonstrated the predominance of group G followed by A infection among school children . Therefore special attention should be paid not only to group A but also to group G . Further studies to determine prevalence of M serotypes are necessary. Lancet Infect Dis, 2004 Apr, 4(4), 240 - 5 Acute rheumatic fever: a chink in the chain that links the heart to the throat? McDonald M, Currie BJ, Carapetis JR. Acute rheumatic fever (ARF) remains a major problem in tropical regions, resource-poor countries, and minority indigenous communities . It has long been thought that group A streptococcal (GAS) pharyngitis alone was responsible for acute rheumatic fever; this belief has been supported by laboratory and epidemiological evidence gathered over more than 60 years, mainly in temperate climates where GAS skin infection is uncommon . GAS strains have been characterised as either rheumatogenic or nephritogenic based on phenotypic and genotypic properties . Primary prevention strategies and vaccine development have long been based on these concepts . The epidemiology of ARF in Aboriginal communities of central and northern Australia challenges this view with reported rates of ARF and rheumatic heart disease (RHD) that are among the highest in the world . GAS throat colonisation is uncommon, however, and symptomatic GAS pharyngitis is rare; pyoderma is the major manifestation of GAS infection . Typical rheumatogenic strains do not occur . Moreover, group C and G streptococci have been shown to exchange key virulence determinants with GAS and are more commonly isolated from the throats of Aboriginal children . We suggest that GAS pyoderma and/or non-GAS infections are driving forces behind ARF in these communities and other high-incidence settings . The question needs to be resolved as a matter of urgency because current approaches to controlling ARF/RHD in Aboriginal communities have clearly been ineffective . New understanding of the pathogenesis of ARF would have an immediate effect on primary prevention strategies and vaccine development. Antimicrob Agents Chemother, 2004 Apr, 48(4), 1410 - 2 Macrolide resistance determinants of invasive and noninvasive group B streptococci in a Turkish hospital; Acikgoz ZC et al.; Macrolide resistance in 156 consecutive group B streptococcal isolates was investigated . Thirty-five isolates (22.4%) had inducible (80%) or constitutive (20%) erythromycin resistance . The genes responsible were erm(B), erm(A) subclass erm(TR), and erm(B) plus erm(TR) in 62.9, 2.9, and 8.6% of isolates, respectively . Nine isolates (25.7%) harbored neither mef nor detectable erm genes. Antimicrob Agents Chemother, 2004 Apr, 48(4), 1105 - 11 Efficacy of BAL5788, a prodrug of cephalosporin BAL9141, in a mouse model of acute pneumococcal pneumonia; Azoulay-Dupuis E et al.; BAL5788 is a water-soluble prodrug of BAL9141, a new broad-spectrum cephalosporin with high levels of in vitro activity against methicillin- and vancomycin-resistant staphylococci and penicillin-resistant streptococci . In plasma BAL5788 is rapidly converted to BAL9141 . We studied the activity of BAL5788 in a mouse model of acute pneumococcal pneumonia . Leukopenic female Swiss albino mice were challenged intratracheally with 10(7) CFU of clinical Streptococcus pneumoniae strains P-52181 (Pen(s) Cro(s) Ctx(s)), P-15986 (Pen(r) Cro(s) Ctx(s)), P-40422 (Pen(r) Cro(r) Ctx(r)), and P-40984 (Pen(r) Cro(r) Ctx(r)) . Infected mice received subcutaneous (s.c.) injections of BAL5788 or ceftriaxone starting 3 h after pneumococcal challenge . Uninfected nonleukopenic mice received single s.c . doses of BAL5788 to determine the BAL9141 concentration-time profiles in serum and lungs . Untreated control mice died within 5 days postinfection . Ten-day cumulative survival rates for infected mice receiving BAL5788 (total daily doses of BAL9141 equivalents, 2.1 to 75 mg/kg of body weight) ranged from 57 to 100%, whereas with ceftriaxone (total daily doses, 10 to 400 mg/kg), the survival rates varied between 13 and 100% . In mice infected with P-15986, the survival rates achieved with BAL5788 (BAL9141 equivalent, 8.4 mg/kg) and those achieved with ceftriaxone (50 mg/kg) were significantly different (93 versus 13%; P < 0.0001) in favor of BAL5788; the outcomes of the trials with all other strains were not significantly different between the two antibiotics, but markedly lower doses of BAL5788 than ceftriaxone were required to obtain similar survival rates . Pharmacokinetic data showed that BAL9141 was effective against the four pneumococcal strains tested at very low values of the time above the MIC (T > MIC), which ranged from 9 to 18% of the dosing interval, whereas the values of T > MICs for ceftriaxone ranged from 30 to 50% of the dosing interval. J Dent Res, 2004 Apr, 83(4), 302 - 6 Influence of resin monomers on growth of oral streptococci; Takahashi Y et al.; Ethyleneglycol dimethacrylate monomers have been previously reported to stimulate the growth of certain caries-associated bacteria on the basis of turbidity measurements . To elucidate the detail of this effect, we examined the influence of resin monomers on the growth of Streptococcus sobrinus and Streptococcus sanguis by determination of bacterial numbers (colony-forming units), morphological observation, and chemical analysis . Although the absorbance values in the stationary phase of bacterial suspension were increased in the presence of ethyleneglycol monomers, no significant differences were observed for bacterial numbers throughout the incubation period . Scanning electron microscopy observation revealed the formation of sparse vesicular material surrounding bacterial cells when incubated with ethyleneglycol monomers, and these products were proved to be resin polymers . The results demonstrate that the apparent biomass increase during incubation with ethyleneglycol monomers is due not to promotion of bacterial multiplication, but to the polymerization of resin monomers to form vesicular structures attached to cells. FEMS Microbiol Lett, 2004 Apr 1, 233(1), 83 - 9 Identification of the anginosus group within the genus Streptococcus using polymerase chain reaction; Takao A et al.; The aim of this study was to establish an identification method for the anginosus group within the genus Streptococcus by polymerase chain reaction (PCR) . Using a primer pair based on the group-specific sequences of penicillin-binding protein 2B (pbp2b) gene, a 275-bp fragment was amplified from each species in the group but no size-matched products were obtained in other streptococci . Further identification in the species or subspecies level was possible by a multiplex PCR with primers for the 16S ribosomal RNA gene of Streptococcus anginosus, the hyaluronate lyase genes both of Streptococcus intermedius and Streptococcus constellatus subsp . constellatus, and the intermedilysin (ily) gene of S . intermedius . In the case ofStreptococcus constellatus subsp . pharyngis, the amplified fragment from the S . intermedius-type hyaluronate lyase gene was obtained, while that from the ily gene was not . These results also indicate that two different hyaluronate lyase genes are distributed among the anginosus group. ANZ J Surg, 2004 Apr, 74(4), 210 - 4 Successful antimicrobial therapy and implant retention for streptococcal infection of prosthetic joints; Everts RJ et al.; BACKGROUND: Streptococci cause up to 20% of prosthetic joint infections but this has received little attention in the published literature . METHODS: We reviewed retrospectively our experience with treatment of streptococcal prosthetic joint infections . Patients were followed up for up to 15 years after discontinuation of antimicrobial therapy and up to 8.5 years while on continuous antimicrobial therapy . RESULTS: Eighteen cases were diagnosed between 1984 and 1995 . These included one group A, seven group B, one group D, seven group G and one viridans-group streptococcal infection as well as one group B and D streptococcal co-infection . All were late-onset infections and most (11 of 18, 61%) were acute . Hip and knee joints were equally affected . Six of seven group G streptococcal infections were associated with skin or soft tissue infections . Sixteen patients were treated primarily with antimicrobial agents including 5 days to 6 weeks given intravenously and 2 weeks to 8.5 years given orally . At latest follow up, 10 patients had been off antimicrobial therapy for at least 18 months without relapse, one patient had been off antimicrobial therapy for 7 months without relapse and four infections were successfully controlled with long-term suppressive antimicrobial therapy . One infection was unable to be controlled with antimicrobial therapy . CONCLUSIONS: Our results, and those of others, show that prosthetic joint infections caused by streptococci have a relatively good outcome with primary antimicrobial therapy and, when necessary, drainage, lavage or debridement . Provided the prosthesis is stable and the patient can tolerate long-term antimicrobial therapy, this may be an effective alternative to excision arthroplasty. Nat Rev Microbiol, 2003 Dec, 1(3), 219 - 30 The pathogenesis of streptococcal infections: from tooth decay to meningitis; Mitchell TJ; The development of bacterial disease has been likened to a 'molecular arms race', in which the host tries to eliminate the bacteria, while the bacteria try to survive in the host . Although most bacteria do not cause disease, some cause serious human infection in a large proportion of encounters . Between these two extremes are bacteria that can coexist with humans in a carriage state but, under appropriate circumstances, cause disease . The streptococci exemplify this group of organisms, and by studying them we can begin to address why bacteria cause such a wide spectrum of disease. Br J Ophthalmol, 2004 Apr, 88(4), 464 - 5 A protocol for low contamination risk of autologous serum drops in the management of ocular surface disorders; Lagnado R et al.; AIM: To assess microbial contamination of 20% autologous serum (AS) eye drops used in a hospital inpatient setting . METHOD: 14 patients received autologous serum drops from 4 to 14 days with a cumulative total of 67 days . For each day the first and last drop (total 134 samples) was cultured on broth and blood agar . RESULTS: Four patients (9 samples) grew Staphylococcus epidermidis only . One patient (1 sample) showed Staphylococcus epidermidis and a scanty growth of viridans streptococci in the same sample, and on different days the same patient grew Staphylococcus aureus in one sample and Staphylococcus epidermidis in another sample . One patient (1 sample) grew micrococcus . There was no clinical or microbial evidence of infection in any of these six patients . CONCLUSION: This study shows that autologous serum drops can be safely used in an inpatient setting, under a strict protocol of preparation and storage, without significant risk of bacterial contamination and consequent infection. J Cataract Refract Surg, 2004 Feb, 30(2), 307 - 15 Effect of prophylactic antibiotics on antimicrobial resistance of viridans streptococci in the normal flora of cataract surgery patients; Seppala H et al.; PURPOSE: To evaluate the effect of prophylactic treatment including vancomycin in the irrigating solution and topical chloramphenicol on antimicrobial resistance in viridans-group streptococci in the normal flora of patients having cataract surgery . SETTING: Department of Ophthalmology, Turku University Central Hospital and Antimicrobial Research Laboratory, National Public Health Institute, Turku, Finland . METHODS: Minimal inhibitory concentrations (MICs) of 15 antimicrobials were determined for 529 viridans streptococci isolated from throat, nasopharyngeal, and conjunctival swabs of 23 patients on 4 sampling occasions: before cataract surgery and 1 day, 1 month, and 3 months after surgery . Resistance mechanisms of erythromycin-resistant isolates were studied by the double-disk test and polymerase chain reaction of resistance genes . RESULTS: No statistically significant changes occurred in the proportions of isolates with elevated MICs between different sampling occasions . Resistance to vancomycin or chloramphenicol was not found . Resistance to tetracycline, erythromycin, penicillin, quinupristin-dalfopristin, clindamycin, levofloxacin, and moxifloxacin was found on different sampling occasions in 27.9% to 38.7%, 13.1% to 21.8%, 11.5% to 19.4%, 8.9% to 16.9%, 2.3% to 5.6%, 0% to 2.4%, and 0% to 2.2% of the isolates, respectively . Of the erythromycin-resistant isolates, 80.8% had the M phenotype and mefA gene and 19.2% has the macrolide-lincosamide-streptogramin B phenotype and ermB gene . CONCLUSIONS: Development of resistance of viridans streptococci in the normal flora to vancomycin and chloramphenicol during prophylactic use with uneventful cataract surgery is unlikely; the effect on resistance patterns of other antimicrobials is minor . Routine use of prophylactic vancomycin is discouraged, however, because of the lack of scientific proof of its efficacy in preventing postoperative endophthalmitis. J Vet Sci, 2004 Mar, 5(1), 5 - 9 Assessment of the California mastitis test usage in smallholder dairy herds and risk of violative antimicrobial residues; Shitandi A et al.; This study evaluated how predictive the California Mastitis Test (CMT) is for sub-clinical mastitis under tropical smallholder dairy production conditions in Kenya . It intended to establish whether the CMT usage could be contributing to misdiagnosis and consequent mistreatment with animal drugs resulting in residue problems . Milk samples (n = 239) were aseptically collected from lactating cows in the Rift Valley of Kenya and tested using the CMT, somatic cell counts (SCC) and bacterial culture . The samples were also screened for violative drug residues using the commercial delvo test and compared to the milks mastitic status for possible association . There was a numerical but non-significant (p > 0.05) difference evident in the frequencies observed using the three different mastitis indicators . The prevalent bacterial species isolated from mammary glands with subclinical mastitis were Staphylococcus aureus (45.6%), coagulase-negative Staphylococci (13.0%), Streptococci (11.7%) and Escherichia coli 5.9% . There was an overall poor but significant (p < 0.05) correlation between the CMT and the violative antimicrobial residues in samples from all quarters, infected and non-infected respectively . The results suggest that the CMT use amongst the smallholder dairy sector as a mastitic indicator may not be a risk factor in violative antimicrobial residues problems in milk. Neth J Med, 2003 Dec, 61(12), 421 - 9 Optimisation of the antibiotic guidelines in The Netherlands . VII . SWAB guidelines for antimicrobial therapy in adult patients with infectious endocarditis; Verhagen DW et al.; The Working Party on Antibiotic Policy (Dutch acronym is SWAB) is a Dutch organisation that develops guidelines for in-hospital antimicrobial therapy of bacterial infectious diseases . This present guideline describes the antimicrobial treatment for adult patients with infective endocarditis . The choice and duration of antimicrobial therapy is determined by the infecting micro-organism, sensitivity of this micro-organism for antimicrobial therapy, location of the endocarditis, left-sided or right-sided, and presence of intracardial prosthetic material . In this guideline, the empirical therapy for endocarditis is discussed as well as the therapy for the most frequent causative organisms: streptococci, enterococci, staphylococci and HACEK micro-organisms. Indian J Pathol Microbiol, 2003 Jul, 46(3), 528 - 9 Occurrence of group C Streptococci in children in a South Indian village; Menon T et al.; Throat swabs were collected from 310 children aged 5-14 years attending a rural health camp at Orathur near Chennai . Group C Streptococci were isolated from 13/310 (4.19%) cases . Seven out of 13 patients had symptoms of respiratory tract infection . Biochemical characterization of the isolates was done by hemolytic characteristics, Voges-Proskauer test, fermentation of trehalose and sorbitol and hydrolysis of 4-methylumbelliferyl-D-a-glucuronide . Four out of 13 strains were identified as S . equisimilis. Diagn Microbiol Infect Dis, 2004 Mar, 48(3), 195 - 9 PCR detection and identification of oral streptococci in saliva samples using gtf genes; Hoshino T et al.; Oral streptococci are major constituents of dental plaque, and their prevalence is implicated in various pathologies . Therefore, accurate identification of oral streptococci would be valuable for studies of cariogenic plaque and for diagnostic use in infective endocarditis . Many oral streptococci possess glucosyltransferase enzymes that synthesize glucan, which is an obligate component of dental plaque . We established a rapid and precise method to identify oral streptococci by PCR using the species-specific region from the glucosyltransferase gene . With the species-specific primers, Streptococcus mutans, S . sobrinus, S . salivarius, S . sanguinis, S . oralis, and S . gordonii could be successfully distinguished . Further, we developed a simple method to extract the bacterial DNA from saliva . Using the resultant DNA as a template, the proposed PCR detection was performed . Their distribution was in accord with results of conventional biochemical tests . These findings indicate that the present PCR method is useful for the analysis of oral streptococci and can be successfully used in clinical applications to identify pathogenic bacteria associated with oral infectious disease and/or endocarditis. Diagn Microbiol Infect Dis, 2004 Mar, 48(3), 161 - 5 Central nervous system infections due to Abiotrophia and Granulicatella species: an emerging challenge? Cerceo E, Christie JD, Nachamkin I, Lautenbach E. Although Abiotrophia and Granulicatella species, previously referred to as nutritionally variant streptococci, were initially identified over 40 years ago, isolation of these pathogens from the central nervous system (CNS) was first noted only recently . Recognition of CNS involvement with these organisms is of great concern given the association of Abiotrophia/Granulicatella infections with increased morbidity and mortality as well as greater bacteriologic failure and relapse rates . We describe A . defectiva and G . adiacens CNS infections in two patients and review the existing literature of CNS involvement with these bacteria . The clinical presentation and initial cerebrospinal fluid analysis has varied substantially across reported patients . While most infections have been characterized primarily by a localized infection (e.g., abscess), evidence of meningitis has usually also been present . Furthermore, nearly all cases have followed neurosurgical procedures suggesting possible introduction of the organism into the CNS at the time of surgery . Given the significant negative clinical impact of Abiotrophia/Granulicatella infections, elucidation of the emerging epidemiology of CNS infections with these bacteria is warranted. FEMS Microbiol Lett, 2004 Mar 12, 232(1), 89 - 92 A high molecular mass cranberry constituent reduces mutans streptococci level in saliva and inhibits in vitro adhesion to hydroxyapatite; Weiss EI et al.; Previous investigations showed that a high molecular mass, non-dialyzable material (NDM) from cranberries inhibits the adhesion of a number of bacterial species and prevents the co-aggregation of many oral bacterial pairs . In the present study we determined the effect of mouthwash supplemented with NDM on oral hygiene . Following 6 weeks of daily usage of cranberry-containing mouthwash by an experimental group (n = 29), we found that salivary mutans streptococci count as well as the total bacterial count were reduced significantly (ANOVA, P < 0.01) compared with those of the control (n = 30) using placebo mouthwash . No change in the plaque and gingival indices was observed . In vitro, the cranberry constituent inhibited the adhesion of Streptococcus sobrinus to saliva-coated hydroxyapatite . The data suggest that the ability to reduce mutans streptococci counts in vivo is due to the anti-adhesion activity of the cranberry constituent. Hua Xi Kou Qiang Yi Xue Za Zhi, 2004 Feb, 22(1), 43 - 5 {A study of oral colonization of mutans streptococci and feeding habits in infants}; Tong L et al.; OBJECTIVE: To study the correlation of prime colonization time of Mutans Streptococci and feeding habits in infants . METHODS: One hundred and eighty children (aged 6-24 months) from Shenyang city were examined for the colonization of MS Related items were registered by completed questionnaires . RESULTS: The study showed a correlation between prime colonization time and feeding mode, breast feeding, feeding frequency during bedtime, asleep habits . CONCLUSION: Advocating reasonable feeding mode and asleep habits is effective to interdict or delay MS's colonization and transmission in child to prevent caries. J Antimicrob Chemother, 2004 Apr, 53(4), 631 - 4 Epub 2004 Mar 10. Nosocomial bloodstream infections due to viridans streptococci in haematological and non-haematological patients: species distribution and antimicrobial resistance; Lyytikainen O et al.; OBJECTIVES: We studied the species distribution and antimicrobial susceptibility of viridans streptococci (VS) isolates causing nosocomial bloodstream infections (BSIs) in Finnish hospitals . PATIENTS AND METHODS: Patients with nosocomial BSIs due to VS were identified through a hospital-wide prospective laboratory-based surveillance in two university and two regional hospitals during September 1998-August 2001 . Isolates of VS were sent to the reference laboratory for species confirmation and antimicrobial susceptibility testing . RESULTS: A total of 2038 nosocomial BSIs were identified; 108 (5%) of the BSIs were caused by VS . Of the VS BSIs, 66% were in patients with a haematological malignancy, 14% in patients with a solid tumour and 18% in patients who had undergone surgery preceding the infection . The most common species group identified was Streptococcus mitis (82%) . High-level penicillin resistance (> or = 4 mg/L) and cefotaxime resistance (> or = 4mg/L) were present in 5% and 4% of isolates, respectively; both were detected only in haematological patients . However, in non-haematological patients, resistance to erythromycin (17%), and reduced susceptibility to levofloxacin (14%) and penicillin (19%) were common . CONCLUSIONS: The resistance problems in VS are not limited to haematological patients . These findings may have significant clinical implications in the choice of both empirical antibiotic and antimicrobial prophylaxis regimens. Clin Diagn Lab Immunol, 2004 Mar, 11(2), 330 - 6 D8/17 and CD19 expression on lymphocytes of patients with acute rheumatic fever and Tourette's disorder; Weisz JL et al.; D8/17, an alloantigen found on B lymphocytes, has been reported to be elevated in patients susceptible to rheumatic fever and may be associated with autoimmune types of neuropsychiatric disorders . The pediatric-autoimmune-neuropsychiatric-disorders-associated-with-streptococci model is a putative model of pathogenesis for a group of children whose symptoms of obsessive-compulsive disorder and Tourette's disorder (TD) are abrupt and may be triggered by an infection with group A streptococci . As a test of this model, we have examined D8/17 levels on the B cells of patients with TD and acute rheumatic fever (ARF) along with those on the B cells of normal controls by flow cytometry . We have utilized several different preparations of D8/17 antibody along with a variety of secondary antibodies but have been unable to show an association with an elevated percentage of D8/17-positive, CD19-positive B cells in either ARF or TD . We did find, however, that the percentages of CD19-positive B cells in ARF and TD patients were significantly elevated compared to those in normal controls . Group A streptococcal pharyngitis patients also had an elevated percentage of CD19 B cells, however . These studies failed to confirm the utility of determining the percentage of B cells expressing the D8/17 alloantigen in ARF patients or our sample of TD patients . In contrast, the percentage of CD19-positive B cells was significantly elevated in ARF and TD patients, as well as group A streptococcal pharyngitis patients, suggesting a role for inflammation and/or autoimmunity in the pathogenesis of these disorders. Yonsei Med J, 2004 Feb 29, 45(1), 56 - 60 Comparison of dio-bacit, bacitracin-trimethoprim/ sulphamethoxazole and latex agglutination in the diagnosis of Group A beta-hemolytic streptococci; Altindis M et al.; Not only is Group A beta-hemolytic Streptococcus (GAS) the most frequent cause of bacterial pharyngitis, it is also the culprit in various skin and systemic infections, acute rheumatic fever, post streptococcal glomerulonephritis, and other disorders and complications . A new, ready-to-use media, Dio-Bacit, in a two section plate containing 5% sheep blood agar on one side and sheep blood agar with bacitracin (2 microg/ml) on the other was compared for its efficiency in identifying GAS with bacitracin and bacitracin + sulphamethaxazole / trimethoprim disk tests applied after isolation of beta-hemolytic colonies . We also used the latex-agglutination test as the gold standard method for differentiating GAS from streptococci belonging to other groups . Compared with the latex-agglutination test, we found the sensitivity and specificity of the Dio-Bacit method to be 92.0% and 96.9%, respectively . Dio-Bacit plates provide an easy and very useful way to identify GAS within one day, saving time, labor, and money for routine diagnostic microbiology laboratories. J Immunol, 2004 Mar 15, 172(6), 3798 - 807 Streptococcal M5 protein prevents neutrophil phagocytosis by interfering with CD11b/CD18 receptor-mediated association and signaling; Weineisen M et al.; Group A streptococci (GAS) are common human pathogens that express major surface-associated virulence factors designated M proteins . In this study, we explored directly the cellular mechanisms behind their supposed ability to prevent phagocytosis . Isolated human neutrophils killed an M-negative GAS mutant (DeltaM5), but not the wild-type parent strain (M5) . After 3 h, 3-4 times as many DeltaM5 as M5 bacteria were associated with the neutrophils, and more DeltaM5 than M5 bacteria were ingested . However, there was no statistically significant difference between DeltaM5 and M5 bacteria in regard to the percentage of the neutrophil-associated bacteria that were ingested, indicating that M5 protein prevents an adhesion receptor-dependent association with neutrophils and not the phagocytic machinery per se . Different Abs against CD11b/CD18 (CR3) blocked adhesion and killing of DeltaM5 bacteria, whereas the blocking of two other complement receptors, CD11c/CD18 (CR4) and CD35 (CR1), did not . The CD11b/CD18-mediated killing of DeltaM5 bacteria resulted in protein tyrosine phosphorylations and Cdc42 activation . Furthermore, inhibition of CD11b/CD18 receptor engagement or tyrosine kinase activity blocked the DeltaM5-induced activation of Cdc42 as well as the killing of these bacteria . We conclude that M5 protein interferes with the CD11b/CD18-dependent association between GAS and neutrophils, and thereby blocks subsequent ingestion of the bacteria. Microb Drug Resist, 2003 Winter, 9(4), 367 - 72 Prevalence, proportions, and identities of antibiotic-resistant bacteria in the oral microflora of healthy children; Ready D et al.; The aims of this study were to determine the prevalence, proportions and identities of oral bacteria resistant to six antibiotics in 35 children (4-5 years old) who had not received antibiotics during the previous 3 months . Ampicillin-, penicillin-, erythromycin-, and tetracycline-resistant bacteria were harbored by 35 (100%), 34 (97%), 35 (100%), and 34 (97%) children, respectively . None of the children harbored metronidazole-resistant anaerobic bacteria or Gram-positive vancomycin-resistant bacteria . The median percentage of the oral microflora resistant to each of the antibiotics was ampicillin 1% (range 0.1-23), erythromycin 13% (1-45), penicillin 1% (0-14), and tetracycline 2% (0-88) . A total of 432 antibiotic-resistant isolates were recovered that comprised 18 genera and 47 species . Ampicillin resistance was widely distributed throughout different genera and species, whereas tetracycline resistance was predominately found in the streptococci . Multiresistant bacteria were frequently isolated with 28% of isolates exhibiting resistance to two or more antibiotics . Veillonella spp., traditionally considered susceptible to penicillin and ampicillin, were found frequently to be resistant to these two antibiotics . This study demonstrates that a diverse collection of antibiotic-resistant pathogenic, opportunistic, and nonpathogenic bacteria can be readily isolated from, and in some subjects dominate, the oral microflora of primary school children in the absence of recently administered antibiotics. Clin Infect Dis, 2004 Mar 15, 38(6), 843 - 50 Epub 2004 Mar 01. Hospital-acquired infective endocarditis: should the definition be broadened? Ben-Ami R, Giladi M, Carmeli Y, Orni-Wasserlauf R, Siegman-Igra Y. Hospital-acquired infective endocarditis (IE) is a growing health-care problem . Hospital-acquired IE, according to the commonly used definition, is IE manifesting > or =72 h after admission to the hospital or within several weeks after a hospital-based invasive procedure . To assess the validity of this definition, we evaluated 87 episodes of IE, with special attention to recent hospitalizations . The incidence rate of IE in the 6-month period after discharge from the hospital was 27 cases per 100,000 person-years, compared with 1.1 cases per 100,000 person-years in a population with no recent hospitalizations . Furthermore, episodes of IE manifesting during this 6-month period were notable for a high proportion of typically hospital-acquired pathogens (26% vs . 0%; P=.001) and a low proportion of viridans streptococci (0% vs . 36%; P<.001), compared with community-acquired episodes that did not involve recent hospitalization . We conclude that characteristics of hospital-acquired IE extend to episodes arising within 6 months after discharge from the hospital and suggest that the definition of hospital-acquired IE be broadened to include these episodes. J Infect Chemother, 2004 Feb, 10(1), 19 - 24 Detection of penicillin-binding protein 2b gene alteration in Streptococcus mitis by polymerase chain reaction; Usui H et al.; Three isolates of beta-lactam-resistant streptococci from the saliva of healthy adults were identified as Streptococcus mitis . Minimum inhibitory concentrations (MICs) were 2 to 4 micro g/ml for ampicillin (ABPC) and 64 to more than 128 micro g/ml for cefaclor (CCL) . To determine the position of base alterations of the penicillin-binding protein 2b ( pbp2b) gene, upstream primers containing possible mutation points were designed, and used for polymerase chain reaction (PCR), together with a downstream primer . Alterations adjacent to the conserved motifs of the pbp2b gene were apparent . DNA sequencing data indicated replacements in deduced amino acid sequences in all resistant isolates: from threonine to alanine just after the serine-serine-asparagine (SSN) motif, and from alanine to glycine two residues downstream of the lysine-threonine-glycine (KTG) motif . These changes were the same as those in penicillin-resistant Streptococcus pneumoniae (PRSP), suggesting importance for the enzymatic activity of the protein . Thus, Beta-lactam susceptibility of S . mitis may be partially predicted by PCR using our primer set for pbp2b. Rinsho Biseibutshu Jinsoku Shindan Kenkyukai Shi, 2003, 14(1), 9 - 16 {Basic and clinical evaluation of the new rapid diagnostic kit for detecting group A streptococci with the immunochromatographical method}; Kawakami S et al.; Basic and clinical performance of a new diagnostic kit that detects Group A Streptococci by an immunochromatographical method, QuickVue Dipstick Strep A (Quidel Corporation; San Diego, CA) were evaluated . In basic specificity study, the QuickVue Dipstick Strep A showed positive reaction only to group A Streptococci strains among 34 strains of 10 species of bacteria . In detection limit study, the QuickVue Dipstick Strep A had a capacity to detect Group A Streptococci in 1.0 x 10(4); cfu/ml (1.0 x 10(3) cfu/test) . This sensitivity was about 6 times higher than that of the existing similar immunochromatographical test, STREP A TESTPACK Plus (TESTPACK, Abbott Japan, Tokyo) . In clinical study compared with bacterial culture test using 100 patients' throat swab specimens, the QuickVue Dipstick Strep A showed a sensitivity of 94.4% (34/36), a specificity of 100% (64/64) and an accuracy of 98% (98/100) . Furthermore in correlation study with the reference test, TESTPACK, the QuickVue Dipstick Strep A showed 100% agreement (34 positive and 66 negative specimens) . As the QuickVue Dipstick Strep A has several advantages as not only simple operation, rapid reaction and good performance but also easy storage (under room temperature), compact size and minimum waste products, we conclude that this new test is useful as Point-of-Care Testing kit and plays a peripheral role in the diagnosis of Group A Streptococci infection and pertinent medical treatment by antibacterial agents. Antimicrob Agents Chemother, 2004 Mar, 48(3), 1007 - 11 In vitro activity of daptomycin against gram-positive European clinical isolates with defined resistance determinants; Fluit AC et al.; The in vitro activity of daptomycin against 337 gram-positive European clinical isolates with known resistance genes was determined . The MIC ranges for Staphylococcus aureus, enterococci, pneunococci, and streptococci were 0.03 to 1, 0.25 to 8, 0.12 to 1, and 0.06 to 8 micro g/ml, respectively . For only one streptococcus isolate and seven enterococcus isolates was the MIC 8 micro g/ml. Arch Tierernahr, 2003 Dec, 57(6), 399 - 412 The influence of Lentinus edodes (Shiitake mushroom) preparations on bacteriological and morphological aspects of the small intestine in piglets; van Nevel CJ et al.; Among substances intended to replace growth promoting antibiotics in pig nutrition, non-digestible oligosaccharides or polysaccharides could be potential alternative compounds . Therefore, the influence of beta-1,3-1,6 glucans on bacteriological, biochemical and morphological aspects of the small intestine in weaned piglets was investigated . As sources of beta-glucans, Lentinan (extract of Lentinus edodes mycelium) or dried L . edodes mycelium were added to the diet . Four homogenous groups of 5 newly weaned piglets (4 weeks of age) received one of four diets: control diet (C), C supplemented with Avilamycin (50 mg/kg, positive control), C supplemented with 0.1% of Lentinan and C supplemented with 5% of dried L . edodes mycelium powder . A first group of 10 piglets was euthanized after 11 days and the remaining 10 on day 12 of the experiment . The gastrointestinal tract was divided in segments and samples taken from digesta (stomach, proximal and distal jejunum, caecum), mucosal scrapings (jejunum) and ring shaped tissue samples (1 cm) of proximal and distal jejunum . Bacterial counts were made with digesta and mucosal samples, and short-chain fatty acids (SCFA), lactic acid and ammonia concentrations were determined . Tissue samples of both jejunal sites were embedded in paraffin wax for morphometrical (villus length, crypt depth) and histological observations (numbers of intraepithelial lymphocytes (IEL), goblet cells, apoptotic enterocytes on villi, mitotic cells in crypts) . Only the diet containing 5% of dried L . edodes consistently resulted in lower viable counts (ca . 1-2 log10 CFU) of total bacteria, E . coli, streptococci and lactic acid bacteria, and luminal and mucosal effects agreed very well . With this diet, acetate and butyrate concentrations in the distal jejunum were doubled, which is favourable in view of the trophic effect on enterocytes and colonocytes . Villus length (V) was increased with both diets containing beta-glucans while crypt depth (C) was not altered, but V/C was higher . IEL counts were decreased by both diets although bacterial numbers, which is only one parameter of bacterial load, were only diminished with the L . edodes feed . The three supplemented feeds lowered the number of apoptotic enterocytes on the villi, but these numbers were very low (control diet : 44 cells per 100 villi), making clear interpretation difficult . The mitotic index was slightly lower with the L . edodes feed, although not statistically significant . Decreased viable counts observed with the latter diet is a favourable effect as it is accepted that a lower bacterial load causes lower turnover rates of the intestinal epithelial cells, while there is also less competition for specific substrates . A higher V/C ratio, a smaller number of IEL in the epithelium and a lower apoptotic index also indicate slower turnover rate of the mucosa when Lentinan and L . edodes diets were fed . The inconsistent effects observed with Lentinan were probably due to the low amount added to the diet . It should be taken into account that the influence of L . edodes mycelium powder was more likely due to the presence of antibacterial compounds (eg . lenthionine, lentinamycin, terpenoids, polyphenols), rather than to an immunostimulating action of beta-glucans with increased release of IgA onto the mucosa surface. Indian J Pediatr, 2004 Jan, 71(1), 41 - 8 Addressing the burden of group A streptococcal disease in India; Shet A et al.; Group A streptococcus-associated disease and sequelae continue to have devastating effects on public health and national economy as they mainly affect children and young adults . There is an urgent need for wider application of methods of primary prevention, in the form of optimal diagnosis and management of the simple group A streptococcal sore throat . This review article briefly summarizes the burden of streptococcal disease in India, and discusses treatment options standardized by the World Health Organization . Penicillin continues to remain the drug of choice for treating group A streptococcal pharyngitis and for prevention of acute rheumatic fever in non-allergic patients . Also discussed in this review are contemporary thoughts on streptococcal "carriers", recurrent infections, antibiotic treatment "failures" and emergence of drug resistance among group A streptococci. J Immunol, 2004 Mar 1, 172(5), 3111 - 8 The group B streptococcal beta and pneumococcal Hic proteins are structurally related immune evasion molecules that bind the complement inhibitor factor H in an analogous fashion; Jarva H et al.; Complement evasion by different mechanisms is important for microbial virulence and survival in the host . One strategy used by pathogenic bacteria is to bind the soluble complement inhibitor factor H (fH) to their surfaces . In group B streptococci and pneumococci, fH binding has been shown to be mediated by the surface proteins beta and Hic, respectively . We showed previously that Hic binds to the middle region of fH and protects the pneumococcus from opsonophagocytosis . As the beta protein and Hic are structurally closely related, we wanted to compare the fH binding characteristics of these two proteins . By using direct binding assays with radiolabeled proteins and surface plasmon resonance analysis we show that both beta and Hic bind to the short consensus repeats 8-11 and 12-14 in the middle region of fH . Peptide mapping analysis suggested that the fH-binding sites on beta and Hic were composed of discontinuous and partially homologous sequences . Thus, the bacterial virulence proteins use multiple binding sites on fH to secure high avidity . Also, the functionally active sites on fH are thereby left free to inhibit C3b deposition and opsonophagocytosis . These results reveal the evolutionary conservation of an analogous immune evasion strategy in different types of pathogenic streptococci . Importantly, the respective virulence factors could be exploited in the development of protein-based vaccines against these pathogens. Am J Respir Crit Care Med, 2004 May 1, 169(9), 1046 - 53 Epub 2004 Feb 20. Reducing atelectasis attenuates bacterial growth and translocation in experimental pneumonia; van Kaam AH et al.; Besides being one of the mechanisms responsible for ventilator-induced lung injury, atelectasis also seems to aggravate the course of experimental pneumonia . In this study, we examined the effect of reducing the degree of atelectasis by natural modified surfactant and/or open lung ventilation on bacterial growth and translocation in a piglet model of Group B streptococcal pneumonia . After creating surfactant deficiency by whole lung lavage, intratracheal instillation of bacteria induced severe pneumonia with bacterial translocation into the blood stream, resulting in a mortality rate of almost 80% . Treatment with 300 mg/kg of exogenous surfactant before instillation of streptococci attenuated both bacterial growth and translocation and prevented clinical deterioration . This goal was also achieved by reversing atelectasis in lavaged animals via open lung ventilation . Combining both exogenous surfactant and open lung ventilation prevented bacterial translocation completely, comparable to Group B streptococci instillation into healthy animals . We conclude that exogenous surfactant and open lung ventilation attenuate bacterial growth and translocation in experimental pneumonia and that this attenuation is at least in part mediated by a reduction in atelectasis . These findings suggest that minimizing alveolar collapse by exogenous surfactant and open lung ventilation may reduce the risk of pneumonia and subsequent sepsis in ventilated patients. Front Biosci, 2004 May 01, 9, 1794 - 802 Extracellular virulence factors of group B Streptococci; Liu GY et al.; Group B Streptococcus (GBS) is the leading cause of severe bacterial infections in human newborn infants . Advances in streptococcal molecular genetics and refinement of in vitro and in vivo model systems of GBS disease have led to the discovery and characterization of several extracellular virulence factors elaborated by this pathogen . This review summarizes our current understanding of GBS extracellular virulence factors including the beta-hemolysin/cytolysin, C5a-peptidase, hyaluronate lyase, CAMP factor, oligopeptidase, and carbohydrate exotoxin CM101 . The molecular basis and potential pathogenic role(s) of each factor are considered in the context of neonatal infection. Front Biosci, 2004 May 01, 9, 1157 - 88 Extracellular virulence factors of streptococci associated with animal diseases; Segura M et al.; A virulence factor denotes a bacterial product or strategy that contributes to virulence or pathogenicity . Streptococci produce a variety of protein toxins and enzymes that are capable of killing host cells and breaking down cell constituents, presumably to provide nutrients for the bacteria or to promote their spread . Some of these secreted products are hemolysins, streptokinases, hyaluronidases, exotoxins and proteases . In some cases, they play an important role in resistance to the host immune system, acting alone or in combination with cell-associated virulence factors (such as the capsule and surface proteins) . Thus, the virulence of streptococci is considered as a multifactorial process . In contrast to well known human pathogens, and in spite of their veterinary importance, knowledge of virulence factors of most animal disease-associated streptococci is limited or almost inexistent . In the present article, the available information regarding the extracellular virulence factors of the most important animal disease-related streptococci is reviewed. Rev Argent Microbiol, 2003 Oct-Dec, 35(4), 183 - 7 {Group B Streptococcus carriers among pregnant women}; Garcia SD et al.; Streptococcus agalactiae--group B streptococci (GBS)--is a main cause of severe neonatal infections with a high mortality rate . The detection of pregnant GBS carriers (5-35%) allows intrapartum administration of antibiotic prophylaxis to these women and prevents perinatal infection . We studied the prevalence of GBS in 259 patients between 28 and 37 weeks gestation from April 2000 to March 2002 . The anorectum (AR) and vaginal introitus swabs (VI) were cultured in selective Todd-Hewitt broth containing colistin (10 micrograms/ml) and nalidixic acid (15 micrograms/ml) while vaginal swabs (VFS) were cultured following conventional methods . A total of 47 strains of EGB were isolated from 259 patients (18.15%) . The prevalence in different samples were: 5.40% in VFS, 13.51% in VI, 11.58% in AR and 17.76% in VI + AR (reference method) . The isolates were tested against penicillin, ceftriaxone, erythromycin, clindamycin, vancomycin, gentamicin and streptomycin to determine the minimum inhibitory concentration . The resistance phenotypes of erythromycin-resistant GBS were determined by the double-disk test . All strains were susceptible to penicillin, ceftriaxone and vancomycin, only one strain was erythromycin and clindamycin resistant by IMLSB mechanism . None of the isolated strains had a high resistant level to aminoglycosides . The sensitivity of cultures increased when selective broths were used as the primary detection method. Diagn Microbiol Infect Dis, 2004 Feb, 48(2), 81 - 8 "Streptococcus milleri" endocarditis caused by Streptococcus anginosus; Woo PC et al.; Unlike other viridans streptococci, members of the "Streptococcus milleri group" are often associated with abscess formation, but are only rare causes of infective endocarditis . Although it has been shown that almost all S . intermedius isolates and most S . constellatus isolates, but only 19% of S . anginosus isolates, were associated with abscess formation, no report has addressed the relative importance of the 3 species of the "S . milleri group" in infective endocarditis . During a 5-year period (April 1997 through March 2002), 6 cases of "S . milleri" endocarditis (out of 377 cases of infective endocarditis), that fulfil the Duke's criteria for the diagnosis of infective endocarditis, were encountered . All 6 "S . milleri" isolates were identified as S . anginosus by 16S ribosomal RNA (rRNA) gene sequencing . Three patients had underlying chronic rheumatic heart disease and 1 was an IV drug abuser . Five had monomicrobial bacteremia, and 1 had polymicrobial (S . anginosus, S . mitis, Granulicatella adiacens, and Slackia exigua) bacteremia . Two patients died . None of the 6 isolates were identified by the Vitek system (GPI) or the API system (20 STREP) at >95% confidence . All 6 isolates were sensitive to penicillin G (MIC 0.008-0.064 microg/mL), cefalothin, erythromycin, clindamycin, and vancomycin . Accurate identification to the species level, by 16S rRNA gene sequencing, in cases of bacteremia caused by members of the "S . milleri group", would have direct implication on the underlying disease process, hence guiding diagnosis and treatment . Infective endocarditis should be actively looked for in cases of monomicrobial S . anginosus bacteremia, especially if the organism is recovered in multiple blood cultures. Klin Med (Mosk), 2003, 81(12), 25 - 30 {Primary acute rheumatic fever in juveniles from an organized community}; Ermolina LM; A closed population of juveniles was studied to follow-up manifestations of primary rheumatic fever . In line with other unfavourable factors, the onset of the disease within the first 6 months of the observation was due to cross streptococcal infection (foci of chronic nasopharyngeal infection were detected in 68.6% examinees, rheumatism debut after acute nasopharyngeal infection was in 91.0% patients) . Persistence of streptococci was established in many blood counts in immunofluorescence reaction in 88.2% patients in acute disease, in more patients with lingering rheumatic process . Clinical manifestations include, aside from arthritis and rheumocarditis, frequent thyroid and gastrointestinal lesions . It is thought valid to raise the dose and duration of administration of penicillin in patients with primary rheumatic fever as it eradicates chronic infection foci, prevents recurrences, reduces the number of patients with a lingering course of the disease, with recurrences and valvular defects of the heart. Ann Pharmacother, 2004 Mar, 38(3), 458 - 63 Epub 2004 Jan 23. Once-daily cefazolin and probenecid for skin and soft tissue infections; Cox VC et al.; OBJECTIVE: To review the pharmacokinetic and clinical evidence for the use of once-daily cefazolin and probenecid in the treatment of skin and soft tissue infections (SSTI) . DATA SOURCES: MEDLINE (1966-July 2003), EMBASE (1980-July 2003), and PubMed (1966-July 2003) databases for English language, human reports were searched . Search terms included cefazolin, probenecid, cellulitis, and soft tissue infections . STUDY SELECTION AND DATA EXTRACTION: Studies that described pharmacokinetic and clinical outcomes that evaluated the use of cefazolin in conjunction with probenecid for SSTI were included . All studies were evaluated independently by both authors . For pharmacokinetic studies, the effect of probenecid on the pharmacokinetics of cefazolin was evaluated . For clinical trials, efficacy and safety endpoints were evaluated . For efficacy endpoints, definition of cure was used as defined by each trial . DATA SYNTHESIS: In all 3 pharmacokinetic studies identified, the addition of probenecid to cefazolin therapy prolonged the half-life and increased serum concentrations of cefazolin . This process allowed serum concentrations to be above the minimal inhibitory concentrations (MIC) for the most likely skin pathogens (Staphylococcus aureus, beta-hemolytic streptococci) at the end of the dosing interval . In the first of 2 clinical trials, 7 (7%) of 96 patients receiving intravenous ceftriaxone 2 g and oral probenecid 1 g daily were reported to fail therapy compared with 8 (8%) of 98 patients receiving intravenous cefazolin 2 g and oral probenecid 1 g daily . In the second clinical trial, clinical success was reported in 51 (86%) of 59 patients receiving the same doses of cefazolin and probenecid as above compared with 55 (96%) of 57 patients receiving intravenous ceftriaxone 1 g and oral placebo daily . CONCLUSIONS: Limited pharmacokinetic and clinical data suggest that intravenous cefazolin 2 g and oral probenecid 1 g daily is an effective regimen in the treatment of SSTI. J Med Microbiol, 2004 Mar, 53(Pt 3), 229 - 30 Biotypes of group A streptococci isolated from children; Kumar MP et al.; Thirty-eight isolates of group A streptococci from patients with pharyngitis, 13 isolates from patients with pyoderma and 28 carrier strains were subjected to biotyping by carbohydrate fermentation tests and production of beta-glucuronidase . Biotype 10 was observed most frequently among clinical isolates and biotypes 3 and 4 were most common among carrier isolates. J Med Microbiol, 2004 Mar, 53(Pt 3), 189 - 95 Autolysin-targeted LightCycler assay including internal process control for detection of Streptococcus pneumoniae DNA in clinical samples; Sheppard CL et al.; The development and clinical evaluation of a LightCycler PCR assay, including an internal process control (IPC), to detect the Streptococcus pneumoniae autolysin gene in clinical samples is reported . The assay was developed to provide a second target for use in conjunction with existing pneumolysin PCR assays to increase the reliability of non-culture PCR diagnosis of pneumococcal infection . Primers amplify a 173 bp fragment of the autolysin gene (lytA), which is detected by fluorescence-labelled hybridization probes . An IPC was designed to check for the presence of PCR inhibitors and loss of assay sensitivity . The IPC product was amplified by the lytA primers and detected by a second set of hybridization probes . The analytical specificity of the autolysin PCR assay was 100% against 39 other bacterial species tested; these included related streptococci and other organisms . The assay, which could reliably detect 50 fg purified pneumococcal DNA per reaction, was capable of distinguishing between S . pneumoniae and atypical Streptococcus mitis and Streptococcus oralis strains known to contain the lytA gene . Using DNA extracts from a panel of EDTA bloods from patients with blood-culture-confirmed pneumococcal infection, the autolysin PCR had a sensitivity of 42.9%, which was similar to a previously reported TaqMan pneumolysin PCR (43.8%) run in parallel . Total agreement was shown between the autolysin assay and the pneumolysin TaqMan assay when used to test 23 culture-negative clinical samples, of which eight were positive by PCR, adding valuable clinical information . A specific autolysin-based LightCycler assay has been developed to complement pneumolysin PCR for the detection of S . pneumoniae in clinical samples . This should be a particularly useful tool for the rapid and sensitive diagnosis of pneumococcal meningitis, even after an antibiotic has been administered . However, poor sensitivity on blood samples limits its usefulness in other bacteraemic infections. J Clin Pediatr Dent, 2004 Winter, 28(2), 163 - 6 Tongue scraping as a means of reducing oral mutans streptococci; White GE et al.; Mutans streptococci (MS) are one of the most virulent cariogenic pathogens in the oral cavity . The effects of three oral hygiene techniques on salivary mutans streptococci levels were evaluated to see which mechanism would be most efficient in reducing salivary MS levels . Sixty patients, all in the permanent dentition, were selected and randomly distributed into three groups . Group I was asked to use a tongue scraper to brush the tongue once daily in the morning after normal tooth brushing routine . Group II was asked to place and let dissolve a Listerine Oral Care Strip on the tongue once daily after normal oral hygiene routine . Group III was asked to rinse once every morning, for thirty seconds, with a saturated saline solution after routine tooth brushing . The instructions were done for a period of seven days . Baseline, one hour, three day, and seven day saliva samples were obtained and plated on CRT" by Vivadent MS-sensitive agar . All treatments groups show a significant reduction in colony counts from baseline and one or more post treatment periods and at one or more time periods between treatment groups . The most effective treatment in reducing colony counts was seen within Group I "Tongue Scraping" which demonstrated the greatest change from baseline to each of the post treatment periods . The least effective was Group II "Listerine Strip" which showed a statistically insignificant increase in colony count from baseline to 1-Hour and a significant decrease from baseline at the 7-day period only. Ann Ig, 2003 Sep-Oct, 15(5), 725 - 33 {Comparison between different methods to monitor the microbial level of indoor air contamination in the dental office}; Petti S et al.; There is no unanimous consensus on the best methodology to monitor the microbial contamination level of the air in the dental offices . Therefore, we compared a precise but expensive and complex active air sampler (Surface Air System--SAS) with a passive method (Air Microbiological Index--AMI) and a microbial parameter of salivary microrganisms, (oral streptococci--OS), with other, more simply detectable, yet more generic, parameters (staphilococci--ST total viable flora--TVF) . We tested the various combinations of systems and parameters in three multi-chair dental departments, for two different weekdays, before (T0) and during (T1) the working period . Using non-parametric statistical tests we analysed, (i) the difference between T0 and T1 contamination levels assessed by various methods, in order to confirm their efficacy; (ii) the association between parameters, in order to assess whether generic parameters were as reliable as the specific parameter; (iii) the association between sampling systems, in order to test whether AMI could efficaciously substitute the active samplers . The microbial levels were significantly higher at T1 than at T0, excluding ST assessed by SAS . The parameters were highly inter-correlated . However, for low SO levels, the level of the association of this parameter with the others decreased . The results provided by SAS and AMI were also significantly correlated . However, for low contamination levels this association was not significant . In conclusion, the complex and expensive method (SO level assessed by SAS) seems more reliable for low aerial contamination levels, whereas for high levels, more simple and cheap methods could also be used. Wiad Lek, 2003, 56(7-8), 353 - 8 {Epidemiology of rheumatic fever}; Grzanka K et al.; Rheumatic fever is a systemic inflammatory sequel of the upper respiratory tract infection with beta-hemolytic group A streptococci . The disease is characterized by joint, heart and subcutaneous tissue inflammation and the nervous system involvement . The incidence of rheumatic fever decreased in the 20th century but periodical resurgences and local epidemics were reported . The disease is still a significant health problem in developing countries. Breast, 2000 Dec, 9(6), 349 - 50 A breast complication of intravenous drug abuse; McIlhenny C et al.; Breast infection is now much less common than it used to be . It most commonly occurs in women in the 18 to 50 age group, and can be divided into lactational and non-lactational infection . The most common causative organism is Staphylococcus aureus, although enterococci and Anaerobic streptococci are also seen in non-lactational infection . An unusual case is reported with a new aetiology for breast sepsis. Am J Ophthalmol, 2004 Feb, 137(2), 329 - 36 Clinical characteristics of microbial keratitis in a university hospital in Taiwan; Fong CF et al.; PURPOSE: To analyze the clinical and microbiological characteristics of microbial keratitis at the National Taiwan University Hospital in the preceding 10 years . DESIGN: Retrospective cross-sectional study . METHODS: Medical records were reviewed for all patients with clinically diagnosed microbial keratitis presenting at the National Taiwan University Hospital from January 1992 to December 2001 . Risk factors, microbial isolations, clinical patterns, treatment, and outcomes were analyzed . RESULTS: Microbial keratitis was diagnosed for 476 eyes in 453 patients (220 female and 233 male; mean age, 40.7 years) . Pseudomonas species were the most commonly isolated organisms (37.7%), followed by fungi (13.5%), staphylococci (8.4%), nontuberculous mycobacteria (7.9%), streptococci (7.6%), and Acanthamoeba (4.4%) . Contact-lens wear was the most common predisposing factor (44.3%) . Medical treatment was successful for a total of 344 eyes (72.3%), with 132 eyes (27.7%) requiring surgery . The duration from symptom onset to diagnosis of microbial keratitis was statistically significantly shorter for the cases treated medically than the cases treated surgically (7.70 +/- 14.37 and 20.53 +/- 28.85 days, respectively, p =.000000332) . Response to medical treatment was more favorable for bacterial infection (except nontuberculous mycobacterial infection) as compared with fungal or Acanthamoeba infection . A total of 84.4% of pseudomonal keratitis cases were cured by medical treatment, while 85% of nontuberculous mycobacterial keratitis cases eventually required surgical treatment to control the infection . CONCLUSION: Contact-lens related pseudomonal keratitis was the most common form of microbial keratitis in Taiwan . Early diagnosis and prompt treatment are important for successful management of microbial keratitis. Pediatr Infect Dis J, 2004 Feb, 23(2), 166 - 71 Pneumococcal endocarditis in infants and children; Choi M et al.; We report a case of pediatric pneumococcal endocarditis (PPE) and review the English language literature on this disease . Thirty-two cases of PPE were identified since 1900 . One-fourth of these were reported since 1990 . Clinical features differed from adult cases, with mitral valve involvement being more frequent and Osler's triad rarely present in children . Congenital heart disease was the only identifiable risk factor . Medical therapy alone resulted in a high mortality rate that was improved in the group of patients receiving combined medical and surgical interventions . PPE is a rare infection that has been reported more frequently in the era of increasing antibiotic resistance . Unlike typical "subacute" endocarditis caused by viridans streptococci, PPE is an aggressive disease with a high mortality rate . Early surgical intervention might improve survival. Indian J Chest Dis Allied Sci, 2004 Jan-Mar, 46(1), 17 - 22 Clinical and bacteriological profile of community acquired pneumonia in Shimla, Himachal Pradesh; Bansal S et al.; BACKGROUND: Community acquired pneumonia (CAP) is a common clinical problem . The present study was designed to evaluate the clinical and bacteriological profile of CAP in Shimla . METHODS: Seventy patients with community acquired pneumonia were enrolled in this study . In all the patients blood culture, sputum culture, pleural fluid culture (if available) and serological studies for the detection of Mycoplasma pneumoniae specific IgM antibodies by enzyme linked immunosorbent assay (ELISA) were done . RESULTS: Of the 70 patients, 53 (75.6%) had an identifiable atiology with 12 patients having evidence of mixed infection . No organisms could be isolated in 17 patients inspite of using serological methods for Mycoplasma pneumoniae, invasive procedures like bronchoscopic aspirations in addition to the conventional methods like sputum culture, blood culture and pleural fluid culture . The most frequent pathogen was Streptococcus pneumoniae (n = 19; 35.8%) followed by Klebsiella pneumoniae (n = 12; 22%), Staphylococcus aureus in (n=9; 17%), Mycoplasma pneumoniae (n = 8; 15%), Escherichia Coli (n = 6; 11%), beta-haemolytic streptococci (n = 4; 7.5%) and other Gram-negative bacilli (n = 5, 9%) . CONCLUSION: Age smoking and under lying co-morbid conditions specially chronic obstructive pulmonary disease (COPD) were significantly associated with the development of CAP (p < 0.01). Pediatr Infect Dis J, 2004 Feb, 23(2 Suppl), S129 - 34 Defining the optimum treatment regimen for azithromycin in acute tonsillopharyngitis; Cohen R; Pharyngitis is one of the most common infectious diseases affecting children . Group A streptococci are the leading bacterial cause of pharyngitis in children and adults . Because inappropriate antibiotic treatment for pharyngitis is becoming a major issue, only true group A beta-hemolytic streptococcus (GABHS) infections, proven by rapid antigen test or culture, should be treated with antibiotics . GABHS pharyngitis is often a mild and self-limiting infection in the absence of antimicrobial therapy . However, antimicrobial treatment must be administered to eradicate the pathogen from the throat, limit the spread of the infection and prevent possible progression to rheumatic fever, suppurative disease or toxin-mediated complications . Penicillin V for 10 days is the standard therapy and is effective in the management of GABHS pharyngitis . However, there are drawbacks to penicillin V therapy, including the length of the dosing regimen, which are leading to decreasing penicillin prescription rates in many countries . In addition bacteriologic treatment failures have been documented in up to 35% of GABHS patients treated with penicillin V, particularly in children <6 years old . A number of mechanisms may be responsible for these failures, but poor compliance with the standard 10-day penicillin treatment is likely to be a major factor . There is growing evidence to suggest that children with GABHS pharyngitis can be effectively treated with non-penicillin V antibiotics, which have the advantage of simpler and shorter dosing regimens compared with penicillin V . Among the antibiotics that have been tested clinically, azithromycin is the most widely studied . A total dose of 60 mg/kg azithromycin, given either as 12 mg/kg once daily for 5 days or 20 mg/kg once daily for 3 days, provides the best rate of GABHS eradication . Thus a total dose of 60 mg/kg azithromycin given during 3 or 5 days constitutes an alternative treatment to standard penicillin therapy in cases of penicillin hypersensitivity, when patient nonadherence to a 10-day penicillin regimen is suspected or for patients who fail therapy with a beta-lactam. J Infect Dis, 2004 Feb 15, 189(4), 717 - 23 Epub 2004 Feb 04. Group A streptococci from a remote community have novel multilocus genotypes but share emm types and housekeeping alleles with isolates from worldwide sources; McGregor KF et al.; Group A streptococci (GAS) cause several human diseases that differentially affect distinct host populations . Genotypes were defined by multilocus sequence typing and emm typing for 137 organisms collected from individuals in a remote aboriginal island community in tropical Australia and compared with >200 isolates obtained from sources elsewhere in the world . The majority of aboriginal-derived isolates shared emm types and housekeeping alleles with GAS isolates recovered from outside Australia, but these emm types and alleles were in novel combinations . There were many examples in which isolates from aboriginal and non-Australian subjects shared the same emm type, but for approximately 50% of emm types, the multilocus genotypes of isolates of the same emm type but from different regions were very different . A single emm type may typically define a single clone within the United States and on the remote island that is the focus of this study, but in many cases, these clones will be different, and this finding has implications for attempts to make global associations between emm types and certain disease manifestations. Caries Res, 2004 Mar-Apr, 38(2), 156 - 62 Assessment of caries risk in preschool children; Pienihakkinen K et al.; The study aimed to assess the additional caries-predictive value of visible plaque, gingival bleeding, and the reported use of fluorides and candies, when combined with the information about mutans streptococci (MS) and incipient carious lesions . The subjects were 2 years of age at the baseline examination (n = 226), and they were all given conventional prevention during the 3-year follow-up period . None of the studied single risk indicators reached an accuracy of 80% in predicting the 3-year caries increment . At best, the accuracy was 75% for the MS strip . Use of candies and incipient caries lesions had additional caries-predictive value (multiple logistic regression analysis) . The combined use of these three risk indicators resulted in an accuracy of 81% . The present results indicate that in 2-year-old children, the combination of two or three risk indicators (MS strip, incipient caries lesions, and use of candies) might have caries-predictive power enough for clinical implications . Caries Res, 2004 Mar-Apr, 38(2), 95 - 103 Colonization of Streptococcus mutans and Streptococcus sobrinus genotypes and caries development in children to mothers harboring both species; Lindquist B et al.; The major route of early acquisition of mutans streptococci in humans is a vertical transmission from mother to child . The purpose of this longitudinal study was to examine the acquisition, distribution and persistence of Streptococcus mutans and Streptococcus sobrinus in children whose mothers harbored both species and to study the caries incidence in relation to colonization of these bacteria . Fifteen mother-child pairs were followed during the child's first 7 years . Stimulated salivary samples were taken from the mothers and the children . Plaque samples were also collected from the teeth and the tongue of the children . The samples were analyzed by cultivating techniques together with genomic fingerprinting and hybridizing . The caries experience was evaluated on the sampling occasions and retrospectively using the records of caries registrations from the community clinics . During the 7-year period 10 of the 15 children acquired mutans streptococci . Only 4 of them were colonized by both S . mutans and S . sobrinus despite the fact that their mothers harbored both species . In 2 of the children S . sobrinus was found later than S . mutans . A total of 26 genotypes were found in the children and 9 of them were identical to their mothers . New genotypes and a gain-loss pattern were noted especially in the children but also in their mothers . The groups of teeth first positive for the two species were the deciduous molars . The caries experience was low during the study period with 8 children showing no caries . Caries Res, 2004 Mar-Apr, 38(2), 85 - 90 Influence of weight on removal of co-adhering bacteria from salivary pellicles by different modes of brushing; van der Mei HC et al.; This study compared removal of pairs of co-adhering and non-co-adhering oral actinomyces and streptococci from salivary pellicles by manual, rotating/oscillating electric and sonic toothbrushes, applying weights up to 240 g . First, actinomyces were allowed to adhere to a pellicle in a parallel plate flow chamber, after which streptococci suspended in saliva were perfused through the chamber at 33 degrees C . On average, 34-39% of the adhering bacteria were adhering as single organisms . For co-adhering and non-co-adhering pairs, 33 and 10% of the adhering bacteria were involved, respectively, in aggregates comprising more than 10 organisms . Brushing by hand removed 82% at low weight (40 g), which was less than by electric (93%) or sonic (92%) brushing, while for all modes of brushing bacterial removal increased with increasing weight to 95-99% . For a non-co-adhering pair, subsequent exposure of brushed pellicles to a streptococcal suspension yielded only 2-16% of bacteria involved in large aggregates, regardless of the mode of brushing . For the co-adhering pair, however, de novo streptococcal adhesion to hand-brushed pellicles yielded 34-57% of bacteria involved in large aggregates, while electric and sonic brushing left 22-35% of the bacteria involved in large aggregates . De novo streptococcal adhesion for the co-adhering pair increased with increasing weight for the electric and sonic brush in contrast to the manual brush . Since a strong influence of co-adhesion is evident in de novo streptococcal adhesion, despite nearly complete removal of all actinomyces, these observations suggest that the three modes of brushing leave footprints to which streptococci preferentially adhere . J Clin Microbiol, 2004 Feb, 42(2), 639 - 44 Genetic diversity of cell-invasive erythromycin-resistant and -susceptible group A streptococci determined by analysis of the RD2 region of the prtF1 gene; Spinaci C et al.; The RD2 region of the internalization-associated gene prtF1, which encodes the fibronectin-binding repeat domain type 2 of protein F1, plays a crucial role in the entry of group A streptococci (GAS) into epithelial cells . A molecular study of the variability of the RD2 region was carried out with 77 independent Italian GAS, 66 erythromycin resistant (ER) and 11 erythromycin susceptible (ES), which had previously been investigated for the association between erythromycin resistance and ability to enter human respiratory cells . The amplicons obtained from PCR analysis of the RD2 region were consistent with a number of RD2 repeats ranging from one to five, more frequently four (n = 30), three (n = 27), and one (n = 18) . A new method to type cell-invasive GAS (RD2 typing) was developed by combining PCR analysis of the RD2 region and restriction analysis of PCR products with endonucleases HaeIII, DdeI, and HinfI . Overall, 10 RD2 types (a to j) were distinguished (all detected among the 66 ER isolates, four detected among the 11 ES isolates) . Comparison and correlation of RD2 typing data with the genotype and phenotype of macrolide resistance and with data from PCR M typing and SmaI macrorestriction analysis allowed us to identify 41 different clones (31 among the 66 ER isolates and 10 among the 11 ES isolates) . Three major clones accounted for 40% of the isolates (47% of ER strains) . Some ES isolates appeared to be related to ER isolates with identical combinations of RD2 type and emm type . While simultaneous use of different typing methods is essential for a thorough investigation of GAS epidemiology, RD2 typing may be especially helpful in typing cell-invasive GAS. J Clin Microbiol, 2004 Feb, 42(2), 497 - 504 rpoB gene sequence-based identification of aerobic Gram-positive cocci of the genera Streptococcus, Enterococcus, Gemella, Abiotrophia, and Granulicatella; Drancourt M et al.; We developed a new molecular tool based on rpoB gene (encoding the beta subunit of RNA polymerase) sequencing to identify streptococci . We first sequenced the complete rpoB gene for Streptococcus anginosus, S . equinus, and Abiotrophia defectiva . Sequences were aligned with these of S . pyogenes, S . agalactiae, and S . pneumoniae available in GenBank . Using an in-house analysis program (SVARAP), we identified a 740-bp variable region surrounded by conserved, 20-bp zones and, by using these conserved zones as PCR primer targets, we amplified and sequenced this variable region in an additional 30 Streptococcus, Enterococcus, Gemella, Granulicatella, and Abiotrophia species . This region exhibited 71.2 to 99.3% interspecies homology . We therefore applied our identification system by PCR amplification and sequencing to a collection of 102 streptococci and 60 bacterial isolates belonging to other genera . Amplicons were obtained in streptococci and Bacillus cereus, and sequencing allowed us to make a correct identification of streptococci . Molecular signatures were determined for the discrimination of closely related species within the S . pneumoniae-S . oralis-S . mitis group and the S . agalactiae-S . difficile group . These signatures allowed us to design a S . pneumoniae-specific PCR and sequencing primer pair. J Dairy Sci, 2004 Jan, 87(1), 95 - 105 Associations between pathogen-specific cases of clinical mastitis and somatic cell count patterns; de Haas Y et al.; Associations were estimated between pathogen-specific cases of clinical mastitis (CM) and somatic cell count (SCC) patterns based on deviations from the typical curve for SCC during lactation and compared with associations between pathogen-specific CM and lactation average SCC . Data from 274 Dutch herds recording CM over an 18-mo period were used . Pathogens found were Staphylococcus aureus, coagulase-negative staphylococci, Escherichia coli, Streptococcus dysgalactiae, Streptococcus uberis, streptococci other than Strep . dysgalactiae and Strep . uberis, and culture-negative samples . The dataset contained 245,595 test-day records on SCC, recorded in 24,012 lactations of 19,733 cows of different parities . Pattern definitions were based on three or five consecutive test-day records . The patterns differentiated between a short or longer period of increased SCC and also between lactations with and without recovery . Logistic regression was applied to identify associations between presence of patterns and occurrence of pathogens . Occurrence of overall CM in a lactation is equally or even more accurately predicted by the presence of SCC in that lactation, than by a lactation average SCC of more than 200,000 cells/mL . Patterns can also distinguish between chances of risk for specific mastitis-causing pathogens . Clinical E . coli mastitis was significantly associated with the presence of a short peak in SCC, whereas Staph . aureus was associated with long increased SCC . Streptococcus dysgalactiae was not strongly associated with any of the defined patterns of peaks in SCC, and no single unambiguous pattern was found for Strep . uberis. Arch Pediatr, 2004 Feb, 11(2), 122 - 5 {Streptococcus pyogenes endocarditis following varicella: a case report}; Merlin E et al.; Although varicella is most often a benign and self-limited disease of childhood, it can be associated with a variety of serious and potential lethal complications . Especially, the incidence of severe infectious complications caused by group A streptococci has been increasing over the last years . We report the case of a previously healthy young boy with an aortic bicuspidy who developed a varicella complicated by endocarditis due to group A streptococcus, and a haemophagocytic syndrome . A favorable outcome was obtained after an early valvular replacement and 6 weeks of intravenous antibiotics. Mol Microbiol, 2004 Jan, 51(2), 497 - 509 Staphylococcus aureus multiresistance plasmid pSK41: analysis of the replication region, initiator protein binding and antisense RNA regulation; Kwong SM et al.; The vast majority of large staphylococcal plasmids characterized to date appear to possess an evolutionarily common replication system, which has clearly had a major impact on the evolution of antimicrobial resistant staphylococci worldwide . Related systems have also been found in plasmids from other Gram-positive genera, including enterococci, streptococci and bacilli . The 46.4 kb plasmid pSK41 is the prototype of a family of conjugative staphylococcal multiresistance plasmids . The replication region of pSK41 encodes a protein product, Rep, which was shown to be essential for replication; mutations that truncated Rep could be complemented in trans . Rep was found to bind in vitro to four tandem repeat sequences located centrally within the rep coding region . An A + T-rich inverted repeat sequence upstream of rep was required for efficient replication, whereas no sequences downstream of rep were necessary . An antisense countertranscript, RNAI, encoded upstream of rep was identified and transcriptional start points for both RNAI and the rep-mRNA were defined. Bone Marrow Transplant, 2004 Apr, 33(8), 847 - 53 Pharmacokinetics and effects on bowel and throat microflora of oral levofloxacin as antibacterial prophylaxis in neutropenic patients with haematological malignancies; Timmers GJ et al.; Gram-positive breakthrough infections pose a major drawback to the use of quinolones for antibacterial prophylaxis in neutropenic patients . Levofloxacin offers the advantage of an augmented Gram-positive spectrum and may potentially overcome this problem . In an open-label, clinical pilot study, we investigated the effects on throat and bowel microflora and pharmacokinetics of a once-daily oral dose of 500 mg levofloxacin, during neutropenia in 20 patients with haematological malignancies . Gram-negative bowel flora and Staphylococcus aureus were successfully eradicated . No Gram-negative infections occurred . Minimal inhibitory concentration values for viridans group (VG) streptococci tended to increase, in four patients over 8 mg/l, indicating resistance to levofloxacin . Four patients developed blood-stream infections with levofloxacin-resistant Gram-positive cocci . No significant changes in numbers of anaerobic microorganisms were observed . Pharmacokinetic parameters of levofloxacin, including the maximum serum concentration (C(max)), time to C(max) (T(max)), area under the concentration-time curve (AUC), volume of distribution at steady state (V(ss)/F) and clearance (CL/F) were not statistically different at first dose and during neutropenia . In conclusion, levofloxacin eradicates Gram-negative microorganisms and S . aureus and spares the anaerobic flora . Its pharmacokinetic profile is unaltered during neutropenia . However, prolonged administration of levofloxacin as antibacterial prophylaxis may be hampered by the emergence of levofloxacin-resistant VG streptococci. J Biol Chem, 2004 Apr 16, 279(16), 15850 - 9 Epub 2004 Jan 28. Streptococcus pyogenes fibronectin-binding protein F2: expression profile, binding characteristics, and impact on eukaryotic cell interactions; Kreikemeyer B et al.; Some Streptococcus pyogenes (group A streptococci, GAS) strains have previously been shown to express the fibronectin-binding protein F2 instead of the functionally related but structurally dissimilar protein F1/SfbI . In this study, recombinant N-terminal and C-terminal portions and the two fibronectin-binding domains of protein F2 were used to assess affinity parameters of the interaction with fibronectin and its N-terminal 70-, 30-, and 45-kDa fragments . The association and dissociation equilibrium constants for both binding domains were in the nanomolar range, although the repeat domain of protein F2 exceeded the affinity of the unique domain by up to one order magnitude . Both domains primarily interacted with the 30-kDa fibronectin fragment . Using a prtF2 gene isogenic mutant of a serotype M49 GAS strain that does not harbor the protein F1/SfbI gene, the attachment values of whole bacteria to immobilized fibronectin and to HEp-2 epithelial cells were found to be 6- and 2-fold decreased, respectively . Reduction of prtF2 mutant internalization rates for eukaryotic cells exceeded the reduction of attachment rates, indicating an independent contribution of protein F2 to both processes . The prtF2 transcription and protein F2 expression profiles documented maximum expression at the transition to the stationary phase especially under aerobic growth condition . The protein F2 function as the major fibronectin-binding adhesin in a subset of GAS strains, its expression pattern, and highly specific interaction with fibronectin would be consistent with a status as an indispensable virulence factor for both earlier and later pathogenetic stages of GAS superficial infections. Mikrobiyol Bul, 2003 Oct, 37(4), 309 - 12 {Streptococcal toxic shock syndrome: a case report}; Ozkurt Z et al.; Streptococcal toxic shock syndrome (STSS) is the most severe form of invasive infections caused by group A streptococci . In this report, a 36-years-old man who was admitted to our clinic with the complaints of fever, rash, skin lesions, abdominal pain, weakness and anuria for 2 days, has been presented . His body temperature was 39.5 degrees C and blood pressure was 50/20 mmHg . In physical examination, diffuse erythematous rash on the body, cellulitis on left leg and foot, fungal lesions on the toes, and abdominal tenderness were noted . Laboratory results revealed a dramatic increase in leukocyte count, increased sedimentation rate, elevated blood urea nitrogen, cretinine, liver enzymes and bilirubin levels . Group A streptococci were isolated from the blood culture of the patient . Despite supportive (intravenous saline, dopamine) and antibiotic (clindamycin-ceftriaxone combination) therapies, adult respiratory distress syndrome has developed in two days, and he died on the third day . This case was presented to draw attention to STSS, which was a rare clinical entity with rapid progression to mortality despite aggressive medical therapy. Mikrobiyol Bul, 2003 Oct, 37(4), 225 - 34 {Macrolide antibiotic resistance rates and phenotypes of group A beta hemolytic streptococci isolated between the years 1999-2000 and 2001-2002}; Senses Z et al.; Macrolide resistance in group A beta hemolytic streptococci (GABHS) have been reported with increasing frequency from various geographic regions in the world, and for the respective treatment alternatives and epidemiologic studies, macrolide resistance rates and phenotypes have been determined . In this study erythromycin, clarithromycin and azithromycin were tested with disc diffusion method against 560 GABHS, isolated from the throat samples collected between 1999-2002 . NCCLS guidelines were followed for the susceptibility tests and MIC values were obtained by E-Test in resistant isolates . For determining the resistance phenotype, erythromycin and clindamycin discs were used . Only one isolate (0.27%) was found intermediately resistant to erythromycin, and clarithromycin, and resistant to azithromycin between May 1999-January 2000, whereas in the period between January 2001-June 2002, one isolate (%0.5) was found susceptible to erythromycin and clarithromycin, but intermediately resistant to azithromycin . In each period three isolates (0.83% and 1.5%, respectively) were found to be resistant to all the tested macrolides . There was no statistically significant difference between the resistance rates in these periods . Three of the resistant isolates had inducible type, and the other five isolates had M phenotype macrolide resistance . Testing for macrolide susceptibilities and screening the resistance phenotypes have crucial importance in case of GABHS infections, since these can be taken into consideration for epidemiological issues as well as a guide for empirical treatment protocols in any geographical setting, as well as in our country. Lett Appl Microbiol, 2004, 38(2), 125 - 9 Species-specific PCR method for identification of Streptococcus downei; Igarashi T et al.; AIMS: To establish a rapid method to differentiate Streptococcus downei and S . sobrinus by multiplex PCR . METHODS AND RESULTS: A PCR primer pair specific to S . downei was designed on the basis of the nucleotide sequence of the dextranase gene of S . downei NCTC 11391T . The primer pair specifically detected S . downei, but none of the other mutans streptococci (16 strains of six species) . The PCR procedure was capable of detecting 1 pg of genomic DNA purified from S . downei NCTC 11391 and as few as 14 CFU of S . downei cells . The mixture of primer pairs specific to each S . downei (this study) and S . sobrinus (Igarashi et al . 2000) detected only the strains of these two species among all the mutans streptococcal strains, and concomitantly differentiated the two species by species-specific amplicons of different lengths . CONCLUSIONS: The present PCR method is highly specific to S . downei and is useful for detection and identification of S . downei . SIGNIFICANCE AND IMPACT OF THE STUDY: Multiplex PCR using dextranase gene primers is a useful method for simultaneous detection and differentiation of S . downei and S . sobrinus. Bone Marrow Transplant, 2004 Apr, 33(7), 745 - 9 Bacteremia after hematopoietic stem cell transplantation: incidence and predictive value of surveillance cultures; Frere P et al.; We studied 622 transplants undertaken between 1982 and 2001 to: (1) determine the incidence, timing and etiology of bacteremias, and (2) examine the ability of routine surveillance cultures to predict bacteremias . A total of 404 episodes (0.65 episode per patient) occurred in 248 patients, due to coagulase-negative staphylococci (n=171, 42%), Gram-negative bacteria (n=129, 32%), streptococci (n=48, 12%), other Gram-positive bacteria (n=33, 8%), anaerobes (n=9, 2%) and fungi (n=14, 3%) . Bacteremias were more frequent in allogeneic (0.96 episode/patient) compared to autologous (0.44) transplants (P<0.0001) . The overall incidence decreased from 0.92 episode/patient until 1990 to 0.66 in 1991-1996 and 0.55 in 1997-2001 (P<0.0001), but this was only observed in autologous transplants . Among them, 212 (53%) occurred before hospital discharge and 192 (47%) thereafter . This proportion was lower for coagulase-negative staphylococci, other Gram-positive bacteria and Gram-negative bacteria compared to other agents (P=0.001) . In 50% of the cases, the agent responsible for the bacteremic episode was present in routine surveillance cultures previously . In conclusion: (1) bacteremias remain a frequent complication, particularly in allogeneic transplantation, even long after hospital discharge; (2) routine surveillance cultures can predict bacteremias in 50% of the cases, but the practical impact of this observation is limited in view of the costs. Antimicrob Agents Chemother, 2004 Feb, 48(2), 677 - 80 Telithromycin susceptibility and genomic diversity of macrolide-resistant serotype III group B streptococci isolated in perinatal infections; Bingen E et al.; We studied the telithromycin, erythromycin, azithromycin, and clindamycin susceptibilities of serotype III macrolide-resistant group B streptococci, together with genetic mechanisms of resistance and genomic diversity . ermB, ermA, and mefA were found in, respectively, 57, 32, and 9% of isolates . The telithromycin MIC at which 90% of isolates were inhibited was 0.5 micro g/ml . Macrolide resistance was associated with dissemination of resistance determinants among isolates of different genetic backgrounds. Antimicrob Agents Chemother, 2004 Feb, 48(2), 473 - 6 Reemergence of macrolide resistance in pharyngeal isolates of group a streptococci in southwestern Pennsylvania; Green M et al.; We previously reported on the emergence of macrolide-resistant pharyngeal isolates of group A streptococci (GAS) in our community . The purpose of the present study was to track longitudinal trends in macrolide resistance in these isolates in southwestern Pennsylvania . Testing for susceptibility to erythromycin and clindamycin was performed for all pharyngeal GAS isolates recovered at the Children's Hospital of Pittsburgh and a local pediatric practice between September 2001 and May 2002 . Macrolide resistance phenotypes and genotypes were determined by double-disk diffusion and PCR, respectively . Strain relatedness was determined by field inversion gel electrophoresis and emm gene sequence typing . A total of 708 isolates of GAS were recovered during the study period; 68 (9.6%) were macrolide resistant, while all isolates were sensitive to clindamycin . The monthly prevalence of macrolide resistance ranged from 0 to 41% . Only 21 of 573 (3.7%) strains recovered from September 2001 through March 2002 were macrolide resistant . A sudden increase in the rate of macrolide resistance (47 of 135 isolates {35%}) was seen in April and May 2002 . Sixty-two isolates demonstrated the M phenotype (resistance to macrolide antibiotics), and six isolates demonstrated the MLS(B) phenotype (resistance to most macrolide, lincosamide, and streptogramin B antibiotics); these isolates were confirmed to be mef(A) and erm(A), respectively . Three unique mef(A) clones and four unique erm(A) clones were identified among the resistant isolates . The MIC at which 50% of isolates are inhibited (MIC(50)) for the mef(A) strains was 16 micro g/ml, while the MIC(50) for erm(A) strains was 8 micro g/ml . The finding of high levels of macrolide resistance among pharyngeal isolates of GAS for a second successive year in our community raises the concern that this problem may be more common in the United States than was previously appreciated . Longitudinal surveillance of isolates from multiple centers is needed to define the prevalence of antimicrobial agent-resistant GAS in the United States. Pharmacotherapy, 2004 Jan, 24(1), 58 - 68 Oritavancin and tigecycline: investigational antimicrobials for multidrug-resistant bacteria; Guay DR; The advent of multidrug-resistant gram-positive aerobes such as Staphylococcus aureus, Streptococcus pneumoniae, and the enterococci, which are resistant to beta-lactams, vancomycin, and a host of other commonly used antimicrobials, has complicated our approach to antibiotic therapy . Despite marketing of the first oxazolidinone, linezolid, and the streptogramin combination, quinupristin-dalfopristin, an urgent need exists for more agents to combat these pathogens . Two such agents, the glycopeptide oritavancin (LY333328) and the glycylcycline tigecycline (GAR-936), are in phase III clinical trials . These agents, which require parenteral administration, exhibit substantial in vitro activity against a variety of gram-positive aerobes and anaerobes, including the multidrug-resistant organisms listed previously . Only tigecycline demonstrates useful activity against gram-negative organisms . Combination therapy of these agents with ampicillin or aminoglycosides frequently leads to synergistic in vitro activity against multidrug-resistant staphylococci and streptococci . These agents are also active in a variety of animal models of systemic and localized infections . Few published efficacy and tolerability data are available in humans . If controlled clinical trial data verify these agents' efficacy and tolerability, both drugs should become welcome additions to the available antimicrobials . However, restricting their use to the treatment of infections caused by bacteria resistant to other antimicrobials, especially multidrug-resistant staphylococci and streptococci, may prolong their clinical utility by retarding the development of resistance . Careful surveillance of bacterial sensitivity to these agents should be undertaken to assist clinicians in the decision whether or not to use these agents empirically to treat infections caused by suspected multidrug-resistant gram-positive pathogens. Ned Tijdschr Geneeskd, 2003 Dec 20, 147(51), 2505 - 8 {A pseudo-epidemic of puerperal sepsis}; Dietz V et al.; Within a four-week period, five patients were admitted to the maternity ward of the Utrecht Children's Hospital diagnosed with puerperal sepsis due to group-A streptococcal infection . The clinical presentation was different for each patient . All patients recovered upon adequate antibiotic treatment . One of the children died, possibly due to sepsis and hypotension of his mother . As group-A streptococci can be extremely contagious and an epidemic was suspected, measures for additional hygiene were taken . Furthermore, all personnel at the maternity ward and the obstetric centre were tested . T-serotyping, M-genotyping, exotoxin A- and C-gene amplification and pulsed field gel electrophoresis were used to characterize the cultured group-A streptococci . Cross-contamination was not found . Therefore, this increase in puerperal sepsis was attributed to polyclonal expansion rather than an epidemic . All mothers of newly born children who present with fever and lower abdominal pain should be suspected of group-A streptococcal infection . Evaluation and treatment in hospital is indicated due to a sometimes fulminant course . When group-A streptococci are cultured again in a new pregnancy, eradication therapy during pregnancy or prophylactic treatment during birth should be considered to prevent recurrent infection. Int J Antimicrob Agents, 2004 Jan, 23(1), 95 - 8 Genetic and phenotypic characterization of resistance to macrolides in Streptococcus pyogenes from Argentina; Martinez S et al.; Five hundred and seventy-eight strains of group A streptococci (GAS) isolated mostly from paediatric pharyngeal swabs were tested to evaluate their susceptibility to erythromycin . Resistant strains were then tested for their MICs to erythromycin and clindamycin, their phenotype of resistance to macrolides-lincosamides-streptogramin (MLS(B)) and for the presence of macrolide resistance genes . The rate of resistance to erythromycin was 8.2% . Constitutive, inducible and M phenotypes of resistance were detected in 2.1, 2.1 and 95.8% of resistant strains, respectively . All M phenotypes harboured the mefA gene, whereas constitutive and inducible phenotypes had ermB and ermTR genes, respectively. Int J Antimicrob Agents, 2004 Jan, 23(1), 67 - 71 Failure to eradicate Group A beta-haemolytic streptococci (GABHS) from the upper respiratory tract after antibiotic treatment; Kafetzis DA et al.; The clinical efficacy, safety and bacteriological eradication of Group A beta-haemolytic streptococci (GABHS) from the throat was studied after treatment of streptococcal tonsillopharyngitis with three commonly used oral antibiotics in a prospective, open labelled, comparative, randomised trial of 265 evaluable patients seen in one centre . All three antibiotics were administered in the recommended doses; penicillin V q8 hourly and clarithromycin q12 hourly were given for 10 days and cefprozil q12 hourly for 5 days . Clinical results and adverse events were similar for all three antibiotics used, with a prompt clinical outcome of >95% . Cefprozil had the best bacteriological eradication rate (failed to eradicate: 13.2, 15.1, 2.3; relapses: 13.2, 11.4, 5.7%, for penicillin, clarithromycin and cefprozil, respectively) . Oral penicillin remains a clinically effective and safe antibiotic for the treatment of streptococcal pharyngitis . However, compliance and convenience for parents and children when they are asked to follow a 10 days course, especially when the patient has improved from the second or third day, together with the high incidence of bacteriological eradication failures, is an issue. Int J Antimicrob Agents, 2004 Jan, 23(1), 6 - 10 Preliminary susceptibility testing guidelines for AZD2563, a long-acting oxazolidinone; Anderegg TR et al.; Rapid expansion of antimicrobial resistance has led to the development of new antimicrobial agents . AZD2563 is a novel oxazolidinone that has activity similar to linezolid and the potential for extended dosing intervals . Recent Gram-positive clinical organisms (1572 strains) were tested including four oxazolidinone-resistant enterococci . Strains processed were: 313 Staphylococcus aureus, 299 coagulase-negative staphylococci, 305 enterococci, 305 Streptococcus pneumoniae, 300 other streptococci (beta-haemolytic and viridans group) and 50 other rarely isolated Gram-positive species . The methods (agar and broth dilution, disk diffusion) of the National Committee for Clinical Laboratory Standards (NCCLS; M7-A6, M2-A8) were followed and linezolid was used as a control agent . A tentative MIC breakpoint (<or=2mg/l) for AZD2563 was based on the manufacturer's recommendation, preliminary pharmacodynamic information and similarity to the current linezolid interpretive criteria . Correlation between AZD2563 MIC values and zone diameters around 30 microg AZD2563 disks indicated a 99.9% categorical agreement and all intermethod errors were minor . Comparison of agar dilution to broth microdilution MIC results for AZD2563 showed 100.0% agreement +/- one log(2) dilution step (89.2% of MIC results were identical) . Scattergrams suggest that all Gram-positive organisms could be accurately tested using the same interpretive criteria: susceptible at <or=2mg/l (>or=20 mm), intermediate at 4 mg/l (17-19 mm) and resistant at >or=8 mg/l (<or=16 mm) . These tentative AZD2563 interpretive guidelines should facilitate in vitro susceptibility testing during clinical trials and detect all oxazolidinone-resistant isolates. Dermatology, 2004, 208(1), 5 - 9 Group a beta-haemolytic streptococcal necrotising fasciitis: early diagnosis and clinical features; Simonart T; Necrotising fasciitis (NF) due to group A beta-haemolytic streptococci (GAS) is a rare but still life-threatening soft-tissue infection characterised by rapidly spreading inflammation and subsequent necrosis of the muscle fascia and of the surrounding tissues . Previous studies have emphasised that the outcome of patients with NF depends essentially on early diagnosis and treatment, consisting of extensive surgical debridement, along with appropriate antibiotic therapy . However, one of the striking features of the published series of GAS NF is that there was a delay in diagnosis in several cases, which underscores the difficulty of the early diagnosis of the condition . The goal of this article was to review the clinical features and diagnostic tools that could facilitate the early recognition of GAS NF . J Antimicrob Chemother, 2004 Feb, 53(2), 271 - 6 Epub 2004 Jan 16. Oropharyngeal carriage of macrolide-resistant viridans group streptococci: a prevalence study among healthy adults in Belgium; Malhotra-Kumar S et al.; OBJECTIVES: Viridans group streptococci (VGS) are gaining significance as reservoirs of resistance determinants for respiratory tract pathogens . Our aim was to investigate healthy adults for oropharyngeal carriage of VGS that are resistant to macrolides, as well as to other common antibiotics . METHODS: Macrolide-resistant VGS were isolated from throat samples of 154 healthy Belgian adults, and phenotyped and genotyped for erm(A), erm(B) and mef(A) . In vitro susceptibilities to 10 antimicrobials and the presence of tetracycline resistance genes were also determined . RESULTS: Carriage was detected in 71% of the population screened, from whom 157 unique, macrolide-resistant VGS were isolated . A constitutive (cMLS) phenotype was present in 105 isolates, of which 102 isolates carried either erm(B) or erm(B) + mef(A) . The remaining three isolates did not present with any of the genes studied . All 45 isolates showing the M phenotype carried mef(A) . The least abundant inducible (iMLS) isolates (n = 7) carried either erm(B) or erm(B) + mef(A) . The most abundant macrolide-resistant VGS species was Streptococcus mitis (51%) . Co-resistance to tetracycline was identified in 114 isolates, of which tet(M) was present in 105, tet(O) in two and both tet(M) and tet(O) in one, while the remaining six isolates did not present with either gene . tet(M) was also present in four tetracycline susceptible and two intermediately resistant isolates . Fluoroquinolone resistance (ciprofloxacin MIC > or = 4 mg/L) was detected in 16 isolates . Resistance to telithromycin, penicillin and chloramphenicol was appreciably low . CONCLUSIONS: This study highlights a high oropharyngeal carriage of macrolide-resistant VGS and its co-resistance to tetracycline and fluoroquinolones among healthy Belgian adults. Clin Infect Dis, 2004 Feb 1, 38(3), 452 - 5 Epub 2004 Jan 09. Nutritionally variant streptococcal infections at a University Hospital in Taiwan: dise