Streptococci

Antimicrob Agents Chemother, 1996 Oct, 40(10), 2252 - 7
ParC subunit of DNA topoisomerase IV of Streptococcus pneumoniae is a primary target of fluoroquinolones and cooperates with DNA gyrase A subunit in forming resistance phenotype; Munoz R et al.; The genes encoding the ParC and ParE subunits of topoisomerase IV of Streptococcus pneumoniae, together with the region encoding amino acids 46 to 172 (residue numbers are as in Escherichia coli) of the pneumococcal GyrA subunit, were partially characterized . The gyrA gene maps to a physical location distant from the gyrB and parC loci on the chromosome, whereas parC is closely linked to parE . Ciprofloxacin-resistant (Cpr) clinical isolates of S . pneumoniae had mutations affecting amino acid residues of the quinolone resistance-determining region of ParC (low-level Cpr) or in both quinolone resistance-determining regions of ParC and GyrA (high-level Cpr) . Mutations were found in residue positions equivalent to the serine at position 83 and the aspartic acid at position 87 of the E . coli GyrA subunit . Transformation experiments suggest that ParC is the primary target of ciprofloxacin . Mutation in parC appears to be a prerequisite before mutations in gyrA can influence resistance levels.

Am J Obstet Gynecol, 1996 Oct, 175(4 Pt 1), 1036 - 42
Group B Streptococcus and preterm premature rupture of membranes: a randomized, double-blind clinical trial of antepartum ampicillin; Grable IA et al.; OBJECTIVE: Our purpose was to determine whether ampicillin prolongs the latency period after preterm premature rupture of membranes in patients colonized with group B Streptococcus . STUDY DESIGN: Sixty patients presenting at < or = 35 weeks' gestation with preterm premature rupture of membranes were included in the study . Cervical, vaginal, and perianal cultures for group B premature rupture were obtained . The participants then were randomized to receive either ampicillin or placebo intravenously for 24 hours and then orally until hospital discharge or delivery . All patients were treated without the use of tocolytic drugs . The chi(2) test, Fisher exact test, Student t test, and Wilcoxon signed-rank test were used for statistical analysis when appropriate . RESULTS: Fifteen patients had cultures positive for group B Streptococcus . Patients with cultures positive for group B Streptococcus who received ampicillin (n = 8) were more likely not to have been delivered of their infants 48 hours after preterm premature rupture of membranes than patients who received placebo (n = 7), a statistically significant difference (100% vs 43%; p = 0.01; relative risk 2.3; 95% confidence interval 1.2 to 4.5) . Seven days after preterm premature rupture of membranes, however, there was no significant difference in percentage of patients with cultures positive for group B Streptococcus who remained undelivered (63% vs 29%; p = 0.19; relative risk, 2.2; 95% confidence interval 0.7 to 7.1) . Among patients with cultures negative for group B Streptococcus, there was a trend for patients who received ampicillin to remain undelivered 48 hours after preterm premature rupture of membranes compared with those who received placebo, but the difference was not statistically significant (87% vs 64%; p = 0.07; relative risk, 1.4; 95% confidence interval 1.0 to 1.9) . There also was no difference in percentage of patients with cultures negative for group B Streptococcus who remained undelivered 7 days after preterm premature rupture of membranes 39% vs 27%; p = 0.40; relative risk, 1.4; 95% confidence interval 0.61 to 3.3) . There were no differences between the treatment and placebo arms of the group B Streptococcus positive and negative cohorts in incidence of cesarean section, chorioamnionitis, postpartum endometritis, or neonatal infectious morbidity . CONCLUSION: Use of antibiotics increases the percentage of patients with cultures positive for group B Streptococcus who remain undelivered 48 hours after preterm premature rupture of membranes . Antibiotic therapy may provide a window of opportunity for maternal treatment with corticosteroids to decrease the risk for neonatal morbidity among these preterm gestations.

Microbiology, 1996 Oct, 142 ( Pt 10), 2747 - 57
Multiply antibiotic-resistant Streptococcus pneumoniae recovered from Spanish hospitals (1988-1994): novel major clones of serotypes 14, 19F and 15F; Coffey TJ et al.; We analysed a collection of 95 multiply antibiotic-resistant pneumococci, recovered since 1988 from 14 Spanish hospitals, that have MICs > or = 0.25 microgram benzylpenicillin ml-1 . The majority of the isolates were of serogroups 14, 23, 6, 19 and 15, which are currently the serogroups mainly associated with multiresistance in Spain . All of the serogroup 23 isolates were members of the major Spanish serotype 23F multiresistant clone . Similarly, most of the serogroup 6 isolates were members of the major multiresistant serotype 6B clone, or variants of this clone . Eighteen of the 24 isolates of serogroup 19 were members of a highly penicillin-resistant clone that appears to be a serotype 19F variant of the major Spanish serotype 23F multiresistant clone . Eighteen of the 25 isolates of serotype 14 were members of a previously uncharacterized highly penicillin-resistant clone . Thirteen of the 16 isolates of serogroup 15 were members of a single previously unreported clone of serotype 15F that had moderate levels of resistance to penicillin . Approximately 65% of the multiresistant pneumococci that are currently circulating in Spain were members of the three new clones of serotype 14, 15F and 19F that we describe here, or the previously described serotype 6B and 23F clones . The other 35% of isolates were minor variants of the major clones, unrelated minor clones, and unique isolates, many of which appeared to have arisen by horizontal gene transfer events.

J Clin Microbiol, 1996 Oct, 34(10), 2609 - 12
Surrogate disks for predicting cefotaxime and ceftriaxone susceptibilities of Streptococcus pneumoniae; Barry AL et al.; Cefotaxime- and ceftriaxone-resistant Streptococcus pneumoniae is now appearing in some medical centers, but 30-micrograms cefotaxime or 30-micrograms ceftriaxone disks are not reliable for detecting such strains . Studies were undertaken to select another cephalosporin disk that might be used as a screening test that could be used in conjunction with a 1-micrograms oxacillin disk . A 30-micrograms cefuroxime disk is proposed: strains with zones > or = 28 mm in diameter are predictably susceptible to cefotaxime and ceftriaxone, and those with smaller zones should be further studied to confirm resistance to either drug . A 30-micrograms ceftizoxime disk may also be used as a screening test with zones > or = 26 mm indicating susceptibility, but cefuroxime disks are preferred.

J Pediatr, 1996 Oct, 129(4), 602 - 4
Complications associated with severe invasive streptococcal syndrome; Montgomery VL et al.; Group A beta-hemolytic streptococcal sepsis may cause life-threatening disease . We describe a child with severe invasive streptococcal syndrome in whom severe respiratory failure and pulmonary pneumatoceles required extracorporeal life support . Physicians should be aware of the full spectrum of pathologic changes and life-threatening complications caused by group A beta-streptococcus.

J Pediatr, 1996 Oct, 129(4), 529 - 36
Children hospitalized for varicella: a prevaccine review; Peterson CL et al.; OBJECTIVES: To describe varicella complications in healthy and previously ill children hospitalized for varicella and to explore trends in group A beta-hemolytic streptococcus complications of varicella . METHODS: A retrospective record review of children hospitalized for varicella between January 1, 1990, and March 31, 1994, was conducted in nine large acute care hospitals in Los Angeles County, California . RESULTS: We identified 574 children hospitalized for varicella in study hospitals during the 4.25-year study period (estimated risk of hospitalization, approximately 1 in 550 cases of varicella); 53% of the children were healthy before the onset of varicella and 47% were previously ill with underlying cancers or other chronic illnesses . Children were hospitalized for treatment of complications (n = 427, 74%) or for prophylactic antiviral therapy or observation (n = 147, 26%) . Systems involved in complications included skin/soft tissue (45%), neurologic (18%), respiratory (14%), gastrointestinal (10%), and hematologic, renal, or hepatic (8% or less) . The mean age of children with skin/soft tissue infections was 2.7 years (range < 1 to 16 years) compared with 4.7 years (< 1 to 18 years) for other complications . Children with skin/soft tissue and neurologic complications were more often previously healthy (p < 0.05), whereas those with respiratory complications were more often previously ill (p < 0.001) . Hospitalizations for skin/soft tissue infections increased during the study period . The proportion of complications as a result of group A beta-hemolytic streptococcus infection increased from 4.7% before 1993 to 12.2% for the remainder of the study period (p = 0.02) . CONCLUSIONS: Prior health status was predictive of the type of complications experienced by children with varicella requiring hospitalization . Our data suggest a recent increase in skin/soft tissue complications of varicella requiring hospitalization and an increase in the proportion of complications related to group A beta-hemolytic streptococcus . Wide-scale vaccine use should reverse this trend and reduce the overall impact of varicella on both healthy and previously ill children.

Am Fam Physician, 1996 Oct, 54(5), 1634 - 6
Use of the rapid streptococcus test in extrapharyngeal sites; Bourgeois SD et al.; The rapid "strep" test is established as a valuable tool for the management of pharyngitis . Because of the recent increase in reports of serious, rapidly progressive streptococcal soft tissue infections, the test can also be useful in determining early management of skin infections . Patients with positive results can be treated immediately with specific therapy, usually with an excellent outcome . As an illustration, use of this technique in 15 patients is described.

Obstet Gynecol, 1996 Oct, 88(4 Pt 1), 577 - 82
Sexual behavior and vaginal colonization by group B streptococcus among minority women; Newton ER et al.; OBJECTIVE: To test the hypothesis that sexual behaviors predict colonization of the vagina by group B streptococcus among minority women . METHODS: We conducted a prospective, descriptive study of 192 consecutive African-American (37%) and Hispanic women (63%) . Each woman underwent a detailed interview concerning sexual behavior . Separate specimens were taken from the endocervix, upper vagina, lower vagina, and anorectum and placed in selective broth media for isolation of group B streptococcus . Significant behavioral predictors of vaginal group B streptococcus colonization and heavy (3-4+) colonization were identified using stepwise logistic regression . RESULTS: The incidence of vaginal colonization was 39% and heavy colonization was 35% . Nineteen percent reported anal intercourse, 46% reported sex at least two times per week, and 21% reported more than one partner in the previous 30 days . The significant predictors of vaginal group B streptococcal infection were: African-American ethnicity, adjusted odds ratio (OR) 6.1 (95% confidence interval {CI} 2.5-15.1); presence of rectal group B streptococcus, adjusted OR 100.6 (95% CI 26.7-379.3); nulliparous, adjusted OR 3.6 (95% CI 1.4-9.5); and nonpregnant status, adjusted OR 3.9 (95% CI 1.3-12.2) . The significant predictors of heavy colonization were: more than one partner in the last 30 days, adjusted OR 2.6 (95% CI 1.2-5.6); and African-American ethnicity, adjusted OR 2.3 (95% CI 1.2-4.5) . Anal intercourse was associated with a reduced likelihood of vaginal group B streptococcal infection, adjusted OR 0.34 (95% CI 0.12-0.91) . CONCLUSION: Sexual behavior, especially anal intercourse, does not predict vaginal colonization by group B streptococcus . African-American women are more likely to have vaginal and heavy group B streptococcus colonization . Heavy vaginal colonization is associated with multiple partners in African-American women.

FEMS Microbiol Lett, 1996 Oct 1, 143(2-3), 279 - 84
Investigation of a choline phosphate synthesis pathway in Streptococcus pneumoniae: evidence for choline phosphate cytidylyltransferase activity; Whiting GC et al.; In this study we have demonstrated the activity of a choline phosphate cytidylyltransferase in cell free extracts of Streptococcus pneumoniae . Southern blot analysis of restricted S . pneumoniae genomic DNA probed with the gene coding for the choline phosphate cytidylyltransferase of Saccharomyces cerevisiae demonstrated that there is homology between the S . cerevisiae cct gene and genomic DNA of S . pneumoniae . We believe that this enzyme is involved in the biosynthesis of the choline containing cell wall antigens, teichoic acid and lipoteichoic acid, catalysing the activation of choline phosphate to CDP-choline which is then incorporated into the polysaccharide moiety.

J Bacteriol, 1996 Oct, 178(20), 6087 - 90
Competence for genetic transformation in encapsulated strains of Streptococcus pneumoniae: two allelic variants of the peptide pheromone; Pozzi G et al.; The nucleotide sequence of comC, the gene encoding the 17-residue competence-stimulating peptide (CSP) of Streptococcus pneumoniae (L . S . Havarstein, G . Coomaraswamy, and D . A . Morrison, Proc . Natl . Acad . Sci . USA 92:11140-11144, 1995) was determined with 42 encapsulated strains of different serotypes . A new allele, comC2, was found in 13 strains, including the type 3 Avery strain, A66, while all others carried a gene (now termed comC1) identical to that originally described for strain Rx1 . The predicted mature product of comC2 is also a heptadecapeptide but differs from that of comC1 at eight residues . Both CSP-1 and CSP-2 synthetic peptides were used to induce competence in the 42 strains; 48% of the strains became competent after the addition of the synthetic peptide, whereas none were transformable without the added peptides.

J Bacteriol, 1996 Oct, 178(19), 5831 - 5
Natural genetic transformation in Streptococcus gordonii: comX imparts spontaneous competence on strain wicky; Lunsford RD et al.; Streptococcus gordonii Wicky becomes competent only after stimulation with conditioned medium from strain Challis as a source of competence factor (CF) . A 3.2-kbp genomic fragment from Challis was found to impart spontaneous competence on Wicky by a complementation assay . Wicky clones containing the fragment secreted a heat-sensitive activity that induced competence in Wicky and in a comA insertion mutant of Challis . Activity was localized to a putative open reading frame, comX, with the potential to encode a 52-amino-acid peptide . comX had no similarity to known sequences, and a comX::ermAM insertion mutant of Challis transformed normally and secreted CF . These data suggest that a CF-independent pathway for competence induction exists in S . gordonii.

J Bacteriol, 1996 Oct, 178(19), 5826 - 30
Rgg is a positive transcriptional regulator of the Streptococcus gordonii gtfG gene; Sulavik MC et al.; The Streptococcus gordonii (Challis) glucosyltransferase-encoding determinant gtfG is regulated by the product of the adjacent gene rgg . Results of analyses described here showed that in both S . gordonii and Escherichia coli Rgg is a positive transcriptional regulator of glucosyltransferase expression . In addition, the transcriptional start sites of both gtfG and rgg were determined.

Curr Microbiol, 1996 Oct, 33(4), 216 - 9
Catabolite regulation in a diauxic strain and a nondiauxic strain of Streptococcus bovis; Kearns DB et al.; Streptococcus bovis JB1 utilized glucose preferentially to lactose and grew diauxically, but S . bovis 581AXY2 grew nondiauxically and used glucose preferentially only when the glucose concentration was very high (greater than 5 mM) . As little as 0.1 mM glucose completely inhibited the lactose transport of JB1 . The lactose transport system of 581AXY2 was at least tenfold less sensitive to glucose, and 1 mM glucose caused only a 50% inhibition of lactose transport . Both strains had phosphotransferase systems (PTSs) for glucose and lactose . The glucose PTSs were constitutive, but little lactose PTS activity was detected unless lactose was the energy source for growth . JB1 had approximately threefold more glucose PTS activity than 581AXY2 (1600 versus 600 nmol glucose (mg protein)-1(min)-1 . The glucose PTS of JB1 showed normal Michaelis Menten kinetics, and the affinity constant (Ks) was 0.12 mM . The glucose PTS of 581AXY2 was atypical, and the plot of velocity versus velocity/substrate was biphasic . The low capacity system had a Ks of 0.20 mM, but the Ks of the high capacity system was greater than 6 mM . On the basis of these results, diauxic growth is dependent on the affinity of glucose enzyme II and the velocity of glucose transport.

J Immunol, 1996 Oct 1, 157(7), 3021 - 9
A highly variable region in members of the streptococcal M protein family binds the human complement regulator C4BP; Johnsson E et al.; Strains of Streptococcus pyogenes express one or more molecules that are members of the M protein family, a group of surface proteins implicated in virulence . A characteristic property of the molecules in this family is the presence of a highly variable N-terminal region, whose function is unknown . Here we show that human C4b-binding protein (C4BP), a regulatory component of the complement system, binds to the highly variable region of many members of the M protein family . Chimeric molecules, in which the N-terminal regions of four different C4BP-binding proteins were combined with the C-terminal part of the non-binding M5 protein, had intact C4BP-binding ability, as judged by binding assays and Scatchard analysis with highly purified molecules . Moreover, work with the C4BP-binding Arp4 protein showed that an N-terminal 52-residue fragment retained binding ability, and that a 21-residue synthetic peptide derived from the variable region completely inhibited the binding of C4BP . Computer-assisted analysis of the four C4BP-binding regions studied here (45-66 amino acid residues) indicated that they lack residue identities that could explain their ability to bind the same ligand, but differ from the nonbinding M5 protein in their lower propensity to form a coiled-coil . Thus, the variable C4BP-binding regions have an extraordinary capacity for sequence variation, while retaining the ability to bind C4BP . These data indicate that an important function of the variable region in members of the M protein family is to bind a host protein that down-regulates the complement system.

Vet Rec, 1996 Sep 28, 139(13), 308 - 13
Respiratory disease in thoroughbred horses in training: the relationships between disease and viruses, bacteria and environment; Burrell MH et al.; A longitudinal study of respiratory disease in racehorses was carried out to assess its relative associations with different infectious agents and to examine any role that the environmental conditions might play . The relationships between coughing, nasal discharge, pyrexia and lower respiratory tract disease were also examined to provide information for improving clinical diagnosis, particularly of disease of the lower respiratory tract . Lower airway disease was closely associated with infection with Streptococcus zooepidemicus . It was also found that equine herpesvirus seroconversions and S pneumoniae infections were independently associated with the development of nasal discharge . Coughing was a specific, but insensitive measure of lower respiratory tract disease (specificity 84 per cent, sensitivity 38 per cent) . However, horses that coughed were very likely to have had lower airway disease for more than one month . Horses housed on straw in loose boxes were twice as likely to suffer from lower airway disease as those kept on shredded paper in American barns . The study was not large enough to assess the significance of rarer infections but it did improve the definition of the problem of respiratory disease in racehorses and revealed some of the trends in the associations between viruses, bacteria and the environment in respiratory disease.

Carbohydr Res, 1996 Sep 23, 291, 21 - 41
Efficient, convergent syntheses of oligosaccharide allyl glycosides corresponding to the Streptococcus group A cell-wall polysaccharide; Auzanneau FI et al.; Convergent syntheses of di-, tri, tetra-, penta-, and hexa-saccharide allyl glycosides corresponding to the beta-hemolytic Streptococcus Group A cell-wall polysaccharide are described . The strategy relies on the preparation of related di- and tri-saccharide building blocks: beta-D-Glc pNAc-(1-3)-alpha-L-Rhap and alpha-L-Rhap-(1-2)-{(beta-D-Glc p NAc-(1-3)}-alpha-L-Rhap, which could be used either as glycosyl donors or acceptors in subsequent glycosylation reactions . The protecting groups were chosen to allow the selective removal of the allyl aglycon to access the intermediate glycosyl donors but also to allow their own removal without affecting the allyl group . The allyl group was intended for use in conjugation of the oligosaccharides to soluble protein carriers or solid supports for the preparation of antigens and immunoadsorbents, respectively.

J Biol Chem, 1996 Sep 20, 271(38), 23395 - 9
Functional cloning of the cDNA for a human hyaluronan synthase; Shyjan AM et al.; Hyaluronan is a constituent of the extracellular matrix of connective tissue and is actively synthesized during wound healing and tissue repair to provide a framework for ingrowth of blood vessels and fibroblasts . Changes in the serum concentration of hyaluronan are associated with inflammatory and degenerative arthropathies such as rheumatoid arthritis . In addition, hyaluronan has been implicated as an important substrate for migration of adhesion of leukocytes during inflammation . A human hyaluronan synthase (HuHAS1) cDNA was isolated by a functional expression cloning approach . Transfection of CHO cells conferred hyaluronidase-sensitive adhesiveness of a mucosal T cell line via the lymphocyte hyaluronan receptor, CD44, as well as increased hyaluronan levels in the cultures of transfected cells . The HuHAS1 amino acid sequence shows considerable homology to the hasA gene product of Streptococcus pyogenes, a glycosaminoglycan synthetase from Xenopus laevis (DG42), and is the human homolog of a recently described murine hyaluronan synthase.

J Biol Chem, 1996 Sep 20, 271(38), 22945 - 8
Molecular identification of a putative human hyaluronan synthase; Watanabe K et al.; To identify the putative mammalian hyaluronan synthase, we cloned a human cDNA that is related to the Streptococcus hyaluronan synthase (HasA) and the Xenopus developmental protein DG42 which has been shown to have chitin synthase activity . The cDNA, for which we propose the name Has2, encodes a novel protein with a predicted molecular mass of 63.6 kDa . Has2 shows 55% amino acid identity with Xenopus DG42 and 52% identity with the mouse HAS protein, another putative hyaluronan synthase recently reported by Itano and Kimata (Itano, N., and Kimata, K . (1996) J . Biol . Chem . 271, 9875-9878) . The deduced primary structure revealed the presence of several hydrophobic stretches which can form multiple transmembrane domains . It also demonstrated the complete conservation of amino acid residues that are known to be critical for N-acetylglucosaminyltransferase activity of yeast chitin synthase . When the Has2 cDNA was transfected into human 293 and Chinese hamster ovary cells, the production of hyaluronan in the transfected cells increased up to 34- and 9-fold, respectively . Strong expression of Has2 mRNA was observed in exponentially proliferating human IMR-90 fibroblasts but not in growth-arrested IMR-90 cells . These results suggest that the Has2 protein is a crucial component of the human hyaluronan synthase system.

FEMS Microbiol Lett, 1996 Sep 15, 143(1), 69 - 76
Cloning and characterization of chsD, a chitin synthase-like gene of Aspergillus fumigatus; Mellado E et al.; A chitin synthase-like gene (chsD) was isolated from an Aspergillus fumigatus genomic DNA library . Comparisons with the predicted amino acid sequence from chsD reveals low but significant similarity to chitin synthases, to other N-acetylglucosaminyltransferases (NodC from Rhizopus spp., HasA from Streptococcus spp . and DG42 from vertebrates . A chsD- mutant strain constructed by gene disruption has a 20% reduction in total mycelial chitin content; however, no differences between the wild-type strain and the chsD- strain were found with respect to morphology, chitin synthase activity or virulence in a neutropenic murine model of aspergillosis . The results show that the chsD product has an important but inessential role in the synthesis of chitin in A . fumigatus.

J Immunol, 1996 Sep 15, 157(6), 2479 - 87
Species-dependent post-translational modification and position 2 allelism: effects on streptococcal superantigen SSA structure and V beta specificity; Stevens KR et al.; Epidemiologic and molecular population genetic analyses support a role for superantigens (SAg) in the pathogenesis of severe staphylococcal and streptococcal infections . To investigate how variations in SAg structure influence immunomodulatory activity, we examined the biochemical and functional properties of two allelic variants of streptococcal SAg SSA that differ at position 2 . Mass spectrometry revealed both recombinant (Escherichia coli) and native (Streptococcus pyogenes) SSA allelic variants to have significantly larger molecular masses than predicted by primary sequence alone and provided evidence that the proteins were modified by the addition of biochemical moieties, a phenomenon that has not been described for related SAg . Furthermore, the molecular masses of native and recombinant SSA were not the same; SSA was differentially post-translationally modified by the two bacterial genera . The substitution of E . coli-dependent processing for that of S . pyogenes altered both protease digestion and V beta specificity, suggesting that recombinant SAg from E . coli may not accurately represent the native toxin . In addition, the observation that SSA allelic variants differed in V beta specificity supports a role for position 2 in SSA-TCR interactions . That SSA position 2 contributes to V beta specificity could not have been predicted from functional or crystallographic studies of other SAg and suggests that SSA may adopt unique interactions with TCR and/or MHC class II molecules . Determining the structural basis for these differences should offer additional clues to the manner in which SAg exert their effects on the immune system during infection and may allow the designing of SAg mutants with specific quantitative and qualitative immunomodulatory properties.

J Biol Chem, 1996 Sep 13, 271(37), 22414 - 21
The ColE1 unidirectional origin acts as a polar replication fork pausing site; Viguera E et al.; Co-orientation of replication origins is the most common organization found in nature for multimeric plasmids . Streptococcus pyogenes broad-host-range plasmid pSM19035 and Escherichia coli pPI21 are among the exceptions . pPI21, which is a derivative of pSM19035 and pBR322, has two long inverted repeats, each one containing a potentially active ColE1 unidirectional origin . Analysis of pPI21 replication intermediates (RIs) by two-dimensional agarose gel electrophoresis and electron microscopy revealed the accumulation of a specific RI containing a single internal bubble . The data obtained demonstrated that initiation of DNA replication occurred at a single origin in pPI21 . Progression of the replicating fork initiated at either of the two potential origins was transiently stalled at the other inversely oriented silent ColE1 origin of the plasmid . The accumulated RIs, containing an internal bubble, occurred as a series of stereoisomers with different numbers of knots in their replicated portion . These observations provide one of the first functional explanations for the disadvantage of head-to-head plasmid multimers with respect to head-to-tail ones.

Arch Intern Med, 1996 Sep 9, 156(16), 1851 - 6
Roentgenographic findings of pneumonia caused by Chlamydia pneumoniae . A comparison with streptococcus pneumonia; Kauppinen MT et al.; BACKGROUND: Pneumonia caused by Chlamydia pneumoniae or Streptococcus pneumoniae cannot be reliably differentiated by clinical signs or symptoms . OBJECTIVE: To find differences in the roentgenographic patterns of community-acquired pneumonia caused by C pneumoniae, S pneumoniae, or both in hospitalized patients during a C pneumoniae epidemic in Finland . METHODS: The patients were divided into 3 groups: 24 patients with serologic evidence of C pneumoniae only; 8 patients with combined C pneumoniae and S pneumoniae infection; and 13 patients with infection caused by S pneumoniae only . The chest roentgenograms obtained on admission to the hospital, during the hospital stay, and at follow-up visits were reevaluated by one of us (S.L.) who was unaware of the causative organism . In the final study groups, other causes of community-acquired pneumonia were excluded by a large pattern of microbiological methods . RESULTS: Bronchopneumonia was observed in 21 (88%) of the group with C pneumoniae and 10 (77%) of the group with S pneumoniae (P = .67) . Lobar or sublobar (air space) pneumonia was seen in 7 (29%) of the patients with C pneumoniae compared with 7 (54%) with pneumonia caused by S pneumoniae . In the combined group, bronchopneumonia was seen as frequently as in the group with C pneumoniae, and air-space involvement was seen as frequently as in the group with S pneumoniae . The pneumonic shadowing was usually unilateral and in the lower lobes in all groups . Of the patients in the C pneumoniae group, 17% had residual abnormalities at follow-up visits . CONCLUSIONS: Roentgenographic changes cannot be used to differentiate pneumonia caused by C pneumoniae from that caused by S pneumoniae . Thus, initial antibiotic treatment should be directed at the pathogens that commonly cause community-acquired pneumonia.

Vet Rec, 1996 Sep 7, 139(10), 225 - 8
Protection of experimentally infected pigs by suilysin, the thiol-activated haemolysin of Streptococcus suis; Jacobs AA et al.; Three groups of three pigs were vaccinated either with vaccine VAC-SLY, containing purified suilysin derived from Streptococcus suis strain P1/7 (serotype 2), or with vaccine VAC-SCF, containing most of the other extracellular antigens produced by strain P1/7 (but essentially free from suilysin), or with a placebo vaccine . The pigs were vaccinated twice at four weeks and six weeks of age and were challenged intravenously with S suis strain P1/7 at eight weeks of age . On the day of challenge, only the VAC-SLY vaccinated pigs showed an increase in haemolysin neutralisation titre . After challenge the placebo vaccinated pigs developed severe clinical signs characterised by lameness involving several joints, a depressed appearance, high temperatures and/or neurological signs . The VAC-SCF vaccinated pigs showed the same clinical signs but less severely . The VAC-SLY vaccinated pigs were the least affected and showed only mild signs which subsided more quickly than those of the other groups . A post mortem investigation and histology of brain tissue samples confirmed the clinical findings; fibrinous arthritis was less severe and less frequently observed in the VAC-SLY vaccinated pigs than in the VAC-SCF or placebo vaccinated pigs, and none of the VAC-SLY vaccinated pigs had meningitis whereas two of the VAC-SCF and two of the placebo vaccinated pigs did so . All the samples of brain, lung and tarsus taken from the VAC-SLY vaccinated pigs were sterile whereas S suis was reisolated from most of these tissues from the other groups.

Vojnosanit Pregl, 1996 Sep-Oct, 53(5), 383 - 6
{Penicillin resistance in strains of Streptococcus pneumoniae}; Tomanovic B et al.; The values of minimal inhibitory concentration (MIC) of penicillin were determined using the agar-dilution method for 114 strains of Streptococcus pneumoniae isolated during 1994 in the patients treated in hospital and outpatient clinics . Diminished susceptibility to penicillin was determined in 50 (43.8%) strains . High level of penicillin resistance was observed in 12 (10.5%) strains . Streptococcus pneumoniae cannot any more be regarded as the agent with presumed susceptibility to penicillin, but every isolated strain must be tested.

Mikrobiologiia, 1996 Sep-Oct, 65(5), 656 - 62
{Biology of lysogenic strains of Streptococcus bovis and virulent mutants of their temperate phages}; Tarakanov BV; Three lysogenic streptococcal strains and four virulent mutants of temperate phages were studied . The bacterial strains proved to be close to the type strain of Streptococcus bovis in their morphological, cultural, physiological, and biochemical properties . Investigation into the interaction of the lysogenic cultures with virulent mutants of temperate phages showed that the culture age optimal for infecting was 3-5 h; intense lysis began in the second hour after infection and was virtually completed by the end of the third hour, i.e., the procedure of obtaining phages in HMT medium took 7-8 h . Phage titers in phage lysates varied from 3.93 x 10(10) to 11.25 x 10(10) active phage particles per ml; residual amounts of viable bacteria varied from 0.7 x 10(6) to 34.0 x 10(6) cells per ml . In liquid HMT medium, phage production by lysogenic cultures was not limited by 0.3% glucose or maltose, 0.5% peptone, or casein hydrolysate . Descriptions of virulent mutants VM 6/6, VM 32/6, VM 28/28, and VM 54/54 of temperate phages of Str . bovis are presented.

Zh Mikrobiol Epidemiol Immunobiol, 1996 Sep-Oct, (5), 7 - 10
{The phage sensitivity and lysogeny of cultures of Streptococcus pyogenes group A isolated in different streptococcal infections}; Asoskova TK et al.; The collection of moderate phages of S . pyogenes, group A, had been created earlier . As shown in this work, group A streptococcal cultures isolated from patients with rheumatism, glomerulonephritis and tonsillitis exhibited different sensitivity to the phages of this collection: the cultures were lyzed by phages of groups II and III in rheumatism, group III in tonsillitis and group I in glomerulonephritis . The study revealed that lysogeny was widely spread among S . pyogenes strains isolated from patients with different diseases under study . Most frequently occurred among cultures isolated from tonsillitis patients . In this disease only phage-resistant streptococcal cultures proved to be lysogenic . Lysogeny was found among both phage-sensitive and phage-resistant cultures in rheumatism and especially in glomerulonephritis.

Pediatr Med Chir, 1996 Sep-Oct, 18(5), 433 - 50
{Colonization by group B hemolytic streptococcus in pregnancy . Note of prevention and therapy of the materno-neonatal infection . Casuistics}; Della Morte MA et al.; As several international studies show, the knowledge of the wide clinical spectrum of perinatal group B streptococcal infection, particularly of the early and of the late-onset neonatal diseases in GBS carrier mothers, is basically important for medical diagnosis . Risk factors analysis further determines both the diagnosis and the maternal intrapartum chemoprophylaxis . The considerable rate of neonatal disease without risk factors and its possible serious and fatal consequences bring to tendentially non selective prevention approaches that must consider the local background . At Merate Hospital, in a 3 years time, vaginal and rectal specimens for GBS cultures were obtained from 1766 pregnant women either at the 32nd or at the 36th week of gestation and regularly at the labor . 376 women (21.29 percent) resulted GBS carriers; the maternal-fetal contamination rate was 15.42 percent (58/376) i.e . 32.6 per 1000 live births (58/1769) . Intrapartum chemoprophylaxis was carried out with i.v . erytromycin, i.v . or i.m . cephalosporins, i.v . ampicillin and per os amoxicillin (which gave the most interesting results) . In infants born to mothers who received an antibiotic therapy at labor as compared with those who received no treatment, GBS neonatal colonization was present in 31 of 286 (10.8 percent) versus 27 of 90 (30 percent; P < 0.001); heavy colonization was observed in 10 of 286 (3.4 percent) versus 15 of 90 (16.6 percent; P < 0.001) and early-onset neonatal disease (both symptomatic and asymptomatic) occurred in none of 286 versus 4 of 90 (4.44 percent; P = 0.0031) . Perinatal risk factors (no-screened mothers, labor at 36th week of gestation, prolonged membrane rupture) were present only in 1 of 4 GBS infected infants (25 percent) . Intrapartum therapy both in carriers and in no-screened women significantly reduced GBS neonatal colonization, particularly the heavy one and, consequently, the early-onset neonatal group B streptococcal disease.

Pathologe, 1996 Sep, 17(5), 391 - 5
{Polypoid ulcerating endocarditis aortalis caused by Streptococcus viridans with perforation of the right atrium . Pathology and clinical aspects of 2 autopsy cases}; Poremba C et al.; We report two cases of patients (one 65 and one 43 years of age, respectively) who died of Streptococcus-viridans induced endocarditis of the aortic valve with perforation into the right atrium . Whereas perforation in Staphylococcus-induced endocarditis is a common complication, it occurs rarely in Streptococcus-induced endocarditis . Because of its uncharacteristic symptoms, the endocarditis was clinically unknown in both cases and was recognized to be the cause of death only at autopsy . To reduce the large number of complications in patients suffering from endocarditis, it is necessary to confirm the diagnosis as soon as possible if endocarditis might be suspected.

Minerva Pediatr, 1996 Sep, 48(9), 397 - 400
{Hepatic abscesses caused by Streptococcus intermedius}; Alessandri C et al.; Pyogenic abscess of the liver is uncommon child's pathology . The authors briefly describe a clinical picture characterized by beginning of an hepatic abscess dues to a germ that is not usually pathogen for men . It is often a mouth saprophyte.

Acta Otorrinolaringol Esp, 1996 Sep-Oct, 47(5), 401 - 3
{Acute sinusitis, bacteremia and meningitis caused by group F beta-hemolytic Streptococcus}; Perez C et al.; A 32-year old man without immunodepression developed sinusitis followed by acute pyogenic meningitis and beta-hemolytic Streptococcus group F bacteremia . Amplicillin treatment produced a favorable outcome with sequela of righ neurosensorial deafness . Beta-hemolytic Streptococcus group F meningitis, sinusitis and bacteremia is a rare association.

Rev Esp Enferm Dig, 1996 Sep, 88(9), 605 - 8
{Bacteremia and endocarditis caused by Streptococcus bovis in patients with alcoholic hepatopathy without evidence of colonic pathology}; Castroagudin JF et al.; The association of Streptococcus bovis bacteremia and endocarditis with colonic pathology, mainly neoplastic, is well known . Its relationship with liver disease without evidence of gastrointestinal disease has been rarely described . To analyze the association between S . bovis infection and liver disease, positive blood cultures for this microorganism in hospitalized patients in the Internal Medicine and Gastroenterology Departments from December 1993 until October 1995, have been reviewed . Three cases of S . bovis infection (one bacteremia, two endocarditis) were found . Alcoholic liver disease was diagnosed in all three patients, with associated hepatitis C virus in one of them . Colonic pathology was excluded by colonoscopy and/or barium enema . Other gastrointestinal disorders were excluded by means of gastroscopy, barium gastrointestinal study and abdominal ultrasonography . Antibiotic therapy was based in betalactamics, with associated aminoglycoside in two cases . One patient needed aortic and mitral valve replacement and another one needed orthotopic liver transplantation . No new gastrointestinal pathology emerged in the follow-up (5-23 months) . Cases of S . bovis bacteremia and endocarditis should be screened not also for colonic pathology, but also for liver disease, particularly in alcoholics.

West Indian Med J, 1996 Sep, 45(3), 95 - 6
Penicillin-resistant Streptococcus pneumoniae in a Jamaican patient with homozygous sickle-cell disease; Wierenga KJ et al.; Penicillin prophylaxis against infection by Streptococcus pneumoniae is now routine in young children with homozygous sickle-cell (SS) disease and the emergence of penicillin-resistant strains is a serious clinical concern . The first death associated with such resistance in a Jamaican child with SS disease is reported.

Diagn Microbiol Infect Dis, 1996 Sep, 26(1), 23 - 7
Tentative interpretive criteria for testing the susceptibility of Streptococcus pneumoniae to eight fluoroquinolones; Fuchs PC et al.; Broth microdilution and disk diffusion methods were used to test ciprofloxacin, clinafloxacin, fleroxacin, grepafloxacin, ofloxacin, PD131628, sparfloxacin, and trovafloxacin against Streptococcus pneumoniae isolates . With each fluroquinolone tested, there was a striking unimodal population . With the exception of fleroxacin, over 96% of pneumococci tested were inhibited by each drug's modal MIC +/-1 twofold concentration . Over 92% of pneumococci produced inhibitory zone diameters equal to the mode +/-4 mm for each drug . For most fluoroquinolones, the interpretive criteria approved or proposed for nonfastidious organisms appear to be appropriate for pneumococci . For clinafloxacin and trovafloxacin, however, the proposed MIC breakpoints for nonfastidious organisms are four-to eightfold greater than the highest MIC encountered with pneumococci . For future surveillance efforts, low concentrations must be evaluated to detect any subtle shift in pneumococcal populations that might be undetected by testing only breakpoint concentrations.

Rev Prat, 1996 Sep 1, 46(13), 1593 - 8
{Erysipelas and impetigo}; Cribier B; Erysipela is a dermal or hypodermal infection of the skin, which predominantly involves the leg and is associated with high fever . Erysipela is most often caused by Streptococcus pyogenes . Venous insufficiency or lymphoedema are important local factors for the development of this infection which spreads from intertrigo, local wound or leg ulcer . Treatment is essentially based on parenteral penicillin G . Impetigo is a superficial infection of the skin due to Staphylococcus aureus or to Streptococcus pyogenes, and is frequent in children . Classical impetigo is made of yellow-brown crusts located around the mouth and nose, whereas bullous impetigo involves frequently the trunk and limbs . Secondary impetigo occurring in pediculosis or scabiosis is frequent . It is a contagious disease which is more frequent in patients with poor hygiene . It can be treated by general antibiotics, mainly macrolides, penicillin M or cephalosporins.

Eur J Clin Microbiol Infect Dis, 1996 Sep, 15(9), 718 - 24
Azithromycin versus penicillin V in the treatment of paediatric patients with acute streptococcal pharyngitis/tonsillitis . Paediatric Azithromycin Study Group; O'Doherty B; The efficacy and safety of azithromycin and penicillin V in the treatment of acute streptococcal pharyngitis/tonsillitis in paediatric patients were compared in a double-blind, double-dummy prospective study . A total of 489 children (age range, 2-13 years) were randomized to receive treatment with penicillin V (125-250 mg 4 x daily for 10 days) or azithromycin in an oral suspension (10 or 20 mg/kg 1 x daily for 3 days) . Only patients with baseline cultures positive for Streptococcus pyogenes and complete clinical and microbiological assessments at the end of the therapy and follow-up one month later were included in the efficacy analysis . A satisfactory clinical response (cure or improvement) was recorded in 99% of the 10 mg/kg azithromycin group, 100% of the 20 mg/kg azithromycin group, and 97% of the penicillin V group at the end of therapy (day 12-14) . At the follow-up evaluation (day 28-30), relapse rates in patients cured or improved at the end of therapy were 6%, 5%, and 2%, respectively . Bacteriological eradication rates at the end of therapy were 98% in both azithromycin groups and 92% in patients who received penicillin V (p = 0.011); pathogen recurrence was recorded at follow-up in 4% of the 20 mg/kg azithromycin group and in 6% of both the 10 mg/kg azithromycin and penicillin V groups . Treatment-related adverse events, the majority of mild to moderate severity, occurred in 13% of patients in the 20 mg/kg azithromycin group, 9% in the 10 mg/kg azithromycin group, and 5% in the penicillin V group . Azithromycin in a dosage of 10 or 20 mg/kg/day one daily for three days was as safe and effective as penicillin V administered four times daily in the treatment of paediatric patients with acute pharyngitis/tonsillitis.

J Nurse Midwifery, 1996 Sep-Oct, 41(5), 355 - 63
Group B streptococcus in the perinatal period . A review; Clay LS; Prior to the 1960s, little was known about morbidity and mortality in humans due to group B streptococcus (GBS) . Since that time, a thorough understanding of the organism's potential has been developed . Of pregnant women, 20-30% are prenatal carriers of GBS and 40-75% of these mothers will transmit GBS to their neonates . However, the actual incidence of GBS disease in infants is one to three cases per 1,000 live births . Several risk factors for transmission and development of early-onset GBS disease have been identified . The understanding of late-onset disease is less clear . Many strategies have been investigated to find an optimal protocol to reduce significantly the incidence of GBS disease in a cost-effective manner . The Centers for Disease Control and Prevention have recently made recommendations for prevention strategies against this disease.

J Dermatol, 1996 Sep, 23(9), 628 - 30
Successful treatment of molluscum contagiosum in the immunosuppressed adult with topical injection of streptococcal preparation OK-432; Inui S et al.; A 37-year-old Japanese woman received an anticancer drug for 5 years following resection of mammary cancer and then developed widespread mollusca contagiosa, which we considered to be caused by immunosuppression induced by the chemotherapy . Because OK-432 (penicillin-treated and heat-treated lyophilized powder by a substrain of Streptococcus pyogenes A) was expected to be effective for immunosuppression, we tried its topical injection . The skin lesions disappeared almost completely within three months . OK-432 therapy is considered hopeful for treating viral skin diseases, even in immunosuppressed patients.

J Perinatol, 1996 Sep-Oct, 16(5), 346 - 51
Effect of intravenous immunoglobulin G on the deposition of immunoglobulin G and C3 onto type III group B streptococcus and Escherichia coli K1; Lassiter HA et al.; Seventeen neonates with suspected or proven sepsis received either a 750 mg/kg dose of intravenous immunoglobulin G (IVIG) or placebo . Compared with values in adult serum, the preinfusion serum concentrations of immunoglobulin G (IgG) and complement component C3 were diminished; the concentrations were unaffected by the administration of placebo to nine infants . Fifteen minutes after infusion in the eight IVIG recipients, the serum concentration of IgG increased from 3.66 mg/ml to 16.58 mg/ml but the C3 concentration of 540 micrograms/ml was unaffected . Similarly, a radioimmunoassay revealed that during incubation of bacteria with sera from the neonates, the quantities of IgG and C3 bound to type III group B streptococcus and Escherichia coli O7:K1: NM were low and were unaffected by the infusion of placebo . During incubation of bacteria with the postinfusion sera from the IVIG recipients, the amount of IgG, but not C3, deposited onto the bacteria increased to a level equivalent to that observed in adult serum . Therefore IVIG enhanced the capacity of sera from ill neonates to deposit IgG but not C3 onto bacteria . We speculate that in neonates with sepsis, a diminished capacity to deposit C3 onto bacteria may possibly limit the therapeutic efficacy of IVIG.

Immunol Invest, 1996 Sep-Nov, 25(5-6), 387 - 96
Nasal-associated lymphoid tissue is an inductive site for rat tear IgA antibody responses; Carr RM et al.; The role of nasal-associated lymphoid tissue (NALT) as a mucosal inductive site for tear IgA antibody responses was investigated in the rat model . Fluorescent microspheres were shown to access and be taken up by NALT after intranasal of ocular-topical administration, although fewer microspheres were found in the latter case . Tear IgA anti-DNP antibody responses to dinitrophenylated Streptococcus pneumoniae were 6 micrograms/ml at day 7, 10 micrograms/ml at day 10, and were still detectable on day 21 (5 micrograms/ml) following ocular or gastrointestinal immunization . Intranasal immunization induced tear IgA responses which were 1.7-fold higher at day 7 (10 micrograms/ml), peaked by day 10 (14 micrograms/ml) and were still 1.6-fold higher (8 micrograms/ml) at day 21 than responses of ocular or gastrointestinal groups . These findings suggest that intranasal immunization may be more effective than ocular or gastrointestinal administration in eliciting tear IgA antibody responses and, taken together with the microsphere data, indicate that NALT can serve as an inductive site for ocular mucosal IgA responses.

Vet Microbiol, 1996 Sep, 52(1-2), 113 - 25
Detection of antibodies against Streptococcus suis capsular type 2 using a purified capsular polysaccharide antigen-based indirect ELISA; del Campo Sepulveda EM et al.; In the present study a purified capsular polysaccharide antigen-based indirect ELISA (CPS-ELISA) to detect antibodies against Streptococcus suis capsular type 2 was developed and compared with a whole cell antigen-based ELISA (WCA-ELISA) . The WCA-ELISA presented a very low specificity when rabbit antisera to other capsular types were tested . Most of these cross-reactions were due to common proteins . The standardized CPS-ELISA gave satisfactory results using a concentration of 0.1 micrograms/well; most cross-reactions decreased significantly, with some exceptions, such as those shared by capsular types 1/2, 12 and 17 . These cross-reactions were mainly due to common epitopes present in the capsule, as shown by immunoblotting . In a second experiment, the CPS-ELISA was used to detect antibodies in experimentally infected piglets . Despite the fact that capsular type 2 S . suis could be reisolated from all infected animals during and/or after the trial, antibody titers against a second infection . Sera from piglets experimentally infected were completely protected against a second infection . Sera from piglets experimentally infected with S . suis capsular types 1/2 or 12 presented cross-reactions at low dilutions, confirming data previously obtained with rabbit sera . Finally, sera of animals from herds with clinical signs associated with S . suis capsular type 2 did not present titers significantly different from those of disease free herds . From our results we concluded that the CPS-ELISA developed in this study can not be used as a diagnostic tool to identify infected animals.

J Dairy Sci, 1996 Sep, 79(9), 1683 - 8
Efficacy of teat dips containing a hypochlorous acid germicide against experimental challenge with Staphylococcus aureus and Streptococcus agalactiae; Boddie RL et al.; Two teat dip formulations containing sodium dichloroisocyanurate, which released hypochlorous acid (2800 ppm) as the active ingredient, were tested for efficacy against new Staphylococcus aureus and Streptococcus agalactiae IMI using an experimental challenge model . Product 1 reduced the number of new Staph . aureus IMI by 73.6% and reduced the number of new Strep . agalactiae IMI by 65.1% . Product 2 reduced the number of new Staph . aureus IMI by 69.0% and reduced the number of new Strep . agalactiae IMI by 63.5% . No adverse effects on teat skin condition were observed over the course of the studies.

J Antimicrob Chemother, 1996 Sep, 38(3), 507 - 21
Treatment of endocarditis with teicoplanin: a retrospective analysis of 104 cases; Wilson AP et al.; Infective endocarditis is an uncommon disease but retains a high mortality . Glycopeptides are used for patients with resistant pathogens, those allergic to penicillins or for those outside the hospital . The once daily administration of teicoplanin and its low toxicity suggest that it would be suitable for use in the long courses required for endocarditis . However, the dosage and combinations to be used require further study . A retrospective review has been made of 104 episodes of endocarditis treated with teicoplanin in 101 patients seen over 7 years . Most patients had been referred to major London hospitals following failure of medical treatment . After three loading doses of 400 mg, teicoplanin was given at a dose of 400 mg/day in combination with other antibiotics such as gentamicin . Follow up was for one year . The most common pathogens were Streptococcus sanguis (15 cases), Staphylococcus aureus (13 cases) and Staphylococcus epidermidis (10 cases) . Of 80 patients febrile at the start of treatment with teicoplanin, 63 (79%) lost their fever within a median of 2 days (1-35 days) . Cure without surgery was effected in 50 (48%) and 75% of patients survived . Other antibiotics, usually gentamicin or rifampicin, were used in 92 (90%) of patients . Two strains of Streptococcus spp . were said to be resistant but there was no relationship between MIC of teicoplanin and outcome . Pathogens with a high MBC tended to be more likely to resist treatment . Adverse effects resulted in the withdrawal of teicoplanin in 20 cases (19%) but most events were mild and renal deterioration occurred in only five patients . Teicoplanin was effective in the treatment of endocarditis and appeared to be safe given the severity of disease in the patients treated.

Drug Metab Dispos, 1996 Sep, 24(9), 1028 - 31
Hemodynamic effects of N-acetylamrinone in a porcine model of group B streptococcal sepsis; Allen EM et al.; High plasma concentrations of N-acetylamrinone, a primary metabolite of amrinone, are measured in some children during prolonged amrinone infusion . The purpose of this investigation was to determine if N-acetylamrinone has direct hemodynamic effects independent of amrinone . Twenty neonatal piglets received an infusion of 6 x 10(9) colony-forming units/kg of group B Streptococcus to induce sepsis . Subsequently, they were divided into 1 of 3 groups and received a 1-hr infusion of either normal saline (N = 4); 8 mg/kg amrinone, followed by 20 micrograms/kg/min (N = 9); or 8 mg/kg N-acetylamrinone, followed by 20 micrograms/kg/min (N = 7) . Hemodynamic measurements and arterial/venous blood-gas determinations were obtained every 30 min during the study . Systemic vascular resistance and pulmonary vascular resistance were calculated . One milliliter of blood was obtained every 30 min during drug administration to determine plasma amrinone and N-acetylamrinone concentrations . The mean amrinone plasma concentrations measured at 30 and 60 min during the infusion time in the group receiving amrinone were 8.8 +/- 1.1 and 6.9 +/- 0.7 micrograms/ml, respectively . These animals experienced a significant decrease in mean pulmonary artery pressure and pulmonary vascular resistance, compared with saline controls after a 30-min infusion of amrinone . The mean N-acetylamrinone plasma concentrations measured at 30 and 60 min during the N-acetylamrinone infusion were 7.3 +/- 0.8 and 5.7 +/- 0.6 micrograms/ml, respectively . There was no difference between any hemodynamic parameter measured in these animals, compared with saline controls at any time during the infusion . We conclude that amrinone, but not N-acetylamrinone, causes pulmonary vasodilation in a porcine model of sepsis and that the parent drug is the sole active component in amrinone.

Zentralbl Veterinarmed B, 1996 Sep, 43(7), 385 - 92
Adherence of Streptococcus uberis to bovine mammary epithelial cells and to extracellular matrix proteins; Almeida RA et al.; Adherence of an encapsulated (UT 101) and a non-encapsulated (UT 102) strain of Streptococcus uberis to a bovine mammary epithelial cell line (MAC-T) and to extracellular matrix proteins (ECMP) including fibronectin, collagen and laminin was investigated . S . uberis was co-cultured at 4 degrees C with MAC-T cell monolayers . Both strains of S . uberis adhered to MAC-T cells . However, the non-encapsulated strain of S . uberis adhered better to MAC-T cells than the encapsulated strain . Preincubation of MAC-T cells with lipoteichoic acid (LTA) and/or treatment of S . uberis with antibodies directed against the carboxyl-terminal half of type 24 M protein reduced adherence of both strains of S . uberis to MAC-T cells . Adherence to ECMP was measured by incubating bis-carboxyethyl-carboxyfluorescein acetomethyl ester (BCECF-AM) labelled S . uberis in 96-well plates coated with fibronectin, collagen or laminin . Both strains adhered to ECMP, however, the encapsulated strain adhered better to ECMP than the non-encapsulated strain . Results of this investigation demonstrated that both strains of S . uberis evaluated were capable of adhering to bovine mammary epithelial cells and to ECMP . Adherence of S . uberis to mammary epithelium may be an extremely important mechanism in the establishment and progression of bovine intramammary infections.

FEMS Immunol Med Microbiol, 1996 Sep, 15(2-3), 81 - 91
Isolation of a new superantigen with potent mitogenic activity to murine T cells from Streptococcus pyogenes; Nemoto E et al.; A mitogenic substance on murine lymphocytes was detected in the culture supernate of Streptococcus pyogenes type 12 strain . This substance had a molecular weight of 28,000 and pI 9.2, and was designated as S . pyogenes mitogen (SPM) . The proliferative response of C3H/HeN spleen cells began at 1 ng ml-1 and reached a maximal response at 100 ng ml-1 of SPM for 4 days culture . Anti-Thy 1.2 mAb and complement-treated spleen cells abrogated the proliferative response to any dose of SPM . Although the anti-major histocompatibility complex class 1 mAbs had no blocking effect on proliferation by SPM, this proliferation was substantially inhibited by the addition of either anti-I-A or anti-I-E mAb, and complete inhibition was produced by the addition of both mAbs . Fixed antigen-presenting cells still induced T cell proliferation by SPM . A significant expansion of T cells bearing V beta 13 T-cell receptor was observed up to 73% among the Thy 1.2+ cells in cultures stimulated with SPM, indicating expansion in a V beta-specific manner . Immunoblotting of IEF-separated proteins showed that anti-streptococcal pyrogenic exotoxin (SPE) C reacted with a protein of pI 6.9 and anti-SPEB did not show any reactivity . SPEA was reported to expand V beta 8.1 and 8.2 bearing murine T cells, and SPM did not . SPM also exhibited potent mitogenic activity on human T cells and V beta 21+ T cells were selectively expanded . These results lead to the conclusion that SPM was neither SPEA, B nor C, but a new protein belonging to a group of streptococcal superantigens with activity on not only human but also murine lymphocytes.

Artif Cells Blood Substit Immobil Biotechnol, 1996 Sep, 24(5), 553 - 66
Kinetic properties of glucosyltransferase adsorbed onto saliva-coated hydroxyapatite; Steinberg D et al.; Results from previous studies have shown that several properties of glucosyltransferase (GTF) adsorbed onto saliva-coated hydroxyapatite beads differ from those of GTF in solution . For example: thermostability, pH-activity dependency, sensitivity to inhibitors . The aim of this study was to compare the kinetics of the adsorbed GTF with its kinetic properties in solution . Hydroxyapatite beads were coated with human parotid saliva (sHA) . Following washes, cell-free GTF enzyme from Streptococcus sobrinus 6715 (S . sobrinus 6715) or Streptococcus mutans GS-5 (S . mutans GS-5) was adsorbed onto sHA . The GTF-coated sHA were then incubated with radiolabeled sucrose for intervals of 5-360 minutes and the amount of glucans synthesized in situ by the adsorbed GTF was determined and compared with that produced in solution . The adsorbed GTF (from S . sobrinus 6715) exhibited a sharp increase in glucan production within the first 5 minutes of incubation while surface-bound GTF of S . mutans GS-5 displayed an initial burst of activity within the first 15 minutes of incubation . During the next 6 hours (duration of experiment) the amount of glucan on the beads did not increase with either enzyme . In contrast, the kinetic profile of the two GTFs in solution demonstrated a linear increase in the amount of glucans formed, with no initial burst effect . The results indicate that the rapid formation of glucans by GTF adsorbed onto sHA could have implications for colonization by oral microorganisms on tooth surfaces . The accelerated synthesis of glucan on tooth surfaces may affect the microbiology of the dental plaque, and might also influence the movement of substances, such as acids and antiplaque agents, across the acquired pellicle and dental plaque.

Antimicrob Agents Chemother, 1996 Sep, 40(9), 2190 - 3
Canadian national survey of prevalence of antimicrobial resistance among clinical isolates of Streptococcus pneumoniae . Canadian Bacterial Surveillance Network; Simor AE et al.; The antimicrobial susceptibilities of 1,089 clinical isolates of Streptococcus pneumoniae obtained from 39 laboratories across Canada between October 1994 and August 1995 were determined . A total of 91 isolates (8.4%) demonstrated intermediate resistance (MIC, 0.1 to 1.0 microgram/ml) and 36 (3.3%) had high-level resistance (MIC, > or = 2.0 micrograms/ml) to penicillin . Penicillin-resistant strains were more likely to have been recovered from normally sterile sites (P = 0.005) and to be cross-resistant to several beta-lactam and non-beta-lactam antimicrobial agents (P < 0.05) . These results indicate that there has been a recent significant increase in the prevalence of antibiotic-resistant S . pneumoniae in Canada.

Antimicrob Agents Chemother, 1996 Sep, 40(9), 2147 - 51
Synergy between amoxicillin and gentamicin in combination against a highly penicillin-resistant and -tolerant strain of Streptococcus pneumoniae in a mouse pneumonia model; Darras-Joly C et al.; In vivo synergy with beta-lactam antibiotics and aminoglycosides has been studied only with penicillin-susceptible Streptococcus pneumoniae strains . We evaluated the interaction between amoxicillin (AMX) and gentamicin (GEN) on the basis of in vitro checkerboard and time-kill curves and of findings in a mouse model of acute bacteremic pneumonia due to a highly penicillin-resistant and -tolerant S . pneumoniae strain of serotype 19 (penicillin and AMX MICs of 4 micrograms/ml; gentamicin MIC of 16 micrograms/ml) . Checkerboard results at 18 h of incubation showed indifference . With regard to AMX alone, in vitro time-kill curves demonstrated synergy between AMX (1 microgram/ml) and GEN (16 micrograms/ml) at 5 and 8 h of incubation and for AMX (16 micrograms/ml) in combination with GEN (16 micrograms/ml) at 3, 5, and 8 h of incubation . In leukopenic mice, pulmonary killing curves after a single drug injection demonstrated that AMX (100 mg/kg of body weight) with GEN (16 mg/kg) was more effective than AMX alone (P = 10(-4) . With repeated-dose treatment, a synergy was apparent at 8 h after four injections with AMX (100 mg/kg) in combination with GEN (8 or 16 mg/kg) (P < or = 0.05) . The cumulative survival rate with AMX (100 mg/kg) every 8 h, combined with GEN (4 or 8 mg/kg) every 8, 12, or 24 h, was better than with AMX alone . Combined use of AMX and GEN may be a valuable therapeutic alternative for pneumococcal pneumonia due to highly penicillin-resistant S . pneumoniae strains.

Antimicrob Agents Chemother, 1996 Sep, 40(9), 2062 - 66
In vivo activity and pharmacodynamics of amoxicillin in combination with fosfomycin in fibrin clots infected with highly penicillin-resistant Streptococcus pneumoniae; Chavanet P et al.; Using a clinical pneumococcal strain for which MICs were 4, 2, and 32 mg/liter for penicillin, amoxicillin, and fosfomycin, respectively, we studied the efficacies of these antibiotics alone and their combinations in the treatment of prolonged (48-h) experimental fibrin clot infection in rabbits . Treatments were as follows: amoxicillin IV at 20 mg/kg of body weight in one dose (Amo20), 50 mg/kg in one dose (Amo50), or two doses 6 h apart (Amo20 x 2 and Amo50 x 2); fosfomycin IV at a fixed dose of 50 mg/kg in one dose (Fos50) or two divided doses 6 h apart (Fos50 x 2); or the combinations of amoxicillin and fosfomycin with the same schedules . Maximum concentrations in clots were 2.03 +/- 1.02 and 2.13 +/- 0.33 mg/liter for Amo20 regimens, 3.7 +/- 1.9 and 4 +/- 1.3 mg/liter for Amo50 regimens, and 24 +/- 7 and 40 +/- 8 mg/liter for fosfomycin regimens, respectively . The mean half-lives of elimination from clots were between 2 and 3 h for amoxicillin regimens and between 5 and 7 h for fosfomycin . We observed the highest bacterial reductions (log10 CFU/gram) for Amo50 in two divided doses with or without fosfomycin . A significantly higher bacterial reduction than that with each monotherapy was observed when Amo20 was combined with fosfomycin in either one dose or two doses 6 h apart (0.16 +/- 0.8 and 1.64 +/- 1.6 log10 CFU/g for Amo20 in one and two doses, respectively, and 0.93 +/- 0.81 and 0.61 +/- 0.56 log10 CFU/g for fosfomycin in one and two doses, respectively, versus 3.46 +/- 1.26 and 3.16 +/- 1.31 log10 CFU/g for Amo20 plus fosfomycin in one and two doses, respectively {P < 0.001}) . A time-dependent effect was observed with amoxicillin regimens . The time of regrowth was significantly delayed when amoxicillin was combined with fosfomycin . By using a multivariate analysis, we demonstrated that the most important parameter correlated to efficacy of the combination amoxicillin-fosfomycin was the length of the period during which the concentration of amoxicillin remained above the MIC . We demonstrated that the in vivo efficacy of the combination of amoxicillin and fosfomycin gave higher antibacterial effect than each monotherapy.

Antimicrob Agents Chemother, 1996 Sep, 40(9), 1977 - 82
Efficacy of single-dose ceftriaxone in experimental otitis media induced by penicillin- and cephalosporin-resistant Streptococcus pneumoniae; Barry B et al.; We used a gerbil model of otitis media to assess the efficacy of single-dose ceftriaxone against three Streptococcus pneumoniae strains highly resistant to penicillin (MICs, 4 to 8 micrograms/ml) and with various susceptibilities to ceftriaxone (MICs, 0.5, 4, and 8 micrograms/ml) . Middle ear infection was induced by bilateral transbullar challenge with 10(7) bacteria per ear . Antibiotic treatment was administered subcutaneously at 2 h postinfection . Infection status was checked 2 days later by counting the bacteria in middle ear and cerebrospinal fluid samples . With the cefriaxone-susceptible strain (MIC, 0.5 microgram/ml), we tested doses of 5 to 100 mg/kg of body weight . With a dose of 50 mg/kg, treatment outcome was equivalent to that with amoxicillin, which was used as a reference (25 mg/kg, two injections); no bacteria were recovered from 82% of the middle ear samples, and the rate of cerebrospinal fluid culture positivity was significantly reduced to 6%, relative to 59% for the untreated controls . Similar efficacy was obtained with a dose of 100 mg/kg against the two ceftriaxone-resistant strains . Pharmacokinetic study indicates that the values of the parameters in plasma after the administration of a dose of 100 mg/kg (peak level of total drug, 268 +/- 33 micrograms/ml; elimination half-life, 0.8 h; area under concentration-time curve, 488 micrograms.h.ml-1) were still suboptimal compared with the values of the parameters measured in pediatric patients after intravenous or intramuscular administration of a dose of 50 mg/kg . Our results indicate the efficacy of ceftriaxone against experimental cephalosporin-resistant pneumococcal otitis and provide a basis for the clinical use of single-dose ceftriaxone against pneumococcal otitis media.

Pediatr Infect Dis J, 1996 Sep, 15(9), 791 - 5
Evaluation of the efficacy, safety and toleration of azithromycin vs . penicillin V in the treatment of acute streptococcal pharyngitis in children: results of a multicenter, open comparative study . The Swiss Tonsillopharyngitis Study Group; Schaad UB et al.; BACKGROUND: For many years alternatives to penicillin have been studied for the management of pediatric group A beta-hemolytic Streptococcus (GABHS) pharyngitis . As a result of its pharmacokinetic profile azithromycin is unique among these alternative antimicrobials in allowing once daily dosing and shorter duration of treatment . However, the optimum dose (e.g . 10 or 12 mg/kg/day) and duration (e.g . 3 or 5 days) of azithromycin therapy have not been defined yet . METHODS: An open, comparative multicenter study was conducted in 343 children with clinical symptoms of GABHS pharyngitis and a positive culture to evaluate the efficacy and safety of azithromycin (10 mg/kg) once daily for 3 days compared with penicillin V three times daily for 10 days . RESULTS: Among the evaluable patients bacteriologic eradication documented at follow-up visits was inferior with azithromycin when compared with penicillin V therapy: at Days 9 to 20 (mean, 12 days), negative cultures in 65% (99 of 152 patients) vs . 82% (128 of 126 patients) (P < 0.001); and at Days 17 to 57 (mean, 25 days), in 55% vs . 80% (P < 0.001) . Overall clinical success (cure or improvement) was achieved in 93% (149 of 160 patients) of azithromycin-treated and in 89% (143 of 160 patients) of penicillin-treated patients (P > 0.50) . There was no correlation between bacteriologic response and clinical outcome, as assessed shortly after completion of therapy or during 6-month follow-up . Both treatments were well-tolerated . CONCLUSIONS: In the present study on GABHS pharyngitis in children, a once daily (10-mg/kg), 3-day oral regimen of azithromycin was as clinically effective and as safe as traditional penicillin but appeared inferior in eliminating GABHS from the throat.

Clin Diagn Lab Immunol, 1996 Sep, 3(5), 517 - 22
Clonal diversity of Streptococcus mitis biovar 1 isolates from the oral cavity of human neonates; Fitzsimmons S et al.; The clonal diversity of 101 isolates of the pioneer bacterium Streptococcus mitis biovar 1 obtained from the oral cavities of 40 human neonates 1 to 3 days, 2 weeks, and 1 month postpartum was examined by using rRNA gene restriction patterns . There was a high degree of genetic diversity, with the 101 isolates comprising 93 unique PvuII ribotypes . There were eight identical pairs of ribotype patterns, and seven of the eight pairs were obtained from individual neonates . Only one identical pair comprised isolates obtained from different neonates . In all but two cases, isolates with matching ribotypes were obtained at one visit . Two pairs of isolates with matching ribotype patterns were obtained from neonates on successive visits . The ribotype patterns of the isolates were examined by cluster analysis . The isolates forming each cluster were very similar, yet each cluster was well separated from its neighbors . When several isolates were obtained from individual neonates at a particular visit, in some instances they were contained in a single cluster, whereas in other cases each isolate was contained in a separate cluster . Isolates obtained from individual neonates on successive visits tended to be contained in different clusters . This high degree of diversity, which has been observed in other mucosal commensal bacteria, may serve as a mechanism for avoiding immune elimination of these bacteria.

J Perinat Neonatal Nurs, 1996 Sep, 10(2), 1 - 16
Perinatal group B streptococcal infections: the nurse's role in identification and prophylaxis; Mahlmeister L; Group B Streptococcus (GBS) is a major cause of perinatal infectious morbidity and mortality in the United States . An estimated 50,000 women and 7,600 neonates experience GBS disease, and as many as 310 infants die each year . In 1992, the American Academy of Pediatrics published recommendations for identification and treatment of pregnant women colonized with GBS . In 1996, the Centers for Disease Control and Prevention and the American College of Obstetricians and Gynecologists developed more comprehensive guidelines . The article describes the central role of perinatal nurses in the identification of pregnant women colonized with GBS, patient education about GBS disease, and successful implementation of intrapartum GBS prophylaxis.

Isr J Med Sci, 1996 Sep, 32(9), 771 - 4
Pneumococcal psoas abscess: report of a case and review of the world literature; Giladi M et al.; A 39-year-old man was admitted to the hospital with fever and right hip pain . CT scan of the pelvis showed a psoas muscle abscess . Pus, which was surgically evacuated, grew Streptococcus pneumoniae . The patient fully recovered after 30 days of intravenous antibiotics . Review of the literature revealed only nine similar cases of primary pneumococcal psoas abscess . Three cases were complicated with pneumococcal meningitis . In four cases there was a history of trauma to the involved area . Pneumococcal psoas abscess is a rare entity that carries a good prognosis provided early surgical drainage is performed and parenteral antibiotic therapy is administered to the patient.

Can J Microbiol, 1996 Sep, 42(9), 927 - 33
Effects of a strain of Saccharomyces cerevisiae (Levucell SC1), a microbial additive for ruminants, on lactate metabolism in vitro; Chaucheyras F et al.; The effect of Levucell SC, a strain of Saccharomyces cerevisiae marked as a feed additive for ruminants, was investigated in vitro on lactate metabolism by the ruminal bacteria Streptococcus bovis and Megasphaera elsdenii . The coculture between 10(7) live cells x mL(-1) of SC and a Streptococcus bovis strain in the presence of glucose reduced lactate production by the bacterial strain . Live yeast cells were able to compete with Streptococcus bovis for glucose utilization in strictly anaerobic conditions, so less glucose was available for the bacterium . SC also stimulated L-lactate utilization by a strain of M . elsdenii . The effect depended on the concentration of yeast cells added . Bacterial growth and fermentation end-product concentrations were also increased in the presence of SC . Some amino acids and vitamins, but not dicarboxylic acids, stimulated the bacterial specific activity of L-lactate uptake . SC was able to provide amino acids to M . elsdenii . In a coculture of Streptococcus bovis and M . elsdenii on glucose, the reduction of lactate concentration was improved by SC, the same trend being observed when maltose or soluble starch were used as carbon and energy source . These results indicate that SC can be a very useful tool to reduce lactate accumulation in vitro during fermentation of soluble sugars.

Br J Haematol, 1996 Sep, 94(4), 729 - 39
Evidence for the involvement of complement proteins in platelet aggregation by Streptococcus sanguis NCTC 7863; Ford I et al.; We investigated the mechanisms of platelet aggregation by the type strain of Streptococcus sanguis (NCTC 7863) . This species is one of the major aetiological agents of infective endocarditis . S . sanguis NCTC 7863 caused aggregation of normal human platelets in vitro following a lag period that varied between donors (7-19 min) . Platelet aggregation was dependent on one or more plasma constituents and all the necessary factors gradually became bound to the bacterial surface during the lag period . The length of the lag period was determined by the plasma of the donor and not by a feature of their platelets . Platelet aggregation by S . sanguis NCTC 7863 could be inhibited by heating plasma at 56 degrees C, by treating plasma with cobra venom factor, or by incubating with soluble Complement Receptor 1, all of which inhibit or deplete complement . Complement activation required Mg2+, but not Ca2+ ions and the the cleavage fragment, Ba, of factor B was produced, indicating that the alternative pathway was operative . Zymosan- and S . sanguis-induced aggregation showed similarities, including the same variability in lag times among donors, and absorption of plasma with zymosan prevented the plasma from supporting platelet aggregation by S . sanguis, C3, C9 and vitronectin were found to bind to S . sanguis NCTC 7863, but the latter two were present at very low levels on a non-aggregating strain of S . sanguis, SK96 . The rate of assembly of the C5b-9 complex on the NCTC 7863 bacterial surface correlated with the lag time . These data suggest a role for the complement pathway in platelet aggregation by the type strain of S . sanguis.

Ann Allergy Asthma Immunol, 1996 Sep, 77(3), 167 - 73; quiz 173-5
Emerging resistance to antibiotics: impact on respiratory infections in the outpatient setting; Green M et al.; OBJECTIVE: To review the major mechanisms of antibiotic resistance and provide an overview of currently available oral antibiotics . This article discusses the impact of antibiotic resistance on respiratory infections (eg, otitis media, sinusitis, and pneumonia) encountered in the outpatient setting and appropriate management strategies for these infections are proposed . DATA SOURCES: A Medline search was performed to identify recent references from the English language pertinent to this topic . Proposed management schemes for infections due to antibiotic-resistant bacteria were derived from current literature as well as the opinion of the authors . RESULTS: Currently available oral antibiotics including penicillins, cephalosporins, macrolides, trimethroprim/sulfamethoxazole, and clindamycin continue to provide effective therapeutic options despite the increasing importance of antibiotic resistance in bacteria causing respiratory tract infections in the outpatient setting . The effectiveness of a given agent may no longer be assured, leading to the need for development of updated management strategies for patients experiencing treatment failure with antibiotics . Diagnostic strategies (ie, tympanocentesis) and novel treatment algorithms (eg, use of amoxicillin in combination with amoxicillin/clavulanate) for patients experiencing clinical failures potentially due to antibiotic-resistant bacteria are proposed . CONCLUSIONS: The increasing prevalence of antibiotic resistant bacteria (especially penicillin-resistant Streptococcus pneumoniae) is leading to new approaches to the management of common respiratory infections in the outpatient setting . Additional experience and careful clinical trials are necessary to identify optimal management strategies for these infections.

J Med Microbiol, 1996 Sep, 45(3), 179 - 85
The effect of oral commensal bacteria on candidal adhesion to human buccal epithelial cells in vitro; Nair RG et al.; The effect of Streptococcus sanguis, S . salivarius, Escherichia coli and Porphyromonas gingivalis on the adhesion of Candida albicans and C . krusei to human buccal epithelial cells (BEC) was investigated with a modified membrane filter system . The filters (12 microns diameter pores) acted as a support for the BEC which were pre-exposed to known concentrations of bacterial suspensions (for 45 min-1 h), and then re-incubated with standardised concentrations of yeast suspensions for various periods . The BEC with adherent yeasts were then transferred on to a glass slide, gram-stained and counted by light microscopy . Three of the four bacterial species significantly suppressed adhesion of C . albicans to BEC; S . sanguis had no effect . Both S . sanguis and S . salivarius suppressed adhesion of C . krusei to BEC pre-exposed to three different bacterial concentrations, although variable results were obtained with P . gingivalis and E . coli . Significant differences in the relative adhesion of C . albicans and C . krusei to BEC were also recorded . These results indicate that the adhesion of yeasts to BEC is modulated both by the composition and the quantity of the pre-existing bacterial flora on the BEC.

J Bacteriol, 1996 Sep, 178(18), 5546 - 9
Physical and genetic chromosomal map of an M type 1 strain of Streptococcus pyogenes; Suvorov AN et al.; A physical map of the chromosome of an M type 1 strain of Streptococcus pyogenes was constructed following digestion with three different restriction enzymes, SmaI, SfiI, and SgrAI, and separation and analysis of fragments by pulsed-field gel electrophoresis . The genome size of this strain was estimated to be 1,920 kb . By employing Southern hybridization and PCR analysis, 36 genes were located on the map.

J Bacteriol, 1996 Sep, 178(18), 5402 - 9
The non-penicillin-binding module of the tripartite penicillin-binding protein 3 of Escherichia coli is required for folding and/or stability of the penicillin-binding module and the membrane-anchoring module confers cell septation activity on the folded structure; Goffin C et al.; The ftsI-encoded multimodular class B penicillin-binding protein 3 (PBP3) is a key element of the cell septation machinery of Escherichia coli . Altered ftsI genes were overexpressed, and the gene products were analyzed with respect to the level of production, stability, penicillin affinity, and cell septation activity . In contrast to the serine beta-lactamases and low-molecular-mass PBPs which are autonomous folding entities, the S-259-to-V-577 penicillin-binding module of M-1-to-V-577 PBP3 lacks the amino acid sequence information for correct folding . The missing piece of information is provided by the associated G-57-to-E-258 non-penicillin-binding module which functions as a noncleaved, pseudointramolecular chaperone . Key elements of the folding information reside within the motif 1-containing R-60-to-W-110 polypeptide segment and within G-188-to-D-197 motif 3 of the n-PB module . The intermodule interaction is discussed in the light of the known three-dimensional structure (at 3.5-A {0.35-nm} resolution) of the analogous class B PBP2x of Streptococcus pneumoniae (S . Pares, N . Mouz, Y . Petillot, R . Hakenbeck, and O . Dideberg, Nature Struct . Biol . 3:284-289, 1996) . Correct folding and adoption of a stable penicillin-binding conformation are necessary but not sufficient to confer cell septation activity to PBP3 in exponentially growing cells . The in vivo activity of PBP3 also depends on the M-1-to-E-56 amino-terminal module which encompasses the cytosol, the membrane, and the periplasm and which functions as a noncleaved pseudo-signal peptide.

J Pediatr, 1996 Sep, 129(3), 396 - 402
An outbreak of M serotype 1 group A Streptococcus in a neonatal intensive care unit; Campbell JR et al.; OBJECTIVE: To describe the investigation and control of an outbreak of M serotype 1, Streptococcus pyogenes (group A Streptococcus, GAS) infections in a neonatal intensive care unit (NICU) . STUDY DESIGN: The study was conducted in an NICU in a large urban university-affiliated hospital . Retrospective review was performed of all infants and health care workers in the NICU, especially those either colonized or infected with GAS during the outbreak and the prospective surveillance period (July through September 1994) . Prospective epidemiologic investigation, including cultures of throat, umbilicus, and anorectum (infants), or throat and anus (NICU personnel), identified a possible common source of the disease in case infants . Antimicrobial susceptibility testing and serotyping of all GAS strains were performed; M serotype 1 isolates were examined by DNA analysis with restriction fragment length polymorphism . The M-1 GAS isolates were tested for streptococcal pyrogenic exotoxin (SPE) A and SPE B production . A retrospective chart review and analysis of infants with GAS infection or colonization was conducted . RESULTS: During a 1-week period, two very low birth weight infants more than 3 weeks of age had GAS septicemia and focal infection . Two additional very low birth weight infants with asymptomatic throat colonization were identified during the first week of surveillance . Benzathine penicillin G was administered to all NICU infants, but failed to eradicate throat colonization in the four case subjects . Seven days after completing parenteral antibiotic therapy, the index patient had a recurrence of GAS septicemia that was fatal . Eradication of throat colonization in the remaining three infants was achieved with a 10-day course of intravenous clindamycin therapy . Among 103 NICU personnel, five (4.9%) had asymptomatic GAS colonization with strains that were uniformly susceptible to penicillin . Each colonized adult was successfully treated with oral clindamycin therapy . Serotyping revealed that five isolates of GAS from four infants and one NICU respiratory therapist were M-1 isolates; DNA analysis confirmed that these were the same strain . The five M-1 isolates produced both SPE A and SPE B . CONCLUSIONS: The previously documented increase in prevalence of M-1 strains of GAS in the United States is likely to be associated with their introduction into closed populations including NICUs . Control of such outbreaks may be achieved by isolation, cohorting of case subjects and possible carriers, and successful eradication of colonization in case subjects and carriers . Although GAS organisms are uniformly susceptible to penicillin G, eradication may require agents other than penicillin.

J Infect Dis, 1996 Sep, 174(3), 520 - 8
Mechanisms of the spread of penicillin resistance in Streptococcus pneumoniae strains causing meningitis in children in France; Doit C et al.; The molecular epidemiology of penicillin-resistant Streptococcus pneumoniae strains causing meningitis in children was studied in France . Typing procedures included analysis of total DNA polymorphism by random amplification of polymorphic DNA, restriction fragment length polymorphism (RFLP) analysis of the ribosomal RNA gene regions, and pulsed-field gel electrophoresis . Penicillin-binding protein (PBP) genes pbp2b and pbp2x were studied by RFLP analysis and DNA sequencing in selected cases . Statistical analysis of the data by factorial analysis of correspondence established that the emergence of penicillin-resistant pneumococci in this pathology is the result of the spread of two highly resistant closely related clusters and a cluster of serotype 23 strains with an intermediate level of resistance, the spread of genes confering high resistance to penicillin between the two highly resistant clusters, and complex genetic events involving the pbp genes in a heterogeneous population of strains leading to an intermediate level of resistance.

J Infect Dis, 1996 Sep, 174(3), 513 - 9
Association of penicillin-resistant pneumococci with residence in a pediatric chronic care facility; Mannheimer SB et al.; Risk factors for the acquisition of penicillin-resistant pneumococci (PRP) were analyzed at a university hospital in New York City . Patients with PRP and control patients with penicillin-sensitive pneumococcal infections were compared . In 1994, 24 (21%) of 113 patients with Streptococcus pneumoniae infections had PRP; 13 PRP isolates were from children and 11 from adults . Only white race (P < .05) and residence in a pediatric chronic care facility (P < .05) were significantly associated with penicillin resistance . An investigation at one chronic care facility revealed that 33% of children (17/52) had PRP colonization . Fourteen of the 17 PRP isolates were also resistant to ceftriaxone . Prior antibiotic use and specifically beta-lactam use were associated with penicillin resistance . All typeable PRP isolates were multidrug-resistant serotype 23 . Pediatric residents in chronic care facilities may be an important reservoir of PRP and may serve as a source of PRP transmission when they are transferred to acute care hospitals.

J Infect Dis, 1996 Sep, 174(3), 507 - 12
Ethanol ingestion reduces antipneumococcal activity of rat pulmonary surfactant; Rubins JB et al.; Because chronic ethanol ingestion decreases pulmonary clearance of Streptococcus pneumoniae in rats, and extracellular antipneumococcal factors in rat surfactant are important in the early clearance of pneumococci from the rat alveolus, the effects of ethanol ingestion on surfactant bactericidal activity were investigated . Normal surfactant from chow-fed rats showed potent anti-pneumococcal activity, even against bacteria growing in nutrient-rich media under favorable conditions . In contrast, surfactant from ethanol-fed rats and from calorie-restricted control-fed rats had significantly reduced antipneumococcal activity compared with surfactant from chow-fed rats . The reductions in surfactant bactericidal activity produced by ethanol ingestion or caloric restriction did not appear to be mediated through changes in either the total amount or the distribution of fatty acids, the antipneumococcal factors in normal surfactant . Rather, ethanol ingestion, and to a lesser extent caloric restriction, produced a surfactant inhibitor of free fatty acids that was partially characterized as a hydrophobic protein.

J Infect Dis, 1996 Sep, 174(3), 500 - 6
High-resolution genotyping elucidates the epidemiology of group A streptococcus outbreaks; Stanley J et al.; Streptococcus pyogenes strains were genotyped by a combination of molecular methods for high- resolution epidemiologic studies of disease outbreaks . Polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) analysis of the emm gene is reported . Alone or in conjunction with other molecular techniques (16S ribotyping, pulsed-field gel electrophoresis, and detection of exotoxin genes), PCR-RFLP could differentiate outbreak-related strains from contemporaneous background strains of the same M serotype . Three outbreaks were studied: pharyngitis in a boarding school (serotype M5), cross-infection in a hospital burn unit (serotype M76), and severe invasive disease in two elderly care homes (serotype R28) . It was possible, for example, to identify within serotype R28 a clone with particular potential for invasive disease . In all cases, the four molecular methods yielded complementary results that were hierarchically related . Strains could be assigned to the outbreak or the background in a precise, reproducible, and rapid manner.

Infect Immun, 1996 Sep, 64(9), 3772 - 7
Uptake of Streptococcus pneumoniae by respiratory epithelial cells; Talbot UM et al.; Although Streptococcus pneumoniae is the leading cause of community-acquired pneumonia in humans, the mechanism whereby the organism penetrates lung tissue is poorly understood . In the present study we have examined the capacity of pneumococci to penetrate A549 cells, a human lung alveolar carcinoma (type II pneumocyte) cell line . Not all clinical S . pneumoniae isolates initially tested were capable of penetration of the cells, as judged by resistance to extracellular antibiotics . The presence of a polysaccharide capsule also significantly reduced the capacity to both adhere to and penetrate A549 cells . Electron micrographs showed the presence of pneumococci enclosed within vacuoles of intact A549 cells, but bacteria were also seen free in the cytoplasm of damaged cells . Ongoing bacterial DNA, RNA, or protein synthesis was not essential for uptake of pneumococci by A549 cells, and uptake was not diminished by pretreatment of the pneumococci with trypsin . However, inhibition of A549 microfilament assembly with cytochalasin D abolished the phenomenon.

Infect Immun, 1996 Sep, 64(9), 3659 - 65
The galactosyl-(alpha 1-4)-galactose-binding adhesin of Streptococcus suis: occurrence in strains of different hemagglutination activities and induction of opsonic antibodies; Tikkanen K et al.; The occurrence of the galactose-(alpha 1-4)-galactose-specific adhesin in Streptococcus suis, a pig and human pathogen causing sepsis, meningitis, and other serious infections, was studied . Poly- and monoclonal anti-bodies to the purified adhesin, as well as pigeon ovomucoid, a specific probe for the adhesin activity, detected one single protein band in extracts of S . suis . The adhesin was detected in all 23 strains studied, representing pathogenic serotypes (1, 2, 4, 5, 7, 8, and nontypeable) and including several weakly hemagglutinating or nonhemagglutinating strains and phase variants . The amount of adhesin detected was not correlated with the hemagglutination activity of the intact bacteria . Extraction of cells showing no binding of pigeon ovomucoid by ultrasonic treatment resulted in extracts with pigeon ovomucoid binding activity, suggesting that the adhesin was not accessible to the probe on the intact cells . Analysis of the amount of capsular polysaccharide revealed an inverse relationship between the hemagglutination activity and expression of capsular polysaccharide, thus suggesting a factor influencing adhesin accessibility . The purified adhesin was highly immunogenic and induced in preliminary experiments bactericidal activity in mice . Thus, the adhesin, with its specific binding mechanism to host cells and a proposed pathogenic role, is widely expressed among strains of different serotypes and therefore appears to represent a novel promising candidate for the development of a vaccine against S . suis.

Infect Immun, 1996 Sep, 64(9), 3652 - 8
Characterization of a P1-deficient strain of Streptococcus mutans that expresses the SpaA protein of Streptococcus sobrinus; Kuykindoll RJ et al.; The Streptococcus sobrinus SpaA protein and the Streptococcus mutans P1 protein share 66% sequence homology at the amino acid level . To determine if the SpaA protein can be expressed in S . mutans and functionally replace the P1 protein, the spaA gene of S . sobrinus 6715 was isolated from plasmid pX1303 and inserted into the Escherichia coli-Streptococcus shuttle vector pVA838 . The resulting plasmid pX1600 was transformed into the P1-deficient strain S . mutans 834 that has defects in saliva-mediated aggregation and in the ability to adhere to saliva-coated hydroxyapatite surfaces . Western blot (immunoblot) analysis of cellular protein fractions of S . mutans 834 (pX1600) detected in mutanolysin-solubilized cell walls a major protein of 210 kDa with an electrophoretic mobility similar to that of S . sobrinus SpaA protein and a minor 210-kDa protein and a major 64-kDa protein in the extracellular protein fraction . Analysis of virulence traits showed that expression of SpaA protein by S . mutans 834(pX1600) cells had restored the ability of the S . mutans 834 cells to aggregate in the presence of saliva or salivary agglutinin but not to adhere to saliva-coated hydroxyapatite . This cell aggregation was inhibited specifically by antisera to S . sobrinus SpaA protein . These results indicate that SpaA plays a role in the virulence of S . sobrinus by specifically interacting with fluid-phase salivary agglutinin to mediate cell aggregation.

Infect Immun, 1996 Sep, 64(9), 3518 - 23
Experimental vaccination against group B streptococcus, an encapsulated bacterium, with highly purified preparations of cell surface proteins Rib and alpha; Larsson C et al.; Encapsulated bacteria cause some of the most common diseases in humans . Although the polysaccharide capsules of these pathogens have attracted the most attention with regard to vaccine development, recent evidence suggests that bacterial surface proteins may also be used to confer protective immunity . We have analyzed this possibility in group B streptococcus (GBS), an encapsulated bacterium that is the major cause of invasive bacterial disease in the neonatal period . Previous work has shown that the majority of GBS strains causing invasive infections express the Rib protein, and that most strains lacking Rib express a protein designated alpha . Here we report that active immunization with highly purified preparations of Rib or alpha protected mice against lethal infection with strains expressing the corresponding protein . Vaccination with the Rib protein protected against two strains of capsular type III and two strains of type II, and vaccination with the alpha protein protected against one strain of type II and one strain of type Ib . The mice vaccinated with Rib or alpha showed a good immunoglobulin G response to the immunogen . These data suggest that a vaccine against GBS disease may be based on cell surface proteins and support the notion that proteins may be used for immunization against encapsulated bacteria.

Vet Rec, 1996 Aug 31, 139(9), 204 - 7
Incidence of clinical mastitis in a random sample of dairy herds in the southern Netherlands; Miltenburg JD et al.; The incidence of clinical mastitis and distribution of pathogens in dairy cows was estimated in 171 randomly selected dairy herds in the southern Netherlands . A total of 1103 quarter cases were reported . The average annual incidence rate was 12.7 quarter cases per 100 cows per year . The most frequent isolates from clinical cases were Escherichia coli (16.9 per cent), Staphylococcus aureus (14.4 per cent), Streptococcus uberis (11.9 per cent) and Streptococcus dysgalactiae (8.9 per cent) . Most cases were reported in early lactation: 25.4 per cent in the first month of lactation for all cows, and 39.1 per cent in the first month for first lactation cows . The rear quarters had a significantly higher incidence rate than the front quarters . Cows with an E coli infection showed more general clinical signs than cows infected with S aureus, S uberis and S dysgalactiae . A significantly higher incidence was observed in herds with a low (< 150,000 cells/ml) bulk milk somatic cell count than in herds with a count above 250,000 cells/ml.

Mol Gen Genet, 1996 Aug 27, 252(1-2), 207 - 11
Cloning of heterologous genes specifying detrimental proteins on pUC-derived plasmids in Escherichia coli; Muller J et al.; A system is described that enables the cloning of genes specifying detrimental proteins in Escherichia coli . The system is based on pUC plasmids and was developed for the expression of the Bacillus subtilis csaA gene, which is lethal when expressed at high levels . Suppressor strains that tolerate the presence of plasmids for high-level expression of csaA were isolated, which contained small cryptic deletion variants of the parental plasmid in high copy numbers . The cryptic plasmids consisted mainly of the pUC replication functions and lacked the csaA region and selectable markers . The co-resident, incompatible, cryptic plasmids enabled the maintenance of the csaA plasmids by reducing their copy number 20-fold, which resulted in a concomitant 3- to 7-fold reduction in the expression of plasmid-encoded genes . Strains carrying these cryptic endogenous plasmids proved to be useful for the construction of pUC-based recombinant plasmids carrying other genes, such as the skc gene of Streptococcus equisimilis, which cannot be cloned in high copy numbers in E . coli . Several strategies to reduce production levels of heterologous proteins specified by plasmids are compared.

MMWR Morb Mortal Wkly Rep, 1996 Aug 2, 45(30), 650 - 3
Invasive infection with Streptococcus iniae--Ontario, 1995-1996; Identification of a family of streptococcal surface proteins with extremely repetitive structure; Department of Medical Microbiology, Lund University, Solvegatan 23, S-223 62 Lund, SwedenThe group B Streptococcus (GBS) causes the majority of life-threatening bacterial infections in newborn children . Most GBS strains isolated from such infections express a surface protein, designated Rib, that confers protective immunity and therefore is of interest for analysis of pathogenetic mechanisms . Sequence analysis demonstrated that Rib has an exceptionally long signal peptide (55 amino acid residues) and 12 repeats (79 amino acid residues each) that account for >80% of the sequence of the mature protein . The repeats are identical even at the DNA level, indicating that an efficient mechanism operates to maintain a highly repetitive structure in Rib . The structure of Rib is similar to that of alpha, a previously characterized surface protein that is common among GBS strains lacking Rib . However, highly purified preparations of Rib and alpha did not cross-react immunologically, although the two proteins show extensive amino acid residue identity (47% in the repeat region) . When analyzed in Western blots, Rib and alpha give rise to a regularly spaced ladder pattern, apparently due to hydrolysis of acid-labile Asp-Pro bonds in the repeats . We conclude that Rib and alpha are members of a novel family of streptococcal surface proteins with unusual repetitive structure.

Bull Tokyo Dent Coll, 1996 Aug, 37(3), 119 - 28
Methicillin-resistant Staphylococcus aureus and Candida albicans on denture surfaces; Tawara Y et al.; Infectious diseases caused by methicillin-resistant Staphylococcus aureus, MRSA, and Candida albicans are often serious in compromised hosts . We enumerated MRSA and C . albicans on denture surfaces and in saliva samples from 29 adults . Staphylococcus species, MRSA, and methicillin-resistant Staphylococcus epidermidis, MRSE, were detected on 17, 3, and 1 of the 29 denture surfaces, respectively . C . albicans were detected on 22 denture surfaces . All saliva samples from patients whose dentures carried Staphylococcus species and C . albicans were also found to contain both microorganisms . Adherence of isolated 3H labeled cells of MRSA and C . albicans to resin beads and saliva-coated resin beads was examined . Cells of both microorganisms adhered in significantly higher numbers to saliva-coated resin beads than to resin beads . The hydrophobicity of the MRSA isolated from denture surfaces varied from strain to strain; that of C . albicans strains was moderately high . The zeta potentials of MRSA isolates and of C . albicans isolates determined in KCI buffer were significantly low . The potential of the resin beads decreased after treatment with saliva . Two out of 5 MRSA strains were found to be inhibited in growth by oral Streptococcus, Actinomyces, and gram-negative bacterial strains, suggesting that some oral bacterial species play a role in inhibiting the colonization of Staphylococcus species . No isolates of C . albicans were inhibited in their growth by any of the oral bacteria tested . Isolates of MRSA and C . albicans coaggregated with Porphyromonas gingivalis and Fusobacterium nucleatum strains . Using denture cleaners every night for 2 weeks did not reduce numbers of Staphylococcus species or C . albicans organisms in saliva.

Int Dent J, 1996 Aug, 46(4), 350 - 6
The effect of areca nut on salivary and selected oral microorganisms; de Miranda CM et al.; The aim of this study was to investigate the effect on the growth of salivary and selected oral microorganisms of areca nut, aqueous extracts of the nut, its major alkaloid arecoline and the components tannic acid and catechin of its tannin fraction . The antibacterial properties of the above were tested on Streptococcus mutans, Streptococcus salivarius, Candida albicans and Fusobacterium nucleatum and, as a control, Staphylococcus aureus . This was followed by investigating its effect on salivary organisms cultured from the saliva after chewing boiled areca nut . Extracts inhibited the growth of the selected organisms in a concentration dependent manner, baked and boiled nuts being significantly more potent than raw nut . Growth of C . albicans was the least affected by the nut extracts . Tannic acid was strongly antibacterial but not catechin or arecoline . No antibacterial effect could be demonstrated on salivary organisms after chewing the nut for 5 minutes but exposure of saliva to the cud for 1 hour caused a significant depression of bacterial growth . It is concluded that the hydrolysable tannins in the tannin fraction, which include tannic acid, are responsible for the antibacterial properties of the nut and that prolonged intraoral exposure to the nut can suppress bacteria in the mouth.

Oral Microbiol Immunol, 1996 Aug, 11(4), 254 - 8
Effect of antibodies on chemiluminescence and on killing of Streptococcus sobrinus by polymorphonuclear leukocytes; van Raamsdonk M et al.; The effect of a polyclonal antiserum and OMVU10, a monoclonal antibody reactive with Antigen B of Streptococcus sobrinus, on the interaction of polymorphonuclear leukocytes with S . sobrinus was studied, using chemiluminescence and bacterial killing assays . Increased stimulation of neutrophils as measured in the chemiluminescence assays was established when S . sobrinus was preincubated with polyclonal antiserum or when polyclonal antiserum was added to the reaction mixture . Higher counts were measured in comparison to preimmune serum . After 90 min, 52% of S . sobrinus preincubated with polyclonal antiserum was killed . Killing was also increased when polyclonal antiserum was added to the reaction mixture in comparison to the controls . No killing was found when bacteria were preincubated with OMVU10 or when OMVU10 was added to the reaction mixture in comparison to Clone 24, a control antibody.

Enferm Infecc Microbiol Clin, 1996 Aug-Sep, 14(7), 422 - 5
{Activity of erythromycin and clarithromicin against isolates of Streptococcus pneumoniae with decreased sensitivity to penicillin obtained from healty carriers . Spanish Collaborative Group}; Garcia de Lomas J et al.; BACKGROUND: Empirical treatment of pneumococcal upper and lower respiratory infections must be chosen on the basis of the susceptibility patterns of nasopharyngeal colonizing strains isolated from healthy carriers . METHODS: The susceptibility to erythromycin and clarithromycin was investigated by a conventional microdilution method among 103 pneumococci isolates recovered from healthy children (n = 63) and adults (n = 40) exhibiting decreased susceptibility to penicillin (MIC > or = 0.12 mg/l) . RESULTS: 63% of penicillin -resistant pediatric isolates were susceptible to erythromycin and 78.9% were susceptible to clarithromycin . Among isolates with diminished susceptibility to penicillin , 77.7% were susceptible to erythromycin and 86.3% to clarithromycin . 90% of adult isolates were susceptible to erythromycin and to clarithromycin . Overall, clarithromycin exhibited a better activity than erythromycin . CONCLUSIONS: Clarithromycin , and to a lesser extent erythromycin , are good alternatives to penicillin in the empirical treatment of respiratory tract infections caused by pneumococci with diminished susceptibility to penicillin .

Neurologia, 1996 Aug-Sep, 11(7), 268 - 71
{Bilateral epidural psoas abscess simulating bilateral proximal diabetic plexopathy}; Roquer J et al.; We describe a diabetic woman with an epidural abscess and associated bilateral psoas abscesses which simulated the clinical course of diabetic bilateral proximal plexopathy . We emphasize three aspects: 1) the rarity of associated epidural abscess and bilateral psoas abscesses, 2) the rarity of the germ isolated (Streptococcus bovis), and 3) the diagnostic difficulties when both processes are associated, particularly in patients with an underlying disease that may simulate other common, clinical pictures.

An Esp Pediatr, 1996 Aug, 45(2), 153 - 6
{Neonatal infections by Streptococcus agalactiae}; Juncosa Morros T et al.; OBJECTIVES: The objectives of the study were to evaluate: 1) The incidence and characteristics of neonatal infections by S . agalactiae in the Hospital Sant Joan de Deu of Barcelona, 2) the efficiency of a microbiological control during the third quarter of pregnancy in order to detect colonization by this microorganism; and 3) the efficiency of intrapartum prophylaxis . MATERIAL AND METHODS: Neonatal infections that took place between May 1991 and December 1994 have been studied . Children were born from women controlled in our hospital (7.772 pregnant women) or from women who delivered in other health centers . RESULTS: Nineteen newborn children with an invasive infection and four asymptomatic bacteriemias were diagnosed and treated during the above mentioned period of time . Early forms of the illness were sepsis (eight cases), meningitis (four cases) and arthritis (one case), whereas late forms were comprised of four cases of meningitis and two of arthritis . Three of the neonates died (mortality rate of 15.7%) and two of them developed neurologic sequelae . CONCLUSIONS: The microbiological control during pregnancy in order to detect S . agalactiae carriers, as well as intrapartum antibiotic prophylaxis contributes to reduce the number of this sort of infections . Negative results of cultures carried out during the third quarter of pregnancy do not exclude a carrier state at delivery, therefore, so posterior controls are necessary until the end of pregnancy.

Tohoku J Exp Med, 1996 Aug, 179(4), 291 - 4
Use of fura-2/AM to measure intracellular free calcium in Selenomonas ruminantium; Nakamura I et al.; This paper describes a procedure for loading the acetoxymethyl ester of fura-2 (fura-2/AM), and the subsequent measurement of the concentration of intracellular free Ca2+ ({Ca2+}i) in Selenomonas ruminantium (S . ruminantium) using this technique . To ascertain the optimal loading conditions, the effect was examined on the loading of fura-2/AM of ethylenediamine-tetraacetic acid (EDTA), lysozyme, pluronic F127 alone, or the simultaneous application of EDTA and pluronic F127 . Individual administration of either EDTA, lysozyme or pluronic F127 did not produce an optimal loading of fura-2/ AM . The co-application of pluronic F127 and bovine serum albumin after treatment with EDTA increased the ratio of the fluorescence due to excitation at 340 nm to that at 380 nm (R340/380) markedly, with a high signal intensity for intracellular fura-2, indicating that adequate loading had been obtained . Using the present loading method, it was found that the resting free {Ca2+}i of S . ruminantium was 48.1 +/- 2.2 nM (n = 6) . This is approximately one half that found in Escherichia coli, Propionibacterium acnes, Streptococcus bovis and eucaryote cells . This is the first measurement of free {Ca2+}i using fura-2/AM in the Gram-negative strict anaerobe S . ruminantium.

Diagn Microbiol Infect Dis, 1996 Aug, 25(4), 201 - 4
Clindamycin resistance among erythromycin-resistant Streptococcus pneumoniae; Jones RN et al.; The increasing proportion of Streptococcus pneumoniae isolates with reduced susceptibility to penicillin has created an urgent need for therapeutic alternatives to some beta-lactam agents . Clindamycin is an antimicrobial agent with excellent bioavailability after oral administration which has been considered for the therapy of community-acquired pneumococcal otitis media . Using the Etest methodology, we have studied the in vitro susceptibility of 59 erythromycin-resistant strains of S . pneumoniae to clindamycin, penicillin, trimethoprim-sulfamethoxazole, and rifampin . The study also addressed the impact of the susceptibility test medium {Mueller-Hinton (MH) vs IsoSensitest (Iso), both 5% blood supplement} on the results . A total of 20 isolates (37%) displayed constitutive clindamycin resistance on Iso blood agar, compared with only 11 (22%) on MH blood agar . The remaining nine strains found to be clindamycin susceptible on MH manifested resistance only with erythromycin induction . Resistance to penicillin, rifampin, and trimethoprim-sulfamethoxazole in erythromycin-resistant isolates was 83%, 2%, and 85%-89% (medium dependent), respectively . These results indicate that the choice of susceptibility test medium affects the expression (constitutive or inducible) of macrolide-lincosamide-streptogramin (MLS) resistance in S . pneumoniae . In addition, the common assumption that erythromycin resistance in S . pneumoniae implies clindamycin resistance may need to be reconsidered and routine susceptibility tests (including induction if MH medium is used) should be considered for MLS-class drugs.

Diagn Microbiol Infect Dis, 1996 Aug, 25(4), 195 - 9
Defining resistance: breakpoints and beyond implications for pediatric respiratory infection; Pelton SI; The emergence of isolates of Streptococcus pneumoniae with reduced susceptibility to penicillins, cephalosporins, trimethoprim-sulfamethoxazole, and macrolide antibiotics requires a re-evaluation of strategies for the treatment of community-acquired respiratory disease . One response has been the consideration of withholding initial antimicrobial therapy for children with acute otitis media (AOM) . Review of clinical studies supports a reduction in suppurative complications, and a more rapid resolution of signs and symptoms as well as the course of middle ear disease in children treated with antimicrobial agents . Breakpoints established by the NCCLS for in vitro susceptibility reporting may not reflect clinical efficacy at all sites of disease . Clinical studies of AOM due to penicillin-resistant S . pneumoniae report success with both cefuroxime and amoxicillin-clavulanic acid, however, microbiologic studies suggest an increase in persistent infection in children with disease due to isolates with reduced susceptibility . Successful therapy for AOM due to highly resistant isolates (MIC > or = 2.0 micrograms/ml for penicillin) has been reported with clindamycin, ceftriaxone, and high-dose amoxicillin . The current risk of AOM due to a resistant S . pneumoniae remains low in most U.S . communities . Amoxicillin remains appropriate for most children, ongoing surveillance for resistance and close monitoring of response to therapy is necessary.

Arch Microbiol, 1996 Aug, 166(2), 116 - 21
Localization of the sequence-determined DNA bending center upstream of the streptokinase gene skc; Gross S et al.; DNA sequences upstream of the core promoter region of the streptokinase gene (skc) from Streptococcus equisimilis H46A increase skc transcription more than tenfold in vivo . This promoter upstream region contains a segment of intrinsically bent DNA, the precise location of which was determined experimentally by circular permutation analysis and theoretically by computer prediction . Electrophoretic analysis of circularly permuted upstream DNA fragments placed the bend center approximately at position -100 with respect to the major transcription initiation site of skc . This position was in excellent agreement with the center of maximum curvature predicted theoretically . Knowledge of the precise location of the bend center will be useful for future studies of the possible effect of DNA bending on skc transcription.

J Dent Res, 1996 Aug, 75(8), 1572 - 7
Cariogenicity of Streptococcus mutans strains with defects in fructan metabolism assessed in a program-fed specific-pathogen-free rat model; Burne RA et al.; To define the role of dental plaque fructans and the enzymes involved in their metabolism in the initiation and progression of dental caries, we constructed otherwise-isogenic mutants of Streptococcus mutans defective in the ability to synthesize fructans, to degrade fructans, or to do both . The cariogenic potential of these organisms was evaluated in a specific-pathogen-free rat model in which the feeding patterns of the animals were controlled by means of a Konig-Hofer programed feeder . Specifically, rats were infected with wild-type S . mutans UA159 or derivatives of this strain which contained an insertionally-inactivated fructanase (fruA) gene, fructosyltransferase (ftf) gene, or which had both genes inactivated . The animals were fed 17 meals per day of Diet 2000 containing 56% sucrose at 70-minute intervals for five weeks, and caries experience was evaluated . Animals infected with S . mutans with a mutated fruA gene only had statistically significant decreases in sulcal caries severity . Such a decrease was not observed in previous studies with ad libitum-fed animals (Wexler et al., 1992) . The manifestation of diminished virulence in the programmed feeding model, but not in ad libitum-fed animals, supports the concept that the primary contribution of FruA to virulence is through the utilization of fructans storage polysaccharides . Animals infected with strains carrying the ftf mutation or simultaneous mutations in ftf and fruA did not display decreased virulence, perhaps indicating that sucrose utilization pathways may compete for substrate in vivo, or that accumulation of fructans may affect the ecology or the physicochemical characteristics of dental plaque in such a way as to reduce its cariogenic potential . The results of this study also emphasize that the contribution of a particular virulence determinant to the caries process may be highly dependent on the experimental design, feeding regimen and diet, and the presence or absence of other enzymatic activities.

Eur J Clin Microbiol Infect Dis, 1996 Aug, 15(8), 686 - 8
In vitro susceptibility of pneumococci to trovafloxacin, penicillin G, and other antimicrobial agents in the Czech Republic and Slovakia; Urbaskova P et al.; The in vitro activity of the new naphthyridone trovafloxacin (CP 99,219) was compared with those of penicillin G and six other agents (cefpodoxime, erythromycin, azithromycin, clindamycin, ciprofloxacin, and sparfloxacin) against 316 penicillin-susceptible and -resistant pneumococci isolated in the former Czechoslovakia . Trovafloxacin was very active against strains of Streptococcus pneumoniae (MIC50 and MIC90 0.25 microgram/ml) . Ciprofloxacin was less active (MIC50 1.0 microgram/ml, MIC90 2.0 micrograms/ml), and MICs of sparfloxacin were between those of trovafloxacin and ciprofloxacin (MIC50 and MIC90 both 0.5 microgram/ml) . MICs of cefpodoxime, erythromycin, azithromycin, and clindamycin were higher for strains intermediately resistant or resistant to penicillin than for penicillin-susceptible strains.

Eur J Clin Microbiol Infect Dis, 1996 Aug, 15(8), 671 - 5
Activity of trovafloxacin against blood isolates of Streptococcus pneumoniae in Sweden; Liljequist BO et al.; The in vitro activity of the fluoroquinolone trovafloxacin (CP-99,219) against 257 blood isolates of Streptococcus pneumoniae obtained from Swedish hospitals was compared with those of commonly prescribed oral antibiotics and also with those of ciprofloxacin and ofloxacin against a collection of strains resistant (n = 6) or intermediately resistant (n = 22) to penicillin (Pc-R) . The MICs of trovafloxacin for Pc-R strains of pneumococci ranged from 0.032 to 0.25 mg/l . No difference was seen between the clinical isolates and the Pc-R strains (MIC50 = 0.064 mg/l and MIC90 = 0.125 mg/l for both collections) . For the Pc-R strains, the MIC50 and MIC90 values of ciprofloxacin were 0.5 and 1 mg/l, and those of ofloxacin 2 and 4 mg/l . The incidence of resistance in the two collections (clinical isolates/Pc-R strains) was 3%/39% for tetracycline, 1%/18% for macrolides, and 3%/57% for trimethoprim/sulfamethoxazole . The results of the current study suggest that the clinical efficacy of trovafloxacin in the treatment of pneumococcal infections should be investigated.

Eur J Clin Microbiol Infect Dis, 1996 Aug, 15(8), 635 - 8
Molecular epidemiological characteristics of pneumococcal meningitis in children; Kornelisse RF et al.; The molecular epidemiological characteristics of pneumococcal meningitis in children were studied . Pneumococcal isolates were characterized by serotyping and two genotyping methods, BOX fingerprinting and restriction fragment end labeling, to evaluate whether clonal strains were present within the serotypes or serogroups . During a 17-year period, 68 children admitted to the Sophia Children's Hospital were diagnosed with meningitis due to Streptococcus pneumoniae . Pneumococcal isolates from 44 patients were still available for analysis . All strains were susceptible to penicillin . Serotypes/ serogroups 14, 19, 6, and 18 represented 56% of all isolates . The results of the molecular typing methods demonstrate the absence of clonal relatedness between isolates from patients with pneumococcal meningitis.

J Periodontal Res, 1996 Aug, 31(6), 393 - 407
Cytokine-inducing components of periodontopathogenic bacteria; Wilson M et al.; Pro-inflammatory cytokines such as interleukin (IL)-1, IL-6, IL-8 and tumour necrosis factor (TNF) are believed to be the major pathological mediators of inflammatory diseases ranging from arthritis to the periodontal diseases . The stimuli inducing proinflammatory cytokine induction in the former disease is unclear but in the periodontal diseases it is obvious that the stimulus is the accumulation of bacteria in the subgingival region . As these bacteria do not invade the lesional tissues in large numbers, it is believed that their soluble components or products interact with host tissues to induce cytokine gene transcription . The paradigm is that lipopolysaccharide is the key bacterial component inducing pro-inflammatory cytokine gene expression . However, over the past decade a growing number of reports on non-oral bacteria have established that many other bacterial components, as well as secretory products, have the capacity to induce cytokine synthesis . Some of these, such as the protein pneumolysin from Streptococcus pneumoniae, are incredibly potent (in this case inducing cytokine synthesis at femtomolar concentrations) . This review surveys the range of bacterial components and products which have been shown to stimulate cytokine synthesis with particular emphasis on the hypothesis that these components play a role in the pathology of the periodontal diseases.

Mol Microbiol, 1996 Aug, 21(4), 853 - 62
Regulation of competence for genetic transformation in Streptococcus pneumoniae by an auto-induced peptide pheromone and a two-component regulatory system; Pestova EV et al.; The regulation of competence for genetic transformation in Streptococcus pneumoniae depends on a quorum-sensing system, but the only molecular elements of the system whose specific role have been identified are an extracellular peptide signal and an ABC-transporter required for its export . Here we show that transcription of comC, the gene encoding a predicted 41-residue precursor peptide that is thought to be processed and secreted as the 17-residue mature competence activator, increased approximately 40-fold above its basal level of expression in response to exogenous synthetic activator, consistent with earlier experiments indicating that the activator acts autocatalytically . We also describe two new genes, comD and comE, that encode members of histidine protein kinase and response-regulator families and are linked to comC . Disruption of comE abolished both response to synthetic activator peptide and endogenous competence induction.

J Antimicrob Chemother, 1996 Aug, 38(2), 293 - 9
Effect of replacing cefotaxime with ceftizoxime in a hospital where penicillin-resistant pneumococcal disease is prevalent; Haas DW et al.; Ceftizoxime and cefotaxime demonstrate very similar activities in vitro against a broad range of bacteria . To reduce costs, our hospital pharmacy implemented an automatic substitution policy whereby ceftizoxime was dispensed and administered whenever cefotaxime was ordered . This policy was modified when penicillin-resistant Streptococcus pneumoniae isolates were found to be markedly less susceptible to ceftizoxime than to cefotaxime, of concern considering the prevalence and virulence of this pathogen . We compared clinical findings among 179 adult patients treated with ceftizoxime for any indication during the substitution months with 200 patients treated with cefotaxime during the previous year . The ceftizoxime group had a shorter mean length of stay, which paralleled a hospital-wide trend toward more efficient discharge planning . After adjusting for this trend, we observed no significant difference in duration of study drug, number of other intravenous antibiotics, likelihood of receiving additional antibiotics after study drug completion, or patient survival . Fortuitously, no penicillin-resistant pneumococcal infections were documented in ceftizoxime-treated patients . This study suggests that cefotaxime and ceftizoxime are comparable . The choice of one versus the other may be dictated by price, provided ceftizoxime is not used for proven or suspected penicillin-resistant pneumococcal infections.

J Antimicrob Chemother, 1996 Aug, 38(2), 283 - 6
Antimicrobial resistance of clinical isolates of Streptococcus pneumoniae in Lebanon; Uwaydah M et al.; A total of 61 clinical isolates of Streptococcus pneumoniae from Lebanon were tested for their susceptibility to penicillin G and seven other antibiotics by the agar dilution technique . All penicillin-susceptible isolates were also susceptible to chloramphenicol, ceftriaxone and erythromycin . Penicillin-resistant isolates were consistently susceptible only to erythromycin.

Mol Microbiol, 1996 Aug, 21(3), 471 - 8
Competence pheromone, oligopeptide permease, and induction of competence in Streptococcus pneumoniae; Alloing G et al.; An unmodified heptadecapeptide pheromone capable of eliciting competence for genetic transformation in Streptococcus pneumoniae has recently been identified and characterized . In considering possible signal-transduction mechanisms for the peptide, the previously characterized Ami oligopeptide permease and the three highly homologous oligopeptide-binding lipo-proteins . AmiA, AliA, and AliB, appeared to be good candidates for receptors . We therefore compared the spontaneous transformability of Ami, AliA and AliB mutants to that of an isogenic wild-type strain and we investigated the response of the various mutants to treatment with synthetic competence-stimulating peptide (CSP) . Our results clearly demonstrate that neither Ami nor any of the three highly homologous oligopeptide-binding lipoproteins identified so far in S . pneumoniae are required for competence induction following treatment with synthetic CSP . Although the existence of a fourth unidentified oligopeptide-binding lipoprotein and/or a second oligopeptide permease operon could not be completely ruled out, we favour the hypothesis that CSP signal transmission rather involves a two-component regulatory system . Although none of the single or double Ami and All mutants tested appeared severely affected for competence, an exceptional aliB plasmid-insertion mutation abolished competence completely . In addition, the triple AmiA-AliA-AliB mutant differed from wild type in showing no sharp peak of competence but exhibiting transformability throughout the exponential phase of growth . These and previous observations are discussed and a general hypothesis is proposed to account for the modulation of competence by peptide permease mutants in S . pneumoniae.

Pharm Res, 1996 Aug, 13(8), 1258 - 64
Excipient interaction with cetylpyridinium chloride activity in tablet based lozenges; Richards RM et al.; PURPOSE: The purpose of the investigation was to determine the effect of tablet excipients on the activity of cetylpyridinium chloride (CPC) and the relative interaction between excipients and CPC . METHODS: An analytical assay was developed to evaluate the interaction between CPC and the excipients . In vivo activity was investigated using six volunteers by determining the reduction in colony forming units recoverable from the oropharynx after sucking each proprietary lozenge separately on different days . In vitro determinations investigated the relative antimicrobial activity of aqueous solutions of the lozenges and, the effect of pH and tablet base excipients on that activity against Staphylococcus aureus, Streptococcus pyogenes and Candida albicans . RESULTS: Both in vivo and in vitro results showed that the tablet based lozenges had markedly reduced antimicrobial activities compared with previous results with a candy based lozenge (in vivo and in vitro) or the same concentration of aqueous CPC (in vitro) . Magnesium stearate suspensions in CPC 250 micrograms/ml indicated that magnesium stearate adsorbed CPC and at 0.4% lozenge weight and above significantly reduced the antimicrobial activity of CPC 250 micrograms/ml . CONCLUSIONS: The reduced activity of CPC in tablet based lozenges resulted from a decreased availability of CPC in solution due to an adsorption of CPC on magnesium stearate . To avoid this reduction in activity tablet based lozenges containing CPC 250 micrograms/ml, or similar concentrations, plus magnesium stearate should contain not more than 0.3% w/w lozenge weight of the lubricant.

Eur J Gastroenterol Hepatol, 1996 Aug, 8(8), 823 - 4
Streptococcus bovis spontaneous bacterial peritonitis in patients with alcoholic cirrhosis; Gloria H et al.; Spontaneous bacterial peritonitis (SBP) is a frequent cause of decompensated alcoholic cirrhosis . The authors describe the first two cases caused by infection with Streptococcus bovis . They suggest that this microorganism may be present in the intestinal flora of these patients more frequently than assumed . Furthermore, the course of SBP due to S . bovis may be particularly severe.

J Pediatr Surg, 1996 Aug, 31(8), 1142 - 6
Necrotizing fasciitis in children: prompt recognition and aggressive therapy improve survival; Moss RL et al.; Necrotizing fasciitis (NF) is a bacterial infection of the soft tissues with a fulminant course and a high mortality rate . The authors performed a review to define the diagnosis, bacteriology, and management of NF in the pediatric population . This report of 20 cases treated over 18 years represents the largest reported pediatric experience . These infections were attributable to secondary infection of varicella lesions (5), omphalitis (4), extremity lesions (4), perineal infections (3), head and neck lesions (2), inguinal herniorrhapy (1), and breast abscess (1) . Nineteen of the 20 children were healthy, without chronic disease or immunosuppression . All patients presented with an altered sensorium and signs of systemic toxicity . Fever (40%), tachycardia (70%), and abnormal white blood cell count (50%) were not uniformly present . There was marked tissue edema in all patients, with a characteristic peau d'orange appearance in 18 . Seven infections were caused by streptococcus; the remainder were polymicrobial, involving multiple aerobes and anaerobes . Initial gram stain was of limited utility; in 14 of 19 cases the result was negative or showed only one of many organisms present . Fifteen patients survived and five died . All survivors underwent aggressive surgical debridement within 3 hours of admission . The survivors required of a mean of 3.8 operations . Fascial excision of up to 35% of total body surface area was required . One patient required amputation, two had colostomies, and six required extensive skin grafting for reconstruction . All five patients who died had delayed initial management . Conclusion: NF is a serious cause of death in previously healthy children . The diagnosis should be considered in the presence of any soft tissue infection presenting with signs of toxicity and marked wound edema, even in the absence of fever or abnormal white blood cell count . Immediate surgical debridement and coverage with penicillin, an aminoglycoside, and metronidazole are essential . Subsequent changes in antibiotics should be based on culture data because gram stain results are not reliable . More than one operation is required in almost all cases.

J Pediatr Surg, 1996 Aug, 31(8), 1138 - 41
Surgical implications of necrotizing fasciitis in children with chickenpox; Waldhausen JH et al.; Varicella (chickenpox) affects approximately 90,000 children each year . Although most cases resolve, some develop necrotizing soft tissue infections secondary to group A streptococcus and staphylococcus . Delay in diagnosis is common . At the time of initial presentation, the need for surgical intervention is not always clear . The authors conducted a retrospective review of 30 patients with varicella (seen from December 1993 to June 1995) for whom there was clinical concern for necrotizing soft tissue infection . Various parameters were examined, including tachycardia, band count, temperature, and clinical symptoms, to differentiate the children who required surgery from those who did not . Of the 30, 22 underwent surgery . Eighteen had necrotizing fasciitis and required debridement, and four had abscesses that were incised and drained . Eight patients had simple cellulitis and did not require operation . Group A streptococcus was the most common organism cultured . All patients were treated with appropriate antibiotics . Twenty of the 22 surgical patients had elevated band count (> or = 5%), 21 had tachycardia, and 18 were febrile at the time of presentation (> 4 days after the onset of chickenpox) . Although all patients with necrotizing fasciitis had tachycardia, this sign was a less specific indicator for surgery than was increased band count . Severe pain, erythemia, and induration was the most common signs/symptoms in the surgical patients . The survival rate for these 30 patients was 100%, and there was little long-term morbidity . The authors recommend immediate surgical intervention for children with chickenpox who present more than 2 or 3 days after the onset of the viral illness with symptoms that include fever, tachycardia, and an elevated band count in association with an erythematous, indurated, painful lesion . With this sign/symptom complex, the presumptive diagnosis must be necrotizing fasciitis until proven otherwise . If the patient has suspicious symptoms or if these symptoms are associated with tachycardia or an elevated band count, the patient warrants admission, institution of intravenous fluids, nafcillin, clindamycin, and close observation over several hours . If the symptoms progress over the next few hours or if the tachycardia persists despite rehydration and antibiotics, the patient should be taken to the operating room for exploration . The authors strongly endorse such exploration despite the risk of a negative operation, because the morbidity and mortality associated with delayed surgical treatment are potentially significant . With prompt aggressive surgical and medical treatment, a good outcome can be anticipated for these patients.

Pediatr Infect Dis J, 1996 Aug, 15(8), 667 - 72
Colonization with penicillin-nonsusceptible Streptococcus pneumoniae in urban and rural child-care centers; Boken DJ et al.; OBJECTIVES: To determine the prevalence of penicillin-nonsusceptible Streptococcus pneumoniae (NS-SP) at 12 child-care centers (CCC) in urban and rural Nebraska and to evaluate the genetic diversity of pneumococcal strains present in the CCC environment . METHODS: Nasopharyngeal cultures for S . pneumoniae were obtained from children 2 to 24 months old . Capsular serotyping, pulsed field gel electrophoresis (PFGE) and microbroth dilution MICs were performed for all S . pneumoniae . Antibiotic exposure was also evaluated as a potential risk factor for colonization with NS-SP . RESULTS: Nasopharyngeal colonization with S . pneumoniae was present in 121 (56%) of 215 children . The MICs of penicillin were 0.12 to 1.0 microgram/ml for 57 (47%) and > 1.0 microgram/ml for 10 (8%) isolates . Clindamycin MICs of > 0.5 microgram/ml were found in 6 isolates (5%) . MICs of ceftriaxone were 0.5 microgram/ml in 28% of S . pneumoniae and 1.0 microgram/ml in 7% . PFGE and capsular serotyping demonstrated multiple strains that were penicillin-nonsusceptible in both the urban and rural CCC . PFGE and capsular serotype defined shared strains within each CCC, but some PFGE "types" could be found in multiple serotypes . Antibiotic exposure during the 2 months before nasopharyngeal culture was not a statistically significant risk factor for nasopharyngeal colonization with NS-SP . CONCLUSIONS: NS-SP are highly prevalent in urban and rural Nebraska . PFGE similarities between serotypes may reflect "serotype switching" but may also reflect genetic similarity between S . pneumoniae strains.

Microb Pathog, 1996 Aug, 21(2), 125 - 37
Enhancement of Streptococcus pneumoniae serotype 6B infection in mice after passive immunization with human serum; Aaberge IS et al.; Passive immunization in an experimental pneumococcal infection model has been proposed as a way to further characterize the protective capacity of human post vaccination sera . However, in experiments described in the present paper, we found that the same human immune serum that induced some degree of protection when NIHS mice were challenged with one strain of Streptococcus pneumoniae serotype 6B, did not confer protection when the mice were challenged with another strain of serotype 6B . On the contrary, with this bacterial strain, six different human sera appeared to enhance pneumococcal infection leading to higher levels of bacteremia and more rapid death of passively immunized than of non-immunized mice . In contrast, mice passively immunized with mouse immune serum showed reduced bacteremia and enhanced survival after challenge with the same dose of the same strain of pneumococci . The enhancing property of human serum did not seem to be caused by anti-type 6B antibodies . However, we cannot exclude the possibility that human antibodies are less protective than mouse antibodies against type 6B infection . Our results indicate that negative results in passive immunization experiments with human sera should be interpreted with caution.

Microb Pathog, 1996 Aug, 21(2), 71 - 83
Sequence variation in the Streptococcus pneumoniae pneumolysin gene affecting haemolytic activity and electrophoretic mobility of the toxin; Lock RA et al.; When 30 clinical isolates of Streptococcus pneumoniae, representing 16 capsular serotypes, were analysed by Western blot for production of the haemolytic toxin pneumolysin (Ply), all strains produced an immunoreactive band of similar intensity . However, six isolates of serotype 8 and two of type 7F expressed Ply whose mobility on SDS-PAGE was anomalously slow . Culture lysates from these strains also had low haemolytic activities compared with those for clinical isolates of other serotypes, suggesting the possibility of mutations affecting specific activity . Genes encoding Ply from one type 8 isolate and one type 7F isolate were cloned into Escherichia coli and sequenced . Compared with the published sequence for Ply, the deduced amino acid sequence for the type 8 Ply variant contained three amino acid substitutions, and the type 7F variant four amino acid substitutions . Both variants also had Val270 and Lys271 deleted . The variant Ply proteins were purified from recombinant E . coli expressing the cloned genes, and shown to have substantially reduced specific haemolytic activities {6.8 x 10(4) haemolytic units (HU)/mg and 2.3 x 10(4) HU/mg for type 8 Ply and type 7F Ply respectively} compared with Ply itself (1.2 x 10(6) HU/mg) . Studies with chimeric toxin gene constructs indicated that both the reduced haemolytic specific activity and the anomalous electrophoretic mobility of the variant Plys were attributable to a single amino acid substitution (Thr172-->Ile).

J Paediatr Child Health, 1996 Aug, 32(4), 333 - 8
Neonatal bacterial sepsis in a neonatal intensive care unit: a 5 year analysis; Sanghvi KP et al.; OBJECTIVE: To study the pattern of neonatal sepsis in a neonatal intensive care unit (NICU) during a 5 year period and assess the relationship between maternal risk factors and early onset sepsis (EOS) . METHODOLOGY: The study reported here was a retrospective analysis of 209 episodes of septicaemia and 5 episodes of bacterial meningitis in 198 newborn infants, 22 of whom died . Eighty-one infants had EOS (< or = 72 h) and 117 infants had late onset sepsis (LOS > 72 h) . All infants had clinical evidence of sepsis, a computerized haematological score for sepsis of 4 or greater, and either treatment with antibiotics for 7 days or more or had earlier death due to sepsis . The organisms causing neonatal sepsis were analyzed according to the day of onset, gestational age, birthweight and year of infection . RESULTS: Sepsis occurred in 5.6 per 1000 live births and 3.8% of NICU admissions . There were 81 episodes of EOS and 128 of LOS . Coagulase negative staphylococci (CONS) 38.8%, group B Streptococcus (GBS) 20.1% and Gram-negative bacilli (GNB) 20.1% were the common causes of sepsis; and GBS (50.6%) and CONS (60.9%) were the most common organisms in EOS and LOS, respectively . The mean gestational age and birthweight were higher in babies with EOS than compared with LOS . The higher likelihood of probable rather than definite infection in infants with EOS was related to more mothers in the EOS group receiving intrapartum antibiotics . GNB infection was more common in their babies . CONCLUSIONS: GBS and CONS were the most common causes of EOS and LOS, respectively . The use of maternal intrapartum antibiotics interferes with neonatal blood culture results . Because blood cultures are not always positive in neonatal septicaemia, a combination of clinical, haematological and other microbiological evidence should be used when diagnosing neonatal septicaemia.

Antimicrob Agents Chemother, 1996 Aug, 40(8), 1889 - 92
Efficacy of clarithromycin treatment of acute otitis media caused by infection with penicillin-susceptible, -intermediate, and -resistant Streptococcus pneumoniae in the chinchilla; Alper CM et al.; Because of the increasing frequencies of recovery of penicillin-resistant Streptococcus pneumoniae from the middle ears of children with acute otitis media, non-beta-lactam antibiotics are being explored as treatment alternatives to amoxicillin . In this study, the efficacy of a 10-day course of clarithromycin was evaluated with chinchillas . After the pharmacokinetic profiles for clarithromycin were established, 180 animals were assigned to one of three susceptibility groups (n = 60/group; penicillin-susceptible, -intermediate, and -resistant S . pneumoniae), and the right middle ear was infected with the appropriate strain of S . pneumoniae . Equal numbers of animals in each group were treated orally beginning on day 2 with a 10-day course of clarithromycin (15 mg/kg of body weight; given twice a day) or amoxicillin as a control (20 mg/kg twice a day) . On days 4, 9, and 13, otomicroscopy and tympanometry were performed, and on day 13, the middle ears were cultured for bacteria . The results showed 100% eradication of the challenge organism in both treatment groups for the susceptible strains of S . pneumoniae . Cultures were negative in 87 and 74% (P > 0.05) of the animals challenged with the intermediate resistant strains and in 100 and 56% (P < 0.05) of the animals challenged with the resistant strains and treated with clarithromycin and amoxicillin, respectively . There were no differences between treatments in the diagnosis of effusion for any group . These results support the use of the chinchilla to evaluate drug efficacy in the treatment of acute otitis media and show clarithromycin to be effective in sterilizing the middle ears of animals challenged with penicillin-susceptible, -intermediate, and -resistant strains of S . pneumoniae.

Antimicrob Agents Chemother, 1996 Aug, 40(8), 1832 - 4
Penetration of cefpodoxime into uterine and vaginal secretions from postpartum women after a single oral dose of cefpodoxime proxetil; Takasugi N et al.; We evaluated the usefulness of cefpodoxime proxetil (CPDX-PR) in the treatment of puerperal infection and obtained the following results . (i) The susceptibilities of 124 clinical isolates from 85 uterine lochia samples were determined . The MIC at which the growth of Streptococcus agalactiae, Escherichia coli, and Bacteroides fragilis isolates was inhibited by 90% (MIC90) was 0.39 micrograms/ml or less . The MIC90 for Staphylococcus aureus was 3.13 micrograms/ml . (ii) Seven puerperal women received 200 mg of CPDX-PR orally . The CPDX concentration in the lochias in the uterine cavity was not statistically different from that in the vagina, suggesting that the vaginal samples, which can be obtained more safely and aseptically, can be substituted for the uterine samples . The CPDX concentration in cubital venous blood reached a peak of 1.61 micrograms/ml at 3 hours after CPDX-PR administration . The CPDX concentration in the lochias gradually increased and reached a peak of 1.20 micrograms/ml in the uterine cavity and 1.27 micrograms/ml in the vagina at 5 h after drug administration and gradually declined thereafter . These results suggest that CPDX-PR, with its good transfer to the lochia and its potent antimicrobial activity, is a promising drug for the prophylactic and therapeutic treatment of puerperal infections caused by susceptible organisms.

Clin Infect Dis, 1996 Aug, 23(2), 320 - 8
Causes of fever in patients infected with human immunodeficiency virus who were admitted to Boston City Hospital; Barat LM et al.; We prospectively studied causes of fever in patients with human immunodeficiency virus (HIV) infection that required admission to a municipal hospital . A total of 168 HIV-infected persons were admitted for 220 episodes of fever: 72% were male, 80% were nonwhite, 65% reported prior injection drug use, and 74% had a baseline CD4 lymphocyte count of < 200/mm3 . Bacterial infections, principally pneumonia, accounted for > 60% of the episodes; Streptococcus pneumoniae and Staphylococcus aureus were most commonly isolated . Pneumocystis carinii pneumonia (PCP) and disseminated infection with Mycobacterium avium complex (MAC) comprised 53% of the remaining sources of fever . In comparison with episodes of fever due to nonbacterial causes, those associated with common bacterial infections were significantly more likely to involve patients with a history of injection drug use (P = .02), higher admission leukocyte count (P < .004), shorter duration of fever (P = .003), shorter hospital stays (P = .0001), and a CD4 count of > 100/mm3 (P = .002) . We conclude that bacterial infection, especially pneumonia, is a common cause of fever in HIV-infected patients admitted to our hospital . Patients with bacterial infections are more likely to report a history of injection drug use and have CD4 counts of > 100/mm3, shorter duration of fever, decreased length of hospitalization, and lower mortality than patients with fever due to PCP, disseminated MAC infection, or other causes.

J Clin Microbiol, 1996 Aug, 34(8), 2020 - 2
Species belonging to the "Streptococcus milleri" group: antimicrobial susceptibility and comparative prevalence in significant clinical specimens; Bantar C et al.; The association between the three species belonging to the "Streptococcus milleri" group and different sites of isolation was examined for 73 successive strains recovered from clinically significant, purulent infections . Susceptibility testing was performed on 64 of these strains . The present study supports the association of particular species with different clinical sources . Susceptibility data suggest that emerging penicillin resistance among Streptococcus anginosus and Streptococcus intermedius isolates may represent a potential clinical problem in the therapeutic management of infections caused by these species.

J Trop Pediatr, 1996 Aug, 42(4), 200 - 3
Henoch-Schonlein purpura: clinical experience and contemplations on a streptococcal association; al-Sheyyab M et al.; Henoch-Schonlein Purpura (HSP) is a common cause of vasculitis in children . The role of an antecedent streptococcal infection is still controversial . The aim of this study is to verify such a relationship, as well as to provide a profile of the clinical features and the magnitude of this disorder in Jordan . We identified 69 cases of HSP below the age of 13 years between January 1991 and April 1994 admitted to the two main hospitals in northern Jordan . Thirty-five of these cases were prospectively enrolled during the last year of the study . Forty-three controls, frequency-matched to the cases on age and sex, were selected from the out-patient clinics of the same two hospitals . The minimum estimate of the annual incidence was 8.5/100,000 . All patients recovered completely and were well after a mean period of follow-up of 16 months . The clinical features were essentially similar to those reported by others . Unusually, two of our cases followed mumps and one occurred after otitis media caused by Streptococcus pneumoniae . Forty-nine per cent of all patients in this series had evidence of a recent streptococcal infection (elevated antistreptolysin O titre) compared to 16 per cent of the controls . The difference was statistically significant (P = 0.004) . This finding supports a role for antecedent streptococcal infection in the pathogenesis of HSP.

Zentralbl Veterinarmed B, 1996 Aug, 43(6), 379 - 84
Bacterial causes of bovine mastitis in Wondogenet, Ethiopia; Abdella M; A survey of selected causative organisms of bacterial mastitis in Zebu-Holstein dairy cows was carried out on four herds in Wondogenet . Pathogens were found in 39% of udder quarters and mastitis in 16% of quarters . The main mastitis causing organisms isolated were Staphylococcus aureus (47%), Streptococcus agalactiae (15%) and Streptococcus uberis (31%) . It was indicated also that udder quarters with micrococci would be less susceptible to infections by pathogenic organisms.

J Pediatr, 1996 Aug, 129(2), 275 - 8
Volume of blood required to detect common neonatal pathogens; Schelonka RL et al.; OBJECTIVE: To determine the minimum volume of blood and the absolute number of organisms required for detection of bacteremia and fungemia by an automated colorimetric blood culture system (BacT/Alert, Organon Teknika) . DESIGN: Common neonatal pathogens, Escherichia coli, Streptococcus agalactiae (group B streptococcus (GBS): one American Type Culture Collection (ATCC) strain and one clinical isolate), Staphylococcus epidermidis, and Candida albicans, were seeded into blood to produce bacteremia or fungemia with low colony counts (1 to 3 colony-forming units (CFU) per milliliter) and ultra-low colony counts (<1 CFU/ml) . For each organism, 96 culture bottles were inoculated with either 0.25, 0.5, 1.0, or 4.0 ml of the two seeded blood concentrations . Blood culture bottles were incubated in the BacT/Alert device for 5 days, and time to positivity was noted when applicable . All bottles were subcultured on plated media . DATA ANALYSIS: The Poisson statistic was used to calculate the probability of finding at least one viable CFU per inoculated culture bottle . The fraction of culture bottles with positive findings per group was divided by the probability of one or more organisms present to give the positivity index . RESULTS: Plated subculture identified no growth of organisms not detected by the colorimetric detection system . The false-positive rate for the automated device was less than 1% . The positivity index for the GBS clinical isolate was 1.13, for the GBS ATCC isolate 0.96, for S . epidermidis 0.94, for C . albicans 0.97, and for E . coli 0.95 . There was a statistically significant difference with time to positivity and inocula volume (p <0.01), but the difference was not clinically important . CONCLUSIONS: If one or two viable colony-forming units are in the blood inoculated into culture media, the BacT/Alert system will detect growth rapidly . Because there appears to be a sizable subset of neonates who are at risk of sepsis with a colony count less than 4 CFU/ml, then a 0.5 ml inoculum of blood into the culture media is inadequate for sensitive and timely detection of bacteremia . One to two milliliters of blood should increase microorganism recovery in the face of low-colony-count sepsis.

Clin Immunol Immunopathol, 1996 Aug, 80(2), 110 - 5
Longitudinal analysis of human salivary immunoglobulins, nonimmune antimicrobial agents, and microflora after tonsillectomy; Kirstila V et al.; In order to study the role of tonsils in the host defense in the oral region one pre- and two postoperative (1 and 6 months) whole saliva samples were collected from 25 young adults referred for tonsillectomy . Saliva samples were analyzed for selected host defense factors, representing both immune (total IgA, IgG, IgM, anti-Streptococcus mutans, anti-EBV, anti-CMV, and anti-adenovirus IgA and IgG) and nonimmunoglobulin (lysozyme, lactoferrin, salivary peroxidases, thiocyanate, hypothiocyanite, and agglutinins) mediators . Following tonsillectomy, a significant (P < 0.04) reduction was observed in specific IgG antibodies, suggesting that tonsils participate in local IgG response to oral antigens . Total IgM levels also decreased (P< 0.006), which may to some extent reflect reduced antigenic stimuli compared to preoperative status with frequent tonsillitis . Saliva-derived nonimmunoglobulin host defense factors, except lactoferrin, which declined significantly, remained normal throughout the study period . Our study indicates that tonsils play a role in local oral IgG-mediated immune response but tonsillectomy does not seem to lead to any significant long-term impairment of salivary defense capacity.

Microbiology, 1996 Aug, 142 ( Pt 8), 2021 - 9
Bacillus subtilis mutS mutL operon: identification, nucleotide sequence and mutagenesis; Ginetti F et al.; The Bacillus subtilis mutS and mutL genes, involved in the DNA mismatch repair system, have been cloned and characterized . From sequence analysis the two genes appear to be organized in a single operon, located immediately downstream of the cotE gene (approximately 150 degrees on the genetic map) . The deduced MutS protein is 49% identical to HexA and MutL is 46% identical to HexB of Streptococcus pneumoniae . Deletion of both mutS and mutL resulted in an increase in the frequency of spontaneous mutations and abolished the marker effect observed in transformation . The expression of the mut operon was studied with the use of a mutSL-lacZ transcriptional fusion . An increase in expression was observed during late exponential growth.

J Exp Med, 1996 Aug 1, 184(2), 665 - 73
Streptococcal cysteine proteinase releases kinins: a virulence mechanism; Herwald H et al.; Previous work has indicated a crucial role for the extracellular cysteine proteinase of Streptococcus pyogenes in the pathogenicity and virulence of this important human pathogen . Here we find that the purified streptococcal cysteine proteinase releases biologically active kinins from their purified precursor protein, H-kininogen, in vitro, and from kininogens present in the human plasma, ex vivo . Kinin liberation in the plasma is due to the direct action of the streptococcal proteinase on the kininogens, and does not involve the previous activation of plasma prekallikrein, the physiological plasma kininogenase . Judged from the amount of released plasma kinins the bacterial proteinase is highly efficient in its action . This is also the case in vivo . Injection of the purified cysteine proteinase into the peritoneal cavity of mice resulted in a progressive cleavage of plasma kininogens and the concomitant release of kinins over a period of 5 h . No kininogen degradation was seen in mice when the cysteine proteinase was inactivated by the specific inhibitor, Z-Leu-Val-Gly-CHN2, before administration . Intraperitoneal administration into mice of living S . pyogenes bacteria producing the cysteine proteinase induced a rapid breakdown of endogenous plasma kininogens and release of kinins . Kinins are hypotensive, they increase vascular permeability, contract smooth muscle, and induce fever and pain . The release of kinins by the cysteine proteinase of S . pyogenes could therefore represent an important and previously unknown virulence mechanism in S . pyogenes infections.

J Exp Med, 1996 Aug 1, 184(2), 639 - 45
Selectins and neutrophil traffic: margination and Streptococcus pneumoniae-induced emigration in murine lungs; Mizgerd JP et al.; The roles of selectins in the pulmonary margination and emigration of neutrophils were investigated by using mice genetically deficient in both E- and P-selectins (E/P mutants) and/or by intravenous injections of fucoidin (inhibiting both L- and P-selectins) . E/P mutants were neutrophilic (14.7 +/- 4.9 x 10(6) vs . 0.8 +/- 0.1 x 10(6) neutrophils/ml) . This neutrophilia was associated with increased margination of neutrophils within pulmonary capillaries (39.7 +/- 9.4 vs . 4.6 +/- 1.1 neutrophil profiles per 100 red blood cell profiles) but no change in margination within noncapillary pulmonary microvessels . After intratracheal instillation of Streptococcus pneumoniae, lungs of E/P mutants displayed increased neutrophil emigration (564 +/- 92 vs . 116 +/- 19 neutrophils per 100 alveolar profiles), edema (5.3 +/- 1.5 vs . 1.5 +/- 0.4 microliter/g body weight), and histologic evidence of lung injury compared with those in wild-type (WT) . Fucoidin treatment did not affect neutrophil emigration during streptococcal pneumonia in WT or E/P mice . During pneumonia, the number of white blood cells (WBC) tethered to or spread upon the noncapillary vessel endothelium increased in both WT and E/P lungs . These are the first data demonstrating that neutrophil margination in uninfected pulmonary capillaries does not require E- and P-selectins; that streptococcal pneumonia induces an E- and P-selectin-independent increase in WBC interactions with noncapillary endothelium; and that migration of neutrophils to alveoli can occur despite deficiency or inhibition of all of the known selectins.

J Exp Med, 1996 Aug 1, 184(2), 449 - 55
Type 3-specific synthase of Streptococcus pneumoniae (Cap3B) directs type 3 polysaccharide biosynthesis in Escherichia coli and in pneumococcal strains of different serotypes; Arrecubieta C et al.; The cap3B gene, which is involved in the formation of the capsule of Streptococcus pneumoniae type 3, encodes a 49-kD protein that has been identified as a polysaccharide synthase . Escherichia coli cells harboring the recombinant plasmid pTBP3 (cap3B) produced pneumococcal type 3 polysaccharide, as demonstrated by immunological tests . Biochemical and cell fractionation analyses revealed that this polysaccharide had a high molecular mass and was localized in substantial amounts in the periplasmic space of E . coli . Unencapsulated (S-2), laboratory pneumococcal strains synthesized type 3 polysaccharide by transformation with plasmid pLSE3B harboring cap3B . In addition, encapsulated pneumococci of types 1, 2, 5, or 8 transformed with pLSE3B can direct the synthesis of pneumococcal type 3 polysaccharide, leading to the formation of strains that display binary type of capsule.

Ann Emerg Med, 1996 Aug, 28(2), 227 - 30
Rapid identification of group A streptococcus as the cause of necrotizing fasciitis; Ault MJ et al.; Group A beta-hemolytic Streptococcus pyogenes (GAS) causes a spectrum of highly aggressive, invasive infections . We report two cases of necrotizing fasciitis in which GAS was identified as the presumptive causative organism with the use of the standard rapid streptococcal diagnostic kit . We believe the rapid test kits may be a useful adjunct in the diagnosis and treatment of this catastrophic illness and may play a role in limiting the spread of infection.

Cancer Res, 1996 Aug 1, 56(15), 3468 - 73
Quantitative differences in GlcNAc:beta1-->3 and GlcNAc:beta1-->4 galactosyltransferase activities between human colonic adenocarcinomas and normal colonic mucosa; Seko A et al.; The activities of GlcNAc:beta1-->3 and GlcNAc:beta1->4 galactosyltransferases in normal human colonic mucosa and well or moderately differentiated colonic adenocarcinomas and their enzyme-kinetic characteristics were investigated . After UDP-{3H}galactose and N-linked type monoantennary oligosaccharides GlcNAc beta1-->2Man alpha1-->3(6)Man beta1-->4GlcNAc) had been incubated with microsome fractions prepared from these tissues, the synthesized {3H}galactose-labeled oligosaccharides were analyzed by Ricinus communis agglutinin-I agarose chromatography, Streptococcus 6646K beta-galactosidase, Gal beta1-->4-specific diplococcal beta-galactosidase, and Gal beta1-->3GlcNAc-specific lacto-N-biosidase digestion . The beta-galactosyltransferases from normal mucosa synthesized both type 1 and type 2 chains at comparable levels, whereas those from adenocarcinomas predominantly synthesized type 2 chains . To our knowledge, this is the first quantitative estimation of GlcNAc:beta1-->3 galactosyltransferase activity toward N-linked sugar chains . Furthermore, we compared the two galactosyltransferase activities in 10 normal mucosa and adenocarcinoma samples and found that while there existed similar levels of GlcNAc:beta1-->4 galactosyltransferase activity in normal mucosa and adenocarcinomas, GlcNAc:beta1-->3 galactosyltransferase activity apparently decreased from 0.67 +/- 0.26 (normal mucosa) to 0.18 +/- 0.11 nmol/min/mg of protein (adenocarcinomas) . These results are consistent with those of comparative structural studies on N-linked sugar chains of carcinoembryonic antigen and its normal counterparts and suggest that in the process of differentiated carcinogenesis of human colonic tissues, the expression of GlcNAc:beta1-->3 galactosyltransferase is negatively regulated.

Infect Immun, 1996 Aug, 64(8), 3148 - 53
Neurotoxicity of glia activated by gram-positive bacterial products depends on nitric oxide production; Kim YS et al.; The present study examined the mechanism by which bacterial cell walls from two gram-positive meningeal pathogens, Streptococcus pneumoniae and the group B streptococcus, induced neuronal injury in primary cultures of rat brain cells . Cell walls from both organisms produced cellular injury to similar degrees in pure astrocyte cultures but not in pure neuronal cultures . Cell walls also induced nitric oxide production in cultures of astrocytes or microglia . When neurons were cultured together with astrocytes or microglia, the cell walls of both organisms became toxic to neurons . L-NAME, a nitric oxide synthase inhibitor, protected neurons from cell wall-induced toxicity in mixed cultures with glia, as did dexamethasone . In contrast, an excitatory amino acid antagonist (MK801) had no effect . Low concentrations of cell walls from either gram-positive pathogen added together with the excitatory amino acid glutamate resulted in synergistic neurotoxicity that was inhibited by L-NAME . The induction of nitric oxide production and neurotoxicity by cell walls was independent of the presence of serum, whereas endotoxin exhibited these effects only in the presence of serum . We conclude that gram-positive cell walls can cause toxicity in neurons by inducing the production of nitric oxide in astrocytes and microglia.

Infect Immun, 1996 Aug, 64(8), 3093 - 100
Intermedilysin, a novel cytotoxin specific for human cells secreted by Streptococcus intermedius UNS46 isolated from a human liver abscess; Nagamune H et al.; A novel cytotoxin (intermedilysin) specific for human cells was identified as a cytolytic factor of Streptococcus intermedius UNS46 isolated from a human liver abscess . Intermedilysin caused human cell death with membrane blebs . Intermedilysin was purified from UNS46 culture medium by means of gel filtration and hydrophobic chromatography . The purified toxin was resolved into major and minor bands of 54 and 53 kDa, respectively, by sodium dodecyl sulfate-polyacrylamide gel electrophoresis . These proteins reacted with an antibody against intermedilysin . Five internal peptide fragments of intermedilysin were sequenced and found to have 42 to 71% homology with the thiol-activated cytotoxin pneumolysin . However, the action of intermedilysin differed from that of thiol-activated cytotoxins, especially in terms of a lack of activation by dithiothreitol and resistance to treatments with N-ethylmaleimide and 5,5'-dithio-bis-(2-nitrobenzoic acid), although cholesterol inhibited the toxin activity . Intermedilysin was potently hemolytic on human erythrocytes but was 100-fold less effective on chimpanzee and cynomolgus monkey erythrocytes . Intermedilysin was not hemolytic in nine other animal species tested . Since human erythrocytes treated with trypsin were far less sensitive to intermedilysin than were the intact cells, a cell membrane protein(s) may participate in the intermedilysin action . These data demonstrated that intermedilysin is distinguishable from all known bacterial cytolysins.

Infect Immun, 1996 Aug, 64(8), 3069 - 73
Experimental immunization of rats with a Streptococcus mutans 59-kilodalton glucan-binding protein protects against dental caries; Smith DJ et al.; Glucan-binding proteins (GBPs) are theoretically important in the molecular pathogenesis of dental caries caused by Streptococcus mutans . The present study evaluated the ability of antibody induced by the S . mutans 59-kDa GBP (GBP59) to affect dental caries caused by experimental infection with S . mutans in a rodent model . Groups of 20-day-old rats were injected twice at 9-day intervals subcutaneously in the salivary gland vicinity with GBP59, glucosyltransferase (GTF), or phosphate-buffered saline (sham injection), each incorporated in an adjuvant . Two weeks after the second injection, GBP59- and GTF-injected rats contained significant levels of salivary immunoglobulin A and serum immunoglobulin G antibody to the respective injected antigens . However, cross-reacting antibody to S . mutans GTF or GBP59 was not induced by the respective antigen . Rats were then orally infected with S . mutans . After 71 days of infection, GBP59- and GTF-injected groups had smaller numbers of S . mutans on their molar surfaces, compared with the sham-injected infected group . Total, sulcal, and smooth-surface molar caries in the GBP59- and GTF-immunized S . mutans-infected groups were each significantly lower (P < or = 0.003) than the respective measures of caries in the sham injected infected group . The results of this investigation demonstrate that immunization with S . mutans GBP59 induces an immune response in rats that can interfere with the accumulation of S . mutans and can reduce the level of dental caries caused by this cariogenic streptococcus . Furthermore, the protective immunity induced by either GBP59 or GTF appears to result from antibodies to independent epitopes since these two S . mutans components do not have a close antigenic relationship.

J Bacteriol, 1996 Aug, 178(15), 4688 - 95
Insertional inactivation of Streptococcus pyogenes sod suggests that prtF is regulated in response to a superoxide signal; Gibson CM et al.; In establishing an infection, Streptococcus pyogenes has the capacity to bind to the host extracellular matrix protein fibronectin via its protein F adhesin . Previous studies have suggested that the expression of protein F is stimulated during aerobic growth or upon addition of superoxide-generating agents to the culture under O2-limited conditions . To further explore the role of superoxide, we have examined the transcription of the gene which encodes protein F (prtF), as well as the expression of superoxide dismutase (SOD) under conditions which promote or repress protein F expression . These studies show that prtF transcription is regulated in response to superoxide concentration and that SOD is regulated in different environments in a manner which directly parallels the expression of protein F . A mutant deficient in SOD activity was constructed by insertional mutation into the gene which encodes SOD (sod) . The resulting mutant was sensitive to superoxide and aerobic conditions, showed hypersensitive induction of prtF in response to superoxide, and expressed prtF under normally unfavorable O2-limited conditions . These findings suggest that a streptococcal signal transduction system which senses superoxide may coordinately control expression of prtF and sod.

Arch Pediatr Adolesc Med, 1996 Aug, 150(8), 809 - 14
Invasive pneumococcal infection in a community hospital, 1993 to 1995 . Characteristics of resistant strains; Orenstein JB; OBJECTIVES: To review all cases of invasive Streptococcus pneumoniae infection at a single institution and to identify factors that may allow distinguishing between penicillin-resistant pneumococcal (PRP) and penicillin-sensitive pneumococcal strains at presentation for emergency care . PATIENTS AND METHODS: Consecutive patient series of all children with positive blood and cerebrospinal fluid cultures for S pneumoniae from January 1993 to April 1995 at a general community hospital . RESULTS: Fifty-three patients with invasive S pneumoniae infections were identified; 21% of the infections were resistant to penicillin, 9% were resistant to multiple antibiotics, and 4% were highly resistant to penicillin (minimum inhibitory concentration, > 2 mg/L) . At admission, a diagnosis of meningitis or sepsis was made in 14 patients; of these, 8 cerebrospinal fluid cultures yielded S pneumoniae, and 5 were PRP (P < .001) . Significant differences between sensitive and resistant strains were not found for sex, age, race, ill household contacts, or physician type . Five of 11 children with PRP strains were either receiving antibiotics concurrently or in the prior 30 days compared with 5 of 42 children with penicillin-sensitive pneumococcal strains (P = .002) . Children with PRP strains had a lower mean white blood cell count (14.9 x 10(9)/L vs 22.8 x 10(9)/L, P = .008) than children with penicillin-sensitive pneumococcal strains, owing to a lower mean absolute neutrophil count (7250 vs 12700, P = .006) . Children with lower white blood cell and absolute neutrophil counts did not, however, differ in other objective measures . Regression analysis showed that the combination of current or prior antibiotic use and an absolute neutrophil count predicted 63% of the resistant strains and 92% of the sensitive strains (P = .001) . CONCLUSIONS: A high proportion of S pneumoniae infections were caused by strains that were resistant to penicillin . We discuss factors that are associated with resistance in this population . The PRP strains were associated with recent antibiotic therapy and a low absolute neutrophil count . Further surveillance is warranted by these findings.

Arch Pediatr Adolesc Med, 1996 Aug, 150(8), 802 - 8
Impact of maternal group B streptococcal screening on pediatric management in full-term newborns; Peralta-Carcelen M et al.; BACKGROUND: The American Academy of Pediatrics strategy to prevent early-onset neonatal sepsis with group B streptococcus (GBS) relies on maternal antepartum GBS cultures, while the American College of Obstetrics and Gynecology strategy does not . OBJECTIVE: To evaluate the impact of the 2 strategies on the care of asymptomatic full-term newborns . DESIGN/SETTING: Self-administered survey mailed to a national random sample of US pediatricians who were members of the American Academy of Pediatrics . PARTICIPANTS: A total of 461 members of the American Academy of Pediatrics who routinely care for newborns . MAIN OUTCOME MEASURE: Self-report of diagnostic and treatment strategies for asymptomatic full-term newborns who were born under different clinical scenarios . Maternal risk factors, antepartum maternal GBS screening status, and maternal treatment with intrapartum antibiotics were varied across the scenarios . RESULTS: Pediatricians treating asymptomatic full-term newborns born to risk factor-negative mothers reported ordering tests (63.3% in GBS-positive cases vs 6.7% with GBS unknown; P = .001) and antibiotics (21.5% in GBS-positive cases vs 0.9% with GBS unknown; P = .001) more frequently when presented with a positive maternal GBS screening result . Maternal intrapartum treatment had little impact on pediatric practice when risk factors were absent . In risk factor-positive mothers, pediatricians reported an increase in their antibiotic usage in response to a positive maternal GBS screen (61.8% in GBS-positive cases vs 36.9% with GBS unknown; P = .001) . In risk factor-positive mothers with unknown results of GBS screening, use of intrapartum antibiotics increased the number of pediatricians who reported that they would prescribe antibiotic therapy . CONCLUSIONS: Obstetrical strategies to decrease the risk of neonatal GBS sepsis increase pediatric services provided to full-term healthy newborns . This increase in services by pediatric practices is likely to be greater with the screening-based strategy recommended by the American Academy of Pediatrics.

Am Fam Physician, 1996 Aug, 54(2), 565 - 9
Pyomyositis; Dunkerley GR et al.; In the past, most cases of pyomyositis occurred among persons living in tropical climates, with the most common pathogen being Staphylococcus aureus . Increased numbers of cases have been reported more recently in North America, particularly in immunocompromised persons, such as those infected with the human immunodeficiency virus (HIV) and those with diabetes mellitus . These patients present with a wider variety of pathogens, including gram-negative bacteria, Streptococcus groups B, C and G, and Mycobacterium avium . Therefore, it seems prudent to consider pyomyositis in the differential diagnosis of persons with HIV infection, diabetes mellitus or other immunocompromising conditions, who present with persistent or worsening muscle aches and pains . Antibiotic treatment with a pencillinase-resistant penicillin is recommended for up to six weeks.

Curr Microbiol, 1996 Aug, 33(2), 133 - 5
The lytA gene and the DNA region located downstream of this gene are not involved in the formation of the type 3 capsular polysaccharide of Streptococcus pneumoniae; Garcia E et al.; Streptococcus pneumoniae strain M31, an unencapsulated, serotype 2 (S2(-)) mutant having a deletion of at least 5.5 kb containing the gene lytA that encodes the main pneumococcal autolysin, was transformed to the encapsulated serotype 3 (S3(+)) with DNA from the clinical pneumococcal strain 406 . Hybridization analysis revealed that the S3(+) transformants also have the deletion demonstrating that lytA and the DNA region located downstream of this gene are not involved in the encapsulation of S . pneumoniae.

Orv Hetil, 1996 Jul 21, 137(29), 1587 - 90
{Purulent meningitis in an adult patient caused by multi-drug resistant Streptococcus pneumoniae 19A}; Vukmirovits G et al.; This is the first report in Hungary about meningitis caused by multiply-resistant Streptococcus pneumoniae in a 54 year old woman . The Streptococcus pneumoniae serotype 19A was highly resistant to penicillin, ampicillin, chloramphenicol, cefuroxime and intermediate resistant to ceftriaxone . The antibiotic treatment was started with penicillin and ampicillin . The antibiotic treatment was changed to vancomycin + ceftriaxone, vancomycin + rifampicin and vancomycin + imipenem on the 2nd, 4th and 11th hospital days, respectively . She died on the 29th day with symptoms of sepsis . Necropsy and microscopic examination of the brain revealed localised inspissed layer of purulent exsudat over the convexities . Under this area the small wessels and capillaries were thrombotic and were surrounded by severe degeneration and necrosis in the white matter . Recommendations: Streptococcus pneumoniae has to be considered penicillin resistant until the organism is proved to be susceptible to penicillin . The authors advise the administration of dexamethasone, based on their own favourable 7 years experience.

Arch Intern Med, 1996 Jul 8, 156(13), 1429 - 34
Recurrent pneumococcal bacteremia . A warning of immunodeficiency; Rodriguez-Creixems M et al.; BACKGROUND . Recurrent pneumococcal infections are known to occur occasionally in patients with profound immune defects . We performed a case-control analysis of recurrent pneumococcal bacteremias) . PATIENTS AND METHODS . The 547 episodes of Streptococcus pneumoniae bacteremia detected from January 1, 1985, to December 31, 1994, were reviewed . We selected all cases with more than 1 episode separated by 30 days or more ("cases") and compared each of them with 2 controls (patients with single episodes of pneumococcal bacteremia) . RESULTS . Fifteen patients (2.8%) had 31 episodes of pneumococcal bacteremia . Except for multiple myeloma (P < .02), the underlying disease was remarkably similar among patients with single and recurrent episodes of pneumococcal bacteremia . However, among patients positive for human immunodeficiency virus infection, those who had recurrences were at a more advanced stage of their disease than those who did not . The presence of an ultimately fatal underlying condition was more frequent in case patients (P < .001) . Overall, 47% of the patients with recurrences died during their second episode of pneumococcal bacteremia . CONCLUSIONS . Our data suggest that recurrence is more than anecdotal in patients with bacteremic infections caused by S pneumoniae (2.8%) . We believe that recurrence is a warning sign of immunodeficiency . Patients with multiple myeloma, human immunodeficiency virus infection, solid organ tumors, and chronic liver disease with bacteremic pneumococcal infections should be offered antipneumococcal vaccine and other potentially preventive measures, despite doubts about their efficacy . This is justified by the high mortality rate associated with recurrent episodes (47%).

Int Endod J, 1996 Jul, 29(4), 242 - 8
The effect of smear layer on microbial coronal leakage of gutta-percha root fillings; Chailertvanitkul P et al.; The aim of this in vitro study was to determine the effect of removal of the smear layer on canal obturation as measured by penetration of bacteria from a coronal direction . One hundred and twenty extracted human teeth with straight, single root canals were decoronated . The canals were prepared using the modified double-flared technique with balanced force under copious irrigation . The apical matrix was prepared to size 40 and apical patency subsequently confirmed with a size 15 file . The teeth were divided randomly into experimental groups (80 teeth) and control groups (40 teeth) . The root canals of 40 experimental and 20 control teeth were rinsed with 40% citric acid and 2% NaOCl to remove the smear layer before obturation . In experimental groups, 20 teeth with smear layer intact and 20 teeth with smear layer removed were obturated with lateral condensation of cold gutta-percha and Apexit sealer . A further 20 teeth with smear layer intact and 20 teeth with smear layer removed were obturated with the Trifecta technique with the same sealer . In control groups, 10 teeth with smear layer intact and 10 teeth with smear layer removed were obturated with lateral condensation of cold gutta-percha and Apexit sealer . These teeth were completely sealed both coronally and apically to serve as negative controls . The remaining 20 teeth with either smear layer intact or smear layer removed were not obturated and served as the positive controls . The root surface of each tooth was sealed with nail varnish . The cut end of a polypropylene tube was sealed around the coronal part of each root canal so that bacteria placed therein could move only through the obturated canal space . Each root was placed in a glass bottle containing sterile Todd-Hewitt Broth (THB) and aliquots of 0.5 ml of THB were injected into the polypropylene tube . The model system was centrifuged at 168 g . An innoculum of Streptococcus sanguis in THB was placed in each coronal chamber at 5-day intervals and daily observations were made for bacterial growth in the apical reservoir for 90 days . All positive control teeth showed bacterial penetration within 24 h, while the negative control teeth remained uncontaminated throughout the test period . Leakage through the experimental teeth was variable ranging from 7 to 86 days . There was no statistical significant difference (P > 0.05) in leakage between the obturated canal when the smear layer was either removed or intact.

Microb Drug Resist, 1996 Summer, 2(2), 187 - 91
Resistance determinants for beta-lactam antibiotics in laboratory mutants of Streptococcus pneumoniae that are involved in genetic competence; Zahner D et al.; Laboratory mutants of Streptococcus pneumoniae resistant to either cefotaxime or piperacillin reveal defects in competence development independent of the selective beta-lactam . A resistance determinant ciaH encoding a putative histidine kinase of a two-component signal-transducing system that is also involved in competence regulation was recently identified in cefotaxime-resistant mutants . We show now that the CiaH protein can be phosphorylated by ATP in vitro, and that it also phosphorylates the cognate response regulator CiaR . The mutant C306 containing the CiaH mutation Thr-230-Pro is completely noncompetent . It does not release competence-inducing activity (competence factor) into the medium nor can such an activity be released from the cells . Competence in C306 cannot be induced upon addition of external competence factor, in contrast to the competence-defective piperacillin-resistant mutants P506 and P408 . A novel resistance determinant cpoA specific for piperacillin was identified in piperacillin-resistant mutants . CpoA is responsible for the competence defect in P506 but not in P408 . The results document a tight link between the action of beta-lactams and competence development in the pneumococcus and confirm that the two beta-lactams piperacillin and cefotaxime act via different primary targets.

Microb Drug Resist, 1996 Summer, 2(2), 183 - 6
Penicillin-binding proteins 2x and 2b as primary PBP targets in Streptococcus pneumoniae; Krauss J et al.; Different penicillin-binding proteins PBPs are affected in cefotaxime-resistant laboratory mutants compared to piperacillin-resistant mutants . PBP2x acts as the primary PBP target in cefotaxime-resistant mutants, whereas PBP2b is the primary target in piperacillin-resistant mutants . Depending on the mutations in PBP2x, it functions as a resistance determinant for cefotaxime only, or for penicillins as well . Mutations in PBP2x of laboratory mutants are found exclusively in the penicillin-binding domain that contains three homology boxes common to all penicillin-interacting enzymes . Most mutations relevant for resistance occur close to the SXN or the KT/SG box, or at the C-terminal end of the penicillin-binding domain, similar to mutations described in PBP2b of laboratory mutants . Amino acid alterations occur at similar sites also in PBP2x of beta-lactam-resistant clinical isolates and most of these proteins also contain changes in the SXXK box with the active site serine, suggesting that these alterations may be critical for resistance development in clinical isolates.

Microb Drug Resist, 1996 Summer, 2(2), 177 - 81
Penicillin-binding proteins as resistance determinants in clinical isolates of Streptococcus pneumoniae; Reichmann P et al.; Altered penicillin-binding proteins (PBPs) with reduced affinity for penicillin are encoded by mosaic genes in penicillin-resistant clinical isolates of Streptococcus pneumoniae . Generally, members of one bacterial clone contain the same mosaic gene . We report here on a serotype 19A clone of penicillin- and multiple-resistant S . pneumoniae prevalent in Hungary, members of which are exceptionally diverse in terms of PBP properties . The pbp2x gene of four 19A isolates was sequenced, and a distinct mosaic structure detected in each case . The pbp2x genes also differed from a homologous gene of a high-level penicillin-resistant S . mitis from Hungary . The contribution of PBPs to resistance development was studied on transformation experiments using the laboratory strain R6 as recipient, and PBP genes from the type 19A isolate Hu11 . pbp2x and pbp2b function as primary resistance determinants for different beta-lactams . Secondary transformation with pbp1a increased the resistance level considerably for penicillins and cefotaxime . Chromosomal DNA of a high-level penicillin- and cefotaxime-resistant S . mitis from Hungary also transformed the R6 strain to increased resistance levels, and PBP2x and PBP2b functioned as primary resistance determinants as above . In contrast, high-level cefotaxime resistance appeared to be due to a low affinity PBP2a, indicating that this PBP can also function as a resistance determinant.

Arch Oral Biol, 1996 Jul, 41(7), 647 - 53
Predominant cultivable microflora of supragingival dental plaque in Chinese individuals; Zee KY et al.; The aim of this study was to determine the predominant supragingival cultivable bacterial flora in Chinese individuals, using the experimental gingivitis model . A total of 11 healthy dental students, mean age 22.5 years (range 20-25) were recruited . All were provided with once-a-week dental prophylaxis and oral hygiene reinforcement for 3 weeks to ensure gingival health . In the fourth week, after prophylaxis, the participants entered a 14-day period without any plaque control . A plaque sample was collected at days 1, 3, 7 and 14 from the buccal surface of the upper right canine, second premolar, first premolar and first molar, respectively . Each sample was then dispensed in tryptic soy-broth transport medium and grown anaerobically to obtain pure cultures, which were subsequently identified . Results showed that Gram-positive cocci and rods were the predominant cultivatable species (51-61%) in the samples throughout the 14-day period; with time there was a decreasing percentage of cocci and an increasing percentage of rods . Gram-negative cocci and rods increased in proportion with the plaque age (11-37%) . Streptococcus spp . were the predominant Gram-positive cocci while Actinomyces were the predominant Gram-positive rods isolated . Fusobacterium and Capnocytophaga spp . were the two most frequent Gram-negative anaerobic rods cultured . The results compared with those from other analogous studies from the West suggest the possibility of interracial differences in supragingival plaque flora.

An Med Interna, 1996 Jul, 13(7), 313 - 6
{Retrospective and comparative study of pneumococcal bacteremia in patients with chronic hepatopathy}; Ramos Rincon JM et al.; BACKGROUND: The chronic hepatopathy predispose to severe infections due to Streptococcus pneumoniae, including bacteremia . METHODS: We have reviewed the clinic characteristics and outcome of 34 patients without HIV infection and compared with 140 HIV-negative patients with pneumococcal bacteremia . RESULTS: From 34 patients with chronic liver diseases, 27 were male (79%) and 7 female (21%), aged from 33 to 83 years . In 16 cases the origin of hepatopathy were alcoholic . The majority of the patients had fever (85%) . From 29 isolations of S . pneumoniae in which a sensibility study was available, 5 (17%) were resistant to penicillin . Among 27 (79%) cases of chronic hepatopathy, the bacteremia was associated with pneumonia; 5 (18%) cases had roentgenographic evidence of multiple-lobe involvement, and 6 (18%) had peritonitis . The independent factors associated with pneumococcal bacteremia in chronic hepatopathy patients were elevated concentrations of amino-transferases (p < 0.001), alcoholism (p < 0.001) and bacteremic peritonitis (p = 0.007) . The overall case of fatality and bacteremia-related mortality rate were higher among patients with chronic hepatopathy than control group, without statistic signification (38% vs 25%; and 29% vs 24% of control group, respectively) . The presence of septic shock was poor prognosis (mortality rate: 83% {10/12}; p < 0.001) . The multilobar involvement was associated with high mortality rate (60%; p = 0.1) . CONCLUSIONS: Pneumococcal bactermia in patients with chronic hepatopathy have a high mortality rate; however clinical outcome is similar to patients without chronic hepatopathy.

HNO, 1996 Jul, 44(7), 365 - 9
{Reliability of the rapid Streptococcus A test}; Schmuziger N et al.; The results of three second-generation immune assays for direct detection of group A streptococcus were compared in 65 patients with acute pharyngitis . The assays included Strep A Plus, (Abbott), Concise Strep A (Hybritech) and Cards Plus (Pacific Biotech) . A standard culture was used as reference . Additionally a nucleic acid hybridization assay (Gen-Probe) was applied after enhanced broth culturing . The sensitivities and specificities of the three immunoassays were similar and showed that Strep A Plus had an 84.2% sensitivity and 88.9% specificity, Concise Strep A an 82.4% sensitivity and 92.3% specificity, and Cards Plus an 84.2% specificity and 90.7% sensitivity . The Concise Strep A had significantly more doubtful results in comparison with the two other rapid immune assays (9.7% versus 2.3%, P = 0.034 . The standard culture and the DNA probe test gave the same results in 94% of cases . Clinical parameters were found to be unreliable for the diagnosis of group A streptococcal pharyngitis . However, findings show that when the rapid immune assay is positive, it is reasonable to start antibiotic treatment without performing a bacterial culture . In cases with a negative assay, management is best tailored to clinical symptoms and laboratory examinations.

APMIS, 1996 Jul-Aug, 104(7-8), 549 - 56
Detection of penicillin resistance in Streptococcus pneumoniae by diffusion tests; Poulsen RL et al.; Four different diffusion tests used to detect penicillin resistance in Streptococcus pneumoniae were evaluated for 34 penicillin-susceptible pneumococci (MIC < 0.1 microgram/ml), 35 intermediate pencillin-resistant (MIC 0.1-1.0 microgram/ml) and 23 penicillin-resistant strains (MIC > 2 micrograms/ml) . The 1 microgram oxacillin disk from AB Biodisk, the 1 microgram oxacillin Neo-Sensitabs from Rosco, the 5 micrograms penicillin Low Neo-Sensitabs and the penicillin E test were tested on Mueller-Hinton blood agar, PDM Antibiotic Sensitivity Medium II supplemented with blood, and Danish Blood Agar . MICs obtained by the agar dilution method were used as reference . The 1 microgram oxacillin AB Biodisk was able to separate all the penicillin-susceptible pneumococci correctly from those with reduced penicillin susceptibility (MIC > or = 0.1 microgram/ml), whereas use of the 1 microgram oxacillin Neo-Sensitabs resulted in high frequencies (14-29%) of intermediate penicillin-resistant strains interpreted as penicillin susceptible . The 5 micrograms penicillin Low Neo-Sensitabs proved completely useless for detecting penicillin resistance in pneumococci . High rates of agreement (82-93%) were found between the penicillin E test and the reference MIC determination method on all the tested media.

Diagn Microbiol Infect Dis, 1996 Jul, 25(3), 137 - 41
Comparative activity of twelve beta-lactam drugs tested against penicillin-resistant Streptococcus pneumoniae from five medical centers: effects of serum protein and capsular material on potency and spectrum as measured by reference tests; Johnson DM et al.; A total of 152 strains of Streptococcus pneumoniae from diverse geographic areas in the United States and with different levels of penicillin resistance were tested against five broad-spectrum cephalosporins, ampicillin, piperacillin, ticarcillin, and three beta-lactamase inhibitor combinations . Also, the effect of human serum proteins on the activity of selected "third-generation" cephalosporins was examined . The overall rank order of activity among the cephalosporins against penicillin-susceptible strains was: ceftriaxone (MIC90, 0.03 microgram/mL) > cefotaxime > ceftizoxime = cefuroxime > ceftazidime (MIC90, 0.5 microgram/mL) . Only cefotaxime and ceftriaxone exhibited significant activity against penicillin-intermediate or -resistant isolates . Ampicillin, piperacillin, and penicillin were generally eight- to 16-fold more potent than ticarcillin and no increase in the effectiveness of these agents was observed with the addition of the beta-lactamase inhibitors (clavulanate, sulbactam, tazobactam) . Ceftriaxone potency was significantly decreased (> or = four-fold) by the modest addition of 25% pooled human serum proteins and this change modified the rank order of potency against nonpenicillin-susceptible pneumococci to favor cefotaxime (41% resistant versus 71% for ceftriaxone; MICs at > or = 2 micrograms/mL) . Induced high-level capsular production had no measurable effect on the MIC results of tested agents . These results confirm the continued activity advantages of cefotaxime and ceftriaxone against various populations of pneumococci compared to other alternative beta-lactams . The predictive value, however, of the utilized breakpoint concentrations of the cephalosporins, remains in question for pneumococcal infections other than those in the central nervous system and at unaltered, "usual" dosing.

Mol Microbiol, 1996 Jul, 21(2), 373 - 84
Protein F2, a novel fibronectin-binding protein from Streptococcus pyogenes, possesses two binding domains; Jaffe J et al.; Binding of the group A streptococcus (GAS) to respiratory epithelium is mediated by the fibronectin (Fn)-binding adhesin, protein F1 . Previous studies have suggested that certain GAS strains express Fn-binding proteins that are different from protein F1 . In this study, we have cloned, sequenced, and characterized a gene (prtF2) from GAS strain 100076 encoding a novel Fn-binding protein, termed protein F2 . Insertional inactivation of prtF2 in strain 100076 abolishes its high-affinity Fn binding . prtF2-related genes exist in most GAS strains that lack prtF1 (encoding protein F1) but bind Fn with high affinity . These observations suggest that protein F2 is a major Fn-binding protein in GAS . Protein F2 is highly homologous to Fn-binding proteins from Streptococcus dysgalactiae and Streptococcus equisimilis, particularly in its carboxy-terminal portion . Two domains are responsible for Fn binding by protein F2 . One domains (FBRD) consists of three consecutive repeats, whereas the other domain (UFBD) resides on a non-repeated stretch of approximately 100 amino acids and is located 100 amino acids aminoterminal of FBRD . Each of these domains is capable of binding Fn when expressed as a separate protein . In strain 100076, protein F2 activity is regulated in response to alterations in the concentration of atmospheric oxygen.

J Antimicrob Chemother, 1996 Jul, 38 Suppl A, 71 - 84
Antimicrobial resistance among lower respiratory tract isolates of Streptococcus pneumoniae: results of a 1992-93 western Europe and USA collaborative surveillance study . The Alexander Project Collaborative Group; Goldstein FW et al.; One thousand, eight hundred and fifty-six Streptococcus pneumoniae strains, collected in 1992 and 1993 from 15 centres in Western Europe and USA were tested for susceptibility to 16 antibiotics . The overall resistance to penicillin was 23% (range 6-54%), with the highest prevalences in Madrid, Barcelona, Toulouse and Cleveland . Seven centres reported low-level penicillin resistance only . Amoxycillin was more active than ceftriaxone against strains with intermediate resistance to penicillin, and at least four-fold more active than cefuroxime; cefaclor and cefixime had poor activity . Against penicillin-resistant strains, ceftriaxone was slightly more active than amoxycillin, cefuroxime exhibited borderline activity and cefixime and cefaclor were inactive . Ten strains fully susceptible to penicillin had MICs of ceftriaxone > or = 0.1 mg/L; this may represent a first step towards the development of cephalosporin resistance . With the exception of fluoroquinolones, resistance to non-beta-lactam antibiotics (chloramphenicol, doxycycline, co-trimoxazole, erythromycin, clarithromycin and azithromycin) was considerably higher in penicillin-resistant strains compared with penicillin-susceptible isolates . Erythromycin-resistant isolates were also resistant to the other macrolides tested.

J Antimicrob Chemother, 1996 Jul, 38(1), 21 - 5
Critical appraisal of E test for the detection of fluoroquinolone resistance; Jones RN et al.; The ability of E test to accurately detect fluoroquinolone resistance was compared with an agar dilution reference method . Nearly 300 isolates belonging to 26 different species (62.5% with documented ciprofloxacin resistance) were tested with ciprofloxacin, fleroxacin, levofloxacin, norfloxacin, ofloxacin, and sparfloxacin . In contrast to earlier reports, E test MIC values for pneumococci and all rapid growing aerobes were routinely higher (approximately 0.5 log2 dilution step) than agar dilution results . The E test stable-gradient method also efficiently identified fluoroquinolone-resistant subpopulations which were not detected by the reference procedure with the standard inoculum . Categorical agreement for 1710 test comparisons was approximately 90% with no very major, false-susceptible errors . We found the E test to be a valid, reproducible method for fluoroquinolone susceptibility testing that provided quantitative results and produced a conservative (1.6% false-resistant results) assessment of susceptibility of bacteria including isolates of Streptococcus pneumoniae and Pseudomonas aeruginosa to compounds in this antimicrobial class.

FEMS Immunol Med Microbiol, 1996 Jul, 14(4), 195 - 203
Role of capsular sialic acid in virulence and resistance to phagocytosis of Streptococcus suis capsular type 2; Charland N et al.; Streptococcus suis capsular type 2 has a capsule rich in sialic acid (NANA) . Sialic acid, known to be an antiphagocytic factor for many bacterial species, inhibits the activation of the alternative complement pathway . The role of capsular NANA in virulence, resistance to phagocytosis and intracellular survival of S . suis capsular type 2 was evaluated . In general, a low concentration of NANA was observed for all the S . suis strains tested . In addition, no difference could be found in NANA concentrations between strains of different virulence degrees . Sialic acid concentration increased in the virulent strain 89-1591 and the avirulent strain 90-1330 after in vivo growth with an increased capsular material thickness compared to growth in vitro . No significant difference could be found in the phagocytosis rate by porcine blood monocytes of either strain and strain 89-1591 treated with sialidase or the sialic acid-binding lectin from Sambucus nigra (SNA I) . Intracellular survival of strain 89-1591 decreased after treatments with sialidase or lectin, becoming comparable to that of strain 90-1330 . Finally, no difference could be seen in virulence using a murine model, even if strain 89-1591 was treated with the enzyme or the lectin . Thus, NANA does not seem to be a critical virulence factor for S . suis capsular type 2.

Zhonghua Min Guo Xiao Er Ke Yi Xue Hui Za Zhi, 1996 Jul-Aug, 37(4), 295 - 7
Poststreptococcal reactive arthritis: report of one case; Hsu JF et al.; Poststreptococcal reactive arthritis (PSRA) is a clinical syndrome of reactive arthritis . It is associated with recent streptococcal infections, but could not fulfill the revised Jones criteria for acute rheumatic fever (ARF) . The incidence of PSRA cardiac complications to develop was as high as the ARF's developing into rheumatic heart disease . A 9-year-old boy presented with limping gait . He had pain in his left knee for 4 days but no fever . His right knee was swelling with a limitation of movement . A throat culture showed positive growth for group A streptococcus, and consequently antistreptolysin-O serum titer and C-reactive protein were elevated . A synovial fluid examination was turbid but sterile . After 3 days the arthralgia subsided rapidly . A cardiac color Doppler and electrocardiogram showed no evidence of valvular disease . Under the threat of high incidence of rheumatic heart disease in PSRA, we treated this patient with prophylactic antibiotics as acute rheumatic fever . A clinic follow up one year later showed neither sequels nor heart murmur on physical examination.

J Investig Allergol Clin Immunol, 1996 Jul-Aug, 6(4), 266 - 9
Anti-Staphylococcus aureus, anti-Streptococcus pneumoniae and anti-Moraxella catarrhalis specific IgE in asthmatic children; Brarda OA et al.; The total serum IgE levels and the presence of anti-Staphylococcu aureus, anti-Streptococcus pneumoniae and anti-Moraxella catarrhalis specific IgE antibodies were studied in 34 asthmatic children (aged 1-12 years) . Eleven of them also suffered also from subacute or chronic sinusitis . Total and specific IgE were determined by radioimmunoassay in solid phase . The total serum IgE levels were increased in 82.3% of the cases . It was observed that 73.5% of the children had detectable specific IgE antibodies to one or more bacteria . Anti-Streptococcus pneumoniae IgE and anti-Moraxella catarrhalis IgE were observed more frequently than anti-Staphylococcus aureus IgE antibodies . There was no correlation among these results . The percentage of cases with increased total serum IgE levels and detectable specific antibacterial IgE was higher in those children who did not have sinusitis . In this group anti-Streptococcus pneumoniae IgE was the most frequent finding . The detection of specific antibacterial IgE is not sufficient to explain the physiopathologic role of such antibodies in the children with asthma.

J Infect, 1996 Jul, 33(1), 47 - 8
Hepatic abscess due to Eikenella corrodens and Streptococcus milleri: implications for antibiotic therapy; Quinlivan D et al.; We report a case of intrahepatic abscess involving infection with Eikenella corrodens . The organism proved difficult to isolate and would not have been covered by some empirical regimens used in penicillin-allergic patients.

J Infect, 1996 Jul, 33(1), 17 - 22
Antibiotic resistance and serotypes of Streptococcus pneumoniae at Birmingham Public Health Laboratory, 1989-94; Boswell TC et al.; Antibiotic resistance of 1515 consecutive laboratory isolates of Streptococcus pneumoniae between 1989 and 1994 was analyzed . Overall, 39 (2.6%) isolates were resistant to penicillin, 102 (6.7%) resistant to erythromycin and 52 (3.4%) resistant to tetracycline . There was a higher proportion of penicillin resistant isolates from sterile sites compared with "non-sterile sites" (5% vs . 2.2%; P < 0.02) . This same pattern occurred with erythromycin (12.5% vs . 5.6%; P < 0.001) . From 1989-90 to 1993-94 the penicillin resistance rate increased from 0.8% to 8% and the erythromycin from 5.7% to 8.4%, whereas the tetracycline resistance rate fell from 3.7% to 2.8% . The increase in resistance to penicillin largely occurred in the final 12 months of this study period . One hundred and fifty isolates (9.9%) were serotyped, including isolates from sterile sites and those with penicillin resistance . The commonest serotypes of penicillin-sensitive pneumococci were 14, 19, 9 and 6 . The majority of penicillin-resistant pneumococci (PRP) were of serotype 9 (64%) followed by 6, 23 and 19 . Overall 95% of these isolates were of serotypes represented in the 23-valent pneumococcal polysaccharide vaccine (Pneumovax II) . PRP were more likely to have resistance to erythromycin (23%) or tetracycline (23%) compared to penicillin-sensitive pneumococci (6% and 3% respectively) . Most of the PRP were isolated from patients aged over 50 years including 11 isolates from blood cultures of patients with pneumonia or septicaemia . There was a possible epidemiological association between four patients with PRP but surveillance cultures of hospital contacts revealed no extra cases . These results show a worrying increase in infections due to PRP which has implications for clinical and laboratory staff in the diagnosis and treatment of serious pneumococcal infections.

J Hand Surg {Am}, 1996 Jul, 21(4), 689 - 92
Necrotizing fasciitis of the upper extremity; Gonzalez MH et al.; Twelve cases of necrotizing fasciitis were identified retrospectively over a 5-year period . All were associated with a history of substance abuse by injection or with diabetes . Eleven of the 12 infections were associated with beta-hemolytic Streptococcus, a mixed anaerobic aerobic infection, or both . Three of five patients tested for human immunodeficiency virus had positive test results . A wide extensile approach was used to debride necrotic fascia . An average of 3 debridements were necessary, with a range of 1-6 debridements . Two patients under-went shoulder disarticulation because of uncontrollable infection . The rapid and destructive nature of this disease makes early recognition, aggressive debridement, and antibiotic therapy necessary to minimize morbidity.

Infect Control Hosp Epidemiol, 1996 Jul, 17(7), 429 - 31
An outbreak of fatal nosocomial infections due to group A streptococcus on a medical ward; Ramage L et al.; Group A streptococcus is an uncommon but important cause of nosocomial infections . Outbreaks of infection most often have occurred in surgical or obstetrical patients . We describe an outbreak of severe group A streptococcal infections that occurred on a medical unit of a community hospital . Within an 8-day period, three patients developed fatal nosocomial skin and soft-tissue infection due to group A streptococcus . Three nurses who had provided care to one or more of these patients subsequently developed streptococcal pharyngitis, and three other nurses were treated with antibiotics for pharyngitis (cultures not obtained) . Patient isolates were serotype M-nontypeable, T-11, opacity factor-positive, and shared identical DNA profiles when typed by pulsed-field gel electrophoresis; staff isolates were not available for typing . To prevent further spread of infection, the ward was closed to new admissions, and symptomatic staff were treated with antibiotics and relieved of patient-care duties . This outbreak demonstrates the ability of group A streptococcus to spread rapidly in a hospital setting and to cause severe life threatening disease in hospitalized patients.

Vet Microbiol, 1996 Jul, 51(1-2), 125 - 36
Characterization of virulence of the Streptococcus suis serotype 2 reference strain Henrichsen S 735 in newborn gnotobiotic pigs; Vecht U et al.; Strain Henrichsen S 735 (NCTC 10234) of Streptococcus suis serotype 2 reference and three other such strains (strains S 4005, S 3921 and T 141) were tested for virulence by inoculating pigs intranasally and intravenously . The taxonomical properties of each strain were determined . Phenotypes were determined by Western blotting based on MRP and EF protein expression and genotypes were determined by Southern hybridization analysis of the mrp and epf genes . Reference strain S 735 and strain S 3921 produced the 136 kDa MRPh and a 180 kDa form of EF, and hence these strains belong to the MRP + EF phenotype . In accordance with previous experiments with this phenotype, strains S 735 and S 3921 appeared to be only weakly virulent for newborn gnotobiotic pigs . Strain S 4005 produced the 136 kDa MRP and the 110 kDa form of EF, hence it belongs to the MRP + EF + phenotype . This strain was highly virulent for pigs . Strain T 141 did not produce MRP or EF, and hence belongs to the MRP-EF- phenotype . It was nonvirulent for pigs . The route of inoculation did not influence the frequency or severity of clinical signs of disease or lesions, which demonstrated that the 110 kDa EF is not essential during invasion . Southern blot analysis showed that all four S . suis type 2 strains contain sequences that are homologous to the epf and mrp genes . For studies on pathogenesis of S . suis type 2 infections in pigs, we recommend the use of strains that have been tested in a standardized pig model and that belong to the MRP + EF + phenotype, such as strain S 4005.

Jpn J Antibiot, 1996 Jul, 49(7), 703 - 9
{Antimicrobial activities of cefozopran against Streptococcus pneumoniae from children}; Deguchi K et al.; In order to evaluate antimicrobial activity of cefozopran (CZOP), minimum inhibitory concentrations (MICs) of CZOP and control drugs were determined against Streptococcus pneumoniae from children that were isolated from October of 1995 to January of 1996 . Determinations were made for the detection frequency of penicillin-insensitive or resistant strains in biovar utilizing hydrolysis products, and for the correlation of antibacterial susceptibility and macrolides (MLs)-resistant patterns . The results are summarized as follows; 1 . MIC90 of CZOP was < or = 0.025 micrograms/ml against benzylpenicillin (PCG)-susceptible S . pneumoniae (PSSP, 50 strains) . MIC distribution of CZOP against these strains was approximately equal to that of PCG, and showed stronger activities of CZOP than those of ceftazidime (CAZ), flomoxef (FMOX) and erythromycin (EM) . 2 . MIC90 of CZOP was 0.39 micrograms/ml against 50 strains of PCG-insensitive S . pneumoniae (PISP) and PCG-resistant S . pneumoniae (PRSP) . Antimicrobial activities of CZOP against these strains were stronger than those of CAZ, FMOX, PCG and EM . 3 . These isolated strains of PISP and PRSP did not show type III biovar, but showed types I and II . The detection frequency of MLs-constitutive resistant strains were high among type III PSSP and those of MLs-inductive resistant strains were high among types I and II PISP and PRSP . These data suggested that CZOP had strong antimicrobial activities against multiple drug resistant S . pneumoniae including penicillin-resistant strains . CZOP will be effective against S . pneumoniae which often are causative organisms in infections of children.

Turk J Pediatr, 1996 Jul-Sep, 38(3), 281 - 8
Sputum bacteriology and its antibiotic susceptibilities in Turkish cystic fibrosis patients; Ozcelik U et al.; To identify lower respiratory tract pathogens and their in-vitro antibiotic susceptibilities in Turkish cystic fibrosis (CF) patients, a total of 383 sputum cultures were evaluated from 45 CF children in 168 symptomatic and 215 control periods over 25 months . Microorganisms were isolated in 252 of the cultures . The isolation rate was 82 percent for symptomatic periods and 53 percent for control periods . The most common microorganism was P . aeruginosa in the symptomatic period and S . aureus in the control period . Other microbiological species included E . coli, H . influenzae, K . pneumoniae, S . epidermidis, beta-hemolytic streptococcus, H . parainfluenzae, K . oxytoca, E . aerogenes and E . aglomerans . P . cepacia was not found . In 20 cultures more than one microorganism was isolated at the same time . In in-vitro conditions, high susceptibility rates were detected to amikacin, ciprofloxacin and ceftazidim for P . aeruginosa; cefuroxime, ceftriaxone, amikacin, cephalothin, chloramphenicol and erythromycin for S . aureus; amikacin and ceftriaxone for E . coli; ampicillin-sulbactam, amoxicillin-clavulanate, cefuroxime, ceftazidime, ceftriaxone and aztreonam for H . influeanzae; and aztreonam and amikacin for K . pneumoniae . Lower respiratory tract pathogens and their antibiotic susceptibilities in Turkish CF children were not significantly different from those indicated previously in the literature.

Psychosom Med, 1996 Jul-Aug, 58(4), 374 - 82
Psychological stress as a determinant of protein levels and salivary-induced aggregation of Streptococcus gordonii in human whole saliva; Bosch JA et al.; Several pathologies of the oral cavity have been associated with stress, so we investigated salivary-induced aggregation during psychological stress . In addition, salivary total protein, alpha-amylase, and secretory immunoglobulin A (s-IgA) were assessed . In this longitudinal study, 28 dental students provided unstimulated whole saliva during 10 minutes before an academic examination and subsequently 2 weeks and 6 weeks later in a nonstress situation . The effect of whole saliva on the aggregation of Streptococcus gordonii (HG 222) was determined spectrophotometrically . The results shows a significant stress-mediated increase of salivary total protein concentration, alpha-amylase activity, amylase/protein ratio, alpha-amylase output, s-IgA concentration, and s-IgA output . There was also a trend for increased total protein output, whereas salivary flow rate was unchanged . The aggregation of S . gordonii in whole saliva collected before examination was 13.1%, whereas the aggregation in whole saliva collected during nonstress was 23.3% . This reduction was statistically significant (p < .01) . Furthermore, the decrease in bacterial aggregation was related to the increase in state-anxiety (p < .05) . The reduction in aggregation of S . gordonii under stress was not correlated with changes in salivary flow rate, s-IgA concentration, total protein concentration, or alpha-amylase activity . These results suggest that acute psychological stress exerts its influence on both salivary composition and salivary function . Reduced bacterial aggregation may be a contributing factor in the often reported relationship between stress and impaired oral health.

Microb Pathog, 1996 Jul, 21(1), 17 - 22
Protection of mice against fatal pneumococcal challenge by immunization with pneumococcal surface adhesin A (PsaA); Talkington DF et al.; Pneumococcal surface adhesin A (PsaA) is a 37-kDa surface protein present on Streptococcus pneumoniae having significant homology with fimbrial adhesion proteins . Immunization of CBA/CaHNJ Xid mice with PsaA using either complete Freund's or TiterMax adjuvants significantly protected mice against heterologous intravenous challenge with type 3 pneumococcal strain WU2 at doses up to 45 times the LD50 . The results indicate that PsaA warrants further evaluation as a vaccine candidate for human pneumococcal disease.

Res Vet Sci, 1996 Jul, 61(1), 55 - 8
Mastitis in Camelus dromedarius and the somatic cell content of camels' milk; Obied AI et al.; Seven hundred and sixty-three camels from 400 herds of local Sudanese camel breeds were investigated for the prevalence of mastitis, identification of its bacterial causes and determination of the leucocyte contents of camel's milk . One hundred and forty-nine (19.5 per cent) of the 763 camels examined were diagnosed as mastitis cases based on clinical signs . One hundred and fifty-nine (47.3 per cent) of the 336 randomly selected milk samples were reactive in a rapid mastitis test and 16 of the 153 tested samples contained Brucella abortus agglutinating antibodies . Streptococcus, Staphylococcus, Micrococcus and Aerobacter species and Escherichia coli were found to be the main causes of mastitis (in descending order) . The leucocyte contents of the 757 milk samples ranged from < 5 x 10(5) to > 7.5 x 10(6) leucocyte ml-1 and 42.8 per cent of the samples contained < 5 x 10(5) cells ml-1 . Neither significant correlation between the leucocyte content of milk and isolated bacterial species nor significant variation in leucocyte contents during different stages of lactation were detected.

J Clin Microbiol, 1996 Jul, 34(7), 1717 - 21
Rapid species identification of "Streptococcus milleri" strains by line blot hybridization: identification of a distinct 16S rRNA population closely related to Streptococcus constellatus; Jacobs JA et al.; A collection of 399 "Streptococcus milleri" strains were identified to the species level by the use of a line blot assay . Their PCR-amplified partial 16S rRNA gene sequences were hybridized with species-specific 5'-biotinylated oligonucleotide probes homologous to the bp 213 to 231 regions of the 16S rRNA gene sequences of the type strains Streptococcus anginosus ATCC 33397, Streptococcus constellatus ATCC 27823, and Streptococcus intermedius ATCC 27335 . The hybridization results were compared with the reference phenotypic identification method data (R . A . Whiley, H . Fraser, J . M . Hardie, and D . Beighton, J . Clin . Microbiol . 28:1497-1501, 1990) . Most strains (357 of 399 {89.5%}) reacted unambiguously with only one probe . However, 42 of the 399 strains (10.5%) reacted with both the S . constellatus- and S . intermedius-specific probes; 41 of them were phenotypically identified as S . constellatus . These dually reactive strains hybridized with a 5'-biotinylated probe based on the bp 213 to 231 region of the 16S rRNA gene sequence of one of two species . Analysis of the 5' ends of the 16S rRNA gene sequences (487 bp) demonstrated that the dually reactive strains represent a distinct rRNA population sharing 98.1% sequence similarity with S . constellatus . Phenotypic consistency between the dually reactive strains and the S . constellatus strains was not demonstrated . Line blot hybridization proved to be a simple and inexpensive method to screen large numbers of strains for genetic relatedness, and it allowed the detection of a distinct 16S rRNA type within the "S . milleri" group.

J Dent, 1996 Jul, 24(4), 289 - 95
Antimicrobial abilities of various dentine bonding agents and restorative materials; Palenik CJ et al.; OBJECTIVES: The purpose of this study was to observe and measure the in vitro effect of various composite restorative materials and dentine bonding agents on the growth and adherence of oral bacterial believed to be responsible for recurrent caries in humans and on micro-organisms commonly used to evaluate the effectiveness of disinfecting agents . METHODS: Five sets of dentine bonding agents and composite resins and ten species of micro-organisms were used . Circular disc specimens of each composite set were placed onto inoculated plates . Zones of growth inhibition around specimens were measured after incubation . On other plates, specimens were placed alone for 48 h, removed, and then the micro-organisms added . Also, the composite sets were placed into sterilized bovine incisors and suspended into sucrose-containing both inoculated with Streptococcus mutans for 3 days . Adhering materials were disclosed and scored . RESULTS AND CONCLUSIONS: Four of the composites sets produced statistically similar (P > 0.05) inhibitory zones . The Gram-negative rods and the Staphylococcus aureus were the most resistant micro-organisms . The five composites sets produced the same (P > 0.05) reduction in bacterial accumulation (> 60%) . Aging of the specimens in water for periods up to 4 weeks prior to exposure to S . mutans did not affect product activity.

Int J Syst Bacteriol, 1996 Jul, 46(3), 774 - 81
Taxonomic study of lancefield streptococcal groups C, G, and L (Streptococcus dysgalactiae) and proposal of S . dysgalactiae subsp . equisimilis subsp . nov; Vandamme P et al.; Streptococcus dysgalactiae consists of at least five distinct subgroups on the basis of serogroups, biotypes, and hosts . A chemotaxonomic and phenotypic examination of 80 S . dysgalactiae strains representing the known diversity within this species and 49 reference strains representing all members of the streptococcal pyogenic species group revealed two subpopulations of strains within S . dysgalactiae . The name S . dysgalactiae subsp . dysgalactiae is proposed for strains of animal origin . These strains belong to Lancefield serogroups C and L, are alpha-, beta-, or nonhemolytic, and do not exhibit streptokinase activity on human plasminogen or proteolytic activity on human fibrin . The name S . dysgalactiae subsp . equisimilis is proposed for human isolates . These strains belong to Lancefield serogroups C and G, are beta-hemolytic, and exhibit streptokinase activity on human plasminogen and proteolytic activity on human fibrin.

Zentralbl Veterinarmed B, 1996 Jul, 43(5), 257 - 66
Influence of Streptococcus dysgalactiae surface hydrophobicity on adherence to mammary epithelial cells and phagocytosis by mammary macrophages; Calvinho LF et al.; Bacterial surface hydrophobicity (SH) plays a role in adhesion of bacteria to host surfaces and ingestion by phagocytic cells . Streptococcus dysgalactiae (n = 60) isolated from bovine intramammary infections were examined for expression of SH after growth in Todd-Hewitt broth (THB) and THB supplemented with skim milk, whey, lactose, and casein . Strains were significantly more hydrophobic after growth in THB and THB plus whey and more hydrophilic after growth in THB plus skim milk . Both trypsin and proteinase K abolished SH in three strains tested . Mild pepsin treatment had little effect on SH, while heat treatment at 70 degrees or 80 degrees C abolished SH in two strains tested . A hydrophilic strain of S . dysgalactiae did not adhere as well to bovine mammary epithelial cells as a hydrophobic strain . Trypsin treatment significantly reduced adherence of a hydrophobic strain of S . dysgalactiae to epithelial cells while adherence of a hydrophilic strain remained unaltered . A hydrophilic strain of S . dysgalactiae was significantly more resistant to phagocytosis by bovine mammary gland macrophages than a hydrophobic strain . Differences in expression of SH may play an important role in determining the ability of S . dysgalactiae to establish successfully within the mammary gland.

Cornea, 1996 Jul, 15(4), 434 - 6
Pneumococcal keratitis, bacteremia, and septic arthritis in an asplenic patient; Rivera P et al.; We report the case of a 66-year-old black woman who presented with concomitant acute infectious keratitis, bacteremia, and septic arthritis caused by Streptococcus pneumonia . The septic arthritis resolved rapidly with surgical drainage and intravenous antibiotics, but despite aggressive topical and intravenous antibiotic therapy for the infectious keratitis, the cornea perforated, the patient developed endophthalmitis, and the eye eventually was eviscerated . To the best of our knowledge this is the first reported case of this nature . This patient had undergone splenectomy > 50 years prior to developing these infections . Although the risk of serious infection in clinically significant bacteremia is greatest in the perioperative period after splenectomy, these patients are at increased risk of such events for a lifetime . Because encapsulated bacteria, especially Pneumococcus, pose the greatest risk of sepsis and infection in asplenic patients, pneumococcal vaccination of penicillin prophylaxis must always be considered in these patients . A careful and complete medical history and systemic evaluation remain a crucial element of the evaluation and management of serious infectious keratitis.

FEMS Microbiol Lett, 1996 Jul 1, 140(2-3), 261 - 4
The multiple-sugar metabolism (msm) gene cluster of Streptococcus mutans is transcribed as a single operon; McLaughlin RE et al.; The multiple-sugar metabolism (msm) locus of Streptococcus mutans constitutes a non-PTS sugar uptake system responsible for the transport and utilization of raffinose, melibiose and isomaltotrioses . While previous studies have used polar mutations to suggest that these genes are co-transcribed, there has not been evidence to support this . In this report we present direct evidence that the msm genes can be transcribed as a single operon.

J Bacteriol, 1996 Jul, 178(14), 4060 - 9
Cloning and characterization of the parC and parE genes of Streptococcus pneumoniae encoding DNA topoisomerase IV: role in fluoroquinolone resistance; Pan XS et al.; DNA topoisomerase IV mediates chromosome segregation and is a potential target for antibacterial agents including new antipneumococcal fluoroquinolones . We have used hybridization to a Staphylococcus aureus gyrB probe in concert with chromosome walking to isolate the Streptococcus pneumoniae parE-parC locus, lying downstream of a putative new insertion sequence and encoding 647-residue ParE and 823-residue ParC subunits of DNA topoisomerase IV . These proteins exhibited greatest homology respectively to the GrlB (ParE) and GrlA (ParC) subunits of S . aureus DNA topoisomerase IV . When combined, whole-cell extracts of Escherichia coli strains expressing S . pneumoniae ParC or ParE proteins reconstituted a salt-insensitive ATP-dependent decatenase activity characteristic of DNA topoisomerase IV . A second gyrB homolog isolated from S . pneumoniae encoded a 648-residue protein which we identified as GyrB through its close homology both to counterparts in S . aureus and Bacillus subtilis and to the product of the S . pneumoniae nov-1 gene that confers novobiocin resistance . gyrB was not closely linked to gyrA . To examine the role of DNA topoisomerase IV in fluoroquinolone action and resistance in S . pneumoniae, we isolated mutant strains stepwise selected for resistance to increasing concentrations of ciprofloxacin . We analysed four low-level resistant mutants and showed that Ser-79 of ParC, equivalent to resistance hotspots Ser-80 of GrlA and Ser-84 of GyrA in S . aureus, was in each case substituted with Tyr . These results suggest that DNA topoisomerase IV is an important target for fluoroquinolones in S . pneumoniae and establish this organism as a useful gram-positive system for resistance studies.

Eur J Biochem, 1996 Jul 1, 239(1), 42 - 51
Cloning, sequencing and functional overexpression of the Streptococcus equisimilis H46A gapC gene encoding a glyceraldehyde-3-phosphate dehydrogenase that also functions as a plasmin(ogen)-binding protein . Purification and biochemical characterization of the protein; Gase K et al.; We previously identified DNA sequences involved in the function of the complex promoter of the streptokinase gene from Streptococcus equisimilis H46A, a human serogroup C strain known to express this gene at a high level . As a prerequisite to understanding possible mechanisms that control the balance between the plasminogen activating and plasmin(ogen) binding capacities of H46A, we describe here its gapC gene encoding glyceraldehyde-3-phosphate dehydrogenase (GraP-DH, EC 1.2.1.12), a glycolytic enzyme apparently transported to the cell surface where it functions as a plasmin(ogen).binding protein . The gapC gene was cloned and sequenced and found to code for a 336-amino-acid polypeptide (approximately 35.9 kDa) exhibiting 94.9% sequence identity to the Plr protein from Streptococcus pyogenes shown by others to be capable of plasmin binding {Lottenberg, R., Broder, C . C., Boyle, M . D., Kain, S . J., Schroeder, B . L . & Curtiss, R . III (1992) J . Bacteriol . 174, 5204-5210} . To study the properties of the GapC protein, its gene was inducibly overexpressed in Escherichia coli from QIAexpress expression plasmids to yield the authentic GapC or (His)6GapC carrying a hexahistidyl N-terminus to permit affinity purification . Both proteins were functionally active, exhibiting specific GraP-DH activities of about 80 kat/mol (approximately 130 U/mg) after purification . Their binding parameters {association (ka) and dissociation (kd) rate constants, and equlibrium dissociation constants (Kd = kd/ka)} for the interaction with human Gluplasminogen and plasmin were determined by real-time biospecific interaction analysis using the Pharmacia BIAcore instrument . For comparative purposes, the commercial GraP-DH from Bacillus stearothermophilus (BstGraP-DH), a nonpathogenic organism, was included in these experiments . The Kd values for binding of plasminogen to GapC, (His)6GapC and BstGraP-DH were 220 nM, 260 nM and 520 nM, respectively, as compared to 25 nM, 17 nM and 98 nM, respectively, for the binding to plasmin . These data show that both the zymogen and active enzyme possess low-affinity binding sites for the gapC gene product and that the hexahistidyl terminus does not affect its function . Prior limited treatment with plasmin enhanced the subsequent plasminogen binding capacity of all three GraP-DHs, presumably by the exposure of new C-terminal lysine residues for binding to the zymogen.

Am J Obstet Gynecol, 1996 Jul, 175(1), 155 - 7
A comparison of the yield of positive antenatal group B Streptococcus cultures with direct inoculation in selective growth medium versus primary inoculation in transport medium followed by delayed inoculation in selective growth medium; Silver HM et al.; OBJECTIVE: Our purpose was to compare the yield of positive group B Streptococcus cultures with standard medium for transport of culture swabs compared with use of selective medium during transport . STUDY DESIGN: Cultures of introitus, perineum, and rectum were obtained on prenatal patients; one was placed in standard transport medium, and the other directly in selective growth medium . Swabs in standard transport medium were plated for routine culture and then transferred to selective growth medium, Todd-Hewitt broth, in the laboratory . RESULTS: A total of 307 of 1222 (25.1%) patients had a positive result by any method . With direct inoculation into selective growth medium at the time of sampling, 4.6% of positive cultures were missed . With delayed inoculation into selective growth medium, 16.3% were missed (p < 0.001) . Without use of selective media (routine culture), 31.9% were missed (p < 0.001) . CONCLUSIONS: Use of standard transport medium with subsequent transfer into selective growth medium results in a significantly decreased yield of positive group B Streptococcus cultures.

Am J Med Sci, 1996 Jul, 312(1), 40 - 2
Case report: acute cellulitis and lymphadenitis caused by mucoid Streptococcus pyogenes; Baddour LM et al.; Most patients with acute cellulitis due to Streptococcus pyogenes have a striking onset of high fever and systemic toxicity . Even if hospitalization is deemed necessary for initial treatment, most patients respond promptly to appropriate antibiotic therapy and can be managed as outpatients for most of the treatment regimen . Described is a 48-year-old, previously healthy woman with acute cellulitis and lymphadenitis who did not initially respond to treatment despite proved in vitro activity against the patient's S . pyogenes isolate . The strain grew as a mucoid colony phenotype on blood agar plates . The mucoid characteristic of the strain may have accounted for the patient's lack of response to initial therapy, and previously published clinical and laboratory data support this impression.

Obstet Gynecol, 1996 Jul, 88(1), 51 - 5
Inadequacy of rapid immunoassays for intrapartum detection of group B streptococcal carriers; Baker CJ; OBJECTIVE: To determine the accuracy of two currently used immunoassays and a newly developed optical immunoassay for rapid intrapartum detection of group B streptococcal colonization compared with culture methods . METHODS: Rayon-tipped swabs were used to collect specimens from the distal vagina of 502 women at admission for labor or rupture of membranes . Four tests were performed on specimens from the first 197 patients: culture in selective broth medium, semiquantitative culture on blood agar medium, and ICON Strep B and Quidel Group B Strep Test enzyme immunoassays . For the remaining 305 women, a fifth test, Strep B OIA, a newly developed optical immunoassay, was also performed . RESULTS: The prevalence of group B streptococcal vaginal colonization was 25.1% by selective broth medium and 17.3% when swabs were plated directly onto blood agar medium, giving the latter method a sensitivity of 69% . When compared with selective broth medium results, the sensitivities of the rapid immunoassays were 12% (Quidel), 15% (ICON), and 37% (Strep B OIA) . These values rose to 16% (Quidel), 21% (ICON), and 53% (Strep B OIA) when compared with nonselective blood agar medium results . For women with heavy group B streptococcal colonization (more than 10(6) colony forming units/mL), the sensitivities were 36% (Quidel), 46% (ICON), and 100% (Strep B OIA) . Specificities for all assays were high (98-100%), but variability was found in positive (79-100%) and negative (77-85%) predictive values . CONCLUSION: Although Strep B OIA reliably detects women with heavy group B streptococcal colonization and is more sensitive than either the ICON or Quidel enzyme immunoassays, none of these rapid assays is sufficiently accurate for routine use in the intrapartum detection of women colonized with group B streptococcus.

J Bacteriol, 1996 Jul, 178(13), 3736 - 41
The capsule polysaccharide synthesis locus of streptococcus pneumoniae serotype 14: Identification of the glycosyl transferase gene cps14E; Kolkman MA et al.; To identify a chromosomal region of Streptococcus pneumoniae serotype 14 involved in capsule polysaccharide synthesis, two strategies were used: (i) Tn916 mutagenesis, followed by the characterization of four unencapsulated mutants, and (ii) cross-hybridization with a capsule polysaccharide synthesis gene (cps) probe from S . agalactiae, which has a structurally similar capsule . The two approaches detected the same chromosomal region consisting of two adjacent EcoRI fragments . One of these EcoRI fragments was cloned and hybridized with a cosmid library . This resulted in clone cMKO2 . A similar cosmid clone was obtained from an unencapsulated Tn916 mutant, Spnl4.H . Sequence analysis of the two cosmid clones revealed that in the Tn916 mutant, a gene, cps14E, which is homologous to other bacterial genes encoding glycosyl transferases, had been inactivated . An open reading frame immediately downstream of cps14E, designated cps14F, shows no significant homology with any known genes or proteins . A functional assay showed that cps14E encodes a glycosyl transferase and that a gene-specific knockout mutant lacks this enzyme activity, whereas inactivation of cps14F does not have this effect.

Am J Ophthalmol, 1996 Jul, 122(1), 1 - 17
Spectrum and susceptibilities of microbiologic isolates in the Endophthalmitis Vitrectomy Study; Han DP et al.; PURPOSE: To determine the microbiologic spectrum and antibiotic susceptibilities of infecting organisms in postoperative endophthalmitis and to evaluate the effects of operative factors on the microbiologic spectrum . METHODS: Patients with bacterial endophthalmitis presenting within six weeks of cataract extraction or secondary intraocular lens implantation (IOL) were evaluated . Cultures and Gram stains were performed on intraocular specimens and susceptibility tests on the isolates . RESULTS: Confirmed microbiologic growth was demonstrated from intraocular specimens from 291 of 420 patients (69.3%) . Gram-positive bacteria were isolated from 274 patients (94.2%) with confirmed growth and gram-negative bacteria from 19 (6.5%) . Two hundred twenty-six of the 323 isolates obtained (70.0%) were gram-positive, coagulase-negative micrococci, 32 (9.9%) Staphylococcus aureus, 29 (9.0%) Streptococcus species, seven (2.2%) Enterococcus species, ten (3.1%) miscellaneous gram-positive species, and 19 (5.9%) gram-negative species . All gram-positive isolates tested were susceptible to vancomycin . Seventeen gram-negative isolates (89%) were susceptible to both amikacin and ceftazidime and two (11%) were resistant to both . Anterior chamber or secondary IOL implantations were associated with higher rates of infection with gram-positives other than coagulase-negative micrococci than were posterior chamber IOL implantations (P = .022) or primary cataract extractions (P = .024) . CONCLUSIONS: Gram-positive, coagulase-negative micrococci predominated in this series . Vancomycin was active against all gram-positive isolates tested . Amikacin and ceftazidime showed equivalent activity against gram-negative isolates . Secondary or anterior chamber lens implantations were associated with a possible spectrum shift toward gram-positive organisms other than the coagulase-negative micrococci.

J Infect Dis, 1996 Jul, 174(1), 75 - 82
The repertoire of human antibodies to the carbohydrate capsule of Streptococcus pneumoniae 6B; Park MK et al.; Antibodies to Streptococcus pneumoniae 6B capsular polysaccharide (PS) induced with a 23-valent PS vaccine among 25 adults were examined . The magnitude of antibody responses among different subjects was highly correlated with the amount of anti-6B antibodies expressing IgG (r = 0.98) and lambda (r = 0.93) isotypes . Most individuals produced one or two dominant IgG antibody clones as identified by their isoelectric points . Two antibody clones with unique amino acid sequences could be readily purified, and the sequences of their light chains match those of A1/A17 V kappa and hslv2046 V lambda genes . Anti-6B antibodies isolated from different subjects used various VL genes and differed in their cross-reactivity with 6A PS . An isoelectric focusing study suggests that some IgG antibodies induced with 6B PS bind 6A PS with lower avidity.

J Infect Dis, 1996 Jul, 174(1), 225 - 8
Effects of granulocyte colony-stimulating factor in cirrhotic rats with pneumococcal pneumonia; Preheim LC et al.; A rat model was used to study the effects of granulocyte colony-stimulating factor (G-CSF) on the pathogenesis of pneumococcal pneumonia in cirrhosis . G-CSF or 5% dextrose in water was administered subcutaneously to cirrhotic and control rats before or after transtracheal infection with type 3 Streptococcus pneumoniae . In both groups, G-CSF significantly increased the total number and percentage of polymorphonuclear leukocytes (PMNL) in peripheral blood (P < .002) and bronchoalveolar lavage fluid (P < .01) . An in vivo phagocytosis assay revealed no increase in uptake of pneumococci by PMNL within the lungs of cirrhotic or control rats receiving G-CSF . G-CSF administered before infection did not protect cirrhotic or control rats, but G-CSF treatment after infection significantly reduced mortality in control (P = .04) but not cirrhotic rats . These data suggest that despite increasing numbers of circulating and pulmonary PMNL, G-CSF does not protect against fatal pneumococcal pneumonia in cirrhotic rats.

FEMS Microbiol Lett, 1996 Jun 15, 140(1), 85 - 91
Isolation and characterization of pLS1 plasmid mutants with increased copy numbers; Acebo P et al.; Streptococcus pneumoniae genetic systems designed for isolation of plasmid mutants with copy-up phenotypes have been developed . The target plasmids have the pLS1 replicon, and two different strategies have been followed: (i) selection of clones exhibiting augmented resistance to antibiotics, or (ii) obligatory co-existence of incompatible plasmids . We have isolated 23 plasmid mutants exhibiting increased number of copies . All the mutations corresponded to four different alleles of the copG gene of plasmid pLS1 . These strategies could be used with other plasmids.

FEMS Microbiol Lett, 1996 Jun 15, 140(1), 49 - 54
Identification of the Streptococcus mutans frp gene as a potential regulator of fructosyltransferase expression; Shibata Y et al.; Four putative open reading frames (ORFs) were previously identified in the regions flanking the Streptococcus mutans GS-5 fructosyltransferase (FTF) gene . One of these, ORF 3, appeared to code for a low-molecular-mass protein containing amino acid sequences sharing homology with several Gram-positive bacterial DNA-binding proteins and it was suggested that the ORF 3 gene product might be an FTF regulatory protein (FRP) . In order to characterize this protein, we have purified the biotinylated tag-FRP fusion protein using the PinPoint protein purification system and this fusion protein was used in gel shift assays with DNA fragments containing the ftf promoter region . FRP bound specifically to the upstream region of the ftf promoter containing the inverted repeat structure that is present upstream of the -35 sequence . In contrast, FRP did not bind to DNA fragments lacking the inverted repeat structure . The results of these experiments suggest that FRP interacts with the inverted repeat region upstream of the ftf promoter and such interactions may regulate FTF expression.

BMJ, 1996 Jun 8, 312(7044), 1454 - 6
Prevalence of antibiotic resistance and serotypes in pneumococci in England and Wales: results of observational surveys in 1990 and 1995; Johnson AP et al.; OBJECTIVE--To assess the prevalence of antibiotic resistance and serotype distribution among pneumococci in England and Wales in 1990 and 1995 . DESIGN--Observational surveys in March 1990 and March 1995 . During two weeks in each survey period all pneumococci isolated in public health laboratories in England and Wales were collected and assessed for sensitivity to antibiotics and the distribution of serogroups or serotypes . SETTING--The network of public health laboratories throughout England and Wales . SUBJECTS--1127 individual patient isolates of Streptococcus pneumoniae obtained during the two surveys . MAIN OUTCOME MEASURES--Sensitivity or resistance to a range of antibiotics; serogroup or serotype . RESULTS--The prevalence of intermediate or full resistance to penicillin increased from 1.5% in 1990 to 3.9% in 1995 and resistance to erythromycin increased from 2.8% to 8.6% . About 92% of isolates belonged to serogroups or serotypes included in the currently available pneumococcal vaccine . CONCLUSION--Resistance to penicillin and erythromycin has increased among pneumococci in England and Wales . Continued surveillance to assess further increases in the prevalence of pneumococcal resistance to antibiotics is essential.

Pharmacoeconomics, 1996 Jul, 10(1), 36 - 58
Cost-effective treatment of lower respiratory tract infections; Garrelts JC et al.; Pneumonia is one of the most frequent causes of hospitalisation, accounting for many deaths each year . Elderly patients, especially those in extended care facilities, are at particular risk for pneumonia and have a higher mortality rate than younger patients . The cost of treating patients with lower respiratory tract infections (LRTIs) is staggering, especially for patients who require hospitalisation . Less extensive diagnostic testing may be utilised in the future to minimise the cost of LRTIs, although this in turn might compromise our knowledge of the pathogens involved and their resistance patterns . Currently, the prevalence of various pathogens is known, and varies on the basis of underlying risk factors such as age, structural or functional lung disease, mental status, immune system function and geographical region . However, resistance patterns of commonly implicated pathogens are ever-changing . For example, Streptococcus pneumoniae, which is the most frequent cause of community-acquired pneumonia, has become resistant to benzylpenicillin (penicillin G) in recent years . This is especially disturbing because cross-resistance with other classes of antibiotics frequently occurs . Many antibiotics have been used in the treatment of LRTIs . Cephalosporins are popular because of their broad spectrum of activity and excellent safety profiles . Penicillins have also been popular, although resistant strains of S . pneumoniae now pose a serious threat . The macrolides have recently enjoyed increased popularity because of their activity against atypical pathogens . Although the fluoroquinolones are second-line agents for community-acquired pneumonia, they have a place in the treatment of LRTIs encountered in the nursing home or hospital setting, and even have activity against atypical bacteria . A variety of innovative programmes have been developed in recent years to control the cost of treating LRTIs . Although limited formulary choices have been used in the hospital setting for years, and are now becoming popular in managed care, there is no proof that this mechanism saves money when looking at the overall picture . A rational approach is to conduct a rigorous pharmacoeconomic evaluation of treatment options, thus identifying the therapies that provide the best value in each setting . Equally important are various programmes that encourage the cost-conscious use of the antibiotics chosen . Some of the methods evaluated in the literature include: notifying prescribers of the true cost of treatment alternatives, notifying prescribers whether or not third-party coverage is available for the prescription, streamlining from combination therapy to a single agent, early switching from parenteral to oral therapy, initiating treatment with oral agents, administering parenteral antibiotics at home from the outset of therapy, and antibiotic streamlining programmes that are partnered with infectious disease physicians . For the most part, these programmes have not been rigorously evaluated . Newer, more innovative ways to provide cost-conscious treatment of LRTIs will undoubtedly be developed . The basic premise for these programmes should be rigorous, well-designed pharmacoeconomic evaluations . Such studies will help ensure that all facets of therapy are evaluated and should prevent choices being made simply on the basis of the lowest acquisition cost.

Braz J Med Biol Res, 1996 Jun, 29(6), 763 - 7
Detection of antibody isotypes to streptolysin O by dot ELISA; Barbosa SF et al.; The presence of antibody isotypes (IgG, IgA and IgM) to streptolysin O was determined by dot ELISA in 222 serum samples from patients with different levels of anti-streptolysin O (SLO) antibodies as measured by the neutralizing assay (NA), from patients with diseases not related to nonsuppurative complications of Streptococcus pyogenes infection, and from clinically healthy individuals . Immunoglobulin G antibodies were found in 72% of sera from patients with SLO antibodies higher than 333 Todd units (TU), and IgA antibodies were also detected in 53%, but no IgM antibodies were demonstrable . High copositivity (0.94), conegativity (0.97), and positive (0.96) and negative (0.96) predictive values were observed when IgG and IgA findings were combined . The dot ELISA gave highly reproducible results . The present data suggest that the assay may be of practical value for routine detection of SLO antibodies when employed with an anti-human immunoglobulin light chain peroxidase conjugate.

Rev Med Chil, 1996 Jun, 124(6), 715 - 9
{Streptococcus pyogenes: in vitro susceptibility to several antimicrobials in two date periods}; Giglio MS et al.; BACKGROUND: The frequency of Streptococcus pyogenes infections with deep tissue invasion and toxic shock syndrome has increased in the last decade throughout the world . AIM: To compare antimicrobial susceptibility of S . pyogenes strains isolated during 1986 and during 1994-95 . MATERIAL AND METHOD: Eighty two S . pyogenes strains isolated in 1986 and 67 strains isolated in 1994-95, were studied . MIC 50 and 90 were determined by and agar dilution method for penicillin, ampicillin, cefazolin, cefuroxime, erythromycin, roxithromycin and miocamycin . RESULTS: Eighty eight strains came from skin of soft tissues, 19 from surgical wounds, 18 from invasive infections, 15 from pharyngeal swabs and 9 from other locations . All strains were susceptible to penicillin, ampicillin, cefazolin, cefuroxime, roxithromycin and miocamycin . Ninety nine percent of strains were susceptible to erythromycin . Strains isolated in 1995-95 had a higher MIC 50 and 90 for erythromycin than those isolated in 1986 . CONCLUSIONS: The changes in susceptibility to erythromycin of recently isolated strains could be due to the widespread use of macrolides in Chile.

Am J Dent, 1996 Jun, 9(3), 120 - 4
Shear bond strength, microleakage and antimicrobial properties of AElitebond; Grobler SR et al.; PURPOSE: To evaluate the shear bond strength (SBS) and microleakage (ML) to dentin as well as the antimicrobial action against five strains of oral bacteria of AElitebond single primer restorative system . MATERIALS AND METHODS: Fifteen molars were tested to failure for each of the four time periods: 15 minutes, 24 hours, 7 days and 30 days, after final cure . The test specimens were prepared on the dentin surfaces of the extracted molars ground on 600 grit SiC paper . The bonded cylinders were removed from the assembly apparatus after cure, stored in physiological saline at 37 degrees C for the four different time periods and subjected to a shear bond load at 0.5 mm/minute until fractured . For the microleakage determination, Class V cavity preparations were done on the facial surfaces of the roots of 15 canines below the cemento-enamel junction and the specimens thermocycled (500x) between 8 degrees C and 15 degrees C in 2% methylene blue . The teeth were cut into 6 mm thick sections and the sections which included the restorations were separately dissolved in acid . The color intensities of the dissolved sections were measured at a wavelength of 590 nm against a standard curve which was constructed from the dye . The modified model cavity method of Meryon & Johnson (1989) was used to assess the antimicrobial properties of the restorative system . RESULTS: The mean SBS values (in MPa) were found to be 10.3, 9.8, 11.47 and 9.9 after 15 minutes, 24 hours, 7 days, and 30 days, respectively . There was no significant increase (P < 5%) in the SBS after 15 minutes . The ML of 0.76 micrograms dye/ restoration was relatively low in comparison to the SBS values . The restorative system significantly (P < 5%) inhibited the growth of Actinomyces naeslundii with 88%, Streptococcus mutans with 42%, Streptococcus sanguis with 39% and Streptococcus oralis with 9% . However, the growth of Veillonella parvula was stimulated with 49%.

Singapore Med J, 1996 Jun, 37(3), 255 - 7
Cefuroxime compared to amoxicillin-clavulanic acid in the treatment of community-acquired pneumonia; Oh HM et al.; The study compared the efficacy and safety of cefuroxime (CFX) versus amoxicillin-clavulanic acid (AC) in the treatment of community-acquired pneumonia . A total of 48 patients (mean age 44 years; 32 males and 16 females) were randomised to receive sequential intravenous/oral CFX (750 mg i.v . 8H for 48 H/500 mg p.o bid) and sequential intravenous/oral AC (1.2 g i.v . 8 H for 48 H/ 750 mg p.o . tid) for 7-14 days . The two groups were well matched for age, sex and treatment duration (median 7 days) . The most frequent causative organisms were Mycoplasma (3), Klebsiella species (2), Pseudomonas aeruginosa (2) and hemolytic streptococcus (2) . clinical cure was obtained in 20 patients (83.3%) and 18 patients (75%) of CFX and AC group respectively . Clinical improvement was observed in one patient of the CFX group . There were 3 failures in the CFX group and 4 failures in the AC group . Two patients in the AC group developed adverse drug reactions (namely vomiting and rash) and were withdrawn from the study . In conclusion, cefuroxime and amoxicillin-clavulanic acid have comparable efficacy and safety in the treatment of community-acquired pneumonia.

Oral Microbiol Immunol, 1996 Jun, 11(3), 181 - 7
Identification and characterization of a protease from Streptococcus oralis C104; Lo CS et al.; Streptococcus oralis is among the earliest colonizers of the tooth surface during plaque formation . As such, its enzymatic activities may influence ecologic succession on the tooth surface . In the current study, we use zymograms and preparative polyacrylamide gel electrophoresis to identify and purify a protease from S . oralis (sanguis) C104 . Proteases from S . oralis C104 were detected in cell pellets at 133, 146 and 176 kDa as clear proteolytic bands on gelatin-substrate zymograms . Preparation of the major (146 kDa) protease were obtained by continuous-elution electrophoresis . The protease was active over the pH range of 7 to 9 with optimum activity between pH 8 and 9 . Protease activity was inhibited by several serine protease inhibitors including phenylmethylsulfonyl fluoride, di-isopropyl-phosphofluoridate and aprotinin . The protease showed highest hydrolytic activity against azoalbumin and Bz-Pro-Phe-Arg-NA . Immunofluorescence studies with a polyclonal antiserum to the 146-kDa protease suggest it is present on the cell surface of S . oralis C104 . Zymograms of cell pellets from other S . oralis strains as well as S . sanguis and Streptococcus mitis suggest that functionally similar proteases are elaborated by many early colonizers of the tooth surface.

Oral Microbiol Immunol, 1996 Jun, 11(3), 172 - 80
Properties of practical oral liposome-Streptococcus mutans glucosyltransferase vaccines for effective induction of caries protection; Childers NK et al.; Here we report the effectiveness of various liposome vaccines containing Streptococcus mutans glucosyltransferase (GTF) in protecting against dental caries after oral immunization . Rats were immunized by gastric intubation of the appropriate liposome vaccine at weaning and boosted 3 times . Rats were infected with S . mutans following initial immunization and fed cariogenic diet (Diet 305) . Saliva and serum were collected during the study and assessed for antibody activity by enzyme-linked immunosorbent assay . Mandibles were removed on day 47 and assessed for S . mutans levels and then for caries . Animals immunized with sonicated, filtered and microemulsified GTF liposome preparations had decreased levels of dental caries compared with control animals given empty liposomes . Rats given dehydrated/rehydrated or purified liposomal GTF also had significantly less caries than control group (GTF alone) . Because of economy, ease of preparation and efficiency in amount of antigen used, filtered, dehydrated/ rehydrated and purified liposomal GTF preparations are most practical for use in further assessing the efficacy of liposomal GTF in oral immunization.

J Endod, 1996 Jun, 22(6), 290 - 3
Regional variation in root dentinal tubule infection by Streptococcus gordonii; Love RM; The purpose of this study was to investigate the pattern of bacterial invasion of dentinal tubules at different regions in human roots . Specimens were obtained from single-rooted teeth that had their root canals prepared in a standard manner . Roots were then sectioned longitudinally through the canals and the resulting specimens chemically treated to remove the smear layers . Specimens were immersed in a suspension of Streptococcus gordonii for 3 weeks and then prepared for histological analysis . Sections from the cervical, midroot, and apical areas were examined . The pattern of bacterial infection of the cervical and midroot areas was similar, characterized as a heavy infection with bacteria penetrating as deep as 200 microns . Invasion of the apical dentin was significantly different, with a mild infection and maximum penetration of 60 microns.

Minerva Ginecol, 1996 Jun, 48(6), 227 - 33
{Vaginal colonization of Streptococcus B in pregnancy}; Citernesi A et al.; In the last few years the importance of GBS as the cause of serious neonatal sepsis has become more evident . The number of cases of this infection clearly exceeds the number of other congenital infections, for which antenatal screening is performed . Asymptomatic colonization of the genital tract of the pregnant woman has the most important role in transmission of GBS and several risk factors are connected to neonatal infection . In order to assess the epidemiological situation in Tuscany, 5079 pregnant women have been recruited by the Obstetrical Department of 16 Hospitals and evaluated for the vaginal colonization by GBS . 3654 couples mother-neonate have also been studied to ascertain the transmission of this germ to the neonate . A vaginal swab was collected at the admission to the Hospital at delivery-time and swabs from several sites of the neonate were obtained just after birth . A blood-agar culture and a latex agglutination test were employed to detect the GBS . GBS was present in 6.6% of the vaginal cultures, with a wide variation in colonization rates . 2.2% of the neonates were positive . The transmission of GBS from the positive mother to the neonate occurred in 20% of the cases . Furthermore one positive neonate out of three was born from a negative mother . No correlation between GBS positivity and preterm delivery was found . The rates of prevalence of GBS in our population, both mother and neonates, suggest a situation that can no longer be neglected . Our data are probably underestimated because of the low sensibility of the culture method . A preventive strategy has to be employed to avoid serious neonatal sepsis . An antenatal screening that provides a vaginal culture at the 36th week of gestation and a chemoprophylaxis intra-partum in the positive cases appears to be the most effective approach.

Diagn Microbiol Infect Dis, 1996 Jun, 25(2), 89 - 95
Activity of penicillin and three third-generation cephalosporins against US isolates of Streptococcus pneumoniae: a 1995 surveillance study; Thornsberry C et al.; In a surveillance study of Streptococcus pneumoniae from the United States the incidence of resistance (including both resistant and relatively resistant strains) to penicillin was 37.2% when tested by the oxacillin disk-diffusion test, or 27.2% when tested by microdilution minimum inhibitory concentrations . Strains that were susceptible to penicillin by the oxacillin test were also susceptible to the third-generation cephalosporins cefotaxime, ceftriaxone, and ceftizoxime . The overall resistance (without regard to penicillin resistance) to cefotaxime was 8.8%, to ceftriaxone was 7.9%, and to ceftizoxime was 17.2%; the rates of resistance among penicillin-resistant and relatively resistant strains (combined), however, were 23.6% for cefotaxime, 21.4% for ceftriaxone, and 43.2% for ceftizoxime . The incidence of penicillin resistance and relative resistance in these pneumococcal isolates varied from one institution to another, but all institutions had these strains and the incidence varied from 4.3% to 60.9% . Having ceftizoxime, the least active of the third-generation cephalosporins, tested on the formulary did not appear to increase selection of beta-lactam-resistant strains . The increased resistance to penicillin with the concomitant increase in resistance to third-generation cephalosporins may greatly increase the difficulty of selecting optimal therapy of patients with life-threatening infections due to S . pneumoniae.

Clin Lab Haematol, 1996 Jun, 18(2), 79 - 82
Experience with the Port-A-Cath in sickle cell disease; McCready CE et al.; Peripheral vein access is often a problem in patients with sickle cell disease (SCD) . Totally implantable venous access devices (TIVAD) have offered other groups of patients safe long-term venous access . We reviewed our own experience with the use of a Port-A-Cath device in five patients with SCD undergoing exchange transfusion programmes . All five lines required removal due to infection associated with SBE, septic arthritis, pulmonary embolus and axillary vein thrombosis . The organisms involved were Staphylococcus aureus (3), Staphylococcus epidermidis (1) and Streptococcus sp . (1) . The median working life of the catheters was 240 days (range 61-428) . The median length of time from presentation to the diagnosis of a line-associated infection was 29 days (range 1-58) . The rate of complications (0.4 per 100 patient days) in this small group of patients contrasts with the lower rates in patients with HIV and malignancy (0-0.1 per 100 patient days) . Our results suggest that patients with SCD suffer an unacceptable incidence of infective complications associated with the Port-A-Cath . Bone infection is more common where there is pre-existing infarcted tissue . While these systems provide a valuable tool, our experience has led us to discontinue the use of TIVADs in SCD.

Eur J Clin Microbiol Infect Dis, 1996 Jun, 15(6), 506 - 9
Colonization and infection with Moraxella catarrhalis in childhood; Berner R et al.; In a prospective clinical study, rates of isolation of Moraxella catarrhalis in nasopharyngeal aspirates from 122 children with respiratory tract infection and 72 healthy controls were compared . In the patient group, Moraxella catarrhalis and Streptococcus pneumoniae were the most frequently isolated pathogens (38% and 42%, respectively) . Monocultures of each pathogen were equally distributed in patients and controls (41% and 42%), whereas mixed infections were found more frequently in the patient group (42% vs 14%; normal flora, 17% vs 44%) . Moraxella catarrhalis appears to be a relevant respiratory pathogen . The isolation of two or more pathogens in nasopharyngeal aspirates seems to be as indicative of relevant infection as is monoculture.

J Antimicrob Chemother, 1996 Jun, 37 Suppl C, 83 - 92
An open comparative study of azithromycin and roxithromycin in the treatment of acute upper respiratory tract infections; Muller O; An open, multicentre study was undertaken in order to evaluate the efficacies and safety profiles of azithromycin and roxithromycin in 440 adults with acute otitis media, sinusitis or acute beta-haemiolytic streptococcal pharyngitis/tonsillitis . Treatment with 500 mg azithromycin, administered orally once daily for 3 days, produced a satisfactory clinical outcome (cure or improvement) in 51/52 (98%) patients with otitis media, 91/91 (100%) patients with pharyngitis/tonsillitis and 64/68 (94%) patients with sinusitis . Treatment with 150 mg roxithromycin, given orally twice daily for 10 days, produced satisfactory clinical responses in 54/55 (98%), 91/92 (99%) and 69/73 (94%) patients with otitis media, pharyngitis/tonsillitis and sinusitis respectively . Of the 17 azithromycin-treated patients with sinusitis who were clinically and bacteriologically evaluable, Staphylococcus aureus persisted in two and Streptococcus pneumoniae in one . S . aureus also persisted in 1/12 clinically and bacteriologically-evaluable patient treated with roxithromycin . Of the 58 and 64 patients with pharyngitis/tonsillitis treated with azithromycin and roxithromycin, respectively, who were clinically and bacteriologically evaluable, Streptococcus pyogenes persisted at the end of treatment in 7/58 (12%) in the azithromycin group and in 13/64 (20%) in the roxithromycin group . At follow-up, there was no evidence of S . pyogenes reinfection in patients treated with azithromycin . Three episodes of reinfection occurred in the roxithromycin treatment group . Also, three patients showed evidence of clinical relapse at follow-up, although no pathogens were isolated . Azithromycin was associated with a lower incidence of adverse events . No azithromycin-treated patient was withdrawn prematurely because of a treatment-related event . Three roxithromycin-treated patients were withdrawn from treatment because of severe headache, thyroiditis or fatigue . In conclusion, for adults with acute upper respiratory tract infections, a 3-day course of once-daily azithromycin was found to be as effective and as well tolerated as a 10-day course of twice-daily roxithromycin.

J Antimicrob Chemother, 1996 Jun, 37 Suppl C, 71 - 81
An open comparative study of azithromycin versus cefaclor in the treatment of patients with upper respiratory tract infections; O'Doherty B; Azithromycin and cefaclor were compared for the treatment of acute otitis media, streptococcal pharyngitis/tonsillitis, or sinusitis in an open multicentre study conducted in 530 adults . At the end of therapy (day 11-15), 228/245 (93%) patients treated with azithromycin 500 mg once daily for 3 days and 233/241 (97%) treated with cefaclor 250 mg given three times daily for 10 days were considered to have responded satisfactorily (cured or improved) . In bacteriologically evaluable patients with pharyngitis/ tonsillitis, Streptococcus pyogenes was eradicated in 116/117 (99%) azithromycin- and in 115/119 (97%) cefaclor-treated patients at day 11-15; one patient in each group had become reinfected after initial eradication of the pathogen . When followed up on day 25-30, S . pyogenes infection had recurred in 5/105 (5%) azithromycin and 4/108 (3%) cefaclor patients who had responded satisfactorily at day 11-15, and whose baseline pathogen had been eradicated . Of these patients, two in the azithromycin and one in the cefaclor group also relapsed clinically; the others remained asymptomatic . Patients tolerated both treatments well; treatment-related adverse events were recorded in 11% of the 267 azithromycin- and 10% of the 263 cefaclor-treated patients assessed for safety . One azithromycin patient and five cefaclor patients withdrew because of adverse events . The results of the study show that a 3-day regimen of azithromycin, given once daily, is as effective and well tolerated as a multiple-daily, 10-day cefaclor regimen for the treatment of upper respiratory tract infections in adults.

Eur J Clin Invest, 1996 Jun, 26(6), 461 - 4
Effects of group-A streptolysin O on neonatal and adult red blood cell deformability and haemolysis; Poschl JM et al.; Neonates are more susceptible than adults to many Gram-positive and Gram-negative bacterial infections . Whereas group B streptococcus causes life-threatening infections in neonates, group A beta-haemolytic streptococcus infections rarely occur in neonates . To test the hypothesis that group A streptococcus may have different effects on neonatal and adult red blood cells (RBCs), haemolysis and deformability (rheoscope) of RBCs from adults, full-term and pre-term neonates were studied during 60 min incubation with 1 haemolytic unit (HU) mL-1 group A streptolysin O (SLO) . SLO incubation of adult RBCs resulted in almost linearly increasing time-dependent haemolysis reaching 82%, whereas haemolysis of neonatal RBCs was below 60% after 1 h . After 60 min SLO incubation, RBC deformation was significantly (P < 0.05) more reduced in adults than in full-term and preterm neonates . An inverse overall relationship (r = 0.68) between SLO-induced haemolysis and RBC deformation was found after 60 min of SLO incubation . We conclude that SLO causes less haemolysis and less impairment of RBC deformation in neonates than in adults . The decreased RBC deformation of unhaemolysed RBC indicates that, before lysis, mechanical RBC membrane properties are altered by SLO.

Aust N Z J Med, 1996 Jun, 26(3), 391 - 5
Streptococcus pneumoniae carriage and penicillin/ceftriaxone resistance in hospitalised children in Darwin; Skull SA et al.; BACKGROUND: The prevalence of resistant Streptococcus pneumoniae (SP) is increasing world-wide . Pneumococcal prevalence and susceptibility patterns are not known for children in the Top End of the Northern Territory . AIMS: To determine the prevalence of nasopharyngeal carriage of pneumococci in children hospitalised in Darwin, and the extent of penicillin and ceftriaxone resistance in these isolates . METHODS: Nasopharyngeal swabs were collected on admission from 85 children who had not received antimicrobials for their admission illness . Antimicrobial resistance was determined following selective culture for SP isolates . Minimal inhibitory concentrations (MICs) for penicillin and ceftriaxone were determined using the E-test method . RESULTS: The overall prevalence of nasopharyngeal SP carriage was 44% . Carriage occurred more often in Aboriginal children from rural areas (56%) than in urban children (24%) (OR 3.94, 95% CI 1.35-11.78, p < 0.01) . Thirty per cent of isolates were penicillin resistant, 35% were ceftriaxone resistant, and 49% were resistant to at least one of these . One isolate showed high-level resistance to both antimicrobials; all other resistant isolates were of intermediate-level resistance . For the same isolate, MICs for ceftriaxone were more often higher than those for penicillin . Five isolates had intermediate resistance to ceftriaxone whilst remaining sensitive to penicillin . CONCLUSIONS: The prevalence of pneumococcal resistance to penicillin and ceftriaxone in hospitalised children in Darwin is much higher than previously reported in Australia . This has implications for future antimicrobial management and highlights the need for regular regional surveillance of SP resistance . The development of conjugate pneumococcal vaccines for children under two years is a priority.

Mol Microbiol, 1996 Jun, 20(5), 927 - 35
Assembly of human contact phase proteins and release of bradykinin at the surface of curli-expressing Escherichia coli; Ben Nasr A et al.; Previous work has demonstrated that most strains of the human pathogen Streptococcus pyogenes bind kininogens through M protein, a fibrous surface protein and virulence determinant . Here we find that strains of several other pathogenic bacterial species, both Gram-positive and Gram-negative, isolated from patients with sepsis, also bind kininogens, especially kininogen (HK) . The most pronounced interaction was seen between HK and Escherichia coli . Among clinical isolates of E . coli, the majority of the enterohaemorrhagic, enterotoxigenic, and sepsis strains, but none of the enteroinvasive and enteropathogenic strains, bound HK . Binding of HK to E . coli correlated with the expression of curli, another fibrous bacterial surface protein, and the binding of HK to purified curli was specific, saturable, and of high affinity; Ka = 9 x 10(7) M-1 . Other contact phase proteins such as factor XI, factor XII, and prekallikrein bound to curliated E . coli, but not to an isogenic curli-deficient mutant strain, suggesting that contact phase activation may occur at the surface of curliated bacteria . Kininogens are also precursor molecules of the vasoactive kinins . When incubated with human plasma, curli-expressing bacteria absorbed HK . Addition of purified plasma kallikrein to the HK-loaded bacteria resulted in a rapid and efficient release of bradykinin from surface-bound HK . The assembly of contact phase factors at the surface of pathogenic bacteria and the release of the potent proinflammatory and vasoactive peptide bradykinin, should have a major impact on the host-microbe relationship and may contribute to bacterial pathogenicity and virulence.

FEMS Immunol Med Microbiol, 1996 Jun, 14(2-3), 145 - 50
Adhesion of Streptococcus uberis to monolayers of cultured epithelial cells derived from the bovine mammary gland; Ditcham WG et al.; Monolayers of epithelial cells obtained by culture of isolated secretory alveoli from the bovine mammary gland were used as target cells in bacterial adhesion assays . The ability of two strains of Streptococcus uberis (EF20 and 0140J) to adhere to these cells was examined using scanning electron microscopy (SEM) . The cultured monolayers consisted of two types of epithelial cell one of which possessed many microvilli and another which exhibited only sparse or no microvilli . Strain EF20 adhered more readily and in greater numbers to the cells without microvilli (MV-) than to cells possessing microvilli (MV+) . Strain 0140J also interacted with a greater proportion of MV- cells but adhered to both MV- and MV+ cell types in similar numbers.

J Chemother, 1996 Jun, 8(3), 188 - 92
Susceptibility of macrolide and beta-lactam antibiotics of Streptococcus pyogenes strains isolated over a four-year period in central Italy; Cellesi C et al.; In vitro susceptibility to erythromycin, azithromycin, penicillin G, ceftriaxone and ceftibuten was investigated in 190 Streptococcus pyogenes strains isolated over a 4-year period (1991-1994) from patients attending a university hospital located in central Italy . The rate of susceptibility to macrolide antibiotics of the S . pyogenes strains showed a progressive decrease (from 90.3% in 1991 to 79.5% in 1994), while all strains were susceptible to the three beta-lactam antibiotics . Owing to the reduced prevalence of macrolide-susceptible S . pyogenes strains, in vitro susceptibility testing of streptococcal isolates appears to be always necessary before starting a macrolide-based chemotherapy . Concerning beta-lactams, ceftriaxone presented minimum inhibitory concentrations (MIC) always equal to or lower than those of penicillin G, while the oral long-acting cephalosporin, ceftibuten, had MICs higher than those of the other beta-lactams, although in the susceptible range . Results of in vitro susceptibility testing are discussed in relation to their implications for antimicrobial chemotherapy of S . pyogenes infections.

J Med Vet Mycol, 1996 Jun-Jul, 34(3), 209 - 14
Late bioprosthetic valve endocarditis caused by Phialemonium aff . curvatum and Streptococcus sanguis: a case report; Schonheyder HC et al.; Dual fungal and Streptococcus sanguis endocarditis is reported in a 63-year-old woman 7 months after placement of a porcine aortic valve prosthesis . Both micro-organisms were isolated by blood cultures, and the patient succumbed after a full course of antibacterial chemotherapy without having received antifungal chemotherapy . The best possible designation of the fungus was Phialemonium aff . curvatum W . Gams & W . B . Cooke, as represented by CBS 331.93 . At autopsy hyphae were revealed in the porcine valve tissue by conventional staining . A hyperimmune rabbit antiserum raised towards strain CBS 331.93 and extensively absorbed with heterologous fungal antigens reacted strongly with hyphae in the valve tissue by indirect immunofluorescence technique . We consider it most likely that the Phialemonium infection evolved insidiously from the time of open heart surgery and led to a haematogenous streptococcal infection of a more fulminant course.

Clin Infect Dis, 1996 Jun, 22(6), 1084 - 6
Gemella morbillorum as a cause of septic shock; Vasishtha S et al.; The gram-positive bacterium Gemella morbillorum has been recovered from patients with endocarditis but has rarely been associated with acute fulminant infections . We describe two children with a rapid onset of septic shock, which was fatal in one, following infection with this organism . G . morbillorum is a commensal organism of the upper respiratory tract; it gained access to the bloodstreams in these patients, and bacteremia occurred . A clinical drawback is that the initial colonial morphology of this organism leads to presumptive identification as a viridans streptococcus, an organism not commonly associated with septic shock syndrome . Resistance of G . morbillorum to penicillin appears to be common; therefore, initial empirical combination therapy (a beta-lactam agent and an aminoglycoside) or vancomycin treatment should be considered.

Clin Infect Dis, 1996 Jun, 22(6), 993 - 6
Tuboovarian abscess and peritonitis caused by Streptococcus pneumoniae serotype 1 in young girls; Sirotnak AP et al.; Streptococcus pneumoniae is a frequent bacterial cause of pneumonia, bacteremia, meningitis, and otitis media in infants and children . Primary pneumococcal peritonitis, however, is rare in children and is usually associated with an underlying medical condition (such as nephrotic syndrome) or with upper genital tract disease in females, Pneumococcal upper genital tract infections in the premenarchal child are extremely unusual . Epidemiologic reviews of pneumococcal serotypes causing infection in children have indicated that serotype 1 is an uncommon pathogen of pelvic disease in children . We describe three children who presented with abdominal pain and a toxic appearance; appendicitis was initially suspected in all three children, but peritonitis due to S pneumoniae serotype 1 was subsequently diagnosed in all three . Each child had a tuboovarian abscess that was demonstrated radiographically . Two children had complicated courses, but all ultimately recovered . The epidemiology and possible tropism of serotype 1 isolates for the female upper genital tract are discussed.

Clin Infect Dis, 1996 Jun, 22(6), 973 - 81
Serogroup-specific epidemiology of Streptococcus pneumoniae: associations with age, sex, and geography in 7,000 episodes of invasive disease; Scott JA et al.; A study sample of 7,010 episodes of invasive Streptococcus pneumoniae disease was obtained by combining 13 existing datasets . Disease episodes due to each of 12 pneumococcal serogroups (1, 3-9, 14, 18, 19, and 23) were then compared with episodes in a constant internal control group to describe serogroup-specific variations in disease frequency by age, sex, and geographic origin . The results are presented as odds ratios (with 95% confidence intervals) derived by logistic regression, with adjustment for the major confounders, including dataset of origin . Variation in the male:female ratios between serogroups is small, suggesting that capsular characteristics are an unlikely explanation for the male preference of S . pneumoniae . Serogroups associated with higher nasopharyngeal prevalence (e.g., 19 and 24) are relatively more common in Europe and North American, while the invasive serotypes 1 and 5 are much more common in South America . The custom of reporting serogroup frequencies in two age groups, children and adults, conceals much of the variation in the age distributions across the whole span of life . The reduction of risk associated with serogroups 6, 14, 18, 19, and 23 beyond childhood follows different gradients, being most abrupt in serogroups 14 and most gradual in serogroup 18 . The relative risk of disease with serotype 1 declines steadily throughout life, while with serotypes 3 and 8 it increases over middle age . Serogroups 7 and 23 are found unusually frequently in the third decade of life . Because of the wide differences in the epidemiology of individual serogroups of S . pneumoniae, it is questionable whether pneumococcal infection should continue to be classified as a single disease entity.

Pediatr Infect Dis J, 1996 Jun, 15(6), 498 - 507
Antibodies to pneumococcal polysaccharides in human milk: lack of relationship to colonization and acute otitis media; Rosen IA et al.; BACKGROUND: This study analyzed antibodies to pneumococcal polysaccharides in human milk and their effect on nasopharyngeal colonization and acute otitis media in breast-fed infants . METHODS: A total of 503 milk samples were collected from 310 mothers . Nasopharyngeal cultures were obtained from their children at 2, 6 and 10 months postpartum, and the capsular groups/types of the Streptococcus pneumoniae isolates were determined . RESULTS: Types 6A, 6B, 19A, 19F and 23F accounted for 54% of the pneumococcal isolates, but type 3 isolates were uncommon . Milk samples were analyzed for antibody activity to the common capsular polysaccharide types 6A, 19F and 23F; to the type 3 polysaccharide; to C-polysaccharide; and to phosphorylcholine (PC), a major component of the pneumococcal cell wall polysaccharide (CWPS) . Anti-capsular antibody activity was low or absent in > 90% of the milk samples . In contrast anti-PC antibody activity was detected in 88% and anti-CWPS in 84% of the samples . The frequency of acute otitis media did not vary with the milk anti-capsular, anti-PC or anti-CWPS antibody activity . CONCLUSIONS: There was no reduction in nasopharyngeal carriage of S . pneumoniae among children fed milk with anti-capsular or anti-PC antibody activity, but carriage was increased in those children who received milk with anti-CWPS antibody activity . A protective role of antipolysaccharide or anti-CWPS antibodies in milk was not detected under the study conditions.

Protein Expr Purif, 1996 Jun, 7(4), 343 - 6
A mild purification method for polysaccharide binding membrane proteins: phase separation of digitonin extracts to isolate the hyaluronate synthase from Streptococcus sp . in active form; Prehm S et al.; A new method was developed to purify the streptococcal hyaluronate synthase in active form to electrophoretic homogeneity . The method is based on the extraction of protoplast membranes with digitonin and a phase separation into an aqueous and a detergent phase induced by addition of polyethylene glycol 6000 at 0 degree C . Proteins bound to hyaluronate were enriched in the aqueous phase, whereas other membrane proteins resided in the detergent phase . Final purification of the hyaluronate synthase was achieved by ion exchange chromatography.

Kansenshogaku Zasshi, 1996 Jun, 70(6), 574 - 83
Enhancement of host resistance to bacterial infections in normal and immunosuppressed mice with Actinobacillus suis; Watanabe T; A single intraperitoneal (ip) inoculation of heat-killed Actinobacillus suis ATCC 15,557 (AS 15,557) into normal and immunosuppressed (dexamethasone-treated) mice led to remarkable nonspecific resistance to ip challenge with lethal doses of opportunistic pathogens such as Pseudomonas aeruginosa, methicillin-resistant Staphylococcus aureus and Candida albicans . The duration of this enhanced protective action and the minimal effective dose, in normal mice, induced by AS 15,557 were superior to those induced by other bacterial immunostimulants such as heat-killed Lavtobacillus casei YIT 9018 (LC 9018) and penicillin-treated Streptococcus pyogenes, Su (OK-432) . In immunosuppressed mice; the reduced in vivo killing activity of peritoneal exudate cells (PECs) against P . aeruginosa infection was markedly augmented by ip injection of AS 15,557 . The degree of PEC augmentation induced by AS 15,557 was higher than that induced by LC 9018 or by OK-432 . The toxicity and histopathological changes associated with AS 15557 were very low, as compared with those by produced by LC 9018 and OK-432 . The results suggest that AS 15,557, which showed a strong resistance-enhancing capacity against opportunistic bacterial infections, may be a useful bacterial immunostimulant.

Nihon Kyobu Shikkan Gakkai Zasshi, 1996 Jun, 34(6), 705 - 9
{Toxic shock-like syndrome with Streptococcus pyogenes in a pleural effusion}; Takamura K et al.; A 58-year-old woman was admitted to the hospital because of fever and hypotension . That night, shock developed . On the second hospital day, a chest roentgenogram showed retention of pleural fluid and the group A-beta hemolytic organism Streptococcus pyogenes was detected in the effusion . The toxic shock-like syndrome was diagnosed . The patient recovered with artificial ventilation, administration of antibiotics, and blood purification . In this patient, the type of pyrogenic exotoxin was B + C.

J Clin Microbiol, 1996 Jun, 34(6), 1546 - 7
Discrepancies between results by E-test and standard microbroth dilution testing of Streptococcus pneumoniae for susceptibility to vancomycin; Hashemi FB et al.; Vancomycin susceptibility testing of Streptococcus pneumoniae by the E-test consistently resulted in MICs that were at the upper limit of the 1-microgram/ml susceptible category defined by current National Committee for Clinical Laboratory Standards guidelines and were always higher than MICs obtained by microbroth dilution . Three of five E-test results for S . pneumoniae ATCC 49619 were higher than the acceptable limits.

Antimicrob Agents Chemother, 1996 Jun, 40(6), 1520 - 5
Noncompromised penicillin-resistant pneumococcal pneumonia CBA/J mouse model and comparative efficacies of antibiotics in this model; Tateda K et al.; The present study confirms that CBA/J mice are susceptible to several clinical isolates of Streptococcus pneumoniae, including four of five penicillin-susceptible and all five penicillin-resistant strains tested, thus providing the first noncompromised animal model for penicillin-resistant S . pneumoniae pneumonia . In this model, doses of penicillin G of 0.6 mg/kg of body weight given six times at 1-h intervals produced effective pulmonary clearance of a penicillin-susceptible strain (penicillin G MIC, 0.015 microgram/ml), while doses of 40 mg/kg given six times at 1-h intervals were required to clear a penicillin-resistant strain (penicillin G MIC, 1 microgram/ml) . Imipenem (MIC, 0.25 microgram/ml) was the most active antibiotic tested against the penicillin-resistant strain, with a calculated dose of 0.42 mg/kg given six times at 1-h intervals, resulting in a 2-log decrease in the number of pulmonary bacteria . Comparable effects were seen with vancomycin (MIC, 0.5 microgram/ml), cefotaxime (MIC, 0.5 microgram/ml), and penicillin G at doses of 3.3, 5.5, and 31.0 mg/kg given six times at 1-h intervals, respectively . The pharmacokinetic profile of vancomycin in infected lungs was superior to those of the other antibiotics, especially in regard to the elimination half-life (215.4 min for vancomycin versus 15.0, 14.5, and 14.5 min for penicillin G, cefotaxime, and imipenem, respectively) . Both imipenem and vancomycin allowed 90% survival when 40-mg/kg doses were administered twice a day beginning 5 days after infection . Survival rates with penicillin G (160-mg/kg doses) and cefotaxime (40-mg/kg doses) were 40 and 30%, respectively, while no saline-treated mice survived . The present study shows that the CBA/J mouse pneumonia model may be useful for evaluating antibiotic efficacies against penicillin-resistant pneumococcal pneumonia in immunocompetent individuals . Our data suggest that imipenem and vancomycin may be the most active agents against penicillin-resistant S . pneumoniae pneumonia.

Immunology, 1996 Jun, 88(2), 275 - 83
Immunogenicity of peptides coupled with multiple T-cell epitopes of a surface protein antigen of Streptococcus mutans; Senpuku H et al.; A surface protein antigen (PAc) of Streptococcus mutans, in particular the A-region of the molecule, has been noted as a possible target of effective dental caries vaccine . We have previously shown that two peptides of 19 amino acids (residues 361-379, NAKATYEAALKQYEADLAA, and residues 301-319, ANAANEADYQAKLTAYQTE), which correspond to parts of the A-region, contain both T- and B-cell epitopes for the induction of cross-reacting antibodies to the PAc . In this study, for development of an appropriate antigen as a peptide vaccine for use in prophylactic dentistry, we analysed in detail the localization of the T- and B-cell epitopes of PAc(361-379) peptide and the T-cell epitope of PAc(301-319) peptide in B10 congenic mice . In four murine major histocompatibility complex (MHC) haplotypes (H-2f,d,a and k), PAc(361-377) peptide showed T- and B-cell epitopes forming a cluster . It was found that the antibody which was induced by the immunization with the peptide was strongly cross-reactive with recombinant (r)PAc . Meanwhile, PAc(305-318) peptide, recognised by five strains of mice of different MHC haplotypes (H-2f,d,a,k and s), also bore multiple T-cell epitopes . PAc(361-377) peptide coupled to PAc(305-318) significantly elevated cross-reacting antibody levels compared to immunization with PAc(361-377) only in four H-2 haplotypes . Moreover, a peptide with PAc(305-318) coupled to the N-terminal region of PAc(361-377) produced significant cross-reacting antibody against rPAc, even in B10.S mice which had not responded to immunization with PAc(361-379) peptide . Therefore, it was suggested that coupling among the peptides forming a cluster might be effective in increasing immunogenicity . These results may provide us with a useful strategy for the design of peptide-based vaccines for S . mutans in the future.

Infect Immun, 1996 Jun, 64(6), 2240 - 5
Relationship between phase variation in colony morphology, intrastrain variation in cell wall physiology, and nasopharyngeal colonization by Streptococcus pneumoniae; Weiser JN et al.; Streptococcus pneumoniae undergoes phase variation in colony morphology, which has been implicated as a factor in the pathogenesis of pneumococcal disease . Phenotypic differences between opaque and transparent colony forms correlate with differences in rates of autolysis . This study examined whether differences in autolysis are caused by differences in expression of the major amidase, LytA, or the structure of its peptidoglycan substrate . No significant difference was detected by high-pressure liquid chromatography analysis of stem peptides released after treatment of purified peptidoglycan with amidase . Differences in the rate of digestion of purified cell walls, furthermore, did not correlate with susceptibility to autolysis . Lower levels of autolysis in opaque variants, however, was associated with decreased levels of immunodetectable LytA on colony immunoblots and Western blots (immunoblots) . Diminished cell-surface-associated LytA in opaque variants was also demonstrated by whole-cell inhibition enzyme-linked immunosorbent assay . Since transparent variants have been shown both to colonize the nasopharynx more efficiently in an animal model and to express more surface-exposed LytA, it was determined whether LytA contributes to colonization in a neonatal rat model of pneumococcal carriage . Defined mutants in the lytA gene were used to show that there was no significant contribution by LytA to nasopharyngeal colonization in this model . Although the expression of LytA was shown to undergo phase variation in association with colony morphology, lytA mutants are still capable of phenotypic variation in colony morphology, which suggests that other factors are responsible for intrastrain differences which affect colonization.

Infect Immun, 1996 Jun, 64(6), 2193 - 200
DNA sequencing and gene expression of the emm gene cluster in an M50 group A streptococcus strain virulent for mice; Yung DL et al.; The strain B514, an M serotype 50 strain, is capable of causing a natural upper respiratory infection leading to death in mice, as reported by Hook et al . in 1960 (E . W . Hook, R . R . Wagner, and R . C . Lancefield, Am . J . Hyg . 72:111-119, 1960) . Thus, this strain was of interest for use in developing an animal model for group A streptococcal colonization and disease . The emm gene cluster for this strain was examined by PCR mapping and found to contain three emm family genes and cluster pattern 5 . PCR-generated fragments corresponding to the SF4 (mrp50), SF2 (emmL50), and SF3 (enn50) genes were cloned and the entire gene cluster was sequenced . The gene cluster has greater than 97% DNA identity to previously sequenced regions of the gene cluster of the M2 strain T2/44/RB4 if two small divergent regions that encode the mature amino terminus of the SF-2 and SF-3 gene products are not included . If expressed, the genes encode proteins which bind human immunoglobulin G (Mrp50 and EmmL50) or immunoglobulin A (Enn50) . However, in isolates taken directly after passage in mice, the surface proteins arising from these genes were barely detectable . The transcription of each gene in the B514 strain was investigated by Northern (RNA) hybridization, and mRNA transcripts were detected and quantitated relative to those of the recA gene, a housekeeping gene . Transcription of all three emm family genes was found to be over 30-fold attenuated relative to transcription of the same genes in strain T2/44/RB4 . This suggests that the positive regulator, Mga, either is not expressed in this strain or has a different requirement for activation; it also suggests that the capsule may be sufficient to inhibit phagocytosis under these circumstances.

Infect Immun, 1996 Jun, 64(6), 2114 - 21
scbA from Streptococcus crista CC5A: an atypical member of the lraI gene family; Correia FF et al.; A new member of the lraI family of putative adhesin genes was cloned, from Streptococcus crista CC5A, and sequenced . The gene, scbA appears to be part of an ABC transport operon and encodes a putative peptide of 34.7 kDa . The protein contains a signal sequence with residues 17 to 21 (L-A-A-C-S) matching the consensus sequence for the prolipoprotein cleavage site of signal peptidase II . ScbA is 57 to 93% identical, at the amino acid level, with the five previous sequenced members of the LraI family . Surprisingly, ScbA does not exhibit adhesion properties characteristic of the other LraI proteins . Strain CC5A bound poorly to saliva-coated hydroxyapatite and did not coaggregate with Actinomyces naeslundii PK606 . An scbA insertion-duplication mutation that abolished expression (of ScbA was created . There was no difference in fibrin binding between this mutant and wild-type CC5A . Since it is possible that ScbA could play a role in corncob formation between S . crista and Fusobacterium nucleatum, this property was examined . The mutant strain retained the ability to form corncobs . On the basis of the lack of adhesin properties it appears that ScbA is an atypical member of the LraI family.

Infect Immun, 1996 Jun, 64(6), 1913 - 7
Substitution of cysteine 192 in a highly conserved Streptococcus pyogenes extracellular cysteine protease (interleukin 1beta convertase) alters proteolytic activity and ablates zymogen processing; Musser JM et al.; Virtually all strains of the human pathogenic bacterium Streptococcus pyogenes express a highly conserved extracellular cysteine protease . The protein is made as an inactive zymogen of 40,000 Da and undergoes autocatalytic truncation to result in a 28,000-Da active protease . Numerous independent lines of investigation suggest that this enzyme participates in one or more phases of host-parasite interaction, such as inflammation and soft tissue invasion . Replacement of the single cysteine residue (C-192) with serine (C192S mutation) resulted in loss of detectable proteolytic activity against bovine casein, human fibronectin, and the low-molecular-weight synthetic substrate 7-amino-4-trifluoromethyl coumarin . The C192S mutant molecule does not undergo autocatalytic processing of zymogen to mature form . Taken together, these data support the hypothesis that C-192 participates in active-site formation and enzyme catalysis.

Infect Immun, 1996 Jun, 64(6), 1906 - 12
Lipoteichoic acid preparations of gram-positive bacteria induce interleukin-12 through a CD14-dependent pathway; Cleveland MG et al.; Interleukin 12 (IL-12) strongly augments gamma interferon production by natural killer (NK) and T cells . IL-12 also promotes effective cell-mediated immune responses, which are particularly important against intracellular bacteria such as Listeria monocytogenes . While the lipopolysaccharide (LPS) of gram-negative bacteria induces monocyte production of IL-12, the relevant gram-positive components which induce IL-12 production are uncharacterized . We used the human monocytic cell line THP-1 to study IL-12 induction by gram-positive bacteria . Muramyl dipeptides as well as the major muramyl tetrapeptide component of Streptococcus pneumoniae were inactive for inducing IL-12 . In contrast, lipoteichoic acid (LTA), a predominant surface glycolipid of gram-positive bacteria, potently induced IL-12 p40 gene expression . A competitive LPS antagonist, Rhodobacter sphaeroides LPS, inhibited LTA-induced IL-12 production, suggesting a common pathway for LPS and LTA in IL-12 activation . Pretreatment of cells with anti-CD14 monoclonal antibody blocked both LPS and LTA induction of IL-12 p40 expression . LTA also induced Thl development in naive CD4 T cells by an IL-12-dependent mechanism, indicating direct induction of physiologic levels of IL-12 . Together, these results show that LTA is a potent surface structure of gram-positive bacteria which induces IL-12 in monocytes through a CD14-mediated pathway.

FEMS Microbiol Lett, 1996 Jun 1, 139(2-3), 195 - 201
Interaction of lysozyme with a surface protein antigen of Streptococcus mutans; Senpuku H et al.; The interaction of salivary lysozyme with the surface protein antigen (PAc) of Streptococcus mutans and the interaction of lysozyme with the pathogen were examined by ELISA using S . mutans MT8148 (PAc+) and the PAc-defective mutant EM-2 (PAc-) . The lysozyme clearly bound to the S . mutans wild type but not to the S . mutans mutant . Furthermore, lysozyme bound directly in the fluid phase to the rPAc, of which the binding kinetics were determined (Kon = 3.63 +/- 0.04 x 10(3) M-1 s-1, K(off) = 1.72 +/- 0.04 x 10-5 s-1 and Kon/K(off) = 2.11 x 10(8) M-1) using surface plasmon resonance . The kinetics of both association and dissociation were relatively slow . In addition, anti-lysozyme antibody significantly inhibited the binding of salivary components to the rPAc . The present findings indicate that lysozyme is one of the major salivary components interacting with S . mutans PAc.

J Virol, 1996 Jun, 70(6), 3678 - 87
Analysis of the complete nucleotide sequence and functional organization of the genome of Streptococcus pneumoniae bacteriophage Cp-1; Martin AC et al.; Cp-1, a bacteriophage infecting Streptococcus pneumoniae, has a linear double-stranded DNA genome, with a terminal protein covalently linked to its 5' ends, that replicates by the protein-priming mechanism . We describe here the complete DNA sequence and transcriptional map of the Cp-1 genome . These analyses have led to the firm assignment of 10 genes and the localization of 19 additional open reading frames in the 19,345-bp Cp-1 DNA . Striking similarities and differences between some of these proteins and those of the Bacillus subtilis phage phi 29, a system that also replicates its DNA by the protein-priming mechanism, have been revealed . The genes coding for structural proteins and assembly factors are located in the central part of the Cp-1 genome . Several proteins corresponding to the predicted gene products were identified by in vitro and in vivo expression of the cloned genes . Mature major head protein from the virion particles results from hydrolysis of the primary gene product at the His-49 residue, whereas the phage gene is expressed in Escherichia coli without modification . We have also identified two open reading frames coding for proteins that show high degrees of similarity to the N- and C-terminal regions, respectively, of the single tail protein identified in phi 29 . Sequencing and primer extension analysis suggest transcription of a small RNA showing a secondary structure similar to that of the prohead RNA required for the ATP-dependent packaging of phi 29 DNA . On the basis of its temporal expression, transcription of the Cp-1 genome takes place in two stages, early and late . Combined Northern (RNA) blot and primer extension experiments allowed us to map the 5' initiation sites of the transcripts, and we found that only three genes were transcribed from right to left . These analyses reveal that there are also noticeable differences between Cp-l and phi 29 in transcriptional organization . Considered together, the observations reported here provide new tangible evidence on phylogenetic relationships between B . subtilis and S . pneumoniae.

J Pediatr, 1996 Jun, 128(6), 757 - 64
Risk factors for carriage of drug-resistant Streptococcus pneumoniae among children in Memphis, Tennessee; Arnold KE et al.; OBJECTIVES: To determine risk factors for carriage of drug-resistant Streptococcus pneumoniae to understand better the factors promoting spread of these isolates . STUDY DESIGN: We obtained medical and demographic information and nasopharyngeal swab specimens from 216 children less than 6 years old with upper respiratory tract infections, seeking medical care at five Memphis, Tenn, study sites . We evaluated risk factors for carriage of penicillin-nonsusceptible S . pneumoniae (NSSP) among 100 children with S . pneumoniae isolates . Patterns of antimicrobial prescription were recorded for enrolled children . RESULTS: Independent risk factors for carriage of NSSP included an increased number of antimicrobial treatment courses during the previous 3 months and white race . Day care attendance approached statistical significance (p = 0.07) . Most children with upper respiratory tract infection received a prescription for antimicrobial drugs . These prescriptions were more common for white children than for black children . CONCLUSIONS: Increased use of antimicrobial drugs enhances the risk of carriage of NSSP . This may contribute to the higher risk among white children of NSSP infection; however, after control for antimicrobial use, white children were still at an increased risk of infection with NSSP, possibly through greater exposure to resistant strains.

J Infect Dis, 1996 Jun, 173(6), 1399 - 407
Streptococcal pyrogenic exotoxin A release, distribution, and role in a murine model of fasciitis and multiorgan failure due to Streptococcus pyogenes; Sriskandan S et al.; The role of streptococcal pyrogenic exotoxin A (SPEA) was evaluated in a murine model of fasciitis and multiorgan failure due to a toxigenic strain of Streptococcus pyogenes . Increased serum levels of SPEA at 15 and 21 h were associated with a survival time of <24 h . Levels of SPEA correlated with interleukin-6 levels . Immunostaining showed SPEA localized to renal and hepatic cells . Neutralizing rabbit antibody to SPEA was administered to mice challenged with S . pyogenes, but no effect on survival was observed . Vaccination of mice with recombinant SPEA enhanced mortality due to streptococcal infection, despite the development of neutralizing immunity to the toxin prior to infection . Hence, SPEA is produced systemically during S . pyogenes soft-tissue infection, and increased levels are associated with reduced survival . In this model, however, SPEA did not appear to play a dominant role in pathogenesis; passive immunization against SPEA was not protective, and active immunization enhanced mortality.

South Med J, 1996 Jun, 89(6), 628 - 30
Escherichia coli lobar pneumonia: fatal infection in a patient with mental retardation; Jaffey PB et al.; Lobar pneumonia due to Escherichia coli is rare . Most lobar pneumonias are caused by either Streptococcus pneumoniae or Klebsiella pneumoniae, and most E coli pneumonias are bronchopneumonias . We report an acute fulminant course of E coli lobar pneumonia in a 37-year-old patient who was profoundly retarded, institutionalized, and nonimmunosuppressed and who died within 2 days of developing initial symptoms . Antemortem blood and postmortem blood and lung specimens isolated pure cultures of E coli . The source of infection in E coli lobar pneumonia is not clear in this patient or in the few cases that have been reported . We postulate that nasopharyngeal colonization of E coli in those who are institutionalized with mental retardation may predispose these patients to E coli pneumonia . Our case illustrates features of pneumonias that are unique in the institutionalized, mentally retarded patient population (ie, the relatively high prevalence of nasopharyngeal colonization of E coli, a higher incidence of E coli pneumonia than in other institutionalized populations, the often fulminant course of the disease), as well as the need for early, aggressive treatment including antibiotics effective against gram-negative bacteria.

Pediatrics, 1996 Jun, 97(6 Pt 2), 964 - 70
Epidemiology and control of acute respiratory diseases with emphasis on group A beta-hemolytic streptococcus: a decade of U.S . Army experience; Brundage JF et al.; OBJECTIVE . To summarize the experiences of the U.S . Army regarding prevention and control, and frequencies, rates, trends, and determinants of febrile acute respiratory diseases (ARDs), particularly Group A beta-hemolytic streptococcus (GABHS) . METHODOLOGY . Since 1966, the U.S . Army has conducted routine surveillance of ARDs among basic trainees . Since 1985, all trainees with fever and respiratory tract symptoms have been cultured for GABHS . Field investigations were conducted when outbreaks of acute respiratory or GABHS-associated illnesses were detected . Mass plus tandem benzathine penicillin prophylaxis were used to interdict and control training center GABHS outbreaks . RESULTS . During the period 1985 to 1994, there were 65,184 hospitalizations for acute febrile respiratory illnesses among Army trainees . The crude hospitalization rate was 0.45 per 100 trainees per week . The rate consistently declined over the period . Incremental declines were temporally associated with increased use of adenovirus immunizations and broader use of benzathine penicillin prophylaxis . During the period, 10,789 of 59,818 (18%) pharyngeal cultures were positive for GABHS . GABHS outbreaks were associated with diverse clinical manifestations including streptococcal toxic shock, acute rheumatic fever, and pneumonia . The emergence of mucoid colony morphology in clinical isolates was a consistent indicator of circulating virulent strains with epidemic potential . Outbreak-associated M types were M1, M3, M5, and M18 . In response to six GABHS outbreaks, mass plus tandem benzathine penicillin chemoprophylaxis produced rapid and sustained GABHS control . ARD and GABHS recovery rates were lowest when benzathine penicillin prophylaxis was widely used . CONCLUSIONS . ARD rates among Army trainees have consistently declined to unprecedented levels . GABHS has reemerged as an important threat to military trainees . Benzathine penicillin chemoprophylaxis is safe and effective for interdicting and preventing GABHS outbreaks in closed, healthy young adult populations.

J Med Microbiol, 1996 Jun, 44(6), 490 - 5
Streptococcus pneumoniae in the nasal cavity of mice causes lower respiratory tract infection after airway obstruction; Iizawa Y et al.; A model of persistent colonisation in the nasal cavity of mice by Streptococcus pneumoniae has been established . S . pneumoniae NNP-4 was introduced to the lungs of CBA/J mice at a density of c . 10(4) cfu/lung by an aerosol method and a high dose of ampicillin was administered 1 h after infection . This antibiotic eliminated bacteria from the lungs and trachea, but did not affect the bacterial counts in the nasal cavity . In mice given ampicillin, the bacteria were recovered from the nasal cavity only more than 2 weeks after infection, but IgG antibody against the colonising organisms was produced in sera around day 8 after infection . Airway obstruction was induced by intratracheal injection of formalin 2% into mice . Organisms appeared in the lungs in greater numbers when formalin was injected before the antibody production than when the immunity was established . In the early stages of infection, 10(3)-10(4) cfu appeared in the lungs 6 h after the formalin injection and the bacterial counts increased to c . 10(6) cfu within 24 h . When ampicillin was administered again 1 h after formalin was given, no bacteria were recovered from lungs 6 h later . However, in some of the mice given ampicillin after formalin, bacteria appeared in the lungs on the next day and the bacterial counts increased thereafter . These results suggest that S . pneumoniae in the nasal cavity invade the lower respiratory tract and that these organisms can localise and proliferate in lungs in the event of damage to the airway.

J Med Microbiol, 1996 Jun, 44(6), 475 - 81
Protective activity of a murine monoclonal antibody against acute and chronic experimental infection with type IV group B streptococcus; Ricci ML et al.; A murine IgM monoclonal antibody (MAb H11) was developed against the type polysaccharide capsular antigen of group B streptococcus (GBS), serotype IV, after intraperitoneal immunisation of BALB/c mice with heat-killed bacteria . MAb H11 reacted in immunodiffusion with the purified polysaccharide in both its sialylated and desialylated form, giving a line of identity, and opsonised type IV GBS strains in an in vitro assay . When administered at the time of intraperitoneal lethal challenge with homologous GBS, or 4 h earlier, MAb H11 protected 90% of the mice . Protection was still observed when MAb H11 was given 4 h after the challenge . This MAb was strongly effective in preventing septic arthritis induced by type IV GBS.

J Med Microbiol, 1996 Jun, 44(6), 409 - 17
Effect of mucin and glucose on proteolytic and glycosidic activities of Streptococcus oralis; Rafay AM et al.; The production of glycosidase and protease activities, which may play a role in the degradation of human glycoproteins, by Streptococcus oralis strains isolated from endocarditis, septicaemia or the oral cavity was investigated with a range of fluorogenic substrates . The pH optima of the proteases ranged from 6.0 to 9.3 and the pH optima for the glycosidases were lower (4.5-6.0), although the pH range over which both groups of enzymes acted was broad . Growth in a minimal medium supplemented with glucose resulted in repression of glycosidase activities and elevated proteolytic activity . Bacteria from cultures supplemented with porcine gastric mucin (PGM), a model glycoprotein, exhibited higher levels of glycosidase activity, while proteolytic activity was suppressed and glycoprotein-derived monosaccharides were transported at significantly higher rates than those observed for cells grown in media with glucose . PGM-derived cells also exhibited high levels of N-acetylneuraminate pyruvate-lyase, the first intracellular enzyme in the pathway of sialic acid catabolism . Taken together, these data indicate that S . oralis strains produce a range of proteolytic and glycosidic enzymes that may play a role in the degradation of host-derived glycoproteins.

MMWR Recomm Rep, 1996 May 31, 45(RR-7), 1 - 24
Prevention of perinatal group B streptococcal disease: a public health perspective . Centers for Disease Control and Prevention; Comparison of infective endocarditis in patients with and without previously recognized heart disease; Service de Cardiologie, CHU de Nancy, FranceIn a consecutive series of patients with infective endocarditis, we compared the charts of 123 nonaddicted patients without previously known heart disease with those of 174 patients with native valve disease . The 2 groups were similar in age, sex, clinical findings, and mortality rates, but infective endocarditis was more often located on the aortic valve, more often due to Streptococcus bovis and enterococci in patients without previously known heart disease.

Rev Inst Med Trop Sao Paulo, 1996 May-Jun, 38(3), 187 - 92
Resistance of streptococcus pneumoniae to antimicrobials in São Paulo, Brazil: clinical features and serotypes; Levin AS et al.; To study resistance to antimicrobials, serotypes and clinical features of S . pneumoniae in S . Paulo, Brazil, 50 patients with a positive culture were evaluated: 7 were considered carriers and 43 had pneumococcal infections . Pneumonia and meningitis were the most common infections . Mortality was 34% and underlying diseases were present in 70% . Relative resistance to penicillin occurred in 24% and complete resistance was not detected . Resistance to tetracycline was 32% and to sulfamethoxazole/trimethoprim 32%; one strain had intermediate susceptibility to erythromycin; no resistance was present for chloramphenicol, rifampin or vancomycin . Resistance to at least one of the drugs tested occurred in 62% . Results by the E-test for penicillin were similar to those by the agar dilution method . There were 24 different serotypes and 74% of the strains belonged to the 23-valent vaccine including all the penicillin-resistant strains . In this study S . pneumoniae caused severe infections and presented a high resistance rate to commonly used antimicrobials . Routine surveillance of resistance and the use of vaccination, as well as the restriction of inappropriate use of antimicrobials, are recommended in Sao Paulo, Brazil.

Microb Pathog, 1996 May, 20(5), 297 - 307
Cloning, sequencing and expression of the CAMP factor gene of Streptococcus uberis; Jiang M et al.; The gene coding for the CAMP factor from a strain of Streptococcus uberis (ATCC 9927) was cloned in Escherichia coli . Chromosomal DNA from Streptococcus uberis was used to construct a gene library in plasmid pTZ18R and six CAMP-reaction positive clones were obtained from a total of 10,000 transformants . One clone, pJLD21, was subcloned and the CAMP factor gene was located in a 3.2 kb BamHI fragment . The nucleotide sequence of Streptococcus uberis CAMP factor gene was determined and the deduced amino acid sequence is highly homologous to the corresponding Streptococcus agalactiae protein . Immunoblot analysis revealed that the recombinant strain pJLD21 expressed a protein with a molecular weight of 28 000 . Antibodies raised against purified Streptococcus uberis CAMP factor cross-reacted with Streptococcus agalactiae protein B.

FEMS Microbiol Lett, 1996 May 1, 138(2-3), 141 - 5
Incorporation of choline into Streptococcus pneumoniae cell wall antigens: evidence for choline kinase activity; Whiting GC et al.; The choline-containing teichoic and lipoteichoic acids play an important part in cell wall metabolism of Streptococcus pneumoniae . We propose that a choline kinase enzyme has a role in the synthesis of these antigens . The presence of this enzyme was demonstrated in cell free extracts of S . pneumoniae by measuring the fall in ATP concentration due to phosphorylation of choline . Genomic DNA of S . pneumoniae hybridised with a probe consisting of an internal fragment of the choline kinase gene of Saccharomyces cerevisiae and one consisting of the choline binding domain of lytA.

Microvasc Res, 1996 May, 51(3), 303 - 16
Fibroblasts are in a position to provide directional information to migrating neutrophils during pneumonia in rabbit lungs; Behzad AR et al.; Previous findings have shown that pulmonary fibroblasts are associated with preexisting holes in the endothelial and epithelial basal laminae through which neutrophils appear to enter and leave the interstitium as they migrate from capillaries to alveoli . To determine their role in neutrophil migration, fibroblast organization within the interstitium was assessed by transmission electron microscope observations of serial-sectioned rabbit lung tissue . Interstitial fibroblasts were found to physically interconnect the endothelial basal lamina holes to epithelial basal lamina holes . Morphometric assessment of rabbit lung tissue instilled with Streptococcus pneumoniae revealed that approximately 70% of the surface area density of migrating neutrophils is in close contact (15 nm or less) with interstitial fibroblasts and extracellular matrix elements (30 and 40%, respectively) . Although migrating neutrophils were close enough to adhere to both fibroblasts and extracellular elements, the interstitial fibroblasts are organized in a manner that would allow them to provide directional information to the neutrophils . A model illustrating this process is proposed.

Chemotherapy, 1996 May-Jun, 42(3), 159 - 69
In vitro and in vivo antibacterial activities of clarithromycin; Ono T et al.; The in vitro and in vivo antibacterial activities of clarithromycin (CAM), a new oral macrolide antibiotic, were compared with those of erythromycin (EM), josamycin (JM) and rokitamycin (RKM) . The antibacterial spectrum and in vitro activities of CAM were similar to those of EM . Therapeutic efficacies of CAM against various experimental infections in mice--including systemic infections caused by gram-positive bacteria such as Staphylococcus aureus, Streptococcus pyogenes and Streptococcus pneumoniae, and subcutaneous abscess due to S . aureus, and bacterial pneumonia caused by S . pneumoniae--were superior to those of EM, JM and RKM . CAM exhibited higher serum levels than EM in mice after a single oral dose of 50 mg/kg.

J Pediatr Hematol Oncol, 1996 May, 18(2), 140 - 4
Antibiotic-resistant pneumococcal infection in children with sickle cell disease in the United States; Wang WC et al.; OBJECTIVE: The purpose of this report is to examine the increasing problem of antibiotic-resistant pneumococcal infection in children with sickle cell disease in the United States . PATIENTS AND METHODS: In this retrospective review, 16 children with sickle cell disease and penicillin-resistant pneumococcal invasive infection were identified . They had a median age of 2 years (range 1-15) and were treated in Memphis, Dallas, Los Angeles, and five other cities between 1987 and early 1995 . RESULTS: At presentation, patients frequently had high fever (> or 40.0 degrees C in 75%) and a toxic appearance (44%) . Meningitis was present initially in two and diagnosed on days 4 and 5 in two . All were treated with an intravenous cephalosporin and nine received vancomycin . The clinical course was variable: two died within 36 h of presentation . In 20-86% of cases the organisms were resistant to cephalosporins, chloramphenicol, trimethoprim/sulfamethoxazole, erythromycin, and clindamycin; none were resistant to vancomycin . CONCLUSIONS: (a) The increasing prevalence of antibiotic-resistant Streptococcus pneumoniae infection in the United States poses special problems for patients with sickle cell disease . (b) Prompt antibiotic susceptibility testing of pneumococcal isolates should be performed . (c) Initial antibiotic management for patients suspected of sepsis/meningitis should include intravenous cephalosporin and vancomycin . (d) No alternative to penicillin prophylaxis is currently available . (e) An effective conjugated pneumococcal vaccine is needed.

Antonie Van Leeuwenhoek, 1996 May, 69(4), 371 - 3
Interactions between Eikenella corrodens and 'Streptococcus milleri-group' organisms: possible mechanisms of pathogenicity in mixed infections; Young KA et al.; Interactions between the 'Streptococcus milleri-group' organisms (SMG; S . intermedius, S . constellatus and S . anginosus) and Eikenella corrodens were investigated . Coaggregation reactions occurred frequently between S . anginosus (83% of strain combinations) or S . constellatus (87%) and E . corrodens isolates, but were infrequent between S . intermedius and E . corrodens (28%) . No enhancement of enzyme activities against lipid, phosphate, peptide and saccharide substrates tested were detected with combinations of species in comparison to the species alone . Exponential growth of S . constellatus and S . intermedius, in mixed culture with E . corrodens, occurred within 6h post inoculation, in comparison to 25h without E . corrodens . No growth stimulation of S . anginosus was observed . It is concluded that both coaggregation and growth stimulation occur between E . corrodens and SMG isolates, and may be important mechanisms in the establishment of mixed infections involving these bacteria.

Diagn Microbiol Infect Dis, 1996 May, 25(1), 43 - 5
Levofloxacin in vitro activity against bacteremic isolates of Streptococcus pneumoniae . Franklin County Pneumonia Study Group; Plouffe JF; Levofloxacin had excellent activity in vitro against bacteremic isolates of Streptococcus pneumoniae with 495 (99.2%) of 499 isolates being susceptible . A total of 38 (97.4%) of 39 isolates with minimal inhibitory concentrations > or = 0.12 micrograms/ml of penicillin were susceptible to levofloxacin . There was excellent correlation between the disk diffusion and broth microdilution methods for determining susceptibility . Resistant isolates belonged to four different serotypes . There was no increase in proportion of isolates of S . pneumoniae resistant between 1991 and 1994.

Arch Oral Biol, 1996 May, 41(5), 505 - 8
Adsorption of saliva-coated and plain streptococcal cells to the surfaces of hydroxyapatite beads; Tanaka H et al.; This study was conducted to observe the differences between the adsorption of Streptococcus sanguis by saliva-coated and non-saliva-coated cells (plain cells) to the surfaces of saliva-coated, bovine serum albumin-coated or buffer-washed hydroxyapatite beads . Saliva treatment of bacterial cells altered the manner of saturation due to changes of affinity and/or the maximal number of adsorption sites on the hydroxyapatite beads . This result indicates that saliva treatment of bacterial cells might be a necessary step in testing bacterial adsorption to saliva-coated hydroxyapatite beads or saliva-coated teeth.

Med Microbiol Immunol (Berl), 1996 May, 185(1), 11 - 7
Structural dissection and functional analysis of the complex promoter of the streptokinase gene from Streptococcus equisimilis H46A; Grafe S et al.; The overlapping tandem promoters of the streptokinase gene, P1 and P2, identified previously by S1 nuclease transcript mapping were functionally dissected by mutagenesis of their -10 regions and fused transcriptionally with or without the 202-bp upstream region (USR) to the luciferase reporter gene (luc) from Photinus pyralis to analyze the contribution of the different sequence elements to promoter activity in Escherichia coli and the homologous Streptococcus equisimilis strain H46A . In E . coli, virtually the entire promoter activity derived from the upstream promoter P1 . In S . equisimilis, luc expression increased in the following order of the involved sequence elements: P2 approximately equal to P2 + USR < P1 < P1 + P2 < P1 + USR < P1 + P2 + USR . This shows that (1) in the homologous system, P1 and P2 alone are extremely weak, (2) in the USR-less arrangement, only the combined core promoters have substantial activity, and (3) the USR stimulates only P1 and the combination of P1 + P2 . Thus, the tandem promoters presumably function by mutual contributary action and their full activity strongly depends on the AT-rich and statically bent upstream region . The distinctive feature determining the strength of P1 in both hosts appears to be its extended -10 region which matches the consensus TRTGN established for strong S . pneumoniae and Bacillus subtilis promoters.

Eur J Clin Microbiol Infect Dis, 1996 May, 15(5), 407 - 10
Recurrent brain abscesses in an HIV-positive patient with hereditary hemorrhagic telangiectasia and arteriovenous malformations of the lung; Thurnheer R et al.; Patients with hereditary hemorrhagic telangiectasia are at risk for the development of brain abscesses . The history of a 47-year-old man infected with the human immunodeficiency virus and with hereditary hemorrhagic telangiectasia is reported . Within eight months, the patient presented twice with life-threatening cerebral abscesses at different sites . On both occasions, Streptococcus anginosus was cultured from the abscess material . Treatment consisted of parenteral antibiotics and neurosurgical drainage . After treatment of the second occurrence, the patient was placed on a prophylactic regimen of clindamycin . He remains relapse-free and is clinically stable 24 months after the second episode.

Acta Otolaryngol, 1996 May, 116(3), 401 - 7
Ultrastructural damage to the organ of corti during acute experimental Escherichia coli and pneumococcal meningitis in guinea pigs; Winter AJ et al.; Experimental meningitis was induced in 16 pigmented guinea pigs by subarachnoid inoculation of mid log-phase 1 x 10(9) E . coli K-12 (n = 8) or 5 x 10(7) Streptococcus pneumoniae type 2 (n = 8) . Animals were killed at various times between 3 and 12 h after inoculation and the ultrastructure of the organ of Corti (including the basilar membrane) was examined with high resolution scanning electron microscopy . Both E . coli and S . pneumoniae induced meningitis and invaded scala tympani . In both types of meningitis the apical surface of inner supporting cells developed craters . inner hair cell stereocilia were also disrupted . In pneumococcal meningitis both these lesions were more pronounced but in addition there were breaks in the junctions between inner hair cells and their adjacent supporting cells and there was ballooning and rupture of the apical surface of outer hair cells . Damage to the organ of Corti after bacterial invasion of the inner ear may be one of the mechanisms by which bacterial meningitis can cause deafness . The more severe cochlear lesions induced by S.pneumoniae may explain the higher incidence of deafness after pneumococcal meningitis.

Arch Dis Child Fetal Neonatal Ed, 1996 May, 74(3), F187 - 190
Group B Streptococcus impairs erythrocyte deformability in neonates more than in adults; Poschl JM et al.; Group B beta-haemolytic Streptococcus (GBS) may cause severe septic shock and death in neonates, whereas this is rarely the case in adults . As impaired red blood cell (RBC) deformability might disturb microcirculation in septic shock, the in vitro effects of GBS (1.7 x 10(8) cfu/ml) on RBC deformation (rheoscope) and haemolysis were studied in blood from preterm infants, term neonates, and adults . Furthermore, RBC deformation was studied in term neonates with GBS sepsis . RBC deformation at a shear stress of 4 Pa decreased significantly within 5 minutes of GBS incubation in preterm infants (-13%) and term neonates (-9%) . In adults RBC deformation did not change during the first 15 minutes, but decreased significantly after 30 (-10%) and 60 minutes (-13%) . In the term infants there was little further decrease in RBC deformation between 5 and 60 minutes of GBS incubation; RBC deformation in preterm infants decreased by 19% after 60 minutes compared with the preincubation values . RBC deformation in septic neonates was significantly decreased at shear stresses of 1, 2, and 3 Pa (-19%, -18%, and -9%) . Sixty minutes of incubation of RBC from adults and neonates with GBS and without GBS resulted in haemolysis below 4% . It is concluded that neither neonatal nor adult RBC are haemolysed by GBS . In vitro, neonatal RBC deformability is more impaired than that in adults . This may contribute to the high risk of neonates for compromised microcirculation and circulatory shock as a result of GBS sepsis.

Zh Mikrobiol Epidemiol Immunobiol, 1996 May-Jun, (3), 118 - 22
{The characteristics of the immune response to the polysaccharide determinants of Streptococcus group A in rheumatism}; Borodiiuk NA et al.; As shown in this study, the formation of antibodies, at least, to the determinants (DT) of polysaccharide of group A streptococcus (A-PS), common with epidermal antigens, occurs in rheumatic fever . Two DT include N-acetylglucosamine; DT common with epidermal basal cell antigen (DT-1) and DT common with antigen of the perinuclear zone of the cytoplasm of cells of differentiated layers (DT-2) . Two other DT seem to contain only rhamnose; DT common with the cytoplasm of cells of differentiated layers (DT-3) and DT common with epidermal antigen, characteristic of the cytoplasm of cells of all epidermal layers (DT-4) . Conclusion has been made that the presence of autoantibodies to epidermal basal cell antigens, common with DT-1 and DT-4 of A-PS, may serve as an additional indicator of the activity of the rheumatic process . Autoantibodies to cross-reacting DT-4 of A-PS are indicative of the chronization of the process with a tendency to relapses of rheumatic fever.

Zh Mikrobiol Epidemiol Immunobiol, 1996 May-Jun, (3), 47 - 9
{The pathogenicity factors of Streptococcus pneumoniae strains causing meningitis}; Kostiukova NN et al.; Pneumococcal meningitis was registered in St.Petersburg in 1985-1991, morbidity rate being 1.7-2.3 cases per 100,000 children, including 7.4-19.8 cases among children under 1 year . Two thirds of the pneumococcal strains isolated in cases of meningitis belonged to serovars 19, 1, 6, 15 and 2 . The comparative study of pneumococcal strains revealed that the presence of capsules, pneumolysin, high hyaluronidase activity or belonging to serovars 1 and 2 (irrespective of their hyaluronidase titers) were the most important factors contributing to the development of generalized infection . The role of such a factor as virulence for mice is not yet clear.

Arch Pediatr, 1996 May, 3(5), 460 - 2
{Neurologic manifestations in a child of a mother with gestational herpes}; Berthier M et al.; BACKGROUND: Herpes gestationis in the neonate is usually associated with an increased risk of premature birth and/or low birth weight for gestational age (GA) and sometimes skin lesions . Neurologic manifestations are nos described in these babies . CASE REPORT: A boy was born at 35 weeks of GA from a mother who developed skin eruption typical of herpes gestationis . His weight was 2320 g and his height was 46 cm . He had transient respiratory distress syndrome and was given antibiotics due to suspected group B streptococcus infection . He developed on day 3 skin vesiculous eruption which disappeared within 3 days and neurologic manifestations: hypertonia and hyperkinesis, abnormal EEG . The CSF was normal . The manifestations spontaneously disappeared within 5 days . The herpes gestationis factor was present in both mother and infant . CONCLUSION: A relationship between the maternal herpes gestationis and neonatal neurologic manifestations is possible; there was no other known causes for the transient neurological disease.

Arch Pediatr, 1996 May, 3(5), 419 - 26
{Pneumococcal meningitis in children: should probabilistic antibiotherapy of infectious meningitis be modified?}; Le Masne A et al.; BACKGROUND: Since a significant proportion of Streptococcus pneumoniae strains is now resistant to penicillin and sometimes to third-generation cephalosporin, it is necessary to reevaluate the initial therapy of bacterial meningitis proposed before identification of the organism and its susceptibility pattern . POPULATION: From 1 January 1992 to 31 March 1994, nine children with acute S pneumoniae meningitis were treated with ceftriaxone plus aminoglycoside as conventional initial therapy . Eight children were less than 1 year-old (five from 3 to 6 months) . Five S pneumoniae strains were penicillin-resistant; four had a ceftriaxone minimal inhibitory concentration (MIC) of 0.047 to 0.094 mg/L and one of 1.5 mg/L . Ceftriaxone was given intravenously at doses of 50 mg/kg twice a day to patients less than 12 months old and 100 mg/kg once a day to patients older than 12 months . Intravenous amikacin (7.5 mg/kg twice daily) or netilmicin (3 mg/kg twice daily) were administered in combination . Dexomethasone was given to all children as adjunctive therapy . Follow-up lumbar puncture was performed after 24 to 36 hours of treatment . RESULTS: For each of the nine patients, cerebrospinal fluid was sterile with normal glucose level . After 2 or 4 days, initial therapy had been modified according to antibiogram and MIC . Monotherapy with ceftriaxone was continued in five children . Rifampicin was associated with initial bitherapy in one case . In two other patients, initial empiric therapy was stopped and changed to chloramphenicol . CONCLUSION: No case of bacteriological failure was noted in our patients but evolution of epidemiology and emergence of decreased penicillin sensibility in S pneumoniae strains (55% in our study) suggests that a third antibiotic (vancocin or rifampicin) should be associated with the standard first-line drug when S pneumoniae is suspected.

J Laryngol Otol, 1996 May, 110(5), 449 - 53
Inhibition of head and neck metastatic and/or recurrent cancer by local administration of multi-cytokine inducer OK-432; Kitahara S et al.; The multi-cytokine inducer OK-432 is a pulverized preparation of the low-virulence SU strain of Streptococcus pyogenes of human origin . A reduction of the tumour mass in the OK-432-injected areas was observed in 11 out of 13 patients with metastatic and/or recurrent head and neck cancer . Complete response (CR), partial response (PR) and minor response (MR) were noted in six, three and two cases respectively . OK-432 local administration therapy could create a new strategy for cancer therapy.

Pathol Biol (Paris), 1996 May, 44(5), 430 - 4
Pulsed field gel electrophoresis in Streptococcus pneumoniae isolated in France and Portugal; Carvalho C et al.; During a multicenter surveillance study on Streptococcus pneumoniae resistant to antibiotics in Portugal we have analyzed, within the predominant serotypes of penicillin G resistant strains, the chromosomal DNA restriction profiles by pulsed field gel electrophoresis . The aim of this work was to compare the PFGE restriction profiles of penicillin resistant pneumococci isolated in France with those of Portuguese strains within each serotype . We have studied fifteen penicillin resistant strains isolated in different geographical regions of France, and representing equally the three predominant resistant serotypes 23F, 9V and 14 . In general we observed an important homogeneity of profiles within each serotype, in the two countries . In serotype 23F, the five French strains studied show subtypes of a pattern called A, also detected in the majority of 23F Portuguese strains; similarly 4 of the 5 serotype 9V strains belong to subtypes of the pattern G, also common within 9V Portuguese strains; 4 of the 5 strains of serotype 14 show a subtype of profile H, found often in Portuguese strains . The observed homogeneity of chromosomal DNA restriction profiles within each serotype in the two countries, confirms the importance of geographic spread of pneumococcal resistant clones, previously described.

Pathol Biol (Paris), 1996 May, 44(5), 355 - 7
{Detection of pneumococci with reduced susceptibility to penicillin G using the ATB++STREP strip}; Romaszko JP et al.; Antibiotic susceptibility of 104 clinical isolates of Streptococcus pneumoniae was routinely tested using ATB STREP strips (Bio-Merieux), and interpreted with ATB PLUS Expert V 2.3.1 software . In parallel, CMI of penicillin G was determined by Etest, strains with MIC < or = 0.06 mg/l were classified as penicillin susceptible . ATB system proved to be both sensitive and specific for the detection of strains of reduced susceptibility to penicillin G, accurately detecting 70 out of the 71 susceptible strains, and all of the 33 resistant strains . However the level of resistance cannot be deduced from ATB results.

Enferm Infecc Microbiol Clin, 1996 May, 14(5), 300 - 3
{Invasive Streptococcus agalactiae infections at a general university hospital over a 10-year period}; Gimenez M et al.; BACKGROUND: Streptococcus agalactiae is a known causal agent of neonatal meningitis, sepsis and puerperal infections . The incidence of invasive infections caused by Streptococcus agalactiae has increased in recent years in non gestating adults: in the elderly, patients receiving prolonged steroid treatment or those with chronic immunosuppressive diseases . The clinical and epidemiological characteristics and risk factors associated to invasive infections caused by S . agalactiae were analyzed . METHOD: A retrospective study was undertaken in patients with invasive disease by S . agalactiae attended in the Hospital Universitari Germans Trias i Pujol in Badalona (Barcelona), Spain, from 1983 to 1993 . RESULTS: S . agalactiae was isolated in 51 patients including 13 (25%) neonates . Three patients presented invasive puerperal infection . Thirty-five adult patients with a mean age of 62 years presented invasive disease . Infection involved bacteremia in 26 (74.2%) patients . S . agalactiae was isolated in the ascitic fluid of 4 patients with liver cirrhosis with spontaneous bacterial peritonitis (one with bacteriemia) and in the peritoneal exudate of two patients with peritonitis secondary to intestinal perforation . Of 5 patients with septic arthritis, 3 involved bacteremia . Two patients presented empyema by S . agalactiae . Mortality was 28%, being directly related with infection in 4 cases (7.8%) . CONCLUSIONS: Without taking pregnant women into account, 68% of the cases of invasive infections by S . agalactiae were observed in adults with associated base disease, with liver cirrhosis, neoplasms and diabetes mellitus being the most frequent . Advanced age was also found to be an important predisposing factor.

J Antimicrob Chemother, 1996 May, 37 Suppl A, 1 - 18
In-vitro activity of sparfloxacin in comparison with currently available antimicrobials against respiratory tract pathogens; Baquero F et al.; Bacterial resistance to antimicrobial agents is an ever-increasing problem . The in-vitro activity of sparfloxacin compared with that of currently available antimicrobial agents against pathogens implicated in respiratory tract infections is reviewed . Sparfloxacin is a fluoroquinolone active against both penicillin-susceptible and -resistant strains of Streptococcus pneumoniae . It is also active against many other respiratory tract pathogens and may be a suitable alternative for empirical therapy of community-acquired respiratory tract infections.

Bone Marrow Transplant, 1996 May, 17(5), 699 - 702
Microbial contamination of peripheral blood stem cell collections; Attarian H et al.; We prospectively evaluated microbiologic cultures for a series of 1263 peripheral blood stem cell harvests collected from 376 sequential patients . The incidence of microbial contamination was 0.23% of all samples, or 47% of samples from patients not receiving systemic antibiotics . This incidence of positive microbial cultures is less than that for cultures of bone marrow (3.8%) after harvesting and before further processing . Of the three positive cultures, two grew coagulase-negative Staphylococcus and the third, Streptococcus viridans . Two patients were reinfused with cultured-positive PBSC components, and neither exhibited the same organism in subsequent blood cultures . Although microbial contamination may occur during peripheral blood stem cell collection and cryopreservation, this report indicates that PBSC contamination does not play a conspicuous role in the infectious complications of PBSC transplantation.

J Clin Microbiol, 1996 May, 34(5), 1249 - 52
Antagonistic effect of oral bacteria towards Treponema denticola; Grenier D; This study was designed to isolate oral bacteria exhibiting antagonism towards Treponema denticola and to characterize the inhibitory activity . Eleven bacterial isolates obtained from subgingival sites and identified as either Staphylococcus aureus or Streptococcus mutans were found to inhibit the growth of T . denticola . When the activity spectra of these isolates were analyzed, two additional periodontopathogens (Porphyromonas gingivalis and Prevotella intermedia) were found to be affected, whereas most gram-positive bacteria were not . Strains of S . aureus produce a bacteriocin-like inhibitory substance (heat stable and protease sensitive), whereas the inhibitory effect of S . mutans appears to be related to the production of lactic acid . The negative interactions reported in this paper may govern population shifts observed in subgingival sites.

J Clin Microbiol, 1996 May, 34(5), 1176 - 9
Novel BOX repeat PCR assay for high-resolution typing of Streptococcus pneumoniae strains; van Belkum A et al.; Typing data obtained by specifically targeting a single, high-stringency PCR at the pneumococcal BOX repeat element for 28 strains of Streptococcus pneumoniae completely corroborated the resolutions attained by five genotypic procedures as described by Hermans et al . (P.W.M . Hermans, M . Sluijter, T . Hoogenboezem, H . Heersma, A . van Belkum, and R . de Groot, J . Clin . Microbiol . 33:1606-1612, 1995) . All pairs of strains, except one, derived from both the cerebrospinal fluid and blood of the same individual were shown to be identical . Moreover, other, epidemiologically unrelated isolates were demonstrated to be unique . Considering the combined data from the five typing techniques applied previously as the "gold standard," the single BOX PCR test demonstrated excellent resolving powers while maintaining epidemiological linkage.

Pediatr Infect Dis J, 1996 May, 15(5), 425 - 30
Immunologic priming of young children by pneumococcal glycoprotein conjugate, but not polysaccharide, vaccines; O'Brien KL et al.; BACKGROUND . Streptococcus pneumoniae is the most common cause of invasive bacterial disease and otitis media in infants and young children . Licensed pneumococcal polysaccharide vaccines are not reliably immunogenic in children younger than 2 years of age; therefore pneumococcal glycoprotein conjugate vaccines are currently being evaluated for safety, immunogenicity and efficacy in various age groups . METHODS . During a 12-month period we determined the kinetics of pneumococcal IgG antibody in 60 children who received primary immunization with one dose of bivalent (serotypes 6A and 23F) pneumococcal polysaccharide-CRM197 vaccines at 18 to 30 months of age . To assess immunologic priming a subgroup of 20 subjects received secondary immunization with pneumococcal polysaccharide vaccine, including serotypes 6B and 23F, at 11 to 20 months after primary immunization . Pneumococcal-specific IgG subclass distributions were also evaluated in the subgroup . RESULTS . In the 12 months after primary immunization with glycoprotein conjugate vaccine, geometric mean pneumococcal IgG antibody concentrations to 6B and 23F serotypes remained stable . Pneumococcal polysaccharide vaccine induced a greater anamnestic response in children primed with glycoprotein conjugate vaccines (13- to 40-fold increases to geometric mean concentrations of 6 to 30 micrograms/ml for type 23F), than in those primed with polysaccharide (2- to 4-fold increases) . A greater IgG response to pneumococcal serotype 23F than to 6B was observed with both primary and secondary immunization . The serotype-specific pneumococcal IgG antibody response was virtually restricted to the IgG1 subclass after primary immunization, but secondary immunization elicited antibodies of IgG1 and IgG2 subclasses . CONCLUSIONS . These glycoprotein conjugate vaccines appear to prime for anamnestic IgG antibody responses to subsequent immunization with polysaccharide vaccine, suggesting that the polysaccharide-CRM197 vaccine effectively induces a predominantly T cell-dependent immune response . The greater IgG response to 23F than to 6B indicates that pneumococcal serotype is a major determinant of immunogenicity of pneumococcal glycoprotein conjugate vaccines.

Am J Vet Res, 1996 May, 57(5), 756 - 61
Effects of potentiated chlorhexidine on bacteria and tarsocrural joints in ponies; Klohnen A et al.; OBJECTIVES--To evaluate the bactericidal properties of chlorhexidine diacetate (CHD) after potentiation with EDTA and Tris buffer (EDTA-Tris), and to find a potentiated CHD concentration that would achieve 90 to 100% killing for all bacteria tested . ANIMALS--6 adult ponies . PROCEDURES--Serial dilutions of CHD, CHD in EDTA-Tris and EDTA-Tris alone were evaluated for bactericidal activity against Staphylococcus aureus, Escherichia coli, and Streptococcus zooepidemicus . The tarsocrural joints of 6 ponies were lavaged with either 1 L phosphate-buffered saline solution (control) or 1 L of 0.0005% CHD in EDTA-Tris . Synovial fluid was collected before lavage and on days 1,4, and 8 . Synovia, cartilage, and bone with cartilage were collected on day 8 when the ponies were euthanatized . RESULTS--In vitro results indicated that 0.0005% CHD in EDTA-Tris was 90% lethal to all bacteria tested . Results of synovial fluid analysis, glycosaminoglycan analysis, and histologic examination of the synovial membrane and articular cartilage indicated that joint lavage with 0.0005% CHD in EDTA-Tris was not detrimental to the synovium or the articular cartilage of pony tarsocrural joints . Changes observed were a result of the actual lavage process, the phosphate-buffered saline solution, and hemarthrosis . CONCLUSIONS--A concentration of 0.0005% CHD in EDTA-Tris was 90% lethal to all bacteria tested . Pony tarsocrural joint lavage with 0.0005% CHD in EDTA-Tris was not detrimental to the synovium or the articular cartilage . The efficacy of 0.0005% CHD potentiated with EDTA-Tris as a potential joint lavage fluid for treatment of infectious arthritis needs to be evaluated in clinical patients.

Antimicrob Agents Chemother, 1996 May, 40(5), 1257 - 9
Directly repeated insertion of 9-nucleotide sequence detected in penicillin-binding protein 2B gene of penicillin-resistant Streptococcus pneumoniae; Yamane A et al.; We investigated the molecular mechanism of 50 penicillin-resistant Streptococcus pneumoniae strains (penicillin: MIC, > or = 0.125 microgram/ml) having neither class A nor class B mutations in the penicillin-binding protein 2B gene (pbp2b) . An analysis of the nucleotide sequences of the pbp2b genes from seven strains revealed an unique direct repeat of 9 nucleotides (TGGTATACT) between active-site serine (residue 385) and Ser-X-Asn (residues 442 to 444) motifs . The same insertion was detected in 13 strains.

Antimicrob Agents Chemother, 1996 May, 40(5), 1208 - 13
Antimicrobial resistance of Streptococcus pneumoniae recovered from outpatients in the United States during the winter months of 1994 to 1995: results of a 30-center national surveillance study; Doern GV et al.; A total of 1,527 clinically significant outpatient isolates of Streptococcus pneumoniae were prospectively collected in 30 different U.S . medical centers between November 1994 and April 1995 . Overall, 23.6% of strains were not susceptible to penicillin, with 14.1% intermediate and 9.5% high-level resistant . The frequencies of recovery of intermediate and high-level resistant strains varied considerably between different medical centers and in different geographic areas . In general, intermediate and high-level penicillin resistance was most common with isolates of S . pneumoniae recovered from pediatric patients . The in vitro activities of 22 other antimicrobial agents were assessed against this collection of isolates . Ampicillin was consistently 1 twofold dilution less active than penicillin . Amoxicillin and amoxicillin-clavulanate were essentially equivalent to penicillin in activity . The rank order of activity for cephalosporins was cefotaxime = ceftriaxone > or = cefpodoxime > or = cefuroxime > cefprozil > or = cefixime > cefaclor = loracarbef > cefadroxil = cephalexin . The National Committee for Clinical Laboratory Standards {Performance Standards for Antimicrobial Susceptibility Testing, Sixth Information Supplement (M100-S6), 1995} has established MIC breakpoints for resistance (i.e., > or = 2 micrograms/ml) with three cephalosporins versus S . pneumoniae, namely, cefotaxime, ceftriaxone, and cefuroxime . The overall percentages of strains resistant to these three antimicrobial agents were 3, 5, and 12, respectively . The overall frequency of resistance was 10% with all three macrolides examined in this study, clarithromycin, erythromycin, and azithromycin . The overall percentages of chloramphenicol, tetracycline, and trimethoprim-sulfamethoxazole resistance were 4.3, 7.5, and 18, respectively . The resistance percentages among the cephalosporins, macrolides, chloramphenicol, tetracycline, and trimethoprim-sulfamethoxazole were consistently higher among penicillin-intermediate strains than among susceptible isolates and even higher still among organisms expressing high-level penicillin resistance . Multiply resistant strains represented 9.1% of the organisms examined in this study . Finally, rifampin resistance was uncommon (i.e., 0.5%), and vancomycin resistance was not detected . The quinopristin-dalfopristin combination was consistently active at concentrations of 0.25 to 4 micrograms/ml, but rates of resistance could not be determined in the absence of established interpretive criteria for MIC results.

Antimicrob Agents Chemother, 1996 May, 40(5), 1148 - 52
Bactericidal activities of cefprozil, penicillin, cefaclor, cefixime, and loracarbef against penicillin-susceptible and -resistant Streptococcus pneumoniae in an in vitro pharmacodynamic infection model; Cappelletty DM et al.; We examined the bactericidal activities of penicillin, cefprozil, cefixime, cefaclor, and loracarbef against three clinical isolates of Streptococcus pneumoniae which were susceptible, moderately susceptible, and resistant to penicillin . An in vitro two-compartment glass infection model was used to simulate human pharmacokinetics in the presence of bacteria . Also, changes in organism susceptibility and development of resistant subpopulations were evaluated . Simulated pediatric dosage regimens and target peak concentrations in the central compartment were as follows: penicillin V-potassium, 26 mg/kg of body weight every 6 h (q6h) and 14 micrograms/ml; cefaclor, 13.4 mg/kg q8h and 16 micrograms/ml; loracarbef, 15 mg/kg q12h and 19 micrograms/ml; cefprozil, 15 mg/kg q12h and 11 micrograms/ml; and cefixime, 8mg/kg q24h and 4 micrograms/ml . Targeted half-lives of each agent were 1 h for penicillin, cefaclor, and loracarbef; 1.3 h for cefprozil; and 3.5 h for cefixime . Growth controls were performed at two different pump rates, 0.8 and 2.0 ml/min (half-lives = 3.5 and 1 h, respectively) . Each isolate demonstrated autolysis at the lower rate which was attributed to a decreased supply of fresh nutrients available to the organisms in the infection compartment . Against the susceptible isolate, the time to 99.9% killing was statistically significant between penicillin V-potassium and both cefaclor and cefixime (P < 0.029) . Loracarbef never achieved a 99.9% reduction in the inoculum . At 48 h penicillin, cefprozil, and cefaclor were equivalent in extent of killing . Against the intermediately resistant isolate, cefprozil was superior to all other regimens with respect to rate of killing (P < 0.013) and extent of killing at 24 h (P < 0.0003) . At 48 h penicillin, cefprozil, and cefaclor were equivalent in extent of killing . All of the regimens exhibited inferior activity against this penicillin-resistant isolate . A 99.9% kill was never obtained with any of the regimens, nor was there an appreciable decrease in the colony counts . In conclusion, it appears that cefprozil, penicillin, and cefaclor are effective therapies against sensitive and even intermediately sensitive isolates of S . pneumoniae . However, none of the oral therapies appear to be of any benefit against penicillin-resistant isolates . The in vitro model may be an effective tool in evaluating other multiple-dose therapies against this fastidious organism, since the continual supply of fresh medium maintains the viability of S . pneumoniae with minimal stationary-phase autolysis.

Australas J Dermatol, 1996 May, 37 Suppl 1, S54 - 5
Immune response to Streptococcus pyogenes and the susceptibility to psoriasis; Muto M et al.; Monoclonal antibodies directed against type 12 Group A streptococcal cell wall antigens cross-react with nuclei and cytoplasm of cells from skin and synovium from controls, uninvolved skin of psoriatics and psoriatic plaques . Patients with psoriasis had high serum titres of antibody against the M12 (C-region) streptococcal antigen compared to controls . An abnormal immune response directed against a "self' antigen after initiation by Group A streptococcal infection may play an important role in the exacerbation or development of psoriasis.

Microbiology, 1996 May, 142 ( Pt 5), 1231 - 7
In vitro phagocytosis and survival of Streptococcus suis capsular type 2 inside murine macrophages; Brazeau C et al.; In this study, data on phagocytosis of Streptococcus suis and its survival inside macrophages are presented . Mouse peritoneal macrophages were incubated in the presence of one of five different strains of S . suis capsular type 2: a virulent wild-type strain (1591), a non-capsulated non-virulent mutant strain (M2), a poorly capsulated non-virulent mutant strain (M42), a non-virulent capsulated strain (1330), and the wild-type reference (virulent) strain S735 . Opsonized or non-opsonized bacteria were incubated with macrophages in vitro and samples were obtained after 1 and 3 h incubation . Phagocytosis as well as live and dead intracellular organisms were determined by acridine orange and crystal violet staining . After 1 h incubation, non-opsonized virulent and non-virulent capsulated bacteria were poorly phagocytosed (by less than 7% of the macrophages), whereas the non-capsulated non-virulent mutant strain was highly phagocytosed (by more than 68% of the macrophages) . The M42 mutant strain was more phagocytosed than the capsulated strains but less than the non-capsulated M2 mutant strain (35%) . In contrast, a higher percentage of live bacteria was observed inside macrophages for the capsulated strains (1591 and S735) than for the non- or poorly capsulated mutant strains (M2 and M42) . Opsonization of bacteria with rabbit serum or heat-inactivated rabbit serum significantly increased phagocytosis . For every opsonized strain, after 3 h incubation, the percentage of live bacteria within macrophages was considerably lower than the corresponding non-opsonized strains . In conclusion, the capsule of S . suis type 2 appears to act as an important anti-phagocytic factor . However, virulent capsulated non-opsonized strains can be phagocytosed by mouse peritoneal macrophages within which they appear to survive for at least 3 h . Serum factors other than complement increase not only phagocytosis but also intracellular killing of S . suis of both capsulated and non-capsulated strains.

Microbiology, 1996 May, 142 ( Pt 5), 1221 - 30
Metabolism of glycoprotein-derived sialic acid and N-acetylglucosamine by Streptococcus oralis; Homer KA et al.; Nine strains of Streptococcus oralis, isolated from blood cultures of patients with infective endocarditis or from the oral cavity as part of the normal flora, were examined for their ability to elaborate sialidase (neuraminidase) and N-acetylglucosaminidase, enzymes which are involved in the degradation of glycoproteins . Both glycosidases were induced when bacteria were grown in a minimal medium supplemented with porcine gastric mucin, a model glycoprotein, and repressed when growth occurred in the presence of glucose . Cell-free extracts mucin-grown cultures expressed elevated levels of N-acetylneuraminate pyruvate-lyase (the first intracellular enzyme in the pathway of N-acetylneuraminate catabolism), N-acetylglucosamine (glcNAc)-6-phosphate deacetylase and glucosamine-6-phosphate deaminase (enzymes involved in the intracellular catabolism of GlcNAc 6-phosphate); activity of each of these intracellular enzymes was markedly repressed when bacteria were grown in media supplemented with alpha 1-acid glycoprotein, a major component of human plasma . Cells from these cultures expressed high levels of sialidase, N-acetylglucosaminidase, and the intracellular enzymes involved in the catabolism of N-acetyl-sugars released by action of these glycosidases . High-resolution 1H-NMR spectroscopy of spent culture supernatants revealed that sialic acid and GlcNAc residues of the molecularly mobile oligosaccharide side-chains of alpha 1-acid glycoprotein had been hydrolysed and the released sugars internalized by the bacteria . These data indicate that S . oralis has the ability to hydrolyse constituents of oligosaccharide side-chains of host-derived glycoproteins and to utilize simultaneously these released carbohydrates . The biochemical characteristics induced by the growth of S . oralis on glycoproteins may play a role in the survival and persistence of these bacteria at the infection site in vivo.

APMIS, 1996 May, 104(5), 367 - 73
The interference of gingival cell cultures with growth of selected bacteria; Johansson A et al.; The aim of the present study was to analyze the interference of oral tissue cells or cell lines (effector cells) with growth of reference bacteria, and furthermore to investigate whether cells derived from different individuals differ in such activity . The reference bacteria were Staphylococcus aureus, Staphylococcus epidermidis, Streptococcus mitis, Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis, and Fusobacterium nucleatum . The effector cells used were gingival fibroblasts (GF) from 21 periodontally involved persons, gingival epithelial cells (E) from 2 such persons, HeLa cells (HeLa), and an amnion cell line (Amnion) . The cells were cultivated and their supernatants tested for antibacterial activity in a Bioscreen robot analyzer (Labsystems, Finland) . Results suggest that the antibacterial activity of each tested primary cell line of tissue had its own profile depending on cell type and donor, and that the composition of oral microbiota was influenced by oral cells, which might, in turn, contribute to the variations in the pathogenesis of periodontal diseases.

Kansenshogaku Zasshi, 1996 May, 70(5), 441 - 8
{Effect of prolonged administration of erythromycin on the drug sensitivity and the biological properties of Streptococcus pneumoniae}; Koizumi A et al.; From April 1990 to February 1992 two hundred and ten strains of Streptococcus pneumoniae were isolated in the laboratory of Nara Medical University Hospital . Frequency of erythromycin resistant Streptococcus pneumoniae, prescription mode of macrolide antibiotics and biological properties were investigated . 1 . Erythromycin resistant Streptococcus pneumoniae was predominantly isolated from the wards of the respiratory unit of Inter- nal Medicine and Pediatrics . 2 . Patients with erythromycin resistant Streptococcis pneumoniae were treated with macrolide antibiotics frequently in the respiratory unit of Internal Medicine and Pediatrics . 3 . MIC90 of EM, CLDM, MINO and ABPC for Streptococcus pneumoniae was 8.0, 8.0, 8.0 and 1.0 micrograms/ml, respectively, indicating moderate resistance to penicillin derivatives and high resistance to macrolides, particularly EM; some strains showed high levels of MIC over 400 micrograms/ml . 4 . Investigations on biological properties using VITEK GPI cards revealed that some erythromycin resistant strains showed less responsiveness to DEX, LAC, PUL and MEL . 5 . The survival rate of mice infected with erythromycin resistant strains was longer than that with erythromycin sensitive strains . These findings suggested that the prolonged administration of erythromycin causes a virulence reduction of the organism.

J Formos Med Assoc, 1996 May, 95(5), 364 - 71
Invasive Streptococcus pneumoniae infection associated with rapidly fatal outcome in Taiwan; Hsueh PR et al.; We observed 42 cases of invasive Streptococcus pneumoniae infections from 1991 through 1993 in southern Taiwan . The antimicrobial susceptibilities and distribution of serotypes of the 42 isolates from these invasive infections were determined . Serotypes 14, 3, 6, 23, 15 and 4 were most commonly identified . Serotypes 14 and 6 most frequently caused infections in pediatric patients, while serotypes 3, 14 and 23 were commonly encountered in adults . Overall, 85.7% of the isolates were included in the serotypes represented in the 23-valent pneumococcal vaccine . Three isolates were intermediately resistant to penicillin and none were fully resistant . Resistance rates were: erythromycin, 61.9%; clindamycin, 47.6%; chloramphenicol, 19%; and tetracycline, 73.8% . Resistance to three or more classes of antibiotics was found in 33.3% of the isolates, in which the majority were serotypes 14 and 6 and nontypeable isolates . Bacteremic pneumonia and primary bacteremia accounted for 64.3% of the infections . Mortality was 42.6% . Factors associated with higher mortality included age of > 16 years, the presence of underlying diseases, development of one or more septic complications, bacteremic pneumonia and the presence of serotype 3 isolates . Rapidly fatal outcome (the illness developed less than 48 hours prior to admission and the death occurred within 48 hours of hospitalization) occurred in 12 (66.7%) of the 18 patients who died . All these patients received adequate antibiotic treatment and aggressive intensive care, indicating the fulminant nature of this infection . Mucoid serotype 3 isolates caused rapidly fatal outcomes . Given the severity of these infections despite adequate antibiotic therapy and the vulnerability of patients with altered immune responses, there is a dire need for introduction of new therapeutic options and preventive measures to prevent mortality due to invasive S . pneumoniae infections.

Obstet Gynecol, 1996 May, 87(5 Pt 2), 823 - 6
Monomicrobial necrotizing fasciitis complicating pregnancy and puerperium; McHenry CR et al.; BACKGROUND: Necrotizing fasciitis is an uncommon, rapidly progressive, life-threatening infection involving the subcutaneous tissue and fascia . Usually, it is a synergistic polymicrobic infection that occurs in patients with coexisting factors predisposing them to bacterial inoculation and the spread of infection . CASES: We report a monomicrobial variant of necrotizing fasciitis affecting three otherwise healthy pregnant or postpartum women . The necrotizing fasciitis involved either the lower extremity or the abdominal wall . The causative bacteria were Streptococcus pyogenes (two cases) and Staphylococcus aureus (one) . All patients presented with an acute fulminant infection, including one woman who died from overwhelming sepsis . CONCLUSION: These cases raise a question about the possible role of increased bacterial virulence and the immunologic changes of pregnancy as potential predisposing factors in the development of necrotizing fasciitis.

Rinsho Byori, 1996 May, 44(5), 465 - 70
{Antibiotic resistance of clinical isolates Streptococcus pneumoniae}; Komori T et al.; Streptococcus pneumoniae is a major pathogenic organism of community-acquired bacterial pneumonia as well as otitis media and bacterial meningitis . Recently penicillin- or multiply resistant pneumococci have been isolated worldwide . In this study we examined the susceptibility tests of 11 antibiotics with the total of 63 clinically isolated pneumococci, using a broth microdilution method . Most of pneumococci were isolated from respiratory specimens . According to NCCLS standard, all these pneumococci were classified as follows: PCG-susceptible S . pneumoniae (PSSP, MIC < or = 0.06 micrograms/ml), PCG-intermediately resistant S . pneumoniae (PISP, 0.12 < or = MIC < or = 1.0 micrograms/ml), and PCG-highly resistant S . pneumoniae (PRSP, MIC > or = 2.0 micrograms/ml) were 45 (71.4%), 14 (22.2%) and 4 isolates (6.4%), respectively . Forty-four percent of isolates from children under 10 years and 29% from outpatients were PISP or PRSP . Resistance to erythromycin (EM) clindamycin (CLDM) or minocycline (MINO) was significantly recognized, but not correlated with that to PCG . On the other hand, the resistance to beta-lactam antibiotics were correlated with that to PCG . Seventeen isolates (27%) were resistant to two or more antibiotics among PCG, EM, MINO, ofloxacin (OFLX), and sulfamethoxazole-trimethoprim (ST) . In pneumococcal infection, we always have to pay a careful attention to susceptibility test before we choose antibiotics.

Ann Otol Rhinol Laryngol, 1996 May, 105(5), 397 - 404
Healing of tympanic membrane after myringotomy during Streptococcus pneumoniae otitis media . An otomicroscopic and histologic study in the rat; Magnuson K et al.; The purpose of our study was to elucidate the course of healing of the tympanic membrane (TM) when myringotomy was performed during acute otitis media . The early and long-lasting structural changes of the TM were studied in an animal model . Rats were inoculated with Streptococcus pneumoniae (PnC) type 3 in the bulla . When the infection was manifest, myringotomy was performed . On days 4 and 12, and 3 and 6 months after myringotomy, the TM status was checked by otomicroscopy and TMs were prepared for light and electron microscopy . Comparison was made with PnC-infected TMs that were not perforated, as well as myringotomized noninfected TMs . The infection resolved more slowly in myringotomized ears compared to PnC-infected ears that were left untouched . After 6 months, the pars tensa of the myringotomized infected ears was thickened and showed a disorganized collagen structure, compared with myringotomized noninfected ears, in which TMs were normalized . The PnC-infected TMs without myringotomy were completely normalized after 2 months . We conclude that a combination of bacterial infection and myringotomy causes long-lasting changes in TM structure . This impaired structure of the connective tissue could be of importance in chronic middle ear disease as a presumptive site for retraction and perforation of the TM.

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