Streptococcal

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: disease emergence and high prevalence of beta-lactam and macrolide resistance; Liao CH et al.; From January 1993 to December 2002, 28 patients with nutritionally variant streptococci (NVS) infections were treated at a university hospital in Taiwan . Twelve (43%) of these patients had various underlying malignancies, and 7 (25%) had underlying valvular heart diseases . Nine patients (32%) had infective endocarditis, and 9 (32%) had primary bacteremia . The deaths of 7 patients (25%) were directly related to NVS infection . Among the 28 isolates recovered from these patients, 50% were not susceptible to penicillin, 33% were not susceptible to cefotaxime, and 93% were not susceptible to azithromycin.

Lancet, 2004 Jan 10, 363(9403), 139 - 49
Infective endocarditis; Moreillon P et al.; Despite improvements in health care, the incidence of infective endocarditis has not decreased over the past decades . This apparent paradox is explained by a progressive evolution in risk factors; while classic predisposing conditions such as rheumatic heart disease have been all but eradicated, new risk factors for infective endocarditis have emerged . These include intravenous drug use, sclerotic valve disease in elderly patients, use of prosthetic valves, and nosocomial disease . Newly identified pathogens, which are difficult to cultivate--eg, Bartonella spp and Tropheryma whipplei--are present in selected individuals, and resistant organisms are challenging conventional antimicrobial therapy . Keeping up with these changes depends on a comprehensive approach, allying understanding of the pathogenesis of disease with the development of new drugs for infective endocarditis . Infection by staphylococci and streptococci is being dissected at the molecular level . New ideas for antimicrobial agents are being developed . These novel insights should help redefine preventive and therapeutic strategies against infective endocarditis.

Indian J Med Res, 2003 Nov, 118, 187 - 91
Spectrum of beta-haemolytic streptococcal soft tissue infections at a tertiary care hospital of north india; Mathur P et al.; BACKGROUND & OBJECTIVES: An increase in the incidence of invasive beta haemolytic streptococcal infections has been observed in many Western countries . However, the role of beta-haemolytic streptococci in soft tissue infections is not well documented in developing countries . A retrospective study was carried out to review the spectrum of soft tissue infections caused by beta-haemolytic streptococci (betaHS) in a tertiary care hospital of north India . METHODS: The laboratory records of all patients with betaHS isolated from soft tissues between January 1996 and December 2000 were reviewed . Detailed clinical, laboratory and demographic data were recorded for all patients . RESULTS: A total of 39288 samples from soft tissue infections were received in the bacteriology laboratory for bacterial culture during the study period . betaHS were recovered from 205 samples . Of these, 56 per cent isolates were obtained from patients of suspected osteomyelitis . A seasonal pattern was observed with maximum isolation occuring in the winter months . Group A was the commonest isolate (75%), followed by group B Streptococcus (11%) . Group C and G betaHS together accounted for about 3 per cent of all the isolates . All the isolates were sensitive to penicillin . INTERPRETATION & CONCLUSION: Soft tissue infections due to betaHS are common in our country . Group A streptococci were encountered most frequently with these infections though other groups of betaHS also contributed substantially . Since these infections are life threatening, there is a need to develop preventive, diagnostic and therapeutic strategies against betaHS.

Scand J Infect Dis, 2003, 35(11-12), 873 - 6
Three cases of viridans group streptococcal bacteremia in children with febrile neutropenia and literature review; Danilatou V et al.; Three cases of viridans group streptococcal bacteremia in 2 children with brain tumours and in 1 with autoimmune neutropenia are presented . All children were neutropenic . The 2 patients with malignancy also had mucositis . The isolated strains of viridans group streptococci showed considerable resistance to antibiotics . All patients were empirically treated with third generation cephalosporins and amikacin, before antibiotic sensitivities were available and recovered without complications . Viridans group streptococcal bacteremia should be suspected in neutropenic children, especially in the presence of mucositis . Prospective, randomized clinical trials of mouth antiseptics are needed to clarify the usefulness, if any, of such measures in the reduction of viridans group streptococcal bacteremia in this group of patients.

J Pediatr Health Care, 2004 Jan-Feb, 18(1), 3 - 7
Childhood cervical lymphadenopathy; Leung AK et al.; Cervical lymphadenopathy is a common problem in children . The condition most commonly represents a transient response to a benign local or generalized infection, but occasionally it might herald the presence of a more serious disorder . Acute bilateral cervical lymphadenopathy usually is caused by a viral upper respiratory tract infection or streptococcal pharyngitis . Acute unilateral cervical lymphadenitis is caused by streptococcal or staphylococcal infection in 40% to 80% of cases . The most common causes of subacute or chronic lymphadenitis are cat scratch disease, mycobacterial infection, and toxoplasmosis . Supraclavicular or posterior cervical lymphadenopathy carries a much higher risk for malignancies than does anterior cervical lymphadenopathy . Generalized lymphadenopathy is often caused by a viral infection, and less frequently by malignancies, collagen vascular diseases, and medications . Laboratory tests are not necessary in the majority of children with cervical lymphadenopathy . Most cases of lymphadenopathy are self-limited and require no treatment . The treatment of acute bacterial cervical lymphadenitis without a known primary source should provide adequate coverage for both Staphylococcus aureus and group A beta hemolytic streptococci.

J Clin Microbiol, 2004 Jan, 42(1), 469 - 73
Identification and molecular characterization of beta-hemolytic streptococci isolated from harbor seals (Phoca vitulina) and grey seals (Halichoerus grypus) of the German North and Baltic Seas; Vossen A et al.; Bacteriological investigations of seals of the German North and Baltic seas resulted in the isolation of bacteria of the genus Streptococcus belonging to Lancefield's serological groups C, F, and L . According to biochemical, serological, and 16S ribosomal DNA analysis, the group C and group F streptococci were identified as Streptococcus phocae . The group L streptococci could be classified as Streptococcus dysgalactiae subsp . dysgalactiae.

J Clin Microbiol, 2004 Jan, 42(1), 369 - 71
Amplified fragment length polymorphism fingerprinting is an effective technique to distinguish streptococcus pneumoniae from other Streptococci and an efficient alternative to pulsed-field gel electrophoresis for molecular typing of pneumococci; Neeleman C et al.; Amplified fragment length polymorphism versus pulsed-field gel electrophoresis was used for fingerprinting of 85 macrolide-resistant pneumococcal isolates identified by using primarily phenotypic methods . Confirmation of identification by 16S rRNA sequencing revealed that 27 isolates were actually nonpneumococci . Amplified fragment length polymorphism but not pulsed-field gel electrophoresis offered simultaneous and accurate discrimination between pneumococci and nonpneumococcal species.

J Clin Microbiol, 2004 Jan, 42(1), 186 - 92
Characterization of group C and G streptococcal strains that cause streptococcal toxic shock syndrome; Hashikawa S et al.; Twelve strains (the largest number ever reported) of group C and G(1) streptococci (GCS and GGS, respectively) that caused streptococcal toxic shock syndrome (STSS) were collected and characterized . Eleven strains were identified as Streptococcus dysgalactiae subsp . equisimilis, and one strain was identified as Streptococcus equi subsp . zooepidemicus . We found that it was the first reported case of STSS caused by S . equi subsp . zooepidemicus . Cluster analysis according to the 16S rRNA gene (rDNA) sequences revealed that the S . dysgalactiae strains belonged to clusters I and II, both of which were closely related . The emm types and the restriction patterns of chromosomal DNA measured by pulsed-field gel electrophoresis were highly variable in these strains except BL2719 and N1434 . The 16S rDNA sequences and other characteristics of these two strains were indistinguishable, suggesting the clonal dissemination of this particular S . dysgalactiae strain in Japan . As the involvement of superantigens in the pathogenesis of group A streptococcus-related STSS has been suggested, we tried to detect known streptococcal superantigens in GCS and GGS strains . However, only the spegg gene was detected in seven S . dysgalactiae strains, with none of the other superantigen genes being detected in any of the strains . However, the sagA gene was detected in all of the strains except Tokyo1291 . In the present study no apparent factor(s) responsible for the pathogenesis of STSS was identified, although close genetic relationships of GCS and GGS strains involved in this disease were suggested.

J Clin Microbiol, 2004 Jan, 42(1), 146 - 50
Comparison of DNA dot blot hybridization and lancefield capillary precipitin methods for group B streptococcal capsular typing; Borchardt SM et al.; Group B streptococci (GBS) (Streptococcus agalactiae) are a major cause of sepsis and meningitis in neonates and infants and of invasive disease in pregnant women, nonpregnant, presumably immunocompromised adults, and the elderly . Nine GBS serotypes based on capsular polysaccharide antigens have been described . The serotype distributions among invasive and colonizing isolates differ between pediatric and adult populations and have changed over time . Thus, periodic monitoring of GBS serotype distributions is necessary to ensure the proper formulation and application of an appropriate GBS vaccine for human use and to detect the emergence of novel serotypes . Since the mid-1990s, the proportion of GBS isolates that are nontypeable by standard serologic methods has increased, creating a need for more sensitive typing methods . We describe a typing method that uses DNA dot blot hybridization with probes generated by PCR from the GBS capsular genes for serotypes Ia, Ib, and II to VIII . PCR primers were designed to amplify type-specific GBS capsular gene sequences . Gene probes were constructed from the PCR products and used to classify isolates based on hybridization profiles . A total of 306 previously serotyped invasive and colonizing isolates were used to compare our dot blot capsular typing (DBCT) identification method with Lancefield serotyping (LS) . A dot blot capsular type was assigned to 99% (303 of 306) of the isolates, whereas 273 of 306 isolates (89%) were assigned a Lancefield serotype . The overall agreement between the methods was 95% (256 of 270 isolates typeable by both methods) . We conclude that the DBCT method is a specific and useful alternative to the commonly used LS method.

J Clin Microbiol, 2004 Jan, 42(1), 83 - 9
Dynamics of Streptococcus agalactiae colonization in women during and after pregnancy and in their infants; Hansen SM et al.; The population dynamics of Streptococcus agalactiae (group B streptococci {GBS}) colonization of the vagina and anorectal area was investigated in a cohort of 77 Danish women during and after their pregnancy by a new sensitive method . The mean carriage rate among individual observations was 36%, and the cumulative carriage rate over the entire observation period was 54% . Examination of more than 1500 GBS isolates by pulsed-field gel electrophoresis demonstrated that the GBS population was remarkably homogeneous and stable in each carrier . Virtually all carriers were colonized by a single GBS clone on all occasions spanning up to 2 years . Repeated detection of the same clone even in women who were recorded as intermittent carriers suggests that the actual carrier rate exceeds 50% but that fluctuations in the GBS proportions of the flora occasionally preclude their detection . Newborns and young infants usually carried the same GBS clone as their mothers . However, only twice were identical clones of GBS detected in different women in contrast to the observed clonal relationships of clinical isolates . These observations strongly suggest differences in the properties and epidemiology of virulent GBS clones compared to clones commonly carried by healthy individuals.

Eur J Clin Microbiol Infect Dis, 2004 Feb, 23(2), 123 - 6 Epub 2004 Jan 08.
Dissemination of emm28 erythromycin-, clindamycin- and bacitracin-resistant Streptococcus pyogenes in Spain; Perez-Trallero E et al.; Reported here is an unusual cluster of non-invasive infections caused by an emm28 Streptococcus pyogenes strain resistant to bacitracin, erythromycin and clindamycin detected in Santander, Spain . Since one of the characteristics of group A streptococci is their almost uniform susceptibility to bacitracin, this finding was unusual, and a search for bacitracin-resistant Streptococcus pyogenes strains was conducted in two other distant cities of Spain (Madrid and San Sebastian) where their presence was confirmed . These strains were frequently associated with erythromycin- and clindamycin-resistance, and most of them belonged to a unique emm28 T28, ST52 clone.

Ann Biol Clin (Paris), 2003 Nov-Dec, 61(6), 705 - 8
{Evaluation of the Granada medium used for the determination of Streptococcus agalactiae at the eighth month of pregnancy}; Rolland C et al.; Granada medium (GM) was evaluated for the detection of group B streptococci (GBS) in vaginal swabs compared with the standard culture on selective blood agar (BA) and classical identification methods . From May to November 2002, samples from 325 pregnant women (34 to 37 weeks of gestation) were processed and 44 of these women (13.5%) carried GBS . Comparatively, GM was found more sensitive than the selective BA (95% versus 91%) in GBS recovery . The characteristic red-orange colonies produced by GBS are so specific that further identification is unnecessary . The technique is simple and results are available after overnight incubation, improving the time to reporting a GBS-positive result by at least 24 h . The inconvenience of anaerobic incubation of GM plates can be avoided when a cover slide is placed upon the inoculum because the same pigmentation is obtained under these aerobic conditions . This study confirms that the routine use of GM appears to be an accurate, easy and highly sensitive method of identification of GBS in pregnant women . Copyright John Libbey Eurotext 2003

Clin Microbiol Infect, 2004 Jan, 10(1), 46 - 53
Risk factors for systemic emboli in infective endocarditis; Deprele C et al.; A retrospective study was undertaken to analyse the risk factors for systemic emboli in infective endocarditis . Patients (n = 80; 70% males; mean age 65 years; range 20-91 years) with infective endocarditis, as defined by the Duke criteria and diagnosed using transoesophageal echocardiography during the period January 1995 to March 2001, were included . The average time between the start of the illness and the beginning of antibiotic treatment was 55 days (range 0-405 days) . The pathogens identified were streptococci (n = 47), staphylococci (n = 11), enterococci (n = 9), and others (n = 4) . In nine cases, blood cultures were sterile . Thirty patients with at least one embolic episode were compared with 50 control patients . According to univariate analysis, the main risk factor for systemic emboli was the size of the vegetation (12.4 mm vs . 7.8 mm; p = 0.0005) . The risk of emboli was 57% when the vegetation measured > 10 mm and only 22% when it was < 10 mm (p = 0.003) . The mobility of the vegetation was also a risk factor: 48% if the vegetation was mobile; and 9% if fixed (p = 0.003) . Sex, age, pathogen, antibiotic treatment, type of valve and the number and position of the vegetations were not found to be risk factors . With multivariate analysis, only mobility was identified as a risk factor . Overall, mobile vegetations > 10 mm in size were associated with an increased risk of embolic episodes in infective endocarditis.

Clin Microbiol Infect, 2004 Jan, 10(1), 37 - 40
The role of group C and group G streptococci in acute pharyngitis in children; Zaoutis T et al.; Group C streptococci (GCS) and group G beta-haemolytic streptococci (GGS) have caused well-documented epidemics of acute pharyngitis in children, but the importance of these organisms in causing endemic or sporadic pharyngitis is uncertain . The heterogeneity of GCS and GGS may obscure the role of certain subtypes, such as the large-colony-forming strains of group C (Streptococcus dysgalactiae subsp . equisimilis) or group G, in endemic pharyngitis . For a 1-year period, children (aged 6 months to 18 years) (n = 2085) who presented with pharyngitis to the children's hospital emergency department and two outpatient offices were enrolled in a cross-sectional study to ascertain the role of large-colony-forming GCS and GGS in acute pharyngitis . Control patients (n = 194) were children who presented to the same locations during the same time period with non-respiratory tract symptoms or to the orthopaedic cast clinic . Throat cultures were obtained by a standard reference method, and swabs were plated on Strep-Selective Agar . Lancefield grouping and species identification was performed on all beta-haemolytic isolates . In total, 65 (3%) large-colony-forming GCS and GGS strains were obtained from pharyngitis patients, and three (1.5%) were obtained from the control group (odds ratio 2.0; 95% confidence interval 0.6-6.1) . The low isolation rate of large-colony-forming strains of GCS and GGS indicates that even if these organisms are associated with acute, sporadic pharyngitis in paediatric patients, they represent an unusual pathogen.

Zhonghua Kou Qiang Yi Xue Za Zhi, 2003 Nov, 38(6), 417 - 9
{Effect of IgY solution on dental plaque}; Wang WH et al.; OBJECTIVE: To observe the effect of the IgY solution on dental plaque and mutans Streptococci in plaque and in saliva . METHODS: A double-blind study was used . 44 school children at the third grade in test group used the IgY solution for 21 days; 41 children in control group used the placebo . The plaque index, the plaque weight, the level of mutans streptococci in saliva and in plaque were tested for all children . RESULTS: The plaque weight in test group was (46.4 +/- 31.2) mg at baseline, and (36.6 +/- 25.6) mg at the end of the study (P = 0.007) . The IgY solution reduced 21.1% plaque weight . Statistically significant differences for other indices were not shown in this study . CONCLUSION: The 0.1% IgY solution reduces the mass of plaque on the tooth surfaces.

J Indian Soc Pedod Prev Dent, 2003 Sep, 21(3), 98 - 104
Comparative evaluation of efficacy of sodium fluoride, chlorhexidine and triclosan mouth rinses in reducing the mutans streptococci count in saliva : an in vivo study; Kulkarni VV et al.; The primary objective of this study was to compare the efficacy of sodium fluoride (0.05%), chlorhexidine (0.12%) and triclosan (0.3%) mouth rinses in reducing the mutans streptococci count in saliva . 60 subjects in the age group of 12 to 14 years were selected from the schools of Mumbai and were equally divided into 4 groups . First 3 groups were test groups and the 4th group was control group . The subjects were instructed to rinse one full marked measure of mouth rinse for 1 minute, twice daily . Salivary samples were collected at baseline and after 2 weeks and cultured on M.S.B.agar . The number of mutans streptococci colonies were counted on agar medium . The results of the study confirmed that chlorhexidine mouth rinses are more efficient in reducing mutans streptococci count in saliva as compared to other mouth rinses.

Turk J Pediatr, 2003 Jul-Sep, 45(3), 231 - 6
Association between early childhood caries and clinical, microbiological, oral hygiene and dietary variables in rural Turkish children; Olmez S et al.; Mutans streptococci are the principal bacteria isolated from children with early childhood caries (ECC) . The aim of this study, therefore, was to determine the relationships between factors related to ECC with salivary mutans streptococci (MS) . A total of 95 children with ECC from low-income families in rural Ankara participated in this study . Breast and/or bottle-feeding habits continued in 31.5% of the children beyond 37 months . Forty percent of the bottle-fed, 35.5% of the breast-fed, and 29.4% of the breast-and bottle-fed children continued their habits beyond 37 months . Caries prevalence was significantly related to the age and feeding habits . Eighty one percent of the children did not have a toothbrushing habit and 41% had been taking sweetened medicine . High counts of MS are determined with increasing age, bottle usage, and snacking habits . We concluded that factors related to ECC are common among Turkish children.

Ned Tijdschr Geneeskd, 2003 Dec 6, 147(49), 2417 - 21
{Optimalization of antibiotic policy in the Netherlands . VII . SWAB-guidelines for antimicrobial therapy in adults patients with infectious endocarditis}; Verhagen DW et al.; The Working Party on Antibiotic Policy (Dutch acronym: SWAB) has developed guidelines for in-hospital antimicrobial therapy of adult patients with infective endocarditis . The choice and the duration of antimicrobial therapy are determined by the infecting micro-organism, the sensitivity of this micro-organism to antimicrobial therapy, the location of the endocarditis (left- or right-sided) and the presence of intracardial prosthetic material . While waiting for the culture results, the antibiotic treatment of an infected native valve is benzylpenicillin (in cases which begin subacutely or have a long history) or flucloxacillin (cases which begin acutely, are fulminant or in i.v . drug users), and gentamicin . If a prosthetic valve is infected then treatment of choice is vancomycin and gentamicin . Further antibiotic treatment depends on the causative micro-organism . Streptococci, enterococci and staphylococci are the most frequently occurring of these.

Antimicrob Agents Chemother, 2004 Jan, 48(1), 323 - 5
In vitro activities of tigecycline against erythromycin-resistant Streptococcus pyogenes and Streptococcus agalactiae: mechanisms of macrolide and tetracycline resistance; Betriu C et al.; The activity of tigecycline was tested against erythromycin-resistant streptococci (107 Streptococcus pyogenes and 98 Streptococcus agalactiae strains) . The presence of erythromycin and tetracycline resistance genes was determined by PCR . Among S . pyogenes strains the most prevalent gene was mef(A) (91.6%) . The erm(B) gene was the most prevalent (65.3%) among S . agalactiae strains . Tigecycline proved to be very active against all the isolates tested (MIC at which 90% of the isolates tested were inhibited, 0.06 micro g/ml), including those resistant to tetracycline.

Antimicrob Agents Chemother, 2004 Jan, 48(1), 297 - 304
Denaturing high-performance liquid chromatography detection of ribosomal mutations conferring macrolide resistance in gram-positive cocci; Canu A et al.; Mutations in genes coding for L4 (rplD) or L22 (rplV) ribosomal proteins or in 23S rRNA (rrl gene) are reported as a cause of macrolide resistance in streptococci and staphylococci . This study was aimed at evaluating a denaturing high-performance liquid chromatography (DHPLC) technique as a rapid mutation screening method . Portions of these genes were amplified by PCR from total DNA of 48 strains of Streptococcus pneumoniae (n = 22), Staphylococcus aureus (n = 16), Streptococcus pyogenes (n = 6), Streptococcus oralis (n = 2), and group G streptococcus (n = 2) . Thirty-seven of these strains were resistant to macrolides and harbored one or several mutations in one or two of the target genes, and 11 were susceptible . PCR products were analyzed by DHPLC . All mutations were detected, except a point mutation in a pneumococcal rplD gene . The method detected one mutated rrl copy out of six in S . aureus . This automated method is promising for screening of mutations involved in macrolide resistance in gram-positive cocci.

Antimicrob Agents Chemother, 2004 Jan, 48(1), 86 - 92
Efficacy of garenoxacin in treatment of experimental endocarditis due to Staphylococcus aureus or viridans group streptococci; Entenza JM et al.; The activity of garenoxacin was investigated in rats with experimental endocarditis due to staphylococci and viridans group streptococci (VGS) . The staphylococci tested comprised one ciprofloxacin-susceptible and methicillin-susceptible Staphylococcus aureus (MSSA) isolate (isolate 1112), one ciprofloxacin-susceptible but methicillin-resistant S . aureus (MRSA) isolate (isolate P8), and one ciprofloxacin-resistant mutant (grlA) of P8 (isolate P8-4) . The VGS tested comprised one penicillin-susceptible isolate and one penicillin-resistant isolate (Streptococcus oralis 226 and Streptococcus mitis 531, respectively) . To simulate the kinetics of drugs in humans, rats were infused intravenously with garenoxacin every 24 h (peak and trough levels in serum, 6.1 and 1.0 mg/liter, respectively; area under the concentration-time curve {AUC}, 63.4 mg . h/liter) or levofloxacin every 12 h (peak and trough levels in serum, 7.3 and 1.5 mg/liter, respectively; AUC, 55.6 mg . h/liter) for 3 or 5 days . Flucloxacillin, vancomycin, and ceftriaxone were used as control drugs . Garenoxacin, levofloxacin, flucloxacillin, and vancomycin sterilized >/=70% of the vegetations infected with both ciprofloxacin-susceptible staphylococcal isolates (P < 0.05 versus the results for the controls) . Garenoxacin and vancomycin also sterilized 70% of the vegetations infected with ciprofloxacin-resistant MRSA isolate P8-4, whereas treatment with levofloxacin failed against this organism (cure rate, 0%; P < 0.05 versus the results obtained with the comparator drugs) . Garenoxacin did not select for resistant derivatives in vivo . In contrast, levofloxacin selected for resistant variants in four of six rats infected with MRSA isolate P8-4 . Garenoxacin sterilized 90% of the vegetations infected with both penicillin-susceptible and penicillin-resistant isolates of VGS . Levofloxacin sterilized only 22 and 40% of the vegetations infected with penicillin-susceptible S . oralis 226 and penicillin-resistant S . mitis 531, respectively . Ceftriaxone sterilized only 40% of those infected with penicillin-resistant S . mitis 531 (P < 0.05 versus the results obtained with garenoxacin) . No quinolone-resistant VGS were detected . In all the experiments successful quinolone treatment was predicted by specific pharmacodynamic criteria (D . R . Andes and W . A . Craig, Clin . Infect . Dis . 27:47-50, 1998) . The fact that the activity of garenoxacin was equal or superior to those of the standard comparators against staphylococci and VGS indicates that it is a potential alternative for the treatment of infections caused by such bacteria.

J Infect Chemother, 2003 Dec, 9(4), 321 - 7
Beta-lactam resistance in Streptococcus mitis isolated from saliva of healthy subjects; Nakayama A et al.; The purpose of this study was to examine the percentage of Beta-lactam-resistant streptococcal carriers in healthy adults, and to investigate the relationships among minimum inhibitory concentrations (MICs) of Beta-lactams, alterations in the penicillin-binding protein genes ( pbp genes), and the affinity of penicillin-binding proteins (PBPs) for ampicillin (ABPC) in Streptococcus mitis . We also compared numbers of surviving bacteria at various ABPC concentrations in both ABPC-susceptible and -resistant S . mitis strains . The percentages of subjects carrying ABPC- and cefaclor (CCL)-resistant streptococci were 52% (27 of 52 subjects) and 100%, respectively . S . mitis, including both antibiotic-susceptible and -resistant strains, were classified into five groups according to the pbp gene mutations that resulted in alterations of the deduced amino-acid sequence in the homology boxes of PBPs . All ABPC-resistant strains showed alterations in PBP1A, 2X, and 2B, while no or only PBP2X alterations were detected in the susceptible strains . These results suggest that the accumulation of pbp gene mutations is strongly related to the MIC of ABPC for S . mitis . In the resistant strains, the affinity of PBPs for ABPC was reduced in comparison with that in the susceptible strains, and the bactericidal effect of ABPC was also reduced . Therefore, we should be aware of conditions such as infective endocarditis that are caused by Beta-lactam-nonsusceptible streptococci in the normal oral flora.

J Formos Med Assoc, 2003 Oct, 102(10), 733 - 6
Septic cavernous sinus thrombosis due to Streptococcus constellatus infection; Chang WN et al.; Adult septic cavernous sinus thrombosis (CST) due to Streptococcus constellatus infection has not been reported . We report a case of CST due to S . constellatus in a 39-year-old man who had typical presentations of septic CST including headache, fever, and ophthalmoplegia, with an evolving course for 10 days before he was sent to our emergency room . Cranial magnetic resonance imaging (MRI) study revealed CST, which was confirmed by cerebral angiography study . Multiple positive blood cultures grew viridans streptococci and further species identification with conventional methods, API-20 STREPT system analysis, and polymerase chain reaction sequencing of bacterial 16S rRNA revealed S . constellatus . The presence of sphenoid sinusitis in this patient was also demonstrated by cranial MRI study, and the presence of meningitis by meningeal irritation signs and inflammatory cerebrospinal fluid (CSF) findings . Chronic alcohol consumption for more than 10 years was the only predisposing condition to this infection . He had a full recovery after 6 weeks of intravenous penicillin G therapy (24 x 10(6) U/day) . Almost complete regression of cavernous sinus lesion and resolution of sphenoid sinusitis were shown on follow-up cranial MRI study about 6 months later.

J Dent Res, 2004 Jan, 83(1), 71 - 5
In situ effect of frequent sucrose exposure on enamel demineralization and on plaque composition after APF application and F dentifrice use; Paes Leme AF et al.; Since the effect of the combination of methods of fluoride use on enamel demineralization and on plaque composition is not clearly established, this study examined the effect of the combination of acidulated phosphate fluoride (APF) application and F dentifrice on enamel demineralization and on plaque composition . In this crossover study, 16 volunteers, wearing a palatal appliance containing bovine enamel blocks, were subjected to 4 treatment groups: non-fluoridated dentifrice (PD), FD, APF+PD, and APF+FD . The APF was applied to the enamel before the 14-day experimental period . During the experimental period, test dentifrices were applied 3x/day, and a 20% sucrose solution was applied 4x and 8x/day by being dripped on the blocks . Although APF application was able either to increase F concentration in plaque or to reduce the % of mutans streptococci, its combination with F dentifrice use neither reduced enamel mineral loss nor changed any other measured plaque variable with respect to the FD group alone.

Pediatr Nephrol, 2004 Mar, 19(3), 306 - 12 Epub 2003 Dec 20.
Post-streptococcal acute glomerulonephritis in Chile--20 years of experience; Berrios X et al.; In order to characterize the epidemiological and clinical picture of post-streptococcal acute glomerulonephritis (PSAGN), a prospective study was designed to investigate all admissions to a general hospital of a local health service in Chile . The protocol included the investigation of previous streptococcal infections (SI), clinical symptoms and signs, socioeconomic situation (SES), throat and skin swabs for the isolation of group A beta-hemolytic streptococci, sequential determination of serum antistreptolysin O (ASO) titer, anti-DNAase B antibodies, and C3 . During the 20 years studied, 926 cases were admitted (56% males) . Incidence showed an endemic period (EP) 1980-1983, an epidemic outbreak (EO) 1984-1989, and a late period (LP) 1990-1999, with a rate per 100,000 inhabitants of 6.2, 13.2, and 1.7, respectively . The clinical picture was similar in the three periods . SES was homogeneous, with 80% of the population in low and middle-low categories . The average size of the family was 6.9 compared with 4.8 in the general population . Pyoderma was more frequent than pharyngeal infection, and more so during the EO . The isolation rate of group A beta-hemolytic streptococci from the pharynx was 20% compared with 60% from skin swabs . During EP, the most prevalent serotypes were T14-M0 and T1-M1 from the pharynx and TImp19-M0 from the skin . During EO, T14-M0 was more prevalent (30%) . M or T classification was possible in EP and EO in 80%-85% of all strains isolated from the two locations . Significant titers for ASO and anti-DNAase B were found on admission: 55% and 75%, respectively . Both tests allowed identification of 100% of previous SI . In conclusion, the incidence of PSAGN had an uneven trend during the observed period . EO was mainly due to skin infection and a predominance of one serotype, T14-MO, was observed . After the EO, the yearly rate gradually decreased from 13.2 in 1988 to 0.0 in 1999, a rate similar to that of industrialized nations.

Pediatr Infect Dis J, 2003 Dec, 22(12), 1048 - 52
Infective endocarditis in Arkansan children from 1990 through 2002; Coward K et al.; BACKGROUND: Recent medical and surgical advances have increased the potential risk of endocarditis . Epidemiology, pathogens, morbidity and/or mortality may have evolved in the past decade in pediatric patients diagnosed with endocarditis . METHODS: Retrospective reviews of medical records from Arkansas Children's Hospital were done to identify patients with infective endocarditis from January 1990 through December 2002 . Basic demographic and clinical data were gathered and reviewed . RESULTS: Of 76 patients identified, 57 were included based on diagnostic criteria . Congenital heart disease with (56%) and without (25%) correction were the most common risk factors . Echocardiograms revealed vegetations in 67% . Echocardiograms remain relatively deficient in patients with complex cyanotic heart disease (50% positive) vs . those with normal anatomy (83% positive) . Streptococci (30%) and Staphylococcus aureus (21%) were the most common organisms identified overall; however, we observed a predominance of enterococci in infants <2 years of age (41%) . Our study revealed a reduced rate of complications, especially of the central nervous system (7% vs . 25 and 33% in prior studies); however, our rate of S . aureus was lower (21% vs . 32 and 39%), and this pathogen continues to be associated with a higher incidence of complications . CONCLUSIONS: Infective endocarditis continues to present a difficult challenge in pediatrics; its associated pathogens and outcomes have changed little in the past decade.

Pediatr Infect Dis J, 2003 Dec, 22(12), 1043 - 7
Improving diagnostic testing and reducing overuse of antibiotics for children with pharyngitis: a useful role for the electronic medical record; Benin AL et al.; BACKGROUND: Because of rising resistance to antibiotics, appropriate use of antibiotics is an important measure of quality of care . The purpose of this study was to use an electronic medical record (EMR) to assess use of diagnostic testing and of antibiotics for pharyngitis in a pediatric outpatient setting and to target areas for improvement . METHODS: Using data retrieved from the EMR, we analyzed visits from March 1, 2001 to February 28, 2002 for children 3 to 18 years old diagnosed with pharyngitis . We determined the proportion of episodes with a diagnostic test for group A streptococci, the proportion for which a prescription for an antibiotic was dispensed and factors that predicted prescribing and testing . RESULTS: Of 391 episodes of pharyngitis, a test was ordered for 303 (78%) . Antibiotics were prescribed for 90 (23%); for 76 of 90 (84%) a test was ordered . Clinicians were less likely to order tests late in the week {relative risk (RR), 0.76; 95% confidence interval (CI), 0.66, 0.87)}, more likely to order tests for patients with an exudate (RR 1.2; 95% CI 1.1, 1.3) and more likely to prescribe an antibiotic for patients with an exudate (RR 1.5; 95% CI 1.1, 2.1) . When prescribing an antibiotic clinicians were less likely to order tests late in the week (RR 0.1; 95% CI 0.02, 0.5) and for patients diagnosed with scarlet fever (RR 0.07; 95% CI 0.01, 0.4) . CONCLUSION: Using data from the EMR, we could assess adherence to the guidelines for antibiotic use and identify areas to target for improving diagnostic testing and reducing overuse of antibiotics in our clinic.

Infect Immun, 2004 Jan, 72(1), 295 - 300
Interleukin-18 is an essential element in host resistance to experimental group B streptococcal disease in neonates; Cusumano V et al.; Previous studies demonstrated that interleukin-12 (IL-12)-dependent gamma interferon (IFN-gamma) responses have a major role in restricting in vivo bacterial growth during infection of mice with group B streptococci (GBS), important human pathogens . Like IL-12, IL-18 is a potent IFN-gamma inducer . The role of IL-18 in experimental GBS infection was investigated here . Significant elevations of IL-18 levels over baseline values were detected in plasma samples from neonatal mice rendered septic with GBS . Neutralization of IL-18 significantly increased mortality and bacterial burden (P < 0.05) . In contrast, administration of recombinant IL-18 (rIL-18) before or after GBS challenge remarkably improved survival and decreased blood colony counts, in association with increased IFN-gamma production by spleen cells . The beneficial effects of rIL-18 were counteracted by administration of neutralizing anti-IFN-gamma monoclonal antibodies, indicating that the effects of IL-18 were mediated by IFN-gamma . Finally, low rIL-18 doses that had no effect of their own on bacterial burden could act in synergy with rIL-12 to protect neonatal mice during GBS infection . Collectively, our data indicate that IL-18 responses have an important role in host defenses against GBS and that rIL-18 may be useful in alternative strategies to treat neonatal GBS disease.

Infect Immun, 2004 Jan, 72(1), 94 - 105
Role of the C-terminal lysine residues of streptococcal surface enolase in Glu- and Lys-plasminogen-binding activities of group A streptococci; Derbise A et al.; Streptococcal surface enolase (SEN) is a major plasminogen-binding protein of group A streptococci . Our earlier biochemical studies have suggested that the region responsible for this property is likely located at the C-terminal end of the SEN molecule . In the present study, the gene encoding SEN was cloned from group A streptococci M6 isolate D471 . A series of mutations in the sen gene corresponding to the C-terminal region (428KSFYNLKK435) of the SEN molecule were created by either deleting one or more terminal lysine residues or replacing them with leucine . All purified recombinant SEN proteins with altered C-terminal ends were found to be enzymatically active and were analyzed for their Glu- and Lys-plasminogen-binding activities . Wild-type SEN bound to Lys-plasminogen with almost three times more affinity than to Glu-plasminogen . However, the recombinant mutant SEN proteins with a deletion of Lys434-435 or with K435L and K434-435L replacements showed a significant decrease in Glu- and Lys-plasminogen-binding activities . Accordingly, a streptococcal mutant expressing SEN-K434-435L showed a significant decrease in Glu- and Lys-plasminogen-binding activities . Biochemical and functional analyses of the isogenic mutant strain revealed a significant decrease in its abilities to cleave a chromogenic tripeptide substrate, acquire plasminogen from human plasma, and penetrate the extracellular matrix . Together, these data indicate that the last two C-terminal lysine residues of surface-exposed SEN contribute significantly to the plasminogen-binding activity of intact group A streptococci and hence to their ability to exploit host properties to their own advantage in tissue invasion.

J Forensic Odontostomatol, 2003 Dec, 21(2), 23 - 30
Isolation and genotypic comparison of oral streptococci from experimental bitemarks; Borgula LM et al.; The feasibility of recovering and genotypically comparing oral bacteria from bitemarks for forensic purposes was assessed experimentally . Volunteers firmly bit their own upper arms and bitemarks were sampled at intervals to recover viable Streptococcus isolates . The recoverability of bacteria decreased over time but an average of more than one thousand viable organisms was recovered 24 hrs after biting, provided the site remained relatively undisturbed . Physical exertion, manual rubbing and application of moisturizing lotion all decreased bacterial recoverability compared to controls . Streptococci could also be recovered from bites inflicted on various fabrics . Genomic profiles (DNA "fingerprints") of bacteria recovered from bitemarks could be identified exclusively with those from the teeth of the individual responsible . These findings suggest that a bacterial genotyping approach to bitemark analysis could have forensic application in situations where the perpetrator's DNA cannot be recovered from an oral contact site.

Caries Res, 2004 Jan-Feb, 38(1), 2 - 8
Antibacterial activity of polyphenol components in oolong tea extract against Streptococcus mutans; Sasaki H et al.; The purpose of the present study was to determine the antibacterial activity of oolong tea extract on oral streptococci, including Streptococcus mutans and Streptococcus sobrinus, and to identify the response to its components . Antibacterial activity was found when the extract was added to S . mutans cells in chemically defined medium but not in complex broth media . Further, pretreatment with bovine serum albumin reduced the antibacterial activity . The extract showed antibacterial activity against all of the oral streptococci examined, with the highest activity against S . mutans MT8148R . This activity was found to originate from a monomeric polyphenol-rich fraction, and it was stronger than that of pure polyphenols . Moreover, some combinations of monomeric polyphenols showed the highest level of antibacterial activity . These results suggest that the antibacterial activity of oolong tea extract is caused by a synergistic effect of monomeric polyphenols, which can easily bind to proteins .

FEMS Microbiol Lett, 2003 Dec 12, 229(2), 259 - 64
Identification of superantigen genes speM, ssa, and smeZ in invasive strains of beta-hemolytic group C and G streptococci recovered from humans; Igwe EI et al.; Group C and G Streptococcus dysgalactiae subspecies equisimilis (GCSE and GGSE) cause a substantial percentage of invasive disease caused by beta-hemolytic streptococci . To determine whether Streptococcus pyogenes superantigen (SAg) genes commonly exist within these organisms, 20 recent invasive GCSE and GGSE human isolates and one group G Streptococcus canis human isolate were tested for the presence of SAg genes speH, speJ, speL, speM, ssa and smeZ by polymerase chain reaction (PCR) . Prior to this work, sequence-based evidence of the speM, ssa, and smeZ genes in GCSE, GGSE, and S . canis had not been documented . Eleven of the 21 isolates were PCR-positive for the presence of one to two of the SAgs speM, ssa, or smeZ, with four of these isolates carrying ssa+speM or ssa+smeZ . No isolate was positive for speH, speJ and speL . All six ssa-positive GGSE strains harbored the ssa3 allele, previously only found among S . pyogenes strains . All three smeZ-positive GGSE isolates carried one of two smeZ alleles previously only found within S . pyogenes, however the single S . canis isolate carried a new smeZ allele . All five GCSE and GGSE speM-positive isolates harbored a newly discovered speM allele . The identification of these SAgs within S . dysgalactiae subsp . equisimilis and S . canis with identical or near-identical sequences to their counterparts in S . pyogenes suggests frequent interspecies gene exchange between the three beta-hemolytic streptococcal species.

Oral Microbiol Immunol, 2004 Feb, 19(1), 26 - 30
Platelet responses and anaphylaxis-like shock induced in mice by intravenous injection of whole cells of oral streptococci; Ohba M et al.; Intravenous injection of lyophilized whole cells of various oral streptococcal strains into muramyldipeptide (MDP)-primed C3H/HeN mice induces rapid anaphylactoid shock . Here we examined the mechanism underlying this shock . In non-primed mice, Streptococcus intermedius K-213K (SiK213) and Streptococcus constellatus T21 (ScT21) produced little or no sign of shock . In MDP-primed mice, SiK213 caused lethal shock, while ScT21 only had a weak effect . SiK213 induced decreases in blood platelets and 5-hydroxytryptamine (5HT) preceding the shock, while the effects of ScT21 were weak . The SiK213-induced 5HT decrease and shock were reduced by a complement-C5 inhibitor . These results suggest that (i) . streptococcal bacterial cells can induce rapid platelet responses, (ii) . complement-dependent degradation of platelets may be involved in streptococcus-induced shock, (iii) . the streptococcus-induced platelet degradation or degranulation may occur largely in the systemic circulation, and (iv) . platelets may play a role not only in infectious diseases caused by gram-negative bacteria, but also in diseases caused by gram-positive bacteria.

Am J Dent, 2003 Sep, 16 Spec No, 9A - 12A
Relationship between feeding habits and mutans streptococci colonization in a group of Spanish children aged 15-20 months; Lamas M et al.; PURPOSES: (1) To determine the prevalence of mutans streptococci (MS) in a group of Spanish children aged 15-20 months, and (2) to analyze the relationship between early colonization and feeding habits . METHODS: In a group of 56 children, various feeding habits with a possible influence on early MS colonization were registered using a questionnaire; saliva samples were taken with a tongue blade in order to detect MS presence . RESULTS: As many as 73% of the children used a nursing bottle at this age, often with sugar content (cereal was added in 83% of children, who were still bottle-fed) . The percentage of MS colonization was relatively high (46%), although no child presented caries at the time . A statistically significant relationship (P < 0.05) was found between MS colonization and sweetening of the bottle contents . A relation was also found, though not significant, between MS colonization and the absence of breastfeeding or, on the other hand, the excessive prolongation of natural or artificial feeding.

Arch Microbiol, 2004 Jan, 181(1), 74 - 81 Epub 2003 Dec 12.
Two-dimensional gel electrophoresis analysis of the abundance of virulent exoproteins of group A streptococcus caused by environmental changes; Nakamura T et al.; Group A streptococci regulate the expression of virulence factors in response to environmental change . In order to investigate this mechanism, the growth of group A streptococci and the abundance of virulent exoprotein production in culture supernatant were analyzed by two-dimensional gel electrophoresis (2-D electrophoresis) under several culture conditions . Judging from alterations in their growth, group A streptococci were affected by various environmental stresses . Under high O(2) and low CO(2 )concentrations, streptococcal pyrogenic exotoxin B (SpeB) and streptococcal pyrogenic exotoxin F (SpeF) significantly decreased, and the streptococcal inhibitor of complement (Sic) increased . At 30 degrees C, increases in endo-beta- N-acetylglucosaminidase (EndoS) and alpha-amylase were also detected, while at 41 degrees C EndoS became undetectable and SpeB and SpeF decreased . Sic, SpeF and mitogenic factor 3 (Mf3) decreased when cells were cultured in higher NaCl concentrations, and EndoS disappeared following culture of the cells in high glucose concentration . An increase in acid phosphatase and a decrease in several other proteins were detected when the cells were cultivated in high iron concentrations . These results suggest that group A streptococci have a versatile adaptation system that responds to several environmental stresses by altering the level of exoprotein production.

Hematol J, 2003, 4(6), 420 - 6
Bacteraemia in hospitalised patients with malignant blood disorders: a retrospective study of causative agents and their resistance profiles during a 14-year period without antibacterial prophylaxis; Cherif H et al.; Bacteraemia is a major cause of morbidity and mortality in patients with haematological disorders during chemotherapy-induced neutropenia . The generally reported trend during the last two decades has been a gradual replacement of Gram-negative bacilli by Gram-positive cocci as the major causes of bacteraemia in neutropenic hosts . However, data that are unaffected by the use of antibacterial prophylaxis are scarce . Our objective therefore was to study the incidence of bacteraemia with different microorganisms in a haematology centre where antibacterial prophylaxis has not been used during the years 1988-2001 . A total of 1402 episodes of clinically significant bacteraemia in 927 patients were identified . All patients were treated in the haematology wards and had an underlying haematological disorder, with lymphoma, leukaemia, and myeloma dominating . There were 536 (58%) male, and 391 (42%) female patients, with a median age of 58 years . The dominating pathogens were coagulase-negative staphylococci (CNS) 17%, Escherichia coli 16%, alpha-haemolytic streptococci 12%, Staphylococcus aureus 9%, Klebsiella spp 9%, Enterococcus spp 7%, and Pseudomonas spp 5% . The only significant incidence change was an increase of E . faecium bacteraemia . The balance between Gram-negative and Gram-positive microorganisms was essentially stable over the 14-year period . The rates of antibiotic resistance were generally low and stable . Gram-negative bacteria exhibited resistance to fluoroquinolones after 1998 . The 7- and 30-day mortality rates were 6.3 and 15.6%, respectively, being significantly higher in patients with bacteraemia caused by Pseudomonas aeruginosa, Stenotrophomonas maltophilia, or E . faecium.

Expert Opin Emerg Drugs, 2003 Nov, 8(2), 297 - 321
Ketolides: an emerging treatment for macrolide-resistant respiratory infections, focusing on S . pneumoniae; Zhanel GG et al.; Resistance to antibiotics in community acquired respiratory infections is increasing worldwide . Resistance to the macrolides can be class-specific, as in efflux or ribosomal mutations, or, in the case of erythromycin ribosomal methylase (erm)-mediated resistance, may generate cross-resistance to other related classes . The ketolides are a new subclass of macrolides specifically designed to combat macrolide-resistant respiratory pathogens . X-ray crystallography indicates that ketolides bind to a secondary region in domain II of the 23S rRNA subunit, resulting in an improved structure-activity relationship . Telithromycin and cethromycin (formerly ABT-773) are the two most clinically advanced ketolides, exhibiting greater activity towards both typical and atypical respiratory pathogens . As a subclass of macrolides, ketolides demonstrate potent activity against most macrolide-resistant streptococci, including ermB- and macrolide efflux (mef)A-positive Streptococcus pneumoniae . Their pharmacokinetics display a long half-life as well as extensive tissue distribution and uptake into respiratory tissues and fluids, allowing for once-daily dosing . Clinical trials focusing on respiratory infections indicate bacteriological and clinical cure rates similar to comparators, even in patients infected with macrolide-resistant strains.

Int J Antimicrob Agents, 2003 Dec, 22(6), 626 - 9
Prevalence and characterization of the mechanisms of macrolide, lincosamide and streptogramin resistance in viridans group streptococci; Ioannidou S et al.; The presence of erm genes conferring constitutive and inducible resistance, as well as that of the mefA gene conferring only constitutive resistance, was investigated using PCR in 70 erythromycin resistant (MIC>or=1 mg/l) strains of viridans group streptococci (VGS) (18 Streptococcus mitis biotype 1, 16 S . mitis biotype 2, 15 S . oralis, 12 S . salivarius and nine S . sanguis) isolated from the oropharynx of healthy Greek children . All of the 56 isolates belonging to resistance phenotype M harbored the mefA gene . All of the 14 isolates constitutively resistant to macrolides and lincosamides (phenotype CR) harbored the ermB gene . Co-presence of both genes was not observed, whereas class A erm gene (previously known as ermTR) was not detected . Our results are consistent with a possible role of VGS as a reservoir of resistance genes now prevalent in pathogenic species of streptococci.

Med Princ Pract, 2004 Jan-Feb, 13(1), 10 - 4
Streptococcus agalactiae (Group B Streptococci) carriage in late pregnancy in Kuwait; Al-Sweih N et al.; OBJECTIVES: This study investigated the vaginal colonization rate of Streptococcus agalactiae (group B streptococci, GBS) in an antenatal population in a maternity hospital . SUBJECTS AND METHODS: Anal, vaginal and combined anal and vaginal specimens were obtained from 110 pregnant women (mean age 30.7 +/- 5.5 years) at 35-37 weeks of gestation, using a commercially prepared culturette, and transported in 0.5 ml of Stuart's transport medium . The specimens were then cultured in standard selective Todd-Hewitt broth medium, supplemented with gentamicin and nalidixic acid . After 36 h of incubation, the broth culture was subcultured onto sheep blood agar and incubated in 5% carbon dioxide for 18-24 h . Representative colonies morphologically resembling GBS were tested with latex agglutination kit . Each culture-positive woman was given ampicillin or piperacillin prophylactically and followed up through labour and postpartum . Detailed records of biodata, antecedent antenatal events and pregnancy outcome were reviewed . RESULTS: The combined vaginal and anal specimens were positive for GBS in 18 (16.4%) women . Gestational age at delivery was 39.01 +/- 1.79 weeks . The deliveries were uneventful and no neonate developed sepsis . Diabetes mellitus and pregnancy-induced hypertension/hypertension were detected antenatally in 16.6 and 11.5%, respectively . GBS carriage was not associated with adverse outcome of pregnancy . CONCLUSION: The colonization rate of GBS in pregnant women in Kuwait is high, and on the basis of the documented benefits of antenatal screening in Western countries, we recommend routine screening especially for our at-risk patients .

BMJ . 2003 Dec 6;327(7427):1324.
Penicillin for acute sore throat in children: randomised, double blind trial; Zwart S et al.; OBJECTIVE: To assess the effectiveness of penicillin for three days and treatment for seven days compared with placebo in resolving symptoms in children with sore throat . DESIGN: Randomised, double blind, placebo controlled trial . SETTING: 43 family practices in the Netherlands . PARTICIPANTS: 156 children aged 4-15 who had a sore throat for less than seven days and at least two of the four Centor criteria (history of fever, absence of cough, swollen tender anterior cervical lymph nodes, and tonsillar exudate) . Interventions Patients were randomly assigned to penicillin for seven days, penicillin for three days followed by placebo for four days, or placebo for seven days . MAIN OUTCOME MEASURES: Duration of symptoms, mean consumption of analgesics, number of days of absence from school, occurrence of streptococcal sequelae, eradication of the initial pathogen, and recurrences of sore throat after six months . RESULTS: Penicillin treatment was not more beneficial than placebo in resolving symptoms of sore throat, neither in the total group nor in the 96 children with group A streptococci . In the groups randomised to seven days of penicillin, three days of penicillin, or placebo, one, two, and eight children, respectively, experienced a streptococcal sequela . CONCLUSION: Penicillin treatment had no beneficial effect in children with sore throat on the average duration of symptoms . Penicillin may, however, reduce streptococcal sequelae.

Int J Mol Med, 2004 Jan, 13(1), 175 - 80
Surface carbohydrates as recognition determinants in non-opsonic interactions and intracellular viability of group B Streptococcus strains in murine macrophages; Monteiro GC et al.; Mononuclear cells have been found to play a key role in phagocytosis and eventual killing of group B streptococci (GBS) . The rich array of sugars on bacterial surface plus the presence of membrane-associated lectin-receptors on the macrophage suggests that this is a likely means for GBS recognition by these host defense cells . Macrophages have been shown to bind GBS in the absence of serum components . However, participation of carbohydrate moieties in GBS intracellular survival had not been completely elucidated . The aim of this study was to assess the involvement of sugars on adherence and intracellular viability in murine macrophages of GBS serotypes Ia (85147 and 90222 strains), III (80340 and 90356 strains) and V (88641 and 90186 strains) isolated from assymptomatic carriers and patients, respectively . Most isolates showed higher adherence within 2-h incubation . Only 90222-Ia strain exhibited progressive adherence rate until 12-h incubation . All strains showed intracellular viability during first 0.5-h of incubation . Except for 90186-V strain that survived only for 2 h, strains of all serotypes tested were found to survive 24 h into macrophages . Treatments of bacteria by glycosidases inhibited macrophage interaction with GBS strains at varied levels . Neuraminidase inhibited 90-97% adherence and 100% intracellular survival of GBS strains (P<0.0001) . Host cell treatments with Rhamnose, N-acetyl-D-glucosaminidase and Fucose (5 mg/ml) inhibited adherence and intracellular viability of GBS strains at varied levels . Removal of GlcNAc residues of invasive GBS isolates enhanced intracellular viability, suggesting that GlcNAc residues may act by intercepting the expression of hidden receptors probably related with invasiveness and survival within macrophages . Lastly, our results demonstrate involvement of sialic acid specific receptors on macrophages and lectinophagocytosis in non-opsonic interaction and survival of GBS invasive isolates.

Pediatrics, 2003 Dec, 112(6 Pt 1), 1427 - 9
Streptococcal intertrigo: an underrecognized condition in children; Honig PJ et al.; Group A beta-hemolytic streptococci have been implicated in a variety of common childhood cutaneous infections . Infants and young children may be particularly susceptible to a form of streptococcal intertrigo that has heretofore been underrecognized in this population . Manifesting as intense, fiery-red erythema and maceration in the intertriginous folds of the neck, axillae, or inguinal spaces, the condition is characterized by a distinctive foul odor and an absence of satellite lesions . Specific clinical features help differentiate this condition from its clinical mimics . Topical and oral antibiotic therapy with or without concomitant low-potency topical steroid application is generally curative.

Hua Xi Kou Qiang Yi Xue Za Zhi, 2003 Oct, 21(5), 392 - 5
{Detection of the transmitted strains and non-transmitted strains of Mutans streptococci by AP-PCR}; Li S et al.; OBJECTIVE: Dental caries is a transmissible infectious disease in which S . mutans plays the major role . The purpose of this study was to detect the S . mutans transmitted strains and non-transmitted strains by AP-PCR fingerprint for laying the foundation of study on the relation between bacterial properties of S . mutans and its transmission . METHODS: Plaque samples were obtained from buccal surfaces of 20 3-4 years old children and their mothers . Caries experience was scored by dmft (DM-FT) . Diet regime, breast feeding and care of the children were recorded . 200 Isolates of S . mutans were detected by S . mutans B medium and confirmed biochemically . DNA from each isolate was purified and AP-PCR fingerprinting was conducted . Amplicons were separated by electrophoresis in 1.5% agarose gels . RESULTS: 45 different patterns among the 200 isolates were found . There were 10 mothers (50%) and 15(75%) children owning one genotype while 10 mothers and 5 children owning more than one (2 mothers owning 5 types) . The data showed that the mothers harbored a more heterogeneous population of S . mutans than their children . Comparisons in genotypes between children and their mothers discovered that 16(80%) children harbored the same genotypes as their mothers, indicating high transmission in the group of people . Detection of the S . mutans transmitted strains and non-transmitted strains in mothers demonstrated that 10 (50%) mothers harbored not only transmitted strains but also non-transmitted strains, suggesting that different strains had different ability of transmission . CONCLUSION: AP-PCR was capable of detecting the S . mutans transmitted strains and non-transmitted strains . Some S . mutans genotypes had higher ability of transmission than others.

Pediatr Neurol, 2003 Oct, 29(4), 288 - 94
Neonatal bacterial meningitis in southern Taiwan; Chang CJ et al.; To determine the epidemiologic trends, prognostic factors, and therapeutic results of neonatal bacterial meningitis, 60 neonatal patients with culture-proven neonatal bacterial meningitis were enrolled in this study . To compare changes over time, the appearance of disease among the patients was divided into two equal periods (1986-1993 and 1994-2001) . Group B streptococci were the most common causative pathogens, accounting for approximately 32% of the episodes . Escherichia coli, the next most common pathogen, was more frequently observed in the second period . Seventy-seven percent of gram-negative bacilli isolates were resistant to ampicillin . Moreover, oxacillin-resistant Staphylococcus and ampicillin-resistant group B streptococci strains occurred in the second periods as late-onset neonatal bacterial meningitis . The overall mortality rates for the first and second study period were 17% and 8%, respectively . However, if individuals with poor outcomes were taken into account, 38% of patients were considered treatment failures . Significant prognostic factors included the presence of seizures, thrombocytopenia, and high cerebrospinal fluid protein and low cerebrospinal fluid glucose concentration . Although the mortality rate was significantly reduced in the second period, there has been increasing incidence of the emergence of resistant strains presenting a therapeutic challenge . The presentation in neonatal bacterial meningitis might be nonspecific, and blood culture results were negative in 45% of the episodes . Early diagnosis, choice of appropriate antibiotics, and correction of metabolic derangement are essential to improving outcomes.

Cell Microbiol, 2003 Dec, 5(12), 849 - 60
Breaking the species barrier: use of SCID mouse-human chimeras for the study of human infectious diseases; Davis PH et al.; Mouse-human chimeras have become a novel way to model the interactions between microbial pathogens and human cells, tissues or organs . Diseases studied with human xenografts in severe combined immunodeficient (SCID) mice include Pseudomonas aeruginosa infection in cystic fibrosis, group A streptococci and impetigo, bacillary and amoebic dysentery, and AIDS . In many cases, disease in the human xenograft appears to accurately reproduce the disease in humans, providing a powerful model for identifying virulence factors, host responses to infection and the effects of specific interventions on disease . In this review, we summarize recent studies that have used mouse-human chimeras to understand the pathophysiology of specific bacterial and protozoan infections.

East Afr Med J, 2003 Sep, 80(9), 456 - 62
Neonatal bacterial meningitis at the newborn unit of Kenyatta National Hospital; Laving AM et al.; BACKGROUND: Meningitis occurs in up to one third of neonates with septicaemia . Diagnosis is difficult due to its non-specificity of signs and symptoms . While neonatal septicaemia is a common problem at Kenyatta National Hospital (KNH), there are no recent data on the incidence and clinical characteristics of neonatal meningitis at the hospital . OBJECTIVE: To evaluate the prevalence and the bacterial aetiology of meningitis in neonates at the Newborn Unit (NBU) of KNH . DESIGN: Descriptive cross-sectional study . SETTING: Newborn Unit of Kenyatta National Hospital, Nairobi, Kenya . SUBJECTS AND METHODS: Lumbar punctures were performed on eighty-four neonates with suspected sepsis based on specified clinical criteria . Cases were defined as meningitis if the cerebrospinal fluid (CSF) was positive for bacteria by Gram stain, aerobic bacterial culture or latex particle agglutination assay . RESULTS: The prevalence of meningitis amongst cases of suspected sepsis was 17.9% . The male:female ratio was 1.5:1 mean birth weight 2116.7 grams (1682.2-2551.2) mean gestational age 35.7 weeks (32.6-38.8) and the mean postnatal age was 4.1 days (2.7-5.4) with none of the parameters being significantly different from those without meningitis . Feed intolerance and lethargy were the most common clinical features, present in 73.3% and 60% of patients with meningitis respectively . Neonates with meningitis had a higher mean CSF protein value (2.67 g/L vs 1.97 g/L, p=0.367) and a significantly higher mean CSF white cell count (21 cells/mL vs 7 cells/mL, p=0.001) . The most common aetiological agents were Escherichia coli (46.7%) . Group B . Streptococci (26.7%) and Klebsiella pneumoniae (13.3%) . Most blood and CSF isolates were resistant to ampicillin and gentamicin but showed good in-vitro sensitivities to amikacin, cefuroxime and the third generation cephalosporins (ceftriaxone, ceftazidime and cefotaxime) . Blood cultures were positive in only 53.3% of neonates with meningitis . CONCLUSION: Neonatal bacterial meningitis is an important clinical problem at KNH with a prevalence of 17.9% amongst cases of suspected sepsis . E . coli and Group B Streptococci were the most common aetiological pathogens . Blood cultures were negative in almost half of the patients with meningitis . Resistance to the commonly employed first-line antibiotics (penicillin and gentamicin) is high and a change of empirical antibiotic use for neonates with suspected sepsis is recommended.

Curr Microbiol, 2003 Oct, 47(4), 319 - 22
Identification of the high-virulence clone of group B streptococci by using a probe containing a putative aldolase gene; Palacios GC et al.; A high-virulence clone (HVC) was proposed as causing much of the morbidity and mortality when a collection of group B Streptococcus (GBS) isolates was examined by multi-locus enzyme electrophoresis . HVC isolates could be further distinguished by their inability to grow at 40 degrees C, and a temperature-sensitive aldolase was identified as responsible for this characteristic . In the present study, the HVC was sought in a collection of 57 GBS isolates by hybridization with a probe containing a putative aldolase gene on genomic DNA restriction enzyme digests . Isolates were initially classified as HVC or non-HVC by their inability to grow at 40 degrees C . Three serotype III invasive isolates had the HVC control restriction/hybridization pattern . They were also unable to grow at 40 degrees C . The remaining 11 invasive and all carrier isolates showed a pattern identical to that of the non-HVC control . These results provide additional support for the existence of a highly virulent clonal group among serotype III isolates and suggest that hybridization with a probe containing the aldolase gene on DNA restriction enzyme digests can be an alternative method for identifying highly virulent isolates.

Infect Immun, 2003 Dec, 71(12), 7119 - 28
Recruitment of complement factor H-like protein 1 promotes intracellular invasion by group A streptococci; Pandiripally V et al.; Numerous microbial pathogens exploit complement regulatory proteins such as factor H (FH) and factor H-like protein 1 (FHL-1) for immune evasion . Fba is an FHL-1 and FH binding protein expressed on the surface of the human pathogenic bacterium, Streptococcus pyogenes, a common agent of pharyngeal, skin, and soft-tissue infections . In the present study, we demonstrate that Fba and FHL-1 work in concert to promote invasion of epithelial cells by S . pyogenes . Fba fragments were expressed as recombinant proteins and assayed for binding of FHL-1 and FH by Western blotting, enzyme-linked immunosorbent assay, and surface plasmon resonance . A binding site for FHL-1 and FH was localized to the N-terminal half of Fba, a region predicted to contain a coiled-coil domain . Deletion of this coiled-coil domain greatly reduced FHL-1 and FH binding . PepSpot analyses identified a 16-amino-acid segment of Fba which overlaps the coiled-coil domain that binds both FHL-1 and FH . To localize the Fba binding site in FHL-1 and FH, surface plasmon resonance was used to assess the interactions between the streptococcal protein and a series of recombinant FH deletion constructs . The Fba binding site was localized to short consensus repeat 7 (SCR 7), a domain common to FHL-1 and FH . SCR 7 contains a heparin binding site, and heparin was found to inhibit FHL-1 binding to Fba . FHL-1 promoted entry of Fba(+) group A streptococci into epithelial cells in a dose-dependent manner but did not affect invasion by an isogenic fba mutant . To our knowledge, this is the first report of a bacterial pathogen exploiting a soluble complement regulatory protein for entry into host cells.

Infect Immun, 2003 Dec, 71(12), 6857 - 63
Subtractive hybridization identifies a novel predicted protein mediating epithelial cell invasion by virulent serotype III group B Streptococcus agalactiae; Adderson EE et al.; Group B Streptococcus agalactiae bacteria (group B streptococci {GBS}) are the most common cause of serious bacterial infection in newborn infants . The majority of serotype III-related cases of neonatal disease are caused by a genetically related subgroup of bacteria, restriction fragment digest pattern (RDP) type III-3, suggesting that these strains possess unique genes contributing to virulence . We used genomic subtractive hybridization to identify regions of genomic DNA unique to virulent RDP type III-3 GBS strains . Within one of these III-3-specific regions is a 1,506-bp open reading frame, spb1 (surface protein of group B streptococcus 1) . A mutant type III GBS strain lacking Spb1 was constructed in virulent RDP type III-3 strain 874391, and the interactions of the wild-type and spb1 isogenic mutant with a variety of epithelial cells important to GBS colonization and infection were compared . While adherence of the spb1 isogenic mutant to A549 respiratory, C2Bbe1 colonic, and HeLa cervical epithelial cells was slightly lower than that of the 874391 strain, invasion of the Spb1(-) mutant was significantly reduced with these cell lines compared to what was seen with 874391 . The defect in epithelial invasion was corrected by supplying spb1 in trans . These observations suggest that Spb1 contributes to the pathogenesis of neonatal GBS infection by mediating internalization of virulent serotype III GBS and confirm that understanding of the population structure of bacteria may lead to insights into the pathogenesis of human infections.

Infect Immun, 2003 Dec, 71(12), 6701 - 6
Genomic location and variation of the gene for CRS, a complement binding protein in the M57 strains of Streptococcus pyogenes; Binks M et al.; All isolates of serotype M1 of group A streptococci possess a gene for streptococcal inhibitor of complement (SIC) in the mga regulon, which harbors genes for other virulence factors, such as M and M-like proteins, C5a peptidase, and a regulator . In serotype M57 the gene for a protein that is closely related to SIC (crs57) is located outside the mga regulon . We mapped the location of the crs57 gene in six strains of emm57 (gene encoding the M57 protein) sequence types to an intergenic region between the ABC transporter gene (SPy0778) and the gene for a small ribosomal protein (rpsU) . The noncoding sequences on both sides of crs57 exhibited high degrees of identity to the corresponding regions of sic from M1 strains . This included one of the inverted repeat sequences of IS1562 but not the insertion element itself . These observations suggest that crs57 was recently acquired by serotype M57 or its progenitor via horizontal acquisition from serotype M1 . The six emm57 sequence type isolates analyzed in this study belong to two distinct molecular types (vir types VT8 and VT101) . Although the crs57 sequences from VT8 strains had very few substitution mutations, the VT101 crs57 sequence had a large number of such mutations . The CRS57 proteins from these strains are secretory products and have the ability to bind to complement proteins . All these proteins contain several tryptophan-rich repeats designated DWS motifs and internal repeat sequences . In all of these structural and biochemical characteristics CRS57 resembles SIC from M1 strains . Hence, CRS57 has a functional role similar to that of SIC in an M1 strain.

J Vet Med B Infect Dis Vet Public Health, 2003 Oct, 50(8), 412 - 6
The effect of kefir on the activities of GSH-Px, GST, CAT, GSH and LPO levels in carbon tetrachloride-induced mice tissues; Guven A et al.; Functional foods including kefir have increasingly become as popular as before in the developing world . The health benefits of kefir including the antioxidative effects are still under evaluation . Vitamin E is also a well-known antioxidant . The biologically damaging effects of reactive oxygen species are controlled in vivo by a wide spectrum of antioxidant defence mechanisms . Dietary constituents of antioxidative vitamins and other nutrients may play an important role in protecting the body against oxidative damage . The study was carried out to investigate the protective effect of kefir against oxidative damage of CCl4 in mice, compared with the well-known antioxidant vitamin E . Three-week-old Swiss Albino mice, weighing 22-26 g were used for the experiment . At the end of the microbiological analysis of kefir, the averages of the total mesophilic aerobic colony counts, lactic acid bacteria, lactic streptococci, enterococci, and yeasts were found to be 1.04 x 10(9), 9.87 x 10(8), 4.38 x 10(8), 7.80 x 10(4) and 1.26 x 10(5) CFU/ml, respectively . While both vitamin E and kefir were found to have a protective effect against CCl4-induced damage, kefir was more protective . This may probably be the first study to compare the antioxidative action of kefir and vitamin E in the animal model.

Diabet Med, 2003 Nov, 20(11), 899 - 903
Pneumococcal necrotizing fasciitis in a patient with Type 2 diabetes; Prakash PK et al.; Necrotizing fasciitis (NF) is a rare and often fatal soft-tissue infection involving the superficial fascial layers of the extremities, abdomen or perineum . Progression to septic shock can occur very rapidly with its associated high morbidity and mortality . NF is usually caused by beta haemolytic streptococci; less often a poly-microbial isolate is the cause . It typically occurs in patients with some degree of immune dysfunction . We present a case of severe pneumococcal necrotizing fasciitis in an obese patient with Type 2 diabetes . There was no history of trauma or evidence of diabetes-related complications . The initial presentation was with features of septic arthritis of the left knee, which subsequently progressed to NF . Differentiation from cellulitis is often difficult in the early stages . Invasive pneumococcal infections are extremely rare, with only a few reported in the literature . Moreover, our case highlights the need to consider other differential diagnoses (and to look out for complications) in patients with diabetes, especially if there is little clinical response to the initial treatment.

Eur J Oral Sci, 2003 Dec, 111(6), 459 - 64
Non-contact removal of coadhering and non-coadhering bacterial pairs from pellicle surfaces by sonic brushing and de novo adhesion; Busscher HJ et al.; Coadhesion between oral microbial pairs is an established factor in the spatiotemporal development and prevalence of mixed-species communities in early dental plaque in vivo . This study compares removal and de novo adhesion of pairs of coadhering and non-coadhering oral actinomyces and streptococci by sonic brushing on salivary pellicles in a non-contact mode as a function of the distance between the brush and the pellicle surface in vitro . First, actinomycetes were adhered to a pellicle surface, after which streptococci suspended in saliva were allowed to adhere . Removal was examined by non-contact, sonic brushing with a wetted brush on a either a wetted or a substratum immersed to a depth of 7 mm . After brushing, de novo adhesion of streptococci to brushed pellicles was studied . For coadhering and non-coadhering pairs, 34% and 9%, respectively, of the adhering bacteria were involved in aggregates comprising more than 10 organisms . Non-contact, sonic brushing removed up to 99% of the adhering bacteria, regardless of the state of immersion of the substratum . Bacterial removal decreased with increasing distance of up to 6 mm between brush and pellicle surface . For the non-coadhering pair, subsequent exposure of pellicles to a streptococcal suspension yielded about 6% of bacteria involved in large aggregates . Alternatively, de novo adhesion of the coadhering streptococcal strain to pellicles brushed on the wetted substratum yielded 31% of bacteria involved in large aggregates, but after brushing the immersed substratum only 12% of the adhering bacteria were found in large aggregates . It is concluded that non-contact sonic brushing, under immersion, removes high percentage of adhering bacterial pairs up to a distance of 6 mm between the brush and the pellicle surface . However, non-contact, sonic brushing with only a thin wet film on the substratum may leave footprints to which streptococci preferentially adhere.

Pediatr Hematol Oncol, 2003 Sep, 20(6), 439 - 44
Viridans streptococcus bacteremia in children on chemotherapy for cancer: an underestimated problem; Ahmed R et al.; The authors discuss the morbidity associated with viridans streptococcus bacteremia, and its implications on the choice of antibiotics used as prophylaxis and treatment . They retrospectively studied the case notes of 38 children who were being treated for various malignant conditions in their unit and developed 40 episodes of bacteremia with viridans streptococci between October 1995 and January 1999 . Viridans streptococci were the third commonest blood culture isolate during this period, after coagulase-negative staphylococci and Staphylococcus aureus . The majority of the isolates were Streptococcus mitis (55%) . Others were S . sanguis (25%), S . oralis (12.5%), S . salivarius (5%), and S . acidominimus (2.5%) . Twenty-five percent of the patients had been treated with regimens that included cytosine arabinoside, 60% were receiving prophylactic co-trimoxazole, and 87.5% were neutropenic . Thirty percent of patients had abnormal chest X-rays, and 15% were hypotensive; 2 patients required admission to the intensive care unit . Initial antibiotic therapy was changed because of failure of clinical response in 60% of cases, despite the infecting organism being sensitive in vitro . This study confirms the importance of viridans streptococci as a cause of bacteremia in pediatric hematology and oncology patients, leading to significant morbidity . Further work is required to establish the optimal treatment for viridans streptococcus bacteremia.

APMIS, 2003 Nov, 111(11), 1004 - 10
New antimicrobial cystatin C-based peptide active against gram-positive bacterial pathogens, including methicillin-resistant Staphylococcus aureus and multiresistant coagulase-negative staphylococci; Jasir A et al.; We describe the synthesis and antibacterial properties of a novel antimicrobial peptidyl derivative, (2S)-2-(Nalpha-benzyloxycarbonyl-arginyl-leucylamido-1-{(E)-cinnamoylamido}-3-methylbutane, structurally based upon the inhibitory centre of the human cysteine protease inhibitor, cystatin C . The derivative, here called Cystapep 1, displayed antibacterial activity against several clinically important gram-positive bacteria . It displayed minimal inhibitory and bactericidal concentrations of about 16 microg/ml for both Staphylococcus aureus and Streptococcus pyogenes . In radial agar diffusion assays, groups A, B, C and G streptococci as well as staphylococci were generally susceptible to the action of Cystapep 1, whereas pneumococci and enterococci were less susceptible . No activity against gram-negative bacteria was observed . Cystapep 1 also showed high activity against methicillin-resistant S . aureus (MRSA) and multiantibiotic-resistant coagulase-negative staphylococci (CNS), suggesting that its mechanism of action differs from those of most currently used antibiotics.

Infect Dis Obstet Gynecol, 2003, 11(2), 89 - 99
Clinical safety-in-use study of a new tampon design; Shehin SE et al.; OBJECTIVE: To confirm the safety of a new experimental Tampax tampon and applicator compared with that of a currently marketed Tampax tampon and applicator using comprehensive gynecological and microbiological assessments . METHODS: A 2-month, single-blind, randomized, crossover study was conducted in which each subject served as her own control . Safety was evaluated by comparing potential product-related irritation (using colposcopic examination and subject diary data), assessment of vaginal discharge, vaginal pH, and effects on selected microorganisms (yeast, Escherichia coli, Staphylococcus aureus and group B streptococci) obtained by vaginal swab cultures after normal menstrual use in the experimental and control groups . RESULTS: In total, 110 women completed the study . There were no significant differences between the groups that used either the experimental or control tampon with regard to prevalence or mean cell density for the selected microorganisms . No differences were observed in the incidence or severity of erythema, in abrasion or ulceration of the cervix, vagina, introitus, vulva or perineum, or in mean vaginal pH and discharge assessments . There were equivalent low incidences of reported symptoms such as discomfort during insertion, wear or removal, and a similar low incidence of burning, stinging or itching during use of either the control or experimental tampon . There was a more favorable overall product rating for the experimental tampon (p = 0.003) . CONCLUSIONS: This approach provides a combination of gynecological, microbiological and self-reported (diary recall) methodologies in order to assess tampon safety during use more thoroughly than has previously been reported, and it supports a comparable safety profile for the experimental tampon and a currently marketed tampon.

Arch Mal Coeur Vaiss, 2003 Feb, 96(2), 111 - 20
{Variations of the profile of infective endocarditis in France . Results of an epidemiologic survey carried out during a year}; Groupe d'enquete de l'Association pour l'etude et la prevention de l'endocardite infectieuse; Since the first modern clinical description of the infective endocarditis by Osler at the late 19th century, the profile of this disease never stopped changing, which has been well described by several epidemiological studies, especially the one performed in France in 1991 . The aim of this study was to update data obtained in 1991 on the epidemiology of infective endocarditis in France . This is a transversal survey conducted between January and December 1999 in all hospitals of 6 French regions representing 26% of the whole population (16 million inhabitants) . Among them 390 subjects presented the diagnosis of definite infective endocarditis according to the Duke criteria . The age- and sex-adjusted annual incidence was at 31 cases per million (95% interval confidence 28-35) . In 47% of cases, no pre-existing cardiac disease was known for the patient . The rate of prosthetic valve endocarditis was at 16% . Micro-organisms involved were distributed as follows: streptococci 48% (D-group 25%, oral streptococci 17%, pyogenic streptococci 6%); enterococci 8%, Abiotrophia sp.: 2%, staphylococci 29%, others or multiple micro-organisms: 8% . Blood cultures were negative in 9% of cases and neither micro-organism was identified in 5% of cases . Early valvular surgery was performed in 49% of them . The in-hospital mortality was at 16% . Compared to the 1991 study, this one highlights a decrease of endocarditis incidence in patients with known cardiac disease (20.6 cases per million vs . 15.1 cases per million, p < 0.001) and a decrease of the incidence of endocarditis due to oral streptococci, which is partially counter-balanced by an increase of the proportion of endocarditis due to D-group streptococci (5.3 cases per million vs . 6.2 cases per million, p = 0.67) and to staphylococci (4.9 cases per million vs . 5.7 cases per million, p = 0.97), an increased rate of surgery in the in-hospital period (31.2% vs . 49.7%, p < 0.001), a decrease of hospital mortality (21.6% vs . 16.6%, p = 0.008) . Even though the global incidence of endocarditis did not change significantly, this study highlights important modification in the infective endocarditis profile, especially concerning the culprit agents, the underlying cardiac disease, the therapeutic strategies engaged and the prognosis.

Clin Lab Sci, 2003 Fall, 16(4), 209 - 13
Group C and G streptococci infections: emerging challenges; Williams GS; New reports of serious complications from Group C (GCS) and Group G streptococci (GGS) with probable respiratory entry have been described . Particularly interesting are cases of toxic shock-like syndrome and rheumatic fever in previously healthy patients . Serious GCS and GGS infections will be missed where selective methods for group A streptococci (GAS) only are used on throat specimens.

Med Microbiol Immunol (Berl), 2005 Jan, 194(1-2), 47 - 53 Epub 2005 Jan.
Enhancement of antimicrobial effects by glucocorticoids; Turck J et al.; In the past few years a body of evidence has accumulated showing that stimulation of human astrocytes and microvascular endothelial cells with IFN-gamma induces a potent antibacterial and anti-parasitic effect . We have found that the IFN-gamma-mediated activation of the tryptophan-degrading enzyme indoleamine 2,3-dioxygenase (IDO) is, at least in part, responsible for this antimicrobial activity . Glucocorticoids are frequently used in inflammatory central nervous system diseases to reduce the inflammatory reaction and cerebral edema . Since in many inflammatory conditions infection is either a primary or secondary factor, steroids are administered, in these circumstances, during infection . We investigated whether steroids could affect the antimicrobial effect of IFN-gamma-induced IDO activation . We found that hydrocortisone and dexamethasone enhance IFN-gamma-mediated IDO activity in both human astrocytoma cells and native human astrocytes . Furthermore, we found that the amounts of IDO mRNA and of IDO protein are enhanced in cells treated with IFN-gamma and glucocorticoids . In addition, we were able to demonstrate that both steroids enhance the IFN-gamma-mediated antimicrobial activity against Toxoplasma gondii, Staphylococcus aureus and group B streptococci . The enhanced antimicrobial effect of IFN-gamma in the presence of glucocorticoids is due to the enhancement of the IDO-mediated tryptophan degradation, demonstrated by the complete abrogation of this antimicrobial effect by tryptophan resupplementation . These data show that glucocorticoids, which were often used to inhibit proinflammatory processes, do not decrease IDO-mediated antimicrobial effects . In contrast, high doses of steroids were able to enhance the IFN-gamma-induced antimicrobial activity.

Scand J Infect Dis, 2003, 35(9), 665 - 9
Association of human leukocyte antigen with outcomes of infectious diseases: the streptococcal experience; Kotb M et al.; The role of host genetic factors in determining susceptibility to infections has become more evident . Certain individuals appear to be predisposed to certain infections, whereas others are protected . By studying the immune response and the genetic makeup of susceptible and resistant individuals a better understanding of the disease process can be achieved . Infections caused by group A streptococci offer an excellent model to study host-pathogen interactions and how the host genetic variation can influence the infection outcome . These studies showed that the same clone of these bacteria can cause severe or non-severe invasive disease . This difference was largely related to the human leukocyte antigen class 11 type of the patient . Certain class II haplotypes present the streptococcal superantigens in a way that results in responses, whereas others present the same superantigens in a way that elicits very potent inflammatory responses that can lead to organ failure and shock . These findings underscore the role of host genetic factors in determining the outcome of serious infections and warrants further investigations into how the same or different genetic factors affect susceptibility to other emerging and re-emerging pathogens.

Mol Microbiol, 2003 Nov, 50(3), 977 - 91
Upstream short sequence repeats regulate expression of the alpha C protein of group B Streptococcus; Puopolo KM et al.; Group B streptococci (GBS) express a family of repeat-containing surface proteins, the prototype of which is the alpha C protein expressed in type Ia/C strain A909 . We have isolated a series of mutant GBS strains by mouse-passage of A909 that do not produce normal levels of the alpha C protein . Polymerase chain reaction amplification and sequencing of the gene encoding the alpha C protein, bca, from four mutant strains revealed the presence of a full-length gene in each strain . However, Northern and RT-PCR analysis revealed greatly reduced levels of RNA encoding the alpha C protein . Sequence analysis of the mutant genes found the coding region unchanged from the wild-type gene in each case, but variation was observed in a specific locus located 110 bp upstream of the start codon . The presence of a 5-nucleotide repeat, AGATT, and a string of adenine residues mark this locus . Both deletion and expansion of the AGATT motif were associated with the complete null phenotype . Deletions in the string of adenine residues were associated with both a decreased-production phenotype and a complete null phenotype . Cloning of this upstream region into a green-fluorescent protein (GFP) reporter system in GBS demonstrated promoter activity that was completely abolished by changes in the pentanucleotide repeat or adenine string . Primer extension studies of the wild-type strain revealed one dominant and two minor transcription start sites . Primer extension studies of the null and low-expression mutant strains revealed that the dominant transcript is completely absent in each mutant . The short sequence repeat locus is located at position - 55 to - 78 relative to the start site of the dominant transcript . We have demonstrated in vitro phase variation in expression of the alpha C protein associated with variation at the pentanucleotide repeat locus . We conclude that this short sequence repeat motif is located upstream of the dominant promoter for the alpha C protein and represents a regulatory site for alpha C protein expression . This is the first evidence of transcriptional regulation by short-sequence repeats in a Gram-positive organism.

Mol Microbiol, 2003 Nov, 50(3), 845 - 55
Growth and division of Streptococcus pneumoniae: localization of the high molecular weight penicillin-binding proteins during the cell cycle; Morlot C et al.; The bacterial peptidoglycan, the main component of the cell wall, is synthesized by the penicillin-binding proteins (PBPs) . We used immunofluorescence microscopy to determine the cellular localization of all the high molecular weight PBPs of the human pathogen Streptococcus pneumoniae, for a wild type and for several PBP-deficient strains . Progression through the cell cycle was investigated by the simultaneous labelling of DNA and the FtsZ protein . Our main findings are: (i) the temporal dissociation of cell wall synthesis, inferred by the localization of PBP2x and PBP1a, from the constriction of the FtsZ-ring; (ii) the localization of PBP2b and PBP2a at duplicated equatorial sites indicating the existence of peripheral peptidoglycan synthesis, which implies a similarity between the mechanism of cell division in bacilli and streptococci; (iii) the abnormal localization of some class A PBPs in PBP-defective mutants which may explain the apparent redundancy of these proteins in S . pneumoniae.

Clin Microbiol Infect, 2003 Aug, 9(8), 852 - 7
Clinical significance of tolerant strains of streptococci in adults with infective endocarditis; Hanslik T et al.; OBJECTIVES: To compare the characteristics of patients with endocarditis due to tolerant and non-tolerant Streptococcus strains . PATIENTS AND METHODS: A retrospective nine-year study was conducted in a single tertiary-care hospital . The study included 24 cases of streptococcal endocarditis with known beta-lactam minimal inhibitory and bactericidal concentrations . RESULTS: Ten of the 24 patients concerned were infected with tolerant streptococcal strains, and 14 with non-tolerant strains . Bacterial tolerance was not associated with higher mortality or increased frequency of surgery . Fewer patients infected with tolerant than non-tolerant strains had serum bactericidal titers reaching success-predictive levels, and more of these experienced failure of initial antibiotic treatment and needed longer treatment . CONCLUSIONS: The results of this study strongly suggest that penicillin tolerance of the streptococci responsible for endocarditis has a clinical impact . Consequently, pending a larger prospective study addressing the problem of tolerance, it is clinically relevant to determine the minimal inhibitory and bactericidal penicillin concentrations for all streptococcal isolates causing endocarditis.

APMIS, 2003 Oct, 111(10), 955 - 62
Role of group A streptococcal IgG-binding proteins in triggering experimental glomerulonephritis in the rabbit; Burova L et al.; Our previous studies have indicated that the IgG-binding M-family proteins (IgGBP) of group A streptococci may be involved in eliciting experimental acute poststreptococcal glomerulonephritis (APSGN) in the rabbit . These surface proteins were also found to trigger production of anti-IgG, which might conceivably act to enhance renal deposition of immune complexes (IC) . In the present study, a clinical isolate of serotype M22 (strain AL168), an isogenic double mutant deficient for both the IgGBPs Mrp and Emm, as well as mutants deficient in only one of the proteins were tested for capacity to induce glomerulonephritis . Streptococci to be used for injecting rabbits were heat-killed . Surface-bound IgG was removed by 1 M KSCN and cells were then repeatedly washed in PBS before use . Rabbits were injected intravenously with 109 cells three times a week for 8 weeks and, following one month of rest, for another 6 weeks . Deposits of IgG and C3 as well as induced chemokines TNF-alpha, IL-1beta and IL-6 were traced in cryostat sections using specific antibodies and appropriate peroxidase-labelled anti-antibodies . In four rabbits immunized with the double mutant strain, no deposits were found, and as examined by TEM, only subtle and transient renal changes were observed . In contrast, the original strain AL168 induced pronounced inflammatory and degenerative glomerular changes in all four rabbits injected, and deposits of TNF-alpha, IL-1beta and IL-6 were found in mesangial and endothelial cells . Similar deposits and glomerular changes were seen in all eight rabbits injected with the mrp-emm+ mutant and in four out of seven animals receiving the mrp+emm- mutant . There was a highly significant correlation between high levels of circulating anti-IgG and development of APSGN . These results confirm an important role of streptococcal IgGBP in triggering experimental APSGN as earlier proposed by our group.

Microbes Infect, 2003 Nov, 5(14), 1329 - 35
Mechanisms of pathogenesis: evasion of killing by polymorphonuclear leukocytes; Allen LA; Few microorganisms evade killing by neutrophils . Summarized here are the mechanisms used by Yersinia, group A streptococci, Helicobacter, Ehrlichia and Francisella to block phagocytosis, disrupt phagosome maturation or perturb the respiratory burst . Also discussed are mechanisms used by neutrophils to control organisms that replicate inside macrophages.

FEMS Microbiol Lett, 2003 Nov 7, 228(1), 115 - 9
Expression of the genes for lysostaphin and lysostaphin resistance in streptococci; Heath Farris M et al.; To determine if the genes for lysostaphin endopeptidase (end) and lysostaphin resistance (epr) function in streptococci, we transferred these genes from Staphylococcus simulans biovar staphylolyticus into two strains of Streptococcus equi subsp . zooepidemicus . The end-containing streptococci were able to produce and process proendopeptidase . Strains containing epr were more resistant to lysis by the streptococcolytic enzyme zoocin A and amino acid analysis of the peptidoglycans of the epr-containing streptococci revealed insertion of serines in their cross bridges . This is the first report of the transfer of a femABX-like immunity factor resulting in a physiologically useful effect in a different genus.

FEMS Microbiol Lett, 2003 Nov 7, 228(1), 73 - 80
Molecular analysis of the inhibitory effects of oolong tea polyphenols on glucan-binding domain of recombinant glucosyltransferases from Streptococcus mutans MT8148; Matsumoto M et al.; An oolong tea polyphenol (OTF6) has been shown to possess a strong anti-glucosyltransferase (GTF) activity and inhibit experimental dental caries in rats infected with mutans streptococci . The effects of OTF6 on the functional domains of GTFs of Streptococcus mutans, an N-terminal catalytic domain (CAT), and a C-terminal glucan-binding domain (GBD), were examined . The maximum velocity of glucan synthesis by recombinant GTFB (rGTFB) and GTFD (rGTFD) became significantly slower in the presence of OTF6, however, Km values remained stable when compared in their absence . These results suggest that OTF6 reduces glucan synthesis by non-competitively inhibiting the GBD of S . mutans GTFB and GTFD . Further, the recombinant proteins of CAT (rCAT) and GBD (rGBD) were expressed using Escherichia coli, and purified by affinity column chromatography . rGBD but not rCAT was found to possess dextran-binding activity, which was shown to be inhibited by OTF6 . These results indicate that OTF6, a polymeric polyphenol specific for oolong tea is able to reduce glucan synthesis by inhibiting the GBD of S . mutans GTFB.

Eur J Clin Microbiol Infect Dis, 2004 Jan, 23(1), 61 - 2 Epub 2003 Nov 06.
Use of direct latex agglutination testing of selective broth in the detection of group B strepptococcal carriage in pregnant women; Guerrero C et al.; Direct latex agglutination testing of selective broth medium for the detection of group B streptococci was evaluated . Results were compared with those obtained by the recommended subculture method . Among the 551 vaginal-rectal specimens tested, 101 (18.3%) were positive by the subculture method . Of these subcultures, latex agglutination testing detected 99 (98%) positive specimens . Agglutination testing of selective broth is a sensitive method which offers the advantage of saving 24 h in the turnaround time for detection of group B streptococci in pregnant women.

Pediatr Res, 2004 Jan, 55(1), 61 - 8 Epub 2003 Nov 06.
Pulmonary Ureaplasma urealyticum is associated with the development of acute lung inflammation and chronic lung disease in preterm infants; Kotecha S et al.; Previously, we have reported marked pulmonary inflammation in infants who develop chronic lung disease of prematurity . We revisited these infants who did not have clinical or laboratory evidence of infection and searched for Ureaplasma urealyticum, group B streptococci, and other microbes by reverse transcription-PCR performed on RNA extracted from 93 bronchoalveolar lavage samples . From infants ventilated for respiratory distress syndrome, 6 (gestation, 28 wk; birthweight, 880 g) were positive for U . urealyticum and 11 (25 wk, 800 g) were negative . Five (83%) positive and four (36%) negative infants developed chronic lung disease . Each infant was colonized with either biovar 1 or biovar 2 but not both . U . urealyticum was very weakly detectable in two infants on d 1 but was detected in five of six infants at d 10 . Furthermore, pulmonary neutrophils, alveolar macrophages, soluble intercellular adhesion molecule-1, and IL-1beta on d 10 and IL-6 and IL-8 at d 1 were significantly increased in the positive group . A variety of organisms were identified in six samples between 14 and 21 d of age, but all samples were negative for group B streptococci . Our data suggest that U . urealyticum colonization is associated with the development of pulmonary inflammation in infants who subsequently develop chronic lung disease.

J Clin Microbiol, 2003 Nov, 41(11), 5188 - 91
Clinical and molecular epidemiology of erythromycin-resistant beta-hemolytic lancefield group G streptococci causing bacteremia; Woo PC et al.; Among 100 patients with group G beta-hemolytic streptococcal bacteremia in a 6-year period (1997 to 2002), seven had bacteremia caused by erythromycin-resistant strains . Five of the seven patients had cellulitis and/or abscesses . The two isolates resistant to erythromycin and clindamycin possessed erm genes, one ermTR and the other ermB . The five isolates resistant to erythromycin but sensitive to clindamycin and one of those resistant to both erythromycin and clindamycin possessed mef genes.

J Clin Microbiol, 2003 Nov, 41(11), 4941 - 9
Site-specific manifestations of invasive group a streptococcal disease: type distribution and corresponding patterns of virulence determinants; Vlaminckx BJ et al.; As part of a national surveillance program on invasive group A streptococci (GAS), isolates that caused specific manifestations of invasive GAS disease in The Netherlands were collected between 1992 and 1996 . These site-specific GAS infections involved meningitis, arthritis, necrotizing fasciitis, and puerperal sepsis . An evaluation was performed to determine whether GAS virulence factors correlate with these different disease manifestations . PCRs were developed to detect 9 genes encoding exotoxins and 12 genes encoding fibronectin binding proteins . The genetic backgrounds of all isolates were determined by M genotyping and pulsed-field gel electrophoresis (PFGE) analysis . The predominant M types included M1, M2, M3, M4, M6, M9, M12, and M28 . Most M types were associated with all manifestations of GAS disease . However, M2 was found exclusively in patients with puerperal sepsis, M6 predominated in patients with meningitis, and M12 predominated in patients with GAS arthritis . While characteristic gene profiles were detected in most M types, the resolution of detection of different gene profiles within M genotypes was enhanced by PFGE analysis, which clearly demonstrated the existence of some clonal lineages among invasive GAS isolates in The Netherlands . M1 isolates comprised a single clone carrying highly mitogenic toxin genes (speA, smeZ) and were associated with toxic shock-like syndrome . Toxin profiles were highly conserved among the most virulent strains, such as M1 and M3.

Clin Pediatr (Phila), 2003 Oct, 42(8), 663 - 71
Short-course antimicrobial therapy of streptococcal pharyngitis; Block SL; While penicillin administered orally or intramuscularly is the least expensive course of pharyngitis treatment, there are many limitations to its use . These include the need for extended treatment (i.e., 10 days) and poor palatability of its liquid formulation and an alarming increase in the rates of failure with standard doses of either IM or oral penicillin . Increasing rates of beta-lactamase-producing normal flora and eradication of protective alpha-streptococci may also play a role in penicillin treatment failure . Thus practitioners may consider switching to amoxicillin in higher doses (up to 40 to 60 mg/kg/day divided twice daily, maximum dose 1 gram twice daily) as first-line therapy (Figure 1), similar to what we have done for acute otitis media . Five-day short-course treatment with cefdinir or cefpodoxime may be suitable alternatives, especially in patients with penicillin hypersensitivity (not anaphylaxis) . Concerns with higher costs of these second-line agents and potential for resistance must be balanced with concerns for patient adherence with penicillin treatment and the recent increasing rate of penicillin failures . In light of recent reports regarding the high rate of failure with azithromycin and increasing macrolide resistance, clinicians should prescribe standard doses of this drug for 5 days with caution.

J Clin Immunol, 2003 Sep, 23(5), 407 - 14
Reduced IFN-gamma responses associated with HLA-DR15 presentation of streptococcal cell wall proteins to dermal Th-1 cells in psoriasis; Baker BS et al.; We have recently described a group A streptococcal (GAS)-reactive Th-1 subset specifically present in skin lesions of chronic plaque psoriasis . To investigate MHC presentation of GAS cell wall proteins, dermal T cell lines (TCL) cultured from the lesional skin of 39 HLA-typed psoriasis patients were stimulated with a cell wall extract, stained for intracellular IFN-gamma expression, and analyzed by flow cytometry . TCL from a further seven psoriasis patients were also tested with S . mutans extract . Eight TCL were tested in the presence of anti-Class II antibodies or allogeneic antigen-presenting cells . The dermal T cell IFN-gamma responses to the cell wall extract, which ranged from < 1 to 28%, were significantly higher than that to S . mutans extract (p = 0.0052) and were self-HLA-DR allele restricted . A significantly decreased response was observed in TCL from DR15+ (n = 13) versus DR15- (n = 26) patients (p = 0.0377) . In addition, DR15+ patients had a later age of onset of disease and a decreased history of sore throats . In contrast, TCL from HLA-DR7+ (n = 23) patients responded similarly to those from individuals lacking the DR7 allele . However, DR7+ patients who coexpressed the MHC Class I antigen, Cw6 (n = 14) had a significantly higher IFN-gamma response than Cw6-, DR7+ patients (n = 7; p = 0.0288) whose responses were also significantly lower than those of patients expressing non-DR7 alleles (n = 16; p = 0.0302) . This study has shown that HLA-DR15 expression is associated with a reduced dermal Th-1 response to GAS cell wall proteins in patients with psoriasis . It is proposed that HLA-DR allelic variation may contribute to disease phenotype via effects on the immune response to group A streptococci.

Epidemiol Infect, 2003 Oct, 131(2), 823 - 33
Molecular epidemiology of group B streptococci in Ireland: associations between serotype, invasive status and presence of genes encoding putative virulence factors; Dore N et al.; Group B streptococcal isolates (n = 159) from the three Dublin maternity hospitals, were serotyped and analysed for the bac, bca, hylB, pepB, and rib genes . The serotype distribution of the isolates was Ia, 19.5%; Ib, 18.9%; II, 10.7%; III, 29.5%; IV, 1.9%; V, 15.1%; non-typeable, 4.4% . There was a statistically significant association between the serotype and invasive status (carriage or infection) of isolates (P < 0.005), but no significant association between serotype and degree of invasiveness was demonstrated . The presence or absence of each analysed gene was not associated with the invasive status of isolates . Statistically significant associations were revealed between bca and hylB (IS1548) (P = 0.0004) and between bac and bca (P=0.014) . The bac, bca, hylB (IS1548) and rib genes and the numbers of tandem repeats in the bca gene showed significant associations with serotype . Almost 50% of serotype III isolates possessed at least one of the bac and bca genes and 55-65% of strains of serotypes Ia, Ib and II possessed the rib gene . Most serotype III isolates had IS1548 in their hylB genes . Serotype Ib was the only serotype in which more than half of the strains contained more tandem repeats in the bca gene than the overall mean for the GBS population studied of 7.4 repeats . These findings indicate that some previously reported associations between putative virulence factors and GBS disease require further study and clarification.

Mikrobiyol Bul, 2003 Apr-Jun, 37(2-3), 117 - 24
{Macrolide resistance phenotypes and genotypes in group G streptococci}; Acikgoz ZC et al.; Group G streptococci (GGS) are among the bacterial causes of pharyngitis . In this study, a total of 57 GGS strains isolated from throat swabs were initially screened by NCCLS disk diffusion test for penicillin and erythromycin susceptibilities . Phenotypes of the erythromycin resistance were determined by a triple-disk test and the responsible genes were sought by polymerase chain reaction (PCR) using mefA, ermA, ermA-subclass ermTR and ermB primer sets . Erythromycin and clindamycin minimal inhibitory concentrations (MIC) of the resistant isolates were measured by NCCLS agar dilution method, while susceptibility rates to some other antibiotics were determined by the disk diffusion test . All isolates were found susceptible to penicillin, and 8 (14%) were resistant to erythromycin . Of the resistant isolates, 3 (37.5%) expressed M phenotype and 5 (62.5%) had inducible macrolide-lincosamide-streptogramine B resistance (iMLS) . All M isolates had mefA determinant . Of non-M isolates, 3 (37.5%) had subclass ermTR . In 2 (25%) isolates none of the four gene determinants was detected . MIC ranges of erythromycin and clindamycin for M and iMLS phenotypes were 4, 4-128 micrograms/ml and < or = 0.06-0.125, 0.25 - > or = 128 micrograms/ml, respectively . All the erythromycin-resistant isolates were also resistant to tetracycline . The high macrolide-resistance rate of GGS in our hospital deserves attention, however this finding should be confirmed by multi-centre studies including more representative isolates.

Surg Infect (Larchmt), 2003 Fall, 4(3), 241 - 6
Biliary tract infection in patients with acute biliary pancreatitis; De Waele B et al.; BACKGROUND: The presence of infective microorganisms in the bilio-pancreatic tract is believed to be important in both the onset and outcome of acute biliary pancreatitis . In this study, the characteristics of bile colonization or infection in human pancreatitis were investigated in order to optimize prophylactic antibiotic therapy . METHODS: In 174 patients, 22 clinical and biological factors were recorded prospectively on admission and compared with the bacteriological findings at the time of surgery . RESULTS: There was a significant difference between patients with negative or positive bile cultures in six parameters: Age (57.7 +/- 1.7 vs . 68.5 +/- 1.5 years, p < 0.001), serum concentrations of glucose (132 +/- 4 vs . 149 +/- 6 mg/dL, p < 0.02) and alanine aminotransferase (ALT) (304 +/- 28 vs . 226 +/- 25 IU/L, p < 0.05) and hematocrit (43.4 +/- 0.4% vs . 41.7 +/- 0.5%, p < 0.05), Glasgow pancreatitis score (1.58 +/- 0.11 vs . 1.97 +/- 0.10, p < 0.01) and APACHE II score (6.20 +/- 0.38 vs . 7.82 +/- 0.35, p < 0.005) . The prediction of the presence of bacteria in bile by each of these individual parameters, however, was of variable accuracy . From 82 patients with positive bile cultures, a total of 150 microorganisms were isolated, including 66 gram-positive aerobes, 66 gram-negative facultative anaerobes, 15 obligate anaerobes, and three fungi . The most common organisms were Escherichia coli (20.6%), followed by enterococci (18%) and streptococci (15.3%) . CONCLUSION: Patients with acute biliary pancreatitis who manifest abnormalities of one or more of the above-mentioned risk factors are more likely to have positive bile cultures . Whether such patients might benefit from early antibiotic therapy directed against both gram-negative bacilli and gram-positive cocci needs to be determined.

Biosci Biotechnol Biochem, 2003 Oct, 67(10), 2203 - 9
Efficient electrotransformation system and gene targeting in pyogenic streptococci; Kimoto H et al.; Hemolytic streptococci are lacking in natural competence for uptake of DNA, and existing electrotransformation methods are still ineffective for most strains . By optimizing biological and electric parameters of electroporation, we established a simple, efficient, and reproducible transformation method for streptococcal cells . The major factor was an increase in the electric field strength . All tested streptococci (6 group A strains and one group C strain) were successfully transformed, and the maximal efficiency was higher than 1 x 10(7) transformants per mug of plasmid DNA . Targeted inactivation of the chromosomal genes of group A and C streptococci was achieved, using the electrotransformation method . The slo- or sagB- mutants constructed by the gene-targeting showed elevated competence for electrotransformation . Availability of the electrotransfer system for cloning and analysis of streptococcal genes is discussed.

Expert Rev Mol Med, 2001 Nov 08, 2001, 1 - 14
New DNA-based PCR approaches for rapid real-time detection and prevention of group B streptococcal infections in newborns and pregnant women; Bergeron MG et al.; Group B streptococci (GBS) are an important cause of neonatal sepsis and meningitis, and maternal infection . Although the pathogenesis of GBS infection is not well understood, several virulence factors have been identified . Two prevention strategies have been proposed: chemoprophylaxis and immunoprophylaxis . Implementation of selective intrapartum chemoprophylaxis on the basis of either screening or risk assessment has led to a substantial decrease in the morbidity and mortality of GBS disease in both mothers and infants . Penicillin remains the antibiotic of choice with no reported resistant GBS so far, whereas resistance of 10-20% of GBS to erythromycin and clindamycin has been reported in North America . Chemoprophylaxis based on screening requires optimal detection methods for GBS, which involve selective broth culture of combined vaginal and anal samples . Other conventional methods are useful for rapid identification of heavily colonised women, but are unreliable for the detection of light GBS colonisation because of poor sensitivity . GBS-specific polymerase chain reaction (PCR) assays using real-time PCR coupled with fluorescence-labelling technology offer powerful tools for sensitive and specific, yet rapid (less than 1 h), detection of GBS directly from clinical specimens at the time of delivery . The application of these assays to the current prevention strategies will simplify the prevention practice and rationalise the use of antibiotics . Immunoprophylaxis relies on the development of new vaccines against GBS, and active research is being conducted in this area.

Tijdschr Diergeneeskd, 2003 Aug 15, 128(16), 474 - 80
{Drying off cows: a comparative study with two dry cow products}; Sampimon OC et al.; From September 1998 to September 1999, at drying off 397 cows on 73 Dutch farms were treated, with two antibiotic containing dry cow products (cloxacillin; penicillin-neomycin) . Farms and cows were selected on an increased bulk milk somatic cell count (BMSCC) and individual cow somatic cell count . The objective of the trial was to compare the efficacy of both products under field conditions . Both products proved to be highly effective against streptococci and penicillin sensitive staphylococci . Because of the low incidence of infections caused by Escherichia coli and penicillin resistant staphylococci no conclusions could be drawn on differences in activity for these two pathogens . No significant differences were found between the two products in cure rate of existing infections at drying off, incidence of new infections during the dry period, incidence of clinical mastitis during the dry period and the course of the individual cow cell counts during the trial.

Microb Pathog, 2003 Dec, 35(6), 293 - 303
Plasminogen-mediated group A streptococcal adherence to and pericellular invasion of human pharyngeal cells; Pancholi V et al.; Alpha-enolase (SEN) is a strong plasminogen-binding protein on the surface of group A streptococci (GAS) . By flow cytometry and immunofluorescence analyses and using human enolase-specific antibody, human pharyngeal cells (Detroit 562) also were found to express enolase on their surface . Detroit 562 cells preferentially bound to Lys-plasminogen and this binding was inhibited in the presence of a lysine analog, epsilon-aminocaproic acid and by carboxypeptidase-B treatment suggesting that the C-terminal lysine residue of the putative pharyngeal cell receptor(s) may play an important role in plasminogen-binding . The increased plasminogen-binding in the presence of free enolase indicated the presence of an enolase/SEN-specific receptor on the pharyngeal cell surface . GAS, when precoated with Lys-plasminogen, adhered to pharyngeal cells significantly more in numbers than when precoated with fibronectin or laminin . Similarly, GAS adhered also significantly more in numbers to pharyngeal cells which were precoated with Lys-plasminogen . GAS adhered similarly in high numbers when incubated with pharyngeal cells in the presence of soluble plasminogen . The de novo pharyngeal cell-bound protease activity, created as a result of activation of bound plasminogen by t-PA, indicated its potential role in pericellular fibrinolytic activity . Further GAS with tPA-activated plasminogen bound on their surface penetrated through Transwell-grown pharyngeal cells in significantly higher numbers . Together, the results presented in this study highlight a novel function of plasminogen in streptococcal adherence to pharyngeal cells and a newly discovered streptococcal ability to pericellularly invade pharyngeal cells as a result of tPA/endogenous plasminogen activator-mediated proteolytic activity.

Circ J, 2003 Nov, 67(11), 901 - 5
Current characteristics of infective endocarditis in Japan: an analysis of 848 cases in 2000 and 2001; Nakatani S et al.; The Japanese Circulation Society appointed a committee to develop guidelines for the prevention, diagnosis and management of infective endocarditis in Japan . In making such guidelines, the committee required information on the current clinical characteristics of infective endocarditis and therefore performed a nationwide questionnaire survey of cases from 2000 and 2001 . In total, data were received for 848 cases from 277 of the 817 hospitals surveyed . Mean age was 55+/-18 years and most patients were aged in their 50 s or 60 s; 53.9% of the patients had infective endocarditis of unknown origin (without any prior predisposing conditions or procedures) and the second most common etiology was post dental procedures . The most common microorganism was Gram-positive cocci (345 streptococci and 221 staphylococci) and methicillin resistant Staphylococcus aureus (MRSA) was found in 7.3% . Although more than 90% of cases with Streptococcus viridans were sensitive to penicillin G, 6.6% were resistant . All MRSAs were sensitive to vancomycin . The information obtained from the survey assisted in the making of the guidelines, which should become an indispensable tool for all clinicians.

Med Dosw Mikrobiol, 2003, 55(2), 117 - 24
{Application of PCR-fingerprinting reactions for typing group B Streptococci using ERIC-1 and ERIC-2}; Dabrowska-Szponar M et al.; Usefulness of PCR--fingerprinting technic using ERIC 1 and ERIC 2 primers for epidemiologic analysis of Group B Streptococci was assessed . 120 strains isolated from various clinical samples were tested . Amplification reactions were carried out in automatic termocycler Poly Gen using two primers ERIC 1 and ERIC 2 . Products of the amplification were subjected to horizontal electrophoresis in 1.5% agarose gel . Using primer ERIC 1 six DNA patterns were found . Patterns B and C were the most often encountered, containing 34.2% and 35.0% of strains . Less often pattern D occurred including 12.5% of strains . In case of primer ERIC 2 lower differentiation has been achieved, because only four DNA patterns has been found, three of them occurred with similar frequency 29.2% to 33.3% . Taking into consideration the patterns gained by means of two primers thirteen genotypes have been identified . Dominated two patterns CD and BC, comprising 30.0% and 24.1% Group B Streptococci . More rarely DA and BA occurred (10.8% and 8.3%) . Remaining patterns make 0.8% to 6.7% strains . Among reference Group B Streptococci strains belonging to nine serologic types using two primers various genetic patterns were obtained.

Infect Immun, 2003 Nov, 71(11), 6171 - 7
The streptococcal exotoxin streptolysin O activates mast cells to produce tumor necrosis factor alpha by p38 mitogen-activated protein kinase- and protein kinase C-dependent pathways; Stassen M et al.; Streptolysin O (SLO), a major virulence factor of pyogenic streptococci, binds to cholesterol in the membranes of eukaryotic cells and oligomerizes to form large transmembrane pores . While high toxin doses are rapidly cytocidal, low doses are tolerated because a limited number of lesions can be resealed . Here, we report that at sublethal doses, SLO activates primary murine bone marrow-derived mast cells to degranulate and to rapidly induce or enhance the production of several cytokine mRNAs, including tumor necrosis factor alpha (TNF-alpha) . Mast cell-derived TNF-alpha plays an important protective role in murine models of acute inflammation, and the production of this cytokine was analyzed in more detail . Release of biologically active TNF-alpha peaked approximately 4 h after stimulation with SLO . Production of TNF-alpha was blunted upon depletion of protein kinase C by pretreatment of the cells with phorbol-12 myristate-13 acetate . Transient permeabilization of mast cells with SLO also led to the activation of the stress-activated protein kinases p38 mitogen-activated protein (MAP) kinase and c-jun N-terminal kinase (JNK), and inhibition of p38 MAP kinase markedly reduced production of TNF-alpha . In contrast, secretion of preformed granule constituents triggered by membrane permeabilization was not dependent on p38 MAP kinase or on protein kinase C . Thus, transcriptional activation of mast cells following transient permeabilization might contribute to host defense against infections via the beneficial effects of TNF-alpha . However, hyperstimulation of mast cells might also lead to overproduction of TNF-alpha, which would then promote the development of toxic streptococcal syndromes.

Caries Res, 2003 Nov-Dec, 37(6), 425 - 30
Synergistic inhibitory effect of cationic peptides and antimicrobial agents on the growth of oral streptococci; Kim SS et al.; Although chlorhexidine is one of the most efficacious antimicrobial agents used for the prevention of dental caries, side effects limit its application . The effects of gaegurin 6 (GGN6), an animal-derived cationic peptide, and its derivatives PTP6 and PTP12 on the growth of oral streptococci were investigated to assess the potential of these agents for use in the prevention of dental caries . The minimal inhibitory concentrations of the peptides for inhibition of the growth of oral streptococci (Streptococcus mutans , S . sobrinus, S . sanguis and S . gordonii) ranged from 1.2 to 8.2 muM . The peptides also exhibited marked synergistic antibacterial effects with chlorhexidine or xylitol . The most effective combinations (fractional inhibitory concentration index of 0.5) were xylitol with GGN6 against S . gordonii 10558 and chlorhexidine with either GGN6 or PTP6 against S . sobrinus OMZ-175 . These results indicate that cationic peptides alone or in combination with chlorhexidine or xylitol might prove effective for the inhibition of the growth of cariogenic oral streptococci in situ .

Caries Res, 2003 Nov-Dec, 37(6), 410 - 5
Fermentation of five sucrose isomers by human dental plaque bacteria; Matsuyama J et al.; Sucrose has five structural isomers: palatinose, trehalulose, turanose, maltulose and leucrose . Although these isomers have been reported to be noncariogenic disaccharides, which cannot be utilized by mutans streptococci, there is no information about their fermentability by other bacteria in dental plaque . The purpose of the present study was to examine whether these isomers were fermented by predominant bacteria in human dental plaque . Clinical bacterial isolates obtained from dental plaque from 3 children aged 22 months to 50 months (146 strains) were inoculated into 3 ml of peptone-yeast extract (PY medium) containing glucose for 1 day, then an aliquot of 20 microl of culture medium was inoculated into 1 ml of PY medium containing 1% (w/v) of the respective test carbohydrates . After incubation for 1 day, the pH values and the optical density at 660 nm of the cultures were measured . Fermentation ability was measured by pH <or=5.5, growth by an OD(660) of >or=0.5 . Of the clinical isolates, 33% fermented palatinose, and 69% of these were Actinomyces species . All of the palatinose-fermenting bacterial strains fermented trehalulose, 25% fermented turanose, 70% fermented maltulose and 23% fermented leucrose . We therefore conclude that, in human dental plaque, there are significant numbers of bacteria that are able to ferment sucrose isomers .

Caries Res, 2003 Nov-Dec, 37(6), 404 - 9
Xylitol inhibition of acid production and growth of mutans Streptococci in the presence of various dietary sugars under strictly anaerobic conditions; Kakuta H et al.; The aim of this study was to investigate the inhibitory effect of xylitol on the growth of and acid production by mutans streptococci in the presence of various dietary sugars, and the relationship between the inhibition and the accumulation of xylitol 5-phosphate (X5P) under strictly anaerobic conditions like those in the deep layers of dental plaque . Xylitol retarded the growth of mutans streptococci in the presence of glucose (G), galactose (Gal), maltose (M), lactose (L) or sucrose (S) as an energy source, though the inhibition of growth on fructose (Fr) was small . Xylitol inhibited acid production by washed cells of Streptococci mutans from G, Gal, M, L or S (12-83% inhibition) . S . mutans accumulated X5P intracellularly through activity of the phosphoenolpyruvate-xylitol phosphotransferase system (PEP-xylitol PTS) when they fermented these sugars in the presence of xylitol . However, in the presence of Fr, no inhibition of acid production was observed . In addition, the amounts of X5P during the fermentation of Fr were smaller than those of other sugars in spite of the presence of PEP-xylitol PTS activity . These results suggest that along with the intracellular accumulation of X5P, xylitol decreases the growth and acid production of mutans streptococci in the presence of various dietary sugars except Fr .

Br J Biomed Sci, 2003, 60(3), 136 - 40
Streptococcus grouping latex kits: evaluation of five commercially available examples; Davies S et al.; This study compares a recently introduced latex agglutination test for the serogrouping of beta-haemolytic streptococci against four internationally used commercial kits . The new kit is Prolex-Blue (Pro-Lab Diagnostics) and the comparators are Streptex (Murex), PathoDx (DPC), Streptococcus Grouping kit (Oxoid) and Prolex-White (Pro-Lab Diagnostics) . A total of 302 consecutive clinical isolates are tested against all five kits, following the individual manufacturer's protocol, for both accuracy and speed . In addition, the data produced permits determination of the strengths or weaknesses of the kits against individual serotypes . Prolex-Blue proved to be both accurate and rapid, with a sensitivity of 99% and a specificity of 100% . Furthermore, average time to agglutination was substantially less than achieved by three of the other four kits evaluated.

J Clin Microbiol, 2003 Oct, 41(10), 4808 - 11
National Department of Defense surveillance data for antibiotic resistance and emm gene types of clinical group A streptococcal isolates from eight basic training military sites; Barrozo CP et al.; Antibiotic resistance and emm gene types were examined from 692 Group A streptococci isolates from eight United States military basic training sites between 1998 and 2001 . Macrolide resistance was associated with geographic sites and emm type . These data are useful for vaccine development initiatives and antimicrobial treatment considerations.

J Clin Microbiol, 2003 Oct, 41(10), 4688 - 94
Six-month multicenter study on invasive infections due to group B streptococci in Argentina; Lopardo HA et al.; There is little information about invasive infections by group B streptococci (GBS) and their antimicrobial susceptibilities in Latin America . We performed a prospective multicenter study to determine the serotype distribution and the antimicrobial susceptibility of GBS in Argentina . We identified 58 cases, but only 44 had sufficient data to be evaluated . Eight early-, four late-, and one fatal late, late-onset neonatal infections due to GBS were found . A total of 31 patients were adults with bacteremia, skin and soft tissue infections, osteomyelitis, arthritis, meningitis, abdominal infections, and renal abscess . Serotype III was prevalent in late-onset neonatal disease, and several serotypes (Ia/c, III, Ia, and II) were involved in early-onset neonatal infections . Serotypes II, Ia/c, III, and IV were commonly found in adults, with serotype II prevalent in younger adults (18 to 69 years old) and serotype Ia/c prevalent in elderly adults (>70 years old) . The mortality rate attributable to GBS infections was 10.8% . All GBS were susceptible to penicillin and ceftriaxone . Resistance to clindamycin (1.7%), erythromycin (5.2%), azithromycin (5.2%), minocycline (69%), and tetracycline (72.4%), to high levels of kanamycin and amikacin (1.7%), and to intermediately high levels of gentamicin (1.7%) was observed . The bifunctional enzyme AAC6'-APH2" was detected in the isolate resistant to aminoglycosides, and other genetic determinants were identified in other resistant isolates: tetM and tetO in tetracycline-resistant streptococci and mefA and ermTR for efflux-mediated and inducible macrolide-lincosamide-streptogramin B-resistant streptococci, respectively . For clinical purposes and rapid and easy detection of high-level aminoglycoside-resistant GBS, a screening method that used 1,000- micro g kanamycin disks is proposed.

Ann Hematol . 2003 Oct 3; {Epub ahead of print}
Spontaneous remission in adult acute myeloid leukemia in association with systemic bacterial infection-case report and review of the literature; Maywald O et al.; Spontaneous remission of acute myeloid leukemia in the adult is a rare event . We report on a 31-year-old male patient suffering from acute myeloid leukemia (AML) M5a according to the French-American-British (FAB) classification with biphenotypic features in flow cytometric examination and severe bacterial infection with group G streptococci at the time of diagnosis . Because of sepsis and stable clinical conditions, chemotherapy was delayed and antibiotics were administered intravenously . Within 6 weeks a spontaneous remission of AML occurred . Remission lasted for about 2 months . At the time of relapse, a change in phenotype of the leukemic blasts with a loss of B-lymphoid markers could be demonstrated by flow cytometry . The patient was treated with an induction therapy according to the multicentric German AMLCG 2000 schedule . To our knowledge, this is the first report of a spontaneous remission in an AML FAB M5a associated with coexpression of myeloid- and lymphoid-associated antigens on the leukemic blasts . Possible mechanisms of this phenomenon are discussed with a review of the literature.

J Dent Child (Chic), 2003 May-Aug, 70(2), 111 - 4
Mutans streptococcus counts following treatment for early childhood caries; Peretz B et al.; PURPOSE: The purpose of the study was to assess mutans streptococci (MS) count in children who were treated for early childhood caries (ECC) in a follow-up examination . METHODS: Forty-four children who were treated for ECC in the pediatric dentistry clinic of the Hebrew University-Hadassah School of Dental Medicine were given paraffin film to chew . A blade containing children's saliva was placed inside a test tube containing MS selective medium to allow bacteria growth . The kits were transferred immediately to the laboratory and incubated for 48 hours in a 37 degrees C incubator . After incubation, bacterial growth was counted by the amount of colonies formed . RESULTS: Children who were examined closer to the end of the dental treatment demonstrated significantly lower MS counts . In addition, children who had higher birth weight also demonstrated lower bacterial counts . Significantly more parents of children with the high MS group than in the low MS group count reported that oral hygiene instructions greatly reduced children's plaque levels . All the children who were born preterm had high MS count, while 77% of children who were born at term demonstrated high MS count . CONCLUSIONS: Children who had dental treatment due to ECC may have high MS count in the future and are at risk for caries attack . Factors that may be associated with high MS counts are low birth weight and mother's education.

Am J Obstet Gynecol, 2003 Sep, 189(3), 861 - 73
The infectious origins of stillbirth; Goldenberg RL et al.; OBJECTIVE: Our objective was to determine the relationship between various types of perinatal infections and stillbirths . STUDY DESIGN: By use of various textbooks on perinatal infections, multiple MEDLINE searches, and the reference list of all appropriate manuscripts, the appropriate English language literature was reviewed to define the relationship between various perinatal infections and stillbirths . RESULTS: Infection may cause stillbirth by a number of mechanisms, including direct infection, placental damage, and severe maternal illness . A large variety of organisms have been associated with stillbirth, including many bacteria, viruses, and protozoa . In developed countries, between 10% and 25% of stillbirths may be caused by an infection, whereas in developing countries, which often have much higher stillbirth rates, the contribution of infection is much greater . Ascending bacterial infection, both before and after membrane rupture, with organisms such as Escherichia coli, group B streptococci, and Ureaplasma urealyticum is usually the most common infectious cause of stillbirth . However, in areas where syphilis is very prevalent, up to half of all stillbirths may be caused by this infection alone . Malaria may be an important cause of stillbirth in women infected for the first time in pregnancy . The two most important viral causes of stillbirth are parvovirus and Coxsackie virus, although a number of other viral infections appear to be causal . Toxoplasma gondii, leptospirosis, Listeria monocytogenes, and the organisms that cause leptospirosis, Q fever, and Lyme disease have all been implicated as etiologic for stillbirth . CONCLUSION: Because infection-related stillbirth is relatively rare in developed countries, and those that do occur are caused by a wide variety of organisms, reducing this etiologic component of stillbirth much further will be difficult . However, in certain developing countries, the stillbirth rate is so high and the infection-related component so great that achieving a substantial reduction in stillbirth should be possible simply by reducing maternal infections.

J Bacteriol, 2003 Oct, 185(20), 5967 - 75
The sloABCR operon of Streptococcus mutans encodes an Mn and Fe transport system required for endocarditis virulence and its Mn-dependent repressor; Paik S et al.; Streptococcus mutans belongs to the viridans group of oral streptococci, which is the leading cause of endocarditis in humans . The LraI family of lipoproteins in viridans group streptococci and other bacteria have been shown to function as virulence factors, adhesins, or ABC-type metal transporters . We previously reported the identification of the S . mutans LraI operon, sloABCR, which encodes components of a putative metal uptake system composed of SloA, an ATP-binding protein, SloB, an integral membrane protein, and SloC, a solute-binding lipoprotein, as well as a metal-dependent regulator, SloR . We report here the functional analysis of this operon . By Western blotting, addition of Mn to the growth medium repressed SloC expression in a wild-type strain but not in a sloR mutant . Other metals tested had little effect . Cells were also tested for aerobic growth in media stripped of metals then reconstituted with Mg and either Mn or Fe . Fe at 10 micro M supported growth of the wild-type strain but not of a sloA or sloC mutant . Mn at 0.1 micro M supported growth of the wild-type strain and sloR mutant but not of sloA or sloC mutants . The combined results suggest that the SloABC proteins transport both metals, although the SloR protein represses this system only in response to Mn . These conclusions are supported by (55)Fe uptake studies with Mn as a competitor . Finally, a sloA mutant demonstrated loss of virulence in a rat model of endocarditis, suggesting that metal transport is required for endocarditis pathogenesis.

Enferm Infecc Microbiol Clin, 2003 Aug-Sep, 21(7), 346 - 9
{Comparative study of three culture media for detecting group B Streptococcus colonization in pregnant women}; Bosch-Mestres J et al.; OBJECTIVE: To compare the efficacy of three culture media to detect vaginal and rectal colonization by group B streptococci (GBS) in pregnant women . METHODS: We processed 1334 samples from 861 pregnant women: in 388 patients only vaginal swab was cultured (Group A) and in 473 vaginal and rectal swabs were cultured (Group B) . Samples were inoculated on blood agar with colistin-nalidixic acid (BA-CNA), on plates with Granada medium, and on Todd-Hewitt broth (THB) with amikacin followed by subculture in BA-CNA . RESULTS: GBS was isolated in 181 samples (13.6%): 114 vaginal swabs (13.2%) and 67 rectal swabs (14.2%) . Among the positive samples, GBS was isolated on BA-CNA in 60.5% of vaginal swabs and in 59.7% of rectal swabs, on Granada medium in 80.7% of vaginal swabs and in 91% of rectal swabs, and on THB in 97.4% of vaginal swabs and in 97% of rectal swabs.We detected 130 GBS carriers, 54 (13.9%) in Group A and 76 (16.1%) in Group B . The percent of carriers detected in groups A and B, respectively, was 59.3% and 75% with BA-CNA, 77.8% and 93.4% with Granada medium, and 96.3% and 97.4% with THB . CONCLUSIONS: THB was the most reliable medium for the detection of GBS . Use of Granada medium allows fast detection of about 87% of carriers . The combination of THB and an initial plate of Granada medium or BA-CNA allows detection of more than 99% of GBS carriers.

Comp Med, 2003 Aug, 53(4), 404 - 12
Qualitative and quantitative differences in normal vaginal flora of conventionally reared mice, rats, hamsters, rabbits, and dogs; Noguchi K et al.; We examined quantitatively the vaginal flora of conventionally reared mice, rats, hamsters, rabbits and dogs, species that are widely used as laboratory animals . Vaginal specimens were examined according to the method of analyzing intestinal flora (Mitsuoka's procedure) . The total number of bacteria (aerobes and anaerobes) and the prevalence of specific bacteria were determined . The total number of bacteria was highest during estrus and lowest during diestrus or anestrus in mice, rats, hamsters, and dogs . The most predominant bacteria during estrus were streptococci in mice; gram-negative rods (GNR), streptococci, and members of the family Bacteroidaceae in rats; GNR, Bacteroidaceae and gram-positive anaerobic cocci in hamsters, and Bacteroidaceae in dogs . The increase in the total number of bacteria during estrus was caused by an increase of predominant bacteria in the vagina . Aerobes were more predominant than anaerobes in mice, and number of aerobes was comparable to that of anaerobes in rats and dogs . On the other hand, in hamsters, anaerobes were more predominant than aerobes and the total number of bacteria was highest among the laboratory animals (mice, rats, hamsters, rabbits, and dogs) . However, in rabbits, bacteria were not isolated from about 90% of the vaginal specimens . Rabbits do not have cyclic reproductive stages and are usually in precoital status in the laboratory . In precoital rabbits, vaginal epithelium manifests few signs of secretion . Therefore, we suspect that the vaginal environment in precoital rabbits is comparable to that during diestrus or anestrus in mice, rats, hamsters, and dogs . These results suggest that the vaginal flora of laboratory animals is influenced by the estrous cycle, and probably by mucous secretion . Our data imply that vaginal flora differ among laboratory animals species, and researchers need to take into consideration the estrous cycle of laboratory animals when studying their vaginal flora.

Diagn Microbiol Infect Dis, 2003 Oct, 47(2), 435 - 40
Comparative activity and spectrum of broad-spectrum beta-lactams (cefepime, ceftazidime, ceftriaxone, piperacillin/tazobactam) tested against 12,295 staphylococci and streptococci: report from the SENTRY antimicrobial surveillance program (North America: 2001-2002); Fritsche TR et al.; A contemporary collection of 12,295 North American isolates (2001-2002) consisting of Staphylococcus aureus (50%), coagulase-negative staphylococci (12%), Streptococcus pneumoniae (24%), beta-hemolytic streptococci (12%), and viridans-group streptococci (2%) were tested against broad-spectrum beta-lactams (cefepime, ceftazidime, ceftriaxone, imipenem, piperacillin/tazobactam) and comparator agents using a reference broth microdilution method to determine their continued effectiveness for empiric antimicrobial therapy . All isolates were very susceptible to vancomycin, linezolid and quinupristin/dalfopristin (>98%) . Oxacillin-susceptible staphylococci were also highly susceptible to the tested beta-lactams (>98%) with the exception of ceftazidime (93%) . beta-hemolytic streptococci were exquisitely susceptible (>99%) to penicillin and all other agents except for clindamycin (94%) and erythromycin (81%) . Viridans group streptococci were routinely less susceptible than were other streptococci . S . pneumoniae remained susceptible to most agents (>91%) with the exceptions of erythromycin (74%) and penicillin (69%) . Among beta-lactams tested against S . pneumoniae, ceftriaxone and cefepime continued to be very active against penicillin-susceptible (>99%) and intermediate (>98%) strains, but less active (80% and 82%, respectively) against penicillin-resistant isolates . These findings confirm that the newer cephalosporins (cefepime and ceftriaxone) among broad-spectrum beta-lactam agents have a spectrum of activity that remains comprehensive for the commonly isolated Gram-positive pathogens.

Int J Tissue React, 2003, 25(2), 47 - 50
Secondary infections with beta-hemolytic streptococci in skin lesions; Higaki S et al.; Secondary infections (SI) in skin lesions are common . In the present study 40 beta-hemolytic streptococci were isolated from 36 patients suffering from SI due to various skin diseases . Staphylococcus aureus coexisted with beta-hemolytic streptococci in 29 of these cases (81%), and beta-hemolytic streptococci were often associated with coagulase-negative staphylococci and gram-positive rods . Eighteen patients (50%) carried beta-hemolytic streptococci predominantly . In most cases of SI due to atopic dermatitis (AD), the predominant species was S . aureus, while in other skin diseases, S . aureus and beta-haemolytica streptococci were predominant in approximately 50% of the patients, except for SI due to tumors and viral diseases . The mean age of patients with SI and beta-hemolytic streptococci was 37 years and that of patients with SI and predominant S . aureus was 32 years . The lower mean age found for S . aureus was due to SI found in patients with AD . This study emphasizes the polymicrobial microbiology of SI.

Scand J Infect Dis, 2003, 35(8), 509 - 10
Recurrent group A Streptococcal genital infection after Puerperal sepsis; Synnestvedt M et al.; Recurrent group A streptococcal infection is a well-known phenomenon . It is well documented as a problem in pharyngotonsillitis and skin infections . This report describes a case of recurrent genital infection after puerperal sepsis caused by group A streptococci.

Hua Xi Kou Qiang Yi Xue Za Zhi, 2003 Aug, 21(4), 295 - 7
{Effects of topical application of immunoglobulin yolk on mutans streptococci in dental plaque}; Zhou Z et al.; OBJECTIVE: To evaluate the inhibitory effects of topical application of specific immunoglobulin yolk antibodies (IgY) to mutans streptococci on composition of human dental plaque . METHODS: A total of 24 healthy adult volunteers were selected and randomly distributed into three experimental groups . After a supragingival scaling, the subjects were treated with an application of IgY containing spray (test group, n = 9), a 0.15% chlorhexidine(CH) spray(positive control group, n = 9) or a placebo phosphate buffered saline(PBS) spray without any active ingredients(negative control group, n = 6) three times daily for three weeks . Pooled plaque samples from the smooth surfaces of teeth were collected for microbiologic analysis before administration (baseline, day 0), during treatment(days 7, 14 and 21) and after withdrawal of the agents(days 28, 42 and 56) and plaque index were recorded . Microbial cultivation were performed by serially diluting the samples with PBS solution an cultivating the aliquots on mitis salivarius agar(MS) and MS supplemented with bacitracin (MSB) for oral streptococci and mutans streptococci respectively . The number of colony-forming unit (CFU) per plate was counted and the percentage of mutans streptococci per oral streptococci in dental plaque were determined . The effect of IgY on colonization of mutans streptococci were analyzed by an analysis of variance (ANOVA) . RESULTS: The plaque indexes remained unchanged, but mutans streptococci in dental plaque was suppressed significantly following a short term(three weeks) application of IgY, and low level of mutans streptococci persisted for at least 5 weeks after withdrawal of IgY . CONCLUSION: The results suggest that the immunization with specific immunoglobulin yolk against mutans streptococci could be useful for long term suppression of mutans streptococci colonization in human dental plaque.

Br J Dermatol, 2003 Sep, 149(3), 530 - 4
Streptococcal throat infections and exacerbation of chronic plaque psoriasis: a prospective study; Gudjonsson JE et al.; BACKGROUND: Guttate psoriasis has a well-known association with streptococcal throat infections but the effects of these infections in patients with chronic psoriasis remains to be evaluated in a prospective study . OBJECTIVES: To determine whether streptococcal throat infections are more common in and can cause exacerbation in patients with chronic psoriasis . METHODS: Two hundred and eight patients with chronic plaque psoriasis and 116 unrelated age-matched household controls were followed for 1 year . At recruitment all patients were examined, their disease severity scored and throat swabs taken . Patients and corresponding controls were then re-examined and tested for streptococcal colonization whenever they reported sore throat or exacerbation of their psoriasis during the study period . RESULTS: The psoriasis patients reported sore throat significantly more often than controls (61 of 208 vs . three of 116, P < 0.0001), and beta-haemolytic streptococci of Lancefield groups A, C and G (M protein-positive streptococci) were more often cultured from the patients than the controls (19 of 208 vs . one of 116, P = 0.003) . A significant exacerbation of psoriasis (P = 0.004) was observed only if streptococci were isolated and the patients were assessed 4 days or later after the onset of sore throat . No difference was observed between groups A, C or G streptococci in this respect . CONCLUSIONS: This study confirms anecdotal and retrospective reports that streptococcal throat infections can cause exacerbation of chronic plaque psoriasis . It is concluded that psoriasis patients should be encouraged to report sore throat to their physician and that early treatment of streptococcal throat infections might be beneficial in psoriasis . A controlled trial for assessing potential benefits of tonsillectomy in patients with severe psoriasis should also be considered.

Dermatol Ther, 2003, 16(3), 206 - 13
Antibiotics and resistance in dermatology: focus on treating the elderly; Hutchison LC et al.; Although elderly patients are at an increased risk for skin infections, the chief culprits are no different than in younger patients . However, many of these organisms have developed resistance to antibiotics . Resistance increases the morbidity, mortality, and cost of treating infections . The mechanisms by which resistance occurs include efflux of antibiotic through a cellular pump, inactivation of the antibiotic by enzymes, or changes in the target affinity for the antibiotic . For dermatologic conditions in the elderly, documented resistance is seen in staphylococci, streptococci, and enterococci . Clinicians can reduce the development of resistance by following infection control and antibiotic use guidelines . To optimize the antibiotic effect and minimize adverse effects in the elderly, pharmacokinetic changes seen with aging should guide antibiotic choice and dosing.

Antimicrob Agents Chemother, 2003 Oct, 47(10), 3187 - 94
Genetic characterization of optochin-susceptible viridans group streptococci; Martin-Galiano AJ et al.; Two clinical isolates of viridans group streptococci (VS) with different degrees of susceptibility to optochin (OPT), i.e., fully OPT-susceptible (Opt(s)) VS strain 1162/99 (for which the MIC was equal to that for Streptococcus pneumoniae, 0.75 micro g/ml) and intermediate Opt(s) VS strain 1174/97 (MIC, 6 micro g/ml) were studied . Besides being OPT susceptible, they showed characteristics typical of VS, such as bile insolubility; lack of reaction with pneumococcal capsular antibodies; and lack of hybridization with rRNA (AccuProbe)-, lytA-, and pnl-specific pneumococcal probes . However, these VS Opt(s) strains and VS type strains hybridized with ant, a gene not present in S . pneumoniae . A detailed characterization of the genes encoding the 16S rRNA and SodA classified isolates 1162/99 and 1174/97 as Streptococcus mitis . Analysis of the atpCAB region, which encodes the c, a, and b subunits of the F(0)F(1) H(+)-ATPase, the target of optochin, revealed high degrees of similarity between S . mitis 1162/99 and S . pneumoniae in atpC, atpA, and the N terminus of atpB . Moreover, amino acid identity between S . mitis 1174/97 and S . pneumoniae was found in alpha helix 5 of the a subunit . The organization of the chromosomal region containing the atp operon of the two Opt(s) VS and VS type strains was spr1284-atpC, with spr1284 being located 296 to 556 bp from atpC, whereas in S . pneumoniae this distance was longer than 68 kb . In addition, the gene order in S . pneumoniae was IS1239-74 bp-atpC . The results suggest that the full OPT susceptibility of S . mitis 1162/99 is due to the acquisition of atpC, atpA, and part of atpB from S . pneumoniae and that the intermediate OPT susceptibility of S . mitis 1174/97 correlates with the amino acid composition of its a subunit.

Infect Immun, 2003 Oct, 71(10), 5962 - 9
Identification and characterization of HtsA, a second heme-binding protein made by Streptococcus pyogenes; Lei B et al.; Group A streptococci (GAS) can use heme and hemoproteins as sources of iron . However, the machinery for heme acquisition in GAS has not been firmly revealed . Recently, we identified a novel heme-associated cell surface protein (Shp) made by GAS . The shp gene is cotranscribed with eight downstream genes, including spy1795, spy1794, and spy1793 encoding a putative ABC transporter (designated HtsABC) . In this study, spy1795 (designated htsA) was cloned from a serotype M1 strain, and recombinant HtsA was overexpressed in Escherichia coli and purified to homogeneity . HtsA binds 1 heme molecule per molecule of protein . HtsA was produced in vitro and localized to the bacterial cell surface . GAS up-regulated transcription of htsA in human blood compared with that in Todd-Hewitt broth supplemented with 0.2% yeast extract . The level of the htsA transcript dramatically increased under metal cation-restricted conditions compared with that under metal cation-replete conditions . The cation content, cell surface location, and gene transcription of HtsA were also compared with those of MtsA and Spy0385, the lipoprotein components of two other putative iron acquisition ABC transporters of GAS . Our results suggest that HtsABC is an ABC transporter that may participate in heme acquisition in GAS.

Eur J Clin Microbiol Infect Dis, 2003 Oct, 22(10), 619 - 21 Epub 2003 Sep 12.
Optimisation of prenatal group B streptococcal screening; Blanckaert H et al.; The purpose of the study presented here was to confirm the high yield of group B streptococci (GBS) on Granada medium for the detection of pregnant GBS carriers and to compare the results with those obtained using standard Columbia blood agar at two participating centers in Belgium . Culture results of the vaginorectal swabs obtained at the two centers were also compared . A total of 1,142 samples (838 in Leuven and 304 in Bonheiden) obtained from consecutive pregnant women were cultured onto both media . Of all GBS carriers 84.7% were detected on Columbia blood agar and 93.4% on Granada agar ( P<0.01, McNemar test) . The addition of Granada agar was responsible for a 15% higher rate of detection of GBS carriers . As a result of this study, both participating hospitals will use a combination of Granada agar with Columbia blood agar for optimal GBS screening in the future.

Ann Otolaryngol Chir Cervicofac, 2003 Sep, 120(4), 237 - 43
{Otogenic cavernous sinus thrombophlebitis . A case report}; Babin E et al.; OBJECTIVES: Acquire knowledge concerning the diagnosis and treatment of otogenic cavernous sinus thrombophlebitis . PATIENT AND METHODS: We report a case of otogenic cavernous sinus thrombophlebitis (CST) in a 6-year-old boy . RESULTS: CST diagnosis was based on clinical signs (septic illness, ocular nerve palsy and chemosis), and neuro-imaging confirmed the diagnosis . Contrast-enhanced CT scan demonstrates different signs: (i) filling defect or heterogeneous enhancement of cavernous sinus, (ii) cavernous sinus enlargement with bulging of the lateral wall, (iii) intensive enhancement of lateral wall corresponding to enhancement of a collateral network replacing the thrombosed cavernous veins, (iiii) and sometimes indirect orbital signs (exophthalmus, densification of the retro-orbital fat, superior ophthalmic dilatation with partial or no enhancement in case of thrombosis extension) . The bacteria most frequently found are Streptococci, Streptococcus pneumoniae, Staphylococcus aureus, Gram-negative rods and anaerobes combined . The therapeutic management of CST consists of intravenous administration of appropriate antibiotics combined radical mastoidectomy if medical therapy has failed . Anticoagulant therapy is controversial . CONCLUSION: Knowledge of early diagnosis of otogenic cavernous sinus is important because prior to the antibiotic era, CST was almost always fatal . Currently, therapeutic outcome is not always favorable due to high morbidity after aggressive treatment.

FEMS Microbiol Lett, 2003 Sep 12, 226(1), 87 - 92
Determination of epidemiological relationships of Streptococcus agalactiae isolated from bovine mastitis; Merl K et al.; In the present study 79 streptococcal cultures isolated from subclinical mastitis of 54 cows from seven dairy farms (A-G) in Hesse, Germany, were comparatively investigated using conventional and molecular methods . The isolates could be identified as Streptococcus agalactiae, belonging to Lancefield's serological group B by determination of cultural, biochemical and serological properties and by polymerase chain reaction (PCR)-mediated amplification of species-specific parts of the 16S ribosomal DNA, the 16S-23S rDNA intergenic spacer region and the CAMP factor gene cfb . The investigated group B streptococci were further characterized serologically for specific polysaccharide and protein antigens . Serotyping the isolates revealed a predominance of surface protein antigen X, either alone or in combination with polysaccharide antigen Ia . This could be observed for 39 isolates of farms A, B and C . Six group B streptococci from farm E displayed the serotype pattern III/Rib, two isolates from farm G showed the serotype pattern Ib/calpha . The remaining cultures from farms D and F (n=32) were non-typable . The occurrence of protein Rib could be confirmed by PCR amplification of the gene rib . The two isolates with serotype pattern Ib/calpha also reacted positively for the cbeta-encoding gene bag . Additional properties which allowed a phenotypic characterization of the S . agalactiae were the degree of pigmentation, growth properties in fluid media and soft agar, the surface hydrophobicity, the ability to hemagglutinate rabbit erythrocytes and their resistance reactions to tetracycline and minocycline . The isolates of the seven farms showed identical or almost identical characteristics . The 79 group B streptococci were additionally investigated by macrorestriction analysis of their chromosomal DNA using the restriction endonucleases SmaI, ApaI and SalI . The restriction patterns obtained by pulsed-field gel electrophoresis displayed identical or closely related patterns for the cultures of the various farms . The pheno- and genotypic characteristics of the 79 group B streptococci of the present study revealed that a single S . agalactiae strain or at least closely related subtypes of this strain were responsible for the mastitis situation of the seven farms.

Eur J Oral Sci, 2003 Oct, 111(5), 383 - 9
Longitudinal study of intrafamilial mutans streptococci ribotypes; Kohler B et al.; To explore the intrafamilial homology and longitudinal stability of colonization by early acquired mutans streptococci, genomic fingerprinting was performed on 254 strains (192 Streptococcus mutans and 62 Streptococcus sobrinus strains) collected from 16 families (16 mother-child pairs, seven fathers and four siblings) . Genomic DNA was digested by the restriction endonuclease HindIII, followed by gel electrophoresis, Southern blotting, and hybridization with a digoxigenin-labeled 16S rDNA probe, and hybrid detection by enhanced chemiluminescence . One to five ribotypes were identified per person, and between two and nine (median five) within each family . Fourteen of the 16 mother-child pairs showed homology for at least one ribotype (range 1-4) . Six of the seven father-child pairs had one ribotype in common . Ten of the 13 longitudinally examined children showed persistence of at least one ribotype over a period of up to 16 yr . The results support the notion of intrafamilial transfer of mutans streptococci, and suggest that colonization of early acquired strains persists into young adulthood.

J Pediatr Hematol Oncol, 2003 Sep, 25(9), 696 - 703
Viridans streptococcal sepsis: clinical features and complications in childhood acute myeloid leukemia; Okamoto Y et al.; PURPOSE: Treatment of acute myeloid leukemia (AML) is associated with substantial adverse effects, including neutropenia and infection . Viridans streptococci (VS) are a primary cause of infection and pneumonia in patients with neutropenia . The authors determined the incidence, clinical features, and complications of VS sepsis in children receiving chemotherapy for AML . METHODS: The authors retrospectively reviewed the records of 172 patients treated on their institutional protocols AML91 (n = 95) and AML97 (n = 77) and identified 36 patients who had VS sepsis . RESULTS: The 1-year cumulative incidence of VS sepsis was significantly higher in AML97 than in AML91 . Patients with favorable cytogenetic features (ie, t(9;11), t(8;21), or inv(16)) had a significantly higher incidence of infection than did other patients . VS sepsis developed at various times after chemotherapy was initiated, and patients remained febrile for a median of 15 days . Twelve patients (33%) experienced hypotension, 10 (28%) acute respiratory distress syndrome, and 6 (17%) fungal infection . Twenty-three patients (64%) required intensive care, 21 (58%), oxygen therapy, and 7 (19%), vasopressor medications . One patient died of pulmonary aspergillosis after VS sepsis . The 3-year cumulative incidence of aspergillosis was higher in patients with VS sepsis than in those without . CONCLUSIONS: Although antibiotic therapy rapidly resolved VS sepsis, complications associated with this infection remained life-threatening in children receiving chemotherapy for AML.

J Antimicrob Chemother, 2003 Oct, 52(4), 645 - 50 Epub 2003 Sep 12.
Bacteria with increased mutation frequency and antibiotic resistance are enriched in the commensal flora of patients with high antibiotic usage; Gustafsson I et al.; BACKGROUND: We examined how prolonged antibiotic treatment affected the resistance and mutation frequency of human microflora isolated from intestine (Escherichia coli, enterococci spp.), pharynx (alpha-streptococci) and nostril (coagulase-negative staphylococci, CoNS) . METHODS: Samples were collected from patients at the Center of Cystic Fibrosis (n=18) and the haematology ward (n=18) of the University Hospital, Uppsala, Sweden . The individually used amount of antibiotics for 1 year was recorded as the defined daily dose (DDD) . Primary health care patients (n=30), with no antibiotic treatment for 1 year before sampling, were used as controls . Three isolates of each bacterium from each patient were examined . Antibiotic susceptibilities were determined by disc diffusion . Mutation frequencies to rifampicin resistance were measured on 30 independent cultures of each bacterial species from each individual by plating on rifampicin agar plates . For alpha-streptococci the mutation frequency to streptomycin resistance was also determined . RESULTS: Isolates from patients with high antibiotic use showed a pronounced shift towards increased resistance and a small but significant increase in the mutation frequency compared with isolates from the controls . For E . coli, enterococci and CoNS the increase in geometric mean mutation frequency in the patient group was 3-, 1.8- and 1.5-fold, respectively (P values 0.0001, 0.016 and 0.012) . For alpha-streptococci there was a significant difference in geometric mean mutation frequency between patient and control groups for streptomycin resistance (P=0.024) but not for rifampicin resistance (P=0.74) . CONCLUSIONS: High antibiotic use selected for commensals with highly increased resistance and a slight increase in mutation frequency.

J Antimicrob Chemother, 2003 Oct, 52(4), 636 - 44 Epub 2003 Sep 12.
Antimicrobial susceptibility patterns and macrolide resistance genes of viridans group streptococci from normal flora; Seppala H et al.; OBJECTIVES: Our aim was to study the antimicrobial susceptibilities and macrolide resistance mechanisms of viridans group streptococci isolated from the normal flora . METHODS: In vitro susceptibilities of 16 antimicrobials were studied for 161 viridans streptococci (on average 5.8 isolates per person) from the normal flora of 28 elderly persons . Resistance mechanisms of erythromycin-resistant isolates were studied by the double disc test and PCR . RESULTS: In all, 16.8% of the isolates were non-susceptible (MIC > or =0.25 mg/L) to penicillin, but none showed high-level resistance (MIC > or =4 mg/L) . Resistance to erythromycin, tetracycline, quinupristin/dalfopristin, levofloxacin and moxifloxacin was found in 22.4, 27.3, 13.0, 1.9 and 1.9% of the isolates, respectively . Combined resistance to erythromycin and tetracycline was found in 13.0% of the isolates . Erythromycin-resistant isolates were isolated from 57% of the study persons . Of the erythromycin-resistant isolates 80.6% were of the M phenotype and 19.4% were of the macrolide-lincosamide-streptogramin B (MLSB) phenotype (one isolate with constitutive and six with inducible expression) . Isolates with the M phenotype were the least susceptible to telithromycin, a new ketolide . The mef(A) gene was found in the isolates with the M phenotype and the erm(B) gene in the isolates with the MLSB phenotype . CONCLUSIONS: The distribution of phenotypes among the viridans streptococci resembles that found in Streptococcus pyogenes, with predominance of the M phenotype . However, the coding gene for the MLSB phenotype, erm(B), is the same in viridans streptococci as in Streptococcus pneumoniae . Viridans group streptococci carrying different resistance traits provide a pool of resistant bacteria that may transfer resistance determinants to more pathogenic organisms.

J Int Med Res, 2003 Jul-Aug, 31(4), 253 - 66
Effect of oral zinc supplementation on agents of oropharyngeal infection in patients receiving radiotherapy for head and neck cancer; Ertekin MV et al.; We aimed to investigate the effect of zinc supplementation on oropharyngeal infections in immunocompromised patients . Thirty patients receiving radiotherapy for head and neck cancer received 150 mg/day zinc or placebo, orally, during radiotherapy and for a further 6 weeks . None received antibiotics during this period . Oropharyngeal samples were collected 1 day before the first course and 1 day after the last course of radiotherapy, and 1 week and 6 weeks after radiotherapy . Samples were cultured and pathogens identified using microbial diagnostic and gas chromatography methods . Coagulase-positive and -negative staphylococci, group A beta-haemolytic streptococci, Streptococcus pneumoniae, and Candida species were detected in both groups, but some infections, especially with Candida species and staphylococci, were prevented by zinc supplementation . We therefore suggest use of low-dose antibiotics and oral zinc supplementation in patients with these infections . No effects of zinc supplementation were observed on group A beta-haemolytic streptococci and Streptococcus pneumoniae, making it essential to start antimicrobial chemotherapy before radiotherapy.

J Infect Dis, 2003 Sep 15, 188(6), 809 - 17 Epub 2003 Sep 04.
Immune response to group A streptococcal C5a peptidase in children: implications for vaccine development; Shet A et al.; The group A streptococcal C5a peptidase (SCPA) is a major surface virulence protein that facilitates the establishment of local infection by group A streptococci (GAS) . We measured the human immune response to SCPA, using a standardized indirect enzyme-linked immunosorbent assay . Paired acute and convalescent serum samples from children with GAS-associated pharyngitis were assayed, and a strong immune response to SCPA was demonstrated that was independent of the infecting M type and the age of the patient . Western blot analysis of bacterial extracts revealed that all tested M types expressed SCPA . The immune response to SCPA correlated with the anti-streptolysin O and anti-DNase B responses . These data confirm the immunogenicity of SCPA in humans . Previous knowledge of SPCA's role in virulence, its highly conserved nature, and the results of mouse protection studies make SCPA an ideal vaccine candidate for the prevention of GAS disease.

An Sist Sanit Navar, 2003 May-Aug, 26(2), 287 - 90
{PANDAS following amygdalectomy}; Arostegui S et al.; PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections) is the denomination for the disorder shown by a subgroup of patients with obsessive symptoms and/or tics that appear in relation to infections by group A beta-hemolytic streptococci . The clinical case that we present corresponds to a girl of 5 years who developed a compulsive-obsessive disorder in temporal relation to an amygdalectomy . This patient fulfilled the diagnostic criteria and the longitudinal evolution corresponding to this type of disorder.

Scand J Immunol, 2003 Sep, 58(3), 335 - 41
Selective response of dermal Th-1 cells to 20-50 kDa streptococcal cell-wall proteins in chronic plaque psoriasis; Baker BS et al.; We have recently described a dermal Th-1 subset in skin lesions of psoriasis which recognizes cell-wall extract isolated from group A streptococci (GAS) . As a first step in the identification of the streptococcal proteins involved, dermal T-cell lines (TCL) cultured from the lesional skin of 12 human leucocyte antigen (HLA)-typed psoriasis patients were stimulated with GAS cell-wall extract and 14 fractions (MWt approximately 20-100 kDa) separated from the cell-wall extract by sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) and electroelution, stained for intracellular interferon-gamma(IFN-gamma) expression and analysed by flow cytometry . All the TCL responded to GAS cell-wall extract to varying extents (3.5-27.6% IFN-gamma+) . This response was consistently directed against 20-50 kDa cell-wall fractions and inhibited by anti-HLA-DR antibody . TCL with higher responses to GAS cell-wall extract recognized a larger number of fractions within this range than the lower responder TCL . No difference between the level and pattern of response to the fractions was observed for TCL from HLA-DR7+ (n = 6) and HLA-DR7- (n = 6) individuals . This preliminary study has shown a selective response to lower MWt proteins expressed on GAS cell wall by skin Th-1 cells in psoriasis . Further studies are required to identify the proteins involved.

J Vet Med A Physiol Pathol Clin Med, 2003 May, 50(4), 179 - 84
Isolation and cryopreservation of functionally competent equine leucocytes; Zerbe H et al.; Sufficient numbers of functionally competent polymorphonuclear neutrophil granulocytes (PMN) seem to be of major importance during the course of equine endometritis . In this study, we wanted to establish a method for cryopreservation of functionally competent neutrophils for an intended local endometritis therapy in mares . The separation of leucocytes by hypotonic lysis of whole blood from clinically healthy mares was superior to the separation by dextrose sedimentation . After suspension of the cells in the cryoprotective solution {equine plasma with 5% (v/v) dimethyl sulphoxide (DMSO)}, the leucocytes were frozen in liquid nitrogen . A temperature gradient with low cooling velocity (1 degree C/min between 4 and -70 degrees C) resulted in highest numbers of viable cells after thawing . Thawed PMN had a high phagocytic capacity for opsonized streptococci . Their ability to generate reactive oxygen species (ROS) after stimulation with a phorbol ester was even higher than that of freshly isolated PMN and was preserved up to 6 h after thawing . The results of this study indicate that cryopreservation of PMN may provide viable and functionally competent neutrophils for therapeutic use in mares susceptible to endometritis.

J Clin Pathol, 2003 Sep, 56(9), 690 - 3
Gemella bacteraemia characterised by 16S ribosomal RNA gene sequencing; Woo PC et al.; AIMS: To define epidemiology, clinical disease, and outcome of gemella bacteraemia by 16S rRNA gene sequencing . To examine the usefulness of the Vitek, API, and ATB systems in identifying two gemella species . METHODS: All alpha haemolytic streptococci other than Streptococcus pneumoniae isolated from blood cultures during a six year period were identified by conventional biochemical methods, the Vitek system, and the API system . 16S rRNA gene sequencing was performed on all isolates identified by both kits as gemella with >or= 95% confidence or by either kit as any bacterial species with < 95% confidence . The ATB expression system was used to identify the two isolates that were defined as gemella species by 16S rRNA gene sequencing . RESULTS: Of the 302 alpha haemolytic streptococci other than S pneumoniae isolated, one was identified as Gemella morbillorum, and another as Gemella haemolysans by 16S rRNA gene sequencing . The patient with monomicrobial G morbillorum bacteraemia was a 66 year old man with community acquired infective endocarditis with septic thromboemboli . The patient with G haemolysans bacteraemia was a 41 year old woman with hospital acquired polymicrobial bacteraemia during the neutropenic period of an autologous bone marrow transplant for non-Hodgkin's lymphoma, the first case of its kind in the English literature . The API and ATB expression systems only identified the second strain as G haemolysans at 94% and 99% confidence, respectively, whereas the Vitek system identified none of the two strains correctly at > 70% confidence . CONCLUSIONS: Gemella bacteraemia is uncommon . 16S rRNA gene sequencing is the method of choice for identification of gemella and gemella-like isolates.

J Eur Acad Dermatol Venereol, 2003 Sep, 17(5), 591 - 3
Necrotizing fascitis induced by mosquito bite; Verma SB; Necrotizing fascitis usually occurs after a perforating trauma or sometimes surgery . It is an acute necrotizing process which involves the fascia of the skin . Within one or two days of the causative event the patient experiences pain, oedema and a dusky bluish-red discolouration of the skin with or without bullae formation . These areas become gangrenous usually by the fifth day . Often any specific organisms are not grown on culture, but the common ones that are include beta-haemolytic streptococci, coliforms, enterococci, pseudomonas . Treatment comprises early detection, surgical debridement, intravenous antibiotics and supportive care . We report a case of grossly neglected necrotizing fascitis caused by mosquito bites . Our treatment consisted of intravenous antibiotics, thorough debridement, regular dressings and a split-thickness skin graft . These measures collectively preserved an otherwise hopelessly mutilated upper limb.

J Dairy Sci, 2003 Aug, 86(8), 2684 - 95
Heritability of intramammary infections at first parturition and relationships with sire transmitting abilities for somatic cell score, udder type traits, productive life, and protein yield; Nash DL et al.; The objective of this study was to determine the relationships among daughter intramammary infections at first parturition and sire transmitting abilities for somatic cell score, udder type traits, productive life, and protein yield . Quarter milk samples from 958 daughters (in eight Pennsylvania herds and one Nebraska herd) of 182 Holstein sires were collected within a few days of first calving and cultured to determine intramammary infection status . A total of 446 cows had intramammary infections in 835 quarters at first parturition . Incidence of intramammary infections at first parturition and the proportion of quarters infected per cow were regressed on age at first calving, days in milk at sample collection, herd-season of calving (a classification variable), and sire transmitting abilities taken one at a time . Linear effects, non-linear effects, and odds ratios were estimated for sire transmitting abilities . Separate, preplanned analyses were conducted on data from one herd that gave all heifers an intramammary antibiotic infusion in each quarter 30 d prior to the expected calving date . Separate analyses were also conducted on dependent variables that considered intramammary infections at first parturition from: all organisms, coagulase-negative staphylococci, coliform species, streptococci other than Streptococcus agalactiae, and the most common environmental organisms (coliform species and streptococci other than Streptococcus agalactiae) . Daughters of sires that transmit the lowest somatic cell score had the fewest intramammary infections at first parturition . Daughters of sires that transmit longer productive life, shorter teats, and closely spaced front teats had fewer intramammary infections at first parturition . Selection for lower somatic cell score, longer productive life, shorter teats, or closely spaced front teats may reduce the incidence of intramammary infections at first parturition.

J Contemp Dent Pract, 2003 Aug 15, 4(3), 1 - 10
Coronal microleakage assessed by polymicrobial markers; Britto LR et al.; Studies have shown significant bacterial leakage following exposure of sealed root canals to artificial and natural saliva . The objective of this study was to determine contamination via bacterial migration in artificial saliva in endodontically treated teeth using different obturation techniques and sealers . A total of 144 extracted, human mandibular anterior teeth were cleaned and shaped to a #40 master apical file using hand and rotary instrumentation . One hundred and twenty teeth were divided into two experimental groups . The teeth in Group 1 were obturated with gutta-percha using lateral compaction and five different sealers, and the teeth in Group 2 were obturated with gutta-percha using thermomechanical compaction and five different sealers . The remaining 24 teeth were prepared as positive and negative controls . All specimens, except the negative controls, were inoculated every five days with Anaerobic streptococci (NCTC 9891) related to Peptostreptococcus micros and Prevotella intermedia (ATCC 25611) . The contamination onset time was continuously recorded and turbid broths cultured for bacteria identification . The controls behaved as expected . Regardless of the combination between obturation techniques and different sealers, all broths became turbid during this experiment . The correlation between the obturation techniques and the sealers revealed statistical significance using ANOVA (p<0.0001), followed by the Duncan Multiple Range Test, which determined the ranking between these interactions . The combination of MicroSeal obturation technique with Ketac-Endo sealer allowed a slower rate of coronal-apical bacterial migration.

Vet Microbiol, 2003 Sep 24, 95(4), 283 - 93
Septicaemia in emerald monitors (Varanus prasinus Schlegel 1839) caused by Streptococcus agalactiae acquired from mice; Hetzel U et al.; The present study was performed to investigate both the identity and the source of the bacteria responsible for a fatal septicaemia observed in a group of three subadult emerald monitors (Varanus prasinus Schlegel 1839) . The emerald monitors were necropsied and examined by light microscopy, including immunohistology, and by electron microscopy . Tissue samples were additionally submitted for bacteriological, virological and parasitological examinations . The virological and parasitological results were noncontributory, whereas the bacteriological investigation resulted in the isolation of gram-positive cocci which were characterized biochemically and serologically and by molecular analysis . The death of the emerald monitors was caused by a partially leukocyte-associated septicaemic infection with streptococci of serological group B of serotype V . Phenotypically and genotypically identical group B streptococci were isolated from the intestine of subadult mice, obtained from the feed used for the monitors . The genotypical characterization included an identical DNA fingerprint of strains of both origins, indicating the epidemiological relation between the feeding mice and the infections of the monitors.

Infect Immun, 2003 Sep, 71(9), 5097 - 103
Serum opacity factor (SOF) of Streptococcus pyogenes evokes antibodies that opsonize homologous and heterologous SOF-positive serotypes of group A streptococci; Courtney HS et al.; Serum opacity factor (SOF) is a protein expressed by Streptococcus pyogenes that opacifies mammalian serum . SOF is also a virulence factor of S . pyogenes, but it has not been previously shown to elicit a protective immune response . Herein, we report that SOF evokes bactericidal antibodies against S . pyogenes in humans, rabbits, and mice . Rabbit antiserum against purified recombinant SOF2 opsonized SOF-positive M type 2, 4, and 28 S . pyogenes in human blood but had no effect on SOF-negative M type 5 S . pyogenes . Furthermore, affinity-purified human antibodies against SOF2 also opsonized SOF-positive streptococci . A combination of antisera against M2 and SOF2 proteins was dramatically more effective in killing streptococci than either antiserum alone, indicating that antibodies against SOF2 enhance the opsonic efficiency of M protein antibodies . Mice tolerated an intravenous injection of 100 microg of SOF without overt signs of toxicity, and immunization with SOF protected mice against challenge infections with M type 2 S . pyogenes . These data indicate that SOF evokes opsonic antibodies that may protect against infections by SOF-positive serotypes of group A streptococci and suggest that different serotypes of SOF have common epitopes that may be useful vaccine candidates to protect against group A streptococcal infections.

Pediatr Res, 2003 Dec, 54(6), 808 - 13 Epub 2003 Aug 20.
Influence of partial liquid ventilation on bacterial growth and alveolar expansion in newborn rabbits with group B-streptococcal pneumonia; Rudiger M et al.; Partial liquid ventilation (PLV) with perfluorocarbons has been considered as an alternative therapy for severe inflammatory lung disease . The present study was performed to test whether PLV influences bacterial growth and lung histology in a rabbit model of congenital pneumonia caused by group B streptococci . Near-term newborn rabbits were tracheotomized, inoculated via the airways with group B streptococci, and subsequently ventilated for 5 h with either PLV or conventional ventilation . At 30 min after group B streptococci administration, animals in the PLV group (n = 16) received 30 mL/kg body weight of perfluorocarbon (PF 5080) via the tracheal tube . Evaporative losses were substituted with 20 mL/kg perfluorocarbon at hourly intervals . Identical volumes of air were injected in control animals at the same times (n = 15) . The number of colony-forming units in left lung homogenate, evaluated at the end of the experiments, tended to be lower in PLV-treated animals than in controls (6.8 x 109 versus 6.4 x 1010 colony-forming units/g body weight; p = 0.06) . Comparison of these numbers with the colony-forming units injected at the beginning of the experiments revealed a reduction in bacterial number in the PLV group and proliferation in the controls (-2.2 x 108 versus +5.6 x 1010 colony-forming units/g body weight; p < 0.05) . Histologic examination demonstrated less inflammation and more homogeneous lung expansion in PLV-treated animals . Two animals in the PLV group had focal interstitial emphysema . Our results suggest that PLV with PF 5080 reduces bacterial proliferation in experimental group B streptococcal pneumonia.

Oral Microbiol Immunol, 2003 Oct, 18(5), 323 - 6
Identification of mutans streptococci by restriction fragment length polymorphism analysis of polymerase chain reaction-amplified 16S ribosomal RNA genes; Sato T et al.; Mutans streptococci are frequently isolated from dental plaque and carious lesions . These bacteria have been identified by conventional methods such as biochemical and serologic tests followed by the isolation of colonies on the mitis-salivarius agar, which are sometimes inconsistent . Recently, species-specific polymerase chain reaction (PCR) has been reported to rapidly identify Streptococcus mutans and Streptococcus sobrinus . However, in the case of identification and classification into several species, e.g . within the group of mutans streptococci consisting of seven species, the identification using species-specific PCR seems somewhat inefficient because of need for the development and preparation of specific primers for each species . Therefore, in this study we developed a simple method using restriction fragment length polymorphism analysis of PCR-amplified 16S ribosomal RNA genes (16S rRNA genes PCR-RFLP) for the identification of seven different species included in the group of mutans streptococci . We amplified 16S rRNA gene sequences from genomic DNA samples by PCR using universal primers and digested the PCR products with the restriction endonucleases, HpaII and HaeIII . HpaII produced six RFLP patterns for eight reference strains, since the patterns for S . sobrinus, Streptococcus downei and Streptococcus ferus were similar . RFLP patterns produced with HaeIII could separate these three species . Furthermore, the RFLP patterns predicted from the 16S rRNA gene sequences in the GenBank database agreed with the actual RFLP patterns produced in the present study . The 16S rRNA sequence comparisons can be used to identify oral mutans streptococci; however, the identification by sequencing is sometimes difficult in large-scale studies and for small laboratories . Therefore, 16S rRNA genes PCR-RFLP, using HpaII and HaeIII, could be an alternative method for the identification of mutans streptococci, and may be applicable for large-scale studies on the cariogenicity of mutans streptococci.

J Oral Sci, 2003 Jun, 45(2), 93 - 8
Does a clinical evaluation of oral cleanliness correlate with caries incidence in preschool children? Findings from a cohort study; Seki M et al.; The aim of this study was to assess whether a clinical evaluation of oral cleanliness reflects subsequent caries incidence . Oral examination of 180 children (1- to 4-year-olds) was carried out twice in a six-month period . Caries prevalence at baseline (dfs) in 1- to 2-year-olds (group A) and 3- to 4-year-olds (group B) correlated significantly with oral cleanliness as well as salivary mutans streptococci count (MS) . Caries increment (delta(dfs)) correlated significantly with oral cleanliness in group A but not in group B, while delta(dfs) significantly correlated with MS in group B and slightly correlated with that in group A . ANCOVA revealed that dfs was significantly higher at the second examination than at baseline in group B, even after adjusting for oral cleanliness . This finding was confirmed by Wilcoxon test when group B was divided in three categories (low, middle and high) based on oral cleanliness . This suggests that the relationship between delta(dfs) and oral cleanliness decreased with age and that the significant positive correlation found in group B by our point-prevalence survey is derived from the remainder of the positive correlation that occurred at a younger age.

Adv Biochem Eng Biotechnol, 2003, 85, 181 - 214
Status of immunodiagnosis and immunocontraceptive vaccines in India; Gupta SK; The article focuses on the Indian initiative of making kits for diagnosis of various infectious and non-infectious diseases as well as reproductive hormones and hormones in various other endocrine disorders . Indigenous diagnostic kits for the detection of various infections such as filariasis, typhoid, amebiasis, Japanese encephalitis, hepatitis, HIV, dengue, leishmaniasis, malaria, rabies, toxoplasmosis, rotavirus, and group A streptococci have been developed . Agreements to transfer the know-how of some of these leads to industries have been signed . The know-how of enzyme-linked immunosorbent assay (ELISA) for detection of hepatitis C has been successfully transferred to industry and is being commercially produced . For detection of HIV-1 and HIV-2, indigenous diagnostic kits based on three different formats, namely ELISA, Western blot and rapid test have been developed and are being commercially produced by Indian industries . The factors influencing the successful transfer of laboratory-scale diagnostic assays from academia to industry and their commercial exploitation have been discussed . Indian scientists have made seminal contributions in exploring the possibility to develop an effective and safe contraceptive vaccine to control the increasing human population of India . Achieving contraception by means of vaccine is a novel approach, which entails generation of a specific antibody response against antigens critically involved in the process of mammalian reproduction . In India, three major programs on contraceptive vaccines based on the beta-subunit of human chorionic gonadotrophin ((beta)hCG) for women, ovine follicle stimulating hormone (oFSH) for men, and riboflavin carrier protein for both males and females have been initiated . The work at the National Institute of Immunology, New Delhi on contraceptive vaccine for women, based on (beta)hCG, has demonstrated, for the first time, that it is feasible to regulate fertility by such an approach . Basic research being carried out to achieve immunocontraception by interfering at sperm-oocyte interaction level has been briefly discussed . These developments are still at the research stage . In addition to advances in the area of contraceptive vaccines, a non-steroidal contraceptive oral pill has been developed by Central Drug Research Institute, Lucknow, commercially produced by two Indian pharmaceutical companies and has been incorporated in the National Family Welfare Program . Another interesting approach for fertility regulation in male has been developed in India, which involves vas occlusion with styrene maleic anhydride (SMA) and is currently undergoing clinical trials in human subjects.

Klin Padiatr, 2003 Jul-Aug, 215(4), 208 - 12
{Bacterial cervical lymphadenitis--surgical aspects}; Trobs RB et al.; In a retrospective study we evaluated clinical features and diagnostic impact of sonography, white blood cell count, C-reactive protein as well as bacterial etiology of children treated surgically for bacterial cervical lymphadenitis . We report on 38 children at the age between 2.5 months and 14 years who were admitted in our departments between 1990 and June 2002 . Leukocytosis (median 16.5 Gpt/l) and/or elevated concentrations of C-reactive protein (median 27 mg/l) occurred in the majority of patients . Clinical appearance and the result of ultrasound examination were relevant for diagnosis of suppurative inflammation . Treatment included incision and drainage in 29 cases, aspiration was performed in 4 children and in 5 cases the affected lymph nodes were removed . We found a predominance of infections due to S . aureus (37%) and group A streptococci (16%) . A mixed aerobic-anaerobic infection was observed in 2 (5%) children and atypical mycobacteriosis in 3 (8%) cases . In conclusion, suppurative cervical adenitis has to be taken into account in children with cervical lymph node enlargement . In these cases surgical drainage is a key to appropriate resolution.

J Immunol, 2003 Sep 1, 171(5), 2532 - 7
Membranous cells in nasal-associated lymphoid tissue: a portal of entry for the respiratory mucosal pathogen group A streptococcus; Park HS et al.; Human tonsils are suspected to be an antibiotic-impervious human reservoir for group A streptococcus . An intranasal infection model in mice and a bioluminescent-tagged strain were used to investigate this possibility . Viable streptococci were predominantly found both intra- and extracellularly in nasal-associated lymphoid tissue (NALT), a human tonsil homologue . Ulex europaeus-1, a membranous (M) cell-specific lectin, identified cells harboring streptococci at the epithelial surface of NALT and blocked bacterial colonization of this tissue . These results suggest that M cells in NALT transport this Gram-positive pathogen across the epithelial layers in a manner similar to those in Peyer's patches, which permit enteric pathogens to invade deeper tissues from the gastrointestinal tract.

Int J Antimicrob Agents, 2003 Aug, 22(2), 160 - 3
In vitro susceptibility, tolerance and MLS resistance phenotypes of Group C and Group G streptococci isolated in Turkey between 1995 and 2002; Ergin A et al.; A total of 105 clinical strains of Group C and Group G streptococci were examined for their susceptibility to penicillin, cefotaxime, erythromycin, meropenem and vancomycin using a broth microdilution method . Minimum bactericidal concentrations of the antimicrobial agents and phenotypes of strains resistant to erythromycin were also evaluated . No resistance to penicillin, cefotaxime, meropenem and vancomycin was found in years 1995-2002, but there was 6.7% resistance to erythromycin . No tolerance was seen for penicillin and vancomycin, but there were strains tolerant to cefotaxime, erythromycin and meropenem . The resistance phenotypes of erythromycin-resistant isolates were determined by the double disc test with erythromycin and clindamycin which showed inducible MLS (57.1%) and M phenotype (42.8%) resistance . This in vitro finding shows that classical antimicrobial agents used for the treatment of GCS and GGS have good activity against clinically significant isolates, but the presence of macrolide resistance and tolerant isolates suggests that careful surveillance of the streptococcal isolates should be carried out.

Am J Orthod Dentofacial Orthop, 2003 Aug, 124(2), 198 - 205
Adhesion of oral streptococci to experimental bracket pellicles from glandular saliva; Ahn SJ et al.; The aim of this study was to evaluate the functions of bracket pellicles as the binding receptors for Streptococcus mutans and Streptococcus gordonii . Four different types of orthodontic brackets were used: stainless steel, monocrystalline sapphire, polycrystalline alumina, and plastic . The bracket pellicles were formed by incubating orthodontic brackets with fresh submandibular-sublingual saliva or parotid saliva for 2 hours . The pellicles were extracted, and their components were confirmed by gel electrophoresis, immunodetection, and amino acid composition analysis . The roles of the bracket pellicles in the adhesion of oral streptococci were evaluated by incubating tritium-labeled streptococci with pellicle-transfer blots . The results showed that the salivary components adhered selectively according to type of bracket and glandular saliva . The selective adsorption was also proven by the amino acid composition profiles . Among the several salivary proteins, MG2, alpha-amylase, and the acidic proline-rich proteins provided the binding sites for S gordonii . However, none of these proteins in the bracket pellicles contributed to the adhesion of S mutans . These findings suggest that numerous salivary proteins can adhere selectively to the orthodontic brackets, and some of them contribute to the binding of S gordonii.

Ann Rheum Dis, 2003 Sep, 62(9), 829 - 34
Systematic safety follow up in a cohort of 107 patients with spondyloarthropathy treated with infliximab: a new perspective on the role of host defence in the pathogenesis of the disease?
Baeten D, Kruithof E, Van den Bosch F, Van den Bossche N, Herssens A, Mielants H, De Keyser F, Veys EM.
BACKGROUND: Recent studies with infliximab indicate the therapeutic potential of tumour necrosis factor alpha blockade in spondyloarthropathy (SpA) . Because defective host defence is implicated in the pathogenesis of SpA, the potential side effects of this treatment due to impact on the antimicrobial defence are a major concern . OBJECTIVE: To report systematically the adverse events seen in a large cohort of patients with SpA treated with infliximab, with special attention to bacterial infections . PATIENTS AND METHODS: 107 patients with SpA were treated with infliximab for a total of 191.5 patient years . All serious and/or treatment related adverse events were reported . RESULTS: Eight severe infections occurred, including two reactivations of tuberculosis and three retropharyngeal abscesses, and six minor infections with clear bacterial focus . One patient developed a spinocellular carcinoma of the skin . No cases of demyelinating disease or lupus-like syndrome were seen . Two patients had an infusion reaction, which, however, did not relapse during the next infusion . Finally, three patients with ankylosing spondylitis developed palmoplantar pustulosis . All patients recovered completely with adequate treatment, and infliximab treatment had to be stopped in only five patients with severe infections . CONCLUSIONS: Although the global safety of infliximab in SpA is good compared with previous reports in rheumatoid arthritis and Crohn's disease, the occurrence of infections such as tuberculosis and retropharyngeal abscesses highlights the importance of careful screening and follow up . Focal nasopharyngeal infections and infection related symptoms, possibly induced by streptococci, occurred frequently, suggesting an impairment of specific host defence mechanisms in SpA.

Mol Immunol, 2003 Sep, 40(2-4), 95 - 107
Complement resistance mechanisms of streptococci; Jarva H et al.; Group A streptococcus (GAS, Streptococcus pyogenes), group B streptococcus (GBS, Streptococcus agalactiae) and pneumococcus (Streptococcus pneumoniae) are all human pathogens that cause significant morbidity and mortality worldwide . These related species cause different spectra of infections spanning from trivial upper respiratory tract or skin infections to septic and severe diseases . In order to cause deep infections and survive in the human body the bacteria must evade the immune system . Complement is an important part of innate immunity both as an opsonizing and membrane destructing cascade and as an effector system of antibodies . In this review, we describe the complement resistance mechanisms of the three clinically most important streptococcal species, groups A and B streptococci and pneumococcus . The complement evasion mechanisms of these three species are analogous, yet different from one another . Several strains of all three species express molecules (M-proteins, Bac or beta, PspC) that acquire host fluid-phase complement regulators factor H or C4b binding protein to their surfaces . Groups A and B streptococci also secrete proteins and/or enzymes that inhibit the activation of the complement system or chemotaxis caused by the complement activation products . Even though a lot is known about the immune evasion by streptococci, the high morbidity and mortality associated with infections caused by streptococci and the need for efficient vaccines warrant further studies on the streptococcal molecules mediating complement resistance.

Pediatr Infect Dis J, 2003 Aug, 22(8), 677 - 86
Linezolid versus vancomycin for treatment of resistant Gram-positive infections in children; Kaplan SL et al.; BACKGROUND: Pediatric infections caused by resistant Gram-positive infections are an increasing concern with limited treatment options . Linezolid, a new oxazolidinone, is active against staphylococci, streptococci and enterococci . OBJECTIVE: To assess clinical efficacy and safety of linezolid vs.vancomycin in antibiotic-resistant Gram-positive infections in children.DESIGN Hospitalized children (birth to 12 years of age) with nosocomial pneumonia, complicated skin/skin structure infections, catheter-related bacteremia, bacteremia of unknown source or other infections caused by Gram-positive bacteria were randomized 2:1 to receive linezolid intravenously followed by oral linezolid or vancomycin and then by an appropriate oral agent . Treatment duration was 10 to 28 days . RESULTS: There were 321 patients enrolled (linezolid 219, vancomycin 102) . Clinical cure rates were 79% vs.74% (P = 0.36) and 89% vs.85% (P = 0.31) for linezolid and vancomycin in intent-to-treat and clinically evaluable patients, respectively . Cure rates were similar by age and infection diagnosis . Pathogen eradication rates in microbiologically evaluable patients were high for linezolid and vancomycin, respectively, for methicillin-susceptible S . aureus (95% vs.94%; P = 0.82), methicillin-resistant S . aureus (88% vs.90%; P = 0.89) and methicillin-resistant coagulase-negative staphylococci (85% vs.83%, P = 0.87) . In clinically evaluable patients, linezolid-treated patients required significantly fewer days of intravenous therapy compared with vancomycin-treated patients (8.0 +/- 4.8; 10.9 +/- 5.8 days, respectively; P < 0.001) . In addition significantly fewer linezolid-treated patients had drug-related adverse events than did vancomycin-treated patients (19% vs.34%, respectively; P = 0.003) . Hematologic events were uncommon and similar between treatment groups . CONCLUSIONS: Linezolid was well-tolerated and as effective as vancomycin in treating serious Gram-positive infections in children.

Appl Environ Microbiol, 2003 Aug, 69(8), 4760 - 9
Characterization of Streptococcus mutans strains deficient in EIIAB Man of the sugar phosphotransferase system; Abranches J et al.; The phosphoenolpyruvate:sugar phosphotransferase system (PTS) is the major sugar uptake system in oral streptococci . The role of EIIAB(Man) (encoded by manL) in gene regulation and sugar transport was investigated in Streptococcus mutans UA159 . The manL knockout strain, JAM1, grew more slowly than the wild-type strain in glucose but grew faster in mannose and did not display diauxic growth, indicating that EIIAB(Man) is involved in sugar uptake and in carbohydrate catabolite repression . PTS assays of JAM1, and of strains lacking the inducible (fruI) and constitutive (fruCD) EII fructose, revealed that S . mutans EIIAB(Man) transported mannose and glucose and provided evidence that there was also a mannose-inducible or glucose-repressible mannose PTS . Additionally, there appears to be a fructose PTS that is different than FruI and FruCD . To determine whether EIIAB(Man) controlled expression of the known virulence genes, glucosyltransferases (gtfBC) and fructosyltransferase (ftf) promoter fusions of these genes were established in the wild-type and EIIAB(Man)-deficient strains . In the manL mutant, the level of chloramphenicol acetyltransferase activity expressed from the gtfBC promoter was up to threefold lower than that seen with the wild-type strain at pH 6 and 7, indicating that EIIAB(Man) is required for optimal expression of gtfBC . No significant differences were observed between the mutant and the wild-type background in ftf regulation, with the exception that under glucose-limiting conditions at pH 7, the mutant exhibited a 2.1-fold increase in ftf expression . Two-dimensional gel analysis of batch-grown cells of the EIIAB(Man)-deficient strain indicated that the expression of at least 38 proteins was altered compared to that seen with the wild-type strain, revealing that EIIAB(Man) has a pleiotropic effect on gene expression.

J Cataract Refract Surg, 2003 Jul, 29(7), 1273 - 80
Postoperative endophthalmitis: establishment and results of a national registry; Sandvig KU et al.; PURPOSE: To determine the incidence, clinical presentation, etiology, and outcomes of postoperative endophthalmitis in Norway and to explore the potential of and establish a platform for improving diagnostics, prophylaxis, and treatment of postoperative endophthalmitis . SETTING: All ophthalmic surgical units and relevant microbiology laboratories in Norway . METHODS: A national registry of cases of postoperative endophthalmitis was established in 1996 . All ophthalmic surgery units in Norway were asked to return forms including preoperative, perioperative, and postoperative data for each case of endophthalmitis occurring between January 1996 and December 1998 after any intraocular surgery irrespective of the time between the surgery and the onset of endophthalmitis symptoms . All microbiology laboratories in Norway were asked to return questionnaires regarding their routine handling procedures of eye specimens in cases of endophthalmitis . RESULTS: From 1996 to 1998, 111 suspected endophthalmitis cases were reported, all after cataract surgery . Eighty cases were culture positive, 75 with gram-positive bacteria, 4 with gram-negative bacteria, and 1 with Candida albicans . Depending on the definition, the incidence of postoperative endophthalmitis was between 0.11% and 0.16% . Thirteen percent of cases had "delayed" endophthalmitis . Twenty-nine percent of eyes had an outcome of permanent amaurosis or light perception visual acuity; 56% (47/84) retained or improved their categorized visual acuity in the affected eye compared to preoperatively . Positive bacterial growth was associated with a worse visual outcome (P =.008) . The degree of inflammation when endophthalmitis was diagnosed and the visual outcomes were worse in cases with growth of streptococci than in cases with growth of staphylococci (P =.009 and P<.001, respectively) . The questionnaire to the microbiology laboratories revealed a lack of consensus on how to handle the specimens . CONCLUSIONS: Postoperative endophthalmitis remains a serious complication of intraocular surgery, although the prognosis depends greatly on the microbe isolated . Common guidelines should be established regarding clinical and microbiological diagnosis and treatment . Further improvement of the registry would make it a suitable platform for evaluating prophylactic treatments.

J Infect Dis, 2003 Aug 15, 188(4), 497 - 505 Epub 2003 Aug 05.
Plasminogen enhances virulence of group A streptococci by streptokinase-dependent and streptokinase-independent mechanisms; Khil J et al.; Interactions between host plasminogen (Plg) and streptokinase (SK) secreted by group A streptococci (GAS) have been hypothesized to promote bacterial invasion of tissues . The virulence of GAS strain UMAA2616, after being subcutaneously inoculated into mice, was studied . Skin lesions and mortality were observed after inoculation of 7x106 cfu . Coadministration of human Plg with UMAA2616 markedly increased virulence . SK-deficient UMAA2616 (UMAA2616-SK(-)) was generated . Mean skin-lesion area and mortality, after bacterial inoculation (3x105 cfu), were significantly greater with UMAA2616 in the presence of human Plg than with UMAA2616-SK(-) in the presence of human Plg (P=.0001) . Human Plg also enhanced UMAA2616-SK(-) virulence . Exogenous human Plg enhanced the virulence of MGAS166, a human clinical isolate . These findings suggest that SK-Plg interactions are an important determinant of GAS invasiveness in vivo and that both SK and host Plg activators appear to promote virulence of GAS by catalyzing plasmin formation.

Can J Microbiol, 2003 May, 49(5), 350 - 6
Characterization of group B streptococcal glyceraldehyde-3-phosphate dehydrogenase: surface localization, enzymatic activity, and protein-protein interactions; Seifert KN et al.; During characterization of the surface antigens of serotype III group B streptococci (GBS), a protein with an apparent M(r) of approximately 173,500 migrating on a SDS--polyacrylamide gel was found to have an N-terminal amino acid sequence identical to that of the plasmin receptor (Plr) of group A streptococci, a surface-localized glyceraldehyde-3-phosphate dehydrogenase (GAPDH) . This work begins to characterize GBS GAPDH and to assess its functional activity on the cell surface . The 1.0-kb gapC gene of GBS was amplified by PCR . plr and gapC demonstrated 87% homology . An anti-Plr monoclonal antibody reacted with GBS whole cells, suggesting GBS GAPDH is surface localized . Multiple serotypes of GBS demonstrated functional GAPDH on their surfaces . The anti-Plr monoclonal antibody recognized GBS protein bands of approximately 41 and 173.5 kDa, by Western blot . Presumably, these represent monomeric and tetrameric forms of the GAPDH molecule . GBS GAPDH was demonstrated by Western blot analysis to interact with lys- and glu-plasminogens . Fluid-phase GBS GAPDH interacted, by means of ELISA, with immobilized lys-plasminogen, glu-plasminogen, actin, and fibrinogen . Enzymatically active GAPDH, capable of binding cytoskeletal and extracellular matrix proteins, is expressed on the surface of GBS.

Biosens Bioelectron, 2003 Oct 1, 18(11), 1371 - 8
A fiber optic biosensor (FOBS) to monitor mutans streptococci in human saliva; Kishen A et al.; A fiber optic biosensor (FOBS) to monitor mutans streptococci activity in human saliva is developed . The biosensor utilizes e fiber optic evanescent wave spectroscopy to monitor a bacterial mediated biochemical reaction . To achieve this, a short length of the cladding is removed; the fiber core surface is treated and coated with a thin film of porous glass medium using sol-gel technique . The mutans streptococci mediated reaction with sucrose is monitored using a photosensitive indicator, which is immobilized within the porous glass coating . Spectroscopic analysis shows that the transmitted intensity at 597 nm increases conspicuously when monitored for 120 min . Two distinct phases are observed, one from 0 to 60 min and the other from 60 to 120 min . A negative correlation coefficient between the rate of increase in absorption peak intensity recorded by the FOBS and the decrease in pH measured using the pH meter, was calculated to be rho=-0.994 . This investigation highlights the potential benefits of this sensor to monitor mutans streptococci activity in saliva.

Ned Tijdschr Geneeskd, 2003 Jul 19, 147(29), 1423 - 7
{Invasive infections due to group A beta-haemolytic streptococci in two families}; Coenraad MJ et al.; An invasive beta-haemolytic Lancefield group A streptococcal (GAS) infection was diagnosed in 4 patients: a 70-year-old woman, her 71-year-old husband, a 62-year-old woman and her 43-year-old son . In the married couple the infection was caused by GAS-type TB3264M100 . The woman had a pneumonia, whilst her husband developed a streptococcal toxic shock-like syndrome; he died . The other woman and her son were infected with GAS-type T6M6 . The son died of a circulatory arrest due to necrotizing fascitis from a wound in his arm . His mother recovered following a severe tonsillitis . The number of invasive GAS infections has increased in the past decades . GAS infections occur mostly in isolated cases, but clusters of patients are also seen, like the two described here . The risk of an invasive GAS-infection is greatest if one has been in the neighbourhood of the index patient during the week prior to the diagnosis in that patient . According to the latest (American) guidelines, there is no reason for prophylactic treatment of the close contacts of patients.

Mymensingh Med J, 2003 Jul, 12(2), 120 - 3
Antioxidant vitamins improves hemoglobin level in children with group a beta hemolytic streptococcal infection; Ahmed J et al.; A study was done on school children infected with group A beta hemolytic streptococci to examine whether antioxidant vitamins play a role in improving the hemoglobin level . A total of 606 primary school children aged 5 to 15 years were randomly divided into two intervention groups . Group 1 (n=299) was treated with pehnoxymethyl penicillin V and group 2 (n=307) was treated with phenoxymethyl penicillin V plus antioxidant vitamins for eight weeks . From each group two blood samples were drawn in acute and convalescent (after eight weeks) states . Before treatment, mean hemoglobin values were 11.0 and 10.8 mg/dL in groups 1 and 2 respectively . After treatment hemoglobin values were 10.5 and 11.6 mg/dL respectively . Values were significantly decreased in group 1 (P=0.0001), whereas increased in group 2 (P=0.001) . Adjustment for age and sex by ANCOVA confirmed the difference in hemoglobin levels between group (LS means-0.5 vs 0.8 in groups 1 and 2 respectively (P=0.0001) . Hemoglobin level increases after antioxidant vitamin supplementation in children suffering from group A beta hemolytic streptococcal infection.

Int J Syst Evol Microbiol, 2003 Jul, 53(Pt 4), 1101 - 4
Streptococcus oligofermentans sp . nov., a novel oral isolate from caries-free humans; Tong H et al.; Five streptococcal strains were isolated from dental plaque and saliva of caries-free humans . The cells were gram-positive, non-spore-forming, non-motile cocci that were arranged in short chains . The strains were catalase-negative, facultatively anaerobic and produced lactic acid exclusively from glucose fermentation . Biochemical analysis that used both conventional methods and the commercial API 20 Strep system showed that the five strains fermented only a few kinds of sugar . The mean DNA G + C content of the five novel strains was 39.5 +/- 0.8 mol% . Phylogenetic analysis based on 16S rDNA sequence homology indicated that the new isolates represented a novel member of the mitis group of the genus Streptococcus, related most closely to the recently described species Streptococcus sinensis . DNA-DNA relatedness between novel strain LMG 21535T and type strains of phylogenetically related species of oral streptococci was 7.1-16.4% . Therefore a novel Streptococcus species, Streptococcus oligofermentans sp . nov., is proposed . The type strain is LMG 21535T=AS 1.3089T.

Pediatr Dent, 2003 May-Jun, 25(3), 223 - 8
Effects of oral health education and tooth-brushing on mutans streptococci infection in young children; Seow WK et al.; PURPOSE: The purpose of this study was to examine the effects of maternal dental health education and tooth-brushing instruction on the levels of mutans streptococci in pre-school children . METHODS: One hundred and seven children (44 boys and 63 girls) with a mean age of 20.5 months, randomly selected from a community child health clinic within a 2-week period, participated in this study . Medical, dental, and dietary information was obtained through a questionnaire . The children's mouths were examined, and plaque samples were obtained by swabbing the teeth and mucosa . A commercial microbiological kit was used to determine the presence of mutans streptococci . The mothers were instructed in tooth-brushing using a soft-scrub method . The children were recalled to the same clinic after a period of 4 weeks to obtain a second evaluation of the mutans streptococci levels . RESULTS: At the first visit, 69 of the 107 children (64%) showed positive infection with mutans streptococci . Ninety (84%) children returned for the recall examination . In the second examination, only 44 (49%) of the 90 children showed positive results for mutans streptococci . The difference in number of children who tested positive is statistically significant (P < .01) . At the first visit, children who did not show infection with mutans streptococci were those who reported greater frequency of tooth-brushing (P < .05) and less snacking (P < .05) . There were 26 children (29%) who converted from positive to negative results for mutans streptococci infection between the first and second visits (P < .01) . This conversion from positive to negative infection was attributed mainly to increased tooth-brushing, as other dental health habits remained the same . CONCLUSIONS: Infection with mutans streptococci in young children is associated with increased snacking frequency and inadequate tooth-brushing . A single dental health education session and tooth-brushing instruction to mothers results in approximately a 25% reduction in mutans streptococci infection in young children from a relatively high socioeconomic status.

J Antimicrob Chemother, 2003 Sep, 52(3), 485 - 8 Epub 2003 Jul 29.
Clonal diversity among erythromycin-resistant beta-haemolytic Streptococcus isolates in La Rioja, Spain; Portillo A et al.; OBJECTIVE: To analyse clonal diversity in 72 erythromycin-resistant beta-haemolytic streptococci . METHODS: Clonal relationships were studied for streptococci of groups A (GAS, n = 30), B (GBS, n = 34), C (GCS, n = 4) and G (GGS, n = 4) by means of PFGE . Streptococcal isolates were obtained from a 450-bed hospital in Spain during the following periods: GAS (1996-2001), GBS (1999-2001), GCS and GGS (1997-2000) . RESULTS: Twenty-two of the 30 GAS isolates showed the M resistance phenotype and harboured the mef(A) gene . Five unrelated PFGE patterns were identified among these 22 GAS isolates . Sixteen of them, obtained during four different years of the study, showed one of the two predominant PFGE patterns . The remaining eight GAS isolates showed the MLSB resistance phenotype, and four unrelated PFGE patterns were detected . All but one erythromycin-resistant GBS showed the MLSB resistance phenotype, and an erm gene was identified in all cases {erm(B) or erm(A)} . Twenty-two unrelated PFGE patterns were demonstrated among 25 GBS with the MLSB resistance phenotype; the remaining eight MLSB GBS isolates could not be typed by PFGE . The eight erythromycin-resistant GGS and GCS isolates of this study presented seven unrelated PFGE patterns . GGS and GCS strains showed an MLSB resistance phenotype and had the erm(A) gene . CONCLUSIONS: High clonal diversity was detected in this series of erythromycin-resistant GBS, whereas lower diversity was seen in the GAS isolates.

J Vet Pharmacol Ther, 2003 Aug, 26(4), 247 - 52
Clinical efficacy of trimethoprim/sulfadiazine and procaine penicillin G in a Streptococcus equi subsp . zooepidemicus infection model in ponies; Ensink JM et al.; Tissue chambers, implanted subcutaneously on both sides of the neck in eight ponies, were inoculated with Streptococcus equi subsp . zooepidemicus in order to compare the clinical efficacy of trimethoprim/sulfadiazine (TMP/SDZ) and penicillin G treatment in a purulent infection . The TMP/SDZ treatment consisted of one intravenous (i.v.) injection of 5 mg/kg TMP and 25 mg/kg SDZ and the same dose of TMP/SDZ per os (p.o.), both given 20 h after inoculation . The oral dose was then repeated every 12 h for 21 days . The penicillin treatment consisted of one i.v . injection of 20 000 IU/kg sodium penicillin G and intramuscular (i.m.) injection of 20 000 IU/kg procaine penicillin G, both given 20 h after infection . The i.m . dose was then repeated every 24 h for 21 days . Eight ponies, each with two tissue chambers, were used in a cross over design; in the first experiment the left tissue chamber (TC) was infected and in the second experiment the right . TMP/SDZ treatment resulted in a limited reduction of viable bacteria in the TC but did not eliminate the infection, resulting in abscessation in 10-42 days in all eight ponies . However, penicillin treatment eliminated the streptococci in seven of eight ponies, and only one pony suffered abscessation on day 10 . This constitutes a significantly better efficacy of the penicillin treatment in this model . The most probable cause of the failure of TMP/SDZ to eliminate the streptococci is inhibition of the action of TMP/SDZ in the purulent TCF . Therefore, TMP/SDZ should not be used to treat purulent infections in secluded sites in horses.

J Microbiol Immunol Infect, 2003 Jun, 36(2), 105 - 10
Antibiotic resistance of pathogenic bacteria from odontogenic infections in Taiwan; Chan Y et al.; The purpose of this study was to evaluate the susceptibility of facultative and anaerobic odontogenic infectious flora to various antibiotics . We assessed 178 bacterial strains isolated from 74 patients with odontogenic infections . The E-test was used to determine susceptibility . The microbial flora was predominantly facultative gram-positive organisms and anaerobic gram-negative bacilli . The results of antimicrobial susceptibility test showed that ampicillin resistance was found with a very high level of minimum inhibitory concentration (MIC) in approximately one third of Fusobacterium nucleatum, Prevotella intermedia, Peptostreptococcus micros, and Eikenella corrodens isolates (MIC > or = 8 microg/mL) . Greater activity was generally noted with amoxicillin than with ampicillin, but even beta-lactamase inhibitor incorporated amoxicillin showed resistance in more than 10% of all groups except viridans group streptococci and Porphyromonas gingivalis . Tetracycline and erythromycin were considerably less active against the majority of the tested bacterial strains, while minocycline and doxycycline exerted strong antimicrobial activity and could inhibit strains grown at a very low concentration . Among all the tested antibiotics, travofloxacin appears to be a promising drug expressing the highest activities (MIC90 < or = 1 microg/mL), and was regarded as a potent bactericidal drug in odontogenic infections.

Zh Mikrobiol Epidemiol Immunobiol, 2003 Mar-Apr, (2), 83 - 92
{Methods of molecular epidemiology of infections caused by group B streptococci}; Dmitriev AV et al.; In this review the comparative analysis of advantages and disadvantages of the known methods for the immunological diagnostics of streptococcal infections (serotyping, phage typing), as well as the methods of molecular epidemiology (PCR typing with the use of "disseminated" priming, ribotyping, electrophoresis in the pulsing electric field, etc.), is presented . Essentially new approaches, capable of being used in future for the control of epidemically topical clones of group B streptococci, are discussed.

Zh Mikrobiol Epidemiol Immunobiol, 2003 Mar-Apr, (2), 46 - 51
{Fc receptors of endothelial cells of cardiac valves: comparison of IgG Fc binding activity of these receptors and of Fc receptors of group A streptococci}; Danilova TA; Normal human and rabbit sera, as well as IgG isolated from them, have proved to be capable of reacting with the cells of the valve endothelium of the human and bovine heart . As shown in this study, these reactions are linked with the presence of Fc receptors on the epithelial cells . This is confirmed by the positive reactions of the endothelial cells with the Fc fragments of IgG, as well as with pure antibodies to egg albumin and to group A streptococcal polysaccharide and their complexes . As revealed in this study, Fc receptors on endothelial cells and staphylococcal Fc receptors bind with the definite fraction of normal human serum IgG with, probably, more pronounced cytophil properties . This fraction is not linked with IgG subclasses . The suggestion may be made that the presence of IgG Fc binding activity in group A streptococci, coinciding with the binding activity of Fc receptors in some cells of the human body, is probably of importance for pathogenic streptococci, facilitating their successful invasion.

Eur J Clin Microbiol Infect Dis, 2003 Aug, 22(8), 475 - 8 Epub 2003 Jul 18.
Group a streptococcal serotypes isolated from healthy schoolchildren in iran; Fazeli MR et al.; Serotypes of group A streptococci are still a major cause of pharyngitis and some post-infectious sequelae such as rheumatic fever . As part of the worldwide effort to clarify the epidemiological pattern of group A streptococci in different countries, the present study was conducted to assess the prevalence of Streptococcus pyogenes serotypes in Iran . A total of 1588 throat swabs were taken from healthy school children in the city of Gorgan during February and March 1999 . Of those isolates, 175 resulted positive for group A streptococci . The distribution pattern was similar for girls and boys, with 10.8% and 11.2%, respectively . Urban school children showed a higher rate of colonization compared to those in rural areas . Serotyping was performed on 65 of the positive isolates using standard techniques, and only 21 (32%) were M-type isolates . Their profiles fell into four types with M1 predominating, which could reflect the presence of rheumatic fever in the region . However, when isolates were challenged for T-antigen types, nearly all were positive (94%) . The pattern of T types was diverse (18 types), with the most common T types being T1 (26%), TB3264 (15%), TB\1-19 & B\25\1-19 (9.2%) and T2 & 2\28 (7.7%) . When isolates were tested for opacity factor, only 23 (35%) were positive while 34 (52%) responded to the serum opacity reaction test . Although the number of isolates in this study was not sufficient to make any epidemiological conclusions, the scarcity of serotyping studies in Iran could render these data useful for future attempts to develop a streptococcal vaccine.

Psychosom Med, 2003 Jul-Aug, 65(4), 604 - 12
Stress as a determinant of saliva-mediated adherence and coadherence of oral and nonoral microorganisms; Bosch JA et al.; OBJECTIVE: The mucosal secretory proteins, such as the salivary proteins, play a key role in the acquisition and regulation of the mucosal microflora . Most notably, some microorganisms utilize the host's secretory proteins to adhere to the mucosa; a first step in colonization and infection . The secretory proteins also influence colonization by affecting the binding among microorganisms, a process denoted as coadherence . Previously we reported that acute stressors cause specific changes in saliva composition . The present study investigated to what extent these changes influence saliva-mediated microbial adherence and coadherence (ex vivo) . METHODS: Thirty-two male undergraduates provided unstimulated saliva before and during a control condition and two stressors: A memory test and a surgery video presentation . We used saliva-coated microplates to test the adherence of bacteria for which the oral cavity is either a natural reservoir (eg, viridans streptococci) or a portal of entry (eg, Helicobacter pylori) . We also tested the saliva-mediated co-adherence between Streptococcus gordonii and the yeast Candida albicans . Correlation analyses were performed to determine the relationships between changes in microbial adherence and the concentrations of potential salivary ligands, viz . cystatin S, the mucins MUC5B and MUC7, S-IgA, lactoferrin, alpha-amylase, and total salivary protein . RESULTS: During the memory test, saliva-mediated adhesion of Streptococcus sanguis, Streptococcus gordonii, and H . pylori increased, whereas the coadherence of C . albicans with S . gordonii decreased . During the surgical video presentation the saliva-mediated adherence of H . pylori, S . sanguis, and Streptococcus mitis increased . These changes were independent of salivary flow rate, but correlated with specific changes in salivary protein composition . CONCLUSION: The results show that even moderate stressors, by altering the activity of the mucosal secretory glands, may affect microbial colonization processes such as adherence and coadherence . This study hereby presents a mechanism by which stress may affect the mucosal microflora and susceptibility to infectious disease.

J Child Adolesc Psychopharmacol, 2003, 13 Suppl 1, S81 - 8
Childhood-onset obsessive-compulsive disorder and tic disorders: case report and literature review; Snider LA et al.; A subgroup of childhood-onset obsessive-compulsive disorder (OCD) and tic disorders has been found to have a postinfectious autoimmune-mediated etiology . Clinical observations and systematic investigations have shown that a subgroup of children with OCD and/or tic disorders have the onset and subsequent exacerbations of their symptoms following infections with group A beta-hemolytic streptococci (GABHS) . This subgroup has been designated by the acronym PANDAS: pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections . Five clinical characteristics define the PANDAS subgroup: presence of OCD and/or tic disorder, prepubertal symptom onset, sudden onset or abrupt exacerbations, association with neurological abnormalities during exacerbations (adventitious movements or motoric hyperactivity), and the temporal association between symptom exacerbations and GABHS infections . The proposed poststreptococcal inflammatory etiology provides a unique opportunity for treatment and prevention, including immunomodulatory therapies such as plasma exchange and intravenous immunoglobulin . A placebo-controlled trial revealed that both intravenous immunoglobulin and plasma exchange were effective in reducing neuropsychiatric symptom severity (40 and 55% reductions, respectively) for a group of severely ill children in the PANDAS subgroup . Further research is required to determine why the treatments are helpful and to ascertain whether or not antibiotic prophylaxis can help prevent poststreptococcal symptom exacerbations.

Expert Opin Pharmacother, 2003 Aug, 4(8), 1259 - 75
Treatment of bacterial skin and skin structure infections; Guay DR; Bacterial skin and skin structure infections (SSSIs) are among the most frequently seen infectious entities in the community setting and occasionally in the institutional setting . A wide variety of SSSIs exist, with cellulitis, impetigo and folliculitis being the most common . Most SSSIs are caused by aerobic staphylococci and streptococci, with aerobic Gram-negative bacilli and anaerobes being involved in more complicated infections . Systemic therapy with a variety of beta-lactams, macrolides and lincosamides (clindamycin) have been the cornerstone of SSSI therapy for many years . With the exception of mupirocin, topical therapy occupies a small therapeutic niche . Despite the emergence of antimicrobial resistance among the pathogens most commonly associated with SSSIs (for example, Streptococcus pyogenes and macrolides; Staphylococcus aureus and methicillin, vancomycin, penicillin and mupirocin), few treatment failures have been reported . The newest antimicrobials reviewed herein (linezolid, quinupristin/dalfopristin, gatifloxacin, gemifloxacin and moxifloxacin) are not a significant improvement upon older agents in the treatment of SSSIs . Perhaps this assessment will change if the penetrance of the antimicrobial resistance patterns described above reach a critical threshold and clinical failures become more widespread.

J Formos Med Assoc, 2003 May, 102(5), 338 - 41
Extensive subgaleal abscess and epidural empyema in a patient with acute frontal sinusitis; Wang WH et al.; Acute frontal sinusitis can be a serious condition because of its potential life-threatening complications . These complications, including spread of infection to the frontal bone and intracranially, require prompt diagnosis and intervention to avoid morbidity and mortality . We report a case of acute frontal sinusitis in a 16-year-old girl who presented with fever, severe headache, and vomiting of 3 days' duration . Generalized fluctuant swelling of the nasal root, and bilateral supraorbital and frontoparietal regions was noted . Computed tomography (CT) demonstrated left pansinusitis, extensive subgaleal abscess and epidural empyema with osteomyelitis of the frontal bone . External frontoethmoidectomy with mucoperiostectomy were performed . Endoscopic sinus surgery was then conducted for intranasal ethmoidectomy . Intraoperative cultures grew viridans streptococci, coagulase-negative staphylococci and Peptostreptococcus micros . The patient received 3 weeks of treatment with intravenous antibiotics (penicillin 3 MU 4-hourly, ceftriaxone 500 mg 12-hourly, metronidazole 500 mg 6-hourly) and was discharged uneventfully and prescribed additional oral antibiotics for 5 weeks (clindamycin 150 mg 6-hourly and chloramphenicol 250 mg 6-hourly) . CT revealed complete resolution of the abscess and clear maxillary and ethmoid sinuses at 7 weeks posttreatment . The patient was free of sinus infection at 4-years follow-up, without noticeable cosmetic deformity.

Eur J Paediatr Dent, 2002 Dec, 3(4), 199 - 204
Association of salivary Streptococcus mutans with caries in young children: effect of dental health education on salivary levels; Kowash MB et al.; AIM: This study aimed to determine the effect of a long-term dental health education (DHE) for mothers with young children on the level of salivary Streptococci mutans (SM) and their association with caries in young children . METHODS: A randomly selected cohort of 228 children born between 1 January and 30 September 1995, in a low socioeconomic high caries suburb of Leeds (UK), was divided into the following groups: A) DHE focused on diet; B) DHE focused on oral hygiene instruction (OHI) using fluoride toothpaste; C) DHE by a combined diet and OHI message . DHE was given using an interview and counselling for at least 15 minutes in each child's home, every three months for the first two years and twice a year in the third year of the study . A fourth group D was given diet and OHI, at home, but once a year only . The children in a fifth group E (control), received no DHE and were never visited, but examined at three years of age only . All children and mothers were examined for caries using the BASCD criteria . The levels of salivary SM were determined by sampling of bacteria from the oral cavity with a 1.8 cm wide wooden spatula, after giving the mother a paraffin pellet to chew for a minute and in children using unstimulated saliva . Bacteria were plated out and counted using image analysis for counting colonies . RESULTS: At three years of age the difference in the level of salivary SM between groups was not statistically significant . However, in group E there was a statistically significant relationship (p<0.05) between salivary SM and caries in children . CONCLUSION: The difference in the level of salivary SM between groups given various programs of dental health education was not statistically significant . There was a statistically significant (p<0.05) relationship between salivary MS and caries in children.

Rev Med Chil, 2003 Apr, 131(4), 412 - 8
{Streptococci mutans: a semi-quantitative method to assess the risk to oral infection in preschool Chilean children}; Linossier A et al.; BACKGROUND: Salivary infection due to Streptococci mutans is considered the main microbiological risk factor for the initiation of dental caries . AIM: To evaluate a semi-quantitative method to assess Streptococci mutans salivary infection and compare it with the existing quantitative method . PATIENT AND METHODS: Saliva samples were obtained from 650 preschool children aged 2 to 6 years old using a TYCSB liquid medium for counting Streptococci mutans . Results were compared with quantitative cultures . RESULTS: There was a 99.3% linear correlation coefficient between both methods . The correlation coefficients with dental caries prevalence were 97% for the semi quantitative method and 90% for the quantitative method . CONCLUSIONS: The semi-quantitative method to assess oral infection with Streptococci mutans, is accurate enough to be used in population studies and oral infection prevention programs in developing countries.

Int J Med Microbiol, 2003 Jun, 293(2-3), 179 - 90
Epidemiology and virulence gene expression of intracellular group A streptococci in tonsils of recurrently infected adults; Podbielski A et al.; Intracellularly persistent group A streptococci (GAS, Streptococcus pyogenes) have been associated with recurrent tonsillopharyngitis and antibiotic treatment failure . As a supplementation of the published in vitro data, conventional bacteriology and molecular epidemiology was performed on material from 29 adult patients of a German army hospital with anamnestic signs of recurrent tonsillopharyngitis . Pre-surgery tonsil swabs and the surgically removed tonsils were examined with respect to growth of aerobic bacteria in absence and presence of antibiotics with exclusively extracellular activity . Under such antibiotic selection, Staphylococcus aureus and GAS were cultured from specimens of 13 and 3 patients, respectively . In every material GAS-positive by culture methods, the intracellular location of the penicillin-susceptible GAS isolates was confirmed by immunohistologic examination of tonsillar sections using a GAS-specific IgG antibody . The three intracellular GAS isolates were typed by emm gene sequencing and could be associated to types M6 and M49 (two isolates) . The bacteria were serially passaged on sheep blood agar, and semiquantitative mRNA analysis from virulence genes was performed using bacteria of the 4th and 25th passage after isolation . An M-type-specific pattern of virulence gene expression and different gene expression levels in relation to the passage number were observed.

Curr Infect Dis Rep, 2003 Aug, 5(4), 285 - 292
Infective Endocarditis in Elderly Patients; Dhawan VK; Infective endocarditis (IE) in elderly patients is a serious disease with significant morbidity and mortality . IE presents unique diagnostic and therapeutic challenges in the elderly . A heightened index of suspicion is necessary due to the atypical presentations of IE among the elderly . Underlying degenerative valvular disease, mitral valve prolapse, and presence of a prosthetic valve are important predisposing risk factors for IE in the elderly . IE in the elderly is somewhat more common in men . The mitral valve is affected somewhat more frequently compared with the aortic valve . Streptococci and staphylococci are the predominant organisms, recovered in approximately 80% of elderly patients with IE . The presence of calcific valvular lesions and prosthetic valves often confound echocardiographic findings in the elderly . Aggressive diagnostic and therapeutic approaches are mandatory for a favorable outcome of IE in this group of patients.

Arch Pediatr Adolesc Med, 2003 Jul, 157(7), 665 - 70
Demographic and clinical characteristics of adolescents in Hawaii with obsessive-compulsive disorder; Guerrero AP et al.; BACKGROUND: A high prevalence rate of obsessive-compulsive disorder (OCD) among Hawaiian adolescents, particularly Native Hawaiians, has been reported . Because Native Hawaiian and other Polynesian youth are at an increased risk for rheumatic fever, caused by an autoimmune response to group A beta-hemolytic streptococci, we hypothesized that the genetic and environmental risk factors for streptococcal infections and their autoimmune sequelae potentially may be associated with the presence of OCD and may partially explain this high OCD prevalence . OBJECTIVE: To describe, among the adolescents in Hawaii diagnosed as having OCD through a previous study, OCD prevalence by ethnicity, household crowding and other measures of socioeconomic status, various measures of physical health and health-seeking behavior, and comorbid psychopathologic features . DESIGN: Six hundred nineteen adolescents from 5 high schools in the state of Hawaii were interviewed from April 15, 1993, to May 7, 1996 . Interview instruments included the Diagnostic Interview Schedule for Children and other measurements of psychopathology . Obsessive-compulsive disorder diagnoses, based on current and past 6-month symptoms elicited via structured interview of the adolescents, were reported . RESULTS: Relative to other ethnicities, Native Hawaiians had a 2-fold higher risk (odds ratio = 2.03) for OCD . Degree of Polynesian ancestry correlated positively with OCD prevalence . Obsessive-compulsive disorder prevalence also correlated positively with crowding in the household; measures of physical illness; and measures of depression, anxiety, aggression, and illicit substance use . CONCLUSIONS: The characteristics of OCD in this sample suggest the need to consider the possibility of a streptococcal origin and the need for further studies to clarify the genetic and environmental risk factors for OCD in Hawaiian and other Polynesian youth.

Vet Microbiol, 2003 Aug 29, 95(1-2), 149 - 56
The association of Streptococcus equi subsp . zooepidemicus with canine infectious respiratory disease; Chalker VJ et al.; Canine infectious respiratory disease (CIRD) is a multi-factorial infection that affects many kennelled dogs despite the wide use of vaccination . Current vaccines aim to protect against viral agents and a single bacterial agent, Bordetella bronchiseptica . We sought to examine the role of streptococcal species in CIRD . The isolation and identification of streptococci in the lower respiratory tract of clinically healthy dogs and those with CIRD were used to correlate the presence of specific streptococcal species with respiratory disease . In this study we report that the presence of S . equi subsp . zooepidemicus is associated with increasing severity of disease in a population of kennelled dogs with endemic CIRD.

Quintessence Int, 2003 Jun, 34(6), 473 - 7
Evaluation of antimicrobial activity of fluoride-releasing dental materials using a new in vitro method; Perez CR et al.; OBJECTIVE: The aim of this study was to research the antimicrobial activity of fluoride-releasing dental materials on strains of mutans streptococci using a new in vitro method . METHOD AND MATERIALS: Using microplaques for the cell cultures, specimens were made with a conventional glass ionomer (Ketac-Cem), a photo-cured ionomer (Vitremer), and a compomer (Dyract) . Three groups were made, each focusing on a distinct situation: In the first group, the antimicrobial activity was tested after curing; in the second, the materials were exhausted from their disposable fluoride for 14 days; and in the third group, fluoride was reincorporated into the specimens after a topical application of 2% sodium fluoride gel for 4 minutes . RESULTS: The results demonstrated that the photo-cured ionomer had the best antimicrobial activity of all groups, followed by the conventional glass ionomer and compomer groups, respectively . All materials studied presented antimicrobial activity in all stages of the experiment, which was statistically proven using the Student's t test . CONCLUSIONS: The fluoride-releasing materials studied in the current report demonstrated antimicrobial activity on strains of mutans streptococci in every group studied . This new method demonstrated more accuracy and practicability than others commonly used.

East Afr Med J, 2000 Jun, 77(6), 323 - 5
Brain abscess at the Kenyatta Nationai, Hospital, Nairobi; Mwang'ombe NJ; OBJECTIVE: To study the aetiology, mode of presentation and outcome following treatment of brain abscesses at the Kenyatta National Hospital, Nairobi . DESIGN: A retrospective study . SETTING: Kenyatta National Hospital, Nairobi . SUBJECTS: Sixty five patients with brain abscesses who were seen at Kenyatta National Hospital between January 1989 and December 1993 . RESULTS: Twenty patients died following surgery (30.7% mortality) . Eight per cent of the patients who underwent surgery were serologically positive for the human immune deficiency virus (HIV) . When these patients were excluded mortality was 25% . There were more male patients than females (ratio 2.4:1) . Thirty eight per cent of the patients were children below the age of ten years . Trauma was the commonest cause of brain abscess . The aetiology was unknown in 24% of the cases . Twenty six patients who were HIV positive and had suspected brain abscesses were not included in this study because they did not undergo surgery . The commonest organisms isolated were Staphylococci, Streptococci, Klebsiella and Haemophylus influenzae . Sixty eight per cent of the patients had seizures . All the patients were diagnosed by computerised tomography (CT) scanning of the brain . Surgical treatment was by multiple burr hole aspirations and excision through craniotomy . CONCLUSION: Brain abscess is still a major cause of morbidity at the Kenyatta National Hospital with a high overall mortality of 30.7% during the period under study.

Clin Microbiol Infect, 2003 Jun, 9(6), 543 - 6
Validation of commercial dry-form broth microdilution panels for susceptibility testing of AZD2563, a new long-acting oxazolidinone; Jones RN et al.; The MIC results using a dry-form broth microdilution panel (TREK Diagnostic/Sensititre, Westlake, OH, USA) were validated for AZD2563, a novel oxazolidinone compound . In comparision studies against reference frozen-form panels, the commercial MIC results were the same as the reference calue for 82.7% of organisms and all results were within +/- one log2 dilution . Using 462 organisms, most from three genus groups (enterococci, staphylococci, streptococci), test results indicate that Sensititre MIC values were comparable to the reference test and can be utilized in clinical trials of for routine laboratory use when testing AZD2563 and linezolid, the drug class comparator.

Acta Obstet Gynecol Scand, 2003 Aug, 82(8), 730 - 5
Incidence, treatment and outcome of peripartum sepsis; Kankuri E et al.; BACKGROUND AND METHODS: Clinical and microbiological features of maternal sepsis in the peripartum period (7 days before to 7 days after delivery) were analyzed to determine possible risk factors, optimal treatment and outcome . In 43 483 deliveries during 1990-98, laboratory-confirmed bacteremia was found in 41 (5.1%) out of 798 clinically suspected septic infections . RESULTS: Preterm deliveries were associated with a crude 2.7-fold risk for peripartum sepsis as compared to term deliveries . Antepartum sepsis was associated with a crude 2.6-fold risk for cesarean section, while postpartum sepsis was 3.2 times more likely to occur after cesarean section than after vaginal delivery . A combination of cefuroxime and metronidazole was used in 80% (33/41) of all treatments . All mothers recovered well, and only one suffered from septic shock . In total, 42 bacterial strains, representing 18 different bacterial species, were isolated from the blood cultures; 37 strains (88%, 37/42) were aerobic and five (12%, 5/42) were anaerobic . The most common species were betahemolytic streptococci, Escherichia coli and Staphylococcus aureus . Most microbes (81%, 34/42) were found to be susceptible to first- or second-generation cephalosporins . CONCLUSION: Our analysis shows that peripartum sepsis is associated with preterm pregnancies and cesarean sections . Treatment of peripartum sepsis with second-generation cephalosporin is usually effective, and the outcome is good.

Infez Med, 1997, 5(4), 240 - 8
{Acute rheumatic fever: a report}; Boccazzi A et al.; Acute rheumatic fever (ARF) is still an important disease of the pediatric and adult age . The increased number of cases described in the literature in the last 10 years brought us to evaluate the ARF cases diagnosed in a Pediatric Teaching Hospital in the period 1988-1997 . Most of the children with ARF presented with joint involvement even if patients with cardiac disease or chorea minor were numerous . About 50% of our patients with ARF did not refer a history of a febrile tonsillopharyngitis in the 15-60 days before the presentation of ARF . The remaining patients have had a preceding pharyngitis not adequately treated . In none of the subjects a throat swab positive for group A beta hemolytic streptococci was available . These results confirm the importance of the correct diagnosis and treatment of streptococcal pharyngitis but suggest that ARF can develop without any outstanding clinical evidence of streptococcal infection.

J Clin Microbiol, 2003 Jul, 41(7), 3051 - 5
Major outbreak of toxic shock-like syndrome caused by Streptococcus mitis; Lu HZ et al.; Severe illness caused by viridans streptococci rarely occurs in immunocompetent hosts . Between December 1990 and May 1991, thousands of patients in the YangZi River Delta area of Jiangsu Province, China, suffered from scarlet fever-like pharyngitis . Fewer cases occurred in subsequent years with the same seasonality . Approximately half of the cases developed complications characteristic of streptococcal toxic shock-like syndrome (TSLS) . Throat cultures yielded predominant growth of alpha-hemolytic streptococci . All cases admitted to Haian People's Hospital were investigated . Clinical specimens were collected, medical records were reviewed, and bacterial isolates were identified phenotypically and analyzed by 16S rRNA gene sequencing and pulsed-field gel electrophoresis (PFGE) . Proteins were purified from culture supernatants by extraction, ammonium sulfate precipitation, and fast-protein liquid chromatography . Biological activities of protein components were determined by subcutaneous inoculation into rabbits . A total of 178 cases of non-beta-hemolytic streptococcal scarlet fever-like pharyngitis were studied . In 88 (79.3%) of 111 patients, oropharyngeal swab cultures grew morphologically identical alpha-hemolytic streptococci . A protein in culture supernatants was pyrogenic in rabbits, was mitogenic for splenocytes, and enhanced rabbit susceptibility to endotoxin challenge . The N-terminal amino acid sequence of this 34-kDa protein showed no homology with known Streptococcus pyrogenic exotoxins . The organism was identified as Streptococcus mitis based on biochemical and 16S rRNA sequence analyses . Representative outbreak isolates from 1990 to 1995 displayed identical PFGE patterns . This TSLS outbreak in southeastern China was caused by a toxigenic clone of S . mitis . An apparently novel toxin may explain the unusual virulence of this organism.

Cytokine, 2003 Jun 7, 22(5), 126 - 33
Involvement of G(i) proteins and Src tyrosine kinase in TNFalpha production induced by lipopolysaccharide, group B Streptococci and Staphylococcus aureus; Fan H et al.; Previous studies have suggested that heterotrimeric G(i) proteins, Src tyrosine kinase and phosphatidylinositol-3 kinase (PI3 Kinase) are involved in signaling events induced by lipopolysaccharide (LPS) leading to pro-inflammatory cytokines gene expression . To investigate the involvement of these mediators in Gram-positive bacteria induced pro-inflammatory cytokine expression, LPS (10 ng/ml), heat killed group B Streptococci (GBS 1 microg/ml) and Staphylococcus aureus (SA 10 microg/ml) were used to induce TNFalpha production in the murine J774A.1 macrophage (MO) cell line and human promonocytic THP-1 cell line . Pertussis toxin (PTx, 1 microg/ml), an inhibitor of G(i) protein; pyrazolopyrimidine-2 (PP2, 1 or 25 microM), a Src tyrosine kinase inhibitor; and LY294002 (100 nM), an inhibitor of PI3 Kinase were used to examine the involvement of G(i), Src tyrosine kinase and PI3 Kinase, respectively, in TNFalpha production . In J774A.1 cells, pretreatment with PTx and PP2 attenuated TNFalpha production induced by LPS (60+/-9% and 81+/-11% inhibition, n=3, p<0.05, respectively), GBS (95+/-1% and 80+/-6% inhibition, n=3, p<0.05, respectively) and SA (51+/-18% and 68+/-16% inhibition, n=4, p<0.05, respectively) . However, pretreatment with LY 294002 inhibited LPS induced TNFalpha production (82+/-13% inhibition, n=3, p<0.05), but did not inhibit GBS or SA induced TNFalpha production . In THP-1 cells, pretreatment with PTx, PP2 and LY 294002 inhibited TNFalpha production induced by LPS (84+/-3%, 59+/-12% and 84+/-4% inhibition, n=3, p<0.05, respectively) and SA (56+/-7%, 87+/-1% and 35+/-6% inhibition, n=3, p<0.05, respectively) . These data support our hypothesis that G(i)-coupled and Src tyrosine kinase-coupled signaling pathways are involved in both Gram-negative and Gram-positive bacteria induced pro-inflammatory cytokine expression . However, unlike LPS, involvement of PI3 Kinase in Gram-positive bacteria induced signaling pathways are species dependent.

Hippocampus, 2003, 13(4), 481 - 8
Bacterial meningitis causes two distinct forms of cellular damage in the hippocampal dentate gyrus in infant rats; Bifrare YD et al.; Bacterial meningitis causes neurological sequelae in up to 50% of survivors . Two pathogens known for their propensity to cause severe neurological damage are Streptococcus pneumoniae and group B streptococci . Some forms of neuronal sequelae, such as learning and memory deficits, have been associated with neuronal injury in the hippocampus . To learn more about hippocampal injury in meningitis, we performed a comparative study in bacterial meningitis due to S . pneumoniae and group B streptococcus, in which 11-day-old infant rats were infected intracisternally with either of the two pathogens . Histopathological examination of the neuronal injury in the dentate gyrus of the hippocampus showed that S . pneumoniae caused predominantly classical apoptotic cell death . Cells undergoing apoptosis were located only in the subgranular zone and stained positive for activated caspase-3 and TUNEL . Furthermore, dividing progenitor cells seemed particularly sensitive to this form of cell death . Group B streptococcus was mainly responsible for a caspase-3-independent (and TUNEL-negative) form of cell death . Compared with the morphological features found in apoptosis (e.g., apoptotic bodies), this form of neuronal death was characterized by clusters of uniformly shrunken cells . It affected the dentate gyrus throughout the blade, showing no preferences for immature or mature neurons . Thus, depending on the infecting agent, bacterial meningitis causes two distinct forms of cell injury in the dentate gyrus.

Wien Med Wochenschr, 2003, 153(9-10), 194 - 7
{Infections caused by piercing and tattoos--a review}; Handrick W et al.; Piercing, i.e . perforation of skin or mucous membranes in order to attach mostly metallic jewelery as well as multicolored skin tattooing have become more popular than ever before and a considerable number of (young) people practise these methods of body art which are supposed to increase the individuality . But there is a lot of side effects, among them especially infections . The most important bacteria cultivated from such patients are Staphylococcus aureus, group A streptococci and Pseudomonas aeruginosa . Viruses which can be transmitted by piercing or tattooing are especially hepatitis B virus and hepatitis C virus . Besides local bacterial infections also systemic infections (sepsis, endocarditis) occur . The main aspects of diagnostics, therapy and prevention are discussed.

Indian J Ophthalmol, 2003 Jun, 51(2), 171 - 6
Microbiological evaluation of various parameters in ophthalmic operating rooms . The need to establish guidelines; Kelkar U et al.; PURPOSE: Postoperative infections can be caused by a contaminated environment, unsterile equipment, contaminated surfaces, and infected personnel as well as contaminated disinfectants . In order to establish guidelines for microbiological monitoring, a detailed microbiological surveillance was carried out in an ophthalmic hospital . METHOD: Over a period of 21 months, we assessed environmental Bacteria Carrying Particle(BCP) load and surface samples weekly (n = 276); the autoclaving system once a month and repeated whenever the process failed (n = 24); the air conditioning filters for fungal growth once in four months (n = 15), and the disinfectant solution for contamination once in two months (n = 10) . Additionally, the personnel involved directly in surgery were screened for potential pathogens such as Staphylococcus aureus and beta haemolytic streptococci . RESULT: On 14 (5.07%) occasions the environment in the operating rooms had a significant risk of airborne infections . Sterilisation of instruments in the autoclaves was unsatisfactory on 4 (16.66%) occasions . Samples from the filters of the air-conditioning units yielded potentially pathogenic fungi on 3 (20%) occasions . Personnel sampling revealed that 5 (8.77%) individuals harboured beta haemolytic Streptococci in the throat and 4 (7.01%) harboured S . aureus in the nasal cavity . The samples of disinfectant in use were not contaminated . CONCLUSION: There is a need to standardise microbiological evaluation protocols for operating rooms.

Ugeskr Laeger, 2003 May 26, 165(22), 2291 - 5
{Diagnosis of streptococcal tonsillitis in the pediatric department with the help of antigen detection test}; Andersen JB et al.; INTRODUCTION: The aim was to examine the validity in the paediatric hospital department of an antigen detection test (ADT) for the diagnosis of streptococcal tonsillitis . MATERIAL AND METHODS: A prospective multicenter study including three Danish paediatric hospital departments was performed from May 1, 1998 to April 30, 1999 . In 353 children aged 0-14 years the result of the ADT, Clearview Strep A, was compared with the result obtained with cultivation in an aerobic culture and the clinical parameters: hyperaemia, swelling, coating, adenitis and a temperature > or = 38.5 degrees C . In 126 patients the results of the ADT were also compared with white blood cell count (WBC), neutrofil count (NC) and C-reactive protein (CRP) . RESULTS: The prevalence of Group A Streptococci (GAS) from culture was 15% . Sensitivity, specificity, positive and negative predictive value of ADT were 67%, 95%, 72% and 94%, respectively . The positive predictive value of the ADT was significantly lower in patients aged 0-4 years than in patients aged > or = 5 years (p = 0.02) . The prevalence of positive ADT was significantly higher in patients with heavy growth of GAS than in patients with moderate or sparse growth (p = 0.01) . The prevalence of adenitis (p = 0.003) and coating (p = 0.003) was significantly raised in ADT-positive patients . In patients with growth of Group A Streptococci in cultivation in an aerobic culture the prevalence of adenitis (p = 0.006) and elevated CRP (p = 0.03) was significantly raised . DISCUSSION: The sensitivity of 67% for the ADT is not satisfactory . However, in our opinion, this is not a sufficient argument against using ADT . It was a problem that the result of the ADT was sometimes difficult to read . Adjustment of the test procedure and the use of easy readable and high-sensitive optical immunoassay tests would probably improve the results significantly . Until the results of such studies exist, we suggest that the method of cultivation in an aerobic culture is used in the case of negative ADT, at least in patients with pronounced symptoms and/or clinical signs of streptococcal tonsilitis (adenitis and coating).

Pediatr Int, 2003 Jun, 45(3), 319 - 23
Colonization with Group B streptococci in pregnancy and outcome of infected neonates in Trinidad; Orrett FA; BACKGROUND: The present study took place at the antenatal clinics of the San Fernando General Hospital located in the south and the Mount Hope Maternity Hospital located in the north-west of the West Indies, respectively . Participants were from the lower socioeconomic group that included representatives from the two major ethnic groups, East Indians and people of African descent . METHODS: We prospectively analyzed data on 201 third trimester pregnant women . All had singleton pregnancies . Culture specimens for group B streptococcus (GBS) were obtained from the rectum and anterior one-third of the vagina, and inoculated directly onto selective media . Blood culture from neonates (born to GBS carrier mothers) suspected of sepsis was also screened for GBS . Group B streptococci were identified via colonial morphology, beta-hemolysis, and biochemical reactions, and confirmed via latex agglutination tests . Antimicrobial susceptibility testing was done . Data were computerized and statistically analyzed using the Statistical Package for the Social Sciences . Associations between age, ethnicity and gravidity were evaluated using Pearson's chi2 test . RESULTS: The prevalence of vaginal and rectal GBS colonization was 32.9% . Group B streptococci were isolated more frequently from women >24 years (36.6%) than those younger than 24 years (26.9%), and more so, from women of East Indian descent (37.3%) than women of African descent (27.2%) . Colonization rates were significantly greater among multigravid women than primigravid women (P < 0.001) . Of the 13 infants admitted after delivery, five were confirmed cases of sepsis . Group B streptococci were isolated from the blood of three of these infants, and one case was fatal . Although all GBS were fully sensitive to ampicillin and amoxicillin-clavulanic acid, 94% were resistant to tetracycline and approximately 88% to co-trimoxazole . Only approximately 8% were resistant to erythromycin . CONCLUSION: The carriage rate of GBS among pregnant women in the present and a previous study, remain high . Attempts to establish and implement a program aimed at GBS disease prevention have met with repeated failure . Data on the prevalence of GBS neonatal disease, preventative measures and outcome of infected infants are greatly needed.

Antimicrob Agents Chemother, 2003 Jul, 47(7), 2370 - 2
Emergence of macrolide resistance in throat culture isolates of group a streptococci in Ontario, Canada, in 2001; Katz KC et al.; Of 500 group A streptococci isolated from pharyngeal swabs, 72 (14.4%) were macrolide resistant, compared to 2.1% in 1997 . Of these, 66 (92%) were of the M phenotype and 6 (8.3%) were of the MLS phenotype . Pulsed-field gel electrophoresis found that two clones, with patterns identical to those of serotypes M1 and M4, accounted for 19.4 and 68.1% of the macrolide-resistant isolates, respectively.

Antimicrob Agents Chemother, 2003 Jul, 47(7), 2072 - 81
Viridans group streptococci are donors in horizontal transfer of topoisomerase IV genes to Streptococcus pneumoniae; Balsalobre L et al.; A total of 46 ciprofloxacin-resistant (Cip(r)) Streptococcus pneumoniae strains were isolated from 1991 to 2001 at the Hospital of Bellvitge . Five of these strains showed unexpectedly high rates of nucleotide variations in the quinolone resistance-determining regions (QRDRs) of their parC, parE, and gyrA genes . The nucleotide sequence of the full-length parC, parE, and gyrA genes of one of these isolates revealed a mosaic structure compatible with an interspecific recombination origin . Southern blot analysis and nucleotide sequence determinations showed the presence of an ant-like gene in the intergenic parE-parC regions of the S . pneumoniae Cip(r) isolates with high rates of variations in their parE and parC QRDRs . The ant-like gene was absent from typical S . pneumoniae strains, whereas it was present in the intergenic parE-parC regions of the viridans group streptococci (Streptococcus mitis and Streptococcus oralis) . These results suggest that the viridans group streptococci are acting as donors in the horizontal transfer of fluoroquinolone resistance genes to S . pneumoniae.

Infect Immun, 2003 Jul, 71(7), 4011 - 7
The Delta subunit of RNA polymerase is required for virulence of Streptococcus agalactiae; Jones AL et al.; Group B streptococci (GBS) remain the most significant bacterial pathogen causing neonatal sepsis, pneumonia, and meningitis in the United States despite the chemoprophylaxis strategies for preventing infection recommended by the Centers for Disease Control and Prevention . Using signature-tagged transposon mutagenesis to screen for novel virulence factors, we identified the rpoE gene as essential for development of sepsis in a neonatal rat model of GBS infection . An rpoE allelic replacement mutant displayed attenuated virulence in the sepsis model of infection identical to that of the transposon mutant, confirming linkage of the phenotype to the mutation in rpoE . The rpoE mutants also displayed increased sensitivity to killing in whole-blood bactericidal assays, which may explain the attenuated virulence . The mutants were otherwise phenotypically identical to the wild-type strain, including growth rate in plasma, indicating that a growth defect is not responsible for the attenuated virulence . rpoE is found only in gram-positive bacterial species and encodes the delta peptide, a subunit of RNA polymerase . Previous in vitro studies in other bacteria suggest that the delta peptide plays a role in maintaining transcriptional fidelity by blocking RNA polymerase binding at all but the strongest promoters, thereby inhibiting initiation of transcription . Despite the availability of rpoE mutants for several gram-positive bacterial species, a role for the peptide in vivo has not been defined, though it has been postulated that the delta peptide may be important for long-term survival in vitro or during growth phase transitions . Our data represent the first report of a phenotype relevant to virulence for rpoE mutants.

Infect Immun, 2003 Jul, 71(7), 3857 - 65
Combined contributions of streptolysin O and streptolysin S to virulence of serotype M5 Streptococcus pyogenes strain Manfredo; Fontaine MC et al.; Streptolysin O (SLO) and streptolysin S (SLS) are potent cytolytic toxins produced by almost all clinical isolates of group A streptococci (GAS) . Allele-replacement mutagenesis was used to construct nonpolar (in-frame) deletion mutations in the slo and sagB genes of the serotype M5 GAS strain Manfredo, producing isogenic single and double SLO- and SLS-defective mutants . In contrast to recent reports on SLS-defective insertion mutants (I . Biswas, P . Germon, K . McDade, and J . Scott, Infect . Immun . 69:7029-7038, 2001; Z . Li, D . Sledjeski, B . Kreikemeyer, A.Podbielski, and M . Boyle, J . Bacteriol . 181:6019-6027, 1999), none of the mutants described here had notable pleiotropic effects on the expression of other virulence factors examined . Comparison of isogenic parent and mutant strains in various virulence models revealed no differences in their abilities to multiply in human blood or in their 50% lethal doses (LD(50)s) upon intraperitoneal infection of BALB/c mice . A single log unit difference in the LD(50)s of the parent and SLS-defective mutant strains was observed upon infection by the subcutaneous (s.c.) route . Comparisons over a range of infective doses showed that both SLO and SLS contributed to the early stages of infection and to the induction of necrotic lesions in the murine s.c . model . Individually, each toxin made an incremental contribution to virulence that was not apparent at higher infective doses, although the absence of both toxins reduced virulence over the entire dose range examined . Interestingly, in some cases, the contribution of SLO to virulence was clear only from an analysis of the double-mutant strain, highlighting the value of not confining virulence studies to mutant strains defective in the expression of only single virulence factors.

Infect Immun, 2003 Jul, 71(7), 3782 - 6
In vivo lysogenic conversion of Tox(-) Streptococcus pyogenes to Tox(+) with Lysogenic Streptococci or free phage; Broudy TB et al.; Temperate bacteriophage can transfer toxin-encoding genes between bacteria, often resulting in acquired pathogenicity . However, little is known regarding the effects of the eukaryotic host on the phage-pathogen interaction . Using Streptococcus pyogenes as a model, we demonstrate, both in vitro and in vivo, that the eukaryote mediates the efficient induction of toxin-encoding temperate phage and the resultant conversion of Tox(-) flora to Tox(+) . Furthermore, we show that both phage induction and subsequent conversion need not happen in the same mammalian host, as host-to-host phage transmission can result in toxigenic conversion within the secondary host . Ultimately, our findings demonstrate that the eukaryotic host serves as an essential component in the phage-mediated evolution of virulence within the microbial population.

What Is Amino Acid?, What Is Genetic Engineering?, What Is Salmonella?, What Is Bioreactor?, What Is Cell Biology?, c, Microorganism, e, Microbiology, c, Bacteria, r, Microorganisms, i, Bacterium, r, S. cerevisiae, i, Pichia, n, Yeasts, s, Microorganisms, o, Erythromycin, a, Gram negative, s, Escherichia coli, s, S. cerevisiae, s, Pasteurella, o, Staphylococcus aureus, n, Escherichia coli, r, Staphylococcus aureus, e, Escherichia coli, a, Pseudomonas, o, Staphylococcus aureus, a, Escherichia coli, c, Microbial, n, Antibiotics, n, Salmonella, s, Haemophilus, s, Escherichia coli

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

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

Last modified: May 25, 2005