CLAO J, 2002 Jul, 28(3), 165 - 8 Clinical presentation of microbial keratitis with daily wear frequent-replacement hydrogel lenses: a case series; Venkata N et al.; Microbial keratitis (MK) is a serious complication associated with contact lens wear . In this case series we report three clinical presentations of MK associated with daily-wear monthly-replacement soft contact lenses . All of these patients were using vifilcon A (55% water content, ionic, U.S . Food and Drug Administration {FDA} group IV) monthly-replacement soft contact lenses . A gram-stained smear of the corneal scrapings of two patients showed numerous gram-negative cocci bacilli, and tissue cultures showed significant growth of Pseudomonas aeruginosa . In the third patient, the corneal scrapings showed numerous gram-negative bacilli, along with gram-positive cocci, and tissue culture showed significant growth of Aeromonas species and alpha-hemolytic streptococci . All these cases were resolved by medical therapy . This case series highlights the importance of patient symptoms, clinical features, and microbiologic work-up in making a differentiation between MK and sterile contact lens-induced peripheral ulcer (CLPU) . A high index of suspicion and close follow-up care will avoid misdiagnosis and reduce complications. Int J Med Microbiol, 2002 Jun, 292(1), 37 - 42 Improved methods for typing nontypeable isolates of group B streptococci; Benson JA et al.; Group B streptococci (GBS) are classified by capsular polysaccharide (CPS) type and by cell surface-expressed proteins (c and R) . Isolates lacking detectable CPS are considered nontypeable (NT) although they frequently express surface proteins . Immunological and genetic methods were used to study 91 NT GBS isolates collected during surveillance studies for invasive disease or colonization in pregnant or non-pregnant women and neonates less than seven days of age . CPS production was upregulated by the addition of glucose and sodium phosphate to Todd-Hewitt broth (THB) and cells were extracted using hot HCl or mutanolysin . Extracts were tested with antisera for specific CPS types Ia, Ib, and II - VIII by double immunodiffusion (DD) in agarose . By mutanolysin extraction, 12 (13.2%) of the 91 isolates were typeable . In contrast, only four of these 12 newly typeable isolates tested positive for CPS with the HCl extracts of cells grown in modified THB . DNA was analyzed by pulsed-field gel electrophoresis (PFGE) using SmaI restriction with NT isolates grouped by protein profile to facilitate analysis . PFGE results of the NT isolates were compared to DNA profiles of typeable isolates and were correlated with the DD results . The DNA profiles of the newly typeable isolates were similar to profiles of isolates with corresponding defined CPS type . Of the remaining 78 NT isolates digested by SmaI, 63 (80.8%) had DNA profiles that resembled those of specific types of GBS . These approaches will be useful for classification of NT isolates in continued epidemiological surveillance associated with GBS vaccine trials. Indian J Pediatr, 2002 Jun, 69(6), 513 - 6 Treatment of rheumatic carditis; Saxena A; Rheumatic fever and rheumatic heart disease continue unabated in most of the developing nations, affecting young individuals . Focal outbreaks of smaller magnitude have also been reported since mid 1980s from industrialized western nations, where this disease had almost disappeared . Introduction of penicillin in mid 1940s had markedly changed the natural history of rheumatic fever, although the incidence of rheumatic fever declined in developed nations before that, due to better living conditions . Treatment of rheumatic fever chiefly involves use of antibiotics (penicillin) to eradicate streptococci, and anti-inflammatory drugs like salicylates or corticosteroids . Patients with severe carditis, congestive heart failure and/or pericarditis are best treated with corticosteroids as these are more potent anti-inflammatory agents than salicylates . Salicylates may be sufficient for cases with mild or no carditis . The treatment must be continued for 12 weeks . Several studies have shown that valvular regurgitation, and not myocarditis, is the cause of congestive heart failure in active rheumatic carditis . Therefore surgery with mitral valve replacement or repair is indicated in cases with intractable hemodynamics due to mitral regurgitation . Development of chronic valvular lesion after an episode of rheumatic fever is dependent upon presence or absence of carditis in the previous attack and compliance with secondary prophylaxis . Recurrences due to inadequate penicillin prophylaxis are responsible for hemodynamically significant chronic valvular lesions requiring surgery. Rev Neurol, 2002 May 1-15, 34(9), 840 - 2 {Streptococcus bovis meningitis . An infrequent cause of bacterial meningitis in the adult patient}; Carnero-Fernandez M et al.; INTRODUCTION: Bacterial meningitis in adult patients, produced by streptococci other than Streptococcus pneumoniae, is not common . CASE REPORT: We report the case of a 74 year old male patient with meningitis and endocarditis due to Streptococcus bovis (group D, not enterococcus), sensitive to penicillin (CMI< 0.1 mg/L), with no characteristic clinical or analytical discoveries . A gastrointestinal exploration revealed only diverticles in the colon and two lesions compatible with splenic infarction, observed by using computerised axial tomography of the abdomen . The patient responded favourably to a four week course of antibiotics; he remained asymptomatic, afebrile and culture negative after the therapy was stopped . CONCLUSIONS: In many previously reported cases, there is an association with gastrointestinal illness, endocarditis or oral lesions . Gram staining of the cerebrospinal fluid is usually negative and the neurological signs are often subtle . In the case of bacteraemia, endocarditis or S . bovis meningitis, the presence of an underlying pathology of the colon due to the frequent association between these processes must be ruled out . Treatment with penicillin G is usually sufficient. J Immunol, 2002 Aug 1, 169(3), 1401 - 9 Mitogen-activated protein kinases and NF-kappa B are involved in TNF-alpha responses to group B streptococci; Mancuso G et al.; TNF-alpha is a mediator of lethality in experimental infections by group B streptococcus (GBS), an important human pathogen . Little is known of signal transduction pathways involved in GBS-induced TNF-alpha production . Here we investigate the role of mitogen-activated protein kinases (MAPKs) and NF-kappa B in TNF-alpha production by human monocytes stimulated with GBS or LPS, used as a positive control . Western blot analysis of cell lysates indicates that extracellular signal-regulated kinase 1/2 (ERK 1/2), p38, and c-Jun N-terminal kinase MAPKs, as well as I kappa B alpha, became phosphorylated, and hence activated, in both LPS- and GBS-stimulated monocytes . The kinetics of these phosphorylation events, as well as those of TNF-alpha production, were delayed by 30-60 min in GBS-stimulated, relative to LPS-stimulated, monocytes . Selective inhibitors of ERK 1/2 (PD98059 or U0126), p38 (SB203580), or NF-kappa B (caffeic acid phenetyl ester (CAPE)) could all significantly reduce TNF-alpha production, although none of the inhibitors used alone was able to completely prevent TNF-alpha release . However, this was completely blocked by combinations of the inhibitors, including PD98059-SB203580, PD98059-CAPE, or SB203580-CAPE combinations, in both LPS- and GBS-stimulated monocytes . In conclusion, our data indicate that the simultaneous activation of multiple pathways, including NF-kappa B, ERK 1/2, and p38 MAPKs, is required to induce maximal TNF-alpha production . Accordingly, in septic shock caused by either GBS or Gram-negative bacteria, complete inhibition of TNF-alpha release may require treatment with drugs or drug combinations capable of inhibiting multiple activation pathways. Pesqui Odontol Bras, 2002 Apr-Jun, 16(2), 107 - 14 {Evaluation of surface disinfectants utilized in dentistry}; Silva CR et al.; Surface disinfection is a procedure carried out on the external parts of the dental equipment as well as on other items of the dental office . The aim of this study was to analyze the efficacy of 4 surface disinfectants utilized in dentistry: 77 degrees GL alcohol, phenolic compound (Duplofen), iodophor (PVP-I) and 77 degrees GL alcohol with 5% of chlorhexidine . Four surfaces of the equipment were analyzed in the study (the carter, the washbasin for hand-washing, the headrest of the chair and the external surface of the reflector), and the spray-wipe-spray procedure was carried out . From each surface, samples were collected by means of surface plates containing Mitis Salivarius bacitracin sucrose agar, Sabouraud Dextrose agar with chloramphenicol, MacConkey agar and blood agar, for counting mutans streptococci, Candida yeasts, gram-negative bacteria and total microorganisms, respectively (ufc/plate) . The results were statistically analyzed by means of the Student's t test in order to compare the mean ufc/plate values . The most effective disinfectant was 77 degrees GL alcohol with 5% of chlorhexidine, mainly against gram-positive bacteria . Iodophor and phenolic compound were also effective in microbial reduction . 77 degrees GL alcohol was the least effective product - however, although it is not considered as a surface disinfectant, it produced, in this study, statistically significant microbial reduction after the disinfecting procedure. Pesqui Odontol Bras, 2002 Apr-Jun, 16(2), 101 - 6 The influence of mouthrinses with antimicrobial solutions on the inhibition of dental plaque and on the levels of mutans streptococci in children; Zanela NL et al.; The effect of daily mouthrinses on dental plaque accumulation and on salivary mutans streptococci was investigated in 200 children . The utilized solutions were: a placebo solution composed of mentholated deionized water (group I); 0.12% chlorhexidine gluconate associated to 0.05% sodium fluoride (group II); 0.2% chlorhexidine digluconate (group III), and 0.5% stevioside mixed with 0.05% sodium fluoride, with pH 3.4 (group IV) . In order to verify the effect on plaque formation, the accumulation of plaque was assessed by means of the Loe12 index, at the beginning and at the end of the experiment, whereas the quantification of cariogenic streptococci was accomplished on three saliva samples collected at 3 different moments: before the first mouthrinse, 24 hours after the first mouthrinse and 1 week after the last mouthrinse . The mouthrinsing routine was carried out on a daily basis during 4 weeks . Five milliliters of solution were rinsed during 1 minute . The results revealed 4.10, 26.75, 41.20, and 5.91% of reduction in plaque accumulation for groups I, II, III, and IV, respectively . Comparisons between the groups as to plaque reduction revealed that groups II and III were significantly different from groups I (control) and IV (p < 0.05), but did not differ from each other . The solution utilized by group III was the least accepted by children and, as the solution utilized by group II, caused mild dental pigmentation . There were no statistically significant differences as to the levels of mutans streptococci, probably due to the low initial levels observed in each one of the four groups. Braz J Med Biol Res, 2002 Jul, 35(7), 811 - 8 In vitro antimicrobial activity of a new series of 1,4-naphthoquinones; Riffel A et al.; The antibacterial activity of a series of 1,4-naphthoquinones was demonstrated . Disk diffusion tests were carried out against several Gram-positive and Gram-negative bacteria . The compound 5-amino-8-hydroxy-1,4-naphthoquinone was the most effective, presenting inhibition zones measuring 20 mm against staphylococci, streptococci and bacilli at 50 microg/ml . Methicillin-resistant Staphylococcus aureus and several clinical isolates of this bacterium were also inhibited . Naphthazarin, 5-acetamido-8-hydroxy-1,4-naphthoquinone, and 2,3-diamino-1,4-naphthoquinone were the next most active compounds . The minimal inhibitory concentration of the active compounds was determined against S . aureus, ranging from 30 to 125 microg/ml . All compounds presented a minimal bactericidal concentration higher than 500 microg/ml, indicating that their effect was bacteriostatic . The EC50, defined as the drug concentration that produces 50% of maximal effect, was 8 microg/ml for 5-amino-8-hydroxy-1,4-naphthoquinone against S . aureus, S . intermedius, and S . epidermidis . These results indicate an effective in vitro activity of 5-amino-8-hydroxy-1,4-naphthoquinone and encourage further studies for its application in antibiotic therapy. Microb Pathog, 2002 Jul, 33(1), 23 - 31 Isolation of a putative laminin binding protein from Streptococcus anginosus; Allen BL et al.; Viridans streptococci, including Streptococcus anginosus, are a common cause of infective endocarditis in humans . Adherence mechanisms involved in colonization of non-diseased native valves (present in 40% of native valve endocarditis) are unknown . We have previously shown that an endocarditis isolate of S . anginosus adheres to exposed basement membrane of human and porcine valve tissue in a laminin dependent manner . We now describe the partial purification of an 80 kDa putative laminin binding protein (PLBP) by biochemical methods . Amino acid sequence of PLBP peptides is similar to substrate binding proteins of ABC transporters in other Gram-positive cocci. Oral Microbiol Immunol, 2002 Aug, 17(4), 257 - 62 Adhesion of viridans group streptococci to sialic acid-, galactose- and N-acetylgalactosamine-containing receptors; Takahashi Y et al.; The binding of 10 viridans group streptococci to sialic acid-, galactose (Gal)- and N-acetylgalactosamine (GalNAc)-containing receptors was defined by analysis of the interactions between these bacteria and structurally defined glycoconjugates, host cells and other streptococci . All interactions with sialic acid-containing receptors were Ca(2+)-independent as they were not affected by ethyleneglycoltetraacetic acid (EGTA), whereas all interactions with Gal- and GalNAc-containing receptors were Ca(2+)-dependent . Recognition of sialic acid-, Gal- and GalNAc-containing receptors varied widely among the strains examined, in a manner consistent with the association of each of the three lectin-like activities with a different bacterial cell surface component. Am J Med Sci, 2002 Jul, 324(1), 51 - 3 Apparent failure of endocarditis prophylaxis caused by penicillin-resistant Streptococcus mitis; Hall GE et al.; Antibiotic resistance among viridans streptococci has increased with Streptococcus mitis being more resistant than other viridans species . In a case presented in this report, it is possible that antibiotic resistance contributed to an apparent failure of endocarditis prophylaxis . The patient had undergone periodontal surgery on 2 separate occasions and in both instances was administered 2 g of amoxicillin orally 1 hour before each procedure . He subsequently developed a subacute illness and had multiple blood cultures drawn that grew S . mitis with a minimum inhibitory concentration of 1.0 microg/mL for penicillin . Transesophageal echocardiogram provided further evidence of infective endocarditis with vegetations seen on the anterior leaflet of the mitral valve . Combination therapy with high-dose intravenous aqueous crystalline penicillin G and gentamicin sulfate for 4 weeks was curative . Clindamycin, rather than amoxicillin, has since been used as dental prophylaxis for subsequent procedures. Southeast Asian J Trop Med Public Health, 2002 Mar, 33(1), 151 - 4 Modified antimicrobial disc susceptibility testing for nutritionally-variant streptococci; Tantimavanich S et al.; Streptococci that were dependent for their growth upon staphylococci were isolated from a patient with sub-acute bacterial endocarditis and subsequently identified as nutritionally-variant streptococci (NVS) . Failure of the isolate to grow on agar media supplemented with pyridoxal hydrochloride or L-cysteine, the known supporting growth factors for NVS, made conventional antimicrobial disc diffusion assay impossible . We modified the assay by co-inoculating Staphylococcus aureus resistant to the drugs being tested as a helper to support the growth of the NVS . Streaking S . aureus closely to the antibiotic discs that were placed above NVS resulted in the growth of satellite colonies of NVS that orbited the S . aureus and that produced a pattern of interrupted zones of growth inhibition . Using an alternative method--adding staphylococcal secreting factor(s) to a 10% staphylococcal cell-free culture supernatant and adding this to an antibiotic susceptibility testing medium,--we found that the NVS formed colonies that formed clear zones of growth inhibition around the disc . When the sizes of the growth inhibition zones produced by both these methods were compared with those recommened by the NCCLS, the NVS were found to be susceptible to penicillin, vancomycin, erythromycin, chloramphenicol, cefoperazone, cefamandole and ofloxacin and resistant to co-trimoxazole, gentamicin and tetracycline . Based on these findings, vancomycin was selected for treatment and the patient was cured of endocarditis . The correlation between the in vitro drug susceptibility testing and the in vivo clinical response indicated that the modified antibiotic susceptibility test is an appropriate method for establishing antibiotic regimens. Infect Immun, 2002 Aug, 70(8), 4643 - 9 High expression of a C protein beta antigen gene among invasive strains from certain clonally related groups of type Ia and Ib group B streptococci; Nagano N et al.; Serotyped strains of group B streptococci can be divided into subtypes based on restriction endonuclease digestion patterns (RDP) . Profiles of cell-bound proteins were compared among RDP types . Proteins that showed a remarkable difference in the degree of expression were found among strains of RDP Ia-3, which has been considered potentially virulent, as well as of RDP Ib-1 . For RDP Ia-3 strains, the protein was predominant in strains from cerebrospinal fluid (CSF) but was mostly a minor component in other strains . For RDP Ib-1 strains, the protein was predominant in strains from CSF, showed diversity in strains from blood, and was mostly a minor component in other strains . By N-terminal sequencing analysis, the protein was identified as a C protein beta antigen . The level of bound immunoglobulin A (IgA) or anti-beta antigen monoclonal antibody correlated with the level of expressed beta antigen, and invasive strains showed remarkably high levels of binding; the exception was a CSF-derived strain of RDP Ib-1 which produced a large amount of beta antigen and showed a high level of binding of anti-beta antigen monoclonal antibody but no IgA binding . PCR-based amplification revealed that the beta antigen gene was detected in all RDP Ia-3 and Ib-1 strains but was not found in any strains of other RDP types . Competitive reverse transcriptase PCR demonstrated that the difference in the amount of protein produced was due to the difference in the level of expression of the beta antigen mRNA . Our findings imply that differences in gene expression for a protein may contribute to the invasiveness of RDP Ia-3 and Ib-1 strains for the host. FEMS Microbiol Lett, 2002 Jul 2, 212(2), 187 - 92 Pheno- and genotypic properties of streptococci of serological group B of canine and feline origin; Yildirim AO et al.; In the present study streptococci of serological group B isolated from canines (n=48) and felines (n=7) were comparatively investigated with group B streptococci from humans and bovines for cultural, biochemical and serological properties for antibiotic resistancies and by molecular analysis . An identification was performed with group B-specific antiserum, biochemical reactions, by PCR amplification and subsequent endonuclease digestion of the 16S rRNA gene and by amplification of species-specific parts of the 16S rDNA the 16S-23S rDNA intergenic spacer region and the CAMP factor gene cfb . Phenotypic similarities of group B streptococci of canine and feline origin with group B streptococci from humans and differences to group B streptococci of bovine origin could be observed in lactose fermentation, serotype patterns, pigmentation, growth properties of the bacteria in fluid medium and soft agar, hemagglutination reactions and in minocycline and tetracycline resistance . A negative hyaluronidase plate test, a hylB amplicon with a size of 4.6 kb and an insertion sequence 1548 could be observed among canine, feline and human group B streptococci of serotype III . The remaining hyaluronidase positive strains, also including all isolates of bovine origin, had a hylB gene with a size of 3.3 kb . Further genotypic differences could be observed in the occurrence of the genes lmb and scpB which appeared generally among canine, feline and human group B streptococci, but less pronounced among bovine isolates of this species . According to the presented data group B streptococci of canine and feline origin seemed to be more related to human than to bovine isolates of this species possibly indicating some epidemiological relation. Eur J Pediatr, 2002 Jul, 161(7), 365 - 7 Epub 2002 May 29. Variables influencing bacteriological outcome in patients with streptococcal tonsillopharyngitis treated with penicillin V; Ovetchkine P et al.; Despite the fact that group A streptococci (GAS) remain susceptible to penicillin V (pen V), an increasing rate of bacteriological treatment failures has occurred . A recent study has suggested that the major variables associated with pen V treatment failures were the number of days ill prior to initiation of treatment (<2 days) and age <6 years . In order to study the link between pen V treatment failures and individual variables, we reviewed the files of all children enrolled in four randomised multicentre trials of oral antibiotic therapy, carried out from 1993 to 1999 . A standard protocol and follow-up examination were used in these four studies: cultures were obtained 4 days and 1 month after completion of treatment . Total DNA restriction fragment length polymorphism was used to compare pre- and post-treatment GAS isolates . We enrolled 1560 children aged 3 to 12 years, 685 received a 10 day pen V regimen (45 mg/kg per day divided into three doses/day), among them 536 were assessable for bacteriological efficacy at the first and second follow-up visit . We found the only variable associated with penicillin treatment failure was the age of the child when infected . The rate of failure was statistically more important for children younger than 6 years (35.5%, 95% CI 29.9--41.1) than for older children (21.9%, 95% CI 16.9-26.9) . CONCLUSION: in this study only young age (<6 years) increases penicillin V treatment failures for group A streptococcal tonsillopharyngitis . This may lead to different antibiotic regimens and follow-up modalities for these targeted patients. Appl Microbiol Biotechnol, 2002 Jul, 59(2-3), 377 - 81 Epub 2002 Apr 23. Detection and characterization of erythromycin-resistant methylase genes in Gram-positive bacteria isolated from poultry litter; Khan AA et al.; The epidemiology of four erythromycin-resistant methylase ( erm) genes, ermA, ermB, ermC and msrA, was determined in erythromycin-resistant staphylococci, enterococci and streptococci isolated from poultry litter . All isolates were resistant to multiple antibiotics . Southern hybridization indicated that 4 of the 20 staphylococci contained the ermC gene on plasmids: on a 2.2 kb plasmid in Staphylococcus hominis and S . sciuri, on a 6.0 kb plasmid in S . xylosus, and on a 7.0 kb plasmid in S . lentus . In 16 of the 20 staphylococci, the ermA gene was harbored exclusively on the chromosome, as a double chromosomal insert on 8.0 and 6.2 kb EcoRI fragments . None of the staphylococci harbored the msrA gene . Dot-blot analysis indicated that all enterococci and streptococci hybridized with a biotinylated ermB gene probe . Southern hybridization indicated that only 2 of the 19 erythromycin-resistant enterococci contained the ermB gene on plasmids . The gene was localized on 4.0 kb and 5.9 kb plasmids, respectively, in two Enterococcus faecium isolates . Results from our studies indicate that the patterns of occurrence of erm genes, the sizes of the plasmids and the copy numbers of the inserts were different from the existing information on the presence of erm genes in clinical strains of Staphylococcus spp. Mayo Clin Proc, 2002 Jul, 77(7), 709 - 10 Septic arthritis due to Streptococcus sanguis; Edson RS et al.; We report an unusual case of septic arthritis due to Streptococcus sanguis, a member of the viridans group of streptococci that are part of the normal flora of the mouth and upper respiratory tract . Our patient had severe underlying periodontal disease, which likely contributed to his joint sepsis through hematogenous spread . Although viridans streptococci are rare causes of septic arthritis in native joints, they should be considered in the setting of severe periodontal disease. Ann Med, 2002, 34(2), 77 - 87 Molecular mechanisms of adhesion, colonization, and invasion of group A streptococci; Courtney HS et al.; The initial step in establishing a bacterial infection is adhesion of the organism to the epithelium of the host . Group A streptococci use multiple adhesins to attach to host cells and the types of adhesins expressed by a particular strain will determine its tissue specificity . Expression of adhesins is regulated in response to changing environmental and growth conditions . Thus, the array of adhesins expressed by a group A streptococcus will depend on the complement of its adhesin genes and on the environment . Expression of some adhesins may trigger internalization of the streptococci by host cells, which may enable the streptococci to evade antibiotics and to facilitate the penetration of deeper tissues . In this review, we present the different molecular mechanisms of adhesion utilized by group A streptococci and how these interactions lead to colonization and invasion. Arch Oral Biol, 2002 Jun, 47(6), 491 - 8 Relationships between dietary behaviours, oral hygiene and mutans streptococci in dental plaque of a group of infants in southern England; Habibian M et al.; This report is part of a prospective study on dietary behaviours, feeding practices, oral hygiene and dental health during the first 18 months of life in a cohort of infants living in southern England . In this part of the study the prevalence of mutans streptococci in the plaque of 1-year-old children and its correlation with sociodemographic status, dietary behaviour and oral hygiene practices over the first 12 months of life were studied . Dietary habits, oral hygiene and dental health at 18 months were also studied . The study group comprised 163 infants . At 12 months of age all children had a dental examination and a plaque sample was removed from the labial surfaces of upper incisors for microbiological examination . A further dental examination took place at 18 months of age; no plaque was sampled . Longitudinal dietary information was obtained with a 3-day food diary at 6, 12 and 18 months of age . Parents/carers completed two structured questionnaires on sociodemographic factors, oral hygiene and feeding behaviour over the first 18 months of life when their children were 12- and 18-month-old . No child exhibited dental caries at 12 and 18 months of age; 18 and 25% had visible dental plaque at 12 and 18 months, respectively . Seven children (4%) had detectable mutans streptococci in their plaque at 12 months of age . Children who had started brushing their teeth or who had had their teeth brushed by 12 months of age were less likely to have detectable mutans streptococci in their plaque than those who had not (P=0.02) . The amount of mutans streptococci was significantly correlated with the total number of eating/drinking events per day (P<0.001) and bordered on significant correlation with the mean daily frequency of consumption of foods and drinks containing non-milk extrinsic sugars (P=0.05) . None of the sociodemographic variables-sex, social class, mother's level of education-were associated with the detection of mutans streptococci in this group of infants . Multiple logistic regression analysis revealed that two variables were independently and positively correlated with the presence of mutans streptococci in the plaque; these were age when tooth brushing started and total eating and drinking events per day. Scand J Immunol, 2002 Jul, 56(1), 12 - 34 Immune regulation in adjuvant disease and other arthritis models: relevance to pathogenesis of chronic arthritis; Waksman BH; Experimental models of arthritis and their human counterparts fall into three distinct classes: (a) responses of T cells to disseminated microbial antigens (Ags) as such; (b) responses of T cells to cartilage autoAgs; and (c) responses of T cells to major histocompatibility complex (HLA-B27, DRB1) or other membrane components (LFA-1) expressed on bone marrow-derived cells . The primary immune response is driven, in naturally occurring disease, by microbial infection, e.g . with streptococci, enteric gram-negative rods or spirochetes, or is experimentally induced with mycobacterial and other adjuvants . The response to cartilage components, such as collagen type-II and various proteoglycans, may be driven by cross-reactive microbial Ags, heat shock proteins (HSPs) in particular, or the adjuvant effect of intense primary joint inflammation, as in rheumatoid arthritis and the spondyloarthropathies . Adjuvant disease appears to be purely T-cell-mediated, whereas both T cells and antibody play a role in collagen and many other forms of arthritis . Experimental evidence suggests a pathogenetic role for T-cell receptor gammadelta T cells in some lesions . Arthritis may be regulated by microbial and tissue HSPs, when these are administered by a nonimmunizing route or as altered peptide ligands, by anti-idiotypic responses that block the action of effector T cells, and by competing Ags . Immune regulation involving natural killer (NK), NK T and certain subsets of gammadelta and alphabeta T cells, which may affect the occurrence, localization and character of this group of diseases, presents a challenge for further investigation. J Microbiol Immunol Infect, 2002 Jun, 35(2), 129 - 32 Endocarditis caused by penicillin-resistant Streptococcus mitis in a 12-year-old boy; Huang IF et al.; A case of congenital coronary arteriovenous fistula with infective endocarditis caused by penicillin-resistant Streptococcus mitis is reported . Lack of prophylactic antibiotics during dental procedure may cause the development of endocarditis . Bactericidal test (Schlichter test) was performed to guide the therapy for this case of bacterial endocarditis caused by penicillin-resistant viridans streptococci . This case highlights the importance of antibiotic prophylaxis in patients with underlying heart disease undergoing dental procedures. J Dent Res, 2002 Jun, 81(6), 411 - 5 Roles of salivary proteins in the adherence of oral streptococci to various orthodontic brackets; Ahn SJ et al.; Knowledge of salivary pellicles on orthodontic brackets provides a better understanding of microbial adherence . The aim of this study was to analyze the effects of bracket pellicles on the adherence of Streptococcus gordonii and Streptococcus mutans . Bracket pellicles were formed by the incubation of 4 kinds of orthodontic brackets with unstimulated whole saliva for 2 hrs, and analyzed by electrophoresis, immunodetection, and amino acid analysis . Binding assays were then performed by the incubation of tritium-labeled streptococci with the pellicle-transfer blots and orthodontic brackets . The results showed that low-molecular-weight mucin, alpha-amylase, secretory IgA, acidic proline-rich proteins, and cystatins adhered to all kinds of brackets, though the amino acid composition of pellicles differed between bracket types . Some of these proteins increased the binding of S . gordonii to saliva-coated brackets . However, salivary pellicles decreased the binding of S . mutans . Collectively, salivary pellicles were found to play a significant role in the initial adhesion of oral streptococci to orthodontic brackets. J Dent Res, 2002 Jun, 81(6), 380 - 6 Inactivation of the Streptococcus mutans fxpC gene confers resistance to xylitol, a caries-preventive natural carbohydrate sweetener; Benchabane H et al.; Xylitol is transported by Streptococcus mutans via a constitutive phosphoenolpyruvate:fructose phosphotransferase system (PTS) composed of a IIABC protein . Spontaneous xylitol-resistant strains are depleted in constitutive fructose-PTS activity, exhibit additional phenotypes, and are associated with the caries-preventive properties of xylitol . Polymerase chain-reactions and chromosome walking were used to clone the fxp operon that codes for the constitutive fructose/xylitol-PTS . The operon contained three open reading frames: fxpA, which coded for a putative regulatory protein of the deoxyribose repressor (DeoR) family, fxpB, which coded for a 1-phosphofructokinase, and fxpC, which coded for a IIABC protein of the fructose-PTS family . Northern blot analysis revealed that these genes were co-transcribed into a 4.4-kb mRNA even in the absence of fructose . Inactivation of the fxpC gene conferred resistance to xylitol, confirming its function . The fxp operon is also present in the genomes of other xylitol-sensitive streptococci, which could explain their sensitivity to xylitol. Folia Microbiol (Praha), 2002, 47(3), 291 - 5 Genetic heterogeneity of the pathogenic potentials of human and bovine group B streptococci; Dmitriev A et al.; One-hundred seventy-two B-streptococcal strains of human and bovine origin were analyzed for the presence of 9 genes potentially involved in virulence . Some of genes (glnA, cyl, hylB, scaA and cfb) were revealed in all the strains . However, the presence of others (bca, bac, scpB, lmb) varied from strain to strain . Taken together, 3 and 5 different types of pathogenic potential were found among human and bovine group B streptococci (GBS) strains, respectively, and only one type (bca+ bac scpB+ glnA+ cyl+ hylB+ lmb+ scaA+ cfb+) was common for both kinds of strains . We propose that different virulence genes can be involved in the development of infectious processes in humans and animals . A reliable PCR protocol with 3 pairs of primers (for the genes bca, bac and scpB) in the same reaction mixture was developed for the fast identification of the pathogenic potential of GBS . In comparison with the classical immunological methods this procedure displayed higher specificity and sensitivity as well as a shorter time of analysis . It can be recommended for use in the clinical and veterinary practice for studying the epidemiological relationship between the isolates and the ready identification of the clone causing the infection. Clin Diagn Lab Immunol, 2002 Jul, 9(4), 892 - 7 Induction of cytokines by glucosyltransferases of streptococcus mutans; Chia JS et al.; Production of proinflammatory cytokines is implicated in the pathogenesis of viridans streptococcus-induced alpha-streptococcal shock syndrome and infective endocarditis . Streptococcus mutans, one of the opportunistic pathogens causing infective endocarditis, was reported previously to stimulate monocytes and epithelial and endothelial cells in vitro to produce various cytokines . We found that glucosyltransferases (GTFs) GtfC and GtfD of S . mutans stimulated predominantly the production of interleukin-6 (IL-6) from T cells cultured in vitro . The level of IL-6 but not of tumor necrosis factor alpha in blood was significantly elevated when rats were injected intravenously with S . mutans GS-5, whereas IL-6 was detected at a much lower level when rats were challenged with NHS1DD, an isogenic mutant defective in the expression of GTFs . The serum IL-6 level was elevated in patients with endocarditis caused by different species of viridans streptococci which express GTF homologues . Affinity column-purified GTFs reduced the levels of detectable IL-2 of T cells stimulated by another bacterial antigen, tetanus toxoid . These results suggested that GTFs might modulate the production of Th1-type cytokines and that GTFs of S . mutans play a significant role in stimulating the production of the proinflammatory cytokine IL-6 in vivo. Curr Treat Options Cardiovasc Med, 2002 Aug, 4(4), 309 - 319 Rheumatic Fever and Long-term Sequelae in Children; Saxena A; Rheumatic fever and rheumatic heart disease continue unabated, affecting young individuals in most of the developing nations . Focal outbreaks of smaller magnitude have also been reported since the mid-1980s from industrialized western nations, where this disease had almost disappeared . The introduction of penicillin in the mid-1940s has markedly changed the natural history of rheumatic fever, although the incidence of rheumatic fever declined in developed nations even before that, mainly due to better living conditions . Treatment of rheumatic fever chiefly involves the use of antibiotics (penicillin) and anti-inflammatory drugs, like salicylates or corticosteroids, to eradicate Streptococci . Patients with severe carditis, congestive heart failure, or pericarditis are best treated with corticosteroids because these are more potent anti-inflammatory agents than salicylates . Salicylates may be sufficient for cases with mild or no carditis . The treatment must be continued for 12 weeks . Several studies have shown that valvular regurgitation, and not myocarditis, is the cause of congestive heart failure in active rheumatic carditis . Therefore, surgery with mitral valve replacement or repair is indicated in cases with intractable hemodynamics due to mitral regurgitation . The development of chronic valvular lesion after an episode of rheumatic fever is dependent upon the presence or absence of carditis in the previous attack and compliance with secondary prophylaxis . Recurrences due to inadequate penicillin prophylaxis are responsible for hemodynamically significant chronic valvular lesions requiring surgery . Primary prevention of rheumatic fever is fraught with difficulties and may not be feasible in most of the countries where the disease is rampant . Secondary prevention, ie, preventing recurrence of rheumatic fever, is the appropriate strategy with proven efficacy . A repository form of penicillin, benzathine penicillin G, given as an intramuscular injection at 3 weekly intervals in the dose of 1,200,000 U, remains the treatment of choice for secondary prevention of rheumatic fever . Alternative antibiotics may be used in those allergic to penicillin . An effective and safe vaccine against rheumatic fever is not yet available. Drugs Aging, 2002, 19(5), 331 - 42 Bacterial skin infections in the elderly: diagnosis and treatment; Laube S et al.; Skin and soft tissue infections are quite common in elderly people . A number of special conditions and circumstances need to be considered in the diagnosis and therapy . It is important to try to establish the causative organism, exclude other cutaneous disorders and identify precipitating factors . Treatment modalities include antiseptics, topical and systemic antibacterials, dressings and biotherapy . Skin infections presenting with erythema, blisters, pustules, and ulcerations or in body folds are described in detail . Cellulitis and infected ulcers are the most commonly encountered cutaneous infections in the elderly . Accurate and quick diagnosis and treatment are imperative to prevent significant morbidity and mortality . Appropriate antibacterials, antiseptics and dressings are necessary depending on the severity of the clinical presentation and resistance patterns . Laboratory tests, such as skin swabs, to establish the exact pathogen take time and the results might represent colonisation rather than infection of the skin . Cellulitis should be clinically distinguished from erysipelas and necrotising fasciitis . The latter is a life-threatening condition, which in the majority of cases requires surgical debridement of the infected tissue . Blisters and honey-coloured crusts are typical features of impetigo . It is very contagious and close contacts should be examined . Folliculitis is a commonly seen skin infection, which often responds to the use of antiseptics and topical antibacterials . More severe pustular skin eruptions, such as furunculosis and carbunculosis, usually require treatment with systemic antibacterials . Intertrigo and erythrasma have a predilection for the body folds, especially the axillae and groin, and topical therapy is usually sufficient . Secondary skin infections are often the result of persistent pruritus associated with increasing dryness of the aging skin . Emollients and antihistamines are useful measures . Primary cutaneous disorders and systemic diseases should be excluded with the aid of appropriate investigations, such as blood tests and skin biopsy . Staphylococcus aureus and beta-haemolytic streptococci are the most common causative organisms of cutaneous infections. Am J Dent, 2002 Apr, 15(2), 103 - 8 Interdental mutans streptococci suppression in vivo: a comparison of different chlorhexidine regimens in relation to restorative material; Heintze SD et al.; PURPOSE: To evaluate the suppressive effect of four different chlorhexidine (CHX) regimens on the interdental levels of mutans streptococci (MS) on enamel and various restorative materials in a group of adults . MATERIALS AND METHODS: 128 subjects with high salivary MS counts were allocated to (A) a single professional tooth cleaning with a 1% CHX gel, (B) duplicate applications of a dental varnish containing 1% CHX and 1% thymol, (C) a single application of a 40% CHX varnish, (D) daily tooth brushing with a 1% CHX gel for 2 weeks . Interdental plaque samples were collected at baseline, 1 week, and 3 months after termination of CHX treatment . RESULTS: The baseline MS levels were significantly higher in plaque from composite surfaces than in plaque from enamel surfaces . All methods decreased the interdental MS levels compared with the baseline on enamel, composite and amalgam surfaces . On both clinically sound enamel and amalgam surfaces, the outcomes in Groups B, C and D were similar and significantly better than in Group A . On composite surfaces, the 40% CHX varnish (C) and the CHX brushing (D) were significantly more effective in decreasing MS than the low-CHX varnish (B) and the professional CHX cleaning (A). Infect Dis Clin North Am, 2002 Jun, 16(2), 437 - 52, xi Special issues in the management of infective endocarditis caused by gram-positive cocci; Hoen B; Gram-positive cocci, mainly streptococci and staphylococci, continue to cause the majority of cases of infective endocarditis . Among the streptococci causing IE, the long-standing predominance of oral or viridans-group streptococci has progressively faded, while the number of cases caused by "enteric streptococci" (Streptococcus bovis and enterococci) has increased . While most oral streptococci and S . bovis strains remain fully sensitive to penicillin, nutritionally variant streptococci--now renamed Abiotrophia--and enterococci can exhibit resistance to penicillin and/or glycopeptides that makes endocarditis more difficult to treat . Among the staphylococci causing endocarditis, the increasing proportion of coagulase-negative and methicillin-resistant strains observed in recent years has changed the approach to choice of antibiotic therapy . The purpose of this paper is to focus on some new aspects of the management of antibiotic therapy of IE due to streptococci and staphylococci, including recent developments such as once-daily aminoglycoside administration in IE, outpatient antibiotic therapy, and the evaluation of new antibiotics. Infect Dis Clin North Am, 2002 Jun, 16(2), 297 - 318 Pathogenesis of streptococcal and staphylococcal endocarditis; Moreillon P et al.; Although streptococcal and S . aureus IE share the same primary site of infection, their pathogenesis and clinical evolution present several major differences . Streptococci adhere to cardiac valves with pre-existing endothelial lesions . In contrast, S . aureus can colonize either damaged endothelium or invade physically intact endothelial cells . These interactions are mediated by multiple surface adhesins, some of which have been only partially characterized . Streptococci produce surface glucans (gtf and ftf), ECM adhesins (e.g., fibronectin-binding proteins, FimA), and platelet aggregating factors (phase I and phase II antigens, pblA, pblB, and pblT), all of which have been. Ear Nose Throat J, 2002 Jun, 81(6), 384 - 9 Peritonsillar abscess: a study of 724 cases in Japan; Matsuda A et al.; We reviewed the records of 724 patients diagnosed with peritonsillar abscess who had been admitted to our hospital between January 1988 and December 1999 . We analyzed their clinical features, disease course, and treatment . The male:female ratio was 3:1, and approximately two-thirds of these patients were between 20 and 39 years of age . The most common aerobic bacteria cultured from patients' pus were alpha-hemolytic streptococci . Severe complications---including deep neck infections and mediastinitis--were seen in 13 patients (1.8%) . This complication rate suggests that patients with peritonsillar abscess should undergo immediate incision and drainage rather than needle aspiration. JAMA, 2002 Jul 3, 288(1), 75 - 81 Changing profile of infective endocarditis: results of a 1-year survey in France; Hoen B et al.; CONTEXT: Since the first modern clinical description of infective endocarditis (IE) at the end of the 19th century, the profile of the disease has evolved continuously, as highlighted in epidemiological studies including a French survey performed in 1991 . OBJECTIVE: To update information gained from the 1991 study on the epidemiology of IE in France . DESIGN AND SETTING: Population-based survey conducted from January through December 1999 in all hospitals in 6 French regions representing 26% of the population (16 million inhabitants) . PATIENTS: Three hundred ninety adult inpatients diagnosed with IE according to Duke criteria . MAIN OUTCOME MEASURES: Incidence of IE; proportion of patients with underlying heart disease; clinical characteristics; causative microorganisms; surgical and mortality outcomes . RESULTS: The annual age- and sex-standardized incidence was 31 (95% confidence interval {CI}, 28-35) cases per million, not including the region of New Caledonia, which had 161 (95% CI, 117-216) cases per million . There was no previously known heart disease in 47% of the cases . The proportion of prosthetic-valve IE was 16% . Causative microorganisms were: streptococci, 48% (group D streptococci, 25%; oral streptococci, 17%, pyogenic streptococci, 6%); enterococci, 8%; Abiotrophia species, 2%; staphylococci, 29%; and other or multiple pathogens, 8% . Blood cultures were negative in 9% and no microorganism was identified in 5% of the cases . Early valve surgery was performed in 49% of the patients . In-hospital mortality was 16% . Compared with 1991, this study showed a decreased incidence of IE in patients with previously known underlying heart disease (20.6 cases per million vs 15.1 cases per million; P<.001); a smaller incidence of oral streptococcal IE (7.8 cases per million vs 5.1 cases per million; P<.001), compensated by a larger proportion of IE due to group D streptococci (5.3 cases per million vs 6.2 cases per million; P =.67) and staphylococci (4.9 cases per million vs 5.7 cases per million; P =.97); an increased rate of early valve surgery (31.2% vs 49.7%; P<.001); and a decreased in-hospital mortality rate (21.6% vs 16.6%; P =.08) . CONCLUSION: Although the incidence of IE has not changed, important changes in disease characteristics, treatment, and outcomes were noted. J Clin Microbiol, 2002 Jul, 40(7), 2437 - 44 Minimizing the workup of blood culture contaminants: implementation and evaluation of a laboratory-based algorithm; Richter SS et al.; An algorithm was implemented in the clinical microbiology laboratory to assess the clinical significance of organisms that are often considered contaminants (coagulase-negative staphylococci, aerobic and anaerobic diphtheroids, Micrococcus spp., Bacillus spp., and viridans group streptococci) when isolated from blood cultures . From 25 August 1999 through 30 April 2000, 12,374 blood cultures were submitted to the University of Iowa Clinical Microbiology Laboratory . Potential contaminants were recovered from 495 of 1,040 positive blood cultures . If one or more additional blood cultures were obtained within +/-48 h and all were negative, the isolate was considered a contaminant . Antimicrobial susceptibility testing (AST) of these probable contaminants was not performed unless requested . If no additional blood cultures were submitted or there were additional positive blood cultures (within +/-48 h), a pathology resident gathered patient clinical information and made a judgment regarding the isolate's significance . To evaluate the accuracy of these algorithm-based assignments, a nurse epidemiologist in approximately 60% of the cases performed a retrospective chart review . Agreement between the findings of the retrospective chart review and the automatic classification of the isolates with additional negative blood cultures as probable contaminants occurred among 85.8% of 225 isolates . In response to physician requests, AST had been performed on 15 of the 32 isolates with additional negative cultures considered significant by retrospective chart review . Agreement of pathology resident assignment with the retrospective chart review occurred among 74.6% of 71 isolates . The laboratory-based algorithm provided an acceptably accurate means for assessing the clinical significance of potential contaminants recovered from blood cultures. Diagn Microbiol Infect Dis, 2002 Jun, 43(2), 157 - 62 Antimicrobial susceptibility patterns of beta-hemolytic and viridans group streptococci: report from the SENTRY Antimicrobial Surveillance Program (1997-2000); Gordon KA et al.; Susceptibility patterns of 15 antimicrobial agents were assessed for 3,400 isolates of beta-hemolytic (betahS) and viridans group (VgS) streptococci in the four regions of the SENTRY Antimicrobial Surveillance Program: Asia-Pacific (APAC), Europe (EU), Latin America (LA) and North America (NA) . In 1997 through 2000, SENTRY Program monitors tested strains by reference broth microdilution methods and results were interpreted using National Committee for Clinical Laboratory Standards criteria . Among the betahS processed, 81.9% of strains were either Streptococcus pyogenes (n = 650) or S . agalactiae (n = 1,190) . The VgS were generally classified as unspeciated alpha-hemolytic streptococci (n = 512; 44%) or S . mitis (n = 254; 22%) . Seven quinolones, two beta-lactams, erythromycin (ER), clindamycin (CM), quinupristin/dalfopristin (Q/D), vancomycin (VA), teicoplanin (TP) and linezolid (LZ) were tested . Rank order of susceptibility for betahS isolates was: ceftriaxone (CTX) = Q/D = VA = TP = LZ (100.0%) > gatifloxacin (GATI) = trovafloxacin (TROV, 99.8%) > levofloxacin (LEVO; 99.7%) > penicillin (PEN; 99.3%) > grepafloxacin (GREPA; 97.4%) > CM (94.4%) > ER (85.5%) . ER versus betahS had the highest MIC(90) values (2 microg/ml) and the lowest susceptibility rates across all regions (range, 81.4% in NA to 97.3% in LA) . Among the VgS, susceptibility rank order was: VA = TP = LZ (100.0%) > Q/D (99.1%) > GATI = LEVO = TROVA (98.0%) > GREPA (96.5%) > CTX (92.8%) > CM (90.3%) > PEN (68.6%) > ER (64.5%) . Macrolide resistance in both streptococcal species groups of the M-phenotype was highest in the Americas, with erm-patterns predominating in EU and APAC regions . BMS284756 among the monitored new agents showed a four- to eight-fold greater potency versus these streptococcal isolates when compared to the other six tested quinolones . Like Streptococcus pneumoniae, these other streptococci appear to have acquired numerous resistances and require continued surveillance to direct adequate therapies. J Dairy Sci, 2002 May, 85(5), 1314 - 23 The effect of pathogen-specific clinical mastitis on the lactation curve for somatic cell count; de Haas Y et al.; Data from 274 Dutch herds recording clinical mastitis (CM) over an 18-mo period were used to investigate the effect of pathogen-specific CM on the lactation curve for somatic cell count (SCC) . Analyzed pathogens were Staphylococcus aureus, coagulase-negative staphylococci, Escherichia coli, Streptococcus dysgalactiae, Streptococcus uberis, other streptococci, and the culture-negative samples . The dataset contained 178,754 test-day records on SCC, recorded in 26,411 lactations of 21,525 cows of different parities . In lactations without both clinical and subclinical mastitis, SCC was high shortly after parturition, decreased to a minimum at 50 days in milk (DIM), and increased slowly toward the end of the lactation . Effects of CM on lactation curves for SCC differed among the pathogens isolated . Before a case of clinical E . coli mastitis occurred, SCC was close to the SCC of lactations without both clinical and subclinical mastitis, and after the case of CM had occurred, SCC returned rather quickly to a low level again . Similar curves were found for lactations with cases of CM associated with culture-negative samples . Before a case of clinical Staph . aureus mastitis occurred, average SCC was already high, and it remained high after the occurrence . Effects of CM associated with Strep . dysgalactiae, Strep . uberis, and other streptococci on the lactation curve for SCC were comparable . They showed a continuous increase in SCC until the case of pathogen-specific CM occurred, and afterwards SCC stayed at a higher level . Using SCC test-day records, these typical characteristics of each pathogen may be used to find more effective indicators of CM. J Dairy Sci, 2002 May, 85(5), 1273 - 84 Relationships among severity and duration of clinical mastitis and sire transmitting abilities for somatic cell score, udder type traits, productive life, and protein yield; Nash DL et al.; The objective of this study was to determine the relationships among severity and duration of clinical mastitis during first and second lactation and sire transmitting abilities for somatic cell score, udder type traits, productive life, and protein yield . Recording of clinical episodes began at first parturition for 1704 Holstein cows (in six Pennsylvania herds and one Nebraska herd) and continued into second lactation for 1055 of these cows . A total of 456 cows (sired by 168 bulls) had at least one clinical episode during first lactation, and 230 cows (sired by 100 bulls) had at least one clinical episode during second lactation . A severity code from 1 (normal milk) to 5 (acute systemic mastitis) was assigned daily (for up to 30 d after detection) to all quarters that had clinical mastitis . Only the severity codes for the first clinical episode to occur during first and second lactation are considered here . The initial and maximum severity codes, as well as the natural logarithms of both the sum of severity codes that were above normal (> 1) and the total days severity codes were above normal were regressed on herd (a classification variable), age at first calving, days in milk at clinical detection, and sire transmitting abilities taken one at a time . Linear and nonlinear effects were estimated for sire transmitting abilities . Separate analyses were conducted on dependent variables that considered severity and duration of clinical mastitis from: all organisms, coagulase-negative staphylococci, coliform species, streptococci other than Streptococcus agalactiae, and the most common environmental organisms (coliform species and streptococci other than Streptococcus agalactiae) . Daughters of sires that transmit the lowest somatic cell score had the least severe and shortest clinical episodes from environmental organisms during first lactation . Selection for lower somatic cell score may reduce the severity and duration of clinical episodes from environmental organisms during first lactation. J Infect Dis, 2002 Jun 15, 185(12), 1745 - 53 Epub 2002 May 22. Group B streptococcal beta-hemolysin induces mortality and liver injury in experimental sepsis; Ring A et al.; New Zealand White rabbits were challenged with the wild-type (wt) group B streptococci (GBS) serotype III strain (COH1) and its isogenic nonhemolytic (NH) and hyperhemolytic (HH) mutants . Mortality differed significantly between rabbits infected with the HH mutant IN40 (67%), compared with rabbits infected with the wt COH1 strain (27%) and the NH strains COH1-20 and COH1:cylEDeltacat (13% and 0%, respectively; P<.05) . Histopathologically, disseminated septic microabscesses surrounded by necrotic foci were found exclusively in the livers of HH mutant IN40-infected animals . Serum transaminase levels were 20-fold higher in the HH-infected group, compared with rabbits infected with the other strains . Positive TUNEL (in situ terminal deoxynucleotide transferase-mediated dUTP nick end labeling) staining and activation of caspase-3 in hepatocytes were more frequent in HH-infected than in wt-infected animals and absent in the NH mutant COH1-20-infected group, indicating that GBS beta-hemolysin triggers apoptotic pathways in hepatocytes . This work provides the first evidence that GBS beta-hemolysin plays a crucial role in the pathophysiology of GBS sepsis by inducing liver failure and high mortality. J Med Assoc Thai, 2002 Jan, 85(1), 1 - 10 Infective endocarditis: prevalence, characteristics and mortality in Khon Kaen, 1990-1999; Pachirat O et al.; OBJECTIVE: To update the prevalence, characteristics and mortality of infective endocarditis in a tertiary care hospital in Khon Kaen, Thailand . BACKGROUND: Numerous studies have shown that the prevalence and course of infective endocarditis remain unchanged inspite of the advance in treatment, diagnosis and of prophylactic recommendations . METHOD: The authors identified 160 patients from 1990-1999 with 86 per cent definite and 14 per cent possible endocarditis based on the Duke criteria . Data were collected from two tertiary care hospitals . RESULTS: The prevalence was 4 patients per 1,000 hospital admissions . The mean age of the 106 male and 54 female patients was 39+/-16 years . Twenty-four percent of the patients had no previously known heart disease . Native valve endocarditis was present in 95 per cent and prosthetic valve endocarditis was diagnosed in 5 per cent . Infective endocarditis was located on the aortic valve in 42 per cent, the mitral valve in 43 per cent, both mitral and aortic valves in 9 per cent and the tricuspid valve in 8 per cent . The infective organism was identified in only 62 per cent of cases . Streptococci was the most common in 43 per cent, followed by Staphylococci in 16 per cent . During the first month after admission, 45 per cent of the patients underwent surgery . In-hospital mortality was 25 per cent . CONCLUSION: Despite improved diagnostic techniques and aggressive surgical therapy, infective endocarditis remains a serious problem associated with a high mortality in Khon Kaen. Eur J Clin Microbiol Infect Dis, 2002 May, 21(5), 393 - 6 Epub 2002 May 07. Identification of viridans streptococcal species causing bacterial meningitis in adults in Taiwan; Chang WN et al.; In order to determine the species responsible for viridans-group streptococcal meningitis in adults in Taiwan, seven cases of culture-proven meningitis due to these organisms were studied . The cases were all identified at the Chang Gung Memorial Hospital-Kaohsiung over a period of 3 years, and they accounted for 9% (7/78) of all cases of culture-proven bacterial meningitis occurring in adults during this period . Of the seven viridans streptococci isolates recovered, Streptococcus constellatus accounted for four, Streptococcus anginosus for two, and Streptococcus oralis for one . Thus, it appears that streptococci of the milleri group are the most common species causing bacterial meningitis in adults in Taiwan . The tendency for these organisms to cause invasive central nervous system infections in adults should not be overlooked when these species are recovered from cerebrospinal fluid specimens. J Pediatr, 2002 Jun, 140(6), 742 - 6 Prevalence of superantigen-secreting bacteria in patients with Kawasaki disease; Leung DY et al.; OBJECTIVES: To assess the prevalence of superantigen secreting bacteria in children with acute Kawasaki disease (KD) relative to control patients . STUDY DESIGN: Bacterial cultures were obtained in a blinded fashion from the throat, rectum, and groin of 45 patients with untreated acute KD and 37 febrile control patients from 6 centers in the United States . Cultures were processed for the presence of superantigen-producing bacteria at a central laboratory . RESULTS: Staphylococci or streptococci that produced superantigens (TSST-1, SEB, SEC, SPEB, SPEC) were isolated from 25 of 45 patients with KD (56%) as compared with 13 of 37 (35%) control patients (P =.078) . Because SEB- and SEC-producing Staphylococcus aureus have not been associated with KD and because they do not induce a Vbeta2+ T-lymphocyte response, we analyzed the difference between groups relative to superantigens TSST-1 or SPEB/SPEC production . TSST-1 secreting S aureus or SPEB/SPEC producing group A streptococci were isolated from 20 of 45 (44%) patients with KD compared with 7 of 37 (19%) control patients (P =.019) . CONCLUSIONS: The overall isolation rates of superantigen (TSST-1, SPEB, SPEC, SEB, SEC) producing bacteria between patients with KD and febrile control patients were not statistically significant . However, future studies should further examine the potential role of Vbeta2-stimulatory superantigens (TSST-1 and SPEB/SPEC) in KD. Biochem J, 2002 Jul 1, 365(Pt 1), 317 - 22 The hyaluronan lyase of Streptococcus pyogenes bacteriophage H4489A; Baker JR et al.; Many pathogenic streptococci produce extracellular hyaluronan lyases which are thought to aid the spread of the organism in host tissues . In addition, several phages of group A streptococci are known to synthesize a bound form of hyaluronidase . It has been suggested that the function of this hyaluronidase is to facilitate penetration of the hyaluronan capsule by phage and thus to gain access for the phage to the cell surface of the host streptococcus {Hynes, Hancock and Ferretti (1995) Infect . Immun . 63, 3015-3020} . In the present work, the hyaluronidase of Streptococcus pyogenes bacteriophage H4489A, expressed in E . coli, has been purified and characterized . The enzyme was shown to be a lyase with a distributive action pathway . Unlike most bacterial hyaluronidases that have been characterized, the phage enzyme was found to specifically cleave hyaluronan, which adds credence to the view that its function is to digest the hyaluronan capsule of the host organism . This bacteriophage lyase may provide a practical alternative to the lyase from Streptomyces hyalurolyticus as a reagent for the specific cleavage of hyaluronan. Arch Dermatol, 2002 Jul, 138(7), 939 - 41 Age-related prevalence and antibiotic resistance of pathogenic staphylococci and streptococci in children with infected atopic dermatitis at a single-specialty center; Arkwright PD et al.; BACKGROUND: Skin staphylococci and streptococci are known to exacerbate atopic dermatitis, but the prevalence changes that occur with age are unknown . This study examined the age-related prevalence and antibiotic resistance of these pathogenic bacteria in children with atopic dermatitis and suspected skin infections . OBSERVATIONS: Medical records of 150 children with atopic dermatitis referred to a regional center, who had skin swabs taken for suspected infection, were studied retrospectively . All patients carried Staphylococcus aureus . The prevalence of methicillin sodium-resistant (P =.05) and fusidic acid-resistant (P =.001) S aureus tripled from infancy to school age . Lancefield groups A and G streptococci were the other pathogens found . The prevalence of group A streptococci was highest in children aged 3 to 6 (53%), compared with 11% of infants and 21% of patients aged 9 to 16 (P =.002) . CONCLUSIONS: Significant differences in the age-related prevalence of group A streptococci skin carriage and antibiotic resistance of S aureus isolates occurred in this group of children with atopic dermatitis and suspected skin infections . Skin swabs to determine bacterial type and antibiotic sensitivities provide an important guide to antibiotic prescribing in these children. Acta Vet Scand, 2002, 43(1), 31 - 41 Antimicrobial susceptibility of udder pathogens isolated from dairy herds in the west littoral region of Uruguay; Gianneechini RE et al.; A total of 522 strains belonging to streptococci, enterococci and staphylococci isolated from sub-clinical and clinical cases of bovine mastitis from the west littoral region of Uruguay were analysed for their susceptibility to several antimicrobial agents . The susceptibility patterns were studied by agar disk diffusion methods (ADDM) and broth micro-dilution to determine the minimum inhibitory concentration (MIC) . The concentration that inhibits 90% (MIC90) of the analysed strains reported in micrograms per millilitre, for Staphylococcus aureus were > 8, 8, < or = 0.5, < or = 4, < or = 1, < or = 0.5, > 64, < or = 0.25, 0.5, < or = 1 and < or = 1 to penicillin, ampicillin, oxacillin, cephalotin, gentamicin, erythromycin, oxitetracycline, enrofloxacin, trimethoprim/sulfamethoxazole, neomycin, and clindamycin, respectively . Coagulase-negative staphylococci (CNS) had different values for penicillin (4) and ampicillin (2), while the other antimicrobial agents had the same MIC90 values as reported for S . aureus . The MIC90 values for streptococci were 0.12, 0.25, < or = 4, 16, < or = 0.25, 0.5, 0.25 for penicillin, ampicillin, cephalotin, gentamicin, erythromycin, oxytetracycline and trimethoprim-sulfamethoxazole, whereas MIC90 for enterococci were 4, 4, 4, < or = 0.5, 2, > 8 for penicillin, ampicillin, gentamicin, erythromycin, oxytetracycline and trimethoprim-sulfamethoxazole, respectively . Of 336 strains of S . aureus, 160 (47.6%) were resistant to penicillin . For 41 CNS strains, 10 (27%) presented penicillin-resistance . All the streptococcal strains were susceptible to penicillin, while 3 (7%) of the 43 enteroccocal strains were resistant . Non significant statistical differences were found between the results obtained by ADDM and broth micro-dilution for classifying bacterial isolates as susceptible or resistant according to the National Committee of Clinical Laboratory Standards. J Pak Med Assoc, 2002 Mar, 52(3), 111 - 6 Predictors of mortality in brain abscess; Qureshi HU et al.; OBJECTIVE: Brain abscess carries significant morbidity and mortality . Our objective was to elucidate the clinical presentation of brain abscess and to assess predictors of mortality in these patients . METHODS: All patients with a brain abscess presenting to the Aga Khan University Hospital, a tertiary care referral center in Karachi, Pakistan, were studied retrospectively . Statistical analysis involved univariate analysis and a logistic regression model . RESULTS: Among the 66 patients analyzed, a distant metastatic focus of infection was the most commonly identified predisposing factor (29%) . Otogenic infection was the commonest contiguous source and sinusitis was noticeably absent . Multiple abscesses were frequent (35%) . Streptococci were the most common isolates (39%) . Lumbar puncture was performed in 44% and steroids administered in 33% . Treatment was surgical in 58% . Most comatose patients were treated conservatively . Overall mortality was 29% . Univariate analysis identified comatose presentation and identification of a distant focus of infection as predictors of mortality . The logistic regression model, however, identified a distant focus of infection as the only independent predictor . CONCLUSION: Age greater than 30 years, corticosteroid use, multiple abscesses, performance of lumbar puncture and conservative management had no affect on outcome. Heart, 2002 Jul, 88(1), 61 - 6 Infective endocarditis: determinants of long term outcome; Netzer RO et al.; OBJECTIVE: To evaluate predictors of long term prognosis in infective endocarditis . DESIGN: Retrospective cohort study . SETTING: Tertiary care centre . PATIENTS: 212 consecutive patients with infective endocarditis between 1980 and 1995 MAIN OUTCOME MEASURES: Overall and cardiac mortality; event-free survival; and the following events: recurrence, need for late valve surgery, bleeding and embolic complications, cerebral dysfunction, congestive heart failure . RESULTS: During a mean follow up period of 89 months (range 1-244 months), 56% of patients died . In 180 hospital survivors, overall and cardiac mortality amounted to 45% and 24%, respectively . By multivariate analysis, early surgical treatment, infection by streptococci, age < 55 years, absence of congestive heart failure, and > 6 symptoms or signs of endocarditis during active infection were predictive of improved overall long term survival . Independent determinants of event-free survival were infection by streptococci and age < 55 years . Event-free survival was 17% at the end of follow up both in medically-surgically treated patients and in medically treated patients . CONCLUSIONS: Long term survival following infective endocarditis is 50% after 10 years and is predicted by early surgical treatment, age < 55 years, lack of congestive heart failure, and the initial presence of more symptoms of endocarditis. Caries Res, 2002 May-Jun, 36(3), 161 - 6 Transmission of mutans streptococci in adults within a Chinese population; Nie M et al.; The purpose of this study was to investigate whether there was transmission between adults in Chinese families using chromosomal DNA fingerprinting . Plaque samples were obtained from buccal and occlusal surfaces of 11 married couples . The colonization levels of mutans streptococci were estimated as colony-forming units per milliliter, and caries experience was scored by decayed, missing and filled teeth . Information about medical history, diet regimes and age at marriage was obtained . The isolates were serotyped by biochemical test and genotyped using the restriction endonuclease HaeIII . The procedure was repeated after 3 months . The results showed that 1 couple had the same genotype of mutans streptococcus at the first examination, but this could not be repeated for the husband who had lost his mutans streptococci at the second examination . On the contrary, another couple that did not have the same mutans streptococcal genotype at the beginning had the same genotype after 3 months . No matching of genotypes was observed within 8 couples . In 1 male, no mutans streptococci were detected, therefore that couple was not considered . These data indicate that spouses had a chance to be infected by strains of mutans streptococci from another person . The results suggest that there may be transmission between adults in Chinese families, but it may be difficult for mutans streptococci to colonize another mouth permanently . Caries Res, 2002 May-Jun, 36(3), 155 - 60 Susceptibility of Streptococcus mutans and Streptococcus sobrinus to cell wall inhibitors and development of a novel selective medium for S . sobrinus; Hirasawa M et al.; Representative strains of Streptococcus mutans and Streptococcus sobrinus showed differences in susceptibility to members of the monobactam group of beta-lactam antibiotics: S . sobrinus was less sensitive than S . mutans . The minimum inhibitory concentrations of aztreonam (AZT) and carumonam, both of which belong to this group, were 2,000 microg/ml for S . sobrinus and 125 microg/ml for S . mutans . Further addition of fosfomycin, bacitracin and sodium chloride to Mitis Salivarius agar (MS) supplemented with AZT resulted in growth inhibition of S . mutans and oral streptococci other than S . sobrinus, and was therefore used as a selective medium for S . sobrinus (MS-SOB medium) . The average growth recovery of laboratory and clinically isolated strains of S . sobrinus on MS-SOB medium was 74.1% compared to that on MS medium . Seventy-eight percent of clinical samples in which S . sobrinus was detected yielded pure growth of S . sobrinus on MS-SOB medium . Infect Immun, 2002 Jul, 70(7), 3935 - 8 Recruitment of mammalian cell fibronectin to the surface of Chlamydia trachomatis; Kleba BJ et al.; Pathogenic bacteria exploit the presence of various host cell molecules in order to colonize new tissues . Fibronectin is involved in a wide range of cell functions in vivo, and staphylococci, streptococci, and gonococci have evolved mechanisms to utilize this glycoprotein to mediate host cell binding . We show that elementary bodies (EB) from two biovars of Chlamydia trachomatis recruit fibronectin to their surfaces upon lysis of the host cell . We also demonstrate that a heparan sulfate lyase-sensitive molecule on chlamydial EB is responsible for binding at least a portion of this fibronectin. Infect Immun, 2002 Jul, 70(7), 3904 - 14 Streptococcus-zebrafish model of bacterial pathogenesis; Neely MN et al.; Due to its small size, rapid generation time, powerful genetic systems, and genomic resources, the zebrafish has emerged as an important model of vertebrate development and human disease . Its well-developed adaptive and innate cellular immune systems make the zebrafish an ideal model for the study of infectious diseases . With a natural and important pathogen of fish, Streptococcus iniae, we have established a streptococcus- zebrafish model of bacterial pathogenesis . Following injection into the dorsal muscle, zebrafish developed a lethal infection, with a 50% lethal dose of 10(3) CFU, and died within 2 to 3 days . The pathogenesis of infection resembled that of S . iniae in farmed fish populations and that of several important human streptococcal diseases and was characterized by an initial focal necrotic lesion that rapidly progressed to invasion of the pathogen into all major organ systems, including the brain . Zebrafish were also susceptible to infection by the human pathogen Streptococcus pyogenes . However, disease was characterized by a marked absence of inflammation, large numbers of extracellular streptococci in the dorsal muscle, and extensive myonecrosis that occurred far in advance of any systemic invasion . The genetic systems available for streptococci, including a novel method of mutagenesis which targets genes whose products are exported, were used to identify several mutants attenuated for virulence in zebrafish . This combination of a genetically amenable pathogen with a well-defined vertebrate host makes the streptococcus-zebrafish model of bacterial pathogenesis a powerful model for analysis of infectious disease. Infect Immun, 2002 Jul, 70(7), 3627 - 36 Dual control of streptokinase and streptolysin S production by the covRS and fasCAX two-component regulators in Streptococcus dysgalactiae subsp . equisimilis; Steiner K et al.; Synthesis of the plasminogen activator streptokinase (SK) by group A streptococci (GAS) has recently been shown to be subject to control by two two-component regulators, covRS (or csrRS) and fasBCA . In independent studies, response regulator CovR proved to act as the repressor, whereas FasA was found to act indirectly as the activator by controlling the expression of a stimulatory RNA, fasX . In an attempt at understanding the regulation of SK production in the human group C streptococcal (GCS) strain H46A, the strongest SK producer known yet, we provide here physical and functional evidence for the presence of the cov and fas systems in GCS as well and, using a mutational approach, compare the balance between their opposing actions in H46A and GAS strain NZ131 . Sequence analysis combined with Southern hybridization revealed that the covRS and fasCAX operons are preserved at high levels of primary structure identity between the corresponding GAS and GCS genes, with the exception of fasB, encoding a second sensor kinase that is not a member of the GCS fas operon . This analysis also showed that wild-type H46A is actually a derepressed mutant for SK and streptolysin S (SLS) synthesis, carrying a K102 amber mutation in covR . Using cov and fas mutations in various combinations together with strain constructs allowing complementation in trans, we found that, in H46A, cov and fas contribute to approximately equal negative and positive extents, respectively, to constitutive SK and SLS activity . The amounts of SK paralleled the level of skc(H46A) transcription . The most profound difference between H46A and NZ131 regarding the relative activities of the cov and fas systems consisted in significantly higher activity of a functional CovR repressor in NZ131 than in H46A . In NZ131, CovR decreased SK activity in a Fas(+) background about sevenfold, compared to a 1.9-fold reduction of SK activity in H46A . Combined with the very short-lived nature of covR mRNA (decay rate, 1.39/min), such differences may contribute to strain-specific peculiarities of the expression of two prominent streptococcal virulence factors in response to environmental changes. Scand J Infect Dis, 2002, 34(4), 316 - 9 Streptococcus viridans septicaemia: a comparison study in patients admitted to the departments of infectious diseases and haematology in a university hospital; Westling K et al.; Infective endocarditis caused by viridans streptococci is a well-described disease . Streptococcus viridans is also an important etiologic agent causing septicaemia in neutropenic patients with haematological diseases . In this study we retrospectively reviewed charts from 111 patients with 121 episodes of viridans streptococci septicaemia during the period 1992-97 for clinical data, presence of endocarditis, subtype and outcome . Forty-seven episodes of S . viridans septicaemia were documented in 45 non-neutropenic patients treated at the Department of Infectious Diseases (Group A) . Thirty of these episodes were defined as definite and 9 as possible infective endocarditis, using Duke's critera . Seventy-four episodes of S . viridans septicaemia were identified in 66 patients treated at the Department of Haematology (Group B), only 1 of which fulfilled the criteria for possible infective endocarditis . S . sanguis was the most common subtype (18/47; 38%) in Group A and S . mitis was the major subtype (51/74; 69%) in Group B. J Antibiot (Tokyo), 2002 Apr, 55(4), 423 - 6 Confirmation of the antibacterial mode of action of SB-219383, a novel tyrosyl tRNA synthetase inhibitor from a Micromonospora sp; Greenwood RC et al.; The compound designated SB-219383 is a potent and selective inhibitor of bacterial tyrosyl tRNA synthetases . It exhibits an IC50 of < 1 nM against Staphylococcus aureus tyrosyl tRNA synthetase and weak in vitro activity against Staphylococci and Streptococci . Here we present data consistent with SB-219383 eliciting an amino acid starvation in both S . aureus and Streptococcus pneumoniae, supporting the conclusion that the antibacterial activity of SB-219383 is due to tyrosyl tRNA synthetase inhibition. J Clin Periodontol, 2002 May, 29(5), 411 - 20 Salivary microbiota levels in relation to periodontal status, experience of caries and miswak use in Sudanese adults; Darout IA et al.; OBJECTIVES: The purpose of the present investigation was to assess the salivary levels of 25 oral bacteria in relation to periodontal status and experience of caries, and to compare the levels of these bacteria between habitual miswak and toothbrush users in adult Sudanese subjects . MATERIAL AND METHODS: The study subjects consisted of 56 individuals with age range 19-53 years (mean 35.2 years) and included 30 miswak and 26 toothbrush users . The periodontal status and presence of dental caries were assessed clinically . Whole saliva was collected from all subjects, and the levels of 25 selected bacterial species in saliva were assessed by the checkerboard DNA-DNA hybridization method using whole genomic DNA probes . RESULTS: A high percentage of the subjects had detectable levels (> or = 105 bacterial cells) of several bacterial species in saliva . Between 12% and 16% of the subjects showed high (> or = 106 cells) salivary levels of the periodontitis-associated bacteria A . actinomycetemcomitans, P . melaninogenica, P . intermedia, C . rectus and E . corrodens, whereas only two (3.6%) and four (7.1%) subjects had high levels of P . gingivalis and F . nucleatum, respectively . There were no significant differences in the levels of all or most bacterial species by age group, gender or periodontal status . Presence of > or = 105 L . acidophilus bacterial cells in saliva was associated with high caries scores (p = 0.02) . There were significantly higher levels of A . actinomycetemcomitans, P . melaninogenica, C . rectus, P . micros, V . parvula, S . mutans, S . anginosus, A . israelii, C . sputigena, and C . gingivalis, and significantly lower levels of P . intermedia, F . nucleatum, S . sputigena, E . corrodens, L . acidophilus, S . sanguis, S . salivarius, S . oralis, and S . mitis in the miswak than in the toothbrush group . CONCLUSIONS: : The findings suggest that miswak may have a selective inhibitory effect on the level of certain bacteria in saliva, particularly several oral streptococci species . This is the first report that the checkerboard DNA-DNA hybridization method can be useful for assessing the levels of a wide range of bacterial taxa in saliva. Ann Dermatol Venereol, 2002 Apr, 129(4 Pt 1), 405 - 7 {Facial cellulite associated with mandibular osteomyelitis in an infant}; Bertocchi M et al.; INTRODUCTION: The discovery of a jugular tumefaction in an infant evokes several diseases . We report the case of a 4-month-old infant whose jugular cellulite revealed mandibular osteomyelitis . CASE REPORT: A 4-month-old boy was referred for hard, hot tumefaction of the right cheek and multiple cervical adenopathies . The suggested diagnosis was cellulite of cutaneous origin . He presented 21 900/mm(3) hyperleukocytosis associated with an inflammatory biological syndrome . Standard x-ray of the facial mass was normal . Sonography of the face showed thickening of the soft subcutaneous tissues and retro and sub-mandibular adenopathies with abcedation . Antibiotherapy with amoxicillin and clavulanic acid led to rapid improvement . Three days after withdrawal of the antibiotherapy, the tumefaction recurred without fever . A facial scan eliminated cystic lymphangioma and showed osteolysis of the external plateau of the ascending branch of the mandible with periosteal appositions . Histological examination of a surgical bone biopsy showed infectious osteitis and culture revealed hemolytic beta streptococci . Six weeks of antibiotherapy (initially with amoxicillin and gentamycin, then amoxicillin in monotherapy) led to the regression of all cutaneous signs . COMMENTS: When confronted with a tumefaction in this area, malignant or benign tumoral causes such as cystic lymphangioma must be eliminated . Infectious causes (abscess, parotid inflammation and osteomyelitis) must be evoked and distinguished from infantile cortical hyperostosis (Caffey-Silverman's syndrome) . Standard radiological imaging, scan or scintigraphy are useful diagnostic tools . If osteolysis is discovered, a biopsy must be taken for anatomopathological and biological examination. J Mol Biol, 2002 Apr 19, 318(1), 179 - 88 Crystal structure of the V-region of Streptococcus mutans antigen I/II at 2.4 A resolution suggests a sugar preformed binding site; Troffer-Charlier N et al.; Antigens I/II are large multifunctional adhesins from oral viridans streptococci that exert immunomodulatory effects on human cells and play important roles in inflammatory disorders . Among them, Streptococcus mutans plays a major role in the initiation of dental caries . The structure of the V-region (SrV+, residues 464-840) of the antigen I/II of S . mutans has been determined using the multiwavelength anomalous diffraction phasing technique with seleno-methionine-substituted recombinant protein and subsequently refined at 2.4 A resolution . The crystal structure of SrV+ revealed a lectin-like fold that displays a putative preformed carbohydrate-binding site stabilized by a metal ion . Inhibition of this binding site may confer to humans a protection against dental caries and dissemination of the bacteria to extra-oral sites involved in life-threatening inflammatory diseases . This crystal structure constitutes a first step in understanding the structure-function relationship of antigens I/II and may help in delineating new preventive or therapeutic strategies against colonization of the host by oral streptococci . Diagn Microbiol Infect Dis, 2002 May, 43(1), 87 - 90 AZD2563, a new oxazolidinone: bactericidal activity and synergy studies combined with gentamicin or vancomycin against staphylococci and streptococcal strains; Jones RN et al.; AZD2563, a novel oxazolidinone, was tested against 10 well characterized multiple-resistant strains of staphylococci and viridans group or beta-hemolytic streptococci using kill curve kinetic methods . Generally, AZD2563 demonstrated bacteriostatic action and modest concentration-dependent cidal activity against a minority of strains of both genera . When combined with gentamicin (MIC/4 concentration), rapid bactericidal action was observed against all streptococci tested, but not against the staphylococci . No enhanced activity was noted when AZD2563 was added to subinhibitory concentrations of vancomycin . Linezolid used as a control, showed the same characteristics, confirming that AZD2563 possesses activity comparable to other agents in the oxazolidinone class . AZD2563 remained active (MIC, < or = 1 microg/ml) against all 10 strains tested. Diagn Microbiol Infect Dis, 2002 May, 43(1), 65 - 73 Spectrum and potency evaluation of a new oxazolidinone, linezolid: report from the SENTRY Antimicrobial Surveillance Program, 1998-2000; Mutnick AH et al.; Resistance (R) among Gram-positive cocci has escalated in the last two decades to levels necessitating the development and use in the newer drug classes, oxazolidinones (linezolid) and streptogramins (quinupristin/dalfopristin {Q/D}) . The SENTRY Antimicrobial Surveillance Program has monitored these classes before, during and after their release by various regulatory agencies . Over 30,000 Gram-positive strains were tested against >30 drugs by reference broth microdilution methods between 1998-2000 in four geographic regions (Asia-Western Pacific {APAC}, Europe {EU}, Latin America {LA}, North America {NA}) . The tested strains were 23,188 staphylococci; 5,103 enterococci and 2,045 streptococci . Among staphylococci, linezolid was active against all isolates (MICs, < or =4 microg/ml) regardless of susceptibility patterns of other antimicrobial agents . Similar results were noted for vancomycin (includes one VISA from Hong Kong), teicoplanin, and Q/D (<1% R) . Gatifloxacin had the widest spectrum among fluoroquinolones (FQ) against Staphylococcus aureus (1.5-9.2% R) and coagulase-negative staphylococci (0.8-4.0%) . Linezolid was also active against all enterococci (MIC50 and (90,) 2 microg/ml) . Q/D was active against only 75.3% of vancomycin-resistant enterococci (VRE) . The VRE rate was highest in NA (12.4%) > EU (3.2%) > LA (1.6%) > APAC (1.3%) . Among streptococci, linezolid was consistently active (MIC(90,) 1 microg/ml) as were the glycopeptides and Q/D . Variable penicillin-R (MIC, > or = 2 microg/ml) was observed among regions: EU (32.5%) > APAC (15.1%) > LA (13.8%) > NA (9.6%), and macrolide-R was higher in EU (40.3%) . Ciprofloxacin-R at > or =4 microg/ml in streptococcal strains was noted world wide highest in viridans group streptococci (18.4-25.6%) . Linezolid remained active (MIC, < or =4 microg/ml) against all Gram-positive species strains tested in the SENTRY Program (1998-2000) . Q/D, glycopeptides and newer FQ compounds were generally less effective in vitro . It remains a prudent practice to continue surveillance programs to detect emerging resistance patterns and recognize significant regional variations in the oxazolidinone susceptibilities. Int Microbiol, 2001 Dec, 4(4), 217 - 22 Diversity among clinical isolates of penicillin-resistant Streptococcus mitis: indication for a PBP1-dependent way to reach high levels of penicillin resistance; Sanchez M et al.; A total of 12 non-epidemiologically related clinical isolates of Streptococcus mitis that showed different levels of resistance to penicillin were studied . Membrane-protein profiles and penicillin-binding protein (PBP) patterns showed a great polymorphism; and patterns of 4-7 PBPs, with sizes that ranged from approximately 101 kDa to approximately 40 kDa, were detected in each strain . No association could be found between PBP pattern and resistance level to penicillin among these isolates . Arbitrarily primed PCR confirmed the genetic diversity among this group of streptococci . One of the isolates of intermediate level of resistance to penicillin, which showed a PBP pattern similar to that of the high-resistance strains, was used as a laboratory model to analyse the mechanism underlying high-resistance acquisition by these strains . A 14-fold increase in penicillin resistance was obtained after a single selection step, which resulted in a decrease in penicillin affinity for PBP1 . The size of this PBP (92 kDa) and the differences in PBP profiles of the penicillin-resistant clinical isolates suggest the existence in S . mitis of PBP-mediated mechanisms to acquire high-level resistance to penicillin, among which alterations in PBP1 seem to play a main role, in contrast to the PBP2X mediated mechanism described for other streptococci. J Virol, 2002 Jul, 76(13), 6852 - 6 Bacterial superantigen exposure after resolution of influenza virus infection perturbs the virus-specific memory CD8(+)-T-cell repertoire; Huang CC et al.; Heterologous viral infections have been shown to impact the preexisting memory CD8(+)-T-cell repertoire . Bacterial superantigens are products of common human pathogenic bacteria, including staphylococci and streptococci, that are potent T-cell-stimulatory molecules . In this report, we show that exposure to staphylococcal enterotoxin B, a bacterial superantigen, causes a selective functional deletion of cross-reactive influenza virus-specific CD8(+) memory T cells . This perturbation of the memory repertoire can have a significant impact on viral clearance after secondary challenge. J Paediatr Child Health, 2002 Jun, 38(3), 229 - 34 Systematic review of rheumatic heart disease prevalence in children in developing countries: the role of environmental factors; Steer AC et al.; OBJECTIVES: To consider the worldwide prevalence of rheumatic heart disease in children in developing countries using surveys with uniform methodologies, and to consider the effect of environmental factors including socio-economic status, overcrowding, urbanization, nutrition and access to medical services on the distribution of rheumatic heart disease in developing countries . METHODS: Sixty-one surveys of the prevalence of rheumatic heart disease in developing countries were found using a systematic review of MEDLINE from January 1976 to July 1999 . Twenty-four studies were selected for comparison based on their uniform methodological and diagnostic techniques . RESULTS: There is a high prevalence of rheumatic heart disease in the Pacific region with a lower prevalence in the Indian subcontinent, Asian, sub-Saharan African, Mediterranean, Latin American and Caribbean regions . However, aside from the Indian subcontinent, these regions have not been well studied, and it may be that the true prevalence is actually higher . CONCLUSIONS: There is a lack of good quality prevalence surveys of rheumatic heart disease in developing countries . It appears that a threshold level where higher socio-economic status is associated with reduced prevalence of rheumatic heart disease is not reached in developing countries . Therefore, differences in prevalence between socio-economic groups in the one area cannot be detected . A similar case can be made for overcrowding . Many regions need well-designed studies of rheumatic heart disease that incorporate assessment of environmental factors as well as the study of the microbiological epidemiology of rheumatic heart disease and group A streptococci. J Antimicrob Chemother, 2002 Jun, 49(6), 1019 - 21 In vitro evaluation of AZD2563, a new oxazolidinone, tested against beta-haemolytic and viridans group streptococci; Anderegg TR et al.; Linezolid was the first clinically applied agent from the oxazolidinone class, and AZD2563, a new agent, is described here . Five hundred and twenty-five streptococcal isolates were tested, including beta-haemolytic (266) and viridans group (259) species . MIC(50)/MIC(90)/% susceptible (susceptibility breakpoint <2 mg/L of AZD2563) results were, for beta-haemolytic species: AZD2563 (1/2/100), linezolid (1/2/100), quinupristin-dalfopristin (0.25/0.25/100), vancomycin (0.25/0.5/100) and levofloxacin (0.5/1/99); for viridans group species: AZD2563 (0.5/1/100), linezolid (1/1/100), quinupristin-dalfopristin (0.5/1/99), vancomycin (0.5/0.5/100) and levofloxacin (1/1/98) . The modal MICs of AZD2563 and linezolid were 0.5 or 1 mg/L and 1 mg/L, respectively . AZD2563 activity screening against these non-pneumococcal streptococci indicated a slightly greater potency of AZD2563 when compared with linezolid . All AZD2563 MICs were <2 mg/L. Biosci Biotechnol Biochem, 2002 Apr, 66(4), 921 - 4 Antimicrobial activity of perilla seed polyphenols against oral pathogenic bacteria; Yamamoto H et al.; A perilla seed (Perilla frutescens Britton var . japonica Hara) extract was examined for its antimicrobial activity against oral cariogenic streptococci and periodontopathic Porphyromonas gingivalis . Luteolin, one of the components of perilla seed, showed the strongest antimicrobial effect among the phenolic compounds . According to our results, perilla seed may be the source of an antimicrobial agent that could prevent dental caries and periodontal diseases. Am J Med, 2002 Jun 1, 112(8), 622 - 6 Bacteremia due to beta-hemolytic Streptococcus group G: increasing incidence and clinical characteristics of patients; Sylvetsky N et al.; PURPOSE: To describe the epidemiology and clinical characteristics of patients diagnosed with Streptococcus group G bacteremia from 1990 to 1999 at a community teaching hospital in Israel . SUBJECTS AND METHODS: We calculated the annual rate of bacteremia with Streptococcus group G, expressed as a percentage of positive blood cultures (after excluding contaminants) and per 1000 admissions . Medical records of patients with Streptococcus group G were reviewed . RESULTS: During the 10-year study period, there was a total of 7415 positive blood cultures, 327 (4.4%) of which were beta-hemolytic Streptococcus species, of which 49 (15%) were group G . The rate of Streptococcus group G bacteremia per 1000 admissions increased from zero (0/18,783) in 1990 to 0.41 (13/31,440) in 1999 (P = 0.001), surpassing Streptococcus group A in frequency . Of the 47 patients with Streptococcus group G, 40 medical records were available for review: 25 patients (63%) were older than 75 years and 32 (80%) were men . The probable source of Streptococcus group G bacteremia was a skin or soft tissue infection in 37 patients (93%) . Six of the 40 patients died . CONCLUSION: Community-acquired group G streptococcal bacteremia occurred with increasing frequency from 1990 to 1999 at our hospital . Most patients were elderly men, and the portal of entry was usually the skin or soft tissue . Our findings suggest a change in the epidemiology of bacteremia due to beta-hemolytic streptococci. Vaccine, 2002 Jun 21, 20(21-22), 2816 - 25 Protection of mice from group A streptococcal infection by intranasal immunisation with a peptide vaccine that contains a conserved M protein B cell epitope and lacks a T cell autoepitope; Olive C et al.; Infection with group A streptococci (GAS) can lead to rheumatic fever (RF) and rheumatic heart disease (RHD) which are a major health concern particularly in indigenous populations worldwide, and especially in Australian Aboriginals . A primary route of GAS infection is via the upper respiratory tract, and therefore, a major goal of research is the development of a mucosal-based GAS vaccine . The majority of the research to date has focused on the GAS M protein since immunity to GAS is mediated by M protein type-specific opsonic antibodies . There are two major impediments to the development of a vaccine-the variability in M proteins and the potential for the induction of an autoimmune response . To develop a safe and broad-based vaccine, we have therefore focused on the GAS M protein conserved C-region, and have identified peptides, J8 and the closely related J8 peptide (J14), which may be important in protective immunity to GAS infection . Using a mucosal animal model system, our data have shown a high degree of throat GAS colonisation in B10.BR mice 24h following intranasal immunisation with the mucosal adjuvant, cholera toxin B subunit (CTB), and/or diptheria toxoid (dT) carrier, or PBS alone, and challenge with the M1 GAS strain . However, GAS colonisation of the throat was significantly reduced following intranasal immunisation of mice with the vaccine candidate J8 conjugated to dT or J14-dT when administered with CTB . Moreover, J8-dT/CTB and J14-dT/CTB-immunised mice had a significantly higher survival when compared to CTB and PBS-immunised control mice . These data indicate that immunity to GAS infection can be evoked by intranasal immunisation with a GAS M protein C-region peptide vaccine that contains a protective B cell epitope and lacks a T cell autoepitope. Vaccine, 2002 Jun 21, 20(21-22), 2635 - 40 Parenteral and mucosal delivery of a novel multi-epitope M protein-based group A streptococcal vaccine construct: investigation of immunogenicity in mice; Dunn LA et al.; Primary vaccine strategies against group A streptococci (GAS) have focused on the M protein--the target of opsonic antibodies important for protective immunity . We have previously reported protection of mice against GAS infection following parenteral delivery of a multi-epitope vaccine construct, referred to as a heteropolymer . This current report has assessed mucosal (intranasal (i.n.) and oral) delivery of the heteropolymer in mice with regard to the induction and specificity of mucosal and systemic antibody responses, and compared this to parenteral delivery . GAS-specific IgA responses were detected in saliva and gut upon i.n . and oral delivery of the heteropolymer co-administered with cholera toxin B subunit, respectively . High titre serum IgG responses were elicited to the heteropolymer following all routes of delivery when administered with adjuvant . Moreover, as with parenteral delivery, serum IgG antibodies were detected to the individual heteropolymer peptides following i.n . but not oral delivery . These data support the potential of the i.n . route in the mucosal delivery of a GAS vaccine. Biochemistry, 2002 Jun 4, 41(22), 7001 - 7 Mechanism of aminoglycoside antibiotic kinase APH(3')-IIIa: role of the nucleotide positioning loop; Thompson PR et al.; The aminoglycoside antibiotic resistance kinases (APHs) and the Ser/Thr/Tyr protein kinases share structural and functional homology but very little primary sequence conservation (<5%) . A region of structural, but not amino acid sequence, homology is the nucleotide positioning loop (NPL) that closes down on the enzyme active site upon binding of ATP . This loop region has been implicated in facilitating phosphoryl transfer in protein kinases; however, there is no primary sequence conservation between APHs and protein kinases in the NPL . There is an invariant Ser residue in all APH NPL regions, however . This residue in APH(3')-IIIa (Ser27), an enzyme widespread in aminoglycoside-resistant Enterococci, Streptococci, and Staphylococci, directly interacts with the beta-phosphate of ATP through the Ser hydroxymethyl group and the amide hydrogen in the 3D structure of the enzyme . Mutagenesis of this residue to Ala and Pro supported a role for the Ser amide hydrogen in nucleotide capture and phosphoryl transfer . A molecular model of the proposed dissociative transition state, which is consistent with all of the available mechanistic data, suggested a role for the amide of the adjacent Met26 in phosphoryl transfer . Mutagenesis studies confirmed the importance of the amide hydrogen and suggest a mechanism where Ser27 anchors the ATP beta-phosphate facilitating bond breakage with the gamma-phosphate during formation of the metaphosphate-like transition, which is stabilized by interaction with the amide hydrogen of Met26 . The APH NPL therefore acts as a lever, promoting phosphoryl transfer to the aminoglycoside substrate, with the biological outcome of clinically relevant antibiotic resistance. Proc Natl Acad Sci U S A, 2002 May 28, 99(11), 7681 - 6 Induction of natural competence in Streptococcus pneumoniae triggers lysis and DNA release from a subfraction of the cell population; Steinmoen H et al.; Naturally competent bacteria have the ability to take up free DNA from the surrounding medium and incorporate this DNA into their genomes by homologous recombination . In naturally competent Streptococcus pneumoniae, and related streptococcal species from the mitis phylogenetic group, the competent state is not a constitutive property but is induced by a peptide pheromone through a quorum-sensing mechanism . Recent studies have shown that natural genetic transformation is an important mechanism for gene exchange between streptococci in nature . A prerequisite for effective gene exchange is the presence of streptococcal donor DNA in the environment . Despite decades of study of the transformation process we still do not know how this donor DNA is released from streptococcal cells to the external milieu . Traditionally, it has been assumed that donor DNA originates from cells that die and fall apart from natural causes . In this study we show that induction of the competent state initiates release of DNA from a subfraction of the bacterial population, probably by cell lysis . The majority of the cells induced to competence take up DNA and act as recipients, whereas the rest release DNA and act as donors . These findings show that natural transformation in streptococci provides a natural mechanism for genetic recombination that resembles sex in higher organisms. Oral Microbiol Immunol, 2002 Jun, 17(3), 193 - 6 An essential amino acid residue for catalytic activity of the dextranase of Streptococcus mutans; Igarashi T et al.; Dextranase (Dex) is an enzyme that hydrolyzes glucan, a polymer of glucose synthesized from sucrose by glucosyltransferases (GTFs) . By comparing amino acid sequences of Dexs and GTFs, we found that the Dex enzymes of Streptococcus mutans, Streptococcus sobrinus, Streptococcus downei and Streptococcus salivarius had similar amino acid sequences to those of the catalytic sites of GTFs of mutans streptococci . We therefore examined the amino acid essential in Dex catalysis by molecular genetic approaches in this study . Site-directed mutagenesis was used to convert the Asp-385 of the Dex molecule of S . mutans Ingbritt to Glu, Asn, Thr or Val . Replacement of Asp-385 with any of the amino acids resulted in complete disappearance of Dex activity . However, replacement of other Asp residues did not affect the enzyme activity . The inactive enzymes still retained dextran-binding ability . These results suggest that Asp-385 of the Dex of S . mutans Ingbritt was essential for enzyme activity and the catalytic and substrate-binding sites were located at different sites within the Dex molecule. J Infect Dis, 2002 Jun 1, 185(11), 1586 - 95 Epub 2002 May 17. A comparison of group A streptococci from invasive and uncomplicated infections: are virulent clones responsible for serious streptococcal infections? Johnson DR, Wotton JT, Shet A, Kaplan EL. From the mid-1980s, numerous reports of invasive group A streptococcal infections suggested that "highly virulent clones" were responsible . However, there have been virtually no extensive reports and comparisons of diverse temporal and geographic community isolates from uncomplicated throat infections to confirm the hypothesis . A unique collection of such "control" strains allowed in-depth assessment of association of M serotypes 1, 3, and 28 "clones" with invasive infections . Clones were defined by using small-fragment chromosomal restriction-enzyme analysis, pulsed-field gel electrophoresis, and M protein gene (emm) sequencing . After comparison with controls, no clone within these M serotypes had statistically increased association with invasive infections . The prevalence of specific virulence-associated clones appeared to essentially reflect their normal population prevalence . Although this does exclude other potential streptococcal factors, these findings suggest that host factors including individual and population-based immunity must also be significant in influencing infection potential. FEMS Microbiol Lett, 2002 Apr 23, 210(1), 135 - 41 Genetic engineering of Streptococcus gordonii for the simultaneous display of two heterologous proteins at the bacterial surface; Maggi T et al.; The Gram-positive bacterium Streptococcus gordonii has been genetically engineered to allow the simultaneous expression of two heterologous proteins at the cell surface . A family of recombinant streptococci displaying two different antigens was constructed . All the strains were genetically stable and expressed both proteins at the surface of the same bacterial cell . S . gordonii co-expressing the immunomodulating molecule LTB (B monomer of Escherichia coli heat-labile toxin) and the V3 domain of HIV-1 gp120 were inoculated subcutaneously to BALB/c mice . Animals were capable of responding to both antigens, producing LTB- and V3-specific serum IgG . The V3-specific IgG titer was four-fold higher in mice immunised with the double protein-expressing bacteria, as compared to control animals inoculated either with S . gordonii expressing the V3 domain alone or with a mixture of the two strains expressing LTB and V3, separately . Therefore, LTB was able to potentiate the antibody response towards the V3 domain, and this effect was observed only when LTB was co-expressed on the same bacterial cell. Chang Gung Med J, 2002 Mar, 25(3), 190 - 3 Successful treatment of meningitis caused by highly-penicillin-resistant Streptococcus mitis in a leukemic child; Jaing TH et al.; In recent years, viridans streptococci have been reported with increasing frequency to cause infections in neutropenic cancer patients . Streptococcus mitis, one of the species included among viridans streptococci, is the most resistant to beta-lactam antibiotics in this group . Bacterial meningitis presenting without pleocytosis in the cerebrospinal fluid (CSF) is rare, and this situation could be confusing to physicians . It is also an uncommon infectious complication in leukemic patients with neutropenia . In patients with