J Clin Invest, 2003 Jun, 111(12), 1905 - 12 Rheumatic fever-associated Streptococcus pyogenes isolates aggregate collagen; Dinkla K et al.; Acute rheumatic fever is a serious autoimmune sequel of Streptococcus pyogenes infection . This study shows that serotype M3 and M18 S . pyogenes isolated during outbreaks of rheumatic fever have the unique capability to bind and aggregate human basement membrane collagen type IV . M3 protein is identified as collagen-binding factor of M3 streptococci, whereas M18 isolates bind collagen through a hyaluronic acid capsule, revealing a novel function for M3 protein and capsule . Following in vivo mouse passage, conversion of a nonencapsulated and collagen-binding negative M1 S . pyogenes into an encapsulated, collagen-binding strain further supports the crucial role of capsule in mediating collagen binding . Collagen binding represents a novel colonization mechanism, as it is demonstrated that S . pyogenes bind to collagen matrix in vitro and in vivo . Moreover, immunization of mice with purified recombinant M3 protein led to the generation of anti-collagen type IV antibodies . Finally, sera from acute rheumatic fever patients had significantly increased titers of anti-collagen type IV antibodies as compared with healthy controls . These findings may suggest a link between the potential of rheumatogenic S . pyogenes isolates to bind collagen, and the presence of collagen-reactive autoantibodies in the serum of rheumatic fever patients, which may form a basis for post-streptococcal rheumatic disease . These anti-collagen antibodies may form a basis for poststreptococcal rheumatic disease. Int J Syst Evol Microbiol, 2003 May, 53(Pt 3), 683 - 5 Enterococcus phoeniculicola sp . nov., a novel member of the enterococci isolated from the uropygial gland of the Red-billed Woodhoopoe, Phoeniculus purpureus; Law-Brown J et al.; A facultatively anaerobic, Gram-positive, coccoid, non-spore-forming, non-motile, catalase-negative bacterium was isolated from the uropygial (preen) gland of wild Red-billed Woodhoopoes (Phoeniculus purpureus) and designated strain JLB-1(T) . Physiological and biochemical testing suggested that this homofermentative, lactic-acid-producing bacterium could belong to the genus Enterococcus or the genus Streptococcus . Comparison of the 16S rRNA gene sequence of strain JLB-1(T) with other 16S rDNA sequences in the GenBank database by BLAST analysis showed that its closest relatives are Enterococcus faecium, Enterococcus avium and Enterococcus asini . Strain JLB-1(T) may be differentiated from these species by the fact that it does not produce acid from lactose, D-mannitol, D(+)-melezitose or D-sorbitol . Furthermore, it does not hydrolyse arginine or hippurate and cannot grow in the presence of 6.5% NaCl or 40% bile . It differs from the streptococci in that it does not lyse erythrocytes . Strain JLB-1(T) is a novel member of the enterococci, for which the name Enterococcus phoeniculicola sp . nov . is proposed . The type strain is JLB-1(T) (=ATCC BAA-412(T) = DSM 14726(T)). J Antimicrob Chemother, 2003 Jul, 52(1), 110 - 2 Epub 2003 Jun 12. Macrolide resistance determinants of group A streptococci in Ankara, Turkey; Acikgoz ZC et al.; OBJECTIVES: Macrolide-lincosamide-streptogramin B (MLSB) resistance determinants of group A streptococci (GAS) in Ankara, Turkey, were defined for the first time . ISOLATES AND METHODS: A total of 1355 GAS isolates, collected from three different regions of Ankara, were screened for erythromycin resistance . Resistance phenotypes were determined by a triple-disc test, and the gene determinants responsible were determined by PCR . MICs of erythromycin, clindamycin and spiramycin were measured for the resistant isolates, and susceptibility rates to some further antibiotics were determined . RESULTS: Thirty-six isolates (2.6%) were resistant to erythromycin . Of these, 17 (47.2%) expressed macrolide-restricted resistance (M phenotype), while the remainder expressed inducible (16 isolates, 44.4%) or constitutive (three isolates, 8.3%) MLSB resistance . All isolates of the M phenotype harboured the mef(A) gene . Of non-M isolates, 14 harboured erm(A) subclass erm(TR) and five had erm(B) genes . There was a significant relationship between tetracycline resistance and the inducible phenotype (P < 0.05) . Macrolide resistance was significantly higher in adults (P < 0.05), and increased more than two-fold in 2002 compared with 2001 (P < 0.05) . CONCLUSION: The prevalence of macrolide resistance in GAS is low in Ankara; therefore, routine antimicrobial susceptibility testing against these agents seems unwarranted. Lett Appl Microbiol, 2003, 37(1), 66 - 9 Nested PCR for detection of mutans streptococci in dental plaque; Sato T et al.; AIMS: Mutans streptococci such as Streptococcus mutans and Streptococcus sobrinus have been implicated in human dental caries . In an attempt to develop a rapid and sensitive method for detecting Strep . mutans and Strep . sobrinus in dental plaque, a nested PCR amplification based on the 16S rRNA gene was employed . METHODS AND RESULTS: A universal set of PCR primers for bacterial 16S rRNA gene was introduced for the first PCR, and then two sets of primers specific for the 16S rRNA gene sequences of either Strep . mutans or Strep . sobrinus were used for the second PCR . Eighteen plaque samples were analyzed, and a nested PCR was shown to be more sensitive for detecting Strep . mutans and Strep . sobrinus than direct PCR . CONCLUSIONS, SIGNIFICANCE AND IMPACT OF THE STUDY: The 16S rRNA gene-based nested PCR method is a rapid and sensitive method for the detection of mutans streptococci, and may also be suitable for carrying out large-scale studies on the cariogenicity of mutans streptococci. J Heart Valve Dis, 2003 May, 12(3), 411 - 3 Endocarditis due to Peptostreptococcus anaerobius: case report and literature review of peptostreptococcal endocarditis; Cone LA et al.; Infective endocarditis caused by anaerobic streptococci occurs rarely, and only five cases have been described in detail, with two additional cases mentioned in a review of anaerobic infective arthritis . All have resulted from infection caused by peptostreptococci . Another case of anaerobic gram-positive endocarditis caused by Peptostreptococcus anaerobius has recently been encountered . The patient was successfully treated with a beta-lactam for six weeks, plus gentamicin (to which the organism was resistant in vitro) for two weeks . In reviewing these six cases, all but one involved a prosthetic valve, and in three instances the organism was isolated only from the infected valve . In four of six patients the aortic valve was involved, and five of the six survived with appropriate antimicrobial therapy . Embolic phenomena were confirmed in only one patient, who also manifested the only non-diagnostic echocardiogram. Lancet, 2003 Jun 7, 361(9373), 1953 - 4 Estimated early-onset group B streptococcal neonatal disease; Luck S et al.; Estimates of incidence of early-onset group B streptococcal (EOGBS) infection are based on blood or cerebrospinal fluid culture-proven cases, which can be falsely negative and hence underestimate the true burden of disease . Probable EOGBS infection can be defined as colonisation by group B streptococci accompanied by features of clinical sepsis . Data collected prospectively in the UK over 1 year for neonates who required a septic screen in the first 72 h of life indicated a combined rate of definite and probable EOGBS infection of 3.6 per 1000 livebirths . This estimate indicates a much greater disease burden in the UK than that suggested by figures of culture-proven sepsis, and lends support to the need for prevention strategies. FEMS Microbiol Lett, 2003 Jun 6, 223(1), 107 - 11 Oral bacteria resistant to mercury and to antibiotics are present in children with no previous exposure to amalgam restorative materials; Ready D et al.; Dental plaque from 76 children without amalgam restorations was screened for bacteria resistant to mercuric chloride . Seventy-one per cent of the children harboured mercury-resistant oral bacteria and the median percentage of the total oral microflora resistant to mercuric chloride was 0.007% (range 0-5.3%) . Eighty-seven mercury-resistant bacteria were isolated and 86% of these were streptococci with Streptococcus mitis predominating . Sixty per cent of the mercury-resistant isolates were also resistant to at least one of the four antibiotics tested (penicillin, ampicillin, erythromycin and tetracycline) with resistance to tetracycline (40% of isolates) most frequently encountered. Vaccine, 2003 Jun 20, 21(21-22), 2698 - 703 Evaluation of synthetic, M type-specific peptides as antigens in a multivalent group A streptococcal vaccine; Bruner M et al.; The recent development of emm gene sequence-based typing methodology has allowed group A streptococci (GAS) M serotype prevalence data to be determined . This information has been used to identify the components of a multivalent M protein peptide vaccine that could theoretically prevent most of the GAS-mediated diseases in the USA . In this study, we have evaluated in mice the immunogenicity and protective ability of multiple synthetic, M type-specific peptides, derived from the N-termini of three prevalent GAS serotypes (three peptides per serotype, total of nine peptides) . At least one peptide, representing each of the three M types tested, was immunogenic . Five of the nine synthetic peptides tested, elicited an immune response in mice, and sera raised against four of the peptides, all possessed functional activity as demonstrated in a bactericidal assay . In vivo nasopharyngeal challenge experiments were carried out with peptides from the M1 (peptide M1-3) and M3 (peptide M3-2) proteins induced in vivo immune protection by reducing intranasal carriage.Reduction in colonization for M1-3 and M3-2 was 90% (P=0.02) and 66% (P<0.17), respectively . A reduction in colonization of 67% (P=0.03) was observed for M3-2 immunized mice when M43, a heterologous serotype, was used as the challenge strain . These results show the utility of synthetic, M type-specific peptides as antigens in a multivalent GAS vaccine. Am J Dent, 2003 Apr, 16(2), 135 - 8 Treatment of cervical sensitivity with a root sealant; Baysan A et al.; PURPOSE: To assess a novel root sealant for cervical sensitivity . MATERIALS AND METHODS: Clinical assessments, impressions and modified USPHS criteria (n = 24) were carried out at baseline, 3, 6 and 19 months . Plaque samplings were performed at baseline and after 3 and 19 months . RESULTS: At 19 months, 20 patients completed the clinical trial . There was a significant reduction for the sensitivity scores . The log10 of total colony-forming units (cfu + 1) from overlying plaque significantly reduced . The percentage of mutans streptococci reduced after 3 months (P < 0.01) and yeasts also reduced after 19 months (P < 0.01) . The mean overall wear (+/- SD) (microm) on the sealant was 78.8 +/- 21.3 at 3 months; 95.4 +/- 7.3 after 6 months and 136.5 +/- 9.8 after 19 months . In conclusion, this sealant was capable of reducing sensitivity . Further wear on the cervical surface was prevented as the mean sealant thickness was 65.3 +/- 3.3 after 19 months. Nippon Jibiinkoka Gakkai Kaiho, 2003 May, 106(5), 532 - 9 {Etiology of acute pharyngitis in adults: the presence of viruses and bacteria}; Hashigucci K et al.; Pharyngeal swabs from patients with acute pharyngitis were evaluated for viruses and bacterial organisms from December 2000 through June 2001 . Viral genomes were detected by PCR . Of 56 patients, potentially pathogenic bacteria were isolated in 34 (60.7%), viruses in 19 (33.9%), and no etiological pathogens in 16 patients (28.6%) . Both viral and bacterial infections were found in 13 (23.2%) . Of 56 patients, beta streptococci were found in 10 (6 with group A streptococci, 4 with other groups), H . influenzae in 13, S . pneumoniae in 8, and S . aureus in 7 . Two bacterial organisms were isolated in 4 and 3 in 1 . Virus infection was found in 19 (29.7%): Adenovirus was most frequently recovered (11 cases; 57.9%), followed by Influenza A and B virus (4 cases; 21.0%), Parainfluenza 1 virus (4 cases; 21.0%) and RS virus (2 cases; 10.5%) . Two cases had 2 viruses infections . On the basis of our results, viral and bacterial coinfections are observed in early illness. J Infect Dis, 2003 Jun 15, 187(12), 1876 - 87 Epub 2003 May 29. Quantitative and qualitative comparison of virulence traits, including murine lethality, among different M types of group A streptococci; Miyoshi-Akiyama T et al.; Epidemiological studies have proposed an association between group A streptococci (GAS) bearing a particular M serological type and pathologic conditions such as streptococcal toxic shock syndrome (STSS) . M1 and M3 GAS are isolated from STSS cases more frequently, whereas M4 and M12 GAS are isolated from non-STSS cases more frequently . To investigate whether there is any difference contributing the M-type association among GAS, we compared various virulence traits, including the murine lethality of M4, M12, M1, and M3 GAS clinical isolates, which are not clonally related to one another . Murine lethality, the activities of superantigens, streptolysin O, and nicotinamide adenine dinucleotide glycohydrolase, and the presence of the speA and speC genes were closely associated with M type . These results indicate that M types may serve, in part, as markers for strains/clones with particular profiles of virulence traits and mouse lethality. J Clin Microbiol, 2003 Jun, 41(6), 2686 - 9 Evaluation of Copan swabs with liquid transport media for use in the Gen-Probe Group A Strep Direct Test; Bourbeau PP et al.; The Gen-Probe Group A Streptococcus Direct Test (GASDT), which detects the presence or absence of group A streptococci directly from pharyngeal specimens, utilizes a specific relative light unit (RLU) cutoff of 4,500 to differentiate between positive and negative test results . In response to a report by a manufacturer that the background RLU values for the Copan rayon swabs with liquid media were higher than the RLU values typically observed with Culturette swabs, we tested multiple lots of Copan rayon swabs with liquid media and determined that the swabs are unacceptable for routine use in the GASDT . The high background RLU values for the Copan rayon swabs appear to be a direct result of the gamma irradiation used to sterilize the swabs . We also performed a comparative clinical evaluation of Copan Dacron swabs with liquid media and Culturette swabs for use in the GASDT . Overall, there was 97.5% agreement between the results obtained with the Copan Dacron swabs and those obtained with the Culturette swabs . Compared to Culturette swabs, the Copan Dacron swabs had a sensitivity and a specificity of 97 and 98%, respectively . Copan Dacron swabs with liquid media are an acceptable alternative to the swabs currently qualified for use with the GASDT, but Copan rayon swabs with liquid transport media should not be used in the GASDT. J Clin Microbiol, 2003 Jun, 41(6), 2659 - 61 Molecular epidemiology of macrolide resistance in neonatal bloodstream isolates of group B streptococci; Diekema DJ et al.; Pulsed-field gel electrophoresis (PFGE) was performed on 122 neonatal bloodstream isolates of group B streptococci (GBS) to further examine the relationship between macrolide resistance and serotype V GBS (GBS-V) . Over one-third (35%) of macrolide-resistant GBS belonged to a single PFGE subtype of GBS-V, which was also the most common GBS-V subtype noted in previous Centers for Disease Control and Prevention surveillance studies . Erm methylase (ermA and ermB) was the most common resistance mechanism detected, present in 12 of 20 macrolide-resistant GBS. Int J Antimicrob Agents, 2003 Jun, 21(6), 536 - 41 Distribution of tetracycline resistance genes tet(M), tet(O), tet(L) and tet(K) in blood isolates of viridans group streptococci harbouring erm(B) and mef(A) genes . Susceptibility to quinupristin/dalfopristin and linezolid; Rodriguez-Avial I et al.; Susceptibility to erythromycin, tetracycline, clindamycin, quinupristin/dalfopristin and linezolid was investigated using 111 consecutive non-duplicate blood culture isolates of viridans-group streptococci (VGS) . The erm(B) and mef(A) genes were detected, either alone or in combination, in the 47 (42%) erythromycin-resistant strains . The tet(M) gene alone was predominant (78%) in the 36 (35%) tetracycline-resistant isolates . Two isolates carried the tet(O) gene alone and two others the tet(L) associated with tet(O) or tet(M) . The association between erythromycin and tetracycline resistance was common and the erm(B) and tet(M) determinants seem to be associated in our VGS . We found three isolates resistant to quinupristin/dalfopristin, all of them were erythromycin and tetracycline-resistant . For all isolates tested, linezolid MICs were <or=2 mg/l. Acta Odontol Scand, 2003 Apr, 61(2), 110 - 4 Economic evaluation of a risk-based caries prevention program in preschool children; Jokela J et al.; We have previously reported that, in young children, a risk-based caries prevention program compared with conventional prevention has a good caries-preventive effect . The present study aimed to assess the economic aspects of this program . We used the presence of mutans streptococci in plaque (Dentocult-SM) and/or the presence of incipient carious lesions at 2 years of age for risk assessment, and measured the outcome of caries (yes/no) at the age of 5 years . Dental assistants carried out the screening and preventive work . The economic analysis included the actual running costs of the program during the 3-year follow-up based on the time spent on dental visits . The costs per child per 3 years were significantly lower in the risk-based group (54 euros) than in the conventional prevention group (69 euros) (Student's t test, P = 0.004) . If a dentist with an assistant had done all the work, the costs would have been twice as high . Compared to conventional prevention, the results suggest that risk-based prevention can be effective in reducing both costs and dental caries in preschool children, provided that the screening and preventive measures are delegated to preventive dental assistants. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 2003 Jun, 95(6), 655 - 9 Microbiology of mandibular third molar pericoronitis: incidence of beta-lactamase-producing bacteria; Sixou JL et al.; OBJECTIVES: The purpose of this study was to evaluate the predominant flora associated with pericoronitis in third molars and to investigate the presence of beta-lactamase-producing strains . STUDY DESIGN: The third molars in 26 adults were evaluated by cultures with nonselective media and with selective media containing amoxicillin, pristinamycin, spiramycin, metronidazole, and spiramycin plus metronidazole . RESULTS: In the majority of cases (19/26), the flora found in an anaerobic atmosphere predominated . Obligate anaerobes were present in 21 of the 26 samples . The bacteria most commonly detected were alpha-hemolytic streptococci (26/26) and the genera Prevotella (15/26), Veillonella (15/26), Bacteroides (9/26), and Capnocytophaga (9/26) . Amoxicillin and pristinamycin were the most active in reducing the anaerobic cultivable counts . beta-Lactamase-producing strains were detected in 9 samples and were mostly bacteria of the genera Prevotella, Staphylococcus, and Bacteroides . CONCLUSIONS: These results highlight (1) the diversity of the microflora associated with pericoronitis and the importance of the anaerobic flora and (2) the existence of selection pressure related to the use of beta-lactams that may culminate in failure of prescribed penicillins. Int J Food Microbiol, 2003 Jul 15, 84(1), 27 - 32 Presence of macrolide resistance genes in streptococci and enterococci isolated from pigs and pork carcasses; Martel A et al.; Macrolide and lincosamide (ML)-resistant streptococci and enterococci from tonsillar and colon swabs from 33 pigs and 99 pork carcasses swabs from animals originating from different farms in Belgium were isolated, and their ML resistance phenotypes and genotypes were determined by disk diffusion test and PCR assay, amplifying the ermB gene and the mefA gene . From each of the 33 pigs and 88 of the 99 carcasses' swabs, at least one resistant strain was isolated . The predominant phenotype was the constitutively expressed macrolides, lincosamides and streptogramin B (MLS(B)) phenotype . This phenotype was most often encoded by the ermB gene . A minority of the strains showed the M phenotype encoded by the mefA gene in streptococci, or the L or ML phenotype. Med Clin (Barc), 2003 May 24, 120(19), 739 - 41 {Meningitis caused by streptococci other than S . pneumoniae: clinical and microbiological features of 13 cases}; Jordano Q et al.; BACKGROUND AND OBJECTIVE: Meningitis caused by streptococci other than S . pneumoniae are uncommon . We present our experience . PATIENTS AND METHOD: We reviewed the clinical, microbiological, and epidemiological features of all patients with meningitis due to streptococci other than S . pneumoniae diagnosed in the Hospital Universitari Vall d'Hebron during the period 1991-2001 . RESULTS: Main causative agents in 13 studied patients were viridans group streptococci (6 cases) and S . agalactiae (5 cases) . There were no differences in the clinical presentation between different streptococci . Bacteremia was common in meningitis due to S . agalactiae (80%) . Only one patient died . CONCLUSIONS: Meningitis caused by streptococci other than S . pneumoniae are often related to a distant focus of infection or to neurosurgical procedures and, in our experience, they seem to have a good outcome. Bull Tokyo Dent Coll, 2003 Feb, 44(1), 9 - 16 Effect of chitosan rinsing on reduction of dental plaque formation; Sano H et al.; The purpose of the present study was to investigate whether the use of a chitosan mouthrinse could be efficacious in reducing plaque and saliva mutans streptococci level . A randomized crossover clinical trial was performed to evaluate the effect of a rinse with 0.5% chitosan for 14 days on plaque formation and mutans streptococci counts in saliva . Twenty-four subjects were randomly assigned either the chitosan rinse or a placebo rinse in addition to their usual oral hygiene procedures . Following the baseline examination, each subject was given a prophylaxis . They were instructed to rinse with 20 ml of the mouthrinse twice daily for 30 seconds . Plaque scores were measured after a 14-day rinsing period, and mutans streptococci counts in saliva were also determined at the start and the end of the each rinsing period . The procedures were repeated with the alternate rinse after a 14-day washout period . Rinsing with 0.5% chitosan was significantly more effective in plaque reduction using the Quigley & Hein Index (chitosan: 1.44, placebo: 1.62, p < 0.001) and Plaque Severity Index (chitosan: 0.138, placebo: 0.186, p = 0.003) . The mutans streptococci count in saliva was less after the chitosan rinsing (chi 2 cal = 13.51, p = 0.035) than placebo rinsing . In conclusion, the chitosan rinsing was effective in reducing plaque formation and counts of salivary mutans streptococci after a 14-day rinsing period . These results would appear to warrant further investigation into the potential value of chitosan as an effective anti-plaque agent for use in oral hygiene products. Eur J Cancer, 2003 Jun, 39(9), 1284 - 9 Viridans streptococci bacteraemia in children with fever and neutropenia: a case-control study of predisposing factors; Paganini H et al.; Viridans streptococci (VS) are an increasing cause of bacteraemia in neutropenic patients with cancer . Case-control studies of predisposing factors for acquisition of this infection in children are not published . Between January 1989 and December 1999, 168 episodes of bacteraemia in 161 children with fever and neutropenia of haemato-oncology origin were analysed . 15 cases (9%) in 15 patients were caused by VS . Each case patient was compared with 6 matched control patients; 2 with other Gram-positive cocci (group 2), 2 with gram-negative bacilli bacteraemia (group 3) and two children with fever and neutropenia without bacteraemia (group 4) . The median age of patients was 4.1 years (range: 2-15 years) . 87% of children had acute leukaemia or lymphomas . Pneumonia was the predominant clinical focus (70%) . Shock was observed in 13% of patients . ARDS was observed in one child who died of this complication . Multivariate analysis of risk factors for the development of VS bacteraemia showed that two factors were independent predictors: high doses of cytosine-arabinoside (ARA-C) as part of the chemotherapy treatment (Odds Ratio (OR): 9.3; Confidence Interval (CI) 1.56-55.5) (P<0.014) and the presence of pneumonia (OR: 1.36: CI 2.27-81.9) (P<0.0043) . We propose that further studies are warranted to confirm these results. J Dent Child (Chic), 2003 Jan-Apr, 70(1), 10 - 4 A comparative study of plaque mutans streptococci levels in children receiving glass ionomer cement and amalgam restorations; Ertugrul F et al.; PURPOSE: The restorative materials amalgam (Standalloy F) and glass ionomer cements (Chelon Silver) were comparatively investigated to determine the number of mutans streptococci METHODS: Saliva and plaque were collected from patients before and 40 days after the insertion of their restorations . RESULTS: Total bateria and mutans streptococci counts were found to be statistically significantly reduced when compared with the prerestoration counts in the saliva samples (P<0.001) . Microbiological analysis of the dental plaque showed that the number of mutans streptococci in the glass ionomer cements was significantly lower than in the amalgam restorations (P<0.001) . CONCLUSIONS: This study showed that silver glass ionomer cements inhibited the growth of mutans streptococci. J Biol Chem, 2003 Jul 25, 278(30), 27721 - 8 Epub 2003 May 20. ERK 1/2- and JNKs-dependent synthesis of interleukins 6 and 8 by fibroblast-like synoviocytes stimulated with protein I/II, a modulin from oral streptococci, requires focal adhesion kinase; Neff L et al.; Protein I/II, a pathogen-associated molecular pattern from oral streptococci, is a potent inducer of interleukin-6 (IL-6) and IL-8 synthesis and release from fibroblast-like synoviocytes (FLSs), cells that are critically involved in joint inflammation . This synthesis implicates ERK 1/2 and JNKs as well as AP-1-binding activity and nuclear translocation of NF-kappaB . The mechanisms by which protein I/II activates MAPKs remain, however, elusive . Because focal adhesion kinase (FAK) was proposed to play a role in signaling to MAPKs, we examined its ability to contribute to the MAPKs-dependent synthesis of IL-6 and IL-8 in response to protein I/II . We used FAK-/- fibroblasts as well as FAK+/+ fibroblasts and FLSs transfected with FRNK, a dominant negative form of FAK . The results demonstrate that IL-6 and IL-8 release in response to protein I/II was strongly inhibited in both protein I/II-stimulated FAK-/- and FRNK-transfected cells . Cytochalasin D, which inhibits protein I/II-induced phosphorylation of FAK (Tyr-397), had no effect either on activation of ERK 1/2 and JNKs or on IL-6 and IL-8 release . Taken together, these results indicate that IL-6 and IL-8 release by protein I/II-activated FLSs is regulated by FAK independently of Tyr-397 phosphorylation. J Antibiot (Tokyo), 2003 Mar, 56(3), 289 - 95 Glycopeptide carboxamides active against vancomycin-resistant enterococci; Zweifel MJ et al.; Glycopeptide antibiotics were synthesized via the PyBOP mediated condensation of aliphatic, heterocyclic and aromatic amines with the C-terminus of vancomycin, LY264826 (A82846B) and semi-synthetic derivatives of these natural products . Amides of LY264826 and vancomycin demonstrated excellent activity against staphylococci and streptococci as compared to the parent natural product . However, the amides of N-alkylated LY264826 and N-alkylated vancomycin were active against vancomycin-resistant enterococci as well as other gram-positive pathogens such as Staphylococcus aureus, S . haemolyticus, S . epidermidis and Streptococcus pneumoniae. J Bacteriol, 2003 Jun, 185(11), 3325 - 32 Genomic sequence of C1, the first streptococcal phage; Nelson D et al.; C(1), a lytic bacteriophage infecting group C streptococci, is one of the earliest-isolated phages, and the method of bacterial classification known as phage typing was defined by using this bacteriophage . We present for the first time a detailed analysis of this phage by use of electron microscopy, protein profiling, and complete nucleotide sequencing . This virus belongs to the Podoviridae family of phages, all of which are characterized by short, noncontractile tails . The C(1) genome consists of a linear double-stranded DNA molecule of 16,687 nucleotides with 143-bp inverted terminal repeats . We have assigned functions to 9 of 20 putative open reading frames based on experimental substantiation or bioinformatic analysis . Their products include DNA polymerase, holin, lysin, major capsid, head-tail connector, neck appendage, and major tail proteins . Additionally, we found one intron belonging to the HNH endonuclease family interrupting the apparent lysin gene, suggesting a potential splicing event yielding a functional lytic enzyme . Examination of the C(1) DNA polymerase suggests that this phage utilizes a protein-primed mechanism of replication, which is prominent in the phi29-like members of Podoviridae . Consistent with this evidence, we experimentally determined that terminal proteins are covalently attached to both 5' termini, despite the fact that no homology to known terminal proteins could be elucidated in any of our open reading frames . Likewise, comparative genomics revealed no close evolutionary matches, suggesting that the C(1) bacteriophage is a unique member of the Podoviridae. Oral Microbiol Immunol, 2003 Jun, 18(3), 171 - 5 Classification of oral streptococci by two-dimensional gel electrophoresis with direct activity stain for glycosyltransferases; Ando T et al.; Thirty eight strains of oral streptococci were divided into six types by two-dimensional gel electrophoresis (2-DE) followed by glycosyltransferase (GLT) activity stain: Type 1, Streptococcus mutans; Type 2, Streptococcus rattus; Type 3, Streptococcus sobrinus and Streptococcus downei; Type 4, Streptococcus cricetus; Type 5, Streptococcus salivarius; and Type 6, Streptococcus sanguis, Streptococcus oralis and Streptococcus gordonii . In Types 1, 2 and 5, two glucosyltransferases synthesizing water-insoluble (GTF-I) and water-soluble glucans (GTF-S) and a fructosyltransferase (FTF) were detected . In Types 3 and 4, GTF-I and two GTF-Ss were detected . Only one GTF-S was detected in Type 6 . The 2-DE patterns for these six types were clearly distinguished from each other based on the kind, number and location of GLTs in gel. Oral Microbiol Immunol, 2003 Jun, 18(3), 144 - 9 Determination of mutacin activity and detection of mutA genes in Streptococcus mutans genotypes from caries-free and caries-active children; Longo PL et al.; Relationships between genetic diversity, mutacin production and sensitivity to mutacins in Streptococcus mutans were evaluated in 19 clinical isolates from caries-free and caries-active children . Mutacin production was tested against 30 indicator strains; results showed significant variations in the inhibitory spectra of the clinical isolates . There was no association between the inhibitory spectrum of the infecting strain and the caries experience or the level of mutans streptococci infection of the host . Homology to the mutA gene coding for mutacin II was detected in one clinical isolate; none of the clinical isolates showed homology to the mutA genes coding for mutacins I or III . Genotyping by random amplified polymorphic DNA (RAPD) reactions grouped the isolates into three clusters, but no correlation was found between any of the clusters and mutacin activity, caries experience or level of mutans streptococci in the host. Int J Paediatr Dent, 2003 May, 13(3), 186 - 92 Microbiological assessment of saliva from children subsequent to atraumatic restorative treatment (ART); Carvalho CK et al.; AIMS: The aim of this study was to evaluate mutans streptococci (MS) in the saliva following use of the atraumatic restorative treatment (ART) technique . METHODS: Sixteen 5-7-year-old children had restorations using the ART technique and employing FUJI IX glass-ionomer cement as the restorative material . Decayed tissue was manually excavated without local anaesthesia, being careful to avoid discomfort . Saliva was collected for microbiological assessment using Kit Caritest MS before treatment, one week, four weeks and one year after ART was used . The procedure for saliva collection, incubation, storage, and comparative reading of MS counts followed the manufacturer's instructions . The data were statistically analysed, using non-parametric tests (Wilcoxon Signed Ranks and Sign Test) at a significance level of 0.05 . RESULTS: The results showed a significant reduction of MS levels in saliva when comparing the results before treatment with those obtained one week (95.95%; P = 0.003), four weeks (93.27%; P = 0.000) and one year (95.56%; P = 0.002) after ART . CONCLUSIONS: It is concluded from the results that the ART technique proved satisfactory and appeared to have produced a significant and sustained reduction in levels of MS . These results need to be confirmed in a larger study. Eur J Biochem, 2003 May, 270(10), 2303 - 11 Interactions between M proteins of Streptococcus pyogenes and glycosaminoglycans promote bacterial adhesion to host cells; Frick IM et al.; Several microbial pathogens have been reported to interact with glycosaminoglycans (GAGs) on cell surfaces and in the extracellular matrix . Here we demonstrate that M protein, a major surface-expressed virulence factor of the human bacterial pathogen, Streptococcus pyogenes, mediates binding to various forms of GAGs . Hence, S . pyogenes strains expressing a large number of different types of M proteins bound to dermatan sulfate (DS), highly sulfated fractions of heparan sulfate (HS) and heparin, whereas strains deficient in M protein surface expression failed to interact with these GAGs . Soluble M protein bound DS directly and could also inhibit the interaction between DS and S . pyogenes . Experiments with M protein fragments and with streptococci expressing deletion constructs of M protein, showed that determinants located in the NH2-terminal part as well as in the C-repeat region of the streptococcal proteins are required for full binding to GAGs . Treatment with ABC-chondroitinase and HS lyase that specifically remove DS and HS chains from cell surfaces, resulted in significantly reduced adhesion of S . pyogenes bacteria to human epithelial cells and skin fibroblasts . Together with the finding that exogenous DS and HS could inhibit streptococcal adhesion, these data suggest that GAGs function as receptors in M protein-mediated adhesion of S . pyogenes. Br J Dermatol, 2003 Apr, 148(4), 670 - 9 Normal keratinocytes express Toll-like receptors (TLRs) 1, 2 and 5: modulation of TLR expression in chronic plaque psoriasis; Baker BS et al.; BACKGROUND: Toll-like receptors (TLRs) are part of the innate immune system involved in the response to microbial pathogens . TLR2 recognizes various ligands expressed by Gram-positive bacteria, while TLR3, TLR4 and TLR5 are specific for double-stranded RNA, Gram-negative lipopolysaccharides and bacterial flagellin, respectively . OBJECTIVES: To determine, firstly, whether epidermal keratinocytes of normal skin express TLRs and, secondly, whether modulation of TLR expression occurs in psoriasis, an inflammatory skin disease associated with certain microorganisms such as streptococci, staphylococci and yeasts . METHODS: Eight samples of normal, and 15 samples of lesional and nonlesional psoriatic skin were stained with polyclonal antibodies specific for TLR1-5 using an avidin-biotin-peroxidase technique . RESULTS: Epidermal keratinocytes in normal skin constitutively expressed TLR1, TLR2 and TLR5, while TLR3 and TLR4 were, in most cases, barely detectable . Cytoplasmic TLR1 and TLR2 were expressed throughout the epidermis, with higher staining of the latter on basal keratinocytes, while TLR5 expression was concentrated in the basal layer . In contrast, in lesional epidermis from patients with psoriasis, TLR2 was more highly expressed on the keratinocytes of the upper epidermis than on the basal layer, while TLR5 was downregulated in basal keratinocytes compared with corresponding nonlesional psoriatic epidermis . In addition, nuclear TLR1 staining was observed in the upper layers of both nonlesional and lesional psoriatic epidermis, but not in that of normal skin . CONCLUSIONS: These findings suggest that TLRs expressed by epidermal keratinocytes constitute part of the innate immune system of the skin . The relevance of altered keratinocyte TLR expression in psoriasis remains to be determined. Scand J Infect Dis, 2003, 35(3), 206 - 7 Streptococcus zooepidemicus meningitis and bacteraemia; Ural O et al.; Group C streptococci are common causative agents of epidemic infections in animals and a rare cause of meningitis in humans . The case is reported of a 75-y-old man with meningitis caused by a group C streptococcus (Streptococcus zooepidemicus) . He had frequent contact with horses, which were a possible source of infection . In spite of treatment with a third generation cephalosporin, the outcome was fatal. Leukemia, 2003 May, 17(5), 925 - 30 Infectious complications in patients with acute promyelocytic leukaemia treated with the AIDA regimen; Girmenia C et al.; Infections represent a frequent complication of chemotherapy used for acute myeloid leukaemia (AML) and are associated with important toxicity frequently leading to treatment discontinuation . Acute promyelocytic leukaemia (APL) is a unique AML subset requiring tailored therapy including all-trans retinoic acid and anthracycline-based chemotherapy . We analysed in this study the incidence and type of infections complicating the clinical course of 89 consecutive APL patients receiving the AIDA protocol at a single institution . A total of 179 febrile episodes were registered during induction and consolidation, 52% of which were of unknown origin . Infections were clinically and microbiologically documented in 10.6 and 37.4% of cases, respectively . Coagulase-negative staphylococci represented the major cause of septicaemia (28%) and were more frequently isolated during induction, whereas viridans group streptococci, the second pathogen most frequently isolated from blood (27%), represented the principal pathogen detected during consolidation and were significantly associated with mucositis . Gram-negative bacteria accounted for 33.3% of all blood isolates . Fungal infections were only occasionally observed . Bloodstream infections in APL patients were compared with those documented in 271 consecutive patients affected by other subtypes of AML . The incidence of total septicaemia episodes, of staphylococcal bacteraemias and of fungaemias was significantly higher in patients with other AMLs . Empirical antibiotic therapy with ceftriaxone plus amikacin was effective in 73% of APL cases, most of the remaining cases being successfully managed by the addition of teicoplanin . One single death apparently related to infectious complication was recorded . Overall, infections led to antileukaemic treatment withdrawal in six patients, five of whom currently remain in haematologic remission for 13-106 months . These results indicate that a particular pattern of infections is observed in APL patients receiving ATRA plus anthracycline-based chemotherapy and that these appear to be effectively counteracted by standard management. Clin Ther, 2003 Feb, 25(2), 422 - 43 Efficacy and tolerability of 5-day, once-daily telithromycin compared with 10-day, twice-daily clarithromycin for the treatment of group A beta-hemolytic streptococcal tonsillitis/pharyngitis: a multicenter, randomized, double-blind, parallel-group study; Quinn J et al.; BACKGROUND: Telithromycin, a ketolide antibacterial, has been developed for the treatment of community-acquired respiratory infections . OBJECTIVE: This study compared the efficacy and tolerability of 5-day, once-daily telithromycin with 10-day, twice-daily clarithromycin in adolescents and adults with acute tonsillitis/pharyngitis caused by group A beta-hemolytic streptococci ({GABHS} Streptococcus pyogenes) . METHODS: In this multicenter, randomized, double-blind, parallel-group study, adolescent (aged > or = 13 years) and adult patients with a diagnosis of GABHS tonsillitis/pharyngitis received once-daily telithromycin 800 mg for 5 days (followed by placebo for 5 days) or twice-daily clarithromycin 250 mg for 10 days . Bacteriologic and clinical outcomes were assessed at a test-of-cure visit (days 16 to 23) and a late posttherapy visit (days 31 to 45) . RESULTS: A total of 526 patients were enrolled in the study, of which 463 (288 females, 175 males) were randomized to receive treatment (telithromycin, n = 232; clarithromycin, n = 231) . The mean age of the telithromycin group was 30.9 years; in the clarithromycin group, it was 30.0 years . Bacterial eradication was achieved in 91.3% of telithromycin-treated patients and 88.1% of clarithromycin recipients (difference, 3.2%; 95% CI, -4.5 to 11.0) . Clinical cure was achieved in 92.7% of telithromycin recipients and 91.1% of clarithromycin-treated patients (difference, 1.6%; 95% CI, -5.5 to 8.6) . Bacteriologic and clinical cures for the 2 treatment groups also were similar at the late posttherapy visit . Treatment-related adverse events occurred more frequently in the telithromycin group than the clarithromycin group (67.2% vs 57.5%, respectively); diarrhea, nausea, and vomiting were significantly more common with telithromycin than with clarithromycin (P = 0.004, 0.010, and 0.001, respectively) . Adverse events were generally mild . CONCLUSION: This study demonstrates that telithromycin 800 mg once daily for 5 days was an effective and generally well-tolerated treatment for tonsillitis/pharyngitis caused by GABHS, providing similar bacteriologic and clinical efficacy to clarithromycin 250 mg twice daily for 10 days in the per-protocol population. Am J Obstet Gynecol, 2003 May, 188(5), 1148 - 50 Predominance of serotype V and frequency of erythromycin resistance in Streptococcus agalactiae in Ohio; Croak A et al.; OBJECTIVE: The purpose of this study was to test the serotype distribution and antibiotic sensitivity patterns of group B Streptococcus from three Ohio regions in comparison to other areas of the United States . STUDY DESIGN: Three hundred forty-nine group B Streptococcus isolates from three Ohio hospitals were serotyped specifically, and disk diffusion was used to determine antibiotic susceptibility . RESULTS: Serotype V was isolated most frequently (27%); major types Ia, Ib, II, and III had frequencies of 18%, 9%, 11%, and 17%, respectively . Erythromycin and clindamycin resistance was 12% (n = 200 isolates) and 8% (n = 49 isolates), respectively . CONCLUSION: The prevalence shift of resistant serotype V group B streptococci in Ohio reflects regional increases and suggests that alternative therapies for patients who are allergic to penicillin may be inadequate. Nephrol Dial Transplant, 2003 Jun, 18(6), 1072 - 8 Increased production of chemotactic cytokines and elevated proliferation and expression of intercellular adhesion molecule-1 in rat mesangial cells treated with erythrogenic toxin type B and its precursor isolated from nephritogenic streptococci; Rincon J et al.; BACKGROUND: Previous reports have demonstrated the presence of streptococcal erythrogenic toxin type B (ETB) as well as proliferation and expression of adhesion molecules along with leukocyte infiltrations in biopsies from patients with acute post-streptococcal glomerulonephritis (APSGN) . The purpose of the present study was to correlate infiltrative and proliferative events with interactions between ETB or its precursor (ETBP) and intrinsic mesangial cells . METHODS: Rat mesangial cells were cultured with ETB or ETBP (50 micro g/ml) while measuring production of monocyte chemoattractant protein-1 (MCP-1) and macrophage inflammatory protein-2 (MIP-2) and while examining proliferation and expression of intercellular adhesion molecule-1 (ICAM-1) . After 24, 48 and 96 h of incubation, MCP-1 and MIP-2 in culture supernatants were assessed by enzyme-linked immunosorbent assay (ELISA) . Cells were assessed for proliferation by incorporation of radioactive thymidine and expression of ICAM-1 was measured by indirect immunofluorescence and by cellular ELISA . RESULTS: Compared with controls, treatment with either ETBP or ETB significantly increased MCP-1 and MIP-2 levels in mesangial cell cultures . Mesangial cells also showed elevated proliferation at 96 h of culture when treated with streptococcal proteins . Although production of MCP-1 and MIP-2 was not correlated with proliferation, treatment with ETBP resulted in a significant correlation between MCP-1 production and proliferation . Immunofluorescence studies revealed an increased expression of ICAM-1 in ETBP/ETB-treated mesangial cells . In addition, cellular ELISA studies showed increased absorbance in cultures treated with ETBP/ETB . Finally, low serum concentrations in the culture medium potentiated the stimulatory effect of ETB on MCP-1 production . CONCLUSIONS: Our findings, by demonstrating a role for cationic streptococcal ETB or ETBP in the induction of chemotactic molecules as well as the proliferation and expression of adhesion molecules, delineate an additional possible pathway for the pathogenesis of APSGN. J Med Microbiol, 2003 Jun, 52(Pt 6), 527 - 30 Molecular comparison of bacterial isolates from blood with strains colonizing pharynx and intestine in immunocompromised patients with sepsis; Murono K et al.; Most causative organisms of sepsis in immunocompromised patients are the same species as those that colonize their own nasopharynx or intestinal tract . To determine whether the strains recovered from blood originate mainly from patients' own flora, isolates from blood and throat and/or stool were investigated by genomic analyses . Surveillance cultures of throat and stool were taken prospectively from cancer patients being treated with intensive chemotherapy followed by haematopoietic stem-cell transplantation . In those cases of sepsis in which the isolate from blood was the same species as that from the throat and/or stool, the genomic profiles of the isolates were compared by PFGE . Ten cases of blood culture-positive sepsis were documented in six of 14 subjects during a 2 year period; isolates of Pseudomonas aeruginosa, Staphylococcus epidermidis, Enterococcus sp., viridans streptococci and Fusobacterium sp . were recovered from blood . In five of seven cases in which the blood isolate was the same species as that from the throat or stool, the genotypes of the isolates from both sites were identical . In the majority of immunocompromised patients, the causative organisms of bloodstream infections originated mainly from their own flora. Syst Appl Microbiol, 2003 Mar, 26(1), 97 - 103 Inter- and intraspecies variations of the 16S-23S rDNA intergenic spacer region of various streptococcal species; Hassan AA et al.; The 16S-23S rDNA intergenic spacer regions (ISR) of different streptococcal species and subspecies were amplified with primers derived from the highly conserved flanking regions of the 16S rRNA and 23S rRNA genes . The single sized amplicons showed a uniform pattern for S . agalactiae, S . dysgalactiae subsp . dysgalactiae (serogroup C), S . dysgalactiae subsp . equisimilis (serogroup G), S . dysgalactiae subsp . dysgalactiae (serogroup L), S . canis, S . phocae, S . uberis, S . parauberis, S . pyogenes and S . equi subsp . equi, respectively . The amplicons of S . equi subsp . zooepidemicus, S . porcinus and S . suis appeared with 3, 5 and 3 different sizes, respectively . ISR of selected strains of each species or subspecies investigated were sequenced and multiple aligned . This allowed a separation of ISR into regions, with 7 regions for S . agalactiae, S . dysgalactiae subsp . dysgalactiae (serogroup C), S . dysgalactiae subsp . equisimilis (serogroup G), S . dysgalactiae subsp . dysgalactiae (serogroup L), S . canis, S . phocae, S . pyogenes and S . suis, 8 regions for S . uberis and S . parauberis and mostly 9 regions for S . equi subsp . equi, S . equi subsp . zooepidemicus and S . porcinus . Region 4, encoding the transfer RNA for alanine (tRNA(Ala)), was present and identical for all isolates investigated . The size and sequence of ISR appears to be a unique marker for streptococci of various species and subspecies and could be used for bacterial identification . In addition the size and sequence variations of ISR of S . equi subsp . zooepidemicus, S . porcinus and S . suis allows a molecular typing of isolates of these species possibly useful in epidemiological aspects. Int J Environ Health Res, 2003 Mar, 13(1), 17 - 22 Bacteriological and chemical quality of swimming pools water in developing countries: a case study in the West Bank of Palestine; Al-Khatib IA et al.; Monitoring was carried out during summer 2000 in all the swimming pools in the West Bank of Palestine . Fifty-eight water samples, collected from 46 swimming pools, were examined for Coliforms and bacterial species including Streptococci, Salmonellae, and Staphylococcus . Salmonellae were isolated in 21 out of 23 samples . All of the examined samples from the swimming pools water were unacceptable according to the Palestinian and WHO standards . Extensive efforts are required to improve the water quality of the swimming pools in the West Bank, mainly public awareness, training of governmental inspectors, operators and owners of the swimming pools, in addition to a strict system for monitoring of the water quality. Folia Microbiol (Praha), 2003, 48(1), 105 - 10 The presence of insertion elements IS861 and IS1548 in group B streptococci; Dmitriev A et al.; The presence of insertion elements (IS) IS861 and IS1548 in the collection of 211 Streptococcus agalactiae strains isolated from pregnant women and dairy cows was assayed . IS861 was found in 67 human strains (59%) and 36 bovine strains (37%), IS1548 in 13 human strains (12%) and 16 bovine strains (16%) . Two combinations, IS861+ IS1548- and IS861- IS1548-, were widely distributed in both human and bovine strains . The copy number and the restriction fragment length polymorphism (RFLP) of the two IS were determined in human group B streptococcus (GBS) strains . A minimum of 8 copies of IS1548 were detected in GBS strains while the copy number of IS861 varied from 1 to 9 . The number of different hybridizing patterns with IS861 and IS1548 probes was 9 and 6, respectively . These hybridization patterns were divided into several clusters . All strains with IS were also clustered according to pulsed field-gel electrophoresis (PFGE) patterns . A correlation was found between the results of PFGE- and IS-based clustering. J Microbiol Immunol Infect, 2003 Mar, 36(1), 26 - 30 Etiology of acute pharyngitis in children: is antibiotic therapy needed? Chi H, Chiu NC, Li WC, Huang FY. Acute pharyngitis is a common upper respiratory tract disease in children . The aim of this study is to find the associated microorganisms and determinate whether antibiotics is needed . This study included a total of 416 children with a diagnosis of acute pharyngitis who were treated in an outpatient clinic In Taipei . Throat swabs for viral and bacterial cultures were taken . Antibiotics were prescribed when bacterial pharyngitis was suspected on the initial visit . The prescription was adjusted according to the results of bacterial culture and clinical manifestations on the second visit 3 to 4 days later . The mean age of the patients was 52.9 +/- 36.9 months . A total of 297 potential pathogens were isolated in 242 patients . Viruses were isolated in 123 (29.6%) patients . Bacteria were isolated in 73 (17.5%) patients, whereas group A streptococci were isolated in only 7 (1.7%) patients . Viruses mixed with bacteria were found in 46 (11.1%) patients . The mean age of patients with viral infections was lower than those with bacterial infections (47.5 +/- 30.4 vs 62.4 +/- 43.7 months, p = 0.01) . There was a longer duration of fever in patients older than 2 years with viral isolates (p < 0.01) . Antibiotics were prescribed for acute pharyngitis on the first visit in 43 (10.3%) patients, and on the second visit in 19 (4.6%) patients . In children with viral infection, mixed isolates, or no growth, there was significantly less prescription of antibiotics on the second visit . Given the low isolation rate of significant bacterial pathogens, routine throat cultures and antibiotics are not indicated in children with acute pharyngitis. Pediatr Res, 2003 Aug, 54(2), 276 - 81 Epub 2003 May 07. Defective production of IL-18 and IL-12 by cord blood mononuclear cells influences the T helper-1 interferon gamma response to group B Streptococci; La Pine TR et al.; Human neonates are uniquely susceptible to group B streptococcal (GBS) infections . We have shown that neonatal mixed mononuclear cells have a deficiency in the production of the T helper-1 (Th-1) cytokine, interferon gamma (IFN-gamma), and that incubation of neonatal neutrophils with recombinant IFN-gamma corrects these neutrophil defects . IL-12 and the more recently described IL-18 are also Th-1 type cytokines that are able to induce the production of IFN-gamma in the presence of bacteria and bacterial products . We examine the ability of GBS to induce the production of IFN-gamma, IL-18, and IL-12 by cord blood mixed mononuclear cells and compared these results with the IFN-gamma, IL-18, and IL-12 response of mixed mononuclear cells from adult blood . We demonstrate that cord blood mixed mononuclear cells produced significantly less IFN-gamma, IL-18, and IL-12 in response to GBS compared with mixed mononuclear cells from adults . Cord blood mixed mononuclear cells' production of IFN-gamma is enhanced by added recombinant IL-18 and IL-12 . The maximal cord blood cell production of IFN-gamma, in response to GBS, is achieved by priming the cells with both IL-18 and IL-12 . We conclude that neonatal mixed mononuclear cells exhibit deficiencies in three main Th-1 type cytokine responses, IFN-gamma, IL-12, and IL-18 . This combined Th-1 type cytokine deficiency may contribute to the enhanced susceptibility of the human neonate to GBS and other microbial infections. J Dent, 2003 May, 31(4), 283 - 90 Evaluation of mutans streptococci in plaque and saliva: correlation with caries development in preschool children; Seki M et al.; OBJECTIVES: To test the ability of a site-specific method of evaluating mutans streptococci (MS) present in plaque in order to predict caries risk in children and to compare the results with those obtained from estimating the levels of MS present in saliva . METHODS: Caries prevalence was examined twice, 6 months apart, in 129 preschool children ranging in age from 1.5 to 5 . A commercial strip method was used to evaluate the MS score (0-3) in plaque collected from four selected tooth surfaces at two interdental spaces and in saliva . RESULTS: The screening criteria of the MS score for caries incidence between scores 1 and 2, and scores 0 and 1 were the most valid for evaluating plaque (accuracy of prediction, 80%) and saliva (accuracy of prediction, 71%), respectively . Based on these screening criteria, the evaluation of saliva MS was invalid when the plaque MS score was considered . Screening plaque MS was effective, regardless of caries experience at baseline, according to the chi-square test (p<0.01), but screening saliva MS was ineffective when caries experience was present at baseline . A multivariate logistic regression analysis including six variables showed that the plaque MS score and caries experience at baseline were significantly correlated with caries incidence: caries experience at baseline (OR=5.02, 95%CI: 1.81-14.59) and high plaque MS score (2 or 3) (OR=12.59, 95%CI: 3.18-67.08) . CONCLUSIONS: These results suggest that the semi-quantitative evaluation of plaque MS sampled from only two proximal sites on the molars is more effective for screening preschool children at a high risk of developing caries in their primary dentition than other important caries risk indicators. Curr Opin Infect Dis, 2003 Apr, 16(2), 103 - 24 Staphylococcal resistance revisited: community-acquired methicillin resistant Staphylococcus aureus--an emerging problem for the management of skin and soft tissue infections; Eady EA et al.; PURPOSE OF REVIEW: In the community non-localized or deep staphylococcal skin and soft tissue infections are typically managed with beta-lactamase stable penicillins . The aims of this review are (1) to evaluate the evidence for the emergence of new strains of community-acquired methicillin resistant Staphylococcus aureus (MRSA), (2) to identify the reasons for their significant association with cutaneous infections, and (3) to consider how they arose and how big a threat they pose to the management of such infections outside hospitals . RECENT FINDINGS: MRSA are emerging as significant community pathogens, especially in previously healthy children with no recognizable risk factors, and are predominantly associated with skin and soft tissue infections (especially abscesses and cellulitis) . When present, risk factors are generally similar to those for infection with methicillin susceptible S . aureus . The MRSA isolates associated with such infections may not be entirely 'new', but could represent the displacement of some hospital clones (e.g . EMRSA-15 or variants thereof) to the community as well as the de-novo generation of novel MRSA clones by multiple horizontal transmissions of the mecA gene into methicillin susceptible S . aureus with different genetic backgrounds, some of which are already circulating globally . Community-acquired MRSA from diverse locations are non multiresistant and almost always contain the novel type IV SCCmec commonly found in coagulase-negative staphylococci, but also in hospital-associated gentamicin susceptible MRSA from France, the paediatric clone and in EMRSA-15 . SUMMARY: More local data on CA-MRSA infections are needed so that dermatologists and community physicians can assess the risk of such infections amongst their patients and avoid the inappropriate administration of beta-lactams . No simple change in prescribing practices will entirely alleviate selective pressure for the spread of community-acquired MRSA and not exacerbate resistance in pyogenic streptococci, commonly found together with S . aureus in skin and soft tissue infections . The importance of hygiene in preventing the spread of community-acquired MRSA in the community must be reemphasized. J Clin Microbiol, 2003 May, 41(5), 2170 - 3 Rapid screening for Streptococcus agalactiae in vaginal specimens of pregnant women by fluorescent in situ hybridization; Artz LA et al.; Group B streptococci (GBS) are the most frequent pathogens in neonates with sepsis . A rapid screening method is required to identify carriage of GBS in pregnant women at the time of delivery . In order to detect GBS in vaginal specimens, the efficiency of the standard culture versus fluorescent in situ hybridization (FISH) was investigated . In 258 examined vaginal specimens, FISH identified 58 of the 59 GBS-positive samples (98.3%), whereas by means of standard culture only 38 specimens were positive (64.4%) . We recommend FISH as a rapid, specific, highly sensitive screening technique for the detection of GBS in pregnant women at delivery. J Clin Microbiol, 2003 May, 41(5), 1894 - 900 Evaluation of a new cellulose sponge-tipped swab for microbiological sampling: a laboratory and clinical investigation; Osterblad M et al.; A new type of swab (Cellswab; Cellomeda, Turku, Finland), utilizing a highly absorbent cellulose viscose sponge material, was compared to some traditional swabs . The survival of 14 aerobic and 10 anaerobic and microaerophilic bacterial species in the Cellswab, two commercial swab transport systems (Copan, Brescia, Italy, and Orion Diagnostica, Espoo, Finland), and one Dacron swab (Technical Service Consultants Ltd . {TSC}, Heywood, United Kingdom) was evaluated . Bacteria were suspended in broth, into which the swabs were dipped . The Cellswab absorbed 1.3 times more fluid and released 3.5 times more fluid upon plating than the other swabs . Aerobic bacteria were stored in dry tubes, the others in transport medium, at 4 degrees C and room temperature (RT), for up to 14 days . Swab samples were transferred to plates at 0, 1, 2, 4, 7, and 14 days . For 10 strains the Cellswab yielded > or =10% of the original CFU for longer than all the other swabs . In the clinical study, the ability of the Cellswab to detect beta-hemolytic streptococci from throat samples (n = 995) was compared to that of the TSC Dacron swab . The swabs performed equally, both when their samples were transferred to plates immediately and after storage for 1 day at 4 degrees C or RT . The changes in normal microbiota after storage were also similar . The Cellswab was found to perform at least as well as ordinary swabs . It was better at storing fastidious strains, and at keeping bacteria viable for long storage times; it might well be a useful replacement or complement to ordinary swabs. J Bacteriol, 2003 May, 185(10), 3081 - 90 Identification of rocA, a positive regulator of covR expression in the group A streptococcus; Biswas I et al.; In the group A streptococcus (GAS; Streptococcus pyogenes), a two-component system known as CovRS (or CsrRS) regulates about 15% of the genes, including several important virulence factors like the hyaluronic acid capsule . Most of these genes, including covR itself, are negatively regulated by CovR . We have isolated two independent ISS1 insertions in an open reading frame (ORF) that increases CovR expression as measured by a Pcov-gusA reporter fusion in single copy in the GAS chromosome . This ORF, named rocA for "regulator of Cov," activates covR transcription about threefold . As expected, a rocA mutant is mucoid and produces more transcript from the has promoter since this promoter is repressed by CovR . This effect is dependent on the presence of a wild-type covR gene . In contrast to its activation of Pcov, RocA negatively regulates its own expression . This autoregulation is not dependent on the presence of the covR gene . All the phenotypes of the rocA mutant were complemented by the presence of the rocA gene on a plasmid . The rocA gene is present in strains of all nine M serotypes of GAS tested and is absent from strains representing 11 other groups of streptococci and related bacteria, including strains of the closely related group C and G streptococci . It seems likely that rocA plays an important role in the pathogenesis of GAS since it affects expression of the global regulator CovR. Ann N Y Acad Sci, 2003 Apr, 987, 207 - 14 Novel method to control pathogenic bacteria on human mucous membranes; Fischetti VA; Nearly all infections begin at a mucous membrane site . Also, the human mucous membranes are a reservoir for many pathogenic bacteria found in the environment (that is, pneumococci, staphylococci, streptococci), some of which are resistant to antibiotics . Clearly, if this human reservoir can be reduced or eliminated, the incidence of disease will be markedly reduced . However, compounds designed to eliminate this reservoir are not available . Towards this goal, we have exploited the highly lethal effects of bacteriophage lytic enzymes (lysins) to specifically destroy disease bacteria on mucous membranes . Such lysins are used by the phage to release their progeny at the end of their replicative cycle . We have identified and purified these enzymes and found that when applied externally to gram-positive bacteria, they are killed seconds after contact . For example, 10(7) S . pyogenes are reduced to undetectable levels 10 s after enzyme addition . A feature of these enzymes is their high specificity; that is, streptococcal lysins kill streptococci and pneumococcal lysins kill pneumococci without effects on the normal flora organisms . In vivo, an oral colonization model for S . pyogenes and a nasal colonization model for S . pneumoniae were developed to test the capacity of the lysins to kill organisms on these surfaces . In both cases, when the animals were pre-colonized with their respective bacteria then treated with a small amount of lysin, specific for the colonizing organism, all the animals were found to be free of colonizing bacteria shortly after lysin treatment . Thus, lysins may be added to our armamentarium to control antibiotic-resistant bacteria. Int J Antimicrob Agents, 2003 May, 21(5), 441 - 5 Telithromycin (HMR 3647) achieves high and sustained concentrations in tonsils of patients undergoing tonsillectomy; Gehanno P et al.; Telithromycin, the first ketolide antimicrobial to be developed for clinical use, has potent activity against group A beta-haemolytic streptococci (GABHS), including macrolide-resistant strains . The penetration of telithromycin into tonsils was assessed in 22 adults undergoing tonsillectomy at 3, 12 or 24 h after the fourth dose of oral telithromycin 800 mg once daily . Telithromycin rapidly penetrated tonsillar tissues, achieving a mean concentration of 3.95 mg/kg at 3 h post dose, 3.4 times greater than the corresponding plasma concentration (1.22 mg/l . The mean tonsil:plasma concentration ratio increased to 13.1 at 24 h post dose, indicating slower elimination from tonsils than plasma . Tonsillar and plasma concentrations exceeded the MIC(50) for GABHS throughout the 24-h dosing period . These findings suggest that telithromycin may be an effective new alternative treatment for GABHS tonsillopharyngitis. J Med Microbiol, 2003 May, 52(Pt 5), 379 - 83 Antibodies raised in animals against the Streptococcus agalactiae proteins c alpha and R4 and normal human serum antibodies target distinct epitopes; Moyo SR et al.; The targets for normal human serum antibodies that react with proteins c(alpha) and R4 isolated from group B streptococci (GBS; Streptococcus agalactiae) have been studied and compared with the targets for murine monoclonal and rabbit polyclonal antibodies raised against these proteins . The proteins were extracted by trypsin digestion and purified by precipitations and gel filtration and testing was based on enzyme immunoassays . The immune antibodies showed specificity for the corresponding protein, targeted that protein in Western blotting and recognized their targets after heat treatment (100 degrees C) of the proteins . Human antibodies in a commercial gammaglobulin preparation targeted a site(s) common to c(alpha) and R4 . This target failed to bind the antibodies in Western blotting and was destroyed by heating . c(alpha)- and R4-reactive antibodies in sera from healthy pregnant women recognized the common, heat-labile determinant(s), but contained little or no antibodies against the heat-stable c(alpha)- or R4-specific determinants . These results are consistent with the notions that (i) the normal human antibodies and the immunization-induced animal antibodies targeted different sites on the c(alpha) and R4 proteins and that (ii) the natural human antibodies targeted conformational epitopes and the immune antibodies targeted linear epitopes . These findings are important for further clarification of GBS immunology and immunoprotection in humans. Rheumatol Int, 2003 Sep, 23(5), 255 - 7 Epub 2003 Apr 26. Septic arthritis caused by Granulicatella adiacens: diagnosis by inoculation of synovial fluid into blood culture bottles; Hepburn MJ et al.; Granulicatella species, formerly known as nutritionally variant streptococci, cause a variety of infections, primarily endocarditis . We report the first culture-proven case of a Granulicatella species causing septic arthritis . A 68-year-old female presented with knee pain and swelling . She was initially evaluated with arthrocentesis and arthroscopy, but no organism was identified . Her pain improved after a brief course of antibiotics but recurred 3 months later . She underwent repeat arthrocentesis, with direct inoculation of synovial fluid into blood culture bottles . Granulicatella adiacens was recovered from both bottles . She was treated with cefazolin for 4 weeks combined with gentamicin for the first 2 weeks . Her knee pain and swelling resolved without evidence of recurrence . Granulicatella should be considered in cases of septic arthritis with initially negative synovial fluid cultures . Inoculation of blood cultures bottles with synovial fluid may increase the diagnostic yield for these species. Cell Microbiol, 2003 May, 5(5), 323 - 42 Host cell caveolae act as an entry-port for group A streptococci; Rohde M et al.; This study identified caveolae as an entry port for group A streptococci into epithelial and endothelial cells . Scanning electron microscopy as well as ultrathin sections of infected cells demonstrated accumulation of small omega-shaped cavities in the host cell membrane close to adherent streptococci . During invasion, invaginations were formed that subsequently revealed intracellular compartments surrounding streptococci . Caveolin-1 was shown to be present in the membrane of invaginations and the compartment membranes . These compartments were devoid of any classic endosomal/lysosomal marker proteins and can thus be described as caveosomes . Disruption of caveolae with methyl-beta-cyclodextrin and filipin abolished host cell invasion . Importantly, streptococci inside caveosomes avoid fusion with lysosomes . Expressing of SfbI protein on the surface of the non-invasive S . gordonii resulted in identical morphological alterations on the host cell as for S . pyogenes . Incubation of HUVEC cells with purified recombinant sole SfbI protein also triggered accumulation of cavity-like structures and formation of membrane invaginations . Tagged to colloidal gold-particles, SfbI protein was shown to cluster following membrane contact . Thus, our results demonstrate that host cell caveolae initiate the invasion process of group A streptococci and that the streptococcal invasin SfbI is the triggering factor that activates the caveolae-mediated endocytic pathway. Antimicrob Agents Chemother, 2003 May, 47(5), 1752 - 5 Influences of linezolid, penicillin, and clindamycin, alone and in combination, on streptococcal pyrogenic exotoxin a release; Coyle EA et al.; An in vitro model was used to compare the effects of linezolid, clindamycin, and penicillin, alone and in combination, on streptococcal pyrogenic exotoxin A (SPE A) release against virulent group A streptococci (GAS) . All regimens exhibited lower (P < 0.05) SPE A release at 1 h than those with penicillin alone . Linezolid and clindamycin, alone or in combination with penicillin, may optimize the treatment of GAS infections by reducing bacterial burden and exotoxin release. Kansenshogaku Zasshi, 2003 Mar, 77(3), 121 - 6 {Serotypes and antibody levels of group B streptococci in pregnant women}; Terakubo S et al.; Group B streptococcus were isolated from 1404 pregnant out-patient women in the Department of Obstetrics and Gynecology, St . Marianna University School of Medicine, from June 1, 1992 to May 31, 2001 . Serotype of 187 (13.3%) fresh isolates of GBS was determined by using hemolytic streptococcus-typing immune sera (Denka Seiken, Tokyo, Japan) . With these strains there were 59 (31.6%), 46 (26.6%), 19 (10.2%), 16 (8.6%), 16 (8.6%), 12 (6.4%) and 3 (1.6%) indicating that their types were VIII, VI, III, Ia, V, Ib and II respectively . Also, bacterial agglutination reaction was employed for detection of titer to GBS in pregnant women serum . Positive reaction showed in 31 (57.4%) samples but 23 (42.6%) samples were not seen in this essay . It is assumed that the high antibody levels in pregnant women serum plays an important role as an in vivo defence factor in neonatal infection by GBS. Microb Drug Resist, 2003 Spring, 9(1), 87 - 91 Antimicrobial susceptibility and survey of macrolide resistance mechanisms among Streptococcus pyogenes isolated in Rio de Janeiro, Brazil; d'Oliveira RE et al.; A total of 357 clinical Streptococcus pyogenes isolates collected between 1994 and 1999 in Rio de Janeiro city were tested for susceptibility to 10 antimicrobial drugs by agar-diffusion tests . All isolates were susceptible to penicillin, cephems, and vancomycin . High resistance rates were observed for tetracycline (43.1%) and trimethoprim/sulfamethoxazole (77.9%) . Three isolates (0.8%) were resistant to erythromycin, and three exhibited intermediate susceptibility . Determination of the erythromycin MICs by the agar dilution method, showed 1.6% of erythromycin resistant isolates (the three erythromycin-resistant and the three erythromycin-intermediate isolates found by agar-diffusion test) . Of the erythromycin-resistant isolates subjected to the double-disc diffusion test for erythromycin and clindamycin, three isolates expressed the iMLSB and three the M phenotype . The resistance phenotypes were confirmed by comparing the clindamycin MICs determined under normal testing conditions and those determined after induction by pre-growth in 0.06 microg/ml of erythromycin . Three ermTR and three mefA-containing isolates were detected by PCR . In strains belonging to the iMLSB phenotype, two clones were identified by PFGE following restriction with SmaI . M phenotype isolates could not be restricted with SmaI . Our results indicate a low rate of erythromycin resistance among S . pyogenes isolated in Rio de Janeiro, Brazil, and pointed to the presence of both resistance mechanisms found in streptococci. Infect Immun, 2003 May, 71(5), 2373 - 83 Potential of lipid core peptide technology as a novel self-adjuvanting vaccine delivery system for multiple different synthetic peptide immunogens; Olive C et al.; This study demonstrates the effectiveness of a novel self-adjuvanting vaccine delivery system for multiple different synthetic peptide immunogens by use of lipid core peptide (LCP) technology . An LCP formulation incorporating two different protective epitopes of the surface antiphagocytic M protein of group A streptococci (GAS)--the causative agents of rheumatic fever and subsequent rheumatic heart disease--was tested in a murine parenteral immunization and GAS challenge model . Mice were immunized with the LCP-GAS formulation, which contains an M protein amino-terminal type-specific peptide sequence (8830) in combination with a conserved non-host-cross-reactive carboxy-terminal C-region peptide sequence (J8) of the M protein . Our data demonstrated immunogenicity of the LCP-8830-J8 formulation in B10.BR mice when coadministered in complete Freund's adjuvant and in the absence of a conventional adjuvant . In both cases, immunization led to induction of high-titer GAS peptide-specific serum immunoglobulin G antibody responses and induction of highly opsonic antibodies that did not cross-react with human heart tissue proteins . Moreover, mice were completely protected from GAS infection when immunized with LCP-8830-J8 in the presence or absence of a conventional adjuvant . Mice were not protected, however, following immunization with an LCP formulation containing a control peptide from a Schistosoma sp . These data support the potential of LCP technology in the development of novel self-adjuvanting multi-antigen component vaccines and point to the potential application of this system in the development of human vaccines against infectious diseases. Infect Immun, 2003 May, 71(5), 2365 - 72 Invasion and killing of human endothelial cells by viridans group streptococci; Stinson MW et al.; Colonization of the cardiovascular endothelium by viridans group streptococci can result in infective endocarditis and possibly atherosclerosis; however, the mechanisms of pathogenesis are poorly understood . We investigated the ability of selected oral streptococci to infect monolayers of human umbilical vein endothelial cells (HUVEC) in 50% human plasma and to produce cytotoxicity . Planktonic Streptococcus gordonii CH1 killed HUVEC over a 5-h period by peroxidogenesis (alpha-hemolysin) and by acidogenesis but not by production of protein exotoxins . HUVEC were protected fully by addition of supplemental buffers and bovine liver catalase to the culture medium . Streptococci were also found to invade HUVEC by an endocytic mechanism that was dependent on polymerization of actin microfilaments and on a functional cytoskeleton, as indicated by inhibition with cytochalasin D and nocodazole . Electron microscopy revealed streptococci attached to HUVEC surfaces via numerous fibrillar structures and bacteria in membrane-encased cytoplasmic vacuoles . Following invasion by S . gordonii CH1, HUVEC monolayers showed 63% cell lysis over 4 h, releasing 64% of the total intracellular bacteria into the culture medium; however, the bacteria did not multiply during this time . The ability to invade HUVEC was exhibited by selected strains of S . gordonii, S . sanguis, S . mutans, S . mitis, and S . oralis but only weakly by S . salivarius . Comparison of isogenic pairs of S . gordonii revealed a requirement for several surface proteins for maximum host cell invasion: glucosyltransferase, the sialic acid-binding protein Hsa, and the hydrophobicity/coaggregation proteins CshA and CshB . Deletion of genes for the antigen I/II adhesins, SspA and SspB, did not affect invasion . We hypothesize that peroxidogenesis and invasion of the cardiovascular endothelium by viridans group streptococci are integral events in the pathogenesis of infective endocarditis and atherosclerosis. Neurosurgery, 2003 May, 52(5), 1075 - 9; discussion 1079-80 Multiloculated pyogenic brain abscess: experience in 25 patients; Su TM et al.; OBJECTIVE: To report our experience in treating multiloculated pyogenic brain abscess and determine whether there are differences in the bacteriology, predisposing factors, treatment choices, and outcomes between multiloculated and uniloculated brain abscesses . METHODS: We studied clinical data collected during a 16-year period from 124 patients with pyogenic brain abscess, including 25 cases of multiloculated abscess . RESULTS: The incidence of multiloculated brain abscess was 20% . In these 25 patients, hematogenous spread from a remote infectious focus was the most common cause of infection, as it was for the cases of uniloculated abscess . Headache and hemiparesis were the most common symptoms in patients with multiloculated abscess . In patients with uniloculated abscess, fever was the most common symptom . Viridans streptococci were the most commonly isolated pathogens . Bacteroides fragilis was the most common anaerobe in multiloculated abscess, and aerobic gram-negative bacilli were the most common pathogens in patients with uniloculated abscess . Of the patients with multiloculated abscess, 21 were treated surgically and 4 were treated with antibiotics only . Overall, eight patients (38%) needed another operation because of abscess recurrence after the initial operation . In uniloculated abscess, the rate of abscess recurrence after initial surgery was 13.1% . Mortality was 16% in multiloculated abscess and 17.1% in uniloculated abscess . CONCLUSION: Multiloculated abscesses accounted for 20% of our patients with pyogenic brain abscess . Excision seems to be the more appropriate surgical choice in multiloculated abscess . Prognosis for patients with multiloculated abscess can be as good as that for patients with uniloculated abscess . However, clinicians must carefully monitor these patients because the possibility of recurrence after surgery is significantly higher in patients with multiloculated abscess than in those with uniloculated abscess. JAMA, 2003 Apr 16, 289(15), 1933 - 40 Complicated left-sided native valve endocarditis in adults: risk classification for mortality; Hasbun R et al.; CONTEXT: Complicated left-sided native valve endocarditis causes significant morbidity and mortality in adults . Lack of valid data regarding estimation of prognosis makes management of this condition difficult . OBJECTIVE: To derive and externally validate a prognostic classification system for adults with complicated left-sided native valve endocarditis.Design, Setting, and PATIENTS: Retrospective observational cohort study conducted from January 1990 to January 2000 at 7 Connecticut hospitals among 513 patients older than 16 years who experienced complicated left-sided native valve endocarditis and who were divided into derivation (n = 259) and validation (n = 254) cohorts . MAIN OUTCOME MEASURE: All-cause mortality at 6 months after baseline . RESULTS: In the derivation and validation cohorts, the 6-month mortality rates were 25% and 26%, respectively . Five baseline features were independently associated with 6-month mortality (comorbidity {P =.03}, abnormal mental status {P =.02}, moderate to severe congestive heart failure {P =.01}, bacterial etiology other than viridans streptococci {P<.001 except Staphylococcus aureus, P =.004}, and medical therapy without valve surgery {P =.002}) and were used to create a prognostic classification system . In the derivation cohort, patients were classified into 4 groups with increasing risk for 6-month mortality: 5%, 15%, 31%, and 59% (P<.001) . In the validation cohort, a similar risk among the 4 groups was observed: 7%, 19%, 32%, and 69% (P<.001) . CONCLUSIONS: Adults with complicated left-sided native valve endocarditis can be accurately risk stratified using baseline features into 4 groups of prognostic severity . This prognostic classification system might be useful for facilitating management decisions. Mol Immunol, 2003 May, 39(15), 933 - 9 Dextran-binding human plasma antibody recognizes bacterial and yeast antigens and is inhibited by glucose concentrations reached in diabetic sera; Chacko BK et al.; Dextran-binding antibody was isolated in high yield from plasma of all 40 blood donors screened in a South Indian population . The antibody was purified by a single step affinity chromatography on Sephadex G100 using 1-O-methyl alpha-D-glucoside as eluant . Analysis of protein peaks obtained in size exclusion high pressure liquid chromatography (HPLC) revealed dominance of IgG and suggested the presence of polymeric IgA in this antibody . Methyl and para-nitrophenyl alpha-D-glucosides, in contrast to their beta-anomers, were very efficient inhibitors of binding of this antibody to dextran . Galactose and glucose were equally good inhibitors . Among disaccharide inhibitors sucrose was more efficient than maltose or melibiose . Hemoglobin artificially glycosylated to contain covalently-linked glucose or alpha-anomeric galactose was sugar-specifically recognized by this antibody . Galactose moieties in glycoproteins or polysaccharides were, however, not recognized . The dextran-binding antibody bound sugar-specifically to glycoconjugates from yeast (Saccharomyces cerevisiae) and to lipopolysaccharides from Klebsiella and group A Streptococci, but not to lipopolysaccharides from E . coli . Inhibition studies suggested glucose moiety with unsubstituted C2 and C4 and alpha-anomeric C1 as ideal for recognition by the dextran-binding antibody . Concentration of glucose required for 50% inhibition of binding of the purified antibody to polystyrene-coated dextran in phosphate buffered saline was above the glucose concentrations in normal sera, but well below those reached in diabetic sera . Binding of the antibody from dialysed plasma to immobilized dextran was lowered only marginally in presence of glucose at 4.5mM (which nears normal serum glucose concentrations), but substantially in presence of the sugar at 20mM and above which are reached in diabetic sera . If verified in vivo, inhibition of this antibody by high serum glucose may possibly be among reasons for the increased susceptibility of diabetics to infection. Vet Microbiol, 2003 May 29, 93(3), 197 - 206 Mutagenesis of Streptococcus equi and Streptococcus suis by transposon Tn917; Slater JD et al.; Genetic tools for studying streptococci are much less sophisticated than those that are available for many other bacterial genera . In this paper, we describe the development of a transposon mutagenesis system that we have used to mutate two important veterinary streptococci, Streptococcus equi and Streptococcus suis . The system uses a temperature-sensitive suicide vector to deliver Tn917 via electroporation, transposing Tn917 into the chromosomal DNA of the two streptococci . The transposon insertions can be rescued from the streptococcal chromosomes by plasmid rescue and selection in E . coli, with subsequent insertion site analysis by DNA sequencing . Transposition appeared to have occurred in an essentially random fashion when chromosomal DNA of S . suis and S . equi mutants was analysed by Southern blotting . However, when analysis of 60 S . equi mutants was carried out using the S . equi genome sequence database, 60% of transposon insertions had occurred within a 15 kb region of the genome whereas the other insertions appeared to have occurred essentially randomly . This finding suggests that Southern blot analysis for assessing the randomness of transposon libraries may need to be interpreted with caution . However, this observation notwithstanding, the Tn917 based system described in this paper will facilitate the study of S . suis and S . equi. Scand J Infect Dis, 2003, 35(2), 84 - 9 Susceptibility of skin and soft-tissue isolates of Staphylococcus aureus and Streptococcus pyogenes to topical antibiotics: indications of clonal spread of fusidic acid-resistant Staphylococcus aureus; Afset JE et al.; Staphylococcus aureus (SA) isolates (n = 255) from outpatients with skin and soft-tissue infections were collected in 3 different areas in Norway . Group A streptococci (GAS, n = 68) were isolated from skin or pharyngotonsillar specimens from outpatients . Minimum inhibitory concentrations (MIC) of bacitracin, fusidic acid and mupirocin were tested using the E-test . Pulsed field gel electrophoresis (PFGE) patterns of fusidic acid-sensitive (FusS) and -resistant (FusR) SA were compared . All GAS isolates showed MIC of bacitracin of < or = 1.0 mg/l, of mupirocin of < or = 0.125 mg/l and of fusidic acid 1.0-4.0 mg/l . All the SA showed MIC of mupirocin < or = 0.5 mg/l and of bacitracin of > or = 2.0 mg/l, 91% with MIC > or = 16 mg/l . FusR was shown by 32.5% of the SA strains with similar prevalence rates in 3 different geographical areas of Norway . One particular PFGE pattern (type 1) was shown by 76% of the FusR SA . SA of type 1 belonged to phage group II and produced exfoliative toxins . Thus, the results demonstrated a high prevalence of FusR among SA causing skin infections and that this was mainly due to dissemination of clonally related FusR SA. J Clin Microbiol, 2003 Apr, 41(4), 1399 - 403 Method for quantitative detection and presumptive identification of group B streptococci on primary plating; Hansen SM et al.; Maternal prenatal screening for group B streptococci (GBS) followed by offering of intrapartum chemoprophylaxis to carriers is one of the strategies used to reduce the incidence of neonatal early-onset GBS infections . Culturing of vaginal and anorectal swab specimens in selective broth is the screening procedure recommended by the Centers for Disease Control and Prevention . This technique is sensitive; it does not, however, allow either evaluation of the degree of colonization or detection of cocolonization with several GBS clones . We have examined the carriage rate and population dynamics of GBS in a group of Danish women during pregnancy and 1 year after delivery using a new detection method . In the present paper we describe a mixed blood agar medium (MB agar) that identifies GBS in the primary cultures by detection of a double hemolysis pattern consisting of characteristic, large zones of partial hemolysis ("CAMP zones") and of narrow zones of complete hemolysis . The MB agar was at least as sensitive as culturing in selective broth for detection of GBS in vaginal and anorectal swab specimens, and GBS strains could be identified directly on the primary plate due to the CAMP zones without the need for subculturing . The carriage rate of GBS in a group of Danish women was found to be more than 30%, a figure considerably higher than the rate that was reported previously. Exp Cell Res, 2003 Apr 15, 285(1), 1 - 8 Supramolecular organization in streptococcal pericellular capsules is based on hyaluronan tertiary structures; Scott JE et al.; Supramolecular organization involving a polyanionic glycan in a bacterial capsule (hyaluronan, HA, in streptococcal capsules) is revealed, for the first time, by electron-histochemical methodology previously used to elucidate ultrastructure in extracellular matrix . Capsular HA filaments thereby revealed closely resemble aligned linear structures demonstrated by similar technology in HA solution . These parallel arrays, spontaneously formed, are based on HA tertiary structures (beta sheet-like) which are stabilized by hydrophobic and hydrogen bonds . HA tertiary structures in aqueous solutions resist shear stress as shown by rheo-NMR . Thus, supramolecular HA wrapping covering many cells probably stabilizes chains of bacteria . Streptococci possibly templated the ordered structures since eukaryotic B6 cell HA did not produce similarly organized envelopes . Supramolecular organization in streptococcal and pneumococcal capsules are compared . Their glycans are very similar but the potential for HA-like tertiary structures is not present in the pneumococcal type 3 polysaccharide and chains of cells are not formed to the same extent by pneumococci . We suggest that the streptococcal capsule exemplifies a simple extracellular matrix analogous to those in animal connective tissues, which contain glycans (chondroitin, keratan, and dermochondan sulfates) of the HA family, capable of undergoing aggregation to similar tertiary structures. Scand J Infect Dis, 2003, 35(1), 77 - 9 Clinical features of district hospital paediatric patients with pharyngeal group A streptococci; Hossain P et al.; The clinical presentation of district hospital paediatric patients with pharyngeal group A streptococci (GAS) was compared with that of children who were proven negative for GAS . The most significant clinical feature of children 3 y of age or under was cervical lymphadenopathy . In all age groups abdominal pain was as common as sore throat and could be intense enough to mask throat symptoms. Vet Clin North Am Food Anim Pract, 2003 Mar, 19(1), 157 - 69 The management and treatment of environmental streptococcal mastitis; Hillerton JE et al.; Environmental streptococci are responsible for at least one third of all cases of clinical mastitis, with the proportion varying widely between herds . Each dairy farmer should know the etiology of mastitis in the herd to allow for appropriate management . Control requires lowering the prevalence of infection, and includes shortening the duration of and preventing new infections . Prompt and aggressive treatment of clinical cases may achieve a high clinical and bactriologic rate of cure . Dry-cow treatment remains highly effective in eliminating infection . Prophylactic dry-cow treatment remains of substantial benefit in preventing new intramammary infections and clinical mastitis . An internal teat sealant has shown a comparable effect in uninfected cows in field studies . Management of exposure to environmental streptococci is essential and requires assessment of the risk of exposure (especially in bedding and other lying areas), reduction of teat-end contamination, and good hygienic milking practices . The key is in the quality of application of management. Curr Top Med Chem, 2003, 3(9), 961 - 89 Recent developments in macrolide antimicrobial research; Asaka T et al.; Clarithromycin and azithromycin, which are more acid-stable than erythromycin A (EM), have been widely prescribed for the treatment of respiratory tract infections because of their high efficacy and safety . However, these macrolide antibiotics are only weakly active against pathogens with an efflux gene (mef) and are inactive against pathogens with a methyltransferase-inducible gene (erm) and constitutively resistant organisms . To address the drug resistance issue, tremendous efforts have been devoted to the modification of the macrolide structure . As a consequence, several types of decladinosyl derivatives, such as ketolide and acylides, have been recognized to be effective against mef-type resistant streptococci and methylase-inducible staphylococci . It has also been recognized that derivatives containing certain 11-, 6- or 4 -tethered aryl substituents, such as telithromycin (HMR 3647), cethromycin (ABT-773) and CP-544372, are effective against erm(B)-type resistant streptococci . Telithromycin was recently approved in several European countries for the treatment of respiratory tract infections and cethromycin is now in the final stage of clinical study . Macrolide antibiotics have been modified to address the issues of acid-instability and inactivity against resistant strains . In this review, we will summarize the progress in the macrolide research area and discuss the desirable features of the next generation macrolide antibiotics. Biol Pharm Bull, 2003 Apr, 26(4), 527 - 31 Effect of a novel type of propolis and its chemical fractions on glucosyltransferases and on growth and adherence of mutans streptococci; Duarte S et al.; Flavonoids have been considered the main biologically active components in propolis . However, a new variety of flavonoid-free propolis was recently found and chemically classified as type 6 . Because it showed activity against oral microorganisms, this study evaluated the effects of the crude ethanolic extract of this propolis and its chemical fractions on the activity of purified glucosyltransferases (GTFs) and on the growth and adherence of mutans streptococci . The inhibitory effect of propolis extracts on GTF activities was determined either in solution or adsorbed onto saliva-coated hydroxyapatite . Streptococcus mutans Ingbritt 1600, Streptococcus sobrinus 6715, and two clinical isolates of each species were used for antibacterial assays . Susceptibilities to the test extracts were analyzed using the agar diffusion method and by determining the minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC); the effect on bacterial adherence to a glass surface was also assessed . The activity of GTFs in solution was effectively inhibited by the ethanolic extract of propolis type 6 (EEP) (>80% inhibition at 0.5 mg/ml), hexane, and chloroform fractions (60-90% inhibition at 100 microg/ml); their inhibitory effects on surface enzymes were less pronounced . The EEP, hexane, and chloroform fractions also showed significant antibacterial activity . The data showed that propolis type 6 remarkably reduced GTF activity and inhibited mutans streptococci growth and adherence; these biological activities are associated with its nonpolar components. Int J Antimicrob Agents, 2003 Apr, 21(4), 297 - 307 The use and resistance to antibiotics in the community; Cizman M; The frequency of resistance to antibiotics among common community-acquired pathogens, and the number of drugs to which they are resistant have been increasing worldwide . The relationship between antibiotic usage and resistance is strongly supported by data from several studies . Countries with the highest per capita antibiotic consumption have the highest resistance . The emergence of penicillin-resistant Streptococcus pneumoniae is related to high consumption of antibiotics in general, as well as to increased use of aminopenicillins and/or probably to wider use of oral cephalosporins . Increased consumption of macrolides, especially the long-acting ones, correlates significantly with the level of macrolide resistance of group A streptococci and S . pneumoniae while increased use of oral cephalosporins might be associated with the increase of beta-lactamase-producing strains of Moraxella catarrhalis . Trimethoprim/sulphamethoxazole resistance is strongly associated with resistance to penicillin . A rise in consumption of fluoroquinolones is consonant with a higher rate of resistance to quinolones of S . pneumoniae, Escherichia coli and other Gram-negative bacteria . Paediatric bacterial isolates are more often resistant to various antimicrobial agents than isolates from adult patients; this higher resistance rate may be due to more frequent antimicrobial treatments in children, and extensive child to child transmission . Reliable data on antimicrobial consumption and resistance should form a basis for national policies devised to reduce the resistance of microorganisms to antibiotics. Clin Microbiol Infect, 2003 Apr, 9(4), 310 - 4 Predominance of two M-types among erythromycin-resistant group A Streptococci from Greek children; Zachariadou L et al.; In order to investigate the potential relationship between erythromycin resistance and specific M-serotypes among clinical isolates of Streptococcus pyogenes from children in Greece, we randomly selected a total of 49 erythromycin-resistant (EryR) and 21 erythromycin-susceptible (EryS) isolates from the 1158 S . pyogenes isolates from the two main children's hospitals of Athens during the period October 1997 to October 1998 . The isolates were further characterized by M-serotyping, examined for their susceptibility to penicillin, vancomycin and clindamycin, and categorized into resistance phenotypes . A total of 248 (21%) S . pyogenes isolates in the two main children's hospitals of Athens during the study period were resistant to erythromycin . All 49 EryR and 21 EryS isolates were susceptible to penicillin and vancomycin . With respect to erythromycin and clindamycin resistance, phenotypes M and IR MLSB dominated, with 30 and 17 isolates, respectively, two isolates belonged to the CR MLSB phenotype . Among the erythromycin resistant isolates, two M serotypes were dominant: M22 (30%) and M84 (41%) . More specifically, M22 and M84 were most prevalent in resistance phenotypes IR MLSB (65%) and M (63%), respectively . In the susceptible group, no isolate belonged to these two M-serotypes, nor was a predominant serotype found . In contrast to susceptible isolates, two distinct M-serotypes were highly represented among EryR S . pyogenes isolates and predominantly associated with two distinct phenotypes. Clin Microbiol Infect, 2003 Apr, 9(4), 306 - 9 Will triclosan in toothpaste select for resistant oral streptococci? Sullivan A, Wretlind B, Nord CE. The aims of the study were to determine the in vitro sensitivity of triclosan against viridans streptococci and the impact of triclosan on the normal oral microflora . Nine subjects used a triclosan-containing toothpaste for 2 weeks . Saliva samples were collected on days 0 and 14 and were analyzed quantitatively . The minimum inhibitory concentrations of triclosan and of several antimicrobial agents were determined for the streptococci isolated on days 0 and 14 . No major changes occurred in the normal oral microflora during the study period . There were no differences in susceptibility between streptococcal strains collected at days 0 and 14 against triclosan or antimicrobial agents . Short-term use of triclosan has no major impact on normal oral microflora or on streptococcal susceptibility of antimicrobial agents . The effects of long-term use should be evaluated. Infect Immun, 2003 Apr, 71(4), 1903 - 10 M type 1 and 3 group A streptococci stimulate tissue factor-mediated procoagulant activity in human monocytes and endothelial cells; Bryant AE et al.; Streptococcal toxic shock syndrome (StrepTSS) is an invasive infection characterized by marked coagulopathy, multiple organ failure, and rapid tissue destruction and is strongly associated with M type 1 and 3 group A streptococci (GAS) . Initiation of the coagulation cascade with formation of microvascular thrombi contributes to multiple organ failure in human cases of gram-negative bacteremia; however, little is known regarding the mechanism of coagulopathy in StrepTSS . Thus, we investigated the abilities of several strains of M type 1 and 3 GAS isolated from human cases of StrepTSS to stimulate production of tissue factor (TF), the principal initiator of coagulation in vivo . Washed, killed M type 1 and 3 GAS, but not M type 6 GAS, elicited high-level TF-mediated procoagulant activity from both isolated human monocytes and cultured human umbilical vein endothelial cells . M type 1 GAS consistently elicited higher levels of TF from monocytes than did M type 3 GAS . GAS-induced TF synthesis in monocytes did not correlate with production of tumor necrosis factor alpha or interleukin-8 . Conversely, M type 3 GAS were consistently more potent than M type 1 GAS in stimulating endothelial cell TF synthesis . These results demonstrate that (i) M type 1 and 3 strains of GAS are potent inducers of TF synthesis, (ii) GAS-induced TF synthesis is not simply an epiphenomenon of cytokine generation, and (iii) induction of TF in endothelial cells and monocytes may be M type specific . In total, these findings suggest that a novel interaction between GAS and host cells contributes to the observed coagulopathy in StrepTSS. Oral Microbiol Immunol, 2003 Apr, 18(2), 114 - 20 Prevalence of Csh-like fibrillar surface proteins among mitis group oral streptococci; Elliott D et al.; The prevalence of Csh-like fibrillar surface proteins among oral streptococci was investigated by ELISA and by immunoelectron microscopy using antiserum raised to recombinant fragments of CshA of Streptococcus gordonii DL1 . The majority of S . gordonii, Streptococcus sanguis and Streptococcus oralis strains tested elaborated short (ca . 50-80 nm long) surface fibrils and reacted with antiserum to the amino acid repeat region of CshA, demonstrating the widespread nature of Csh-like proteins among these species . In contrast, reactivity with antiserum raised to the adhesion-mediating non-repetitive region of CshA was more restricted . On the basis of the ELISA results, several isolates were selected for immunogold analysis using CshA antisera . Immunogold-negative staining showed a surface distribution of 10 nm gold particles consistent with antibody binding to short fibrils . Long fibrils (>150 nm long), where present, were not significantly labelled with gold . The results suggest that some of the short peritrichous fibrils on many mitis group streptococci comprise Csh-like fibrillar protein . Further, the data are consistent with our hypothesis that the antigenically conserved amino acid repeat region of Csh-like proteins forms a scaffold for cell-distal presentation of the amino-terminal non-repetitive region that, at least in S . gordonii DL1, functions as an adhesin. Mikrobiyol Bul, 2002 Apr, 36(2), 147 - 52 {Penicillin tolerance in group A beta-hemolytic streptococci isolated from throat cultures of children with tonsillopharyngitis}; Ciftci E et al.; The most common bacterial cause of tonsillopharyngitis is group A beta-hemolytic streptococci (GABHS) and penicillin is the drug of choice for the treatment of these infections . However, a disturbing trend toward penicillin failure has developed in some communities . It has been proposed that penicillin tolerance is a possible explanation for this failure . In this study, penicillin tolerance of GABHS strains isolated from 263 children with tonsillopharyngitis, was investigated between December 2000-March 2001 . As a result, none of the isolated strains was found to be penicillin resistant or penicillin tolerant according to minimal inhibitory concentration and minimal bactericidal concentration values for penicillin G, determined by microdilution method. Clin Infect Dis, 2003 Apr 1, 36(7), 845 - 9 Epub 2003 Mar 20. Outcome of penicillin-susceptible streptococcal prosthetic joint infection treated with debridement and retention of the prosthesis; Meehan AM et al.; Debridement with retention of the prosthesis was the initial treatment modality for 19 cases of penicillin-susceptible streptococcal prosthetic joint infection that occurred in 18 patients who presented to the Mayo Clinic (Rochester, Minnesota) during 1969-1998 . All of the cases of prosthetic joint infection occurred >30 days after implantation of the prosthesis, which was well fixed at the time of debridement . The median duration of symptoms before debridement was 4 days (range, 1-10 days) . Treatment failure (defined as relapse of infection with the original microorganism) occurred in 2 cases (10.5%) during a median follow-up period of 3.9 years (range, 0.3-21.7 years) . The 1-year cumulative risk of relapse was 11% (95% confidence interval, 0%-26%) . Relapse of prosthetic joint infection due to penicillin-susceptible streptococci after debridement and retention of the prosthesis is uncommon . For patients who present with a well-fixed prosthesis and a short duration of symptoms, debridement with retention appears to be an effective treatment modality. Fam Pract, 2003 Apr, 20(2), 108 - 11 Rapid test, throat culture and clinical assessment in the diagnosis of tonsillitis; Johansson L et al.; OBJECTIVES: Our aim was to identify a group of patients with clinical signs of tonsillitis to whom antibiotics could be prescribed without further diagnostic actions, and to compare the outcome of clinical assessment with the result of an antigen detection test using culture as the gold standard . METHODS: During two winter months, patients aged > or =4 years attending for sore throat at three primary health care centres in Malmo, Sweden, were examined . Odds ratios, sensitivities, specificities and predictive values were calculated for clinical assessment and for an antigen detection test . RESULTS: Among the 169 participating patients, growth of group A beta-haemolytic streptococci (GAS) was found in 53 cultures, and 23 patients (14%) were clinically assessed as 'absolutely positive', representing positive clinical assessment . Nineteen had positive cultures for GAS . The sensitivity, specificity and predictive positive and negative value for the antigen detection test were 82, 96, 90 and 93%, respectively, and for positive clinical assessment 36, 97, 83 and 77% . CONCLUSION: It is possible to identify a small group of patients with convincing signs of tonsillitis in which the specificity as well as the predictive positive value of the rapid test and the clinical assessment are close to equal . Antibiotics may be prescribed to these patients without further diagnostic actions. Infect Dis Obstet Gynecol, 2002, 10(4), 165 - 9 Serotyping group B streptococci in a small community hospital: an analysis of distribution and site of isolation; Smith JM et al.; OBJECTIVE: To determine the prevalence and site of isolation of different serotypes of group B streptococcus (GBS) colonization or infection at a small community hospital . METHODS: GBS isolates were obtained from a small community hospital and were then serotyped as la, Ib, II, III, IV, V or nontypeable . Hospital records were reviewed for patient sex, age and pregnancy status as well as the site of GBS isolation . RESULTS: GBS serotypes Ia, III and V were most common and accounted for over 60% of the total number of isolates . Serotype Ia was most prevalent in reproductive-age females, while serotypes V and III were most prevalent in non-reproductive-age females and males, respectively . Serotype la was most frequent in both pregnant and nonpregnant females . Serotype IV was more common in this study population than in those from other locations . CONCLUSIONS: The GBS serotype distribution in this small community did not differ significantly from distributions described in larger North American centers . A GBS vaccine designed against multiple serotypes would be protective for most of this population. Eur J Oral Sci, 2003 Apr, 111(2), 144 - 8 Comparison of antiadhesive and antibacterial effects of antiseptics on Streptococcus sanguinis; Decker EM et al.; Three antiseptic (chlorhexidine, Olaflur, Octenisept) and one putative antiadhesive (chito