Streptococci

Rev Med Chil, 1997 Feb, 125(2), 200 - 8
{Invasive extrapulmonary infections due to Streptococcus pneumoniae . Report of three fatal cases and review}; Ossa G et al.; Streptococcus pneumoniae is a most important patogen in respiratory and meningeal infections . It is also a relevant agent of septic arthritis, pericarditis, acute endocarditis and spontaneous peritonitis in cirrhotic patients with ascites . It is less well known as a cause of infections in many other sites, including abdominal organs and soft tissues, which may be very severe . In this report, we describe three fatal cases (phlegmonous gastritis, cellulitis and primary peritonitis without pre-existing ascites) due to Streptococcus pneumoniae . In the last years it has become clear that this agent can cause infections at almost any body level, which is worth remembering . We review the literature and discuss some clinical aspects of two rare infectious syndromes, like primary peritonitis without previous ascites and phlegmonous gastritis.

Arch Inst Cardiol Mex, 1997 Jan-Feb, 67(1), 46 - 50
{Infectious endocarditis at the National Institute of Cardiology "Ignacio Chavez" . Five year's experience (1990-1994)}; Souto Meirino CA et al.; BACKGROUND: Infective endocarditis (IE) is one of the most life threatening infections in both medical and surgical practices . In the last few years, changes in its epidemiology, diagnostic methods and therapeutical trends have appeared . We analysed our experience in the diagnosis and treatment of IE . METHODS: The clinical records of patients admitted to our hospital with definitive (Group I) and highly probable (Group II) diagnosis of IE, during a period of five years (1990-1994), were retrospectively reviewed . Age, sex, clinical features, risk, factors, echocardiographic abnormalities, microbiologic and surgical findings, as well as mortality were recorded . In addition, an evaluation was made of the accuracy of the diagnostic criteria proposed by Von Reyn versus those brought forward by Duke University . RESULTS: One hundred thirty one patients were included, 99 in Group I and 32 in Group II . The mean age was 35 years . Native valve endocarditis was present in 88 patients and prosthetic valve endocarditis in 43 patients . Streptococcus sp . (48%) was the most frequently causative german and 16.7% of cases were culture negative . The sensitivity of transesophageal echocardiography was higher than transthoracic echocardiography in the diagnosis of both vegetations (76% vs 55%) and abscesses (30% vs 16.5%), (p < 0.05) . Vegetations (95%) were the most frequent surgical finding followed by abscesses (23%) . Inpatient mortality was 22% in Group I and 45% in Group II (p < 0.05) . The sensitivity of Von Reyn's diagnostic criteria and that of Duke's University group was 49% and 85.8% (p < 0.05) . Mean follow up was 531 days . Two patients had a new event of IE and no outpatient deaths were recorded . CONCLUSION: IE is a medical and surgical emergency . Because of the high mortality rate, in the medically treated group, surgery should be considered in all cases as early as possible in the course of the disease.

An Esp Pediatr, 1997 Aug, 47(2), 151 - 5
{Invasive disease caused by Streptococcus pneumoniae: a 7-year study}; Pocheville Gurutzeta I et al.; OBJECTIVE: The purpose of this study was to study the epidemiology of invasive childhood pneumococcal infection in our hospital . PATIENTS AND METHODS: The records of all children attending our hospital from whom Streptococcus pneumoniae was isolated from the blood or CSF were reviewed . Serotyping and MIC were performed at C.N.M.V.S . (Majadahonda) . RESULTS: Seventy-one pneumococci were isolated in 70 patients . The annual incidence increased from 0.14% to 0.40% . The clinical entities were: bacteremia without focus (45%), pneumonia (29.6%), meningitis (12.7%), cellulitis (5.6%), mastoiditis (5.6%) and endocarditis (1.4%) . The age of 72% of the patients was less than 3 years . In 26.8% of the cases, the patient had an underlying disease and/or was previously hospitalized . The antibiotic susceptibility pattern was: penicillin (MIC < or = 0.06 microgram/ml) 45.7%, cefotaxime (MIC < or = 0.5 microgram/ml) 82.8% and erythromycin (MIC < or = 0.5 microgram/ml) 70% . Penicillin resistance of the isolated pneumococci was more often present in the group with risk factors than in those without such risk factors (p < 0.05) . There were 13 different serotypes, the most prevalent were 6 (23%), 19 (17%), 14 (14%) and 23 (12%) and the most frequently penicillin-resistant (Resistant N(o)/Total N(o) were: 6 (15/15), 9 (4/4), 14 (8/9) and 23 (6/8) . CONCLUSIONS: Streptococcus pneumoniae is a common cause of invasive infections in children in our hospital . There was a high prevalence of serotype 6 (penicillin-resistant) as compared to in adults where serotype 3 (penicillin-susceptible) is the most prevalent . A higher rate of antibiotic resistant strains associated with risk factors (underlying disease or nosocomial acquisition), probably related to prior antibiotic use, was observed.

An Otorrinolaringol Ibero Am, 1997, 24(4), 361 - 7
{Necrotizing fasciitis of the neck: diagnosis by computer tomography}; Melgarejo Moreno P et al.; Necrotizing fasciitis is a rare but serious infection of subcutaneous tissue and deep fascia with resulting skin gangrene and septicaemia . Compute tomography (CT) seems to play a role in completing the clinical suspicion, especially in those case in which the disease does not manifest itself with subcutaneous crepitus or emphysema . Condition's causation reminded unknown and the microbial culture showed members of Streptococcus milleri genus.

Schweiz Rundsch Med Prax, 1997 Sep 3, 86(36), 1389 - 92
{Recurrent fever, nocturnal sweating, weight loss}; Schar B et al.; A 69-year-old woman was admitted to the hospital for fever of unknown origin with nightsweats and weight loss . Diagnosis of endocarditis lenta with streptococcus viridans and a preexisting mitral-valve prolapse with small regurgitation jet was established . Signs and symptoms of endocarditis lenta are stressed in the discussion . Special attention is given to transesophageal echocardiography and to the connection of endocarditis with mitral-valve prolapse.

Klin Lab Diagn, 1997 Sep, (9), 43 - 6
{Immunoenzyme test system for detecting antibodies to group-specific antigens of group A Streptococcus on the base of conjugated N-acetylglucosamine and its use in medical practice}; Briko NI et al.; Enzyme immunoassay kit has been created for detecting antibodies to group A Streptococcus, based on N-acetylglucosamine . N-acetylglucosamine was selected as the group-specific determinant due to the structure of group A Streptococcus polysaccharide, in which this monosaccharide residue is lateral to the main polysaccharide chain and hence more available for antibodies . Water-soluble polyacrylamide is the carrier in this kit, for this carrier is stable and not liable to nonspecific reaction with proteins . In addition, the synthesis of polyacrylamide conjugates ensures reproducible results . Use of this kit permits the identification of group A streptococcal etiology of the disease and thus carry out appropriate therapy; moreover, it helps predict the outcome of an acute streptococcal infection and detect the poststreptococcal complications in the early period of the disease.

Ophthalmologe, 1997 Aug, 94(8), 552 - 6
{Primary vitrectomy in endophthalmitis}; Bermig J et al.; From January 1994 to January 1996, 18 patients underwent vitrectomy as a result of endophthalmitis . All patients received intraocular and systemic antibiotics in accordance with the first group of patients in the Endophthalmitis Vitrectomy Study . The aim of this retrospective study was to analyze the visual outcome of surgical treatment . METHODS: Data from 18 consecutive patients, 11 women and 7 men, with the diagnosis of endophthalmitis as indication for vitrectomy were evaluated . The patients' ages ranged from 14 to 93 years (mean 66.6 +/- 21.3) . Postoperative follow-up ranged from 6 weeks to 10 months . RESULTS: Endophthalmitis resulted from cataract surgery with implantation of an intraocular lens in 14 patients and from ocular trauma in 2 patients . Endophthalmitis followed the resection of posterior capsule fibrosis in 1 patient . Another patient suffered from endogenous endophthalmitis . Positive cultures were obtained in 12 patients . The most frequent causative organisms were coagulase-negative Staphylococcus (n = 7) and Streptococcus species (n = 4) . Visual outcome: 13 of 18 patients (72%) gained a visual acuity of 20/400 or better at the final examination after vitrectomy . Four patients (22%) reached a visual acuity of 20/50 or better . Two eyes were enucleated . Good functional outcome was achieved in 2 patients with streptococcal infection (20/200; 30/50) . CONCLUSION: Vitrectomy in combination with intraocular antibiotics is a suitable method for the treatment of endophthalmitis and results in preservation of ambulatory vision in 72% of patients . Vitrectomy in endophthalmitis can result in good functional outcome even in the case of infections with streptococcal species.

Enferm Infecc Microbiol Clin, 1997 May, 15(5), 237 - 42
{Infectious bursitis: study of 40 cases in the pre-patellar and olecranon regions}; Gomez-Rodriguez N et al.; BACKGROUND: Septic bursitis usually affects subcutaneous localized bursae such the prepatellar and elbow bursae . This condition is infrequently reported in the spanish medical literature . The aim of this report was to study patients suffering from septic bursitis with regard to predisposing conditions, the causative agents, therapy and clinical outcome . METHOD: A retrospective study was undertaken in patients with infectious bursitis attended in the Service of Rheumatology of the POVISA Medical Centre (Vigo) and Juan Canalejo Hospital (La Coruna), Spain, from january 1989 to january 1995 . The diagnosis of septic bursitis was confirmed with positive bursal fluid cultures in all cases . RESULTS: We recovered forty cases of infectious bursitis (23 olecranon bursitis and 17 prepatellar bursitis) . Most patients were male (80%), and patient mean age was 52 years (range: 14-94) . The most common predisposing factors to bacterial infection were steroid therapy (15%) and alcoholism (8%), in addition to cutaneous lesions associated with occupational or recreational trauma (55%) . Prepatellar septic bursitis was associated with a more aggressive clinical presentation with fever (71% vs 48%), leukocytosis (76% vs 52%), cellulitis (59% vs 48%) and positive blood cultures (25% vs 0%) . Staphylococcus aureus was isolated from 87.5% of bursal fluid aspirations, the other etiologic microrganism were Staphylococcus epidermidis (2 cases), Streptococcus agalactiae (2 cases) and Streptococcus pneumoniae (1 case) . The majority of patients (80%) required initial intravenous therapy of which average duration was 11 days (range: 5-21 days) . Successful resolution of septic bursitis without open surgical drainage was seen in 38 patients (95%) and there ware no functional impairment, serious complications or recurrences . CONCLUSIONS: The majority of patients with septic bursitis suffered systemic and/or local predisposing illness . S . aureus is the commonest pathogen . Prepatellar septic bursitis is associated with a more aggressive clinical presentation and bacteremia . Usually, the prompt and proper antibiotic therapy make innecessary surgical drainage.

Oral Dis, 1997 May, 3 Suppl 1, S79 - 84
Salivary and mucosal immune responses to HIV and its co-pathogens; Challacombe SJ et al.; The profound effects that HIV induces in systemic immunity have been well characterised, but the situation with regard to mucosal immune responses is less clear . Oral cavity fluids have been used as a marker of the mucosal immune system . Whole and parotid saliva IgA, IgA1 and IgA2 concentrations have been found to be lower in both HIV infection and AIDS subjects, whereas serum IgA and IgA subclasses are markedly raised, suggesting a dichotomy between systemic and secretory immunity . Salivary antibodies to HIV can be readily detected and secretory IgA antibody can be neutralising to some strains of HIV . HIV vaccines can also induce antibody responses in saliva, but vaccination routes other than parenteral immunisation are needed . Antibody responses to oral microbes have also been studied and it has been shown that IgA, IgA1 and IgA2 subclass antibody titres to Candida albicans and to Streptococcus mutans are increased in whole or parotid saliva from HIV patients, but reduced in AIDS patients, suggesting a compensatory response which is overcome with progressive immunodeficiency . The avidity of salivary IgA antibodies to Candida in HIV seems unimpaired, whereas relative avidities of serum antibodies in HIV patients with candidiasis are lowered . Non-specific factors which may inhibit Candida and other opportunist pathogens are also found in saliva . The candidacidal, myelomonocytic protein calprotectin is present in saliva at levels which are biologically active, although levels are lowered in HIV infection . Overall, HIV infection appears to be associated with disregulation of a number of immune factors at the mucosal surface, but the ability of patients with HIV infection to mount specific antibody secretory responses seems to be relatively intact until late in infection.

Am J Otol, 1998 Jan, 19(1), 42 - 5
Effect of penicillin on polyp formation in acute otitis media; Caye-Thomasen P et al.; HYPOTHESIS/BACKGROUND: The mucoperiosteal lining of the middle ear cavity is subject to radical changes during and after acute infection . Among these is the formation of mucosal polyps . Previous studies on experimental acute otitis media have shown a marked impact of penicillin on mucosal histomorphology . This study reports on the effect of penicillin administration on polyp formation . METHODS: The mucosa of 75 rat middle ears in a model of acute otitis media was examined . Whole-mount and section preparations from 25 normal ears, 25 ears inoculated with Streptococcus pneumoniae, and 25 inoculated, penicillin-treated ears were inspected for number, size, anatomic localization, and histopathologic morphology of occurring polyps . RESULTS: The total number of polyps was unaffected by penicillin administration, although polyps occurred in fewer ears . The polyps from treated ears tended to be smaller and stalky, appeared later in the timespan covered, and often were located around the tubal orifice . Histopathologic morphology of polyp base, core, and epithelial covering was otherwise unaffected by penicillin . CONCLUSIONS: Administration of penicillin has inconspicuous effect on the formation of polyps in experimental otitis media caused by S . pneumoniae in contrast to a marked impact on mucosal goblet cell density and other histopathologic features reported in previous studies.

Glycobiology, 1997 Dec, 7(8), 1061 - 6
Further characterization of the binding properties of a GalNAc specific lectin from Codium fragile subspecies tomentosoides; Wu AM et al.; Previous study on the binding properties of a lectin isolated from Codium fragile subspecies tomentosoides (CFT) indicates that this lectin recognizes the GalNAc alpha1--> sequence at both reducing and nonreducing ends . In this study, the carbohydrate specificity of CFT was further characterized by quantitative precipitin (QPA) and inhibition of lectin-enzyme binding assays . Of the glycoforms tested for QPA, all asialo-GalNAc alpha1--> containing glycoproteins reacted well with the lectin . Asialo hamster and ovine submandibular glycoproteins, which contain almost exclusively Tn (GalNAc alpha1-->Ser/Thr) residues as carbohydrate side chains, and Streptococcus type C polysaccharide completely precipitated the lectin added, while the GalNAc beta1-->containing Tamm-Horsfall Sd(a+) glycoprotein and its asialo product were inactive . Among the oligosaccharides tested for inhibiting lectin-glycoprotein interaction, GalNAc alpha1-->3GalNAc beta1-->3Gal alpha1-->4Gal beta1--> 4Glc(Fp) and Gal beta1-->3GalNAc alpha1-->benzyl (T alpha) were the best, and about 125-fold more active than GalNAc . They were about 3.3, 6.6, and 43 times more active than Tn containing glycopeptides, GalNAc alpha1-->3(LFuc alpha1--> 2)Gal(Ah) and Gal beta1-->3GalNAc(T), respectively . From the present and previous results, it is concluded that the combining site of CFT is probably of a groove type that recognizes from GalNAc alpha1--> to pentasaccharide(Fp) . The carbohydrate specificity of this lectin can be constructed and summarized in decreasing order by lectin determinants as follows: Fp and T alpha > Tn cluster > Ah >> I/II.

Pacing Clin Electrophysiol, 1997 Dec, 20(12 Pt 1), 2992 - 4
Infections in transvenous cardiac pacemakers: two more cases; Mezilis N et al.; Two patients with metastatic pacemaker infections, one caused by Pseudomonas aeruginosa, 5 months after implantation, and the second by Streptococcus pneumoniae, 8 years after implantation, were treated successfully by removal of the pacemaker systems . Infection reoccurred in the patient with Pseudomonas aeruginosa, who initially underwent partial pacing system removal allowing the atrial lead to remain . Repeat partial atrial lead removal and contralateral pacemaker implantation was followed by clinical infection, which was resolved when both the implanted atrial lead fragment and the recently implanted pacemaker were both removed . Removal of all hardware is required for cure of pacemaker infection.

Clin Infect Dis, 1998 Jan, 26(1), 165 - 71
Review of pneumococcal endocarditis in adults in the penicillin era; Aronin SI et al.; Streptococcus pneumoniae is an infrequent cause of infectious endocarditis in adults . In the past 2 years, however, we have encountered several cases at our institution, and additional cases have been reported in the literature . This infection typically follows pneumonia in the setting of chronic alcoholism and may additionally be complicated by meningitis . Less commonly, pneumococcal endocarditis occurs in other hosts or follows primary infection at other extrapulmonary sites . In such cases, the diagnosis may be initially missed, with a resultant delay in institution of appropriate therapy . Moreover, there are controversies regarding the optimal therapy for infections of this nature in the era of penicillin resistance . Since a comprehensive review of this topic has not been published since 1990, we reviewed cases of pneumococcal endocarditis in the penicillin era, with particular attention to disease recognition, the role of echocardiography, and the dilemmas surrounding medical and surgical therapeutic interventions.

Clin Infect Dis, 1998 Jan, 26(1), 103 - 10
Weekly oral azithromycin as prophylaxis for agents causing acute respiratory disease; Gray GC et al.; Since the 1950s the U.S . military has used intramuscular injections of benzathine penicillin G (BPG) to control outbreaks of respiratory disease . In an effort to find an alternative prophylaxis, a randomized field trial was conducted among 1,016 male U.S . Marine trainee volunteers at high risk for respiratory disease . Participants were evaluated for evidence of acute respiratory infection by serological tests on pretraining and posttraining sera (63 days apart) . Oral azithromycin prophylaxis (500 mg/w) outperformed BPG, preventing infection from Streptococcus pyogenes (Efficacy {E} = 84%; 95% confidence interval {CI}, 63%-93%), Streptococcus pneumoniae (E = 80%; 95% CI, 50%-92%), Mycoplasma pneumoniae (E = 64%; 95% CI, 25%-83%), and Chlamydia pneumoniae (E = 58%; 95% CI, 15%-79%) in comparison with results in a no-treatment group . Azithromycin group subjects reported few side effects and less respiratory symptoms than the BPG and no-treatment groups . According to serological tests, oral azithromycin is an effective alternative prophylaxis to BPG for military populations.

Rev Med Chir Soc Med Nat Iasi, 1995 Jul-Dec, 99(3-4), 215 - 9
{Pyogenic infections with different locations caused by Streptococcus anginosus alone or in association with anaerobic bacteria}; Coman G et al.; Isolation and identification of S . anginosus from pathologic products are possible to be realised in informed clinical laboratory, allowing so a better knowledge of these infections' incidences and on adequate treatment . The authors' report 11 cases of pyogenic infection caused by S . anginosus . Five out of these 11 cases evaluated as mixed infections, S . anginosus being associated with anaerobic bacteria . 10 children hospitalised in surgery Department of Children Hospital had infections with different localisations; necrotizing fasciitis, preknee cap abscess, generalised peritonitis, abscess postappendectomy, pleurisy and acute mediastinitis, knee arthritis, acute osteomyelitis of mandible and an infection of the fracture's focus in upper 1/3 of the thigh bone . For all these patients the favoring factor was represented by a traumatic or surgical lesion of the skin or diverse mucosa; oral, oesophageal, intestinal, allowing the access of the normal flora of these covers to normally sterile sites . The eleventh case was an adult with a lung abscess and pleurisy, as a complication of an aspiration pneumonia . The treatment of S . anginosus infections consisted especially in penicillin or ampicillin, associated with metronidazol when anaerobic bacteria were present.

Infect Immun, 1998 Feb, 66(2), 771 - 6
Genetic inactivation of an extracellular cysteine protease (SpeB) expressed by Streptococcus pyogenes decreases resistance to phagocytosis and dissemination to organs; Lukomski S et al.; Streptococcal pyrogenic exotoxin B (SpeB), a conserved cysteine protease expressed by virtually all Streptococcus pyogenes strains, has recently been shown to be an important virulence factor (S . Lukomski, S . Sreevatsan, C . Amberg, W . Reichardt, M . Woischnik, A . Podbielski, and J . M . Musser, J . Clin . Invest . 99:2574-2580, 1997) . Genetic inactivation of SpeB significantly decreased the lethality of a serotype M49 strain for mice and abolished the lethality of a serotype M3 strain after intraperitoneal (i.p.) injection . In the present study, a wild-type M3 isolate and an M3 speB mutant derivative were used to investigate the mechanism responsible for altered virulence . Following i.p . injection, the mutant and wild-type strains induced virtually identical cellular inflammatory responses, characterized largely by an influx of polymorphonuclear leukocytes (PMNs) . In addition, the mutant and wild-type strains rapidly entered the blood and were recovered from all organs examined . However, significantly fewer (P < 0.05) CFUs of the isogenic mutant derivative than of the wild-type parent strain were recovered from blood and organs . PMNs effectively cleared the M3 speB mutant from the peritoneum by 22 h, thereby sparing the host . In contrast, the wild-type M3 strain continued to replicate intraperitoneally and had the ability to kill phagocytes . This process allowed the wild-type strain to continuously disseminate, resulting in host death . Our results indicate that genetic inactivation of the cysteine protease decreased the resistance of the mutant to phagocytosis and impaired its subsequent dissemination to organs . These results provide insight into the detrimental effect of SpeB inactivation on virulence.

Lakartidningen, 1997 Dec 17, 94(51-52), 4914 - 8
{A handling program for resistant pneumococci . Physicians sometimes neglect mandatory notification}; Hedlund J et al.; Streptococcus pneumoniae infections belong to the leading worldwide causes of illness and death among young children, people with underlying debilitating medical conditions, and the elderly . Following early documentation of infections due to pneumococcal strains with reduced penicillin susceptibility in Australia in 1967, and of infections due to penicillin-resistant strains in South Africa in 1978, pneumococcal resistance to penicillin and other antibiotics has progressed rapidly and is now a global problem . In Sweden, notification of the occurrence of pneumococci with a minimum inhibitory concentration (MIC) > or = 0.5 mg/L for penicillin G (PcG) has been mandatory for general practitioners (GPs) and clinical microbiological laboratories since 1 January 1996 . In 1996, 1,057 cases of infection by such pneumococci were reported by microbiological laboratories, but only 262 cases by GPs . With a view to minimising the impact of pneumococci with reduced penicillin susceptibility in Sweden, the National Board of Health and Welfare set up a working group of experts in November 1994 . To reduce the transmission of such bacteria in the community, the working group introduced a control programme which includes the isolation of day-care children under six years of age carrying pneumococci with PcG-MICs > or = 0.5 mg/L . An enquiry among the 25 regional centres for infectious disease control in the country to ascertain compliance in the different counties of Sweden showed the programme to have been adhered to in a majority of counties, although many had chosen alternative measures to deal with the problem.

J Gynecol Obstet Biol Reprod (Paris), 1997, 26(6), 617 - 22
{Primary peritonitis caused by Streptococcus pneumoniae}; Garnache F et al.; Primary peritonitis caused by Streptococcus pneumoniae is a rare but serious complication of childbirth . We present here three cases of young women who developed abdominal pain after childbirth . All of the patients had fever with abdominal pain, diarrhea and clinical signs of peritonitis . In two cases a laparotomy was performed to remove pus . Cultures taken were positive for Streptococcus pneumoniae . Culture of vaginal swabs and blood cultures were also positive for the same pathogen . For the third patient, both vaginal swabs and blood cultures were positive for Streptococcus pneumoniae, antibiotic therapy only was administered . Outcome was favorable for all . We discuss the pathogenesis, clinical presentation, management and the usefulness for systematic search "for" Streptococcus pneumoniae in vaginal swabs.

Infect Immun, 1998 Feb, 66(2), 839 - 42
Role of tumor necrosis factor alpha in the host response of mice to bacteremia caused by pneumolysin-deficient Streptococcus pneumoniae; Benton KA et al.; Pneumolysin-deficient mutant strains of Streptococcus pneumoniae are known to cause less-severe sepsis than wild-type pneumococcal strains that produce pneumolysin . This difference is associated with greater host resistance in mice infected with the pneumolysin-deficient strains . These studies show that the host resistance developed during the first 1 to 2 days after infection with a pneumolysin-deficient mutant strain is dependent on tumor necrosis factor alpha but is apparently independent of interleukin 1beta (IL-1beta) or IL-6 . Survival beyond 5 days appeared to depend on the ability of the mice to produce IL-1beta.

Infect Immun, 1998 Feb, 66(2), 820 - 2
Adherence of Streptococcus pneumoniae to human bronchial epithelial cells (BEAS-2B); Adamou JE et al.; Pneumococcal adherence to alveolar epithelial cells and nasopharyngeal epithelial cells has been well characterized . However, the interaction of Streptococcus pneumoniae with bronchial epithelial cells has not been studied . We have now shown that pneumococci bind specifically to a human bronchial epithelial cell line (BEAS-2B cells) . Pneumococci adhered to BEAS-2B cells in a time- and dose-dependent manner . These results suggest that the bronchial epithelium may serve as an additional site of attachment for pneumococci and demonstrate the utility of the BEAS-2B cell line for studying mechanisms of pneumococcal infection.

Infect Immun, 1998 Feb, 66(2), 765 - 70
Expression and characterization of group A Streptococcus extracellular cysteine protease recombinant mutant proteins and documentation of seroconversion during human invasive disease episodes; Gubba S et al.; A recent study with isogenic strains constructed by recombinant DNA strategies unambiguously documented that a highly conserved extracellular cysteine protease expressed by Streptococcus pyogenes (group A Streptococcus {GAS}) is a critical virulence factor in a mouse model of invasive disease (S . Lukomski, S . Sreevatsan, C . Amberg, W . Reichardt, M . Woischnik, A . Podbielski, and J . M . Musser, J . Clin . Invest . 99:2574-2580, 1997) . To facilitate further investigations of the streptococcal cysteine protease, recombinant proteins composed of a 40-kDa zymogen containing a C192S amino acid substitution that ablates enzymatic activity, a 28-kDa mature protein with the C192S replacement, and a 12-kDa propeptide were purified from Escherichia coli containing His tag expression vectors . The recombinant C192S zymogen retained apparently normal structural integrity, as assessed by the ability of purified wild-type streptococcal cysteine protease to process the 40-kDa molecule to the 28-kDa mature form . All three recombinant purified proteins retained immunologic reactivity with polyclonal and monoclonal antibodies . Humans with a diverse range of invasive disease episodes (erysipelas, cellulitis, pneumonia, bacteremia, septic arthritis, streptococcal toxic shock syndrome, and necrotizing fasciitis) caused by six distinct M types of GAS seroconverted to the streptococcal cysteine protease . These results demonstrate that this GAS protein is expressed in vivo during the course of human infections and thereby provide additional evidence that the cysteine protease participates in host-pathogen interactions in some patients.

Infect Immun, 1998 Feb, 66(2), 448 - 50
Role of monocytes and bacteria in Staphylococcus epidermidis endocarditis; Bancsi MJ et al.; The endocardial vegetation which is formed in the course of bacterial endocarditis (BE) contains tissue factor (TF)-dependent procoagulant activity . Earlier studies showed that monocytes are the main source of TF in the vegetations . The TF activity (TFA) of vegetations isolated from Streptococcus sanguis-infected rabbits depended on the numbers of bacteria as well as monocytes in the vegetation . In this study, we investigated whether for Staphylococcus epidermidis, a frequent pathogen in BE, an effect similar to that found for S . sanguis could be shown . In vitro, S . epidermidis was found to stimulate TFA of fibrin adherent monocytes significantly . This stimulation was maximal at a bacterium-to-monocyte ratio of 7 . In vivo, TFA was found to be significantly higher in S . epidermidis-infected than in sterile catheter-induced vegetations . Reduction of vegetational bacterial numbers by teicoplanin treatment lead to a small but significant decrease of TFA . Reduction of monocyte numbers by etoposide did not affect vegetational TFA . Comparison of data for S . epidermidis and S . sanguis revealed that at equivalent bacterial numbers, vegetational TFAs were approximately the same for both microorganisms . Combining the results of the present study with those of a previous study using S . sanguis, we conclude that the main factor determining monocyte-dependent vegetational TFA is the number of vegetation-associated bacteria . The lower TFA found for S . epidermidis-infected than for S . sanguis-infected vegetations can be explained by the significantly lower bacterial numbers in the infected vegetations and consequently a lower stimulation of vegetation-associated monocytes.

Neurosci Lett, 1997 Nov 21, 237(2-3), 105 - 8
Central nervous system TNFalpha-mRNA expression during rabbit experimental pneumococcal meningitis; Bitsch A et al.; In pneumococcal meningitis inflammatory mediators such as tumor necrosis factor alpha (TNFalpha) are produced in large quantities and play a major role in pathogenesis . It is not known exactly which cells produce these mediators during infection . We investigated the localisation of TNFalpha-mRNA in the central nervous system (CNS) by in situ hybridisation during experimental Streptococcus pneumoniae meningitis . TNF-positive cells were detected only in inflammatory infiltrates within the meninges . Cells within the brain parenchyma and the choroid plexus were completely negative . After monocyte depletion, no TNFalpha-mRNA positive cells were detected in the CNS . These findings suggest that TNFalpha in pneumococcal meningitis is produced in the CNS mainly by blood-derived, infiltrating monocytes.

Eur J Biochem, 1997 Nov 15, 250(1), 163 - 7
Identification of the common antigenic determinant shared by Streptococcus pneumoniae serotypes 35A and 20 capsular polysaccharides--structural analysis of the Streptococcus pneumoniae serotype 35A capsular polysaccharide; Beynon LM et al.; The specific polysaccharide antigen of Streptococcus pneumoniae serotype 35A was shown, by a combination of one- and two-dimensional NMR methods and chemical analyses, to be a high-molecular-mass polymer composed of D-galactose, D-glucose, mannitol, and phosphate (3:1:1:1) . The pentasaccharide repeating unit is polymerized through phosphate diester linkages to give the structure, {formula in text} O-Acetyl substituents are present at positions 5 and 6 of the 3)-beta-D-Galf residue and at position 2 of the 6)-beta-D-Galf residue . The capsular polysaccharides of S . pneumoniae serotypes 20 and 35A both contain the disaccharide unit -->3)-beta-D-Galf-(1-->3)-beta-D-Glcp-(1--> which is the probable structural determinant responsible for the serological cross reactivity of the two polysaccharides.

J Lab Clin Med, 1998 Jan, 131(1), 21 - 7
Pneumolysin: a multifunctional pneumococcal virulence factor; Rubins JB et al.; Pneumolysin (PLY) is a multifunctional pneumococcal virulence factor that appears to augment intrapulmonary growth and dissemination during the early pathogenesis of Streptococcus pneumoniae infection . Through its cytotoxicity to respiratory epithelium and endothelium, PLY disrupts pulmonary tissue barriers that serve as mechanical pulmonary defenses, thus facilitating S . pneumoniae growth and dissemination . Through direct inhibitory effects on immune and inflammatory cells and by activating complement, PLY inhibits bacterial clearance from the pulmonary interstitium and the blood . Because PLY stimulates local and systemic immune responses and enhances the immunogenicity of S . pneumoniae polysaccharide (PS), PLY-PS conjugates may form the basis for vaccines that not only induce protective and durable immune responses to pneumococcal PS but also generate neutralizing anti-PLY antibodies that can protect the respiratory mucosa from toxin-induced injury.

Harefuah, 1997 Dec 15, 133(12), 613 - 5, 663
{Pyogenic liver abscess in children}; Spiegel R et al.; 2 children with pyogenic liver abscesses were hospitalized during the past 2 years . A 6-year-old boy had high fever and hepatomegaly, and a large liver abscess was found in the right hepatic lobe . Streptococcus milleri was isolated from the pus . Treatment with a combination of prolonged drainage of the abscess and antibiotic therapy was successful . A 4-month-old girl who had prolonged fever was found to have osteomyelitis of 3 thoracic vertebrae and 2 liver abscesses in the right lobe . She was treated successfully with broad spectrum antibiotics . Additional workup revealed that she had chronic granulomatous disease.

Vet Microbiol, 1997 Oct 31, 58(1), 53 - 60
Virulence of Streptococcus suis type 2 for mice and pigs appeared host-specific; Vecht U et al.; A murine model for Streptococcus suis infection in pigs was validated by inoculating groups of 5 BALB/c and 5 CF1 mice with 10(7) CFU/ml of 13 different S . suis serotype 2 strains . The pathogenicity of these strains had been established in a standardized pig model of S . suis infection using one-week-old gnotobiotic pigs . We inoculated groups of mice intraperitoneally with 4 strains that were highly virulent for pigs and belonged to the phenotype MRP+EF+, with 4 strains, that were weakly virulent for pigs and belonged to the phenotype MRP+EF+, and with 5 strains that were non-virulent for pigs and belonged to phenotype MRP-EF- . The S . suis strains that were highly virulent for pigs caused high morbidity and an intermediate mortality in mice, the S . suis strains that were weakly virulent for pigs caused high morbidity but low mortality, and the strains that were non-virulent for pigs, induced highest morbidity and mortality . These results were comparable in both breeds of mice . In contrast to the pathology of S . suis infection in pigs with specific lesions, lesions in mice were histologically often characterized as non-specific, i.e., necrotizing encephalitis and focal or diffuse hepatitis sometimes with abscesses . Irrespective of breed (BALB/c vs . CF1), the murine model used for S . suis infection was incompatible with the pig model . This indicates that virulence of S . suis type 2 for mice and pigs is host-specific . Therefore, we regard the presently available murine models unsuitable for studying S . suis infections in pigs.

Otolaryngol Head Neck Surg, 1998 Jan, 118(1), 44 - 8
Effects of 21-aminosteroid U-74389G on acute otitis media in a guinea pig model; Haddad J Jr et al.; Free radicals participate in the development of disease under inflammatory conditions . Lipid peroxides such as malondialdehyde are regarded as markers of cell membrane damage by oxidative stresses . Previous work from our laboratory has demonstrated that lipidperoxidation is increased in acute otitis media in guinea pigs, implicating a role for free radicals as contributors to inflammation . In this study we examined the effect of lazaroid U-74389G, a 21-aminosteroid, on acute otitis media in guinea pigs . Streptococcus pneumoniae organisms were inoculated into the right tympanic cavity; sterilized phosphate-buffered saline solution was injected into the left ear to serve as a control . The guinea pigs were given intraperitoneal injections of 40 mg/kg of a lazaroid compound or its vehicle every 12 hours . Middle ear mucosa was collected and used for assay . We quantified lipid peroxide by means of the methylene blue-hemoglobin method and by means of measurement of thiobarbituric acid reactive substance . Lazaroid significantly (p < 0.05) suppressed production of lipid hyproperoxide of the middle ear mucosa of the guinea pigs with acute otitis media for up to 24 hours . These results suggest that lazaroid may reduce lipoperoxidation in the middle ear at an early stage of acute otitis media.

Otolaryngol Head Neck Surg, 1998 Jan, 118(1), 15 - 21
Induction of labyrinthitis ossificans after pneumococcal meningitis: an animal model; Brodie HA et al.; Newly formed disorganized bone fills the open spaces within the otic capsule in various pathologic conditions, resulting in labyrinthitis ossificans . The pathologic mechanisms of this disease remain poorly understood . To better study the sequence of events and contributing mechanisms involved in labyrinthitis ossificans, an animal model was developed . Three groups of Mongolian gerbils received either an intralabyrinthine injection of normal saline solution (group 1) or Streptococcus pneumoniae polysaccharide capsule antigens (groups 2 and 3) . The temporal bones were harvested after 3 months and serially sectioned . None of the eight control animals (group 1), which received intralabyrinthine injections of normal saline solution had any histologic changes in their temporal bones . Nine of the surviving 19 animals in groups 2 and 3 had fibrosis or evidence of early ossification . A fourth group of Mongolian gerbils received two intrathecal injections of live S . pneumoniae organisms . The temporal bones were harvested after 3 months and serially sectioned . Fourteen of the surviving 15 animals had fibrosis or ossification or both . This animal model will provide a method for study of the mechanisms of labyrinthitis ossificans.

J Med Microbiol, 1998 Jan, 47(1), 17 - 27
Pneumococci causing invasive disease in Britain 1982-1990; Colman G et al.; A total of 5348 isolates of Streptococcus pneumoniae was serotyped and screened for insusceptibility to tetracycline, penicillin, erythromycin and chloramphenicol . Of these, 4238 (79%) were isolated from patients who had pneumonia or meningitis or were bacteraemic . Altogether, 3948 (74%) of the isolates belonged to one or other of the serotypes 1, 3, 4, 6, 8, 9, 14, 19 or 23 with serotypes 6, 14, 18, 19 and 23 being frequent causes of invasive disease in young children . Many isolates of type 1 were isolated from pneumonia and few from meningitis . Some 768 (14%) isolates were insusceptible to one or more antibiotic and 591 of these belonged to serotypes 6, 9, 14, 19 or 23 . Representatives of type 14 resistant to erythromycin were prominent from 1986 onwards . There was an increase in the number of multi-resistant pneumococci from 1985 . Among these were isolates of type 23 insusceptible to penicillin, chloramphenicol and tetracycline and cultures of type 6 resistant additionally to erythromycin.

Carbohydr Res, 1997 Nov 10, 304(2), 165 - 72
Structural elucidation of the capsular polysaccharide from Streptococcus pneumoniae type 18B; Karlsson C et al.; The structure of the capsular polysaccharide from Streptococcus pneumoniae type 18B has been determined using NMR spectroscopy and methylation analysis as the principal methods . It is concluded that the polysaccharide is composed of pentasaccharide repeating units with a glycerol phosphate substituting the 3-position of the branch point residue . The carbohydrate backbone in type 18B is identical to that in S . pneumoniae type 18F but without the O-acetyl groups present in that type . {formula: see text} In this structure, the absolute configuration of the glycerol phosphate moiety has not been determined but should be D, in analogy with that determined for the capsular polysaccharide from S . pneumoniae type 18A {T . Rundlof, G . Widmalm, Anal . Biochem., 243 (1996) 228-233}.

Antimicrob Agents Chemother, 1998 Jan, 42(1), 199 - 201
Concentrations of cefpirome in cerebrospinal fluid of children with bacterial meningitis after a single intravenous dose; Friedland IR et al.; A single intravenous dose of cefpirome, 50 mg/kg, was administered to 15 children with bacterial meningitis 24 to 48 h after initiation of standard antibiotic and steroid therapy . Cefpirome concentrations in serum and cerebrospinal fluid were determined at selected time intervals . The mean (standard deviation) peak concentration in cerebrospinal fluid (n = 5) was 10.8 (7.8) microg/ml . Drug concentrations in cerebrospinal fluid above the MIC for Streptococcus pneumoniae at which 90% of the isolates were inhibited were found 2, 4, and 8 h after the dose of cefpirome was given . The penetration of cefpirome into cerebrospinal fluid compares favorably with that of other extended-spectrum cephalosporins and suggests that this agent would be useful in the therapy of childhood meningitis, including cases caused by drug-resistant S . pneumoniae.

Antimicrob Agents Chemother, 1998 Jan, 42(1), 173 - 5
In vitro activity of sanfetrinem and affinity for the penicillin-binding proteins of Streptococcus pneumoniae; Sifaoui F et al.; Against penicillin-susceptible pneumococci, the activity of sanfetrinem was similar to those of penicillin, amoxicillin, cefotaxime, imipenem, and meropenem, while against penicillin-resistant strains, sanfetrinem and the carbapenems exhibited superior activity (MICs at which 90% of strains are inhibited, < or =1 microg/ml) . PBP 1a in the penicillin-susceptible strain and PBP 1a and PBP 2b in the more resistant isolates seemed to be the essential penicillin-binding proteins for imipenem and sanfetrinem.

Antimicrob Agents Chemother, 1998 Jan, 42(1), 23 - 7
Efficacy of CS-834 against experimental pneumonia caused by penicillin-susceptible and -resistant Streptococcus pneumoniae in mice; Fukuoka T et al.; The efficacy of CS-834, a novel oral carbapenem, was assessed by using a murine model of pneumonia caused by penicillin-susceptible and penicillin-resistant Streptococcus pneumoniae and was compared with those of oral cephems, i.e., cefteram pivoxil, cefpodoxime proxetil, cefdinir, and cefditoren pivoxil . Intranasal inoculation of 10(6) CFU of penicillin-susceptible or penicillin-resistant S . pneumoniae in the exponential growth phase induced pneumonia and bacteremia in ddY mice within 48 h . For the treatment of infections caused by the penicillin-susceptible strain the antibiotics were administered orally at 0.4, 2, and 10 mg/kg of body weight twice daily for 2 days beginning at 24 h after bacterial inoculation, and for the treatment of infections caused by a penicillin-resistant strain the antibiotics were administered at 2, 10, and 50 mg/kg twice daily for 2 days beginning at 24 h after bacterial inoculation . Among the antibiotics tested, CS-834 exhibited the most potent efficacy against both types of strains . Against infections caused by penicillin-susceptible S . pneumoniae, CS-834 at all doses significantly reduced the numbers of viable cells in both the lungs and blood . Cefpodoxime proxetil at all doses and cefteram pivoxil and cefditoren pivoxil at doses of 2 and 10 mg/kg showed comparable efficacies . Against infections caused by penicillin-resistant S . pneumoniae, CS-834 at doses of 10 and 50 mg/kg showed the most potent efficacy among the antibiotics tested, resulting in the maximum decrease in the numbers of viable cells in the lungs . Comparable efficacies were observed with cefteram pivoxil and cefpodoxime proxetil at doses of 50 mg/kg each . The concentration of CS-834 in the lungs and blood was higher than that of cefdinir and was lower than those of the other antibiotics tested, suggesting that the potent therapeutic efficacy of CS-834 reflects its strong activity against S . pneumoniae.

Anesthesiology, 1998 Jan, 88(1), 218 - 23
Partial liquid ventilation with perfluorocarbon in the treatment of rats with lethal pneumococcal pneumonia; Dickson EW et al.; BACKGROUND: Partial liquid ventilation with perfluorocarbon is a new therapeutic strategy to treat various lung disorders . The current study was undertaken to determine the efficacy of partial liquid ventilation with a perfluorocarbon (FC-77) in the treatment of pneumococcal pneumonia in rats . METHODS: Male Wistar rats (weight, 275-300 g; n, 75) were infected via direct intratracheal inoculation with ca 10(9) colony-forming units of viable Streptococcus pneumoniae, serotype 3, and 24 h after infection were placed into one of five groups, each containing 15 rats . The groups were (1) no treatment, (2) one intramuscular injection of penicillin G benzathine (200,000 U), (3) partial liquid ventilation with FC-77, (4) partial liquid ventilation with FC-77 and a single intramuscular dose of penicillin G benzathine (200,000 U), and (5) gas ventilation . Animals were observed every 24 h for survival . RESULTS: All untreated or gas-ventilated animals or animals that received only partial liquid ventilation were dead by 7 days . Those receiving only partial liquid ventilation survived longer than untreated controls, but ultimately all succumbed by day 7 . Survival was 40% for penicillin-treated rats compared with controls (P < 0.05) and 80% for animals treated with both partial liquid ventilation and penicillin versus antibiotic alone (P < 0.05) . CONCLUSIONS: These observations suggest that partial liquid ventilation with perfluorocarbon in combination with antibiotic administration may be an effective therapeutic modality in pneumococcal pneumonia.

Bull World Health Organ, 1997, 75(5), 453 - 62
Nasopharyngeal carriage of community-acquired, antibiotic-resistant Streptococcus pneumoniae in a Zambian paediatric population; Woolfson A et al.; The emergence of antibiotic-resistant Streptococcus pneumoniae is an international health problem . Apart from South Africa few data on pneumococcal resistance are available for sub-Saharan Africa . This study examines the nasopharyngeal carriage and prevalence of antibiotic resistance in pneumococci isolated from 260 Zambian children aged < 6 years . Pneumococci were isolated from 71.9% of the children; the odds of carrying organisms were twice as high among children < 2 years of age compared with older children . Antibacterial resistance was found in 34.1% of the isolates; resistance to tetracycline, penicillin, sulfamethoxazole + trimethoprim, and chloramphenicol occurred in 23.0%, 14.3%, 12.7%, and 3.9% of the isolates, respectively . Only 4% of the isolates were resistant to three drugs . High-level resistance was found in all isolates resistant to tetracycline; but only intermediate level penicillin resistance was found . A total of 11.1% of the isolates demonstrated intermediate resistance to sulfamethoxazole + trimethoprim . Children aged < 6 months were less likely to carry antibiotic-resistant organisms . Antibiotic resistance in S . pneumoniae appears to be an emerging public health problem in Zambia, and the national policy for the empirical treatment of pneumococcal meningitis and acute respiratory tract infections may need to be re-evaluated . The establishment of ongoing surveillance to monitor trends in pneumococcal resistance should be consideredPIP: Pneumococcal pneumonia accounts for up to 25% of deaths in children under 5 years of age in sub-Saharan Africa . This study investigated the nasopharyngeal carriage rate of Streptococcus pneumoniae in a Zambian pediatric population and the prevalence of antibiotic resistance . Enrolled were 260 children under 6 years of age (mean age, 20 months) treated at the University Teaching Hospital in Lusaka, Zambia, in 1994 . S . pneumoniae was isolated from the nasopharynx of 187 children (71.9%) . The odds of carrying pneumococci were twice as high among children under 2 years of age (76.2%) than older children (59.7%) . Overall, 83 (65.9%) of the 126 isolates available for antibiotic resistance profiles were sensitive to the drugs . Resistance to tetracycline, penicillin, sulfamethoxazole plus trimethoprim, and chloramphenicol was found in 23.0%, 14.3%, 12.7%, and 3.9%, respectively, of the isolates . The highest level of resistance was recorded in all isolates resistant to tetracycline . All but one of the multidrug-resistant isolates were serotype 14 . Children under 6 months old were least likely to carry antibiotic-resistant organisms . In an anonymous questionnaire completed by 160 mothers, 38% reported they obtained antibiotics without a prescription and 49.4% acknowledged feeling dissatisfied when not given antibiotics to treat their sick child . Ongoing surveillance is recommended in Zambia to ensure that recommended treatment regimens keep pace with trends in antibiotic resistance .

Nat Biotechnol, 1998 Jan, 16(1), 45 - 8
Bacterial transcript imaging by hybridization of total RNA to oligonucleotide arrays; de Saizieu A et al.; We have used high-density oligonucleotide probe arrays (chips) for bacterial transcript imaging . We designed a chip containing probes representing 106 Hemophilus influenzae genes and 100 Streptococcus pneumoniae genes . The apparent lack of polyadenylated transcripts excludes enrichment of mRNA by affinity purification and we thus used total, chemically biotinylated RNA as hybridization probe . We show that hybridization of Streptococcus RNA to a chip allows simultaneous quantification of the transcript levels . The sensitivity was found to be in the range of one to five transcripts per cell . The quantitative chip results were in good agreement with conventional Northern blot analysis of selected genes . This technology allows simultaneous and quantitative measurement of the transcriptional activity of entire bacterial genomes on a single oligonucleotide probe array.

Recenti Prog Med, 1997 Nov, 88(11), 521 - 5
{Native valve infective endocarditis caused by Streptococcus bovis . Efficacy of short-term antibiotic therapy and usefulness of serial echocardiographic evaluation}; Perrotta E et al.; We report a case of infective endocarditis on native valve, due to Streptococcus bovis, treated successfully with short time antibiotic therapy (10 days versus minimum suggested treatment of two weeks) by using penicillin G together with streptomycin (six days), followed, by treatment with imipenem (four days) because of allergic reactions . Diagnosis was simpler thanks to Durack's new criteria that include positive echocardiographic findings (valvular vegetations) within major clinical criteria for definite diagnosis of infective endocarditis, different from preceding Von Reyn's criteria which did not provide diagnostic weight for echocardiographic data . Serial echocardiograms have also been useful to evaluate the early response to the treatment and its persistent efficacy in the follow-up.

Laryngoscope, 1998 Jan, 108(1 Pt 1), 102 - 6
Myringotomy: a prerequisite for the development of myringosclerosis?
Mattsson C, Magnuson K, Hellstrom S.
Streptococcus pneumoniae was inoculated into the left middle-ear cavity in two groups of rats, resulting in purulent otitis media . After 3 days, one group of infected animals and a third group of noninfected animals were subjected to left-sided myringotomy . The tympanic membranes were examined both otomicroscopically and histologically 1 and 3 months later . On otomicroscopic examination the noninfected myringotomized animals had developed extensive myringosclerotic lesions, whereas only minimal sclerotic deposits were noted in the myringotomized animals with acute otitis media (AOM) . On histologic examination both the noninfected myringotomized animals and the myringotomized animals with AOM were similar in the frequency and extension of sclerotic lesions in the tympanic membrane . The nonmyringotomized rats with AOM were free of sclerotic lesions, except for minor changes found in one animal.

Mol Microbiol, 1997 Oct, 26(1), 197 - 208
Capsular polysaccharide synthesis in Streptococcus pneumoniae serotype 14: molecular analysis of the complete cps locus and identification of genes encoding glycosyltransferases required for the biosynthesis of the tetrasaccharide subunit; Kolkman MA et al.; We have reported previously on seven genes (cps14B-H) of Streptococcus pneumoniae serotype 14, which are part of the type 14 capsular polysaccharide synthesis (cps14) locus . This study describes the cloning and sequencing of the remaining part of the cps14 locus . The entire cps14 gene cluster consists of 12 open reading genes (cps14A to cps14L), which appear to be arranged as a single transcriptional unit . The flanking regions of the cps14 locus contain vestiges of insertion elements . Moreover, a 115-bp-long repeated DNA element, which is also present in several other intergenic regions on the pneumococcal chromosome, has been identified upstream of cps14A . All 12 open reading frames (ORFs) were inactivated by the insertion of a tetracycline resistance cassette . The cps14A to cps14J and cps14L mutants were unencapsulated, whereas only a limited amount of capsular polysaccharide was expressed by a cps14K insertion mutant . Comparison with DNA and protein sequences available in databases allowed us to predict functions for four out of the five new cps14 gene products . The biosynthetic function of Cps14I was determined experimentally by analysis of intermediates in the synthesis of the type 14 tetrasaccharide subunit, catalysed by membrane preparations of Escherichia coli expressing pneumococcal glycosyltransferases . The cps14I gene encodes the beta-1,3-N-acetylglucosaminyltransferase activity necessary for the addition of the third sugar in the synthesis of the type 14 repeating unit . The activity encoded by cps14J was established using a synthetic glycosyltransferase acceptor: cps14J encodes a beta-1,4-galactosyltransferase, which requires beta-linked GlcNAc as an acceptor . Thus, Cps14J is responsible for the addition of the last (fourth) sugar in the synthesis of the type 14 subunit.

Mol Microbiol, 1997 Oct, 26(1), 65 - 79
Cloning and characterization of a relA/spoT homologue from Bacillus subtilis; Wendrich TM et al.; A PCR-amplified DNA fragment of the relA gene from genomic Bacillus subtilis DNA was used to isolate the entire relA/spoT homologue and two adjacent open reading frames (ORFs) from a lambda ZAP Express library . The relA gene, which encodes a protein of 734 amino acid residues (aa), is flanked by an ORF (170aa) that shares high similarity to adenine phosphoribosyltransferase genes (apt), and downstream by an ORF (131 aa) of unknown function . This genetic organization is similar to that in Streptomyces coelicolor A3(2) and Streptococcus equismilis H46A . relA shows significant similarity to the Escherichia coli relA and spoT genes, which are responsible for the synthesis and degradation of the highly phosphorylated guanosine nucleotides (p)ppGpp, triggering the stringent response . Deletion of the relA gene generated a (p)ppGpp0 phenotype that demonstrated its essential role in the response to amino acid deprivation and resulted in impaired/lowered induction of proteins involved in stress response as well as amino acid biosynthesis, as judged by two-dimensional gel electrophoresis . The same effects of impaired induction of some sigmaB-independent proteins could also be shown in a sigB/relA double mutant, supporting the role of relA in derepression/induction of catabolic and anabolic genes during stringent response.

Chemotherapy, 1998 Jan-Feb, 44(1), 12 - 6
In vitro and in vivo antibacterial activities of a new carbapenem BO-2727 for use in obstetrics and gynecology; Mikamo H et al.; The antibacterial activity of BO-2727 against 100 clinical isolates of Streptococcus agalactiae (20 strains), Escherichia coli (20 strains), Peptostreptococcus magnus (20 strains), Bacteroides fragilis (20 strains) and Prevotella bivia (20 strains) was compared with those of imipenem, panipenem, meropenem, biapenem and ceftazidime (CAZ) . Minimal inhibitory concentrations (MICs) for 50% of tested strains (MIC50s) of BO-2727 against S . agalactiae, E . coli, P . magnus, B . fragilis and P . bivia were 0.05, 0.05, 0.1, 0.78 and 0.78 mg/l, respectively . MIC90s of BO-2727 against S . agalactiae, E . coli, P . magnus, B . fragilis and P . bivia were 0.05, 0.05, 0.1, 0.78 and 0.78 mg/l, respectively . The efficacy of BO-2727 was evaluated using a polymicrobial pyometra model (E . coli and B . fragilis) in rats . Both the inflammatory changes in the uterus, from the point of view of neutrophil accumulation, and the bacteriological response in the treated group were milder than those in either the nontreated group or the CAZ-treated group . These results indicate that BO-2727 may be useful for the treatment of polymicrobial infections in patients with pyometra.

Acta Otorhinolaryngol Belg, 1997, 51(4), 315 - 22
Sinusitis of dental origin; Bertrand B et al.; Acute or chronic sinusitis may be odontogenic . Bacteria involved in odontogenic sinusitis are specific organisms associated with the teeth (Streptococcus sanguis, Streptococcus salivarius, Streptococcus mutans, anaerobic germs) . They are often secondary to an intrasinus foreign body following periodontitis . The treatment is both naso-sinusal and dental . Cysts of the maxilla can also invade the sinus . In particular, radiculo-dental cysts (periapical) must be surgically excised, in some cases associated with a middle meatotomy . Finally, one should look for oro-antral fistulae . The surgical technique for its closure should take into account the reversibility of the sinus lesions.

Acta Otorhinolaryngol Belg, 1997, 51(4), 285 - 304
Chronic sinusitis in children; Daele JJ; In children, sinusitis is a common, generally uncomplicated, and self limiting disease which drops with age . The diagnosis is difficult because of relatively non specific signs and symptoms that overlap with viral upper respiratory infection and allergy . Plain paranasal sinus radiographs are not adequate, in determining the extent of involvement in recurrent or chronic sinusitis and so CT scan has become the standard . Viral illness appears to be the most common predisposing factor . Immune defects (mainly IG2 and IGA) may exist in a significant percentage of children . The role of allergy seems less important . With advances in the genetic field of cystic fibrosis, genetic factors are advocated in chronic or recurrent sinusitis . The most common bacterial pathogens in pediatric sinusitis patients are SP (Streptococcus Pneumoniae), HI (Hemophilus Influenza) and MC (Moraxella Catarrhalis) . Other less frequent bacterial species include group A streptococcus, group C streptococcus, streptococcus viridans, peptostreptococcus, moraxella species and Eikenella corrodens . Respiratory anaerobes are not common . Antibiotics resistant to the action of the beta-lactamase are the cornerstone in medical treatment . In recurrent acute sinusitis prophylactic antimicrobials may be helpful . The indication for surgery remains controversial . To date, we have no prospective studies comparing surgical to medical therapy in order to guide us in deciding surgical indication . It is therefore recommended to follow a conservative track and to limit surgical procedures in children with suppurative complications, nasal obstruction from polyposis or refractory sinusitis aggravating chronic pulmonary disease such as asthma.

Microb Drug Resist, 1997 Winter, 3(4), 391 - 400
Autolysis and cell wall degradation in a choline-independent strain of Streptococcus pneumoniae; Severin A et al.; Streptococcus pneumoniae has an auxotrophic requirement for choline, and choline residues that incorporate into the wall and membrane teichoic acids are intimately involved with the control of autolytic phenomena of this bacterium . We report here the re-examination of the role of choline in autolytic cell wall degradation using the choline-independent S . pneumoniae strain R6Cho- recovered from a heterologous cross with DNA from Streptococcus oralis . S pneumoniae Cho- cultured in choline-free medium grew with normal generation time but formed long chains, failed to undergo stationary-phase autolysis, and was also resistant to lysis induced by deoxycholate or penicillin . Cell walls produced under these conditions had reduced phosphorus content, contained no choline residues detectable by nuclear magnetic resonance, and had reduced binding capacity for the pneumococcal autolytic amidase, and complete hydrolysis of such walls by the amidase required prolonged incubation with high concentrations of the enzyme . Addition of choline to the growth medium reversed at these phenomena . High-performance liquid chromatography analysis of amidase digests of cell walls prepared from strain R6Cho- grown with or without choline produced identical stem peptide profiles, which were also similar to that of the parental S . pneumoniae strain R6 . Peptidoglycans prepared by hydrofluoric extraction of cell walls from Cho- growth with or without choline or from the parental strain R6 were uniformly susceptible to the autolytic amidase and were fully degraded to the normal family of stem peptides, indicating that, in sharp contrast to the case of cell walls, the amidase degradation of teichoic acid-free peptidoglycan did not require the presence of choline residues in the substrate.

Microb Drug Resist, 1997 Winter, 3(4), 385 - 9
Three predominant clones identified within penicillin-resistant South African isolates of Streptococcus pneumoniae; Smith AM et al.; The worldwide spread of antibiotic-resistant pneumococcal clones is cause for concern . In South Africa, penicillin-resistant pneumococci are mostly associated with serogroups 6 and 19, therefore, we have analyzed the clonal relationships between resistant isolates of these two serogroups . DNA fingerprinting of penicillin-binding protein genes and arbitrarily-primed PCR, have identified two penicillin-resistant pneumococcal clones of serotype 19A and serotype 6B, and a third multi-resistant serotype 19A clone, of which all three clones are predominant within South Africa's penicillin-resistant pneumococcal population . These clones are represented by strains isolated from hospitals that are widely separated in South Africa . Further studies are required to establish whether these clones have expanded in the rest of Africa or spread to other continents.

Microb Drug Resist, 1997 Winter, 3(4), 327 - 37
Cloning and expression of pneumococcal genes in Streptococcus pneumoniae; Lacks SA; An overview of gene cloning in Streptococcus pneumoniae is presented . The advantages of such cloning, especially for pneumococcal genes, are enumerated . The molecular fate of DNA in transformation of S . pneumoniae, in particular, the conversion of DNA to single-strand segments on entry, determines the mechanisms for plasmid establishment and interaction with the chromosome . One of these mechanisms, the chromosomal facilitation of plasmid establishment, is useful for obtaining recombinant plasmids and for introducing an allele from the chromosome into a plasmid . The difference between linear and circular synapsis of donor DNA strands with the chromosome is illustrated . Circular synapsis can give rise to circular integration, which is useful for insertional mutagenesis of chromosomal genes, for coupled cloning in Escherichia coli, and for sequential cloning of DNA along the pneumococcal chromosome . Cloning in S . pneumoniae is not notably affected by DNA mismatch repair or restriction systems in the host cell . Unusual features of gene expression in S . pneumoniae are discussed . Transcription begins most often at promoters with extended -10 sequences, and in a small but significant number of cases, translation does not require a ribosome-binding site with a Shine-Dalgarno sequence.

Can J Vet Res, 1998 Jan, 62(1), 75 - 9
Production of virulence-related proteins by Canadian strains of Streptococcus suis capsular type 2; Gottschalk M et al.; The production of muramidase-released protein (MRP), extracellular protein factor (EF) and hemolysin (suilysin) by 101 Canadian field strains of Streptococcus suis capsular type 2 is described . Most strains (72%) isolated from diseased pigs were MRP-EF- and only 1 strain was MRP+EF+ . This strain was also the only 1 to produce the hemolysin . Thirteen strains (15%) were MRP+ EF- and only 3 strains were MRP* EF- . All the strains isolated from clinically healthy pigs as well as a bovine and 2 human isolates had a MRP-EF- phenotype . In addition, 7 strains (8%) had a MRPS phenotype, which had so far been described for S . suis capsular type 1 . In conclusion, most Canadian field isolates of S . suis capsular type 2 tested in this study do not produce the virulence-related proteins described so far for this bacterial pathogen.

Can J Vet Res, 1998 Jan, 62(1), 49 - 55
Pathogenesis and clinical signs of equine herpesvirus-1 in experimentally infected ponies in vivo; Sutton GA et al.; Equine herpesvirus-1 (EHV-1) causes respiratory disease, neonatal death, abortion and neurologic disease . The main purpose of this study was to identify viral antigen in respiratory tract samples by immunoperoxidase staining . Six pony foals were selected on the basis of demonstrating seronegativity to EHV-1 by virus neutralization and housed in isolation . They were infected experimentally by administering EHV-1 nebulized ultrasonically through a face mask . Successful infection was clinically apparent as each of the foals had febrile responses, nasal discharge, and enlarged submandibular lymph nodes . Sporadic coughing was also heard . EHV-1 was isolated from nasopharyngeal swabs of 4/6 ponies and seroconversion was demonstrated in all foals . Bronchoscopic examination of the large airways revealed hyperemia . The incidence of recovery of Actinobacillus suis from nasopharyngeal swabs increased initially, with recovery of Streptococcus zooepidemicus isolates predominating at 3 wk post-infection . Cytology brushes were used to sequentially sample the respiratory tract of the infected ponies at the nasopharynx, mid-trachea and the mainstem bronchus . Bronchoalveolar lavage provided lung cells . Immunocytochemistry techniques were applied to both types of samples to locate EHV-1 antigen . Indirect immunoperoxidase staining of samples utilizing monoclonal antibodies specific for EHV-1 demonstrated viral antigen associated with cellular debris, primarily in the nasopharyngeal samples on days 3-9 post-infection.

Can J Vet Res, 1998 Jan, 62(1), 21 - 6
Colonization of suckling pigs by Streptococcus suis with particular reference to pathogenic serotype 2 strains; Torremorell M et al.; Three swine commercial farms with high mortality rates in nursery pigs due to Streptococcus suis serotype 2 were studied . Brain samples from diseased animals were collected for a period of 6 to 10 mo and used to isolate the strain that was responsible for the mortality (virulent strain) in each farm . Tonsil swabs from piglets at 5, 10 and 15 d were taken to assess both total colonization and colonization by the virulent strain . The effect of sow vaccination against S . suis on colonization was evaluated in 1 of the farms . All suspect tonsil isolates were identified biochemically and then tested against serotype 2 . The genomic patterns of serotype 2 isolates were compared to that of the virulent strain using Rep-PCR . Results showed that total colonization by S . suis occurred very early in the pigs' life, with most animals being colonized by weaning age . Prevalence of colonization by serotype 2 strains was much lower than total colonization . After comparing serotype 2 isolates with the virulent strains, only 1 tonsillar isolate had the same genomic pattern as the virulent strain and it belonged to a 4-week-old weaned pig . The genomic pattern of the virulent strain was not found in any tonsillar isolate from 15-day-old or younger pigs . Although limited by sample size, sow vaccination against S . suis increased total colonization at the same time significantly decreasing colonization by serotype 2 strains . Even though most pigs are colonized early in age by S . suis, colonization by the virulent strain is of low prevalence and delayed in time . This could constitute a risk factor for developing the disease later in time, because animals would be colonized when maternal immunity is no longer present, allowing the organism to become systemic.

Acta Otolaryngol, 1997 Nov, 117(6), 883 - 8
An intracellular sanctuary for Streptococcus pyogenes in human tonsillar epithelium--studies of asymptomatic carriers and in vitro cultured biopsies; Osterlund A et al.; A novel method for the in vitro culture of tissue biopsies is presented . Infected tonsillar biopsies were successfully cultured by means of the continuous flow of media without the addition of antibiotics . Histological and immunohistological examinations were carried out on sections of Streptococcus pyogenes-infected cultured tonsillar biopsies and sections from the surgically removed tonsils of asymptomatic S . pyogenes carriers . Low numbers of intracellular S . pyogenes were detected inside epithelial cells in eight out of 12 (67%) S . pyogenes-infected biopsies, and in four out of 11 (36%) tonsils of asymptomatic carriers . Our findings support the hypothesis that the sanctuary where S . pyogenes avoids antibacterial treatment is intracellular, which may provide a possible explanation of recurrent tonsillitis.

J Bacteriol, 1998 Jan, 180(2), 210 - 7
Functional analysis of the two-gene lysis system of the pneumococcal phage Cp-1 in homologous and heterologous host cells; Martin AC et al.; The two lysis genes cph1 and cpl1 of the Streptococcus pneumoniae bacteriophage Cp-1 coding for holin and lysozyme, respectively, have been cloned and expressed in Escherichia coli . Synthesis of the Cph1 holin resulted in bacterial cell death but not lysis . The cph1 gene was able to complement a lambda Sam mutation in the nonsuppressing E . coli HB101 strain to produce phage progeny, suggesting that the holins encoded by both phage genes have analogous functions and that the pneumococcal holin induces a nonspecific lesion in the cytoplasmic membrane . Concomitant expression of both holin and lysin of Cp-1 in E . coli resulted in cell lysis, apparently due to the ability of the Cpl1 lysozyme to hydrolyze the peptidoglycan layer of this bacterium . The functional analysis of the cph1 and cpl1 genes cloned in a pneumococcal mutant with a complete deletion of the lytA gene, which codes for the S . pneumoniae main autolysin, provided the first direct evidence that, in this gram-positive-bacterium system, the Cpl1 endolysin is released to its murein substrate through the activity of the Cph1 holin . Demonstration of holin function was achieved by proving the release of pneumolysin to the periplasmic fraction, which strongly suggested that the holin produces a lesion in the pneumococcal membrane.

Indian J Med Res, 1997 Dec, 106, 500 - 3
E test as an alternative to conventional MIC determination for surveillance of drug resistant Streptococcus pneumoniae; Lalitha MK et al.; A commercial E test was compared with the standard agar dilution method for the determination of minimum inhibitory concentration (MIC) of penicillin, erythromycin, chloramphenicol and cefotaxime for 36 strains of Streptococcus pneumoniae from patients with invasive diseases . Additional strains were tested for MIC values for penicillin (6), erythromycin (14) and cefotaxime (13) for a better statistical evaluation . Besides, 5 reference standards with predetermined MIC values obtained from WHO pneumococcal reference center at Copenhagen, Denmark were tested for penicillin and erythromycin, for quality assessment using both agar dilution as well as E test methods . An overall agreement within +/- 2 dilutions was noted for 97 per cent of the strains tested for all the antimicrobials . A high degree of correlation was noted for erythromycin (r = 1), penicillin (r = 0.99), chloramphenicol (r = 0.95) and cefotaxime (r = 0.9) . In MIC determination of a single antimicrobial for diagnostic purpose, E test was found to be more cost effective than conventional agar dilution method . E test was simple to perform, easy to interpret and a valid method for MIC determination of antimicrobials for S . pneumoniae in our center.

Zhonghua Yi Xue Za Zhi (Taipei), 1997 Oct, 60(4), 191 - 4
In vitro antimicrobial activity of levofloxacin against Streptococcus pneumoniae; Hu BS et al.; BACKGROUND: Infections caused by Streptococcus pneumoniae continue to be a significant cause of mortality and morbidity in humans . Diseases caused by multi-resistant pneumococci are increasing rapidly worldwide . The fluoroquinolones have been widely used clinically to treat infectious diseases . The results of a study here on the five fluoroquinolones susceptibilities of S . pneumoniae are reported from the Taichung Veterans General Hospital . METHODS: Minimum inhibitory concentrations (MICs) of five quinolones (enoxacin, norfloxacin, ofloxacin, levofloxacin and ciprofloxacin) were determined for 106 strains of S . pneumoniae . All MICs were determined by the agar dilution method utilizing Mueller-Hinton agar supplemented with 5% sheep blood . RESULTS: MIC90 of levofloxacin was 1 microgram/ ml, and was unaffected by penicillin-susceptibility . MIC90 of ofloxacin and that of ciprofloxacin were 2 and 4 micrograms/ml, respectively, with 90.6% sensitive to ofloxacin . MIC90 of enoxacin and that of norfloxacin were higher than other compounds . CONCLUSIONS: The in vitro activity of levofloxacin is twice that of ofloxacin, 4-fold of ciprofloxacin, 16-fold of norfloxacin, and 64-fold of enoxacin . MICs of these five quinolones were unaffected by penicillin-susceptibility . The antibacterial activity of levofloxacin was better than that of ofloxacin and ciprofloxacin, norfloxacin, or enoxacin against S . pneumoniae.

Biosci Biotechnol Biochem, 1997 Dec, 61(12), 2015 - 8
Effects of a hydrogenated isomaltooligosaccharide mixture on glucan synthesis and on caries development in rats; Tsunehiro J et al.; The caries inhibitory effect of the hydrogenated derivative of an isomaltooligosaccharides mixture (IMO-H) was examined in vitro and in vivo experiments . IMO-H could not be used as a substrate for the crude glucosyltransferases (GTases) of Streptococcus sobrinus 6715 to synthesize water-insoluble glucan . Moreover, it not only significantly inhibited the synthesis of water-insoluble glucan from sucrose, but also the sucrose-dependent adherence of these growing cells the glass surfaces . In the in vivo experiment, the addition of IMO-H to a sucrose-containing diet resulted in significant reduction of caries development in specific-pathogen-free (SPF) rats infected with S . sobrinus 6715.

J Biol Chem, 1997 Dec 19, 272(51), 32539 - 46
Molecular cloning, expression, and characterization of the authentic hyaluronan synthase from group C Streptococcus equisimilis; Kumari K et al.; We previously reported the first cloning of a functional glycosaminoglycan synthase, the hyaluronan synthase (HAS) from Group A Streptococcus pyogenes (spHAS) (DeAngelis, P . L., Papaconstantinou, J., and Weigel, P . H . (1993) J . Biol . Chem . 268, 19181-19184) . Group A spHAS was unrelated to a putative Group C HA synthase reported by others (Lansing, M., Lellig, S., Mausolf, A., Martini, I . , Crescenzi, F., Oregon, M., and Prehm, P . (1993) Biochem . J . 289, 179-184) . Here we report the isolation of a bona fide HA synthase gene from a highly encapsulated strain of Group C Streptococcus equisimilis . The encoded protein, designated seHAS, is 417 amino acids long (calculated molecular weight, 47,778; calculated pI, 9.1) and is the smallest member of the HAS family identified thus far . The enzyme migrates anomalously fast in SDS-polyacrylamide gel electrophoresis (approximately 42,000 Da) . The seHAS protein shows no similarity (<2% identity) to the previously reported Group C gene, which is not an HA synthase . The seHAS and spHAS protein and coding sequences are 72 and 70% identical, respectively . seHAS is also similar to eukaryotic HAS1 (approximately 31% identical), HAS2 (approximately 28% identical), and HAS3 (28% identical) . The deduced protein sequence of seHAS was confirmed by reactivity with a synthetic peptide antibody . Recombinant seHAS expressed in Escherichia coli was recovered in membranes as a major protein (approximately 10% of the total protein) and synthesized very large HA (Mr >7 x 10(6)) in the presence of UDP-GlcNAc and UDP-GlcA . The product contained equimolar amounts of both sugars and was degraded by the specific Streptomyces hyaluronidase . Comparison of the two recombinant streptococcal enzymes in isolated membranes showed that seHAS and spHAS are essentially identical in the steady-state size distribution of HA chains they synthesize, but seHAS has an intrinsic 2-fold faster rate of chain elongation (Vmax) than spHAS . seHAS is the most active HA synthase identified thus far; it polymerizes HA at an average rate of 160 monosaccharides/s . The two bacterial HA synthase genes may have arisen from a common ancient gene shared with the early evolving vertebrates.

Alcohol Clin Exp Res, 1997 Dec, 21(9), 1630 - 7
Vaccination with protein-conjugated and native type 3 capsular polysaccharide in an ethanol-fed rat model of pneumococcal pneumonia; Henriksen JL et al.; A chronic ethanol-fed rat model was used to determine the effect of alcohol ingestion on production of antibody to type 3 pneumococcal capsular polysaccharide . Sprague-Dawley rats were fed a liquid diet containing 36% of calories as ethanol (ethanol-fed), an isocaloric diet containing dextrin-maltose (pair-fed) or standard rat chow (chow-fed) . After 7 days of feeding, the rats were vaccinated subcutaneously with placebo or with either 25 microg of type 3 pneumococcal capsular polysaccharide (SpnCP) or 5 microg of SpnCP linked to the protein carrier CRM197 (SpnCP/CRM197) . Rats given the conjugated vaccine received a booster injection 14 days later . Maximum antibody titers were observed six days postvaccination for rats given SpnCP alone and 21 days postvaccination for rats given SpnCP/CRM197 . All rats were infected transtracheally with 2-3 times the expected lethal dose50 for each feeding group of type 3 Streptococcus pneumoniae on the day of peak antibody titers . Mortality was recorded for a 10-day period . Vaccination with SpnCP increased survival of ethanol- and chow-fed, but not pair-fed rats . This protection was only statistically significant in the chow-fed group (p < 0.01) . Vaccination with SpnCP/CRM197 moderately increased survival of rats in all three feeding groups, but this was not statistically significant in any of them.

Semin Respir Infect, 1997 Dec, 12(4), 329 - 33
Empirical therapy of community-acquired pneumonia: macrolides are not ideal choices; Bartlett JG; Macrolides are a rational option for patients with community-acquired pneumonia managed as outpatients . For hospitalized patients, they may be used to supplement other drugs, usually betalactams, because of their excellent activity versus Legionella, Chlamydia pneumoniae, and Mycoplasma pneumoniae . The reason for lack of confidence for macrolides as single agents in hospitalized patients, especially for seriously ill patients, is the lack of studies confirming good results for seriously ill patients, and relatively poor in vitro activity against some important pathogens . Resistance is noted to erythromycin, clarithromycin, and azithromycin by 10% to 15% of Streptococcus pneumoniae, about 40% of penicillin resistant S pneumoniae, most Fusobacteria, some Streptococcus aureus, and all gram-negative bacilli.

Semin Respir Infect, 1997 Dec, 12(4), 322 - 8
Macrolides are ideal for empiric therapy of community-acquired pneumonia in the immunocompetent host; Vergis EN et al.; We propose that macrolides, especially the newer macrolides (azithromycin, clarithromycin, roxithromycin), are ideal agents for community-acquired pneumonia in the immunocompetent host who is not a resident of a nursing home or long-term care facility . Macrolides have proven effective in clinical trials against typical and atypical pathogens; thus, unlike beta-lactam agents, they can be given as monotherapy . Streptococcus pneumoniae isolates exhibiting high-level resistance to penicillin and cephalosporins pose a problem not only for the macrolides, but also for quinolones, tetracyclines, and most other beta-lactam agents . The tetracycines, quinolones, and beta-lactam agents have broader spectrum activity against aerobic gram-negative bacilli, which are uncommon pathogens of community-acquired pneumonia in the immunocompetent host . This broader spectrum is not only superfluous, but the potential of emergence of resistant bacteria is enhanced unnecessarily . Serious adverse reactions to the macrolides are rare . The newer macrolides have improved bioavailability and improved pharmacokinetics such that once- or twice-daily dosing regimens can be used . Finally, a comparison of the costs of macrolides to quinolones and beta-lactam agents (especially cephalosporins) show that the oral macrolides are among the least expensive antibiotics that can be prescribed for pneumonia . Thus, macrolides seem to be the ideal empiric antibiotic for community-acquired pneumonia based on spectrum of activity, safety, and cost.

Medicina (B Aires), 1997, 57(1), 64 - 6
{Acute meningitis caused by Streptococcus agalactiae in adult patient with a spinal fluid fistula}; Roel JE et al.; Acute meningitis in adults caused by Streptococcus agalactiae is a rare entity . To our knowledge, there are only two cases associated with a central spinal fluid fistula published in the English literature from 1942 to the present . We report the third case . It was diagnosed in a 60-year-old woman with a twelve-year history of cerebrospinal rhinorrhea after a blunt head trauma . A CT scan of the base of the skull with administration of intrathecal contrast showed a disruption of the posterior and superior aspect of the sphenoid sinus with central spinal fluid leakage.

Scand J Infect Dis, 1997, 29(5), 518 - 9
Cellulitis due to Streptococcus pneumoniae with diminished susceptibility to penicillin in an immunocompromised patient; Souweine B et al.; A 74-year-old man with multiple myeloma developed facial and cervical cellulitis and severe sepsis as a complication of surgery (alar region basal cell carcinoma) . The etiological agent was, surprisingly, penicillin-resistant Streptococcus pneumoniae (PRSP) . The patient successfully received 16 days of antibiotics . Amoxicillin was given as monotherapy during the last 14 days of treatment . PRSP can be responsible not only for otitis media, pneumonia or meningitis, but also for various other types of infection in patients with predisposing factors.

Scand J Infect Dis, 1997, 29(5), 473 - 8
Streptococcus pyogenes bacteraemia: a 27-year study in a London teaching hospital; Breathnach AS et al.; The clinical and epidemiological features of 120 episodes of Streptococcus pyogenes bacteraemia in St . Thomas' Hospital between 1970 and 1997 were analysed . One-third of episodes were nosocomial . M1 was the most common serotype, and 29% of strains were non-typable . There was a variety of presenting features, but nearly half of the patients had cellulitis, 15% were shocked, and 6% had necrotic infections . There was no focus of infection in 13% . 54% of patients had an underlying disease, and 23% of infections were associated with a medical procedure or device . The mortality rate was 19%, and was associated with shock, coma, no focus of infection, and underlying disease . Since 1989, the annual incidence has more than doubled, and M1 strains and necrotic infections have increased, but the mortality rate and the proportion of patients presenting with shock have decreased, and the increase in cases involved many different M-types.

Plasmid, 1997, 38(3), 158 - 73
Construction and characterization of versatile cloning vectors for efficient delivery of native foreign proteins to the periplasm of Escherichia coli; Jobling MG et al.; Induction of the wild type cholera toxin operon (ctxAB) from multicopy clones in Escherichia coli inhibited growth and resulted in low yields of cholera toxin (CT) . We found that production of wild type CT or its B subunit (CT-B) as a periplasmic protein was toxic for E . coli, but by replacing the native signal sequences of both CT-A and CT-B with the signal sequence from the B subunit of E . coli heat-labile enterotoxin LTIIb we succeeded for the first time in producing CT holotoxin in high yield in E . coli . Based on these findings, we designed and constructed versatile cloning vectors that use the LTIIb-B signal sequence to direct recombinant native proteins with high efficiency to the periplasm of E . coli . We confirmed the usefulness of these vectors by producing two other secreted recombinant proteins . First, using phoA from E . coli, we demonstrated that alkaline phosphatase activity was 17-fold greater when the LTIIb-B signal sequence was used than when the native leader for alkaline phosphatase was used . Second, using the pspA gene that encodes pneumococcal surface protein A from Streptococcus pneumoniae, we produced a 299-residue amino-terminal fragment of PspA in E . coli in large amounts as a soluble periplasmic protein and showed that it was immunoreactive in Western blots with antibodies against native PspA . The vectors described here will be useful for further studies on structure-function relationships and vaccine development with CT and PspA, and they should be valuable as general tools for delivery of other secretion-competent recombinant proteins to the periplasm in E . coli.

Pediatr Emerg Care, 1997 Dec, 13(6), 408 - 9
Cyanotic limb in a newborn: a peculiar presentation of septic hip; Mordehai J et al.; A 12-day-old infant presented with marked cyanosis of the right lower limb, mimicking vascular compromise . Physical examination, plain radiography, and laboratory evidence of systemic infection suggested septic arthritis of the hip . Pyoarthrosis was verified by needle aspiration and open drainage . Streptococcus pneumoniae was isolated . A cyanotic limb may be an atypical presentation for septic arthritis in the newborn.

Isr J Med Sci, 1997 Nov, 33(11), 757 - 9
Penicillin-resistant pneumococcal meningitis in Israel; Steinberg T et al.; Penicillin-resistant Streptococcus pneumoniae (PRP) is of worldwide concern . Treatment failures and fatalities of meningitis caused by PRP have been reported in other locations but not yet in Israel . We describe an 11-month-old infant with meningitis caused by PRP who failed to respond to initial treatment with cefotaxime . Vancomycin treatment caused a prompt cure . The minimal inhibitory concentrations of the isolate to penicillin, cefuroxime and cefotaxime were 1.0, 4.0 and 1.0 micrograms/ml, respectively . New guidelines for the treatment of meningitis in Israel are suggested.

Gene, 1997 Dec 19, 204(1-2), 213 - 8
Molecular characterization and expression analysis of the superoxide dismutase gene from Streptococcus agalactiae; Gaillot O et al.; We have cloned and sequenced a 3103-bp DNA fragment carrying the gene encoding the Mn-SOD from Streptococcus agalactiae NEM318 serotype III . This DNA fragment contained four orfs that have the same polarity of transcription . Orf1 was truncated by molecular cloning and the corresponding 228-aa-long polypeptide did not exhibit any significant homology with other cognate proteins . Orf2 encodes a protein of 345 aa that displays some similarity (29% identity) with the YqeN peptide of Bacillus subtilis, the function of which is unknown . Orf3 encodes the 202-aa-long Mn-SOD which was functionally expressed in Escherichia coli . Orf4 was also truncated by molecular cloning and encodes 99 aa of the N-terminal moiety of a protein that displays significant homology (40% f identity) with the antiterminator LicT of B . subtilis . Transcriptional analysis revealed that the sodA gene of S . agalactiae NEM318 was transcribed monocistronically from a promoter, the activity of which is neither regulated by pH, O2, nor CO2 concentrations of the culture medium . Analysis by high resolution agarose gel electrophoresis of the AluI DNA polymorphism of the sodA locus in wild-type strains of S . agalactiae belonging to serogroups I, II, or III revealed no detectable difference.

Surg Neurol, 1998 Jan, 49(1), 21 - 4
Colonic perforation by ventriculoperitoneal shunt tubing: a case of suspected silicone allergy; Brownlee JD et al.; BACKGROUND: A case of colonic perforation by a ventriculoperitoneal shunt is presented in a patient with several previous complications associated with shunt tubing . CASE DESCRIPTION: Initially managed by intravenous antibiotics, shunt externalization, and colonoscopy, the entire ventriculoperitoneal shunt system was subsequently replaced after cerebrospinal fluid cultures had grown Propionibacterium acnes and Streptococcus sanguis organisms . The patient has had three episodes of skin breakdown over his shunt tubing (two prior and one subsequent to colonic perforation) without evidence of shunt infection or malfunction . CONCLUSIONS: The etiology of these complications is consistent with silicone tubing allergy . Replacement with a polyurethane system produced no similar complications thus far, which further supports a possible silicone allergy to the ventriculoperitoneal shunt and possible etiology of this patient's colonic perforation.

Arch Med Res, 1997 Winter, 28(4), 559 - 63
Streptococcus pneumoniae: low frequency of penicillin resistance and high resistance to trimethoprim-sulfamethoxazole in nasopharyngeal isolates from children in a rural area in Mexico; Miranda Novales MG et al.; Due to the changes in the frequency of penicillin-resistant strains of S . pneumoniae, it is necessary to perform surveillance studies of bacterial resistance . Isolates from the upper respiratory tract of asymptomatic children have been useful . There is no information about the difference between isolates from children with and without upper respiratory tract infection (URTI) . The objective of the authors in this paper is to establish the prevalence of carrier-state, serotype and antimicrobial resistance of S . pneumoniae isolates from children with and without acute upper respiratory tract infection (URTI) in a rural area in Mexico . A cross-sectional comparative study was performed in Tlaxcala, Mexico . Children from one month 5 years of age were included . Nasopharyngeal swabs were obtained . Identification was done by international microbiology standards . Serotyping was done by the capsular Quellung test . The susceptibility testing was performed by the agar dilution method . Four-hundred and fifty patients were included . S . pneumoniae was isolated in 134 children (29.7%) . Frequency of carriers was greater in patients with URTI (107/323) than without URTI (27/127) (33.1% vs . 21.1% p = 0.012, OR 1.84, IC 95% 1.1-3.08) . The six most frequent serotypes were: 6B (16.4%); 19F (11.9%); 19A (6.7%); 14, 23F, and 35 (5.2% each), with no difference among the groups . Only 3% of the strains had high level resistance to penicillin, and 12.6% had intermediate resistance, and for ampicillin 4%, amoxicillin 4%, amoxicillin-clavulanate 4%, ceftriaxone 3%, cefotaxime 1.5%, erythromycin 6%, miocamycin 3%, chloramphenicol 4%, and vancomycin 0% . Trimethoprim-sulfamethoxazole resistance was very high (42%) . In conclusion, colonization is higher in children with URTI . Five of the most frequent serotypes identified in this study were the same as those identified in patients with S . pneumoniae invasive diseases in Mexico City . In Tlaxcala, Mexico, beta-lactams could be the drug of choice for the treatment of S . pneumoniae lower respiratory tract infections . It is necessary to perform clinical assays to evaluate the efficacy of trimethoprim-sulfamethoxazole due to the high resistance in vitro.

Retina, 1997, 17(6), 521 - 9
Implication of pneumolysin as a virulence factor in Streptococcus pneumoniae endophthalmitis; Ng EW et al.; PURPOSE: To determine if pneumolysin, a multifunctional cytotoxin produced by Streptococcus pneumoniae, may be a virulence determinant in the pathogenesis of pneumococcal endophthalmitis . METHODS: Lewis rats (n = 20) were injected intravitreally with purified recombinant pneumolysin at the following doses; 3.9 hemolytic units (HU), 39 HU, 390 HU, 3.9 x 10(3) HU, and 3.9 x 10(4) HU . After 24 hours, eyes were examined clinically and enucleated for histopathologic examination to elucidate the dose-response relationship . To determine the temporal progression of the disease model, a second group of rats (n = 8) were injected intravitreally with 390 HU of pneumolysin . At 6 and 48 hours, eyes were examined clinically and enucleated for histopathology . RESULTS: Eyes injected with pneumolysin demonstrated increasing anterior and posterior segment inflammation in response to increasing doses of administered toxin . The onset of inflammation and tissue damage occurred rapidly, and was maximal at 24 to 48 hours . The clinical and histopathologic changes observed mimicked those of S . pneumoniae endophthalmitis . Histopathologic analysis demonstrated rapid onset of iridocyclitis and vitritis with polymorphonuclear leukocyte influx, inner retinal necrosis, and retinal detachment . Retinal pigment epithelial necrosis and choroiditis were noted at the highest doses administered . Inflamed eyes were shown to be sterile . CONCLUSIONS: Pneumolysin injected intravitreally induces many of the clinical and histopathologic features of pneumococcal endophthalmitis, and may play an important role in the inflammation and tissue damage that occurs in pneumococcal endophthalmitis.

J Heart Valve Dis, 1997 Nov, 6(6), 621 - 4
Penetrating mitral valve annular abscess; Terry SM et al.; We report a rare case of occult myocardial abscess due to group B Streptococcus that arose several weeks following streptococcal pneumonia . Hemopericardium was the initial presentation . Visualization of the abscess cavity was not possible with transthoracic echocardiography . A definitive diagnosis was made by left ventricular imaging during coronary arteriography . Rupture of the left ventricular free wall occurred during induction of anesthesia for operative exploration and debridement . Patch repair of the left ventricle was ultimately unsuccessful . Post-mortem examination revealed staphylococcal endocarditis of the mitral valve, valve ring abscess and multiple abscess cavities of the left ventricular free wall . A review of the clinical, diagnostic and therapeutic aspects of myocardial abscess is also presented.

Infection, 1997 Nov-Dec, 25(6), 368 - 71
Overwhelming postsplenectomy infection with vaccine-type Streptococcus pneumoniae in a 12-year-old girl despite vaccination and antibiotic prophylaxis; Klinge J et al.; This report describes a 12-year-old girl who developed vaccine-type pneumococcal septicemia (type 4, Danish nomenclature) 2 years after splenectomy for recurrent idiopathic thrombocytopenia despite vaccination with the 23-valent vaccine 4 weeks before surgery and antibiotic prophylaxis with penicillin V . The disease presented as high fever with shivering and vomiting followed by disseminated petechiae and a deteriorated general condition . Initial laboratory studies showed severe sepsis with leucocytopenia and thrombocytopenia, a markedly elevated CRP, and disseminated intravascular coagulation . Despite antibiotic treatment, which was initiated with clindamycin, cefotaxime and trimethoprim/sulfamethoxazole and was switched to cefotaxime and penicillin after the result of the blood culture had been obtained, the patient had to be ventilated, and hemofiltration became necessary because of acute renal insufficiency . Furthermore, she required amputation of all her toes because of severe necrosis . No type-specific pneumococcal antibody titers were detected during and after infection . It remains unclear whether the susceptibility to Streptococcus pneumoniae was due to primary failure of antibody production or a decline in antibody levels after vaccination . Patients and/or their relatives should be informed that neither vaccination nor continuous antibiotic prophylaxis can guarantee full protection against infection with S . pneumoniae in patients after splenectomy.

Am J Clin Pathol, 1998 Jan, 109(1), 55 - 61
Ambiguity in the identification of Streptococcus pneumoniae . Optochin, bile solubility, quellung, and the AccuProbe DNA probe tests; Mundy LS et al.; We prospectively evaluated 639 sequential clinical isolates of alpha-hemolytic gram-positive cocci as possible Streptococcus pneumoniae . On the basis of results of tests for optochin susceptibility, tube bile solubility, and the quellung reaction, 74 strains (11.6%) were categorized as unequivocal pneumococci (optochin positive, tube bile solubility positive, quellung reaction positive) . Among 450 optochin- and tube bile solubility-negative organisms, a subset of 56 strains was tested for quellung reaction (all negative); these isolates were categorized as unequivocal nonpneumococci . A final 115 organisms with an inconsistent or discordant combination of susceptibility to optochin, tube bile solubility, and quellung reaction were categorized as equivocal strains . With the unequivocal isolates, a commercial molecular probe for S pneumoniae (AccuProbe; Gen-Probe, San Diego, Calif) showed 100% sensitivity (74/74) and 100% specificity (56/56) . Among the 115 equivocal strains, however, 33 (28.7%) reacted with the AccuProbe, whereas only 3 (2.6%) showed a capsule that reacted in the quellung test . A subset of the equivocal strains identified in this group of primarily respiratory isolates may have been S pneumoniae that only partially expressed their classic phenotype of optochin susceptibility and bile solubility and only rarely expressed capsular antigens . A practical, cost-sparing algorithm is proposed to facilitate the routine clinical identification of S pneumoniae.

Infect Immun, 1998 Jan, 66(1), 181 - 90
A comprehensive genetic study of streptococcal immunoglobulin A1 proteases: evidence for recombination within and between species; Poulsen K et al.; An analysis of 13 immunoglobulin A1 (IgA1) protease genes (iga) of strains of Streptococcus pneumoniae, Streptococcus oralis, Streptococcus mitis, and Streptococcus sanguis was carried out to obtain information on the structure, polymorphism, and phylogeny of this specific protease, which enables bacteria to evade functions of the predominant Ig isotype on mucosal surfaces . The analysis included cloning and sequencing of iga genes from S . oralis and S . mitis biovar 1, sequencing of an additional seven iga genes from S . sanguis biovars 1 through 4, and restriction fragment length polymorphism (RFLP) analyses of iga genes of another 10 strains of S . mitis biovar 1 and 6 strains of S . oralis . All 13 genes sequenced had the potential of encoding proteins with molecular masses of approximately 200 kDa containing the sequence motif HEMTH and an E residue 20 amino acids downstream, which are characteristic of Zn metalloproteinases . In addition, all had a typical gram-positive cell wall anchor motif, LPNTG, which, in contrast to such motifs in other known streptococcal and staphylococcal proteins, was located in their N-terminal parts . Repeat structures showing variation in number and sequence were present in all strains and may be of relevance to the immunogenicities of the enzymes . Protease activities in cultures of the streptococcal strains were associated with species of different molecular masses ranging from 130 to 200 kDa, suggesting posttranslational processing possibly as a result of autoproteolysis at post-proline peptide bonds in the N-terminal parts of the molecules . Comparison of deduced amino acid sequences revealed a 94% similarity between S . oralis and S . mitis IgA1 proteases and a 75 to 79% similarity between IgA1 proteases of these species and those of S . pneumoniae and S . sanguis, respectively . Combined with the results of RFLP analyses using different iga gene fragments as probes, the results of nucleotide sequence comparisons provide evidence of horizontal transfer of iga gene sequences among individual strains of S . sanguis as well as among S . mitis and the two species S . pneumoniae and S . oralis . While iga genes of S . sanguis and S . oralis were highly homogeneous, the genes of S . pneumoniae and S . mitis showed extensive polymorphism reflected in different degrees of antigenic diversity.

Infect Immun, 1998 Jan, 66(1), 115 - 21
Binding of salivary glycoprotein-secretory immunoglobulin A complex to the surface protein antigen of Streptococcus mutans; Oho T et al.; The interaction between a surface protein antigen (PAc) of Streptococcus mutans and human salivary agglutinin was analyzed with a surface plasmon resonance biosensor . The major component sugars of the salivary agglutinin were galactose, fucose, mannose, N-acetylglucosamine, N-acetylgalactosamine, and N-acetylneuraminic acid . Binding of salivary agglutinin to PAc was calcium dependent and heat labile and required a pH greater than 5 . Binding was significantly inhibited by N-acetylneuraminic acid and alpha2,6-linked sialic acid-specific lectin derived from Sambucus sieboldiana in a dose-dependent manner . Pretreatment of the salivary agglutinin with sialidase reduced the binding activity of the agglutinin to the PAc molecule . The agglutinin was dissociated into high-molecular-mass glycoprotein and secretory immunoglobulin A (sIgA) components by electrophoretic fractionation in the presence of 1% sodium dodecyl sulfate and 1% 2-mercaptoethanol . Neither of the components separated by electrophoretic fractionation, high-molecular-mass glycoprotein or sIgA, bound to the PAc molecule . Furthermore, the high-molecular-mass glycoprotein strongly inhibited the binding of the native salivary complex to PAc . These results suggest that the complex formed by the high-molecular-mass salivary glycoprotein and sIgA is essential for the binding reaction and that the sialic acid residues of the complex play an important role in the interaction between the agglutinin and PAc of S . mutans.

J Biol Chem, 1997 Dec 5, 272(49), 30860 - 5
The maltose/maltodextrin regulon of Streptococcus pneumoniae . Differential promoter regulation by the transcriptional repressor MalR; Nieto C et al.; The Streptococcus pneumoniae MalR protein regulates the transcription of two divergent operons, malXCD and malMP, involved in maltosaccharide uptake and utilization, respectively . MalR belongs to the LacI-GalR family of transcription repressors . The protein binds specifically to two operator sequences in the intergenic region between these operons . The affinity of MalR for the malMP binding sequence is higher than for the malXCD site . Results obtained in vivo using transcriptional fusions with reporter genes indicate low repression level of malXCD by MalR when compared with malMP . This behavior may be correlated with the existence of separate induction pathways for maltose, maltotriose, and maltotetraose . The similarities found at the operator sequences and binding domains for MalR and enterococcal repressor proteins suggest that the pneumococcal maltosaccharide regulation system is closely related to several Gram-negative metabolic pathways, but not to the structurally similar Escherichia coli maltose regulon.

Clin Diagn Lab Immunol, 1997 Nov, 4(6), 778 - 82
Western blot analysis of antibody response to pneumococcal protein antigens in a murine model of pneumonia; Mouneimne H et al.; To detect new antigen candidates for serological tests, we studied the antibody response to pneumococcal protein antigens in mice infected intratracheally with various Streptococcus pneumoniae strains . Sera were tested by Western blotting against whole-cell protein extracts . Mice developed a detectable immunoglobulin G-type response against a small number of polypeptides . The antibody response was strain dependent: sera from individuals infected with the same strain gave similar banding patterns on immunoblots . The banding patterns varied with the strain used for infection . However, a band at 36 to 38 kDa was recognized by all reactive sera . This band appeared to correspond to a polypeptide that was antigenically well conserved among the different S . pneumoniae serotypes . An antibody response to this antigen developed in mice irrespective of the capsular type, the virulence, and the susceptibility to penicillin G of the infecting strain . Thus, this 36- to 38-kDa protein antigen may be of value for the development of a serological test for humans.

Clin Diagn Lab Immunol, 1997 Nov, 4(6), 635 - 8
Antibody responses of splenectomized patients with non-Hodgkin's lymphoma to immunization with polyvalent pneumococcal vaccines; Petrasch S et al.; The serum antibody responses of splenectomized patients with non-Hodgkin's lymphoma (NHL) who had been immunized with a polyvalent pneumococcal vaccine (Pneumovax 23) were evaluated by an enzyme-linked immunosorbent assay with the 23-valent pneumococcal vaccine as the antigen . A response to immunization, defined as a twofold-or-higher rise of the prevaccination titer of antibodies against Streptococcus pneumoniae polysaccharide, was elicited in 5 of 11 patients with NHL . No significant difference in the level of antibodies against S . pneumoniae polysaccharide between lymphoma patients and patients who had undergone splenectomy for other reasons was detected (P = 0.83 and 0.87 before and after vaccination, respectively) . NHL patients who did not respond to the first immunization received a booster dose of the polysaccharide vaccine . This injection did not increase the pneumococcal-antibody titer significantly (P = 0.7) . We conclude that vaccination with pneumococcal polysaccharides in splenectomized patients with NHL elicits an adequate antibody response in 45.4% of the cases and should therefore be administered . Revaccination of the nonresponders does not further increase the pneumococcal-antibody levels.

J Bacteriol, 1998 Jan, 180(1), 167 - 70
Diacylglycerol kinase is involved in regulation of expression of the lantibiotic mutacin II of Streptococcus mutans; Chen P et al.; Genetic characterization of a Tn916 transposon mutant, Streptococcus mutans T8-1, defective in mutacin II production, revealed that the transposon was inserted into the 3' region of a diacylglycerol kinase (dgk) gene . The insertion occurred in the same region as described for another S . mutans mutant, GS5Tn1, which was altered in its ability to respond to environmental stress (Y . Yamashita, T . Takehara, and H . K . Kuramitsu, J . Bacteriol . 175:6220-6228, 1993) . Quantitative primer extension from the mutacin structural gene mutA showed a decreased level (about eightfold) of mutA transcription for mutant T8-1 . Mutacin production was restored by transforming mutant T8-1 with integration vector pVA891 containing an intact dgk gene . These data indicated that the full-length dgk gene product along with the mutacin biosynthetic operon are required for the production of the mutacin II lantibiotic.

J Bacteriol, 1998 Jan, 180(1), 83 - 9
Lagging-strand replication from the ssoA origin of plasmid pMV158 in Streptococcus pneumoniae: in vivo and in vitro influences of mutations in two conserved ssoA regions; Kramer MG et al.; The streptococcal plasmid pMV158 replicates by the rolling-circle mechanism . One feature of this replication mechanism is the generation of single-stranded DNA intermediates which are converted to double-stranded molecules . Lagging-strand synthesis initiates from the plasmid single-stranded origin, sso . We have used the pMV158-derivative plasmid pLS1 (containing the ssoA type of lagging-strand origin) and a set of pLS1 derivatives with mutations in two conserved regions of the ssoA (the recombination site B {RS(B)} and a conserved 6-nucleotide sequence {CS-6}) to identify sequences important for plasmid lagging-strand replication in Streptococcus pneumoniae . Cells containing plasmids with mutations in the RS(B) accumulated 30-fold more single-stranded DNA than cells containing plasmids with mutations in the CS-6 sequence . Specificity of lagging-strand synthesis was tested by the development of a new in vitro replication system with pneumococcal cell extracts . Four major initiation sites of lagging-strand DNA synthesis were observed . The specificity of initiation was maintained in plasmids with mutations in the CS-6 region . Mutations in the RS(B) region, on the other hand, resulted in the loss of specific initiation of lagging-strand synthesis and also severely reduced the efficiency of replication.

Infect Dis Clin North Am, 1997 Dec, 11(4), 867 - 74
The clinical impact of resistance in the management of pneumococcal disease; Leggiadro RJ; The prevalence of drug-resistant Streptococcus pneumoniae (DRSP) has increased worldwide . Although unfavorable outcomes in meningitis due to DRSP have been well-described, the clinical impact of DRSP on other manifestations of pneumococcal infection warrants further study . Empiric combination vancomycin and extended-spectrum cephalosporin (cefotaxime or ceftriaxone) therapy is indicated for the following clinical indications: purulent meningitis, life-threatening pneumonia, and suspected sepsis in patients predisposed to invasive pneumococcal disease, for example, sickle cell disease, HIV infection, and nephrotic syndrome . In addition to clinical management issues, other implications of the emergence of DRSP include identification of resistant strains, local and national surveillance, and prevention . Preventive measures include judicious antibiotic use, appropriate use of the currently available 23-valent pneumococcal vaccine, and development and implementation of a protein-conjugate vaccine.

J Antimicrob Chemother, 1997 Nov, 40(5), 659 - 66
Effects of triclosan and triclosan monophosphate on maximum specific growth rates, biomass and hydrolytic enzyme production of Streptococcus sanguis and Capnocytophaga gingivalis in continuous culture; Greenman J et al.; Dental plaque species, Streptococcus sanguis and Capnocytophaga gingivalis, were grown in continuous culture with progressively increasing concentrations of triclosan or its phosphorylated derivative, triclosan monophosphate (TMP) . For both organisms, the maximum specific growth rates decreased with increasing concentrations of triclosan or TMP until complete inhibition of growth occurred, which for S . sanguis was at 20 mg/L and 50 mg/L, and for C . gingivalis was at 10 mg/L and 5 mg/L for triclosan and TMP respectively . For both species, biomass levels remained approximately constant or, in some cases, increased slightly at low levels of triclosan or TMP . However, biomass levels then decreased significantly as the triclosan or TMP concentrations approached lethal levels . For S . sanguis, levels of hydrolytic enzymes (acid phosphatase, leucine aminopeptidase and esterase) generally remained approximately constant or increased with increasing concentrations of triclosan or TMP until close to inhibitory levels where enzyme levels were reduced . The ratio of extracellular soluble enzymes to cell-bound enzymes remained constant or increased slightly with increasing levels of triclosan or TMP . For C . gingivalis, production of hydrolytic enzymes (neutral phosphatase, leucine aminopeptidase and trypsin-like protease) remained constant or were reduced when grown with low levels of triclosan and TMP but in some cases increased with higher levels of agents . The proportion of extracellular soluble activity increased significantly when concentrations of agent neared inhibitory levels . The results taken together show that the physiology of cells is significantly altered and that hydrolytic enzymes are released from the cells when these are grown in the presence of increasing concentrations of triclosan or TMP . Enzyme release is more pronounced in the Gram-negative C . gingivalis and indicates that triclosan or TMP can cause membrane perturbation with subsequent release of membrane-located (S . sanguis) or periplasmic (C . gingivalis) hydrolytic enzymes . S . sanguis was more sensitive to triclosan than TMP while C . gingivalis was more sensitive to TMP . This suggests that, in C . gingivalis, TMP may diffuse into the cell wall more easily than triclosan and then be converted to triclosan by phosphatase activity within the cell wall complex, where it may give rise to high localized concentrations and subsequent cell damage.

Antimicrob Agents Chemother, 1997 Dec, 41(12), 2719 - 23
Cloning and characterization of a novel macrolide efflux gene, mreA, from Streptococcus agalactiae; Clancy J et al.; A strain of Streptococcus agalactiae displayed resistance to 14-, 15-, and 16-membered macrolides . In PCR assays, total genomic DNA from this strain contained neither erm nor mef genes . EcoRI-digested genomic DNA from this strain was cloned into lambda Zap II to construct a library of S . agalactiae genomic DNA . A clone, pAES63, expressing resistance to erythromycin, azithromycin, and spiramycin in Escherichia coli was recovered . Deletion derivatives of pAES63 which defined a functional region on this clone that encoded resistance to 14- and 15-membered, but not 16-membered, macrolides were produced . Studies that determined the levels of incorporation of radiolabelled erythromycin into E . coli were consistent with the presence of a macrolide efflux determinant . This putative efflux determinant was distinct from the recently described Mef pump in Streptococcus pyogenes and Streptococcus pneumoniae and from the multicomponent MsrA pump in Staphylococcus aureus and coagulase-negative staphylococci . Its gene has been designated mreA (for macrolide resistance efflux).

Harefuah, 1997 Nov 2, 133(9), 365 - 6, 414
{Isolated susceptibility of Streptococcus pyogenes to 3 macrolides}; Sakran W et al.; Erythromycin is considered the drug of choice in the treatment of streptococcal pharyngitis in patients allergic to penicillin . However, in recent years several publications, especially in Finland and Italy, showed high resistance rates of S . pyogenes isolates to erythromycin and other new macrolides . To evaluate the situation in Israel, we checked the MIC of isolates from patients with tonsillitis during 1996 . E-test results showed an MIC-50 of 0.23, 0.13 and 0.47 mcg/ml for erythromycin, clarithromycin and roxithromycin, respectively and a MIC-90 of 0.37, 0.23 and 0.78 mcg/ml . Only 2 isolates (2.1%) were partially or completely resistant to all 3 antibiotics . We conclude that empiric therapy with macrolides in Israel is still a viable option and can be recommended in S . pyogenes tonsillitis for patients allergic to penicillin.

Int Immunol, 1997 Nov, 9(11), 1735 - 43
Purification, and biochemical and biological characterization of an immunosuppressive and lymphocyte mitogenic protein secreted by Streptococcus sobrinus; Ferreira P et al.; An immunosuppressive/mitogenic (ISM) protein was purified from the supernatants of cultures of Streptococcus sobrinus with an isoelectric point of 4.75 and a relative molecular mass of 38 kDa (p38) . Treatment of C57BL/6 mice with p38 induced an increase in the numbers of non-specific splenic Ig-secreting plaque-forming cells (PFC) with peak responses on day 3 for IgM-secreting PFC and on day 5 for IgG-secreting PFC, with an isotype pattern consisting predominantly of IgG2a and IgG2b . This increase was accompanied by a lymphocyte blastogenic response of both T and B lymphocytes . The in vitro effects of p38 on pure B, T and total splenic lymphocytes indicated that this ISM protein was primarily a B cell mitogen, being T cells activated subsequently by the generation of B blasts . Suppression of the murine primary immune response against sheep red blood cells was observed in C57BL/6 mice treated 4 days before with p38 . The amino acid sequence of the N-terminus of p38 has a significant similarity with several enolases, particularly with rabbit enolase . However, the biological effects ascribed to p38 have not been detected after in vivo treatment with that enolase . The immunosuppressive effect of p38 was abrogated by depletion of IL-10 but not of IL-4 . In agreement with this observation IL-10 was the only cytokine detected in serum of C57BL/6 mice after p38 treatment and the peak of serum levels was observed as soon as 2 h after treatment.

Int Immunol, 1997 Nov, 9(11), 1723 - 33
Mapping the minimal murine T cell and B cell epitopes within a peptide vaccine candidate from the conserved region of the M protein of group A streptococcus; Hayman WA et al.; The highly conserved C-terminus of the M protein of group A streptococcus (GAS) is a promising vaccine candidate . An epitope within the conserved C-terminus of the M protein, peptide 145 (a 20-mer with the sequence: LRRDLDASREAKKQVEKALE), has been defined which is the target of opsonic antibodies in both humans and mice, and is recognized by the sera of most adults living in areas of high streptococcal exposure . However, due to potential cross-reactivity between T cells stimulated by this region of the M protein and host cardiac myosin, it is critical to define precisely the minimal protective epitopes within p145 . Studies have shown that the immunodominant epitope expressed by p145 is conformational, occurring as an alpha-helical coiled-coil . To enable us to map the murine minimal B cell and T cell epitopes within p145, we have used a novel strategy that allowed us to present shorter sequences of p145 in a native-like conformation . The minimal B cell epitope was found to be contained within residues 7-20 of the p145 sequence, and we have shown that mice immunized with this region are able to generate antibodies that bind to and also opsonize the organism GAS . The T cell epitope is located at the N-terminal region of the p145 sequence, residues 3-14 . We have managed, therefore, to define a vaccine candidate--a minimal opsonic B cell epitope within the p145 sequence--that does not incorporate a potentially deleterious T cell epitope.

Schweiz Rundsch Med Prax, 1997 Oct 8, 86(41), 1608 - 13
{Severe soft tissue infection with bulla formation, sepsis, multiple organ failure}; Bramer R et al.; A 53-year old patient with diabetes mellitus presented with a painful swelling of the left thigh in an out-of-town hospital . Because of the slow progression associated with multiorgan dysfunction, a soft-tissue infection with sepsis was suspected . Strains of streptococcus of serogroup B were isolated from specimens, taken from certain areas of the affected skin . After transferring the patient to our hospital the diagnosis of a B-streptococcal associated necrotizing fasciitis was confirmed . Despite intensive medical treatment and several surgical interventions the patient deceased due to an acute severe liver failure as a consequence of a secondarily developed septic shock . In comparison to the well-known cases caused by streptococcus group A, the B-streptococcal associated necrotizing fasciitis is a rather rare occurring disease.

Clin Ther, 1997 Sep-Oct, 19(5), 936 - 53
Sparfloxacin versus cefaclor in the treatment of patients with community-acquired pneumonia: a randomized, double-masked, comparative, multicenter study; Donowitz GR et al.; Community-acquired pneumonia remains an important infectious disease problem, with more than 4 million cases occurring in the United States annually . Although Streptococcus pneumoniae remains the most commonly identified organism, a variety of bacterial and nonbacterial pathogens may be involved . Hospitalization is unnecessary in most cases, and oral antibiotic therapy is common . In the majority of cases, the etiology of pneumonia is unknown at the time of presentation, necessitating the use of empiric therapy . Quinolones have not been utilized in this setting in the past because of their inconsistent coverage of S pneumoniae . Sparfloxacin (RP 64206) is a broad-spectrum fluoroquinolone with excellent activity in vitro against the majority of bacteria involved in community-acquired pneumonia, including pneumococcus . We therefore studied the efficacy and safety of sparfloxacin compared with the second-generation cephalosporin cefaclor as empiric therapy for patients with community-acquired pneumonia in a double-masked, double-dummy, multicenter trial . Three hundred thirty patients aged 18 years or older with community-acquired pneumonia suspected of being bacterial in etiology were enrolled at 74 centers in the United States from June 1, 1992, to March 4, 1995 . Patients meeting the inclusion criteria were randomized to receive 10 days of either sparfloxacin 400 mg orally once followed by sparfloxacin 200 mg orally daily (n = 168), or cefaclor 500 mg orally every 8 hours (n = 162) . There were no significant differences between groups with regard to baseline characteristics . Patients were followed up serially at 4 +/- 1 days, 20 +/- 3 days, and 38 +/- 7 days after the beginning of therapy . Patients were evaluated for clinical response, clinical recurrence of infection, and eradication of baseline pathogens . The primary efficacy variable was the clinical response (cured or improved) in the subgroup of patients meeting the definition of clinically assessable . Responses were also evaluated in the intent-to-treat population . In the intent-to-treat population, 35.7% of patients receiving sparfloxacin were clinically cured, compared with 32.1% of patients receiving cefaclor . Clinical successes (patients clinically cured plus improved) were also comparable (72.6% of patients in the sparfloxacin group and 71.0% of patients in the cefaclor group) . Similar clinical success rates were noted using only the clinically assessable population (primary efficacy variable) . Forty-four percent of patients receiving sparfloxacin and 39.1% of patients receiving cefaclor were clinically cured . In the sparfloxacin group, 86.6% of patients were clinical successes, compared with 84.4% of patients in the cefaclor group . Microbiologic cures were comparable in both groups . There was no difference in the incidence of recurrence of infection or superinfection . Adverse events thought to be due to study drug occurred equally in both groups (14.3% in the sparfloxacin group vs 14.8% in the cefaclor group) . Results show that sparfloxacin is a safe and effective empiric therapy for patients with community-acquired pneumonia and is comparable to cefaclor.

Diagn Microbiol Infect Dis, 1995 Dec, 23(4), 147 - 54
Macrolides resistance of common bacteria isolated from Taiwan; Chang SC et al.; To determine the susceptibility to macrolides of common pathogenic bacteria isolated from Taiwan, the in vitro activities of erythromycin, roxithromycin, azithromycin, clarithromycin, and dirithromycin were tested against 492 clinical isolates of eight different bacteria, collected from the National Taiwan University Hospital . The results showed high minimum inhibitory concentrations (MICs) against most of the tested bacteria . The MIC90s for Staphylococcus aureus (both methicillin-resistant and -sensitive strains), coagulase-negative staphylococci (both methicillin-resistant and -sensitive strains), Streptococcus pyogenes, Streptococcus pneumoniae, enterococci, peptostreptococci, and Bacteroides fragilis were all > or = 256 micrograms/ml . The MIC50s for methicillin-resistant strains of S . aureus and coagulase-negative staphylococci, and enterococci were > or = 256 micrograms/ml . For S . pneumoniae, peptostreptococci, and B . fragilis, the MIC50s were > 8 micrograms/ml . The resistance rates to macrolides were 80% or more in methicillin-resistant staphylococci and about 30% in methicillin-sensitive staphylococci . Around 55% of S . pneumoniae strains and 37 approximately 42% of S . pyogenes strains were resistant to macrolides . Cross-resistance to different macrolides was clearly demonstrated in most of the resistant strains.

J Am Vet Med Assoc, 1997 Dec 15, 211(12), 1571 - 2
Paraintestinal mesenteric abscess and chronic peritonitis in a bull; Voros K et al.; A 2-year-old bull was examined because of intermittent anorexia, signs of mild colic, and weight loss of 3 weeks' duration . A tympanitic resonance (ping) could be heard during simultaneous auscultation and percussion of the right paralumbar fossa, and a mass could be felt in the right dorsal quadrant of the abdominal cavity during palpation per rectum . Right flank laparotomy was performed, and intraoperative ultrasonography and ultrasound-guided fine-needle aspiration were used to determine that the mass was an abscess . However, the abscess could not be removed or drained into the colon because of extensive adhesions to other organs . Because the owner refused to pursue continued medical treatment, the bull was euthanatized . At necropsy, the abscess was found to be connected to a caudal mesenteric lymph node through a fistula . Histologic evaluation of the lymph node revealed hyperplastic lymphadenitis, and an alpha-hemolytic streptococcus was recovered from the abscess fluid . The most likely possibility for the findings in this bull were that the lymphadenitis was of hematogenous origin and that the abscess developed as a direct extension of the infectious process, similar to development of mesenteric abscesses in horses with chronic streptococcal infection (i.e., strangles).

Am J Respir Crit Care Med, 1997 Dec, 156(6), 1922 - 9
Community-acquired aspiration pneumonia in intensive care units . Epidemiological and prognosis data; Leroy O et al.; Over a 9-yr period, among 505 patients exhibiting severe community-acquired pneumonia and admitted into a total of six medical ICUs in the north of France, we collected 116 patients (23%) meeting the usual criteria for aspiration pneumonia . Main medical grounds of ICU admission were respiratory distress in 54 patients and neurological disturbances in 62 patients . The main underlying risk factor for aspiration pneumonia was drug overdose (39%) . Mechanical ventilation was required for 73 patients . Initial shock was present in 15 patients . Pulmonary involvement was bilateral in 27 patients . There were 94 aerobic organisms isolated from 70 patients (60%), the most frequent being gram-negative bacilli (n = 38), Staphyloccus spp . (n = 27) and Streptococcus pneumoniae (n = 22) . Overall mortality was 22%, but only 11 (11%) deaths were directly or indirectly related to aspiration pneumonia . Stepwise multivariate analysis identified four independent predictors of mortality: ineffective initial antimicrobial therapy (p = 0.0001), positive initial blood culture (p = 0.0001), hospital-acquired lower respiratory tract superinfections (p = 0.0054), and use of inotropic support (p = 0.0078) . The importance of prevention of hospital-acquired superinfections and permanent optimization of our antimicrobial strategies warranting efficacy of the initial antimicrobial therapy is underlined.

Antibiot Khimioter, 1997, 42(8), 34 - 7
{Development of resistance to difuracil (PAP-49) in bacteria and its activity in combination with other antibacterial drugs}; Pavlov PA; Possible increasing of resistance to difuracil or N-(5-nitrofurfuryliden)-5-nitrofuran-2-(N'-acetyl) carboxamidohydrazon (PAP-49) in Staphylococcus sp., Streptococcus sp . and Escherichia coli was studied and the level of the resistance increasing was determined by the method of 30-fold passage of the cultures in subbacteriostatic concentrations of the drug . It was shown in vitro that the increase of the resistance to the new nitrofuran was insignificant . The most intensive adaptation was observed during the first 10 passages . During the following 10-15 passages the susceptibility level remained unchanged (E.coli) or was even somewhat higher (S . aureus and Streptococcus sp.) . After that a new increase of the resistance was observed . The most marked changes in the susceptibility were detected in Streptococcus sp . and the least marked in Staphylococcus sp . and E.coli . Combinations of difuracil in subbacteriostatic concentrations with various antibacterial drugs provided both additive and synergistic effects with respect to S.epidermidis, S . pneumonase, E.coli and P.mirabilis . The most active combinations were those of difuracil with aminoglycoside antibiotics, penicillins or chloramphenicol.

Antibiot Khimioter, 1997, 42(10), 38 - 42
{Community-acquired pneumonia: Etiological diagnosis}; Sinopalnikov AI et al.; Microbiological and immunoserological approaches were used in etiological diagnosis of community-acquired pneumonia . It was concluded that Streptococcus pneumoniae, Staphylococcus aureus, Pseudomonas aeruginosa, Legionella pneumophila and Klebsiella pneumoniae predominated in the etiological structure of present severe community-acquired pneumonia . The most actual causative agents of nonsevere community-acquired pneumonia in persons under 60 were S . pneumoniae, Hemophilus influenzae, Mycoplasma pneumoniae and Chlamydia pneumoniae . Nonsevere community-acquired pneumonia in persons over 60 and/ or at the background of chronic obstructive pulmonary diseases, diabetes mellitus or other affections was most frequently due to S . pneumoniae, H . influenzae and aerobic gramnegative microbes.

Med Dosw Mikrobiol, 1997, 49(1-2), 55 - 60
{Occurrence of Moraxella catarrhalis in patients with respiratory tract infections}; Jakubicz P et al.; The study was undertaken to evaluate the incidence of Moraxella catarrhalis in patients with respiratory tract infections . Overall 514 specimens including 370 throat swabs and 114 sputum specimens were examined . The 78 strains isolated basing on morphological and biochemical characteristics were classified as Moraxella catarrhalis . The sensitivity of the strains to antibiotics was also estimated . The frequency of M . catarrhalis isolation from the throat swabs (15.9%) was higher than from the sputum (13.2%) . Selected 25 specimens of sputum were tested simultaneously by quantitative and qualitative methods . Quantitative method was more sensitive (84% positive findings) than qualitative method (60% positive findings) . Resistance to ampicillin was found in 52 (66.7%) strains of M . catarrhalis determined mainly by beta-lactamase production (over 70% strains were producers of beta-lactamase) . All strains were sensitive to ofloxacin and amoxycillin/clavulanic acid combination . The frequency of M . catarrhalis isolation was higher in autumn-winter period than in summer (May-September) . We conclude that M . catarrhalis, beside Streptococcus pyogenes (20.2%) and Streptococcus pneumoniae (17.1%), are the most frequently isolated bacteria in patients with respiratory tract infections.

Clin Exp Immunol, 1997 Dec, 110(3), 341 - 8
Humoral immune response within the lung in HIV-1 infection; Moja P et al.; In order to study the humoral immune defences in the respiratory tract during HIV-1 infection, we measured the levels, local productions and anti-HIV and antibacterial activities of IgG and IgA in the bronchoalveolar lavage fluid (BALF) and serum of 61 adult patients with severe HIV infection and of 56 HIV- controls . Albumin was used as the serum transudation factor . The increase of immunoglobulin levels in the serum of HIV-infected patients was confirmed . The IgG level was also increased in epithelial lining fluid (ELF), whereas the total IgA level was unchanged and secretory IgA (SIgA) level was decreased . The ELF/serum immunoglobulin ratios suggested that the IgG present in ELF resulted mainly from transudation, in contrast to SIgA, which was synthesized locally in controls but greatly diminished in HIV-infected patients . IgG to HIV-1 could be detected in BALF of all the patients, but IgA to HIV-1 only in 30% of patients . BAL IgG reacted more consistently and with a broader array of HIV-1 antigens than did IgA . BAL IgA, when present in samples, reacted primarily with viral envelope antigens . Because IgA specificities to some HIV-1 antigens were detected more intensively by BAL than by serum immunoglobulins, we conclude that the mucosal immune response is distinct from that in serum . IgG antibody activity to Streptococcus pneumoniae was decreased in HIV-infected patients' sera, and IgA antibody activities to S . pneumoniae and to Pseudomonas aeruginosa were decreased in ELF in HIV-infected patients.

J Vet Med Sci, 1997 Nov, 59(11), 1031 - 3
Isolation of Streptococcus equi subsp . equi from thoroughbred horses in a racehorse-breeding area of Japan; Anzai T et al.; For determination whether strangles has invaded the Hidaka district of Hokkaido, the main racehorse-breeding area of Japan, a epizootiological survey with bacterial isolation was carried out during the breeding season in 1995 . Streptococcus equi subsp . equi, which is the causative agent of strangles, was isolated from two Thoroughbred horses with submandibular lymphadenitis . Isolates were identified by serological grouping, biochemical tests and analysis of cell surface proteins by Western immunoblotting . Through this survey, it revealed that S . equi subsp . equi has invaded the Hidaka district and that strangles has become prevalent in racehorse-breeding farms in this area.

Gene, 1997 Oct 24, 200(1-2), 125 - 34
Transcriptional analysis of mga, a regulatory gene in Streptococcus pyogenes: identification of monocistronic and bicistronic transcripts that phase vary; Bormann NE et al.; Transcription of several surface virulence proteins of Streptococcus pyogenes is regulated by Mga, a protein that shows homology to response regulators of two-component signal-transducing systems . Two of these surface virulence proteins, M protein and C5a peptidase, undergo phase variation . To determine whether Mga itself undergoes phase variation and might allow the phasing switch to coordinate the activity of these genes, expression of the mga gene was analyzed . We show for the first time that there are two mga-specific transcripts: a 3.8-kb bicistronic message that includes both mga and emm12 genes and a monocistronic 1.6-kb mga message . Both transcripts phase vary and are present in higher amounts in M+ variants than in M- variants . Incubation of RNA with rifampicin indicates that the smaller 1.6-kb message is not a processed product . Two promoters were mapped upstream of mga: P1 at position 666 (-395) and P2 at position 978 (-83) . In strain CS46 (delta mga), transcription initiation from the P1 promoter does not occur, and multiple start sites are found around the P2 promoter . Complementation experiments indicate that sequences upstream of the P2 promoter are required for activation of emm12 and scpA by Mga in trans.

Appl Environ Microbiol, 1997 Dec, 63(12), 4941 - 4
Purification, characterization, and nucleotide sequence of an intracellular maltotriose-producing alpha-amylase from Streptococcus bovis 148; Satoh E et al.; An intracellular alpha-amylase from Streptococcus bovis 148 was purified and characterized . The enzyme was induced by maltose and soluble starch and produced about 80% maltotriose from soluble starch . Maltopentaose was hydrolyzed to maltotriose and maltose and maltohexaose was hydrolyzed mainly to maltotriose by the enzyme . Maltotetraose, maltotriose, and maltose were not hydrolyzed . This intracellular enzyme was considered to be a maltotriose-producing enzyme . The enzymatic characteristics and hydrolysis product from soluble starch were different from those of the extracellular raw-starch-hydrolyzing alpha-amylase of strain 148 . The deduced amino acid sequence of the intracellular alpha-amylase was similar to the sequences of the mature forms of extracellular liquefying alpha-amylases from Bacillus strains, although the intracellular alpha-amylase did not contain a signal peptide . No homology between the intracellular and extracellular alpha-amylases of S . bovis 148 was observed.

J Dairy Sci, 1997 Nov, 80(11), 2809 - 14
Efficacies of teat germicides containing 0.5% chlorhexidine and 1% iodine during experimental challenge with Staphylococcus aureus and Streptococcus agalactiae; Boddie RL et al.; Two germicides, one containing 0.5% chlorhexidine and one containing 1% iodine, were tested for efficacy against new intramammary infections (IMI) caused by Staphylococcus aureus and Streptococcus agalactiae . The model for the experimental challenge in the trials that were designed to test the efficacy of the two postmilking teat dips was recommended by the National Mastitis Council . The 0.5% chlorhexidine product reduced the number of new IMI caused by Staph . aureus by 73.2% and reduced the number of new IMI caused by Strep . agalactiae by 53.9% . The 1% iodine product reduced the number of new IMI caused by Staph . aureus by 75.6% and reduced the number of new IMI caused by Strep . agalactiae by 53.5% . In both trials, the incidence of clinical mastitis was also reduced in dipped quarters compared with control quarters . Use of the two teat dips over the trial periods had no effect on the condition of teat skin or teat ends.

Int Angiol, 1997 Sep, 16(3), 176 - 9
Mycotic aneurysm of the bilateral tibioperoneal trunks associated with bacterial endocarditis: a case report; Murashita T et al.; Since antibiotics have been widely used in the treatment of bacterial endocarditis, mycotic aneurysms caused by septic emboli have become extremely rare . We report the case of a 34-year-old man who had mycotic aneurysms in the tibioperoneal trunks of both legs six weeks after he had a mitral valve replacement due to Streptococcus viridans endocarditis . Color Doppler sonography was used to diagnose pseudoaneurysms in both legs . Surgical treatment included the closures of the orifices of both aneurysms in both legs and arterial reconstructions were not required . In the literature, however, the location of mycotic aneurysms in peripheral arteries related to endocarditis were usually reported to be in the upper extremities or femoral arteries . Thus, we present the extremely rare case of mycotic aneurysms because the aneurysms occurred in the infrapopliteal vessel and developed in both legs.

Rinsho Shinkeigaku, 1997 Aug, 37(8), 693 - 6
{An adult case of bacterial meningitis caused by penicillin-resistant Streptococcus pneumoniae with gene mutations of penicillin binding proteins}; Nozaki K et al.; A 62-year-old Japanese male developed acute bacterial meningitis . Administration of ABPC, CDZM, INH, and RFP was started . The causative bacteria was identified as penicillin-resistant Streptococcus pneumoniae (PRSP) 3 days later . We changed ABPC to PAPM/BP and the bacterial meningitis improved dramatically . Measurement of minimum inhibitory concentration (MIC) of the bacterial strain from CSF and blood showed that it is susceptible to PAPM/BP and RFP . Mechanism of drug resistance is considered to be gene mutations of penicillin binding protein (PBP) that decreases drug affinity to PBP . Recently penicillin resistance of Streptococcus pneumoniae has been found to be associated with mutations of pbp-2b, 1a genes and the cefem resistance of that is with those of pbp-2x, and 1a genes . By PCR (polymerase chain reaction) analysis we identified the mutations of pbp-1a, 2x, and 2b genes of the isolated strain of Streptococcus pneumoniae . We emphasize the importance of detection of pbp gene mutations for the diagnosis of PRSP infections.

Microbiol Immunol, 1997, 41(10), 795 - 8
Hyaluronidase activity in human pus from which Streptococcus intermedius was isolated; Takao A et al.; Hyaluronidase (HAase) activity was detected in both a human pus sample and the culture supernatant of the only bacterial isolate from the pus, Streptococcus intermedius, using a zymographic technique . The optimum pH range for HAase activity was similar for both samples . Although the bands showing the strongest HAase activity of these samples differed from each other with respect to molecular size, both samples were equally inhibited by an antiserum raised against HAase of S . intermedius . These results suggest that S . intermedius may produce HAase in vivo as well as in vitro, and that this enzyme and/or its fragments may play an important role in host tissue degradation.

J Clin Periodontol, 1997 Nov, 24(11), 830 - 5
Comparison of the subgingival microbiota of periodontally healthy and diseased adults in northern Cameroon; Ali RW et al.; Our study is the 1st report on subgingival microbiota in adult Cameronians . The aim was to investigate, using the checkerboard DNA-DNA hybridization technique, the prevalence of 18 oral species in subgingival plaque samples obtained from sex- and age-matched Cameronian adults with and without periodontal destruction . We also compared cultivation and the Affirm DP test with the checkerboard technique in their capability to detect some selected species among the 18 . 21 adult periodontitis patients and 21 periodontally healthy subjects were examined and the results were compared statistically . Each periodontitis patient had at least 4 pockets of > or = 6 mm depth, while the healthy subjects had no sites more than 3 mm deep . Results of the checkerboard analysis showed that significantly (p < 0.05) more periodontitis patients tested positive for most of the 18 bacterial species . The Gram-positive species Actinomyces naeslundii, Streptococcus mitis and Streptococcus sanguis, known as microbiota of healthy sites, were detected significantly more frequently in the healthy group . Cultivation demonstrated P . gingivalis, B . forsythus, A . actinomycetemcomitans, P . intermedia and F . nucleatum in significantly lower %s of patients as compared to the checkerboard technique . Furthermore, the Affirm DP test detected P . gingivalis and B . forsythus in significantly fewer patients than did the checkerboard technique . A . actinomycetemcomitans was detected in 52.3% of the patients by the latter technique while the Affirm DP test failed to detect the bacterium in any of the samples . Overall, the results of the present study confirm the importance of the screening method and indicate that the prevalences of the investigated putative periodontal pathogens and beneficial species in the healthy and diseased adult Cameronians were similar to those reported for adults in the West and in some developing countries.

J Clin Periodontol, 1997 Nov, 24(11), 823 - 9
Reduced serum IgG reactivities with bacteria from dental plaque in HIV-infected persons with periodontitis; Steinsvoll S et al.; Serum samples were obtained from 44 HIV-seropositive (HIV+) and 37 HIV-seronegative (HIV-) persons that were grouped according to periodontal status . Serum IgG and IgA reactivities towards Streptococcus mutans, Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis . Prevotella intermedia, Prevotella nigrescens and Fusobacterium nucleatum were measured by means of ELISA . HIV+ persons with chronic marginal periodontitis showed significantly lower IgG reactivities to the periodontal pathogens A . actinomycetemcomitans, P . gingivalis, P . intermedia and F . nucleatum as compared with their HIV- counterparts (p < 0.05) . Specific serum IgA reactivities were similar in the two periodontitis groups, except for P . nigrescens where the HIV+ group with chronic marginal periodontitis had lower values than their systemically healthy counterparts (p < 0.05) . The results indicate that HIV infection affects the humoral serum immune responses against bacteria in dental plaque; the depressed antibody responses may contribute to the increased susceptibility for periodontal infections in HIV-infected patients.

Clin Infect Dis, 1997 Nov, 25(5), 1180 - 7
Group B streptococcal meningitis in adults: report of twelve cases and review; Domingo P et al.; Group B streptococcus (GBS) is the leading etiologic agent of bacterial meningitis and sepsis during the neonatal period, but it is an infrequent cause of meningitis in adults . We report 12 episodes of group B streptococcal meningitis in adults and review 52 cases reported in the literature . A total of 24 men and 40 women were included in the study; the mean age (+/- SD) was 49.2 +/- 20.5 years (range, 17-89 years) . All the patients had cerebrospinal fluid cultures positive for GBS . Eighty-six percent of the patients had comorbid conditions, 50% had a distant focus of infection, and blood cultures yielded GBS for 78.7% . The overall case-fatality rate was 34.4% (22 patients) . Factors associated with a poor outcome were advanced mean age (+/- SD) (61.5 +/- 17.4 years vs . 42.8 +/- 19.2 years; P = .0003) and the presence of complications on admission (P = .0001) . Seven percent of survivors had neurological sequelae . Group B streptococcal meningitis in adults has become increasingly frequent in recent years; it tends to occur in patients with severe underlying conditions and is associated with a high case-fatality rate . Factors associated with a poor prognosis are advanced age and the occurrence of neurological and extraneurological complications.

Clin Infect Dis, 1997 Nov, 25(5), 1165 - 72
Streptococcus pneumoniae blood culture isolates from patients with and without human immunodeficiency virus infection: alterations in penicillin susceptibilities and in serogroups or serotypes; Crewe-Brown HH et al.; We performed a 3-year retrospective study of Streptococcus pneumoniae blood culture isolates recovered at Baragwanath Hospital, Soweto, South Africa, from 1993 to 1995 . The study group comprised 457 patients, including 98 children, of known human immunodeficiency virus (HIV) serostatus . Of these patients, 70 (30 {8.4%} of 359 adults and 40 {40.8%} of the 98 children) were infected with penicillin-resistant S . pneumoniae strains (minimal inhibitory concentration, > or = 0.12 microg/mL); 56 of these strains were intermediately resistant to penicillin . HIV-positive patients had significantly more penicillin-resistant isolates than did HIV-negative patients (43 {29.7%} of 145 HIV-positive patients vs . 27 {8.6%} of 312 HIV-negative patients; P < .001); this difference was found for both adults (19% vs . 4.3%; P < .001) and children (53.3% vs . 30.2%; P < .0343) . Multiple resistance occurred more frequently in HIV-positive children (P = .02) . HIV-positive adults had a statistically significant increase in the percentage of serogroups and serotype usually found in children and commonly associated with antimicrobial resistance, i.e., serotype 14 and serogroups 6, 19, and 23 (48% vs . 28.6%; P < .001) . The increased prevalence of serogroups or serotypes usually found in children was also found among penicillin-susceptible strains . These data suggest that HIV-infected adults may again become susceptible to the serogroups or serotypes found in children.

Clin Infect Dis, 1997 Nov, 25(5), 1113 - 7
Duration of nasopharyngeal carriage of penicillin-resistant Streptococcus pneumoniae: experiences from the South Swedish Pneumococcal Intervention Project; Ekdahl K et al.; As a part of an intervention project, all detected carriers of penicillin-resistant pneumococci (PRP) (MIC, > or = 0.5 mg/L) in Malmohus County, southern Sweden, were followed by means of weekly nasopharyngeal cultures . The median duration of carriage in 678 individuals was 19 days (range, 3-267 days) . The duration of carriage was longest in children < 1 year old (median, 30 days) and shortest in adults > 18 years old (median, 14 days) . Index cases, whose cultures were performed during an acute infection, were carriers for a mean of 10 days longer than asymptomatic contact cases (P < .05) . The PRP spontaneously disappeared from the nasopharynx within 4 weeks in 68%, within 8 weeks in 87%, and within 12 weeks in 94% of the individuals . Other significant risk factors for prolonged carriage were the occurrence of > 6 episodes of acute otitis media (AOM) or first episode of AOM before the age of 1 year (P < .01), the carriage of PRP by other family members (P < .05), and the obtainment of a first positive culture during the winter months (P < .05).

Clin Infect Dis, 1997 Nov, 25(5), 1108 - 12
Pyogenic brain abscess caused by Streptococcus pneumoniae: case report and review; Grigoriadis E et al.; While Streptococcus pneumoniae is the most common cause of bacterial meningitis in adults, cases of pneumococcal brain abscess have rarely been reported . We describe a case of otogenic brain abscess caused by S . pneumoniae that developed in a patient who was receiving ciprofloxacin for the empirical treatment of otitis media . We also review 23 additional cases of pyogenic brain abscess caused by S . pneumoniae that have previously been reported . The development of a pneumococcal brain abscess was associated with a contiguous intracranial focus of infection in 50% of cases . The majority of patients presented with headache (81%) and focal neurological deficits (86%) . However, the classic triad of headache, fever, and focal neurological deficits was present in only 24% of patients . The mortality rate for patients with brain abscess caused by S . pneumoniae was 35%; persistent neurological deficits were documented in 40% of patients who survived.

Clin Infect Dis, 1997 Nov, 25(5), 1090 - 3
Chlamydia pneumoniae in children with otitis media; Storgaard M et al.; In this study the polymerase chain reaction was used to test for the presence of Chlamydia pneumoniae DNA in 118 middle-ear aspirates from 20 children with acute otitis media (AOM) and 53 children with otitis media with effusion (OME) . C . pneumoniae was detected in 8 samples obtained from 5 children with OME and, together with Streptococcus pneumoniae, in a sample from 1 child with AOM . The mean age of these five children (6.6 +/- 1.4 years) was significantly higher than that of the 48 children with OME in whom C . pneumoniae could not be detected (4.3 +/- 1.9 years) . The presence of C . pneumoniae in 9.4% of the examined children with OME suggests that C . pneumoniae might be a significant supplementary factor in the etiology of this common children's disease.

Diagn Microbiol Infect Dis, 1997 Nov, 29(3), 139 - 45
A comparison of the BioStar Strep A OIA rapid antigen assay, group A Selective Strep Agar (ssA), and Todd-Hewitt broth cultures for the detection of group A Streptococcus in an outpatient family practice setting; Hart AP et al.; In some studies the BioStar Strep A OIA (optical immunoassay) has yielded inconsistent results, although originally it was reported to be more sensitive than conventional culture for the detection of group A Streptococcus (GAS) . The Group A Selective Strep Agar with 5% sheep blood (ssA) incubated anaerobically has been reported to be more sensitive than conventional culture in the detection of GAS . We compared the BioStar Strep A OIA GAS rapid antigen detection kit to anaerobic culture on ssA with and without preincubation in Todd-Hewitt broth (THB) for the detection of GAS . From September 1995 through January 1996, throat swabs were collected in duplicate from 75 children (< or = 18 years) and 188 adults (> 18 years) who presented with pharyngitis in the outpatient University of New Mexico Family Practice Clinic . Thirty-one (12%) of the 263 cases were positive for GAS by culture and/or broth . Compared with anaerobic culture on the ssA, with and without preincubation in THB, the sensitivity, specificity, positive predictive value, and negative predictive value of the BioStar Strep A OIA were 77, 62, 22, and 95%, respectively . Compared with enrichment in THB followed by subculture on ssA and anaerobic incubation, the sensitivity, specificity, positive predictive value, and negative predictive value of direct culture on ssA and anaerobic incubation were 79, 99, 98, and 96%, respectively . All isolates were serologically grouped . The BioStar Strep A OIA is as sensitive as direct culture on ssA incubated anaerobically, but the low specificity and low positive predictive value when the OIA is used in low prevalence populations could lead to unnecessary antibiotic treatment.

Natl Med J India, 1997 Sep-Oct, 10(5), 221 - 4
Microbial resistance to drugs--a universal problem in urgent need of a comprehensive approach; Kumar A; The last two decades have seen an increase in bacterial resistance to commonly used antibiotics all over the world . In the past five years the emergence of vancomycin-resistant Enterococcus and multidrug-resistant Streptococcus pneumoniae was particularly notable . Several factors have contributed to this, including inappropriate use of readily available antibiotics, survival of high-risk patients in critical care units, burn wards and cancer centres following treatment with multiple antibiotic combinations, increasing poverty and worsening of living conditions . The data available from South-east Asia, albeit limited, indicate that prevalence of antibiotic resistance in bacteria isolated from human and animal sources is higher than that reported from western countries . To combat this global problem, a multi-pronged approach is needed . Accurate antibiotic susceptibility data will be required to define the extent of the problem . Medical experts and scientific organizations will have to develop guidelines for the use of antibiotics in ambulatory, inpatient and animal husbandary areas . Cooperation between the medical community, regulating agencies and pharmaceutical industry will be needed to define policies governing the sale of antibiotics, drug promotional materials, physician education programmes and consumer education regarding the hazards of inappropriate antibiotic use . For long term control of infectious diseases, it is imperative that existing vaccines be appropriately utilized and new vaccines developed.

J Clin Microbiol, 1997 Dec, 35(12), 3220 - 4
Characterization of group A Streptococcus strains recovered from Mexican children with pharyngitis by automated DNA sequencing of virulence-related genes: unexpectedly large variation in the gene (sic) encoding a complement-inhibiting protein; Mejia LM et al.; Sequence variation was studied in several target genes in 54 strains of group A Streptococcus (GAS) cultured from children with pharyngitis in Mexico City . Although 16 distinct emm alleles were identified, only 4 had not been previously described . Virtually all bacteria (31 of 33 {94%} with the streptococcal pyrogenic exotoxin gene (speA) had emm1-related, emm3, or emm6 alleles . The gene (sic) encoding an extracellular GAS protein that inhibits complement function was unusually variable among isolates with the emm1 family of alleles, with a total of seven variants identified . The data suggest that many GAS strains infecting Mexican children are genetically similar to organisms commonly encountered in the United States and western Europe . Sequence variation in the sic gene is useful for rapid differentiation among GAS isolates with the emm1 family of alleles.

J Clin Microbiol, 1997 Dec, 35(12), 3198 - 202
Disk diffusion test interpretive criteria and quality control recommendations for testing linezolid (U-100766) and eperezolid (U-100592) with commercially prepared reagents; Biedenbach DJ et al.; Two new oxazolidinones were tested to determine interpretive susceptibility testing criteria for MIC and disk diffusion methods . Commercial lots of linezolid (formerly U-100766) and eperezolid (formerly U-100592) disks containing 30 microg of drug were tested against 728 isolates of bacteria with defined mechanisms of resistance . Results from linezolid were highlighted because of its choice for clinical development . By using preliminary pharmacokinetic data, a tentative susceptibility breakpoint of < or = 4 microg/ml was selected . Corresponding breakpoint zone diameters for linezolid were > or = 21 mm (< or = 4 microg/ml) for susceptibility and < or = 17 mm (> or = 16 microg/ml) for resistance . Regression statistics demonstrated a high correlation coefficient (r > or = 0.98), and absolute categorical agreement between methods was obtained, when staphylococci and enterococci were tested with the cited criteria . When Streptococcus spp . (including S . pneumoniae) were tested, only the susceptibility breakpoint was suggested . Quality control (QC) guidelines for linezolid disk diffusion tests were established by a multilaboratory trial as follows: 27 to 31 mm for Staphylococcus aureus ATCC 25923 and 28 to 34 mm for S . pneumoniae ATCC 49619 . More than 95% of all QC results were within these proposed ranges . Although not advanced to clinical trials, eperezolid demonstrated potency comparable to that of linezolid and had identical interpretive testing criteria . These preliminary interpretive criteria and QC limits (accepted by the National Committee for Clinical Laboratory Standards) should be applied to linezolid tests during the clinical-trial phases of oxazolidinone drug development in order to ensure test accuracy and reproducibility.

Immunol Invest, 1997 Aug-Dec, 26(5-7), 531 - 48
Identification of core B cell epitope in the synthetic peptide inducing cross-inhibiting antibodies to a surface protein antigen of Streptococcus mutans; Senpuku H et al.; A surface protein antigen (PAc) of Streptococcus mutans, in particular, A-region of the molecule, has been considered as a possible target for the development of an effective anticaries vaccine . This region might be implicated in the induction of dental caries via interaction with salivary components . We have recently specified a unique peptide, TYEAALKQYEADL, as one of the minimum peptides that completely corresponds to the amino acid sequence of a part of the A-region . The unique peptide contains both T and B cell epitopes for the induction of cross-reacting antibodies to the PAc . In this study, we synthesized valine or glycine-substituted peptide analogs of this peptide and examined core B cell epitopes of this unique peptide by using ELISA inhibition assay . As a result, the core amino acid residues of -Y------Y---- for B cell recognition were found to likely be not only important amino acids stabilizing the structure, but also might be essential for induction of the cross-inhibiting antibodies against PAc . These results will hopefully provide us with useful information for the design of an effective anticaries peptide vaccine.

Proc Natl Acad Sci U S A, 1997 Nov 25, 94(24), 13251 - 6
Inactivation of the alpha C protein antigen gene, bca, by a novel shuttle/suicide vector results in attenuation of virulence and immunity in group B Streptococcus; Li J et al.; The alpha C protein of group B Streptococcus (GBS) is a major surface-associated antigen . Although its role in the biology and virulence of GBS has not been defined, it is opsonic and capable of eliciting protective immunity . The alpha C protein is widely distributed among clinical isolates and is a potential protein carrier and antigen in conjugate vaccines to prevent GBS infections . The structural gene for the alpha C protein, bca, has been cloned and sequenced . The protein encoded by bca is related to a class of surface-associated proteins of gram-positive cocci involved in virulence and immunity . To investigate the potential roles of the alpha C protein, bca null mutants were generated in which the bca gene was replaced with a kanamycin resistance cassette via homologous recombination using a novel shuttle/suicide vector . Studies of lethality in neonatal mice showed that the virulence of the bca null mutants was attenuated 5- to 7-fold when compared with the isogenic wild-type strain A909 . Significant differences in mortality occurred in the first 24 h, suggesting that the role of the alpha antigen is important in the initial stages of the infection . In contrast to A909, bca mutants were no longer killed by polymorphonuclear leukocytes in the presence of alpha-specific antibodies in an in vitro opsonophagocytic assay . In contrast to previous studies, alpha antigen expression does not appear to play a role in resistance to opsonophagocytosis in the absence of alpha-specific antibodies . In addition, antibodies to the alpha C protein did not passively protect neonatal mice from lethal challenge with bca mutants, suggesting that these epitopes are uniquely present within the alpha antigen as expressed from the bca gene . Therefore, the alpha C protein is important in the pathogenesis of GBS infection and is a target for protective immunity in the development of GBS vaccines.

Ann Acad Med Singapore, 1997 Jul, 26(4), 421 - 5
Group B streptococcus: maternal carriage rate and early neonatal septicaemia; Lim CT et al.; Between January 1984 and December 1994, 30 cases of early neonatal group B streptococcus (GBS) septicaemia were managed in the Neonatal Unit, University Hospital, Kuala Lumpur . Two neonates were outborn and 28 were inborn, giving an average annual incidence of neonatal GBS septicaemia of 0.4/1000 livebirths among inborn babies . In a separate survey over a three-month period, GBS genital carriage rate among 196 parturients was found to be 9.7% . Of the infants with GBS septicaemia, the mean gestational age was 37.5 +/- 3.8 weeks and the mean birthweight was 2540 +/- 716 g . Twelve (40%) were preterm infants and 14 (47%) were low birthweight infants . Male and female infants were almost equally affected . Prolonged rupture of membranes and maternal pyrexia accounted for only 5 (17%) and 3 (10%) of the cases respectively . Twenty-four (80%) neonates had onset of symptoms within 6 hours of life and respiratory symptoms were observed in 24 (80%) of the cases, while meningitis was uncommon . Six (20%) neonates died . Preterm and low birthweight infants had higher mortality than their term counterparts: 42% versus 6% and 36% versus 6% respectively . Of those who died, 4 (67%) required respiratory support right from birth and the mean time of onset of symptoms was 4 hours (range 0 to 21 hours) and the duration of survival was only 28.8 hours (range 12 to 38 hours) . As the incidence of neonatal GBS septicaemia was low, mass screening and chemoprophylaxis for GBS were not recommended . All the GBS isolates were sensitive to penicillin and ampicillin, thus one of these antibiotics should be included in the antimicrobial therapy of septic neonates.

Kansenshogaku Zasshi, 1997 Oct, 71(10), 1085 - 9
{Case report: lung abscess caused by Streptococcus agalactiae}; Obase Y et al.; Streptococcus agalactiae is a well-recognized cause of neonatal sepsis and meningitis . In adults, infections by S . agalactiae are rare . We report an adult case of lung abscess and pyogenic spondylitis caused by S . agalactiae . A 51-year-old male was admitted to our hospital because of an abnormal shadow in the chest and lumbago on May 25, 1995 . He was diagnosed as lung abscess from the chest roentgenogram and CT scan and the subcutaneous pus was aspirated . The pus culture was only positive for S . agalactiae . He was treated with IPM/CS 1 g/day and CLDM 1.2 g/day and the abscess was drained . MRI showed his lumbago was caused by pyogenic spondylitis . The underlying disease of this case was diabetes mellitus . He recovered from the infections with in about 10 weeks of antibiotic treatment.

Kansenshogaku Zasshi, 1997 Oct, 71(10), 1066 - 70
{Toxic shock-like syndrome after acupuncturation}; Harada K et al.; A 80-year-olkd male was admitted to our hospital because of severe pain and swelling on his left lower leg on January 23, 1996 . He had received an acupuncture to both legs because of intermittent claudication once a week from July, 1995 to January 18, 1996 . On the next day of the last acupuncture, pain and swelling on his left leg appeared . On admission, his left leg showed diffuse swelling and redness with blisters . We diagnosed this patient as toxic shock-like syndrome (TSLS), based on the rapid exacerbation of the skin changes, necrotizing superficial fasciitis, multiple organ failure with shock, and the detection of group A streptococcus from culture samples obtained from both skin blister and necrotic fascia . He recovered from the disease by amputation of the involved leg and antibiotic therapy . Acupuncture could have been the cause of streptococcal infection.

Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 1997 Nov, 84(5), 513 - 6
Evaluation of a new device for sterilizing dental high-speed handpieces; Larsen T et al.; Dental high-speed turbines and handpieces can take up and expel microorganisms during operation and thus need regular sterilization . This study established a method for validating devices used to sterilize high-speed turbines and handpieces . The air and water channels and turbine chambers were contaminated with suspensions of Streptococcus salivarius or endospores of Bacillus stearothermophilus . The effect of flushing and/or autoclaving performed by a new device combining both procedures was evaluated by counting the number of viable bacteria recovered from these devices . Further, the effect on clinically used handpieces was evaluated . In an initial experiment, the device partially reduced S . salivarius, and the endospores survived . In a second experiment, a 5 to 6 log reduction of S . salivarius in air and water channels was obtained . No growth was observed in clinically used high-speed handpieces, and both S . salivarius and endospores were eliminated from the turbine chambers . Thus, the method of validation proved capable of discriminating between different levels of bacterial reduction.

Jpn J Antibiot, 1997 Sep, 50(9), 739 - 55
{Clinical evaluation of faropenem against infections in pediatric fields}; Sunakawa K et al.; The recent increases in the prevalence of penicillin-resistant Streptococcus pneumoniae becomes a point at issue clinically . We carried out a clinical study in 40 cases in the pediatrics department, as faropenem (FRPM) was proved to have an excellent antimicrobial activity against penicillin-resistant Streptococcus pneumoniae . The study was planned to investigate in detail the movement of stools that had been a problem in a clinical development studies out before . In this study, an observation of the daily movement of stools was one of the principal evaluation items, hence the patients were divided into two groups . One group (S-group) were administered FRPM only, the other group (E-group) were administered FRPM in combination with a medicine for intestinal disorders (Enteronon-R) . An observed frequencies of any loose bowel movements were 94.7% in S-group, and 63.2% in E-group, hence the study suggested that the combination drug was effective . The patients observed higher frequencies of development of the movement of stools, all of them were recovered from in the course of administration or within 4 days after administration, however whether or not being treated symptomatic therapy . Clinical efficacy rates of FRPM on mainly respiratory infections were 94.6% . In this study, 4 strains (patients) of penicillin-resistant Streptococcus pneumoniae were isolated . Against penicillin-resistant Streptococcus pneumoniae, FRPM demonstrated more potent antibacterial activity than the oral penicillins and cephems tested here except cefditoren . Clinical efficacies was deemed effective in all of the 4 cases, and bacteriologically, 3 organisms were eradicated . As for side effects including diarrhea and loose stool, no serious side effects were observed . Based on the above results, FRPM is effective against most infections in the pediatric field which Streptococcus pneumoniae are isolated at high frequencies highly, and is considered to cases in be useful an attention will have to be paid to stool movement, however.

Ir J Med Sci, 1997 Oct-Dec, 166(4), 231 - 4
Acute bacterial meningitis in adults: analysis of 218 episodes; Hosoglu S et al.; A retrospective study was conducted to examine the laboratory, clinical features and outcome of 206 adult acute bacterial meningitis patients (218 episodes) during the years 1985-1996 . Pneumonia (8.7 per cent), head trauma (7.8 per cent) and chronic otitis media (6.0 per cent) were identified as the main predisposing factors for acute bacterial meningitis . Aetiology was described only in 61 episodes (28.0 per cent) . Streptococcus pneumonia was the most commonly identified pathogen overall, causing 33 of the 218 episodes (15.2 per cent) . Antibiotic treatment before admission was given to 48.4 per cent of patients . On admission, the following symptoms of meningitis were predominant: 83 per cent had neck stiffness, 81 per cent had a headache and 73 per cent had fever . Case fatality rate was 27.1 per cent (59 patients) . The important factors in mortality were as follows: old age, a long duration of symptoms before admission, a lack of neck stiffness, obtunded mental state on admission, low glucose levels in first CSF, low CSF/blood glucose ratio, and abnormality in computerised tomography scanning.

Infect Immun, 1997 Dec, 65(12), 5103 - 9
Oligoclonality of serum immunoglobulin G antibody responses to Streptococcus pneumoniae capsular polysaccharide serotypes 6B, 14, and 23F; Lucas AH et al.; Serum antibodies (Abs) specific for the capsular polysaccharides of Streptococcus pneumoniae provide protection against invasive pneumococcal disease . Previous studies indicate that Abs to pneumococcal polysaccharide (PPS) serotypes 1 and 6B have limited clonal diversity . To determine if restricted diversity was a feature common to other PPS specificities, we examined the light (L)-chain expression and isoelectric heterogeneity of type 6B, 14, and 23F Abs elicited in 15 adults following PPS vaccination . At the population level, both PPS-6B and PPS-14 Abs expressed kappa and lambda chains, although 6B Abs more frequently expressed lambda chains lambda and 14 Abs more frequently expressed kappa chains . In individual sera, Abs were generally skewed towards either kappa or lambda expression . 23F-specific Abs had predominantly kappa chains . Isoelectric focusing analyses showed that sera contained one or at most a few immunoglobulin G Ab spectrotypes to all three respective capsular serotypes, a result indicative of oligoclonality . A sequence analysis of a purified PPS-14-specific Ab having a single spectrotype gave uniform amino-terminal sequences for both the heavy chain (V(H)III subgroup) and the L chain (kappaIII-A27 V region) . From these results we conclude that within individual adults, serum Ab responses to PPS serotypes 6B, 14, and 23F derive from a small number of dominant B-cell clones, and consequently variable-region expression is probably individually limited as well . Oligoclonality appears to be a general characteristic of human PPS-specific Ab repertoires, and we suggest that this property could lead to individual differences in Ab fine specificity and/or functional activity against encapsulated pneumococci.

Infect Immun, 1997 Dec, 65(12), 5042 - 51
A specific cell surface antigen of Streptococcus gordonii is associated with bacterial hemagglutination and adhesion to alpha2-3-linked sialic acid-containing receptors; Takahashi Y et al.; A Ca2+-independent lectin activity for alpha2-3-linked sialic acid-containing receptors is associated with Streptococcus gordonii DL1 (Challis) but not with a spontaneous mutant, strain D102, that specifically lacks hemagglutinating activity . Comparison of crossed-immunoelectrophoresis patterns of parent and mutant sonicated cell extracts identified a unique antigen (Hs antigen) in the parent cell extract that was purified by DEAE Sephacel column chromatography and by a wheat germ agglutinin (WGA) lectin affinity column . The purified antigen formed a single arc in crossed immunoelectrophoresis with anti-DL1 serum and migrated as a diffuse band above the 200-kDa marker in sodium dodecyl sulfate-polyacrylamide gel electrophoresis . Immunoelectron microscopy with specific anti-Hs antibody revealed labeling of structures in the fibrillar layer of strain DL1 and no labeling of fibrillar structures on strain D102 . Rabbit anti-DL1 serum and anti-Hs Fab inhibited the hemagglutinating activity of strain DL1, and the inhibition was specifically neutralized by purified Hs antigen . Anti-Hs Fab did not inhibit the hemagglutinating activities of several heterologous S . gordonii strains; however, these bacteria were agglutinated by anti-Hs immunoglobulin G and also by WGA . In contrast, two S . gordonii strains that lacked hemagglutinating activity did not react with anti-Hs antibody or with WGA . These findings associate the sialic acid-binding lectin activity of S . gordonii DL1 with a specific fibrillar antigen, which is composed of protein and WGA reactive carbohydrate, and indicate that cross-reactive antigens occur on other strains of this species that possess hemagglutinating activity.

J Ark Med Soc, 1997 Nov, 94(6), 263 - 6
The approach to treatment of invasive pneumococcal disease in the 1990s; Knapp KM et al.; Streptococcus pneumoniae is the most common cause of pediatric invasive infections and an important cause of morbidity and mortality . In the past, S . pneumoniae responded universally to penicillin until nonsusceptible isolates were first noted in the 1960s . Before 1990, penicillin-nonsusceptible isolates remained a minor component of all reported isolates . Since that time, 20-30% of isolates in many centers in the United States and up to 50% of isolates in some other countries are penicillin-nonsusceptible . Of greater concern has been the development of isolates which are nonsusceptible to more than one antimicrobial agent . This review presents data on pediatric invasive pneumococcal disease in Arkansas and outlines the new treatment recommendations which have been developed in response to these problems . Streptococcus pneumoniae is an important pathogen worldwide and is considered the most common etiology of bacterial sinusitis, otitis media, pneumonia, meningitis and bacteremia . Before 1990, 95-96% of pneumococcal isolates were susceptible to penicillin . The first report of penicillin-nonsusceptible S . pneumoniae was made by Hansman and Bullen in 1967, who identified the strain in the sputum of a patient with hypogammaglobulinemia . Soon thereafter, penicillin-nonsusceptible pneumococci were reported in New Guinea and Australia as well . Over the last several years, the incidence of penicillin-nonsusceptible isolates has greatly increased . Of particular concern is the concomitant increase in the number of organisms that are nonsusceptible to more than one antimicrobial agent . Due to the development of such isolates, clinicians are having to approach patients with invasive disease due to pneumococci more cautiously . In an attempt to clarify confusion with terminology, the Centers for Disease Control and Prevention (CDC) have recommended the same nomenclature be used to classify resistance for all organisms: nonsusceptible organisms are those with an MIC (minimal inhibitory concentration) greater than or equal to that defined for the intermediate category of resistance and the term resistant should be reserved for those organisms with an MIC greater than or equal to that defined for the resistant category . Therefore, resistant isolates are a subgroup of the nonsusceptible isolates.

Eur Respir J, 1997 Oct, 10(10), 2423 - 4
Pneumococcal spherical pneumonia multiply distributed in one lung; Katsumura Y et al.; Spherical pneumonia, which is seen more frequently in children than in adults, is usually manifested as a solitary nodule . We report the case of a middle-aged man with small spherical pneumonia, with multiple distribution in the right lung, caused by Streptococcus pneumoniae . This type of pneumonia is very unusual and should be included in the differential diagnosis of multiple nodular densities of the lung.

Microbiology, 1997 Nov, 143 ( Pt 11), 3607 - 14
Characterization and protective activity of a monoclonal antibody against a capsular epitope shared by Streptococcus suis serotypes 1, 2 and 1/2; Charland N et al.; A monoclonal antibody (mAb Z3) was produced using BALB/c mice immunized with whole cells of Streptococcus suis serotype 2 reference strain S735 . Screening by dot-ELISA showed that mAb Z3, of isotype IgG2b, reacted only with reference strains and field isolates of S . suis serotypes 1, 2 and 1/2 . The recognized epitope was demonstrated to be polysaccharide in nature by periodate oxidation, and located in the capsule, since mAb Z3 reacted with purified capsular material by immunoblotting and was able to stabilize the capsule as shown by electron microscopy . Further characterization indicated that mAb Z3 may react specifically with the sialic acid moiety of the capsule, a common constituent of the polysaccharidic capsular material of the three capsular types, since sialidase-treated cells did not react with mAb Z3 in immunoblotting or indirect ELISA . Purified mAb Z3 was shown to significantly increase the rate of phagocytosis of S . suis cells by porcine monocytes and to activate the clearance of bacteria from the circulation in experimentally infected mice . However, mAb Z3 only offered partial protection to mice challenged with a minimal lethal dose . Thus, even though the capsule of S . suis seems to be an important virulence factor, the epitope recognized by mAb Z3 does not appear to be involved in complete protection against infection.

Microbiology, 1997 Nov, 143 ( Pt 11), 3491 - 500
Identification of staphylococcal and streptococcal causes of bovine mastitis using 16S-23S rRNA spacer regions; Forsman P et al.; Bovine mastitis is caused mainly by certain Staphylococcus and Streptococcus species . The sequences of the 16S-23S rRNA spacer regions were determined for the nine species which cause mastitis: Staphylococcus aureus, Staphylococcus chromogenes, Staphylococcus epidermidis, Staphylococcus hyicus, Staphylococcus simulans, Staphylococcus xylosus, Streptococcus agalactiae, Streptococcus dysgalactiae and Streptococcus uberis . Significant variation was found between the spacer sequences of different species with the lengths of the spacers varying from 240 to 461 bp . Between genera the spacers shared only short conserved regions (8-9 bp) and within genera the sequence identities varied from 53 to 85% . This variation made it possible to construct specific primer pairs for these species and genera . The specificities of these primers were tested with 25 bacterial species and 51 isolates from cattle with clinical mastitis . The DNA-based identification of the mastitis species was mostly successful.

Otolaryngol Head Neck Surg, 1997 Nov, 117(5), 475 - 9
Nebulized surfactant for experimentally induced otitis media with effusion; Nemechek AJ et al.; Eustachian tube dysfunction frequently results in clinical evidence of otitis media with effusion (OME) . Surface active substances, surfactants, are hypothesized to play a role in normal eustachian tube function . Recent work in a rodent model has demonstrated improved eustachian tube function with topical application of surfactants to the middle ear . A novel, noninvasive, and clinically practical method of delivering surfactant to the eustachian tube was studied in a gerbil model of OME . Otitis media with effusion was experimentally induced in 20 gerbils by transtympanic inoculation of heat-killed Streptococcus pneumoniae . This represents a well established model for creating a serous effusion in the gerbil that significantly increases eustachian tube opening pressure . Effusion developed in 27 of 40 ears (67.5%) after inoculation . An inhaled nebulized surfactant was used to treat the animals with microscopically confirmed OME in one or both ears . The treatment period was 5 days . Eustachian tube opening studies were performed on both affected and nonaffected animals . Successful eustachian tube opening pressures were obtained in 30 of 36 ears (83.3%) . The mean opening pressure for ears without effusion (healthy ears) was 42.8 mmHg . The mean opening pressure for ears with effusion in animals treated with nebulized surfactant was 41.4 mmHg . The difference between these mean values was not statistically significant (t = 0.32; p > 0.50) . This pilot study suggests that inhaled nebulized surfactant may be efficacious in treating eustachian tube dysfunction when manifested in disorders such as OME.

Antimicrob Agents Chemother, 1997 Nov, 41(11), 2414 - 7
Pharmacodynamics and bactericidal activity of ceftriaxone therapy in experimental cephalosporin-resistant pneumococcal meningitis; Lutsar I et al.; Adequate concentrations of beta-lactam antibiotics in cerebrospinal fluid (CSF) are difficult to achieve for meningitis caused by drug-resistant Streptococcus pneumoniae . Ceftriaxone in dosages of 150 or 400 mg/kg of body weight per day, given in one or two doses, was used for the treatment of experimental highly cephalosporin-resistant (MIC and MBC, 4 microg/ml) pneumococcal meningitis . The bacterial killing rate (delta log10 CFU per milliliter per hour) and pharmacokinetic indices, including percentage of time the antibiotic concentration exceeded the MBC during a 24-h period (T>MBC), CSF peak concentration above the MBC, and area under the concentration-time curve from 0 to 24 h above MBC, were measured and correlated . By multiple stepwise regression, only T>MBC independently predicted the bacterial killing rate . There was a direct linear correlation between T>MBC in CSF and the bacterial killing rate during the first 24 h of therapy (r = 0.87; P = 0.004) . Sterilization of CSF was achieved only when the T>MBC was 95 to 100% . In the first 24 h, the 200-mg/kg/12-h regimen, compared with the 400-mg/kg/24-h regimen, was associated with a greater T>MBC (87% +/- 10% versus 60% +/- 22%; P = 0.03) and greater bacterial killing rate (0.2 +/- 0.04 versus 0.13 +/- 0.07; P = 0.003), confirming that ceftriaxone exhibits time-dependent bactericidal activity . After 24 h, the T>MBC and the CSF sterilization rates were similar whether ceftriaxone was given once or twice daily.

Antimicrob Agents Chemother, 1997 Nov, 41(11), 2406 - 13
Mutations in the dihydrofolate reductase gene of trimethoprim-resistant isolates of Streptococcus pneumoniae; Adrian PV et al.; Streptococcus pneumoniae isolates resistant to several antimicrobial agent classes including trimethoprim-sulfamethoxazole have been reported with increasing frequency throughout the world . The MICs of trimethoprim, sulfamethoxazole, and trimethoprim-sulfamethoxazole (1:19) for 259 clinical isolates from South Africa were determined, and 166 of these 259 (64%) isolates were resistant to trimethoprim-sulfamethoxazole (MICs > or =20 mg/liter) . Trimethoprim resistance was found to be more strongly correlated with trimethoprim-sulfamethoxazole resistance (correlation coefficient, 0.744) than was sulfamethoxazole resistance (correlation coefficient, 0.441) . The dihydrofolate reductase genes from 11 trimethoprim-resistant (MICs, 64 to 512 microg/ml) clinical isolates of Streptococcus pneumoniae were amplified by PCR, and the nucleotide sequences were determined . Two main groups of mutations to the dihydrofolate reductase gene were found . Both groups shared six amino acid changes (Glu20-Asp, Pro70-Ser, Gln81-His, Asp92-Ala, Ile100-Leu, and Leu135-Phe) . The first group included two extra changes (Lys60-Gln and Pro111-Ser), and the second group was characterized by six additional amino acid changes (Glu14-Asp, Ile74-Leu, Gln91-His, Glu94-Asp, Phe147-Ser, and Ala149-Thr) . Chromosomal DNA from resistant isolates and cloned PCR products of the genes encoding resistant dihydrofolate reductases were capable of transforming a susceptible strain of S . pneumoniae to trimethoprim resistance . The inhibitor profiles of recombinant dihydrofolate reductase from resistant and susceptible isolates revealed that the dihydrofolate reductase from trimethoprim-resistant isolates was 50-fold more resistant (50% inhibitory doses {ID50s}, 3.9 to 7.3 microM) than that from susceptible strains (ID50s, 0.15 microM) . Site-directed mutagenesis experiments revealed that one mutation, Ile100-Leu, resulted in a 50-fold increase in the ID50 of trimethoprim . The resistant dihydrofolate reductases were characterized by highly conserved redundant changes in the nucleotide sequence, suggesting that the genes encoding resistant dihydrofolate reductases may have evolved as a result of inter- or intraspecies recombination by transformation.

Dis Colon Rectum, 1997 Nov, 40(11), 1386 - 90
Toxic shock syndrome and necrotizing fasciitis complicating neglected sacrococcygeal pilonidal sinus disease: report of a case; Velitchkov N et al.; PURPOSE: This study was conducted to report the rare combination of necrotizing fasciitis and toxic shock syndrome, which both complicated neglected sacrococcygeal pilonidal sinus disease . METHODS: A case report is presented . RESULTS: We describe the rare case of a previously healthy adult male patient who developed necrotizing fasciitis and toxic shock syndrome associated with Streptococcus pyogenes and Bacteroides fragilis . Patient's response to emergency surgery followed by repeated debridements of necrotic tissue, together with aggressive fluid resuscitation, broad-spectrum antibiotic coverage, and hyperbaric oxygenation was good . CONCLUSION: This case serves again as a clear reminder that neglected pilonidal sinus disease can lead to unusual and life-threatening consequences.

FEMS Microbiol Lett, 1997 Nov 1, 156(1), 161 - 4
Induction of surface-associated proteins of Streptococcus uberis by cultivation with extracellular matrix components and bovine mammary epithelial cells; Gilbert FB et al.; Surface-associated protein expression by Streptococcus uberis was influenced by the presence of collagen, laminin and bovine mammary epithelial cells in the culture medium . After electrophoresis and silver staining, four proteins stained more intensively in samples from S . uberis cultivated with epithelial cells and extracellular matrix components than in samples from S . uberis cultivated alone . Induction of these proteins was more obvious after multiple bacterial passages . The correlation between the phenotype of S . uberis and its potential virulence status as illustrated by an immunoblotting study with sera obtained from infected cows revealed that these proteins are probably expressed in vivo during infection.

Pediatr Neurol, 1997 Sep, 17(2), 144 - 9
Risk factor of complications requiring neurosurgical intervention in infants with bacterial meningitis; Chang YC et al.; Among 50 consecutive cases of bacterial meningitis in infants aged 6 months or less, 9 (Group I) were confirmed to have complications requiring neurosurgery during the first 2 weeks of antibiotic treatment . Neurosurgery was performed in 40, 33, and 30% of cases caused by Streptococcus pneumoniae, Pseudomonas aeruginosa, and Escherichia coli, respectively . There were 5 cases of subdural empyema, 1 case of brain abscess, 1 case of subdural empyema and brain abscess, and 2 cases of ventriculitis with severe hydrocephalus . All complications requiring neurosurgery were initially detected by cranial ultrasonography . The other 41 patients who did not undergo neurosurgery were classified as Group II . Comparison of clinical presentations and laboratory findings between the two groups showed that Group 1 contained more patients with a history of inadequate treatment, and longer duration of illness before diagnosis . Except for prolonged disturbance of consciousness, there was no difference between the two groups in clinical and laboratory data on admission or in clinical course during therapy . Due to the high incidence of complications requiring neurosurgical treatment, cost-effective cranial ultrasound is recommended for screening every young infant with bacterial meningitis, especially in cases caused by S . pneumoniae.

Mol Microbiol, 1997 Sep, 25(5), 819 - 29
Contribution of novel choline-binding proteins to adherence, colonization and immunogenicity of Streptococcus pneumoniae; Rosenow C et al.; The surface of Streptococcus pneumoniae is decorated with a family of choline-binding proteins (CBPs) that are non-covalently bound to the phosphorylcholine of the teichoic acid . Two examples (PspA, a protective antigen, and LytA, the major autolysin) have been well characterized . We identified additional CPBs and characterized a new CBP, CbpA, as an adhesin and a determinant of virulence . Using choline immobilized on a solid matrix, a mixture of proteins from a pspA-deficient strain of pneumococcus was eluted in a choline-dependent fashion . Antisera to these proteins passively protected mice challenged in the peritoneum with a lethal dose of pneumococci . The predominant component of this mixture, CbpA, is a 75-kDa surface-exposed protein that reacts with human convalescent antisera . The deduced sequence from the corresponding gene showed a chimeric architecture with a unique N-terminal region and a C-terminal domain consisting of 10 repeated choline-binding domains nearly identical to PspA . A cbpA-deficient mutant showed a >50% reduction in adherence to cytokine-activated human cells and failed to bind to immobilized sialic acid or lacto-N-neotetraose, known pneumococcal ligands on eukaryotic cells . Carriage of this mutant in an animal model of nasopharyngeal colonization was reduced 100-fold . There was no difference between the parent strain and this mutant in an intraperitoneal model of sepsis . These data for CbpA extend the important functions of the CBP family to bacterial adherence and identify a pneumococcal vaccine candidate.

Acta Paediatr Jpn, 1997 Oct, 39(5), 546 - 9
Minimization of the number of pregnant women to be treated with preventive procedure against GBS infection by means of antibody measurement . GBS Infection Group; Hoshina K; To study preventive strategies, it is essential to screen pregnant women having group B Streptococcus (GBS) infection in the birth canal . For the purpose of studying preventive measures against this infection, nationwide multicenter research was performed in GBS-carrying pregnant women . Of a total of 10,267 pregnant women, 1860 cases (18.1%) had GBS . The most common serotypes of detected GBS were type NT6 and JM9, followed by type III, type Ia and then type Ib . Type-specific antibody titer was below the cut-off point of 10 units/mL in 30.9% of Ia carriers, 58.5% of Ib carriers, 45.9% of II carriers and 32.9% of III carriers . Fortunately, no neonatal GBS infection occurred during this research . We concluded that 18.1% of studied pregnant women were GBS carriers and one-third of these GBS carriers required preventive procedures with antibody measurement.

Glycobiology, 1997 Oct, 7(7), 929 - 34
Structural aspects of glucans formed in solution and on the surface of hydroxyapatite; Kopec LK et al.; Streptococcus mutans glucosyltransferases (GtfB, -C, and -D) and their products formed from sucrose, glucans, play an essential role in the pathogenesis of dental caries . Enzymatically active Gtf is found in whole human saliva (solution), and incorporated into the salivary pellicle that is formed on teeth in vivo (surface) . GtfB glucans are predominantly 1,3-linked; however, surface-formed glucans from GtfB contain greater amounts of 3-linked glucose than glucans formed in solution . In contrast, the major linkage of glucans formed on the surface by GtfB in the presence of sucrose and starch hydrolysates in 4-linked glucose . GtfC-derived glucans in solution have a major linkage of 6-linked glucose, while surface-formed glucans from the same enzyme have 3-linked glucose as the major linkage . GtfD glucans formed either in solution or on the surface are predominantly 1,6-linked; however, surface-formed glucans contain more 6-linked glucose than solution-formed glucans . Digestion with the glucanohydrolases mutanase and dextranase shows differences in susceptibility among glucans formed either in solution or on the surface by each of the Gtf enzymes, and differences are also seen in the soluble end products from these digestions . Our results show that the same Gtf enzyme can form structurally distinct glucans in solution and on a surface . These observations are important in the study of naturally occurring microbial films.

Curr Opin Pulm Med, 1996 May, 2(3), 174 - 80
New pathogens for respiratory infections; Cosentini R et al.; The emergence of new pathogens and the increasing antimicrobial resistance patterns of old pathogens are contributing factors to the high epidemiologic impact of lower respiratory tract infections . Hantaviruses, Chlamydia pneumoniae, and penicillin-resistant Streptococcus pneumoniae have recently gained most of the attention of international researchers . Hantavirus pulmonary syndrome has been confirmed in 100 cases with a very high mortality (52%) . Risk factors for infection are peridomestic cleaning, agricultural activities, and an increased number of small rodents like deer mouse, mainly Peromyscus maniculatus . Pulmonary capillary leak and multiorgan involvement characterise Hantavirus pulmonary syndrome . Most recent reports rank C . pneumoniae among the three most common etiologic agents in community-acquired pneumonia, but it is also involved in chronic diseases such as chronic obstructive pulmonary disease and asthma . Several recent reports indicate the striking increase of penicillin-resistant S . pneumoniae strains . These data emphasize the crucial need for new therapeutic agents and more effective prevention programs.

Curr Opin Pulm Med, 1996 May, 2(3), 166 - 73
Pathogenesis of respiratory infections and host defenses; Zeiher BG et al.; At the cellular level, the respiratory tract has a variety of defense mechanisms to prevent bacterial infection . Recent data have demonstrated that the respiratory epithelium plays a very active role in host defense . In this review we start by examining the respiratory epithelia and its function in mucociliary clearance, and extend our review to include its role in the secretion and regulation of inflammatory cytokines and production of antimicrobial factors . Furthermore, we examine how recent advances in understanding cystic fibrosis have provided useful insights into the pathogenesis of lower respiratory tract infection . In addition, we examine how two common respiratory pathogens, Streptococcus pneumoniae and Pseudomonas aeruginosa, subvert the defense mechanisms at the cellular level . Finally, we attempt to identify new or potential therapeutic approaches that have arisen from some of the insights into the pathogenesis of lower respiratory tract infections.

Zentralbl Bakteriol, 1997 Oct, 286(3), 441 - 6
An outbreak of Streptococcus equi ssp . zooepidemicus infection of probable human origin in Wanderoos (Macaca silenus)--case report; Brack M et al.; Three out of ten young to adult wanderoos (M . silenus) of a breeding colony at the Rheine Zoo died within two days from a peracute illness, characterized by salivation, vomiting, apathy and minor CNS symptoms . Streptococcus equi ssp . zooepidemicus was isolated in pure cultures from all organs of two animals investigated bacteriologically . The strains were penicillin-susceptible, and penicillin treatment of all remaining animals cured two already sick animals and prevented further cases . A volunteer worker with upper respiratory disease was suspected as source of infection; contact with equine materials and rodents could be excluded.

Zentralbl Bakteriol, 1997 Oct, 286(3), 421 - 33
Streptococcal pyrogenic exotoxin A, streptolysin O, exoenzymes, serotype and biotype profiles of Streptococcus pyogenes isolates from patients with toxic shock syndrome and other severe infections; Muller-Alouf H et al.; The determination of protein M and T serotypes, biotypes and pyrogenic (erythrogenic) exotoxin A (SPE A), streptolysin O (SLO), streptokinase (SK), hyaluronidase (HA) and cysteine proteinase release by 212 S . pyogenes isolates from patients with severe invasive group A streptococcal (GAS) infections, among them 74 cases of streptococcal toxic shock syndrome (STSS) has been investigated . M1 or M3 serotypes were expressed by 25% of the isolates (53/212), whereas 59% (125/212) belonged to 15 other different serotypes and 16% (34/212) were untypeable . Of the 74 isolates from STSS patients, 42% (31/74) expressed M1 and to a lesser extent M3 serotypes versus 19% of the non STSS isolates (26/138) . Among the ten different biotypes known, biotypes 1 and 3 were prevalent, particularly the former in the case of STSS isolates . SPE A was detectably produced by about 25% (54/212) of the strains . However, as high as 40.5% of the STSS isolates (30/74) versus 17.4% of non STSS isolates (24/138) released SPE A . Moreover, 67% of the SPE A producing strains were of serotype M1 or M3 . SK and HA were released by 71% and 10% of the isolates respectively . All strains released SLO (4 to 256 HU/ml) and 85% cysteine proteinase . No relationship between toxin or enzyme titer and the type of disease or clinical origin of the strains was found . Culture supernatants of all isolates showed moderate to high lymphocyte transforming activity with index values ranging from 14.5 to 50.3 including those strains which did not release detectable amounts of SPE A suggesting that SPE C and other mitogenic factor(s) are released by the isolates investigated.

J Dairy Sci, 1997 Oct, 80(10), 2592 - 8
Bovine mastitis pathogens in New York and Pennsylvania: prevalence and effects on somatic cell count and milk production; Wilson DJ et al.; Milk samples were collected from 108,312 dairy cows during 1601 farm visits made between January 1991 and June 1995 . The herd visits were made by personnel from the Central Laboratory of the Quality Milk Promotion Services at Cornell University (Ithaca, NY) to farms located in central New York and northern Pennsylvania . Dairy Herd Improvement Association records were available for 32,978 cows in 327 herds . Intramammary infections, as defined by positive milk cultures, were present in 48.5% of all cows and in 36.3% of cows in herds enrolled in the Dairy Herd Improvement Association . Over 75% of the intramammary infections were caused by Streptococcus agalactiae, Streptococcus spp . other than Strep . agalactiae, Staphylococcus aureus, and coagulase-negative staphylococci . Mean days in milk at the time of diagnosis, linear score of the somatic cell count, cost of milk loss per lactation, and milk production effects were calculated for 24 etiologic agents of bovine mastitis.

J Infect Dis, 1997 Nov, 176(5), 1401 - 5
BOX-polymerase chain reaction-based DNA analysis of nonserotypeable Streptococcus pneumoniae implicated in outbreaks of conjunctivitis; Ertugrul N et al.; Nonserotypeable isolates predominate in epidemic conjunctivitis caused by Streptococcus pneumoniae . Previous evaluations of outbreaks of pneumococcal conjunctivitis have relied on epidemiologic factors and the nontypeability of the isolates to infer that a single clone was involved . In the present study, BOX-polymerase chain reaction DNA analysis was used to characterize nonserotypeable S . pneumoniae isolated by conjunctival culture during a recent conjunctivitis outbreak and to compare these isolates with those from outbreaks described earlier . The recent outbreak was caused by a single pneumococcal clone . Outbreaks in separate parts of the United States in 1980-1981 were all caused by the same clone . Cluster analysis revealed a high degree of genetic relatedness among isolates causing conjunctivitis compared with that among other nonserotypeable S . pneumoniae, with the closest relatedness being found among the 1996 and 1980-1981 conjunctival isolates.

J Nurse Midwifery, 1997 Sep-Oct, 42(5), 410 - 3
Patient preference for self-collected cultures for group B streptococcus in pregnancy; Taylor MC et al.; To determine pregnant women's preference for self-culture technique, 251 women between 24 and 42 weeks' gestation were interviewed after performing self-collected cultures (vaginal and rectal) for group B streptococcus . Patient receptiveness to self-culture, the ability to perform self-culture, and the desire for choice in the future were derived using the Patient Preference Tool . The majority of women (77%, n = 194) gave positive descriptions of self-culture technique, and the majority of women preferred self-culture technique over nurse-collected sampling (57%, n = 142) . Seventy-nine percent (n = 197) stated their desire to have a choice about self-culture in the future when similar testing was needed, and 89% (n = 224) believed that other women would also like this choice . Additionally, patient samples were highly correlated with nurse-collected samples for accuracy of culture results . This study provides data supporting that women desire active participation in their care.

Clin Infect Dis, 1997 Oct, 25(4), 819 - 23
Streptococcus bovis infection of the central nervous system: report of two cases and review; Cohen LF et al.; Streptococcus bovis is an uncommon cause of meningitis and subdural empyema . We report one case each of meningitis and subdural empyema in which S . bovis biotype II was isolated from both the spinal fluid and blood . In one case, the organisms were seen on a gram-stained preparation of cerebrospinal fluid . The first patient presented with gastrointestinal symptoms of unknown etiology, was immunosuppressed, and recovered . The second patient presented with syncope, developed a subdural empyema, and died; at autopsy, a colonic adenoma was found . A review of the English-language literature revealed only 14 previously reported cases of meningitis due to S . bovis and no cases of subdural empyema due to S . bovis . These cases indicate the importance of complete laboratory identification of specific organisms and confirm the need for a thorough neurological examination and search for underlying gastrointestinal disease in cases of S . bovis infection.

Am J Clin Nutr, 1997 Nov, 66(5), 1257 - 63
A cross-sectional study of dental caries, intake of confectionery and foods rich in starch and sugars, and salivary counts of Streptococcus mutans in children in Spain; Garcia-Closas R et al.; In this cross-sectional study of 236 schoolchildren living in Manresa, Spain, we evaluated the association between prevalence of dental caries and frequency of consumption of various food groups, including sweetened baked goods and similar foods (rich in starch and sugars) and confectionery (rich in sugars but not starch), using a food-frequency questionnaire . Because Streptococcus mutans is associated with the cariogenicity of carbohydrates, we also evaluated the modification of these associations by salivary counts of this microorganism . Odds ratios (ORs) were used to measure the association between caries and tertiles of consumption . Sex, age, use of fluorides, tooth-brushing frequency, frequency of dental visits, socioeconomic status, and intake of other potentially cariogenic food groups were considered as potential confounders . We did not find a significant association between any of the food groups evaluated and caries prevalence . Failure to detect an association could have been due to the low prevalence of caries in our population (decayed, missing, or filled permanent teeth = 1.3 at age 10.6 y) or to underestimation of the association due to diet misclassification . In this population, the association between consumption of sweetened baked goods and caries appeared to be modified by the numbers of S . mutans {OR = 6.1 (95% CI: 1.6, 23.0) for low compared with high intake in children with moderate-to-high S . mutans counts and OR = 0.3 (95% CI: 0.1, 1.6) for low compared with high intake in children with low S . mutans counts} . These results suggest that a high intake of sweetened baked goods may be a determinant of caries prevalence in children with moderate-to-high salivary counts of S . mutans.

Biochem J, 1997 Oct 1, 327 ( Pt 1), 65 - 71
Specificity of the hyaluronate lyase of group-B streptococcus toward unsulphated regions of chondroitin sulphate; Baker JR et al.; The purification and properties of a hyaluronate lyase secreted by Streptococcus agalactiae, which is believed to facilitate the invasion of host tissues by the organism, have been described previously {Pritchard, Lin, Willingham and Baker (1994) Arch . Biochem . Biophys . 315, 431-436} . The specificity of the limited cleavage of chondroitin sulphate by the enzyme is the subject of this report . To simplify the task, a chondroitin sulphate from the Swarm rat chondrosarcoma, which contains only 4-sulphated and unsulphated disaccharide repeats, was used in this study . Tetrasaccharides from an ovine testicular hyaluronidase digest of the chondroitin sulphate were isolated, identified and tested as substrates of the streptococcal hyaluronate lyase . Only tetrasaccharides with an unsulphated disaccharide at the reducing end were cleaved (by elimination at the N-acetylgalactosaminidic bond) . Thus chondroitin sulphate chains are cleaved by the action of this lyase at every unsulphated disaccharide repeat, but release of unsaturated unsulphated disaccharides only occurs from sites where two or more sequential unsulphated disaccharide repeats are present . Analysis of the chondrosarcoma chondroitin sulphate showed that of approximately five unsulphated disaccharide repeats per chain, two are clustered . The ability of group-B streptococcal hyaluronate lyase to cleave chondroitin sulphate may allow the organisms to invade tissues more efficiently . The demonstrated specific and highly limited cleavage of chondroitin sulphate by this bacterial lyase promises to be a useful tool in the determination of chondroitin sulphate structure and variability.

J Infect, 1997 Sep, 35(2), 197 - 8
Penicillin-resistant Streptococcus pneumoniae isolated in Barbados; Levett PN et al.; An imported case of pneumonia caused by penicillin-resistant Streptococcus pneumoniae occurred in a tourist, shortly after arriving in Barbados . The isolate was of serogroup 6 and exhibited intermediate resistance to penicillin . This was the first isolation of penicillin-resistant S . pneumoniae in Barbados.

J Nihon Univ Sch Dent, 1997 Sep, 39(3), 154 - 5
Arg-Gly-Asp(RGD) peptides inhibit Streptococcus mitis to adhere to fibronectin; Sugano N et al.; Fibronectin (Fn) is a multifunctional adhesive protein found on cell surfaces as well as in plasma . It is also believed to play an important role in bacterial adherence to host tissues . Molecular analyses of Fn have shown that the amino acid triplet arginine-glycine-aspartic acid (RGD) sequence functions as a binding site . We examined the role of the RGD sequence on bacterial adherence to Fn . The pretreatment of Streptococcus mitis with synthetic RGD-containing peptide reduced the number of bound bacteria to the Fn coated plates by 76% . In contrast, a control peptide containing the RGE sequence showed no inhibition . These data indicate that synthetic RGD peptides may be useful for the inhibition of bacterial adherence to Fn on host cell surfaces.

J Nihon Univ Sch Dent, 1997 Sep, 39(3), 136 - 41
Anti-bacterial action of onion (Allium cepa L.) extracts against oral pathogenic bacteria; Kim JH; In this study, the focus was on the antibacterial activity of onions . This study researched the activities of onion extracts on Streptococcus mutans and Streptococcus sobrinus, the main causal bacteria for dental caries, and Porphyromonas gingivalis and Prevotella intermedia, considered to be the main causal bacteria of adult periodontitis . The results showed that the onion extracts possess an effect on all test bacterial strains (S.mutans JC-2, S . sobrinus OMZ176, P . gingivalis ATCC 33277 and P . intermedia ATCC 25611), and the effects were bactericidal against cultured and resting bacterial cells . The activity of the onion extracts was stable even after 48 hours in the culture medium . This result suggests that no decomposition or volatility of onion extracts occurred in the culture medium . The antibacterial activity of onion extracts was not markedly influenced by cysteine (10 mM) treatment . However, activity significantly decreased with alkali treatment . Grated onion left to stand at 37 degrees C for 48 hours did not show antibacterial activity . Also, activity of steam treated (100 degrees C, 10 min.) onion was not observed . Using avicel plate by thin layer chromatography with the solvent of n-butanol:acetic acid:water (3:3:1), the main component of the substance (the substance which develops color with ninhydrin) was observed at an Rf value of about 0.9.

Caries Res, 1997, 31(6), 457 - 62
Protective effect of hexetidine against in vitro bacterial demineralisation of bovine enamel and dentin in the presence of fluoride; Chmelarova R et al.; Bovine enamel and dentin specimens were overlaid with acidogenic Streptococcus mutans suspensions in agarose . In this model, the minimal demineralisation-inhibiting concentrations (MDIC) of hexetidine was determined in the presence of fluoride . A commercially available mouthwash containing 0.1% (2.9 mmol/l) hexetidine was diluted serially and added to the bacterial suspensions together with 0, 5.3, or 26.3 mumol/l fluoride (NaF) . After 22 h of incubation at 37 degrees C the bacterial suspensions were removed and assessed for calcium and lactate . The results showed significant inhibitory effects of hexetidine on the demineralisation of the enamel specimens with a MDIC between 15 and 31 mumol/l hexetidine . In the presence of fluoride, approximately fourfold higher concentrations of hexetidine were needed for a significant additional protection of the enamel . No synergistic effect between hexetidine and fluoride was observed . For the demineralisation of the dentin specimens, the MDIC of hexetidine had a value between 31 and 61 mumol/l . At both these concentrations the dentin specimens were relatively less protected in the presence than in the absence of fluoride, and some synergistic effect between hexeditine and fluoride was observed.

Caries Res, 1997, 31(6), 429 - 33
Effectiveness of calcium lactate added to food in reducing intraoral demineralization of enamel; Kashket S et al.; Following the demonstration that rinses with solutions of soluble calcium salts reduced sucrose-induced demineralization, a study was undertaken to determine whether a similar effect could be obtained by the supplementation of a solid food with calcium lactate (CL) . Subjects wore palatal appliances containing blocks of bovine enamel that were coated with Streptococcus mutans IB 1600 and ate 5-gram portions of cookies made with defined levels of CL . Determinations were made of changes in iodide penetrability (delta Ip) of the enamel, as well as the pH, calcium and inorganic phosphate of the streptococcal plaque . CL at 3.2% (w/w) reduced delta Ip from 12.9 +/- 1.7 to 6.1 +/- 0.9 units, i.e . by 52.7% . Plaque pH was not affected . Demineralization was reduced progressively with increasing concentrations of added CL, and CL was most effective with increasingly sweet cookies . Plaque contained 32.4 +/- 6.0 and 17.1 +/- 4.2 mM calcium after 1 and 5 min, respectively . Calculations showed that the plaque was saturated with respect to enamel during the first 5-10 minutes after food ingestion, in spite of the progressive drop in plaque pH . In conclusion, the present study demonstrated the reduction of the cariogenic potential of solid food by relatively low concentrations of CL . The effect appeared to be related to the ability of the food to maintain high levels of calcium in the streptococcal plaque during the period of active acidogenesis.

Infect Immun, 1997 Nov, 65(11), 4725 - 33
Exclusion of bioactive contaminations in Streptococcus pyogenes erythrogenic toxin A preparations by recombinant expression in Escherichia coli; Fagin U et al.; The streptococcal erythrogenic exotoxin A (SPEA) belongs to the family of bacterial superantigens and has been implicated in the pathogenesis of a toxic shock-like syndrome and scarlet fever . Concerning its biological activity, mainly T-cell-stimulatory properties, conflicting data exist . In this study, we show that most of the SPEA preparations used so far contain biologically active contaminations . Natural SPEA from the culture supernatant of Streptococcus pyogenes NY-5 and recombinant SPEA purified from the culture filtrate of S . sanguis are strongly contaminated with DNases . We show that natural SPEA induces more tumor necrosis factor alpha (TNF-alpha) than recombinant SPEA, but we also show that DNases are able to induce TNF-alpha . In commercial SPEA preparations, we identified a highly active protease, which was shown not to be SPEB . To exclude these contaminations, we overexpressed SPEA cloned in the effective high-level expression vector pIN-III-ompA2 in Escherichia coli . The expressed SPEA shows the same amino acid composition as natural SPEA, whereas functional studies reported so far were carried out with toxins containing an incorrect amino terminus . We describe the rapid purification of lipopolysaccharide-, DNase-, and protease-free SPEA in two steps from the host's periplasm and its structural characterization by circular dichroism . Our results represent for the first time the production in E . coli of recombinant SPEA with the authentic N-terminal sequence and a proven superantigenic activity . Collectively, our results indicate that immunological studies of superantigens require highly purified substances free of biologically active contaminations.

Infect Immun, 1997 Nov, 65(11), 4701 - 4
Development of a model of low-inoculum Streptococcus pneumoniae intrapulmonary infection in infant rats; Saladino RA et al.; We have developed a model of low-inoculum Streptococcus pneumoniae infection in infant rats . We challenged 4-day-old Sprague-Dawley pups via intraperitoneal or intrapulmonary injection of S . pneumoniae serotypes 1, 3, 4, 5, 6b, 7f, 9v, 14, 19f, and 23f . To achieve bacteremia with low inocula, it was necessary to passage the isolates in rats . Inocula of the 10 S . pneumoniae serotypes producing bacteremia in 50% or more animals ranged from 1 to 400 CFU . Virulence was similar by intraperitoneal and intrapulmonary routes . Lung specimens from animals challenged by the intrapulmonary route grew S . pneumoniae and demonstrated histologic evidence of focal infection . Meningitis was detected in 20 to 50% of bacteremic animals, and mortality invariably followed bacteremia within 24 to 48 h . This model of intrapulmonary infection uses low inocula of S . pneumoniae and results in bacteremia, meningitis, and death in infant rats.

Infect Immun, 1997 Nov, 65(11), 4411 - 8
A role for pneumolysin but not neuraminidase in the hearing loss and cochlear damage induced by experimental pneumococcal meningitis in guinea pigs; Winter AJ et al.; We investigated the roles of pneumolysin and neuraminidase in the pathogenesis of deafness and cochlear damage during experimental pneumococcal meningitis . Anesthetized guinea pigs were inoculated intracranially with 7.5 log10 CFU of either (i) wild-type Streptococcus pneumoniae D39 (n = 8), (ii) PLN-A, a defined isogenic derivative of D39 deficient in pneumolysin (n = 5), or (iii) deltaNA1, a new derivative of D39 deficient in neuraminidase constructed by insertion-duplication mutagenesis of the nanA gene (n = 5) . To quantify hearing loss, the auditory nerve compound action potential evoked by a tone pulse was recorded from the round window membrane of the cochlea every 3 h for 12 h . The organ of Corti was intravitally fixed for subsequent examination by high-resolution scanning and transmission electron microscopy . All animals sustained similar meningeal inflammatory responses . PLN-A induced significantly less hearing loss than D39 over the frequency range of 3 to 10 kHz . Levels of mean hearing loss at 10 kHz 12 h postinoculation were as follows: D39, 50 dB; deltaNA1, 52 dB (P = 0.76 versus D39), and PLN-A, 12 dB (P < 0.0001 versus D39) . The mean rates of hearing loss at 10 kHz were 4.4 dB/h for D39, 4.3 dB/h for deltaNA1, and just 1.0 dB/h for PLN-A (P < 0.0001 versus D39) . Suppurative labyrinthitis was universal . PLN-A induced the accumulation of less protein in the cerebrospinal fluid (P = 0.04 versus D39) . Infection with D39 and deltaNA1 induced significant damage to the reticular lamina, the sensory hair cells, and supporting cells of the organ of Corti . By contrast, after infection with PLN-A, the organ of Corti appeared virtually intact . Pneumolysin seems to be the principal cause of cochlear damage in this model of meningogenic deafness . No clear pathogenic role was demonstrated for neuraminidase.

J Bacteriol, 1997 Nov, 179(21), 6837 - 42
Analysis of promoters in Borrelia burgdorferi by use of a transiently expressed reporter gene; Sohaskey CD et al.; A transient chloramphenicol acetyltransferase (CAT) expression system was developed for Borrelia burgdorferi . An Escherichia coli vector containing a promoterless Streptococcus agalactiae cat gene was constructed . Promoters for ospA, ospC, and flaB were placed upstream of this cat gene, and CAT assays were performed in E . coli from these stably maintained plasmids . The plasmids with putative promoters ospA and flaB were found to be approximately 20-fold more active than were the plasmids with ospC or no promoter . The level of activity correlated well with the resistance to chloramphenicol that each plasmid provided . Next, the nonreplicative plasmid constructs were transformed by electroporation into B . burgdorferi . CAT assays were performed by both thin-layer chromatography and the fluor diffusion method . Measurement of CAT activity demonstrated that the ospA promoter was again about 20-fold more active than the promoterless cat gene . The flaB and ospC promoters increased the activity seven- and threefold, respectively, over that with the promoterless construct . This simple transient-expression assay was shown to be an effective method to study promoter function in B . burgdorferi in the absence of a well-developed genetic system.

Microbiol Res, 1997 Sep, 152(3), 315 - 8
Laccase-catalyzed formation of cinnabarinic acid is responsible for antibacterial activity of Pycnoporus cinnabarinus; Eggert C; Concentrated culture fluid of the wood-rotting basidiomycete Pycnoporus cinnabarinus showed biological activity against a variety of bacterial strains . The maximal inhibitory effect was obtained for Gram-positive bacteria of the genus Streptococcus . In general, inhibition was higher for Gram-positive than Gram-negative bacteria . P . cinnabarinus produces the phenoxazinone derivative, cinnabarinic acid . This red pigment accumulates in sporocarps as well as in liquid cultures . As shown previously, laccase secreted by the fungus oxidizes the precursor 3-hydroxyanthranilic acid to cinnabarinic acid . The present study demonstrates that this reaction is necessary for the production of antibacterial compounds by the fungus . The biological activity of concentrated P . cinnabarinus culture fluid was nearly identical with that of cinnabarinic acid, synthesized by purified laccase in vitro.

Eur J Clin Microbiol Infect Dis, 1997 Sep, 16(9), 644 - 7
Pneumococcal resistance patterns in Europe; Pradier C et al.; The emergence of Streptococcus pneumoniae strains with decreased susceptibility to penicillin has been reported worldwide over the past 20 years . However, there are striking discrepancies in penicillin susceptibility among various European countries, suggesting that local conditions may affect clonal propagation or de novo selection of resistant strains . In the present study, data on penicillin resistance patterns, antibiotic use and mode of administration, and treatment compliance in five European countries (France, Spain, Germany, Italy, and the UK) were compared . High prevalence rates of penicillin-resistant pneumococci have been reported in Spain and France, where antibiotics are widely prescribed, and overall in Europe, patient compliance with more than 50% of oral antimicrobial prescriptions is inadequate . The low prevalence of penicillin resistance in Germany and the UK coincides with lower antibiotic consumption and better treatment compliance in these countries . Recent attempts to raise public awareness and to restrict and improve indications for antimicrobial agents have resulted in decreased pneumococcal resistance in Hungary and Iceland, suggesting that pneumococcal resistance can be reversed.

Am J Respir Crit Care Med, 1997 Oct, 156(4 Pt 1), 1235 - 40
Bacterial pneumonia causes augmented expression of the secretory leukoprotease inhibitor gene in the murine lung; Abe T et al.; The cDNA of murine secretory leukoprotease inhibitor (SLPI) was cloned from a mouse lung cDNA library . The amino acid sequence deduced from the cDNA showed 58 and 51% homology with those of human and porcine SLPI, respectively . A two-domain structure with similar amino acid sequences, four intradomain disulfide bonds, and high proline content, which are characteristics common to human and porcine SLPI, was also found in the mouse protein . The amino acid residues for the signal sequence and active site are also conserved in mouse SLPI . RNase protection assay showed the expression of the SLPI gene in liver, intestine, spleen, and epididymis, suggesting the distribution of SLPI in tissues other than lung and seminal vesicles . In the lung infected with Streptococcus pneumoniae strain FP1284, 10 h after inoculation of bacteria the number of SLPI mRNA transcripts was three times higher than baseline . The increased level of expression remained constant for at least 48 h . This result clearly contrasts to that obtained for spleen, in which the SLPI mRNA transcript level was mostly unchanged during the course of pneumonia . These facts suggested the local regulation of the SLPI gene expression in vivo in response to inflammatory stimuli at the site of inflammation.

Gastrointest Endosc, 1997 Oct, 46(4), 321 - 3
Prospective study of bacteremia rate after elastic band ligation and sclerotherapy of esophageal varices in patients with hepatosplenic schistosomiasis; da Silveira Rohr MR et al.; BACKGROUND: Esophageal band ligation is considered to be as efficient as endoscopic sclerotherapy, with a lower complication rate, including bacteremia . There are few studies comparing the two methods . The aim of this study was to compare the incidence of bacteremia after both treatments in patients with portal hypertension secondary to schistosomiasis . METHODS: Endoscopic sclerotherapy and band ligation were performed using standard techniques . Blood samples were obtained 5 and 30 minutes after endoscopic band ligation or sclerotherapy and cultured for aerobic and anaerobic organisms . RESULTS: In the sclerotherapy group 2 of 43 (4.6%) blood cultures were positive (Peptostreptococcus sp and Streptococcus mitis) . A similar result was obtained in the band ligation group: 2 of 35 (5.7%) had positive cultures, both with Staphylococcus aureus . CONCLUSIONS: There is no difference in the frequency of bacteremia after treatment of esophageal varices with endoscopic sclerotherapy or endoscopic band ligation in patients with portal hypertension secondary to schistosomiasis.

Mol Microbiol, 1997 Sep, 25(6), 1113 - 24
SpsA, a novel pneumococcal surface protein with specific binding to secretory immunoglobulin A and secretory component; Hammerschmidt S et al.; The interaction of pathogenic bacteria with host serum and matrix proteins is a common strategy to enhance their virulence . Streptococcus pneumoniae colonizes the human upper respiratory tract in healthy individuals and is also able to cause invasive diseases . Here, we describe a novel pneumococcal surface protein, SpsA, capable of binding specifically to human secretory immunoglobulin A (SIgA) . The dissociation constant of SIgA binding to SpsA was 9.3 x 10(-9) M . Free secretory component (SC) also binds to S . pneumoniae, whereas serum IgA does not, suggesting that pneumococcal binding to SIgA is mediated by the SC . To our knowledge, this is the first defined interaction of SC with a prokaryotic protein . The spsA gene encodes a polypeptide of 523 amino acids with a predicted molecular mass of 59 151 Da . The SIgA- or SC-binding domain is located in the N-terminal part of SpsA and exhibits no significant homology to any other proteins . The purified SIgA-binding domain of SpsA could completely inhibit the binding of SIgA to pneumococci . SpsA was expressed by 73% of the tested S . pneumoniae isolates and was substantially conserved between different serotypes . The interaction between S . pneumoniae and SC via SpsA represents a novel biological interaction that might increase virulence by the impairment of bacterial clearance.

J Clin Microbiol, 1997 Nov, 35(11), 2733 - 9
Molecular diagnosis of bacterial endocarditis by broad-range PCR amplification and direct sequencing; Goldenberger D et al.; Broad-range PCR amplification of part of the 16S rRNA gene followed by single-strand sequencing was applied to samples of 18 resected heart valves from patients with infective endocarditis . The PCR results were compared with those of cultures of valves and with those of previous blood cultures . For two patients there was agreement with the cultures of the valves; for nine patients there was agreement with the previous blood cultures, which were positive, while the cultures of the valves were negative; a Streptococcus sp . and Tropheryma whippelii each were found in one patient with negative cultures (valve and blood); for two patients the cultures of the valves as well as the PCR results were negative but the blood cultures were positive; for one patient amplification was inhibited; and for two patients the PCR results were positive but the amplicons could not be sequenced . It is concluded that broad-range PCR is a promising tool for patients with culture-negative endocarditis and allows the detection of rare, noncultivable organisms.

Commun Dis Rep CDR Rev, 1997 Oct 17, 7(11), R159 - 64
Serogroups/types and antibiotic resistance of referred isolates of Streptococcus pneumoniae: 1993 to 1995; George RC et al.; Surveillance of prevalent serogroups/types of Streptococcus pneumoniae and their susceptibility to antimicrobial agents is important for understanding the epidemiology of pneumococcal infections and for guiding empirical treatment . Current vaccines for prevention of pneumococcal infection utilise serotype specific antigens, so knowledge of the prevalence of particular serotypes is relevant to vaccine use and development . Five thousand seven hundred and ninety-six isolates of S . pneumoniae from separate patients were serogrouped or serotyped by the Streptococcus and Diphtheria Reference Unit between 1993 and 1995 . Antibiotic susceptibility testing was carried out by the Antibiotic Reference Unit on 3821 (65.9%) of these isolates . A total of 40 distinct serogroups/types, together with a small number of non-typable isolates, were noted over the three year period . The same five serogroups/types (6, 9, 14, 19, and 23) occurred most commonly in each year of the study, not only in the total population of isolates studied, but also in isolates obtained from blood or cerebrospinal fluid, and among isolates with antibiotic resistance . Ninety-six per cent of the isolates belonged to serogroups/types included in the currently available 23-valent capsular polysaccharide pneumococcal vaccine; the conjugate petna-, hepta-, and nonavalent vaccines covered 51%, 75%, and 80% of isolates respectively . The nonavalent vaccine offers the most promise as 74% of all blood and cerebrospinal fluid isolates and 90% of antibiotic resistant isolates belonged to serogroups or types included in this formulation.

Int Orthop, 1997, 21(4), 277 - 8
Sepsis due to group G Streptococcus after a total hip arthroplasty . A case report; Pons M et al.; A patient with a total hip arthroplasty developed an aggressive infection with group G Streptococcus . Very few similar cases have been reported, but they all resolved with antibiotics or drainage . A Girdlestone resection was necessary in our case because of loosening and extensive bony destruction . The true incidence may be greater than that reported and the prognosis may be worse.

Schweiz Rundsch Med Prax, 1997 Jul 2, 86(27-28), 1097 - 100
{Pneumococcal vaccination--why so rare?}; Persili SA et al.; Pneumococcal infections are common even in 1997 and are still responsible for high mortality rates particularly in groups at high risk . Because of increasing resistance of streptococcus pneumoniae against antibiotics the use of pneumococcal vaccination available so far could be an important preventive measure in particular in patients at high risk . This is demonstrated by means of some proper cases and the current literature.

Klin Monatsbl Augenheilkd, 1997 May, 210(5), 337 - 8
{Refractory endophthalmitis after bulbus perforation after careless handling of orthodontic headgear}; Kammann MT et al.; HISTORY: Dental regulation with the Headgear System is a method applied worldwide, and only few cases of device induced injuries have been documented . However, such injuries can be very severe, as can be seen from our case . Therefore, the risk/benefit relation should be considered . PATIENT: In December 1995, a 10-year-old female patient with a scleral perforation near the limbus was sent to Zurich university eye clinic as emergency case . The evening before, the patient had tried to remove her dental brace (Headgear) by pulling it over her head without disengaging the rubber bands serving for fixation before . During this attempt, the brace escaped at eye level, shot into her face and caused a skeletal perforation in her left eye as well as contusion bulbi in her right eye . In the further course, a fulminant endophthalmitis (streptococcus spp and anaerobic mixed oral flora) developed in the patient's left eye, which could not be controlled inspite of two interventions with vitrectomy and finally made an enucleation necessary . CONCLUSION: Disregarding the worldwide application of this device in the treatment of defective positions of teeth, the present case demonstrates that it is necessary to thoroughly instruct the patients regarding the handling of the Headgear and to inform them of possible dangers.

Eur J Clin Microbiol Infect Dis, 1997 Aug, 16(8), 608 - 10
Comparison of E-test with agar dilution for determining susceptibility of Streptococcus pneumoniae to penicillin; Scheel O et al.; Minimum inhibitory concentrations (MICs) of penicillin for Streptococcus pneumoniae were determined by the E-test and the agar dilution method . Ninety Streptococcus pneumoniae strains were tested, of which 16 were resistant, 33 intermediate, and 41 susceptible by agar dilution . By the E-test, 80 (88.9%) strains agreed with these determinations within one log2 dilution step, and no strains disagreed by more than two dilution steps . Sixty-eight of the 70 strains with discrepant MICs read lower in the E-test, resulting in 15 strains being placed in different susceptibility categories when classified by this test . Exact MICs rather than classification groups should be used to determine appropriate antibiotic therapy, since small differences in MICs determined by different methods can lead to a significant degree of misclassification.

Mol Gen Genet, 1997 Aug, 255(6), 611 - 8
Primary structure requirements for in vivo activity and bidirectional function of the transcription terminator shared by the oppositely oriented skc/rel-orf1 genes of Streptococcus equisimilis H46A; Steiner K et al.; The region between the Streptococcus equisimilis streptokinase (skc) gene and the oppositely oriented rel-orf1 transcription unit contains only one termination site known to function bidirectionally in both the homologous host and in Escherichia coli . The terminator sequence is similar to other factor-independent terminators . Using two sets of point mutations that interrupt the hairpin-upstream oligo(dA) tract or the hairpin-downstream oligo(dT) tract, we examined the possible contribution of extended base pairing between the upstream rA and downstream rU residues to efficient termination and bidirectionality in both hosts, using terminator-cat reporter gene fusions in either polarity . The results show that interrupting the oligo(dA) tract preceding the hairpin has relatively little effect on terminator strength in either orientation in the homologous host, but abolishes termination in skc polarity in E . coli . Disruption of the hairpin-distal oligo(dT) tract inactivated the terminator in skc polarity in both hosts, had little effect on termination efficiency in rel-orf1 polarity in S . equisimilis, and also retained appreciable terminator activity in E . coli . In general, these alterations of the terminator sequence, together with additional mutations that reduce the spacing between the skc stop codon and the termination site or introduce a base substitution in the terminator stem, adversely affected the efficiency of termination to a greater extent in E . coli than in the homologous host . The disparity between the effects of certain mutations in the two hosts suggests that, in addition to thermodynamic properties, specific host factors, including RNA polymerase, contribute to terminator strength.

JAMA, 1997 Sep 24, 278(12), 989 - 95
Antibiotic therapy for reduction of infant morbidity after preterm premature rupture of the membranes . A randomized controlled trial . National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network; Mercer BM et al.; CONTEXT: Intrauterine infection is thought to be one cause of preterm premature rupture of the membranes (PPROM) . Antibiotic therapy has been shown to prolong pregnancy, but the effect on infant morbidity has been inconsistent . OBJECTIVE: To determine if antibiotic treatment during expectant management of PPROM will reduce infant morbidity . DESIGN: Randomized, double-blind, placebo-controlled trial . SETTING: University hospitals of the National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network . PATIENTS: A total of 614 of 804 eligible gravidas with PPROM between 24 weeks' and 0 days' and 32 weeks' and 0 days' gestation who were considered candidates for pregnancy prolongation and had not received corticosteroids for fetal maturation or antibiotic treatment within 1 week of randomization . INTERVENTIONS: Intravenous ampicillin (2-g dose every 6 hours) and erythromycin (250-mg dose every 6 hours) for 48 hours followed by oral amoxicillin (250-mg dose every 8 hours) and erythromycin base (333-mg dose every 8 hours) for 5 days vs a matching placebo regimen . Group B streptococcus (GBS) carriers were identified and treated . Tocolysis and corticosteroids were prohibited after randomization . MAIN OUTCOME MEASURES: The composite primary outcome included pregnancies complicated by at least one of the following: fetal or infant death, respiratory distress, severe intraventricular hemorrhage, stage 2 or 3 necrotizing enterocolitis, or sepsis within 72 hours of birth . These perinatal morbidities were also evaluated individually and pregnancy prolongation was assessed . RESULTS: In the total study population, the primary outcome (44.1 % vs 52.9%; P=.04), respiratory distress (40.5% vs 48.7%; P=.04), and necrotizing enterocolitis (2.3% vs 5.8%; P=.03) were less frequent with antibiotics . In the GBS-negative cohort, the antibiotic group had less frequent primary outcome (44.5% vs 54.5%; P=.03), respiratory distress (40.8% vs 50.6%; P=.03), overall sepsis (8.4% vs 15.6%; P=.01), pneumonia (2.9% vs 7.0%; P=.04), and other morbidities . Among GBS-negative women, significant pregnancy prolongation was seen with antibiotics (P<.001) . CONCLUSIONS: We recommend that women with expectantly managed PPROM remote from term receive antibiotics to reduce infant morbidity.

Am J Infect Control, 1997 Oct, 25(5), 395 - 400
Secular trends in bloodstream infection caused by antimicrobial-resistant bacteria in New Jersey hospitals, 1991 to 1995; Tokars JI et al.; INTRODUCTION: Antimicrobial resistance among bacteria is an increasing public health problem . In 1991, New Jersey was the first state to establish statewide, hospital-based surveillance for antimicrobial-resistant bacteria . METHODS: Each month, all 96 nonfederal New Jersey hospital laboratories complete a form listing the species identity and drug susceptibility results for selected antimicrobial-resistant bacteria isolated from blood cultures from hospital inpatients . Penicillin-resistant Streptococcus pneumoniae and aminoglycoside-resistant gram-negative rods were studied from 1991 to 1995 . Vancomycin-resistant enterococci and imipenem-resistant gram-negative rods were studied from 1992 through 1995 . RESULTS: From 1992 to 1995, the vancomycin-resistant enterococci bloodstream infection prevalence rate increased from 11 to 29 per 100,000 hospital admissions (p < 0.001); the rate was higher at larger hospitals, urban and inner-city hospitals, and teaching hospitals . From 1991 to 1995, the penicillin-resistant S . pneumoniae bloodstream infection rate increased from 1.1 to 9.9 per 100,000 admissions (p < 0.001) . In contrast, bloodstream infection rates did not change significantly for imipenem-resistant (12.5 during 1992 and 14.1 during 1995, p = 0.4) or aminoglycoside-resistant (8.0 during 1991 and 6.8 during 1995, p = 0.4) gram-negative rods . CONCLUSIONS: We found that vancomycin-resistant enterococci and penicillin-resistant S . pneumoniae, but neither of two groups of antimicrobial-resistant gram-negative rods, are increasing rapidly in prevalence in New Jersey . Continued monitoring and interventions to slow these increases are needed.

Can J Vet Res, 1997 Oct, 61(4), 275 - 9
Immunization of pigs against Streptococcus suis serotype 2 infection using a live avirulent strain; Busque P et al.; Streptococcus suis capsular type 2 is still an important cause of economic losses in the swine industry . At the present time, vaccination of pigs against this infection is generally carried out with autogenous bacterins and results are equivocal . In this study, the protective effect of a live avirulent S . suis type 2 strain (#1330) which had induced a good protection in mice, was evaluated in swine . The experiment was performed in triplicate using 4 week-old piglets . A total of 15 piglets were vaccinated 3 times, 15 others were vaccinated 2 times, and 15 piglets were injected 3 times with sterile Todd-Hewitt broth . Using an indirect ELISA, an increase in the IgG response to S . suis antigens was noted in 27 of the 30 vaccinated piglets . On day 21 post-vaccination, all animals were challenged intravenously with a virulent S . suis type 2 strain (#999) . In the 2 vaccinated groups, 26 animals were fully protected . Only 1 out of the 15 piglets vaccinated 3 times developed mild clinical signs . In the group vaccinated twice, 3 piglets showed clinical signs and 1 of them died after the challenge . In the control group, 7 animals died out of the 11 with clinical signs of infection . In conclusion, a protective immunity was observed in swine when using strain 1330 . However, more studies are needed to assess the use of a live S . suis strain in a vaccine for pigs.

J Biol Chem, 1997 Oct 24, 272(43), 26978 - 84
A matrix form of fibronectin mediates enhanced binding of Streptococcus pyogenes to host tissue; Okada N et al.; The pathogenic Gram-positive bacterium Streptococcus pyogenes (group A streptococcus) binds to fibronectin via protein F . In this study, we have investigated the binding properties of protein F to various multimeric tissue forms of fibronectin that appear on cell surfaces and in the extracellular matrix . We show that binding of S . pyogenes through protein F is more efficient to an in vitro-derived polymerized form of fibronectin (superfibronectin) than to soluble fibronectin immobilized in a solid phase . In addition, Chinese hamster ovary cells overexpressing the alpha5beta1 integrin produced an increased amount of a fibronectin matrix and consequently bound a higher number of S . pyogenes cells . Inhibition and direct binding assays using purified proteins demonstrated that binding to a fibronectin matrix involved both domains of protein F (UR and RD2) that have previously been implicated in interactions with fibronectin . Using intact S . pyogenes bacteria in which various domains of protein F were expressed as hybrids with the surface-exposed region of an unrelated protein, we revealed that, in contrast to the predominantly UR-mediated binding to soluble fibronectin, the maximal binding to the fibronectin matrix required RD2 in addition to UR . Since in some infections S . pyogenes may initially encounter a matrix form of fibronectin, these results suggest that UR and RD2 may be important for the initiation of streptococcal infectious processes.

J Bacteriol, 1997 Oct, 179(19), 6172 - 80
Constitutive expression of fibronectin binding in Streptococcus pyogenes as a result of anaerobic activation of rofA; Fogg GC et al.; Protein F is a fibronectin-binding surface protein of Streptococcus pyogenes (group A streptococcus) that mediates adherence to host cells . A gene product encoded by rofA activates transcription of the gene that encodes protein F (prtF) and was identified in a strain of S . pyogenes that expressed high levels of protein F under all conditions tested . Insertional inactivation of rofA in this strain results in a phenotype similar to that of other strains where high-level transcription of prtF occurs only in response to increased oxygen tension . In this study, we have compared the regulation of prtF and rofA in O2-regulated and constitutive strains in order to gain further insight into the function of rofA . Comparison of the prtF and rofA transcripts by S1 nuclease and primer extension assays indicated that the same promoters for each transcript are used in both O2-regulated and constitutive strains . However, analyses of rofA-lacZ reporter alleles revealed that a key difference between strains involves regulation of rofA itself . In O2-regulated strains, expression of rofA was elevated following culture under conditions of reduced O2 tension . However, a much more robust activation of rofA expression was observed when constitutive strains were grown under similar conditions . Exchange of reporter and rofA alleles between strains demonstrated that host genetic background, and not the sequence of the respective rofA allele or regulatory region, dictates the expression phenotype . Activation of rofA required RofA, and RofA was shown to bind specifically to DNA containing the promoters for rofA and prtF . Finally, overexpression of either allele of rofA caused constitutive expression of prtF regardless of host background . These data suggest a model where anaerobic expression of prtF in constitutive hosts is controlled at the level of transcription of rofA and implicate additional factors in this regulatory pathway.

Arthritis Rheum, 1997 Sep, 40(9), 1716 - 9
Invasive soft tissue infections with Streptococcus pneumoniae in patients with systemic lupus erythematosus: case report and review of the literature; Hill MD et al.; Pneumococcal infections of the soft tissues are uncommon . However, patients with systemic lupus erythematosus (SLE) may be predisposed to this condition, perhaps by virtue of hypocomplementemia and low, nonprotective concentrations of antipneumococcal antibodies . We report a case of severe cellulitis and fasciitis of the anterior neck in a young woman with SLE . The literature on SLE and pneumococcal soft tissue infections is reviewed . A clinical syndrome of SLE and pneumococcal soft-tissue infections of the neck and pharynx is described.

J Antimicrob Chemother, 1997 Sep, 40(3), 359 - 63
In-vitro susceptibility, tolerance and glycocalyx production in Streptococcus mutans; De la Higuera A et al.; We studied the presence of high-level resistance to aminoglycosides, penicillin tolerance and glycocalyx production in 160 isolates of Streptococcus mutans . Susceptibility to amoxycillin, cefazolin, imipenem, erythromycin, clindamycin, vancomycin and teicoplanin was also investigated . Of the isolates analysed, 58.8% produced glycocalyx in vitro and 2.5% were penicillin-tolerant . High-level resistance to streptomycin was found in 16.3% of the isolates, but all were sensitive to all other antibiotics tested . We found no significant relationship between glycocalyx production and high-level streptomycin resistance, penicillin tolerance or antibiotic susceptibility, except for a greater susceptibility to clindamycin and vancomycin in isolates that produced glycocalyx . Although our findings reflect the clinically favourable pattern of susceptibility currently found in this species, the appearance in some isolates of resistance, tolerance and glycocalyx production should be investigated because of the risks involved in endocarditis caused by S . mutans.

MMWR Morb Mortal Wkly Rep, 1997 Oct 10, 46(40), 944 - 8
Outbreak of invasive group A Streptococcus associated with varicella in a childcare center -- Boston, Massachusetts, 1997; Synthetic histatin analogues with broad-spectrum antimicrobial activity; Vrije Universiteit, ACTA, Department of Oral Biochemistry, Amsterdam, The NetherlandsHistatins are salivary histidine-rich cationic peptides, ranging from 7 to 38 amino acid residues in length, that exert a potent killing effect in vitro on Candida albicans . Starting from the C-terminal fungicidal domain of histatin 5 (residues 11-24, called dh-5) a number of substitution analogues were chemically synthesized to study the effect of amphipathicity of the peptide in helix conformation on candidacidal activity . Single substitutions in dh-5 at several positions did not have any effect on fungicidal activity . However, multi-site substituted analogues (dhvar1 and dhvar2) exhibited a 6-fold increased activity over dh-5 . In addition, dhvar1 and dhvar2 inhibited the growth of the second most common yeast found in clinical isolates, Torulopsis glabrata, of oral- and non-oral pathogens such as Prevotella intermedia and Streptococcus mutans, and of a methicillin-resistant Staphylococcus aureus . In their broad-spectrum activity, dhvar1 and dhvar2 were comparable to magainins (PGLa and magainin 2), antimicrobial peptides of amphibian origin . Both the fungicidal and the haemolytic activities of dhvar1, dhvar2 and magainins increased at decreasing ionic strength.

Antimicrob Agents Chemother, 1997 Oct, 41(10), 2121 - 6
Mechanism of sulfonamide resistance in clinical isolates of Streptococcus pneumoniae; Maskell JP et al.; The genetic basis of sulfonamide resistance in six clinical isolates of Streptococcus pneumoniae was demonstrated to be 3- or 6-bp duplications within sulA, the chromosomal gene encoding dihydropteroate synthase . The duplications all result in repetition of one or two amino acids in the region from Arg58 to Tyr63, close to but distinct from the sul-d mutation, a duplication previously reported in a resistant laboratory strain (P . Lopez, M . Espinosa, B . Greenberg, and S . A . Lacks, J . Bacteriol . 169:4320-4326, 1987) . Six sulfonamide-susceptible clinical isolates lacked such duplications . The role of the duplications in conferring sulfonamide resistance was confirmed by transforming 319- or 322-bp PCR fragments into the chromosome of a susceptible recipient . Two members of a clone of serotype 9V, one susceptible and one resistant to sulfonamide, which are highly related by other criteria, were shown to have sulA sequences that differ in 7.2% of nucleotides in addition to the duplication responsible for resistance . It is postulated that horizontal gene exchange has been involved in the acquisition (or loss) of resistance within this clone . However, five of the six resistant isolates have distinct duplications and other sequence polymorphisms, suggesting that resistance has arisen independently on many occasions.

Adv Exp Med Biol, 1997, 418, 589 - 92
Structure-function and pathogenesis studies of Streptococcus pyogenes extracellular cysteine protease; Burns EH Jr et al.; Replacement of the single cysteine residue (C192) with serine in the Streptococcus pyogenes extracellular cysteine protease (SCP) prevented auto-catalytic processing of the 40-kDa zymogen to the 28-kDa mature form and eliminated proteolytic activity . SCP incubated with human endothelial cells induced a time- and concentration-dependent increase in a 66-kDa gelatinase/type IV collagenase in culture supernatants . Activation of this gelatinase/collagenase may contribute to endothelial cell damage, tissue destruction, and hemodynamic derangement observed in some patients with severe, invasive S . pyogenes infection.

Int J Syst Bacteriol, 1997 Oct, 47(4), 1073 - 7
Streptococcus hyovaginalis sp . nov . and Streptococcus thoraltensis sp . nov., from the genital tract of sows; Devriese LA et al.; Two groups of strains isolated from sows were shown to belong to new sublines in the genus Streptococcus . Based on phenotypic and phylogenetic analyses, we propose that these bacteria should be classified as two new species, Streptococcus hyovaginalis sp . nov . and Streptococcus thoraltensis sp . nov . These two species are found in the genital tract, but the capnophilic species S . thoraltensis may also occur in the intestinal tract of pigs . The type strain of S . hyovaginalis is SHV515 (= LMG 14710), and S69 (= LMG 13593) is the type strain of S . thoraltensis.

J Bacteriol, 1997 Oct, 179(20), 6509 - 11
Genetic diversity in temperate bacteriophages of Streptococcus pyogenes: identification of a second attachment site for phages carrying the erythrogenic toxin A gene; McShan WM et al.; Bacteriophage T12, the prototypic bacteriophage of Streptococcus pyogenes carrying the erythrogenic toxin A gene (speA), integrates into the bacterial chromosome at a gene for a serine tRNA (W . M . McShan, Y.-F . Tang, and J . J . Ferretti, Mol . Microbiol . 23:719-728, 1997) . This phage is a member of a group of related temperate phages, and we show here that not all speA-carrying phages in this group use the same attachment site for integration into the bacterial chromosome . Additionally, other phages in the group use the same serine tRNA gene attachment site as phage T12 and yet do not carry speA . The evidence suggests that recombination between phage genomes has been an important means of generating diversity and disseminating virulence-associated genes like speA.

J Exp Med, 1997 Oct 20, 186(8), 1357 - 64
Neutrophil emigration in the skin, lungs, and peritoneum: different requirements for CD11/CD18 revealed by CD18-deficient mice; Mizgerd JP et al.; To determine the role of CD11/CD18 complexes in neutrophil emigration, inflammation was induced in the skin, lungs, or peritoneum of mutant mice deficient in CD18 (CD18-/- mutants) . Peripheral blood of CD18-/- mutants contained 11-fold more neutrophils than did blood of wild-type (WT) mice . During irritant dermatitis induced by topical application of croton oil, the number of emigrated neutrophils in histological sections of dermis was 98% less in CD18-/- mutants than in WT mice . During Streptococcus pneumoniae pneumonia, neutrophil emigration in CD18-/- mutants was not reduced . These data are consistent with expectations based on studies using blocking antibodies to inhibit CD11/CD18 complexes, and on observations of humans lacking CD11/CD18 complexes . The number of emigrated neutrophils in lung sections during Escherichia coli pneumonia, or in peritoneal lavage fluid after 4 h of S . pneumoniae peritonitis, was not reduced in CD18-/- mutants, but rather was greater than the WT values (240 +/- 30 and 220 +/- 30% WT, respectively) . Also, there was no inhibition of neutrophil emigration during sterile peritonitis induced by intraperitoneal injection of thioglycollate (90 +/- 20% WT) . These data contrast with expectations . Whereas CD11/CD18 complexes are essential to the dermal emigration of neutrophils during acute dermatitis, CD18-/- mutant mice demonstrate surprising alternative pathways for neutrophil emigration during pneumonia or peritonitis.

Antimicrob Agents Chemother, 1997 Oct, 41(10), 2251 - 5
mefE is necessary for the erythromycin-resistant M phenotype in Streptococcus pneumoniae; Tait-Kamradt A et al.; Recently, it was shown that a significant number of erythromycin-resistant Streptococcus pneumoniae and Streptococcus pyogenes strains contain a determinant that mediates resistance via a putative efflux pump . The gene encoding the erythromycin-resistant determinant was cloned and sequenced from three strains of S . pneumoniae bearing the M phenotype (macrolide resistant but clindamycin and streptogramin B susceptible) . The DNA sequences of mefE were nearly identical, with only 2-nucleotide differences between genes from any two strains . When the mefE sequences were compared to the mefA sequence from S . pyogenes, the two genes were found to be closely related (90% identity) . Strains of S . pneumoniae were constructed to confirm that mefE is necessary to confer erythromycin resistance and to explore the substrate specificity of the pump; no substrates other than 14- and 15-membered macrolides were identified.

Clin Infect Dis, 1997 Aug, 25(2), 260 - 6
A clinical and bacteriologic investigation of invasive streptococcal infections in Japan on the basis of serotypes, toxin production, and genomic DNA fingerprints; Nakashima K et al.; In a survey of invasive streptococcal infections in Japan, we analyzed isolates of Streptococcus pyogenes collected between 1992 and 1994 . Genomic DNA fingerprints produced by pulsed-field gel electrophoresis (PFGE) were compared by computer-assisted analysis . Conventional serologic M types were subdivided into PFGE types showing close genetic similarity . Among the 42 isolates from patients with invasive diseases, 16 PFGE types were identified and genetic diversity was clearly demonstrated . Identical fingerprints were observed in both invasive and noninvasive isolates . Only 43% of invasive isolates produced streptococcal pyrogenic exotoxin A (SPE A), and 31% did not contain the speA gene . These findings suggest that the dissemination of a specific clone is not sufficient to explain all cases of these diseases in Japan and pose a question as to the role of SPE A as a major virulent factor . Bacterial factors other than SPE A and host factors should be considered in evaluation of the pathogenesis of the diseases.

Clin Infect Dis, 1997 Aug, 25(2), 188 - 94
Resistance patterns of streptococcus pneumoniae from carriers attending day-care centers in southwestern Greece; Syrogiannopoulos GA et al.; The resistance to beta-lactam and non-beta-lactam antibiotics of 133 nasopharyngeal isolates of Streptococcus pneumoniae recovered from December 1995 to February 1996 from children attending seven day-care centers in southwestern Greece was studied . Reduced susceptibility to one or more anti-microbial agents was found in 70 isolates (53%), as follows: penicillin, 17% intermediate, 12% resistant; cefotaxime, 10.5% intermediate, 1.5% resistant; trimethoprim-sulfamethoxazole, 8% intermediate, 35% resistant; chloramphenicol, 27% resistant; tetracycline, 29% resistant; and erythromycin/clindamycin, 19% resistant . Eighty-seven percent of penicillin-intermediate or -resistant strains belonged to serogroups/serotypes 19, 21, and 23 . Fifty-six percent of the antibiotic-resistant pneumococci were multiply resistant, including serogroup 6 strains that were penicillin-susceptible but resistant to all non-beta-lactam drugs tested, as well as serogroup 23 strains resistant to penicillin, chloramphenicol, tetracycline, and trimethoprim-sulfamethoxazole . The high incidence of antibiotic-resistant pneumococci and the divergent and unique resistance patterns found in this study underline the need for global surveillance of S . pneumoniae to document the evolution and spread of resistant strains and to guide therapy.

Adv Exp Med Biol, 1997, 418, 923 - 4
Nonneutralizing antibody to erythrogenic toxin A alpha(NY5ETA) in human sera; Nakano S et al.; A solid phase adsorption experiment was performed to detect anti-ETA alpha(NY5 strain ETA) nonneutralizing antibody . Toxin was applied to the Protein A-Sepharose column retaining IgG bound after pretreatment with test serum . Mitogenic activity recovered in the effluent and in the eluate containing the IgG was measured separately in rabbit lymphocyte culture . A significantly increased recovery in the eluate was found in combination with decreased recovery in the effluent of three sera from Kawasaki disease and one from Streptococcus pyogenes infection among 13 ELISA-positive, antimitogen assay (AMA)-negative sera tested . The nonneutralizing antibody may play an important role in the immune protection against ETA by binding to nonmitogenic epitope(s) on ETA and enabling to handle the toxin not as a superantigen but as a conventional peptide antigen.

Adv Exp Med Biol, 1997, 418, 451 - 2
Guidelines for detection of penicillin tolerance in Streptococcus pyogenes by MIC-MBC method; Van Asselt GJ et al.; Disagreement on a uniform and accepted method of testing penicillin tolerance in Streptococcus pyogenes prevents a meaningful comparison of results of various studies on tolerance and an assessment of the contribution of this phenomenon to treatment failure . Therefore guidelines are needed.

Adv Exp Med Biol, 1997, 418, 211 - 5
Group A streptococcal outbreak of perianal infection in a day-care centre; Muotiala A et al.; Within 9 days in a day-care centre of 20 children 3 cases and 2 suspected cases of perianal infection (PAI) were revealed . The causative agent for PAI was confirmed to be beta-haemolytic group A streptococcus (GAS) . The isolates were further characterized by T- and M-serotyping, conventional restriction endonuclease analysis (REA) and pulsed field gel electrophoresis (PFGE) . The typing methods revealed that all outbreak isolates were of same T28R28-serotype and genetically identical . Unrelated, control GAS isolates of the same serotype differed genetically from the outbreak isolates indicating that a single clone had caused the perianal infections.

Laryngoscope, 1997 Oct, 107(10), 1405 - 8
Murine model of interleukin-8-induced otitis media; Johnson M et al.; Interleukin-8 (IL-8), a potent inflammatory mediator that is thought to control leukocyte recruitment and activation during inflammatory reactions, has been implicated in a variety of inflammatory diseases . Recent studies in our laboratory have demonstrated the presence of IL-8 in chronically inflamed human middle ear effusions . These data have led us to hypothesize that IL-8 is responsible for the leukocyte recruitment seen in otitis media . Because the effect of IL-8 on the middle ear mucosa has not been investigated and therefore its role in middle ear inflammation is not known, we investigated the ability of IL-8 to directly induce inflammation in the murine middle ear . For these studies, ICR mice were used to test the hypothesis that IL-8 could directly induce inflammation in the middle ear . Murine middle ears received 8-mL transtympanic injections of human IL-8 (25 mg/mL) in saline, heat-killed Streptococcus pneumoniae (1 x 10(8)/mL), or normal saline . Temporal bones were removed at 1, 4, 8, 24, and 48 hours, decalcified, and processed for histologic examination . Noninjected murine temporal bones served as controls . Normal saline-injected ears demonstrated little to no change as compared with temporal bones from noninjected ears . IL-8-injected ears histologically demonstrated thickening of the epithelial layer and subepithelial space (SES), with inflammatory cell infiltration in the SES peaking at 4 to 8 hours and resolving by 48 hours . Bacteria-injected ears demonstrated findings similar to, although not as extensive as, those found in IL-8-injected ears (i.e., inflammatory reactions peaked at 8 to 24 hours and resolved by 72 hours) . Our results demonstrate that IL-8 is a potent inducer of middle ear inflammation and support the concept that IL-8 may be one of the key cytokines responsible for the leukocyte accumulation and activation seen in otitis media.

J Clin Invest, 1997 Oct 15, 100(8), 2099 - 106
Host defense against systemic infection with Streptococcus pneumoniae is impaired in E-, P-, and E-/P-selectin-deficient mice; Munoz FM et al.; Endothelial selectins mediate rolling of leukocytes on endothelium, a crucial step for leukocyte firm adhesion and emigration into sites of tissue injury and infection . To characterize the role of the endothelial selectins during bacterial sepsis in vivo, Streptococcus pneumoniae (1-10 x 10(6) colony-forming units) was inoculated intraperitoneally into wild-type mice and mice with E-, P-, or E-/P-selectin deficiencies . Mice were followed 10 d for morbidity, survival, clearance of bacteremia, and leukocyte migration to the peritoneal cavity and organs 48 h after infection . All selectin-deficient mice showed a more pronounced morbidity, a significantly higher mortality associated with persistent bacteremia, and a higher bacterial load when compared with wild-type mice . These differences were most remarkable in the E-selectin-deficient mice, which showed the highest rate of mortality and bacteremia (P </= 0.0001) . No significant differences were observed among the groups in the inflammatory response present in the peritoneal cavity, brain, liver, spleen, or kidney at 48 h after inoculation . Extensive hepatic and splenic necrosis and thrombosis were noted in E- and P-selectin-deficient mice . Although the absence of endothelial selectins did not substantially impair leukocyte emigration to sites of infection 48 h after pneumococcal sepsis, it resulted in increased mortality and a higher bacterial load in the bloodstream of selectin-deficient mice . These results demonstrate a definitive phenotypic abnormality in E-selectin-deficient mice, and suggest that E- and P-selectin are important in the host defense against S . pneumoniae infection.

Biochem J, 1997 Sep 15, 326 ( Pt 3), 657 - 60
Absorption of kininogen from human plasma by Streptococcus pyogenes is followed by the release of bradykinin; Ben Nasr A et al.; H-kininogen (high-molecular-mass kininogen, HK) is the precursor of the vasoactive peptide hormone bradykinin (BK) . Previous work has demonstrated that HK binds to Streptococcus pyogenes through M-proteins, fibrous surface proteins and important virulence factors of these bacteria . Here we find that M-protein-expressing bacteria absorb HK from human plasma . The HK bound to the bacteria was found to be cleaved, and analysis of the degradation pattern suggested that the cleavage of HK at the bacterial surface is associated with the release of BK . Moreover, addition of activated plasma prekallikrein to bacteria preincubated with human plasma, resulted in BK release . This mechanism, by which a potent vasoactive and proinflammatory peptide is generated at the site of infection, should influence the host-parasite relationship during S . pyogenes infections.

FEMS Immunol Med Microbiol, 1997 Sep, 19(1), 25 - 32
Experimental endocarditis induction and platelet aggregation by Streptococcus anginosus, Streptococcus constellatus and Streptococcus intermedius; Kitada K et al.; A total of 18 'Streptococcus milleri' strains including the ATCC type strains of Streptococcus anginosus, Streptococcus constellatus and Streptococcus intermedius were compared with Streptococcus oralis ATCC10557 for their ability to induce infective endocarditis in catheterized rats . Three days after intravenous injection of 10(8) colony-forming units all 8 S . anginosus strains tested produced infective vegetations and bacteremia in almost all rats whereas 5 S . constellatus strains and the S . oralis strain produced infective vegetations and bacteremia less frequently and 5 S . intermedius strains only occasionally . The vegetations infected with the S . anginosus strains harbored microbial cells in significantly higher numbers that those with the other strains . No strong correlation was found between the endocardial infectivity and platelet-aggregating capacity of these strains . The platelet-aggregating strains were members of the Lancefield groups F and G or ungroupable but not of group A or C.

Infect Immun, 1997 Oct, 65(10), 3997 - 4004
Natural polyreactive secretory immunoglobulin A autoantibodies as a possible barrier to infection in humans; Quan CP et al.; Secretory immunoglobulin A (S-IgA) was investigated in human secretions for the presence of natural antibodies (Abs) acting as the first "immune barrier" to infection before induction or boosting of specific responses . These molecules could be the secretory counterpart of the natural Abs in serum that were previously shown by our laboratory to be polyreactive to autoantigens . Significant levels of S-IgA Abs to human actin, myosin, tubulin, and spectrin were detected in 10 saliva and 8 colostrum samples from normal subjects . Computer-assisted analysis of immunoblots of extracts from human muscles showed these Abs to react with a large number of autoantigens . Their polyreactivity was confirmed by cross-inhibition and by immunoblotting studies of affinity-purified natural Abs, assayed against a large variety of surface or secreted antigens from Streptococcus pyogenes . The thiocyanate elution method showed that functional affinities of some natural Abs can be of the same order of magnitude as those of tetanus vaccine antitoxins . Moreover, nonimmune binding of these natural Abs to the gut protein Fv (Fv-fragment binding protein) can enhance their effector functions . This demonstrates that human secretions contain polyreactive auto-Abs which can also react with pathogens . These secretory Abs of "skeleton key" specificities are possibly produced by a primordial B-1-cell-associated immune system and can be involved in a plurispecific mucosal protection against pathogens, irrespective of the conventional immune response.

J Clin Microbiol, 1997 Oct, 35(10), 2689 - 91
PCR-enzyme-linked immunosorbent assay and sequencing as an alternative to serology for M-antigen typing of Streptococcus pyogenes; Saunders NA et al.; A rapid PCR-enzyme-linked immunosorbent assay for identification of 10 important emm gene types of Streptococcus pyogenes was developed . The emm genotypes of a coded panel of strains of known M serotype were determined, and in 144 of 149 cases (97%) the results were congruous . Strains of types that were not included in the panel of capture probes were emm genotyped by sequencing.

J Clin Microbiol, 1997 Oct, 35(10), 2573 - 9
Characterization of Streptococcus agalactiae strains by randomly amplified polymorphic DNA analysis; Chatellier S et al.; A collection of 54 unrelated Streptococcus agalactiae strains isolated from cerebrospinal fluid samples from neonates and 60 unrelated strains isolated from carriers that had been previously studied by multilocus enzyme electrophoresis (R . Quentin, H . Huet, F.-S . Wang, P . Geslin, A . Goudeau, and R . K . Selander, J . Clin . Microbiol . 33:2576-2581, 1995) were characterized by randomly amplified polymorphic DNA (RAPD) assay . Four primers, 5'AGGGGGTTCC3', 5'AACGCGCAAC3', 5'GCATCAATCT3', and 5'AGTCGGGTGG3', named OPS16, AP42, A4, and OPS11, respectively, were selected from 29 primers tested . This investigation identified 71 RAPD types . The three families of strains defined by multilocus enzyme electrophoresis analysis, which contain most of the cerebrospinal fluid isolates, were also identified by clustering analysis of RAPD data . Each of these three groups exhibits specific RAPD patterns or fragments . The discriminatory power of the RAPD typing method was also evaluated . The simplest typing scheme was obtained by the combination of RAPD typing done with primers AP42 and OPS11 and serotyping (index of discrimination, 0.97).

Mol Microbiol, 1997 Aug, 25(4), 727 - 39
Competence and virulence of Streptococcus pneumoniae: Adc and PsaA mutants exhibit a requirement for Zn and Mn resulting from inactivation of putative ABC metal permeases; Dintilhac A et al.; The adcCBA putative operon of Streptococcus pneumoniae, an important human pathogen, was identified in a search for transformation-deficient mutants . It was found to exhibit homology to ATP-binding cassette (ABC) transport operons encoding streptococcal adhesins such as FimA of Streptococcus parasanguis and PsaA of S . pneumoniae . The latter was recently shown to be essential for virulence as judged by intranasal or intraperitoneal challenge of mice . We suggested previously that AdcA, together with a set of 14 proteins, including PsaA and homologous adhesins, defines a new family of external solute-binding proteins specific for metals . In this work, Northern analysis revealed the existence of two adcB-adcA specific transcripts originating within adcC or further upstream, consistent with the hypothesis that adc is an operon . Investigation of growth of adc and psaA mutants in synthetic medium revealed that the addition of Zn improved the growth rate of the former, whereas the latter exhibited an absolute requirement for added Mn . A psaA-adc double mutant turned out to be essentially non-viable unless both metals were added in the appropriate ratio . Taken together, these results suggest a previously undocumented requirement of S . pneumoniae for Zn and Mn . The addition of Zn also restored near-normal spontaneous transformation of adc mutant cells in standard transformation medium . Zn was found to be specifically required soon after contact of cells with the competence-stimulating peptide, revealing an unsuspected need for Zn in transformation of S . pneumoniae . The removal of Mn from standard transformation medium also resulted in transformation deficiency of psaA mutant cells . Taken together, these results lead us to propose that Adc is an ABC-type Zn permease, the first such protein complex identified in any organism, and that Psa is an ABC-type Mn permease complex.

Drugs, 1997, 54 Suppl 1, 29 - 32
Inhibition of Streptococcus pneumoniae adhesion by specific salivary IgA after oral immunisation with a ribosomal immunostimulant; Hbabi-Haddioui L et al.; Oral 'Ribomunyl' has been shown to increase levels of specific salivary IgA . The ability of specific salivary IgA to inhibit the adhesion of Streptococcus pneumoniae to buccal epithelial cells was investigated in vitro using 13 saliva samples from healthy volunteers who received 'Ribomunyl' therapy for 3 weeks . The S . pneumoniae strain contained in 'Ribomunyl' was {3H}thymidine-labelled and pretreated with dilutions of saliva for 1 hour at 37 degrees C . Bacterial adhesion was measured after 2 hours' contact with human oral epidermal cell monolayers at 37 degrees C under CO2 . Nonadherent bacteria were washed off, and the residual radio-activity of the monolayers was compared with that of bacteria not pretreated with saliva . A significant decrease (p < 0.05) in S . pneumoniae adhesion was observed with 6 saliva samples with high levels of specific IgA . This decrease was seen at all dilutions from 1/5 to 1/1000 . In contrast, no significant modification of adhesion was seen in the 7 saliva samples with unmodified levels of IgA . These data demonstrate that the increase in salivary IgA levels during 'Ribomunyl' therapy was linked with the capacity of saliva samples to specifically and efficiently inhibit adhesion of S . pneumoniae to buccal epithelial cells in vitro.

Am J Perinatol, 1997 Sep, 14(8), 483 - 6
Prolonged rupture of membranes in the term newborn; Marlowe SE et al.; Of 8791 consecutive newborns, we studied 205 (2.3%) women with a history of prolonged rupture of membranes (PROM) greater than 24 hr to assess the incidence of infection, to identify the rate of clinical symptoms, and to examine the use of the white blood count (WBC) and neutrophil values as screening tools to predict infection . Blood culture and complete blood counts (CBC) were obtained in 175 (85%) . Fifteen (8.2%) had positive blood cultures including group B streptococcus, streptococcus viridans, streptococcus pneumoniae, staphlococcus epidermidis, and staphlococcus aureus . In the remaining 8586 infants born to mothers without PROM, 10 had positive blood cultures for an incidence of 0.1% . In the PROM group, the six who manifested clinical symptoms had abnormal CBCs; abnormal white blood count (2), abnormal neutrophil count (5), high band/metatamyelocyte count (4), and increased immature to total neutrophil ratio (4) . Of the nine asymptomatic infants, seven (78%) had abnormal CBCs, five (56%) with a high WBC, five (56%) had a high neutrophil count, two (22%) had a high band/metatamyelocyte count, and one a high immature to total neutrophil ratio . CBC values were obtained from infants with PROM and negative blood cultures . Five of these 15 controls had an abnormal CBC . In the term newborn, PROM is associated with significantly increased incidence of positive blood cultures . The sensitivity of the CBC was 86% and specificity 66% . In view of this data a conservative clinical approach utilizing blood cultures and CBC evaluations in the management of PROM is warranted.

J Dairy Sci, 1997 Sep, 80(9), 2020 - 4
Mastitis increases growth factor messenger ribonucleic acid in bovine mammary glands; Sheffield LG; Multiparous Holstein cows were infected in two quarters by intramammary infusion with Streptococcus agalactiae and slaughtered approximately 36 h later . Mammary tissue was removed from the infected quarters, uninfected contralateral quarters, and from pair-slaughtered uninfected controls; the tissue was frozen in liquid nitrogen . The RNA was extracted, and Northern blot analysis was performed for a variety of growth factors, stress-induced genes, milk protein genes, and control genes . Infection increased levels of mRNA coding for heat shock proteins 89 alpha, 89 beta, 70, 60, and 27 . Simultaneously, concentrations of alpha-lactalbumin and casein mRNA decreased; alpha-lactalbumin mRNA showed a greater decline . The mRNA for several growth factors, including acidic fibroblast growth factor, basic fibroblast growth factor, epidermal growth factor, transforming growth factor-alpha, IGF-I, and IGF-II, were also increased as was the apoptosis marker, testosterone-repressed prostate mucin-2 . Concentrations of mRNA for controls, beta-actin, and glyceraldehyde-3-phosphate dehydrogenase were unaffected . These results indicate that mastitis induces changes in the levels of mRNA encoding for a variety of peptide growth factors . Such changes in growth factors could be important in a variety of processes that occur during infection, such as protection against injury or tissue repair and recovery processes.

J Burn Care Rehabil, 1997 Sep-Oct, 18(5), 406 - 10
In vitro susceptibility testing of topical antimicrobial agents used in pediatric burn patients: comparison of two methods; Rodgers GL et al.; One hundred and seventy-seven bacterial isolates obtained from pediatric burn victims were tested for in vitro susceptibility against bacitracin, silver sulfadiazine, mafenide acetate, nitrofurazone, and mupirocin by two methods: standard microbroth dilution and Nathan's agar well diffusion (NAWD) . Nitrofurazone had the broadest spectrum of activity . Mupirocin was the most potent agent against methicillin-susceptible Staphylococcus aureus . Silver sulfadiazine showed activity against gram-positive organisms and higher minimum inhibitory concentration (MIC) values, and smaller zone sizes were seen for methicillin-resistant S . aureus and gram-negative bacilli . Bacitracin showed activity against S . aureus and Streptococcus pyogenes by the microbroth method; activity could not be assessed by NAWD . Mafenide acetate had the highest MICs for all isolates tested . Correlation between methods for all isolates tested was best for mupirocin and nitrofurazone . NAWD was labor intensive and difficult to interpret; MIC method was easy to perform and reproducible . Clinical correlation is necessary to establish breakpoints for interpretation of test results.

Antibiot Khimioter, 1997, 42(6), 34 - 8
{Effectiveness of ciprofloxacin in the treatment of hospital infections of the lower respiratory tract}; Chuchalin AG et al.; The efficacy of ciprofloxacin was studied in the treatment of 22 patients with hospital infection of the lower respiratory tract: 10 patients with nosocomial pneumonia, 8 with exacerbation of chronic obstructive bronchitis, 3 with exacerbation of mucoviscidosis and 1 with bronchiectasis . The drug was administered intravenously in a dose of 200 to 400 mg or orally in a dose of 500 to 750 mg twice a day for 6 to 21 days . The clinical and bacteriological efficacies of ciprofloxacin amounted to 90.9 and 86.4 per cent respectively . The treatment failed in 2 patients: 1 with pneumonia due to Streptococcus pneumoniae and 1 with mucoviscidosis and persistence of Pseudomonas aeruginosa . Ciprofloxacin was well tolerated . The side effects were observed in 2 patients and required no discontinuation of the drug use.

EMBO J, 1997 Sep 15, 16(18), 5784 - 95
Plasmid rolling circle replication: identification of the RNA polymerase-directed primer RNA and requirement for DNA polymerase I for lagging strand synthesis; Kramer MG et al.; Plasmid rolling circle replication involves generation of single-stranded DNA (ssDNA) intermediates . ssDNA released after leading strand synthesis is converted to a double-stranded form using solely host proteins . Most plasmids that replicate by the rolling circle mode contain palindromic sequences that act as the single strand origin, sso . We have investigated the host requirements for the functionality of one such sequence, ssoA, from the streptococcal plasmid pLS1 . We used a new cell-free replication system from Streptococcus pneumoniae to investigate whether host DNA polymerase I was required for lagging strand synthesis . Extracts from DNA polymerase I-deficient cells failed to replicate, but this was corrected by adding purified DNA polymerase I . Efficient DNA synthesis from the pLS1-ssoA required the entire DNA polymerase I (polymerase and 5'-3' exonuclease activities) . ssDNA containing the pLS1-ssoA was a substrate for specific RNA polymerase binding and a template for RNA polymerase-directed synthesis of a 20 nucleotide RNA primer . We constructed mutations in two highly conserved regions within the ssoA: a six nucleotide conserved sequence and the recombination site B . Our results show that the former seemed to function as a terminator for primer RNA synthesis, while the latter may be a binding site for RNA polymerase.

Kansenshogaku Zasshi, 1997 Aug, 71(8), 738 - 44
{Anti-bacterial activities of a sulfonated human immunoglobulin preparation against penicillin resistant Streptococcus pneumoniae and Pseudomonas aeruginosa}; Matsuda K et al.; Anti-bacterial activities of a sulfonated human immunoglobulin preparation against penicillin resistant Streptococcus pneumoniae and Pseudomonas aeruginosa were examined . Five week old CBA/J mice were challenged by 10 times of 50% lethal doses of penicillin sensitive (SP1) and resistant (SP2) strains of Streptococcus pneumniae serotype 19, and were treated with a sulfonated human immunoglobulin preparation (hIg) . Fifty % protective dose (ED50) were 2-4 mg hIg/ mouse . These doses were parallel with the challenged doses despite of the challenged bacteria, and it was calculated that 6 x 10(6) bacteria were killed by one mg of hIg in both bacteria . Minimal inhibitory concentrations (MIC) of piperacillin, flomoxef, imipenem, amikacin and ofloxacin against SP1 and SP2 were estimated under the presence of various concentrations of hIg . It was found that under the presence of over 10-20 mg/ml of hIg, SP1 and SP2 were not grown even without any antibiotic . That is, MIC of hIg itself against penicillin sensitive and resistant Streptococcus pneumoniae serotype 19 were 10-20 mg/ml . Since about 10(6) bacteria/ml were used for this test, it was calculated that 5-10 x 10(4) bacteria were killed by one mg of hIg in vitro . This result suggested that in vivo anti-bacterial activities of hIg could be 100 times higher than that in vitro . Synergistic or at least additive effects between hIg and all antibiotics tested were seen by the MIC . If hIg was 100 times effective in in vivo, these results suggested that hIg could improve the effect of chemotherapy in clinical cases . Similar in vitro test were carried out for Pseudomonas aeruginosa, and synergistic or at least additive effects between hIg and all antibiotics tested were also confirmed in Pseudomonas aeruginosa . This result suggested that hIg could be effective for clinical pseudomonas infection.

FEMS Microbiol Lett, 1997 Sep 15, 154(2), 289 - 92
The regulation of Streptococcus mutans glucan-binding protein A expression; Banas JA et al.; The S . mutans GBP-A is hypothesized to be constitutively expressed and to contribute to the sucrose-dependent colonization of S . mutans . To investigate GBP-A expression, a reporter gene encoding chloramphenicol acetyltransferase (CAT) was placed downstream of the gbpA promoter and CAT activity was measured under conditions that would be associated with the sucrose-dependent colonization of S . mutans . Expression of GBP-A was optimal under anaerobiosis and neutral pH conditions, and correlated with optimal growth . The addition of sucrose to the growth medium did not elevate the expression of GBP-A.

AIDS Res Hum Retroviruses, 1997 Sep 20, 13(14), 1179 - 85
High-level ability of secretory IgA to block HIV type 1 transcytosis: contrasting secretory IgA and IgG responses to glycoprotein 160; Hocini H et al.; The IgG and secretory IgA (S-IgA) responses to the HIV-1 envelope (gp160 antigen) were analyzed in the colostrum (Col) and in the cervicovaginal fluid (CVF) of HIV-l-infected women . We show IgG antibodies (Abs) to the recombinant gp160 to be predominant as compared with the corresponding S-IgA isotype . The low level of the S-IgA response cannot be related to a general disturbance of the mucosal-associated Iymphoid tissue (MALT) because the level of a current Ab to a caries-associated antigen from Streptococcus sobrinus was in the normal range in these secretions . The major subclass of IgA to gp160 was of the alpha1 isotype both in Col and in CVF . However, the specific activities of S-IgA1 and S-IgA2 were different when expressed as the ratio of the anti-gp160 related to total Ig of each subclass . Indeed, the specific activity of the S-IgA2 was predominant over S-IgA1 in the Col, whereas the reciprocal results were found in CVF, showing a subcompartmentalization of these secretions . The ability of S-IgA and IgG to block one of the pathways involved in the HIV-1 penetration across mucosa, i.e., transcytosis through epithelial cells, was evaluated using a functional in vitro assay . Both S-IgA and IgG Abs impaired virus transcytosis, irrespective of the level of antigp160 specific activities . However, specific S-IgA was more efficient than IgG . These features suggest that mucosal specific S-IgA to HIV-1 could be relevant in decreasing infectivity of HIV-1 in corporal fluids.

Chemotherapy, 1997 Sep-Oct, 43(5), 316 - 22
The incidence of penicillin-resistant pneumococci in the Slovak Republic . Pneumococcus Study Group; Trupl J et al.; The prevalence of penicillin-resistant Streptococcus pneumoniae and multiresistant strains isolated in Europe from the early 1970s has continued to rise . Twenty-four microbiology laboratories in the Slovak Republic analyzed 4,018 S . pneumoniae strains isolated from September 1, 1993, to December 31, 1993 . The overall resistance rate to penicillin was 3.4% in strains isolated from outpatients and 8.5% from inpatients with considerable variation between regions . The highest regional resistance rate to penicillin was 21% from outpatients in Levice, in the western Slovakia, and ranged between 13 and 52% in strains collected from hospitalized patients in 6 regions . Rates of penicillin-resistant pneumococci were significantly higher (p < or = 0.01) in children aged < or = 3 years . Two thirds of penicillin-resistant strains had intermediate levels of resistance (MICs 0.1-1 microgram/ml) and one third was resistant (MICs 2-8 micrograms/ml) . Resistance to multiple classes of agents was found in 75.9% of penicillin-resistant strains . These data support continued surveillance of antimicrobial resistance in pneumococcal infections . Standardization of susceptibility testing methods and monitoring of clinical outcomes is of critical importance to this complex problem.

Arch Intern Med, 1997 Sep 22, 157(17), 1965 - 71
Adult bacteremic pneumococcal pneumonia in a community teaching hospital, 1992-1996 . A detailed analysis of 108 cases; Watanakunakorn C et al.; OBJECTIVES: To review the clinical and laboratory findings of 108 adult patients with bacteremic pneumococcal pneumonia admitted to a community hospital and to determine the value of sputum Gram stains and cultures in the diagnosis of pneumococcal pneumonia in this setting . METHODS: Using the laboratory logbooks to identify adult inpatients with pneumococcal bacteremia from January 1, 1992, to June 30, 1996, were reviewed medical records . RESULTS: We found 108 patients . There was an apparent increase in prevalence from 1995 to 1996 compared with 1992 to 1994 . Patients included 44 men and 64 women . Ages ranged from 20 to 95 years (median, 70 years) . The fatality rate was 24.1% and increased with advancing age (no patient younger than 45 years died, and 36.8% of patients aged 85-95 years died) . Cigarette smoking, cardiovascular disease, chronic obstructive lung disease, malignant disease, and diabetes mellitus were major underlying conditions . Fever, dyspnea, and cough were the most common presenting symptoms . Sputum Gram stain was useful in the diagnosis when moderate to abundant Gram-positive diplococci were seen . Sputum culture was less useful . Factors associated with higher fatality rate were being 65 years of age or older, APACHE II (Acute Physiologic and Chronic Health Evaluation II) score greater than 15, intensive care unit admission, low or normal leukocyte count, thrombocytopenia, renal dysfunction, diffused infiltrates on chest radiography, bilateral pneumonia, and sputum culture positive for Streptococcus pneumoniae . CONCLUSIONS: We found a recent increase in the prevalence of bacteremic pneumococcal pneumonia in adults . Gram stain of sputum is useful, but sputum culture is less sensitive in the diagnosis of pneumococcal pneumonia . The fatality rate remains high . More effort should be made at prevention using pneumococcal immunization.

J Formos Med Assoc, 1997 Sep, 96(9), 745 - 8
Streptococcus adjacens endocarditis in a patient with nephrotic syndrome; Chen MH et al.; Streptococcus adjacens has never previously been reported as an etiologic organism of infective endocarditis in Taiwan . We describe a case of severe native valve endocarditis caused by S . adjacens, involving the mitral valve, the aortic valve, and the left atrium, in a 29-year-old woman with nephrotic syndrome on steroid therapy . Blood cultures yielded gram-positive cocci that grew poorly on blood agar but strongly on chocolate agar . Despite aggressive antibiotic treatment, the patients continued to have high fever and progressive congestive heart failure, which necessitated surgical intervention . Symptoms were alleviated after surgery; teicoplanin was continued for 4 weeks and the patient remained symptom-free at the 6 month follow up . To our knowledge, this is the first reported case of bacterial endocarditis involving the left atrium without preexisting myxoma.

Microb Drug Resist, 1997 Fall, 3(3), 259 - 62
Molecular characterization of a mutation affecting the amount of Streptococcus pneumoniae penicillin-binding protein 3; Selakovitch-Chenu L et al.; We have studied the molecular structure of the gene for the penicillin binding protein (PBP 3) of the Streptococcus pneumoniae wild-type strain and a laboratory mutant strain that exhibits a reduced amount of this protein on PBP gels . This mutation affects cefotaxime resistance when transferred into resistant strains . We have sequenced the PBP3 gene, dacA, and upstream regions from the wild-type isogenic strain and the laboratory mutant . We show that a deletion of one base-pair in the upstream sequence of this gene account for the phenotype by decreasing the amount of PBP3.

Microb Drug Resist, 1997 Fall, 3(3), 253 - 7
Spread of the Spanish multi-resistant serotype 23F clone of Streptococcus pneumoniae to Seoul, Korea; McGee L et al.; Multi-resistant serotype 23F pneumococcal strains from an outbreak in a day-care centre in South Africa and strains from sporadic cases in Korea were analysed for their relatedness, by means of arbitrarily-primed PCR (AP-PCR), repetitive extragenic palindromic PCR (rep-PCR) and penicillin-binding protein (PBP) gene profiles . The South African strains previously shown to be identical to the 23F Spanish clone had identical AP-PCR and rep-PCR patterns to 13 Korean isolates . PBP gene analysis of strains from this cluster showed identical fingerprints, suggesting clonality . Isolates, identical genotypically to the 23F clone appeared to have acquired the type 19F and 14 capsular serotypes, respectively, a result that suggests horizontal transfer of capsular biosynthetic genes . These same techniques revealed three serotype 9V isolates not closely related to the 23F clone but which harbour PBP genes identical to the 23F clone . The data presented suggests that a clone of S . pneumoniae serotype 23F related to isolates from Spain and South Africa has become disseminated in Korea.

Microb Drug Resist, 1997 Fall, 3(3), 233 - 42
Control of recombination rate during transformation of Streptococcus pneumoniae: an overview; Mortier-Barriere I et al.; Despite the fact that natural transformation was described long ago in Streptococcus pneumoniae, only a limited number of recombination genes have been identified . Two of them have recently been characterized at the molecular level, recA which encodes a protein essential for homologous recombination and mmsA which encodes the homologue of the Escherichia coli RecG protein . After a survey of the available information regarding the function of RecA, RecG, and other proteins such as the mismatch repair proteins HexA and HexB that can affect the outcome of recombinants, the different levels at which horizontal genetic exchange can be controlled are discussed . It is shown that the specific induction of the recA gene which occurs in competent cells is required for full recombination proficiency . Results regarding the ability of the Hex generalized mismatch repair system to prevent recombination between partially divergent sequences during transformation are also summarized . A structural analysis of homeologous recombinants which suggests that formation of mosaic recombinants can occur independently of mismatch repair in a single-step transformation is also reported . Finally, arguments in favor of an evolutionary origin of transformation as a means of genome evolution are discussed and the different types of recombination events observed which could potentially contribute to S . pneumoniae genome evolution are listed.

Microb Drug Resist, 1997 Fall, 3(3), 215 - 32
Invasive pneumococcal disease in the immunocompromised host; Janoff EN et al.; A normal constituent of the human upper respiratory flora, Streptococcus pneumoniae also produces respiratory tract infections that progress to invasive disease at high rates in specific risk groups . The individual factors that contribute to the development of invasive pneumococcal disease in this distinct minority of persons, include immune (both specific and innate), genetic, and environmental elements . Specific defects in host responses may involve age, deficiencies in levels of antibodies and complement factors, and splenic dysfunction . Combinations of these immune defects contribute to the increased rates of invasive pneumococcal disease in patients with sickle cell disease, nephrotic syndrome, neoplasms, and underlying medical conditions such as diabetes and alcoholic liver disease . The number of risk factors are greatest and the rates of invasive disease are highest in patients with HIV-1 infection, which has emerged as a major risk factor for serious S . pneumoniae infection worldwide.

Antimicrob Agents Chemother, 1997 Sep, 41(9), 2050 - 2
Bactericidal activity against intermediately cephalosporin-resistant Streptococcus pneumoniae in cerebrospinal fluid of children with bacterial meningitis treated with high doses of cefotaxime and vancomycin; Doit C et al.; Cerebrospinal fluid (CSF) was taken from 19 children with bacterial meningitis treated with cefotaxime (300 mg/kg of body weight/day) and vancomycin (60 mg/kg/day) . Median levels of drugs in CSF were smaller than expected, as follows: 4.4 microg/ml for cefotaxime, 3.2 microg/ml for desacetylcefotaxime, and 1.7 microg/ml for vancomycin . The median CSF bactericidal titer against an intermediately cefotaxime-resistant pneumococcus was 1:4 . Our data suggest at least an additive interaction between the drugs used in this study.

Antimicrob Agents Chemother, 1997 Sep, 41(9), 1973 - 8
Active efflux as a mechanism of resistance to ciprofloxacin in Streptococcus pneumoniae; Zeller V et al.; The accumulation of fluoroquinolones (FQs) was studied in a FQ-susceptible laboratory strain of Streptococcus pneumoniae (strain R6) . Uptake of FQs was not saturable, was rapidly reversible, and appeared to occur by passive diffusion . In the presence of glucose, which energizes bacteria, the uptake of FQs decreased . Inhibitors of the proton motive force and ATP synthesis increased the uptake of FQs in previously energized bacteria . Similar results were observed with the various FQs tested and may be explained to be a consequence simply of the pH gradient that exists across the cytoplasmic membrane . From a clinical susceptible strain (strain SPn5907) we isolated in vitro on ciprofloxacin an FQ-resistant mutant (strain SPn5929) for which the MICs of hydrophilic molecules were greater than those of hydrophobic molecules, and the mutant was resistant to acriflavine, cetrimide, and ethidium bromide . Strain SPn5929 showed a significantly decreased uptake of ciprofloxacin, and its determinant of resistance to ciprofloxacin was transferred by transformation to susceptible laboratory strain R6 (strain R6tr5929) . No mutations in the quinolone resistance-determining regions of the gyrA and parC genes were found . In the presence of arsenate or carbonyl cyanide m-chlorophenylhydrazone, the levels of uptake of ciprofloxacin by the two resistant strains, SPn5929 and R6tr5929, reached the levels of uptake of their susceptible parents . These results suggest an active efflux of ciprofloxacin in strain SPn5929.

Antimicrob Agents Chemother, 1997 Sep, 41(9), 1916 - 21
Successful single-dose teicoplanin prophylaxis against experimental streptococcal, enterococcal, and staphylococcal aortic valve endocarditis; Perdikaris GS et al.; Teicoplanin is a glycopeptide antibiotic that is administered both intramuscularly and intravenously . It has a prolonged half-life and a less toxic profile in comparison to those of vancomycin . The efficacy of a single dose of teicoplanin (18 mg/kg of body weight given intramuscularly) for the prevention of endocarditis due to Streptococcus oralis, Enterococcus faecium, and methicillin-resistant Staphylococcus aureus (MRSA) was evaluated after applying the rabbit model . Vancomycin at a single dose of 30 mg/kg given intravenously was used as the comparative agent for the prevention of endocarditis due to MRSA and E . faecium, while ampicillin at a single dose of 40 mg/kg given intravenously was used as the comparative agent for the prevention of endocarditis due to S . oralis . Rabbits in the teicoplanin group were infected at 1 h postdosing with approximately 10(7) CFU of each strain . Rabbits in the other groups were infected at 0.5 h postdosing with approximately 10(7) CFU of S . oralis (ampicillin group) or E . faecium and MRSA (vancomycin group) . All rabbits were sacrificed 5 days later . Teicoplanin and vancomycin protected the animals challenged with E . faecium by 87.5 and 50%, respectively, and protected the animals challenged with MRSA by 100 and 92%, respectively . Teicoplanin and ampicillin protected the animals challenged with S . oralis by 100 and 77%, respectively . Prevention of endocarditis by teicoplanin was likely to be due to a prolonged inhibition of bacterial growth by the sustained supra-MICs . It is concluded that teicoplanin is very effective in preventing experimental streptococcal, enterococcal, and staphylococcal endocarditis and may be an attractive alternative antibiotic in patients allergic to beta-lactams, especially in the outpatient setting.

Antimicrob Agents Chemother, 1997 Sep, 41(9), 1888 - 91
Cerebrospinal fluid bactericidal activity against cephalosporin-resistant Streptococcus pneumoniae in children with meningitis treated with high-dosage cefotaxime; Friedland IR et al.; We determined cefotaxime and desacetyl-cefotaxime concentrations in children with bacterial meningitis receiving high-dose cefotaxime (300 mg/kg of body weight/day) and concomitant dexamethasone therapy . The median peak cerebrospinal fluid cefotaxime and desacetyl-cefotaxime concentrations were 4.7 and 8.1 microg/ml, respectively . In vitro bactericidal activity (>99.9% killing in 6 h) was found in 17 (94%), 13 (72%), and 8 (44%) of 18 cerebrospinal fluid specimens against cefotaxime-susceptible, -intermediate (MIC, 1 microg/ml), and -resistant (MIC, 4 microg/ml) strains, respectively . High-dose cefotaxime, while safe, is not reliably sufficient therapy for cephalosporin-nonsusceptible pneumococcal meningitis, and combination therapy is recommended.

AIDS, 1997 Sep, 11(11), 1357 - 64
Profound immunosuppression across the spectrum of opportunistic disease among hospitalized HIV-infected adults in Abidjan, Côte d'Ivoire; Grant AD et al.; OBJECTIVES: To describe the spectrum of opportunistic disease in HIV-infected patients admitted to hospital in Abidjan, Cote d'Ivoire, and to describe the level of immunosuppression at which these diseases occur . DESIGN: Cross-sectional study . SETTING: In-patient wards of the University Hospital Infectious Diseases Unit . PATIENTS: A total of 250 adult patients recruited by systematic sampling at the point of hospital admission . MAIN MEASURES: HIV status; CD4 count; diagnoses, confirmed by microbiological/radiological investigations whenever possible; and outcome of hospitalization (death or discharge) . RESULTS: Overall, 79% patients were HIV-positive . The most frequent diagnoses in HIV-positive patients were septicaemia (20%, with non-typhoid salmonellae, Escherichia coli and Streptococcus pneumoniae the most common organisms), HIV wasting (16%), meningitis (14%), tuberculosis (TB; 13%), isosporiasis (10%), cerebral toxoplasmosis (7%) and bacterial enteritis (7%) . Most HIV-positive patients had evidence of severe immunosuppression: 39% had CD4 counts < 50 x 10(6)/l, 17% had 50-99 x 10(6)/l, and 20% had 100-199 x 10(6)/l . In-hospital mortality among HIV-positive patients was 38% compared with 27% among HIV-negative patients {age-adjusted odds ratio (OR), 1.5; 95% confidence interval (CI), 0.7-2.9} . Among HIV-positive patients, the highest case-fatality rates were among patients with meningitis, toxoplasmosis and TB: in a multivariate analysis the strongest independent risk factors for death were an abnormal level of consciousness (OR, 9.3; 95% CI, 3.5-24.6), a haemoglobin concentration below 8 g/dl (OR, 4.2; 95% CI, 1.4-12.8) and age > 40 years (OR, 3.9; 95% CI, 1.5-10.2) . CONCLUSIONS: Our data show that, as in industrialized countries, most HIV-infected individuals admitted to and dying in hospital in Abidjan are profoundly immunosuppressed . Potentially preventable infections are the main causes of in-hospital morbidity and mortality among HIV-infected persons in Abidjan, and the evaluation of appropriate primary prophylactic regimes is a priority.

J Antimicrob Chemother, 1997 Aug, 40(2), 275 - 7
Comparative effects of clindamycin and ampicillin on superantigenic activity of Streptococcus pyogenes; Sriskandan S et al.; We have tested the ability of Streptococcus pyogenes to produce streptococcal pyrogenic exotoxin A (SPEA) and superantigenic activity in the presence of sub-inhibitory concentrations of ampicillin and clindamycin . After 6 h of culture, SPEA production by S . pyogenes was higher in broths containing ampicillin (715.7 +/- 296.4 pg/10(6) cfu) than in broths containing clindamycin (167.1 +/- 31.9 pg/10(6) cfu), a difference that was not significant (P = 0.25) . Promitogenic activity of bacterial supernatants was also greater in ampicillin-treated cultures (467.5 +/- 17.2 ccpm/10(6) cfu) than in clindamycin-treated cultures (169.2 +/- 8.9 ccpm/10(6) cfu), a difference that was highly significant (P = 0.0001) . The data support the use of clindamycin in the treatment of streptococcal toxic shock-like syndrome, in order to inhibit superantigen synthesis.

Rinsho Kyobu Geka, 1989 Apr, 9(2), 157 - 61
{The effect of aortic valve translocation and a few problems}; Sakamoto S et al.; Aortic valve endocarditis is frequently associated with an aortic root abscess, so that it is difficult to insert a prosthetic valve . Between April, 1983 and June, 1988 we treated four out of seven patients with aortic valve endocarditis by translocation of the aortic valve, closure of the native coronary ostia, and placement of saphenous vein grafts on the coronary arteries . In each case, the operation was undertaken because of rapidly progressing heart failure . Infection was due to alpha-Streptococcus in two instances, to Staphylococcus epidermidis and fungus in the other cases . In one of the four patients, the prosthetic aortic valve was sutured to the ascending aorta and two saphenous vein grafts were placed on the proximal coronary arteries . In the other three patients, the composite Woven Dacron graft was used to replace the ascending aorta and two saphenous vein grafts were placed on the distal coronary arteries . One patient died one year postoperatively of LOS because of rapidly progressing coronary grafts ostial stenosis . The other three patients survived and doing well with satisfactory hemodynamic function and no infection . Translocation of the aortic valve for infective aortic valve endocarditis is a useful operative technique when conventional aortic valve replacement technique cannot be utilize.

Neurol Med Chir (Tokyo), 1997 Aug, 37(8), 630 - 6
Treatment of brain abscess associated with ventricular rupture--three case reports; Isono M et al.; Three patients presented with brain abscess associated with ventricular rupture . The origins of infection were sepsis, congenital heart disease, and unknown, and the organisms were Gram-negative cocci in one and Streptococcus species in two . Ventricular rupture occurred before administration of antibiotics and caused consciousness disturbance in all three patients . Continuous ventricle drainage was begun and antibiotics were directly administered into the ventricles . Aspiration and drainage from the abscess was also performed in two patients . Ventricular irrigation resulted in an excellent effect in one patient . The outcomes were excellent in two patients and fair in one . Aggressive ventricular drainage in the very early stage and direct intraventricular administration of antibiotics are very important to obtain a favorable outcome in patients with brain abscess and ventricular rupture.

Biosci Biotechnol Biochem, 1997 Aug, 61(8), 1317 - 22
Caries-inducing activity of the hydrogenated derivative of an isomaltooligosaccharide mixture in rats; Tsunehiro J et al.; The caries-inducing activity of the hydrogenated derivative of an isomaltooligosaccharide mixture (IMO-H) was evaluated in vitro for its acidogenicity and in vivo an experimental caries system with specific-pathogen-free (SPF) rats . Streptococcus sobrinus 6715 (serotype g) did not produce a significant amount of acid from IMO-H, whereas Streptococcus mutans MT8148 (serotype c) gradually produced a small amount of acid, although the degree was less than that of sucrose . In vivo experiments were conducted on rats which were provided with the test sugars at two different times: at the time of organism inoculation, and after the organisms had become completely established . IMO-H did not induce significant dental caries in rats infected with the S . sobrinus 6715 or S . mutans MT8148R strain.

Biol Pharm Bull, 1997 Aug, 20(8), 927 - 30
In vitro antibacterial activity of vanadate and vanadyl compounds against Streptococcus pneumoniae; Fukuda N et al.; All of the vanadate and vanadyl compounds tested in this study showed potent antibacterial activity against Streptococcus pneumoniae: the MIC (minimum inhibitory concentration) values of the vanadium compounds were 4-32 micrograms/ml, while the MIC values of tungstates and molybdates were 128-->8000 micrograms/ml . Scanning electron microscopy showed the elongation of S . pneumoniae strains under low concentrations (< MIC) of vanadium compounds such as (tert-BuNH3)4{V4O12} (1), (tert-BuNH3)6{V10O28} (2), Na3VO4 (7) and VOSO4 (8) . The vanadium compounds non-selectively inhibited the incorporation of thymidine, uridine, leucine and glucose into the cells of S . pneumoniae and led to an efflux of potassium ions from the cells . It implies that the vanadium compounds interfere in or on the cell membrane with the transport of substrates and ions through the cell membrane, resulting in antibacterial activity against S . pneumoniae cells.

Biochem Biophys Res Commun, 1997 Sep 18, 238(2), 313 - 6
Secretion of Porphyromonas gingivalis fimbrillin polypeptides by recombinant Streptococcus gordonii; Sharma A et al.; The fimbriae of Porphyromonas gingivalis plays an important role in the pathogenesis of periodontal disease . A structural subunit of the P . gingivalis fimbriae, fimbrillin, has been shown to promote adherence of the bacteria to host surfaces and also induce an immune response . Biologically active domains of fimbrillin responsible for adherence or eliciting immune responses have been determined . In a previous study, we engineered the human oral commensal organism Streptococcus gordonii to express such biologically active domains on the surface of the bacteria as a vaccine delivery system . In this study we report an alternative approach of secreting fimbrillin polypeptide domains into the medium by modification of the surface-expression system described earlier . Such recombinant S . gordonii, in addition to being a source for antigen presentation to trigger a protective immune response, may have the added advantage of directly blocking the fimbriae-mediated adherence of P . gingivalis to the oral cavity following implantation . This approach can also be utilized for secreting other biologically important therapeutic molecules on mucosal surfaces for modulating local microenvironments .

Antonie Van Leeuwenhoek, 1997 Aug, 72(2), 91 - 100
Thermophysiology of Streptococcus mutans and related lactic-acid bacteria; Ma Y et al.; The temperature ranges for growth of Streptococcus mutans GS-5 and S . sobrinus 6715 were found to be very narrow, from about 30 to 47 degrees C, with optimal growth around 37 degrees C . Thus, the organisms showed little potential to grow in the environment outside of the animal host . In contrast wider ranges were found for Enterococcus hirae, S . rattus and S . sanguis . Detailed study of S . mutans GS-5 showed that energetic coupling, reflected in yields of biomass per mol of glucose utilized, were not greatly affected by changes in temperature within the growth range . However, since glycolysis occurred over a wider temperature range (about 10 to 52 degrees C) than growth, yield values dropped to zero at temperatures above or below the growth range . The temperature range for glycolysis could be related to temperature sensitivity of the phosphoenolypyruvate: sugar phosphotransferase system for sugar uptake . F-ATPases were active over a similar range of temperatures, but with a broad optimal range from about 30 to 50 degrees C . Proton permeability of S . mutans increased steadily with temperature in a manner similar to that of other mesophilic bacteria, such as Escherichia coli . Growth of the bacteria in media supplemented with various fatty acids had major effects on proton permeabilities but the effects were not well reflected by changes in growth or glycolysis of the bacteria . The overall conclusions were that S . mutans is a typical mesophile in relation to membrane and catabolic functions but its narrow temperature range for growth is related to temperature sensitivities of anabolic systems.

Am J Med Sci, 1997 Sep, 314(3), 207 - 12
Isolated tricuspid valve endocarditis in nonaddicted patients: a diagnostic challenge; Nandakumar R et al.; Isolated native nonrheumatic tricuspid valve endocarditis rarely is described in the absence of intravenous drug use, intracardiac catheters, or cardiac anomalies . We diagnosed tricuspid valve endocarditis in two elderly nonaddicted patients with recurrent pulmonary infiltrates, anemia, and microscopic hematuria that occurred during several months and was caused by Gemella morbillorum and Candida glabrata, respectively . We have reviewed 27 other cases of nonaddicted patients with tricuspid valve endocarditis from the literature and discussed etiology, clinical characteristics, and outcome . Mean age was 53.5 years (range, 22 to 74 years old), and 72% had underlying medical conditions . Staphylococcus oureus, Streptococcus bovis, and candida species were the causative organisms in 70% of the cases . Average duration of infection before diagnosis was 9.3 months . We conclude that isolated tricuspid valve endocarditis in nonaddicted patients occurs mainly in the middle-aged and older persons, mimicking chronic illness and community-acquired pneumonia . In the absence of a history of intravenous drug use, diagnostic delays are common . We suggest that right-sided endocarditis must be considered in any patient with the "Tricuspid Syndrome," consisting of recurrent pulmonary events, anemia, and microscopic hematuria . Careful evaluation of prior medical records and clinical course can be very helpful . Echocardiography and serial blood cultures provide the key to diagnosis.

FEMS Microbiol Lett, 1997 Sep 1, 154(1), 123 - 9
Streptococcus uberis acquires plasmin activity following growth in the presence of bovine plasminogen through the action of its specific plasminogen activator; Leigh JA et al.; Three (0140J, C197C and EF20) out of four strains of Streptococcus uberis exhibited high levels of bound plasmin activity following growth in the presence of bovine plasminogen . The remaining strain (C197) bound considerably less plasmin following growth in the same medium . In contrast to the others, this strain was unable to activate bovine plasminogen . Following growth of strain C197 in the presence of bovine plasminogen and a source of plasminogen activator (urokinase or culture filtrate from strain 0140J) high levels of bacterially associated plasmin were detected . None of the strains was able to activate human plasminogen and only trace levels of plasmin activity were detected in association with the S . uberis following growth in the presence of human plasminogen . All strains were able to bind plasmin activity following incubation in the presence of either bovine or human plasmin . However, in each case the level of activity detected following incubation in human plasmin was approximately five-fold less than that observed following incubation with bovine plasmin . None of the strains bound detectable levels of either human or bovine plasminogen . It is concluded that activation of plasminogen is required prior to binding of plasmin by S . uberis.

Arch Mal Coeur Vaiss, 1997 May, 90(5), 651 - 4
{Cerebral abscess and cyanotic congenital heart disease}; Guerin P et al.; Cerebral abscess is a classical complication of cyanotic congenital heart disease . The authors report 7 cases of cerebral abscess diagnosed since 1982 . One asymptomatic patient died of a postoperative cerebral haemorrage . The child was repatriated from Africa for complete correction of his cardiac lesion . The presentation of the other 6 cases was quite typical : headaches, pyrexia and vomiting with a neurological deficit in 4 cases : two hemiparesias and two homonymous lateral hemianopsia . These 6 patients recovered without sequeilae . Four underwent surgical drainage of the abscess with antibiotic therapy . Two recovered with antibiotic therapy alone . The causal organism was only identified in patients undergoing surgical drainage and then only in 3 cases . They were gram positive cocci, in particular the streptococcus . The association ampicillin-chloramphenicol has often been proposed as the treatment of first intention . Adaptation of antibiotic therapy then depends on clinical, biological, bacteriological (CSF, blood cultures, portal of entry) outcomes and the results of CT scanning . The association of a third generation cephalosporin and an imidazole may be proposed as treatment of second intention . The minimal duration of treatment is generally acknowledged to be 4 weeks for intravenous therapy in cases of medical therapy alone, and 2 to 3 weeks in cases with surgical drainage . The age of apparition of this complication seems to be increasing as the average age was 16 in this series (cerebral abscess is classically described as occurring between 8 and 12 years of age) . This may be due to palliative surgery which reduces systemic hypoxia and polycythaemia . It also appears that neurological drainage is not systematic now because of early diagnosis of this complication . Finally, in the last few years, a new population of patients is becoming more common : patients repatriated by humanitary organisations in the third world, which should incite great vigilance in the preoperative period in this pathology.

Br J Clin Pract, 1997 Apr-May, 51(3), 133 - 7
Comparison of clarithromycin suspension and amoxycillin syrup for the treatment of children with pharyngitis and/or tonsillitis; Kearsley NL et al.; Twenty-three general practices in the UK randomised 229 paediatric patients (aged 1-12 years, body weight > 8 kg) with clinical evidence suggestive of streptococcal tonsillitis and/or pharyngitis in this physician-blind study . Patients received either clarithromycin suspension (7.5 mg/kg twice daily) or amoxycillin syrup (125 mg/kg three times daily body weight < 25 kg, or 250 mg/kg three times daily body weight 25 kg) for 7 days and were followed up 3-8 days post treatment and 21-28 days later . Clinical and microbiological assessments were made at each visit . A total of 189 patients (98 on clarithromycin and 91 on amoxycillin) were clinically evaluable . At the post-treatment visit, clinical success rates were high and comparable: 98% on clarithromycin and 97% on amoxycillin . Streptococcus pyogenes was eradicated in 88% of clarithromycin patients and 86% of amoxycillin patients . Both treatments were well tolerated . In conclusion, clarithromycin suspension was as safe and at least as effective as amoxycillin syrup for the treatment of pharyngitis and/or tonsillitis in children, and would be a suitable alternative therapy.

J Cataract Refract Surg, 1997 Jul-Aug, 23(6), 951 - 3
Endophthalmitis after radial keratotomy enhancement; Heidemann DG et al.; A 45-year-old man developed endophthalmitis after a radial keratotomy (RK) enhancement . He developed severe intraocular inflammation, hypopyon, and dense vitreous membranes 4 days after the enhancement surgery . Cultures of the corneal wound yielded a heavy growth of Streptococcus viridans . The inflammation subsided after treatment with intraocular, intravenous, and topical antibiotics . The patient subsequently developed a cataract and retinal detachment . This case demonstrates the risk of endophthalmitis after RK enhancement.

J Cataract Refract Surg, 1997 Jul-Aug, 23(6), 948 - 50
Endophthalmitis after astigmatic myopic laser in situ keratomileusis; Mulhern MG et al.; A 36-year-old woman had uneventful astigmatic myopic laser in situ keratomileusis (LASIK) to correct -12.00 -1.50 x 70 . Three days later, she developed a corneal abscess, hypopyon, and an intense vitreous cellular reaction-endophthalmitis . The patient was immediately given intravenous ciprofloxacin and topical vancomycin and ceftazidime . The infecting organism was Streptococcus pneumoniae . One day after therapy was instituted, the hypopyon resolved . Seven months later, best corrected visual acuity was 20/25 and refractive error, -4.00 diopters . A stromal scar (grade 2 haze) was causing a slight reduction in acuity . Endophthalmitis after LASIK, if treated promptly, need not lead to a permanent reduction in visual acuity.

J Clin Pharm Ther, 1997 Feb, 22(1), 53 - 9
Hydrocortisone 17-butyrate degradation in the presence of micro-organisms; Rabouan-Guyon SM et al.; OBJECTIVE: This study compared the degradation of hydrocortisone 17-butyrate (H17B) in the presence of six different bacteria, commonly found on psoriatic skin . METHOD: H17B and its degradation products (hydrocortisone and hydrocortisone 21-butyrate (H21B)) were assayed by HPLC . RESULTS: In the absence of micro-organisms, we observed 16.6 +/- 7.1% degradation . In the presence of micro-organisms and otherwise similar conditions, we noted that H17B degradation was not modified by cocci (Staphylococcus aureus, Staphylococcus epidermidis, Streptococcus agalactiae) . Three bacilli increased degradation, Escherichia coli 59.1 +/- 19.4%, Klebsiella oxytoca 62.1 +/- 6.7% and Pseudomonas aeruginosa 56.0 +/- 17.9% . CONCLUSION: The degradation of H17B into hydrortisone and H21B may produce a loss of therapeutic activity.

J Infect Dis, 1997 Sep, 176(3), 698 - 703
Identification of cross-reactive antibodies with low opsonophagocytic activity for Streptococcus pneumoniae; Nahm MH et al.; Opsonophagocytic capacity and concentrations of antibodies to the capsular polysaccharide (PS) of Streptococcus pneumoniae serotypes 6A, 6B, 19F, and 19A were determined for sera from adults immunized with 14- and 23-valent S . pneumoniae capsular PS vaccines . The concentration of anticapsular PS antibodies strongly correlated (r = .72 to r = .91) with the opsonophagocytic activities . However, 10%-20% of serum samples display strikingly less opsonophagocytic activity for the cross-reactive serotypes than expected on the basis of their antibody concentrations to the cross-reactive serotypes . From 1 poorly opsonic serum sample, kappa and lambda fractions of anti-6B antibodies were purified by affinity chromatography . Kappa (but not lambda) type antibody was found to have less opsonophagocytic capacity than expected . Thus, ELISA measurements of antibody responses to pneumococcal capsular PSs may not be reflective of opsonophagocytic function of the antibody.

J Oral Rehabil, 1997 Aug, 24(8), 624 - 7
In vitro adherence of bacteria to bleached or unbleached enamel surfaces; Gurgan S et al.; The purpose of this in vitro study was to evaluate the effects of three 10% carbamide peroxide bleaching agents on adherence of bacteria to tooth enamel surface . Enamel specimens were subjected to one of three carbamide peroxide solutions for 8 h per day for 30 days . Control specimens were kept in saline solution . Profilometer evaluation of surface roughness was performed on all specimens . The adherence of Streptococcus mutans was determined bacteriologically . There was no significant difference in surface roughness between the untreated and treated enamel specimens but a statistically significant difference was found in the adherence of S . mutans to bleached and unbleached enamel specimens . Specimens treated with Opalescence showed the highest adherence.

J Pediatr, 1997 Aug, 131(2), 293 - 9
Elevated IgG titer against the C region of streptococcal M protein and its immunodeterminants in patients with poststreptococcal acute glomerulonephritis; Mori K et al.; OBJECTIVE: To determine the immune responses to the streptococcal M protein in patients with poststreptococcal acute glomerulonephritis (PSAGN) . STUDY DESIGN: The gene coding type 12 M protein of group A streptococcus (M12), a known PSAGN-associated serotype, was cloned and expressed in Escherichia coli to investigate the specific immune responses to the M12 protein in patients with PSAGN . Recombinant M proteins for the variable N-terminal half (AB region) and conserved C-terminal half (C region) were produced separately . IgG titers against each region were measured by enzyme-linked immunosorbent assay in patients with PSAGN (n = 51), uncomplicated streptococcal pharyngitis (n = 26), chronic glomerulonephritis (n = 10), and in healthy control subjects (n = 51) . Immunodominant domains within the M protein in PSAGN were further investigated by use of overlapping synthetic peptides . RESULTS: IgG titers against the C region, but not the AB region, were markedly higher in the PSAGN group than in other groups (p < 0.01), and these titers were maintained for at least several months after antistreptolysin O or antistreptokinase levels had returned to normal . Studies with overlapping synthetic peptides demonstrated that increased IgG reactivity was observed against the C repeat blocks . CONCLUSION: IgG titers against the C region are significantly elevated in patients with PSAGN, and it may be a diagnostic marker for PSAGN.

J Formos Med Assoc, 1997 Aug, 96(8), 628 - 33
Clinical characteristics and antimicrobial susceptibility of invasive group B streptococcal infections in nonpregnant adults in Taiwan; Liu JW et al.; To understand group B streptococcal infections other than peripartum events in adults and to provide a regional antimicrobial therapy guide, we conducted a retrospective analysis of invasive diseases caused by group B streptococcus (GBS) in 33 nonpregnant adults treated in a medical center in southern Taiwan, from January 1993 to July 1994 . Antimicrobial susceptibility tests were performed using the agar dilution method . The incidence of the disease was 1.6 per 1,000 nonpregnant adult admissions, and the mean age of patients was 58 years (range 17-86 years) . Primary bacteremia (13) and soft-tissue infections (11) were the most common manifestations . Nearly all the patients had underlying disease(s) and/or condition(s); the three most common were diabetes mellitus (13), malignancy (5), and liver cirrhosis (5) . There were eight nosocomial infections and six patients died . Of 32 GBS strains tested, 27 were susceptible to penicillin G and the rest were intermediately susceptible . All strains were uniformly susceptible to cephalothin, cefotaxime, ofloxacin, and vancomycin; two strains were susceptible to gentamicin and nearly half were intermediately susceptible . Our findings imply a requirement for higher doses of penicillin or combination with an aminoglycoside for treatment of GBS infection . First-generation cephalosporins may be an alternative for the treatment of GBS infections in Taiwan.

Pediatr Res, 1997 Sep, 42(3), 259 - 62
Fc gammaRIIa polymorphism in human immunodeficiency virus-infected children with invasive pneumococcal disease; Abadi J et al.; Invasive pneumococcal disease (IPD) occurs frequently in HIV-infected children and adults . Defects in complement function, opsonic capsular antibodies, and Fc receptor antibody-mediated phagocytosis could contribute to impaired host defense against Streptococcus pneumoniae . The objective of this study was to define the distribution of the three Fc gammaRIIa genotypes in HIV+ children, including those with IPD . Forty-eight HIV+ Hispanic children, including eight with IPD, followed at Bronx-Lebanon Hospital Center, Bronx, New York, nine HIV+ adults with IPD, and 56 HIV- Hispanic control subjects were studied . The children and adults were identified retrospectively except for one child who developed IPD during the study . Fc gammaRIIa genotypes were determined by PCR amplification of the Fc gammaRIIa locus from genomic DNA samples and hybridization of the PCR products with allele-specific oligonucleotides . Naturally occurring serum antibodies reactive with four pneumococcal polysaccharide serotypes were determined by ELISA in seven of eight children with IPD . There were no statistical differences in Fc gammaRIIa genotypes between HIV+ children with and without IPD, HIV+ adults with IPD, or HIV- Hispanics . The predominant IgG subclass of pneumococcal polysaccharide binding antibodies in the seven HIV+ children with IPD studied was IgG1 . The distribution of Fc gammaRIIa genotypes in HIV+ children with and without IPD is similar to that of the normal Hispanic population . The prospect of passive immunotherapy with specific anticapsular antibodies might be a promising alternative for the treatment and/or prevention of IPD in HIV+ children and other immunodeficient groups.

Infect Immun, 1997 Sep, 65(9), 3936 - 8
Allelic variation in Streptococcus pneumoniae autolysin (N-acetyl muramoyl-L-alanine amidase); Gillespie SH et al.; The lytA gene encoding the autolysin of Streptococcus pneumoniae may be a virulence determinant . Single-strand conformational polymorphism analysis demonstrated heterogenicity throughout the gene in clinical isolates and strains from the clonal serotypes 7 and 14 . Sequence analysis of part of the choline-binding domain showed that in two isolates four amino acid substitutions occurred.

Infect Immun, 1997 Sep, 65(9), 3913 - 23
Molecular analysis of human cardiac myosin-cross-reactive B- and T-cell epitopes of the group A streptococcal M5 protein; Cunningham MW et al.; The group A streptococcal M protein is an important virulence determinant eliciting protective and autoimmune responses against the streptococcus and cardiac myosin, respectively . In this report, the major human cardiac myosin-cross-reactive T-cell epitopes of M5 protein are identified and localized to myosin-like repeats within the M5 molecule . BALB/c mice were immunized with human cardiac myosin, and the dominant myosin-cross-reactive T-cell epitopes of M5 protein were identified with a panel of 23 overlapping peptides spanning the A, B, and C repeat regions of M5 protein . Human cardiac myosin-cross-reactive T-cell epitopes of M5 protein were localized to several sequences in the M5 peptides NT4 (GLKTENEGLKTENEGLKTE), NT5 (KKEHEAENDKLKQQRDTL), B1B2 (VKDKIAKEQENKETIGTL), B2 (TIGTLKKILDETVKDKIA), B3A (IGTLKKILDETVKDKLAK), and C3 (KGLRRDLDASREAKKQ) . The NT4 repeated sequence LKTEN was highly homologous with a site conserved in cardiac myosins, the B repeat region peptides were 47% homologous to human cardiac myosin amino acid sequence, and the C3 sequence RRDL was identical to a highly conserved site in skeletal and cardiac myosins . Immunization of BALB/c mice with each of the overlapping M5 peptides revealed myosin-cross-reactive B-cell epitopes throughout the A and C repeat regions and one major epitope in the B repeat region containing the previously reported Gln-Lys-Ser-Lys-Gln (QKSKQ) epitope . The data suggest that the M5 peptides elicited higher antibody titers to cardiac myosin than to skeletal myosin and that several sites in the A and B repeat regions of M5 protein induced myocardial inflammatory infiltrates.

Infect Immun, 1997 Sep, 65(9), 3828 - 33
Streptococcal mitogenic exotoxin Z, a novel acidic superantigenic toxin produced by a T1 strain of Streptococcus pyogenes; Kamezawa Y et al.; Streptococcus pyogenes T1 was previously found to produce an acidic mitogenic exotoxin, designated A beta, antigenically distinct from erythrogenic toxin type A (ETA) of strains T1 and NY5 . Following chemical analysis and biological characterization, we have renamed this toxin streptococcal mitogenic exotoxin Z (SMEZ) . Physicochemical separation of SMEZ from ETA was successfully performed on a hydrophobic chromatograph . The isoelectric point was pH 5.3, and the molecular size was estimated to be 28 kDa . These values were similar to those of ETA, but the amino acid composition and the NH2-terminal sequence of SMEZ were distinct from those of any mitogenic exotoxins hitherto described . Its mitogenic activity was found to be more potent than that of ETA in rabbit lymphocyte cultures . A specific antiserum raised against SMEZ did not cross-react with ETA, ETB, or ETC in the neutralization tests of mitogenic and erythrogenic activities . Its superantigenic nature was evident from the reverse transcriptase PCR findings of the T-cell receptor Vbeta profiles of rabbit lymphocytes stimulated in vitro . The Vbeta 8 subfamily was unique to SMEZ, while the Vbeta 2 and 6 subfamilies were found to be common among lymphocytes stimulated with ETA, ETB, ETC, or SMEZ . The results from this study provide an additional example of the diversity that exists among mitogenic or superantigenic exotoxins of streptococcal origin.

Infect Immun, 1997 Sep, 65(9), 3815 - 21
Streptococcus sanguis expresses a 150-kilodalton two-domain adhesin: characterization of several independent adhesin epitopes; Gong K et al.; Streptococcus sanguis binds to saliva-coated hydroxylapatite (sHA), an in vitro model of the enamel pellicle . To learn if more than one adhesin functions during adhesion, 12 reactive monoclonal antibodies (MAbs) were isolated by screening against both adhesive and nonadhesive strains . Two of these MAbs, 1.1 and 1.2, inhibited adhesion in a dose-dependent fashion, although maximum inhibition with either was only 37% . When these two MAbs plus a polyclonal antibody to P1-like adhesin were combined, the inhibition was additive to about 82% . These data indicated that there were at least three distinct, functional adhesion epitopes on the surface of S . sanguis . Western blot analyses of S . sanguis surface macromolecules showed antigens at 36 and 56 (with MAb 1.2), 87 and 150 (with both MAb 1.1 and MAb 1.2), and 100, 130, and 170 kDa (with anti-P1 antibody) . The antigens were eluted from gels . Isolated antigens and corresponding antibodies inhibited adhesion similarly . Additivity experiments suggested the distinct epitopes were in three groups: (i) 36/56 kDa, (ii) 87/150 kDa, and (iii) 100/130/170 kDa . The 150-kDa antigen reacting with both MAbs was isolated from gels and digested with trypsin . The digestion revealed a series of tryptic bands . A band at 38 kDa reacted with MAb 1.1 whereas a band at 54 kDa reacted with MAb 1.2 in Western blot analysis, indicating two distinct adhesive epitopes on the 150-kDa antigen . These data strongly suggest that S . sanguis adhesion to sHA is maximized when several adhesin epitopes are coexpressed on surface antigens of different sizes.

Infect Immun, 1997 Sep, 65(9), 3781 - 7
Increased susceptibility of RAG-2 SCID mice to dissemination of endodontic infections; Teles R et al.; Specific immunity has been implicated in the pathogenesis of periapical lesions, although the extent to which these mechanisms are actually involved in either protection or destruction of the pulp-periapex complex is yet to be established . To investigate this question we compared periapical-lesion pathogenesis in RAG-2 severe combined immunodeficient (SCID) mice with immunocompetent control mice following surgical pulp exposure . In order to equalize the bacterial challenge, an infection protocol using Prevotella intermedia, Fusobacterium nucleatum, Peptostreptococcus micros, and Streptococcus intermedius was devised . The results demonstrated that after infection, the proportion of the root canal flora represented by the four pathogens was almost identical in both groups (39.9 and 42.2% for RAG-2 and immunocompetent control mice, respectively) . The effects of abrogation of T- and B-cell mechanisms on periapical pathogenesis were then assessed . Approximately one-third of the RAG-2 mice developed endodontic abscesses, while no immunocompetent controls had abscesses, results which indicated regional dissemination of the infection . A similar incidence of abscesses was found in two additional experiments . Abscessed RAG-2 teeth had significantly larger periapical lesions than did nonabscessed RAG-2 teeth (P < or = 0.05) and exposed immunocompetent controls (P < or = 0.01), whereas nonabscessed RAG-2 teeth were not significantly different from those of exposed immunocompetent controls in periapical-lesion size . We conclude that B- and T-cell-mediated immunity protects the host from the dissemination of endodontic infections and that RAG-2 mice are more susceptible to infection-induced pulp-periapex destruction.

Infect Immun, 1997 Sep, 65(9), 3638 - 43
Bordetella pertussis binds the human complement regulator C4BP: role of filamentous hemagglutinin; Berggard K et al.; C4BP (C4b-binding protein) is a high-molecular-weight plasma protein that inhibits the classical pathway of complement activation . Recent experiments have demonstrated that C4BP binds to many strains of the gram-positive bacterium Streptococcus pyogenes, a major respiratory tract pathogen . Binding to S . pyogenes was shown to be due to members of the M protein family, a group of surface proteins important for virulence . Here we report that human C4BP also binds to all clinical isolates of the gram-negative bacterium Bordetella pertussis, the etiologic agent of whooping cough . In addition, binding of C4BP was demonstrated for other Bordetella species that can cause disease in humans . Characterization of different B . pertussis mutants showed that the binding of C4BP is strongly dependent on the expression of the cell surface protein filamentous hemagglutinin, a well-known virulence factor . Inhibition experiments suggested that B . pertussis and S . pyogenes bind to the same region in C4BP . The finding that B . pertussis and S . pyogenes both have the ability to bind human C4BP suggests that these two unrelated respiratory tract pathogens may use a common mechanism during the establishment of an infection.

Infect Immun, 1997 Sep, 65(9), 3600 - 5
Comparison of the sequences and functions of Streptococcus equi M-like proteins SeM and SzPSe; Timoney JF et al.; Streptococcus equi (Streptococcus equi subsp . equi), a Lancefield group C streptococcus, causes strangles, a highly contagious purulent lymphadenitis and pharyngitis of members of the family Equidae . The antiphagocytic 58-kDa M-like protein SeM is a major virulence factor and protective antigen . The amino acid sequence and structure of SeM has been determined and compared to that of a second, 40-kDa M-like protein (SzPSe) of S . equi and to those of other streptococcal proteins . Both SeM and SzPSe are mainly alpha-helical fibrillar molecules with no homology other than that between their signal and membrane anchor sequences and are only distantly related to other streptococcal M and M-like proteins . The sequence of SzPSe indicates that it is an allele of SzP that encodes the variable protective M-like and typing antigens of S . zooepidemicus (S . equi subsp . zooepidemicus) . SeM is opsonogenic for S . equi but not for the closely related S . zooepidemicus, whereas SzPSe is strongly opsonogenic for S . zooepidemicus but not for S . equi . Both proteins bind equine fibrinogen . SeM and SzPSe proteins from temporally and geographically separated isolates of S . equi are identical in size . The results taken together support previous evidence that S . equi is a clonal pathogen originating from an ancestral strain of S . zooepidemicus . We postulate that acquisition of SeM synthesis was a key element in the success of the clone because of its effect in enhancing resistance to phagocytosis and because protective immunity entails a requirement for SeM-specific antibody.

Microb Pathog, 1997 Sep, 23(3), 127 - 37
Establishment of a Streptococcus pneumoniae nasopharyngeal colonization model in adult mice; Wu HY et al.; Human nasopharyngeal carriage of Streptococcus pneumoniae constitutes the major natural reservoir of pneumococci and is thought to be the prelude to virtually all pneumococcal disease . If carriage could be greatly reduced, pneumococcal transmission and disease could be largely eliminated . To facilitate the studies of mechanisms important in carriage and to identify immunogens that can elicit protection against carriage, we characterized an adult mouse model of nasopharyngeal carriage . Non-anaesthetized mice were inoculated intranasally with pneumococci in 10 microl of fluid . Nasopharyngeal carriage was observed with strains of capsular types 3, 4, 6A, 6B, 14, 19, and 23 . Carriage was stable over time, and the numbers of pneumococci carried were relatively independent of inoculation dose; findings which indicate that the recovery of pneumococci from 1 day to 2 weeks post inoculation was dependent on colonization, rather than just temporary contamination . To ensure carriage in the largest percentage of mice, without causing sepsis or death, inoculations of 10(7) colony forming units (cfu) should be used . In this model, carriage was generally observed without concomitant bacteremia or sepsis and carriage was observed even with strains that were avirulent when injected i.v . The model should be useful for the identification of protection-eliciting antigens, since intranasal immunization with heat-killed pneumococci or lysates of pneumococci protected against carriage.

Phytochemistry, 1997 Sep, 46(1), 97 - 102
Antimicrobial compounds from Ceanothus americanus against oral pathogens; Li XC et al.; During the search for antimicrobial compounds from higher plant sources, a methanol extract of Ceanothus americanus demonstrated antimicrobial activity against selected oral pathogens . Through further bioassay-guided fractionation and purification, three triterpenes (ceanothic acid, 27-hydroxy ceanothic acid and ceanothetric acid) and two flavonoids (maesopsin and maesopsin-6-O-glucoside) were identified . Among these, ceanothetric acid and maesopsin-6-O-glucoside were new compounds . Ceanothic acid and ceanothetric acid demonstrated growth inhibitory effect against Streptococcus mutans, Actinomyces viscosus, Porphyromonas gingivalis, and Prevotella intermedia with MICs ranging from 42 to 625 micrograms ml-1 . Maesopsin, its glucoside, and 27-hydroxy ceanothic acid, were inactive below the concentration of 500 micrograms ml-1.

Pediatr Surg Int, 1997 Sep, 12(7), 538 - 40
Necrotizing fasciitis and myonecrosis in early childhood: a report of three patients; Mordehai J et al.; Necrotizing fasciitis (NF) is a rare and life-threatening disease . It usually presents as a postoperative complication, but rarely appears following trauma or without apparent cause . Over a period of 2 years we have treated three infants with NF, aged 15, 5, and 30 months, respectively . Two patients developed this complication following minor trauma while the third was post-elective bilateral inguinal hernia repair . The micro-organisms isolated were Staphylococcus aureus with Enterococcus durans in one patient, beta-hemolytic streptococcus in a second, and Staph . aureus in the third . The cornerstone of therapy is prompt, early, aggressive surgical debridement of the massive necrotic tissue and repeated debridement if necessary, with appropriate parenteral antibiotic therapy and hyperalimentation . All three patients survived . Early recognition of this life-threatening situation is mandatory in achieving survival.

Curr Microbiol, 1997 Sep, 35(3), 133 - 8
Gene knockout of the intracellular amylase gene by homologous recombination in Streptococcus bovis; Brooker JD et al.; Streptococcus bovis expresses two different amylases, one intracellular and the other secreted . A suicide vector containing part of the intracellular alpha-amylase gene from Streptococcus bovis WI-1 was recombined into the S . bovis WI-1 chromosome to disrupt the endogenous gene . Recombination was demonstrated by Southern blot, and zymogram analysis confirmed the loss of the intracellular amylase . Amylase activity in cell-free extracts of the recombinant grown in the presence of 1% starch was only 7% of wild type . The rate of logarithmic growth of the recombinant was 15-20% of the wild type in medium containing either 1% glucose, starch, or cellobiose . Revertants and non-amylase control recombinants had logarithmic growth rates that were the same as wild type . Plasmid transformants containing multiple copies of the cloned gene expressed up to threefold higher levels of intracellular amylase activity than wild type but did not demonstrate elevated growth rates . These results suggest that a critical level of expression of the intracellular amylase gene may be important for rapid growth of the bacterium.

N Engl J Med, 1997 Aug 28, 337(9), 589 - 94
Invasive infections due to a fish pathogen, Streptococcus iniae . S . iniae Study Group; Weinstein MR et al.; BACKGROUND: Streptococcus iniae is a pathogen in fish, capable of causing invasive disease and outbreaks in aquaculture farms . During the winter of 1995-1996 in the greater Toronto area there was a cluster of four cases of invasive S . iniae infection in people who had recently handled fresh, whole fish from such farms . METHODS: We conducted a prospective and retrospective community-based surveillance for cases of S . iniae infection in humans . To obtain a large sample of isolates, we studied cultures obtained from the surface of fish from aquaculture farms . Additional isolates were obtained from the brains of infected tilapia (oreochromis species) . All the isolates were characterized by pulsed-field gel electrophoresis (PFGE) . RESULTS: During one year, our surveillance identified a total of nine patients with invasive S . iniae infection (cellulitis of the hand in eight and endocarditis in one) . All the patients had handled live or freshly killed fish, and eight had percutaneous injuries . Six of the nine fish were tilapia, which are commonly used in Asian cooking . Thirteen additional S . iniae isolates (2 from humans and 11 from infected tilapia) were obtained from normally sterile sites . The isolates from the nine patients were indistinguishable by PFGE and were highly related to the other clinical isolates . There was substantial genetic diversity among the 42 surveillance isolates from the surface of fish, but in 10 isolates the PFGE patterns were identical to those from the patients with S . iniae infection . CONCLUSIONS: S . iniae can produce invasive infection after skin injuries during the handling of fresh fish grown by aquaculture . We identified a clone of S . iniae that causes invasive disease in both humans and fish.

FEMS Microbiol Lett, 1997 Aug 15, 153(2), 447 - 53
Development of a technique for multiple site-directed mutagenesis of the ftf gene of Streptococcus salivarius containing palindromic sequences; Rathsam C et al.; Attempts at site-directed mutagenesis of the fructosyltransferase (ftf) gene of Streptococcus salivarius ATCC 25975 using standard protocols were unsuccessful and resulted in a series of deletions . These deletions appeared to commence at points within the ftf gene where there were palindromic sequences which were capable of forming closed loop structures that acted as terminators under the conditions of mutagenesis . To overcome this problem, two modified mutagenic techniques were developed . They made use of T4 DNA polymerase in conjunction with either T7 DNA polymerase at 37 degrees C or Vent DNA polymerase from Thermococcus litoralis at an elevated temperature . These methods eliminated the need for a single-stranded DNA template and allowed polymerisation through palindromic sequences to rapidly produce multiple site-directed mutations.

FEMS Microbiol Lett, 1997 Aug 15, 153(2), 439 - 45
The N-terminal half part of the oral streptococcal antigen I/IIf contains two distinct binding domains; Sciotti MA et al.; In order to investigate the binding properties of the antigen I/IIf from Streptococcus mutans, we analyzed the binding activity of five I/IIf derivatives expressed by I/IIf gene derivatives obtained by insertion of a kanamycin resistance marker . ELISA-derived binding assays showed that the derivatives containing both the N-terminal alanine-rich domain (A-region) and an A-region distal domain extending to amino-acid 766 were the most effective in binding biotinylated (Biot-) human salivary components (SAC) and Biot-epithelial cell membrane components . Sodium metaperiodate treatment of SAC inhibited these interactions, suggesting a binding specificity of the A-region distal domain for carbohydrate residues . All the I/IIf derivatives were found to bind Biot-type I collagen, Biot-laminin, Biot-keratin, and Biot-fibronectin, the derivatives containing the A-region but lacking the A-region distal domain exhibiting the highest binding levels . Sodium metaperiodate treatment of laminin had no effect on its binding to the derivatives, suggesting that carbohydrate residues of the ligand were not involved.

FEMS Microbiol Lett, 1997 Aug 15, 153(2), 379 - 85
Identification of a Streptococcus suis 60-kDa heat-shock protein using western blotting; Benkirane R et al.; This study was initiated to investigate the presence of stress or heat shock proteins in Streptococcus suis . SDS-PAGE and Western blotting using polyclonal and monoclonal antibodies directed against different bacterial heat shock proteins demonstrated cross-reactivity with a protein with an apparent molecular mass of 60 kDa in all S . suis serotypes tested . The 60-kDa cross-reactive protein was present in virulent and avirulent strains of S . suis serotype 2 tested . A rabbit antiserum raised against the 60-kDa S . suis protein recognized the 60-65-kDa heat shock proteins in different Gram-positive and Gram-negative bacteria . Finally, the 60-kDa heat shock protein of S . suis was shown to be mostly secreted into the culture supernatant and, to a lesser extent, cell-associated . Growth under heat stress conditions (42 degrees C) increased the expression of the 60-kDa S . suis protein . This protein is, to our knowledge, the first common antigen found in different serotypes of S . suis.

Rheum Dis Clin North Am, 1997 Aug, 23(3), 545 - 68
Acute rheumatic fever . Still a challenge; da Silva NA et al.; At the end of the 20th century, after an apparent decline, acute rheumatic fever (ARF) now constitutes a great challenge for developed and developing countries . It is caused by a group A beta-hemolytic Streptococcus upper airways infection, but the exact pathogenetic mechanisms are not yet clear . The role of the immune system in the pathogenesis of ARF is understood better than genetic host factors . ARF can mimic many other diseases, and the diagnosis is based on clinical criteria . It is still overdiagnosed and underdiagnosed in different settings . Penicillin has greatly contributed to the reduction in the incidence and recurrence of this disease . Current schemes of prophylaxis, however, present many problems, and failures are common . Future efforts to reduce the burden of this disease should induce public health measures the vaccine strategiesPublication Types:

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