Streptococcal

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 leukopenia caused by myelosuppression after chemotherapy, bacterial meningitis must be considered a possibility when a patient develops meningeal signs, even if no pleocytosis is found in the CSF . We report on a 6-year-old boy with leukemia and neutropenia who developed sepsis and meningitis caused by S . mitis with high-level resistance to penicillin and cephalosporins (MIC of both, >2 mg/l); he was a long-term survivor receiving chronic trimethoprim-sulfamethoxazole prophylaxis . The patient was successfully treated with a combination of vancomycin, ceftriaxone, and granulocyte-colony-stimulating factor.

Antimicrob Agents Chemother, 2002 Jun, 46(6), 1816 - 22
Resistance determinants and clonal diversity in group A streptococci collected during a period of increasing macrolide resistance; Cresti S et al.; Susceptibility to macrolides and lincosamides was investigated with 299 consecutive nonduplicate Streptococcus pyogenes clinical isolates collected over a 6-year period (1992 to 1997) from an area of central Italy . During this period, macrolide resistance rates steadily increased (from 9% in 1992 to 53% in 1997; P < 0.001) . The increase was caused by isolates with a macrolide-lincosamide-streptogramin B resistance phenotype, carrying mostly erm(B) but also erm(TR) genes, that were not detected in the first 2 years and were detected with increasing prevalence (8, 5, 26, and 37%, respectively) during the following 4 years . During the same period, the prevalence of isolates with a macrolide resistance phenotype, carrying mef(A) determinants, did not vary significantly; on average it was 13%, with modest rate fluctuations in different years and no definite trend . Molecular typing revealed a remarkable clonal diversity among susceptible and resistant isolates and a notable heterogeneity of the genetic environment of the resistance genes . The analysis of clonal diversity in relation with resistance phenotypes and genotypes revealed that increased macrolide resistance rates were due to a complex interplay of different mechanisms, with a relevant contribution played by an "epidemic" spread of genetic elements carrying the erm(B) gene among the circulating streptococcal population.

Curr Infect Dis Rep, 2002 Jun, 4(3), 211 - 216
The Use of Probiotics in Head and Neck Infections; Roos K et al.; Recurrent episodes of infections in the upper respiratory tract are very common . The pathogenesis behind these recurrences is still not well understood, but much attention has been paid to the adherence of the microorganisms to epithelial structures and to the protective function of the normal bacterial flora (bacterial interference) . Thus, in vitro as well as in vivo studies have shown that both aerobic and anaerobic bacteria of the normal flora in the upper respiratory tract can hinder the growth of pathogens and the establishment of a renewed infection . Studies have shown that lack of interfering bacteria facilitates recurrence of these diseases . Recolonization with interfering alpha-streptococci has been performed successfully in acute streptococcal pharyngotonsillitis, as well as in acute otitis media . The number of recurrences has significantly been lowered in these diseases after recolonization with alpha-streptococci, which is the dominating normal bacteria in the upper respiratory tract . Several mechanisms have been proposed to be responsible for this interaction, such as competition of the adhering sites at the epithelial cells, production of hydrogen peroxide, competition for nutritients, and production of specific growth inhibiting factors such as bacteriocins . Other human components like lactoferrin are also important in the defense against microorganisms, and are important parts of the unspecific and specific immune system.

Clin Infect Dis, 2002 Jun 1, 34(11), 1524 - 9 Epub 2002 May 06.
Infections caused by viridans streptococci in patients with neutropenia; Tunkel AR et al.; The frequency of isolation of viridans streptococci from the blood of neutropenic patients with cancer has significantly increased over the course of the last 10-15 years . Risk factors in this patient population include severe neutropenia, oral mucositis, administration of high-dose cytosine arabinoside, and antimicrobial prophylaxis with either trimethoprim-sulfamethoxazole or a fluoroquinolone . In some patients with cancer and neutropenia who develop viridans streptococcal bacteremia, a toxic shock-like syndrome has been described; Streptococcus mitis has been the causative species in most cases . Because resistance of viridans streptococci to a variety of antimicrobial agents is increasingly recognized, penicillin susceptibility cannot be assumed, and empirical vancomycin therapy should be used to treat neutropenic patients with cancer who have shock or are developing acute respiratory distress syndrome . Given the seriousness of septicemia caused by viridans streptococci and the potential for selection of other resistant microorganisms, the routine practice of antimicrobial prophylaxis for neutropenic patients with cancer should be reconsidered.

Clin Infect Dis, 2002 Jun 1, 34(11), 1469 - 74 Epub 2002 May 07.
Bacteremia due to viridans group Streptococci with diminished susceptibility to Levofloxacin among neutropenic patients receiving levofloxacin prophylaxis; Razonable RR et al.; Despite the use of levofloxacin prophylaxis during the neutropenic period after autologous peripheral blood stem cell transplantation, viridans group (VG) streptococcal bacteremia developed in 6 (16.2%) of 37 patients who underwent transplantation between 1 January and 25 February 2001 at the Mayo Clinic in Rochester, Minnesota . All 6 patients presented with fever and mucositis after a mean of 4.5 days of neutropenia, and 3 developed septic shock . All 6 VG streptococcal isolates from these patients exhibited distinct patterns on pulsed-field gel electrophoresis . All isolates had diminished susceptibility to levofloxacin, 5 to gatifloxacin, and 4 to moxifloxacin . Quinolone resistance was associated with mutations in the quinolone resistance-determining region of GyrA and (for 1 isolate) of ParC . The use of levofloxacin may select VG streptococci with diminished susceptibility to levofloxacin and other quinolones with enhanced activity against gram-positive organisms and, therefore, may not be optimal for preventing VG streptococcal bacteremia in neutropenic patients.

Curr Opin Infect Dis, 2002 Jun, 15(3), 307 - 13
Group B streptococci during pregnancy and infancy; Berner R; Group B streptococcus (Streptococcus agalactiae) is still of great relevance in the perinatal period, although maternal antimicrobial prophylaxis has significantly reduced the rate of culture-confirmed invasive infection in neonates . This strategy, however, raises considerable concern because preterm delivery or late-onset sepsis cannot be prevented, and antibiotic resistance is increasing worldwide . Several advances in the development of conjugate vaccines and in research on virulence factors and pathways involved in the immune response to group B streptococcus have been accomplished, some of which might reach clinical practice in the near future.

Int J Tissue React, 2002, 24(1), 37 - 44
Clarithromycin mediated the expression of polymorphonuclear granulocyte response against streptococcus pneumoniae strains with different patterns of susceptibility and resistance to penicillin and clarithromycin; Cuffini AM et al.; There is an urgent need for antibiotics that can be used in the therapy of infections caused by penicillin-resistant Streptococcus pneumoniae, the incidence of which is often associated with considerable morbidity and mortality . Antibiotics that can interact positively with the immune response and that also possess microbicidal properties might significantly contribute to improving the outcome of S . pneumoniae infections . Therefore, in the present study we investigated the effect of clarithromycin, an extended spectrum macrolide currently used in the treatment of respiratory tract infections, on the in vitro interaction between human polymorphonuclear granulocytes (PMN) and three strains of S . pneumoniae with different susceptibility or resistance patterns to both penicillin and clarithromycin . At a concentration of one-half the minimal inhibitory concentration (MIC), clarithromycin significantly enhanced human PMN functions, particularly intracellular bactericidal activity, against all the S . pneumoniae strains, including resistant ones . This finding may help to explain clarithromycin activity in vivo despite apparent resistance in vitro . Preexposure of PMNs to one-half the MIC of clarithromycin had no effect on either phagocytosis or intracellular killing, ruling out a direct antibiotic action on PMNs . Preexposure of streptococci to clarithromycin increased the susceptibility of S . pneumoniae to the bactericidal mechanisms of human PMNs compared with untreated bacteria, indicating that this macrolide may partly reduce bacterial virulence via changes in S . pneumoniae.

Infect Immun, 2002 Jun, 70(6), 2891 - 8
Expression and characterization of streptococcal rgp genes required for rhamnan synthesis in Escherichia coli; Shibata Y et al.; Six genes (rgpA through rgpF) that were involved in assembling the rhamnose-glucose polysaccharide (RGP) in Streptococcus mutans were previously identified (Y . Yamashita, Y . Tsukioka, K . Tomihisa, Y . Nakano, and T . Koga, J . Bacteriol . 180:5803-5807, 1998) . The group-specific antigens of Lancefield group A, C, and E streptococci and the polysaccharide antigen of Streptococcus sobrinus have the same rhamnan backbone as the RGP of S . mutans . Escherichia coli harboring plasmid pRGP1 containing all six rgp genes did not synthesize complete RGP . However, E . coli carrying a plasmid with all of the rgp genes except for rgpE synthesized the rhamnan backbone of RGP without glucose side chains, suggesting that in addition to rgpE, another gene is required for glucose side-chain formation . Synthesis of the rhamnan backbone in E . coli required the initiation of transfer of N-acetylglucosamine to a lipid carrier and the expression of the rgpC and rgpD genes encoding the putative ABC transporter specific for RGP . The similarities in RGP synthesis between E . coli and S . mutans suggest common pathways for rhamnan synthesis . Therefore, we evaluated the rhamnosyl polymerization process in E . coli by high-resolution sodium dodecyl sulfate-polyacrylamide gel electrophoresis of the lipooligosaccharide (LOS) . An E . coli transformant harboring rgpA produced the LOS modified by the addition of a single rhamnose residue . Furthermore, the rgpA, rgpB, and rgpF genes of pRGP1 were independently mutated by an internal deletion, and the LOS chemotypes of their transformants were examined . The transformant with an rgpA deletion showed the same LOS profile as E . coli without a plasmid . The transformant with an rgpB deletion showed the same LOS profile as E . coli harboring rgpA alone . The transformant with an rgpF deletion showed the LOS band with the most retarded migration . On the basis of these results, we speculated that RgpA, RgpB, and RgpF, in that order, function in rhamnan polymerization.

Infect Immun, 2002 Jun, 70(6), 2877 - 85
A glutamine transport gene, glnQ, is required for fibronectin adherence and virulence of group B streptococci; Tamura GS et al.; Group B streptococci (GBS) are a leading cause of neonatal sepsis and meningitis . GBS adhere to fibronectin when it is attached to a solid phase . We isolated a Tn917 transposon mutant, COH1-GT1, which shows decreased adherence to fibronectin . COH1-GT1 also shows decreased adherence to and invasion of respiratory epithelial cells in vitro and decreased virulence in vivo . COH1-GT1 contains a Tn917 insertion in a homolog of glnQ, a gene from Escherichia coli which is required for glutamine transport and codes for a cytoplasmic ATP-binding cassette protein . To confirm that the decreased fibronectin adherence of COH1-GT1 was due to the mutation in glnQ, we constructed COH1-GT2, a strain with a nonpolar site-directed mutation in glnQ . COH1-GT2 showed decreased binding to fibronectin . We also demonstrated that complementation of glnQ in trans restored fibronectin adherence to COH1-GT1 . COH1-GT1 shows decreased uptake of radiolabeled glutamine and is resistant to the toxic glutamine analog gamma-L-glutamylhydrazide, demonstrating that the glnQ gene is required for glutamine transport in GBS . glnQ lacks a signal sequence and is a cytoplasmic protein in E . coli and thus is unlikely to act as a fibronectin adhesin . glnQ is transcribed in an operon with a putative glutamine permease gene, glnP, which has a novel predicted structure containing three distinct domains linked in a single gene . The first two domains are putative glutamine binding domains with homology to the E . coli periplasmic glutamine binding gene glnH . The third is a putative permease domain with homology to the E . coli glutamine permease gene glnP . RT-PCR analysis demonstrated that glnP and glnQ are contained within a single transcript . Transcription of scpB, encoding the only known fibronectin-binding adhesin of GBS, is unaffected . We speculate that glnQ may regulate expression of fibronectin adhesins by affecting cytoplasmic glutamine levels and that regulation may be posttranscriptional.

Infect Immun, 2002 Jun, 70(6), 2869 - 76
Identification of novel adhesins from Group B streptococci by use of phage display reveals that C5a peptidase mediates fibronectin binding; Beckmann C et al.; Group B streptococci (GBS) are a major cause of pneumonia, sepsis, and meningitis in newborns and infants . GBS initiate infection of the lung by colonizing mucosal surfaces of the respiratory tract; adherence of the bacteria to host cells is presumed to be the initial step in and prerequisite for successful colonization (G . S . Tamura, J . M . Kuypers, S . Smith, H . Raff, and C . E . Rubens, Infect . Immun . 62:2450-2458, 1994) . We have performed a genome-wide screen to identify novel genes of GBS that mediate adherence to fibronectin . A shotgun phage display library was constructed from chromosomal DNA of a serotype Ia GBS strain and affinity selected on immobilized fibronectin . DNA sequence analysis of different clones identified 19 genes with homology to known bacterial adhesin genes, virulence genes, genes involved in transport or metabolic processes, and genes with yet-unknown function . One of the isolated phagemid clones showed significant homology to the gene (scpB) for the GBS C5a peptidase, a surface-associated serine protease that specifically cleaves the complement component C5a, a chemotaxin for polymorphonuclear leukocytes . In this work we have demonstrated that affinity-purified recombinant ScpB and a peptide ScpB fragment (ScpB-PDF), similar to the peptide identified in the phagemid, bound fibronectin in a concentration-dependent manner . Adherence assays to fibronectin were performed, comparing an isogenic scpB mutant to the wild-type strain . Approximately 50% less binding was observed with the mutant than with the wild-type strain . The mutant phenotype could be fully restored by in trans complementation of the mutant with the cloned wild-type scpB gene, providing further evidence for the role of ScpB in fibronectin adherence . Our results suggest that C5a peptidase is a bifunctional protein, which enzymatically cleaves C5a and mediates adherence to fibronectin . Since binding of fibronectin has been implicated in attachment and invasion of eukaryotic cells by streptococci, our results may imply a second important role for this surface protein in the pathogenesis of GBS infections.

Clin Microbiol Infect, 2002 Mar, 8(3), 174 - 81
Streptococcal toxic shock syndrome: a description of 14 cases from North Yorkshire, UK; Barnham MR et al.; OBJECTIVE: To analyze the clinical and laboratory features of patients diagnosed with streptococcal toxic shock syndrome (TSS) in North Yorkshire from 1986 to 1999 . METHODS: Records of patients with features satisfying the published criteria for streptococcal TSS were reviewed from laboratory and clinical records made at the time and from the hospital case notes . Isolates of streptococci were analyzed for serotype and genes encoding for the production of streptococcal pyrogenic exotoxins . RESULTS: Fourteen patients satisfied the entry criteria . In one district, where the data were complete, the annual incidence of detected streptococcal TSS rose from 1.1 to 9.5 cases per million population in the 1990s . TSS was associated with various M serotypes of group A streptococci and various exotoxin genotypes . Two cases (14% of the series) were associated with severe group G streptococcal infection . The fatality rate was 64%, and the mode of time to death was 4 days . Local tissue necrosis occurred in 71% of cases, including necrotizing fasciitis, intrathoracic and intra-abdominal forms . Non-steroidal anti-inflammatory drugs (NSAIDs) had been taken around the time of onset of disease by 92% of the patients with TSS . CONCLUSIONS: There has been a dramatic increase in the number of detected cases of streptococcal TSS over the 14 years since the first case was recognized here . There was a wide range of invasive forms of infection, a high fatality rate even in fit young adults, and a rapid course from onset to death . There was a high association of TSS with aggressive streptococcal infection producing local tissue necrosis.

Vaccine, 2002 May 22, 20(17-18), 2197 - 205
Biological consequences of antigen and cytokine co-expression by recombinant Streptococcus gordonii vaccine vectors; Byrd CM et al.; To test the effect of co-expression of immunomodulatory molecules, together with target antigen, two recombinant Streptococcus gordonii strains were constructed which secreted either murine interleukin-2 (IL-2) or interferon-gamma (IFN-gamma) in addition to a surface anchored test antigen (the conserved C-repeat region (CRR) of the M6 protein of Streptococcus pyogenes) . The secretion of functional cytokines by S . gordonii was achieved by in-frame fusion of sequences encoding mature IL-2 or IFN-gamma to the sequences encoding the leader signal of the M6 protein . Expression of the M protein CRR region from a separate chromosomal site produced double recombinants expressing a secreted cytokine and the M protein CRR region anchored to the surface . Protein expression was verified by streak blot, immunoblot, and ELISA on both the single and double recombinants . A cytokine bioassay using HT-2 cells verified biological activity of recombinant IL-2 secreted from S . gordonii . When mice were immunized subcutaneously with the different S . gordonii expression strains, cytokine co-expression apparently modulated the systemic immune response . These results show that streptococci can deliver biologically active molecules such as cytokines along with antigens to the immune system . These results demonstrate that a cytokine-secreting, noninvasive, bacterial vaccine vector can be used to modulate immune responses to a co-expressed antigen.

Diagn Microbiol Infect Dis, 2002 Apr, 42(4), 263 - 8
Possible overestimation of penicillin resistant Streptococcus pneumoniae colonization rates due to misidentification of oropharyngeal streptococci; Wester CW et al.; Standard identification of Streptococcus pneumoniae by optochin and bile solubility testing can lead to ambiguous results for certain isolates . Newer bacteriologic identification techniques (e.g., DNA probes) now exist . In a prospective point prevalence study of oropharyngeal S . pneumoniae carriage rates among outpatients, we compared standard organism identification techniques to DNA probe testing . By standard identification criteria, 35 (4%) of 872 isolates were characterized as presumptive S . pneumoniae . Thirty of 35 presumptive isolates were recoverable for DNA probing; 9 (30%) presumptive isolates were confirmed using a DNA probe . The antimicrobial susceptibility pattern of these DNA probe positive isolates closely paralleled that of clinical blood isolates of S . pneumoniae obtained during the study period . The 21 (70%) DNA probe negative isolates, which may represent phylogenetically related species (such as S . mitis or S . oralis), had significantly reduced antimicrobial susceptibility patterns when compared with the DNA probe positive isolates . In colonization studies, if classic criteria (optochin disc zone and bile solubility) are the sole means of identification, S . pneumoniae penicillin resistance rates may be over-reported.

J Antimicrob Chemother, 2002 May, 49(5), 777 - 83
Prevalence and antibiotic resistance profile of mercury-resistant oral bacteria from children with and without mercury amalgam fillings; Pike R et al.; Genes encoding resistance to mercury and to antibiotics are often carried on the same mobile genetic element and so it is possible that mercury-containing dental materials may select for bacteria resistant to mercury and to antibiotics . The main aim of this study was to determine whether the prevalence of Hg-resistant oral bacteria was greater in children with mercury amalgam fillings than in those without . A secondary aim was to determine whether the Hg-resistant isolates were also antibiotic resistant . Bacteria in dental plaque and saliva from 41 children with amalgam fillings and 42 children without such fillings were screened for mercury resistance by cultivation on a HgCl(2)-containing medium . Surviving organisms were identified and their susceptibility to mercury and to several antibiotics was determined . Seventy-eight per cent and 74% of children in the amalgam group and amalgam-free group, respectively, harboured Hg-resistant bacteria; this difference was not statistically significant . Nor was there any significant difference between the groups in terms of the proportions of Hg-resistant bacteria in the oral microflora of the children . Of Hg-resistant bacteria, 88% and 92% from the amalgam group and the amalgam-free group, respectively, were streptococci; 41% and 33% were resistant to at least one antibiotic, most frequently tetracycline . The results of this study show that there was no significant difference between children with amalgam fillings and those without such fillings with regard to the prevalence, or the proportion, of Hg-resistant bacteria in their oral microflora . The study also found that Hg-resistant bacteria were common in children regardless of whether or not they had amalgam fillings and that many of these organisms were also resistant to antibiotics.

Biol Res Nurs, 2002 Jan, 3(3), 132 - 9
Physiologic factors contributing to a transition in oral immunity among mechanically ventilated adults; O'Neal PV et al.; Ventilator-associated pneumonia (VAP), a specific type of nosocomial pneumonia, occurs in approximately 21% of patients in intensive care, and the mortality can be as high as 71% . VAP causes considerable mortality and morbidity, and it exponentially increases health care costs . The incidence of VAP is associated with oropharyngeal colonization of gram-negative bacteria . Within 48 h of hospital admission, the composition of the oropharyngeal flora of critically ill patients undergoes a change from the usual gram-positive streptococci and dental pathogens to a predominant gram-negative flora that includes more virulent organisms, which predispose patients to VAP . Identification and understanding of this oral transition from gram-positive to predominantly gram-negative flora may assist health care professionals in differentiating among oral immune markers that suggest compromised immunity . The purpose of this article is to provide a review of the literature that promotes an understanding of current knowledge about the transition of oral immunity in mechanically ventilated patients.

Microb Drug Resist, 2002 Spring, 8(1), 39 - 44
Erythromycin resistance in italian isolates of Streptococcus pyogenes and correlations with pulsed-field gel electrophoresis analysis; Zampaloni C et al.; Erythromycin resistance among Streptococcus pyogenes strains has been reported in Italy at high rates during the last few years . A total of 152 erythromycin-resistant isolates of this species from southern Italian regions were characterized for the macrolide-resistance phenotype and screened by PCR for the corresponding genetic determinant . A close correlation was found between these phenotypic/genotypic data concerning macrolide resistance and results of Sma I macrorestriction fragment patterns (PFGE) analysis . In fact, the vast majority of the isolates assigned to individual PFGE classes mostly belonged to a single phenotype of macrolide resistance . All untypeable isolates belonged to the M phenotype . Twenty-two distinct PFGE types were recognized, of which 11 were recorded in only one isolate (one-strain type); about 50% of typeable isolates fell into five type clusters and 70% in seven . The increased erythromycin resistance among Italian isolates of S . pyogenes does not appear to be due to the spread of a single clone, but results indicate that the majority of group A streptococci examined are probably spread from a limited number of clones.

Microb Drug Resist, 2002 Spring, 8(1), 27 - 33
Increased prevalence of erythromycin resistance in streptococci: substantial upsurge in erythromycin-resistant M phenotype in Streptococcus pyogenes (1979-1998) but not in Streptococcus pneumoniae (1985-1999) in Taiwan; Hsueh PR et al.; A total of 394 nonduplicate isolates of Streptococcus pyogenes collected from 1979 to 1998 and 267 nonduplicate isolates of Streptococcus pneumoniae collected from October, 1998, to May, 1999, in Taiwan were evaluated . Among the 220 erythromycin-resistant (MIC, > or =1 microg/ml) S . pyogenes isolates, 35% had an M phenotype and 65% had an ML phenotype (inducible resistance {iML}, 0.5%, and constitutive resistance {cML}, 64.5%) . Among the 243 erythromycin-resistant S . pneumoniae isolates, the majority (65.4%) had an ML phenotype (iML, 0.4%, and cML, 65%) and 34.6% had an M phenotype . A substantial upsurge in the incidence of M-phenotype erythromycin-resistant isolates was found with time for S . pyogenes (0% in 1979-1984 and 100% in 1997-1998), and an increasing incidence of M-phenotype among erythromycin-resistant S . pneumoniae was also noted (<20% before 1994 and 45.4% in 1999) . All S . pyogenes and all but four S . pneumoniae isolates exhibiting a cML or iML phenotype had harbored the ermAM gene . The presence of the mefA gene was demonstrated in all isolates of S . pyogenes and the mefE gene in all but four S . pneumoniae isolates exhibiting the M phenotype . Due to the increasing susceptibility of S . pyogenes and S . pneumoniae isolates to clindamycin, susceptibility tests of these two organisms to macrolides and clindamycin should be performed simultaneously in the clinical microbiology laboratory, particularly in areas with high rates of macrolide resistance.

J Am Board Fam Pract, 2002 Mar-Apr, 15(2), 93 - 100
Clinical judgment predicts culture results in upper respiratory tract infections; Bloom HR et al.; BACKGROUND: We wanted to describe the natural history, familial transmission, microbiology, and accuracy of clinical judgment of potential pathogens of respiratory tract infections in a community family practice . METHODS: The study was a prospective case series in which consecutive patients requesting treatment for respiratory tract infections were evaluated after nurse triage during 3 fall-spring months in a solo family practice in suburban Cleveland, Ohio . According to the physician's usual practice, patients were classified into high-, medium-, and low-risk groups for bacterial illness based on their clinical signs and symptoms . Cultures were performed and sensitivities were determined for pathogens from the infected throat, nasopharynx, conjunctiva, or other sites . Patient symptoms and well-being were scored at the initial visit and at 3, 7 and 14 days later . RESULTS: There were 111 illness episodes in 86 patients; 94% had cultures taken, of which 38% grew a potentially pathogenic bacteria, most commonly group A streptococci, Branhamella catarrhalis or Staphylococcus aureus . The physician's judgment of bacterial infection was associated (P < .001) with having a positive culture (sensitivity 53%, specificity 78%, positive and negative predictive values 60% and 73%, respectively) . A positive culture was associated with 2 of 16 signs or symptoms: purulent discharge from any site or a red swollen eye . There was no association of treatment status with clinical outcomes during 2 weeks of follow-up observation . CONCLUSION: Infection with a potentially pathogenic bacteria is difficult to determine solely by clinical signs and symptoms, but clinical judgment is associated with positive culture results . The effect of selective treatment of upper respiratory tract infection based on clinical signs and symptoms and patient and family culture results remains to be determined, but using clinical judgment could result in more selective antibiotic use than found in current practice patterns.

Community Dent Oral Epidemiol, 2002 Apr, 30(2), 143 - 50
Clinical outcomes of risk-based caries prevention in preschool-aged children; Pienihakkinen K et al.; OBJECTIVE: The aim of this study was to evaluate outcomes in young children of risk-based management of dental caries in comparison with routine prevention . METHODS: The study was carried out in two municipal health centers in Central Finland . The risk-based prevention group consisted of 299 children from Vanha Korpilahti, and the routine prevention group of 226 children from Saarijarvi . The children were 2 yr old at baseline, and they were followed up for 3 yr . All children received regular annual oral health care . In the risk-based prevention group, the presence of mutans streptococci (MS) in plaque (Dentocult-SM strip mutans -test, Orion Diagnostica, Espoo, Finland) and incipient caries lesions were the screening criteria . Additional prevention was targeted at MS-positive subjects twice a year, consisting of health education and application of fluoride varnish . For those who had incipient lesions, 'the high-risk category', additional prevention was given four times a year and this included also chlorhexidine varnish treatments . RESULTS: The screening and the preventive measures were successfully carried out by specially trained dental assistants . The proportion of children with cavitated caries or fillings was significantly lower in the risk-based than in the routine prevention group . The treatment effect was strongest within the high-risk category: two subjects had to be treated with intensive care for 3 yr to avoid restorative treatment of dental caries by the age of 5 yr in one subject (number needed to treat (NNT) = 2.0; 95% CI 1.4-3.8) . The accuracy of screening was evaluated in the routine prevention group and found acceptable . CONCLUSIONS: The results indicate that in young children, risk-based management of caries seems practical, and prevention of caries can be targeted efficiently to individuals at risk.

Community Dent Oral Epidemiol, 2002 Jun, 30(3), 176 - 81
Maternal risk indicators for childhood caries in an inner city population; Smith RE et al.; OBJECTIVES: This study evaluated whether characteristics of mothers, such as high mutans streptococci (MS) level, caries experience, reported sugar consumption and demographic variables, could be important risk indicators of caries for their children . METHODS: Mothers selected on the basis of the caries status of their 3-5-year-old-children were tested for MS, caries, reported sugar consumption and demographic variables . RESULTS: We found strong associations between children's caries and their mothers' MS levels (high/low adj . OR = 11.3), maternal active caries (yes/no adj . OR = 4.0) and maternal sugar consumption (high/low adj . OR = 4.2) . In this small study, mothers' demographic variables were not associated with the status of caries in their children . CONCLUSIONS: Our findings suggest that maternal high MS levels, maternal active decay and maternal sugar consumption are strong risk indicators for children's caries . Although further study is needed, these three maternal risk indicators, taken together, may prove useful in predicting children's caries risk.

Cas Lek Cesk, 2002 Mar, 141(5), 139 - 42
{Acute pharyngotonsillitis}; Lukas J; The article reviews rent findings on the acute pharyngotonsilitis . In the aetiology of the disease viral infections prevail . In the bacterial aetiology of the acute pharyngotonsilitis mainly group A streptococci predominate . Individual types of pharyngotonsilitis are specified, and their typical clinical symptoms, diagnostics and therapy are given.

Int J Pediatr Otorhinolaryngol, 2002 May 15, 63(3), 199 - 207
Decreased serum and pharyngeal antibody levels specific to streptococcal lipoteichoic acid in children with recurrent tonsillitis; Yokoyama Y et al.; OBJECTIVE: Streptococcus (S.) pyogenes is a common cause of primary as well as recurrent tonsillitis (RT) . Lipoteichoic acid (LTA) has been proposed as a possible candidate for vaccine formulation against streptococcal infections, because LTA is a common constituent of streptococci and the antibody to LTA inhibits bacterial attachment to epithelial cells in vitro . Streptolysin-O and streptococcal whole cell body are highly immunogenic and the antibodies to these antigens are reported to be better parameters for streptococcal infections The objective of the present study is to investigate how systemic and local immune activities against S . pyogenes may be associated with RT . METHODS: Sera from 178 children with or without RT aged 1-15 years with a median age of 5 years were investigated for the levels of total immunoglobulins and antibodies specific to streptococcal antigens such as whole cell body, LTA, and streptolysin-O . Pharyngeal secretions from 67 children with or without RT aged 2-14 years with a median age of 6 years were subjects to secretory IgA (SIgA) antibody levels to streptococcal LTA . The antibodies to whole cell body and LTA were measured by enzyme-linked immunosorbent assay . Total immunoglobins and the anti-streptolysin-O antibody were assayed by nephelometry . RESULTS: An age-matched comparison revealed that either levels of serum IgG antibody or pharyngeal SIgA antibody to streptococcal LTA at 2-5 years of age were significantly lower in RT children than in non-RT children (1.39 vs . 5.14 microg/ml, P=0.001; 10.6 vs . 29.9 units/ng/ml total SIgA, P=0.015; respectively) and correlated inversely to episodes of tonsillitis (r=-0.242, P=0.024; r=-0.3, P=0.024; respectively) . Either serum total immunoglobulin levels of IgG or IgA correlated positively to episodes of tonsillitis in children aged 2-5 years (r=0.293, P=0.011; r=0.361, P=0.002; respectively) . No difference was found on either serum levels of IgG antibody to streptococcal whole cell body or antibody to streptolysin-O between RT and non-RT children in any age-matched comparisons . High serum antibody levels to whole cell body was associated with high antibody levels to streptococcal LTA in non-RT children (r=0.198, P<0.05), but no association was found between these antibody levels in RT children . CONCLUSIONS: Selective immunologic failure in systemic and pharyngeal antibody response to streptococcal LTA may be a potential cause of RT in young children.

Eur J Immunol, 1975 Oct, 5(10), 661 - 6
Induction of T and B cell immunity by anti-idiotypic antibody; Eichmann K et al.; A small dose of the IgG1 fraction of anti-idiotypic antibody (aId1) raised in guinea pigs against a strain A/J antibody specific for streptococcal Group A carbohydrate sensitizes A/J mice against Group A streptococci . This is opposed to the previously established suppressive function of anti-idiotypic antibody of the IgG2 class (aId2) . Correspondingly, aId1 but not aId2 is eliminated from the circulation in the way typical of an immunogenic molecule . However, the stimulatory component in the IgG1 fraction is not necessarily itself IgG1 antibody . Sensitization occurs in both B and helper T lymphocytes and is specific for Group A streptococci . In the B cell compartment sensitization is restricted to precursor cells expressing the idiotype . The concomitant activation of T helper cells therefore suggests that these cells make use of receptors with a similar or identical idiotype . Efficient sensitization by aId1 of both T and B cells is also demonstrated in strain C57L/J mice which upon immunization with Group A streptococci express a partially cross-reacting idiotype as a minor component . When such animals were primed with aId1, essentially all of the anti-carbohydrate antibody carried the partially cross-reacting idiotype.

Microbiology, 2002 May, 148(Pt 5), 1501 - 11
Group A streptococcal RofA-type global regulators exhibit a strain-specific genomic presence and regulation pattern; Kreikemeyer B et al.; RofA-like protein (RALP) type regulators have been shown to exist in different forms in group A streptococci (GAS) and to regulate the expression of important bacterial adhesins . This study shows that the vast majority of strains from different GAS M serotypes carried a rofA virulence regulator gene in their genome and that this gene could be detected in combination with other RALP genes and RALP-dependent adhesin genes in a strain-specific manner . The gene encoding the Nra regulator was predominantly found in opacity factor (OF)-negative serotypes . When analysing a rofA mutant in a serotype M2 strain, the strain specificity was also found in the positive and negative regulatory functions of RALP genes as well as in the type and number of virulence genes and functions controlled by the RALP genes . Of 17 virulence-associated genes tested, only one, the putative streptolysin S gene, was observed to be derepressed in RALP mutants of three different GAS serotype strains . This strain-specific variability of RALP regulon sizes is associated with different patterns of host cell attachment and internalization . In addition, RofA2 was shown to control expression of the ribosomal protein gene rpsL . As a consequence, it was demonstrated for the first time in streptococci that aminoglycoside resistance mediated by rpsL expression is apparently controlled by a virulence gene regulator.

Eur J Immunol, 2002 May, 32(5), 1319 - 27
The CD14+CD16+ monocytes in erysipelas are expanded and show reduced cytokine production; Horelt A et al.; In human peripheral blood the classical CD14(++)DR(+) monocytes and the pro-inflammatory CD14(+)CD16(+)DR(++) monocytes can be distinguished . In erysipelas we found strongly increased numbers of CD14(+)CD16(+) monocytes on the day of diagnosis (day 1) in 11 patients with an average of 150.5+/-76.0 cells/microl, while 1 patient had low levels (35 cells/microl, control donors 48.8+/-19.8 cells/microl) . The classical monocytes were only moderately elevated in the erysipelas patients (factor 1.7 as compared to controls) . Patients exhibited increased body temperature, erythrocyte sedimentation rate and increased serum levels for C-reactive protein (CRP), IL-6 and macrophage-colony-stimulating factor . Among these, body temperature and CRP showed a significant correlation to the numbers of CD14(+)CD16(+) monocytes . In 4 of 4 patients with high levels of CD14(+)CD16(+) monocytes, these levels returned to that seen in controls by day 5 of antibiotic therapy . Determination of intracellular TNF was performed by three-color immunofluorescence and flow cytometry after ex vivo stimulation with lipoteichoic acid, a typical constituent of streptococci . Here, patient CD14(+)DR(++) pro-inflammatory monocytes showed a twofold lower level of intracellular TNF . By contrast, expression of TNF was unaltered in the classical CD14(++) monocytes . These data show that in erysipelas the pro-inflammatory CD14(+)CD16(+)DR(++) monocytes are substantially expanded and selectively tolerant to stimulation by streptococcal products.

Indian J Pediatr, 2001 Jul, 68 Suppl 3, S46 - 50
Skin and soft tissue infection; Sharma S et al.; Abstract . Normal skin is heavily colonized by bacterial flora . The most common are the various nonpathogenic gram-positive bacteria such as Staphylococcus epidermidis (coagulase-negative) . Skin and soft tissue infections are usually caused by Staphylococcus aureus (S . aureus) and Streptococcus pyogenes . This article discusses common and some not so common bacterial skin infections, including impetigo, folliculitis, furncles and carbuncles, cellulitis and erysipelas, gangrenous cellulitis, staphylococcal scalded skin syndrome and scarlet fever . Impetigo and ecthyma are common bacterial infections of the skin commonly caused by S . aureus and / or Group A streptoccus . In mild and localized impetigo topical antibiotics whereas in widespread or severe one and in ecthyma systemic antibiotics like, cloxacillin, erythromycin, azithromycin or cephalexin should be used . Folliculitis, furunculosis and carbuncle are folliculocentric infections caused by S . aureus involving the variable depth and extent of the follicle(s) and surrounding tissue . These conditions can be treated with topical or systemic antibiotics like cloxacillin, cephalexin, erythromycin, amoxicillin/clavulanic acid or vancomycin . Staphylococcal scalded skin syndrome is a toxin mediated exfoliative dermatosis caused by S . aureus of phase group II . Intravenous penicillinase-resistant anti-staphylococcal antibiotics like methicillin, cloxacillin, cephalosporin or erythromycin are required . Erysipelas and cellulitis are acute infections of dermal and subcutaneous tissues caused most frequently by Group A beta-hemolytic streptococci (erysipelas) or S . aureus requiring systemic antibiotics like oral or intravenous penicillin, erythromycin, cephalexin, cloxacillin, vacomycin, minocycline or ciprofloxacin depending upon the severity, suspected causative organism and culture/sensitivity results . Gangrenous cellulitis is characterized by infection with necrosis of skin and underlying subcutaneous tissue due to various pathogens occurring at different site . Ampicillin, gentamicin, and either metronidazole or clindamycin intravenously in standard doses are recommended for the treatment.

Curr Opin Infect Dis, 2001 Apr, 14(2), 127 - 32
Necrotizing fasciitis; Seal DV; Necrotizing fasciitis continues to occur due to beta-haemolytic streptococci but is now also recognized as being due to Vibrio spp . in fishermen and those in contact with warm water in the Gulf of Mexico and South-East Asia, including Hong Kong . Magnetic resonance image scanning has identified the extent of fasciitis and soft tissue oedema infiltrating fascial planes prior to necrosis presenting clinically and is a useful tool in early diagnosis . Surgical debridement or incisional drainage remains essential . An enhanced bactericidal response against beta-haemolytic streptococci has been found with a combination of penicillin and clindamycin . Intravenous immunoglobulin has been shown to reduce mortality if the necrotizing fasciitis is associated with the toxic shock syndrome, by decreasing the superantigen activity of the beta-haemolytic streptococci on cytokine release by T cells.

Kansenshogaku Zasshi, 2002 Mar, 76(3), 155 - 60
{Streptococcus dysgalactiae subsp . equisimilis possessing Lancefield's group A antigen}; Katsukawa C et al.; We isolated Streptococcus dysgalactiae subsp . equisimilis with Lancefield's group A antigen from a patient in Osaka City . This clinical isolate formed beta-hemolytic large colonies on sheep blood agar, and was catalase-negative gram-positive cocci carrying Lancefield's group A antigen . Therefore, Streptococcus pyogenes and this clinical isolate could not be classified by the conventional method on the basis of Lancefield's group antigen . In addition, the rapid detection system of group A streptococci based on group A antigen detection techniques could not divide into two species . Recently, S . dysgalactiae subsp . equisimilis with Lancefield's group G antigen has been isolated from severe invasive streptococcal infection in an increasing frequency in Japan . A possibility that group A S . dysgalactiae subsp . equisimilis cause a serious infection from now on cannot be denied . Thus the discrimination of S . pyogenes from group A S . dysgalactiae subsp . equisimilis is very important . To identify beta-hemolytic streptococci, it is necessary to consider a serogrouping test as one of characteristics of streptococci, and to identify by checking biochemical tests like the PYR test.

MMW Fortschr Med, 2002 Mar 21, 144(12), 30 - 2, 34-5
{Skin changes of the penis . Differentiation between local findings and systemic diseases!}; Kohn FM; In the event of diseases affecting the penis, both patient and doctor may first have to overcome a certain "threshold of inhibition" . Since, however, the clinical examination of the genitals is uncomplicated and informative, the general practitioner should be familiar with the major pathological conditions that may affect the male organ . Diseases of the penis can take the form of a local condition or be part of a generalized cutaneous disease . Examples of the latter that frequently involve the penis are psoriasis and lichen planus . Infections are caused by bacteria, fungi, viruses or parasites, and Candida, streptococci and anaerobes need particular mention . Other major differential diagnoses are cutaneous drug reactions, contact dermatitis and neoplastic lesions . But, excessive hygiene may also cause problems ("over-treatment balanitis").

Vaccine, 2002 May 15, 20(16), 2027 - 44
Immunization against dental caries; Koga T et al.; Dental caries is one of the most common infectious diseases . Of the oral bacteria, mutans streptococci, such as Streptococcus mutans and S . sobrinus, are considered to be causative agents of dental caries in humans . There have been numerous studies of the immunology of mutans streptococci . To control dental caries, dental caries vaccines have been produced using various cell-surface antigens of these organisms . Progress in recombinant DNA technology and peptide synthesis has been applied to the development of recombinant and synthetic peptide vaccines to control dental caries . Significant protective effects against dental caries have been shown in experimental animals, such as mice, rats and monkeys, which have been subcutaneously, orally, or intranasally immunized with these antigens . Only a few studies, however, have examined the efficacy of dental caries vaccines in humans . Recently, local passive immunization using murine monoclonal antibodies, transgenic plant antibodies, egg-yolk antibodies, and bovine milk antibodies to antigens of mutans streptococci have been used to control the colonization of the organisms and the induction of dental caries in human . Such immunization procedures may be a safer approach for controlling human dental caries than active immunization.

Anasthesiol Intensivmed Notfallmed Schmerzther, 2002 Apr, 37(4), 199 - 204
{New treatment option for gram-positive infections in critically ill patients - overview over linezolid}; Krueger WA et al.; INTRODUCTION: During the last decade, there has been an emergence of multiresistant Gram-positive bacteria in intensive care units . Oxazolidinones are a new class of antibiotics without cross-resistance to other antimicrobial agents, and linezolid was recently introduced as first oxazolidinone on the German market . In this overview, we summarize important data and discuss possible indications for linezolid in the treatment of infections in critically ill patients . ANTIMICROBIAL ACTIVITY AND PHARMACOLOGY: The antimicrobial spectrum comprises mainly Gram-positive bacteria, especially Staphylococcus aureus (including MRSA), coagulase-negative staphylococci, enterococci, and streptococci . Linezolid is mostly bacteriostatic and inhibits the bacterial protein synthesis at an early stage . Adults may receive 600 mg b.i.d . intravenously or p . o . About 30 % of the dose are excreted by the kidneys as mother compound and 50 % as metabolites . Dosage reductions are not necessary, even in severe renal impairment, but about one third of the dose is eliminated during dialysis . Overall, linezolid is well tolerated, but approximately 5 % of the patients may suffer from diarrhea or nausea and there have been a few reports about reversible myelosuppressive side effects . CLINICAL STUDIES: Linezolid has been compared to vancomycin for treatment of Gram-positive nosocomial pneumonia, and the clinical cure rates were 66.4 % and 68.1 %, respectively . Linezolid is highly active and bactericidal against pneumococci . The clinical cure rates for treatment of skin and soft tissue infections were 88.1 % with linezolid and 86.1 % with penicillinase-stable penicillins . MRSA were excluded in this study, but it may be assumed from data in vitro that linezolid is equally effective against these bacteria . Data for the treatment of catheter-associated and other forms of bacteremias are mainly derived from the compassionate-use-program, where linezolid has been used in complicated cases, mainly after failure of standard therapy . The majority of infections was caused by multiresistant Enterococcus faecium and the clinical cure rates were approximately 80 % . COMMENT: The currently available data suggest that linezolid will serve as useful agent in the treatment of severe infections caused by multiresistant staphylococci and enterococci . Further studies are necessary to define the role of linezolid as first-line agent, e . g . in the treatment of central venous catheter infections . In light of the severe prognosis of pneumonias caused by MRSA, studies on the combination of linezolid and vancomycin are warranted . Despite the low level of resistance, it seems prudent not to use linezolid as first line agent in the treatment of uncomplicated infections, as long as effective standard antibiotics are available.

Mol Microbiol, 2002 Apr, 44(1), 257 - 69
NAD+-glycohydrolase acts as an intracellular toxin to enhance the extracellular survival of group A streptococci; Bricker AL et al.; Group A streptococci (GAS) produce several secreted products that are thought to enhance pathogenicity by facilitating spread of the organisms through host tissues . Two such products, streptolysin O (SLO) and NAD+-glycohydrolase, appear to be functionally linked, in that SLO is required for transfer of NAD+-glycohydrolase into epithelial cells . However, the effects of NAD+-glycohydrolase on host cells are largely unexplored . We now report that SLO-mediated delivery of NAD+-glycohydrolase to the cytoplasm of human keratinocytes results in major changes in host cell biology that enhance GAS pathogenicity . We derived isogenic mutant strains deficient in the expression of SLO, NAD+-glycohydrolase or both proteins in the background of a virulent, M-type 3 strain of GAS . All three mutant strains were internalized by human keratinocytes more rapidly and in higher numbers than were organisms from the wild-type strain . Association of the mutant strains with keratinocytes also resulted in reduced cytotoxicity and reduced keratinocyte apoptosis compared with wild-type GAS . These results support a model in which NAD+-glycohydrolase contributes to GAS pathogenesis by modulating host cell signalling pathways to inhibit GAS internalization, to augment SLO-mediated cytotoxicity and to induce keratinocyte apoptosis . We conclude that NAD+-glycohydrolase is a novel type of bacterial toxin that acts intracellularly in the infected host to enhance the survival and proliferation of an extracellular pathogen.

Akush Ginekol (Sofiia), 1999, 38(1), 33 - 6
{A clinical and microbiological study of bacterial vaginosis and vaginitis in pregnant women}; Chervenkova A et al.; Infectious complications in pregnancy and delivery are still y serious problem in obstetrical, gynecological and neonatological practice . The main part of them are caused from the anaerobic organisms associated with bacterial vaginosis as well from sexually transmitted pathogens . In this study we present data about the frequency of spreading of bacterial vaginosis and vaginitis in pregnant women at different stages of pregnancy . We held y study of 106 pregnant women aged between 15 and 35, registrated at the Pregnancy Consultation Office in eleven . About half of the women did not have data for genital discharge and the microbiological analysis showed normal vaginal flora . Two thirds of the rest investigated women had data for candidiasis, bacterial vaginosis, or both . Only one case of Trichomonas vaginalis-vaginitis was detected . The results from the microscopic examination of the specimens from 10 (9.4%) of the women were suspected for N . gonorrhoeae and/or Chlamydia trachomatis-cervicitis . Group B streptococci in significant quantity was found in five cases . These results showed high frequency of spreading of bacterial vaginosis and cervico-vaginitis in pregnant women.

Caries Res, 2002 Jan-Feb, 36(1), 36 - 9
Effect of a triclosan-containing toothpaste supplemented with 10% xylitol on mutans streptococci in saliva and dental plaque . A 6-month clinical study; Jannesson L et al.; The aim of the present investigation was to evaluate the effect of the combination of triclosan and xylitol in toothpaste on mutans streptococci (MS) in saliva and dental plaque . 155 individuals with >10(5) MS/ml saliva were included in a 6-month double-blind clinical study . They were divided into three groups (n = 51-52) balanced according to their MS counts at baseline . Each group used one of the following types of dentifrice: (1) Colgate Total with the addition of 10% xylitol (Total-Xylitol), (2) Colgate Total and (3) Colgate Total without triclosan and without xylitol . Whole saliva and pooled plaque samples were obtained after 2, 4 and 6 months . When comparing the MS counts within the groups for saliva and plaque samples, Total-Xylitol showed significant reduction at all three sampling occasions (p < 0.001) . Mean reduction at the 6-month sample for saliva was 0.81/ml and for plaque 0.89 per sample (log values) . ANOVA revealed significant differences between Total-Xylitol and the two other products at 6 months for MS in saliva and dental plaque . The conclusion from this 6- month study is that the addition of 10% xylitol to a triclosan-containing dentifrice reduces the number of MS in saliva and dental plaque .

N Engl J Med, 2002 Apr 18, 346(16), 1200 - 6
Erythromycin-resistant group A streptococci in schoolchildren in Pittsburgh; Martin JM et al.; BACKGROUND: Resistance to erythromycin has been very uncommon among group A streptococci in the United States . METHODS: As part of a longitudinal study, we obtained surveillance throat cultures twice monthly and with each new respiratory tract illness from children in kindergarten through grade 8 at one school in Pittsburgh . Screening for resistance to erythromycin and clindamycin was initially accomplished with use of the Kirby-Bauer disk-diffusion test . The minimal inhibitory concentration of resistant isolates was determined by the E test . A double disk-diffusion test was used to characterize the resistance phenotype, and the polymerase-chain-reaction assay was used to identify the resistance gene . The molecular relatedness of strains was determined by field-inversion gel electrophoresis . RESULTS: A total of 1794 throat cultures were obtained from 100 children between October 2000 and May 2001, of which 318 cultures (18 percent) from 60 of the children were positive for group A streptococci . Forty-eight percent of these isolates (153 of 318) were resistant to erythromycin . None were resistant to clindamycin . Results of the double disk-diffusion test indicated the presence of the M phenotype of erythromycin resistance . Molecular typing indicated that the outbreak was due to a single strain of group A streptococci . Of 100 randomly selected isolates of group A streptococci obtained from the community between April and June 2001, 38 were resistant to erythromycin . CONCLUSIONS: In January 2001, during a longitudinal study of schoolchildren, we detected the emergence of erythromycin resistance in pharyngeal isolates of group A streptococci . This clonal outbreak also affected the wider community.

Antimicrob Agents Chemother, 2002 May, 46(5), 1553 - 6
Activities of new fluoroquinolones, ketolides, and other antimicrobials against blood culture isolates of viridans group streptococci from across Canada, 2000; Gershon AS et al.; The rates of nonsusceptibility to penicillin, erythromycin, and clindamycin of 191 blood culture isolates of viridans group streptococci collected from across Canada in 2000 were 36, 42, and 10%, respectively . Although 8% of the strains were resistant to ciprofloxacin (MIC >or= 4 microg/ml), the MICs of gemifloxacin, BMS 284756, telithromycin, and ABT 773 at which 90% of the strains were inhibited were 0.06, 0.06, 0.12, and 0.03 microg/ml, respectively.

Infect Immun, 2002 May, 70(5), 2408 - 13
The group B streptococcal C5a peptidase is both a specific protease and an invasin; Cheng Q et al.; The group B streptococcus (GBS) is a major cause of pneumonia, sepsis, and meningitis in neonates and a serious cause of mortality or morbidity in immunocompromised adults . Although these streptococci adhere efficiently and invade a variety of tissue-specific epithelial and endothelial cells, adhesins and invasins are still unknown . All serotypes of GBS studied to date express C5a peptidase (SCPB) on their surface . This investigation addresses the possibility that this relatively large surface protein has additional activities . Rabbit anti-SCPB serum inhibited invasion of lung epithelial A549 cells by the serotype Ia strain O90R, suggesting that SCPB is an invasin . This was confirmed by inserting an in-frame 25-amino-acid deletion into the scpB gene . Invasion of HEp2 and A549 human cell lines was significantly reduced by the mutation . Enzyme-linked immunosorbent assays were used to demonstrate that purified SCPB protein binds directly to HEp2 and A549 cells and also binds the extracellular matrix protein fibronectin . Binding was dose dependent and saturable . These results suggested that SCPB is one of several potential invasins essential for GBS colonization of damaged epithelium.

Clin Microbiol Infect, 2002 Feb, 8(2), 85 - 92
Erythromycin susceptibility of viridans streptococci from the normal throat flora of patients treated with azithromycin or clarithromycin; King A et al.; OBJECTIVE: To study the emergence of macrolide resistance in throat flora following treatment with clarithromycin or azithromycin . METHODS: Throat samples were collected before and after treatment and plated as a lawn on Columbia blood agar with an erythromycin E test strip . Minimum inhibitory concentrations (MICs) of erythromycin, clarithromycin and azithromycin were determined against isolates of distinct morphology with erythromycin E test MIC results equal to or greater than 2 mg/L . Polymerase chain reaction techniques were used to determine the genetic mechanisms of resistance . RESULTS: There were 749 resistant isolates of which 474 (63%) were streptococci . Only a quarter of the patients had no resistant streptococci before treatment started . There were increases in the numbers of resistant isolates and in the number of patients carrying a resistant flora during and after treatment . The most common genes identified were mefA/E in isolates with low-level resistance and ermA/M in isolates with high-level resistance . CONCLUSIONS: There is a pool of streptococci carrying genes associated with macrolide resistance in the normal respiratory flora of generally healthy adults . Differences between the patients treated with clarithromycin and those treated with azithromycin were difficult to assess because of the large number of patients in each group with macrolide-resistant streptococci before treatment . Although there were some differences these were not statistically significant.

Clin Microbiol Infect, 2002 Feb, 8(2), 65 - 9
Viridans group streptococci: a reservoir of resistant bacteria in oral cavities; Bryskier A; The worldwide spread of erythromycin A-resistant streptococci, including Streptococcus pneumoniae, is of concern . Many studies have demonstrated that the viridans group streptococci can be a reservoir of erythromycin A resistance . Within oral streptoccoci, an important difference in the susceptibility pattern has been noted . The purpose of this short editorial is to highlight the importance of this group of bacteria as a reservoir of resistance to erythromycin A and the possible transfer of resistance to S . pneumoniae and S . pyogenes.

Clin Infect Dis, 2002 May 1, 34(9), 1215 - 23 Epub 2002 Apr 02.
Infectious complications of dental and periodontal diseases in the elderly population; Shay K; Retention of teeth into advanced age makes caries and periodontitis lifelong concerns . Dental caries occurs when acidic metabolites of oral streptococci dissolve enamel and dentin . Dissolution progresses to cavitation and, if untreated, to bacterial invasion of dental pulp, whereby oral bacteria access the bloodstream . Oral organisms have been linked to infections of the endocardium, meninges, mediastinum, vertebrae, hepatobiliary system, and prosthetic joints . Periodontitis is a pathogen-specific, lytic inflammatory reaction to dental plaque that degrades the tooth attachment . Periodontal disease is more severe and less readily controlled in people with diabetes; impaired glycemic control may exacerbate host response . Aspiration of oropharyngeal (including periodontal) pathogens is the dominant cause of nursing home-acquired pneumonia; factors reflecting poor oral health strongly correlate with increased risk of developing aspiration pneumonia . Bloodborne periodontopathic organisms may play a role in atherosclerosis . Daily oral hygiene practice and receipt of regular dental care are cost-effective means for minimizing morbidity of oral infections and their nonoral sequelae.

Immunol Cell Biol, 2002 Apr, 80(2), 178 - 87
Enhancing the immunogenicity and modulating the fine epitope recognition of antisera to a helical group A streptococcal peptide vaccine candidate from the M protein using lipid-core peptide technology; Hayman WA et al.; A conserved helical peptide vaccine candidate from the M protein of group A streptococci, p145, has been described . Minimal epitopes within p145 have been defined and an epitope recognized by protective antibodies, but not by autoreactive T cells, has been identified . When administered to mice, p145 has low immunogenicity . Many boosts of peptide are required to achieve a high antibody titre (> 12 800) . To attempt to overcome this low immunogenicity, lipid-core peptide technology was employed . Lipid-core peptides (LCP) consist of an oligomeric polylysine core, with multiple copies of the peptide of choice, conjugated to a series of lipoamino acids, which acts as an anchor for the antigen . Seven different LCP constructs based on the p145 peptide sequence were synthesized (LCP1-->LCP7) and the immunogenicity of the compounds examined . The most immunogenic constructs contained the longest alkyl side-chains . The number of lipoamino acids in the constructs affected the immunogenicity and spacing between the alkyl side-chains increased immunogenicity . An increase in immunogenicity (enzyme-linked immunosorbent assay (ELISA) titres) of up to 100-fold was demonstrated using this technology and some constructs without adjuvant were more immunogenic than p145 administered with complete Freund's adjuvant (CFA) . The fine specificity of the induced antibody response differed for the different constructs but one construct, LCP4, induced antibodies of identical fine specificity to those found in endemic human serum . Opsonic activity of LCP4 antisera was more than double that of p145 antisera . These data show the potential for LCP technology to both enhance immunogenicity of complex peptides and to focus the immune response towards or away from critical epitopes.

Saudi Med J, 2002 Jan, 23(1), 56 - 61
Detection of genital colonization of group B streptococci during late pregnancy; El-Kersh TA et al.; OBJECTIVE: To detect group B streptococcal carrier state of Saudi females during 3rd trimester of pregnancy and to assess type of specimens and the techniques used for the organism detection . METHODS: A total of 867 consecutive vaginal and rectal swabs were obtained from 217 pregnant women at > 28 weeks of gestation and their follow up testing from King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia . Swab-specimens were cultured comparatively on Islam and Edwards blood agar plates, and into selective Lim broth . Enrichment Lim broth cultures (>12 hours) with and without positive modified coagglutination test were then subcultured on Islam and Edwards sheep blood agar plates . Presumptive colonies were then tested for group B streptococcus identity by convential biochemical reactions, serogrouping and serotyping . Collected neonatal swab-specimens (184) were also treated similarly . RESULTS: In comparison to Lim broth enrichment culture, the direct swab specimen culture on Edwards blood agar or Islam agar plates technique revealed 84% sensitivity and 100% specificity, whereas modified coagglutination test after selective Lim broth enrichment revealed 100% sensitivity and 96% specificity . Group B streptococcus was isolated in at least one of the specimens from the 217 patients in 66 cases . Of these 66 cases, group B streptococcus was isolated from both vaginal and rectal swabs in 33 (50%) cases and only from vaginal swabs in 22 (33%) and rectal swabs in 11 (17%) cases . Of the group B streptococcus positive cases, 10 (15%) cases had spontaneously lost their carriage, upon follow up testing, whereas out of the 151 negative cases, 4 (2.6%) cases became positive for group B streptococcus colonization upon follow up testing with an overall carriage rate of (60/217) 27.6% . Certain demographic factors were found to alter such rate of carriage . Additionally, 50% of group B streptococcal colonized mothers vertically transmitted the homologous serotypes of the organism to their newborns, but clinical infection was not recorded during the study period . CONCLUSION: Group B streptococci colonization rate among term Saudi pregnant women is relatively high (27.6%); and thereby constitutes a group of women whose infants are at great risk of early-onset invasive disease . The modified coagglutination test after growth amplification seems rapid and cost-effective to detect lightly or heavily group B streptococcal colonized women . Vaginal and rectal swab specimens at late pregnancy appeared necessary to accurately identify group B streptococcus maternal colonization.

Hong Kong Med J, 2002 Apr, 8(2), 92 - 8
Group A streptococcal infection in patients presenting with a sore throat at an accident and emergency department: prospective observational study; Wong MC et al.; OBJECTIVES: To determine the prevalence of group A streptococcal infection and to evaluate the predictive value of clinical findings and rapid streptococcal antigen detection testing in patients presenting with a sore throat or suspected clinically to have acute pharyngitis . DESIGN: Prospective observational study . SETTING: Accident and emergency department of a public hospital, Hong Kong . PATIENTS: All patients presenting with a sore throat as the chief complaint, or suspected clinically to have acute pharyngitis, from April to September 2000 . MAIN OUTCOME MEASURES: Demographic data, clinical features, microbiological throat culture results, and rapid streptococcal antigen detection (Accustrip) test results . RESULTS: Of 1449 patients recruited during the 6-month study period, only 44 (3.0%) had positive throat cultures for group A beta-haemolytic streptococcus . The majority of group A beta-haemolytic streptococci were isolated from patients between the age of 3 and 60 years . Clinical findings other than an absence of cough were found to be unhelpful in predicting group A beta-haemolytic streptococcal throat infection . The sensitivity of the rapid group A streptococcal antigen detection test was 52.6% and the specificity was 98.2% . CONCLUSIONS: The prevalence of group A beta-haemolytic streptococcus in patients presenting with a sore throat, or suspected clinically of having acute pharyngitis, was low . If empirical antibiotics were given to all such patients, 97% of them would be unnecessarily treated . Age and absence of cough were the only clinical findings helpful in predicting the presence of group A beta-haemolytic streptococcal throat infection . The rapid group A streptococcal antigen detection test can provide a quick guide to clinicians on the necessity of antibiotic therapy . However, a confirmatory throat culture backup is recommended for patients with a negative test result.

J Chemother, 2001 Nov, 13 Spec No 1(1), 112 - 8
Role of glycopeptides in the treatment of septic complications after cardiac surgery; Bourgoin A et al.; Agents like Staphylococcus epidermidis and Staphylococcus aureus are common agents in both early and late prosthetic valve endocarditis (PVE) . Streptococci, especially vividans and enterococci are more apt to occur late . Diphtheroids and gram-negative bacteria are also frequent in early and late PVE . Fungi are found at a frequency of 5 to 8% and a variety of unusual organisms are found in individual case reports . Treatment is based on parenteral therapy with a bactericidal agent that can achieve trough serum levels in excess of 8-10 X MICs of the infecting organisms . Initially the antibiotic selection should be active against the most common isolates . Because most S . epidermidis are beta-lactam-resistant, vancomcyin must be part of the initial empiric regimen . Vancomycin should be combined with rifampin or an aminoglycoside (usually gentamicin) or both . When there is a high level of resistance to aminoglycoside, vancomycin may be used alone until susceptibility data are available and then rifampin can be given together with an aminoglycoside or a quinolone to which the organism is susceptible . The aminoglycoside should be given for a maximum of 2 weeks, to avoid nephrotoxicity, and vancomycin for 6 weeks . Surgery is required in case of major emboli, hemodynamic decompensation, and uncontrolled infection . The presence of bacteremia for more than 1 week may warrant surgical intervention but, if the patient appears to be well and without emboli or hemodynamic problems, serum levels of antibiotic, particularly vancomycin, should be evaluated . Dosage regimen should be modified to achieve trough levels of vancomycin between 15 to 20 microg/ml . Use of vancomycin by continuous infusion may be considered with a targeted blood concentration of 15 to 20 microg/ml.

Trop Doct, 2002 Apr, 32(2), 83 - 5
Infective endocarditis: report of a prospective study in an Indian hospital; Khanal B et al.; Forty-six patients who fulfilled the Duke's clinical diagnostic criteria for infective endocarditis (IE) were evaluated . Thirty-five (76%) patients were below 40 years of age with rheumatic heart disease being the most common underlying heart lesion affecting 26 (56%) . An obvious predisposing cardiac lesion could not be ascertained in 22% . Blood culture positivity was 44% with streptococcus heading the list . The incidence of the staphylococcal (25%) and gram negative bacillary endocarditis (15%) were found to be increasing . Streptococci were susceptible to penicillin with minimum bactericidal concentration: minimum inhibitory concentration within acceptable limits . However, the appearance of methicillin resistant staphylococcus aureus and high level gentamicin resistant enterococcus as aetiological agents of infective endocarditis were found to add to the complexity of the problem . With the emergence of drug-resistant organisms as causative agents of IE, whenever medical therapy is the primary method of treatment of this condition, the selection of antibiotics should depend upon extensive in vitro testing and in vivo monitoring of clinical efficacy.

Int J Syst Evol Microbiol, 2002 Mar, 52(Pt 2), 665 - 9
Streptococcus entericus sp . nov., isolated from cattle intestine; Vela AI et al.; Biochemical, molecular chemical and molecular genetic studies were performed on an unknown gram-positive, catalase-negative, coccus-shaped organism isolated from the intestine of a cow affected with catarrhal enteritis . The organism was tentatively identified as a streptococcal species based on results of cellular morphological and biochemical tests . 16S rRNA gene sequencing studies confirmed its provisional identification as a member of the genus Streptococcus, but the organism did not correspond to any recognized species of this genus . The nearest phylogenetic relatives of the unknown coccus from a calf were Streptococcus acidominimus and Streptococcus suis . The unknown bacterium, however, was distinguished from these species and other animal streptococci by biochemical tests and electrophoretic analysis of whole-cell proteins . Based on both phenotypic and phylogenetic findings, it is proposed that the unknown bacterium be classified as a novel species of the genus Streptococcus, Streptococcus entericus sp . nov . The type strain is CECT 5353T (= CCUG 44616T).

Oral Microbiol Immunol, 2002 Apr, 17(2), 119 - 24
Fluoride and organic weak acids as respiration inhibitors for oral streptococci in acidified environments; Phan TN et al.; Oxygen metabolism (respiration) of Streptococcus mutans GS-5 involving NADH oxidases, mainly of the H(2)O-producing type, was found to be acid sensitive, as was NADH oxidase activity of cell extracts . Respiration of intact cells in acidified media was also highly sensitive to fluoride, with a 50% inhibitory concentration of about 0.02 mM at pH 4 . In contrast, NADH oxidases in cell extracts were fluoride insensitive . Fluoride inhibition of respiration of intact cells was related to weak-acid effects leading to enhanced proton permeability of cells, cytoplasmic acidification and resultant acid inhibition of NADH oxidases and glycolysis . Organic weak acids, such as indomethacin and benzoate, were also effective inhibitors . H(2)O(2) production by intact cells of Streptococcus sanguis NCTC 10904, a peroxide producer, was similarly inhibited by fluoride or organic weak acids in acidified media . Thus, weak acids act as respiratory inhibitors for oral streptococci indirectly by acidifying the cytoplasm rather than acting as direct inhibitors of NADH oxidases.

Oral Microbiol Immunol, 2002 Apr, 17(2), 95 - 9
Cariogenic traits in xylitol-resistant and xylitol-sensitive mutans streptococci; Assev S et al.; Long-term xylitol consumption leads to the emergence of xylitol-resistant (X-R) mutans streptococci . The aim of the present study was to compare cariogenic traits in X-R and xylitol-sensitive (X-S) strains . Six strains of mutans streptococci, three X-R and three X-S strains, were studied . Xylitol resistance and sensitivity were confirmed by growth in xylitol-supplemented media . Acid production from glucose or fructose or uptake of xylitol was initiated by adding (14)C-labelled glucose, fructose or xylitol to bacterial suspensions . The resultant metabolites were identified by HPLC . Lactate was the major metabolite from glucose, whether the bacteria were grown in the presence or the absence of xylitol . Lactate production per colony-forming unit was lower in X-S cells than in X-R cells . Fructose was metabolized by both X-R and X-S cells . Both X-R and X-S cells took up xylitol, but xylitol-5-P was detected in X-S cells only . Total polysaccharides were measured through production of C(14)-labelled ethanol-insoluble polymers from {U(14)-C}-sucrose . No difference in polysaccharide production was found between X-R and X-S cells . The present study thus does not support the contention that X-R are less cariogenic than X-S mutans streptococci.

Oral Microbiol Immunol, 2002 Apr, 17(2), 65 - 71
Influences of orthodontic appliances on oral populations of mutans streptococci; Jordan C et al.; A study was conducted to assess the influence of fixed appliances on the mutans streptococcal in a group of patients receiving orthodontic treatment . Mutans streptococcal counts in stimulated saliva of 27 patients were obtained at baseline, and at 1-month intervals for 4 months . The difference in mutans streptococcal counts at baseline and at the 4-month sampling was less than an order of magnitude in 18 of the patients, between 1 and 2 orders of magnitude in eight of the patients, and 3 orders of magnitude in one patient . Restriction endonuclease digests of genomic DNA from representative mutans streptococci isolates taken from baseline and 4-month saliva samples, as well as from 4-month tooth and appliance surfaces, were examined by pulsed field gel electrophoresis, after restriction endonuclease digestion . Results of the DNA banding patterns associated with isolates from 19 patients showed that, for 12 patients, all isolates examined represented the same clone of Streptococcus mutans, whereas for six patients two different S . mutans clones were detected . One patient yielded three different clones of S . mutans . A much larger number of baseline, as well as post-appliance, isolates will have to be examined from each patient in future studies, in order to determine if the number of different S . mutans clones harbored by individual patients is related to orthodontic treatment.

Drugs, 2002, 62(6), 967 - 73; discussion 974-5
Moxifloxacin in uncomplicated skin and skin structure infections; Muijsers RB et al.; Moxifloxacin is a fluoroquinolone antibacterial agent which attains good penetration into peripheral tissues and inflammatory fluids . The drug shows good in vitro activity against staphylococci and streptococci . Moxifloxacin is therefore a suitable option for the treatment of uncomplicated skin and skin structure infections of bacterial origin . In clinical trials, moxifloxacin was as effective as cephalexin in the treatment of uncomplicated skin and skin structure infections in patients aged >or=18 years . Moxifloxacin 400mg once daily or cephalexin 500mg three times daily for 7 days both resulted in clinical resolution in 84% of patients during a double-blind, randomised trial in 401 patients (intent-to-treat) . The main infectious agent in this study was Staphylococcus aureus . Similar results were obtained in two other randomised, double-blind trials published as abstracts . The bioavailability of moxifloxacin is substantially reduced by coadministration with antacids or iron preparations . Moxifloxacin, however, does not show pharmacokinetic interaction with theophylline or warfarin . Dosage adjustments are not required in patients with renal impairment or in patients with mild to moderate hepatic insufficiency . The most common adverse events reported during moxifloxacin treatment are gastrointestinal disturbances . The potential for photosensitivity reactions during moxifloxacin treatment is low.

Scand J Infect Dis, 2002, 34(2), 83 - 7
Group G streptococcal bacteraemia: an opportunistic infection associated with immune senescence; Lewthwaite P et al.; The number of cases of group G streptococcal bacteraemia reported worldwide is increasing . Twenty-six cases of group G streptococcal bacteraemia were identified during a 70-month period at a single university teaching hospital in Sheffield, UK . These cases represented 20% of all bacteraemias due to beta-hemolytic Streptococci, a higher proportion than previously reported . The median age of these cases was 72 y and although medical comorbidities were common only cutaneous ulceration was clearly linked to the presenting syndromes . The skin was the source of infection in 16 cases (62%) and the most frequent clinical presentations were cellulitis in 13 cases (50%) and endovascular infection in 5 (19%) . Eight (31%) of the cases died during the period of follow-up but only 2 deaths were related to the streptococcal infection . Immunosenescence represents the major risk factor for group G streptococcal infection in this population and comorbidities, including carcinoma, may be markers of the senescent immune system rather than direct contributing factors to group G streptococcal bacteraemia.

J Dent Res, 2001 Sep, 80(9), 1834 - 9
Association of caries activity with the composition of dental plaque fluid; Gao XJ et al.; This study tests the hypothesis that caries activity is associated with lower degrees of saturation with respect to enamel mineral in dental plaque fluid following sucrose exposure . Plaque fluids were obtained from caries-free, caries-positive, and caries-active subjects . Samples were collected before and at 3 and 7 min after a sucrose rinse on consecutive weeks and analyzed for organic acids, inorganic ions, pH, calcium activity, and, in selected samples, total protein . After sucrose, pH values were significantly lower in the caries-active group in comparison with the caries-free and caries-positive groups . Total and free calcium concentrations increased with decreasing pH, with free calcium being about one-third of total calcium . The caries-active group exhibited significantly lower degrees of saturation with respect to enamel mineral, after sucrose, and had significantly higher mutans streptococci levels in plaque than did the caries-free samples . Thus, saturation levels in post-sucrose plaque fluids reflect the cariogenic potential of dental plaque.

Ned Tijdschr Tandheelkd, 1997 Oct, 104(10), 370 - 2
{The new fight against mutant streptococci}; Straetemans MM et al.; Mutans streptococci are an important factor in the aetiology of dental caries . New ways of combating these bacteria have become available with the development of molecular biological techniques . One of these strategies involves the genetic modification of mutans streptococci to develop less cariogenic mutants . Acid production and the production of intracellular polysaccharides have been eliminated . But it is not clear yet whether these less cariogenic mutant strains are able to replace the normal mutans streptococci in dental plaque . Immunization is another possibility to suppress mutans streptococci . Antibodies against proteins involved in adherence of mutans streptococci have been raised by active immunization . It is also possible to raise antibodies in cow serum and milk, in eggs of chickens and even in tobacco plants . After isolation, these antibodies are to be applied topically . In the future, these new strategies may prevent or reduce caries . However, further research is necessary to resolve the obstacles on the way to commercial application.

Arch Oral Biol, 2002 Apr, 47(4), 327 - 32
Identification of mouse submaxillary gland protein in mouse saliva and its binding to mouse oral bacteria; Lee B et al.; The mouse submaxillary gland protein (mSMGP) is highly expressed in the submandibular gland of the adult mouse and rat . It shares 51% identity at the amino-acid level with a human protein, the prolactin-inducible protein (PIP)/gross cystic disease fluid protein 15 (GCDFP-15), which has been found in saliva, tears, sweat, seminal plasma, submucosal glands of the lung and amniotic fluid . More recently, the human PIP has been reported to bind to bacterial strains normally found in the mouth, ear canal and human skin . Sequence analysis of mSMGP/PIP earlier identified the presence of a signal peptide, suggesting that it is a secreted protein . Here, by Western blotting, mSMGP/PIP has been identified in mouse saliva . To investigate further the role of this secreted protein, its ability to bind specifically to oral bacteria was examined; the hypothesis was that mSMGP/PIP is involved in non-immune host defence by binding to bacteria . Several bacterial strains, found to belong to the genera Streptococcus, Aerococcus, Pseudomonas, Staphylococcus, Sphingomonas, Vibrio and Aeromonas, were isolated from the mouse oral cavity . Following incubation of these bacteria with (35)S-labeled, in vitro-translated mSMGP/PIP, the protein was found to bind specifically and selectively to several but not all strains tested, showing the highest affinity for the streptococci . The protein also bound specifically to an Aerococcus sp., and a low binding interaction with the Pseudomonas and Staphylococcus spp . was observed . The conservation of SMGP sequences among several animal species suggests that this protein may play an important part in the biology of the submandibular gland . As the function of the mSMGP/PIP is still undetermined, these findings provide insight into a possible involvement of this protein in host defence.

Arthritis Rheum, 2002 Mar, 46(3), 806 - 17
The beneficial effect of interleukin-12 on arthritis induced by group B streptococci is mediated by interferon-gamma and interleukin-10 production; Puliti M et al.; OBJECTIVE: To assess the effect of interleukin-12 (IL-12) administration on the evolution of systemic infection and septic arthritis induced by group B streptococci (GBS) in mice . METHODS: CD1 mice were inoculated intravenously with arthritogenic strain 1/82 of type IV GBS . Exogenous murine IL-12 was administered intraperitoneally 18 hours or 5 days after infection with 1 x 10(7) GBS, at doses ranging from 0.5 to 2.5 microg per mouse . Mice were monitored daily for survival and for signs of arthritis . In a subsequent set of experiments, mice were killed at selected times for examination of bacterial clearance, histopathologic changes in the joints, and cytokine production . RESULTS: IL-12 administration before the onset of clinical signs had a beneficial effect on GBS-induced arthritis and was clearly dose-dependent . The 2.5-microg dose per mouse totally prevented death from GBS-induced arthritis . The decrease in pathology was associated with a reduction of the bacterial burden and a change in the cytokine profile . In particular, systemic and joint levels of interferon-gamma (IFN gamma) and IL-10 significantly increased in mice treated with IL-12, whereas a decrease in IL-6 and IL-1 beta production was observed . The beneficial effects of IL-12, in terms of the incidence and severity of articular lesions, were reversed by coadministration of anti-IFN gamma or anti-IL-10-neutralizing antibodies . CONCLUSION: The findings of this study demonstrate that IL-12 is important in controlling the cytokine production that leads to the evolution of GBS-induced experimental arthritis . The amelioration of articular lesions is mostly attributable to IL-12-induced IFN gamma, but with a relevant participation of IL-12-induced IL-10.

Salud Publica Mex, 2002 Jan-Feb, 44(1), 50 - 6
{Exposure to group B Streptococcus among Mexican women in reproductive age}; Palacios-Saucedo G et al.; OBJECTIVE: To assess the prevalence of IgG antibodies against Group B streptococci (GBS) among women of reproductive age in Mexico . MATERIAL AND METHODS: Serum specimens were drawn from 15 to 40 year-old women, representative of all regions and socioeconomic levels of the country . The sample was randomly selected from Banco Nacional de Sueros (National Sera Bank); serum samples were collected during a national seroepidemiologic survey conducted in 1987-1988 . The assays for standardization and for evaluation of seroprevalence were carried out at the Hospital de Pediatria del Centro Medico Nacional Siglo XXI (Children's Hospital) Instituto Mexicano del Seguro Social (IMSS) (Mexican Institute of Social Security) from January to November 1995 . IgG antibodies against group B antigen were studied with an enzyme-linked immunosorbent assay (ELISA) developed in our lab . Group B antigen was produced and purified from the reference strain GBS 110 . RESULTS: A total of 2669 serum samples were studied; 2405 were positive to anti-group B antigen IgG antibodies, for a seroprevalence of 90.2% . No differences in prevalence were found among the different age groups or among the different states of the country . CONCLUSIONS: The high seroprevalence of antibodies against GBS suggests that young women in Mexico are commonly exposed to GBS infection.

Curr Microbiol, 2002 Apr, 44(4), 236 - 40
Mapping the fibrinogen-binding domain of serum opacity factor of group a streptococci; Courtney HS et al.; Serum opacity factor (SOF) is a large, extracellular, and cell-bound protein of group A streptococci that has two known functions, opacification of serum and binding of fibronectin . Herein, we describe a new function of SOF, the binding of fibrinogen . Utilizing purified, truncated recombinant SOF proteins, the fibrinogen-binding domain was localized to a region in the C-terminus of SOF encompassing amino acid residues 844-1047 . Western-blot analysis revealed that SOF bound primarily to the beta subunit of fibrinogen . A SOF-negative mutant bound 50% less fibrinogen than did its wild-type parent . Furthermore, fibrinogen blocked the binding of SOF to fibronectin . These data suggest that fibrinogen and fibronectin bind to the same domain within SOF . It remains to be determined whether the binding of fibrinogen to SOF contributes to the virulence of group A streptococci.

Biochem Cell Biol, 2002, 80(1), 119 - 24
Anti-invasive activity of bovine lactoferrin towards group A streptococci; Ajello M et al.; Group A streptococci (GAS) are able to invade cultured epithelial and endothelial cells without evidence of intracellular replication . GAS, like other facultative intracellular bacterial pathogens, evolved such ability to enter and to survive within host cells avoiding the host defences, and bacterial intracellular survival could explain the recurrence of infections . We report here that 1 mg bovine lactoferrin (bLf)/mL significantly hindered the in vitro invasion of cultured epithelial cells by GAS isolated from patients suffering from pharyngitis and completely inhibited the invasiveness of GAS pretreated with subinhibiting concentrations of erythromycin or ampicillin . One milligram of bLf per millilitre was also able to increase the number of epithelial cells undergoing apoptosis following GAS invasion, although the number of intracellular GAS in the presence of bLf decreased by about 10-fold . The ability of bLf to decrease GAS invasion was confirmed by an in vivo trial carried out on 12 children suffering from pharyngitis and already scheduled for tonsillectomy . In tonsil specimens from children treated for 15 days before tonsillectomy with both oral erythromycin (500 mg t.i.d . (three times daily)) and bLf gargles (100 mg t.i.d.), a lower number of intracellular GAS was found in comparison with that retrieved in tonsil specimens from children treated with erythromycin alone (500 mg t.i.d.).

Kansenshogaku Zasshi, 2002 Feb, 76(2), 83 - 8
{Clinical and bacteriological features of six cases with intracranial abscess in childhood}; Hoshino T et al.; From October 1988 to March 2001, 5 patients with 6 episodes of intracranial abscesses were admitted to Chiba-Children's Hospital . Average age when they were admitted was 10 years and 1 month . Initial clinical symptoms were fever in 5 cases, and headache in 1 case . It took 21 days from the appearance of the initial symptoms to diagnose the intracranial abscess . Four out of 5 patients had underlying diseases that were prone to cause intracranial abscess . Two patients of these were cyanotic congenital heart diseases (tetralogy of Fallot and asplenic heart), and the other 2 were sinusitis . Computed tomography revealed that brain abscess was found in 5 cases, and subdural empyema in 1 case . There were 3 single and multiple abscesses each . The most common lesion was the temporal lobe . Eight bacterial strains were isolated from 5 cases . Five were streptococci (3 were Streptococcus milleri group, other 2 were Streptococcus oralis and microaerophilic Streptococcus) and 3 were anaerobes (Prevotella loescheii, Prevotella bivia and Fusobacterium nucleatum) . Antimicrobial therapy was started with panipenem-betamiprone in 3 cases, imipenem-cilastatin, ceftriaxone, and ampicillin in the other cases resre ctinely . Duration of therapy ranged from 28 to 67 days (45 days, average) . In 5 cases, drainage with craniotomy was performed in addition to antimicrobial therapy . One case was treated medically alone, but this was the only case with recurrence after 1 year 2 months . There were no serious complications such as intraventricular rupture of abscess . All patients had good outcomes, but mild neurological sequela was found in 1 case.

Acta Odontol Scand, 2002 Jan, 60(1), 37 - 41
Effect of a hydrophobic tooth coating on gingival health, mutans streptococci, and enamel demineralization in adolescents with fixed orthodontic appliances; Fornell AC et al.; The effect of an anti-adhesive enamel coating on plaque accumulation, gingival health, and enamel demineralization was evaluated in 39 adolescents undergoing treatment with fixed orthodontic appliances using a prospective split-mouth design . Immediately after bracket insertion, the polymer was randomly applied after enamel etching to the buccal surfaces of the teeth in the left or right upper quadrant, leaving the opposite quadrant as an untreated control (218 test and 216 control teeth) . Reapplications were carried out every 3rd month during the course or the study . The following data were collected at baseline and at designated follow-ups: visible plaque index, total viable counts and proportion of mutans streptococci in plaque samples, gingival bleeding index, and amount of gingival crevicular fluid . The incidence of enamel demineralization adjacent to the appliances was scored clinically at the termination of the orthodontic treatment . The observation time ranged from 6-24 months, during which the participants used fluoride rinses and toothpaste daily . A slightly impaired gingival health and increased levels or mutans streptococci compared with baseline was disclosed during the treatment . Five subjects showed enamel demineralization on a total of 30 teeth at the time of de-bonding . The results indicated no statistically significant differences between the enamel-coated and untreated teeth with regard to the studied variables at any follow-up . In conclusion, the present findings did not support a clinically beneficial effect of the polymeric tooth coating in a low-caries group of adolescents treated with fixed orthodontic appliances.

Expert Rev Mol Diagn, 2001 Jul, 1(2), 175 - 81
Molecular methods for rapid detection of group B streptococci; Ke D et al.; Group B streptococci (GBS) are an important cause of neonatal sepsis and meningitis . Implementation of selective intrapartum chemoprophylaxis based on either a screening-based approach or a risk-based approach has led to a substantial decrease in the morbidity and mortality of GBS disease . Current 'gold-standard' detection methods for GBS are selective broth cultures of combined vaginal and anal specimens collected at 35-37 week's gestation . Rapid immunological detection methods, including latex agglutination test, enzyme immunoassay and optical immunoassay, as well as hybridization-based test, are available . These methods are useful in rapid identification of heavily colonized women, but are unable to detect light GBS colonization due to poor sensitivity . Recent development of real-time PCR and fluorescence labeling technologies has provided new detection platforms for bacterial identification . GBS-specific PCR assays using these new technologies offer promising tools for sensitive and specific detection of GBS directly from clinical specimens . The application of these assays in the current prevention strategy will simplify the prevention practice and rationalize antibiotic use.

Curr Mol Med, 2001 Sep, 1(4), 475 - 91
Genetic bases and medical relevance of capsular polysaccharide biosynthesis in pathogenic streptococci; Llull D et al.; Many streptococci are human and/or animal pathogens and the frequent cause of life-threatening diseases . Among various streptococcal virulence factors, capsular polysaccharides (CPs) are recognized as essential to prevent phagocytosis by macrophages and neutrophils . In the last decade, an impressive advance on the knowledge of the genetic bases underlying capsule formation has been achieved . The capsular gene cluster driving the formation of the CP of Streptococcus pyogenes and other hyaluronate-producing streptococci, represents one of the simplest cases of gene organization to synthesize a capsule . A more complex situation has been found in Streptococcus pneumoniae, Streptococcus agalactiae, Streptococcus suis, and other streptococci . On the whole, there exists a direct relationship between the structural and chemical complexity of the repeating unit of the polysaccharide and the number of genes found in the corresponding capsular locus . Streptococcal vaccines, either polysaccharide or conjugate, are currently being tested in clinical trials to overcome the rise of worldwide antibiotic resistance, although, for different reasons, none of these vaccines are expected to provide the required full coverage in a near future . This concern has prompted to explore alternative possibilities with an improved therapeutic potential against streptococcal diseases.

Infect Immun, 2002 Apr, 70(4), 2171 - 7
Immunogenicity of a 26-valent group A streptococcal vaccine; Hu MC et al.; A multivalent vaccine containing amino-terminal M protein fragments from 26 different serotypes of group A streptococci was constructed by recombinant techniques . The vaccine consisted of four different recombinant proteins that were formulated with alum to contain 400 microg of protein per dose . Rabbits were immunized via the intramuscular route at 0, 4, and 16 weeks . Immune sera were assayed for the presence of type-specific antibodies against the individual recombinant M peptides by enzyme-linked immunosorbent assay and for opsonic antibodies by in vitro opsonization tests and indirect bactericidal tests . The 26-valent vaccine was highly immunogenic and elicited fourfold or greater increases in antibody levels against 25 of the 26 serotypes represented in the vaccine . The immune sera were broadly opsonic and were bactericidal against the majority of the 26 different serotypes . Importantly, none of the immune sera cross-reacted with human tissues . Our results indicate that type-specific, protective M protein epitopes can be incorporated into complex, multivalent vaccines designed to elicit broadly protective opsonic antibodies in the absence of tissue-cross-reactive antibodies.

Infect Immun, 2002 Apr, 70(4), 2166 - 70
Antibodies against a synthetic peptide of SagA neutralize the cytolytic activity of streptolysin S from group A streptococci; Dale JB et al.; Virtually all group A streptococci (GAS) produce streptolysin S (SLS), a cytolytic toxin that is responsible for the beta-hemolysis surrounding colonies of the organisms grown on blood agar . SLS is an important virulence determinant of GAS, and recent studies have identified a nine-gene locus that is responsible for synthesis and transport of the toxin . SLS is not immunogenic; thus, no neutralizing antibodies are evoked during the course of natural infection . In the present study, we show that a synthetic peptide containing amino acid residues 10 to 30 of the putative SLS (SagA) propeptide {SLS(10-30)} coupled to keyhole limpet hemocyanin evoked antibodies in rabbits that completely neutralized the hemolytic activity of the toxin in vitro . Inhibition of hemolysis was reversed by preincubation of the immune serum with soluble, unconjugated peptide, indicating the specificity of the antibodies . In addition, antibodies that were affinity purified over an SLS(10-30) peptide column completely inhibited SLS-mediated hemolysis . The SLS(10-30) antisera did not opsonize group A streptococci; however, when combined with type-specific M protein antisera, the SLS antibodies significantly enhanced phagocytosis mediated by M protein antibodies . Thus, we have shown for the first time that it is possible to raise neutralizing antibodies against one of the most potent bacterial cytolytic toxins known . Our data also provide convincing evidence that the sagA gene actually encodes the SLS peptide of GAS . The synthetic peptide may prove to be an important component of vaccines designed to prevent GAS infections.

Infect Immun, 2002 Apr, 70(4), 1703 - 14
Genetic analysis of the rgg-gtfG junctional region and its role in Streptococcus gordonii glucosyltransferase activity; Vickerman MM et al.; Glucans synthesized by glucosyltransferase enzymes of oral streptococci facilitate bacterial accumulation on surfaces . The Streptococcus gordonii glucosyltransferase gene, gtfG, is positively regulated by rgg, which encodes a putative cytoplasmic protein . The gtfG promoter and ribosomal binding sequences are located within a DNA inverted repeat immediately downstream of rgg . Polycistronic rgg-gtfG as well as rgg- and gtfG-specific transcripts are associated with this chromosomal region . Previous studies have shown that the rgg product acts in trans near the gtfG promoter to increase the level of gtfG transcript, but it does not affect the level of rgg-gtfG transcript . To further analyze regulation by rgg, a series of strain Challis derivatives was constructed and glucosyltransferase activities were determined . Strains in which rgg was separated from gtfG by integrated vector sequences had decreased levels of glucosyltransferase activity; plasmid-borne rgg could not increase activity to parental levels . As expected, strains with chromosomal deletions involving the rgg structural gene and either the rgg or gtfG promoter also showed decreased glucosyltransferase activity . Plasmid-borne rgg could increase glucosyltransferase activity only in strains which had a 36-bp chromosomal region beginning 72 nucleotides upstream of the gtfG transcriptional start site . Results suggest that these nucleotides, located within the 3' end of rgg, are necessary, either by direct involvement in binding or by indirectly affecting secondary structure, for Rgg to increase glucosyltransferase activity . Surprisingly, the presence of the rgg promoter upstream of this 36-bp region significantly increased the effects of plasmid-borne rgg . Implications for glucosyltransferase regulation and applicability to other rgg-like determinants are considered.

APMIS, 2001 Oct, 109(10), 670 - 8
Killing of Gram-positive cocci by fatty acids and monoglycerides; Bergsson G et al.; The susceptibilities of three Gram-positive cocci to medium-chain saturated and long-chain unsaturated fatty acids and their one-monoglycerides were studied . The bacteria were incubated with equal volumes of lipid solutions for 10 min . Lauric acid, palmitoleic acid and monocaprin reduced the number of CFU by 6.0 log10 or greater at 5 mM concentration for streptococci of group A (GAS) and group B (GBS) . When further compared at lower concentrations and after longer incubation time monocaprin proved to be the most active . Capric acid showed the highest activity against Staphylococcus aureus at 10 mM . However, at lower concentrations monocaprin was the only lipid that showed significant activity against S . aureus . The mode of action of monocaprin against GBS was studied by a novel two-color fluorescent assay of bacterial viability and by electron microscopy . The results indicate that the bacteria are killed by disintegration of the cell membrane by the lipid, leaving the bacterial cell wall intact . The highly lethal effect of monocaprin indicates that this lipid might be useful as a microbicidal agent for prevention and treatment of infections caused by these bacteria.

Paediatr Drugs, 2002, 4(2), 95 - 110
Corneal ulceration in pediatric patients: a brief overview of progress in topical treatment; Stretton S et al.; Pediatric microbial keratitis is a rare but potentially devastating condition . The condition is similar to adult microbial keratitis, but is often characterized by a more severe inflammatory response . The micro-organisms that cause microbial keratitis in children are similar to the causative agents in adults, with herpes simplex and bacteria being the predominant causative agents, and fungi being less frequent . Of the bacterial pathogens, Pseudomonas aeruginosa, Staphylococcus aureus and alpha-hemolytic streptococci are common . The risk factors for pediatric keratitis include colonization of the eyes during birth and trauma to the cornea . Certain microbial factors involved in microbial keratitis are common to all micro-organisms, including adhesion to the cornea, penetration into the cornea, destruction of the corneal stroma (usually by microbial and/or host proteases), and recruitment of white blood cells to help defend the eye . Specific inflammatory responses that occur during pediatric microbial keratitis are not known in detail, but it is likely that cytokines and polymorphonuclear leucocytes are major factors, as they are in adult microbial keratitis . Treatment for pediatric microbial keratitis is usually the same as treatment for adult microbial keratitis; topical application of antimicrobial agents initially, followed by application of anti-inflammatory agents . With pediatric microbial keratitis, extra care must be taken to ensure nontoxicity due to blood adsorption . New microbial keratitis treatments are being developed and these mainly focus on new antimicrobials, antivirulence agents (such as vaccination against microbial toxins) or specific anti-inflammatory agents . There remains a clear need for increased research into the specific responses during microbial keratitis in children which will help progress new therapies as well as the development of new antimicrobials, especially new antifungal therapies.

Recenti Prog Med, 2002 Feb, 93(2), 92 - 5
{Polymicrobial infective endocarditis in Italy}; Cicalini S et al.; In our series, including 1053 cases of infective endocarditis (IE) collected from 86 Infectious Diseases Centres in Italy between 1984 and 1999, we identified 34 cases (3.2%) with a polymicrobial etiology . Intravenous drug abuse was the most important risk factor for the development of polymicrobial IE . Twenty three patients had a left sided-IE and 6 patients had a right-sided IE . The most commonly encountered microorganisms were Staphylococci and Streptococci and the most frequently observed associations of microorganisms were those between Staphylococci and Gram-negative bacteria and between Staphylococci and fungi . Twelve patients (35.3%) underwent surgery, and 5 patients (16.7%) died . Polymicrobial endocarditis did not differ clinically from IE caused by a single microorganism, and the prognosis seems to be related to the site of infection and to some specific pathogens.

Ann Acad Med Singapore, 2002 Jan, 31(1), 86 - 91
Epidemiology of beta-haemolytic group G streptococcal bacteraemia in Singapore (1996 to 1998); Tee WS et al.; INTRODUCTION: Group G streptococcus (GGS) accounted for 8% to 44% of all bacteraemias due to beta-haemolytic streptococci according to various reports . The aims of this study were 1) to describe the epidemiology of GGS bacteraemia in Singapore for which local data are lacking and 2) to compare its frequency of isolation to the other Lancefield groups . PATIENTS AND METHODS: The study period was from 1 January 1996 to 30 June 1998 . The laboratory records of 2 large acute care hospitals were examined . There was a total of 85 patients . The medical records of 52 patients were available for analysis . In addition, laboratory microbiological data from 1993 to 1999 were reviewed and the number of blood cultures that were positive for beta-haemolytic streptococci groups A, B, C and G was collated . RESULTS: The majority involved the elderly . The mean age was 67 years . The skin was the major portal of entry . Local conditions predisposing the skin to infection occurred in 40.4% . Co-morbidity included malignancies in 28.8% of patients, diabetes mellitus in 11.5% and liver disease in 9.6% . Mortality was 15.4% including fatal septic shock . Recurrent bacteraemia occurred in 5.8% of the patients . The majority (90.4%) were community-acquired infections . GGS, along with group B streptococcus (GBS), was the most common streptococcus among the beta-haemolytic streptococci causing bacteraemia in these 2 hospitals.

Acta Odontol Latinoam, 1994-1995, 8(2), 17 - 25
Effect of self-brushing with acidulated phosphate fluoride (pH 5.6) on dental caries in children; Bordoni N et al.; The aim of this work was to study the effect of a preventive program on the dental plaque and on the caries incidence in school children . The program comprised weekly supervised self brushing with acidulated phosphate fluoride (APF) gel (pH 5.6; concentration: 4520 ppm of ion F-) . The program involved 240 children of 1st., 3rd and 5th grade of a primary school in the City of Buenos Aires (Argentina) . The population was divided in 2 groups: A (experimental) and B (control) . Ninety children from both groups (45 experimental and 45 control) were submitted to baseline clinical examination (DMFT and plaque index) and microbiological analysis (total streptococci, St mutans and St . mutans and St . mutans percentage) . Group A was then submitted to a preventive program which included self brushing with APF gel (4520 ppm of ion F-) . The 90-children sample was monitored after 1 and 2 years of program . Results were statistically processed and they revealed the following: a--DMFT was significantly greater in the control group than in the experimental group after 1 and 2 years of program; b--an 81.43% reduction in caries increment rate at the end of the 2-years program in the experimental group as compared to the control group; c--a rise in the number of colonies of total streptococci and of St . Mutans; d--a reduction in the % of St . mutans in the total streptococci flora in the plaque of children in the experimental group; e--the presence of St . mutans colonies featuring a rough surface; f--the effectiveness of the program in the modifying the profile of the diagnosed dental pathology.

Acta Odontol Latinoam, 1997, 10(1), 47 - 53
Mitis salivarius-bacitracin 10% sacarose agar for oral streptococci and Streptococcus mutans counts; Gutierrez de Annan S et al.; The MSB Agar (mitis salivarius-bacitracin) 20% sacarose medium is frequently used for the isolation and count of total streptococci and Streptococcus mutans . Although it is considered a selective culture medium for this micro-organism, S . mutans recovery in this medium is much lower than in this Mitis Salivarius Agar (MSA) . Because the number of S . mutans in saliva is used for estimating caries risk and activity from a microbiological stand point, the aim of this work was to find a modification of the MSB 20% sacarose medium so that it would offer not only selectivity in the isolation but also maximum recovery . This would detect people at risk more efficiency and would evaluate the preventive odontological treatments more accurately . The results show that: 1) the greatest recovery of total streptococci and S . mutans is obtained in the MSB 10% sacarose medium, 2) S . mutans must be incubated in aerobiosis and the total streptococci in a candle jar (10% CO2) . MSB 10% sacarose medium is proposed as a choice medium for the microbiological estimation of cariogenic risk and activity, to detect infection levels and evaluate preventive odontological treatments.

Acta Odontol Latinoam, 1997, 10(1), 1 - 9
Screening of antiadherent activity on Streptococcus sobrinus culture; Pauli M et al.; The mutans group of streptococci is considered to play a key role in the etiology of dental caries . We have evaluated the ability of different substances to prevent dental plaque formation without affecting Streptococcus sobrinus viability . Viable organisms were detected as CFU/mL in agar plates and bacterial adherence was assessed by dry weight . We studied 23 compounds and we demonstrated that phenyl salicylate, phenylmercuric nitrate and potassium iodate are more effective to inhibit adhesion without showing antibacterial activity.

J Mol Biol, 2002 Mar 8, 316(5), 1083 - 99
Differences in backbone dynamics of two homologous bacterial albumin-binding modules: implications for binding specificity and bacterial adaptation; Johansson MU et al.; Proteins G and PAB are bacterial albumin-binding proteins expressed at the surface of group C and G streptococci and Peptostreptococcus magnus, respectively . Repeated albumin-binding domains, known as GA modules, are found in both proteins . The third GA module of protein G from the group G streptococcal strain G148 (G148-GA3) and the second GA module of protein PAB from P.magnus strain ALB8 (ALB8-GA) exhibit 59% sequence identity and both fold to form three-helix bundle structures that are very stable against thermal denaturation . ALB8-GA binds human serum albumin with higher affinity than G148-GA3, but G148-GA3 shows substantially broader albumin-binding specificity than ALB8-GA . The (15)N nuclear magnetic resonance spin relaxation measurements reported here, show that the two GA modules exhibit mobility on the picosecond-nanosecond time scale in directly corresponding regions (loops and termini) . Most residues in G148-GA3 were seen to be involved in conformational exchange processes on the microsecond-millisecond time scale, whereas for ALB8-GA such motions were only identified for the beginning of helix 2 and its preceding loop . Furthermore, and more importantly, hydrogen-deuterium exchange and saturation transfer experiments reveal large differences between the two GA modules with respect to motions on the second-hour time scale . The high degree of similarity between the two GA modules with respect to sequence, structure and stability, and the observed differences in dynamics, binding affinity and binding specificity to different albumins, suggest a distinct correlation between dynamics, binding affinity and binding specificity . Finally, it is noteworthy in this context that the module G148-GA3, which has broad albumin-binding specificity, is expressed by group C and G streptococci known to infect all mammalian species, whereas P.magnus with the ALB8-GA module has been isolated only from humans .

J Med Chem, 2002 Mar 14, 45(6), 1387 - 90
Lipoamino acid-based adjuvant carrier system: enhanced immunogenicity of group a streptococcal peptide epitopes; Horvath A et al.; Lipoamino acid-based synthetic peptides (lipid core peptides, LCP) derived from the type-specific and conserved region determinants of group A streptococci (GAS) were evaluated as potential candidate sequences in a vaccine to prevent GAS-associated diseases, including rheumatic heart disease and poststreptococcal acute glomerulonephritis . The LCP peptides had significantly enhanced immunogenicity as compared with the monomeric peptide epitopes . Furthermore, the peptides incorporated into the LCP system generated epitope-specific antibodies without the use of any conventional adjuvant.

Zh Mikrobiol Epidemiol Immunobiol, 2001 Nov-Dec, (6), 74 - 7
{Dysbioses of the oral cavity and intestines and immune reactivity in of adolescent bronchial asthma patients}; Gavrish TV; Sixty bronchial asthma (BA) patients aged 15-18 years were examined between attacks . The composition of the oral cavity and intestine microflora as well as the total IgE level, peripheral blood eosinophils and lymphocytes expressing receptors CD3, CD4, CD8, CD22, CD11b, CD71, HLA-DR were detected . Colonization of the oral cavity by Staphylococcus aureus in 9%, by hemolytic streptococci in 10%, by fungi of the genus Candida in 25% and by enterococci in 7% of the patients was revealed . From the intestines S . aureus were isolated in 21%, hemolytic Escherichia coli in 18% and fungi of the genus Candida from 45% of the patients, while lactic acid bacteria were isolated only in 39% of the patients . The patients of this group were found to have eosinophilia (4.21 +/- 0.05%, p < 0.001) and a high concentration of IgE (330.2 +/- 29.31%, p < 0.01); in these patients the index CD4/CD8 was lower (< 0.05), the number of CD11b-, CD71- and HLA-DR positive lymphocytes was elevated . Thus, at periods between attacks the examined BA patients were found to have dysbiosis of mucous membranes, an elevated content of IgE, eosinophilia and lymphocyte activation indicative of the absence of immunological remission and required adequate diagnostic and therapeutic measures.

Int Rev Immunol, 2001, 20(2), 263 - 73
Anti-idiotypic vaccination against group B streptococci; Beninati C et al.; We describe the antigenic properties of an anti-idiotypic single chain fragment variable (scFv) recombinant antibody mimicking the type III capsular polysaccharide of group B streptococci (GBS), an important cause of neonatal sepsis . This scFv could compete with the nominal antigen for binding to specific mouse or rabbit antibodies . Moreover, the scFv elicited, in mice, the production of antibodies which reacted against the type IlI polysaccharide and passively protected neonatal pups from GBS disease . Maternal immunization with the scFv also protected neonatal mice against GBS infection . Next, the scFv was expressed on the surface of the commensal bacterium Streptococcus gordonii . Intravaginal inoculation of mice with these recombinant bacteria induced significant elevations in serum titers of anti-GBS type III antibodies . Therefore, the expression scFv in commensal bacteria may be a convenient and effective way of delivering anti-idiotypic vaccines.

Semin Perinatol, 2002 Feb, 26(1), 75 - 8
The origins of stillbirth: infectious diseases; Gibbs RS; This article reviews the literature on infectious diseases as a cause of stillbirth . Identifying a specific infection as a cause of stillbirth is limited by many obstacles . Nevertheless, "good faith" efforts estimate that approximately 9% to 15% of stillbirths are caused by infections . Infection may be especially important as a cause of stillbirth occurring early in pregnancy . Recognized causes include syphilis, toxoplasmosis, parvovirus B-19, chorioamnionitis, and Listeria monocytogenes . Other organisms that are "purported to cause" stillbirth include the genital mycoplasmas, Chlamydia trachomatis, HIV, group B streptococci, and others . No single strategy has been developed for effective prevention of stillbirth caused by infection . Six potential strategies and their rationale are presented, but the low rate of stillbirth in most situations would require large intervention trials for hypothesis testing . Infection is an important cause of stillbirth . Within the framework if determining epidemiological etiology, research should be initiated in the role of infectious causes.

Syst Appl Microbiol, 2001 Dec, 24(4), 486 - 9
Surface immunolocalisation of HPr in the equine pathogen Streptococcus equi; Dixon S et al.; We have investigated the surface localisation of the phosphotransferase system protein HPr in the equine pathogen Streptococcus equi subsp . equi using immunogold localisation and transmission electron microscopy . Like the LppC acid phosphatase lipoprotein, a reference surface antigen, the S . equi HPR could be clearly detected on the surfaces of intact cells . This study is consistent with previous reports that some streptococcal HPr is cell surface associated and suggests that the extracytoplasmic mobilisation and transfer of phosphate groups by streptococci warrant further investigation.

Isr Med Assoc J, 2002 Feb, 4(2), 98 - 102
Factors influencing oral colonization in premature infants; Makhoul IR et al.; BACKGROUND: Factors influencing the oral flora of premature infants have not been adequately investigated . OBJECTIVE: To investigate the effects of gestational age and of anti-bacterial therapy on the oral flora of premature infants . METHODS: Oral cultures were obtained at age 1 day and age 10 days from 65 premature infants, divided into three groups: a) 24 neonates of 30-34 weeks gestation who did not receive ABT, b) 23 neonates of 30-34 weeks gestation who received ABT, and c) 18 neonates < 30 weeks gestation who received ABT . RESULTS: Oral bacterial colonization increased from day 1 to day 10 of life . In 24-34 week neonates, gestational age did not affect early bacteremia or oral colonization at birth . Neither gestational age nor ABT affected late bacteremia or oral colonization at day 10 . In 30-34 week neonates with ABT, the oral flora consisted mainly of non-Escherichia coli gram-negative bacteria, whereas those who did not receive ABT grew mainly alpha-hemolytic streptococci, Klebsiella pneumoniae and E . coli . In neonates < 30 weeks who received ABT the oral flora were mainly coagulase-negative staphylococci . Oral colonization with anaerobes was zero and colonization with fungi was minimal . CONCLUSIONS: Acquisition of oral bacteria rose from day 1 to day 10 of life, regardless of gestational life or ABT . On day 10 of life, the spectrum of oral bacterial flora changed following ABT and consisted mainly of coagulase-negative Staphylococcus and non-E . coli gram-negative bacteria . Oral colonization showed few fungi but no anaerobes . These microbiologic observations merit attention when empirical anti-microbial therapy is considered in premature infants suspected of having late-onset sepsis.

Clin Microbiol Infect, 1998 Mar, 4 Suppl 1, S9 - S14
Grepafloxacin: microbiological properties; Marriott MS; Grepafloxacin is a new broad-spectrum fluoroquinolone characterized by having a methyl-substituted piperazine at the 7 position . It is a water-soluble racemate with both stereoisomers having the same activity . Its mode of action involves inhibition of topoisomerases II and IV . Grepafloxacin is not recognized by the NorA efflux mechanism in Staphylococcus aureus and, thus, some strains of Staphylococcus aureus that are resistant to other fluoroquinolones remain susceptible to grepafloxacin . Grepafloxacin has potent in vitro activity against streptococci and staphylococci, respiratory Gram-negative pathogens, atypical respiratory pathogens and sexually transmitted disease pathogens . It combines the positive properties of the beta-lactams against conventional Gram-positive and Gram-negative respiratory pathogens with the activity of the macrolides against the atypical pathogens . Unlike macrolides, it is bactericidal at concentrations close to the MIC . Its in vitro activity has been reflected in animal models of respiratory tract infections . Concentrations above MICs are maintained throughout nearly all of the 24-h dosing interval . Grepafloxacin provides important improvements over older quinolones and over other classes of antibiotics.

Scand J Infect Dis, 2001, 33(12), 883 - 90
Efficacy of short-course therapy with the ketolide telithromycin compared with 10 days of penicillin V for the treatment of pharyngitis/tonsillitis; Norrby SR et al.; This randomized, double-blind study compared the efficacy and safety of a 5-d course of the new ketolide antimicrobial, telithromycin, with those of a standard 10-d course of penicillin V (phenoxymethylpenicillin) in patients with group A beta-hemolytic streptococci (GABHS) pharyngitis/tonsillitis . Patients aged 15-65 y (n = 395) with clinical signs and symptoms of pharyngitis/tonsillitis and a positive streptococcal antigen test or throat culture for GABHS were randomized to receive either telithromycin 800 mg once daily for 5 d (n = 198) or penicillin V 500 mg three times daily for 10 d (n = 197) . Clinical and bacteriologic outcomes were assessed at post-therapy, test-of-cure (Days 16-20) and late post-therapy (Days 38-45) visits . Telithromycin for 5 d was equivalent to 10 d of penicillin V in terms of bacteriologic and clinical outcome (per-protocol): at post-therapy, test-of-cure visit, bacteriologic outcome was satisfactory in 84.3% and 89.1% of patients in the telithromycin and penicillin V groups, respectively, while clinical cure was achieved in 94.8% and 94.1% of patients, respectively . At late post-therapy, 82.4% of patients treated with telithromycin achieved a satisfactory bacteriologic outcome, compared with 84.7% of penicillin V recipients . The GABHS eradication rates for telithromycin and penicillin post-therapy were 85.2% and 89.1%, respectively, and 86.1% and 86.5%, respectively at late post-therapy . Both treatments were well tolerated, with a similar overall incidence of treatment-emergent adverse events . Short-course (5 d) therapy with telithromycin 800 mg once daily is comparable to a standard 10 d course of penicillin V for the treatment of GABHS pharyngitis/tonsillitis in adults and adolescents.

Hawaii Med J, 2002 Jan, 61(1), 10 - 2
Abiotrophia endocarditis: a case report and review of literature; Wijetunga M et al.; Nutritionally Variant Streptococci (NVS) were first grouped under viridans streptococci, although they differed from the latter by variant growth characteristics . NVS cause approximately 5% of cases of bacterial endocarditis . Infective endocarditis caused by NVS has a higher rate of complications than endocarditis caused by other viridans streptococci . Recently NVS were separated from other viridans streptococci to form a new genus Abiotrophia . Since then, only four case reports have described the clinical course of Abiotrophia endocarditis . Therefore, current knowledge on this disease derives from previous data on NVS endocarditis . We present the case of Abiotrophia endocarditis, followed by discussion of relevant literature.

J Biol Chem, 2002 May 10, 277(19), 16599 - 605 Epub 2002 Feb 26.
Fluoride exposure attenuates expression of Streptococcus pyogenes virulence factors; Thongboonkerd V et al.; Fluoridation causes an obvious reduction of dental caries by interference with cariogenic streptococci . However, the effect of fluoride on group A streptococci that causes rheumatic fever and acute poststreptococcal glomerulonephritis is not known . We have used proteomic analysis to create a reference proteome map for Streptococcus pyogenes and to determine fluoride-induced protein changes in the streptococci . Cellular and extracellular proteins were resolved by two-dimensional polyacrylamide gel electrophoresis and identified by matrix-assisted laser desorption ionization mass spectrometry . 183 protein spots were visualized, and 74 spots representing 60 unique proteins were identified . A 16-h exposure to sodium fluoride caused decreased expression of proteins required to respond to cellular stress, including anti-oxidants, glycolytic enzymes, transcriptional and translational regulators, and protein folding . Fluoride caused decreased cellular expression of two well-characterized S . pyogenes virulence factors . Fluoride decreased expression of glyceraldehyde-3-phosphate dehydrogenase, which acts to bind fibronectin and promote bacterial adherence . We also performed proteomic analysis of protein released by S . pyogenes into the culture supernatant and observed decreased expression of M proteins following fluoride exposure . These data provide evidence that fluoride causes decreased expression by S . pyogenes proteins used to respond to stress, virulence factors, and implicated in non-suppurative complications of S . pyogenes, including glomerulonephritis and rheumatic fever.

J Antimicrob Chemother, 2002 Mar, 49(3), 437 - 44
Role of aminoglycosides in the treatment of bacterial endocarditis; Graham JC et al.; Aminoglycosides are often used in combination with glycopeptides and beta-lactams for the treatment of bacterial endocarditis caused by alpha-haemolytic streptococci, staphylococci and enterococci . Recommendations on dosing and duration of aminoglycoside therapy vary; we detail the laboratory and clinical evidence base for the treatment regimens advised . A number of deficiencies in the published guidelines are highlighted, as is the limited evidence base upon which many of the regimens are recommended . With the increasing use of outpatient treatment of severe infections and once daily administration of aminoglycosides the opportunity should be taken for larger, multicentre clinical trials to evaluate formally both old and new regimens.

Clin Microbiol Infect, 1997 Aug, 3(4), 447 - 454
Efficacy of 5-day cefpodoxime proxetil for recurrent pharyngitis in adults . A comparative study with 10-day penicillin V or amoxycillin---clavulanate; Portier H et al.; OBJECTIVE: To compare the clinical and bacteriologic efficacy of a 5-day course of cefpodoxime proxetil (CPD) with that of a 10-day course of penicillin V (PNV) or amoxycillin---clavulanate (AMC) in recurrent pharyngitis in adults . A cost-effectiveness study (reported elsewhere) was carried out at the same time . METHODS: This multicenter, randomized, open label trial involved 580 adult patients consulting general practitioners for clinical recurrent pharyngitis (greater-than-or-equal3 episodes within the last 12 months) regardless of the bacterial etiology . Patients were treated for 5 days with CPD, 100 mg twice daily, or for 10 days with PNV, 1x106 IU three times a day, or for 10 days with AMC, 500 mg (amoxycillin) three times a day . Clinical and bacteriologic outcomes were noted at the end of treatment, and cases of clinical recurrence were recorded during a 6-month follow-up period . RESULTS: At the end of treatment, clinical response was satisfactory in 157 of 170 (92.3%) patients on CPD, 147 of 166 (88.5%) patients on PNV, and 168 of 177 (94.9%) patients on AMC . Group A beta-hemolytic streptococci (GABHS) were eradicated in 22 of 23 (95.65%) patients on CPD, 16 of 16 (100%) patients on PNV, and 19 of 20 (95%) patients on AMC . The rates of clinical success and GABHS eradication were not significantly different between the groups . Compliance (p<0.001) and tolerance (p<0.001) were significantly better in the CPD group than in the other two groups . Among the 389 patients evaluable 6 months after the end of treatment, the recurrence rate of acute pharyngitis (due to any bacterium) was significantly lower in the CPD group (p=0.01 versus PNV; p<0.01 versus AMC) . A Kaplan---Meier analysis (469 patients over 6 months) of the rate of non-recurrence, with comparison by the log-rank test, also showed a significant difference in favor of CPD . CONCLUSIONS: A 5-day treatment of recurrent pharyngitis with CPD was as effective and better tolerated than a 10-day treatment with PNV or AMC . The risk of recurrence was lower with CPD.

J Med Microbiol, 2002 Feb, 51(2), 178 - 86
Rapid identification of Streptococcus intermedius by PCR with the ily gene as a species marker gene; Goto T et al.; Streptococcus intermedius belongs to the anginosus group of streptococci (AGS) and is associated with endogenous infections leading to abscesses in the oral cavity and at deepseated sites, such as the brain and liver . Two other species, S . anginosus and S . constellatus, and some presently unnamed taxa, are also classified as AGS . Recently, S . constellatus subsp . pharyngis, a new subspecies with biochemical characteristics similar to S . intermedius, was described with the potential for causing confusion when trying to identify isolates of these two species routinely with commercial identification kits, such as Rapid ID32 Strep and Fluo-Card Milleri . To correctly identify S . intermedius, this study attempted to develop an accurate PCR identification system with the ily gene as a species marker . This approach relies on amplification of an 819-bp fragment of the ily gene and its 3'-flanking region and is shown here to be specific for S . intermedius strains among all other streptococcal species . Moreover, this PCR system was applicable in direct rapid PCR with whole bacterial cells and TaKaRa Z-Taq (TaKaRa), a highly efficient DNA polymerase, as the template and DNA amplification enzyme, respectively.

Zhonghua Yu Fang Yi Xue Za Zhi, 2000 May, 34(3), 150 - 2
{Studies on human streptococcal infectious syndrome caused by infected pigs}; Hu X et al.; OBJECTIVES: To demonstrate the clinical manifestations of S . suis infectious syndrome; to study the characteristics of causative organism and its source . METHODS: 25 cases of unknown causes of food poisoning were identified in the central area of Jiangsu province, China in July 1998 . Biological specimens was collected in some patients, and the causative organism was isolated using a number of different culture medium . Isolated organisms were identified by serum antibody tests, API biochemical tests, drug sensitivity tests and animal model experiments . The human born strains and the pig born strains were compared by RAPD technique . Epidemiological methods were applied to trace the source of causative organisms . RESULTS: Cases were clinically categorized into two types: Streptococcal toxic shock syndrome (STSS) and streptococcal meningitis syndrome (SMS) . Three strains of streptococci were isolated respectively from the blood and cerebrospinal fluid of 6 cases . All these 6 strains were confirmed to be S . suis type 2 by culture characteristics, morphology, biochemical characteristics, serum antibody tests and fatty acid profile analysis . Animal model experiment showed that these strains were sensitive to rabbits and pigs, but not to rats . RAPD fingerprint test revealed an identity between human born and pig born strains . CONCLUSIONS: The aetiological agent of these human cases was S . suis type 2 . Human cases were contracted by direct contact with the infected pigs or the corpse of infected pigs.

J Dairy Sci, 2002 Jan, 85(1), 132 - 8
Antibiotic susceptibility patterns for environmental streptococci isolated from bovine mastitis in central California dairies; Rossitto PV et al.; Environmental streptococci are frequently isolated from bovine mastitis in dairy cows with only limited information available on the antimicrobial susceptibility of these organisms . A total of 362 environmental streptococci isolated from cases of bovine mastitis from the central San Joaquin Valley of California over a 3-yr period were used in the study . Overall, 39.9% of the strains tested were Streptococcus uberis, 42.2% were Streptococcus dysgalactiae, and 11.1% were Enterococcus spp . The antimicrobial susceptibility for these organisms was determined for the following antimicrobial agents: penicillin, ampicillin, cephalothin, ceftiofur, penicillin + novobiocin, erythromycin, pirlimycin, tetracycline, and sulfadimethoxine . Results demonstrate substantial differences in the susceptibility patterns for the various organisms collectively referred to as the environmental streptococci . The MIC90 for penicillin was 0.06 microg/ml for 152 strains of S . dysgalactiae compared with 0.25 microg/ml for 133 strains of S . uberis . However, the Enterococcus spp . were the most resistant organisms tested . These data also indicate that the use of interpretive criteria based on human data may provide misleading results . In conclusion, these data confirm that the environmental streptococci are a diverse group of organisms comprised of several different genera and species and that identification of environmental streptococci to the species level is needed to appropriately modify control methods . Moreover, the use of the agar disk diffusion (Kirby-Bauer) susceptibility test for agents with human-based interpretive criteria is contraindicated, and these tests should only be performed with agents with mastitis specific interpretive criteria.

Diagn Microbiol Infect Dis, 2002 Feb, 42(2), 107 - 12
In vitro activity of the new ketolide ABT-773 against community acquired respiratory tract isolates and Viridans Streptococci; Casellas JM et al.; A total of 230 isolates were collected from clinical specimens of patients attending five health centers of the Buenos Aires, Argentina . ABT-773 was compared to erythromycin, azithromycin and clindamycin against bacterial isolates responsible for community-acquired respiratory tract infections and viridans streptococci showing different resistance patterns . Time-kill curves were also performed against selected resistant isolates.All but one of the 105 pneumococcal isolates were susceptible to ABT-773 . Among the erythromycin resistant S . pyogenes isolates, all the M type and inducible isolates were susceptible to ABT-773 . ABT-773 showed excellent activity against macrolide, azalide, lincosamide (MAL) inducible S . aureus producers but was inactive against constitutive producers . ABT-773 activity against viridans streptococci was also excellent.ABT-773 exerted bactericidal activity against selected isolates of S . pneumoniae, M . catarrhalis and H . influenzae, however, it was only bacteriostatic against methicillin-susceptible S . aureus.

Nippon Jibiinkoka Gakkai Kaiho, 2002 Jan, 105(1), 14 - 21
{Clinical relevance of the Streptococcus milleri group in head and neck infections}; Fujiyoshi T et al.; Streptococcus constellatus, S . intermedius, and S . anginosus, the 3 species of the S . milleri group, form part of the normal flora commonly found in the mouth, throat, and gastrointestinal and genital tracts . This group has become known as an important pathogen in infections and abscesses, but data on the anatomical distribution of these species is lacking in relation to clinical significance . We obtained 275 strains of the S . milleri group from different departments at our hospital over the last 3 years, including 54 strains from dental surgery, 47 from internal medicine, 44 from otolaryngology (head and neck), 43 from surgery, 32 from gynecology, 17 from urology, 16 from dermatology, 11 from brain surgery, 6 from pediatrics, 3 from orthopedics, and 2 from opthalmology . The 44 strains from head and neck were found in 42 patients,--23 with primary infection and 19 with secondary infection induced by cancer treatments . The primary infection group included 4 deep neck abscesses, 1 peritonsillar abscess, 5 tonsillitis, 4 paranasal sinusitis, 3 congenital aural fistula infections, 2 dental infections, 2 paranasal sinus cysts, 1 supprative parotitis, and 1 postoperative wound infection . The secondary infection group included 7 postoperative wound infections, 3 postoperative pulmonary infections, 3 laryngitis and pharyngitis, 3 terminal pneumonias, and 3 infections of the local recurrence site . The S . milleri group was the only isolated organism in 13 cases (56.5%) of primary infection and in 5 (26.3%) of secondary infection . Among other organisms from the primary infection group, no so-called major pathogens were found . Antimicrobial susceptibility tests of the S . milleri group showed that 50% were resistant to CCL and 33% to CTM . ABPC, CPDX, and CFDN were also found to be less sensitive, although no resistant strains were detected . To adequately culture the S . milleri group, incubation in air containing carbon dioxide or in an anaerobic atmosphere is required, and differentiation of the 3 requires biochemical reactivity tests . Since not all facilities use identical techniques in routine bacteriological examination, a considerable number of the S . milleri group could be missed in unknown species of alpha-,beta-, and gamma-streptococci and culture-negative cases . With antibiotics now being used widely, normal flora such as the S . milleri group may have become an important pathogen in head and neck infections due to an imbalance between organisms and host defense.

Rev Esp Quimioter, 2001 Dec, 14(4), 364 - 8
{In vitro activity of six fluoroquinolones and penicillin against 101 viridans group streptococci characterized by their susceptibility to erythromycin}; Rodriguez-Avial I et al.; The increase in the use of the fluoroquinolones, including for the treatment of lower respiratory tract infections, seems to be associated with a parallel increase in bacterial resistance . We studied the activity of penicillin and six fluoroquinolones against 101 viridans group streptococci isolated from blood (58 erythromycin-susceptible and 43 erythromycin-resistant) . The percentage of strains not susceptible to penicillin was 35% and there were statistically significant differences in the percentages of penicillin resistance between erythromycin-susceptible and -resistant strains . The fluoroquinolones studied showed good activity against our viridans group streptococci independent of their susceptibility to erythromycin . The norfloxacin MIC(50) and MIC(90) were 8 and 16 mg/l, respectively . Ofloxacin and ciprofloxacin showed the same activity (MIC(50) 1 mg/l and MIC(90) 2 mg/l); levofloxacin was similar with MIC(50) and MIC(90) of 1 mg/l . The fluoroquinolones with enhanced activity were moxifloxacin and trovafloxacin (MIC(50) 0.12 mg/l and MIC(90) 0.25 mg/l) . However, we found two strains resistant to trovafloxacin (MIC = 4 mg/l) that showed reduced susceptibility to all the fluoroquinolones tested, including moxifloxacin (MIC = 2 mg/l) . Mutations in the topoisomerase genes parC and gyrA have been shown to occur in strains with reduced susceptibility; therefore, ongoing surveillance for the development of fluoroquinolone resistance in viridans streptococci is necessary.

Clin Microbiol Infect, 1999 Feb, 5(2), 73 - 77
Current status of taxonomic groups of oral streptococci in endocarditis . Can virulence factors discriminate between endocarditis and non-endocarditis strains?
Larsen T, Fiehn NE, Gutschik E, Bangsborg JM.
OBJECTIVE: Infective endocarditis is frequently caused by oral streptococci, especially Streptococcus sanguis . In this group, many strains have recently been reclassified on the basis of new taxonomic schemes . The purpose of this study was to classify oral streptococci from patients with infective endocarditis and, further, to assess the importance of specific virulence factors for the development of streptococcal endocarditis . METHODS: Twenty-eight previously identified and 10 new streptococcal isolates from infective endocarditis were classified according to Kilian et al (1989) and compared to 30 streptococcal isolates from the oral cavities of periodontal patients without endocarditis . Subsequently, surface hydrophobicity was assessed by hydrophobic interaction chromatography, production of extracellular dextran was determined by precipitation, and non-specific proteolytic activity was evaluated by determination of hydrolysis of gelatin, and casein-precipitating activity . RESULTS: Eight streptococcal species were represented in the endocarditis isolates . Most strains were highly hydrophobic and none showed non-specific proteolytic activity . Dextran was produced with similar frequency in endocarditis and non-endocarditis isolates . CONCLUSIONS: The present study showed that infective endocarditis may be caused by a variety of oral streptococcal species . The possible virulence factors investigated were found in the same proportions in endocarditis and non-endocarditis isolates, and thus did not seem to be crucial for development of endocarditis.

Curr Infect Dis Rep, 2002 Feb, 4(1), 17 - 27
The Oxazolidinones; Evans GA; The need for effective antibiotics to manage the ever increasing frequency of antibiotic-resistant gram-positive infections in much of the developed world has led to the clinical development of the first oxazolidinone antibiotic, linezolid . Linezolid possesses bacteriostatic activity against both antibiotic-susceptible and resistant strains of staphylococci, enterococci, and streptococci of relevance to human infection . Clinical trials have confirmed its effectiveness in the treatment of serious infections of skin and soft tissue and the lower respiratory tract . Linezolid has also provided improved outcomes in the treatment of serious vancomycin-resistant enterococci and methicillin-resistant Staphylococcus aureus infections in a compassionate use program . Emergence of linezolid-resistant gram-positive cocci during clinical use has recently been described, suggesting that its present role in therapy should be reserved for the treatment of antibiotic-resistant gram-positive infections.

Clin Microbiol Infect, 1999 Jul, 5(7), 417 - 423
Evaluation of the Rapid ID 32 Strep system; Gorm Jensen T et al.; OBJECTIVE: To evaluate the performance of the Rapid ID 32 Strep system in the hands of clinical microbiologists without expert knowledge of streptococci or enterococci . METHODS: One hundred and twenty-two strains of streptococci and enterococci conventionally identified in a reference laboratory were sent under code numbers to a clinical microbiology laboratory and identified with the Rapid ID 32 Strep system . RESULTS: Regardless of whether automatic reading and identification or visual reading with identification using tables were done, 75-77% of the 122 examined strains were correctly identified, 7% were misidentified and 16-18% could not be identified with certainty to the species level . The system correctly identified the majority of the examined pyogenic streptococci and enterococci, but only two-thirds of the viridans streptococcal strains . CONCLUSIONS: In a routine laboratory, the Rapid ID 32 Strep system can be used to give a rapid preliminary identification of streptococci and enterococci, but with viridans streptococci one would have to accept a certain risk of mis-identification . The assay can, however, be used to biotype viridans streptococci in order to attempt to establish identity between separate isolates, e.g . from blood in patients suspected of having endocarditis.

Ther Umsch, 2002 Jan, 59(1), 41 - 5
{Significance of antibiotic resistance in treatment of soft tissue infections}; Ruef Ch; Soft tissue infections are common . The clinical spectrum includes infections of skin, subcutaneous tissue, and of deeper structures such as fascia and muscles . The pathogenesis of these infections is quite variable . Introduction of microorganisms through skin breaks or through trauma of other soft tissue is usually at the origin of such infections . Staphylococci, especially S . aureus, as well as streptococci, mainly group A streptococci cause most soft tissue infections . In immunocompromised patients or in particuluar circumstances gram-negative bacteria may also be found to cause such infections . Occasionally, infections are polymicrobial . Given the predominance of gram-positive cocci, betalactam antibiotics with good antistaphylococcal activity are the drugs of choice for empiric treatment . Penicillins or cephalosporins that are stable against penicillinase should be chosen, since many staphylococci produce penicillinase . Over the course of the last 40 years staphylococci first became resistant against penicillin, and later developed resistance against methicillin . Methicillin-resistant S . aureus (MRSA) is now a significant problem worldwide . There continue to be major differences in the prevalence of MRSA between geographic regions . In areas with a high prevalence of methicillin resistance among S . aureus, empiric treatment of life-threatening soft tissue infections should include treatment with a glycopeptide (i.e . vancomycin or teicoplanin) . New antibiotics such as oxazolidinones (i.e . linezolid) or quinupristin/dalfopristin are interesting alternatives to the glycopeptides in the treatment of soft tissue infections.

Antimicrob Agents Chemother, 2002 Mar, 46(3), 783 - 6
Comparison of in vitro activities of ABT-773 and telithromycin against macrolide-susceptible and -resistant streptococci and staphylococci; Shortridge VD et al.; The activity of a new ketolide, ABT-773, was compared to the activity of the ketolide telithromycin (HMR-3647) against over 600 gram-positive clinical isolates, including 356 Streptococcus pneumoniae, 167 Staphylococcus aureus, and 136 Streptococcus pyogenes isolates . Macrolide-susceptible isolates as well as macrolide-resistant isolates with ribosomal methylase (Erm), macrolide efflux (Mef), and ribosomal mutations were tested using the NCCLS reference broth microdilution method . Both compounds were extremely active against macrolide-susceptible isolates, with the minimum inhibitory concentrations at which 90% of the isolates tested were inhibited (MIC90s) for susceptible streptococci and staphylococci ranging from 0.002 to 0.03 microg/ml for ABT-773 and 0.008 to 0.06 microg/ml for telithromycin . ABT-773 had increased activities against macrolide-resistant S . pneumoniae (Erm MIC90, 0.015 microg/ml; Mef MIC90, 0.12 microg/ml) compared to those of telithromycin (Erm MIC90, 0.12 microg/ml; Mef MIC90, 1 microg/ml) . Both compounds were active against strains with rRNA or ribosomal protein mutations (MIC90, 0.12 microg/ml) . ABT-773 was also more active against macrolide-resistant S . pyogenes (ABT-773 Erm MIC90, 0.5 microg/ml; ABT-773 Mef MIC90, 0.12 microg/ml; telithromycin Erm MIC90, >8 microg/ml; telithromycin Mef MIC90, 1.0 microg/ml) . Both compounds lacked activity against constitutive macrolide-resistant Staphylococcus aureus but had good activities against inducibly resistant Staphylococcus aureus (ABT-773 MIC90, 0.06 microg/ml; telithromycin MIC90, 0.5 microg/ml) . ABT-773 has superior activity against macrolide-resistant streptococci compared to that of telithromycin.

Roum Arch Microbiol Immunol, 1999 Jan-Mar, 58(1), 57 - 63
Antimicrobial susceptibility of some streptococci strains of anginosus group isolated from oral and maxillofacial infections; Bancescu G et al.; Streptococci strains of the anginosus group isolated from various oral and maxillofacial infections (OMF) were screened for their susceptibility to the following antimicrobial agents: benzylpenicillin, ampicillin, oxacillin, cephalothin, ceftazidime, cefotaxime, cefuroxime, erythromycin, clindamycin, tetracycline, chloramphenicol, vancomycin and trimethoprime-sulphamethoxazole . The isolates were susceptable to: clindamycin, chloramphenicol, vancomycin and all beta-lactam antibiotics, except ceftazidime to which 54.5% of the strains showed intermediate susceptibility . Intermediate susceptibility to tetracycline was found in 11.3% of the strains, whereas resistance to the same antibiotic was demonstrated in 61.4% . Resistance to erythromycin and trimethoprime-sulphamethoxazole was of 2.3% for both . In conclusion, penicillin is the drug of choice in infections caused by streptococci of the anginosus group.

Roum Arch Microbiol Immunol, 1999 Jan-Mar, 58(1), 49 - 55
Streptococci species of anginosus group isolated from oral and maxillofacial infections; Bancescu G et al.; The aim of the study was to isolate and identify at species level streptococci strains of anginosus group in pus samples collected from 110 patients with oral and maxillofacial (OMF) infections . Gram-stained smears and cultures on selective and nonselective media were done from each of the 111 pus samples (2 samples were collected from one of the patients, who presented 2 oral abscesses at the same time) . The isolates were identified on the basis of cultural and biochemical characteristics . Speciation of the anginosus group isolates was performed using the Rapid ID 32 Strep system (Bio Merieux, France) . Fourty-four anginosus group strains were isolated from 42 patients . Fourty of these isolates were identified as Streptococcus anginosus (2 nonidentical isolates were found in 2 patients), 3 isolates as Streptococcus constellatus and only one as Streptococcus intermedius . The study confirmed that the anginosus group is often involved in OMF infections alone or in association with other aerobic and/or anaerobic bacteria . In the investigated cases, Streptococcus anginosus was by far the most frequently isolated species within the anginosus group.

Am Surg, 2002 Feb, 68(2), 109 - 16
Necrotizing fasciitis: a fourteen-year retrospective study of 163 consecutive patients; Childers BJ et al.; This review was prompted by continued public and professional interest of necrotizing fasciitis as well as worldwide increases in the incidence of streptococcal invasive infections . Our objective was to outline the clinical course of necrotizing fasciitis and delineate factors relating to mortality among 163 diagnosed patients . Over 14 years patients diagnosed with necrotizing fasciitis were reviewed for patient history, comorbid conditions, and progression of clinical course . A logistic regression model was used to identify factors increasing mortality risk among necrotizing fasciitis patients . Nearly 17 per cent of the patients showed no identifiable antecedent trauma . Seventy-one per cent of tissue culture-positive patients (145) had multibacterial infections . Although no streptococcal species were recovered from one-third of these culture-positive patients there was an increase in mortality noted with beta-Streptococcus infections . Ninety-six per cent of the patient deaths were correlated with variables organized into the following categories: 1) patient history (intravenous drug use and age <1 or >60 years), 2) comorbid conditions (cancer, renal disease, and congestive heart failure), 3) characteristics of clinical course (trunk involvement, positive blood cultures, peripheral vascular disease, and positive cultures for beta-streptococcus or anaerobic bacteria), and 4) quantitative timeline of clinical course (time: injury to diagnosis, diagnosis to treatment) . Mortality is correlated to patient history, comorbid conditions, and progression of clinical course . Necrotizing fasciitis can occur idiopathically and is generally a polymicrobial infection that sometimes occurs in the absence of streptococci . Clearly the mortality and morbidity associated with necrotizing fasciitis can be decreased with clinical awareness, early diagnosis, adequate surgical debridement, and intensive supportive care.

J Perinatol, 2002 Jan, 22(1), 50 - 6
Feasibility of nitric oxide administration by oxygen hood in neonatal pulmonary hypertension; Ambalavanan N et al.; OBJECTIVE: To test the hemodynamic efficacy and feasibility of nitric oxide (NO) administration by oxygen hood in neonatal pulmonary hypertension . STUDY DESIGN: A double-hood apparatus was used in which a combination of NO, O(2), and N(2) was introduced into the inner hood and suctioned from the outer hood . Chronically instrumented non-intubated piglets were exposed to 10% O(2) (hypoxia; n=8) or group B streptococci infusion (GBS; n=5) to produce pulmonary hypertension and were then exposed to 20 ppm NO . RESULTS: NO decreased (>50%) pulmonary artery pressure and vascular resistance in both hypoxia- and GBS-induced pulmonary hypertension, with minimal effects on systemic arterial pressure and cardiac output . NO administration could be performed without detectable environmental leakage . CONCLUSION: Hood NO administration is feasible and shows hemodynamic efficacy in neonatal piglets with pulmonary hypertension.

Ned Tijdschr Tandheelkd, 1994 May, 101(5), 180 - 2
{Prevention of dental caries with chlorhexidine}; van Loveren C; The presence of > or = 10(6) mutans streptococci per ml saliva may indicate a high caries risk or activity . Individuals exhibiting these high levels of mutans streptococci are ironically called 'millionaires' . It has been demonstrated that the reduction of the mutans streptococci with a series of chlorhexidine gel treatments, reduces the caries incidence in millionaire children . Recently, two chlorhexidine varnishes have been shown to reduce the mutans streptococci in plaque and saliva significantly . It may be expected that the application of these chlorhexidine varnishes may reduce caries incidence in 'millionaires' . It may also be possible to treat individual sites of the teeth that are at risk.

Clin Infect Dis, 2002 Mar 15, 34(6), 806 - 12 Epub 2002 Jan 31.
Infective endocarditis in elderly patients; Dhawan VK; Infective endocarditis (IE) in elderly patients presents a unique diagnostic and therapeutic challenge . Atypical presentations frequently lead to delayed diagnosis and poor outcome . IE in elderly persons is somewhat more common among men . Underlying degenerative valvular disease, mitral valve prolapse, and the presence of a prosthetic valve are important risk factors predisposing elderly persons to IE . Streptococci and staphylococci are the predominant organisms, which are recovered from approximately 80% of elderly patients with IE . In older patients, IE occurs somewhat more frequently on the mitral valve than it does on the aortic valve . The presence of calcific valvular lesions and the prosthetic valves often confound the echocardiographic findings in elderly patients . A high index of suspicion and an aggressive diagnostic approach are required to ensure timely diagnosis and appropriate therapy.

Ann Rheum Dis, 2002 Mar, 61(3), 267 - 9
No changes in the distribution of organisms responsible for septic arthritis over a 20 year period; Dubost JJ et al.; OBJECTIVE: To assess changes in the distribution and resistance of the pathogens responsible for septic arthritis over a 20 year period in patients admitted to the same hospital unit . PATIENTS AND METHODS: Retrospective study of the hospital records of patients admitted between 1979 and 1998 for septic arthritis with positive microbiological diagnosis after blood or joint cultures, or both . RESULTS: 303 cases of septic arthritis were studied, 141 in the period 1979-88 and 162 in the period 1989-98 . The incidence between the first and second period did not vary significantly for the staphylococci (67% v . 63%), streptococci (16% v . 20%), and Gram negative bacilli (7% v . 10%) . Tuberculous infections decreased from 9% to 4% (p<0.04) . No gonococci were isolated in the second 10 year period . Among the staphylococcal species, there was an increase in the number of coagulase negative staphylococci (10 cases v . 21, p<0.05) between the two periods . There was no significant difference in the frequency of occurrence of methicillin resistant pathogens (12.6% v . 16.6%) . The number of streptococcal B infections increased (2 v . 10 cases), and beta-lactamine resistant pneumococci emerged . In the second 10 year period, patients were older and were more likely to have co-existing disease, particularly tumoral growth, and less commonly were receiving dialysis . Localisation of joint infection was comparable except for an increase in prosthetic knee infections . CONCLUSION: The distribution and sensitivity of pathogens causing septic arthritis changed little over a 20 year period.

J Microbiol Methods, 2002 Apr, 49(2), 193 - 205
PCR ligation mutagenesis in transformable streptococci: application and efficiency; Lau PC et al.; PCR ligation mutagenesis is a novel technique that can easily be adapted for many gene modification purposes . Successful application of this versatile technique involves sequence identification of the target gene region, creation of a mutagenic construct consisting of two gene-flanking proximal sequences specifically ligated to a selectable marker, and incorporation of this construct into the genome via genetic transformation and homologous recombination . In this study, we demonstrate the use of PCR, followed by restriction digestion and re-ligation to generate transforming constructs for the rapid deletion of open reading frames in transformable streptococci . Moreover, we characterized the dependence of transformation efficiency for mutant generation on the length of the homologous regions harbored by the mutagenic construct . Our results indicated that PCR ligation mutagenesis could be reliably employed for the systematic generation of gene deletion mutants in both highly transformable Streptococcus mutans and S . pneumoniae . Evaluation of the method showed a strong influence of the length of homologous flanking region on integration efficiency.

Cutis, 2002 Jan, 69(1), 46 - 8
Coexistent infections on a child's distal phalanx: blistering dactylitis and herpetic whitlow; Ney AC et al.; We report a case of coexistent Staphylococcus aureus and herpes simplex virus (HSV) infections responsible for a bullous and vesicular eruption on a child's distal phalanx . Blistering distal dactylitis (BDD), a superficial infection of the distal portion of the finger, is seen most commonly in children and is caused by either beta-hemolytic streptococci or S aureus . Herpetic whitlow, also a blistering infection found on children's distal fingers, is a bacteriologic sterile infection caused by HSV-1 or HSV-2 . In this report, we note that these infections may coexist on the distal phalanx . This case has implications for diagnosis and treatment of children's blistering hand diseases.

J Clin Microbiol, 2002 Feb, 40(2), 679 - 81
PCR m typing: a new method for rapid typing of group a streptococci; Vitali LA et al.; A new approach for the M-typing of Streptococcus pyogenes is reported . Oligonucleotide primers were used in a PCR to amplify the N-terminal region of the emm gene . The presence of the PCR amplification product is associated with the corresponding M serotype . This technique offers potential advantages over other molecular typing methods.

J Clin Microbiol, 2002 Feb, 40(2), 620 - 6
Molecular profiles of group B streptococcal surface protein antigen genes: relationship to molecular serotypes; Kong F et al.; The study of surface protein antigens of group B streptococci (GBS) is important for understanding of the pathogenesis and epidemiology of infection, and several of these antigens have been proposed as components of GBS conjugate vaccines . In a previous study, we developed a novel PCR-and-sequencing system for identification of GBS serotypes and serosubtypes based on the capsular polysaccharide synthesis (cps) gene cluster . In this study, we used published sequences to develop PCR assays for identification of genes encoding GBS surface proteins including C alpha (bca), C alpha-like proteins 2 and 3 (alp2 and alp3), Rib (rib), and C beta (bac) . We showed that the prototype R reference strain, Prague 25/60, contained a novel alpha-like protein antigen gene (the proposed alp4), which presumably encodes an atypical, but antigenically similar, R-like protein . Initial evaluation of these gene-specific assays showed excellent specificity . By combining cps serotypes, serosubtypes, and surface protein gene profiles, we were able to divide 224 GBS isolates into 31 serovariants . GBS bac-positive strains could be further subtyped into 11 groups and 20 subgroups . Our results confirmed and extended reported associations between some cps serotypes and serosubtypes, on the one hand, and surface protein genes, on the other: serosubtypes III-1 and III-2 were associated with rib, serosubtype III-3 with alp2, serotype Ib with bca and bac, and serotype V with alp3 . The associations between serotype Ia and bca, bca repetitive unit, and bca repetitive unit-like sequence-containing genes need to be studied further . These PCR-based methods will provide an alternative and objective tool for subtyping of GBS based on surface protein antigen genes.

Arch Pathol Lab Med, 2002 Feb, 126(2), 147 - 9
Do proficiency testing participants learn from their mistakes? Experience from the EXCEL throat culture module; Novak RW; CONTEXT: Participation in proficiency testing is required under the Clinical Laboratory Improvement Amendments of 1988 . Although the primary purpose of this testing is evaluation of current laboratory performance, a major secondary benefit of such testing is postulated to be progressive improvement in laboratory performance over time as laboratories learn from their previous experiences and feedback . OBJECTIVE: To test the hypothesis that a secondary result of proficiency testing is improvement over time of laboratory performance . DESIGN: The performance of participants in a large proficiency testing program (EXCEL), designed for clinic and office laboratories, on a specific problematic competence, the ability to differentiate group A streptococcus from group C streptococci, was monitored during a 6-year period (1996-2001) for changes in participant performance . INTERVENTIONS: With each testing cycle, feedback on performance relative to peers and an educational discussion analyzing performance and suggesting best practices was submitted to participants . RESULTS: Despite consistent feedback, there was no significant change in participant performance throughout the period studied . CONCLUSIONS: In a large, stable proficiency testing program, a significant throat culture competence, which demonstrated less than optimal performance, did not improve over time, suggesting that current utilization of proficiency testing results in laboratory improvement programs is suboptimal.

Arch Intern Med, 2002 Jan 14, 162(1), 90 - 4
Changing patient characteristics and the effect on mortality in endocarditis; Cabell CH et al.; BACKGROUND: Limited data exist on recent demographic and microbiological changes in infective endocarditis (IE) and the impact of these changes on patient survival . METHODS: Data were collected from all patients with definite or possible IE at Duke University Medical Center, Durham, NC, from 1993 to 1999 . Logistic regression analysis was used to identify demographic and microbiological changes that occurred in patients with IE over the study period . The impact of these changes on survival was evaluated using Cox proportional hazards modeling . RESULTS: Among the 329 study patients, rates of hemodialysis dependence, immunosuppression, and Staphylococcus aureus infection increased during the study period (P=.04, P=.008, and P<.001, respectively), while rates of infection due to viridans group streptococci decreased (P=.007) . Hemodialysis was independently associated with S aureus infection (odds ratio, 3.1; 95% confidence interval, 1.6-5.9) . Patients with S aureus IE had a higher 1-year mortality rate (43.9% vs 32.5%; P=.04) that persisted after adjustment for other illness severity characteristics (hazard ratio, 1.5; 95% confidence interval, 1.03-2.3) . CONCLUSIONS: The demographic and microbiological characteristics of IE at our institution have changed over the past decade in ways that suggest a link between medical practice and IE characteristics . Staphylococcus aureus has emerged as a dominant cause of IE, and is an independent predictor of mortality . These findings identify clinical settings that may warrant closer surveillance and more aggressive measures in the identification and prevention of endocarditis.

Microb Drug Resist, 2001 Winter, 7(4), 317 - 22
Unusual inducible cross resistance to macrolides, lincosamides, and streptogramins B by methylase production in clinical isolates of Staphylococcus aureus; Clarebout G et al.; Clinical strains of Staphylococcus aureus UCN7 and UCN8 were inducibly resistant to erythromycin, clindamycin, lincomycin, and quinupristin . This unusual inducible MLS(B) resistance was due to the presence of an erm(A) or an erm(B) gene, which both encode a ribosomal methylase, in S . aureus UCN8 and UCN7, respectively . The inducible cross resistance expressed by S . aureus UCN8 was associated with an 83-bp deletion in the attenuator of the erm(A) gene that removed the second of the two leader peptides and several inverted repeats . The presence of an inducible erm(B) gene in S . aureus UCN7 conferred a cross-resistance MLS(B) phenotype, similar to that usually observed in streptococci . Therefore, in S . aureus, besides the classical inducible MLS(B) phenotype characterized by inducible resistance to 14- to 15-membered ring macrolides, an additional type of inducible cross resistance to macrolides, lincosamides, and streptogramins B due to variants of erm(A) or erm(B) genes exist.

FEMS Immunol Med Microbiol, 2002 Jan 14, 32(2), 175 - 7
Fluoride modifies adhesion of Streptococcus pyogenes; Cao J et al.; Streptococcus pyogenes grown in the presence of subinhibitory concentrations of sodium fluoride had a diminished ability, compared to control cells, to adhere to buccal cells, collagen, fibronectin, and laminin . In addition, sodium fluoride was a competitive inhibitor of streptococcal adhesion to collagen and fibronectin, but not laminin . It is suggested that sodium fluoride may be useful in therapy or prophylaxis in infections involving group A streptococci.

Diagn Microbiol Infect Dis, 2002 Jan, 42(1), 21 - 8
A comparative study of the etiology of adult upper and lower respiratory tract infections in the community; Lieberman D et al.; Lower respiratory tract infection and upper respiratory tract infection (URTI) are very common, but the etiology is not diagnosed in routine practice . The objective of this study was to determine and compare the frequency distribution of the various infectious etiologies for these diseases . One hundred seventy five adults in the community with febrile LRTI and 75 with febrile URTI were included in a purely serologically based prospective study . Paired sera were obtained for each of the patients and were tested by EIA or immunofluorescence methods to identify 14 different pathogens . Only a significant change in antibody titers between the paired sera was considered diagnostic . At least one infectious etiology was identified in 167 patients (67%) . In the LRTI group, infection with at least one of 7 respiratory viruses was found in 88 patients (50%) . One of the atypical pathogens was found in 40 patients (23%), of these Legionella spp . in 19 (11%) and Mycoplasma pneumoniae in 18 (10%) . A bacterial etiology was found in 19 patients (11%), of these Streptococcus pneumoniae in 8 (5%) and beta-hemolytic streptococci group A in 5 (3%) . The frequency distribution of etiologies in the URTI group was not significantly different from the LRTI group, except for M . pneumoniae that was identified in only one patient with URTI (p = 0.015) . More than one etiologic agent was found in 42 (17%) of the patients . LRTI is caused by a broad spectrum of etiologies, with respiratory viruses predominating and a moderate, but significant, prevalence of atypical pathogens . The frequency distribution of etiologies for URTI is similar to LRTI . In a significant proportion of patients with URTI and LRTI there is serologic evidence of infection with more than one pathogen . The justification and benefit of distinguishing between URTI and LRTI in routine clinical work is doubtful . When a decision is reached to treat RTI patients with an antibiotic, it is logical to use a macrolide or tetracycline.

Dent Mater J, 2000 Dec, 19(4), 363 - 72
Adhesion in vitro of oral streptococci to porcelain, composite resin cement and human enamel; Takatsuka T et al.; We investigated the initial adhesion in vitro of oral streptococci to porcelain inlays . Four strains of streptococci, Streptococcus mitis NCTC12261, Streptococcus oralis ATCC9811, Streptococcus sanguis ATCC10556 and Streptococcus sobrinus OMZ176, were used in this study . The disc specimens were made of porcelain, composite resin cement and human enamel . These specimens, with or without a saliva-coat, were immersed in a suspension of each streptococci strain at 37 degrees C for 1 hr, and the numbers of cells adhering to specimens were counted after staining . The saliva-coat significantly decreased the numbers of adhering cells in all strains tested (t-test, p < 0.05) . The adhesion to the porcelain and resin cements could be explained by a thermodynamic approach, although the adhesion to enamel could not be explained . These results indicated the possibility that the mechanism is different in initial adhered strains of streptococci between enamel and dental restorative materials.

J Pediatr, 2002 Jan, 140(1), 20 - 6
High incidence of penicillin resistance among alpha-hemolytic streptococci isolated from the blood of children with cancer; Bruckner LB et al.; OBJECTIVES: To survey the susceptibility profiles to several beta-lactam antibiotics and to identify factors related to resistance among blood isolates of alpha-hemolytic streptococci (AHS) obtained from children with cancer . STUDY DESIGN: All pediatric oncology patients with AHS bacteremia occurring from January 1996 through June 1999 at one cancer center were identified . Isolates were categorized based on the minimum inhibitory concentration as susceptible, intermediate, or resistant to several beta-lactam antibiotics . Demographics and potential factors related to antibiotic resistance were obtained from the medical record . RESULTS: Thirty-eight AHS isolates were obtained from 33 patients . Penicillin susceptibility testing revealed that only 8 (21%) isolates were susceptible, 16 (42%) were intermediate, and 14 (37%) were resistant . All 14 of the penicillin-resistant isolates were also resistant to the 3 cephalosporins tested . Ceftriaxone and ceftazidime were the most active cephalosporins . Antibiotic resistance correlated with the recent use of systemic antibiotics, number of prior infectious episodes, and species type . CONCLUSIONS: Blood culture isolates of AHS obtained from children with cancer are frequently resistant to beta-lactam antibiotics . These results indicate that clinically relevant AHS isolates should be tested for antibiotic susceptibility and that beta-lactam antibiotics may not be optimal empiric therapy for fever and neutropenia in children with cancer who have a high risk of AHS infections.

J Antimicrob Chemother, 2002 Feb, 49(2), 337 - 44
Five day clarithromycin modified release versus 10 day penicillin V for group A streptococcal pharyngitis: a multi-centre, open-label, randomized study; Portier H et al.; OBJECTIVE: A multicentre, comparative, randomized, open-label, Phase III trial evaluated the efficacy and tolerability of clarithromycin modified release (MR) versus penicillin V for pharyngitis due to group A beta-haemolytic streptococci (GABHS) . METHODS: Three hundred and forty-nine patients (12-40 years) with acute pharyngotonsillitis and a positive Streptococcus A antigen immunoassay test were randomized to receive clarithromycin MR 500 mg od for 5 days or penicillin 590 mg tds for 10 days . Patients were clinically evaluated and a throat swab for culture obtained before treatment, after treatment (day 8 or 13 depending on the treatment arm) and at the follow-up visit (day 30) . The main criterion for efficacy was the bacteriological cure rate after treatment . RESULTS: Three hundred and forty-nine patients were considered for the intent-to-treat analysis . After treatment, clinical cure rates were 88.1% in the clarithromycin group and 92.4% in the penicillin group, and eradication rates were 82.8% and 83.6%, respectively . There were no statistically significant differences between the two treatments . Three hundred and three (87%) patients had a positive culture before treatment, among which 29 (9.7%) were found to be clarithromycin resistant . Two hundred and thirty-nine patients were clinically and bacteriologically evaluable for per protocol analysis . After treatment, clinical cure rates were 95.2% in the clarithromycin group and 97.3% in the penicillin group, and eradication rates were 94.4% and 92%, respectively . No statistically significant difference was shown . Adverse events occurred in 46 patients of the clarithromycin group and 31 of the penicillin group (with no statistical difference) . Most of them were of mild or moderate severity . CONCLUSION: Clarithromycin MR administered once daily for 5 days is as safe and effective as penicillin V administered three times a day for 10 days in the treatment of GABHS pharyngitis.

Am J Ophthalmol, 2002 Feb, 133(2), 268 - 9
Gemella haemolysans keratitis and consecutive endophthalmitis; Ritterband D et al.; PURPOSE: To report a case of Gemella hemolysans keratitis with consecutive endophthalmitis . METHODS: Interventional case report . A 47-year-old woman with a history of sarcoidosis treated chronically with systemic prednisone developed bacterial keratitis and consecutive endophthalmitis in the left eye . RESULTS: Corneal, aqueous, and vitreous cultures yielded G . hemolysans . Emergent keratoplasty, pars plana vitrectomy, and injection of intravitreal antibiotics led to resolution of the infection and improved vision . Five months after surgery, the corneal graft has remained clear since cessation of antibiotics . CONCLUSION: This is the first report, to our knowledge, of ocular G . hemolysans infection, an uncommon gram-positive pathogen often confused with viridans-type streptococci.

Am J Obstet Gynecol, 2002 Jan, 186(1), 128 - 38
Identification of matrix metalloproteinase-9 in amniotic fluid and amniochorion in spontaneous labor and after experimental intrauterine infection or interleukin-1 beta infusion in pregnant rhesus monkeys; Vadillo-Ortega F et al.; OBJECTIVE: The purpose of this study was to examine the roles of intrauterine infection, inflammation, and spontaneous labor on the expression of matrix metalloproteinase-9 in fetal membranes and amniotic fluid of late pregnant rhesus monkeys . STUDY DESIGN: Pregnant rhesus monkeys with timed gestations were chronically catheterized to allow serial sampling of amniotic fluid before and during experimentally induced intrauterine inflammation . Six animals received group B streptococci into the chorionic-decidual space, and 4 animals received intra-amniotic interleukin-1 beta infusions (10 microg) . Three additional animals were serially sampled by amniocentesis through late pregnancy until spontaneous term labor . Amniotic fluid samples were examined by zymography for matrix metalloproteinase-9 and -2 and Western immunoblot for matrix metalloproteinase-9 and -2 and tissue inhibitors of metalloproteinase-1 and -2 . Fetal membranes were obtained at cesarean delivery during labor (before rupture), formalin fixed, and embedded in paraffin for immunocytochemistry of matrix metalloproteinase-9 and in situ hybridization of matrix metalloproteinase-9 messenger RNA . Tissues from 2 additional animals were collected as age-matched non-labor controls . RESULTS: In amniotic fluid, the 92-kd latent matrix metalloproteinase-9 was detectable in late pregnancy and increased dramatically, followed by the appearance of the 83-kd active form before spontaneous term delivery . Amniotic fluid matrix metalloproteinase-2 levels (both latent and active forms) remained relatively constant throughout pregnancy and in labor . Both bacteria and interleukin-1 beta rapidly increased the signal of latent matrix metalloproteinase-9 without a consistent increase in the active form before the onset of labor . Chorionic-decidual inoculation of group B streptococci was followed by the expression of latent matrix metalloproteinase-9 before the appearance of group B streptococci in amniotic fluid or the onset of labor . Matrix metalloproteinase-2 increased to a new steady-state level or remained unchanged after group B streptococci inoculation or interleukin-1 beta infusion, respectively . Amniotic fluid tissue inhibitors of metalloproteinase-1 declined and tissue inhibitors of metalloproteinase-2 remained unchanged during early group B streptococci infection, after interleukin-1 beta infusion and on the day of spontaneous term labor . However, both tissue inhibitors of metalloproteinase-1 and -2 levels increased after preterm labor that was induced by group B streptococci . Immunocytochemistry localized matrix metalloproteinase-9 protein to amnion and chorion epithelial and mesenchymal cells and decidual stromal cells . Granular matrix metalloproteinase-9 staining was observed in the connective tissue layer of inflamed fetal membranes . In situ hybridization for messenger RNA confirmed the production of matrix metalloproteinase-9 by amnion and chorion . CONCLUSION: Bacterial- and interleukin-1 beta-induced preterm labor and spontaneous term labor are preceded and accompanied by progressive increases in amniotic fluid matrix metalloproteinase-9 (92 kd) in rhesus monkeys . Amniotic fluid matrix metalloproteinase-9 may serve as a clinical marker for the onset of both preterm and term labor.

Gerodontology, 2000 Dec, 17(2), 67 - 76
The effectiveness of 10% chlorhexidine varnish treatment on dental caries incidence in adults with dry mouth; Banting DW et al.; OBJECTIVES: This study compared a 10% chlorhexidine varnish treatment with placebo and sham treatments for preventing dental caries in adult patients with xerostomia (dry mouth) . DESIGN: The study was a multicentred, randomized, parallel group, double blind, placebo-controlled clinical trial . SETTING: All examinations and procedures were performed at Tuft's University, Boston, MA, the University of British Columbia, Vancouver, BC or the University of Western Ontario, London, ON . SUBJECTS: Subjects were adults with recent or current dental caries experience, high salivary levels of cariogenic microorganisms and low salivary flow rates . RESULTS: 236 subjects completed at least one post-treatment examination . There were 697 new carious lesions diagnosed, 446 (64%) located on coronal surfaces and 251 (36%) located on root surfaces . The mean attack rate was 0.23 surfaces/100 surfaces at risk . A treatment difference observed between the Active and Placebo groups was statistically significant for root caries increment (p = .02) and total caries increment (p = .03) . A treatment difference observed between the Active and Sham groups was not statistically significant for coronal, root or total caries increment . Analysis of variance of treatment group differences was performed using mutans streptococci counts, salivary flow rates, age, sex, caries prevalence, medications, time to first event and early withdrawal as co-variables . These factors did not meaningfully alter the findings . CONCLUSIONS: The difference between the 10% chlorhexidine varnish and placebo treatments is considered to be highly clinically significant for root caries increment (41% reduction) and for total caries increment (25% reduction) but only for coronal caries increment (14%).

J Infect Dis, 2002 Feb 1, 185(3), 368 - 74 Epub 2002 Jan 17.
Quantitative determination of immunoglobulin G specific for group B streptococcal beta C protein in human maternal serum; Lachenauer CS et al.; The beta C protein of group B streptococci (GBS) elicits antibody that is protective against GBS challenge in animals and is considered to be a potential component of a GBS conjugate vaccine . We developed a quantitative enzyme-linked immunosorbent assay to measure beta-specific serum immunoglobulin G (IgG) levels and used it to compare beta-specific IgG in a group of mothers of neonates with invasive type Ib/beta GBS disease and a group of mothers colonized with Ib/beta strains whose neonates remained well . beta-Specific IgG concentrations from these 2 groups were similar . To investigate differences in beta-specific antibody in animals and humans, protein fragments were generated that corresponded to major regions within the beta C protein . A single major region was predominantly recognized in human and rabbit serum samples . Thus, in contrast to immunized animals, no relationship was seen between levels of naturally acquired human beta-specific IgG and protection from neonatal disease . This difference was not explained by a major difference in epitope specificity.

J Infect Dis, 2002 Feb 1, 185(3), 357 - 67 Epub 2002 Jan 17.
Stimulation of cytokine release and adhesion molecule expression by products of Viridans streptococci; Hanage WP et al.; The viridans streptococci (VS) are associated with the development of a rapidly fulminant shock syndrome in neutropenic patients . A panel of 52 VS strains isolated from the blood of neutropenic patients was used to demonstrate the ability of culture supernatants and cell walls of VS to induce release of the proinflammatory cytokines tumor necrosis factor (TNF)-alpha, interleukin (IL)-1beta, and IL-8 from whole blood in a dose- and strain-dependent fashion . Intercellular adhesion molecule-1 was shown to be markedly up-regulated on endothelial cells after incubation with plasma from blood exposed to cell walls or culture supernatants . This up-regulation was blocked by IL-1 receptor antagonist but not neutralizing antibody against TNF-alpha . These data may help explain the pathogenesis of the viridans streptococcal shock syndrome in neutropenic patients.

Annu Rev Pharmacol Toxicol, 2002, 42, 381 - 408
Glycopeptide antibiotic resistance; Pootoolal J et al.; Glycopeptide antibiotics are integral components of the current antibiotic arsenal that is under strong pressures as a result of the emergence of a variety of resistance mechanisms over the past 15 years . Resistance has manifested itself largely through the expression of genes that encode proteins that reprogram cell wall biosynthesis and thus evade the action of the antibiotic in the enterococci, though recently new mechanisms have appeared that afford resistance and tolerance in the more virulent staphylococci and streptococci . Overcoming glycopeptide resistance will require innovative approaches to generate new antibiotics or otherwise to inhibit the action of resistance elements in various bacteria . The chemical complexity of the glycopeptides, the challenges of discovering and successfully exploiting new targets, and the growing number of distinct resistance types all increase the difficulty of the current problem we face as a result of the emergence of glycopeptide resistance.

J Bacteriol, 2002 Feb, 184(4), 971 - 82
Characterization of Streptococcus suis genes encoding proteins homologous to sortase of gram-positive bacteria; Osaki M et al.; Many surface proteins which are covalently linked to the cell wall of gram-positive bacteria have a consensus C-terminal motif, Leu-Pro-X-Thr-Gly (LPXTG) . This sequence is cleaved, and the processed protein is attached to an amino group of a cross-bridge in the peptidoglycan by a specific enzyme called sortase . Using the type strain of Streptococcus suis, NCTC 10234, we found five genes encoding proteins that were homologous to sortases of other bacteria and determined the nucleotide sequences of the genetic regions . One gene, designated srtA, was linked to gyrA, as were the sortase and sortase-like genes of other streptococci . Three genes, designated srtB, srtC, and srtD, were tandemly clustered in a different location, where there were three segments of directly repeated sequences of approximately 110 bp in close vicinity . The remaining gene, designated srtE, was located separately on the chromosome with a pseudogene which may encode a transposase . The deduced amino acid sequences of the five Srt proteins showed 18 to 31% identity with the sortases of Streptococcus gordonii and Staphylococcus aureus, except that SrtA of S . suis had 65% identity with that of S . gordonii . Isogenic mutants deficient for srtA, srtBCD, or srtE were generated by allelic exchanges . The protein fraction which was released from partially purified cell walls by digestion with N-acetylmuramidase was profiled by two-dimensional gel electrophoresis . More than 15 of the protein spots were missing in the profile of the srtA mutant compared with that of the parent strain, and this phenotype was completely complemented by srtA cloned from S . suis . Four genes encoding proteins corresponding to such spots were identified and sequenced . The deduced translational products of the four genes possessed the LPXTG motif in their C-terminal regions . On the other hand, the protein spots that were missing in the srtA mutant appeared in the profiles of the srtBCD and srtE mutants . These results provide evidence that the cell wall sorting system involving srtA is also present in S . suis.

Spec Care Dentist, 2001, 21(1), 32 - 6
One-year compliance and effects of amine and stannous fluoride on some salivary biochemical constituents and oral microbes in institutionalized elderly; Meurman JH et al.; Due to old age and poor general health, the institutionalized elderly have often not been used as research subjects for the investigation of oral health protocols . Because the number of elderly is increasing, they are an important target group for the development of oral hygiene aids . This trial was designed to investigate whether the institutionalized elderly could successfully use an amine-fluoride- and stannous-fluoride-containing mouthwash and toothpaste during a 12-month period . A dental hygienist visited the subjects weekly, instructed them, and recorded their self-reported compliance . Plaque and saliva samples were taken at three-month intervals . Some salivary biochemical constituents reflecting mucosal integrity were analyzed . The carrier status of Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis, Bacteroides forsythus, Prevotella intermedia, and Prevotella nigrescens was studied by the polymerase chain-reaction method, and acidogenic bacteria and yeasts by dip-slide methods (Orion Diagnostica, Espoo, Finland) . Of those 98 subjects originally included, 44 elderly (30 women and 14 men; mean age, 81.7 +/- 5.9 yrs) completed the trial . Their observations were positive or very positive regarding the use of mouthwash and toothpaste . The number of residents with P . gingivalis decreased statistically significantly throughout the trial, while the carrier status of the other periodontal bacteria and mutans streptococci remained on the same level . The number of subjects with high counts (> or = 10(5) cfu/mL) of yeasts decreased during the study: 26.2% at baseline, 9.1% one year later, respectively . Biochemical analyses of salivary immunoglobulins showed no effect on IgA and IgM levels, but IgG reduced significantly . Albumin and other salivary protein concentrations were found to have a decreasing tendency . Thus, the overall effect of the protocol was beneficial with regard to subjects' oral health as measured in this study . The residents were pleased to participate, but the number of drop-outs was very high, confirming the expected difficulties with the utilization of a group of frail elderly as research subjects.

Laryngoscope, 2001 Oct, 111(10), 1771 - 3
The microbiology of mucopyocele; Brook I et al.; OBJECTIVE: To evaluate the aerobic and anaerobic microbiology of mucopyocele . STUDY DESIGN: Retrospective review of clinical and microbiologic records of patients with mucopyocele between June 1982 and September 1997 . METHODS: Aspirates of 36 mucopyocele were processed for aerobic and anaerobic bacteria . RESULTS: One hundred six bacterial isolates, 42 aerobic and facultatives and 64 anaerobic, were recovered . The predominant aerobic isolates were Staphylococcus aureus (6 isolates), alpha-hemolytic streptococci (6), Hemophilus spp . (5), and Gram-negative bacilli (6) . The predominant anaerobes were Peptostreptococcus sp . (22), Prevotella sp . (15), Fusobacterium sp . (5), and Propionibacterium acnes(5) . Thirty-three beta-lactamase-producing bacteria were isolated from 23 patients . CONCLUSIONS: These findings illustrate the polymicrobial aerobic and anaerobic bacteriology of mucopyocele.

Swed Dent J Suppl, 2001, (148), 1 - 66
Mutans streptococci--in families and on tooth sites . Studies on the distribution, acquisition and persistence using DNA fingerprinting; Emanuelsson IM; Mutans streptococci (MS) are bacteria showing several cariogenic traits . This thesis is based on the concept that humans acquire MS directly or indirectly from each other . Previous research on the transmission of the bacteria in families has indicated that children acquire MS from their mothers . Just a few studies have included fathers . Diverging results have been presented about spouses acquiring MS from each other . The information on the distribution of MS types at a tooth surface level has been limited . The methods used for identification of MS types have been refined during the years making further studies in the field interesting . The present thesis deals primarily with the distribution of MS in families . Twenty-five Swedish families including a 3-year-old first-born child (I) and 11 corresponding Chinese families (II) were studied . The Swedish families were followed up 2-5 years later (III and IV) . Study V deals with the colonization of MS on tooth sites in 13 young adults . MS were isolated from bacterial plaque samples obtained from the teeth of the subjects . Identification of MS types was carried out through DNA analysis methods, REA and RAPD respectively . MS were detected in 11 of the 25 Swedish children . The distribution of MS genotypes in these families indicated that the mothers and individuals outside the family were the sources of MS to the children (I) . The distribution of MS genotypes in the Chinese families (II) pointed to the fact that the father played a more pronounced role as MS source compared to in the Swedish families . The intra-familial distribution of MS seemed to be different in the two groups of families with different cultural backgrounds . At the follow-up, genotypes of MS were found again among the MS positive children and their parents . This indicated that genotypes of MS persisted . Even though some alterations in the prevalence of MS genotypes were shown (III) . Among the MS negative children some had acquired the bacteria, but most of them remained MS negative by the age of 5-8 years (IV) . The father was in some few cases the MS source to the child in the Swedish families (III, IV) . Few spouses acquired MS from each other . It is not clear to which extent the parents' salivary levels of MS, caregiver of the child, breast-feeding or antibiotic treatment influenced the acquisition of MS in the groups studied (I-IV) . Finally it was shown that several different genotypes of MS colonized a particular tooth site simultaneously . Within each individual the same genotype occurred on two or more tooth sites . Genotypes persisted 4-7 months on their site . The colonization diverged inter-individually in terms of the number and the distribution of MS genotypes on the tooth sites (V).

J Infect, 2001 Oct, 43(3), 173 - 6
Bacteraemic Streptococcus pyogenes infection in the peri-partum period: now a rare disease and prior carriage by the patient may be important; Barnham MR et al.; OBJECTIVES: To describe the features of invasive peri-partum Streptococcus pyogenes infection as it occurs in current day practice in North Yorkshire . METHODS: The case and laboratory records of all mothers and/or babies with detected S . pyogenes bacteraemia in the Harrogate and Northallerton districts of North Yorkshire (combined catchment population 260 000) were reviewed for the 20 years 1980-99 . An additional bacteraemic case occurring recently in the York district was included . RESULTS: In six recorded episodes, both mother and baby were affected in three, mother only in two and baby only in one . The incidence of detected infection was one such episode per million population per year, one episode per 11 000 live births and one infected baby per 18 000 live births . Maternal features included endometritis, septicaemia, peritonitis, necrotising fasciitis and toxic shock syndrome while, in babies, infection was manifest by stillbirth or septicaemia, cyanosis, jaundice, lethargy and cellulitis . CONCLUSION: Peri-partum S . pyogenes infection is rare in North Yorkshire, with a local incidence revealed in this study of 1/million population/year, or 1:11 000 live births . Invasive neonatal infection with S . pyogenes appears to be six times less frequent in this locality than with group B streptococci . Mothers and/or their babies can be affected . Data suggests that some infection is autogenous from streptococci carried in the mother's genital tract . Although data in this setting are currently few, when a mother has suspected invasive group A streptococcal infection we recommend that the newborn child should also receive antibiotics without delay .

Clin Infect Dis, 2002 Feb 15, 34(4), 454 - 60 Epub 2002 Jan 07.
Severe group a streptococcal soft-tissue infections in Ontario: 1992-1996; Sharkawy A et al.; A prospective, population-based, surveillance study of invasive soft-tissue infections due to group A streptococci was conducted in Ontario, Canada, from 1992 through 1996 . Demographic and clinical information was obtained by patient interview and chart review . Isolates were characterized by M protein and T agglutination typing . The incidence of necrotizing fasciitis (NF) increased from 0.08 cases per 100,000 population in 1992 to 0.49 cases per 100,000 population in 1995 . The case-fatality rate was 13% (68 of 520 patients died) . Hypotension and multiorgan dysfunction complicated 64 cases (12%), and NF complicated 119 cases (23%) . Underlying diabetes, alcohol abuse, cancer, and cardiac and pulmonary disease increased the risk of disease . Prior use of nonsteroidal anti-inflammatory agents did not influence disease severity . All 197 patients without NF, underlying illness, and hypotension at presentation survived, as did 95 (99%) of 96 normotensive patients who were <65 years old but who had underlying chronic illness . Previously healthy patients without hypotension or NF may be considered for outpatient treatment.

Infect Immun, 2002 Feb, 70(2), 803 - 11
Molecular analysis of group B protective surface protein, a new cell surface protective antigen of group B streptococci; Erdogan S et al.; Group B streptococci (GBS) express various surface antigens designated c, R, and X antigens . A new R-like surface protein from Streptococcus agalactiae strain Compton R has been identified by using a polyclonal antiserum raised against the R protein fraction of this strain to screen a lambda Zap library . DNA sequence analysis of positive clones allowed the prediction of the primary structure of a 105-kDa protein designated BPS protein (group B protective surface protein) that exhibited typical features of streptococcal surface proteins such as a signal sequence and a membrane anchor region but did not show significant similarity with other known sequences . Immunogold electron microscopy using a BPS-specific antiserum confirmed the surface location of BPS protein on S . agalactiae strain Compton R . Anti-BPS antibodies did not cross-react with R1 and R4 proteins expressed by two variant type III GBS strains but reacted with the parental streptococcal strain in Western blot and immunoprecipitation analyses . Separate R3 and BPS immunoprecipitation bands were observed when a cell extract of strain Compton R was tested with an antiserum against Compton R previously cross-absorbed to remove R4 antibodies . Immunization of mice with recombinant BPS protein by the subcutaneous route produced an efficient antigen-specific response, and immunized animals survived challenge with a lethal dose of a virulent strain . Therefore, BPS protein represents a new R-like protective antigen of GBS.

Gerodontology, 2001 Dec, 18(2), 87 - 94
Effects of mouthrinses with linseed extract Salinum without/with chlorhexidine on oral conditions in patients with Sjögren's syndrome . A double-blind crossover investigation; Johansson G et al.; OBJECTIVES: To study the effect of mouthrinses with salivary replacement substances on oral conditions in patients with primary Sjogren's syndrome . DESIGN: Cross-over, double-blind study . SETTING: Facilities at the Centre for Oral Health Sciences, Malmo University and at Malmo University Hospital, Malmo, Sweden . SUBJECTS: Twenty-two patients with Sjogren's syndrome . INTERVENTION: Linseed extract Salinum alone (Sal) or with addition of chlorhexidine (Sal/Chx) was used for mouthrinsing during 3-week periods of rinsings separated by a 3-week "wash-out" period . MEASUREMENTS: Recordings of percentages of sites with dental plaque and bleeding on probing, mirror friction test and microbiological analyses . Questionnaire on oral symptoms due to reduced salivation . RESULTS: Dental plaque and bleeding on probing were reduced after Sal and after Sal/Chx . Friction was reduced after both treatments . No significant differences for counts of studied microbial groups were seen after Sal but the total anaerobically cultured microorganisms and of mutans streptococci fell after Sal/Chx (p<0.05 and p<0.001) . Symptoms of oral dryness improved following Sal and Sal/Chx (p<0.05 and p<0.001 respectively) . Speaking problems and burning mouth symptoms improved after use of Sal (p<0.05) . CONCLUSIONS: Positive effects on symptoms in patients with Sjogren's syndrome were seen after use of Salinum without or with chlorhexidine.

Vet Microbiol, 2002 Feb 26, 85(1), 31 - 5
Identification and characterization of Streptococcus agalactiae isolated from horses; Yildirim AO et al.; Seven group B streptococcal cultures isolated from three horses reacted with group B-specific antiserum, were CAMP positive, pigmented and showed the typical biochemical properties of Streptococcus agalactiae . The identification could be confirmed by PCR amplification of the 16S rRNA gene and a subsequent RsaI restriction pattern typical for S . agalactiae . In addition, the isolates were identified by amplification of species specific parts of the 16S rRNA gene, the 16S-23S rRNA intergenic spacer region and by amplification of the CAMP-factor (cfb) gene . Six isolates could be classified as serotype III/Rib, one isolate as serotype Ia/cbeta . The occurrence of the protein antigens Rib and cbeta could be confirmed by PCR amplification of the respective genes . The six isolates of serotype III/Rib were hyaluronidase negative, had a hylB gene with a size of 4.6 kb and an insertion element IS1548 of 0.98 kb . The isolate of serotype Ia/cbeta was hyaluronidase positive, had a hylB gene with a size of 3.3 kb and no insertion element IS1548 . In addition, all seven isolates had the insertion element ISSag2 and the gene lmb encoding the laminin binding surface protein Lmb and the gene scpB encoding C5a peptidase . According to the present results the group B streptococci isolated from horses showed characteristics of human isolates of this species.

Acta Microbiol Immunol Hung, 2001, 48(3-4), 359 - 91
Resistance to beta-lactams and glycopeptides in staphylococci and streptococci; Rozgonyi F et al.; Molecular mechanisms of the action of beta-lactam and glycopeptide antibiotics, as well as genetic background and phenotypical features of the resistance of staphylococci, streptococci and enterococci to these antibiotics are reviewed . Furthermore, susceptibility patterns concerning beta-lactam and glycopeptide drugs of staphylococcal, streptococcal, as well as enterococcal strains isolated from clinical specimens at the Semmelweis University of Medicine, Budapest, Hungary between January 1997 and December 2000 are also presented.

Wien Med Wochenschr, 2001, 151(3-4), 47 - 52
{Changes in the epidemiology of infections in patients with febrile neutropenia}; Karthaus M et al.; Over the last years, advances in the treatment and supportive care of patients with cancer have led to substantial improvement in long-term survival . Nevertheless, bacterial infection continues to contribute significantly to illness and death in patients developing chemotherapy-induced neutropenia . In this severely ill population, the early administration of appropriate empirical antibiotic therapy for febrile episodes is crucial . This therapeutic approach has been shown to decrease morbidity and mortality due to infections caused by gram negative bacilli . However, in recent years, gram positive pathogens have been recovered at a notably increased rate from neutropenic patients with cancer . Although mortality associated to gram positive bacteremia is commonly lower than that caused by gram negative bacilli, an increasing frequency of serious complications of bacteremia due to viridans group streptococci has been observed in some institutions . Moreover, the emerging problems of bacterial resistance to various antimicrobial agents is of great concern . Herein, we examine major changes in the epidemiology of bacterial infections in neutropenic patients with cancer and some clinical aspects of infections caused by most frequent pathogens.

Infection, 2001 Dec, 29(6), 305 - 9
Adults with meningitis caused by viridans streptococci; Lu CH et al.; BACKGROUND: We analyzed the clinical features and therapeutic outcomes of adults with meningitis caused by viridans streptococci . PATIENTS AND METHODS: 12 adult patients with meningitis caused by viridans streptococci were enrolled in this study . Clinical data were collected over a period of 15 years . RESULTS: Of the 12 patients, 11 patients had community-acquired meningitis, while one had nosocomially acquired meningitis . 11 contracted the spontaneous form and one contracted the postneurosurgical form . All isolates were susceptible to penicillin . The portals of entry of infection were determined in all 12 patients; five patients had otopharyngeal infections with or without their being spread hematogenously . The infections in six patients were spread hematogenously, but one of them was spread hematogenously with endocarditis . One patient became infected after a craniotomy . The patients infected by viridans streptococci had a high incidence of focal suppuration and cerebral vasculitis but no deaths occurred . CONCLUSION: Adult bacterial meningitis caused by viridans streptococci is not uncommon and otopharyngeal infection appears to be an important portal of entry . Clinical manifestations varied according to the different underlying conditions . The results of this study also demonstrate the high incidence of intracranial focal suppuration and cerebral vasculitis concomitant with meningitis . Penicillin remains the treatment of choice for patients with meningitis caused by viridans streptococci . Therapeutic outcome is favorable for patients who receive prompt treatment.

Community Dent Oral Epidemiol, 2001 Dec, 29(6), 443 - 8
Efficacy of a dip slide test for mutans streptococci in caries risk assessment; Pinelli C et al.; The aim of this study was to evaluate the efficacy of a dip slide test for mutans streptococci in caries risk assessment, when the microbiological results were compared to well-defined clinical criteria (DCC) for caries risk, clinically measured through high and low caries activity . Eighty-one volunteers from the 6th to 8th grades from public schools of Piracicaba, Sao Paulo, Brazil, were evaluated for dental caries . All free smooth surfaces were evaluated to check whether or not there were white spots . Based on the subjects' caries experience, a calibrated clinician divided them into groups of high and low caries activity . The subjects were submitted to a salivary test (CARITEST SM) from the same batch number . Kappa statistics (kappa) were applied to verify the reproducibility of the simplified test, checked through interexaminer agreement when the results were classified by independent and blind means . The microbiological results were validated according to expressions of sensitivity and specificity . A moderate agreement was verified as the results were classified according to 6 scores (kappa=0.55), and the agreement was substantial when the results were classified according to high and low microbiological count (kappa=0.78) . The sensitivity and specificity values were 0.59 and 0.85, respectively, showing that the test was more specific than sensitive, and could thus better identify the low caries risk subjects.

Braz J Infect Dis, 2001 Oct, 5(5), 269 - 76 Epub 2003 Feb 21.
In vitro susceptibility of gram-positive cocci isolated from skin and respiratory tract to azithromycin and twelve other antimicrobial agents; Mendes CM et al.; This study was conducted to evaluate the activity of azithromycin in comparison to 12 other antibacterial agents against recent isolates obtained consecutively from patients with respiratory tract or skin infections, from January to July, 2000 . A total of 717 Gram-positive cocci were analyzed in this study and the following species were studied: Staphylococcus aureus (n=576), beta-hemolytic streptococci (n=115), and Streptococcus pneumoniae (n=26) . Susceptibility testing was carried out by the disk diffusion method and interpreted according to NCCLS breakpoints . The activity of azithromycin was compared to erythromycin, clindamycin, chloramphenicol, ciprofloxacin, ofloxacin, oxacillin, penicillin, ceftriaxone, tetracycline, trimethoprim/sulfamethoxazole, teicoplanin, and vancomycin . Of the 26 S . pneumoniae isolates recovered from the respiratory tract, 5 (19.2%) were intermediate resistant to penicillin . All of these strains were susceptible to chloramphenicol, ofloxacin, and vancomycin, and 24 (92%) were also susceptible to azithromycin, clindamycin, and erythromycin . Among the 67 beta-hemolytic streptococci strains isolated from the respiratory tract, 66 (99%) were susceptible to azithromycin, erythromycin, clindamycin, and ofloxacin . All 48 beta-hemolytic streptococci strains isolated from skin were susceptible to azithromycin and clindamycin, 47 (98%) were susceptible to erythromycin, and 46 (96%) were susceptible to ofloxacin . Of the 576 strains of S . aureus, 253 (43.9%) were isolated from the respiratory tract and 323 (56.1%) from skin . Among S . aureus isolates from the respiratory tract and skin, 46 (18%) and 78 (24%), respectively were resistant to oxacillin . Isolates from the respiratory tract and skin showed the same percentage of resistance (36%) to azithromycin . These in vitro results suggest that azithromycin can be a therapeutic option for treatment of infections caused by these bacteria since the newer macrolides have several distinct advantages over erytromycin including improved oral bioavailability, longer half-life allowing once or twice daily administration, higher tissue concentrations and less gastrointestinal adverse effects.

J Clin Microbiol, 2002 Jan, 40(1), 216 - 26
Serotype identification of group B streptococci by PCR and sequencing; Kong F et al.; Group B streptococcus (GBS; Streptococcus agalactiae) is the most common cause of neonatal and obstetric sepsis and is an increasingly important cause of septicemia in elderly individuals and immunocompromised patients . Ongoing surveillance to monitor GBS serotype distribution will be needed to guide the development and use of GBS conjugate vaccines . We designed sequencing primers based on the previously published sequences of the capsular polysaccharide (cps) gene clusters to further define partial cps gene clusters for eight of the nine GBS serotypes (serotypes Ia to VII) . Subsequently, we designed and evaluated primers to identify serotypes Ia, Ib, III, IV, V, and VI directly by PCR and all eight serotypes (serotypes Ia to VII) by sequence heterogeneity . A total of 206 clinical GBS isolates were used to compare our molecular serotype (MS) identification method with conventional serotyping (CS) . All clinical isolates were assigned an MS, whereas 188 of 206 (91.3%) were assigned a serotype by use of antisera . A small number of isolates (serosubtypes III-3 and III-4) showed different serotype specificities between PCR and sequencing, but the PCR results correlated with those obtained by CS . The overall agreement between the MS identification method and CS for isolates for which results of both tests were available was 100% (188 of 188 isolates) . The MS identification method is a specific and practical alternative to conventional GBS serotyping and will facilitate epidemiological studies.

J Otolaryngol, 2001 Dec, 30(6), 324 - 9
Failure of penicillin to eradicate group A beta-hemolytic streptococci tonsillitis: causes and management; Brook I; Despite the fact that group A beta-hemolytic streptococci (GABHS) is always susceptible to penicillin, bacteriologic failure occurs in up to 20% of the patients treated with penicillin, and half of these cases are also a clinical failure . Various theories have been offered to explain this phenomenon . One explanation is that beta-lactamase-producing bacteria (BLPB) "shield" GABHS by inactivating penicillin . Beta-lactamase-producing bacteria were recovered from over 75% of the tonsils of patients who had tonsillectomy for recurrent infection . The absence of interfering aerobic and anaerobic organisms in many patients may also lead to failure of penicillin therapy in these individuals . Other explanations include noncompliance with a 10-day course of therapy, carrier state, re-infection, bacterial interference, GABHS intracellular internalization, and penicillin tolerance . Penicillin is still considered the antibiotic of choice for the therapy of GABHS tonsillitis . However, antibiotics other than penicillin were found to be more effective in eradicating the infection . These included cephalosporins (of all generations), clindamycin, macrolides, and amoxicillin-clavulanate . These agents were more effective than penicillin, especially in treating patients who failed previous penicillin therapy . Treatment of tonsillitis in patients who failed penicillin therapy is aimed at the eradication of the the BLPB that protect GABHS from penicillin, while preserving the oropharyngeal "protective" organisms . This review will describe the scientific and clinical data that demonstrate and explain the phenomena of beta-lactamase production and bacterial interference.

Clin Nephrol, 2001 Dec, 56(6), 481 - 5
Necrotizing fasciitis in a renal transplant recipient treated with FK 506: the first reported case; Tang S et al.; Necrotizing fasciitis is a rare but devastating condition usually caused by group A streptococci . A renal transplant recipient with necrotizing fasciitis complicated by the streptococcal toxic shock syndrome is presented . The importance of prompt diagnosis, antimicrobial treatment and early surgical intervention in achieving a successful outcome is discussed.

Presse Med, 2001 Nov 24, 30(35), 1747 - 51
{Obsessive-compulsive disorder in children induced by streptococcal infection}; Kochman F et al.; FROM OBSESSIVE-COMPULSIVE DISORDER TO PANDAS: Obsessive-compulsive disorder (OCD) represents a potentially severe and handicapping disorder that affects several hundreds of thousands of children in France . OCD has, for many years, been considered as a neurosis resulting from mental conflicts . It is currently seen as a neurobiological disorder, the etiological substratum of which is more organic than mental . Recently a sub-type of OCD was isolated in children following infection by Group A b-hemolytic streptococci . This sub-type has been described as Paediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcal Infections (PANDAS) . A NEW PHYSIOPATHOLOGICAL APPROACH: The putative dysimmune relationship between bacterial infection and neurotic disorder has led to the development of an original etiopathogenic model that may lead to new therapeutic strategies . The clinical case report of an adolescent presenting with trichotillomania associated with recurrent pharyngitis is a good illustration of this . PUBLISHED DATA: Data published in medical literature over the last 10 years indicates a 10% prevalence in the young suffering from OCD, i.e . 0.1 to 0.3% of the young population.

Vestn Otorinolaringol, 2001, (6), 41 - 4
{Role of non-spore-forming anaerobic microflora in the onset and development of otogenic abscesses of the brain and cerebellum}; Mirazizov KD; The role of non-spore-forming anaerobic microflora in development of otogenic cerebral and cerebellar abscesses was studied in 49 patients with brain abscesses . Microfloral study of the middle ear discharge and content of cerebral abscess demonstrates that at present the role of pathogenic pyogenic staphylococci, streptococci and other kinds of purulent infection is lower than that of previously unreported non-spore-forming anaerobs in the pus of otogenic brain abscesses . It means that urgent sanation of the primary focus and cerebral abscesses should be supplemented with targeted combined antibacterial conservative therapy.

Eur J Oral Sci, 2001 Dec, 109(6), 388 - 92
Effect of removable orthodontic appliances on oral colonisation by mutans streptococci in children; Batoni G et al.; Little is known about the effect of removable orthodontic appliances on oral colonisation by mutans streptococci (MS) . In the present study, the frequency of isolation and serotype distribution of MS were evaluated in two groups of children, one undergoing therapy with removable appliances and the other not subjected to any kind of orthodontic treatment, respectively . Streptococci isolated from dental plaque samples from both groups of children were identified as mutans streptococci on the basis of their morphological and biochemical properties and were then serotyped in an enzyme immuno-assay using monoclonal antibodies . The number of subjects harbouring MS in their dental plaque was statistically higher in the group of orthodontic children without caries experience (CF) in comparison with CF children of the control group (10/12, 83.3% vs . 15/44, 34%) . No clear difference was observed in the distribution of the different MS serotypes between the experimental and control group: S . mutans c,f serotype was the most frequently isolated in both groups of children followed by S . mutans serotype e and S . sobrinus serotype g . Such results suggest that the use of removable appliances may lead to the creation of new retentive areas and surfaces, which favour the local adherence and growth of MS . The data obtained stress the importance of a careful monitoring of patients treated orthodontically for risk of caries development.

Recenti Prog Med, 2001 Nov, 92(11), 690 - 5
{Neonatal sepsis}; Lanari M et al.; Sepsis is still one of the most important causes of mortality and morbidity in the neonatal period . Infection is responsible for approximately 2 million neonatal deaths per year in developing countries . In Italy, as in other industrialized countries, the mortality rate has declined to 5.1 per 1000 livebirths . Progress in obstetrics and neonatal intensive care competence have improved survival particularly of preterm and low birth weight neonates . These neonates, for the immunological state and the invasive therapies they are subjected to, are extremely at risk for sepsis . Knowledge of neonatal risk factors, together with cytokines evaluation as early markers of sepsis and laboratory tests such as polymerase chain reaction, have allowed us to accelerate the diagnosis of sepsis with prognostic improvements . The frequent involvement of group B streptococci and coagulase-negative staphylococci requires empiric antibiotic therapy, effective for these pathogens, in all infants with suspected infection, waiting for blood cultures and antibiotic susceptibility results . Breast milk, carrier of immunologically active agents, is still the best prophylaxis for neonatal sepsis.

J Ir Dent Assoc, 2001, 47(3), 83 - 5
Staphylococcal submandibular lymphadentitis of childhood; Hardee PG et al.; The presentation of two patients with the condition is described . The difficulty of finding an underlying cause of the infection is discussed, and the importance of a history of recent head and neck infection emphasised . Recommendations are made for appropriate antibiotic therapy to cover Staphylococci as well as the more common Streptococci.

Transfus Apheresis Sci, 2001 Oct, 25(2), 107 - 12
The evaluation of microbial contamination in platelet concentrates prepared by two different methods; Kocazeybek B et al.; The microbial contamination of platelet concentrates (PCs) prepared by two different methods both with a high risk of bacterial contamination during preparation and storage were evaluated . For apheresis platelets, the concentrates were obtained using the Haemonetics MCS 3P device . For the random method, platelets were obtained by two phase centrifugation, in the Heraeus Cryofuge 8500 I device using the Kansuk 3-way bags which permit storage for five days . 1620 plateletpheresis units prepared by apheresis, and 9838 units prepared by the random method, were included in the study . Of the 11,458 PCs studied . 32 (0.27%) were false positives and 24 (0.2%) were real positives . All of the positive results occurred in platelets prepared by the random method . C . xerosis and S . epidermidis, S . hominis, Alpha-hemolytic streptococci, all flora of the skin, were isolated in the contaminated concentrates . The risk of microbial contamination of PCs, prepared both by apheresis and from whole blood, continues at a low rate although the products were collected into specific bags following rules including appropriate disinfection of the skin, correct centrifugation collection time and optimal storage conditions including temperature and agitation . These results again emphasize the importance of: obeying phlebotomy rules and hand disinfection of the person who collects the blood as well as the need for careful skin decontamination of the donor, during donation.

J Dent Res, 2001 Nov, 80(11), 2000 - 4
Identification of cariostatic substances in the cacao bean husk: their anti-glucosyltransferase and antibacterial activities; Osawa K et al.; The cacao bean husk has been shown to possess two types of cariostatic substances, one showing anti-glucosyltransferase (GTF) activity and the other antibacterial activity, and to inhibit experimental dental caries in rats infected with mutans streptococci . In the present study, chromatographic purification revealed high-molecular-weight polyphenolic compounds and unsaturated fatty acids as active components . The former, which showed strong anti-GTF activity, were polymeric epicatechins with C-4beta and C-8 intermolecular bonds estimated to be 4636 in molecular weight in an acetylated form . The latter, which showed bactericidal activity against Streptococcus mutans, were determined to be oleic and linoleic acids, and demonstrated a high level of activity at a concentration of 30 microgram/mL . The cariostatic activity of the cacao bean husk is likely caused by these biologically active constituents.

Indian J Pediatr, 2001 Oct, 68(10), 985 - 6
Prevalence of beta hemolytic streptococci carrier rate among schoolchildren in Salem; Navaneeth BV et al.; A preliminary study was conducted to identify the carriers of beta hemolytic streptococci (BHS) among school children . BHS were identified, grouped by latex agglutination test and tested for susceptibility to penicillin, erythromycin and cefazolin from their throat swabs . Prevalence of BHS was found to be 21.6% with group G (43.2%) as the predominant group followed by group A (28.8%) . All the isolates were sensitive to the antibiotics tested . Health cards were issued to the carriers of group A beta hemolytic streptococci.

J Infect Dis, 2002 Jan 1, 185(1), 85 - 90 Epub 2001 Dec 06.
Interaction between human polymorphonuclear leukocytes and Streptococcus milleri group bacteria; Wanahita A et al.; Because Streptococcus milleri group (SMG) bacteria--Streptococcus constellatus, Streptococcus intermedius, and Streptococcus anginosus--exhibit a striking propensity to cause abscesses, the interaction of these organisms with human polymorphonuclear leukocytes (PMNL) was examined . After incubation in pooled normal human serum, SMG stimulated less chemotaxis than did Staphylococcus aureus, in contrast to viridans streptococci, which caused greater chemotaxis than did S . aureus . PMNL ingested greater numbers of SMG and viridans streptococci than S . aureus but killed these organisms more slowly and less completely . Relative resistance to killing by PMNL is expected in organisms that cause abscesses, and inhibition of chemotaxis may contribute to pathogenicity, because delayed arrival of PMNL gives a head start to proliferating bacteria . This study helps explain the capacity of SMG to cause abscesses . It is unclear, however, why viridans streptococci, bacteria that rarely produce abscesses, share some of these same properties.

Rev Esp Quimioter, 2001 Sep, 14(3), 275 - 80
{Susceptibility to penicillin and 13 antimicrobial agents in erythromycin-resistant viridans group streptococci isolated from blood cultures}; Rodriguez-Avial C et al.; From March 1998 to June 1999, we studied 63 sequential blood culture isolates of viridans group streptococci which showed a 49% resistance to erythromycin . A high level of resistance to penicillin (46%) was also found . A statistically significant correlation was detected between the two types of resistance . The erythromycin-resistant strains were phenotypically and genotypically characterized, and no differences were found between the resistance to penicillin and the M or MLS(B) phenotypes . The penicillin-erythromycin-resistant strains included: 16 S . mitis, five S . sanguis and one S . salivarius . The rank order of activity (% of susceptibility) for all 14 agents against 31 erythromycin- resistant isolates was the following: vancomycin = rifampicin (100) > chloramphenicol (98) > meropenem (65) > cefotaxime (61) > amoxicillin- clavulanic acid (42) > cefepime = ciprofloxacin (39) > tetracycline = trimethoprim-sulfamethoxazole (36) > cefuroxime (32) > penicillin = ampicillin = cefaclor (29) . The species S . milleri and S . bovis were the most susceptible . The most resistant strains were two S . mitis and one S . sanguis and showed multiresistance to six different groups of antimicrobial agents . The frequent association between macrolide resistance and resistance to other antimicrobial agents suggests that the susceptibility of all clinically significant isolates needs to be evaluated and alternative agents for the prevention and treatment of viridans group streptococci infections should be identified.

Minerva Anestesiol, 2001 Nov, 67(11), 811 - 4
{Ludwig angina: a disease of the past century . Case report}; Doldo G et al.; The case of a patient with Ludwig's angina, diffuse inflammation of the submandibular and sublingual spaces, a rare but life threatening disease, is described . This disorder can develop almost always as a complication of the dental infection . Causative bacteria include many Gram-negative, anaerobic organisms, streptococci and staphylococci . The potential for rapid respiratory obstruction is the greatest concern . Other serious complications include sepsis, mediastinitis, pleural empidema, pericarditis, pericardial tamponade . A cervico thoracic CT-scan and neck RNM, were performed to determine the extent of the inflammatory lesion . Treatment consists of ensuring adequate ventilation, with tracheostomy, broad spectrum antibiotic therapy and surgical drainage of the source of infection . The patient recovered without complications.

J Biol Chem, 2002 Mar 8, 277(10), 8114 - 20 Epub 2001 Dec 18.
Structure, specificity, and mode of interaction for bacterial albumin-binding modules; Johansson MU et al.; We have determined the solution structure of an albumin binding domain of protein G, a surface protein of group C and G streptococci . We find that it folds into a left handed three-helix bundle similar to the albumin binding domain of protein PAB from Peptostreptococcus magnus . The two domains share 59% sequence identity, are thermally very stable, and bind to the same site on human serum albumin . The albumin binding site, the first determined for this structural motif known as the GA module, comprises residues spanning the first loop to the beginning of the third helix and includes the most conserved region of GA modules . The two GA modules have different affinities for albumin from different species, and their albumin binding patterns correspond directly to the host specificity of C/G streptococci and P . magnus, respectively . These studies of the evolution, structure, and binding properties of the GA module emphasize the power of bacterial adaptation and underline ecological and medical problems connected with the use of antibiotics.

Antimicrob Agents Chemother, 2002 Jan, 46(1), 239 - 41
Multicenter study on spreading of the tet(M) gene in tetracycline-resistant Streptococcus group G and C isolates in Argentina; Jeric PE et al.; A prospective multicenter study on invasive infections caused by beta-hemolytic streptococci was performed over 6 months and involved 42 centers from 16 cities in Argentina . Among 33 isolates recovered, 9 group G Streptococcus isolates (39.1%) and 2 group C Streptococcus isolates (20%) exhibited resistance to tetracycline and harbored the tet(M) gene . Genealogical analysis revealed that tetracycline resistance has a polyclonal origin in Argentina.

Antimicrob Agents Chemother, 2002 Jan, 46(1), 234 - 8
Antimicrobial activities of BMS-284756 compared with those of fluoroquinolones and beta-lactams against gram-positive clinical isolates; Bassetti M et al.; The in vitro antibacterial activity of BMS-284756 was compared to those of ciprofloxacin, gatifloxacin, moxifloxacin, ceftriaxone, imipenem, piperacillin-tazobactam, and amoxicillin-clavulanic acid against 492 gram-positive clinical isolates . BMS-284756 was the most-active agent against Streptococcus pneumoniae, Streptococcus viridans, beta-hemolytic streptococci, methicillin-sensitive and -resistant Staphylococcus aureus, methicillin-sensitive and -resistant coagulase-negative staphylococci, and enterococci.

Eur J Vasc Endovasc Surg, 2002 Jan, 23(1), 11 - 6
Prosthetic patch infection after carotid endarterectomy; Naylor AR et al.; OBJECTIVES and DESIGN: prospective audit of the management and outcome of prosthetic patch infection after carotid endarterectomy (CEA) at Leicester Royal Infirmary plus review of the literature . RESULTS: 8/936 CEA patients (0.85%) developed a prosthetic patch infection . Responsible organisms included MRSA (n=3), Staphylococcus epidermidis(n=2), haemolytic Streptococcus (n=1), Staphylococcus aureus(n=1) and Pseudomonas (n=1) . Early wound complications preceded 4/5 infections presenting within 9 weeks of surgery . In addition to systemic antibiotics and debridement, management included patch removal and: (i) carotid ligation (n=3), vein patch repair (n=1), vein bypass (n=3) . One patient had antibiotic irrigation of the in-situpatch . No patient died, one suffered a disabling postoperative stroke and two had temporary cranial nerve injuries . Including this series, a literature review identified 43 prosthetic patch infections, 91% culturing Staphylococci or Streptococci . Cumulative freedom from perioperative stroke/death or re-infection was 65% at 2 years . Patients treated by patch excision and autologous venous reconstruction had the best outcome with a cumulative freedom from perioperative stroke/death or re-infection of 91% at 2 years . CONCLUSION: prosthetic patch infection after CEA is rare . This study emphasises the importance of close surveillance of early wound complications . Surgical decision-making, especially the safety of carotid ligation, was facilitated by access to transcranial Doppler .

Infect Immun, 2002 Jan, 70(1), 422 - 5
Vaccination with FimA from Streptococcus parasanguis protects rats from endocarditis caused by other viridans streptococci; Kitten T et al.; The FimA protein of Streptococcus parasanguis is a virulence factor in the rat model of endocarditis, and immunization with FimA protects rats against homologous bacterial challenge . Because FimA-like proteins are widespread among the oral streptococci, the leading cause of native valve endocarditis, we evaluated the ability of this vaccinogen to protect rats when challenged by other streptococcal species . Here we report that FimA vaccination produced antibodies that cross-reacted with and protected against challenge by the oral streptococci S . mitis, S . mutans, and S . salivarius . FimA thus has promise as a vaccinogen to control infective endocarditis caused by oral streptococci.

Infect Immun, 2002 Jan, 70(1), 350 - 9
M(+) group a streptococci are phagocytized and killed in whole blood by C5a-activated polymorphonuclear leukocytes; DeMaster E et al.; Historically, resistance to phagocytosis has been determined by incubating group A streptococci in human blood and comparing the numbers of CFU before and after incubation . Utilizing a flow cytometry-based technique, we have investigated the phagocytosis of M(+) group A streptococci by polymorphonuclear leukocytes (PMNs) in heparinized human peripheral whole blood . Intracellular labeling of streptococci with a nontoxic fluorescent dye allowed us to quantify the association and phagocytosis of M(+) streptococci by PMNs in whole blood in the presence or absence of C5a, a physiologically important chemotactic activator of PMNs . We found that wild-type strains of group A streptococci that are resistant to phagocytosis (determined by the classical Lancefield method) readily associate with C5a-activated whole-blood PMNs . In the absence of opsonizing M-type-specific antibodies, the M(+) streptococci associated with PMNs are phagocytized and killed . In addition, blockade of the beta(2) integrin, CD11b/CD18, with anti-human CD11b monoclonal antibody inhibited association between M(+) streptococci and C5a-activated PMNs . These findings establish a new relationship between M(+) streptococci and PMNs, in which C5a-activated PMNs have the capacity to kill M(+) streptococci in whole blood through a receptor-mediated phagocytic mechanism.

Infect Immun, 2002 Jan, 70(1), 49 - 54
Cytokine responses to group B streptococci induce nitric oxide production in respiratory epithelial cells; Goodrum KJ et al.; Streptococcus agalactiae (group B streptococcus {GBS}) is a leading cause of neonatal pneumonia, sepsis, and meningitis . Early-onset GBS pneumonia is characterized by marked pulmonary epithelial and endothelial cell injury . Innate proinflammatory responses to GBS infection that may contribute to the respiratory pathology include the synthesis and release of cytokines, prostaglandins, and nitric oxide (NO) . The hypothesis that NO is directly induced in lung epithelial cells by invading GBS or indirectly induced by cytokines released by GBS-infected mononuclear cells was tested . A549 transformed human respiratory epithelial cells were directly cultured with GBS, cocultured with GBS-infected human mononuclear cells or purified macrophages, or exposed to conditioned culture medium from human mononuclear cells infected by GBS . The culture medium of A549 cultures was assayed for NO secretion, and the cell lysates were tested for presence of inducible nitric oxide synthase (iNOS) mRNA by reverse transcriptase PCR (RT-PCR) . GBS-treated A549 cells neither secreted detectable NO nor expressed iNOS mRNA . GBS interaction with human mononuclear cells, however, stimulated release of soluble factors that readily induced iNOS mRNA expression and NO secretion by A549 cells . Inflammatory mediator-induced nitric oxide (NO) production by alveolar epithelium may exceed that of other lung cell types such as macrophages, and induction during GBS infection may play a significant role in pulmonary defense or free-radical-mediated lung injury.

Eur J Gastroenterol Hepatol, 2001 Dec, 13(12), 1485 - 9
Liver abscesses associated with stromal tumour of the stomach in a young woman; Matsutani T et al.; A 23-year-old Japanese woman was admitted to hospital because of pyrexia and anaemia . She was found to have liver abscesses and a gastric submucosal mass by computed tomography and ultrasonography . Gastroscopy and a barium swallow revealed a round submucosal mass with a giant ulceration in the body of the stomach . The liver abscesses were successfully treated by percutaneous transhepatic drainage and intravenous administration of antibiotics . Cultures of the fluid from a liver abscess and gastric juice yielded alpha-haemolytic streptococci . Three weeks after the drainage, partial gastrectomy was performed . The tumour was diagnosed as a stromal tumour of the stomach (leiomyosarcoma) in the final histological report . The patient was discharged on postoperative day 17 without receiving adjuvant radio-chemotherapy . There have been no signs of recurrence two years after surgery . This is a rare case of a liver abscess associated with a stromal tumour of the stomach in a young patient . The bacteriological examinations suggested a possible association between these diseases.

Pediatr Infect Dis J, 2001 Dec, 20(12), 1144 - 9
Carriage of penicillin-resistant Streptococcus pneumoniae by children in day-care centers during an intervention program in Malmo, Sweden; Nilsson P et al.; BACKGROUND: An increasing incidence of penicillin-resistant Streptococcus pneumoniae (PRP) was detected in Malmo in 1994 . OBJECTIVE: To evaluate clonality and factors facilitating the spread of PRP among children in day-care centers (DCCs) . METHODS: We used phenotypic and DNA-fingerprinting methods in conjunction with epidemiologic data from the South Swedish Pneumococcal Intervention Project's investigation of 63 DCCs during a 3-year period (1995 to 1997) in the Malmo region . RESULTS: A questionnaire about building and hygiene standards disclosed no statistically significant risk factor for carriage of pneumococci . However, age younger than the mean age at the DCC or in the child group was positively associated with carriage . Contrary to expectations no association with the number of children, either at the DCC or in the individual groups, was found . Of 2912 investigated children 1224 (42%) were carriers of S . pneumoniae, and 373 (12.8%) were PRP carriers (MIC > or = 0.1 microg/ml) . Among isolates with MIC > or = 0.5 microg/ml 9 serogroups and 30 genetic types were found . Two clones in serogroups 9 (33%) and 19 (24%) were dominant in most municipality districts, and dominance was sustained during the whole study period . The previously internationally recognized serotype 9V clone seemed to be very stable, with a single DNA type and resistance pattern during the study period . In contrast the serogroup 19 isolates and other serogroups had diverse DNA types and resistance patterns, supporting the hypothesis that DCCs have a unique microenvironment facilitating the recombination of penicillin-binding protein genes among streptococci . In five DCCs we found PRP isolates with two different serogroups but an identical genetic type, indicating that serotype shift may be a common phenomenon in DCCs . CONCLUSION: Multivariate logistic regression of risk factors disclosed that young age of the children in the child groups was a significant risk factor for carriage of S . pneumoniae.

J Immunol, 2001 Dec 15, 167(12), 7069 - 76
Novel engagement of CD14 and multiple toll-like receptors by group B streptococci; Henneke P et al.; Group B streptococcus (GBS) imposes a major health threat to newborn infants . Little is known about the molecular basis of GBS-induced sepsis . Both heat-inactivated whole GBS bacteria and a heat-labile soluble factor released by GBS during growth (GBS-F) induce nuclear translocation of NF-kappaB, the secretion of TNF-alpha, and the formation of NO in mouse macrophages . Macrophages from mice with a targeted disruption of MyD88 failed to secrete TNF-alpha in response to both heat-inactivated whole bacteria and GBS-F, suggesting that Toll-like receptors (TLRs) are involved in different aspects of GBS recognition . Immune cell activation by whole bacteria differed profoundly from that by secreted GBS-F . Whole GBS activated macrophages independently of TLR2 and TLR6, whereas a response to the secreted GBS-F was not observed in macrophages from TLR2-deficient animals . In addition to TLR2, TLR6 and CD14 expression were essential for GBS-F responses, whereas TLR1 and TLR4 or MD-2 did not appear to be involved . Heat lability distinguished GBS-F from peptidoglycan and lipoproteins . GBS mutants deficient in capsular polysaccharide or beta-hemolysin had GBS-F activity comparable to that of wild-type streptococci . We suggest that CD14 and TLR2 and TLR6 function as coreceptors for secreted microbial products derived from GBS and that cell wall components of GBS are recognized by TLRs distinct from TLR1, 2, 4, or 6.

Oral Microbiol Immunol, 2001 Dec, 16(6), 332 - 7
Microbial flora of root canal-treated teeth associated with asymptomatic periapical radiolucent lesions; Cheung GS et al.; This study aimed to investigate the composition of microflora in endodontically treated teeth associated with asymptomatic periapical lesions in southern Chinese patients . Twenty-four teeth which had received nonsurgical root canal treatment more than 4 years previously, and which presents an acceptable coronal restoration with a periapical radiolucent area, were re-treated nonsurgically . Bacteriological samples were obtained after removal of the old root canal filling . The samples were inoculated on enriched trypticase soy agar and four selective media for incubation at 37 degrees C in both a carbon dioxide-enriched atmosphere and anaerobically . Eighteen teeth that had received gutta-percha root canal fillings were grouped for analysis, 12 (66.7%) of which contained cultivable microorganisms . The total colony forming units per ml of transport medium ranged from 0 to 2.3 x 10(5) . The number of bacterial genera recovered ranged between 0 and 6, with facultative gram-positive cocci being the most prevalent group of bacteria isolated . Facultative anaerobic bacteria were present in all, whereas strict anaerobic bacteria were found in 3 out of the 12 teeth with positive growth . The size of the periapical rarefaction did not show any relationship with the quantity of microorganisms recovered . Coagulase-negative staphylococci, streptococci and Pseudomonas aeruginosa were most frequently isolated in this group of patients . The possible origin of these organisms is discussed.

Eur J Clin Invest, 2001 Oct, 31(10), 902 - 6
Dysregulation of monocyte oxidative burst in streptococcal endocarditis; Presterl E et al.; BACKGROUND: Streptococcal subacute endocarditis is characterized by low-grade systemic inflammation . Although structural cardiac defects are pivotal, phagocytic cells, i.e . monocytes and neutrophils, are involved in the induction and the course of bacterial endocarditis . Decreased production of reactive oxygen metabolites was described in long-lasting infections . We hypothesized that the oxidative burst of phagocytes induced by the infecting organism is defective in patients with streptococcal endocarditis . PATIENTS AND METHODS: The monocytes and neutrophils of 11 patients with streptococcal native valve endocarditis were challenged with the respective pathogens and two control streptococcal strains, and the oxidative burst was determined by fluorescence-activated cell sorter analysis . These experiments were done before any antibiotic therapy was administered, and repeated at least 12 months after recovery . Eight volunteers served as healthy controls . RESULTS: The monocyte response to the respective pathogens was decreased in the patient groups compared to the response to the control streptococci . After cure the monocyte response to the pathogens was not different to the response to the control strains . The monocyte response of the healthy volunteers did not show any differences between the patients' pathogens and the control strains . The neutrophil oxidative burst to the pathogens was similar to that to the control streptococci in both patient and the volunteer group . CONCLUSION: The decreased response of patient monocytes to the pathogens may contribute to the low-grade inflammatory response and to the course of streptococcal endocarditis.

Pediatr Infect Dis J, 2001 Aug, 20(8), 807 - 9
Outbreak of scarlet fever caused by an erythromycin-resistant Streptococcus pyogenes emm22 genotype strain in a day-care center; Espinosa de los Monteros LE et al.; We report an outbreak of scarlet fever and pharyngeal colonization with Streptococcus pyogenes in a day-care center in Mexico City . The outbreak strain was resistant to erythromycin but susceptible to clindamycin . T-type 11,12 serotype was found in eight isolates, from two patients and six carriers, which had the emm22 gene . The recognition of streptococci resistant to macrolides causing outbreaks has implications for infection control and for improving antibiotic prescribing patterns in the day-care setting.

Clin Infect Dis, 2002 Jan 1, 34(1), 28 - 38 Epub 2001 Nov 26.
Extension of the Lancefield classification for group A streptococci by addition of 22 new M protein gene sequence types from clinical isolates: emm103 to emm124; Facklam RF et al.; Classic M protein serotyping has been invaluable during the past 60 years for the determination of relationships between different group A streptococci (GAS) strains and the varied clinical manifestations inflicted by these organisms worldwide . Nonetheless, during the past 20 years, the difficulties of continued expansion of the serology-based Lancefield classification scheme for GAS have become increasingly apparent . By use of a less demanding sequence-based methodology that closely adheres to previously established strain criteria while being predictive of known M protein serotypes, we recently added types emm94-emm102 to the Lancefield scheme . Continued expansion by the addition of types emm103 to emm124 are now proposed . As with types emm94-emm102, each of these new emm types was represented by multiple independent isolates recovered from serious disease manifestations, each was M protein nontypeable with all typing sera stocks available to international GAS reference laboratories, and each demonstrated antiphagocytic properties in vitro by multiplying in normal human blood.

J Emerg Med, 2001 Nov, 21(4), 393 - 6
Delayed diagnosis of meningitis caused by beta-haemolytic group G . Streptococcus in an older woman; Luyx C et al.; A case of meningitis caused by group G beta-hemolytic Streptococcus (dysgalactiae, subspecies equisimilis) is reported in an 83-year-old woman . Streptococci species other than Streptococcus pneumoniae are seldom found in patients with acute bacterial meningitis, therefore, our discussion is focused on this rare organism . The question of the diagnosis of meningitis in the elderly is also addressed.

Scand J Infect Dis, 2001, 33(10), 734 - 7
A 7-month outbreak of relapsing postpartum group A streptococcal infections linked to a nurse with atopic dermatitis; Ejlertsen T et al.; A 7-month outbreak of 15 cases of postpartum sepsis with group A haemolytic Streptococci (GAS) was stopped when a carrier was identified . Comparing delivery dates with duty rotas revealed that the carrier had been present during delivery in 13 of the 15 cases . The epidemic GAS type, T3-13-B3264, was found in a carbuncle in her groin and in atopic dermatitis lesions behind her ears and on her eyelids . Thus, it was not the microbiological screening of staff that helped detect the carrier . The outbreak went unnoticed for 6 months, as no 2 cases were diagnosed by the same physician and 5 cases were diagnosed by different general practitioners . The main risk factors for infection were presence of the carrier relative risk (relative risk RR 47.8, 95% confidence interval (CI) 10.9-209.5) and suturing of episiotomy (RR 11.0; 95% CI 2.6-47.9) . We recommend that a thorough epidemiological investigation should be carried out in every single case of GAS postpartum infection . Despite initial intravenous treatment with penicillin, 8 patients experienced > 15 recurring postpartum GAS infections, such as endometritis, wound infection, tonsillitis, erysipelas and Brodie's abscess . Eradication of GAS should be confirmed after completion of treatment.

Arch Mal Coeur Vaiss, 2001 Oct, 94(10), 1099 - 102
{Infectious endocarditis in France today}; Selton-Suty C et al.; Infectious endocarditis (IE) is an uncommon condition carrying a relatively high mortality and morbidity . Two epidemiological studies, undertaken eight years apart, provide data allowing an appreciation of changes in the epidemiological and clinical profiles of IE . They show a progressive increase in the age of patients affected by IE and a decrease in percentage of IE on native pathological valves and valvular prostheses, compensated by the increase in incidence of IE occurring in patients with no known underlying cardiac disease . Moreover, there has been a change in microbiological profile, with the emergence of Streptococcus bovis and increase in staphylococcal IE, a decrease in IE due to oral streptococci and an improvement in microbiological diagnosis with negative blood cultures . Finally, from the therapeutic point of view, surgery is used more frequently and at an earlier stage of the disease . The global mortality of IE at the end of the initial hospital period remains 16%.

Ann Otol Rhinol Laryngol, 2001 Nov, 110(11), 1051 - 4
Deep neck abscess: a retrospective review of 210 cases; Parhiscar A et al.; This study was performed to review our experience with deep neck abscesses (DNAs) and compare it to the experiences in the available literature, and to study changing trends within our patient population . We retrospectively studied 210 patients who had DNAs between 1981 and 1998 . Peritonsillar abscesses and limited intraoral abscesses were excluded . Demographics, presentation, etiology, site of abscess, associated systemic diseases, bacteriology, radiology, treatment, airway management, and outcome were reviewed . We compared the entire group to those in the available literature and studied changing trends within this patient population . Dental infection (43%) was the most common cause, followed by intravenous drug abuse (12%) and pharyngotonsillitis (6%) . The incidences of intravenous drug abuse and mandibular fractures as causes of DNA were 19% and 8%, respectively, during the period 1981 to 1990, but were only 1% each during the period 1991 to 1998 . Streptococcus viridans was the most common pathogen (39% of positive cultures), followed by Staphylococcus epidermidis (22%) and Staphylococcus aureus (22%) . Lateral pharyngeal space abscess was the most common DNA (43%), followed by submandibular space abscess, Ludwig's angina, and retropharyngeal space abscess (28%, 17%, and 12%, respectively) . Seventy-five percent of patients with true Ludwig's angina underwent tracheotomy . Nondental infections are no longer a significant etiologic factor in DNA . Streptococcus viridans has replaced S aureus and beta-hemolytic streptococci as the most common pathogen . Lateral pharyngeal space abscess was the most common DNA; however, its incidence has progressively decreased over the past decade . Intravenous drug abuse and mandibular fractures are no longer major etiologic factors . Tracheotomy is indicated in patients with Ludwig's angina.

Antimicrob Agents Chemother, 2001 Dec, 45(12), 3623 - 4
Antimicrobial susceptibilities of group B streptococci isolated from patients with invasive disease: 10-year perspective; Murdoch DR et al.; Antimicrobial susceptibility testing of 192 group B streptococcal isolates from patients with invasive disease demonstrated that 31 (16%) were resistant to erythromycin and 17 (9%) were resistant to clindamycin . One isolate demonstrated high-level resistance to streptomycin, but none was highly resistant to gentamicin . Erythromycin and clindamycin are no longer reliable empirical alternatives to penicillin for the treatment and prevention of group B streptococcal infections.

Semin Perinatol, 2001 Oct, 25(5), 295 - 309
Infection, antibiotics, and preterm delivery; Locksmith G et al.; The relationship between genital tract infection and preterm delivery has been established on the basis of biochemical, microbiological, and clinical evidence . In theory, pathogenic bacteria may ascend from the lower reproductive tract into the uterus, and the resulting inflammation leads to preterm labor, rupture of the membranes, and birth . A growing body of evidence suggests that preterm labor and/rupture of the membranes are triggered by micro-organisms in the genital tract and by the host response to these organisms, ie, elaboration of cytokines and proteolytic enzymes . Epidemiologic and in vitro studies do not prove a cause-and-effect relationship between infection and preterm birth . However, the preponderance of evidence indicates that treatment of asymptomatic bacteriuria and symptomatic lower genital tract infections such as bacterial vaginosis (BV), trichomoniasis, gonorrhea, and chlamydia will lower the risk of preterm delivery . Based on current evidence, pregnant women who note an abnormal vaginal discharge should be tested for BV, trichomonas, gonorrhea, and chlamydia . Those who test positive should be treated appropriately . A 3- to 7-day course of antibiotic treatment for asymptomatic bacteriuria during pregnancy is clinically indicated to reduce the risk of pyelonephritis and preterm delivery . Routine screening for chlamydia and gonorrhea should be performed for women at high risk of acquiring sexually transmitted diseases . The practice of routine screening for BV in asymptomatic women who are at low risk for preterm delivery cannot be supported based on evidence from the literature . Routine screening for asymptomatic bacteriuria during pregnancy is cost-effective, particularly in high-prevalence populations . The results of antibiotic trials for the treatment of preterm labor have been inconsistent . In the absence of reasonable evidence that antimicrobial therapy leads to significant prolongation of pregnancy in the setting of preterm labor, antibiotics should be used only for protecting the neonate from group B streptococci sepsis . They should not be used for the purpose of prolonging pregnancy . Multiple investigations have shown that, in patients with preterm premature rupture of the membranes, prophylactic antibiotics are of value in prolonging the latent period between rupture of the membranes and onset of labor and in reducing the incidence of maternal and neonatal infection . The most extensively tested effective antibiotic regimen for prophylaxis involves erythromycin alone or in combination with ampicilln . Controversy still exists regarding the appropriate length and route of antibiotic prophylaxis.

Paediatr Drugs, 2001, 3(10), 703 - 18
Antibacterials for the prophylaxis and treatment of bacterial endocarditis in children; Capitano B et al.; Although the overall incidence of infective endocarditis in the paediatric population is considered to be low, over the last 20 years a rising trend in infective endocarditis has been observed among children . This could be due to several reasons including the availability of improved diagnostic techniques, use of continuous central venous catheters and cardiac implants increasing the risk of infection, and the survival of a greater number of infants with congenital heart disease as a result of improved medical management . The predominant causative organisms of paediatric endocarditis include staphylococci and streptococci . There is increased concern surrounding the emergence of endocarditis in children caused by methicillin-resistant Staphylococcus aureus and drug resistant strains of Streptococcus pneumoniae . The treatment approach to paediatric endocarditis is similar to that for adult patients with endocarditis because of similarities in disease pathogenesis and aetiology . The therapeutic goal is to achieve sterilisation of the cardiac vegetations . The choice of antibacterial is dependent upon the susceptibility profile of the causative organism . Vancomycin or gentamicin is recommended for enterococcal endocarditis, according to guidelines from the American Heart Association . For staphylococcal endocarditis in patients with no prosthetic valve, oxacillin or nafcillin with or without gentamicin is the treatment of choice . In the case of endocarditis caused by methicillin-resistant S . aureus, vancomycin is commonly used in patients with no prosthetic valve and a combination of vancomycin, gentamicin and rifampicin (rifampin) for patients with prosthetic material . Cefazolin or ceftriaxone is the treatment of choice for penicillin allergic paediatric patients with endocarditis caused by viridans streptococci . While there have been no major changes in endocarditis therapy for the last decade, the current focus is on the recognition of multiple-drug resistant pathogens and the use of newer agents such as quinupristin/dalfopristin in the treatment of resistant bacterial endocarditis . Prophylactic antibacterial therapy is recommended for procedures thought to be associated with the occurrence of bacteraemia involving organisms commonly associated with endocarditis . These include dental extractions and oral, respiratory tract, genitourinary, gastrointestinal or oesophageal procedures . Prophylactic antibacterials recommended by the American Heart Association during genitourinary and gastrointestinal surgical procedures in high risk patients include ampicillin + gentamicin or vancomycin + gentamicin in high risk patients with penicillin allergy . Ampicillin has been recommended for prophylaxis of bacterial endocarditis in children undergoing oral, respiratory tract or oesophageal procedures . In the case of penicillin allergy in these patients, cephalosporins, clindamycin, azithromycin or clarithromycin have been recommended . The general consensus is that antibacterial prophylaxis during dental procedure is unnecessary, and in fact propagates bacterial resistance.

Infect Immun, 2001 Dec, 69(12), 7512 - 6
Identification of independent Streptococcus gordonii SspA and SspB functions in coaggregation with Actinomyces naeslundii; Egland PG et al.; The initial stages of dental plaque formation involve the adherence of early colonizing organisms such as Streptococcus gordonii and Actinomyces naeslundii to the saliva-coated tooth surface and to each other . The S . gordonii surface proteins SspA and SspB are known to play a role in adherence to salivary proteins and mediate coaggregation with other bacteria . Coaggregation is the adhesin receptor-mediated interaction between genetically distinct cell types and appears to be ubiquitous among oral isolates . To define the function of SspA and SspB separately on the surface of their natural host, we constructed and analyzed the coaggregation properties of an isogenic sspB mutant of S . gordonii DL1, an sspAB double mutant, and a previously described sspA mutant . A . naeslundii strains have been previously classified into six coaggregation groups based on the nature of their coaggregations with S . gordonii DL1 and other oral streptococci . Coaggregation assays with the sspA and sspB mutants showed that SspA and SspB are the streptococcal proteins primarily responsible for defining these coaggregation groups and, thus, are highly significant in the establishment of early dental plaque . SspA exhibited two coaggregation-specific functions . It participated in lactose-inhibitable and -noninhibitable interactions, while SspB mediated only lactose-noninhibitable coaggregations . Accordingly, the sspAB double mutant lacked these functions and allowed us to detect a third coaggregation interaction with one of these organisms . These proteins may play an important role in development of S . gordonii-A . naeslundii communities in early dental plaque . Understanding these adhesin proteins will aid investigations of complex microbial communities that characterize periodontal diseases.

Infect Immun, 2001 Dec, 69(12), 7402 - 12
Group A streptococci bind to mucin and human pharyngeal cells through sialic acid-containing receptors; Ryan PA et al.; The first step in the colonization of group A streptococci (Streptococcus pyogenes) is adherence to pharyngeal epithelial cells . Prior to adherence to their target tissue, the first barrier that the streptococci encounter is the mucous layer of the respiratory tract . The present study was undertaken to characterize the interaction between mucin, the major glycoprotein component of mucus, and streptococci . We report here that S . pyogenes is able to bind to bovine submaxillary mucin in solid-phase microtiter plate assays . Western blots probed with (125)I-labeled mucin and a panel of monoclonal antibodies revealed that the streptococcal M protein is one of two cell wall-associated proteins responsible for this binding . The binding was further localized to the N-terminal portion of the M molecule . Further analysis revealed that the M protein binds to the sialic acid moieties on mucin, and this interaction seems to be based on M-protein conformation rather than specific amino acid sequences . We found that sialic acid also plays a critical role in the adherence of an M6 streptococcal strain to the Detroit 562 human pharyngeal cell line and have identified alpha2-6-linked sialic acid as an important sialylated linkage for M-protein recognition . Western blot analysis of extracted pharyngeal cell membrane proteins identified three potential sialic acid-containing receptors for the M protein . The results are the first to show that sialic acid not only is involved in the binding of the streptococci to mucin but also plays an important role in adherence of group A streptococci to the pharyngeal cell surface.

Pesqui Odontol Bras, 2001 Jan-Mar, 15(1), 41 - 6
{Effect of antiseptic treatment of alveolar surgical wounds on bacterial growth on cotton suture threads}; Soares UN et al.; The objective of this study was to evaluate bacterial growth on cotton suture . The efficiency of cetylpyridinium chloride (50%), hydrogen peroxide (3%) and chlorhexidine (0.12%) in antisepsis was investigated . For that, 20 patients who were submitted to extraction of impacted lower third molars were studied . Five days after extraction, samples were obtained from the oral and alveolar sides of the sutures, before and after antisepsis of the wounds, and were submitted to bacteriological analysis . Bacterial growth was observed in all examined samples . The number of streptococci decreased after antisepsis and there were no statistically significant differences between the methods of antisepsis used.

Pesqui Odontol Bras, 2001 Jan-Mar, 15(1), 12 - 7
{In vitro utilization of fructooligosaccharide by streptococci mutans}; Linardi MM et al.; Neosugar is the trade name of a fructooligosaccharide (FOS) whose utilization by oral bacteria is not well known yet . The aim of the present study was to evaluate in vitro the effect of this product on the growth, fermentation and production of plaque by mutans streptococci: S . mutans, serotypes c, e and f, S . sobrinus, serotype d, S . downei, serotype h, S . cricetus, serotype a and S . rattus, serotype b . The evaluation of growth was carried out in Brain Heart Infusion (BHI) broths containing or not sucrose and FOS and in buffered broths having glucose or FOS as carbon sources, through optical density reading in spectrophotometer after 24 hours of incubation at 37 degrees C . Thereafter the reading of pH was made in the same media . The plaque produced on glass sticks in BHI broths containing 5% sucrose or FOS was weighed and carbohydrates and proteins were assayed . The possible cariogenicity of Neosugar was confirmed, since it sustained the same growth and intensity of fermentation of sucrose in BHI broth for all streptococci and permitted in vitro production of plaque by some of them . The amount of plaque as well as its content of proteins and carbohydrates were smaller than those produced with sucrose, although the difference was statistically significant only for carbohydrates.

Pesqui Odontol Bras, 2001 Jul-Sep, 15(3), 196 - 200
Retention of oral microorganisms on conventional and resin-modified glass-ionomer cements; Pedrini D et al.; Secondary caries are a worldwide public and socioeconomic problem . The placement of restorations can lead to the development of environmental conditions favorable to microbial colonization, especially on the tooth/restoration interface, which is a predisposing factor for secondary caries . The aim of this study was to evaluate microbial retention on conventional (Chelon-Fil and Vidrion R) and resin-modified (Vitremer and Fuji II LC) glass-ionomer cements, in situ, using a hybrid composite resin (Z100) as a control . Twelve volunteers wore Hawley appliances with specimens made of all tested filling materials for 7 days . The specimens were then removed from the appliances and transferred to tubes containing 2.0 ml of Ringer-PRAS . Microorganisms from the samples were inoculated onto blood agar and Mitis Salivarius Bacitracin agar and incubated under anaerobiosis (90% N2, 10% CO2), at 37 degrees C, for 10 and 2 days, respectively . The resin-modified glass-ionomer cements and the composite resin retained the same levels of microorganisms on their surfaces . The resin-modified glass-ionomers retained less mutans streptococci than the composite resin and conventional glass-ionomer cements . The conventional glass-ionomer cements retained less mutans streptococci than the composite resin, but that difference was not statistically significant.

Pesqui Odontol Bras, 2001 Jul-Sep, 15(3), 181 - 6
Prevalence of mutans streptococci in 93 members from six Brazilian families; Pimenta FC et al.; Several studies report that mutans streptococci (MS) are closely associated with caries in humans and that there is a correlation between the number of carious lesions and the levels of MS in the saliva of children and adults . The presence of MS in the saliva of 93 members of six Brazilian families with at least 3 generations was investigated . Samples of whole unstimulated saliva were collected and diluted . Aliquots of 50 microliters of each suspension were dropped onto SB20 agar and incubated in a candle jar at 37 degrees C for 72 h . Colonies resembling MS were counted, collected, seeded in thioglycoilate medium and subjected to biochemical typing . Mutans streptococci were isolated from 80 subjects (86.0%) and the counts ranged from 3.0 x 10(2) (log 2.477) to 1.6 x 10(8) (log 8.204) CFU/ml of saliva . All of the 73 adults were colonized by MS, but the bacteria were detected in only 7 (35.0%) of the 20 children evaluated . Streptococcus mutans occurred in 78 subjects (97.5%), and 51 (63.7%) were monocolonized . S . sobrinus occurred in 29 individuals (36.3%) and 2 (2.5%) were monocolonized . Twenty-seven (33.8%) subjects were multicolonized with S . mutans and S . sobrinus . This study showed a high prevalence (86.0%) of mutans streptococci in the saliva of members of the studied families, which suggests the risk of intrafamilial transmission.

Obstet Gynecol, 2001 Nov, 98(5 Pt 1), 846 - 8
Group A streptococcal puerperal sepsis preceded by positive surveillance cultures; Stefonek KR et al.; BACKGROUND: Screening of pregnant women for vaginal and rectal carriage of group B streptococci may also identify group A streptococcal carriers . The clinical significance of prenatal group A streptococcal carriage is unknown . CASES: Two women developed group A streptococcal puerperal sepsis after delivery at one hospital 15 months apart . The first patient required hysterectomy and suffered complications including subcapsular hepatic hematoma, pleural effusion, and prolonged ileus . She recovered after a 35-day hospitalization . The second patient had endometritis and recovered . Both had had group A streptococci isolated from vaginal and rectal cultures taken for prenatal group B streptococcal screening . The acute sepsis isolates were both M-type 28, but pulsed-field gel electrophoresis determined that the strains were unrelated . CONCLUSIONS: Finding group A streptococci on prenatal culture may presage serious postpartum infection.

Microbiology, 2001 Nov, 147(Pt 11), 2971 - 9
Effect of carbon starvation and proteolytic activity on stationary-phase acid tolerance of Streptococcus mutans; Svensater G et al.; Previous research with Streptococcus mutans and other oral streptococci has demonstrated that the acid shock of exponential-phase cells (pH 7.5 to 5.5) resulted in the induction of an acid tolerance response (ATR) increasing survival at low pH (3.5-3.0) . The current study was designed to determine whether two fresh isolates, H7 and BM71, and two laboratory strains, Ingbritt and LT11, were capable of a stationary-phase ATR as estimated by a survival test at pH 3.5 for 3 h . All four strains were unable to generate a stationary-phase ATR under control conditions at pH 7.5, with the exception of a burst of survivors in the transition between the exponential and stationary phases when the carbon source (glucose) was depleted . Adaptation at pH 5.5 resulted in the expected pH-dependent exponential-phase ATR, but only the fresh isolates exhibited a stationary-phase ATR at this pH . Glucose starvation of cells in complex medium was shown to enhance acid tolerance for the fresh isolates, but not the laboratory strains . This tolerance was, however, greatly diminished for all strains in a defined medium with a low concentration of amino acids . Growth of strain H7 in complex medium resulted in the formation of at least 56 extracellular proteins, nine of which were degraded in the early stationary phase following the induction of proteolytic activity during the transition period . No proteolytic activity was observed with strain LT11 and only 19 extracellular proteins/peptides were apparent in the medium with only one being degraded in the early stationary phase . Strain H7 was also shown to have two- to fourfold higher levels of intracellular glycogen in the stationary phase than strain LT11 . These results suggest that S . mutans H7 possessed the required endogenous metabolism to support amino acid/peptide uptake in the early-stationary phase, which resulted in the formation of basic end products that, in turn, contributed to enhanced intracellular pH homeostasis.

Eur J Oral Sci, 2001 Oct, 109(5), 330 - 4
Biochemical and genetic characterization of serologically untypable Streptococcus mutans strains isolated from patients with bacteremia; Fujiwara T et al.; Four out of 522 streptococcal isolates from the peripheral blood of patients with bacteremia exhibited typical properties of Streptococcus mutans in terms of sucrose-dependent adhesion, expression of glucosyltransferases, fermentation profiles of sugars, the presence of surface protein antigen, and DNA-DNA hybridization . Two strains were determined as serotype f and e by immunodiffusion, whereas the other two isolates did not react with the specific antiserum to S . mutans serotype c . e . or f of the eight different serotypes of mutans streptococci . The latter two untypable isolates, however, expressed a new antigenic determinant that was different from serotype c/e/f specificity as revealed by immunodiffusion . Analysis of the cell wall polysaccharides revealed very low contents of glucose in the untypable isolates . Furthermore, Southern blot analysis demonstrated that the untypable strains lacked at least one gene corresponding to a glucose-adding enzyme . These results indicate that the serologically untypable nature is due to the loss of glucosidic residue from the serotype-specific polysaccharide antigens of S . mutans.

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