Eur J Oral Sci, 2001 Oct, 109(5), 325 - 9 Co-adhesion and removal of adhering bacteria from salivary pellicles by three different modes of brushing; Yang J et al.; This study compares removal of pairs of co-adhering and non-co-adhering oral actinomyces and streptococci by hand, electric and sonic brushing from salivary pellicles . In addition, re-deposition of a co-adhering and non-co-adhering streptococcal strain to brushed pellicles was studied . First, actinomyces were allowed to adhere to a pellicle in a flow chamber, after which streptococci suspended in saliva were perfused through the chamber at 33 C . Pellicles with adhering bacterial pairs were brushed and the number of bacteria remaining determined . Whereas sonic brushing removed nearly all adhering bacteria, greater numbers of larger aggregates of the co-adhering pair, involving Streptococcus oralis J22, were left behind after hand and electric brushing than of the non-co-adhering pair with Streptococcus sanguis PK1889 . Re-deposition of streptococci to electrically and sonically brushed pellicles, however, was two-fold higher for the co-adhering pair than for the non-co-adhering pair . This demonstrates a role for co-adhesion in de novo plaque formation . Removal by the three different modes of brushing was not affected by the presence of fluoride, indicating that fluoride is not able to disrupt calcium bridges between co-adhering pairs . In contrast, in the presence of lactose only small aggregates of co-adhering pair were left behind. Rev Med Interne, 2001 Oct, 22(10), 992 - 6 {Adult cutaneous periarteritis nodosa and dental infections . Role of streptococci}; Leveque L et al.; INTRODUCTION: Periarteritis nodosa can be associated with streptococcal infections in children . We report two cases of adult cutaneous periarteritis nodosa that disappeared after the treatment of dental infection . EXEGESIS: A 23-year-old woman presented with necrotic ulceration on the legs for 6 months, with a histology of necrotizing vasculitis . Many sites of dental infections could be noted . Immunological data were negative and so were serologies of hepatitis . Corticosteroid therapy failed . The teeth removal with antibiotic therapy allowed the disappearance of cutaneous lesions in a month . A 26-year-old woman was hospitalized for growing thin, fever, diffuse arthralgia and myalgia and cutaneous nodules on the legs with necrotizing vasculitis on dermal vessels at histological analysis . The biology showed no pecularity . Radiography of the teeth showed many dental infection sites . The removal of six teeth with antibiotic therapy led to the disappearance of vasculitis in 6 weeks . CONCLUSION: The search for an infectious problem is important when vasculitis is diagnosed, in particular periarteritis nodosa . The treatment of dental infection could occasionally mean avoiding immunosuppressive therapy in certain cases. Pediatrics, 2001 Nov, 108(5), 1180 - 6 Unexplained reduced microbiological efficacy of intramuscular benzathine penicillin G and of oral penicillin V in eradication of group a streptococci from children with acute pharyngitis; Kaplan EL et al.; OBJECTIVE: To evaluate the efficacy of oral penicillin V and intramuscular benzathine penicillin G (BPG) in eradicating group A streptococci from the upper respiratory tract . METHODOLOGY: Two randomized, single-blind, multicenter antibiotic efficacy trials in children using recommended doses of either oral penicillin V or intramuscular BPG for treatment of acute-onset pharyngitis associated with isolation of group A streptococci were conducted . Throat examinations and cultures were obtained at enrollment and on days 5 to 8, 10 to 14, and 29 to 31 . RESULTS: Thirty-five percent of 284 evaluable patients treated with oral penicillin V and 37% of BPG-treated patients were microbiologic treatment failures at either 10 to 14 or 29 to 31 days . CONCLUSIONS: Although these findings do not provide sufficient evidence to change current treatment recommendations or public health policy, important questions are raised about currently recommended penicillin doses, about the role of the carrier state, and possibly about adequate bioavailability of intramuscular BPG . These findings require confirmation. Pediatrics . 2001 Nov;108(5):E79. Severe complications of varicella in previously healthy children in Germany: a 1-year survey; Ziebold C et al.; OBJECTIVE: Varicella is a common infectious disease, usually benign and self-limited, and complications are believed to be rare . The purpose of this study was to describe the epidemiology of severe varicella complications in immunologically healthy children in Germany . METHODS: Information on any admission of children with a severe complication associated with chickenpox was solicited throughout 1997 from all 485 pediatric hospitals in Germany using an established surveillance system . The case definition included nonimmunocompromised individuals who were up to 16 years of age and hospitalized with neurologic complications, bacterial superinfections, or hematologic complications . RESULTS: The response rate to the surveillance questionnaire during the observation period was high: 93.4% . Of the 153 reported cases, 119 met the case definition . There was a seasonal distribution of reported complications with a peak in March . The majority of complications occurred in preschool-age children with a maximum age of 4 years . No gender predominance was found with a distribution of 56 female and 63 male patients . Multiple entries for complications were allowed . The most frequent complications were neurologic, which were reported in 73 children (61.3%); cerebellitis was the leading diagnosis (n = 48), followed by encephalitis (n = 22), meningitis (n = 2), and central facial palsy (n = 1) . A total of 46 (38.6%) infectious complications were identified . Superinfections of the skin were present in 31 (26.0%), pyogenic arthritis was present in 5 (4.2%), osteomyelitis was present in 4 (3.3%), necrotizing fasciitis was present in 3 (2.5%), orbital cellulitis was present in 2 (1.6%), and pneumonia was present in 1 (0.8%) . Streptococcus pyogenes was the leading cause of bacterial infections (18 cases {15.1%}), with invasive disease in 6 patients (8.4%) and linked to 4 of 8 cases with defect healing . Infectious complications were reported in the majority in younger children up to 4 years of age, whereas neurologic complications occurred more frequently in an older age range . Five children experienced thrombocytopenia or severe anemia . There was no bleeding disorder, no fatality, and no case of Reye syndrome reported during the 1-year observation period . In total, 8 (6.7%) of 119 patients reported having long-term sequelae, 6 attributable to infectious complications and 2 to persistent deficits after neurologic complications . CONCLUSION: This is the first prospective nationwide study of severe complications of varicella in immunologically healthy children . Related to 14 025 867 children up to the age of 16, a crude incidence of severe chickenpox complications of 0.85/100 000 could be calculated {corrected} . The actual hospitalization rate attributable to complicated chickenpox is probably much higher, because this calculation refers to a population theoretically at risk and not the truly susceptible individuals . The results of this study demonstrate considerable morbidity with a comparatively high rate of encephalitis, osteomyelitis, and pyogenic arthritis . Although infectious complications were present in only 38.6% of the reported cases, they contributed disproportionately to the cases with chronic sequelae . Looking at these cases in more detail, S pyogenes involvement was identified as the major risk factor for invasive disease with an unfavorable long-term outcome . varicella-zoster virus, chickenpox/epidemiology, chickenpox/complications, encephalitis, cellulitis, osteomyelitis, necrotizing fasciitis, group A beta-hemolytic streptococci, Europe. J Natl Cancer Inst Monogr, 2001, (29), 31 - 6 Infection and mucosal injury in cancer treatment; Khan SA et al.; The oral and gastrointestinal mucosa acts as an important mechanical barrier that prevents local or systemic invasion by microorganisms . Cytotoxic chemotherapy-induced mucosal injury (MI) of oral cavity and intestinal epithelium occurs in many patients treated for malignancy . Compromise of the mucosal barrier can contribute to local invasion by colonizing microorganisms and, subsequently, to systemic infection . Historically, gram-negative bacteremia has been the most problematic bacterial infection in neutropenic patients, but its incidence has reduced over time because of the use of prophylactic antibiotics . There has been a shift in the type of infecting organisms responsible for bacteremia in these patients, from predominantly gram-negative organisms to gram-positive cocci . The viridans group of streptococci is composed of the most frequent bacterial pathogens associated with MI . When speciated, oral colonizers such as Streptococcus mitis, Streptococcus oralis, and Streptococcus sangulis II are the most frequently identified pathogens . Other systemic infections caused by vancomycin-resistant enterococci, Stenotrophomonas maltophilia, and Candida species have also been associated with MI after cancer treatment . Infection can also exacerbate MI after cancer treatment . The best recognized example is herpes simplex virus type 1 (HSV-1) . Latent virus is frequently reactivated in HSV-seropositive patients; this reactivation leads to stomatitis, which can be indistinguishable from MI caused by cytoreductive therapies . Antiviral prophylaxis or treatment can control the virus-induced MI and bring about overall amelioration of MI . Recognition of this infectious cause of MI is important in order for clinicians to anticipate and minimize oral toxicity and to facilitate optimal delivery of the antineoplastic regimen. Isr Med Assoc J, 2001 Oct, 3(10), 722 - 4 Antibiotic use in patients with erysipelas: a retrospective study; Bishara J et al.; BACKGROUND: Erysipelas is a skin infection generally caused by group A streptococci . Although penicillin is the drug of choice, some physicians tend to treat erysipelas with antibiotics other than penicillin . OBJECTIVES: To define the pattern of antibiotic use, factors affecting antibiotic selection, and outcome of patients treated with penicillin versus those treated with other antimicrobial agents . METHODS: A retrospective review of charts of adult patients with discharge diagnosis of erysipelas was conducted for the years 1993-1996 . RESULTS: The study group comprised 365 patients (median age 67 years) . In 76% of the cases infection involved the leg/s . Predisposing condition/s were present in 82% of cases . Microorganisms were isolated from blood cultures in only 6 of 176 cases (3%), and Streptococcus spp . was recovered in four of these six patients . Cultures from skin specimens were positive in 3 of 23 cases . Penicillin alone was given to 164 patients (45%) . Other antibiotics were more commonly used in the second half of the study period (P < 0.0001) in patients with underlying conditions (P = 0.06) and in those hospitalized in the dermatology ward (P < 0.0001) . Hospitalization was significantly shorter in the penicillin group (P = 0.004) . There were no in-hospital deaths . CONCLUSIONS: We found no advantage in using antibiotics other than penicillin for treating erysipelas . The low yield of skin and blood cultures and their marginal impact on management, as well as the excellent outcome suggest that this infection can probably be treated empirically on an outpatient basis. Int J Antimicrob Agents, 2001 Oct, 18(4), 395 - 8 Penicillin and clindamycin differentially inhibit the production of pyrogenic exotoxins A and B by group A streptococci; Mascini EM et al.; Streptococcal pyrogenic exotoxins A (SPE-A) and B (SPE-B) have been implicated in the pathogenesis of serious group A streptococcal infections including streptococcal toxic shock-syndrome . Current antibiotics used for the treatment of these infections are penicillin and clindamycin . The effects of sub- and suprainhibitory concentrations of penicillin and clindamycin were evaluated in 14 isolates of Streptococcus pyogenes that were fully susceptible to both antibiotics . Clindamycin was superior to penicillin in reducing the production of SPE-A and SPE-B by invasive and non-invasive Dutch group A streptococcal isolates in vitro. Clin Microbiol Infect, 2001, 7 Suppl 4, 47 - 52 Empirical therapy of febrile neutropenic patients with mucositis: challenge of risk-based therapy; Blijlevens NM et al.; Nowadays Gram-positive cocci, especially oral viridans streptococci (OVS) and coagulase-negative staphylococci (CoNS), are the most common bloodstream isolates in febrile neutropenic patients . Although in general these cocci are quite indolent, Streptococcus mitis is associated with serious complications such as sepsis and/or adult respiratory distress syndrome . Neutropenia is the most significant predisposing factor but the impact of mucositis, i.e . damage to the mucosal barrier of mouth and intestines (mucosal barrier injury, MBI), is very much greatly underestimated . Oral mucositis is a strong predictor of OVS bacteremia and simultaneously CoNS bacteremia is clearly associated with mucositis . Treatment with especially high dose cytarabine, cyclophosphamide and idarubicin, when given to allogeneic hematopoietic stem cell transplant recipients, predictably results in mucositis . Hence, the occurrence of mucositis should have implications for complementing empirical therapy with specific drugs such as glycopeptides, because risk patients can be selected based upon the chemotherapeutic therapy administered . An algorithm is presented for dealing with patients at high risk of mucositis and bacteremia due to Gram-positive cocci. Clin Diagn Lab Immunol, 2001 Nov, 8(6), 1136 - 9 Passive immunization with milk produced from an immunized cow prevents oral recolonization by Streptococcus mutans; Shimazaki Y et al.; Cell surface protein antigen (PAc) and water-insoluble glucan-synthesizing enzyme (GTF-I) produced by cariogenic Streptococcus mutans are two major factors implicated in the colonization of the human oral cavity by this bacterium . We examined the effect of bovine milk, produced after immunization with a fusion protein of functional domains of these proteins, on the recolonization of S . mutans . To prepare immune milk, a pregnant Holstein cow was immunized with the fusion protein PAcA-GB, a fusion of the saliva-binding alanine-rich region (PAcA) of PAc and the glucan-binding (GB) domain of GTF-I . After eight adult subjects received cetylpyridinium chloride (CPC) treatment, one subgroup (n = 4) rinsed their mouths with immune milk and a control group (n = 4) rinsed with nonimmune milk . S . mutans levels in saliva and dental plaque decreased after CPC treatment in both groups . Mouth rinsing with immune milk significantly inhibited recolonization of S . mutans in saliva and plaque . On the other hand, the numbers of S . mutans cells in saliva and plaque in the control group increased immediately after the CPC treatment and surpassed the baseline level 42 and 28 days, respectively, after the CPC treatment . The ratios of S . mutans to total streptococci in saliva and plaque in the group that received immune milk were lower than those in the control group . These results suggest that milk produced from immunized cow may be useful for controlling S . mutans in the human oral cavity. Clin Diagn Lab Immunol, 2001 Nov, 8(6), 1110 - 4 Antibodies against Streptococcus agalactiae proteins c(alpha) and R4 in sera from pregnant women from Norway and Zimbabwe; Moyo SR et al.; Group B streptococci (GBS) express strain-variable and surface-localized proteins, which are important serotype markers and targets of protective antibodies . These include the c(alpha) and R4 proteins, one or the other of which is expressed by approximately 75% of clinical GBS isolates . These proteins have been considered vaccine candidates . In this study, the c(alpha) and R4 proteins were extracted by trypsin digestion of GBS and purified by sequential precipitation with trichloroacetic acid and ammonium sulfate followed by gel filtration chromatography . The proteins were used as antigens in an indirect enzyme-linked immunosorbent assay (ELISA) to measure the levels of c(alpha)- and R4-reactive antibodies in sera from pregnant women from Norway (n = 100) and from Zimbabwe (n = 124) . Antibody levels in the Norwegian group of women were significantly higher than in the Zimbabwean group, and a higher proportion of the Norwegian women contained appreciable levels of antibodies against both proteins . The antibodies traversed the placental barrier . With individual sera, a significant correlation between the anti-c(alpha) and anti-R4 antibody levels was observed and each of the two protein antigens effectively competed for human serum antibodies both against itself and against the other antigen . Inhibition ELISA results demonstrated specificity for each of the proteins of immune antibodies raised in rabbits . These results demonstrate that (i) the majority of women of childbearing age have antibodies against c(alpha) and R4, (ii) the levels of these antibodies differ among pregnant women in different parts of the world, and (iii) the normal human serum antibodies may target a common c(alpha) and R4 protein site, whereas immune antibodies targeted a different site(s) specific for each protein. Ann Pathol, 2001 Aug, 21(4), 337 - 9 {Infectious crystalline keratopathy: a case report}; Terrier JP et al.; We report a case of perforated infectious crystalline keratopathy in a 88-year-old woman . Corneal surgery like keratoplasty and topical corticosteroids are the main causative factors present in the rare reported cases . Clinically, the anterior layers of cornea exhibit slowly progressive stellate infiltrates . "Viridans streptococci" are the most common micro-organisms involved but their culture for identification is difficult . As compared to cultures, histologic examination is more sensitive for diagnosis, by showing clusters of bacteria in the corneal stroma with no inflammatory response. Jpn J Infect Dis, 2001 Aug, 54(4), 137 - 9 Isolation of group A beta-hemolytic streptococci in the tonsillopharynx of school children in Madras City and correlation with their clinical features; Rajkumar S et al.; Today, rheumatic fever is the most common cause of heart disease in children and young adults, and it accounts for about half of all cardiovascular diseases causing death in the first four decades of life, in India . In the present study, conducted during 1991-1992 at Chennai, India, a total of 666 school girls aged 5-15 years were examined clinically for one or more of the following signs and symptoms: repeated sore throat, joint pain/swelling, epistaxis, chest pain, breathlessness, palpitation, abdominal pains, etc . Out of the 666 children screened, 124 were recruited for the present study, based on their meeting one or more of the above mentioned clinical criteria . They were screened for the presence of group A beta-hemolytic streptococci, and for antistreptolysin O and C-reactive protein . Thus, the aim of the present study was to reduce the load of streptococcal infection and the consequent risk of developing rheumatic fever and rheumatic heart disease . In the present study group, 89.5% of the children indicated a history of repeated sore throat . However, only 4.0% of the children in the study group were positive for group A beta-hemolytic streptococci . The antistreptolysin O and C-reactive protein levels were higher in 11- to 15-year-old patients than in 5- to 10-year-old patients in the study group. Lancet, 2001 Oct 20, 358(9290), 1334 - 7 Dynamic epidemiology of group A streptococcal serotypes associated with pharyngitis; Kaplan EL et al.; BACKGROUND: Despite the past 15 years of heightened awareness of the disease-causing potential of group A streptococci, the possible epidemiological influence of rapid changes in prevalent serotypes has not been fully appreciated . METHODS: We analysed throat cultures collected as part of routine medical care in a semi-closed community of nearly 500 children and adults between January, 1999, and April, 2000 . beta-haemolytic streptococci from all positive cultures were characterised by serological grouping, T-agglutination pattern, and serotyping for M protein or opacity factor . FINDINGS: We saw an increase in the number of symptomatic individuals with pharyngitis beginning in mid-1999 . Between July 1 and Dec 31, 1999, 111 (29%) of 378 throat cultures yielded group A streptococci, 102 (92%) of which were serotype M1 . Between Jan 1 and Mar 31, 2000, 126 (45%) of 277 throat cultures yielded group A streptococci . Unexpectedly, 106 (84%) of these throat isolates were serotype M6, and only 16 (13%) were M1 . 20 (28%) of the 71 individuals with M1 infection subsequently acquired infection with M6 . INTERPRETATION: This rapid and almost complete shift in predominance of group A streptococcal serotype in this community draws attention to the dynamic epidemiology of these organisms . This change has important implications for further understanding the epidemiology of group A streptococcal infections, and for the development and use of a vaccine. Herz, 2001 Sep, 26(6), 418 - 23 {Possibilities and limits of outpatient antibiotic therapy of infective endocarditis}; Ritter M et al.; BACKGROUND: Infective endocarditis has a high morbidity and lethality . Therefore antibiotic treatment has to be intravenous to achieve high blood levels and has to last several weeks without an interruption of treatment at the weekends . PATIENT SELECTION FOR OUTPATIENT THERAPY: It is therefore crucial to select the patient group that is suited for an outpatient, antibiotic therapy very carefully . In general only hemodynamically stable patients without complications in whom the responsible organism has been identified should be considered . TREATMENT: From a pharmacological point of view intravenous or intramuscular application for the complete duration of therapy is obligatory . Endocarditis caused by penicillin-susceptible streptococci, the biggest group of organisms responsible for endocarditis, can be treated with Ceftriaxon once daily for 4 weeks . For other organisms there are at present no data available which support the feasibility of an outpatient therapy . In particular antibiotic therapy with a complex regimen for those organisms is not practicable for outpatient usage . Possibly, in the near future computer controlled pumps might overcome this disadvantage . LIMITS: Every outpatient therapy should be initiated under inpatient conditions and only after an initial response to the antibiotic therapy continued in an outpatient setting . Today reliable outpatient therapy and follow-up 7 days a week under the given outpatient infrastructure is problematic and remains an exception . However, considering cost-effectiveness outpatient as compared to inpatient antibiotic therapy could be an interesting economically advantageous alternative. J Clin Microbiol, 2001 Nov, 39(11), 4196 - 9 Identification of isolates of Streptococcus canis infecting humans; Whatmore AM et al.; During a survey of Group G and C streptococcal infections of humans two epidemiologically unrelated Group G streptococcal isolates were identified, one from a case of bacteremia and one from a wound infection . These isolates were atypical among this sample in that the emm gene could not be amplified from them by PCR . Biochemical characterization identified the isolates as Streptococcus canis, an organism normally associated with animal hosts . The biochemical identification was confirmed by sequencing of the 16S rRNA gene from both isolates and comparison with sequences of the S . canis type strain and other related streptococci of animals and humans . Comparative sequencing of fragments of two other housekeeping genes, sodA and mutS, confirmed that the isolates are most closely related to S . canis . The identification of two isolates of S . canis from a relatively small sample set suggests that the practice of identifying streptococci only by the Lancefield serological group may result in underestimation of the presence of S . canis in the human population. Rinsho Biseibutshu Jinsoku Shindan Kenkyukai Shi, 2001, 12(1), 39 - 46 {Some proposals for anaerobic primary culture from the supply side}; Enari H; Many researchers paid attention to Bacteroides fragilis group chiefly for the past this 20 years . Most of B . fragilis groups encountered in clinical specimens possesses beta-lac- tamase . However recently, many researchers report that beta-lactamase-producing anaerobic Gram-negative bacilli except for B . fragilis groups are often encountered in clinical specimens . These strains belonging to Prevotella spp . or Fusobacterium spp . These organisms are often coexist with streptococci such as "S . milleri" group in specimens . Because these facts are very important in chemotherapy, such as beta-lactamase producers must be detected securely . For such a specimen, selective media that phenylethyl alcohol or gentamicin was added is not suitable . On the other hand, paromomycin vancomycin Brucella HK agar is suitable selective medium for not only these organisms but also for B . fragilis . Therefore, paromomycin vancomycin Brucella HK agar is recommended as the first choice of selective agar to use together with non-selective agar at present. Mol Microbiol, 2001 Oct, 42(1), 75 - 86 Fba, a novel fibronectin-binding protein from Streptococcus pyogenes, promotes bacterial entry into epithelial cells, and the fba gene is positively transcribed under the Mga regulator; Terao Y et al.; In infection by Streptococcus pyogenes, fibronectin (Fn)-binding proteins play important roles as adhesins and invasins . Here, we present a novel Fn-binding protein of S . pyogenes that exhibits a low similarity to other Fn-binding proteins reported . After searching the Oklahoma Streptococcal Genome Sequencing Database for open reading frames (ORFs) with an LPXTG motif, nine ORFs were found among those recognized as putative surface proteins, and one of them was designated as Fba . The fba gene was found in M types 1, 2, 4, 22, 28 and 49 of S . pyogenes, but not in other serotypes or groups of streptococci . Fba, a 37.8 kDa protein, possesses three or four proline-rich repeat domains and exhibits a high homology to FnBPA, the Fn-binding protein of Staphylococcus aureus . Recombinant Fba exhibited a strong binding ability to Fn . In addition, Fba-deficient mutants showed diminished invasive capabilities to HEp-2 cells and low mortality in mice following skin infection . The fba gene was located downstream of the mga regulon and analysis using an mga-inactivated mutant revealed that it was transcribed under the control of the Mga regulator . These results indicate that Fba is a novel protein and one of the important virulence factors of S . pyogenes. Am J Cardiol, 2001 Oct 15, 88(8), 871 - 5 Comparison of clinical and echocardiographic characteristics of Streptococcus bovis endocarditis with that caused by other pathogens; Pergola V et al.; The aim of our study was to compare the clinical, echographic, and prognostic features of Streptococcus bovis (S . bovis) endocarditis with those caused by other streptococci and pathogens in a large sample of patients with definite endocarditis by Duke criteria, using transesophageal echocardiography . Two hundred six patients (149 men, mean age 57 +/- 15 years) with a diagnosis of infective endocarditis formed the study population . All patients underwent multiplane transesophageal echocardiography and blood cultures . Cerebral, thoracoabdominal computed tomographic scan was performed in almost all patients (95%) . All patients with S . bovis endocarditis underwent colonoscopy . Incidence of S . bovis endocarditis in our sample was 19% . Patients with S . bovis endocarditis were older than other groups . Multiple valve involvement, native valves, and large vegetations (>10 mm) were more frequent in patients with S . bovis . There was a significantly higher occurrence of embolism in the S . bovis group . Splenic embolism and multiple embolisms were significantly more frequent in patients with S . bovis . Gastrointestinal lesions, anemia, and spondylitis were observed more frequently with S . bovis endocarditis . In addition to the requirement for gastrointestinal examination for S . bovis endocarditis, our study underlines the need for systematic screening for vertebral and splenic localizations, and suggests the use of early surgery to prevent the high risk of embolism in these patients. Int J Antimicrob Agents, 2001 Sep, 18(3), 267 - 70 In vitro activity of linezolid against clinical Gram-positive bacterial isolates from Taiwan: an area with a high prevalence of antibiotic resistance; Fang CT et al.; The prevalence of antibiotic-resistant bacteria in Taiwan is due to the heavy use of antimicrobial agents in both animal husbandry and clinical practice over the past decades . Minimum inhibitory concentrations (MICs) of linezolid were established for 371 clinical isolates of staphylococci, pneumococci, enterococci and group A streptococci from Taiwan . All isolates tested including those resistant to beta-lactams, erythromycin, vancomycin and quinupristin-dalfopristin were uniformly susceptible to linezolid, with MICs ranging from 0.125 to 2 mg/l . Our data support the observation that there is no cross-resistance between linezolid and other classes of antimicrobial substances. J Public Health Dent, 2001 Summer, 61(3), 161 - 7 Mutans streptococci oral colonization in 12-30-month-old Brazilian children over a one-year follow-up period; Mattos-Graner RO et al.; OBJECTIVES: The infection levels of mutans streptococci were investigated during a one-year follow-up in children aged 12 to 30 months attending school nurseries where a sucrose-rich diet was provided . METHODS: Oral levels of mutans streptococci obtained from 101 children at baseline and after a one-year follow-up were compared by age, number of teeth, feeding habits, and presence of visible plaque at baseline . Baseline predictors and changes in mutans streptococci levels during the study were compared to caries incidence after one year . RESULTS: Fluctuations in mutans streptococci levels during the follow-up period were not related to feeding habits or presence of visible plaque . Mutans streptococci levels increased after one year among children aged 12 to 24 months, while a significantly higher proportion of those aged 25-30 months showed a decrease in mutans streptococci levels during the study . Multiple logistic regression analysis suggested that high levels of mutans streptococci (> or = 100 cfu) at baseline were associated with a higher caries increment, while reduction in mutans streptococci was negatively associated with caries incidence . CONCLUSIONS: Our data suggest that despite early mutans streptococci infection and high exposure to sucrose, mutans streptococci may achieve relatively stable levels after 2 years of age . Heavy colonization by mutans streptococci in an early age was related to an extremely high caries incidence during childhood, while decreasing levels of mutans streptococci can be associated to the decrease in caries activity. Geriatrics, 2001 Oct, 56(10), 33 - 8, 41 Skin and soft tissues . Management of four common infections in the nursing home patient; O'Donnell JA et al.; Common skin and soft tissue infections in nursing home patients include herpes zoster, cellulitis, pressure ulcer infections, and scables . Treatment of shingles with an oral antiviral should be started within 24 hours of symptom onset . Dissemination and bacterial superinfection require antibiotic therapy . Use of corticosteroids to prevent post-herpetic neuralgia remains controversial . Cellulitis is most often caused by Staphylococcus aureus and beta-hemolytic streptococci (groups A and B) . Therapy for cellulitis is empiric; gram-negative bacilli should be covered in diabetic patients . Most pressure ulcers never become infected; for those that do, empiric therapy should cover S aureus, gram-negative bacilli, and anaerobes . Topical treatment of scables with 5% permethrin cream or 1% lindane lotion is recommended. Caries Res, 2001 Sep-Oct, 35(5), 338 - 43 Cariogenic potential of lactosylfructoside as determined by acidogenicity of oral streptococci in vitro and human dental plaque in situ; Hata S et al.; The cariogenic potential of lactosylfructoside {O-beta-D-galactopyranosyl-(1-->4)-O-alpha-D-glucopyranosyl-(1<-->2)-beta-D-fructofuranoside} was estimated by experiments on oral streptococci in vitro and human dental plaque in situ . Lactosylfructoside was unable to support growth of the strains of Streptococcus mutans and S . sobrinus used in this study . However, it was able to support growth of strains of S . sanguis, S . mitis and S . oralis . Acid was produced rapidly by cell suspensions of S . oralis ATCC 10557 incubated with lactosylfructoside . Application of 5% w/v solution decreased the pH of human dental plaque . The minimum pH value was below 5.3 . The results suggest that lactosylfructoside is as acidogenic as lactose and could be cariogenic if it is consumed frequently and retained for a long period in the mouth. Nippon Jibiinkoka Gakkai Kaiho, 2001 Sep, 104(9), 866 - 71 {Clinical significance of the Streptococcus milleri group in peritonsillar abscesses}; Fujiyoshi T et al.; Few researchers have microbiologically studied peritonsillar abscesses in detail, and their results have been conflicting . Although Streptococcus pyogenes (Group A beta-streptococcus) is commonly considered an important pathogen in this infection, recent studies have demonstrated the recovery of many other streptococci mainly consisting of alpha-streptococci . Few studies have identified these streptococci at the species level, however . We studied details of bacteriology in 31 cases of peritonsillar abscess treated between 1991 and 2000 . The Streptococcus milleri group was most frequently isolated (25.8%), followed by Eikenella corrodens (9.7%), Staphylococcus aureus (6.5%), and S . pyogenes (3.2%) . The S . milleri group, consisting of 3 species of Streptococcus constellatus, S . intermedius, and S . anginosus, forms part of the normal flora most commonly found in the mouth, throat, gastrointestinal tract, and genital tract . These species have become known as an important pathogen in abscess disease but little attention has been paid to their role in peritonsillar abscesses . To adequately culture the S . milleri group, incubation in air containing carbon dioxide or in an anaerobic condition is required, and then the differentiation of the 3 species requires the biochemical reactivity tests . Since hemolytic patterns of the S . milleri group vary, we studied the population of alpha-, beta-, and gamma-hemolytic strains among 36 strains of this group . We found 32 (88.8%) to be alpha-hemolytic . Although not all alpha-hemolytic strains belong to the S . milleri group, a considerable number of this group could be missed among alpha-streptococci isolated from the peritonsillar abscess . As antibiotics began being used widely, normal flora such as the S . milleri group may have become an important pathogen in peritonsillar abscesses due to an imbalance between organisms and host defense. Crit Rev Oral Biol Med, 2001, 12(4), 301 - 14 Genetics of acid adaptation in oral streptococci; Quivey RG et al.; A growing body of information has provided insights into the mechanisms by which the oral streptococci maintain their niches in the human mouth . In at least one case, Streptococcus mutans, the organism apparently uses a panel of proteins to survive in acidic conditions while it promotes the formation of dental caries . Oral streptococci, which are not as inherently resistant to acidification, use protective schemes to ameliorate acidic plaque pH values . Existing information clearly shows that while the streptococci are highly related, very different strategies have evolved for them to take advantage of their particular location in the oral cavity . The picture that emerges is that the acid-adaptive regulatory mechanisms of the oral streptococci differ markedly from those used by Gram-negative bacteria . What future research must determine is the extent and complexity of the acid-adaptive systems in these organisms and how they permit the organisms to maintain themselves in the face of a low-pH environment and the microbial competition present in their respective niches. Enferm Infecc Microbiol Clin, 2001 Oct, 19(8), 371 - 5 {Invassive infections caused by Group A streptococci: clinical characteristics and microbiological analyses in 31 cases}; Bosch T et al.; BACKGROUND: In the last two decades an increase in the incidence of invassive Streptococcus pyogenes infections has been reported in several countries . The objective of this study was to determine the clinical features of these infections in our hospital . METHODS: Retrospective study (1995-1998) of patients admitted at Son Dureta Hospital, Palma de Mallorca, Spain, who had S . pyogenes recovered from blood, sterile fluids or soft tissues . Patients clinical records were reviewed and bacterial isolates characterized . RESULTS: A total of 31 patients with invassive infections caused by S . pyogenes were identified . The annual incidence rates (number of episodes/1,000 admissions) were: 0.13 (1995), 0.20 (1996), 0.27 (1997), and 0.23 (1998) . The mean age of patients was 41 years . Seventy four percent of patients had some underlying disease, and the most relevant conditions included: diabetes mellitus (5), parenteral drug abuse (4), chronic alcoholism (3), chronic liver disease (3) and infection with the human immunodeficiency virus (3).The most common portal of entry was the skin (78%) . The initial clinical presenting form was cellulitis (39%) . Necrotizing fasciitis, septic shock, and streptococcal toxic shock syndrome (STSS) were observed in 9.6%, 12.9%, and 6.4% of patients, respectively . The mortality rate was 16.1%.The phenotypic characterization of S . pyogenes isolates indicated that most isolates were of mucoid type and identified 11 different M serotypes, M1 being the most common . CONCLUSIONS: A steady increase in the incidence of invassive infections caused by S . pyogenes was observed since 1995 to 1997 in our hospital . Patients with certain underlying conditions are more susceptible to acquire these infections . The worst outcome of these infections corresponded to elderly patients, those with septic shock or STSS . Most strains responsible for these infections were encapsulated and the M1 serotype predominated. Acta Trop, 2001 Oct 22, 80(2), 169 - 75 Necrotizing fasciitis: a 10-year retrospective study of cases in a single university hospital in Oman; Rangaswamy M; OBJECTIVE: (1) To study the clinical profile of all cases of necrotizing fasciitis (NF) diagnosed in a university hospital in Oman . (2) To evolve a strategy for early diagnosis . PATIENTS AND METHODS: The inpatient records of the Sultan Qaboos University hospital from 1990-99 were searched for the words "fasciitis", "necrosis" or "gangrene" and cases of NF (defined as a soft tissue infection characterized by widespread necrosis of the subcutaneous tissues confirmed at surgery or pathology or both) were selected and analyzed . Cases with necrosis due to other obvious causes were excluded . RESULTS: Of the seven cases of NF (hospital incidence-8.4/10(5)), there were three post-operative, three spontaneous and one post-traumatic . Sites involved: upper limb (1), lower limb (2), abdomen (2), gluteal (1), and breasts (1) . The median age was 50 years (range 21-85) and the male:female ratio was 4:3 . All patients had local pain out of proportion to the signs and six had fever . Hypotension, liver or kidney dysfunction or coagulopathy were seen in four and a drop in haemoglobin was seen in six . In none was NF even considered by the referring or admitting physician, diagnosis being delayed by 2-10 days . In four cases a diagnostic incision under local anesthesia revealed the correct diagnosis . At surgery, extensive fascial and fat necrosis were seen in all, but only two had myonecrosis . The commonest isolate was beta-hemolytic group D streptococcus (4/7) . Blood and tissue were positive for beta-hemolytic group A streptococci in one fatal case . Mean hospital stay was 54.5 days (11-134), mean surgical procedures were 2.3 per case, two required ICU admission with one death . CONCLUSION: NF is a rare but serious bacterial disease that is often incorrectly diagnosed . Unexplained severe local pain, deep tenderness without impressive local signs, fall in haemoglobin, organ system dysfunction and constitutional upsets were regular features . A high index of suspicion and immediate direct inspection of the fascia facilitates an early diagnosis. Infect Immun, 2001 Nov, 69(11), 6683 - 8 Absence of a cysteine protease effect on bacterial virulence in two murine models of human invasive group A streptococcal infection; Ashbaugh CD et al.; The cysteine protease of group A streptococci has been suggested to contribute to the pathogenesis of invasive infection through degradation of host tissue, activation of the host inflammatory response, release of protective molecules from the bacterial cell surface, or other mechanisms . However, studies of the effects on virulence of inactivating the cysteine protease gene speB have yielded conflicting results . In some reports, a speB mutant was relatively avirulent in mouse models of invasive infection whereas little or no attenuation of virulence was observed in other studies of similar mutant strains . Possible reasons for these discordant results include differences in the streptococcal strains from which the speB mutants were derived, differences in the infection models employed, or unintended effects on another virulence determinant(s) that arose during the derivation of a speB mutant . We attempted to clarify these issues by characterizing the phenotypic properties and relative virulence in mice of two speB mutant strains, both derived from wild-type strain AM3: speB mutant AM3speB, which has been shown to be markedly attenuated in virulence in mice after intraperitoneal or subcutaneous challenge, and AM3speBOmega, a new mutant strain derived for this investigation . Both mutant strains were negative for protease activity, as expected, and both produced wild-type amounts of type 3 M protein and streptolysin O . However, AM3speB produced significantly less cell-associated hyaluronic acid capsule than did parent strain AM3 or strain AM3speBOmega . Compared to wild-type strain AM3, AM3speB was more sensitive to opsonophagocytic killing in vitro and was significantly less virulent in mice after intraperitoneal challenge . By contrast, AM3speBOmega was fully resistant to phagocytosis and did not differ significantly from the wild-type strain in mouse virulence after an intraperitoneal or subcutaneous challenge . We concluded that previous reports attributing loss of virulence in strain AM3speB to inactivation of speB are in error . Within the limitations of the models used, we found no effect of cysteine protease on invasive streptococcal infection. Surg Neurol, 2001 Sep, 56(3), 189 - 94 Streptococcal brain abscess: analysis of clinical features in 20 patients; Su TM et al.; BACKGROUND: To assess the clinical features and therapeutic outcomes of brain abscess caused by streptococci . METHODS: Twenty patients, 18 males and 2 females, aged 3 to 76 years, collected over a 14-year period, have been identified at Kaohsiung Chang Gung Memorial Hospital . RESULTS: Among these 20 patients, 13 had viridans streptococci infection alone, one had non-A, non-B, and non-D streptococci infection alone, and the other 6 had mixed infections each including streptococci . The locations of all of the abscesses were supratentorial . Among these patients, 18 had a single abscess and 2 had multiple abscesses . Underlying conditions were common in our patients, including head trauma, heart disease, otopharyngeal infection, and medical procedures . Nineteen patients were treated surgically and 1 was treated with antibiotics alone . Nineteen survived and 1 died, with an overall mortality rate of 5% . CONCLUSION: The clinical presentations and underlying conditions varied according to the different streptococcal species . Streptococcal brain abscesses accounted for 17% of our cases with brain abscesses, and 30% of our streptococcal infections had polymicrobial infections . Although streptococcal brain abscesses were commonly associated with otopharyngeal infections or infectious endocarditis, they also appeared to be often related to neurosurgical events or medical procedures in recent years . Based on our study, prognosis is favorable with early diagnosis and prompt treatment. Rev Argent Microbiol, 2001 Jul-Sep, 33(3), 167 - 76 {Cryptosporidium y Giardia in surface water}; Abramovich BL et al.; The aim of this work was to determine Giardia and Cryptosporidium levels in surface water used either as recreational or drinking water source, and to estimate the relationship with bacteriological and physicochemical parameters determining water quality . This study was carried out during 22 months, in Santa Fe and Santo Tome cities (Santa Fe Province, Argentina) . Cryptosporidium from 100% of the recreational samples (44-2404 oocysts/100 l) and from 92% of water sources (< 20-539 oocysts/100 l) was detected, while Giardia was found in lower concentrations and frequencies: 72% (< 20-670 cysts/100 l) and 31% (< 20-65 cysts/100 l), respectively . Statistically significant relationships were found between these parasites and organic matter, turbidity and bacteriological indicators of contamination (Escherichia coli, streptococci, Enterococcus spp, Pseudomonas aeruginosa) . These relationships, however, vary according to the sampling place, the source and levels of contamination. Plasmid, 2001 Sep, 46(2), 140 - 8 Thermosensitive suicide vectors for gene replacement in Streptococcus suis; Takamatsu D et al.; Three thermosensitive (Ts) suicide vectors, pSET4s, pSET5s, and pSET6s, have been constructed for gene replacement in Streptococcus suis . Each vector contains an antibiotic-resistance gene (spc or cat), a Ts replication origin of pWV01 lineage, multiple cloning sites, lacZ', and the ColE1 replication origin of pUC19 . These vectors could be propagated at 37 degrees C in Escherichia coli, but their replication was blocked above 37 degrees C in S . suis . Moreover, the thermosensitivity of the replication origin was confirmed in S . equi ssp . equi, S . equi ssp . zooepidemicus, and S . dysgalactiae by using pSET4s . For inactivation of the sly gene, which encodes a thiol-activated hemolysin of S . suis, pSLYK, in which the sly gene was interrupted by the cat gene, was constructed using pSET4s and introduced into S . suis DAT2 . After growth at the nonpermissive temperature under the antibiotic pressure, the chromosomal sly gene was replaced with the sly::cat gene of pSLYK by a double-crossover event at a rate of 2.6% among chloramphenicol-resistant cells . Moreover, complementation of the sly gene by use of the previously reported S . suis-E . coli shuttle vector pSET2 was demonstrated . These results indicate that the Ts suicide vectors described here will facilitate the genetic analysis of S . suis and other streptococci of veterinary importance by means of allelic exchange of the genes of interest via homologous recombination . J Allergy Clin Immunol, 2001 Oct, 108(4 Suppl), S107 - 10 Use of intravenous immunoglobulin in the treatment of staphylococcal and streptococcal toxic shock syndromes and related illnesses; Schlievert PM; Pyrogenic toxin superantigens comprise a large family of exotoxins made by Staphylococcus aureus and group A streptococci . These toxins include toxic shock syndrome toxin-1, the staphylococcal enterotoxins, and the streptococcal pyrogenic exotoxins (synonyms: scarlet fever toxins and erythrogenic toxins), all of which have the ability to cause toxic shock syndromes and related illnesses . These toxins have a similar three-dimensional structure that allows them to interact with relatively invariant regions of major histocompatibility complex class II molecules on the surface of antigen-presenting cells and with certain variable regions of the T-cell receptor-beta chain . The consequence of these interactions (and other immunobiological properties of the toxins) is the exaggerated release of bioactive cytokines . The latter molecules are responsible for the clinical signs of illness associated with these toxins. J Antimicrob Chemother, 2001 Oct, 48(4), 579 - 82 Change of antimicrobial susceptibility of group B streptococci over 15 years in Japan; Matsubara K et al.; We compared antimicrobial susceptibility patterns of 206 group B streptococcal (GBS) strains isolated from pregnant women and six from neonates/infants with invasive infection during the two periods 1985-1986 and 1999-2000 . All strains in both periods were susceptible to the penicillins, cephalosporins and carbapenem tested . Seven (3%) isolates were resistant to erythromycin and three (1%) were resistant to clindamycin . There were no significant differences between the two study periods in the incidence of GBS resistant to the 14 antibiotics tested . These results showed that penicillins are still the first choice to prevent vertical transmission of GBS in Japan. Cell Microbiol, 2001 Oct, 3(10), 703 - 12 NF-kappaB and the MAP kinases/AP-1 pathways are both involved in interleukin-6 and interleukin-8 expression in fibroblast-like synoviocytes stimulated by protein I/II, a modulin from oral streptococci; Neff L et al.; As in rheumatoid arthritis (RA), it was demonstrated recently that bacterial fragments of DNA or rRNA are present in the joint and therefore could play a role in inducing or perpetuating the disease, this work was initiated to define mechanisms that account for the stimulatory activities of the oral streptococcal modulin, protein I/II, on fibroblast-like synoviocytes (FLSs) from RA patients . FLSs from RA patients were stimulated with protein I/II, and expression of interleukin (IL)-6 and IL-8 mRNA was evaluated by reverse transcription-polymerase chain reaction (RT-PCR) . Immunoblotting by antibodies specific for activated forms of MAPKs and electrophoretic mobility shift assays (EMSAs) were performed to study downstream signalling, which allowed the synthesis of IL-6 and IL-8 . We reported that protein I/II interactions with FLSs from RA patients trigger the synthesis and release of IL-6 and IL-8 . We also demonstrated that protein I/II enhances the phosphorylation of ERK 1/2, p38 and JNKs and that ERK 1/2 and JNK MAPKs seem to play a more important role than p38 in protein I/II-mediated synthesis of IL-6 and IL-8 . Our experiments also indicated that stimulation of FLSs with protein I/II induces nuclear translocation of NF-kappaB, AP-1-binding activity and that NF-kappaB plays a major role in IL-6 and IL-8 secretion from activated cells. Cutis, 2001 Sep, 68(3), 183 - 4 Two familial cases of perianal streptococcal dermatitis; Lunghi F et al.; Two cases of perianal streptococcal dermatitis (PSD) occurred in a brother and sister, aged 4 and 6 years, respectively . The diagnosis was confirmed by the detection of group A beta-hemolytic streptococci in the perineal area and pharynx of both patients . We emphasize the importance of a quick and accurate diagnosis of the infection because PSD is frequently confused with other perianal diseases of infancy. J Clin Microbiol, 2001 Oct, 39(10), 3520 - 3 Granulicatella and Abiotrophia species from human clinical specimens; Christensen JJ et al.; One hundred one isolates of nutritionally variant streptococci from 97 patients were phenotypically characterized and compared with the type strains of Granulicatella adiacens (formerly Abiotrophia adiacens) (ATCC 49175(T)) Abiotrophia defectiva (ATCC 49176(T)), and Granulicatella elegans (formerly Abiotrophia elegans) (DSM 11693(T)) . Of the isolates, 55 and 43 resembled G . adiacens and A . defectiva, respectively, while 3 strains resembled G . elegans . Phenotypic characteristics useful in differentiating between species within the genera Granulicatella and Abiotrophia (G . adiacens, G . elegans, Granulicatella balaenopterae, and A . defectiva) were production of alpha- and beta-galactosidase; production of beta-glucuronidase; hippurate hydrolysis; arginine dihydrolase activity; and acid production from trehalose, sucrose, pullulan, and tagatose . From the reports submitted with the specimens, the clinical diagnosis was endocarditis in 58% of patients and septicemia or bacteremia in 26% of patients. J Dairy Sci, 2001 Sep, 84(9), 2036 - 43 Environmental gram-positive mastitis treatment: in vitro sensitivity and bacteriologic cure; Cattell MB et al.; A clinical trial was conducted in a large dairy herd to determine the efficacy of intramammary pirlimycin hydrochloride administration during lactation for bacteriologic clearance of gram-positive environmental clinical and subclinical mastitis infections . Quarters infected with environmental streptococci that received pirlimycin therapy (13/28) were 1.8 times more likely to resolve infection than untreated quarters (5/14) . The small numbers of quarters infected with coagulase-negative staphylococci resulted in inadequate power to assess treatment differences in cure rate . Although the association was not statistically significant, quarters from cows with sensitive environmental streptococci isolates from composite samples (8/13) resolved infection with treatment at approximately twice the rate of treated quarters with resistant isolates (3/10). J Am Board Fam Pract, 2001 Sep-Oct, 14(5), 375 - 80 Group A streptococcal sepsis and ovarian vein thrombosis after an uncomplicated vaginal delivery; Gourlay M et al.; BACKGROUND: Group A streptococcal puerperal sepsis is an uncommon peripartum infection that can quickly progress to a fulminant, multisystemic infection and life-threatening toxin-mediated shock . This infection can be asymptomatic during a short hospital stay after a routine delivery . Early treatment with antibiotics might not alter the course of tissue destruction caused by the exotoxin A . METHODS: Literature searches were performed using the key words "puerperal infections," "streptococcal infections," "septic sacroiliitis," "postpartum septic arthritis," and "postpartum ovarian vein thrombosis." After patient consent was obtained, a report was prepared documenting the disease course, diagnosis, and treatment of a case of puerperal sepsis with multiple serious complications . RESULTS AND CONCLUSION: Puerperal sepsis occurs when streptococci colonizing the genital tract or acquired nosocomially invade the endometrium, adjacent structures, lymphatics, and bloodstream . A lack of symptoms early in the course of infection is common; later, minor somatic complaints can quickly progress to septic shock as effects of the exotoxin A are manifest . Women who complain of fever, pelvic pain, or unexplained systemic symptoms in the early postpartum period should have a detailed history and physical examination . All sites of suspected infection should be cultured . If sepsis is suspected, diagnostic imaging includes chest radiographs, contrast-enhanced computed tomographic scans, or magnetic resonance imaging to rule out ovarian vein thrombosis, pelvic abscess, or sacroiliac septic arthritis . Broad-spectrum antibiotic coverage must be initiated immediately after collection of cultures . Clindamycin plus a beta-lactam antibiotic is preferred for streptococcal toxic shock syndrome. Biochem J, 2001 Oct 1, 359(Pt 1), 243 - 8 Human salivary agglutinin binds to lung surfactant protein-D and is identical with scavenger receptor protein gp-340; Ligtenberg TJ et al.; Salivary agglutinin is a 300-400 kDa salivary glycoprotein that binds to antigen B polypeptides of oral streptococci, thereby playing a role in their colonization and the development of caries . A mass spectrum was recorded of a trypsin digest of agglutinin . A dominant peak of 1460 Da was sequenced by quadrupole time-of-flight (Q-TOF) tandem MS . The sequence showed 100% identity with part of the scavenger receptor cysteine-rich ('SRCR') domain found in gp-340/DMBT1 (deleted in malignant brain tumours-1) . The mass spectrum revealed 11 peaks with an identical mass as a computer-simulated trypsin digest of gp-340 . gp-340 is a 340 kDa glycoprotein isolated from bronchoalveolar lavage fluid that binds specifically to lung surfactant protein-D . DMBT1 is a candidate tumour suppressor gene . A search in the human genome revealed only one copy of this gene . The molecular mass, as judged from SDS/PAGE and the amino acid composition of agglutinin, was found to be nearly identical with that of gp-340 . It was shown by Western blotting that monoclonal antibodies against gp-340 reacted with salivary agglutinin, and monoclonals against agglutinin reacted with gp-340 . It was demonstrated that gp-340 and agglutinin bound in a similar way to Streptococcus mutans and surfactant protein-D . Histochemically, the distribution of gp-340 in the submandibular salivary glands was identical with the agglutinin distribution, as shown in a previous paper {Takano, Bogert, Malamud, Lally and Hand (1991) Anat . Rec . 230, 307-318} . We conclude that agglutinin is identical with gp-340, and that this molecule interacts with S . mutans and surfactant protein-D. Indian J Pediatr, 2001 Aug, 68(8), 715 - 7 Neonatal sepsis: Staphylococcus aureus as the predominant pathogen; Karthikeyan G et al.; 96 consecutive inborn neonates with blood culture proven bacterial sepsis during the period January to June 1997 were studied . Lethargy with refusal of feeds (28%), fever (28%) and respiratory distress (31.3%) were the major presenting features . Half of them (n = 48) were of early onset (< 48 hours) and the remaining half were of late onset (> 48 hours) . Staphylococcus aureus (n = 59, 61.5%) was the predominant pathogen and 66% of them were methicillin resistant followed by Klebsiella pneumoniae (n = 24, 21.9), Escherichia coli (n = 13, 13.5%) and streptococci (n = 3, 3.1%) . Antibiotic resistance was common, with the sensitivity to various antibiotics being ampicillin 19%, gentamicin 21.6%, cefotaxime 32.8%, amikacin 50%, chloromycetin 59.6% and ciprofloxacin 90.3%. J Microbiol Immunol Infect, 1999 Jun, 32(2), 126 - 8 Lemierre's syndrome caused by viridans streptococci: a case report; Tsai MS et al.; A 53-year-old man had fever, chills, and a progressively enlarged mass over the left mandibular angle for one month . A chest radiograph showed two small nodules in the upper right lung field . A contrast-medium-enhanced head-and-neck computed tomograph revealed severe necrosis within the left lateral pharyngeal space and total obliteration of the left internal jugular vein . Viridans streptococci were identified in the blood culture and the debrided tissue culture 2 days post-admission . The presentations were characteristic of Lemierre's syndrome and were evident in this case, however, the causative agent was viridans streptococci and the host was much older than the others previously reported . The normal flora of the oropharynx could become a fatal bacterium when the intact mucosal barrier of the mouth is impaired, regardless of the patient's age. Chemotherapy, 2001 Sep-Oct, 47(5), 332 - 43 Comparative activity of cefditoren and other oral beta-lactams against nonpneumococcal streptococci; Thornsberry C et al.; BACKGROUND: In vitro studies of cefditoren activity have focused primarily on Streptococcus pneumoniae and other bacterial species isolated from patients with respiratory infections, but relatively few reports have been published describing the activity of cefditoren against clinical isolates of nonpneumococcal streptococci . METHODS: Cefditoren activity was determined by broth microdilution (M7-A5, NCCLS, 2000) for 450 viridans group streptococci, 917 Streptococcus pyogenes and 800 other beta-hemolytic streptococci collected throughout the US during 1999-2000 . RESULTS: Against viridans group streptococci, cefditoren (MIC(90), 0.5 microg/ml) was 4- to 32-fold more active than the other beta-lactams tested (penicillin ampicillin, amoxicillin-clavulanate, cefprozil and cefuroxime) . The difference in activity between cefditoren and the other beta-lactams was greater for penicillin-nonsusceptible isolates (MIC(90s), 1 microg/ml versus 8-32 microg/ml) than among penicillin-susceptible isolates (MIC(90s), 0.12 versus 0.25- 1 microg/ml) . Cefditoren also demonstrated potent activity against S . pyogenes (MIC(90), 0.015 microg/ml) and other beta-hemolytic streptococci (MIC(90), 0.06 microg/ml), comparable to that of the other beta-lactams . CONCLUSIONS: The activity demonstrated by cefditoren against nonpneumococcal streptococci, including beta-lactam- and macrolide-resistant isolates, suggests that this agent holds promise as therapy for infections caused by all clinically significant species of streptococci . Curr Infect Dis Rep, 2001 Oct, 3(5), 461 - 465 Recent Considerations in Recurrent Cellulitis; Baddour LM; Cellulitis is a frequently diagnosed syndrome that causes considerable morbidity . For a subset of patients, recurrent bouts of infection impact their quality of life . Most cases are due to beta-hemolytic streptococci or Staphylococcus aureus . Inclusion of interdigital space (toe web) or mucosal (anal) swab cultures may increase the ability to define pathogens among patients with lower extremity cellulitis . The pathogenesis of cellulitis is complex, and more work is needed so that novel therapies and vaccines can be developed to improve treatment and prevention of this disorder. JAMA, 2001 Sep 12, 286(10), 1181 - 6 Antibiotic treatment of adults with sore throat by community primary care physicians: a national survey, 1989-1999; Linder JA et al.; CONTEXT: Most sore throats are due to viral upper respiratory tract infections . Group A beta-hemolytic streptococci (GABHS), the only common cause of sore throat warranting antibiotics, is cultured in 5% to 17% of adults with sore throat . The frequency of antibiotic use for pharyngitis has greatly exceeded the prevalence of GABHS, but less is known about specific classes of antibiotics used . Only penicillin and erythromycin are recommended as first-line antibiotics against GABHS . OBJECTIVES: To measure trends in antibiotic use for adults with sore throat and to determine predictors of antibiotic use and nonrecommended antibiotic use . DESIGN, SETTING, AND SUBJECTS: Retrospective analysis of 2244 visits to primary care physicians in office-based practices in the National Ambulatory Medical Care Survey, 1989-1999, by adults with a chief complaint of sore throat . MAIN OUTCOME MEASURES: Treatment with antibiotics and treatment with nonrecommended antibiotics, extrapolated to US annual national rates . RESULTS: There were an estimated 6.7 million annual visits in the United States by adults with sore throat between 1989 and 1999 . Antibiotics were used in 73% (95% confidence interval {CI}, 70%-76%) of visits . Patients treated with antibiotics were given nonrecommended antibiotics in 68% (95% CI, 64%-72%) of visits . From 1989 to 1999, there was a significant decrease in use of penicillin and erythromycin and an increase in use of nonrecommended antibiotics, especially extended-spectrum macrolides and extended-spectrum fluoroquinolones (P<.001 for all trends) . In multivariable modeling, increasing patient age (odds ratio {OR}, 0.86 per decade; 95% CI, 0.79-0.94) and general practice specialty (OR, 1.54 compared with family practice specialty; 95% CI, 1.10-2.14) were independent predictors of antibiotic use . Among patients receiving antibiotics, nonrecommended antibiotic use became more frequent over time (OR, 1.17 per year; 95% CI, 1.11-1.24) . CONCLUSIONS: More than half of adults are treated with antibiotics for sore throat by community primary care physicians . Use of nonrecommended, more expensive, broader-spectrum antibiotics is frequent. Lett Appl Microbiol, 2001 Sep, 33(3), 188 - 92 The ability of direct fluorescence-based, two-colour assays to detect different physiological states of oral streptococci; Decker EM; AIMS: To investigate the ability of six fluorescent-based, two-colour viability assays to detect different physiological growth stages of two oral streptococci species . METHODS AND RESULTS: The growth of Streptococcus sanguinis and Strep . mutans from 0 to 73 h culture periods was monitored by cell labelling with six mixtures of fluorescent stains, in addition to the growth parameters optical density (O.D.), log values of the total cell counts (log BC ml(-1)) and of the colony-forming units (log cfu ml(-1)) . CONCLUSION: In comparison with the corresponding cfu values as control, the vitality proportions determined by the Syto 9/PI test best reflected the dynamic growth pattern of both test strains . The direct fluorescent-based, two-colour assay Syto 9/PI provides valuable information about microbial viability stages . SIGNIFICANCE AND IMPACT OF THE STUDY: The detection of viable but non-culturable bacteria requires more precise direct methods such as the fluorescent staining technique presented here, in addition to the classical plate count method. Zh Mikrobiol Epidemiol Immunobiol, 2001 May-Jun, (3), 99 - 105 {Invasive infection caused Streptococcus group A and streptococcal toxic shock syndrome}; Danilova TA; Modern data on the etiology and pathogenesis of invasive streptococcal infection and the syndrome of streptococcal toxic shock are presented . In the course of the last 10-15 years essential changes in the system of interaction of group A streptococci and the macroorganism have been noted . The growth of morbidity in severe invasive forms of streptococcal infection with different clinical manifestations, including the syndrome of toxic shock, is observed . Most often this disease develops in elderly people, making up a group of risk, but sometimes affects healthy young people . Different pathogenicity factors of streptococci, capable of inducing the development of infection, are analyzed . Special attention is given to superantigens: pyrogenic toxins and M-protein . The suggestion that the development of the disease is seemingly linked with the state of specific protective immunity is substantiated . In spite of achievements in the field of the microbiology and immunology of group A streptococci, the causes of the appearance and development of invasive streptococcal infection have not yet been determined. J Infect Dis, 2001 Oct 1, 184(7), 846 - 52 Epub 2001 Aug 29. Genetic control of susceptibility to group A streptococcal infection in mice; Medina E et al.; The influence of genetic background on the ability to control infection with group A streptococci was investigated in different inbred strains of mice . Whereas BALB/c, C57BL/10, and DBA/2 mice were the most resistant strains, with lower bacteria loads and higher survival times, C3H/HeN and CBA/J mice exhibited substantially higher bacterial growth and 100% mortality . Differences in susceptibility were not dependent on the inoculum size . Resistance was influenced by sex, with males being much more susceptible than females . B cell- and T cell-deficient mice from the resistant background were as resistant to infection as were immunocompetent mice, which suggests that the effector mechanisms are independent of adaptive immunity . These results demonstrate for the first time the influence of genetic background and sex on susceptibility to infection with Streptococcus pyogenes in mice . The use of this mouse model of group A streptococcal infection will allow for a better definition of parameters involved in the outcome of the disease. N Z Dent J, 1986 Jul, 82(369), 84 - 6 Adherence of Streptococcus sanguis; Jenkinson HF; The presence of adhesins on the cell surface of S . sanguis enables the organism to grow and survive in the oral cavity . Many workers are now actively involved in attempting to characterise these adhesins and the molecular basis for adherence of various streptococci . The complexity of the adhesion processes is underlined by the many varied opinions as to the nature of the molecular components and biochemical interactions that are involved . Understanding the molecular mechanisms involved in bacterial adherence and in dental plaque formation will have significant impact on the prevention and treatment of oral diseases. Crit Care Med, 2001 Sep, 29(9), 1786 - 91 Effects of perfluorocarbons and perfluorocarbons/surfactant emulsions on growth and viability of group B streptococci and Escherichia coli; Rudiger M et al.; OBJECTIVE: Partial liquid ventilation with perfluorocarbons (PFC) might be used as a new ventilatory strategy to treat respiratory insufficiency in congenital pneumonia . The present study investigates for the first time effects of PFC on growth and viability of group B streptococci (GBS) and Escherichia coli, bacteria frequently causing congenital pneumonia . DESIGN: Prospective, in vitro study . SETTING: Research laboratory in a university . MATERIAL: Group B streptococci 090 Ia HD Colindale and E . coli K12, JM 101 . INTERVENTIONS: E . coli (10(7)/mL) were grown in the absence or presence of different PFC (RM 101, PF 5080, FO 6167) for up to 6 hrs . To study bacterial viability, GBS (5 x 10(7)/mL) were incubated in saline with or without different PFC, PFC/surfactant emulsions, or surfactant (Curosurf) for up to 5 hrs . Every 2 hrs, the colony forming units were determined by plating different dilutions of bacteria on agar . MEASUREMENTS AND MAIN RESULTS: RM 101 or PF 5080 alone and in emulsions with surfactant had no effect on viability of GBS or growth of E . coli . For FO 6167, a previously described toxicity was found, even if 1 mL of GBS suspension was incubated with only 100 microL of FO 6167, verifying the experimental design that guarantees a PFC bacteria contact . The toxic effects were almost prevented by forming a PFC-in-surfactant emulsion but not by preincubation of GBS with surfactant and subsequent FO 6167 exposure . CONCLUSION: RM 101 and PF 5080 did not influence bacterial growth in vitro; direct effects on bacterial proliferation during partial liquid ventilation in congenital pneumonia seem, therefore, unlikely . Interestingly, we found that the known toxic effects of FO 6167 can be prevented by covering PFC with a surfactant film . Surfactant reduced the cytotoxic effects of FO 6167, probably by preventing a direct contact between FO 6167 and the bacterial cell wall. Annu Rev Microbiol, 2001, 55, 77 - 104 Toxic shock syndrome and bacterial superantigens: an update; McCormick JK et al.; Toxic shock syndrome (TSS) is an acute onset illness characterized by fever, rash formation, and hypotension that can lead to multiple organ failure and lethal shock, as well as desquamation in patients that recover . The disease is caused by bacterial superantigens (SAGs) secreted from Staphylococcus aureus and group A streptococci . SAGs bypass normal antigen presentation by binding to class II major histocompatibility complex molecules on antigen-presenting cells and to specific variable regions on the beta-chain of the T-cell antigen receptor . Through this interaction, SAGs activate T cells at orders of magnitude above antigen-specific activation, resulting in massive cytokine release that is believed to be responsible for the most severe features of TSS . This review focuses on clinical and epidemiological aspects of TSS, as well as important developments in the genetics, biochemistry, immunology, and structural biology of SAGs . From the evolutionary relationships between these important toxins, we propose that there are five distinct groups of SAGs. BioDrugs, 2001, 15(8), 501 - 8 A vaccine against dental caries: an overview; Michalek SM et al.; Dental caries continues to be a costly and prevalent oral disease . Research efforts towards developing a well tolerated and effective vaccine against dental caries were initiated following the demonstration of a specific bacterial aetiology for this disease . The cariogenic mutans streptococci are the principal bacteria causing this disease . Specific immune defence against these bacteria is provided mainly by secretory immunoglobulin (Ig) A antibodies present in saliva, which are generated by the common mucosal immune system . Progress in the development of a vaccine against dental caries has increased due to both advancements in molecular biology and our understanding of the mucosal immune system and mucosal vaccines . Advancements in molecular biology have facilitated the cloning and functional characterisation of virulence factors of the mutans streptococci, including the cell-surface fibrillar proteins, which mediate adherence to the tooth surface, and the glucosyltransferase enzymes, which synthesise adhesive glucans and allow microbial accumulation on the teeth . Current strategies for immunisation against dental caries are using these virulence factors as key antigens and incorporating them into novel mucosal vaccine systems and delivering them with or without adjuvants to mucosal IgA inductive sites . The most popular routes of mucosal immunisation are via the oral or nasal route . The mucosal immune system is functional in newborn infants, who develop salivary IgA antibodies as they become colonised by oral micro-organisms . Mucosal immunisation strategies result in the induction of salivary IgA antibody responses and pose fewer problems than parenteral injection of antigen . Therefore, mucosal immunisation of infants prior to the appearance of their first teeth may be a well tolerated and effective way to induce immunity against the colonisation of teeth by mutans streptococci and protection against subsequent dental caries . The purpose of this article is to provide an overview of the recent progress on the development of a vaccine against infection by Streptococcus mutans for the prevention of dental caries, with emphasis on the mucosal immune system and vaccine design. Clin Neurol Neurosurg, 2001 Oct, 103(3), 137 - 42 Streptococcal meningitis in adults: therapeutic outcomes and prognostic factors; Lu CH et al.; Thirty-eight patients with streptococcal meningitis, aged 17-75 years, have been identified over a period of 13.5 years . Among these 38 patients, 35 had community-acquired infections, and the other three had nosocomial infections . Twelve of the 38 patients were found to have postneurosurgical forms and 26 to have spontaneous forms . These 38 cases of streptococci included Streptococcus (S.) pneumoniae in 19 cases, viridans group streptococci in 13, non-A, non-B, and non-D streptococci in three, Group D streptococci in one, and Group B streptococci (S . agalactiae) in two . Although one case was found to have penicillin-resistant S . pneumoniae PRSP in 1994, multi-antibiotic resistant strains were rare in this study . Therapeutic outcomes varied according to the different species of streptococci . In this study, the overall mortality rate was 34% . In the multiple logistic regression analysis, only initial consciousness level and the presence of seizure were strongly associated with the mortality rate even after other potentially confounding factors were adjusted for . Early diagnosis and the use of appropriate antibiotics are essential for survival. Mol Microbiol, 2001 Aug, 41(4), 925 - 35 Horizontal gene transfer and host specificity of beta-haemolytic streptococci: the role of a putative composite transposon containing scpB and lmb; Franken C et al.; Beta-haemolytic streptococci are important human and animal pathogens: their genetic traits that are associated with the ability to infect human hosts remain, however, unclear . The surface protein, Lmb, mediates the adherence of Streptococcus agalactiae to human laminin . For further analysis of the corresponding gene, the adjacent genomic regions were sequenced . Lmb is localized on a putative composite transposon of 16 kb and is flanked by two copies of a novel insertion sequence element (ISSag2) . It harbours the genes scpB and lmb, which are 98% identical with the respective genes of Streptococcus pyogenes . Analysis of the distribution of these genes and ISSag2 among 131 streptococcal strains revealed that all of the human isolates, but only 20% (12 of 61) of the animal isolates, contained scpB and lmb or their homologues . To investigate if the putative transposon can be mobilized, an erythromycin resistance marker was incorporated into the lmb gene of S . agalactiae . Screening for mutant strains with a regained susceptibility for erythromycin identified strains with a deletion of scpB, lmb, and one copy of ISSag2 . We hypothesize that a horizontal gene transfer caused the exchange of scpB and lmb and that the ability of S . pyogenes, S . agalactiae and group C and G streptococcal strains to colonize or infect human hosts is dependent on their presence. Mol Microbiol, 2001 Aug, 41(4), 817 - 26 Group A streptococcal phagocytosis resistance is independent of complement factor H and factor H-like protein 1 binding; Kotarsky H et al.; Factor H (FH) and factor H-like protein 1 (FHL-1) regulate complement activation through the alternative pathway . Several extracellular bacterial pathogens, prime targets for the complement system, bind FH and FHL-1, thereby acquiring a potential mechanism for minimizing complement deposition on their surface . For group A streptococci (GAS), surface-bound antiphagocytic M proteins mediate the interaction . To study the role of the FH-FHL-1 interaction for complement deposition and opsonophagocytosis of GAS, we first constructed a set of truncated M5 protein variants and expressed them on the surface of a homologous M-negative GAS strain . Binding experiments with the resulting strains demonstrated that the major FH-FHL-1 binding is located in a 42-amino-acid region within the N-terminal third of M5 . Measurement of bacteria-bound complement factor C3 after incubation in plasma showed that the presence of this region had little impact upon complement deposition through the alternative pathway . Moreover, streptococci expressing M5 proteins lacking the major FH and FHL-1 binding sequence resisted phagocytosis in human blood as efficiently as bacteria expressing the wild-type protein . Consequently, the data suggest that the binding of the regulators of the alternative pathway is of limited importance for GAS phagocytosis resistance. Mol Microbiol, 2001 Aug, 41(3), 561 - 73 De novo formation of focal complex-like structures in host cells by invading Streptococci; Ozeri V et al.; Group A streptococcus (GAS) induces its own entry into eukaryotic cells in vitro and in vivo . Fibronectin (Fn) bound to protein F1, a GAS surface protein, acts as a bridge connecting the bacterium to host cell integrins . This triggers clustering of integrins, which acquire a polar pattern of distribution similar to that of protein F1 on the GAS surface . A unique and transient adhesion complex is formed at the site of GAS entry, which does not contain alpha-actinin . Vinculin is recruited to the site of GAS entry but is not required for uptake . The invading GAS recruits focal adhesion kinase (FAK), which is required for uptake and is tyrosine phosphorylated . The Src kinases, Src, Yes and Fyn, enhance the efficiency of GAS uptake but are not absolutely required for GAS entry . In addition, Rac and Cdc42, but not Rho, are required for the entry process . We suggest a model in which integrin engagement by Fn-occupied protein F1 triggers two independent signalling pathways . One is initiated by FAK recruitment and tyrosine phosphorylation, whereas the other is initiated by the recruitment and activation of Rac . The two pathways subsequently converge to trigger actin rearrangement leading to bacterial uptake. Clin Diagn Lab Immunol, 2001 Sep, 8(5), 895 - 8 Identification of the psaA gene, coding for pneumococcal surface adhesin A, in viridans group streptococci other than Streptococcus pneumoniae; Jado I et al.; The gene encoding the pneumococcal surface adhesin A (PsaA) protein has been identified in three different viridans group streptococcal species . Comparative studies of the psaA gene identified in different pneumococcal isolates by sequencing PCR products showed a high degree of conservation among these strains . PsaA is encoded by an open reading frame of 930 bp . The analysis of this fragment in Streptococcus mitis, Streptococcus oralis, and Streptococcus anginosus strains revealed a sequence identity of 95, 94, and 90%, respectively, to the corresponding open reading frame of the previously reported Streptococcus pneumoniae serotype 6B strain . Our results confirm that psaA is present and detectable in heterologous bacterial species . The possible implications of these results for the suitability and potential use of PsaA in the identification and diagnosis of pneumococcal diseases are discussed. Nat Immunol, 2001 Sep, 2(9), 797 - 801 Autoimmunity provoked by infection: how good is the case for T cell epitope mimicry? Benoist C, Mathis D. Autoimmune diseases remain one of the mysteries that perplex immunologists . What makes the immune system, which has evolved to protect an organism from foreign invaders, turn on the organism itself? A popular answer to this question involves the lymphoid network's primordial function: autoimmunity is a by-product of the immune response to microbial infection . For decades there have been tantalizing associations between infectious agents and autoimmunity: beta-hemolytic streptococci and rheumatic fever; B3 Coxsackieviruses and myocarditis; Trypanosoma cruzi and Chagas' disease; diverse viruses and multiple sclerosis; Borrelia burgdorfii and Lyme arthritis; and B4 Coxsackievirus, cytomegalovirus or rubella and type 1 diabetes, to name the most frequently cited examples . In addition, animal models have provided direct evidence that infection with a particular microbe can incite a particular autoimmune disease . Nonetheless, many of the associations appear less than convincing and, even for those that seem to be on solid footing, there is no real understanding of the underlying mechanism(s). J Clin Microbiol, 2001 Sep, 39(9), 3373 - 5 Identification of Streptococcus pneumoniae revisited; Kellogg JA et al.; The sensitivities and specificities of several different diagnostic assays for Streptococcus pneumoniae were assessed using 99 clinical isolates of S . pneumoniae and 101 viridans streptococci and were as follows: Pneumoslide, 99 and 87%, respectively; Directigen, 100 and 85%, respectively; Phadebact, 100 and 98%, respectively; deoxycholate drop test, 99 and 98%, respectively; deoxycholate tube test, 100 and 99%, respectively; optochin, 99 and 98%, respectively; and Gram Positive Identification Card, 90 and 96%, respectively . Identification of clinical isolates of S . pneumoniae should be confirmed using one or more diagnostic assays with well-documented high (e.g., > or =95%) sensitivities and specificities. Burns, 2001 Sep, 27(6), 595 - 7 Bacteriology of burn wounds--the first three years in a new burn unit at the Medical College Chandigarh; Kaushik R et al.; A retrospective study was conducted at Government Medical College and Hospital, Chandigarh to analyse the bacterial isolates from the wounds of patients admitted to the Burns Unit and to determine the sensitivity pattern of the commonly cultured organisms over a 3-year period from May 1997 to May 2000 . A total of 336 samples were analysed, with 293 positive samples yielding 324 isolates . The isolates obtained from the culture of wound swabs were single in the majority of cases (78.0%) . Pseudomonas was the most commonly cultured organism (54.2%) followed by Staphylococcus aureus (20.8%) . Isolation of other organisms was uncommon by comparison . No isolates of beta-hemolytic streptococci or diptheroids were encountered. J Dent, 2001 May, 29(4), 247 - 54 Prevention of pit and fissure caries using an antimicrobial varnish: 9 month clinical evaluation; Joharji RM et al.; OBJECTIVE: The purpose of this study was to determine whether Cervitec--a chlorhexidine--containing varnish could reduce the development of pit and fissure caries in children . METHODS: One hundred children each in age groups 7-8 and 12-14 years were selected from schools in Riyadh, Saudi Arabia . To be included in the study, each child had to have at least two sound contra-lateral first or second permanent molars with deep fissures . A split mouth method was used with one test tooth and one control within the same jaw . The left or the right side was selected randomly for test or control . The plaque samples from the occlusal surfaces of the test and control and the saliva samples were collected at baseline examination and after 9 months to estimate the number of Streptococcus mutans by the strip mutans method of Jensen and Bratthall (Jensen B, Bratthall D . A new method for the estimation of mutans streptococci in human saliva . Journal of Dental Research 1989;68:468-471) . Cervitec varnish containing 1% chlorhexidine (CHx) and thymol was applied at baseline, at 3-4 months and at 6 months to the test tooth after isolation while the control had prophylaxis using cotton pellet in water each time the varnish was applied to the test tooth . Caries examination of the test and control followed after 9 months, according to the criteria and methods of WHO (World Health Organization . Oral Health Surveys . Basic Methods 4th ed., Geneva, WHO 1997).The blind technique was used in the diagnosis of caries and in the examination of the S . mutans count at the end of the study . RESULTS: Ninety four of the 7-8 year old and 86 of the 12-14 year old children completed the study . The results showed that the caries increment in both control groups of teeth after 9 months is significantly higher than in the test teeth (McNemar test: chi2 = 11.60, P < 0.001) . The rate of caries development in a fissure was significantly correlated to the plaque mutans score of that fissure and there was considerable reduction in the S . mutans count of the plaque in the test teeth compared with the control (Spearman Rank Correlation: P < 0.001) . CONCLUSION: It is concluded that the CHx varnish reduced the development of fissure caries significantly. Clin Infect Dis, 2001 Sep 15, 33(6), 751 - 6 Epub 2001 Aug 10. Group B streptococcal disease: from trials and tribulations to triumph and trepidation; Schuchat A; Group B streptococci garnered attention during the 1970s when they surpassed Escherichia coli and Staphylococcus aureus to become the principal causes of sepsis in early infancy . During the 1980s, several clinical trials demonstrated that administration of antimicrobial agents during labor could interrupt vertical transmission and prevent invasive disease in the first week of life (i.e., early-onset disease) . However, prophylaxis was not widely used during the next 10 years . On the basis of efforts by clinician-researchers, professional organizations, community-based parent advocacy groups, and the public health community, consensus recommendations for group B streptococcal prophylaxis were finally issued in 1996 . By the end of 1999, the incidence of early-onset disease in selected counties within the United States had decreased by 70%, and the gap between black and white persons with disease narrowed by 75% . This recent triumph leaves the professional community treading lightly, alert to the need to monitor for unintended consequences that may threaten recent progress. Vestn Otorinolaringol, 2001, (3), 50 - 1 {Causes of lethal outcomes in croup syndrome in children}; Savenkova MS et al.; The paper reports 40 cases of lethal outcomes in children with croup syndrome treated in Morozov Children's Moscow City Hospital in 1985-1998 . 92.5% of them died of severe pneumonia complications, 7.5%--of sepsis . 70% of the deceased were infants aged 0-2 years, 75% of them were boys . All the children had aggravated premorbid background . The sputum and organ tissues contained in most cases association of viruses with staphylococci and streptococci resistant to standard antibiotics (penicillin, ampicillin, cefazoline) . The conclusion is made that children with croup died primarily of severe pneumonia complications in low systemic reactivity and bacterial-viral association of the agents resistant to the antibacterial therapy. Pol Merkuriusz Lek, 2001 Jun, 10(60), 442 - 4 {Drug resistance of group B streptococci}; Dabrowska-Szponar M et al.; The group B streptococci (GBS) are one of the main infections' factors in neonates . The source of the infection is mother and the infection follows during childbirth . In many countries various methods of prophylaxis in reference to mother and neonate are introduced . Thus far the widest application have found a method of giving to pregnant women penicillins or cephalosporins . The purpose of the present work was to study how the drug-resistant of the GBS forms in our country and if using antibiotics in prophylactic purposes without doing any antibiograms is burdened with risk, resulted from the possibility of meeting resistant strains . 365 strains of the GBS, derived from colonised neonates, pregnant women and clinical materials were put to the scientific research . 120 animal strains isolated from events of mastitis in cows, represented the second group . The GBS, derived from pregnant women were sensitive to every examined antibiotics except lincomycin (5.9%) . Amid the streptococcus isolated from neonates there were some strains resistant to every examined antibiotic (1.9-4.4%) . More often resistant strains were isolated from clinical materials (3.9-9.0%) . The highest percentage of the resistant strains was identified in animals (7.5-20.0%) . The GBS as a rule were insensitive to cotrimoxasolum . As follows from our scientific researches, the GBS derived from people as a rule are sensitive to used antibiotics . But there were some strains resistant even to several antibiotics . Possibility of meeting these strains should be taken into consideration as in prophylaxis as in treatment of the infections . Amid the animal strains of the GBS the phenomenon of the resistance to antibiotics is more often met than in human ones. Semin Arthritis Rheum, 2001 Aug, 31(1), 43 - 51 Acute bacterial arthritis caused by group C streptococci; Gonzalez Teran B et al.; OBJECTIVES: To summarize the characteristics of and clinical experience with joint infection by group C streptococcus . METHODS: Two new cases of acute bacterial arthritis due to group C streptococci are reported, and a MEDLINE search was performed, which located 22 additional cases . RESULTS: Mean age (+/- standard deviation) of all 24 patients was 46 +/- 25 years, and most patients were men (75%) . The species most frequently identified was Streptococcus equisimilis (12 cases) . Eight patients (33%) had a general risk factor for infection, and the same percentage had some type of arthropathy . Only 3 patients had previous contact with animals . The infection was polyarticular in a third of cases, and the joint most frequently involved was the knee . The majority of patients showed a good response to the treatment with intravenous penicillin . However, 3 patients had functional sequelae, 2 more had residual radiological lesions, and 3 died . CONCLUSIONS: Acute bacterial arthritis due to group C streptococci is a serious but uncommon entity that can affect patients without risk factors . Rapid diagnosis and treatment may improve the outcome . Semin Arthritis Rheum 31:43-51 . Antimicrob Agents Chemother, 2001 Sep, 45(9), 2631 - 4 Interspecies recombination contributes minimally to fluoroquinolone resistance in Streptococcus pneumoniae; Bast DJ et al.; Analysis of 71 ciprofloxacin-resistant (MIC > or = 4 microg/ml) Streptococcus pneumoniae clinical isolates revealed only 1 for which the quinolone resistance-determining regions of the parC, parE, and gyrB genes were genetically related to those of viridans group streptococci . Our findings support the occurrence of interspecies recombination of type II topoisomerase genes; however, its contribution to the emergence of quinolone resistance among pneumococci appears to have been minimal. Diagn Microbiol Infect Dis, 2001 Jul, 40(3), 111 - 6 Correlation of MIC methods and tentative interpretive criteria for disk diffusion susceptibility testing using NCCLS methodology for fusidic acid; Skov R et al.; Three hundred and eight staphylococci and 43 Streptococcus pyogenes were tested by agar dilution, microbroth dilution, E-test, and disk diffusion using 5, 10 and 50 microg disks, as outlined by the NCCLS, in order to correlate the different MIC methods and to establish tentative species specific interpretive zone diameter breakpoints for fusidic acid . MIC results of the three methods were comparable . For Staphylococcus aureus, using MIC breakpoints of < or = 0.5 mg/L for susceptible and > or = 2 mg/L for resistant tentative interpretive zone diameters of > or = 20 mm and > or = 21 mm for susceptible and < or = 17 mm and < or = 18 mm for resistant are suggested for the 5 microg and the 10 microg disk, respectively . The 50 microg disk did not separate susceptible from resistant isolates . For streptococci a uniform MIC distribution of 2-8 mg/L was found. J Heart Valve Dis, 2001 Jul, 10(4), 478 - 85 Infective endocarditis of native cardiac valves: 22 years' surgical experience; Cotrufo M et al.; BACKGROUND AND AIM OF THE STUDY: Most previous studies on surgery for endocarditis included cases of both prosthetic and native valve endocarditis (NVE), which clearly differ in their course and prognosis . METHODS: Between February 1979 and July 2000, 199 patients underwent surgical treatment for NVE . The native valve was replaced in 185 patients, and repaired in 14 . Correlations between previous heart disease and site of NVE, site and etiology, site and embolism, and etiology and extracardiac infection were analyzed . Viability of echocardiography to identify NVE features was compared with surgical inspection . Risk factors for hospital, late mortality and recurrence were assessed by multivariate analysis, including preoperative, operative and postoperative variables . RESULTS: Streptococci were found in 52 cases (26.1%), mostly spreading from splanchnic (n = 10) and cutaneous (n = 9) infections; Staphylococci were found in 43 cases (21.6%), mostly from cutaneous foci (n = 20) . Tricuspid valve endocarditis was due to Staphylococcus sp . in all documented cases (11/15; p <0.001), while Streptococcus sp . predominated in the mitral (p = 0.026) position . Echocardiography was reliable in identifying anatomic features of NVE, except for periannular abscess (13 versus 31 found at surgery; p <0.001) . Hospital mortality was 6% (n = 12): preoperative NYHA class IV (p = 0.034) and emergency surgery (p = 0.001) were significant predictors of mortality . Average follow up was 57.2+/-4.4 months and was 96.3% complete . There were 27 late deaths (15%) . Actuarial survival was 75.7% at 10 years and 60.3% at 20 years . Low social status (p = 0.022), diabetes mellitus (p = 0.003), fever at time of surgery (p = 0.041) and persistent postoperative fever (p = 0.0002) were predictors for late mortality . Endocarditis recurred in 28 patients (15.5%), with 74.1% freedom at 10 years and 68.7% at 20 years . Drug abuse (p = 0.001), mitral endocarditis (p = 0.002), positive blood cultures (p = 0.0003), homograft implantation (p = 0.0012) and persistent postoperative fever (p <0.0001) were significant predictors for recurrence . CONCLUSION: Preoperative conditions of patients with NVE significantly affect early and long-term outcomes . Prognosis is worsened by delayed diagnosis and operation during the active septic process. New Microbiol, 2001 Jul, 24(3), 281 - 8 Salivary levels of mutans streptococci associated with restorations: a case-control study; Petti S et al.; Our aim was to estimate whether restorative therapy with amalgam and composite resin could decrease salivary mutans streptococcal level, thus also decreasing the risk for other caries development . We selected a case group of 93 children with detectable salivary mutans levels (i.e., at least 1x10(4) cfu/ml), and a control group (n=93 subjects) with undetectable levels . Children had the same age (12 years), no extracted teeth, crowns, temporary fillings, and restorations other than amalgam and composite resin, and the two groups had similar gender distribution . We clinically examined children and recorded active caries, restorations and oral hygiene level by means of gingival bleeding on probing; we also investigated sucrose intake at breakfast . The case group had statistically significant higher prevalence of restorations (36.6% vs . 18.3%), active caries (44.1% vs . 12.9%), and bad oral hygiene (84.9% vs . 68.8%) than the control group . However, the logistic regression analysis showed that presence of active caries was the only significant variable associated with mutans streptococci (OR=4.0; p=0.0002), while the effects of sucrose intake and of restorations were marginally significant . This apparent contrast between statistical analyses was due to the concomitant presence, in children with detectable mutans streptococci level, of restorations and decayed teeth at the same time, and, on the basis of the multivariate analysis, presence of mutans streptococci in these children was explained by the presence of active caries, more than restorations. J Infect Dis, 2001 Sep 1, 184(5), 597 - 605 Epub 2001 Jul 31. Platelet microbicidal activity is an important defense factor against viridans streptococcal endocarditis; Dankert J et al.; To study the role of platelet microbicidal activity in host defense against infective endocarditis (IE) due to viridans streptococci (VS), the susceptibility to platelet releasate of blood and oral VS isolates from patients with and without IE was compared . The influence of neutralization of platelet microbicidal activity was studied in 2 experimental IE models . Resistance to platelet releasate was more prevalent among VS from blood of patients with IE than from blood of bacteremic patients without IE and among oral VS isolates . Serum from rabbits vaccinated with human platelet sonicate supernatants neutralized human and rabbit platelet-released microbicidal activity and had antibodies recognizing microbicidal proteins thrombocidin-1 and -2 and other human platelet proteins . In the 2 rabbit IE models, vaccination increased the susceptibility to experimental IE due to platelet releasate-susceptible VS . Thus, platelet-released microbicidal activity is an important host defense factor against IE due to VS. J Trauma, 2001 Aug, 51(2), 352 - 5 Antibiotic prophylaxis for group A streptococcal burn wound infection is not necessary; Sheridan RL et al.; BACKGROUND: Historically, group A beta-hemolytic streptococci (GAS) burn wound infection has been a major source of morbidity and mortality in burn patients and has prompted the prophylactic administration of antibiotics to children with burns . Wound monitoring, surveillance cultures, and early excision of deep wounds may have changed this . Our objective in this project was to determine the efficacy of routine antibiotic prophylaxis in the era of early excision and closure of deep burn wounds . METHODS: Two cohorts of burned children were compared: all children admitted during calendar years 1992 through 1994 (group 1) and during calendar years 1995 through 1997 (group 2) . All group 1 children received routine GAS antibiotic prophylaxis . Only those group 2 children with documented positive admission or surveillance cultures for GAS were treated . RESULTS: There were 511 children in group 1 and 406 children in group 2 . They were well matched for age (4.7 +/- 0.21 years vs . 5.3 +/- 0.26 years, p = 0.06) and burn size (11.0% +/- 0.7% vs . 12.4% +/- 0.8%, p = 0.18) . GAS species were recovered at admission or during hospitalization from 11 (2.6%) of group 1 children and 18 (4.4%) of group 2 children (p = 0.05), indicating a marginally higher rate of carriage in group 2 . Nevertheless, in group 1 there were three (0.6%) who developed GAS wound infection and in group 2 there were four (0.98%, p = 0.71) . The incidence of GAS infection in those patients with positive admission cultures was three (27%) of group 1 and four (22%) of group 2 . No child developed fulminant GAS infection . CONCLUSION: Routine antibiotic prophylaxis of burn wounds in children in not effective in further reducing a low baseline incidence of GAS wound infection if admission screening by culture is used to identify those children who carry the organism and early excision of deep burns is practiced. Int J Syst Evol Microbiol, 2001 Jul, 51(Pt 4), 1277 - 81 Streptococcus australis sp . nov., a novel oral streptococcus; Willcox MD et al.; Strains of streptococci were isolated from the mouths of children attending the United Dental Hospital, Sydney, Australia . These strains were analysed biochemically using the Rapid ID32 Strep microsystem, were subjected to DNA-DNA hybridization with other members of the oral streptococci and had their 165 rRNA analysed . On the basis of DNA-DNA hybridization, their nearest relative was Streptococcus parasanguinis, whereas, on the basis of 16S rRNA analysis, it was Streptococcus infantis . The name Streptococcus australis sp . nov . is proposed for the new species . The type strain is AI-1T (= ATCC 700641T = NCTC 13166T). J Natl Med Assoc, 2001 Jul-Aug, 93(7-8), 276 - 7 Streptococcus milleri: a cause of pyogenic liver abscess; Dorvilus P et al.; We report a case of Streptococcus milleri in a patient with a history of hypertension, alcohol abuse, and tobacco smoking . S . milleri is associated with liver abscesses much more frequently than other streptococci. J Bacteriol, 2001 Sep, 183(17), 5145 - 54 Diversity of Streptococcus salivarius ptsH mutants that can be isolated in the presence of 2-deoxyglucose and galactose and characterization of two mutants synthesizing reduced levels of HPr, a phosphocarrier of the phosphoenolpyruvate:sugar phosphotransferase system; Thomas S et al.; In streptococci, HPr, a phosphocarrier of the phosphoenolpyruvate:sugar phosphotransferase transport system (PTS), undergoes multiple posttranslational chemical modifications resulting in the formation of HPr(His approximately P), HPr(Ser-P), and HPr(Ser-P)(His approximately P), whose cellular concentrations vary with growth conditions . Distinct physiological functions are associated with specific forms of HPr . We do not know, however, the cellular thresholds below which these forms become unable to fulfill their functions and to what extent modifications in the cellular concentrations of the different forms of HPr modify cellular physiology . In this study, we present a glimpse of the diversity of Streptococcus salivarius ptsH mutants that can be isolated by positive selection on a solid medium containing 2-deoxyglucose and galactose and identify 13 amino acids that are essential for HPr to properly accomplish its physiological functions . We also report the characterization of two S . salivarius mutants that produced approximately two- and threefoldless HPr and enzyme I (EI) respectively . The data indicated that (i) a reduction in the synthesis of HPr due to a mutation in the Shine-Dalgarno sequence of ptsH reduced ptsI expression; (ii) a threefold reduction in EI and HPr cellular levels did not affect PTS transport capacity; (iii) a twofold reduction in HPr synthesis was sufficient to reduce the rate at which cells metabolized PTS sugars, increase generation times on PTS sugars and to a lesser extent on non-PTS sugars, and impede the exclusion of non-PTS sugars by PTS sugars; (iv) a threefold reduction in HPr synthesis caused a strong derepression of the genes coding for alpha-galactosidase, beta-galactosidase, and galactokinase when the cells were grown at the expense of a PTS sugar but did not affect the synthesis of alpha-galactosidase when cells were grown at the expense of lactose, a noninducing non-PTS sugar; and (v) no correlation was found between the magnitude of enzyme derepression and the cellular levels of HPr(Ser-P). J Endod, 2001 May, 27(5), 354 - 7 In vitro bacterial penetration of endodontically treated teeth coronally sealed with a dentin bonding agent; Wolanek GA et al.; This study evaluated the effectiveness of a dentin bonding agent as a barrier to prevent coronal microleakage and examined the effect of a eugenol-based sealer on the sealing ability of this resin adhesive . Fifty-one extracted human mandibular molars were incorporated in a model system using an oral streptococci as a microbial marker . Group 1 consisted of 15 teeth that were obturated with only gutta-percha and received a coronal barrier of Clearfil Liner Bond 2V . Group 2 was identical to group 1, but included the use of a eugenol-based sealer in the obturation . Group 3 consisted of 15 teeth that were obturated with gutta-percha and sealer, but did not receive a coronal barrier . Six teeth served as controls . Bacterial penetration was monitored for 90 days . Results were analyzed after 30, 60, and 90 days with Fisher's exact test (p < 0.05) . All controls behaved as expected . Neither group 1 nor group 2 exhibited any bacterial leakage . Eleven of the 15 specimens in group 3 leaked between 15 and 76 days . The coronal barriers in group 1 and group 2 were significantly better in preventing coronal microleakage at 60 days (p = 0.002) and 90 days (p = 0.00005) . The presence of eugenol in the sealer had no significant effect on the sealing ability of Clearfil Liner Bond 2V (p = 1). J Antimicrob Chemother, 2001 Aug, 48(2), 291 - 4 Genetic and phenotypic characterization of macrolide resistance in group A streptococci isolated from adults with pharyngo-tonsillitis in France; Weber P et al.; Three hundred and three strains of group A streptococci (GAS) isolated from adults with pharyngitis were tested to evaluate their phenotype of resistance to macrolides-lincosamides and to search for macrolide resistance genes . MICs of clarithromycin were determined . The overall rate of resistance to both erythromycin and clarithromycin was 9.6% . Constitutive, inducible and M phenotypes of resistance were detected in 4.3, 2 and 3.3% of strains, respectively . All constitutive phenotypes harboured ermB genes, whereas inducible phenotypes had the ermTR gene and M phenotypes had the mefA gene . In France, the current resistance rate of GAS to erythromycin and clarithromycin remains low. J Antimicrob Chemother, 2001 Aug, 48(2), 283 - 6 In vitro activity of LY333328 (oritavancin) against Gram-positive aerobic cocci and synergy with ciprofloxacin against enterococci; Noviello S et al.; Gram-positive cocci are a major cause of nosocomial bacteraemias and are often resistant to most antibiotics . The emergence of enterococci with reduced susceptibility to vancomycin has created an urgent need for novel antibiotics to combat