Streptococci

Vaccine, 1997 Aug, 15(11), 1165 - 73
Vaccinator device for delivering propellant-driven aerosols of Streptococcus suis bacterin into the respiratory tracts of swine; Brown AR et al.; Metered-dose propellant-driven small particle aerosols of a killed whole bacterium, Streptococcus suis, were produced and characterized for their aerodynamic particle sizes and antigenicity as potential respiratory mucosal vaccines against S . suis infections in swine . To facilitate the efficient delivery of such vaccine aerosols to large animals, an electro-mechanical device was developed to synchronize aerosol release to an animal's inhalation cycles . The device was tested for its capacity to deliver a fluorescein conjugate of this bacterin (FITC-S . suis) into the respiratory tracts of 18 pigs . Results showed that FITC-S . suis could be detected in the lungs of swine as small as 4.5 kg with as few as two aerosol actuations . Metered-dose propellant-driven aerosols of bacterin vaccines delivered by this respiratory vaccinating device are discussed as a new approach for stimulated mucosal immunity against respiratory infections in animals.

J Vet Pharmacol Ther, 1997 Aug, 20(4), 318 - 22
Pharmacokinetics of ampicillin and sulfadimidine in pigs infected experimentally with Streptococcus suum; Yuan ZH et al.; Twenty-three hybrid pigs (23 +/- 3 kg body wt) were assigned to three groups to investigate the pharmacokinetics of ampicillin (APC, 10 mg/kg) administered intravenously (i.v.) and intramuscularly (i.m.), and sulfadimidine (SDM, 50 mg/kg) administered intravenously as a bolus injection . In the first series of experiments the animals remained healthy . Subsequently, the pigs were infected with Streptococcus suum by subcutaneous (s.c.) inoculation and the experiments were repeated . The total apparent distribution volume of APC given intravenously was increased from 0.512 +/- 0.026 L/kg in uninfected pigs to 0.68 +/- 0.06 L/kg (P < 0.01) in infected pigs, whereas there were no significant changes in the same parameter for SDM (P > 0.05) . The clearance of APC was increased markedly from 0.52 +/- 0.07 L/kg/h in uninfected pigs to 0.62 +/- 0.10 L/kg/h in infected pigs . In contrast, SDM clearance was decreased markedly from 0.023 +/- 0.003 L/kg/h to 0.017 +/- 0.003 L/kg/h (P < 0.05) . As a result, the biological half-lives of the drugs were altered to varying degrees in infected pigs . The half-life of SDM was increased from 15.0 +/- 3.0 h in uninfected pigs to 20 +/- 7h in infected pigs (P < 0.05), but differences in APC half-lives between uninfected and infected animals were not observed (P > 0.05) . There were no statistically significant differences in pharmacokinetic parameters of APC administered by intramuscular injection between the healthy and the diseased status, although its half-life was shortened from 0.76 +/- 0.22 h in the healthy to 0.57 +/- 0.23 h in the diseased . The results suggest that blood concentrations of APC and SDM are affected differently by the same disease due to its specific effects on their distribution and elimination.

J Dairy Sci, 1997 Aug, 80(8), 1846 - 50
Evaluation of two iodophor teat germicides: activity against Staphylococcus aureus and Streptococcus agalactiae; Boddie RL et al.; Two germicides containing 0.5 and 1% titratable iodine were tested for efficacy against the development of new intramammary infections (IMI) caused by Staphylococcus aureus and Streptococcus agalactiae . The two trials for postmilking teat dip used a model for experimental challenge that was recommended by the National Mastitis Council . The 0.5% iodine formulation reduced new Staph . aureus IMI by 78.2% and reduced new Strep . agalactiae IMI by 73.2% . The 1% iodine product reduced new Staph . aureus IMI by 43.5% and reduced new Strep . agalactiae IMI by 46.4% . No adverse effects on the condition of teat skin or on teat ends were observed over the course of the trials . At the completion of each trial, the teat skin of dipped quarters was characterized as normal, smooth skin that was free from scales, cracks, or chapping; the teat orifice was characterized as smooth without evidence of irritation.

Can J Surg, 1997 Aug, 40(4), 313 - 4
Clenched-fist injury complicated by methicillin-resistant Staphylococcus aureus; Berlet G et al.; Hand infections are a common sequela of clenched-fist injuries . The majority of these infections are due to Staphylococcus and Streptococcus species . Methicillin-resistant Staphylococcus aureus (MRSA) is increasingly being isolated in Canadian health care facilities . In addition, MRSA now needs to be considered in community acquired hand infections that fail to respond to common empiric therapy . A 51-year-old man with MRSA due to a hand injury was treated successfully with vancomycin . The prevalence, mechanism of resistance and treatment of MRSA are briefly reviewed.

Vet Res Commun, 1997 Aug, 21(6), 381 - 407
Streptococcus suis: past and present; Staats JJ et al.; Steptococcus suis is a Gram-positive, facultatively anaerobic coccus that has been implicated as the cause of a wide range of clinical disease syndromes in swine and other domestic animals . In swine, the disease has spread worldwide but is more prevalent in countries with intensive swine management practices . The disease syndromes caused by S . suis in swine include arthritis, meningitis, pneumonia, septicaemia, endocarditis, polyserositis, abortions and abscesses . S . suis has also been implicated in disease in humans, especially among abattoir workers and swine and pork handlers . In humans, S . suis type 2 can cause meningitis, which may result in permanent hearing loss, septicaemia, endocarditis and death . The pathogenic mechanism of S . suis is not well defined . Several virulence factors have been identified, but their roles in pathogenesis and disease have not been well elucidated . Much work is in progress on characterization of virulence factors and mechanisms, with emphasis on the control of the disease . Because of the non-availability of suitable immunoprophylaxis, control of S . suis infection has depended mainly on the use of antimicrobials.

Ann Plast Surg, 1997 Aug, 39(2), 131 - 6
Evaluation of penicillin and hyperbaric oxygen in the treatment of streptococcal myositis; Zamboni WA et al.; The purpose of this study was to evaluate effects of hyperbaric oxygen (HBO) and penicillin (PCN) therapy in a murine model of streptococcal myositis . The thighs of Swiss Webster mice were inoculated with Streptococcus pyogenes . Four groups were evaluated: (1) control (N = 10), (2) HBO treatment (N = 10), (3) PCN treatment (N = 8), and (4) PCN and HBO treatment (N = 6) . Mortality (day of death) and the number of colony-forming units (cfu) were measured . PCN significantly lowered cfu from control (p < 0.05) . Cfu in group 4 was significantly lower than PCN alone (p = 0.006) . Survival was significantly longer in the PCN group compared with the control (p < 0.01) . Survival in the combined treatment group was significantly longer than PCN alone (p < 0.01) . These results suggest that (1) HBO treatment alone does not decrease mortality or bacterial proliferation in vivo significantly, (2) PCN therapy alone improves outcome significantly, and (3) the combined treatment of PCN and HBO exerts at least additive effects in both decreasing bacterial counts in vivo and increasing survival in this model.

J Bacteriol, 1997 Aug, 179(16), 5178 - 87
Role of mga in growth phase regulation of virulence genes of the group A streptococcus; McIver KS et al.; To determine whether growth phase affects the expression of mga and other virulence-associated genes in the group A streptococcus (GAS), total RNA was isolated from the serotype M6 GAS strain JRS4 at different phases of growth and transcript levels were quantitated by hybridization with radiolabeled DNA probes . Expression of mga (which encodes a multiple gene regulator) and the Mga-regulated genes emm (which encodes M protein) and scpA (which encodes a complement C5a peptidase) was found to be maximal in exponential phase and shut off as the bacteria entered stationary phase, while the housekeeping genes recA and rpsL showed constant transcript levels over the same period of growth . Expression of mga from a foreign phage promoter in a mga-deleted GAS strain (JRS519) altered the wild-type growth phase-dependent transcription profile seen for emm and scpA, as well as for mga . Therefore, the temporal control of mga expression requires its upstream promoter region, and the subsequent growth phase regulation of emm and scpA is Mga dependent . A number of putative virulence genes in JRS4 were shown not to require Mga for their expression, although several exhibited growth phase-dependent regulation that was similar to mga, i.e., slo (which encodes streptolysin O) and plr (encoding the plasmin receptor/glyceraldehyde-3-phosphate dehydrogenase) . Still others showed a markedly different pattern of expression (the genes for the superantigen toxins MF and SpeC) . These results suggest the existence of complex levels of global regulation sensitive to growth phase that directly control the expression of virulence genes and mga in GAS.

Antimicrob Agents Chemother, 1997 Aug, 41(8), 1673 - 6
Efficacy of azithromycin or clarithromycin for prophylaxis of viridans group streptococcus experimental endocarditis; Rouse MS et al.; The efficacy of azithromycin or clarithromycin was compared to that of amoxicillin, clindamycin, or erythromycin for the prevention of viridans group streptococcus experimental endocarditis . Rabbits with catheter-induced aortic valve vegetations were given no antibiotics or two doses of amoxicillin at 25 mg/kg of body weight, azithromycin at 10 mg/kg, clarithromycin at 10 mg/kg, clindamycin at 40 mg/kg followed by clindamycin at 20 mg/kg, or erythromycin at 10 mg/kg . Antibiotics were administered 0.5 h before and 5.5 h after intravenous infusion of 5 x 10(5) CFU of Streptococcus milleri . Forty-eight hours after bacterial inoculation, the rabbits were killed and aortic valve vegetations were aseptically removed and cultured for bacteria . Infective endocarditis occurred in 88% of untreated animals, 1% of animals receiving amoxicillin, 9% of animals receiving erythromycin, 0% of animals receiving clindamycin, 2.5% of animals receiving clarithromycin, and 1% of animals receiving azithromycin . All five regimens were more effective (P < 0.001) than no prophylaxis . Erythromycin was less effective (P < 0.05) than amoxicillin or clindamycin . Azithromycin or clarithromycin was as effective as amoxicillin, clindamycin, or erythromycin for the prevention of viridans group streptococcus experimental endocarditis in this model.

J Bacteriol, 1997 Aug, 179(15), 4953 - 8
Molecular and genetic characterization of the capsule biosynthesis locus of Streptococcus pneumoniae type 19B; Morona JK et al.; We have previously reported the nucleotide sequence of the Streptococcus pneumoniae type 19F capsular polysaccharide synthesis locus (cps19f), which consists of 15 open reading frames (ORFs) designated cps19fA to -O . Hybridization analysis indicated that close homologs for cps19fA to -H and cps19fK to -O were found in type 19B, but there were no homologs for cps19fI and -J . In this study we used long-range PCR to amplify and clone a 10.5-kb section of the S . pneumoniae type 19B capsule locus (cps19b) between cps19bH and cps19bK . This region of the cps19b locus is 4 kb larger than that in the cps19f locus and replaces cps19fI and cps19fJ with five new ORFs, designated cps19bP, -I, -Q, -R, and -J . We have proposed functions for four of the protein products, including functional homologs of Cps19fI and Cps19fJ . Transformation of a S . pneumoniae mutant containing an interrupted type 19F capsule locus with the 10.5-kb cps19b PCR product converted the recipient strain to type 19B . Southern hybridization analysis indicated that cps19bP, -I, -Q, -R, and -J are unique to type 19B and the closely related type 19C.

J Bacteriol, 1997 Aug, 179(15), 4901 - 8
Biochemical characterization of penicillin-resistant and -sensitive penicillin-binding protein 2x transpeptidase activities of Streptococcus pneumoniae and mechanistic implications in bacterial resistance to beta-lactam antibiotics; Zhao G et al.; To understand the biochemical basis of resistance of bacteria to beta-lactam antibiotics, we purified a penicillin-resistant penicillin-binding protein 2x (R-PBP2x) and a penicillin-sensitive PBP2x (S-PBP2x) enzyme of Streptococcus pneumoniae and characterized their transpeptidase activities, using a thioester analog of stem peptides as a substrate . A comparison of the k(cat)/Km values for the two purified enzymes (3,400 M(-1) s(-1) for S-PBP2x and 11.2 M(-1) s(-1) for R-PBP2x) suggests that they are significantly different kinetically . Implications of this finding are discussed . We also found that the two purified enzymes did not possess a detectable level of beta-lactam hydrolytic activity . Finally, we show that the expression levels of both PBP2x enzymes were similar during different growth phases.

Biomaterials, 1997 Aug, 18(15), 1051 - 7
In vitro inhibition of caries around a resin composite restoration containing antibacterial filler; Syafiuddin T et al.; Class V cavities were prepared and restored with resin composite containing antibacterial filler powder (Apacider-AW, Ap-AW) using experimental restorations . The restored teeth were incubated in vitro with the cariogenic bacteria Streptococcus mutans IFO 13955 . Ground sections were then prepared and examined using macrophotography . Lesions of the outer and inner wall were noted, and the depths of which the lesions penetrated were measured . We found that, in restorations containing 1-5 wt% Ap-AW, caries penetrated the marginal area, while in restorations containing 10 wt% Ap-AW the margin remained free of caries out to a distance of about 1.1 and 1.8 mm on the occlusal and gingival sides, respectively.

J Infect Dis, 1997 Aug, 176(2), 526 - 9
A new multiantigen immunoassay for the quantification of IgG antibodies to capsular polysaccharides of Streptococcus pneumoniae; Roth F et al.; A new nitrocellulose-based solid-phase multiantigen immunoassay (MAIA) for the detection of serum antibodies to Streptococcus pneumoniae capsular polysaccharides (PPSs) is presented . Evaluation with human sera showed that the MAIA test is reproducible, sensitive, and specific . It correlated well with a conventional ELISA method . The multiantigen strip system allowed quantification of antibodies against several PPS serotypes simultaneously and with a minimal amount of serum specimen . The presented solid-phase immunoassay for the quantification of anti-PPS antibodies seems to be a superior and attractive alternative to currently used ELISA tests and offers possibilities for standardization.

J Infect Dis, 1997 Aug, 176(2), 439 - 44
Interleukin-6 gene-deficient mice show impaired defense against pneumococcal pneumonia; van der Poll T et al.; Induction of pneumonia in C57Bl/6 mice by intranasal inoculation with 10(6) cfu of Streptococcus pneumoniae resulted in sustained expression of interleukin (IL)-6 mRNA in lungs and increases in lung and plasma IL-6 concentrations . In IL-6-deficient (IL-6-/-) mice, pneumonia was associated with higher lung levels of the proinflammatory cytokines tumor necrosis factor-alpha, IL-1beta, and interferon-gamma and of the antiinflammatory cytokine IL-10 than in wild type (IL-6+/+) mice (all P < .05) . Also, the plasma concentrations of soluble tumor necrosis factor receptors were higher in IL-6-/- mice (P < .05), while the acute-phase protein response was strongly attenuated (P < .01) . Lungs harvested from IL-6-/- mice 40 h after inoculation contained more S . pneumoniae colonies (P < .05) . IL-6-/- mice died significantly earlier from pneumococcal pneumonia than did IL-6+/+ mice (P < .05) . During pneumococcal pneumonia, IL-6 down-regulates the activation of the cytokine network in the lung and contributes to host defense.

J Biol Chem, 1997 Aug 1, 272(31), 19502 - 8
Functional analysis of glycosyltransferases encoded by the capsular polysaccharide biosynthesis locus of Streptococcus pneumoniae serotype 14; Kolkman MA et al.; Bacteria belonging to the species Streptococcus pneumoniae vary in their capsule . Presently, 90 capsular serotypes are known, all possessing their own specific polysaccharide structure . Little is known about the biosynthesis of these capsular polysaccharides . The cps locus of S . pneumoniae serotype 14 was cloned . So far, 7 open reading frames have been sequenced, cps14B to cps14H . The gene products are similar to proteins involved in bacterial polysaccharide biosynthesis, both of Gram-negative and -positive micro-organisms . Gene-specific mutants were created for cps14D to cps14H by insertional mutagenesis . All mutants no longer agglutinated with a monoclonal antibody against type 14 capsule polysaccharides . The biosynthetic function of cps14E and cps14G was determined by analysis of the intermediates in the synthesis of the oligosaccharide subunit, formed in membrane preparations of the wild-type and mutant strains and in membrane preparations of Escherichia coli expressing the pneumococcal glycosyltransferases . The enzyme encoded by cps14E is a glucosyl-1-phosphate transferase that links glucose to a lipid carrier, the first step in the biosynthesis of the type 14 repeating unit . The gene product of cps14G encodes a beta-1,4-galactosyltransferase, the enzyme responsible for the second step in the subunit synthesis, the transfer of galactose to lipid-linked glucose.

Infect Immun, 1997 Aug, 65(8), 3255 - 60
Coexistence of CD14-dependent and independent pathways for stimulation of human monocytes by gram-positive bacteria; Cauwels A et al.; The cell wall is a key inflammatory agent of gram-positive bacteria . Possible receptors mediating cell wall-induced inflammation include CD14 and platelet-activating factor (PAF) receptor . To delineate the conditions under which these various receptors might be used, human monocytic THP-1 cells and heparinized whole human blood were stimulated with lipopolysaccharide (LPS), intact Streptococcus pneumoniae bacteria, or purified pneumococcal cell wall . THP-1 culture supernatant or cell-free plasma was analyzed for the presence of tumor necrosis factor, interleukin-1beta (IL-1beta), and IL-6 . For the cultured monocytes, anti-CD14 inhibited induction of the inflammatory cytokines by the cell wall and LPS but not by intact pneumococcal bacteria . Despite the difference in CD-14 usage, the intracellular pathways induced by the three agents demonstrated similarities, as revealed in the presence of specific signal transduction inhibitors such as cholera toxin, pertussis toxin, and genistein . Cytokine production in whole human blood indicated that anti-CD14 failed to block responses to cell wall and intact pneumococci, whereas while LPS-induced responses were inhibited . PAF receptor antagonist had no effect under any conditions in both assays . These results indicate that although cell walls bind to both CD14 and PAF receptor, only CD14 appears to engender a cytokine response under restricted conditions . Furthermore, host cell responses to intact pneumococci are consistently independent of CD14 and PAF receptor.

J Clin Microbiol, 1997 Aug, 35(8), 2111 - 4
Molecular epidemiology of Streptococcus pyogenes in an area where acute pharyngotonsillitis is endemic; Nguyen L et al.; During an open clinical trial in an area where streptococcal infections are hyperendemic, we studied the genetic polymorphism of Streptococcus pyogenes isolates collected from patients and from healthy carriers living in close contact with them . The clonal diversity of isolates was analyzed by pulsed-field gel electrophoresis with three restriction enzymes (SmaI, ApaI, and SacII) . The pharynx of each patient and healthy carrier was colonized by a single clone, suggesting the clonal nature of streptococcal colonization in individuals . Among 52 isolates obtained from patients with acute pharyngotonsillitis, we found 14 genetically unrelated clones, showing the genetic diversity of S . pyogenes . However, two clones belonging to the M1 and M12 serotypes represented about 70% of isolates in carriers and patients . Pharyngeal colonization in cured patients was monitored for 3 to 4 months . After the initial elimination of S . pyogenes following antibiotic therapy, the rate of recolonization was high by day 30 (about 20%) and was also at that level between days 90 and 120; this was similar to the carriage rate in family contacts . Thus, cured patients can be recontaminated by unrelated clones, suggesting that colonization of healthy carriers might be a potential source of spread and redistribution of S . pyogenes isolates.

Gene, 1997 Jul 31, 194(2), 249 - 55
Analysis of a Streptococcus pneumoniae gene encoding signal peptidase I and overproduction of the enzyme; Zhang YB et al.; The spi gene of Streptococcus pneumoniae was cloned and its nucleotide sequence was determined . It encodes a protein of 204 amino acids that is homologous to bacterial signal peptidase I proteins . The S . pneumoniae protein contains all of the conserved amino acid sequence motifs previously identified in this enzyme from both prokaryotic and eukaryotic sources . Sequence comparisons revealed several additional motifs characteristic of the enzyme . The cloned S . pneumoniae gene complemented an Escherichia coli mutant defective in its leader peptidase gene . Expression of the spi gene in S . pneumoniae appeared to be essential for viability . The cloned gene was shown to produce a polypeptide of approximately 20 kDa . Overproduction of the S . pneumoniae spi gene in an E . coli expression system gave a native protein product, soluble in the presence of a non-ionic detergent, which should be amenable to structural determination.

BMJ, 1997 Jul 26, 315(7102), 216 - 9; discussion 220
Effect of cleansing the birth canal with antiseptic solution on maternal and newborn morbidity and mortality in Malawi: clinical trial; Taha TE et al.; OBJECTIVE: To determine if cleansing the birth canal with an antiseptic at delivery reduces infections in mothers and babies postnatally . DESIGN: Clinical trial; two months of no intervention were followed by three months of intervention and a final month of no intervention . SETTING: Queen Elizabeth Central Hospital (tertiary care urban hospital), Blantyre, Malawi . SUBJECTS: A total of 6965 women giving birth in a six month period and their 7160 babies . INTERVENTION: Manual wipe of the maternal birth canal with a 0.25% chlorhexidine solution at every vaginal examination before delivery . Babies born during the intervention were also wiped with chlorhexidine . MAIN OUTCOME MEASURES: Effects of the intervention on neonatal and maternal morbidity and mortality . RESULTS: 3635 women giving birth to 3743 babies were enrolled in the intervention phase and 3330 women giving birth to 3417 babies were enrolled in the non-intervention phase . There were no adverse reactions related to the intervention among the mothers or their children . Among infants born in the intervention phase, overall neonatal admissions were reduced (634/3743 (16.9%) v 661/3417 (19.3%), P < 0.01), as were admissions for neonatal sepsis (7.8 v 17.9 per 1000 live births, P < 0.0002), overall neonatal mortality (28.6 v 36.9 per 1000 live births, P < 0.06), and mortality due to infectious causes (2.4 v 7.3 per 1000 live births, P < 0.005) . Among mothers receiving the intervention, admissions related to delivery were reduced (29.4 v 40.2 per 1000 deliveries, P < 0.02), as were admissions due to postpartum infections (1.7 v 5.1 per 1000 deliveries, P = 0.02) and duration of hospitalisation (Wilcoxon P = 0.008) . CONCLUSIONS: Cleansing the birth canal with chlorhexidine reduced early neonatal and maternal postpartum infectious problems . The safety, simplicity, and low cost of the procedure suggest that it should be considered as standard care to lower infant and maternal morbidity and mortalityPIP: A clinical trial of the effects of cleansing both the birth canal and the newborn with an antiseptic indicates that this simple procedure substantially reduces early neonatal and maternal postpartum infection . The antiseptic used, a 0.25% chlorhexidene solution, has been shown to reduce neonatal morbidity due to group B streptococcus and can neutralize HIV . Enrolled in the study were 6965 women giving birth to 7160 infants at Queen Elizabeth Central Hospital in Blantyre, Malawi, in a 6-month period in 1994 . 2 months of no intervention were followed by 3 months of intervention and a final month of no intervention . Significant differences were recorded between the 3743 infants delivered during the intervention phase and the 3417 controls in terms of overall neonatal admissions (16.9 vs . 19.3/1000 live births), admissions for neonatal sepsis (7.8 vs . 17.9/1000 live births), overall neonatal mortality (28.6 vs . 36.9/1000 live births), and mortality due to infectious causes (2.4 vs . 7.3/1000 live births) . Significant differences also were found between the 3635 mothers in the intervention group and the 3330 controls in delivery-related admissions (29.4 vs . 40.2/1000 deliveries), admissions due to postpartum infection (1.7 vs . 5.1/1000 deliveries), and the average duration of hospitalization (48.7 vs . 50.2 hours) . The cleansing procedure was easily administered, required almost no extra staff time, and cost less than US $0.10 per patient, making it appropriate for standard care .

FEMS Microbiol Lett, 1997 Jul 15, 152(2), 363 - 9
Determination of specific DNA strand discontinuities with nucleotide resolution in exponentionally growing bacteria harboring rolling circle-replicating plasmids; Grohmann E et al.; Plasmid replication by the rolling circle mechanism and conjugative transfer of plasmids require the generation of a specific strand discontinuity in the DNA . In both processes cleavage at the so-called nic site is catalyzed by plasmid-encoded proteins . The strand discontinuities at the conjugative origins of transfer of plasmid pE194 and pMV158 were determined in Bacillus subtilis and Streptococcus pneumoniae, respectively, with a recently developed runoff DNA synthesis assay . The positions of intracellular cleavage within the respective transfer origins were shown to coincide with the site predicted for pE194 and with the nic site determined in vitro for pMV158 . For pMV158, the influence of a mutation in the S . pneumoniae polA gene on the efficiency of replication was investigated . In addition, the nic site within the double-stranded origin of the-rolling circle-replicating plasmid pMV158 in S . pneumoniae as well as that of pFX2 in Escherichia coli was mapped with nucleotide resolution.

Proc Natl Acad Sci U S A, 1997 Jul 8, 94(14), 7435 - 40
Specific cleavage of chromosomal and plasmid DNA strands in gram-positive and gram-negative bacteria can be detected with nucleotide resolution; Zechner EL et al.; A sensitive and precise in vitro technique for detecting DNA strand discontinuities produced in vivo has been developed . The procedure, a form of runoff DNA synthesis on molecules released from lysed bacterial cells, mapped precisely the position of cleavage of the plasmid pMV158 leading strand origin in Streptococcus pneumoniae and the site of strand scission, nic, at the transfer origins of F and the F-like plasmid R1 in Escherichia coli . When high frequency of recombination strains of E . coli were examined, DNA strand discontinuities at the nic positions of the chromosomally integrated fertility factors were also observed . Detection of DNA strand scission at the nic position of F DNA in the high frequency of recombination strains, as well as in the episomal factors, was dependent on sexual expression from the transmissable element, but was independent of mating . These results imply that not only the transfer origins of extrachromosomal F and F-like fertility factors, but also the origins of stably integrated copies of these plasmids, are subject to an equilibrium of cleavage and ligation in vivo in the absence of DNA transfer.

Mol Microbiol, 1997 Jul, 25(2), 329 - 41
Transcriptional analysis of the Streptococcus mutans hrcA, grpE and dnaK genes and regulation of expression in response to heat shock and environmental acidification; Jayaraman GC et al.; The dental pathogen Streptococcus mutans persists and causes diseases in highly dynamic environments and gains a selective ecological advantage in environmental conditions that frequently exceed the limits for growth of the organism, particularly with regard to environmental pH . The goal of this study was to begin a molecular genetic analysis of a major stress protein, DnaK/Hsp70, to begin to understand how stress responses are regulated in this lactic acid bacterium and to establish a relationship between dnaK gene expression and exposure to acidic environments . Cloning and nucleotide sequence analysis revealed that the dnaK gene is preceded by, and is in an operon-like arrangement with, the hrcA and grpE genes, although intergenic spacing was unlike that described in other bacteria . An inverted repeat (a CIRCE element) was identified by sequence analysis and, using primer extensions, a heat shock-responsive, sigmaA-type promoter, P1, 5' to the hrcA gene, and a sigmaB-type promoter, 5' to the grpE translational start site, were identified . No promoters were detected between grpE and dnaK . A strain carrying a strongly polar insertion in the hrcA gene had markedly diminished levels of dnaK mRNA, indicating that dnaK was transcribed as part of an operon from P1, and to a lesser extent from P2 . Results from physiological manipulation of S . mutans in continuous chemostat culture demonstrated that steadystate levels of S . mutans dnaK mRNA and DnaK protein were (i) increased in response to acid shock; (ii) elevated in acid 'adapted' cells; and (iii) induced in response to alkali shock of acid 'adapted' cells . In all cases, increased amounts of dnaK mRNA could be correlated with enhanced transcription from P1 . This study provides the first detailed analysis of the expression of a heat shock gene from an oral isolate, and the evidence provided suggests that sigmaB-like promoters may also be involved in class I heat shock gene expression in some Gram-positive organisms.

J Laryngol Otol, 1997 Jul, 111(7), 666 - 8
Lateral neck abscess caused by Streptococcus bovis in a patient with undiagnosed colon cancer; Goumas PD et al.; Bacteraemia or endocarditis caused by Streptococcus bovis, a non-enterococcal group D streptococcus, is a very common finding in patients suffering from intestinal tumours or other colon diseases . A case of a patient with a laternal neck abscess caused by S . bovis is reported . During the treatment the patient was found to have colonic malignant lesions . The problems in the appropriate diagnosis and the possible correlation between these two clinical entities are presented and discussed.

Zentralbl Veterinarmed A, 1997 Jul, 44(5), 271 - 80
Microbiology and pathology of fibrinous pericarditis in Danish slaughter pigs; Buttenschon J et al.; The prevalence of fibrinous pericarditis detected at slaughter in Danish slaughter pigs is approximately 0.02% . The microbiology and pathology of this disorder was studied through 46 field cases collected at slaughter from May 1994 to August 1995 . Mycoplasmas (Mycoplasma hyopneumoniae, M . hyosynoviae and M . hyorhinis) were isolated from the pericardium in 38 cases and from the joints in six . M . Hyopneumoniae dominated with 33 isolates from the pericardium . Actinobacillus pleuropneumoniae was isolated from the pericardium in three cases (as mono-infection in one and together with M . hyopneumoniae in two cases) and Actinomyces pyogenes was isolated from the pericardium twice (as mono-infection in one case and together with M . hyopneumoniae in another) . A . pyogenes was also present in the lung, liver and kidney in one of these cases . Streptococcus suis was isolated together with mycoplasmas from the pericardium in three cases . The pericardium was sterile in three cases and contained a low grade mixed flora in two; the latter is believed to be a result of the slaughter procedure rather than an infection . No chlamydiae were found in connection with the microbiological examination . Parvovirus was found in one case in the pericardium and in two cases in the spleen . Forty-five cases were subacute to chronic . The gross pathological examination showed that bronchopneumonia, chronic pleuritis and synovitis or a low grade arthritis occurred in most cases . Only the arthritic lesions are believed to be pathogenetically concurrent with the pericarditis . Slight evidence of stasis of the liver and/or periangiolar edema was present in six cases . The histopathological examination confirmed the above mentioned findings . Bacterial colonies were found within the fibrinous layer on the pericardium in all cases from which either A . pleuropneumoniae, A . pyogenes or S . suis was isolated . It is concluded that in this study mycoplasmas, particularly M . Hyopneumoniae, are the more likely cause of fibrinous pericarditis in slaughter pigs.

Eur J Clin Microbiol Infect Dis, 1997 Jul, 16(7), 512 - 6
Effect of clavulanic acid and/or polymorphonuclear neutrophils on amoxicillin bactericidal activity against Streptococcus pneumoniae; Martin M et al.; The effects of polymorphonuclear neutrophils (PMNs) and/or clavulanic acid on the bactericidal activity of amoxicillin (at human serum achievable concentrations) against a serotype 3 penicillin-susceptible Streptococcus pneumoniae strain {minimal inhibitory concentration/minimal bactericidal concentration (MIC/MBC) values of penicillin, amoxicillin, and amoxicillin/clavulanic acid (2:1) = 0.01/0.01 microgram/ml} and a serotype 9 penicillin-resistant strain {MIC/MBC of penicillin, amoxicillin, and amoxicillin/clavulanic acid (2:1) = 1/2 microgram/ml} were studied . Against the penicillin-resistant strain, subinhibitory concentrations of amoxicillin reduced the growth rate; this effect was increased by the addition of clavulanic acid . A reduction of the penicillin-resistant initial inocula (3 x 10(6) cfu/ml) at subinhibitory concentrations was obtained only with amoxicillin plus clavulanic acid and PMNs . At suprainhibitory concentrations, both clavulanic acid and PMNs increased the bactericidal activity of amoxicillin, as evidenced by an increased reduction in the penicillin-resistant initial inocula . The combined effect of these antibiotics and immune defenses may help explain the maintenance of their clinical efficacy in respiratory tract infections, despite the increase in the incidence of penicillin-resistant pneumococci.

Clin Exp Rheumatol, 1997 Jul-Aug, 15(4), 399 - 404
Antibodies to streptococcal cell wall in psoriatic arthritis and cutaneous psoriasis; Rantakokko K et al.; OBJECTIVE: To evaluate the possible role of streptococcal cell wall antigens in the development of psoriatic arthritis . METHODS: IgM, IgA and IgG class serum antibodies against peptidoglycan-polysaccharide (PG-PS) and peptidoglycan (PG), both from group A streptococcus, were measured in patients with psoriatic arthritis (PA), non-arthritic psoriasis (NAP), rheumatoid arthritis (RA) and in healthy controls, using ELISA . RESULTS: Both groups of psoriatic patients had elevated IgA levels specific to streptococcal PG-PS . No association with the severity of the skin disease or with the different subsets of PA was detected . Higher concentrations of IgG against the two streptococcal preparations was observed in PA than in RA . Analysis of antibody levels in patients with recent onset arthritis showed lower concentrations of IgM antibodies against streptococcal as well as control antigens in early than in late PA, whereas an overall increase of specific IgA and IgG antibodies was observed in early RA . CONCLUSION: The results suggest chronic mucosal stimulation of lymphocytes by long-lived streptococcal antigens in patients with psoriasis, without any difference observed between PA and NAP . The differences between recent onset versus established PA and RA could reflect a distinct immunopathology in the two arthritides.

Vaccine, 1997 Jul, 15(10), 1138 - 43
Further studies on the efficacy of a live vaccine against mastitis caused by Streptococcus uberis; Finch JM et al.; Three groups of dairy cows were immunized by subcutaneous (s.c.) administration of a preparation of live Streptococcus uberis (strain 0140J) and an intramammary infusion of a soluble surface extract derived from same the bacteria . Animals in Groups 1 and 2 received two s.c . vaccinations plus an intramammary inoculation . Animals in Group 3 received two s.c . vaccinations but did not receive the intramammary infusion . In addition to the vaccinated animals, each group also contained two non-vaccinated (control) animals . All animals were challenged experimentally by intramammary infusion (in two quarters per animal) of ca 100 c.f.u . of S . uberis (strain 0140J or C221) and monitored for clinical signs of disease, bacterial numbers in milk, somatic cell count in milk, and daily milk yield for the following 10 days . Animals in Group I were challenged with strain 0140J . Only one out of six challenged quarters of three vaccinated cows developed clinical disease compared to all (four out of four) quarters of non-vaccinated cows . Animals in Group 2 were challenged with strain C221 . All challenged quarters of three vaccinated (six out of six) and two non-vaccinated (four out of four) cows developed clinical mastitis . Animals in Group 3 were challenged with strain 0140J . Five out of eight quarters on four vaccinated cows developed clinical mastitis but the onset was delayed in comparison with that in both non-vaccinated cows in which four out of four challenged quarters developed clinical mastitis . These results indicated that vaccination with live S . uberis protects against challenge with the homologous strain but was less effective against a heterologous strain . Reduced protection was also seen when the intramammary booster was omitted.

Infection, 1997 Jul-Aug, 25(4), 250 - 1
Analysis of a case of recurrent bacteraemia due to group A Streptococcus equisimilis by pulsed-field gel electrophoresis; Bert F et al.; An 86-year-old woman with a history of metastatic breast cancer developed two episodes of streptococcal bacteraemia and erysipelas separated by an interval of 3 months . The isolates belonged to Lancefield group A but were biochemically identified as Streptococcus equisimilis . The similarity of the two isolates was established by DNA macrorestriction analysis and pulsed-field gel electrophoresis, indicating that the second episode was due to relapse and not reinfection.

J Pediatr Hematol Oncol, 1997 Jul-Aug, 19(4), 327 - 33
Influence of penicillin prophylaxis on antimicrobial resistance in nasopharyngeal S . pneumoniae among children with sickle cell anemia . The Ancillary Nasopharyngeal Culture Study of Prophylactic Penicillin Study II; Woods GM et al.; PURPOSE: To evaluate the consequences of prolonged prophylactic penicillin use on the rates of nasopharyngeal colonization with Streptococcus pneumoniae and the prevalence of resistant pneumococcal strains in children with sickle cell anemia . METHODS: Nasopharyngeal specimens were obtained from children with sickle cell anemia (Hb SS or Hb S beta degrees thalassemia) at 10 teaching hospitals throughout the United States . These patients were participating in a prospective, randomized, placebo-controlled trial in which they were prescribed prophylactic penicillin before their fifth birthday and were randomized to prophylactic penicillin or placebo after their fifth birthday (PROPS II) . The specimens were cultured for S . pneumoniae, and isolates were analyzed for antimicrobial susceptibility to nine commonly prescribed antimicrobial agents . RESULTS: Of the 226 patients observed, an average of 8.4 specimens were collected per patient . From 1,896 individual culture specimens, 5.5% of the specimens were positive for S . pneumoniae; 27% of patients had at least one positive culture . Nine percent of the study patients had at least one isolate of penicillin intermediate or resistant pneumococci . There was no significant difference in the percent of positive cultures for S . pneumoniae in those patients given penicillin prophylaxis after 5 years of age (4.1%) compared with those patients given placebo after 5 years of age (6.4%) . Likewise, there was no significant difference (p = 0.298) in the percent of patients with at least one positive culture for S . pneumoniae in the group given prophylactic penicillin after 5 years of age (21.8%) compared with the group given placebo after 5 years of age (28.3%) . There was no difference between the penicillin and placebo groups in the proportion of patients with penicillin intermediate or resistant pneumococci, but there was a trend toward increased carriage of multiply drug-resistant pneumococci in children > 5 years of age receiving prophylactic penicillin compared to children > 5 years of age receiving placebo . The increased colonization rate with multiply drug-resistant organisms of children > 5 years of age receiving penicillin prophylaxis is not statistically significant . CONCLUSIONS: The potential for continued penicillin prophylaxis to contribute to the development of multiply resistant pneumococci should be considered before continuing penicillin prophylaxis in children with sickle cell anemia who are older than 5 years of age . Added to the published data from PROPS II, which demonstrated no apparent advantage to continue prophylaxis, the data support the conclusion that, for children with no history of invasive pneumococcal disease, consideration should be given to discontinue prophylactic penicillin after their fifth birthday.

J Hosp Infect, 1997 Jul, 36(3), 191 - 200
Outbreak of scarlet fever at a hospital day care centre: analysis of strain relatedness with phenotypic and genotypic characteristics; Hsueh PR et al.; An outbreak of scarlet fever involving 12 children occurred at a hospital day care centre from February to March 1996 . Twenty-five throat isolates of Streptococcus pyogenes (GAS, group A streptococcus) available from 24 children, including 10 children with scarlet fever and 14 asymptomatic carriers, and one asymptomatic staff member were studied for the presence of genes encoding streptococcal pyrogenic exotoxin types A (speA), B (speB), and C (speC) and for protease activity . Antimicrobial susceptibilities using the E-test, cluster analysis by cellular fatty acid composition and random amplified polymorphic DNA (RAPD) patterns by means of arbitrarily-primed polymerase chain reaction (APPCR) of the isolates were performed to investigate the outbreak . Only one isolate from an asymptomatic child possessed the speA gene . All isolates possessed the speB gene and 24 (96%) isolates were positive for the speC gene . There was no difference in protease activity between isolates from children with scarlet fever and from asymptomatic carriers . Thirteen isolates (10 recovered from children with scarlet fever, two from asymptomatic children, and one from the staff member) were considered to be the same strain according to the identical antimicrobial susceptibility profile and RAPD patterns and were also considered to be similar by cluster analysis of fatty acid composition . These findings suggest that the outbreak was caused by a unique clone of GAS . We conclude that RAPD typing and cluster analysis by cellular fatty acids composition both provide a powerful tool for epidemiological investigation of GAS infections.

Auris Nasus Larynx, 1997 Jul, 24(3), 247 - 54
The role of immune complex in otitis media with effusion; Ueyama S et al.; Fifteen chinchillas were inoculated with immune complexes of Streptococcus pneumoniae into the tympanic cavity, and with formalin-killed bacteria into the opposite side . Middle ear effusion (MEE) were found in 14 ears having inoculation with immune complexes and in only four ears having inoculation with formalin-killed S . pneumoniae . In another experiment, 20 chinchillas received intra-tympanic inoculation with live S . pneumoniae after systemic immunization with formalin-killed S . pneumoniae of the same strain . As a control, 12 chinchillas were inoculated with live bacteria of the same strain into the tympanic cavity without pre-immunization . MEE was observed in nine of pre-immunized animals and persistent MEE lasting for more than 3 weeks was observed in seven of the animals . In control, persistent MEE was not observed . Though six animals developed otitis media with effusion (OME) . The results suggest that the formation of immune complexes in the tympanic cavity plays an important role in the occurrence of persistent MEE after pneumococcal otitis media.

Microb Pathog, 1997 Jul, 23(1), 11 - 21
Heat shock response of Streptococcus pneumoniae: identification of immunoreactive stress proteins; Hamel J et al.; In order to investigate whether pneumococcal heat shock proteins (HSPs) were major immunogens of humoral immune response, we first characterized the heat shock response of S . pneumoniae . Three HSPs, HSP62, HSP72 and HSP80, having an apparent molecular mass of 62, 72, and 80 kDa, respectively, were detected by labelling proteins synthesized with {35S}methionine after a shift from 37 degrees C to 45 degrees C and fluorography of SDS-polyacrylamide gels . Radioimmunoprecipitation and immunoblot analyses with mouse anti-pneumococcal sera revealed that HSP72 was a major immunogen . S . pneumoniae HSP62 was another antigen which was precipitated by some immune sera . Anti-HSP72 antibodies appeared after the first immunization with S . pneumoniae antigens and subsequent immunization elicited a booster response . Monoclonal antibodies (MAbs) to pneumococcal HSP72 were produced and their specificities defined . The epitopes reactive with four MAbs are highly conserved in S . pneumoniae since 20 out of 20 different strains were recognized by each individual MAb . Western blot analysis revealed cross-reactivities with few non-pneumococcal strains . By N-terminal sequence analysis, the S . pneumoniae HSP72 was found to belong to the heat shock protein 70 family . That HSP72 is an important highly conserved antigen in S . pneumoniae should provide a basis for further investigation of its physiological and potential pathogenic role.

J Periodontol, 1997 Jul, 68(7), 626 - 31
The relationship between gingivitis and the serum antibodies to the microbiota associated with periodontal disease in children with Down's syndrome; Morinushi T et al.; Gingival inflammation in Down's syndrome children (DS) develops earlier and is more rapid and extensive than in non-DS children . Abnormalities in host response to the oral flora have been proposed as etiological factors of this gingival inflammation . However, the relationship between gingivitis and the host response to oral microorganisms in DS by age has not been determined . The objective of this study was to clarify this relationship . Sera were obtained from 75 DS subjects (aged 2 to 18 years) and their gingival health assessed using a modified PMA Index (M-PMA) . Antibody titers to Porphyromonas gingivalis (Pg), Prevotella intermedia (Pi), Treponema denticola (Td), Fusobacterium nucleatum (Fn), Selenomonas sputigena (Sel), Actinobacillus actinomycetemcomitans (Aa), and Streptococcus mitis (Mi) were determined using the micro-ELISA . DS subjects under 4 years old were found to have significantly more gingival inflammation than did normal children the same age . A significant positive correlation (r = 0.548, P < 0.0001) existed in the relationship between M-PMA score and plaque score for subjects in the G1 age group (deciduous dentition) . At G1, the average antibody titers to Aa, Mi, and Fn exceeded those of the normal adult reference serum pool . In addition, IgG antibody titers to Pg, Aa, Fn, Sel, and Mi correlated significantly with the M-PMA scores in the G1 age group . There was a correlation between age (2 to 18 years) and these antibody titers . IgG antibody titers to Pg, Aa, Sel, and Mi increased significantly with increasing M-PMA score . Furthermore, the IgG antibody titers to Pg were higher (P < 0.05) in the most extensive disease group compared to the DS no-disease group . The IgG antibody titers to Pg at G3 (early puberty) were significantly higher when compared to G1 (preschool children) . The IgM antibody titers to Aa at G3 were higher (P < 0.05) when compared to G1 . This study suggests that colonization by Aa and Fn are closely associated with the onset of gingival inflammation in DS patients under 5 years old . Colonization by Pg, Aa, Sel, and Mi in DS appears to be associated with gingivitis at puberty.

J Antimicrob Chemother, 1997 Jul, 40(1), 105 - 8
Decreased susceptibility to imipenem among penicillin-resistant Streptococcus pneumoniae; Pikis A et al.; We assessed the antimicrobial susceptibilities of 59 penicillin-intermediate or penicillin-resistant pneumococci . All strains were susceptible to vancomycin and rifampicin . The frequency of strains with decreased susceptibility to cefotaxime, chloramphenicol, imipenem and meropenem was 15, 31, 47 and 49% respectively . The high percentage of penicillin-intermediate or penicillin-resistant Streptococcus pneumoniae with decreased susceptibility to third-generation cephalosporins, chloramphenicol and carbapenems limits the therapeutic options for the treatment of invasive pneumococcal infections and particularly of meningitis.

No To Hattatsu, 1997 Jul, 29(4), 291 - 7
{Factors associated with the prognosis of bacterial meningitis in children}; Takayanagi M et al.; Treatment of bacterial meningitis depends on its severity . The signs, symptoms, and laboratory values of 51 patients with bacterial meningitis admitting to the Department of Pediatrics at Sendai City Hospital from January 1985 to December 1994 were analyzed in order to evaluate their prognostic value . The overall mortality rate was 3.9% . The incidence of neurological deficit on discharge was 31.4% . According to their prognoses, patients were divided into two groups: those who recovered with no detectable disabilities (good prognosis) and those who died or were left with neurological deficits (poor prognosis) . An analysis of these groups using Fisher's exact probability test revealed that the following risk factors were associated with poor prognosis: 1) duration of fever (including the periods of relapse) for more than 10 days ; 2) abnormal findings on brain imaging, such as cerebral infarction, cerebral hemorrhage, cerebral abscess and subdural effusion: 3 initial serum CRP value above 16 mg/dl; 4) initial CSF glucose value below 12 mg/dl; and 5) initial CSF LDH value above 220 IU/l . Streptococcus pneumoniae infection carried the worst prognosis: the causal organism of both the two fetal cases was S . pneumoniae . The incidence of poor prognosis was also high in S . pneumoniae meningitis (60.0%), compared to those by Hemophilus influenzae (46.7%) and group B streptococcus (25.0%) . In the cases in which causal agents were not detected, this incidence was as low as 10 percent, showing significant difference from cases in which causal agents were identified . In order to improve the prognosis of bacterial meningitis, factors associated with poor prognosis should be recognized at early stages of the illness.

Lett Appl Microbiol, 1997 Jul, 25(1), 38 - 42
In vitro cariogenicity of trans-galactosyl-oligosaccharides; Hartemink R et al.; Trans-galactosyl-oligosaccharides (TOS) are a class of oligosaccharides produced by transgalactosylation of lactose . TOS are used as bifidogenic factors in human and animal nutrition . TOS can be present in the oral cavity and form a risk of caries . All oral bacteria tested were able to degrade and ferment both TOS and galactosyllactose (GLL), one of its components . Growth was improved compared with carbohydrate-free media and acid was produced after 24 h incubation of the bacteria with TOS and GLL . Degradation patterns, using HPAEC, showed degradation of most components . GLL was degraded only partially . Rapid acidification was only observed for Streptococcus mutans, resulting in a pH of 5.4 within 30 min . All other strains fermented TOS and GLL only slowly . Plaque formation could not be detected on both substrates . It can be concluded that TOS and GLL present only a small risk of caries formation, unless proven otherwise in animal studies.

Microbiology, 1997 Jul, 143 ( Pt 7), 2449 - 55
Mitogenic factor secreted by Streptococcus pyogenes is a heat-stable nuclease requiring His122 for activity; Iwasaki M et al.; The gene encoding a mitogenic factor, termed MF, was cloned from Streptococcus pyogenes and the recombinant MF was overexpressed in Escherichia coli . Both the natural and recombinant MF had heat-resistant nuclease activity . The nuclease activity of MF was characterized using the recombinant protein . MF showed endonuclease activity, digesting ssDNA, dsDNA and tRNA . The optimal pH for the DNase activity of MF was 9.5 . The DNase activity was enhanced approximately tenfold by the simultaneous presence of two divalent cations, Mg2+ and Ca2+, compared to either alone and was inhibited by EDTA or NaCl . The heat stability of MF was biphasic; the DNase activity was heat-stable from 0 to 50 degrees C over 80 degrees C but very unstable at around 60 degrees C . DNA digested by MF possessed 5'-phosphorylated and 3'-hydroxylated termini, identical to those obtained by digestion of DNA by pancreatic deoxyribonuclease I . A mutant clone revealed that His122 was a residue essential to the nuclease activity.

Acta Paediatr, 1997 Jul, 86(7), 769 - 71
Neonatal pleural empyema with group A Streptococcus; Thaarup J et al.; A case of early neonatal septicaemia with pneumonia and pleural empyema is reported . The causal microorganism was beta-haemolytic Streptococcus pyogenes group A originating from the mother, who had a perineal infection and bacteraemia.

Clin Radiol, 1997 Jul, 52(7), 541 - 5
Lobar or segmental consolidation on chest radiographs of patients with HIV infection; Amin Z et al.; PURPOSE: To correlate chest radiographic abnormalities with diagnoses in HIV infected patients presenting with acute respiratory symptoms and lobar or segmental consolidation . MATERIALS AND METHODS: Retrospective review of chest radiographs of 53 HIV infected patients with lobar or segmental consolidation, and their microbiological and cytological diagnoses . RESULTS: A specific diagnosis was made in 35 patients of which 12 had Pneumocystis carinii pneumonia (including four co-infections) and 23 had bacterial pneumonias (10 of these were due to Streptococcus pneumoniae and four to Mycobacterium tuberculosis) . Microbiological and cytological tests were negative in 18 patients . Non-specific radiographic features included bronchial wall thickening (79%), reticulonodular or reticular change (55%), effusions (38%) and lymphadenopathy (25%); effusions favoured a bacterial aetiology . Ten of the 12 cases with P . carinii pneumonia had upper lobe consolidation (three of these had received inhaled pentamadine) . Of 13 other cases of upper lobe consolidation, eight were due to pyogenic infection and only one to M . tuberculosis alone . CONCLUSION: A wide variety of causative agents may produce lobar or segmental consolidation in HIV infected individuals, and the most common cause is bacterial infection . Where there is upper lobe consolidation P . carinii pneumonia should be considered in the differential diagnosis.

Pediatr Infect Dis J, 1997 Jul, 16(7), 667 - 74
Immune responses of infants vaccinated with serotype 6B pneumococcal polysaccharide conjugated with tetanus toxoid; Sigurdardottir ST et al.; BACKGROUND: Streptococcus pneumoniae is a major cause of meningitis, bacteremia, pneumonia and otitis media . Pneumococcal polysaccharides are not immunogenic in infants, but improved immunogenicity of polysaccharide-protein conjugates has been demonstrated . Antibiotic-resistant pneumococci have increased the need for an effective vaccine . OBJECTIVE: To study the safety and immunogenicity of a pneumococcal type 6B polysaccharidetetanus toxoid conjugate (Pn6B-TT) in infants and to assess the function of antibodies . METHODS: Healthy infants were injected, Group A at 3, 4 and 6 months (n = 21) and Group B at 7 and 9 months (n = 19) . Booster injection was given at 18 months . Antibodies were measured by enzyme-linked immunosorbent assay and radioimmunoassay, and functional activity was measured by opsonization of radiolabeled pneumococci . Nasopharyngeal cultures were obtained . RESULTS: No significant adverse reactions were observed . Pn6B-IgG (enzyme-linked immunosorbent assay) increased to a geometric mean of 0.62 microgram/ml (P = 0.367, compared with prevaccination titers) in Group A at 7 months and 1.22 micrograms/ml (P < 0.001) in Group B at 10 months . Total Pn6B antibodies (radioimmunoassay) were 44 ng of antibody N/ml (P < 0.053) in Group A and 211 ng of antibody N/ml (P < 0.001) in Group B . A smaller increase in IgM and IgA anti-Pn6B was observed . Reinjection at 18 months elicited booster responses in total and IgG anti-Pn6B; 62% of those in Group A and 79% of those in Group B had > 300 ng of antibody N/ml . Opsonic activity, after initial and booster vaccinations, correlated with Pn6B-antibody titers . Three infants with nasopharyngeal cultures repeatedly positive for serogroup 6 had poor serum IgG responses . CONCLUSION: Our results demonstrate that Pn6B-TT is safe, elicits functional antibodies and memory responses in infants.

Int J Syst Bacteriol, 1997 Jul, 47(3), 893 - 4
The tannin-degrading species Streptococcus gallolyticus and Streptococcus caprinus are subjective synonyms; Sly LI et al.; The tannin-degrading species Streptococcus gallolyticus and Streptococcus caprinus have been shown to be subjective synonyms on the basis of their levels of 16S rRNA sequence similarity (98.3%) and DNA-DNA homology (> 70%) and the phenotypes of their type strains . S . gallolyticus has nomenclatural priority according to Rule 24b(2) of the International Code of Nomenclature of Bacteria.

J Clin Periodontol, 1997 Jul, 24(7), 478 - 85
Occurrence of invading bacteria in radicular dentin of periodontally diseased teeth: microbiological findings; Giuliana G et al.; Bacterial invasion in roots of periodontally diseased teeth, which has been recently documented using cultural and microscopic techniques, may be important in the pathogenesis of periodontal disease . The purpose of this investigation was to determine the occurrence and the species of invading bacteria in radicular dentin of periodontally diseased teeth . Samples were taken from the middle layer of radicular dentin of 26 periodontally diseased teeth . 14 healthy teeth were used as controls . Dentin samples were cultured anaerobically . The chosen methodology allowed the determination of the numbers of bacteria present in both deeper and outer part of dentinal tubules, and the bacterial concentration in dentin samples, expressed as colony forming units per mg of tissue (CFU/mg) . Invading bacteria was detected in 14 (53.8%) samples from periodontally diseased teeth . The bacterial concentration ranged from 831.84 to 11971.3 CFU/mg (mean+/-standard deviation: 3043.15+/-2763.13) . Micro-organisms identified included putative periodontal pathogens such as Prevotella intermedia, Porphyromonas gingivalis, Fusobacterium nucleatum, Bacteroides forsythus, Peptostreptococcus micros and Streptococcus intermedius . These findings suggest that radicular dentin could act as bacterial reservoir from which periodontal pathogens can recolonize treated periodontal pockets, contributing to the failure of therapy and recurrence of disease.

Clin Diagn Lab Immunol, 1997 Jul, 4(4), 415 - 22
Standardization of an opsonophagocytic assay for the measurement of functional antibody activity against Streptococcus pneumoniae using differentiated HL-60 cells; Romero-Steiner S et al.; Host protection against pneumococcal disease i primarily mediated by phagocytosis . We developed and standardized an opsonophagocytic assay using HL-60 cells (human promyelocytic leukemia cells) . Fifty-five serum samples were analyzed for the presence of functional antibody against seven pneumococcal serogroups or serotypes (4, 6B, 9V, 14, 18C, 19F, and 23F) by using differentiated HL-60 cells (granulocytes) and peripheral blood leukocytes (PBLs) . Six of the 55 serum samples were from unvaccinated adult volunteers, 31 serum samples were from adults who received one dose of the 14-valent or the 23-valent polysaccharide vaccine, and 18 serum samples were from 16-month-old infants who received four doses of an investigational 7-valent polysaccharide-protein conjugate vaccine . The results of an opsonophagocytic assay with HL-60 cells correlated highly with those of an assay with PBLs as effector cells (median r for seven serotypes = 0.87: P < 0.01) . Opsonophagocytic titers were compared with the immunoglobulin G antibody concentrations determined by enzyme-linked immunosorbent assay (ELISA) . The r values for serogroups or serotypes 4, 6B, 9V, 14, 18C, 19F, and 23F were 0.61, 0.60, 0.67 0.90, 0.61, 0.39, and 0.57, respectively, when HL-60 cells were used as effector cells and 0.56, 0.47, 0.61, 0.90, 0.71, 0.31, and 0.62, respectively, when PBLs were used . The assay requires small amounts of serum (40 microliters per serotype), making this test suitable for assaying infant sera . Culturable cells aid in assay standardization and likely reduce donor-to-donor variability . This standardized assay, in combination with the standardized ELISA, can be used to evaluate current and developing pneumococcal vaccines, in which functional opsonophagocytic antibody activity may correlate with protection against pneumococcal disease.

Can Vet J, 1997 Jul, 38(7), 429 - 37
Streptococcus agalactiae mastitis: a review; Keefe GP; Streptococcus agalactiae continues to be a major cause of subclinical mastitis in dairy cattle and a source of economic loss for the industry . Veterinarians are often asked to provide information on herd level control and eradication of S . agalactiae mastitis . This review collects and collates relevant publications on the subject . The literature search was conducted in 1993 on the Agricola database . Articles related to S . agalactiae epidemiology, pathogen identification techniques, milk quality consequences, and control, prevention, and therapy were included . Streptococcus agalactiae is an oblique parasite of the bovine mammary gland and is susceptible to treatment with a variety of antibiotics . Despite this fact, where state or provincial census data are available, herd prevalence levels range from 11% (Alberta, 1991) to 47% (Vermont, 1985) . Infection with S . agalactiae is associated with elevated somatic cell count and total bacteria count and a decrease in the quantity and quality of milk products produced . Bulk tank milk culture has, using traditional milk culture techniques, had a low sensitivity for identifying S . agalactiae at the herd level . New culture methods, using selective media and large inocula, have substantially improved the sensitivity of bulk tank culture . Efficacy of therapy on individual cows remains high . Protocols for therapy of all infected animals in a herd are generally successful in eradicating the pathogen from the herd, especially if they are followed up with good udder hygiene techniques.

Ann Pharmacother, 1997 Jul-Aug, 31(7-8), 897 - 906
Prevention of group B Streptococcus infection in neonates; Logsdon BA et al.; OBJECTIVE: To review the epidemiology of group B Streptococcus (GBS) infection, risk factors for infection, and clinical manifestations of disease in the neonate, as well as the role of chemoprophylaxis and immunoprophylaxis in prevention of GBS disease and current recommendations for prevention . DATA SOURCES AND STUDY SELECTION: MEDLINE searchers (1976-1997) of the English-language literature . DATA SYNTHESIS: Despite clinical advances in health care in the past two decades, GBS remains a leading cause of serious neonatal infection . Most early-onset GBS infections can be prevented through the use of intrapartum antimicrobial chemoprophylaxis . Preventing GBS infection in neonates is more cost-effective than treating GBS infections, and implementing prevention programs can reduce morbidity and mortality resulting from GBS disease . Many proposals have been made regarding prevention strategies; however, they have not been implemented widely and consistently in the US . To coordinate both pediatric and obstetric supported strategies, the Centers for Disease Control and Prevention (CDC) recently published recommendations for prevention of neonatal GBS disease through two possible strategies . In the first strategy, intrapartum antibiotic chemoprophylaxis should be offered to all women identified by prenatal culture as colonized and those who develop premature membrane rupture or onset of labor at less than 37 weeks gestation . The second strategy involves administration of intrapartum antibiotics to all women who develop one or more risk factors at the time of membrane rupture or onset of labor . CONCLUSIONS: GBS is difficult to eradicate, causing many women to be colonized with the organism during pregnancy and labor, thereby infecting their infant . Prevention strategies have been published for more than 10 years without successful implementation . Although optimal prevention management has not been defined, following one of two strategies recommended by the CDC can prevent the majority of GBS infections in neonates.

Chemotherapy, 1997 Jul-Aug, 43(4), 297 - 302
Comparison of ceftibuten versus amoxicillin/clavulanate in the treatment of acute exacerbations of chronic bronchitis; Aubier MA; The efficacy and tolerability of once- or twice-daily ceftibuten (400 mg daily) were compared with three-times daily amoxicillin/clavulanate (AMX/CA, 500 mg/125 mg) in the treatment of acute exacerbations of chronic bronchitis (AECB) in an open, parallel-group 10- to 14-day study in 443 patients . Patients were assessed at baseline and on days 5, 10-14 and after 4-6 weeks of treatment, and the clinical response defined as cured, improved, stabilized or failed . Clinical efficacy between the 3 groups was equivalent (p = 0.002) with 90% of patients in each group responding to treatment (cured or improved) and the incidence of complete cures (with no clinical signs of relapse) was also equivalent . In conclusion, this study showed that ceftibuten is clinically equivalent to a standard regimen of amoxicillin/clavulanate in the treatment of AECB, including those patients infected with Streptococcus pneumonia . Ceftibuten was better tolerated than AMX/CA and was associated with significantly fewer gastrointestinal side effects . Furthermore, once-daily was a well tolerated and effective as twice-daily ceftibuten.

Chemotherapy, 1997 Jul-Aug, 43(4), 264 - 71
Rifabutin for experimental pneumococcal meningitis; Schmidt H et al.; Rifabutin is a lipophilic antibacterial with high in vitro activity against many pathogens involved in bacterial meningitis including pneumococci . Resistance to beta-lactam antibiotics in pneumococci is not associated with a decreased sensitivity to rifabutin (30 strains from Germany with intermediate penicillin resistance; MIC range of penicillin: 0.125-1 mg/l, MIC of rifabutin: < 0.008-0.015 mg/l) . Rifabutin at doses of 0.625, 1.25, 2.5, 5 and 10 mg/kg/h i.v . was investigated in a rabbit model of meningitis using a Streptococcus pneumoniae type 3 (MIC/MBC of rifabutin: 0.015/0.06 mg/l) . The bacterial density in CSF at the onset of treatment was 7.3 +/- 0.6 log CFU/ml (mean +/- SD) . Rifabutin decreased bacterial CSF titers in a dose-dependent manner {delta log CFU/ml/h (slope of the regression line log CFU/ml vs . time) at a dose of 0.625 mg/kg/h: -0.16 +/- 0.06 (n = 3), at 1.25 mg/kg/h: -0.20 +/- 0.12 (n = 4), at 2.5 mg/kg/h: -0.24 +/- 0.04 (n = 4), at 5 mg/kg/h: -0.31 +/- 0.10 (n = 8), and at 10 mg/kg/h: -0.29 +/- 0.10 (n = 5)} . At high doses rifabutin was as active as ceftriaxone at 10 mg/kg/h (delta log CFU/ml/h: -0.29 +/- 0.10, n = 10) . Two and 5 h after initiation of therapy, CSF TNF-alpha activities were lower with rifabutin 5 mg/kg/h than with ceftriaxone (medians 2 vs . 141 U/ml, p = 0.005 at 2 h; median 51 vs . 120 U/ml 5 h after initiation of therapy, p = 0.04) . This did not result, however, in a decrease of indicators of neuronal damage . In conclusion, intravenous rifabutin was bactericidal in experimental pneumococcal meningitis . Provided that a well-tolerated i.v . formulation will be available it may qualify as a reserve antibiotic for pneumococcal meningitis, in particular when strains with a reduced sensitivity to beta-lactam antibiotics are the causative pathogens.

Chemotherapy, 1997 Jul-Aug, 43(4), 232 - 8
Trends of genetic relationship of serotype 23F penicillin-resistant Streptococcus pneumoniae in Japan; Yoshida R et al.; No data on the genetic analysis of penicillin-resistant Streptococcus pneumoniae (PRP) in Japan has been reported . The SmaI restriction endonuclease digested patterns of chromosomal DNAs from 15 PRP serotyped 23F isolated in Japan were analyzed by pulsed-field gel electrophoresis (PFGE) . The isolates were genetically heterogeneous and seven different PFGE patterns were identified . Nine strains were also resistant to erythromycin and tetracycline . Four strains revealed resistance to ceftriaxone . The PFGE patterns of some strains isolated in Nagasaki University Hospital were identical to each other and closely resembled those of isolates from three different areas of Japan . These results indicate a need for additional studies by PFGE to determine the possibility of clonal spread in Japan.

Chemotherapy, 1997 Jul-Aug, 43(4), 227 - 31
Serum concentrations and ex vivo inhibitory/bactericidal activity of clindamycin after administration of two oral dosages; Dan M et al.; Two dosages of clindamycin, 300 and 600 mg, were given orally to 10 patients each . The patients were admitted for minor elective surgery . Their mean age was 39.3 years; mean weight was 67.5 kg . None of them had taken antibiotics for at least 1 month . After administration of a single dose, blood samples were obtained at 0.5, 1, 1.5, 2, 3, 4, 6, 8, 10 and 12 h after dosing . Drug levels were determined by the bioassay method using Micrococcus luteus as test organism . Serum inhibitory and bactericidal activities against five isolates each of Staphylococcus aureus and Streptococcus pyogenes were determined by the microdilution method according to the National Committee for Clinical Laboratory Standards guidelines . The mean peak serum level was 3.4 mg/l for the 300-mg dose and 4.8 mg/l for the 600-mg dose . The mean reciprocal peak inhibitory titers for the 300-/600-mg doses were 13.7/23.8 and 15.2/34.7 against S . aureus and S . pyogenes, respectively . Most serum samples did not show bactericidal activity against S . aureus.

Biochemistry, 1997 Jul 1, 36(26), 8107 - 13
C repeats of teh streptococcal M1 protein achieve the human serum albumin binding ability by flanking regions which stabilize the coiled-coil conformation; Gubbe K et al.; The M and M-like proteins of Streptococcus pyogenes are fibrous cell surface proteins . They have multiple binding sites for several human proteins and are composed of the C-terminal anchor domain, the alpha-helical coiled-coil domain, and the N-terminal non-coiled-coil domain . The coiled-coil domain of the M1 protein consists of repeat units called B, C, and D and a spacer unit S between B and C . Recombinant fragments A-B-S-C-D, A-B-S, B-S-C, S-C, S-C-D, C-D, and C of the coiled-coil domain were studied by analyzing their secondary structures and binding affinities to human serum albumin (HSA) . As shown by circular dichroism, all fragments are in an alpha-helical conformation . C-D and S-C-D form coiled coils at room temperature and bind below 37 degrees C with high affinity to HSA . C-D and S-C-D unfold in two steps with Tm values of approximately 31 and approximately 65 degrees C; complex formation with HSA increases the unfolding temperatures . B-S-C has a lower alpha-helical content, a less pronounced coiled-coil conformation, and a reduced thermal stability, binds HSA weaker, and is only slightly stabilized by HSA binding in comparison to C-D and S-C-D . C and S-C are less stable than the other fragments and are not organized as coiled coils showing some features of alpha-helical single strands only below 20 degrees C, and binding of HSA was not observed . The results indicate that the formation of coiled-coil structures, supported by flanking D regions and, to a lesser extent also B regions, is essential for the binding of C repeat units to HSA.

Infect Immun, 1997 Jul, 65(7), 2868 - 75
Analysis of toxicity of streptococcal pyrogenic exotoxin A mutants; Roggiani M et al.; Streptococcal pyrogenic exotoxin A (SPE A) is secreted by some strains of Streptococcus pyogenes and is strongly associated with streptococcal toxic shock syndrome (STSS), a severe and often fatal illness . SPE A possesses a number of biological properties, some of which are shared with a group of exotoxins of streptococcal and staphylococcal origins, the pyrogenic toxin superantigens (PTSAgs) . SPE A's most extensively studied property is superantigenicity . Superantigenic activation of T cells and monocytes stimulates the release of cytokines such as tumor necrosis factors alpha and beta, interleukin 1, and gamma interferon . These endogenous mediators are considered to be the primary cause of capillary leak, hypotension, and shock, the most severe manifestations of STSS . However, several studies have suggested that other properties of SPE A, such as ability to greatly enhance host susceptibility to endotoxin and ability to interact directly with endothelial cells, may play substantial roles in the syndrome . In this work we generated single- and double-site mutations of SPE A at residues K16, N20, C87, C90, C98, K157, S195, N20/C98, and N20/K157 . The mutant SPE A's were analyzed in vivo for their lethal activity and in vitro for their superantigenic ability . Our results indicate that SPE A's ability to induce lethality and endotoxin enhancement does not require superantigenicity, and conversely superantigenicity does not necessarily lead to lethality . Thus, these properties and their relative contributions to the onset of hypotension and shock may be separable . Furthermore, evidence is presented that certain mutant toxins may be suitable for use as vaccine toxoids.

Infect Immun, 1997 Jul, 65(7), 2759 - 64
High-frequency invasion of epithelial cells by Streptococcus pyogenes can be activated by fibrinogen and peptides containing the sequence RGD; Cue DR et al.; The ability of Streptococcus pyogenes to invade human epithelial cells has been suggested to be an important contributing factor to the bacterium's ability to cause severe, invasive infections . We know little, however, of the mechanism underlying intracellular invasion by this organism . In this study, we demonstrate that the invasion of cultured human epithelial cells by a serotype M1 strain of S . pyogenes (strain 90-226) is stimulated over 50-fold by the addition of fetal calf serum (FCS) to the cell culture medium (RPMI medium) . Purified human fibrinogen and peptides containing the sequence Arg-Gly-Asp (RGD) were also found to promote bacterial invasion of cultured cells . Experiments that demonstrate that the agonists stimulate invasion by interacting with bacterial cells are described . Invasion stimulation did not appear to involve de novo synthesis of a bacterial protein, as FCS and fibrinogen stimulated invasion in the presence of chloramphenicol . Although the agonists stimulated adherence by up to threefold, strain 90-226 efficiently adhered to cultured cells in unsupplemented RPMI medium . The invasion index (the number of internalized CFU/the number of adherent CFU) of strain 90-226 was increased 10- to 25-fold by the addition of the agonists . Postinternalization survival of bacteria was unaffected by fibrinogen or FCS . Thus, the agonistic factors affect the efficiency by which adherent bacteria are internalized by epithelial cells.

Infect Immun, 1997 Jul, 65(7), 2537 - 41
Increased intracellular survival of Mycobacterium smegmatis containing the Mycobacterium leprae thioredoxin-thioredoxin reductase gene; Wieles B et al.; The thioredoxin (Trx) system of Mycobacterium leprae is expressed as a single hybrid protein containing thioredoxin reductase (TR) at its N terminus and Trx at its C terminus . This hybrid Trx system is unique to M . leprae, since in all other organisms studied to date, including other mycobacteria, both TR and Trx are expressed as two separate proteins . Because Trx has been shown to scavenge reactive oxygen species, we have investigated whether the TR-Trx gene product can inhibit oxygen-dependent killing of mycobacteria by human mononuclear phagocytes and as such could contribute to mycobacterial virulence . The gene encoding M . leprae TR-Trx was cloned into the apathogenic, fast-growing bacterium Mycobacterium smegmatis . Recombinant M . smegmatis containing the gene encoding TR-Trx was killed to a significantly lesser extent than M . smegmatis containing the identical vector with either no insert or a control M . leprae construct unrelated to TR-Trx . Upon phagocytosis, M . smegmatis was shown to be killed predominantly by oxygen-dependent macrophage-killing mechanisms . Coinfection of M . smegmatis expressing the gene encoding TR-Trx together with Staphylococcus aureus, which is known to be killed via oxygen-dependent microbicidal mechanisms, revealed that the TR-Trx gene product interferes with the intracellular killing of this bacterium . A similar coinfection with Streptococcus pyogenes, known to be killed by oxygen-independent mechanisms, showed that the TR-Trx gene product did not influence the oxygen-independent killing pathway . The data obtained in this study suggest that the Trx system of M . leprae can inhibit oxygen-dependent killing of intracellular bacteria and thus may represent one of the mechanisms by which M . leprae can deal with oxidative stress within human mononuclear phagocytes.

Microb Drug Resist, 1997 Summer, 3(2), 177 - 93
Molecular bases of three characteristic phenotypes of pneumococcus: optochin-sensitivity, coumarin-sensitivity, and quinolone-resistance; de la Campa AG et al.; Streptococcus pneumoniae is uniquely sensitive to amino alcohol antimalarials in the erythro configuration, such as optochin, quinine, and quinidine . The protein responsible for the optochin (quinine)-sensitive (Opts, Qins) phenotype of pneumococcus is the proteolipid c subunit of the FzeroF1 H(+)-ATPase . OptR/QinR isolates arose by point mutations in the atpC gene and produce different amino acid changes in one of the two transmembrane alpha-helices of the c subunit . In addition, comparison of the sequence of the atpCAB genes of S . pneumoniae R6 (Opts) and M222 (an OptR strain produced by interspecies recombination between pneumococcus and S . oralis), and S . oralis (OptR) revealed that, in M222, an interchange of atpC and atpA had occurred . We also demonstrate that optochin, quinine, and related compounds specifically inhibited the membrane-bound ATPase activity . Equivalent differences between Opts/Qins and OptR/QinR strains, both in growth inhibition and in membrane ATPase resistance, were found . Pneumococci also show a characteristic sensitivity to coumarin drugs, and a relatively high level of resistance to most quinolones . We have cloned and sequenced the gyrB gene, and characterized novobiocin resistant mutants . The same amino acid substitution (Ser-127 to Leu) confers novobiocin resistance on four isolates . This residue position is equivalent to Val-120 of Escherichia coli ryGB, a residue that lies inside the ATP-binding domain but is not involved in novobiocin binding in E . coli, as revealed by crystallographic data . In addition, the genes encoding the ParC and ParE subunits of topoisomerase IV, together with the region encoding amino acids 46 to 172 (residue numbers as in E . coli) of the pneumococcal ryGA subunit, were characterized in respect to fluoroquinolone resistance . The gyrA gene maps to a physical location distant from the gyrB and parEC loci on the chromosome . Ciprofloxacin-resistant (CpR) clinical isolates had mutations affecting amino acid residues of the quinolone resistance-determining region of ParC (low-level CpR), or in both resistance-determining regions of ParC and GyrA (high-level CpR) . Mutations were found in residue positions equivalent to Ser-83 and Asp-87 of the E . coli GyrA subunit . Transformation experiments demonstrated that topoisomerase IV is the primary target of ciprofloxacin, DNA gyrase being a secondary one.

Microb Drug Resist, 1997 Summer, 3(2), 165 - 76
Bacteriophages of Streptococcus pneumoniae: a molecular approach; Garcia P et al.; We have characterized four families of pneumococcal phages with remarkable morphologic and physiological differences . Dp-1 and Cp-1 are lytic phages, whereas HB-3 and EJ-1 are temperate phages . Interestingly, Cp-1 and HB-3 have a terminal protein covalently linked to the 5' ends of their lineal DNAs . In the case of Dp-1, we have found that the choline residues of the teichoic acid were essential components of the phage receptors . We have also developed a transfection system using mature DNAs from Dp-4 and Cp-1 . In the later case, the transfecting activity of the DNA was destroyed by treatment with proteolytic enzymes, a feature also shared by the genomes of several small Bacillus phages . DNA replication was investigated in the case of Dp-4 and Cp-1 phages . The terminal protein linked to Cp-1 DNA plays a key role in the peculiar mechanism of DNA replication that has been coined as protein-priming . Recently, the linear 19,345-bp double-stranded DNA of Cp-1 has been completely sequenced, several of its gene products have been analyzed, and a complete transcriptional map has been ellaborated . Most of the pneumococcal lysins exhibit an absolute dependence of the presence of choline in the cell wall substrate for activity, and phage lysis requires, as reported for other systems, the action of a second phage-encoded protein, the holin, which presumably forms some kind of lesion in the membrane . The two lytic gene cassettes, from EJ-1 and Cp-1 phages, have been cloned and expressed in heterologous and homologous systems . The finding that some lysogenic strains of Streptococcus pneumoniae harbor phage remnants has provided important clues on the interchanges between phage and bacteria and supports the view of the chimeric origin of phages.

Microb Drug Resist, 1997 Summer, 3(2), 159 - 63
Capsular type distribution and susceptibility to antibiotics of Streptococcus pneumoniae clinical strains isolated from Uruguayan children with systemic infections . Pneumococcus Study Group; Hortal M et al.; Children under 24 months of age are at high risk for serious infection with Streptococcus pneumoniae but they do not elicit effective immune responses to the currently available capsular polysaccharide vaccines . A polysaccharide protein conjugated vaccine involving the most frequent types has become an urgent need . To produce such a vaccine for Latin America, information on type distribution is required . Recently, Uruguay was 1 of the 6 countries in Latin America where surveillance for invasive pneumococcal infections in children under the age of 5 years was carried out . Seventy percent of the 182 invasive S . pneumoniae isolates were recovered from patients under 24 months of age, and 19% were recovered from infants under 6 months . The 7 most frequent types were 14, 5, 1, 6B, 3, 7F, and 19A; representing 80% of invasive isolates . Twenty-one types were identified, 16 in pneumonia and 14 in meningitis . Resistance to penicillin increased during the study period, from 29% in 1994, to 40% in 1995-1996, mainly because of the spread of type 14 strains resistant to penicillin and trimethoprim/sulphamethoxazol (89% of resistant isolates) . The high proportion of systemic pneumococcal infections recorded in patients under 24 months of age and the increasing resistance of these agents to first-choice antibiotics point to an urgent need for a capsular polysaccharide protein conjugated vaccine.

Microb Drug Resist, 1997 Summer, 3(2), 153 - 7
Antimicrobial susceptibilities and capsular types of invasive Streptococcus pneumoniae isolated in children in Mexico City; Echaniz-Aviles G et al.; As part of the Sistema Regional de Vacunas (SIREVA) initiative, we conducted a surveillance study to determine the relative prevalence of capsular types of Streptococcus pneumoniae and antimicrobial susceptibility of invasive isolates in children less than 5 years old . We collected 220 isolates and found 33 of the 90 known types, with type 23F as the most common followed by types 6A+B, 14, 19F, and 19A . High penicillin resistance was found in 49 strains (22.2%), 31 belonging to type 23F . Twenty-nine (13.1%) were resistant to erythromycin, 95 (43.1%) were resistant to chloramphenicol, and 24 (10.9%) were resistant to cefotaxime . No strains were resistant to vancomycin.

Microb Drug Resist, 1997 Summer, 3(2), 147 - 52
Distribution of capsular types and antimicrobial susceptibility of invasive isolates of Streptococcus pneumoniae in Colombian children . Pneumococcal Study Group in Colombia; Castaneda E et al.; Streptococcus pneumoniae is the leading bacterial cause of childhood pneumonia in the developing world . This study describes the type distribution and antimicrobial susceptibility of invasive pneumococcal isolates from Colombian children and is part of the Sistema Regional de Vacunas (SIREVA), a PAHO regional initiative designed to determine the ideal serotype composition of a protein polysaccharide pneumococcal conjugate vaccine for use in children less than 5 years old in Latin America . In Colombia, during the study period, centres in Bogota, Medellin, and Cali collected 324 S . pneumoniae isolates from invasive diseases, 238 (73.5%) from children under the age of 2 . Pneumonia was the clinical diagnosis in 41.3% cases, meningitis in 41%, and sepsis in 11.2% . The seven most frequent types included 14(21.9%), 5(10.5%), 23F(9.6%), 1(9%), 6B(9%), 19F(7.1%), and 6A(6.2%) . The frequency of diminished susceptibility to penicillin (DSP) was 12%, with 8.9% of isolates showing intermediate level resistance and 3.1% showing high level resistance . Among DSP isolates, 23% were also resistant to cefotaxime, 33.3% to erythromycin, 48.7% to chloramphenicol, and 74.3% to trimethoprim/sulfamethoxazole . Multiple resistance was detected in 59% of the isolates that have DSP . Penicillin resistance was associated with types 23F (53.8%) and 14 (25.6%) . These data provides information on capsular types prevalent in Colombia that will not only allow the formulation of an ideal vaccine for the region but also reinforce the need for ongoing regional surveillance.

Microb Drug Resist, 1997 Summer, 3(2), 141 - 6
Prevalence of serotypes and antimicrobial resistance of streptococcus pneumoniae strains isolated from Brazilian children with invasive infections . Pneumococcal Study Group in Brazil for the SIREVA Project . Regional System for Vaccines in Latin America; Brandileone MC et al.; A laboratory surveillance study was developed in Brazil in 1993 to determine capsular types and antimicrobial susceptibility of Streptococcus pneumoniae strains . By studying 360 strains isolated from children with invasive infections in three different cities, 8 out of 34 types were identified as being the most prevalent and considered as the reference group for further analyses . This group comprised 77.7% of all strains studied, and includes the types 1, 5, 6A/B, 9V, 14, 19F, 19A, and 23F . The prevalence of this reference group was significantly higher among strains isolated from children with pneumonia than meningitis . Similarly, this group was more prevalent among strains isolated from children 3 to 6 years of age than from children under 2 years of age . Most strains (78.6%) were found to be susceptible to penicillin and only 1.4% showed high resistance to this antibiotic . However, intermediate resistance to penicillin was detected in 20% of the strains . This laboratory surveillance will be maintained and extended to other cities of Brazil to better define and monitor the trends of pneumococcal infections for proper control and prevention.

Microb Drug Resist, 1997 Summer, 3(2), 135 - 40
Distribution of capsular types and penicillin-resistance of strains of Streptococcus pneumoniae causing systemic infections in Argentinian children under 5 years of age . Streptococcus pneumoniae Working Group; Rossi A et al.; Streptococcus pneumoniae (SPN) is the most common cause of invasive infections in children, with high levels of mortality in developing countries . An increase in frequency of penicillin-resistant strains is reported in most parts of the world . A study was undertaken in Argentina and 5 other countries of the region, to determine the type distribution and penicillin resistance rate of SPN isolated from invasive infections in children less than 5 years old . Between June 1994 and March 1996, a total of 505 SPN isolated from sterile sites were collected from 15 hospitals located in 9 cities of different geographic areas . Clinical and epidemiological data from 443 children were analyzed . Sixty five percent SPN were isolated from children less than 2 years old . Pneumonia was the clinical diagnosis in 58% of the cases, meningitis in 22%, and sepsis in 10.6% . Isolates were recovered from blood (51.2%), pleural fluid (22.7%), CSF (20.7%), and other sterile sites (5.4%) . Thirty different pneumococcal capsular types were identified and the 10 most frequent in descending order were: 14, 5, 1, 6A/6B, 7F, 9V, 19F, 19A, 16F y 23F, representing 89.3% of the total . Overall, 13.1% of isolates showed intermediate resistance to penicillin while 11.3% showed high resistance . Lethality was 8.8%, without correlation with penicillin-resistance and/or type . These result should be used in selecting the optimal combination of specific types for a conjugate vaccine, useful in children less than 2 years old and for considering therapeutic strategies for invasive pneumococcal infections.

Microb Drug Resist, 1997 Summer, 3(2), 125 - 9
Epidemiology of pneumococcal serotypes and conjugate vaccine formulations; Butler JC; The incidence of bacteremia and meningitis due to Streptococcus pneumoniae is highest among preschool-age children, particularly those < 2 years of age . Clinical trials of capsular polysaccharide vaccines among young children have been disappointing . Conjugation of bacterial polysaccharides to proteins can increase antibody responses following vaccination of young children . Most conjugate vaccines proposed to date have been seven-valent . To identify serotypes most commonly associated with infection in young children, we serotyped pneumococcal isolates submitted to the CDC through national surveillance from 3884 children < 6 years old with pneumococcal bacteremia (n = 3169), meningitis (n = 401), or otitis media (n = 314) from 1978 to 1994 . Seven serotypes (14, 6B, 19F, 18C, 23F, 4, and 9V) accounted for 3045 (78%) isolates . A conjugate pneumococcal vaccine protecting against these seven serotypes and serologically cross-reactive serotypes could potentially prevent 86% of bacteremia, 83% of meningitis, and 65% of otitis media cases . The proportion of isolates covered by such a vaccine increased from 78% to 87% from 1978 to 1994 . Of 70 isolates submitted during 1992-1994 which were nonsusceptible to penicillin (minimal inhibitory concentration {MIC} > 0.1 microgram/mL, 56 (80%) were among the seven most prevalent serotypes . All 21 isolates resistant to penicillin (MIC > or = 2.0 micrograms/mL) were among these seven serotypes.

FEBS Lett, 1997 Jun 30, 410(2-3), 275 - 9
Purification and structure of mutacin B-Ny266: a new lantibiotic produced by Streptococcus mutans; Mota-Meira M et al.; Mutacins are bactericidal substances of proteinaceous nature produced by Streptococcus mutans . Lantibiotics are antibacterial substances containing post-translationally modified amino acids such as lanthionine . Mutacin B-Ny266 was purified from the cell pellet of S . mutans strain Ny266 by ethanol extraction at pH 2.0 followed by reversed-phase chromatography (Sep-Pak cartridge) and by HPLC on a C18 column . The mean purification factor was 3240 +/- 81 and the mean yield was 1.0 +/- 0.1% . Molecular mass of mutacin B-Ny266 as determined by mass spectroscopy is 2270.29 +/- 0.21 Da . The amino acid sequence of the purified active fraction was obtained by Edman degradation after treatment with alkaline ethanethiol . Twenty-one amino acids were detected in this analysis . Mutacin B-Ny266 belongs to the type A lantibiotics . The proposed sequence is: F-K-A-W-U-F-A-Abu-P-G-A-A-K-O-G-A-F-N-U-Y-A . The molecule differs from that of epidermin/staphylococcin 1580 and gallidermin at positions 1, 2, 4, 5 and 6.

FEMS Microbiol Lett, 1997 Jun 15, 151(2), 205 - 11
Construction and characterization of a recombinant ureolytic Streptococcus mutans and its use to demonstrate the relationship of urease activity to pH modulating capacity; Clancy A et al.; To begin to understand the contribution of oral microbial ureolysis to the inhibition of dental caries, we sought to construct a recombinant, ureolytic mutans streptococcus and correlate the ureolytic capacity of plaque bacteria with pH moderating ability . Streptococcus mutans GS-5 was transformed with a plasmid containing the urease genes from Streptococcus salivarius 57.I . The recombinant strain, S . mutans AC04, stably maintained the urease genes . High levels of urease activity were detected, with a maximum specific activity of 0.9 mumol of urea hydrolyzed/min/mg cell dry weight when the growth medium was supplemented with 50 microM exogenous NiCl2 . Harboring the recombinant plasmid, or growth in NiCl2, did not markedly affect the glycolytic capacity of S . mutans . In vitro pH drop analysis of S . mutans AC04, metabolizing glucose and physiologically relevant concentrations of urea simultaneously, demonstrated that increasing the urease activity of plaque bacteria resulted in a corresponding reduction in the depth and the duration of the glycolytic pH fall . The results demonstrate the feasibility of engineering urease producing S . mutans and suggest that enhancing the ureolytic capacity of dental plaque, particularly cariogenic plaque, may help to offset the progression of the caries process.

FEMS Microbiol Lett, 1997 Jun 15, 151(2), 155 - 62
Restriction fragment length polymorphisms of 16S rDNA and of whole rRNA genes (ribotyping) of Streptococcus iniae strains from the United States and Israel; Eldar A et al.; Streptococcus iniae (junior synonym S . shiloi) isolated from tilapia and trout in Israel and in the United States were subtyped by restriction length polymorphism (RFLP) based on PCR amplified 16S rDNA and by ribotyping . 16S rDNA RFLP discriminated between S . iniae and other fish pathogens but not between S . iniae strains . HindIII and EcoRI ribotypes of S . iniae discriminated American from Israeli strains rejecting the possibility of an epidemiological link between S . iniae infections in the two countries . Israeli strains isolated from tilapia and trout could not be completely differentiated . The S . iniae ATCC 29178T (T = Type strain) strain, isolated from a freshwater dolphin belonged to a ribotype different from those of all the fish isolates.

J Am Vet Med Assoc, 1997 Jun 15, 210(12), 1774 - 8
Acute hemorrhagic pulmonary infarction and necrotizing pneumonia in horses: 21 cases (1967-1993); Carr EA et al.; OBJECTIVE: To characterize history, clinical signs, and pathologic findings in horses with histologically confirmed acute hemorrhagic pulmonary infarction and necrotizing pneumonia . DESIGN: Retrospective study . ANIMALS: 21 horses . RESULTS: 19 of the 21 horses were Thoroughbred racehorses in training . Eighteen horses had had strenuous exercise immediately prior to onset of illness . Fifteen horses had a serosanguineous nasal discharge during hospitalization . Seventeen horses had radiographic evidence of pulmonary consolidation and pleural effusion . Nine of 14 horses had ultrasonographic evidence of large pulmonary parenchymal defects consistent with consolidation . Pleurocentesis yielded a suppurative, serosanguineous effusion in the 14 horses in which it was performed . Bacteria were isolated from all transtracheal aspirates (14) and from 6 of 12 pleural fluid samples . Actinobacillus suis-like organisms and Streptococcus equi subsp zooepidemicus were most commonly isolated . Nineteen horses were hospitalized and treated . Mean duration of treatment was 5 days, and most horses were euthanatized because of secondary complications, continued costs of medical treatment, or poor prognosis for future performance . Pathologic lesions included well-demarcated regions of hemorrhagic pulmonary infarction with necrosis and a serosanguineous pleural effusion . Thrombosis of pulmonary vessels was found in 11 horses . CLINICAL IMPLICATIONS: An acute or peracute onset of severe respiratory distress, with serosanguineous nasal discharge, ultrasonographic and radiographic evidence of severe pulmonary consolidation, and serosanguineous suppurative pleural effusion, is strongly suggestive of pulmonary infarction in horses . Horses with pulmonary infarction responded poorly to conventional treatment for pleuropneumonia and had a poor prognosis for recovery.

Thorac Cardiovasc Surg, 1997 Jun, 45(3), 150 - 2
Fibrous tissue overgrowth and prosthetic valve endocarditis: report of a case; Kaneko Y et al.; Mechanical valve stenosis without restricted occluder motion and paravaluvular leakage developed in a patient who had undergone patch closure of partial atrioventricular septal defect and replacement of the left atrioventricular valve 13 years previously . Dense calcification of the supravalvular region was shown in a cineradiogram, whereas transthoracic and transesophageal echocardiography failed to reveal any obstructive mechanism . Elevated transprosthetic pressure gradient with unrestricted occluder motion suggested prosthetic valve stenosis resulting from fibrous tissue overgrowth, although this was not visualized by the modern diagnostic imaging tools . Reoperation confirmed calcified fibrous tissue overgrowth obstructing the mechanical valve inflow . Examination of resected tissue revealed prosthetic valve endocarditis due to alpha-streptococcus . Paravalvular leakage accompanying fibrous tissue overgrowth may indicate the presence of prosthetic valve infection even if the clinical manifestations are scarce.

S Afr Med J, 1997 Jun, 87 Suppl 3, C157 - 60
Sydenham's chorea--analysis of 27 patients and a review of the literature; Van der Merwe PL et al.; The first documented epidemic of Sydenham's chorea was in 1418 . In 1686 Thomas Sydenham was the first to describe the condition, but it was Richard Bright who in 1831 first made the association between chorea and rheumatic fever . Chorea is one of the major diagnostic criteria for rheumatic fever . Chorea is often considered a benign self-limiting condition . Little is known about the pathophysiological process . A link between the group A beta-haemolytic streptococcus through an antibody-mediated immune response targeting the basal ganglia has been described . Special investigations have been done to ascertain the pathophysiology, but none is of diagnostic value . The aims of this study were to analyse the clinical findings, the role of special investigations in the management and course of Sydenham's chorea and to review the literature . Data on 27 patients were analysed . Special investigations in these patients can be divided into those necessary to assist in diagnosing acute rheumatic fever and those to exclude other causes that mimic chorea . None of these tests was helpful in diagnosing chorea due to other causes; neither did they influence the management of these patients . In conclusion, Sydenham's chorea remains a clinical diagnosis and extensive and expensive special investigations are seldom warranted.

Eur J Oral Sci, 1997 Jun, 105(3), 258 - 63
Caries and plaque inhibition in rats by five topically applied dentifrices; Guggenheim B et al.; The effectiveness of 5 different brands of dentifrices on caries and plaque were tested in rats in 2 experiments . 10 litters of rats each were infected with Streptococcus sobrinus OMZ-176 and Actinomyces viscosus Ny1 . The rats were offered the diet 2000a containing either 40% of sucrose (study I) or 10% of sucrose (study II) . The following products were tested topically: (1) H2O, (negative control); (2) chlorhexidine diacetate, (positive control); (3) Parodontax NF; (4) Meridol; (5) Colgate Total; (6) Mentadent C; (7) Dent Xpress . Comparisons with the water control in study I showed that plaque extent was decreased by chlorhexidine diacetate, Dent Xpress and by Mentadent C only . All fluoride-containing dentifrices tested reduced caries . In study II, comparisons with the water control showed that plaque extent was reduced by chlorhexidine diacetate, Parodontax, Meridol, Dent Xpress and by Mentadent C . All dentifrices reduced caries, however, the incidence was low . These 2 studies confirm that fluorides incorporated in dentifrices decrease dental caries in the rat . Differences in the effectiveness of caries inhibition between the 5 dentifrices could not be explained either by the form of fluoride utilized or by the antimicrobials added . Rather, the performance of a given dentifrice depended upon the concerted action of the particular ingredients . It appears that the effect of antiplaque agents should be evaluated in the rat model using a diet containing sucrose at a low level.

J Laryngol Otol, 1997 Jun, 111(6), 546 - 50
Retropharyngeal abscess: a clinical review; Goldenberg D et al.; Retropharyngeal abscesses are uncommon but potentially lethal infections, especially in the paediatric population under the age of five years . Abscesses in this group are classically secondary to upper respiratory infections especially oropharyngeal infections, while in the adult group they are usually secondary to trauma, foreign bodies, or as a complication of dental infections . Early diagnosis and the wide spread use of antibiotics have made these infections less common today . Between the years 1985-1996, 19 cases of retropharyngeal abscesses were treated in our department . Factors such as age, sex, aetiology, presenting signs, symptoms, methods of diagnosis, treatment and complications were reviewed . Thirty-two per cent of the cases were secondary trauma . A lateral neck film showing widening of the prevertebral space was the most important diagnostic tool, computed tomography (CT) scan was used in 63 per cent of cases to verify the signs of an abscess and to provide more accurate anatomical localization . Thirteen cases required surgical drainage . The single most commonly-isolated pathogen was Streptococcus pyogenes . There were no deaths and only one recurrence requiring repeated surgical drainage . One case was complicated by a spinal canal abscess . We also report two cases of retropharyngeal abscess in children caused by swallowing of unusual foreign bodies.

Eur J Emerg Med, 1997 Jun, 4(2), 111 - 4
Fatal Streptococcus viridans descending mediastinitis: case report and review of the literature; Berlot G et al.; Mediastinitis is a life-threatening complication of cardiac, neck and oesophageal surgery . It has also been reported following upper digestive and respiratory procedures and as a consequence of oesophageal perforation following the ingestion of foreign bodies . Much more infrequently, mediastinitis can occur in association with oropharyngeal or cervical infections . We describe the case of a patient with fatal mediastinitis and septic shock . The onset of mediastinitis was preceded by a 2-day course of sore throat and other flu-like symptoms.

Jpn Circ J, 1997 Jun, 61(6), 467 - 70
Timing of surgical treatment for active native value endocarditis; Iemura J et al.; The aim of the study was to assess the optimum timing of surgical treatment for the active phase of native valve endocarditis . A retrospective study was conducted of the records of patients who had undergone aortic and/or mitral valve replacement for active native valve endocarditis during 1979-94 at Kinki University Hospital . Thirty-three patients with active infective endocarditis of the native valves were treated surgically . Their mean age was 45.4 years (range 11-71) . The infective organism was streptococcus in 9 cases, Staphylococcus aureus in 8, and enterococcus in 4 cases . Blood cultures were negative in 9 cases . Of the patients infected with Staphylococcus aureus, 3 died soon after the operation and 1 died later during hospitalization . These 4 patients had been treated medically more than 2 weeks before operation . Another patient who was also treated medically more than 2 weeks before surgery survived . In contrast, all 3 patients infected with Staphylococcus aureus who were operated on within 2 weeks after the onset survived . No early or in-hospital deaths were documented among patients infected with organisms other than Staphylococcus aureus . Among patients who had suffered preoperative embolic episodes, the time from the initial pyrexia to the embolic event was clearly shorter in those infected with Staphylococcus aureus than in those infected with other organisms . Among the former group, 5 out of 6 patients suffered an embolism within 2 weeks of the onset of pyrexia and the remaining 1 within 3 weeks . Thus, in patients presenting with active native valve endocarditis caused by Staphylococcus aureus, surgical treatment should be performed as soon as possible after the onset of pyrexia, preferably within 2 weeks or as soon as the infective organism is identified as Staphylococcus aureus.

J Antimicrob Chemother, 1997 Jun, 39 Suppl B, 51 - 5
In-vitro and in-vivo activity of trovafloxacin against Streptococcus pneumoniae; Klugman KP et al.; Trovafloxacin had greater in-vitro activity than comparative fluoroquinolone agents against penicillin-sensitive pneumococci in studies from the USA, UK, Slovakia, Czech Republic, Sweden and South Africa . This activity was maintained against penicillin-resistant strains, with MIC90 values of < or = 0.25 mg/L observed for both groups . Bactericidal activity appeared to occur within one or two dilutions of the MIC and, in the limited number of strains studied, the MIC was independent of the medium tested and pH over the range pH 5-8 . Mutation to decreased susceptibility to trovafloxacin occurred in vitro at a low frequency in the pneumococcus (< or = 8.9 x 10(-9)) . Mutants with changes in the topoisomerase IV A subunit (GrlA) were still inhibited by 0.5 mg/L of trovafloxacin . Trovafloxacin was more efficacious than ciprofloxacin, temafloxacin or ofloxacin in mouse pneumonia models for both penicillin-susceptible and penicillin-resistant pneumococci . Trovafloxacin was also highly efficacious in a rabbit pneumococcal meningitis model . These data suggest that the clinical efficacy of trovafloxacin against pneumococci should be evaluated further.

J Antimicrob Chemother, 1997 Jun, 39(6), 781 - 8
Trovafloxacin delays the antibiotic-induced inflammatory response in experimental pneumococcal meningitis; Nau R et al.; This study evaluates the ability of the new fluoroquinolone trovafloxacin to attenuate the inflammatory burst known to occur after initiation of antibiotic treatment in pneumococcal meningitis . After exposure to trovafloxacin or ceftriaxone for 3 h in vitro, Streptococcus pneumoniae was injected intracisternally (i.c.) into rabbits every 3 h over 9 h (n = 6 for each antibiotic) . Ceftriaxone-treated S . pneumoniae induced consistently higher CSF leucocyte counts (median 2568/microL versus 543/microL at 6 h; P = 0.03; 4560/microL versus 2207/microL at 18 h; P = 0.03) than trovafloxacin-treated bacteria . Meningitis induced in rabbits by i.c . injection of live S . pneumoniae was treated with equal doses of trovafloxacin or ceftriaxone i.v . (ten per group) . The bactericidal rates of both antibacterial agents in CSF were almost identical . In comparison with ceftriaxone, trovafloxacin resulted in lower tumour necrosis factor (TNF) and interleukin 1beta (IL-1beta) CSF levels 2 h after the initiation of treatment (TNF levels, median 26 U/mL versus 141 U/mL; P = 0.02; IL-1beta levels 455 pg/mL versus 1399 pg/mL; P = 0.02) . Twelve hours after initiation of therapy, however, TNF and IL-1beta were higher in trovafloxacin-treated animals (TNF, 61 U/mL versus 7 U/mL; P = 0.001; IL-1beta, 4320 pg/mL versus 427 pg/mL; P = 0.006) . The increase in CSF lactate was less during trovafloxacin therapy than with ceftriaxone (median: 2.0 mmol/L versus 4.0 mmol/L; P = 0.03) . In conclusion, S . pneumoniae treated in vitro with trovafloxacin induced less CSF leucocytosis than ceftriaxone-treated S . pneumoniae . After i.c . inoculation of live S . pneumoniae, trovafloxacin therapy delayed, but did not inhibit, the release of the proinflammatory cytokines TNF and IL-1beta, probably by slowing the liberation of bacterial cell wall components into the subarachnoid space.

J Antimicrob Chemother, 1997 Jun, 39(6), 719 - 23
The bactericidal activity of levofloxacin compared with ofloxacin, D-ofloxacin, ciprofloxacin, sparfloxacin and cefotaxime against Streptococcus pneumoniae; George J et al.; The bactericidal activity of levofloxacin was compared with that of four other quinolones and one cephalosporin against four strains of Streptococcus pneumoniae with varying degrees of penicillin G susceptibility . Levofloxacin was found to be the most bactericidal quinolone at its optimum bactericidal concentration, followed by ofloxacin, ciprofloxacin, sparfloxacin and D-ofloxacin, in that order . There was no correlation between quinolone-susceptibility and penicillin-susceptibility with any quinolone tested . To allow a comparison between the bactericidal activity of the quinolones and cefotaxime to be made a bactericidal index was used . Against two penicillin-sensitive pneumococci and a penicillin-intermediate pneumococcus, cefotaxime was the most potent antibacterial agent tested, followed by levofloxacin . However, against the penicillin-resistant pneumococcus, levofloxacin was considerably more potent than cefotaxime . The remaining quinolones tested were inferior to levofloxacin . Levofloxacin has enhanced activity against pneumococci compared with clinically available quinolones . In addition, levofloxacin may be the future quinolone of choice in the treatment of penicillin-resistant pneumococci.

Mol Microbiol, 1997 Jun, 24(5), 895 - 904
Quorum sensing by peptide pheromones and two-component signal-transduction systems in Gram-positive bacteria; Kleerebezem M et al.; Cell-density-dependent gene expression appears to be widely spread in bacteria . This quorum-sensing phenomenon has been well established in Gram-negative bacteria, where N-acyl homoserine lactones are the diffusible communication molecules that modulate cell-density-dependent phenotypes . Similarly, a variety of processes are known to be regulated in a cell-density- or growth-phase-dependent manner in Gram-positive bacteria . Examples of such quorum-sensing modes in Gram-positive bacteria are the development of genetic competence in Bacillus subtilis and Streptococcus pneumoniae, the virulence response in Staphylococcus aureus, and the production of antimicrobial peptides by several species of Gram-positive bacteria including lactic acid bacteria . Cell-density-dependent regulatory modes in these systems appear to follow a common theme, in which the signal molecule is a post-translationally processed peptide that is secreted by a dedicated ATP-binding-cassette exporter . This secreted peptide pheromone functions as the input signal for a specific sensor component of a two-component signal-transduction system . Moreover, genetic linkage of the common elements involved results in autoregulation of peptide-pheromone production.

Br J Haematol, 1997 Jun, 97(4), 737 - 46
The role of immunoglobulin G and fibrinogen in platelet aggregation by Streptococcus sanguis; Ford I et al.; Previous work has shown that the type strain of Streptococcus sanguis, NCTC 7863, induces aggregation of normal platelets by a complement-dependent mechanism . We investigated the roles of IgG and fibrinogen in the aggregation process . Plasma depleted of IgG by passage through protein A-sepharose failed to support platelet aggregation, as did plasma absorbed at 0 degrees C with whole bacteria . However, absorption of plasma with a non-aggregating strain of S . sanguis, SK96, did not remove aggregating activity for NCTC 7863 . Supplementing 0 degrees C-absorbed plasma with purified IgG restored the aggregation supporting activity . A monoclonal antibody to the Fc gammaRII receptor inhibited platelet aggregation by the bacteria, indicating a requirement for bacteria-IgG complexes interacting with the Fc receptor in platelet aggregation . There was a lag time to the onset of platelet aggregation of 7-19 min depending upon the platelet donor, but the length of this lag did not correlate with either total IgG concentration recognizing NCTC 7863 in subjects' plasma, or the concentration any of the four IgG subclasses or with IgG avidity levels . Fibrinogen was shown to bind rapidly to the bacterial cell surface . Monoclonal antibody to GPIIb/IIIa, RGDS peptide, and a specific antagonist for the platelet fibrinogen receptor, GPIIb/IIIa, FK633, inhibited platelet aggregation by NCTC 7863, indicating that platelet aggregation is fibrinogen dependent . These data suggest that platelet aggregation by some strains of S . sanguis requires multiple stimuli/agonists, including IgG-Fc receptor interaction, complement and fibrinogen.

J Formos Med Assoc, 1997 Jun, 96(6), 414 - 8
Penicillin-resistant pneumococcal infections in children; Huang FY et al.; Penicillin-resistant pneumococcal infections have been reported worldwide, but rarely reported in Taiwan . From 1990 to 1995, the rate of penicillin-resistant Streptococcus pneumoniae (PRSP) infections in our hospital increased from less than 10% during the first 2 years (1990-91) to 45% during the last 2 years (1994-95) . From 1990 to 1995, twenty-four patients with systemic pneumococcal infections were diagnosed in the Department of Pediatrics at Mackay Memorial Hospital . Pneumococci were isolated from blood in 20 patients, cerebrospinal fluid in 12 patients, joint fluid in one patient and pleural effusion in one patient . Four patients had underlying diseases, including ileal atresia, Wiskott-Aldrich syndrome, congenital heart disease, and perilymph fistula . Of the 24 isolates of S . pneumoniae, 17 (70.8%) were intermediately penicillin resistant (minimum inhibitory concentrations between 0.1 and 1.0 microgram/mL), and 7 (29.2%) were highly resistant (minimum inhibitory concentrations > 1.0 microgram/ml) . Fourteen patients recovered completely, two had minor sequelae, two had major sequelae, and six died . Four of the 12 patients with meningitis died . In this study, both the rate of PRSP as well as the mortality of patients with PRSP meningitis were high, as compared to previous reports . To reduce the mortality and morbidity of systemic pneumococcal infections, the oxacillin disc diffusion test is important in addition to appropriate antibiotic therapy.

Eur J Pediatr, 1997 Jun, 156(6), 440 - 3
Herpes virus (KSHV) associated Kaposi sarcoma in a 3-year-old child with non-HIV-induced immunodeficiency; Kusenbach G et al.; A 3-year-old boy of German descent suffered from two episodes of Streptococcus pneumoniae meningitis within 2 months . One month previously, the first skin lesion of Kaposi sarcoma (KS) had been observed behind his right ear . During the following 2 years KS disseminated not only mucocutaneously but also to visceral organs . Immunological evaluation revealed severe lymphocytopenia with reduced helper/suppressor T-cell ratio and impaired humoral immune response to pneumococci . Extensive laboratory tests gave no evidence for known immunocompromising infections . However, recently described DNA sequences from a Kaposi sarcoma-associated herpesvirus (KSHV) could be identified within skin tissue . As chemotherapy failed to stop tumour progression the patient was referred for bone marrow transplantation . Eighteen months later the KS is in remission and the patient in a good general condition . CONCLUSION: The case supports the hypothesis that KSHV is involved in the aetiology of KS . Bone marrow transplantation is possibly a therapeutic option for KS in patients with immunodeficiency not related to human immunodeficiency virus infection.

Microbiology, 1997 Jun, 143 ( Pt 6), 2047 - 55
Interruption of the Streptococcus gordonii M5 sspA/sspB intergenic region by an insertion sequence related to IS1167 of Streptococcus pneumoniae; Demuth DR et al.; Streptococcus gordonii M5 and DL1 each express two related adhesin polypeptides, SspA and SspB, which are members of the antigen I/II family of streptococcal surface proteins . The sspA and sspB genes are tandemly arranged in both strains, with sspA residing upstream of sspB . The genes are separated by approximately 400 nucleotides in S . gordonii DL1 and 1300 nucleotides in S . gordonii M5 . The nucleotide sequence of the sspA/sspB intergenic region of strain M5 is reported and the difference in length compared to S . gordonii DL1 shown to arise from the presence of an insertion sequence, designated ISSg1, consisting of 1197 bp . The nucleotide sequence of ISSg1 is highly homologous to IS1167 to Streptococcus pneumoniae and is related to a lesser extent to other members of the IS1096 family of bacterial insertion sequences . It contains a single ORF of 1026 bp, encoding a putative transposase polypeptide of 342 amino acids . The deduced transposase sequence exhibits 93% identity with the transposase polypeptides encoded by IS1167 . However, the S . gordonii protein lacks a 90 residue central domain that is present in the IS1167 transposase and in the transposase polypeptides encoded by the related IS elements . In addition, the organization of the inverted repeats flanking the transposase gene in S . gordonii differs from IS1167 . Extension products generated from a sspB-specific primer indicated that transcription initiates within the intergenic region in both S-gordonii strains, suggesting that sspA and sspB are independently transcribed . Transcription appears to initiate 42 bases upstream of sspB in S . gordonii DL1 . In contrast, sspB transcription in M5 initiates at least 125 bases upstream of sspB, in close proximity to the terminal inverted repeat of ISsg1 . These results indicate that the sspB promoter of S . gordonii M5 and DL1 are not conserved and suggest that ISSg1 sequences may play a role in directing the expression of sspB in S . gordonii M5.

Clin Infect Dis, 1997 Jun, 24(6), 1118 - 21
Familial transmission of a serious disease--producing group A streptococcus clone: case reports and review; Gamba MA et al.; Invasive group A streptococcus (GAS) infections are emerging diseases; however, person-to-person transmission of invasive GAS producing life-threatening infection has been observed rarely . We report a small intrafamilial cluster of life-threatening GAS infections . A previously healthy 47-year-old father developed necrotizing fasciitis of the neck . Two days later, his 16-year-old daughter developed streptococcal angina, pneumonia, and pleural empyema . Both patients had signs of streptococcal toxic shock syndrome . Pulsed field gel electrophoresis revealed that the M6 strains of GAS isolated from the father and daughter had identical patterns . Cases of person-to-person transmission of invasive GAS infection reported in the literature are also reviewed.

Clin Infect Dis, 1997 Jun, 24(6), 1052 - 9
Multivariate analysis of risk factors for infection due to penicillin-resistant and multidrug-resistant Streptococcus pneumoniae: a multicenter study; Clavo-Sanchez AJ et al.; Pneumococcal disease was studied prospectively to determine the risk factors associated with resistance to penicillin and other antibiotics . One hundred twelve clinically significant pneumococcal isolates were recovered from 95 patients . Approximately one-half (49.47%) of the cases were due to penicillin-resistant strains . Multivariate analysis showed that previous use of beta-lactam antibiotics (odds ratio {OR}, 2.81; 95% confidence interval {CI}, 0.95-8.27), alcoholism (OR, 5.22; 95% CI, 1.43-19.01), and noninvasive disease (OR, 4.53; 95% CI, 1.54-13.34) were associated with penicillin resistance, whereas intravenous drug use (OR, 0.14; 95% CI, 0.03-0.74) was not . Statistical analyses of the variables associated with resistance to multiple antibiotics detected age of younger than 5 years (OR, 16.79; 95% CI, 1.60-176.34) or of 65 years or older (OR, 4.33; 95% CI, 1.42-13.21) and previous use of beta-lactam antibiotics by patients with noninvasive disease (OR, 7.92; 95% CI, 1.84-34.06) as parameters associated with increased risk . We conclude that multivariate analysis provides clues for empirical therapy for pneumococcal infection.

Arch Ophthalmol, 1997 Jun, 115(6), 719 - 24
The value of routine donor corneal rim cultures in penetrating keratoplasty; Wiffen SJ et al.; OBJECTIVE: To investigate the value of donor corneal rim cultures performed routinely at the time of penetrating keratoplasty . DESIGN: Retrospective review of Mayo Clinic medical records for all corneal transplantations for which donor rim cultures have been performed . MAIN OUTCOME MEASURES: Frequency of positive cultures, occurrence of endophthalmitis within 2 months of undergoing surgery, action taken in response to the culture results, and costs of cultures . RESULTS: Donor rim culture results were available for 1078 of 1083 consecutive transplantations performed from 1981 to 1995 . Three cases of endophthalmitis (0.28%) and 1 suture abscess occurred . Rim cultures were negative in all of these cases . Action was documented in response to positive cultures in 17 cases (8.1%) . The estimated average cost of routine rim cultures in 1994 was $137 per donor cornea . Bacterial or fungal cultures were positive in 209 (19.4%) cases . Two microorganisms were cultured simultaneously in 17 cases (1.6%) and 3 in 2 cases (0.2%) . Staphylococcus coagulase-negative (130 cases {12.1%}), and Streptococcus species, viridans group (23 cases {2.1%}), were the most common isolates . Fifty-two (62.7%) of 83 coagulase-negative Staphylococcus species isolates tested were resistant to gentamicin . There were more positive cultures from corneas stored in Optisol (37/183 {20%}) than in Optisol GS (16/144 {11%}) (P = .03) . Fewer cultures were positive from live donors (9/93 {10%}) compared with cadaveric donors (181/ 909 {20%}) (P = .02) . Positive cultures were more frequent for corneas excised in situ (39/125 {31.2%}) than for those enucleated (152/851 {17.9%}) (P < .001) . CONCLUSIONS: Despite differences in rates of positive donor rim cultures with different harvesting and storage techniques, for our practice, routine donor corneal rim cultures had no predictive value for infective complications of penetrating keratoplasty and, therefore, added an unnecessary expense to the management of our patients.

Pediatr Infect Dis J, 1997 Jun, 16(6), 555 - 60
Change in nasopharyngeal carriage of Streptococcus pneumoniae resulting from antibiotic therapy for acute otitis media in children; Cohen R et al.; BACKGROUND: Acute otitis media is the leading reason for antibiotic prescriptions in childhood . The increase in antibiotic resistance of Streptococcus pneumoniae is generally attributed to the extensive use of antibiotics and the selective pressure on the bacterial strains of the nasopharyngeal flora . OBJECTIVE: To evaluate the change in nasopharyngeal carriage of S . pneumoniae during antibiotic therapy prescribed for acute otitis media . METHODS: Between October, 1993, and March, 1994, we conducted a clinical trial comparing cefpodoxime-proxetil and amoxicillin-clavulanate in acute otitis media . From 364 children, 4 months to 4.5 years old, a nasopharyngeal sample was obtained before and after treatment . Antibiotic susceptibility was established by determining minimal inhibitory concentrations by the agar dilution method . Serotype and randomly amplified polymorphic DNA analysis were used to compare pre- and posttreatment S . pneumoniae strains . RESULTS: The risk for a child to carry penicillin-resistant S . pneumoniae (MIC > or = 0.125 mg/l) did not increase after antibiotic treatment: 84 of 364 (23.1%) before, 70 of 364 (19.2%) after . There was a significant decrease of penicillin-susceptible S . pneumoniae carriage, 117 of 364 (32.1%) before treatment compared with 24 of 364 (6.6%) (P = 0.0001) after treatment . However, among the children carrying S . pneumoniae at the end of the treatment there was an increase in the percentage of penicillin-resistant pneumococci: 84 of 201 (41.8%) before treatment and 70 of 94 (74.5%) after treatment . Among the 94 children carrying S . pneumoniae at the end of the treatment, 22 did not harbor pneumococcus before, 16 carried another genotypically different serotype and 56 harbored the same serotype . Among these 56 children 2 patients harbored strains that had increased MICs for the tested beta-lactam antibiotics . The randomly amplified polymorphic DNA analysis showed that in one case, the strains were genetically different . CONCLUSIONS: These data illustrate that antibiotic therapy did not increase the rate at which children carried penicillin-resistant S . pneumoniae, but there was an increase in the rate of resistance among the children carrying pneumococci at the end of the treatment, mainly as a result of reduction of susceptible strains.

Arch Otolaryngol Head Neck Surg, 1997 Jun, 123(6), 630 - 2
Peritonsillar abscess in early childhood . Presentation and management; Friedman NR et al.; OBJECTIVE: To highlight the modes of presentation and management of a peritonsillar abscess in children younger than 5 years . DESIGN: Retrospective case series . SETTING: Tertiary referral pediatric otolaryngology practice . PATIENTS: Seven children younger than 5 years . RESULTS: The mean age of the children studied was 27 months (age range, 7-41 months) . Five (71%) of the 7 patients underwent computed tomographic scanning to confirm the diagnosis . Pus was cultured at surgery in every case . The most common organism detected was Streptococcus viridans . The average hospital stay was 72 hours (range, 22 hours to 12 days) . After diagnosis of an abscess, all patients underwent an electrocautery tonsillectomy and had an uneventful recovery . CONCLUSIONS: Children younger than 5 years who present with poor oral intake, high fever, drooling, and trismus should be suspected of having a peritonsillar abscess . A computed tomographic scan of the neck is usually required to confirm a suspected diagnosis . Prompt diagnosis and treatment will lead to a considerable decrease in morbidity . Immediate tonsillectomy is a safe and effective means of abscess drainage.

South Med J, 1997 Jun, 90(6), 649 - 52
Pneumococcal sacroiliitis; Pinson AG et al.; We report an unusual case of Streptococcus pneumoniae sacroiliitis in a previously healthy 31-year-old woman . Six cases of pneumococcal sacroiliitis have been reported; the only two cases in adults occurred in young women in the preantibiotic era . Our patient had fever and a depressed level of consciousness, with subsequent right buttock and thigh pain . Blood cultures revealed S pneumoniae, and a bone scan showed increased tracer activity in the right sacroiliac joint . Although the cerebrospinal fluid white blood cell count was only 3/microL, culture of cerebrospinal fluid grew S pneumoniae . Our patient was successfully treated with a 6-week course of intravenous antibiotics (penicillin G after an initial week of ceftriaxone), followed by 2 weeks of oral penicillin therapy.

South Med J, 1997 Jun, 90(6), 621 - 6
In vitro activities of oral antimicrobial agents against penicillin-resistant Streptococcus pneumoniae: implications for outpatient treatment; Waites K et al.; We tested 83 penicillin-intermediate (Peni) and 50 penicillin-resistant (Penr) isolates of Streptococcus pneumoniae against eight oral antimicrobials . Clarithromycin's MICs (minimal inhibitory concentration) were generally the same or one to two dilutions less than those of azithromycin . Seventy-two percent of Peni isolates were susceptible to clarithromycin and azithromycin, in contrast to 42% and 40%, respectively, of Penr isolates . Cefuroxime activity exceeded that of cefprozil, which exceeded that of cefaclor, in Peni isolates . For all three cephalosporins, MICs of 90% of isolates tested were > or = 3 dilutions higher for Penr isolates than for Peni isolates . Percentages of Peni isolates susceptible to clindamycin and tetracycline were 92% and 83%, respectively, and 78% and 82% for Penr . Only 49% of Peni isolates and 4% of Penr isolates were susceptible to trimethoprim-sulfamethoxazole . Azithromycin, clarithromycin, cefuroxime, cefprozil, clindamycin, and tetracycline may be useful in treating infections caused by Peni S pneumoniae, but Penr isolates are frequently resistant to both old and newer agents.

J Bacteriol, 1997 Jun, 179(12), 4056 - 60
Characterization of the L-malate permease gene (maeP) of Streptococcus bovis ATCC 15352; Kawai S et al.; A gene which was shown to be cotranscribed with the NAD+-dependent malic enzyme gene (maeE) of Streptococcus bovis ATCC 15352 was revealed to encode L-malate-specific permease (MaeP), which showed high activity at low pHs (pH 5.1 to 5.9) . MaeP was strongly inhibited by the ionophores nigericin and valinomycin.

J Bacteriol, 1997 Jun, 179(12), 3828 - 36
The rnhB gene encoding RNase HII of Streptococcus pneumoniae and evidence of conserved motifs in eucaryotic genes; Zhang YB et al.; A single RNase H enzyme was detected in extracts of Streptococcus pneumoniae . The gene encoding this enzyme was cloned and expressed in Escherichia coli, as demonstrated by its ability to complement a double-mutant rnhA recC strain . Sequence analysis of the cloned DNA revealed an open reading frame of 290 codons that encodes a polypeptide of 31.9 kDa . The predicted protein exhibits a low level of homology (19% identity of amino acid residues) to RNase HII encoded by rnhB of E . coli . Identification of the S . pneumoniae RNase HII translation start site by amino-terminal sequencing of the protein and of mRNA start sites by primer extension with reverse transcriptase showed that the major transcript encoding rnhB begins at the protein start site . Comparison of the S . pneumoniae and E . coli RNase HII sequences and sequences of other, putative bacterial rnhB gene products surmised from sequencing data revealed three conserved motifs . Use of these motifs to search for homologous genes in eucaryotes demonstrated the presence of rnhB genes in a yeast and a roundworm . Partial rnhB gene sequences were detected among expressed sequences of mouse and human cells . From these data, it appears that RNase HII is universally present in living cells.

Ophthalmology, 1997 Jun, 104(6), 986 - 95
Blebitis, early endophthalmitis, and late endophthalmitis after glaucoma-filtering surgery; Ciulla TA et al.; PURPOSE: The differentiating characteristics in blebitis and early and late endophthalmitis after glaucoma filtration surgery are reviewed . METHODS: All admission records and operative reports, as well as available office notes, on patients with blebitis or bleb-associated endophthalmitis admitted to a large referral eye center from 1985 to 1995 were reviewed retrospectively . RESULTS: Ten cases of blebitis and 33 cases of bleb-associated endophthalmitis were identified . One patient with blebitis progressed to culture-positive endophthalmitis . Of the 33 cases of bleb-associated endophthalmitis, there were 6 cases of early endophthalmitis (before postoperative week 6) and 27 cases of late endophthalmitis . In early endophthalmitis, Staphylococcus epidermidis was isolated on vitreous culture in 4 (67%) of 6 cases, whereas in late endophthalmitis, this organism was isolated in only 1 (4%) of 27 cases . In the 27 late cases, Streptococcus species and gram-negative organisms comprised 48% of isolates; of 33 cases of endophthalmitis, 15 (45%) demonstrated no growth on vitreous culture . Patients with endophthalmitis fared more poorly than those with blebitis in terms of visual outcome . CONCLUSIONS: Because blebitis may be prodromal to endophthalmitis, aggressive antimicrobial therapy, perhaps with oral quinolones, is warranted . In addition, patients with blebitis should be observed closely to identify extension into the vitreous cavity so that intravitreous antibiotics can be administered in a timely fashion . Finally, clinicians should not extrapolate the results of the Endophthalmitis Vitrectomy Study to the postfiltration surgery endophthalmitis given the differing pathogenesis and unique spectrum of organisms.

J Infect Dis, 1997 Jun, 175(6), 1413 - 22
Penicillin-resistant Streptococcus pneumoniae in the Netherlands: results of a 1-year molecular epidemiologic survey; Hermans PW et al.; The molecular epidemiologic characteristics of penicillin-resistant pneumococci in the Netherlands were investigated in 1995 . Dutch electronic surveillance data showed that 0.7% of all pneumococci were intermediately resistant and 0.4% were highly resistant to penicillin . From March 1995 to March 1996, 89 penicillin-resistant isolates were collected by 39 medical microbiology laboratories . Thirty different genotypes were observed by restriction fragment end labeling . Twenty-one DNA types were unique, whereas 9 distinct genotypes were shared by > or = 2 isolates . Different serogroups were found within 6 of the 9 genetically identical clusters of penicillin-resistant isolates, suggesting that horizontal transfer of capsular genes is common . Finally, nosocomial transmission of penicillin-resistant pneumococci was observed among 21 elderly adults with chronic obstructive pulmonary disease . This study demonstrates that multiple clones of penicillin-resistant pneumococci have been introduced in the Netherlands, a country with a low prevalence of pneumococcal infection . Some clones spread among the population in and outside hospitals.

Antimicrob Agents Chemother, 1997 Jun, 41(6), 1396 - 8
Apparent involvement of a multidrug transporter in the fluoroquinolone resistance of Streptococcus pneumoniae; Baranova NN et al.; A Streptococcus pneumoniae strain selected for resistance to ethidium bromide demonstrated enhanced energy-dependent efflux of this toxic dye . Both the ethidium resistance and the ethidium efflux could be inhibited by the plant alkaloid reserpine . The ethidium-selected cells demonstrated cross-resistance to the fluoroquinolones norfloxacin and ciprofloxacin; this resistance could also be completely reversed by reserpine . Furthermore, reserpine potentiated the susceptibility of wild-type S . pneumoniae to fluoroquinolones and ethidium . The most plausible explanation for these results is that S . pneumoniae, like some other gram-positive bacteria, expresses a reserpine-sensitive multidrug transporter, which may play an important role in both intrinsic and acquired resistances of this pathogen to fluoroquinolone therapy.

Antimicrob Agents Chemother, 1997 Jun, 41(6), 1389 - 91
Pharmacodynamic effects of amoxicillin versus cefotaxime against penicillin-susceptible and penicillin-resistant pneumococcal strains: a phase I study; Aguilar L et al.; Serum bactericidal activity against a penicillin-susceptible strain and a penicillin-resistant strain of Streptococcus pneumoniae (amoxicillin and cefotaxime MICs, 0.001 and 1 microg/ml, respectively, and MBCs, 0.01 and 2 microg/ml, respectively) was measured in 12 healthy volunteers who each received an oral 875-mg dose of amoxicillin and an intramuscular 1-g dose of cefotaxime in a crossover fashion . The areas under the bactericidal activity-time curves for the two strains were found to be similar for both antibiotics despite the significantly higher (P < 0.002) AUC/MIC and peak level/MIC values for cefotaxime.

Appl Environ Microbiol, 1997 Jun, 63(6), 2477 - 80
Development of a radioactive protein A-based assay for analysis of surface protein expression in gram-positive bacteria; Coyle TC et al.; This paper describes an immunochemical method which uses radioactive protein A for the detection and analysis of streptococcal M6 protein epitopes on the surface of recombinant Streptococcus gordonii . With this assay, recombinant S . gordonii cells expressing a portion of the M6 protein on their surfaces show a 75-fold increase in bound radioactivity over cells of the control S . gordonii parental strain . Furthermore, use of the assay to monitor the amount of M6 protein present on the surface of the S . gordonii recombinant during growth in culture demonstrated that expression is highest at late log phase, with the protein being sloughed off during stationary phase . This simple assay allows analysis of surface protein without any protein purification or sophisticated instrumentation . As such, it should be broadly applicable to following the expression of most surface-accessible bacterial proteins.

Appl Environ Microbiol, 1997 Jun, 63(6), 2155 - 8
Activity of H(+)-ATPase in ruminal bacteria with special reference to acid tolerance; Miwa T et al.; Batch culture experiments showed that permeabilized cells and membranes of Ruminococcus albus and Fibrobacter succinogenes, acid-intolerant celluloytic bacteria, have only one-fourth to one-fifth as much H(+)-ATPase as Megasphaera elsdenii and Streptococcus bovis, which are relatively acid tolerant . Even in the cells grown in continuous culture at pH 7.0, the acid-intolerant bacteria contained less than half as much H(+)-ATPase as the acid-tolerant bacteria . The amounts of H(+)-ATPase in the acid-tolerant bacteria were increased by more than twofold when the cells were grown at the lowest pH permitting growth, whereas little increase was observed in the case of the acid-intolerant bacteria . These results indicate that the acid-intolerant bacteria not only contain smaller amounts of H(+)-ATPase at neutral pH but also have a lower capacity to enhance the level of H(+)-ATPase in response to low pH than the acid-tolerant bacteria . In addition, the H(+)-ATPases of the acid-intolerant bacteria were more sensitive to low pH than those of the acid-tolerant bacteria, although the optimal pHs were similar.

Am J Epidemiol, 1997 Jun 1, 145(11), 1048 - 56
Low cord blood pneumococcal immunoglobulin G (IgG) antibodies predict early onset acute otitis media in infancy; Salazar JC et al.; Low maternally derived serum immunoglobulin G (IgG) antibodies to Streptococcus pneumoniae capsular polysaccharides (PS) combined with the inability of infants to produce anti-PS antibody may explain onset of otitis media in the first 6 months of life . To explore this relation, cord blood samples were assayed for anti-PS IgG antibodies from 414 of 592 infants enrolled in a study of early onset otitis media between 1991 and 1994 . Infants' ears were examined at health supervision and illness visits for the first 6 months of life in a large Minneapolis-St . Paul, Minnesota, health maintenance organization . Antibodies to seven common pneumococcal serotypes (3, 4, 6B, 14, 18C, 19F, and 23F) were measured by enzyme-linked immunoabsorbent assay (ELISA) . Cox's regression analysis revealed that among infants with a sibling otitis media history, those with low concentrations of type 14 or 19F anti-PS cord blood antibody had earlier otitis media onset than those with higher cord blood antibody concentrations (relative risks (RR) (95% confidence intervals (CI)) = 1.77 (1.05-2.99) and 1.89 (1.11-3.23), respectively) . Day care attendance also increased risk (RR = 1.56, 95% CI 0.96-2.52) . Breastfeeding, parental smoking, and low anti-PS antibody to pneumococcal serotypes 3, 4, 6B, 18C, and 23F did not significantly affect the risk of early otitis media.

Infect Immun, 1997 Jun, 65(6), 2488 - 90
Expression of the Streptococcus mutans fructosyltransferase gene within a mammalian host; Grey WT et al.; In vivo expression of the virulence-associated fructosyltransferase gene (ftf) of Streptococcus mutans has been examined . S . mutans ftf expression is affected by both the specific carbohydrate consumed and the age of the host animal.

Infect Immun, 1997 Jun, 65(6), 2292 - 8
Effects of antibodies against cell surface protein antigen PAc-glucosyltransferase fusion proteins on glucan synthesis and cell adhesion of Streptococcus mutans; Yu H et al.; Cell surface protein antigen (PAc) and glucosyltransferases (GTFs) produced by Streptococcus mutans are considered to be major colonization factors of the organism, and the inhibition of these two factors is predicted to provide protection against dental caries . In this study, we have constructed fusion protein PAcA-GB, a fusion of the saliva-binding alanine-rich region (PAcA) of PAc with the glucan binding (GB) domain of GTF-I, an enzyme catalyzing the synthesis of water-insoluble glucan from sucrose, and fusion protein PAcA-SB, a fusion of PAcA with the sucrose binding (SB) domain of GTF-I . The recombinant fusion proteins were purified from cell extracts of Escherichia coli harboring the fusion genes, and rabbit antibodies against these fusion proteins were prepared . Water-insoluble glucan synthesis by cell-associated and cell-free GTF preparations from S . mutans as well as total glucan synthesis by GTF-I was markedly inhibited by anti-PAcA-GB immunoglobulin G (IgG) antibodies but not by anti-PAcA-SB IgG antibodies . Significant inhibition of the sucrose-independent and sucrose-dependent adhesion of S . mutans to saliva-coated hydroxyapatite beads was observed when anti-PAcA-GB antibodies were added to the reaction mixture . Anti-PAcA-SB antibodies inhibited the adhesion of S . mutans to the beads in the absence of sucrose but not in the presence of sucrose . Immunization with the fusion protein PAcA-GB may be useful for controlling the colonization of teeth by S . mutans.

Infect Immun, 1997 Jun, 65(6), 2265 - 71
Environmental regulation of fimbrial gene expression in Porphyromonas gingivalis; Xie H et al.; Porphyromonas gingivalis fimbriae are an important virulence factor involved in attachment and invasion . Fimbrillin, encoded by the fimA gene, is the major subunit protein of the fimbriae . To elucidate the influence of environmental signals on the expression of the fimA gene, a strain of P . gingivalis (designated PLE) containing a chromosomal transcriptional fusion between a promoterless lacZ gene and the fimA promoter region was constructed . Promoter activity was assessed by measurement of beta-galactosidase activity of PLE . An 11-fold increase in activity of fimA promoter was found as growth temperature declined from 39 to 34 degrees C . Promoter activity decreased by approximately 50% in response to hemin limitation and upon culture on solid medium . In addition, the presence of serum or saliva in the growth medium decreased fimA promoter activity by similar amounts . A correlation between fimA promoter activity and phenotypic properties dependent upon fimbriae was established . P . gingivalis grown at 34 degrees C, compared to 39 degrees C, showed an increased ability to adhere to Streptococcus gordonii and to invade primary cultures of gingival epithelial cells . These studies indicate that expression of the P . gingivalis fimA gene is regulated at the transcriptional level in response to several environmental conditions and that altered fimA expression can also modulate the adherence and invasion abilities of P . gingivalis.

Infect Immun, 1997 Jun, 65(6), 2074 - 9
Induction of nitric oxide production by polyosides from the cell walls of Streptococcus mutans OMZ 175, a gram-positive bacterium, in the rat aorta; Martin V et al.; The cardiovascular dysfunctions associated with septic shock induced by gram-negative or gram-positive bacteria (gram-positive or gram-negative septic shock) are comparable . In gram-negative septic shock, lipopolysaccharide (LPS) induces nitric oxide (NO) synthase, which contributes to the vascular hypotension and hyporeactivity to vasoconstrictors . The role of NO in gram-positive septic shock and the nature of the bacterial wall components responsible for the vascular effects of gram-positive bacteria are not well known . This study investigated the vascular effects of cell wall serotype polyosides, rhamnose glucose polymers (RGPs), from Streptococcus mutans, in comparison with lipoteichoic acid (LTA) from Staphylococcus aureus, on the induction of NO synthase activity in the rat aorta . We show that 10 microg of both RGPs and LTA per ml induced hyporeactivity to noradrenaline, L-arginine-induced relaxation, increases of 2.2- and 7.8-fold, respectively, of cyclic GMP production, and increases of 7- and 12-fold in nitrite release . All of these effects appeared after several hours of incubation and were inhibited by N(omega)-nitro-L-arginine methyl ester (L-NAME), an inhibitor of NO synthase . Electron paramagnetic resonance spin trapping experiments demonstrated directly that RGPs and LTA induced NO overproduction (four- to eightfold, respectively) in rat aortic rings; this production was inhibited by L-NAME and prevented by dexamethasone . These results demonstrate directly the induction of NO production in vascular tissue by LTA and show that another, chemically different component of gram-positive bacteria can also have these properties . This result suggests that different components of the gram-positive bacterial wall could be implicated in the genesis of cardiovascular dysfunctions observed in gram-positive septic shock.

J Clin Invest, 1997 Jun 1, 99(11), 2574 - 80
Inactivation of Streptococcus pyogenes extracellular cysteine protease significantly decreases mouse lethality of serotype M3 and M49 strains; Lukomski S et al.; Cysteine proteases have been implicated as important virulence factors in a wide range of prokaryotic and eukaryotic pathogens, but little direct evidence has been presented to support this notion . Virtually all strains of the human bacterial pathogen Streptococcus pyogenes express a highly conserved extracellular cysteine protease known as streptococcal pyrogenic exotoxin B (SpeB) . Two sets of isogenic strains deficient in SpeB cysteine protease activity were constructed by integrational mutagenesis using nonreplicating recombinant plasmids containing a truncated segment of the speB gene . Immunoblot analyses and enzyme assays confirmed that the mutant derivatives were deficient in expression of enzymatically active SpeB cysteine protease . To test the hypothesis that the cysteine protease participates in host mortality, we assessed the ability of serotype M3 and M49 wild-type strains and isogenic protease-negative mutants to cause death in outbred mice after intraperitoneal inoculation . Compared to wild-type parental organisms, the serotype M3 speB mutant lost virtually all ability to cause mouse death (P < 0.00001), and similarly, the virulence of the M49 mutant was detrimentally altered (P < 0.005) . The data unambiguously demonstrate that the streptococcal enzyme is a virulence factor, and thereby provide additional evidence that microbial cysteine proteases are critical in host-pathogen interactions.

J Clin Microbiol, 1997 Jun, 35(6), 1616 - 7
Endocarditis caused by nonhemolytic group B streptococcus; Miranda C et al.; We report a case of bacterial endocarditis caused by nonhemolytic group B streptococcus (GBS) in a 67-year-old man with no predisposing risk factors . Nonhemolytic GBS strains rarely cause illness and are usually detected in perinatal infections . We believe this to be the first reported case of endocarditis caused by a nonhemolytic strain of GBS.

J Clin Microbiol, 1997 Jun, 35(6), 1595 - 6
Demonstration of vertical transmission of Streptococcus suis in swine by genomic fingerprinting; Amass SF et al.; Isolates of Streptococcus suis serotype 5 collected from three sows and nine of their pigs at birth were analyzed by genomic DNA fingerprinting . The cleavage patterns of DNA from S . suis isolated from the sows matched the cleavage patterns of DNA from S . suis isolated from their respective pigs.

J Clin Microbiol, 1997 Jun, 35(6), 1469 - 72
Clinical comparison of BACTEC 9240 plus aerobic/F resin bottles and the isolator aerobic culture system for detection of bloodstream infections; Cockerill FR 3rd et al.; The Plus Aerobic/F resin bottle of the BACTEC 9240 automated blood culture system (Becton Dickinson Diagnostic Instrument Systems, Sparks, Md.) was compared with aerobic culture of the Isolator system (Wampole Laboratories, Cranbury, N.J.) for the detection of bloodstream microorganisms from 6,145 blood cultures collected from adult patients with suspected septicemia . The BACTEC resin bottles were incubated for 7 days, and the sediment from the Isolator tube was inoculated to sheep blood and chocolate agars which were incubated for 72 h and to inhibitory mold, brain heart infusion, and Sabouraud agars which were incubated for 21 days . A total of 622 microorganisms were recovered from 583 blood cultures . The BACTEC resin bottle recovered statistically significantly more pathogens overall than the Isolator system (P = 0.0006) . When individual pathogens isolated from either system for a 7-day study period were assessed, it was determined that the BACTEC resin bottle detected statistically significantly more isolates of Staphylococcus aureus (P = 0.0113) and coagulase-negative Staphylococcus spp . (P = 0.0029) than the Isolator system . The BACTEC resin bottle also detected statistically significantly more bloodstream infections (septic episodes) caused by coagulase-negative Staphylococcus spp . (P = 0.0146) . The Isolator system recovered statistically significantly more contaminants overall (P < 0.0001), and among this group of microorganisms, recovered statistically significantly more Bacillus spp . (P < 0.0001), coagulase-negative Staphylococcus spp . (P < 0.0001), and viridans group Streptococcus spp . (P = 0.0156) . The Isolator system detected statistically significantly more isolates of Histoplasma capsulatum (P = 0.004), but all of these isolates were detected at > or = 7 days of incubation of fungal plates, i.e., after the system to system comparison study period (7 days) . In blood culture sets which produced growth of the same pathogen in both systems, there was a statistically significant difference in median time to detection for all pathogens combined favoring the BACTEC resin bottle over the Isolator tube (P < 0.05) . When assessing individual microorganisms, the median times for detection of S . aureus, Enterococcus spp., and Pseudomonas spp . were all statistically significantly less for the BACTEC system (P < 0.05) . The BACTEC instrument had 79 (1.3%) false positive signals . The BACTEC system required less processing time than the Isolator system and eliminates the hands-on time for detection of positive cultures required with the Isolator system.

Commun Dis Intell, 1997 May 15, 21(10), 133 - 6
Emergence of further serotypes of multiple drug-resistant Streptococcus pneumoniae in Queensland; Gratten M et al.; We describe 27 cases of multiple drug-resistant pneumococcal infection in Queensland children (7 cases) and adults (20 cases), between February 1995 and October 1996 . Seven patients had invasive disease . Serotypes were those commonly associated with paediatric infections and included types 19F (15 strains), 14 (6), 23F (4), 6A (1) and 19A (1) . No rifampicin or vancomycin resistance was encountered . However, pneumococci fully resistant to cotrimoxazole, erythromycin and tetracycline were isolated from 25 of 27 cases (93%) . Strains with high level resistance to penicillin and chloramphenicol were also recovered from 16 (59%) and 19 (70%) patients respectively . Twelve of 16 penicillin-resistant isolates showed intermediate resistance to ceftriaxone and two strains were fully resistant to this antibiotic . Clones of types 19F and 14 pneumococci, each with two distinctive resistance patterns, appear to be established in south-east Queensland.

FEMS Microbiol Lett, 1997 May 15, 150(2), 233 - 7
Prevalence of the speA2 and speA3 alleles in Streptococcus pyogenes isolated from TSLS patients in Japan; Matsumoto M et al.; More than 100 cases have been identified as streptococcal toxic shock-like syndrome (TSLS) in Japan, since the first case was reported in 1993 . Of 26 S . pyogenes isolates associated with TSLS, 69% were M-types 1 and 3 . This study focused on speA alleles which were carried by all M-type 1 and 3 isolates and isolates of some other M-types, irrespective of sources . We sequenced the nucleotides of the relevant region of the speA allele in all of these isolates . Consistent with other reports, these M-type 1 and 3 isolates carried the speA2 and speA3 alleles, respectively . Our results indicate that these two speA alleles, which were prevalent world-wide have been disseminating in Japan.

Gene, 1997 May 6, 190(2), 257 - 61
Cloning and characterization of a dextranase gene (dexS) from Streptococcus suis; Serhir B et al.; A gene (dexS) coding for a Streptococcus suis capsular type 2 dextranase (DexS) was detected in a recombinant gene library constructed in phage lambda ZapII, and its nucleotide sequence was determined . Sequence comparison showed that the dexS gene product had significant similarities with enzymes which hydrolyze glucose polymers . Moreover, conserved amino acids that are suggested to be part of the active site of the glucosidases are also found in DexS . The dexS gene, adjacent to the gene encoding a S . suis IgG-binding protein, encoded a protein of approximately 62 kDa which exhibited DexS activity.

Pathologe, 1997 May, 18(3), 257 - 60
{Fulminant infection outcome after splenectomy}; Rodriguez Gomez M et al.; A report is given of two patients with a history of splenectomy many years previously due to traumatic rupture . No vaccination was given to either patient . From a state of good health, both patients developed fulminant, therapy-resistant sepsis with proof of Streptococcus pneumonlae in the blood culture . Autopsy findings were similar to Waterhouse-Friderichsen-syndrome . In conjunction with the history of splenectomy, the final pathological diagnosis was a so-called OPSI syndrome . This postsplenectomy sepsis is discussed further.

J Chemother, 1997 May, 9 Suppl 1, 36 - 46
In vitro antibiotic sensitivity testing breakpoints and therapeutic activity in induced infections in animal models; Soriano F et al.; Antimicrobial susceptibility breakpoints are artificially designated to classify organisms as susceptible, intermediate or resistant but such values may differ according to the relative weight given to the microbiological, pharmacological and clinical information . Animal models of bacterial infections are considered necessary to establish tentative breakpoints before initiating clinical trials in humans . Studies in animals provide a preliminary indication of the most effective and least toxic concentration of the antibiotic and give a rational basis for the selection of dosages and schedules . Animal models of therapeutic efficacy have demonstrated the importance of the inoculum effect, showing that the minimum inhibitory concentration (MIC) determined with high inoculum (10(7)-10(8) CFU/ml) is, under some experimental conditions, a better predictor of therapeutic efficacy than the value obtained with standard (10(4)-10(5) CFU/Ml) inoculum . Studies in animals have demonstrated the failure of some fluoroquinolones in respiratory tract infections where Streptococcus pneumoniae was present or the efficacy of penicillins and third-generation cephalosporins for treating respiratory tract infections and meningitis by pneumococci with diminished susceptibility to such agents . Although most therapeutic models in animals should be carried out during preclinical studies, many are done during later phases of antibiotic development, as explicate models of what is seen in clinical practice.

Eur J Clin Microbiol Infect Dis, 1997 May, 16(5), 388 - 91
Etiology and response to antibiotic therapy of community-acquired pneumonia in French children; Gendrel D et al.; The aim of this study was to determine the etiologic agents associated with community-acquired pneumonia in 104 French children ages 18 months to 13 years . Potential respiratory pathogens were identified in 87 (85%) cases; these included respiratory syncytial virus in ten, other viruses in 20, Streptococcus pneumoniae in 14 and Mycoplasma pneumoniae (diagnosed by serologic procedures) in 43 . Of 32 patients with Mycoplasma pneumoniae infection who were initially treated with beta-lactam antibiotics, 30 failed treatment . Recovery from mycoplasma infection occurred rapidly in patients treated with macrolide antibiotics (which included spiramycin in 31 patients, josamycin in 7, and erythromycin in 3); however, cough persisted in 12 patients for one month . The high frequency of Mycoplasma pneumoniae in children over 18 months of age must be considered when selecting an antibiotic for initial therapy.

Vet Immunol Immunopathol, 1997 May, 56(1-2), 175 - 83
Development and efficacy of a vaccine against Streptococcus iniae infection in farmed rainbow trout; Eldar A et al.; Formalin killed bacteria were used as a vaccine against Streptococcus iniae infections in farmed rainbow trout . A single intraperitoneal injection of this vaccine in trout resulted in specific antibody production detectable for 6 months . Trout vaccinated at 50 g were protected under laboratory (experimental disease) and field conditions (natural disease) for at least 4 months against S . iniae infection . Passive transfer of S . iniae specific antibodies conferred protection . Under field conditions, mortality of non vaccinated trout exceeded 50%, whereas mortality of vaccinated trout did not reach 5% . In addition, vaccinated trout under field conditions gained 20% weight when compared with non vaccinated fish.

Br J Gen Pract, 1997 May, 47(418), 280 - 4
A randomized controlled trial of antibiotics on symptom resolution in patients presenting to their general practitioner with a sore throat; Howe RW et al.; BACKGROUND: Sore throat is a common symptom presented to general practitioners (GPs), and there remains controversy about the appropriate use of antibiotics . AIM: To compare, in a randomized controlled trial, the effectiveness of penicillin, cefixime and placebo on symptom resolution in patients presenting with a sore throat in general practice . METHOD: Twenty-two GPs in Avon recruited 154 patients, aged 16-60 years, presenting to their GP with a sore throat, and for whom the GP would normally prescribe an antibiotic . Patients were randomized to one of three groups: penicillin V 250 mg four times a day; cefixime 200 mg daily; and placebo . Each was prescribed for five days . The main outcome measures were a diary of symptom resolution over seven days and eradication of group A beta-haemolytic streptococcus (GABHS) . RESULTS: Of the 103 (67%) patients who completed symptom diaries, 40 were allocated to receive penicillin, 29 cefixime and 34 placebo . In the analysis including all patients, symptom resolution was greater by day 3 in the cefixime group than in the placebo group . Penicillin did not improve symptom resolution by day 3 compared with placebo, and cefixime was not statistically significantly different from penicillin . There were significant differences in the proportion of patients using analgesia at day 3, with the proportion being lowest in the cefixime group . The results for the subgroup of patients without GABHS were similar to those for all patients; in particular, the only statistically significant difference was between cefixime and placebo . Although numbers were too small for statistical significance, among patients with GABHS the effects of penicillin and cefixime were similarly raised in relation to placebo . CONCLUSION: Compared with placebo, cefixime can improve the rate of resolution of symptoms in patients with a sore throat who are selected for antibiotic treatment by their GP . The unexpected finding that cefixime was of benefit compared with placebo for patients without GABHS suggests that bacteria other than GABHS may be important in the pathogenesis of sore throat.

Diagn Microbiol Infect Dis, 1997 May, 28(1), 27 - 9
Reproducibility of broth microdilution and disk diffusion susceptibility tests of nine antimicrobial agents against Streptococcus pneumoniae ATCC 49619; Fuchs PC et al.; Collaborative studies documented the reproducibility of broth microdilution susceptibility tests of Streptococcus pneumoniae against nine antimicrobial agents and of disk diffusion tests with six of those drugs . Replicate tests of Streptococcus pneumoniae ATCC 49619 in five different laboratories led to the following provisional quality control limits: cefdinir--0.03 to 0.25 microgram/ml and 26 to 31 mm; cefetamet--0.5 to 2 micrograms/ml and 20 to 25 mm; ciprofloxacin--0.25 to 1 microgram/ml and 20 to 26 mm; clinafloxacin--0.03 to 0.125 microgram/ml and 28 to 34 mm; grepafloxacin--0.06 to 0.5 microgram/ml and 21 to 28 mm; PD131628--0.125 to 0.5 microgram/ml and 24 to 29 mm; clindamycin--0.03 to 0.12 microgram/ml; cefpodoxime--0.03 to 0.12 microgram/ml; and trospectomycin--1 to 4 microgram/ml (disk tests were not evaluate for the latter three drugs).

Kansenshogaku Zasshi, 1997 May, 71(5), 459 - 63
{A case of severe odontogenic infection with allergic skin reaction for beta-lactam antibiotics}; Kuriyama T et al.; A 54-aged woman consulted with right buccal phlegmon caused by lower apical periodontitis . The primary chemotherapy using flomoxef induced allergic skin eruption . A decision was made for using clindamycin, levofloxacin and fosfomycin as chemotherapeutic agents . Cultured organisms from the abscess revealed the mixed infection with Streptococcus sanguis, Veillonella sp., Prevotella loescheii, Wolinella spp . On 12th hospital day, her serum CRP turned to negative . This case carried numerous implications for the use of antibiotics as chemotherapy agents.

Kansenshogaku Zasshi, 1997 May, 71(5), 421 - 9
{Prevalence of antimicrobial resistance among clinical isolates of Streptococcus pneumoniae in a children's hospital}; Nakamura A; Eleven hundreds and seventy-six strains of Streptococcus pneumoniae were isolated from pediatric clinics of Chiba Children's Hospital during 1990 through 1995 . Annual penicillin-resistant rates of these strains were as follows; 24.0% (1990), 29.0% (1991), 36.2% (1992), 55.8% (1993), 58.6% (1994), and 59.3% (1995) . Overall penicillin-resistance during these 6 years was 45.8% . Nine out of 11 cases of systemic pneumococcal infections were due to penicillin-resistant S . pneumoniae (PRSP) during the same period . Of PRSP strains, their PCG-MIC levels had become higher and their spectra of resistance had expanded not only to beta-lactam but also to non-beta-lactam antimicrobials . Although panipenem was the most efficacious antibiotics in this study and was recommended currently to use in the case of pneumococcal meningitis, it should be noted that a strain with high-level MIC (2 micrograms/ml) had emerged in 1995 . Close surveillance of pneumococcal antimicrobial susceptibility including panipenem is necessary.

Pediatr Dermatol, 1997 May-Jun, 14(3), 192 - 5
Microbiology of nonbullous impetigo; Brook I et al.; Our objective was to establish the aerobic and anaerobic microbiology of nonbullous impetigo (NI) in children . We used a retrospective review of clinical microbiology laboratory and patients' records . Specimens were obtained from 40 patients with NI lesions and showed bacterial growth . Aerobic or facultative anaerobic bacteria only were present in 24 patients (60%), strict anaerobic bacteria only in 5 patients (12.5%), and mixed anaerobic-aerobic flora was present in 11 patients (27.5%) . Sixty-four isolates were recovered (1.6 per specimen): 43 aerobic or facultative, and 21 anaerobic . The predominant aerobic and facultative bacteria were Staphylococcus aureus (29 isolates), Group A beta hemolytic streptococcus (GABHS) (13 isolates), and Escherichia coli (1 isolate) . The predominant anaerobes were Peptostreptococcus spp . (12), pigmented Prevotella spp . (5), Fusobacterium spp . (2), and Bacteroides fragilis (1) . Single bacterial isolates were recovered in 17 patients (42.5%), 13 of which were S . aureus . S . aureus alone or mixed with GABHS or Peptostreptococcus spp . were isolated from all body sites . Mixed flora of Peptostreptococcus spp . with Prevotella spp . or Fusobacterium spp . was mostly found in infections of the head and neck, while E . coli mixed with B . fragilis and Peptostreptococcus spp . were isolated from one infection of the buttocks area . Thirty-three organisms isolated from 32 patients (80%) produced the enzyme beta-lactamase . This study demonstrates the polymicrobial aerobic-anaerobic microbiology of NI lesions.

Rev Rhum Engl Ed, 1997 May, 64(5), 339 - 41
Destructive polyarthritis due to a group B streptococcus; Straus C et al.; A new case of destructive polyarthritis due to a Group B streptococcus is reported . The patient was a 55-year-old male whose predominantly axial manifestations in the absence of evidence of an infection initially suggested psoriatic arthritis . Although rare, Group B streptococcal arthritis has been reported outside the postpartal and neonatal periods . Monoarthritis with a favorable outcome has been the most common clinical pattern . Several cases of destructive polyarthritis with axial involvement have been reported in which the joint destruction and longer time to diagnosis as compared with monoarticular forms resulted in permanent functional impairment.

Int Immunol, 1997 May, 9(5), 665 - 77
Sequence changes at the V-D junction of the VH1 heavy chain of anti-phosphocholine antibodies alter binding to and protection against Streptococcus pneumoniae; Guo WX et al.; X-linked immune deficient (Xid) mice fail to produce anti-phosphocholine (PC) antibodies even after immunization with Streptococcus pneumoniae . Consequently, Xid mice are extremely susceptible to infection with S . pneumoniae, PC-specific B cells appear to undergo clonal deletion in Xid mice; however, a new thymus-dependent form of PC, 6-(O-phosphocholine)hydroxyhexanoate (EPC), can rescue PC-specific B cells from the bone marrow presumably by providing T cell help before clonal deletion . Analysis of PC-specific IgG hybridomas from Xid mice revealed utilization of several V-D junctional variants of the VH1 gene segment rearranged to different D and JH gene segments . The majority of Xid anti-PC antibodies exhibit an Asp-->Gly95H replacement at the V-D junction . These Gly95H VH1 variants associate with kappa 1C L chains to produce anti-PC antibodies that: (1) have low relative affinity for PC, (ii) are heteroclitic for nitrophenylphosphocholine and (iii) fall to bind to or provide protection against S . pneumoniae . Single prototypic V-D variants of the T15 idiotype (Asp95H), M603 idiotype (Asn95H) and M167 idiotype (Asp95H-Ala96H) were also induced in Xid mice . The M603-like and M167-like antibodies bound to and protected against S . pneumoniae even though they exhibited Kas for PC which were lower than T15 idiotype+ antibodies . These data demonstrate that small changes in the V-D junctional sequence of the T15 (VH1) heavy chain alter L chain usage and the structure of the PC binding site so that the PC expressed on S . pneumoniae is no longer recognized.

J Antimicrob Chemother, 1997 May, 39(5), 609 - 15
Non-gyrA-mediated ciprofloxacin resistance in laboratory mutants of Streptococcus pneumoniae; Piddock LJ et al.; Two strains of Streptococcus pneumoniae, M4 (NCTC 7465, type strain) and M5 (clinical isolate), and their respective ciprofloxacin-resistant mutants, M4/C1, M5/C1 and M5/C3, were evaluated . All mutants were stable after one year's storage and all grew more slowly in Brain Heart Infusion broth than the parent . The MICs of ciprofloxacin, sparfloxacin and tosufloxacin were increased for the mutants of M4, whereas the mutants of M5 were less susceptible to ciprofloxacin only . The optimal bactericidal concentration (OBC) of each quinolone for all the strains was approximately ten-fold greater than the MIC . The OBCs for the mutants were increased for ciprofloxacin, but not for the other two quinolones . The DNA synthesis IC50 values of all quinolones correlated well with the MIC of each drug . All quinolones accumulated rapidly within all five strains; 10 mM magnesium chloride decreased the concentration of quinolone accumulated, but carbonyl cyanide m-chlorophenyl hydrazone had no effect . Mutant strains M4/C1, M5/C1 and M5/C3 accumulated less quinolone than their respective parent strains . DNA sequencing of those regions of gyrA and gyrB corresponding to the quinolone resistance-determining region in other bacteria did not reveal any differences between the parent and mutant strains.

Clin Rheumatol, 1997 May, 16(3), 314 - 6
Pyogenic arthritis caused by streptococcus equisimilis (group-C streptococcus) in a patient with AIDS; Steinfeld S et al.; A patient with the Acquired ImmunoDeficiency Syndrome (AIDS) treated with a daily low dose of corticosteroids for chronic atopic dermatitis experienced a sudden episode of unilateral knee arthritis . Culture of the purulent synovial liquid yielded a pure culture of Streptococcus Equisimilis . A four week period of intravenous antibiotherapy combined with repeated drainages allowed a complete recovery of articular function.

Acta Paediatr, 1997 May, 86(5), 533 - 8
Increase of staphylococci in neonatal septicaemia: a fourteen-year study; Kallman J et al.; All cases of neonatal septicaemia during 1981-94 were studied at Orebro Medical Centre Hospital, Sweden . One hundred and thirty-two children fulfilled laboratory and clinical criteria for neonatal septicaemia and were included . Staphylococcus aureus (n = 41), Group B streptococcus (GBS) (n = 32) and coagulase-negative staphylococci (CoNS) (n = 27) were the dominating aetiologies . The annual incidence of septicaemia increased significantly, from 2.3 cases during the first 7-year period to 3.3 per 1000 live births during 1988-94 . This increase was caused by S . aureus and CoNS, which mainly affected premature children and had an onset more than 48 h after delivery . GBS, on the other hand, slightly decreased and affected full-term children within 48 h . The overall mortality was 11% . CoNS isolated during the latter 7-year period were more resistant to antibiotics than those isolated during 1981-87; resistance to methicillin increased from 14 to 45% and to gentamicin from 0 to 20% . These changes in aetiology and antibiotic susceptibility should be considered when selecting antibiotic treatment in neonatal septicaemia.

J Dairy Sci, 1997 May, 80(5), 859 - 63
The effects of early antibiotic treatment following diagnosis of mastitis detected by a change in the electrical conductivity of milk; Milner P et al.; Mastitis was induced experimentally by infusion of Streptococcus uberis or Staphylococcus aureus into the mammary glands of lactating dairy cows . Clinical mastitis was identified when clots appeared in foremilk (conventional diagnosis) or was predicted by changes in the electrical conductivity of foremilk (early diagnosis) . The responses to intramammary antibiotic treatment that was initiated after early diagnosis of mastitis and after conventional diagnosis were compared . Early treatment significantly limited the severity of the disease and, in many cases, prevented the appearance of any visible signs of infection . Milk yield was less depressed, and the somatic cell count (SCC) was lower, when treatment was initiated earlier . The SCC of the quarter at the time mastitis was predicted was approximately 2 x 10(6) cells/ml for both pathogens, which was significantly less than when clots appeared at conventional diagnosis, approximately 4 x 10(6) and 12 x 10(6) cells/ml for Staph . aureus and Strep . uberis, respectively . The time required for SCC to recover to < 4 x 10(5) cells/ml was significantly less, approximately half, for both pathogens following early detection and early initiation of treatment . When treatment was administered in response to early detection, the bacteriological and clinical cure was almost complete, and the amount of antibiotic used was < or = 50% less . Obvious benefits for milk yield and quality and the health of the cow would result when changes in the electrical conductivity of milk are used to predict clinical mastitis and when treatment is initiated early.

J Dairy Sci, 1997 May, 80(5), 854 - 8
Field trials of a vaccine against bovine mastitis . 2 . Evaluation in two commercial dairy herds; Calzolari A et al.; A vaccine against bovine mastitis was developed . The vaccine was based on inactivated, highly encapsulated Staphylococcus aureus cells; a crude extract of Staph . aureus exopolysaccharides; and inactivated unencapsulated Staph . aureus and Streptococcus spp . cells . In this study, the vaccine was evaluated in 164 cows from two commercial dairies (A and B) during a 4-mo period . Two doses of the vaccine were administered subcutaneously to 82 cows in the brachiocephalicus muscle of the neck within a 4-wk interval . The results of this trial revealed significantly fewer intramammary infections caused by Staph . aureus at various levels of severity (clinical, subclinical, and latent) in cows that were vaccinated . The odds ratios of all types of intrammammary infections caused by Staph . aureus for dairies A and B, which were determined by a logistic model, were 1.84 and 1.89, respectively, for quarters of vaccinated cows and quarters of control cows . The colony counts for Staph . aureus in milk from infected quarters of vaccinated cows were significantly lower than those in milk from infected quarters of control cows . Also, the somatic cell counts per milliliter in milk from vaccinated cows were significantly decreased when the initial somatic cell count was < 500,000 cells/ml at the start of the trial . The vaccine had no observable effect on fat production in milk or on streptococcal infections.

J Dairy Sci, 1997 May, 80(5), 845 - 53
Field trials of a vaccine against bovine mastitis . 1 . Evaluation in heifers; Giraudo JA et al.; A vaccine was developed against bovine mastitis based on inactivated, highly encapsulated Staphylococcus aureus cells; a crude extract of Staph . aureus exopolysaccharides; and inactivated, unencapsulated Staph, aureus and Streptococcus spp . cells . This vaccine was tested on 30 heifers during a 7-mo period . The 30 heifers were randomly assigned to three groups of 10 heifers each . The prepartum group received two injections of the vaccine at 8 and 4 wk before calving, and the postpartum group received two injections at 1 and 5 wk after calving . The control group received two injections of a placebo at 8 and 4 wk before calving . The vaccine or the placebo was administered subcutaneously in the brachiocephalicus muscle of the neck . The frequencies of intramammary infections caused by Staph . aureus were reduced from 18.8% for heifers in the control group to 6.7 and 6.0% for heifers in the prepartum and postpartum groups, respectively . This protective effect was maintained for at least 6 mo . The relative risk of mastitis caused by Staph . aureus was 0.31 and 0.28 for heifers in the prepartum and postpartum groups, respectively, compared with that for heifers in the control group . The results of the trial indicated the effectiveness of the vaccine in decreasing the incidence of intrammammary infections caused by Staph . aureus . A slight but nonsignificant increase occurred in fat production in the milk of vaccinated cows . The vaccine had no observable effect on somatic cell count or streptococcal infections.

J Dent, 1997 May-Jul, 25(3-4), 257 - 62
Restoration-related salivary Streptococcus mutans level: a dental caries risk factor?
Petti S, Pezzi R, Cattaruzza MS, Osborn JF, D'Arca AS.
OBJECTIVES: The salivary level of Streptococcus mutans related to filled teeth was compared with the levels related to decayed and sound teeth, in order to establish whether the presence of restorations may increase the risk of infection of other teeth by Streptococcus mutans . METHODS: The sound, decayed and filled teeth were recorded in 809, 6-7-year-old school-children . Salivary Streptococcus mutans detection (i.e . more than 1 x 10(4) CFU/ml) and counts were evaluated . Streptococcus mutans log count means and prevalence values of subjects with only sound teeth (group 1), with filled, without decayed teeth (group 2), with decayed, without filled teeth (group 3), were calculated and compared using the Student's t-test and the chi-square test . The effect of filled, decayed and sound teeth on Streptococcus mutans level was also evaluated using logistic regression . RESULTS: Log count means and prevalence values of group 2 subjects were significantly lower than values of group 3 subjects (means, 0.92 vs 1.66: prevalence, 73.17% vs 94.63%) and statistically not-different from values of group 1 subjects (mean . 0.75: prevalence, 70.06%) . The logistic regression analysis showed that the factors significantly increasing the risk of Streptococcus mutans being detected in saliva were only primary and/or permanent decayed teeth . The risk of Streptococcus mutans being detected in saliva was not affected by filled teeth more than sound teeth . CONCLUSIONS: In the present study population, the salivary Streptococcus mutans level attributable to filled teeth was low; this suggests that treatment of a carious lesion would cause a lowering of Streptococcus mutans concentration to the same levels as those shown by healthy subjects, thus reducing the risk of infection to other teeth.

J Appl Microbiol, 1997 May, 82(5), 653 - 8
Microbial contamination of hydrogel contact lenses; Gopinathan U et al.; Bacterial contamination of contact lenses (CLs) may contribute to CL-related corneal infection and inflammation . This study reports CL biota over time during daily and extended wear . Microbial contamination of a 58% water, ionic hydrogel CL and a 38% water, non-ionic hydrogel CL was evaluated in an Australian and an Indian population . Fifty wearers were repeatedly sampled over 18 months . Overnight CL use did not alter the frequency of positive cultures, nor the spectrum of organisms compared with daily CL wear . There were no differences in type and frequency of CL contamination between the CL types . Positive cultures were more frequently recovered from the Indian population compared with the Australian population . Streptococcus spp . and Propionibacterium spp . were more frequently isolated from the Australian population . Fungi and Bacillus spp . were more frequently isolated from the Indian population . Normal CL biota alone cannot explain the increased rate of infection and inflammation in extended wear.

Genomics, 1997 May 1, 41(3), 493 - 7
Chromosomal localization of the human and mouse hyaluronan synthase genes; Spicer AP et al.; We have recently identified a new vertebrate gene family encoding putative hyaluronan (HA) synthases . Three highly conserved related genes have been identified, designated HAS1, HAS2, and HAS3 in humans and Has1, Has2, and Has3 in the mouse . All three genes encode predicted plasma membrane proteins with multiple transmembrane domains and approximately 25% amino acid sequence identity to the Streptococcus pyogenes HA synthase, HasA . Furthermore, expression of any one HAS gene in transfected mammalian cells leads to high levels of HA biosynthesis . We now report the chromosomal localization of the three HAS genes in human and in mouse . The genes localized to three different positions within both the human and the mouse genomes . HAS1 was localized to the human chromosome 19q13.3-q13.4 boundary and Has1 to mouse Chr 17.HAS2 was localized to human chromosome 8q24.12 and Has2 to mouse Chr 15 . HAS3 was localized to human chromosome 16q22.1 and Has3 to mouse Chr 8 . The map position for HAS1 reinforces the recently reported relationship between a small region of human chromosome 19q and proximal mouse chromosome 17 . HAS2 mapped outside the predicted critical region delineated for the Langer-Giedion syndrome and can thus be excluded as a candidate gene for this genetic syndrome.

Eur Respir J, 1997 May, 10(5), 1130 - 6
Penetration of sparfloxacin and ciprofloxacin into alveolar macrophages, epithelial lining fluid, and polymorphonuclear leucocytes; Schuler P et al.; Sparfloxacin (SPX), a novel fluoroquinolone with a broad spectrum of antibacterial activity, has been shown, in vitro, to be more effective against common pulmonary pathogens, particularly Streptococcus pneumoniae, Mycoplasma pneumoniae and some intracellular organisms, than ciprofloxacin (CPX) . The objective of this open, comparative, randomized study in two parallel groups was to assess the serum concentrations and penetration of SPX and CPX into alveolar macrophages (AMs), epithelial lining fluid (ELF), and peripheral polymorphonuclear leucocytes (PMNs) . Patients received either a single oral dose of SPX, 400 mg (16 patients), or CPX, 500 mg (15 patients), at various times before a routine diagnostic bronchoscopy was performed . Antibiotic concentrations were determined by using a microbiological assay . The median serum elimination half-lives were 17.3 h for SPX and 5.3 h for CPX . Peak levels (median+/-68% confidence range) of CPX were attained in AMs (7.6+/-1.7 mg x L(-1)) at 5 h after admission, and in both ELF (2.13+/-0.91 mg x L(-1)) and PMNs (9.1+/-6.2 mg x L(-1)) at 2.5 h after administration . SPX achieved comparable peak levels in PMNs (median+/-68% range, 9.4+/-1.1 mg x L(-1) at 5 h), but peak concentrations attained in AMs and ELF (35.1+/-15.4 and 32.2+/-28.2 mg x L(-1), respectively, at 24 h) were several times higher than those of CPX . SPX demonstrated substantially greater accumulation in all three sites than did CPX (peak site to serum ratios of 11.0+/-4.3, 65.5+/-28.4 and 63.0+/-66 versus 4.94+/-0.64, 10.6+/-3.7 and 10.6+/-3.7 for PMNs, AMs and ELF, respectively) . The results indicate, that sparfloxacin has a long elimination half-life and that it achieves higher concentrations in alveolar macrophages and epithelial lining fluid than ciprofloxacin . Site concentrations of sparfloxacin greatly exceeded the minimal inhibitory concentrations of common respiratory pathogens.

Eur Respir J, 1997 May, 10(5), 1125 - 9
White blood cells, C-reactive protein and erythrocyte sedimentation rate in pneumococcal pneumonia in children; Korppi M et al.; We evaluated the applicability of C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), white blood cell count (WBC), and absolute neutrophil count (ANC), in the screening of pneumococcal (PNC) pneumonia in children . In 1981-1982, 161 children were treated for radiologically verified community-acquired pneumonia in the hospital during a period of 12 months . The Streptococcus pneumoniae aetiology of infection was studied by antigen, antibody and immune complex assays in acute and convalescent sera . In acute blood samples, CRP was measured by the immunonephelometric method, ESR by the Westergren method, WBC using an automatic cell counter, and thereafter the ANC was calculated after microscopic examination of peripheral smears . CRP and ESR were significantly higher in patients with alveolar (n=53) than in those with interstitial (n=108) pneumonia . CRP, ESR and ANC were significantly higher in PNC (n=29) than in viral (n=23) pneumonia . The values in mixed PNC and viral infections (n=17) were approximately midway between PNC and viral cases . All cases with serologic evidence of S . pneumoniae aetiology were combined (n=46) for calculation of diagnostic parameters . When a cut-off limit of 60 mg x L(-1) was used, CRP had a sensitivity of 26% and a specificity of 83% in the screening of PNC pneumonia . We conclude that C-reactive protein and erythrocyte sedimentation rate have a limited capacity to differentiate between pneumococcal and nonpneumococcal pneumonia . C-reactive protein is recommended as the first-line method of screening, and the value of 60 mg x L(-1) as the cut-off limit.

Ophthalmology, 1997 May, 104(5), 816 - 22
Ulcerative keratitis in bullous keratopathy; Luchs JI et al.; PURPOSE: The authors review a large series of patients with bullous keratopathy (BK) to analyze the frequency of ulcerative keratitis, and determine the contributory roles of bullae, bandage soft contact lenses, steroids, and prophylactic antibiotics . METHODS: A retrospective review of all cases of pseudophakic or aphakic bullous keratopathy presenting to the cornea service between January 1, 1986 and September 1, 1995 was performed . The influence of time, bullae, bandage contact lenses, steroids, and prophylactic antibiotics was evaluated by actuarial methods and multivariate analysis . RESULTS: Nine hundred eighteen patients were included in this study, 44 (4.7%) of whom had infectious or inflammatory complications; 813 cases were available for statistical analysis . Steroids (P < 0.0001), bandage soft contact lens use (P = 0.004), and bullae (P = 0.01) had statistically significant independent effect on the risk of developing ulcerative keratitis, and the combination of steroids and bandage lenses yielded the highest risk (P < 0.001) . Propylactic antibiotic use paradoxically had a statistically significant association with ulcerative keratitis in these patients (P = 0.01) . Increasing BK time was also associated with ulcer development, and the risk remained relatively constant over the 60 months of the study . Streptococcus was the most frequent organism cultured . CONCLUSIONS: Ulcerative keratitis developed in 4.7% of patients with bullous keratopathy . Prolonged BK time alone was a risk factor for infection . The strongest single additional risk factor for ulcer development was steroid use, followed by bandage soft contact lens use, and their simultaneous use had the greatest effect . The presence of bullae was also a risk factor for infection, and prophylactic antibiotic use did not prevent ulcer development.

Nippon Rinsho, 1997 May, 55(5), 1266 - 71
{The possibility of drug design of quinolones effective for multiresistant gram-positive pathogens}; Hayakawa I; Recently rapid increase in the emergence of multiresistant Gram-positive pathogen such as MRSA, penicillin resistant Streptococcus pneumoniae (PRSP), and vancomycin resistant Enterococcus (VRE) . Whether quinolone antibacterial agent (quinolone) come to a promising drug or not for the treatment of these infectious diseases, it depend on an appropriate drug design of quinolones which have good toxicological and pharmacokinetic profile along with excellent antibacterial activities against these Gram-positive pathogens . In this chapter, we examine the possibility by following the history of the advances in quinolone research.

J Pediatr, 1997 May, 130(5), 814 - 6
Recurrent Streptococcus pneumoniae sepsis in children with sickle cell disease; Hongeng S et al.; Streptococcus pneumoniae sepsis is the most common invasive infection among patients with sickle cell disease . The risk of a recurrent episode of sepsis and subsequent death in those patients who have had a previous septic event is much higher . Patients with sickle disease who have had pneumococcal sepsis should continue penicillin prophylaxis indefinitely and should not be candidates for out-patient management of febrile episodes.

J Fam Pract, 1997 May, 44(5), 499 - 503
Treatment of penicillin-resistant pneumococcus with penicillin: a case report; Spencer J et al.; Antibiotic resistance of Streptococcus pneumoniae is on the rise in many parts of the world, and varies widely across the United States . This is of growing concern as organisms become resistant to cephalosporins and macrolides as well as to beta-lactam antibiotics . Susceptibility testing has become a critical element in antibiotic selection . In vitro susceptibility, however, may not correlate with clinical susceptibility . For example, penicillin G in appropriate doses is often effective therapy for drug-resistant Streptococcus pneumoniae pneumonia . This report takes into account in vitro susceptibility as well as the patient's coexisting morbidities in the treatment of penicillin-resistant S pneumoniae with penicillin G.

J Bacteriol, 1997 May, 179(10), 3342 - 9
A novel resistance mechanism against beta-lactams in Streptococcus pneumoniae involves CpoA, a putative glycosyltransferase; Grebe T et al.; Piperacillin resistance in Streptococcus pneumoniae was mediated by mutations in a novel gene, cpoA, that also confer transformation deficiency and a decrease in penicillin-binding protein la . cpoA is part of an operon located downstream of the primary sigma factor of S . pneumoniae . The deduced protein, CpoA, and the peptide encoded by the adjacent 3' open reading frame contained domains homologous to glycosyltransferases of procaryotes and eucaryotes that act on membrane-associated substrates, such as enzymes functioning in lipopolysaccharide core biosynthesis of gram-negative bacteria, RodD of Bacillus subtilis, which is involved in teichoic acid biosynthesis, and the human PIG-A protein, which is required for early steps of glycosylphosphatidylinositol anchor biosynthesis . This suggests that the cpo operon has a similar function related to cell surface components.

J Bacteriol, 1997 May, 179(10), 3122 - 6
comYA, a gene similar to comGA of Bacillus subtilis, is essential for competence-factor-dependent DNA transformation in Streptococcus gordonii; Lunsford RD et al.; Tn4001 mutagenesis identified a new competence gene in Streptococcus gordonii Challis designated comYA . A comYA mutant was completely deficient in transformation and exhibited decreased levels of DNA binding and hydrolysis . The deduced 319-amino-acid ComYA protein exhibited 57% similarity and 33% identity to the ComGA transporter protein of Bacillus subtilis and contained the Walker A-box motif conserved in ATP-binding proteins as well as aspartic acid boxes Asp-1 and Asp-2 present in some components of the general secretory pathway of gram-negative bacteria . comYA appeared to be part of a putative operon encompassing a comGB homolog, designated comYB, together with sequences that could encode ComGC- and ComGD-like peptides designated ComYC and ComYD, respectively, as well as other components . The putative ComYC and ComYD peptides had leader sequences similar to the type IV N-methylphenylalanine pilins of gram-negative bacteria, but unlike other examples in this class, including B . subtilis, they contained an alanine at position -1 of the leader instead of the usual glycine residue . Northern analysis identified a single 6.0-kb comYA-containing transcript strictly dependent on exogenous competence factor for expression in ComA1 cells . An identical pattern of expression was seen in wild-type Challis cells grown under conditions of maximal competence but not in cells that were noncompetent.

Am J Otol, 1997 May, 18(3), 298 - 303
Development of tympanosclerosis: can predicting factors be identified?
Forseni M, Eriksson A, Bagger-Sjoback D, Nilsson J, Hultcrantz M.
HYPOTHESIS: The etiological hypothesis is that there might be factors triggering an immunological chain reaction that eventually leads to tympanosclerosis formation . BACKGROUND: Tympanosclerosis is a condition leading to a calcification process in the middle ear and, occasionally, also to the lining of the inner ear . This sometimes leads to hearing loss due to fixation of the middle ear ossicles . In severe cases . deafness may occur as a result of the inner ear impairment . Surgery is the treatment offered, often with poor long-term results, and, alternatively, prescription of hearing aids . Some patients develop tympanosclerosis after mild inflammatory otitis media processes whereas some heal without tympanosclerosis after more aggressive infections . This difference may be due to individual variations in the inflammatory response . The biological mechanism of calcification in tympanosclerosis is probably similar to that occurring in other calcifying tissues due to diseases . METHODS: The present investigation was performed to develop methods for immunohistochemical analyses of this delicate tissue consisting of both hard bone and the very thin tympanic membrane . Sprague-Dawley rats were inoculated with a suspension of Streptococcus pneumoniae, type 3, into the middle ear and sacrificed after 1 week up to 6 months . A new technique was elaborated where the whole specimen was prefixed briefly and then en bloc incubated with the primary antibodies and after that decalcified in edetic acid (EDTA) . Primary antibodies against macrophages were used for the immunohistochemical staining . RESULTS: Acute otitis media was successfully induced in the rats and myringosclerosis was seen in 30% of the animals, often localized close to the bony frame where macrophages could also be detected . CONCLUSIONS: Acute otitis media and myringosclerosis were introduced in the animals . Conventional immunological techniques were tested on this delicate tissue . A new method for immunohistochemical staining was elaborated in which specimens were stained en bloc before decalcification and sectioning were performed . Expression of macrophages was demonstrated in the tympanic membrane.

Laryngoscope, 1997 May, 107(5), 640 - 7
Intracellular reservoir of Streptococcus pyogenes in vivo: a possible explanation for recurrent pharyngotonsillitis; Osterlund A et al.; Numerous theories have been presented that attempt to explain the frequent recurrences of pharyngotonsillitis caused by Streptococcus pyogenes; these recurrences occur after seemingly adequate antibiotic treatment . We previously have demonstrated that Spyogenes can survive for up to 7 days intracellularly in immortalized human respiratory epithelial cells grown in an antibiotic supplemented medium . Viable S pyogenes were externalized and established an extracellular infection, whenever the extracellular antibiotic was removed . We have investigated the presence of intracellular S pyogenes in two in vivo studies using respiratory epithelial cells collected from patients with tonsillitis and the tonsils of asymptomatic carriers . Electron microscopy and immunohistochemistry demonstrated intracellular S pyogenes in pharyngeal epithelial cells in 13 of 14 patients with tonsillitis (93%) . Furthermore, intracellular S pyogenes were found in macrophage-like cells in eight (73%) and in epithelial cells in four (36%) tonsils from 11 asymptomatic S pyogenes carriers . These in vivo data strongly support the hypothesis that intracellular S pyogenes can constitute a reservoir of bacteria with the potential to cause reinfections.

Laryngoscope, 1997 May, 107(5), 634 - 9
Immune responses against Streptococcus pyogenes in human palatine tonsils; Kerakawauchi H et al.; We investigated cellular immunity against Streptococcus pyogenes in human tonsils by measuring antigen-specific immunoglobulin-secreting cells and the production of cytokines from CD4+ T cells in response to M proteins . The incidence of S pyogenes in tonsils was significantly higher in patients with recurrent tonsillitis (RT) than in patients with tonsillar hypertrophy (TH) . M protein-specific immunoglobulin A (IgA) and immunoglobulin G spot-forming cells were increased in patients with RT compared with patients with TH . In RT the number of M protein-specific IgA spot-forming cells was significantly greater in the S pyogenes-negative subjects than in the S pyogenes-positive subjects . Proliferation of CD4+ T cells and production of interferon-gamma (IFN-gamma) and interleukins -2, -4, -5, and -6 (IL-2, IL-4, IL-5, and IL-6) from those T cells were observed in response to M protein . The concentrations of IFN-gamma and IL-4 were higher in RT than in TH . These findings suggest that S pyogenes is associated with the pathogenesis of RT and that immune responses against M protein may play an important role in preventing the colonization of this bacteria in tonsils.

Antimicrob Agents Chemother, 1997 May, 41(5), 1186 - 9
Trovafloxacin in treatment of rabbits with experimental meningitis caused by high-level penicillin-resistant Streptococcus pneumoniae; Kim YS et al.; The fluoroquinolone trovafloxacin was bactericidal (0.47 +/- 0.23 delta log10 CFU/ml x h after 10 mg/kg of body weight and 0.78 +/- 0.15 delta log10 CFU/ml x h after 30 mg/kg) in the treatment of experimental meningitis caused by a highly penicillin-resistant (MIC and minimum bactericidal concentration = 4 and 4 microg/ml) strain of Streptococcus pneumoniae . Combinations with ampicillin and rifampin were indifferent compared to single drugs.

Antimicrob Agents Chemother, 1997 May, 41(5), 1173 - 4
Ampicillin susceptibilities of vaginal and placental isolates of group B streptococcus and Escherichia coli obtained between 1992 and 1994; Meyn LA et al.; Vaginal group B streptococcus (GBS) and Escherichia coli isolates were tested for their susceptibilities to ampicillin . All 414 GBS isolates tested were susceptible to ampicillin; the MIC at which 90% of the isolates were inhibited (MIC90) was 0.125 microg/ml, and the range was 0.06 to 0.25 microg/ml . The MIC50 for the 342 E . coli isolates tested was 4.0 microg/ml, and 27% were resistant to ampicillin.

Antimicrob Agents Chemother, 1997 May, 41(5), 1166 - 7
Characterization of a mutation in the parE gene that confers fluoroquinolone resistance in Streptococcus pneumoniae; Perichon B et al.; We report a mutation in the parE genes of two in vitro mutants of Streptococcus pneumoniae responsible for low-level resistance to fluoroquinolones . Sequential acquisition of mutations in parE and gyrA leads to higher levels of resistance . This confirms that topoisomerase IV is the primary target of fluoroquinolones in S . pneumoniae.

Antimicrob Agents Chemother, 1997 May, 41(5), 950 - 5
Comparison of the postantibiotic and postantibiotic sub-MIC effects of levofloxacin and ciprofloxacin on Staphylococcus aureus and Streptococcus pneumoniae; Licata L et al.; The postantibiotic subminimum inhibitory concentration effect (PA SME) may simulate in vivo drug exposure more accurately than the postantibiotic effect (PAE) since subinhibitory concentrations of drug persist between antibiotic dosings . In this study, we compared the PAEs and PA SMEs of levofloxacin and ciprofloxacin for clinical isolates of fluoroquinolone-susceptible Staphylococcus aureus and Streptococcus pneumoniae . At two times the MIC, PAEs of levofloxacin were an average of 0.6 h longer than the PAEs obtained for ciprofloxacin for methicillin-susceptible and methicillin-resistant S . aureus strains . The PAEs of levofloxacin and ciprofloxacin ranged from 1.8 to 3.1 and 1.1 to 2.4 h, respectively . Continued exposure of the methicillin-resistant strain to 1/16, 1/8, and 1/4 the MIC resulted in PA SMEs of 6.5, 15.3, and >22.3 h, respectively, for levofloxacin and 3.8, 8.0, and 12.3 h, respectively, for ciprofloxacin . For isolates of S . pneumoniae, at two times the MIC of both fluoroquinolones, the average PAEs of levofloxacin and ciprofloxacin were equivalent: 1.3 h for the penicillin-susceptible isolate and 0.6 h for the penicillin-resistant isolate . Continued exposure of the penicillin-susceptible S . pneumoniae strain to 1/16, 1/8, and 1/4 the MIC resulted in average PA SMEs of 1.0, 1.4, and 2.8 h, respectively, for levofloxacin and 1.8, 2.0, and 2.5 h, respectively, for ciprofloxacin . Continued exposure of penicillin-resistant S . pneumoniae to 1/16, 1/8, and 1/4 the MIC of the same fluoroquinolones resulted in average PA SMEs of 0.6, 1.1, and 2.9 h, respectively, for levofloxacin and 0.6, 1.1, and 1.5 h, respectively, for ciprofloxacin . The PA SMEs observed demonstrate the superior activity of levofloxacin against methicillin-susceptible or methicillin-resistant S . aureus . Although PAEs were similar for the penicillin-susceptible and penicillin-resistant S . pneumoniae strains, the PA SME of levofloxacin at one-fourth the MIC was longer for penicillin-resistant S . pneumoniae.

Antimicrob Agents Chemother, 1997 May, 41(5), 936 - 42
A mutation in the D,D-carboxypeptidase penicillin-binding protein 3 of Streptococcus pneumoniae contributes to cefotaxime resistance of the laboratory mutant C604; Krauss J et al.; Cefotaxime resistance in laboratory mutant C604 of Streptococcus pneumoniae, for which the MIC is 1.5 microg/ml, is independent of alterations in high-molecular-mass penicillin-binding protein (PBP) 1a . Instead, a point mutation in PBP 3, the D,D-carboxypeptidase of this organism, caused a reduced affinity for penicillin and contributed to the decreased susceptibility . The mutation Thr-242 to Ile was located directly adjacent to the triad Lys-239-Thr-Gly, a position known to be important for beta-lactam interaction with high-molecular-mass PBPs and beta-lactamases . This mutation was absent in the PBP 3's of four genetically distinct clinical isolates resistant to high levels of penicillin . None of the pbp3 genes had a mosaic structure, but in three cases there was evidence for a site-specific recombination event within a BOX element immediately downstream of pbp3.

Clin Diagn Lab Immunol, 1997 May, 4(3), 291 - 6
Antigenic characterization of fimbria preparations from Streptococcus mutans isolates from caries-free and caries-susceptible subjects; Perrone M et al.; The adhesion of pathogenic bacteria to the host surface is an essential step in the development of numerous infections, including dental caries . Attachment of Streptococcus mutans, the main etiological agent of human dental caries, to the tooth surface may be mediated by glucan synthesized by glucosyltransferase (GTF) and by cell surface proteins, such as P1, which bind to salivary receptors . Fimbriae on the surfaces of many microorganisms are known to function in bacterial adhesion . Previous studies in this laboratory have initially characterized the fibrillar surface of S . mutans . The purpose of this investigation was the comparison of the antigenic properties of fimbria preparations of S . mutans isolates from five caries-resistant (CR) and six caries-susceptible (CS) subjects . Sodium dodecyl sulfate-polyacrylamide gel electrophoresis analysis of S . mutans fimbrial preparations revealed five major protein bands at 200, 175, 157, 86, and 66 kDa in preparations from CR and CS subjects . Immunoblot analysis indicated the presence of the same major bands recognized by anti-S . mutans fimbria antisera . Furthermore, the 175- and 157-kDa bands were recognized by antibodies to P1 and GTF, respectively . Immunoblot analysis with antisera to the fimbria preparation, to P1, or to GTF indicated that the levels of fimbria-reactive components and P1 and GTF antigens were higher in S . mutans fimbria preparations from CS subjects than in those from CR individuals . For example, four of six fimbria preparations from CS patients had demonstrable P1, and all had GTF . In contrast, only two of five CR fimbrial preparations exhibited P1 and GTF . Enzyme-linked immunosorbent assay demonstrated similar results for levels of GTF antigen in the fimbrial preparations from CR and CS subjects . The results suggest that differences between the compositions of S . mutans fimbriae in CR and CS individuals may play an important role in the virulence of this microorganism in dental caries.

World J Surg, 1997 May, 21(4), 384 - 8; discussion 388-9
Single and multiple pyogenic liver abscesses: clinical course, etiology, and results of treatment; Chou FF et al.; A total of 483 patients with pyogenic liver abscess during the years 1986 to June 1995 were studied at Chang Gung Memorial Hospital in Kaohsiung: 343 were a single abscess and 140 were multiple abscesses . Males were predominantly affected by this disease . Abdominal pain was more frequent with the single abscess than with multiple abscesses, and jaundice was more frequent with multiple abscesses . Blood levels of alkaline phosphatase, bilirubin, and creatinine and the white blood cell count were significantly higher in patients with multiple abscesses than in those with a single abscess; and the hemoglobin level was higher with single abscesses . The single abscess was usually larger than 5 cm, and the multiple abscesses were usually smaller than 5 cm . The single abscess was always located on the right side (72%) and the multiple abscesses always on the right or both sides . Single abscesses mainly had a cryptogenic origin (58.9%) and multiple abscesses a biliary origin (45.0%) . Liver aspirates revealed Klebsiella pneumoniae, Escherichia coli, Streptococcus, Bacteroides, Enterococcus, among others . K . pneumoniae was more often found in a single abscess and E . coli more often in multiple abscesses . Percutaneous catheter drainage and aspiration comprised the main treatment initially, and the failure rate with multiple abscesses was higher than that with single abscesses . Surgical intervention should be considered for multiple abscesses because of the underlying disease . The overall mortality with multiple abscesses (22.1%) was higher than that with a single abscess (12.8%) . Partial hepatectomy produced a low mortality rate for both single and multiple abscesses and should be considered in the presence of severe hepatic destruction by an abscess or a stone.

Chemotherapy, 1997 May-Jun, 43(3), 179 - 81
Increase in high resistance to penicillin of clinical isolates of Streptococcus pneumoniae in Cádiz, Spain; Garcia-Martos P et al.; The aim was to determine the increase and present standing of penicillin-resistant Streptococcus pneumoniae in Cadiz, Spain . We have studied retrospectively a total of 385 strains of S . pneumoniae obtained during the years 1991, 1993 and 1995 . Strains tested were isolated from clinical samples of patients attended at the University Hospital Puerta del Mar of Cadiz, Spain . The resistance rate to penicillin was 71.2% (47.0% in 1991, 72.8% in 1993 and 89.3% in 1995) . The percentage of strains with high resistance was 51.4% . The increase was from 29.4% in 1991 to 75.2% in 1995 . The incidence of penicillin-resistant pneumococci was more marked in nasopharyngeal carrier children (75.8%) than in invasive strains (30.2%) . The increase in high resistance to penicillin in clinical isolates of S . pneumoniae is very pronounced in Cadiz, Spain.

Am J Vet Res, 1997 May, 58(5), 482 - 7
Diversity of Streptococcus agalactiae and Staphylococcus aureus ribotypes recovered from New York dairy herds; Rivas AL et al.; OBJECTIVES: To develop a reference database for characterization of bovine Staphylococcus aureus and Streptococcus agalactiae strains by automated ribotyping and to use it to assess the discriminatory power of this typing procedure and the geographic distribution of Sta aureus and Str agalactiae strains in New York state dairy herds . SAMPLE POPULATION: 22 commercial dairy herds . PROCEDURE: Isolates of Sta aureus and Str agalactiae from bovine milk were identified by standard bacteriologic procedures, then typed by automated ribotyping . Antimicrobial susceptibility of isolates was tested in vitro . Two indicators made from the data were percentage of farms with multiple ribotypes and percentage of single ribotypes found in several geographic regions . Standard bacteriologic diagnosis, automated ribotyping, and determination of antibiograms (Kirby-Bauer method) also were done . RESULTS: Of 50 Sta aureus and 44 Str agalactiae isolates from composite milk samples of 12 and 10 herds, respectively, 18 and 14 ribotypes, respectively, were identified . The discriminatory power of automated ribotyping was approximately 0.96 (Hunter-Gaston's formula) . A higher percentage of herds with Sta aureus had multiple ribotypes . The most common Sta aureus ribotypes tended to have broader geographic distribution . Some Sta aureus ribotypes were significantly associated with antibiotic resistance profiles . CONCLUSIONS: Automated ribotyping appears to characterize bovine strains of bacteria associated with intramammary infections with a high discriminatory index . Potential applications include identification of strains that appear to have broad geographic distribution suggesting interfarm transfer, discrimination between recurrent versus new intramammary infections (ie, for control of Str agalactiae and Sta aureus), and evaluation of antibiotic therapy.

J Immunol, 1997 May 1, 158(9), 4336 - 40
Surfactant protein A-deficient mice are susceptible to group B streptococcal infection; LeVine AM et al.; To determine the role of surfactant protein A (SP-A) in host defense, the murine SP-A locus was targeted by homologous recombination to produce mice lacking SP-A . SP-A -/- and control mice were infected with group B streptococcus (GBS) by intratracheal instillation . Pulmonary infiltration 6 and 24 h following infection was more severe in SP-A -/- than in control mice, and was associated with increased numbers of GBS in lung homogenates . Dissemination of GBS to the spleen was observed more frequently in SP-A -/- mice . Pulmonary infiltration with macrophages was similar in both groups; however, the number of bacteria associated with alveolar macrophages was decreased in the SP-A-deficient mice . There was no detectable compensatory increase in surfactant protein D, the other known pulmonary collectin, in response to GBS instillation . SP-A plays an important role in vivo, enhancing clearance of GBS from the lung and inhibiting systemic dissemination of the organism.

Infect Immun, 1997 May, 65(5), 1956 - 9
Temporal production of streptococcal erythrogenic toxin B (streptococcal cysteine proteinase) in response to nutrient depletion; Chaussee MS et al.; The effects of various growth conditions on the production of streptococcal erythrogenic toxin B (streptococcal pyrogenic exotoxin B {SPE B}) by Streptococcus pyogenes were analyzed . SPE B was detected in broth culture supernatant fluid only during the stationary phase of growth when glucose and other potential carbon sources were depleted from the medium . Additionally, SPE B production was inhibited when the concentration of glucose in the medium was maintained . These results suggest that SPE B is secreted under conditions of starvation and may be involved in nutrient acquisition.

Infect Immun, 1997 May, 65(5), 1767 - 72
The role of nitric oxide in experimental murine sepsis due to pyrogenic exotoxin A-producing Streptococcus pyogenes; Sriskandan S et al.; Nitric oxide (NO) produced by inducible NO synthase (iNOS) mediates hypotension in endotoxemia . In this study, NO induction by a toxin-producing Streptococcus pyogenes isolate, H250, and by recombinant streptococcal pyrogenic exotoxin A (rSPEA) has been examined, both in vitro and in vivo . Streptococcal supernatants, but not rSPEA, induce production of nitrite by murine macrophages when both are coincubated with gamma interferon . Intraperitoneal injection of rSPEA did not cause significant production of NO . However, an elevated level of nitrate in serum was detected in a model of streptococcal fasciitis due to live H250 . iNOS was localized to Kupffer cells, hepatocytes, and renal tubular cells by immunostaining . Administration of a NOS inhibitor, N(G)-monomethyl-L-arginine (L-NMMA), reduced peak concentrations of nitrate in serum but did not affect survival . NO is induced by H250, both in vitro and in vivo, mainly via SPEA-independent mechanisms . In this model, iNOS is expressed predominantly in the liver . Furthermore, in this model L-NMMA is not protective.

J Mol Evol, 1997 May, 44(5), 552 - 72
Molecular evolutionary analysis of the thiamine-diphosphate-dependent enzyme, transketolase; Schenk G et al.; Members of the transketolase group of thiamine-diphosphate-dependent enzymes from 17 different organisms including mammals, yeast, bacteria, and plants have been used for phylogenetic reconstruction . Alignment of the amino acid and DNA sequences for 21 transketolase enzymes and one putative transketolase reveals a number of highly conserved regions and invariant residues that are of predicted importance for enzyme activity, based on the crystal structure of yeast transketolase . One particular sequence of 36 residues has some similarities to the nucleotide-binding motif and we designate it as the transketolase motif . We report further evidence that the recP protein from Streptococcus pneumoniae might be a transketolase and we list a number of invariant residues which might be involved in substrate binding . Phylogenies derived from the nucleotide and the amino acid sequences by various methods show a conventional clustering for mammalian, plant, and gram-negative bacterial transketolases . The branching order of the gram-positive bacteria could not be inferred reliably . The formaldehyde transketolase (sometimes known as dihydroxyacetone synthase) of the yeast Hansenula polymorpha appears to be orthologous to the mammalian enzymes but paralogous to the other yeast transketolases . The occurrence of more than one transketolase gene in some organisms is consistent with several gene duplications . The high degree of similarity in functionally important residues and the fact that the same kinetic mechanism is applicable to all characterized transketolase enzymes is consistent with the proposition that they are all derived from one common ancestral gene . Transketolase appears to be an ancient enzyme that has evolved slowly and might serve as a model for a molecular clock, at least within the mammalian clade.

J Clin Microbiol, 1997 May, 35(5), 1231 - 5
Survey of emm gene sequences and T-antigen types from systemic Streptococcus pyogenes infection isolates collected in San Francisco, California; Atlanta, Georgia; and Connecticut in 1994 and 1995; Beall B et al.; The variable 5' emm (M-protein gene) sequences and T-antigen types were determined from 340 systemic group A streptococcal (GAS) isolates taken from hospitalized patients in San Francisco, Calif.; Atlanta, Ga.; and Connecticut in 1994 and 1995 . Eighty percent of these isolates had emm sequences and T-antigen types in agreement with previously recorded M- and T-antigen associations . Most of the remaining strains either were T nontypeable (11%) or contained emm genes encoding M proteins for which T-antigen associations have not been made (6%) . One newly encountered emm gene, designated ST2974, from each of 13 isolates had the T type 8/25/Imp19 . Another new emm gene, ST2967, from 8 of 11 isolates was T nontypeable . Six other unique emm gene sequences from seven isolates were encountered . Sequencing of the variable region of the emm gene of GAS isolates (emm typing) is effective for surveying the sequence variability of the M virulence protein, and combined with T typing, emm typing is useful for monitoring GAS strain diversity.

J Clin Microbiol, 1997 May, 35(5), 1049 - 53
Virulent strains of Streptococcus suis serotype 2 and highly virulent strains of Streptococcus suis serotype 1 can be recognized by a unique ribotype profile; Smith HE et al.; The ribotype profiles of 42 different Streptococcus suis strains were studied . These strains belonged to five serotypes and differed in their virulence for pigs as well as in the expression of the muramidase-released protein and the extracellular protein factor . For the ribotyping, chromosomal DNAs were digested with EcoRI and were hybridized with a 1,066-bp ribosomal DNA probe . The hybridization patterns showed genetic heterogeneity within and between the serotypes . Pathogenic strains of serotype 2 and highly pathogenic strains of serotype 1 could be recognized by their unique ribotype profiles . Nonpathogenic strains showed a high degree of genetic heterogeneity . Moreover, by comparing the 16S ribosomal DNA sequences of a number of S . suis strains, we were able to design two DNA probes which specifically hybridized with S . suis strains.

Mol Cells, 1997 Apr 30, 7(2), 264 - 71
Cloning and analysis of the DNA polymerase-encoding gene from Thermus caldophilus GK24; Kwon ST et al.; The gene encoding Thermus caldophilus GK24 (Tca) DNA polymerase was cloned into Escherichia coli using the structural gene coding for Thermus aquaticus YT-1 (Taq) DNA polymerase as a hybridization probe . The nucleotide sequence of the cloned DNA was determined . The primary structure of the Tca DNA polymerase was deduced from the nucleotide sequence . The Tca DNA polymerase comprised 834 amino acid residues and its molecular mass was determined to be 93,810 . On alignment of the whole amino acid sequence, Tca DNA polymerase showed a high sequence homology with the E . coli DNA polymerase I-like DNA polymerases, and 86% identity with Taq DNA polymerase, 38% with E . coli and Streptococcus pneumoniae (Spn) DNA polymerase I . An extremely high sequence identity was observed in the region containing the polymerase activity . The codon usage in the Tca DNA polymerase gene was in fact similar to the characteristic usages in the genes for proteins from bacteria of genus Thermus: the G+C content in the third position of the codons was as high as 93% . The Tca DNA polymerase gene was expressed under the control of tac promoter on a high copy plasmid, pTCA in E . coli.

Gene, 1997 Apr 21, 189(2), 255 - 61
Cloning and sequence analysis of zooA, a Streptococcus zooepidemicus gene encoding a bacteriocin-like inhibitory substance having a domain structure similar to that of lysostaphin; Simmonds RS et al.; The nucleotide sequence has been determined for zooA, a gene encoding the bacteriocin-like inhibitory substance zoocin A in Streptococcus zooepidemicus strain 4881 . The zooA gene product corresponds to the 285-amino acid (aa) zoocin A pre-peptide from which a leader sequence is cleaved to form the 262-aa biologically active molecule of estimated molecular mass 27,877 Da . Expression of zooA in a Gram-negative host was shown by the extracellular release from Escherichia coli, containing cloned zooA, of a biologically active peptide having an identical range of anti-bacterial activity to that of zoocin A, purified from S . zooepidemicus strain 4881 . Data base searches revealed sequences having homologies with known muralytic proteins produced by both Gram-positive and Gram-negative bacteria and indicate a 'mix and match' blending of domain-type structures, the C-terminal putative receptor-recognition region of the molecule being joined by a threonine-proline-rich linker to an N-terminal putative catalytic region having homology with several known endopeptidases, including lysostaphin.

MMWR Morb Mortal Wkly Rep, 1997 Apr 11, 46(14), 297 - 9
Surveillance for penicillin-nonsusceptible Streptococcus pneumoniae--New York City, 1995; Molecular cloning and characterization of a cDNA encoding the third putative mammalian hyaluronan synthase; Department of Biochemistry and Molecular Biology, Mayo Clinic Scottsdale, Scottsdale, Arizona 85259, USAWe report the isolation of a cDNA encoding the third putative hyaluronan synthase, HAS3 . Partial cDNAs and genomic fragments of mouse Has3 were obtained using a degenerate polymerase chain reaction approach . Partial clones facilitated the isolation of genomic and cDNA clones representing the mouse Has3 open reading frame . The open reading frame of 554 amino acids predicted a protein of 63.3 kDa with multiple transmembrane domains and several consensus HA binding motifs . Sequence comparisons indicated that mouse Has3 is most closely related to Has2 (71% amino acid identity) and also related to Has1 (57% identity), Xenopus laevis DG42 (56% identity), and Streptococcus pyogenes HasA (28% identity) . Isolation of a genomic fragment of human HAS3 indicated high conservation between mouse and human sequences, similar to those observed for HAS1 and HAS2 . Expression of the mouse Has3 open reading frame in transfected COS-1 cells led to high levels of hyaluronan synthesis, as determined through a classical particle exclusion assay, and by in vitro HA synthase assays . These results suggest that there are three putative mammalian hyaluronan synthases encoded by three separate but related genes which comprise a mammalian hyaluronan synthase (HAS) gene family.

Eur J Epidemiol, 1997 Apr, 13(3), 287 - 91
Simultaneous influenza and pneumococcal vaccination in elderly individuals; Grilli G et al.; The study was performed to evaluate the effects of influenza and pneumococcal vaccines administered alone or in combination . 124 elderly subjects living in community were vaccinated either with influenza split vaccine or with pneumococcal 23-valent or with both vaccines at the same time in different sites . Sera were tested for hemoagglutination inhibiting antibodies for influenza and for antibodies against 23-valent vaccine for streptococcus pneumoniae . No side effects were observed in the vaccinated population . Serological results indicated that influenza vaccine increased significantly antibody levels . No difference was observed between the group which received influenza vaccine alone and that which received influenza and pneumococcal vaccines associated, considering either G.M.T or the percentages of protected individuals or the percentages of subjects who seroconverted . When pneumococcal vaccine was administered at the same time with influenza vaccine, there was a not statistically significant reduction in both mean antibody concentration and mean fold increase . It is concluded that the simultaneous administration of influenza and pneumococcal vaccines to elderly individuals, including subjects at risk, is safe, effective and economically advantageous.

Rev Clin Esp, 1997 Apr, 197(4), 245 - 7
{Polymicrobial endocarditis: a clinical and evolutive study of 12 cases diagnosed during a 10-year period}; Valencia Ortega ME et al.; Polymicrobial endocarditis (PE) is uncommon, whether in series of cases of polymicrobial bacteriemia or of endocarditis . Among the 201 cases of infective endocarditis seen between 1986 and 1995 by an infectious diseases service, 12 patients had PE (6%) . Nine were males, mean age was 28 years and ten were active intravenous drug users . All of them were HIV (+) and 50% had AIDS . Eleven subjects had infection of the tricuspid valve and 58% developed septic pulmonary emboli . The most common organism encountered was Staphylococcus aureus in 8 patients followed by Streptococcus viridans and S . pneumoniae in three . The most common combinations of organisms were S . aureus and S . pneumoniae in 3 cases and S . aureus and Pseudomonas aeruginosa in two . Two patients died, one with Xantomona maltophilia and another with Candida albicans . The symptoms of PE were usually indistinguishable from endocarditis caused by a single organism and the prognosis depended on the species rather than the number of organisms isolated.

Eur J Drug Metab Pharmacokinet, 1997 Apr-Jun, 22(2), 141 - 4
Tonsillar diffusion kinetics of amoxycillin after oral administration of 1 g to adults; Chomarat M et al.; Although amoxycillin is widely used to treat pharyngo-tonsillitis, the kinetics of tonsillar diffusion have rarely been studied . The aim of this work was to study the kinetics of amoxycillin diffusion in the tonsils of adults, by measuring tonsillar concentrations 1.5, 3, 6 and 12 h after oral administration of 1 g of amoxycillin (Clamoxyl dispersible tablet, 1 g) relative to concomitant serum levels by using an HPLC method and a microbiological technique . At enrollment, the 20 patients were randomly divided into four groups of five, corresponding to the time intervals (1.5, 3, 6 or 12 h) between the third amoxycillin intake and the start of surgery . The results given by the two assay methods correlated well (r = 0.92-0.99) . Amoxycillin showed excellent penetration into the tonsils, with both tonsillar and serum concentrations exceeding the MIC for most pathogens encountered in this setting (including Streptococcus pyogenes), even 12 h after repeated dosing with 1 g of amoxycillin.

Oral Microbiol Immunol, 1997 Apr, 12(2), 82 - 90
Molecular analysis of representative Streptococcus gordonii Spp phase variants reveals no differences in the glucosyltransferase structural gene, gtfG; Vickerman MM et al.; Streptococcus gordonii glucosyltransferase polymerizes sucrose to form glucans, which confer a hard, sucrose-promoted phenotype (Spp+) to colonies on sucrose agar plates . The glucosyltransferase structural gene, gtfG, is positively regulated by the upstream determinant, rgg . Strain Challis undergoes a spontaneous, reversible phase variation between high (Spp+) and low (Spp-) levels of glucosyltransferase activity . Representative strains were examined to gain insights into the basis of glucosyltransferase phase variation . Western blots indicated that the level of glucosyltransferase activity was related to the amount of extracellular glucosyltransferase protein produced by Spp- and Spp+ strains . The nucleotide sequence of rgg and gtfG of the Spp- strain CH97 was found to be identical to that of the Spp+ parent, indicating that DNA differences in these regions are not the basis for glucosyltransferase phase variation . Indeed, 13C-NMR spectroscopy suggested that glucans synthesized by strain CH97 glucosyltransferase were similar to those synthesized by glucosyltransferase of the Spp+ parental strain, indicating a quantitative rather than qualitative change . However, one Spp- strain, CH1C1, had a point mutation in rgg; replacement of the parent rgg with the CH1C1 allele resulted in decreased levels of glucosyltransferase protein and activity . The results indicate that glucosyltransferase phase variation can occur in more than one way, and suggest that glucosyltransferase regulation may involve distally located regulatory gene(s) that affect rgg and/or gtfG expression.

Oral Microbiol Immunol, 1997 Apr, 12(2), 77 - 81
Effect of sodium and potassium ions on intracellular pH and proton excretion in glycolyzing cells of Streptococcus mutans NCTC 10449 under strictly anaerobic conditions; Iwami Y et al.; The effect of sodium and potassium ions on intracellular acid production and acid excretion by glycolyzing cells of Streptococcus mutans was examined . S . mutans NCTC 10449 grown under glucose-limited and strictly anaerobic conditions in a continuous culture system was loaded with bis(carboxyethyl)-carboxyfluorescein, a pH-sensitive fluorescent dye, washed and suspended in 0.00-0.30 M NaCl/KCl solution . The dye allowed for the continuous monitoring of intracellular pH while proton excretion was measured simultaneously with a pH-stat . Sodium ions inhibited and potassium ions, at low pH, accelerated the amount of measurable acid excreted extracellularly . In the presence of both NaCl and KCl, proton excretion following the addition of glucose was slightly higher or similar to that observed in the presence of 0.15 M KCl alone . Sodium and potassium ions did not affect the proton-ATPase enzyme or the intracellular level of ATP, suggesting that these ions did not directly effect proton pumping activity itself . The inhibition of proton excretion by sodium ions was considered to have probably occurred as a result of an indirect inhibition of proton-ATPase activity by the low intracellular pH induced by sodium ions.

Med Vet Entomol, 1997 Apr, 11(2), 187 - 92
Summer mastitis experimentally induced by Hydrotaea irritans exposed to bacteria; Chirico J et al.; Summer mastitis is an acute suppurative bacterial infection of the udder in heifers and dry cows . To ascertain the possible role of flies in the transmission of the disease, experimental exposures of recipient heifers to Hydrotaea irritans previously exposed to bacteria were carried out . Flies were allowed to feed on secretions from clinical cases of summer mastitis . The pathogens present were the bacteria Staphylococcus aureus, Streptococcus dysgalactiae, Actinomyces pyogenes, Stuart-Schwan cocci, Peptococcus indolicus, Fusobacterium necrophorum and Bacterioides species . The teats of eight heifers were exposed to flies with verified pathogen content . Two teats of each animal were deliberately damaged before fly exposure . One teat was cut, another pricked with insect needles to mimic insect bites . Two of the heifers developed summer mastitis in the quarters where teats had been cut . The bacterial species isolated from these quarters corresponded to those that had previously been fed to the flies . For the first time, it is now demonstrated that H.irritans is capable of transmitting summer mastitis pathogens and so causing summer mastitis in recipient heifers . Lesions on the teat orifice may be a predisposing factor in the development of the disease.

Arch Oral Biol, 1997 Apr, 42(4), 317 - 22
Influence of fluoride co-cystallized with sugar on caries development in desalivated rats; Rosalen PL et al.; Previous studies have shown that fluoride (F) administered concomitantly with sucrose in drinking water, in the diet, or alone is an effective cariostatic agent . The purpose of the present study was to determine the minimum concentration of F co-crystallized with sugar that may be used to prevent dental caries in rats subjected to a severe cariogenic challenge . Desalivated Sprague-Dawley rats, infected with Streptococcus sobrinus, were placed in a Konig-Hofer programmed feeder . The rats received 17 meals daily for 21 days as follows: group (1) sucrose and sterile distilled water (s.d.w.); (2) sucrose and 1 part/10(6) F-water; (3) 1 part/10(6) F-sucrose and s.d.w.; (4) 4 parts/10(6) F-sucrose and s.d.w.; (5) 8 parts/10(6) F-sucrose and s.d.w.; (6) sucrose and 10 parts/10(6) F-water . Essential nutrition was administered by gavage . At death, blood was collected from each animal and one-half of the lower jaw was sonicated in 0.9% saline solution for microbial assessment and F analysis . Keyes smooth-surface and sulcal caries scores were significantly lower in the groups that received 10 parts/10(6) F-water and 8 parts/10(6) F-sucrose than in all other groups . The F concentration in the jaw suspension and plasma were significantly higher in the 10 parts/10(6) F-water and the 8 parts/10(6) F-sucrose groups than in all other groups . The total cultivable flora and Strep . sobrinus populations were lowest in F groups but this did not reach statistical significance . It is concluded that 8 parts/10(6) F co-crystallized with sucrose reduces the cariogenic potential of sugar as effectively as 10 parts/10(6) F in water, that is as little as 1 part/10(6) in sucrose has a significant effect, and that this cariostatic action is related to the amount of F in the oral environment.

An Esp Pediatr, 1997 Apr, 46(4), 383 - 8
{Characteristics of group b streptococcus vertical transmission}; Andreu Domingo A et al.; OBJECTIVE: The goal of this study was to compare the characteristics of group B streptococcus (GBS) or Streptococcus agalactiae vertical transmission in woman, receiving or not intrapartum . antimicrobial prophylaxis, at risk of delivering an infant with GRS disease . MATERIALS AND METHODS: The study included 330 women, with risk factors for delivering an infant with GBS disease . The vaginal GBS colonization was studied by conventional culture . A clinical and microbiological follow-up was done in both women and neonates . RESULTS: GHS was detected in 37 women (11.2%) . Among these, 21 (56.8%) received intrapartum antibiotics and 16 (43.2%) did not . Forty-one neonates were born from these 37 women . Of these, 11 showed signs of infection (3 with positive blood culture and 8 with blood culture negative for GBS) and 2 presented an asymptomatic bacteremia A GBS neonatal infection (with positive blood culture) was produced in 4.8% of newborns from mothers who received intrapartum antibiotics versus 25% of newborns from mothers who did not receive intrapartum antibiotics . However, this difference was not significant nor was the difference between external colonization by GBS between these two groups of newborns . On the contrary, significant differences were found in the percentage of clinically suspected sepsis (with negative blood cultures), which was more frequent among newborns from mothers without intrapartum antibiotics (30.4% vs 5.6%) . A good correlation between the intensity of vaginal colonization and the incidence of microbiologically demonstrated sepsis, suspected sepsis an asymptomatic bacteremia in the newborn was found . CONCLUSION: In conclusion, in order to minimize the vertical transmission of GBS, the most efficient strategy seems to be to offer antibiotic prophylaxis to women identified as GBS carriers, since the antibiotic administration to women with "obstetric risks" often means that it is impossible that two hours elapse between antibiotic administration and delivery, resulting in the loss of efficacy of this second strategy.

An Esp Pediatr, 1997 Apr, 46(4), 378 - 82
{Evaluation of three rapid methods for intrapartum detection of group B streptococcus}; Andreu Domingo A et al.; OBJECTIVE: The goal of this study was to evaluate three methods for rapid group B streptococcus (GBS) intrapartum vaginal detection . MATERIALS AND METHODS: In 330 women, at risk of delivering an infant with GBS disease, vaginal exudates were collected and a culture performed . The following rapid tests were also performed: 1) Equate Strep B immunoassay in 133 samples . 2) Icon Strep B immunoassay in 192 samples . 3) Co-agglutination with Phadebact Strep B, with a previous incubation (> 4 hours) of the vaginal swabs in Lim Group B Strep broth, in 88 samples . In some patients, two of these methods were performed simultaneously . RESULTS: GBS was detected in 37 women (11.2%) by culture . The sensitivity of Equate Strep B was 47%, Icon Strep B was 35% and co-agglutination with Phadebact Strep B was 38% . The specificity was 91%, 99% and 100% for each one of these methods . PPV 44%, 90% and 100%, respectively and NPV 92%, 91% and 90%, respectively . CONCLUSION: In conclusion, none of these methods was shown sensitive enough to be used for the routine detection of GBS . Therefore, in order to know the GBS carrier status and prevent its vertical transmission, the practice of vaginal culture during late pregnancy is mandatory.

Vet Med (Praha), 1997 Apr, 42(4), 101 - 9
{A method for estimating the prevalence of mammary Staphylococcus aureus and Streptococcus agalactiae infections in herds based on an examination of bulk milk samples}; Benda P et al.; Parallel quantitative determination executed in 92 herds at 107 sampling dates was focused on the counts of major pathogens (Staphylococcus aureus, Streptococcus agalactiae) in bulk milk samples and on the prevalence of the above pathogens in a herd by examination of individual milk samples . The counts of main pathogens were also determined in terms of quantity in rinsing water before milking and in bulk samples in 5 herds with pipeline milking . Tab . I shows the qualitative analysis of the relation . Sensitivity of the method is satisfactory for the pathogens observed (95% and 91%, resp.), but method is less specific for Staph . aureus (67% against 92% Str . agalactiae) . Figs . 1 and 2 show coordinate graphs of the results obtained while Figs . 3 and 4 document the distribution of frequency of the particular values in data sets . The values do not exhibit normal distribution (P < 0.01) . Spearman's coefficient of rank correlation of bulk milk and individual examinations amounted to 0.823 and 0.900 for Staph . aureus and Str . agalactiae, respectively . Four mathematical models were tested in the course of quantitative analysis, describing the relation between bulk milk examination and individual examination: (1) linear regression, (2) linear regression with fixed starting point, (3) logarithmic regression and (4) irrational function . A model based on the equation of irrational function (4) was found to be best: y = a + bx + c square root of x + k +/- a1 + i(t)c1 square root of x + k1 . Tab . II shows the parameters of the equation for examined microorganisms . Correlation coefficients for the above equation are r = 0.733 and r = 0.842 for Staph . aureus and Str . agalactiae, respectively . Prediction curves (Figs . 5 to 8) and confidence regions of prediction curves were also determined for the best model, and a prediction table was constructed (Tab . III) . It was confirmed that the milking machines were not a significant source of direct contamination of bulk milk samples with the examined pathogens (Tab . V).

J Nat Prod, 1997 Apr, 60(4), 378 - 81
Spinonin, a novel glycoside from Ononis spinosa subsp . leiosperma; Kirmizigul S et al.; The roots of Ononis spinosa subsp . leiosperma (Leguminosae) afforded a new glycoside, spinonin (1), possessing a novel skeleton, in addition to the known isoflavonoid glycoside, ononin {7beta-(glucosyloxy)formononetin} (2) and the known pterocarpan, 7-demethoxy-7-D-(glucosyloxy)homopterocarpin (3) . The structure of the new isolate was elucidated by spectral methods including 1H and 13C NMR, COSY, APT, HETCOR, HMBC, NOESY, CD, FABMS, HRMS, EIMS, CIMS, and some chemical reactions . Spinonin was inactive against a number of human cancer cell lines and HIV-1 reverse transcriptase . The compounds 1 and 3 showed weak activity against Pseudomonas aeruginosa, whereas 2 was active against beta-hemolytic Streptococcus.

Eur J Clin Microbiol Infect Dis, 1997 Apr, 16(4), 311 - 4
Assessment of the oxacillin disk screening test for determining penicillin resistance in Streptococcus pneumoniae; Doern GV et al.; The 1 microgram oxacillin disk diffusion screening test was performed on 1516 recent clinical isolates of Streptococcus pneumoniae obtained in a 1994-1995 U.S . surveillance study and the results compared to penicillin MICs determined using a standardized broth microdilution method . The oxacillin disk screening method failed to distinguish penicillin-resistant strains from those that were intermediately susceptible . Furthermore, a high percentage (11.1%) of penicillin-susceptible strains, for which MICs of penicillin were usually 0.06 or 0.03 microgram/ml, yielded zone diameters of < or = 19 mm with the oxacillin screen test and thus would have been falsely categorized as being resistant to penicillin.

Gene Ther, 1997 Apr, 4(4), 375 - 7
Immunization with a plasmid expressing pneumococcal surface protein A (PspA) can elicit protection against fatal infection with Streptococcus pneumoniae; McDaniel LS et al.; Pneumococcal surface protein A (PspA) is a protectioneliciting protein of Streptococcus pneumoniae . We observed that immunization of BALB/c mice with a plasmid expressing PspA significantly protected the mice from lethal challenge with S . pneumoniae when compared to control mice that received injections of the plasmid vector alone . The plasmid construct expressing PspA has been designated pKSD2601 . Mice immunized intramuscularly with pKSD2601 had a mean log of colony-forming units of 2.67 +/- 0.25 pneumococci circulating in their blood at 24 h after challenge as compared with control mice that had a mean log of colony-forming units of 4.95 +/- 0.59 . Those mice with lower numbers of pneumococci subsequently survived the challenge . Given the quantitative nature and ultimate end point (ie live versus dead) our mouse model should be useful in working out optimum expression of bacterial genes for DNA immunization.

Kansenshogaku Zasshi, 1997 Apr, 71(4), 313 - 7
{Clinical study on penicillin insusceptible/resistant Streptococcus pneumoniae in the elderly patients}; Takahira K et al.; Clinical features of respiratory infection in the elderly with penicillin insusceptible (31 cases) and resistant (7 cases) Streptococcus pneumonia (PSSP/PRSP) are compared to those with penicillin sensitive S . pneumoniae (PSSP) (29 cases) . Incidence of bacteremia and pneumonia was higher in the PSSP group . PISP/PRSP tend to be isolated from patients with bronchitis underlaid with chronic pulmonary disease without statistic significance . Efficacy of the penicillins and 1st and 2nd generation cephem was satisfactory except in only one case of pneumonia with PISP which needed an alternative choice to the 3rd generation cephem . Now a day the degree of resistance is not so high and the available antibiotics are sufficient for the treatment of pneumococcal infection in the elderly patients . However, the wide use of oral cephems and certain new quinolones which do not have enough activity against Streptococcus pneumoniae may increase resistance . In which case, continuous surveillance and clinical caution against this resistant strain is necessary.

Tijdschr Diergeneeskd, 1997 Apr 1, 122(7), 190 - 2
{Vitamin E as a possible aid in the control of disease problems on pig farms: a field test}; Lamberts FJ; In two sow-herds problems with weaning-diarrhoea and Streptococcus suis meningitis were successfully controlled by strategic use of antibiotics during the post-weaning period . In an attempt to reduce the intake of antibiotics by farm animals, the vitamin E level in the post-weaning diet was increased from 20 IE/kg to 80 IE/kg, because vitamin E is thought to increase resistance . The effect on both farms was stunning, so a small field trial was started . In this trial the higher level of vitamin E had a statistically significant beneficial effect on weaning-diarrhoea . The author concludes that in some cases an increased level of vitamin E can have a positive effect on disease management on pig-farms and can lead to reduced use of antibiotics.

J Clin Microbiol, 1997 Apr, 35(4), 985 - 7
Infected abdominal aortic aneurysm due to penicillin-, ceftriaxone-, and cefotaxime-resistant Streptococcus pneumoniae; Albrecht WE et al.; The clinical course for a patient hospitalized with pneumonia and meningitis due to penicillin-, ceftriaxone-, and cefotaxime-resistant Streptococcus pneumoniae is described . The pneumonia and meningitis responded to antimicrobial therapy, but the patient died following rupture of an infected abdominal aortic aneurysm; gram-positive cocci resembling S . pneumoniae were detected within the aneurysm.

Respir Med, 1997 Apr, 91(4), 201 - 6
Rapid detection of pneumococcal antigen in lung aspirates: comparison with culture and PCR technique; Ruiz-Gonzalez A et al.; Detection of pneumococcal antigen has been used to increase the rate of diagnosis of pneumococcal pneumonia . The present study was designed to determine the value of rapid detection of pneumococcal antigen in samples obtained by transthoracic needle aspiration (TNA) from patients with community-acquired pneumonia (CAP) in a comparative analysis with culture and polymerase chain reaction (PCR) . Pneumococcal antigen was detected by latex agglutination . One hundred and ten consecutive patients diagnosed with CAP underwent TNA . Patients were grouped, according to PCR, culture and serological results, into pneumococcal pneumonia (n = 18), other known aetiology (n = 67) and unknown aetiology (n = 25) . In patients with pneumococcal pneumonia, antigen was detected in 17 (94.4%) cases . Antigen was detected in one and nine patients with pneumonia of other known or unknown aetiologies, respectively, yielding a specificity of 89.1% . In conclusion, detection of pneumococcal antigen on samples obtained by TNA from patients with CAP provides a sensitive and specific diagnosis of Streptococcus pneumoniae infection . Furthermore, its rapid results would reduce the dependence on empirical treatments.

Respir Med, 1997 Apr, 91(4), 193 - 9
Aetiology of pneumonia following isolated closed head injury; Cazzadori A et al.; Patients undergoing mechanical ventilation (MV) after an isolated closed head injury (ICHI) have often been found to develop hospital-acquired pneumonia (HAP) well before subjects who require MV for different reasons . In a prospective study of patients receiving MV after an ICHI . 38 subjects (out of 65 with clinically suspected HAP) had a bacteriological diagnosis established on the basis of correspondence between cultures made from bronchoalveolar lavage and protected specimen brush (with quantitative thresholds of 10(4) and 10(3) cfu ml-1, respectively) . Patients were separated according to the time of onset of HAP, with 20 subjects who developed HAP within 4 days of the start of MV (early onset pneumonia, EOP) and 18 subjects who developed HAP after the fourth day (late onset pneumonia, LOP) . In those who had LOP, an expected spectrum of organisms was found, with Gram-negatives (especially Pseudomonas sp.) accounting for the majority of isolates . However, in EOP cases, Gram-positive bacteria (especially Staphylococcus sp . and Streptococcus pneumoniae) were found to largely predominate (P = 0.0000026) . This confirms the high incidence of staphylococcal pneumonia in neurosurgery patients, and also provides evidence that the vast majority of such staphylococcal pneumonia are EOP . Unlike most previous reports, the microbiological findings from the present study suggest that a cut-off point of 4 days successfully distinguishes between EOP and LOP . Since these two clinical entities differ significantly in terms of pathogenesis and aetiology, preventive measures and therapeutical protocols have to be tailored accordingly.

Postgrad Med J, 1997 Apr, 73(858), 222 - 4
Pneumococcal vaccine; Hattotuwa KL et al.; Streptococcus pneumoniae is a frequent cause of pneumonia and meningitis . This article looks at the pneumococcal vaccine, its uses, efficacy, and adverse effects and how vaccination may be improved . We also look at the role of the new conjugate vaccines.

Clin Infect Dis, 1997 Apr, 24(4), 710 - 2
Streptococcus suis infection complicated by purpura fulminans and rhabdomyolysis: case report and review; Tambyah PA et al.; Streptococcus suis infection, an important zoonotic occupational disease in humans, is associated with meningitis, arthritis, and perceptive deafness . We report a case of severe S . suis infection in a previously healthy man who developed purpura fulminans and rhabdomyolysis, complications not previously reported with this disease.

Biosci Biotechnol Biochem, 1997 Apr, 61(4), 588 - 91
Chemical and functional properties of mutastein, an inhibitor of insoluble glucan synthesis by Streptococcus sobrinus; Hayashida O et al.; Mutastein, a potent inhibitor of insoluble glucan synthesis by Streptococcus sobrinus, is a protein with a molecular weight of approximately 2 x 10(6) . Amino acid and ELISA analyses suggested that mutastein is a mixture of heterogenous polymers of alpha-casein contained in the culture medium of the producing strain, Aspergillus terreus M3328 . Mutastein strongly inhibited the primer-dependent insoluble glucan synthase of S . sobrinus B13 . The primer-independent soluble glucan synthase was not affected by mutastein while primer-dependent soluble glucan synthase was slightly activated.

J Trop Pediatr, 1997 Apr, 43(2), 65 - 70
Neonatal sepsis in Karachi: factors determining outcome and mortality; Bhutta ZA et al.; Neonatal sepsis is a major cause of morbidity and mortality among newborns in the developing world . In a consecutive cohort of 292 infants with culture proven neonatal sepsis, the mortality was 68 (22 per cent) . We analysed the association of predisposing factors, clinical, and laboratory characteristics of the infected newborns with mortality by univariate methods and logistic regression analysis . Comparatively higher rates of mortality were seen among home-delivered newborn infants and those referred from other maternity facilities . The mortality was significantly higher among infants weighing < 1500 g and those with birth asphyxia (P < 0.05) . The overall mortality was higher for gram negative infections and the highest case fatality rates were seen in infections with Pseudomonas species (52 per cent) and Streptococcus pneumoniae (100 per cent) . Several clinical features suggestive of septicaemic shock and metabolic derangement were associated with significantly increase risk of death . Of these, the logistic regression model identified hypotensive shock (odds ratio 3.6) and acute renal failure (odds ratio 11.2) as significant factors associated with risk of death . Our data suggest that delayed presentation and recognition of neonatal sepsis is associated with rapid development of multiorgan dysfunction and increased risk of mortality.

Mol Microbiol, 1997 Apr, 24(1), 191 - 202
Analysis of the interaction between the bacterial superantigen streptococcal pyrogenic exotoxin A (SpeA) and the human T-cell receptor; Kline JB et al.; Streptococcus pyogenes that produces the bacterial superantigen streptococcal pyrogenic exotoxin A (SpeA) is associated with outbreaks of streptococcal toxic shock syndrome (STSS) in the United States and Europe . SpeA stimulates V beta 2.1, 12.2, 14.1, and 15.1-positive T cells, and the lymphokine production from the activated T cells is believed to result in the symptoms associated with STSS . The T-cell receptor (TCR)-SpeA interaction is crucial for superantigenic activity, and studies were undertaken to determine regions of both SpeA and the TCR involved in the formation of MHC/SpeA/TCR complexes . Previously, recombinant toxins encoded by speA alleles 1, 2, and 3 as well as toxins resulting from 19 distinct point mutations in speA1 were generated . Here, these 22 toxin forms were incubated with human peripheral blood mononuclear cells (PBMCs), and the percentages of T-cell blasts bearing V beta chains 2.1, 12.2, and 14.1 were quantified by flow cytometry . The analysis indicates that the residues of SpeA needed for a productive TCR interaction differ for each V beta chain examined . An amino acid substitution at only one site significantly affected the toxin's ability to stimulate V beta 2.1-expressing T cells, three individual amino acid substitutions resulted in significant loss of ability to stimulate V beta 12.2-expressing T cells, and substitution at 13 individual sites significantly affected the ability to stimulate V beta 14.1-expressing T cells . To elucidate the regions of the V beta chains that interacted with SpeA, synthetic peptides representative of the human V beta 12.2 complementary-determining regions (CDRs) 1, 2, and 4 were used to block the SpeA-mediated proliferation of human PBMCs . The CDR1, CDR2 and CDR4 peptides were each able to block proliferation, with the activity of CDR1 > CDR2 > CDR4 . Combinations of CDR1 peptide with CDR2 or CDR4 peptides allosterically enhanced the ability of each to block proliferation, suggesting SpeA has distinct binding sites for the CDR loops.

Microb Pathog, 1997 Apr, 22(4), 227 - 34
Insertional inactivation of streptolysin S expression is associated with altered riboflavin metabolism in Streptococcus pyogenes; Liu S et al.; Transposon Tn916 mutagenesis was used to create a mutant of Streptococcus pyogenes M type 3, designated ISS417, in which the ability to produce streptolysin S (SLS) and several other exoproteins was impaired . Concomitantly, the mutant became dependent upon riboflavin for growth and was able to grow in Todd Hewitt broth (THB) when supplemented with riboflavin or riboflavinrich yeast extract . The parent strain was apparently able to utilize THB-derived components as a substitute for riboflavin, while the mutant was not . Although the parent strain grew well in synthetic medium, it was unable to produce SLS, except when it was supplemented with a small amount of THB . Thus, a component of THB was able to "trigger" SLS formation in the parent strain . The mutant grew well in this medium, but was unable to produce SLS even when it was supplemented with THB . Southern hybridization analysis revealed that the ISS417 mutant harbours a single transposon insertion in its chromosome . Phage transduction experiments showed that the riboflavin dependency and the inability to make SLS phenotypes are co-transducible . The pleotrophic properties of the ISS417 mutant differ from those reported for insertional inactivation of the mga locus which regulates production of a number of surface proteins in S . pyogenes and the sar locus which regulates production of a number of exoproteins in Staphylococcus aureus . In view of the possibility that there exist a genetic linkage between the riboflavin biosynthetic pathway and expression of the oxygen-stable SLS, we hypothesize that SLS has a role in the growth economy of S . pyogenes.

Microb Pathog, 1997 Apr, 22(4), 209 - 17
Molecular population genetic analysis of a Streptococcus pyogenes bacteriophage-encoded hyaluronidase gene: recombination contributes to allelic variation; Marciel AM et al.; Many strains of the human pathogenic bacterium Streptococcus pyogenes produce hyaluronidase, an enzyme that degrades hyaluronic acid, a major component of the extracellular matrix . Degradation of hyaluronic acid is thought to aid in host tissue invasion and dissemination of S . pyogenes . The molecular population genetics of the bacteriophage-encoded hyaluronidase gene (hyl) was analysed by sequencing the gene from 13 streptococcal strains representing seven well-differentiated multilocus enzyme electrophoretic types and eight M or T protein serotypes . Substantial levels of allelic polymorphism were identified, and the analysis found strong statistical evidence that recombinational processes have contributed to the generation of molecular variation in this gene . A 111 base pair segment of hyl encoding a collagenous motif, that may bind collagen, was absent in a serotype M14 isolate and 13 serotype M18 multilocus enzyme electrophoretic type 20 strains examined . The analysis provides a molecular population genetics framework for studies examining the role of naturally occurring hyaluronidase variation in host-pathogen interactions.

Gene, 1997 Apr 1, 188(2), 279 - 84
Oligonucleotides identify conserved and variable regions of pspA and pspA-like sequences of Streptococcus pneumoniae; Swiatlo E et al.; Pneumococcal surface protein A (PspA) is an immunogenic surface protein of Streptococcus pneumoniae . PspA of S . pneumoniae strain Rx1 is a 65-kDa protein composed of an alpha-helical N-terminus of 288 amino acids followed by an 82-amino-acid proline-rich region, 10 repeats of 20 amino acids each, and a 17-amino-acid C-terminus . It has been demonstrated that the 3'-half of pspA is relatively conserved among unrelated pneumococcal isolates and the 5'-half of the gene is highly variable . Additionally, nearly all pneumococcal strains contain at least one other locus with sequence homology to pspA . In this study oligonucleotides derived from the DNA sequence of pspA of Rx1 were used both as hybridization probes and as primers in the polymerase chain reaction (PCR) to investigate genetic variation within domains of pspA and in the pspA-like sequences from 18 strains representing 12 capsule and 9 PspA serotypes . Sequences encoding the leader peptide, the proline-rich region, and the repeat region are highly conserved among pspA and pspA-like sequences . The alpha-helical coding domain is highly diverse among pspA and pspA-like sequences of different strains.

Hum Immunol, 1997 Apr 1, 53(2), 206 - 15
Streptococcus pyogenes type 5 M protein is an antigen, not a superantigen, for human T cells; Degnan B et al.; M proteins are coiled-coil dimers expressed on group A streptococcal cell surfaces . They have an important role in host antistreptococcal immunity and in poststreptococcal autoimmune sequelae . Controversy has arisen regarding whether type 5 M proteins are superantigenic for human T cells . To investigate this, we have produced and tested M5 in the form of two novel recombinant proteins . We found no evidence of superantigenicity using either recombinant whole M5 protein (rM5) or recombinant pep M5 protein (rpepM5) to activate peripheral blood mononuclear cells (PBMC) from healthy adult volunteers . Short-term, rM5-specific T-cell lines from different subjects were uniformly self-APC restricted and showed no consistent pattern of TCR V beta usage . A synthetic peptide of M5 residues 217-237 was found to contain epitope(s) recognized by some rM5-specific human T cells . PBMC responses to rM5 and rpepM5 in 3- and 7-day proliferation assays were characteristic of antigenic rather than superantigenic stimulation . We conclude that type 5 M protein activates human T cells as a conventional antigen.

Epidemiol Infect, 1997 Apr, 118(2), 105 - 10
Genetic relationship of penicillin resistant Streptococcus pneumoniae serotype 19B strains in Japan; Yoshida R et al.; Pulsed field gel electrophoresis (PFGE) of the genomic DNA of penicillin resistant serotype 19B Streptococcus pneumoniae was carried out . Thirteen strains form the Nagasaki area and 12 strains from other areas in Japan were examined . Twenty-three strains were resistant to erythromycin, tetracycline and trimethoprim/sulfamethoxazole but susceptible to chloramphenicol . Eight strains were resistant to ceftriaxone . All strains were multiply resistant . Five strains isolated from Nagasaki were indistinguishable from each other by using restriction enzymes Apa I and Sma I . Two strains isolated from other areas were indistinguishable from the above five strains . We could classify 13 Nagasaki strains into 3 groups and the total of 25 Japanese strains into 6 groups . These results suggest that the increasing prevalence of multiply drug resistant S . pneumoniae serotyped 19B in Japan is not due to a single clone, but at least one clone has spread widely in Japan.

Infect Immun, 1997 Apr, 65(4), 1531 - 5
Role of the charged tail in localization of a surface protein antigen of Streptococcus mutans; Murakami Y et al.; To make clear the role of the C terminus of a surface protein antigen (PAc) of Streptococcus mutans, stepwise truncations beginning at the C terminus of PAc were performed by utilizing site-directed mutagenesis . A remarkable increase in the amount of cell-free PAc was observed upon deletion of four or more amino acid residues at the C terminus . On the other hand, the amount of cell surface PAc gradually decreased when increasing numbers (four or more) of amino acid residues were deleted at the C terminus, and deletion of six amino acids involving both the total charged tail and Leu, an amino acid residue immediately upstream of the charged tail, resulted in a drastic reduction in the amount of cell surface PAc . These results indicate that the cytoplasmic charged tail and Leu residue are required for cell surface localization of PAc in S . mutans.

Infect Immun, 1997 Apr, 65(4), 1462 - 7
Characterization of two distinct opsonic and protective epitopes within the alpha C protein of the group B Streptococcus; Kling DE et al.; Group B Streptococcus (GBS) is a major cause of neonatal sepsis, meningitis in early infancy, postpartum endometritis, and serious invasive infections in adults in the United States . We previously cloned, sequenced, and characterized the alpha antigen gene, bca, and showed that the alpha C protein of GBS is a trypsin-resistant, surface-associated polypeptide that contains a signal sequence, a unique N terminus, nine identical tandem repeats, and a C-terminal membrane anchor structure . Polyclonal antiserum raised to the recombinant alpha C protein and an opsonic monoclonal antibody, 4G8, raised to the native protein from GBS have been shown to be protective in a mouse model . The binding site of 4G8 has now been localized to the tandem repeat region of the alpha C protein . To determine whether the N terminus of the alpha C protein contains additional opsonic and/or protective epitopes, the sequence corresponding to the alpha C protein N terminus was subcloned into a pET vector, the expressed peptide from Escherichia coli was purified by Ni2+ affinity chromatography, and rabbit polyclonal antibodies were raised to the purified recombinant peptide . Antibodies to the alpha C protein N terminus were shown to be opsonic by an in vitro opsonophagocytosis assay . In addition, 69% of newborn mouse pups from mothers passively immunized with the antiserum to the recombinant N-terminal polypeptide of the alpha C protein were protected against lethal challenge with GBS A909 . These data indicate that at least two distinct regions of the alpha C protein, the N terminus and the tandem repeat region, contain opsonic and protective epitopes.

Infect Immun, 1997 Apr, 65(4), 1422 - 30
Role of putative virulence factors of Streptococcus pyogenes in mouse models of long-term throat colonization and pneumonia; Husmann LK et al.; To investigate the role of putative virulence factors of Streptococcus pyogenes (group A streptococcus; GAS) in causing disease, we introduced specific mutations in GAS strain B514, a natural mouse pathogen, and tested the mutant strains in two models of infection . To study late stages of disease, we used our previously described mouse model (C3HeB/FeJ mice) in which pneumonia and systemic spread of the streptococcus follow intratracheal inoculation . To study the early stages of disease, we report here a model of long-term (at least 21 days) throat colonization following intranasal inoculation of C57BL/10SnJ mice . When the three emm family genes of GAS strain B514-Sm were deleted, the mutant showed no significant difference from the wild type in induction of long-term throat colonization or pneumonia . We inactivated the scpA gene, which encodes a complement C5a peptidase, by insertion of a nonreplicative plasmid and found no significant difference from the wild type in the incidence of throat colonization . However, there was a small but statistically significant decrease in the incidence of pneumonia caused by the scpA mutant . Finally, we demonstrated a very important effect of the hyaluronic acid capsule in both models . Following intranasal inoculation of mice with a mutant in which a nonreplicative plasmid was inserted into the hasA gene, which encodes hyaluronate synthase, we found that all bacteria recovered from the throats of the mice were encapsulated revertants . Following intratracheal inoculation with the hasA mutant, the incidence of pneumonia within 72 h was significantly reduced from that of the control strain (P = 0.006) . These results indicate that the hyaluronic acid capsule of S . pyogenes B514 confers an important selective advantage for survival of the bacteria in the upper respiratory tract and is also an important determinant in induction of pneumonia in our model system.

Infect Immun, 1997 Apr, 65(4), 1237 - 44
Differences in virulence for mice among Streptococcus pneumoniae strains of capsular types 2, 3, 4, 5, and 6 are not attributable to differences in pneumolysin production; Benton KA et al.; We observed that differences in the in vivo growth kinetics of pneumococcal strains of capsular types 3, 4, 5, and 6 were reminiscent of differences that we had previously reported for type 2 strain D39 and its pneumolysin-deficient mutant, PLN . Capsular type 2 Streptococcus pneumoniae D39 exhibits exponential growth in the blood of XID mice until the death of the mice at 24 to 36 h . In contrast, PLN reaches a plateau in growth that is maintained for several days . Capsular type 3 and 5 strains exhibited exponential growth and caused rapid death of XID mice following intravenous challenge, similar to the observation with D39 . Strains of capsular types 4 and 6 exhibited growth kinetics reminiscent of PLN . Since the observed differences in the pathogenesis of types 3 and 5 compared to 4 and 6 were reminiscent of the effects of pneumolysin deficiency in type 2, we examined the levels of in vitro pneumolysin production for the entire panel of strains . The onset of pneumolysin production in most strains was rapid and occurred near the end of log-phase growth . Differences in in vivo growth patterns of capsular type 2, 3, 4, 5, and 6 strains were not found to be associated with differences in the levels of pneumolysin.

Can J Microbiol, 1997 Apr, 43(4), 315 - 21
Cloning and sequencing of the hyaluronate lyase gene from Propionibacterium acnes; Steiner B et al.; The hyaluronate lyase (hyaluronidase) gene from Propionibacterium acnes was cloned and sequenced . The gene was isolated on an EcoRI-generated 3-kb piece of DNA . Expression was less in Escherichia coli than in P . acnes; in E . coli, active enzyme was only cell associated and not secreted . The gene is 2256-pb long and codes for a protein of 82 kDa . Amino terminal sequencing of the protein of the partially purified gene indicated the presence of a 32-amino-acid leader sequence . The leader sequence showed a membrane-spanning domain and all of the features usually associated with the leader for a secreted protein . The amino acid sequence is predicted to share homology with the hyaluronidase enzymes from Streptococcus pneumoniae, Streptococcus agalactiae, and Staphylococcus aureus . A potential hyaluronate-binding domain was identified and antibody against this domain was inhibitory to the enzyme.

Clin Pediatr (Phila), 1997 Apr, 36(4), 187 - 91
Risk factors for penicillin-resistant systemic pneumococcal infections in children; Doone JL et al.; The purpose of this study was to identify risk factors that may differentiate children who develop systemic infections with resistant strains of Streptococcus pneumoniae from those who develop penicillin-susceptible pneumococcal infections . A retrospective case-controlled study was performed of all patients with positive blood and/or cerebrospinal fluid isolates for S . pneumoniae over a 13 1/2-month period . Patients with penicillin-susceptible strains of S . pneumoniae were compared with those with penicillin-resistant infections in terms of age, race, gender, diagnosis, underlying conditions, antibiotic therapy within 1 month prior to systemic infection, treatment, and outcome . Sixty-nine patients with systemic pneumococcal infections were identified over the study period . Nine (13%) of these patients had infection with a penicillin-resistant isolate . Six of these patients were infected with a relatively resistant strain (MIC 0.1-1.0 microgram/mL) while three were infected with a fully resistant strain (MIC > or = 2.0 micrograms/mL) . There was no difference between the two groups in terms of age, race, gender, underlying diagnosis, treatment, or outcome . Sixty-seven percent of the patients who developed a penicillin-resistant pneumococcal infection had received antibiotics in the month prior to systemic illness versus 4% of those infected with a penicillin-susceptible strain (P < 0.0000097) . In conclusion, when compared with children who develop systemic infection with a penicillin-susceptible strain of S . pneumoniae, children who develop infection with a penicillin-resistant strain are significantly more likely to have received antibiotics within 1 month prior to their illness.

Hear Res, 1997 Apr, 106(1-2), 123 - 36
Tympanic membrane changes in experimental purulent otitis media; von Unge M et al.; The stiffness properties of the gerbil tympanic membrane (TM) were investigated during the early course of experimental purulent otitis media produced by middle ear inoculation (n = 49) with type 3 Streptococcus pneumoniae . In a first approach the acoustic admittance and susceptance were measured in vitro with tympanometry and in a second approach the tympanic membrane displacement in response to static pressure was measured with moire interferometry . A histological assessment of the tympanic membrane was made concurrently . The acoustic admittance and susceptance reduced during the initial days post-inoculation . These reductions seem to correlate with an oedema simultaneously developing in the pars tensa . The pressure-induced displacement increased with time of disease, i.e . the mechanical stiffness of the TM reduced . Local deformation zones, or 'weak spots' appeared in the inferior half of the pars tensa in three out of eight cases measured at 3 or 4 days post-inoculation . The loss of stiffness in the pars tensa may affect the further course of otitis media, and the 'weak spots' are possible precursors of retraction pockets and/or perforations . The stiffness reductions may be caused by changes on a sub-microscopical, molecular level.

Pediatr Infect Dis J, 1997 Apr, 16(4), 400 - 7
Immunologic and clinical correlations in rheumatic fever and rheumatic heart disease; Veasy LG et al.; The intimate relationship of Streptococcus pyogenes and rheumatic fever is well-established, but the precise pathogenesis of rheumatic fever and rheumatic heart disease continues to elude intense investigative efforts by students of the disease worldwide . Technologic advances in molecular biology, not thought possible two decades ago, have given additional insight into the immunologic aspects of the disease . On the clinical side echocardiography has proved to be a marvelous, non-invasive technique to evaluate cardiac anatomy and function . We are now able to gain a closer correlation of the clinical presentation and the autoimmune response . The increased understanding acquired both from the "bench" and the "bedside" are making this perplexing disease somewhat less mysterious . We seem tantalizingly close to grasping a complete understanding of the pathogenesis of rheumatic fever and rheumatic heart disease.

Microb Drug Resist, 1997 Spring, 3(1), 105 - 9
Spread of the serotype 23F multidrug-resistant Streptococcus pneumoniae clone to South Korea; Tarasi A et al.; Thirty-eight antibiotic-resistant isolates of Streptococcus pneumoniae recovered in a hospital in Seoul, Korea, between February 1990 and March 1992 were analyzed for serotype, antibiotic susceptibility patterns, and chromosomal relatedness using pulsed-field gel electrophoretic (PFGE) analysis of SmaI chromosomal digests . Most of the isolates were from sputum samples, and a few strains were from otitis media and meningitis . The great majority of isolates (34 of 38, or 89%) were multiresistant, sharing virtually identical, elevated minimal inhibitory concentration (MIC) values (microgram/ml) for penicillin (1-2), chloramphenicol (12-25), tetracycline (25-30), and sulfamethoxazole/trimethoprim (> 100) . Twenty of the isolates were also resistant to erythromycin, and all isolates were also considered to be resistant to ceftriaxone and cefotaxime (1-2) according to the new breakpoint definitions . The most frequent serotypes were 23F (17 of 38) and 19F(14 of 38); 2 belonged to serotype 15B and 1 of 24F . Of the remaining 4 isolates (2 serotype 3, 1 type 6B, and 1 type 9V) all were resistant to tetracycline and sulfamethoxazole/trimethoprim and with the exception of 1 of the type 3 strains, were also resistant to chloramphenicol . Eleven of the 14 serotype 19F isolates shared a relatively homogeneous PFGE pattern, which was indistinguishable from the PFGE pattern shown by most (12 of 17) of the 23F isolates . The PFGE pattern of these 19F and 23F isolates was also indistinguishable from the PFGE pattern shown by representative multiresistant capsular type 23F isolates from Croatia, Portugal, and New York City and the findings document the extensive geographic spread of this multidrug-resistant S . pneumoniae clone . The data also suggests in vivo capsular transformation of the multiresistant clone from serotype 23F to serotype 19F.

Microb Drug Resist, 1997 Spring, 3(1), 101 - 4
Electrotransformation of Streptococcus pneumoniae: evidence for restriction of the DNA on entry; LeFrancois J et al.; Electrotransformation is a method generally used in biotechnology to introduce recombinant DNA into a wide range of bacteria . However the mechanism of DNA entry is poorly understood . We report that in Streptococcus pneumoniae, a naturally transformable species, electrotransformation efficiently introduces a plasmid replicon . DNA is strongly restricted by the restriction-modification systems DpnI and DpnII which degrade methylated and nonmethylated DNA respectively at GATC sequences . This suggests that in electrotransformation double-strand DNA penetrates into these bacteria without a single-strand step in contrast to natural transformation . Single-strand DNA by itself is able to electrotransform very weakly and linearized double-stranded plasmid DNA yields barely detectable levels of transformants.

Microb Drug Resist, 1997 Spring, 3(1), 89 - 99
Characterization of the capsular polysaccharide biosynthesis locus of Streptococcus pneumoniae type 19F; Paton JC et al.; We have used a combination of plasmid insertion/rescue and inverse Polymerase Chain Reaction (PCR) to clone the region of the Streptococcus pneumoniae type 19F chromosome encoding biosynthesis of type 19F capsular polysaccharide (cps19f), which was then subjected to sequence analysis . The cps19f locus is located in the S . pneumoniae chromosome between dexB and aliA, and consists of 15 open reading frames (ORFs), designated cps19fA to cps19fO, that appear to be arranged as a single transcriptional unit . Insertion-duplication mutants in 13 of the 15 ORFs have been constructed in a smooth type 19F strain, all of which resulted in a rough (unencapsulated) phenotype, confirming that the operon is essential for capsule production . Comparison with sequence databases has allowed us to propose functions for 12 of the cps19f gene products, and a biosynthetic pathway for type 19F capsular polysaccharide . Southern hybridization analysis indicated that cps19fA and cps19fB were the only cps genes found in all 16 S . pneumoniae serotypes/groups tested . The region from cps19fG to cps19fK was found only in members of serogroup 19, and within this cps19fI was unique to type 19F.

Microb Drug Resist, 1997 Spring, 3(1), 73 - 88
A functional analysis of the Streptococcus pneumoniae genes involved in the synthesis of type 1 and type 3 capsular polysaccharides; Garcia E et al.; Type 3 pneumococci produce a capsule composed of cellobiuronic acid units connected in a beta (1-->3) linkage . Cellobiuronic acid is a disaccharide consisting of D-glucuronic acid (GlcA) beta (1-->4) linked to D-glucose (Glc) . The genes implicated in the biosynthesis of the type 3 capsule have been cloned, expressed, and biochemically characterized . The three type 3-specific genes--designated as cap3ABC--are transcribed together . However, the two complete open reading frames located upstream of cap3A are not transcribed and, consequently, are not required for capsule formation . The promoter of the cap3 operon was localized by primer extension analysis . The products of cap3A, cap3B, and cap3C were biochemically characterized as a UDP-Glc dehydrogenase, the type 3 polysaccharide synthase, and a Glc-1-P uridyltransferase, respectively . The Cap3B synthase was expressed in Escherichia coli, and pneumococcal type 3 polysaccharide was synthesized in this heterologous system . When a recombinant plasmid (pLSE3B) containing cap3B was introduced by transformation into encapsulated pneumococci of types 1, 2, 5, or 8, the lincomycin-resistant transformants displayed a binary type of capsule, this is, they showed a type 3 capsule in addition to that of the recipient type . Unencapsulated (S2) laboratory strains of S . pneumoniae also synthesized a type 3 capsule when transformed with pLSE3B . On the other hand, we have cloned and sequenced seven type 1-specific genes (designated as cap1A-G), and their functions have been preliminarily assigned based on sequence similarities.

Microb Drug Resist, 1997 Spring, 3(1), 65 - 72
Structural organization of the Streptococcus pneumoniae chromosome and relatedness of penicillin-sensitive and -resistant strains in type 9V; Gasc AM et al.; Fragmentation of Streptococcus pneumoniae genomic DNA with low-frequency-cleavage restriction endonucleases and separation of the fragments by field-inversion gel electrophoresis (FIGE) provides a DNA-fingerprint of a strain . This method enables us to construct a physical and genetic map of the R6 laboratory strain what will be presented . The origin of replication containing several Dna boxes was located in the dnaA region . It was of interest to compare the profiles of subclones . Two clones of strain R36A (R6 and C13) were cultivated separately for more than 15,000 generations in two laboratories . FIGE profiles differed by only one band . Another R36A descendant, isolated in 1958 by Ravin, strain Rx was of interest since it was deficient in Dpn restriction enzymes and methylases and in the hex B function . Its origin was questionable; its profile is identical to others R6 descendants, demonstrating that Rx is derived from R36A . FIGE analysis was carried out on several penicillin-resistant strains of type 9V because penicillin-resistance in this type increased recently . The profiles of a collection of a number of these resistant isolates were very similar, showing that they result from a clone . The profiles of penicillin sensitive isolates of the same type are very similar to the resistant isolates . This suggests that the 9V type has spread recently from a clone, and the resistance genes have mutated and were selected when penicillin was extensively used.

Microb Drug Resist, 1997 Spring, 3(1), 39 - 52
Ubiquitous distribution of the competence related genes comA and comC among isolates of Streptococcus pneumoniae; Ramirez M et al.; DNA probes specific for the pneumococcal competence regulatory genes comA and comC were used to test the presence of these genes in 214 pneumococcal isolates selected to represent a wide variety of clonal types and genetic backgrounds (as defined by chromosomal macrorestriction patterns and multilocus enzyme analysis), a variety of serotypes, isolation dates (between 1916 and 1996), geographic origins (on four continents), as well as different clinical origins (including both infection sites and colonization sites) . Each isolate gave positive signal with both DNA probes . The comA and comC genes were never on the same SmaI restriction fragment and the comA gene showed a considerable degree of polymorphism from one strain to another . While DNA sequencing of 50 of the isolates have identified three distinct alleles of the comC gene, the number of mutations within the leader peptide were minimal . The results suggest that the mechanism to undergo genetic transformation is widespread within the species of Streptococcus pneumoniae.

Microb Drug Resist, 1997 Spring, 3(1), 19 - 26
Biological properties of pneumolysin; Mitchell TJ et al.; Pneumolysin is a thiol-activated membrane-damaging toxin produced by Streptococcus pneumoniae . The toxin plays a role in virulence of the pneumococcus in animal models of infection . Pneumolysin has a range of biological activity including the ability to lyse eukaryotic cells and to interfere with the function of cells and soluble molecules of the immune system . The use of purified native and mutant toxin and of isogenic mutants of the pneumococcus expressing altered versions of the toxin has allowed the contribution of the various activities of this multifunctional toxin to virulence to be defined.

Am Fam Physician, 1997 Apr, 55(5), 1647 - 54, 1657-8
Resistant pneumococci: protecting patients through judicious use of antibiotics; Dowell SF et al.; Increasing resistance to antimicrobial agents has occurred among many pathogens, but the emergence of resistant Streptococcus pneumoniae will have the greatest impact on the practice of outpatient medicine . Consequences of resistance include complicated management of acute otitis media and meningitis treatment failures . Pneumococci have acquired resistance to penicillin, third-generation cephalosporins and other antibiotics at an alarming rate; in some areas, 25 percent of isolates are nonsusceptible to penicillin . In areas with high resistance rates, the addition of vancomycin to cefotaxime or ceftriaxone is warranted for empiric treatment of bacterial meningitis . Changes in empiric therapy for pneumonia, bacteremia and otitis media may eventually be necessary . Previous antibiotic use is a risk factor for invasive disease with resistant pneumococci . Patients may be best protected by avoiding unnecessary use of antibiotics . Patient education materials as well as recommendations for avoiding the use of antibiotics for some upper respiratory tract infections are currently being developed to help physicians achieve this goal.

FEMS Microbiol Lett, 1997 Apr 1, 149(1), 1 - 10
Molecular biology of the capsular genes of Streptococcus pneumoniae; Garcia E et al.; The polysaccharide capsule of Streptococcus pneumoniae is the main virulence factor of this microorganism . Although the study of the genes responsible for the synthesis of the pneumococcal capsule enabled genetic and molecular analysis, the precise structure, organization, and functioning of these genes have only been investigated very recently . The genes implicated in the production of the type 3 capsule have been sequenced, expressed and their corresponding products biochemically characterized . In addition, partial information on the genes responsible for the biosynthesis of the capsules of pneumococcal types 1, 14 or 19 F is currently available.

Pediatrics . 1997 Apr;99(4):E7.
Nasopharyngeal carriage of penicillin-resistant Streptococcus pneumoniae in children with sickle cell disease; Daw NC et al.; OBJECTIVE: We studied the prevalence of nasopharyngeal (NP) carriage, antimicrobial susceptibilities, and serotypes of Streptococcus pneumoniae (SP) in children with sickle cell disease (SCD) in the Mid-South . In addition, we examined risk factors for NP carriage of penicillin-resistant SP (PRSP) . STUDY DESIGN: Between July 1994 and December 1995, we obtained NP cultures from 312 children with SCD followed at the Mid-South Sickle Cell Center, 208 (67%) of whom were receiving penicillin prophylaxis . RESULTS: Among the 312 patients, colonization with SP occurred in 42 (13%), 30 (71%) of whom were receiving penicillin prophylaxis . Twenty-three of the 42 SP isolates (55%) were resistant to penicillin; 5 of the 23 (22%) were highly resistant . PRSP organisms were also resistant to cefotaxime (43%), trimethoprim-sulfamethoxazole (57%), and erythromycin (22%) . Serotypes 6A, 6B, 14, 19A, and 23F accounted for 19 (90%) of 21 resistant strains . Children who were treated with antibiotics during the preceding month were more likely to carry PRSP than children who were not treated . CONCLUSIONS: There is a high prevalence of NP carriage of PRSP in children with SCD in the Mid-South, which raises concerns regarding the continued effectiveness of penicillin prophylaxis in these children . Further studies on the antimicrobial susceptibilities of resistant organisms and the relationship between NP carriage of SP and invasive disease are needed before developing new recommendations for prophylaxis and treatment.

Drugs, 1997 Apr, 53(4), 700 - 25
Sparfloxacin . A review of its antibacterial activity, pharmacokinetic properties, clinical efficacy and tolerability in lower respiratory tract infections; Goa KL et al.; Sparfloxacin is a fluoroquinolone antibacterial agent with activity against a broad range of Gram-negative and Gram-positive organisms including Streptococcus pneumoniae, one of the main pathogens in community-acquired pneumonia . In this infection, sparfloxacin has shown efficacy similar to that of amoxicillin, erythromycin, roxithromycin, amoxicillin/clavulanic acid and amoxicillin plus ofloxacin, producing clinical cure rates of 80 to 84% assessed by intention-to-treat analyses in European or multinational trials . US studies showed similar results for sparfloxacin to those for erythromycin and cefaclor . Sparfloxacin was also as effective as all other comparator drugs in patients with other lower respiratory tract infections, usually acute exacerbations of chronic obstructive pulmonary disease (COPD) . The profile of adverse effects for sparfloxacin is generally similar to that of other quinolones: gastrointestinal discomfort and CNS effects are the most common in clinical trials . Sparfloxacin causes fewer gastrointestinal disturbances than agents such as amoxicillin and erythromycin and doses not interact with theophylline, an important consideration when treating patients with respiratory disease . Its long elimination half-life permits once-daily dosage regimens . On the other hand, there are infrequent reports of prolonged QTc interval (3% increase) during sparfloxacin therapy . Photosensitivity occurs more frequently than with the other fluoroquinolones (2% of patients in an ongoing postmarketing study and 7.9% of those in US trials), and requires ongoing surveillance . In summary, the good activity of sparfloxacin against S . pneumoniae and other respiratory pathogens supports its use in lower respiratory tract infections, particularly community-acquired pneumonia . Its profile of good efficacy, once-daily dosage, good gastrointestinal tolerability and lack of interaction with theophylline are advantageous, but clinicians and patients must be alert to the possibility of photosensitivity reactions . On this basis, sparfloxacin, when appropriately prescribed, can provide the clinician with a useful alternative treatment option for these common infections.

Dermatol Clin, 1997 Apr, 15(2), 213 - 20
Necrotizing fasciitis . The changing spectrum; Stone DR et al.; Necrotizing fasciitis, by nature of its high inoculum of aggressive bacteria and the depth of the fascial involvement, is one of the most serious infections known to humans . Rapid tissue destruction of skin and fascia, along with bacteremia, is common . The mortality for this disease is much higher than that for cellulitis . Unfortunately, delay in diagnosis occurs commonly . The emergence of toxic shock strains of Streptococcus leading to fasciitis with organ dysfunction makes it necessary to make a rapid diagnosis and institute early antibiotic and surgical interventions.

J Bacteriol, 1997 Apr, 179(8), 2658 - 67
Characterization of the stringent and relaxed responses of Streptococcus equisimilis; Mechold U et al.; The 739-codon rel(Seq) gene of Streptococcus equisimilis H46A is bifunctional, encoding a strong guanosine 3',5'-bis(diphosphate) 3'-pyrophosphohydrolase (ppGppase) and a weaker ribosome-independent ATP:GTP 3'-pyrophosphoryltransferase {(p)ppGpp synthetase} . To analyze the function of this gene, (p)ppGpp accumulation patterns as well as protein and RNA synthesis were compared during amino acid deprivation and glucose exhaustion between the wild type and an insertion mutant carrying a rel(Seq) gene disrupted at codon 216 . We found that under normal conditions, both strains contained basal levels of (p)ppGpp . Amino acid deprivation imposed by pseudomonic acid or isoleucine hydroxamate triggered a rel(Seq)-dependent stringent response characterized by rapid (p)ppGpp accumulation at the expense of GTP and abrupt cessation of net RNA accumulation in the wild type but not in the mutant . Tetracycline added to block (p)ppGpp synthesis caused the accumulated (p)ppGpp to degrade rapidly, with a concomitant increase of the GTP pool (decay constant of ppGpp, approximately 0.7 min(-1)) . Simultaneous addition of pseudomonic acid and tetracycline to mimic a relaxed response caused wild-type RNA synthesis to proceed at rates approximating those seen under either condition in the mutant . Glucose exhaustion provoked the (p)ppGpp accumulation response in both the wild type and the rel(Seq) insertion mutant, consistent with the block of net RNA accumulation in both strains . Although the source of (p)ppGpp synthesis during glucose exhaustion remains to be determined, these findings reinforce the idea entertained previously that rel(Seq) fulfils functions that reside separately in the paralogous reL4 and spoT genes of Escherichia coli . Analysis of (p)ppGpp accumulation patterns was complicated by finding an unknown phosphorylated compound that comigrated with ppGpp under two standard thin-layer chromatography conditions . Unlike ppGpp, this compound did not adsorb to charcoal and did not accumulate appreciably during isoleucine deprivation . Like ppGpp, the unknown compound did accumulate during energy source starvation.

Antimicrob Agents Chemother, 1997 Apr, 41(4), 795 - 801
Treatment of experimental pneumonia due to penicillin-resistant Streptococcus pneumoniae in immunocompetent rats; Gavalda J et al.; A model of pneumonia due to Streptococcus pneumoniae resistant to penicillin was developed in immunocompetent Wistar rats and was used to evaluate the efficacies of different doses of penicillin, cefotaxime, cefpirome, and vancomycin . Adult Wistar rats were challenged by intratracheal inoculation with 3 x 10(9) CFU of one strain of S . pneumoniae resistant to penicillin (MICs of penicillin, cefotaxime, cefpirome, and vancomycin, 2, 1, 0.5, and 0.5 microg/ml, respectively) suspended in brain heart broth supplemented with 0.7% agar . The rats experienced a fatal pneumonia, dying within 5 days and with peak mortality (70 to 80%) occurring 48 to 72 h after infection, and the bacterial counts in the lungs persisted from 8.87 +/- 0.3 log10 CFU/g of lung at 24 h of the infection to 9.1 +/- 0.3 log10 CFU/g at 72 h . Four hours after infection the animals were randomized into the following treatment groups: (i) control without treatment, (ii) penicillin G at 100,000 IU/kg of body weight every 2 h, (iii) penicillin G at 250,000 IU/kg every 2 h, (iv) cefotaxime at 100 mg/kg every 2 h, (v) cefpirome at 200 mg/kg every 2 h, and (vi) vancomycin at 50 mg/kg every 8 h . Two different protocols were used for the therapeutic efficacy studies: four doses of beta-lactams and one dose of vancomycin or eight doses of beta-lactams and two doses of vancomycin . Results of the therapy for experimental pneumonia caused by penicillin-resistant S . pneumoniae showed that initially, all the antimicrobial agents tested had similar efficacies, but when we prolonged the treatment, higher doses of penicillin, cefotaxime, and cefpirome were more effective than penicillin at lower doses in decreasing the residual bacterial titers in the lungs . Also, when we extended the treatment, vancomycin was more efficacious than penicillin at lower doses but was less efficacious than higher doses of penicillin or cefpirome . The model that we have developed is simple and amenable for inducing pneumonia in immunocompetent rats and could be used to explore the pathophysiology and to evaluate optimal therapy of this infection in the immunocompetent host.

Antimicrob Agents Chemother, 1997 Apr, 41(4), 781 - 4
Comparative study of bactericidal activities, postantibiotic effects, and effects of bacterial virulence of penicillin G and six macrolides against Streptococcus pneumoniae; Fuursted K et al.; In this report, we present MIC, bactericidal activity, postantibiotic effect (PAE), and in vivo infectivity data for postantibiotic-phase pneumococci . We compared and evaluated penicillin G and six macrolides, erythromycin, azithromycin, clarithromycin, dirithromycin, roxithromycin, and spiramycin, against 10 strains of pneumococci with various levels of susceptibility to penicillin . All of the agents, except azithromycin, exhibited a bactericidal effect (a > or = 3 log10 decrease in the number of CFU per milliliter) after 4 h of exposure to a concentration equal to 10 times the MIC, displaying the following hierarchy: spiramycin = penicillin G = erythromycin = dirithromycin = clarithromycin = roxithromycin > azithromycin . The bactericidal rate of penicillin G was significantly lower for resistant strains (MIC, > or = 2 microg/ml), while bactericidal rates of macrolides were unaffected by penicillin susceptibility . A PAE was induced in all of the strains by all of the antibiotics after exposure for 1 h to a concentration equivalent to 10 times the MIC . The mean duration of PAEs varied between 2.3 and 3.9 h, showing the following hierarchy: spiramycin = dirithromycin = clarithromycin = erythromycin = roxithromycin > azithromycin > penicillin G . Virulence studies were performed with immunocompetent mice by intraperitoneal inoculation of virulent, penicillin-susceptible serotype 3 pneumococci which had been pre-exposed to penicillin G or a macrolide for 1 h . A significant decrease in the virulence of postantibiotic-phase pneumococci was induced only by erythromycin, azithromycin, dirithromycin, and spiramycin, displaying 5.9-, 7.1-, 4.2-, and 3.6-fold increases in the 50% lethal dose (LD50) compared to a control suspension, respectively . No significant correlation could be demonstrated between the LD50 and the MIC, bactericidal activity, or PAE duration . These results suggest that antimicrobial interaction with host defenses in terms of virulence might be a significant parameter that could influence the drug or drug regimen of choice.

Antimicrob Agents Chemother, 1997 Apr, 41(4), 739 - 42
Study of use of cefdinir versus cephalexin for treatment of skin infections in pediatric patients . The Cefdinir Pediatric Skin Infection Study Group; Tack KJ et al.; Three hundred ninety-four patients, aged 6 months to 12 years, entered a multicenter, randomized, controlled, investigator-blind study comparing cefdinir, 7 mg/kg of body weight twice a day, with cephalexin, 10 mg/kg four times a day, each given for 10 days . The most common infections treated were impetigo and secondary infection of preexisting dermatitis . The most common pathogens isolated were Staphylococcus aureus and Streptococcus pyogenes . Two hundred thirty-one patients were microbiologically evaluable . Microbiologic eradication rates were 164 of 165 pathogens (99.4%) in the cefdinir group and 152 of 156 pathogens (97.4%) in the cephalexin group (P = 0.14) . Clinical cure rates were 116 of 118 patients (98.3%) in the cefdinir group and 106 of 113 patients (93.8%) in the cephalexin group (P = 0.056) . Sixteen percent of cefdinir patients and 11% of cephalexin patients experienced adverse events (P = 0.11), the most common being diarrhea, which affected 8% of the cefdinir group and 4% of the cephalexin group . Cefdinir appears to be an effective and well-tolerated agent for the treatment of uncomplicated skin and skin structure infections in pediatric patients.

J Infect Dis, 1997 Apr, 175(4), 979 - 82
Serotype-related differences in inflammatory response to Streptococcus pneumoniae in experimental meningitis; Engelhard D et al.; It has been suggested that serotype influences severity of experimental pneumococcal meningitis . This hypothesis was tested with strains of serotypes 1, 5, 6B, 7F, 14, and 23F, prevalent in Israel, in an experimental rabbit model . Cerebrospinal fluid (CSF) bacterial titers, leukocyte densities, concentrations of lactate, protein, and glucose, tumor necrosis factor-alpha levels, brain water content, and cerebral blood flow were measured 18 h after inoculation of pneumococci . Serotypes 5 and 7F exhibited mild inflammatory responses (leukocytosis <1000/mm3, lactate <4 mmol/L); types 6B, 14, and 23F showed severe inflammatory responses (leukocytosis >5000/mm3, lactate >10 mmol/L); serotype 1 had intermediate inflammatory responses but exceptionally high CSF bacterial titers . Leukocyte count correlated with all other variables; lactate with all except brain water content . On the basis of 6 Streptococcus pneumoniae serotypes, three discrete levels of inflammatory responses could be delineated in experimental pneumococcal meningitis.

J Infect Dis, 1997 Apr, 175(4), 975 - 8
Responsiveness of human immunodeficiency virus type 1-infected Kenyan women with or without prior pneumococcal disease to pneumococcal vaccine; Janoff EN et al.; In East Africa, Streptococcus pneumoniae is a common and serious, but potentially preventable, human immunodeficiency virus type 1 (HIV-1)-associated pathogen . For 54 HIV-1-infected women, baseline levels of capsule-specific antibody to 2 of 4 pneumococcal serotypes were lower than levels in 15 seronegative women (P < .05) . After immunization, specific antibody to all 4 serotypes increased in HIV-1-infected and -uninfected women (P < .05) . Convalescent levels for 2 of 4 serotypes were greater in seronegative women, but the levels were not different between HIV-1-infected women with (n = 21) or without (n = 33) prior invasive pneumococcal disease . The baseline functional activity to kill S . pneumoniae type 14 was lower in HIV-1-infected than -uninfected women but also rose significantly in all groups after immunization . It is concluded that HIV-1 infection in Kenyan women is associated with decreased levels of natural antibody to selected pneumococcal capsular serotypes, but the vaccine is immunogenic in these patients who are at high risk of invasive pneumococcal disease.

J Infect Dis, 1997 Apr, 175(4), 839 - 46
Intranasal immunization of mice with PspA (pneumococcal surface protein A) can prevent intranasal carriage, pulmonary infection, and sepsis with Streptococcus pneumoniae; Wu HY et al.; Many pathogens, including Streptococcus pneumoniae, are carried asymptomatically on the nasopharyngeal mucosa and spread among individuals by close contact . Clinical disease results when pneumococci escape from the mucosa and invade sterile sites . Although systemic immunity can prevent invasive disease, control of person-to-person spread is probably dependent on immunity acting at the mucosal surface . Intranasal immunization of mice with PspA (pneumococcal surface protein A) or a capsular 6B polysaccharide-tetanus toxoid conjugate induced mucosal and systemic antibody responses and provided long-lasting protection against carriage of S . pneumoniae . Resistance to carriage was dependent on mucosal rather than systemic immunity and was effective against heterologous strains of heterologous PspA types . Intranasal immunization with PspA also protected against systemic infection following intravenous, intratracheal, and intraperitoneal challenge.

J Bacteriol, 1997 Apr, 179(7), 2348 - 55
Translation initiation factor IF2 of the myxobacterium Stigmatella aurantiaca: presence of a single species with an unusual N-terminal sequence; Bremaud L et al.; The structural gene for translation initiation factor IF2 (infB) was isolated from the myxobacterium Stigmatella aurantiaca on a 5.18-kb BamHI genomic restriction fragment . The infB gene (ca . 3.16 kb) encodes a 1,054-residue polypeptide with extensive homology within its G domain and C terminus with the equivalent regions of IF2s from Escherichia coli, Bacillus subtilis, Bacillus stearothermophilus, and Streptococcus faecium . The N-terminal region does not display any significant homology to other known proteins . The S . aurantiaca infB gene encodes a single protein which cross-reacted with antiserum to E . coli IF2 and was able to complement an E . coli infB mutant . The S . aurantiaca IF2 is distinguished from all other IF2s by a sequence of 160 residues near the N terminus that has an unusual composition, made up essentially of alanine, proline, valine, and glutamic acid . Within this sequence, the pattern PXXXAP is repeated nine times . Complete deletion of this sequence did not affect the factor's function in initiation of translation and even increased its capacity to complement the E . coli infB mutant.

Commun Dis Intell, 1997 Mar 20, 21(6), 73 - 6
Invasive Streptococcus pneumoniae in Perth teaching hospitals, 1990 to 1994; McLaughlin V et al.; Streptococcus pneumoniae causes pneumonia, otitis media and meningitis . Reports of penicillin resistance and the development of vaccines highlight the need for baseline information about pneumococcal disease in Australia . We surveyed Perth teaching hospital laboratory records for the period 1990 to 1994 for isolates of S . pneumoniae recovered from normally sterile sites, and obtained isolate and patient demographic information . Highest rates of invasive disease were found at the extremes of age and were associated with Aboriginality . Isolates were rarely penicillin resistant . Surveillance of invasive pneumococcal disease will be of importance in monitoring the emergence of penicillin resistance and the impact of conjugate vaccines.

Proc Natl Acad Sci U S A, 1997 Mar 18, 94(6), 2454 - 9
Exploring the basis of peptide-carbohydrate crossreactivity: evidence for discrimination by peptides between closely related anti-carbohydrate antibodies; Harris SL et al.; To investigate the molecular basis of antigenic mimicry by peptides, we studied a panel of closely related mAbs directed against the cell-wall polysaccharide of group A Streptococcus . These antibodies have restricted V-gene usage, indicating a shared mechanism of binding to a single epitope . Epitope mapping studies using synthetic fragments of the cell-wall polysaccharide supported this conclusion . All of the mAbs isolated crossreactive peptides from a panel of phage-displayed libraries, and competition studies indicated that many of the peptides bind at or near the carbohydrate binding site . Surprisingly, the peptides isolated by each mAb fell into distinct consensus-sequence groups that discriminated between the mAbs, and in general, the peptides bound only to the mAbs used for their isolation . Similar results were obtained with polyclonal antibodies directed against synthetic oligosaccharide fragments of the streptococcal cell-wall polysaccharide . Thus, the peptides appear to be specific for their isolating antibodies and are not recognized by the same mechanism as their carbohydrate counterparts.

Biochemistry, 1997 Mar 18, 36(11), 3278 - 92
NMR and molecular dynamics studies of the conformational epitope of the type III group B Streptococcus capsular polysaccharide and derivatives; Brisson JR et al.; The conformational epitope of the type III group B Streptococcus capsular polysaccharide (GBSP III) exhibits unique properties which can be ascribed to the presence of sialic acid in its structure and the requirement for an extended binding site . By means of NMR and molecular dynamics studies on GBSP III and its fragments, the extended epitope of GBSP III was further defined . The influence of sialic acid on the conformational properties of GBSP III was examined by performing conformational analysis on desialylated GBSP III, which is identical to the polysaccharide of Streptococcus pneumoniae type 14, and also on oxidized and reduced GBSP III . Conformational changes were gauged by 1H and 13C chemical shift analysis, NOE, 1D selective TOCSY-NOESY experiments, J(HH) and J(CH) variations, and NOE of OH resonances . Changes in mobility were examined by 13C T1 and T2 measurements . Unrestrained molecular dynamics simulations with explicit water using the AMBER force field and the GLYCAM parameter set were used to assess static and dynamic conformational models, simulate the observable NMR parameters and calculate helical parameters . GBSP III was found to be capable of forming extended helices . Hence, the length dependence of the conformational epitope could be explained by its location on extended helices within the random coil structure of GBSP III . The interaction of sialic acid with the backbone of the PS was also found to be important in defining the conformational epitope of GBSP III.

Ned Tijdschr Geneeskd, 1997 Mar 15, 141(11), 534 - 6
{Spondylodiscitis caused by Streptococcus agalactiae}; Sijpkens YW et al.; Two previously healthy adults, a man aged 69 and a woman aged 51 years, presented with spondylitis caused by Streptococcus agalactiae . One patient had fever and acute pain in the neck, the other progressive pain in the lower back . From cultures of blood and bone respectively . S . agalactiae was isolated . Both patients recovered after treatment with benzylpenicillin . S . agalactiae (group B streptococcus) is a wellknown cause of invasive infections in neonates and pregnant adults . Infections in nonpregnant adults are increasingly reported . Chronic conditions such as diabetes mellitus are strongly associated with disease caused by S . agalactiae.

Eur J Biochem, 1997 Mar 15, 244(3), 913 - 7
Small-angle X-ray scattering analysis of pneumococcal lipoteichoic acid phase structure; Fischer W et al.; X-Ray-scattering analysis was performed on micelles of lipoteichoic acid from Streptococcus pneumoniae . This lipoteichoic acid differs from poly(glycerophosphate) and poly(glycosylglycerophosphate) lipoteichoic acids by a unique positively charged diacylglyceroglycolipid anchor and a complex structure of the hydrophilic chain which is composed of zwitterionic tetrasaccharide ribitol phosphate repeats each carrying two zwitterionic phosphocholine substituents . The size distribution of the lipoteichoic acid micelles was sufficiently homogenous to determine their size and some related molecular parameters by small-angle scattering analysis . Nearly independent on the ionic strength of the aqueous dispersion, an average micelle contained about 150 lipoteichoic acid molecules arranged in a spherical assembly with a diameter of about 23 nm, whereby the hydrophilic region occupied an outer shell of about 8.5 nm thickness . Taken this as the average chain length of LTA in the micelle and 7.2 repeats per chain, each repeat contributed about 1.2 nm to the thickness of the hydrophilic shell as compared to 2.4 nm for a fully extended chain conformation and 1.1 nm estimated for a more helical arrangement {Klein, R . A., Hartmann, R., Egge, H., Behr, T . & Fischer, W . (1994) Carbohydr . Res . 256, 189-222} . A comparison with the micelle of poly(glycerophosphate) lipoteichoic acid of Staphylococcus aureus suggests that the supramolecular structure is largely independent of the structure of the hydrophilic chain and solely dictated by the small cross-sectional area of the diacylglycerol moiety common to all lipoteichoic acids and lipoglycans of gram-positive bacteria.

Zh Mikrobiol Epidemiol Immunobiol, 1997 Mar-Apr, (2), 20 - 3
{A method for preventing experimental pneumococcal infection}; Vishniakova LA et al.; Lethal pneumococcal infection in mice, infected intranasally, can be induced only by highly virulent strains of pneumococci . The introduction of N-acetylglucosamine and/or D-galactose, both 1 hour before the introduction of pneumococci or simultaneously with their introduction, prevented the development of this infection in 83-91% of mice used in the experiment . The use of the mixture of these carbohydrates did not change the level of their activity . These carbohydrates were shown to be capable of protecting mice from the intranasal introduction of 100-1000 LD50 of Streptococcus pneumoniae highly virulent strains, adapted to the respiratory tracts and lungs of mice.

Ann Acad Med Singapore, 1997 Mar, 26(2), 175 - 8
Necrotising fasciitis--an old enemy or a new foe; Li YH et al.; Necrotising fasciitis when described by Meleney was caused predominantly by Streptococcus pyogenes . Since then, there were several reports which confirmed streptococcus as the main organism identified in this disease entity . However, recently there were reports of necrotising fasciitis caused by organisms other than Streptococcus . We analysed 19 cases of necrotising fasciitis seen in the Department of Orthopaedic Surgery over a period of 24 months to see if this disease entity has changed significantly . The patients in our series were between the ages of 19 to 85 years with an average age of 57.2 years . Males were more often affected (16 out of 19) . The majority of the patients have some form of underlying disease (16 out of 19 cases) . There was a trend towards polymicrobial infection and many were resistant to standard antimicrobial therapy . The mortality rate was 21.1% . Our results are comparable to many earlier series.

Onderstepoort J Vet Res, 1997 Mar, 64(1), 25 - 32
Ulcerative pododermatitis in free-ranging African elephant (Loxodonta africana) in the Kruger National Park; Keet DF et al.; The occurrence of severe lameness in adult African elephant bulls in a shrub Mopane (Colophospermum mopane) ecosystem was investigated . Large ulcers in the soles of at least one front foot were seen in each of the recorded cases . Microscopically, the lesion can be described as a severe, chronic-active, ulcerative, bacterial pododermatitis (complicated by hypersensitivity/septic vasculitis) . A variety of bacteria were isolated from these lesions as well as from regional lymph nodes . Streptococcus agalactiae was the most consistent isolate, while Dichelobacter nodosus, the only organism known to be involved with foot disease in domestic ruminants, was isolated from two cases . Contributory factors such as body mass, portal of entry and origin of potential pathogens may have predisposed to the development of the lesions.

Curr Opin Pulm Med, 1997 Mar, 3(2), 89 - 97
Incidence, etiologic pathogens, and diagnostic testing of community-acquired pneumonia; File TM Jr et al.; Determination of the etiologic pathogens of community-acquired pneumonia has been problematic because of the lack of reliable rapid laboratory diagnostic tools as well as the controversy concerning diagnostic criteria . In the studies reviewed here, a specific pathogen was identified in 39% to 88% of patients . Streptococcus pneumoniae remains the most common cause of community-acquired pneumonia . Depending on the demographics of the study, between 2% to 43% of cases have been attributed to legionella or Chlamydia pneumoniae . More recently, other pathogens have emerged, including respiratory syncytial virus in adults, hantavirus, and possibly legionella-like amoebal pathogens and Streptococcus milleri group . Treatment guidelines published by various societies of experts have been helpful, but they cannot replace the need for better and rapid diagnostic techniques.

ASDC J Dent Child, 1997 Mar-Apr, 64(2), 107 - 11
Streptococcus mutans in children using nursing bottles; Kreulen CM et al.; This study aimed at comparing S.mutans in pairs of children within families; both children used a sweetened nursing bottle beyond the dietary need, while one child was affected with nursing bottle caries (NBC), the other not . Seven families were selected . The children of a pair showed no dissimilarities as regards dietary habits . Mean patient-age was 3.7 yrs, controls 5.7 yrs . Saliva and plaque were sampled for CFU-counting and clonal (DNA) type-screening of S.mutans . The NBC-patients harbored significantly more S.mutans than the controls (mean 5.8 CFU/ml vs . 2.9 CFU/ml) . While the controls were colonized with 2-5 clonal types of S.mutans, in the patients only one type was observed . The results were not consistent for NBC-risk assessment by CFU-counting . An inverse relationship between the number of clonal S.mutans types and NBC is suggested.

East Afr Med J, 1997 Mar, 74(3), 151 - 3
Survey of penicillin resistant pneumococci at Kenyatta National Hospital, Nairobi; Ndinya-Achola JO et al.; During a four year period, a survey of antibiotic sensitivity patterns in clinical isolates of pneumococci was conducted at Kenyatta National Hospital, Nairobi . The isolation and characterisation of Streptococcus pneumoniae was done using standard laboratory procedures . Sensitivity testing was by disc diffusion method using discs supplied by Oxoid . During the period, 45 clinical isolates were recorded . This figure is somewhat lower than the expected rate of pneumococcal isolation at the hospital . Penicillin resistance of 24% among the pneumococcal isolates was recorded . Among the antibiotics tested, amoxycillin/clavulanic acid, ceftazidime, erythromycin and chloromphenicol had highest activity against the pneumococci . Surprisingly low sensitivity rates were recorded for trimethoprim/ sulphamethoxazole and cefuroxime . Implications of these findings in the management of pneumococcal infections are discussed.

West Indian Med J, 1997 Mar, 46(1), 25 - 7
Invasive streptococcal infections . Report of four cases occurring in Trinidad; Swanston WH et al.; Many countries are reporting a resurgence of virulent streptococcal strains but there is little information from the Caribbean . Four cases of severe invasive streptococcal infections, three of them fatal, are reported . The portal of entry was infected scabatic lesions in one patient and infected mosquito bites in another patient who developed cellulitis and gangrene; but no portal of entry was detected in the other patients . Group A beta haemolytic Streptococcus (GAS) was isolated from the blood of three patients, one of them GAS M type 3, which had the genome for streptococcal pyrogenic exotoxins A (SPeA) and B (SPeB) . GAS M type 72, which had the genome for SPeB and SPeC, were isolated from the tissues (but not from the blood) of the patient who developed cellulitis and who was the sole survivor . Physicians in the Caribbean must be alerted to the presence of these virulent streptococcal strains, and must be prepared to manage serious invasive disease.

J Infect, 1997 Mar, 34(2), 151 - 3
Streptococcus B meningitis in post-partum; Guerin JM et al.; We report a case of post-partum meningitis due to group B-streptococcus developing 24 h after vaginal delivery . Diagnosis was established by latex agglutination of streptococcus B-antigenes and confirmed by cerebrospinal fluid-culture later on . Clinical and haematological signs of meningitis disappeared after treatment with ampicillin . In a review of the literature we found eight other cases of streptococcal post-partum meningitis . In all of these cases, delivery was vaginal and no antibioprophylaxis was given.

Eur J Clin Microbiol Infect Dis, 1997 Mar, 16(3), 233 - 7
Molecular DNA analysis for differentiation of persistence or relapse from recurrence in treatment failure of Streptococcus pyogenes pharyngitis; Fitoussi F et al.; In the evaluation of treatment failure in group A streptococcal pharyngitis, it is essential to distinguish persistence or relapse with homologous streptococcal strains from the acquisition of new, unrelated strains . Randomly amplified polymorphic DNA analysis and restriction fragment length polymorphism analysis of total DNA were used as epidemiological tools to compare 122 pre- and post-treatment Streptococcus pyogenes isolates obtained from 61 patients . The results obtained by molecular typing showed that bacteriological failures were due to the original strains in 43 cases (70%) and to new strains in 18 cases (30%) . In the present study, restriction fragment length polymorphism analysis of total DNA appeared to be more discriminative than randomly amplified polymorphic DNA analysis . Thus, molecular analysis of DNA is an effective way to distinguish recurrence from persistence or relapse and will be useful in assessing the efficacy of new antibiotic treatments.

Lab Invest, 1997 Mar, 76(3), 375 - 84
Prevention of endotoxemia-induced acute respiratory distress syndrome-like lung injury in rabbits by a monoclonal antibody to IL-8; Yokoi K et al.; We have herein established an endotoxemia-induced acute respiratory distress syndrome (ARDS)-like lung injury administered a sublethal dose of lipopolysaccharide (LPS) intravenously 36 hours after the intratracheal instillation of heat-killed Streptococcus pyogenes (OK-432) . At 36 hours after OK-432 priming, a mild infiltration into the lungs, consisting of a small number of neutrophils and macrophages, was observed without destruction of pulmonary architecture . A subsequent challenge with a sublethal dose of LPS induced pathologic changes characteristic of ARDS--such as extensive edema in alveolar lumina, marked infiltration composed of a large number of neutrophils and a few macrophages, fibrin deposit in alveolar space, and destruction of pulmonary architecture--resulting in severe hypoxemia . Concomitantly, LPS challenge after priming with OK-432 induced a marked elevation of IL-8 levels in serum and bronchoalveolar lavage fluid with local IL-8 production in lungs, as revealed by immunohistochemical analysis . An anti-IL-8 antibody treatment almost completely prevented pulmonary edema, destruction of pulmonary architecture, and impairment in gas exchange as well as neutrophil infiltration in lungs; there was also a significant reduction in the rate of acute lethality . These results provide evidence that IL-8 has a pivotal role in the induction of ARDS associated with endotoxemia, probably by recruiting and activating neutrophils locally.

Can Fam Physician, 1997 Mar, 43, 485 - 93
Reconsidering sore throats . Part I: Problems with current clinical practice; McIsaac WJ et al.; OBJECTIVE: To provide evidence-based answers to clinical questions posed by family physicians about Group A streptococcus pharyngitis and to further understanding of why management is controversial . QUALITY OF EVIDENCE: Evidence from randomized trials was not found for most questions . The most critical information came from high-quality community prevalence studies and criterion standard studies of physician clinical judgement . MAIN FINDINGS: Expert recommendations for physician management are not likely to help prevent rheumatic fever, as most people with sore throats do not seek medical care . Current clinical practices result in overuse of antibiotics because accuracy of clinical judgment is limited . CONCLUSIONS: Costs associated with visits for upper respiratory infections as well as increasing antibiotic resistance necessitate reconsidering the current clinical approach . An alternative management strategy is presented in part 2.

Clin Infect Dis, 1997 Mar, 24(3), 449 - 51
Polymicrobial brain abscess in a patient infected with human immunodeficiency virus; Maniglia RJ et al.; Although intracranial mass lesions that occur as a result of infection have commonly been reported in patients infected with human immunodeficiency virus, polymicrobial pyogenic brain abscess has not been described in this setting . We report the first case of a patient with a polymicrobial brain abscess involving Streptococcus bovis, Fusobacterium necrophorum, Peptostreptococcus, and group G Streptococcus, and we review the relevant world literature.

Clin Infect Dis, 1997 Mar, 24(3), 441 - 6
Emergence of antibody to capsular polysaccharides of Streptococcus pneumoniae during outbreaks of pneumonia: association with nasopharyngeal colonization; Musher DM et al.; Antibody to pneumococcal capsular polysaccharides (PPS) of Streptococcus pneumoniae plays a major role in protecting the host against pneumococcal infection . A variable proportion of healthy adults have antibody to PPS, often in the absence of recognized pneumococcal infection . To determine whether exposure to pneumococci or colonization by pneumococci, or both, stimulates the emergence of antibody to PPS, we studied outbreaks of pneumonia at two military camps . Of the men who were present at a military training camp during an outbreak of pneumonia due to S . pneumoniae serotype 1 but who did not develop pneumonia, 27.8% had IgG antibody to PPS 1, whereas only 3.6% of controls had this antibody . In another outbreak caused by S . pneumoniae serotypes 7F and 8, 35.9% of asymptomatic soldiers who had nasopharyngeal colonization by one of these strains had antibody to the relevant PPS, and another 30.8% who originally did not have antibody developed it within 30 days; thus, 66.7% of these soldiers had antibody to the relevant PPS . These data show that serotype-specific antibody promptly appears following exposure to an outbreak of pneumococcal pneumonia and is probably mediated through acquisition of nasopharyngeal pneumococcal carriage.

Clin Infect Dis, 1997 Mar, 24(3), 356 - 62
A prospective study of the impact of community-based azithromycin treatment of trachoma on carriage and resistance of Streptococcus pneumoniae; Leach AJ et al.; In February 1995, single-dose azithromycin was given to children with trachoma and their household contacts who were children . For children with trachoma, rates of carriage of pneumococci immediately before treatment with azithromycin and 2-3 weeks, 2 months, and 6 months after treatment were 68% (54 of 79), 29% (11 of 38), 78% (29 of 37), and 87% (34 of 39), respectively . The proportion of carriage-positive children with azithromycin-resistant Streptococcus pneumoniae strains was 1 of 54 (1.9%) before treatment and then 6 of 11 (54.5%), 10 of 29 (34.5%), and 2 of 34 (5.9%) at follow-up visits . The profile of pneumococcal serotypes changed after azithromycin treatment . Azithromycin-resistant strains (serotypes 10F, 23A, and 45) were isolated from 1 (1.3%) of 79 pretreatment swab specimens, from 16 (21.3%) of 75 swab specimens collected up to 2 months after treatment, and from 2 (6%) of 32 obtained 6 months after treatment . Mathematical modeling showed a more rapid appearance of azithromycin-resistant pneumococcal strains in previously colonized children than in previously noncolonized children . Thus, it appears that the selective effect of azithromycin allowed the growth and transmission of preexisting azithromycin-resistant strains . More research is needed to clarify the clinical relevance and implications of azithromycin use.

Infection, 1997 Mar-Apr, 25(2), 90 - 4
IL-1beta and IL-6 in community-acquired pneumonia: bacteremic pneumococcal pneumonia versus Mycoplasma pneumoniae pneumonia; Lieberman D et al.; Interleukin-1beta (IL-1beta) and interleukin-6 (IL-6) levels in 20 patients with bacteremic Streptococcus pneumoniae community-acquired pneumonia (CAP) were compared with these cytokine levels in 20 patients with Mycoplasma pneumoniae CAP . All 40 patients survived hospitalization and underwent a follow-up examination one month later . Serum IL-1beta and IL-6 levels were determined by the enzyme immunoassay (EIA) method using commercial kits . In the acute phase of CAP, IL-6 levels were significantly higher in the S . pneumoniae group (p = 0.014), while IL-1beta levels were higher in the M . pneumoniae group (p = 0.046) . In the convalescence phase, the two cytokines were detected in a considerable number of patients in both groups . In this phase, only the level of IL-1beta was significantly higher in the M . pneumoniae group than in the S . pneumoniae group (p = 0.03) . We conclude that the levels of IL-1beta and IL-6 are different between patients with S . pneumoniae-CAP and M . pneumoniae-CAP during the acute phase . In the convalescence phase, cytokine levels remain high in some of the CAP patients, but a significant difference between the groups exists only for IL-1beta . Further studies are required.

J Dairy Sci, 1997 Mar, 80(3), 464 - 70
Herd prevalence and incidence of Streptococcus agalactiae in the dairy industry of Prince Edward Island; Keefe GP et al.; Herd prevalence and incidence of mastitis caused by Streptococcus agalactiae was determined for dairy cattle on Prince Edward Island during December 1992 and June 1994 . For each census, bulk tank milk samples from all dairy herds (n = 452) in the province were tested on two occasions, and the results were interpreted in parallel . The combined sensitivity of the testing protocol was estimated to be 91% . The confirmatory latex agglutination test had previously reported specificities approaching 100% . Therefore, the estimated specificity of the testing protocol was assumed to be 100% . The apparent prevalence of S . agalactiae in December 1992 and in June 1994 was 17.7 and 13.1%, respectively . Based on the characteristics of the test, the estimated true prevalence was 18.9% in December 1992 and 14.4% in June 1994 . Infection with S . agalactiae was associated with elevated bulk tank somatic cell count (SCC) and elevated standard plate counts . Economic losses associated with S . agalactiae were attributed to production losses (associated with bulk tank SCC), milk quality penalties (associated with bulk tank SCC and standard plate count), and decreases in milk quality (associated with bulk tank SCC) . For herds that had been negative for S . agalactiae in December 1992, evaluation in June 1994 yielded an incidence of new infections of 3.51 per 100 herds per year.

J Hosp Infect, 1997 Mar, 35(3), 207 - 14
The surgical team as a source of postoperative wound infections caused by Streptococcus pyogenes; Kolmos HJ et al.; Postoperative wound infection, caused by Streptococcus pyogenes transmitted during the operation from members of the surgical team, is a rare but serious complication of surgery . This study describes three cases, which could be traced to an orthopaedic surgeon, who carried the epidemic strain in this throat . Epidemiological characteristics of 14 other outbreaks, published in the English-language literature, are summarized . In total, these 15 outbreaks involved 136 patients . The overall case fatality rate was 12% . Anaesthesiologists and other assisting staff members were involved more often than surgeons and obstetricians . In outbreaks where an attack rate could be calculated, it was at least 7% . T-28 was the most commonly involved T-type, accounting for seven outbreaks . The anus and vagina were the most common carrier sites in staff members . A combination of penicillin and oral vancomycin seemed to be the most efficient treatment for anal and vaginal carriage . Relapse of carriage could occur several months after apparent eradication, and was often associated with a carrier in the family household.

J Matern Fetal Med, 1997 Mar-Apr, 6(2), 120 - 3
Influence of diabetes on group B Streptococcus colonization in the pregnant patient; Raimer K et al.; To compare the incidence of group B Streptococcus colonization in diabetic (n = 98) and nondiabetic (n = 10) patients, 199 pregnant women were cultured at the vaginal introitus using a standardised technique . Eight diabetic patients had positive findings for group B Streptococcus cultures, and three nondiabetic patients had positive cultures . No significant difference (P = .109) was found in the group B Streptococcus colonization rates between these two groups of patients . In addition, no significant difference was found in the group B Streptococcal colonization rates between gestational and pregestational diabetics (P = .498) . A within-group comparison of diabetic patients revealed that ethnicity (Hispanics versus nonhispanics) did generate a significant difference in the rate of colonization (P = .033) . The results of the present study suggest that there is no substantial evidence to consider diabetes mellitus as a higher risk criterion for group B Streptococcus screening . However, population differences and ethnicity should be noted as important contributing factors when considering the implementation of group B Streptococcus screening protocols for pregnant women.

Pediatr Infect Dis J, 1997 Mar, 16(3 Suppl), S34 - 8
Toward an integrated program for patient care in pediatric infections; Schaad UB; BACKGROUND: Clinicians and scientists have important and complementary roles to play in improving the management of pediatric infectious diseases . The clinician's role is to provide optimal care for the individual patient, whereas the scientist is closely involved in teaching and research . OBJECTIVES: To review the current challenges in the management of childhood infections and the contributions of different groups to meeting these challenges . DISCUSSION: The pattern of infectious diseases in children is constantly changing, emphasizing the importance of microbiologic research in meeting these challenges . In the clinical setting the research results must be applied and integrated in routine practice . The development and successful clinical use of new diagnostic techniques, new antibiotics and new vaccines provide good examples of the teamwork between scientists and clinicians, which is essential for progress in the field of common childhood infectious diseases . The most urgent challenges in this area that now face physicians are the increasing prevalence of antibiotic-resistant bacteria, especially the spread of penicillin-resistant Streptococcus pneumoniae, and the growing numbers of immunocompromised children . Devising and implementing strategies to meet these demands will require a continuing commitment from pediatricians and microbiologists.

Eur J Obstet Gynecol Reprod Biol, 1997 Mar, 72(1), 15 - 8
Legionnaire's disease during pregnancy: a case presentation and review of the literature; Eisenberg VH et al.; Acute pneumonia complicating pregnancy can have serious consequences for both the mother and the fetus . Streptococcus pneumoniae remains the most common bacterial pathogen, but Legionella pneumophila must be considered as well, especially in severe multisystem disease . With severe disease, premature delivery may occur as has been described in the only previous report of Legionnaire's disease during pregnancy . We present here the first report of Legionnaire's disease in pregnancy, resulting in the term delivery of a healthy infant . Also presented is an extensive review of the literature.

Microb Pathog, 1997 Mar, 22(3), 129 - 32
Streptococcus pneumoniae produces a second haemolysin that is distinct from pneumolysin; Canvin JR et al.; Pneumococci are described as alpha-haemolytic but under certain circumstances they produce zones of beta-haemolysis on blood-containing medium . This observation was investigated using wild type strains and a genetically-modified strain unable to produce the haemolytic toxin, pneumolysin . beta-haemolysis was produced by all pneumococci tested . It was not inhibited by anti-pneumolysin antibody but could be inactivated by cholesterol . These data confirm that pneumococci elaborate a second haemolysin, distinct from pneumolysin.

Anal Biochem, 1997 Mar 1, 246(1), 96 - 101
A capillary electrophoretic study on the specificity of beta-galactosidases from Aspergillus oryzae, Escherichia coli, Streptococcus pneumoniae, and Canavalia ensiformis (jack bean); Zeleny R et al.; The specificities of the beta-galactosidases from Aspergillus oryzae, Escherichia coli, Streptococcus pneumoniae, and Canavalia ensiformis (jack bean) have been studied by capillary zone electrophoresis . Various di- and oligosaccharides as well as a biantennary asialo N-glycan were used as substrates . Following enzymatic hydrolysis, the mixtures of substrates and products were derivatized with ethyl 4-aminobenzoate and separated by high-performance capillary electrophoresis in a borate buffer system using uv detection . Baseline separation of the respective peaks was obtained in 4 min, allowing the analysis of a large number of samples . Therefore, initial rates of hydrolysis could be determined . The beta-galactosidase from A . oryzae exhibited minimal activity toward Galbeta1-3GlcNAc . In contrast to the enzyme from S . pneumoniae which is almost specific for beta1-4 linkages, the Aspergillus galactosidase readily hydrolyzed Galbeta1-4GlcNAc and Galbeta1-6GlcNAc . Neither of the four beta-galactosidases acted upon Galbeta1-4(Fucalpha1-3)GlcNAcbeta1-3Galbeta1-4Gl c (lacto-N-fucopentaose III) even though the corresponding nonfucosylated oligosaccharides were good substrates . With the exception of the enzyme from E . coli, the beta-galactosidases degalactosylated a biantennary N-linked oligosaccharide.

Antimicrob Agents Chemother, 1997 Mar, 41(3), 630 - 5
Bactericidal activity of low-dose clindamycin administered at 8- and 12-hour intervals against Staphylococcus aureus, Streptococcus pneumoniae, and Bacteroides fragilis; Klepser ME et al.; Twelve volunteers received 300 mg of clindamycin intravenously (i.v.) or orally (p.o.) administered every 8 h (q8h) or q12h by random assignment over four study periods . Serum bactericidal titers were determined for each regimen against two isolates each of Staphylococcus aureus, Streptococcus pneumoniae (one penicillin-sensitive isolate and one penicillin-resistant isolate), and Bacteroides fragilis . The duration of measurable bactericidal activity over the dosing interval (expressed as a percentage of the dosing interval) was determined for each isolate . No significant differences in the duration of activity were observed between i.v . and p.o . regimens dosed according to the same interval (P > 0.05) . All regimens provided bactericidal activity against S . pneumoniae for 100% of their respective dosing intervals . Against B . fragilis, bactericidal activity was observed for greater than 80% of the dosing interval for each of the regimens . Although a statistically significant difference favoring the q8h i.v . regimen (P < 0.05) was detected, this difference is not believed to be clinically significant . The q8h and q12h regimens provided measurable bactericidal activity against S . aureus for greater than 85 and 50% of the dosing intervals, respectively (P < 0.001) . Clindamycin dosed at 300 mg i.v . or p.o., q8h or q12h, provides adequate coverage against S . aureus, S . pneumoniae, and B . fragilis.

Antimicrob Agents Chemother, 1997 Mar, 41(3), 504 - 10
Abnormal physiological properties and altered cell wall composition in Streptococcus pneumoniae grown in the presence of clavulanic acid; Severin A et al.; Subinhibitory concentrations of clavulanate caused premature induction of stationary-phase autolysis, sensitization to lysozyme, and reductions in the MICs of deoxycholate and penicillin for Streptococcus pneumoniae . In the range of clavulanate concentrations producing these effects, this beta-lactam compound was selectively bound to PBP 3 . Cell walls isolated from pneumococci grown in the presence of clavulanate showed increased sensitivity to the hydrolytic action of purified pneumococcal autolysin in vitro . High-performance liquid chromatography analysis of the peptidoglycan isolated from the clavulanate-grown cells showed major qualitative and quantitative changes in stem peptide composition, the most striking feature of which was the accumulation of peptide species carrying intact D-alanyl-D-alanine residues at the carboxy termini . The altered biological and biochemical properties of the clavulanate-grown pneumococci appear to be the consequences of suppressed D,D-carboxypeptidase activity.

J Bacteriol, 1997 Mar, 179(5), 1563 - 72
Genetic and physiologic analysis of a formyl-tetrahydrofolate synthetase mutant of Streptococcus mutans; Crowley PJ et al.; Previously we reported that transposon Tn917 mutagenesis of Streptococcus mutans JH1005 yielded an isolate detective in its normal ability to produce a mutacin (P . J . Crowley, J . D . Hillman, and A . S . Bleiweis, abstr . D55, p . 258 in Abstracts of the 95th General Meeting of the American Society for Microbiology 1995, 1995) . In this report we describe the recovery of the mutated gene by shotgun cloning . Sequence analysis of insert DNA adjacent to Tn917 revealed homology to the gene encoding formyl-tetrahydrofolate synthetase (Fhs) from both prokaryotic and eukaryotic sources . In many bacteria, Fhs catalyzes the formation of 10-formyl-tetrahydrofolate, which is used directly in purine biosynthesis and formylation of Met-tRNA and indirectly in the biosynthesis of methionine, serine, glycine, and thymine . Analysis of the fhs mutant grown anaerobically in a minimal medium demonstrated that the mutant had an absolute dependency only for adenine, although addition of methionine was necessary for normal growth . Coincidently it was discovered that the mutant was sensitive to acidic pH; it grew more slowly than the parent strain on complex medium at pH 5 . Complementation of the mutant with an integration vector harboring a copy of fhs restored its ability to grow in minimal medium and at acidic pH as well as to produce mutacin . This represents the first characterization of Fhs in Streptococcus.

J Clin Microbiol, 1997 Mar, 35(3), 785 - 7
Serotypes of Streptococcus pneumoniae causing invasive childhood infections in Bangladesh, 1992 to 1995; Saha SK et al.; One hundred sixty-five invasive Streptococcus pneumoniae strains were isolated from children under five at Dhaka Shishu (Children's) Hospital during the period 1992 to 1995 . Ninety-four strains were from cerebrospinal fluid, and 71 were from blood . More than 91% of the strains were isolated from patients aged 24 months or less . Predominant serotypes were, in descending order 7F, 12F, 14, 15B, 18, 5, and 22A . These comprised 70% of all isolates . The marked differences in serotype distribution in different countries indicate the need for a sentinel surveillance study for the countries of South Asia, particularly Bangladesh, China, India, and Pakistan.

J Clin Microbiol, 1997 Mar, 35(3), 777 - 9
Septicemia caused by Streptococcus canis in a human; Bert F et al.; We describe a case of septicemia due to Streptococcus canis in a 77-year-old man . The organism was presumably transmitted from a domestic animal . Ulcers of the lower limbs were the likely portals of entry . The differentiation between Streptococcus canis and Streptococcus dysgalactiae was based on biochemical properties and DNA macrorestriction analysis by pulsed-field gel electrophoresis.

J Clin Microbiol, 1997 Mar, 35(3), 764 - 6
Dot blot assay for the serotyping of pneumococci; Fenoll A et al.; To simplify the serotyping of Streptococcus pneumoniae, a dot bot assay has been developed and compared with the standard quellung reaction in 1,082 isolates . The technique has been demonstrated to be sensitive, specific, easy to perform, and inexpensive . The dot blot assay could be useful when large numbers of pneumococci have to be studied.

J Infect Dis, 1997 Mar, 175(3), 723 - 6
Transmission of Streptococcus pyogenes causing toxic shock-like syndrome among family members and confirmation by DNA macrorestriction analysis; Ichiyama S et al.; Streptococcus pyogenes can cause severe infections, such as toxic shock-like syndrome (TSLS) . The transmission and pathogenesis of TSLS are poorly understood, and information is needed to develop prevention strategies . Four cases were identified in which the organism was transmitted among patients with TSLS and their family members . DNA macrorestriction endonuclease analysis using pulsed-field gel electrophoresis demonstrated the spread of S . pyogenes clones that caused TSLS among the family members . Although 14 persons related to the case-patients experienced only colonization or self-limited disease, 3 developed invasive infections (pneumonia, severe pharyngitis requiring hospitalization, and puerperal sepsis) . These findings indicate that antimicrobial prophylaxis for close contacts of patients with TSLS should be considered and reinforce the need for further studies on epidemic control of TSLS.

J Infect Dis, 1997 Mar, 175(3), 590 - 7
Colonization by Streptococcus pneumoniae among human immunodeficiency virus-infected adults: prevalence of antibiotic resistance, impact of immunization, and characterization by polymerase chain reaction with BOX primers of isolates from persistent S . pneumoniae carriers; Rodriguez-Barradas MC et al.; Pharyngeal colonization by Streptococcus pneumoniae was evaluated in 103 human immunodeficiency virus (HIV)-infected subjects (<200 CD4 cells/microL, 57; > or = 200 CD4 cells/microL, 46) and 39 non-HIV-infected controls who were participants in a vaccine study . At baseline, 7%, 20%, and 10% of subjects in the <200 and > or = 200 CD4 cell groups and in the control group were colonized with S . pneumoniae: Rates at 6 months were 23%, 22%, and 0%, respectively . Of 34 isolates from HIV-infected subjects, 25 were penicillin-resistant and 19 were resistant to > or = 3 antimicrobials; of 8 isolates from controls, 1 was resistant . Resistance to trimethoprim-sulfamethoxazole was significantly higher among HIV-infected subjects with <200 CD4 cells/microL than in those with more CD4 cells . Polymerase chain reaction DNA analysis with BOX primers demonstrated that 12 HIV-infected subjects were persistently colonized with the same S . pneumoniae strain for > or = 1 month compared with none of the controls . HIV-infected subjects were more likely to be persistent pneumococcal carriers and to carry antibiotic-resistant isolates than were non-HIV-infected subjects.

Pediatrics, 1997 Mar, 99(3), 438 - 44
Do oral antibiotics prevent meningitis and serious bacterial infections in children with Streptococcus pneumoniae occult bacteremia? A meta-analysis; Rothrock SG et al.; OBJECTIVE: To determine whether oral antibiotics prevent meningitis and serious bacterial infections in children with Streptococcus pneumoniae occult bacteremia . DATA SOURCES: Using the Medline database, the English-language literature was searched for all publications concerning bacteremia, fever, or S pneumoniae from 1966 to April 1996 . STUDY SELECTION: All studies that included a series of children with S pneumoniae occult bacteremia containing orally treated and untreated groups . Children were excluded from individual studies if they were immunocompromised, had a serious bacterial infection, underwent a lumbar puncture, or received parenteral antibiotics . DATA EXTRACTION: Three authors independently reviewed each article to determine the number of eligible children and the outcome of children meeting entry criteria . DATA SYNTHESIS: Eleven of 21 studies were excluded, leaving 10 evaluable studies with 656 total cases of S pneumoniae occult bacteremia identified . Patients who received oral antibiotics had fewer serious bacterial infections than untreated patients (3.3% vs 9.7%; pooled odds ratio, 0.35; 95% confidence interval, 0.17 to 0.73) . Meningitis developed in 3 (0.8%) of 399 children in the oral antibiotic group and 7 (2.7%) of 257 untreated children (pooled odds ratio, 0.51; 95% confidence interval, 0.12 to 2.09) . CONCLUSION: Although oral antibiotics modestly decreased the risk of serious bacterial infections in children with S pneumoniae occult bacteremia, there was insufficient evidence to conclude that oral antibiotics prevent meningitis . Published recommendations that oral antibiotics be administered to prevent serious bacterial infections in children with possible S pneumoniae occult bacteremia should be reevaluated in light of the lower risk of sequelae from S pneumoniae occult bacteremia and newer data concerning side effects from treatment.

Infect Immun, 1997 Mar, 65(3), 1126 - 30
Antigenicity of a synthetic peptide from glucosyltransferases of Streptococcus mutans in humans; Chia JS et al.; Human salivary immunoglobulin A (IgA) and serum IgG antibodies to the Streptococcus mutans glucosyltransferases (Gtfs) and to a synthetic peptide of 19 amino acids from a conserved region in the Gtfs (residues 435 to 453) were determined in young adults by enzyme-linked immunosorbent assay . Varying levels of antibody to Gtfs were detected in saliva or serum, with significantly higher levels of antibody to GtfD than to GtfB/C or GtfC . Anti-Gtf IgA levels in saliva did not correlate with those of IgG in serum . Caries-free (CF) volunteers exhibited significantly higher salivary IgA antibody levels to the peptide and to GtfB/C or GtfC than did the caries-active (CA) subjects . Preincubation of CF saliva and serum with the peptide inhibited the antibodies to the Gtfs in a dose-dependent manner, whereas preincubation of the samples from the CA group resulted in only partial inhibition . Our results indicated that this 19-amino-acid peptide includes one of the major B-cell epitopes of Gtfs and that CF individuals have higher titers of antibodies than CA subjects.

Infect Immun, 1997 Mar, 65(3), 1083 - 7
Characterization of hemin binding activity of Streptococcus pneumoniae; Tai SS et al.; Streptococcus pneumoniae is a causative agent of bacterial pneumonia, otitis media, meningitis, and bacteremia . It causes considerable morbidity and mortality throughout the world, especially among children, the elderly, and immunocompromised individuals . We have demonstrated previously that the growth of S . pneumoniae is limited under iron-depleted conditions and can be restored by the addition of either hemin or hemoglobin . In the present study, we showed that S . pneumoniae had the ability to bind hemin and that the level of hemin binding activity was not affected by supplementation of the growth medium with iron . Approximately 70 to 80% of the hemin binding activity was mediated by proteinase-resistant components, and the remainder was mediated by proteins . Hemin binding proteins were located in both soluble extract and envelope fractions of pneumococcal cells . By batch affinity chromatography, a major hemin binding polypeptide with an apparent molecular mass of 43 kDa was identified in the cell lysate of S . pneumoniae . Polyclonal antibodies against this polypeptide were raised . By immunoblot analysis, this hemin binding polypeptide was localized in the envelope and did not exhibit any variation in molecular weight among all serotypes tested . The subcellular distribution of hemin binding activity may have functional implications.

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