Crit Care Med, 2000 Mar, 28(3), 800 - 8 The hemodynamic effects of inhaled nitric oxide and endogenous nitric oxide synthesis blockade in newborn piglets during infusion of heat-killed group B streptococci; Barrington KJ et al.; OBJECTIVE: To determine the effects of therapy with inhaled nitric oxide (NO) gas and partial or complete blockade of endogenous NO synthesis with N(omega)nitro-L-arginine (L-NA) on the hemodynamic responses to group B streptococci infusion in newborn piglets . DESIGN: Randomized, acute intervention study . SETTING: Animal research laboratory . SUBJECTS: Twenty-five anesthetized piglets younger than 3 days of age divided into five groups . INTERVENTIONS: Heat-killed group B streptococci (GBS) were infused systemically until a 50% increase in pulmonary artery pressure (PAP) was obtained, and the infusion was continued for another 2 hrs . The five groups were designed as follows: group 1, sepsis control: continuous GBS infusion, with two brief trials (10 mins) of inhaled NO given after the initial development of pulmonary hypertension and again 2 hrs later; group 2, continuous inhaled NO: NO was given at 40 ppm for 2 hrs during GBS infusion; group 3, high-dose L-NA pretreatment: 10 mg/kg L-NA bolus followed by 1 mg/kg/min before, and continuing throughout, GBS infusion; group 4, high-dose L-NA: same dose as in group 3, but given after the start of the GBS infusion with continuous inhaled NO at 40 ppm; and group 5, low-dose L-NA: 3 mg/kg bolus given after start of GBS infusion with continuous inhaled NO at 40 ppm . MEASUREMENTS AND MAIN RESULTS: The sepsis controls, group 1, had an increase in PAP, which took 15-45 mins to develop, from a mean of 3.4 (SD 0.7) to 5.9 (1.9) kPa (p < .05), at which time the cardiac index had decreased from 169 (28) to 146 (46) mL/kg/min (p < .05) . Brief inhaled NO during the early phase decreased PAP to normal . Two hours later, PAP had increased to 6.1 (0.2) kPa and cardiac index had decreased to 88 (31) mL/kg/min . Inhaled NO after 2 hrs decreased PAP to 3.2 (0.5) kPa and increased cardiac index to 106 (44) ml/kg/min (p < .05) . Continuous inhaled NO (group 2) ameliorated the deterioration in cardiac index, which at 2 hrs was 140 (30) mL/kg/min (significantly greater than in the sepsis controls) (p < .05) . The L-NA-pretreated animals (group 3) had a greater increase in PAP and pulmonary vascular resistance index when GBS infusion was started . PAP increased from 3.0 (0.7) to 7.3 (1.5) kPa within 15 mins, and cardiac index simultaneously decreased to 68 (20) mL/kg/min . Cardiac index subsequently rapidly deteriorated to 48 (21) mL/kg/min, and only one of five animals survived for 2 hrs . Group 4 animals also developed a rapid deterioration in cardiac output, and only two of five survived for 2 hrs . Group 5 animals had results indistinguishable from group 2 animals . CONCLUSION: Pulmonary hypertension and shock resulting from GBS infusion in newborn piglets are much worse if endogenous NO production is completely inhibited . Continuous inhaled NO with or without low-dose L-NA inhibits the decrease in cardiac output. Presse Med, 2000 Dec 2, 29(37), 2069 - 71 {Surveillance of bacterial antibiotic resistance}; Pean Y; A NEW RESISTANCE MECHANISM FOR E . COLI: E . coli can develop plasmid-transmitted resistance against fluoroquinolones via a specific protection of DNA gyrase . FOR STREPTOCOCCI: Two mechanisms of natural or acquired resistance linked to 2 genes can be considered: ermTR/B leads to the synthesis of methylase, the most frequent mechanism; mef E/A causes active efflux . For S . pyogenes, resistance against macrolides varies from one country to another; it is 9.6% in France . Among the commensal flora of the oropharynx, S . viridans, is the most important reservoir of resistance against macrolides . ANIMAL RESERVOIRS: Both house pets and farm animals constitute a reservoir of resistant bacteria . It is difficult to establish a relationship between the use of antibiotics and the frequency of resistance . The presence of a relationship between animal reservoirs and human infection remains controversial . ANTIBIOTIC USE AND RESISTANCE: Several publications have concluded that, from an individual point of view, there is a quasi-direct relationship between antibiotic use and bacterial resistance to antibiotics . Actually, the methodology of most of these studies can be criticized because they did not follow 3 fundamental rules: selection of controls, date the risk was measured, comorbidity. Presse Med, 2000 Dec 2, 29(37), 2042 - 3 {Telithromycin, a once-a-day ketolide in the treatment of community acquired pneumonia}; Carbon C; KETOLIDES: The principal advantage of this series of original compounds elaborated from macrolides is their activity against pneumococci and against macrolide-resistant streptococci while preserving the remainder of the macrolide spectrum of activity, particularly for intracellular germs . TELITHROMYCIN: To date, the main indications have been assessed in adults: pneumonia, super-infection of chronic bronchitis, sinusitis and pharyngitis . The recommended dose is 800 mg once a day . The safety of this dose has been validated for patients treated for 7 to 10 days for community-acquired pneumonia . CONTRIBUTION TO CURRENT STRATEGIES: Should telithromycin be proposed as first line treatment for community-acquired respiratory tract infections or should it be used as an alternative treatment for situations where no other antibiotic can be used? Artif Intell Med, 2001 Jan-Mar, 21(1-3), 235 - 9 Using fuzzy sets to analyze putative correlates between age, blood type, gender and/or race with bacterial infection; Cundell DR et al.; Previous studies have suggested that the demographic variables of age and blood type may serve as "risk factors" for infection by specific bacterial species . Since both demographic variables and bacterial species are defined using generally accepted parameters, they constitute highly suitable variables for the generation of a fuzzy logic program . A prospective study was therefore undertaken to examine the influence of age, blood type, gender and race on bacterial infection rates using a real database generated from 187 bacteremic patients admitted to Albert Einstein Medical Center . A fuzzy logic program was created using 155 randomly selected patients' data with four input (demographic variables) and four output classes (infections with "staphylococci", "streptococci", "Escherichia coli" or "non-E . coli gram negative rods (non-E.coli GNR)") . To see whether bacterial infection could be predicted based on demographic data alone, the program was tested using the remaining 32 patients' data . The program was able to correctly determine the bacterial output group of 27 of 32 randomly selected patients, giving an overall correlation of 84.38% . This study suggests that the direct correlation of demographic variables with a predisposition to bacterial infection allow the design of an intelligent medical system, which shows great future potential as a powerful diagnostic tool for all physicians. Oral Microbiol Immunol, 2000 Aug, 15(4), 263 - 8 Abiotrophia species in early dental plaque; Mikkelsen L et al.; The most characteristic traits that distinguish Abiotrophia strains from other streptococci are nutrient requirements, satellitism and pyrrolidonyl arylamidase activity . The presence of Abiotrophia strains was studied in early dental plaque formed on sucrose-containing and sucrose-free (glucose-containing) diets . The isolates were from 0- to 3-day dental plaque formed on the buccal surface of a lower premolar in six subjects . Identification of Abiotrophia strains was based on their pyrrolidonyl arylamidase activity . They were among the predominant cultivable microorganisms isolated from diluted suspensions of early dental plaque formed on both diets . Using biochemical tests without testing for pyrrolidonyl arylamidase activity, the Abiotrophia strains would be biochemically identified as Streptococcus mitis or unidentified streptococci, and many isolates first classified as unidentified streptococci were Abiotrophia strains . Generally, identifications using partial 16S rRNA sequences confirmed the identifications obtained biochemically . However, Abiotrophia elegans and Gemella strains were biochemically identified as Abiotrophia adiacens . Abiotrophia strains produce hydrogen sulfide, which may influence the metabolism and ecology of dental plaque and act as a virulence factor in periodontal disease . They are not able to grow on tryptic soy agar . In the present study, some S . mitis strains were not able to grow on mitis salivarius agar, and some Abiotrophia strains were able to grow on this medium . These observations indicate that the use of these media for estimation of total viable counts and number of streptococci introduces systematic error in studies of microorganisms in dental plaque. Berl Munch Tierarztl Wochenschr, 2000 Nov-Dec, 113(11-12), 440 - 3 {Influence of the treatment of subclinical mastitis on the electric conductivity of milk before ejection}; Barth K et al.; 10 cows (German Brown x Brown Swiss) with 29 infected quarters (14 Staphylococcus aureus, 10 esculin positive streptococci, 5 Staphylococcus spec.) were treated daily after morning milking over a period of 4 days . Ampicillin and cloxacillin (500 mg each per dose) were administered to all 40 quarters intracisternally . During the evening milkings on 4 test days (day 3 before treatment, day 1 of treatment, days 5 and 9 after the last treatment), electrical conductivity based on 25 degrees C (EC) was measured in fore milk . To avoid ejection of alveolar milk, EC measurement was the first contact to the udder . Independent of the initial level, EC of all quarters was elevated by 2.1 mS/cm on average at the first milking following the first treatment . 9 days after the end of treatment, EC had declined to the initial level in all quarters classified as mastitic, non specific and latent infected before treatment . By contrast, EC values of healthy quarters remained elevated compared to their initial level (p < 0.01) . This might be due to increased cistern tissue permeability caused by mechanical and pharmacological effects of antibiotic treatment . Despite the fact that somatic cell count and total bacteria count were reduced by treatment (p < 0.01), results showed that EC measurement on the first days following treatment was unsuitable for checking the success of treatment. J Antimicrob Chemother, 2001 Jan, 47(1), 87 - 91 High rates of resistance to cephalosporins among viridans-group streptococci causing bacteraemia in neutropenic cancer patients; Marron A et al.; The prevalence of resistance to cephalosporins among viridans-group streptococci causing 88 (18%) cases among 485 bacteraemias in neutropenic cancer patients was studied . Rates of resistance to ceftriaxone, ceftazidime, cefpirome and cefepime were 22, 53, 14 and 34%, respectively . Previous administration of beta-lactam therapy was the only factor significantly associated with bacteraemia due to cephalosporin-resistant strains; only 11 (16%) of 68 patients infected with cephalosporin-susceptible bacteria had received these antibiotics compared with 10 (50%) of 20 patients infected with cephalosporin-resistant bacteria (P = 0.0052). J Antimicrob Chemother, 2001 Jan, 47(1), 77 - 81 In vitro activity of linezolid against multiply resistant Gram-positive clinical isolates; Cercenado E et al.; The in vitro activity of the oxazolidinone linezolid was compared with the activities of vancomycin and teicoplanin against 450 Gram-positive clinical isolates, including a variety of multiply resistant strains . Linezolid inhibited all microorganisms tested at < or = 4 mg/L, including methicillin- and teicoplanin-resistant staphylococci, glycopeptide-resistant enterococci, penicillin- and multiply resistant pneumococci and viridans streptococci, and erythromycin-resistant beta-haemolytic streptococci . The MIC(90) of linezolid for all isolates was 2 mg/L. J Antimicrob Chemother, 2001 Jan, 47(1), 15 - 25 In vitro Gram-positive antimicrobial activity of evernimicin (SCH 27899), a novel oligosaccharide, compared with other antimicrobials: a multicentre international trial; Jones RN et al.; The antimicrobial activity of evernimicin (formerly SCH 27899), a novel oligosaccharide antimicrobial of the everninomicin class, was evaluated against four groups of Gram-positive pathogens: (i) Streptococcus pneumoniae (n = 1452); (ii) methicillin- or oxacillin-resistant Staphylococcus aureus (MRSA) and coagulase-negative staphylococci (MR-CoNS; n = 1427); (iii) enterococci (n = 1517); and (iv) non-pneumococcal streptococci (n = 1388), using the Etest method at each study centre throughout Eastern and Western Europe, Scandinavia, South Africa, Turkey and North America . Comparative MICs were determined for a variety of reference compounds, including vancomycin, quinupristin/dalfopristin, chloramphenicol, penicillin, ampicillin, oxacillin, ceftriaxone and ciprofloxacin . Evernimicin was highly active against all strains tested, with MIC90 values < or = 1.0 mg/L, ranging from 0.047 mg/L against S . pneumoniae to 1.0 mg/L against MRSA/MR-CoNS and enterococci . Compared with the reference agents, the MIC90 of evernimicin were lower against all species . Against MRSA and MR-CoNS the MIC90s of evernimicin, quinupristin/dalfopristin and vancomycin (the three most active agents) were 1.0, 1.5 and 3.0 mg/L, respectively . Against all species tested, the relative activities and spectra of these agents were: evernimicin > vancomycin > quinupristin/dalfopristin . The Etest proved to be reliable and reproducible, despite occasional interpretive difficulties caused by observer inexperience . Quality control results were excellent among the 33 participant sites . The results of this in vitro, multicentre, multinational study demonstrate that evernimicin possesses high antimicrobial activity against Gram-positive organisms that compares favourably with established antibacterial treatments and newer agents such as quinupristin/dalfopristin . Further clinical investigations of everninomicin class compounds appear warranted. Hepatogastroenterology, 2000 Nov-Dec, 47(36), 1504 - 8 Bile duct bacterial isolates in primary sclerosing cholangitis and certain other forms of cholestasis--a study of bile cultures from ERCP; Bjornsson ES et al.; BACKGROUND/AIMS: The pathogenesis of the inflammatory lesion in primary sclerosing cholangitis is unknown . We have recently demonstrated a high positivity rate of bacterial cultures in bile and bile ducts of explanted livers from primary sclerosing cholangitis patients compared with patients with primary biliary cirrhosis . In particular, alpha-hemolytic Streptococci was a frequent finding, suggesting an etiopathogenic role of that particular bacteria in primary sclerosing cholangitis . We therefore wanted to study naive primary sclerosing cholangitis patients and compare them with primary sclerosing cholangitis patients that have previously undergone endoscopic retrograde cholangiopancreatography, in order to evaluate the potential role of these bacteria in the etiopathogenesis in primary sclerosing cholangitis . METHODOLOGY: Samples for bacterial cultures were obtained during a diagnostic endoscopic retrograde cholangiopancreatography . Participants: 12 naive primary sclerosing cholangitis patients, 10 patients with primary sclerosing cholangitis, previously investigated using endoscopic retrograde cholangiopancreatography, 47 patients with choledocholithiasis, 19 patients with cancer obstructing the common bile duct, and 29 patients with other forms of biliary disorders . RESULTS: Positive cultures were obtained from 3 of the naive primary sclerosing cholangitis patients and from 6 of the primary sclerosing cholangitis patients with previous endoscopic retrograde cholangiopancreatography (NS) . The most frequent finding in all the primary sclerosing cholangitis patients was alpha-hemolytic Streptococci . Bacteria were cultured from the bile in 64% of the patients with choledocholithiasis, higher than the 25% in the naive primary sclerosing cholangitis patients (P < 0.03), and in 56% of patients with obstructing cancer (NS) but in only 24% of patients with other forms of biliary disorders, all of whom, except 4, had normal cholangiograms . In the 22 patients with primary sclerosing cholangitis, 75% of the positive bacterial cultures consisted of Gram-positive isolates and 25% were enteric bacteria, which differed statistically from the 74% enteric bacteria and 26% Gram-positive bacteria in the patients with common duct stone (P < 0.01) . CONCLUSIONS: Alpha-hemolytic Streptococci do not seem to play a primary role in the etiopathogenesis of primary sclerosing cholangitis since most naive primary sclerosing cholangitis patients were found to have negative bacterial cultures . This does not exclude the possibility that they play a role in the progression of primary sclerosing cholangitis following infection in conjunction with the first endoscopic retrograde cholangiopancreatography. Lung, 2000, 178(5), 317 - 29 Direct and phagocyte-mediated lipid peroxidation of lung surfactant by group B streptococci; Bouhafs RK et al.; In newborn infants, group B streptococci (GBS) often cause pneumonia, with polymorphonuclear leukocytes (PMN) migrating into the lungs . Because surfactant therapy may be needed in such patients, we evaluated the interaction between GBS or GBS-stimulated PMN and a surfactant preparation (Curosurf) in vitro . The superoxide production of GBS strains or GBS-activated PMN was measured, using the nitroblue tetrazolium (NBT) test and the subsequent lipid peroxidation (LPO) as the content of malondialdehyde (MDA) and 4-hydroxyalkenals (4-HNE) . The growth of GBS in surfactant was determined and related to the LPO . Finally, the effect of LPO on surfactant activity, caused by GBS-stimulated PMN, was assessed by measuring dynamic surface tension in a pulsating bubble surfactometer . Curosurf diminished the NBT reduction by both live GBS and GBS-stimulated PMN . Surfactant was peroxidized by reactive oxygen species (ROS) from both GBS and GBS-stimulated PMN in a time-dependent manner . Vitamin E significantly reduced the peroxidation level of surfactant in both cases . Surfactant peroxidation was associated with a reduction in the number of live bacteria . The biophysical activity of Curosurf was impaired by GBS-stimulated PMN, as reflected by increased minimum surface tension during cyclic compression . These findings indicate that Curosurf undergoes LPO by ROS produced by GBS and/or PMN . We speculate that exogenous surfactant preparations should be supplemented with vitamin E or another antioxidant, when given to infants with GBS pneumonia. J Dent Res, 2000 Nov, 79(11), 1885 - 9 Occurrence of dental decay in children after maternal consumption of xylitol chewing gum, a follow-up from 0 to 5 years of age; Isokangas P et al.; Studies have shown that prevention of mutans streptococci (MS) colonization in early childhood can lead to prevention of dental decay . In the microbiological part of the present study in Ylivieska, Finland, with 195 mothers with high salivary MS levels, regular maternal use of xylitol chewing gum resulted in a statistically significant reduction in MS colonization in their children's teeth at the age of 2 years compared with teeth in children whose mothers received fluoride or chlorhexidine varnish treatment . The children did not chew gum or receive varnish treatments . For the present study, the children were examined annually for caries occurrence by experienced clinicians who did not know whether the children were colonized with MS . Regardless of the maternal prevention group, the presence of MS colonization in children at the age of 2 years was significantly related to each child's age at the first caries attack in the primary dentition . In children at the age of 5 years, the dentinal caries (dmf) in the xylitol group was reduced by about 70% as compared with that in the fluoride or chlorhexidine group . We conclude that maternal use of xylitol chewing gum can prevent dental caries in their children by prohibiting the transmission of MS from mother to child. Arthritis Rheum, 2000 Dec, 43(12), 2678 - 86 Influence of interferon-gamma administration on the severity of experimental group B streptococcal arthritis; Puliti M et al.; OBJECTIVE: To assess the effect of interferon-gamma (IFNgamma) administration on the evolution of systemic infection and septic arthritis induced by group B streptococci (GBS) in mice . METHODS: CD1 mice were inoculated intravenously with arthritogenic strain 1/82 of type IV GBS . Exogenous murine IFNgamma or anti-IFNgamma monoclonal antibodies were administered intravenously either 2 hours (-2 hours) before or 18 hours after infection with 1 x 10(7) GBS . Mice were monitored daily for survival and for signs of arthritis . In a subsequent set of experiments, mice were killed at selected times for examination of bacterial clearance, joint histopathology, and cytokine production . RESULTS: Mortality in mice treated with IFNgamma at -2 hours was 100%, compared with 20% in those treated at 18 hours and with 40% in controls . As indicated by the arthritis score, mice treated with IFNgamma at -2 hours developed early and more severe arthritis, whereas those treated at 18 hours had milder arthritis compared with infected controls . Less severe joint pathology in the mice treated with IFNgamma at 18 hours correlated with low levels of interleukin-6 (IL-6) and IL-1beta and a low bacterial load in the joints, whereas rapid onset and worsening of articular lesions in those treated at -2 hours corresponded to early and sustained levels of IL-6 . CONCLUSION: The findings of this study demonstrate that the effects mediated by IFNgamma on GBS-induced arthritis may be detrimental or beneficial, depending on the time of administration of IFNgamma in relation to infection with the antigen. J Laryngol Otol, 2000 Nov, 114(11), 848 - 52 Bacterial penetration into tonsillar surface epithelium during infectious mononucleosis; Stenfors LE et al.; Bacterial penetration into epithelial cells, scraped from the palatine tonsils of 14 patients (10 males, four females; median age 16 years) with current infectious mononucleosis and concomitant membranous tonsillitis, was studied using the transmission electron microscopic (TEM) technique . Bacteria were seen to adhere to and penetrate the epithelial cells, some of which were completely filled with bacteria . This finding suggests intracellular proliferation of bacteria . Epstein-Barr virus, the causative agent of infectious mononucleosis, especially when associated with growth of beta-haemolytic streptococci on the palatine tonsils, induces bacterial penetration into tonsillar tissue, that in turn might be a causative mechanism in the development of peritonsillar abscess. Can Fam Physician, 2000 Nov, 46, 2248 - 55 Prophylaxis for infective endocarditis . Who needs it? How effective is it? Press N, Montessori V. OBJECTIVE: To review guidelines for using antibiotic prophylaxis to prevent infective endocarditis, and to present recent changes and controversies regarding these guidelines . QUALITY OF EVIDENCE: Data are from physiologic and in vitro studies, as well as studies of animal models, and from retrospective analyses of human endocarditis cases . Systematic reviews and guidelines are also examined . As no randomized clinical trials have examined prophylaxis for bacterial endocarditis, many recommendations presented are based on consensus guidelines . MAIN MESSAGE: Antibiotic prophylaxis to prevent bacterial endocarditis should be used in high- and moderate-risk patients with cardiac disease . It should be given before procedures in which bacteremias are likely with organisms that cause endocarditis, such as viridans streptococci . For most procedures, a single dose of amoxicillin (2 g by mouth 1 hour before the procedure) is sufficient to ensure adequate serum levels before and after the procedure . CONCLUSION: Infective endocarditis continues to have high rates of morbidity and mortality . Antibiotic prophylaxis, therefore, is important to combat this preventable disease . For high- and moderate-risk patients with cardiac disease, the cost-benefit ratio favours prophylaxis. Int J Pediatr Otorhinolaryngol, 2000 Dec 22, 56(3), 185 - 90 Inhibition of OM pathogens by alpha-hemolytic streptococci from healthy children, children with SOM and children with rAOM; Tano K et al.; The present study was undertaken to elucidate the inhibitory activity of the normal nasopharyngeal flora against the three most common otitis media (OM) pathogens in healthy children, children with secretory otitis media (SOM) and children with recurrent otitis media (rAOM) . Isolates of alpha-hemolytic streptococci (AHS) and OM pathogens were recovered from the tubal orifice in each child . The samples were taken from 20 healthy children under general anesthesia, from 19 children with SOM and 20 children with rAOM . The method used to test the bacterial interference in vitro was a modified agar overlay method . The AHS sampled from the tubal orifice of the healthy children were able to inhibit 92% of the S . peumoniae isolates, 74% of the non-typable H . influenzae isolates and 89% of the M . catarrhalis isolates . The corresponding figures for children with SOM and children with rAOM were: 73% of the S . pneumoniae isolates, 58 and 54% of the non-typable H . influenzae isolates and 86 and 89% of the M . catarrhalis isolates . The AHS from children with SOM and children with rAOM were significantly less capable of inhibiting the S . peumoniae and the H . influenzae isolates (P<0.001) . There was no significant difference between the three groups of children regarding inhibitory activity against M . catarrhalis . The results suggest that the inhibitory activity of the normal bacterial flora at the tubal orifice against pneumococci and H . influenzae may be reduced in children with SOM and rAOM. Int J Antimicrob Agents, 2000 Nov, 16 Suppl 1, S35 - 7 Trends in post-operative infections by Gram-positive bacteria; Koontz FP; Surgical patients are now more prone than ever to have a post-operative infection . On average, they are now older and more have chronic disease histories with reduced immunocompetence or iatrogenic immunosuppression, and many undergo more aggressive, more complex surgical procedures . Moreover, the infectious agents have changed . A comparison of data collected by the SENTRY Antimicrobial Surveillance Program for the years 1988 and 1998 from North and Latin America and Europe shows important shifts in the nature of the infectious agents . Among the Gram-positive agents, Staphylococcus aureus was the most frequent isolate in both years, but its share has more than doubled . Beta-hemolytic streptococci increased their share from 3 to 5% while enterococci fell from 13 to 8% . Perhaps more important than the shifts in incidence are dramatic changes in the antimicrobial resistance patterns of these agents . Data from the past several years show increasing resistance for the drugs that were previously considered 'first line' treatment for post-surgical infections . The majority of S . aureus and coagulase-negative staphylococci are now resistant to most classes of antibiotics . Antimicrobial resistance is beginning to be detected in beta-hemolytic streptococci, and vancomycin-resistant enterococci, which were not even reported in 1987-1988, now represent 17% of all enterococci isolated in the USA and Canada . To stay ahead in the fight against surgical infections, we must react in a combination of ways, using disinfection, prophylaxis, new antibiotics and, above all, we must practice superb hospital infection control and world-wide antimicrobial epidemiology studies. Gene, 2000 Dec 30, 260(1-2), 77 - 86 The galU gene of Streptococcus pneumoniae that codes for a UDP-glucose pyrophosphorylase is highly polymorphic and suitable for molecular typing and phylogenetic studies; Mollerach M et al.; The enzyme UTP-glucose-1-phosphate uridylyltransferase (UDP-glucose pyrophosphorylase, UDPG:PP) is synthesized by practically all organisms, although prokaryotic UDPG:PPs are evolutionarily unrelated to the eukaryotic counterparts . The primary structure of prokaryotic UDPG:PPs is well conserved, although little information exists on the polymorphism of the genes coding for these enzymes . It has been reported that the galU gene encoding the Streptococcus pneumoniae UDPG:PP is absolutely required for the synthesis of the capsular polysaccharide, a sine qua non prerequisite for virulence . A 594 bp fragment covering 66% of the galU gene from 37 pneumococcal isolates and the type strains of Streptococcus mitis, Streptococcus oralis, Streptococcus gordonii, Streptococcus sanguinis, Streptococcus salivarius, and Streptococcus sobrinus has been amplified by PCR and sequenced . Up to 21 different alleles were found in S . pneumoniae . They possess a mosaic-like structure and belong to, at least, two evolutionarily distinct families that show a sequence divergence of 15-20% . In spite of its marked polymorphism, phylogenetic relationships among pneumococcal strains deduced from the galU gene matched those previously established by using alternative approaches . Comparison of the pneumococcal galU alleles with those from other streptococci indicated the existence of a complex network of genetic interchange . The galU gene represents an informative marker to be used alone or in conjunction with other molecular typing methods. J Clin Microbiol, 2001 Jan, 39(1), 392 - 3 Skin disease presenting as an outbreak of pseudobacteremia in a laboratory worker; Simhon A et al.; An outbreak of pseudobacteremia due to Streptococcus pyogenes (group A streptococci {GAS}) and methicillin-susceptible Staphylococcus aureus (MSSA) was traced to the venting procedure for aerobic bottles prior to their loading into the incubator of the BacT/Alert analyzer (Organon Teknika) . Bacteria shed by a laboratory worker suffering from impetigo and cellulitis contaminated the aerobic bottles of 10 patients . All blood culture isolates, in addition to the isolates from the laboratory worker, were of the same GAS M and T types . All MSSA isolates from blood cultures and the index case's hands had the same lytic phage profile . Procedural breakdowns were identified in the laboratory . Bottles were vented outside the biological safety cabinet, gloves were not worn, and unprotected needles were used for the venting procedure . The source of the aspirated bacteria that contaminated the bottles was identified and the index case was treated promptly. Mol Microbiol, 2001 Jan, 39(2), 236 - 47 Genetic basis for the beta-haemolytic/cytolytic activity of group B Streptococcus; Pritzlaff CA et al.; Group B streptococci (GBS) express a beta-haemolysin/cytolysin that contributes to disease pathogenesis . We report an independent discovery and extension of a genetic locus encoding the GBS beta-haemolysin/cytolysin activity . A plasmid library of GBS chromosomal DNA was cloned into Escherichia coli, and a transformant was identified as beta-haemolytic on blood agar . The purified plasmid contained a 4046 bp insert of GBS DNA encoding two complete open reading frames (ORFs) . A partial upstream ORF (cylB) and the first complete ORF (cylE) represent the 3' end of a newly reported genetic locus (cyl) required for GBS haemolysin/cytolysin activity . ORF cylE is predicted to encode a 78.3 kDa protein without GenBank homologies . The GBS DNA fragment also includes a previously unreported ORF, cylF, with homology to bacterial aminomethyltransferases, and the 5' end of cylH, with homology to 3-ketoacyl-ACP synthases . Southern analysis demonstrated that the cyl locus was conserved among GBS of all common serotypes . Targeted plasmid integrational mutagenesis was used to disrupt cylB, cylE, cylF and cylH in three wild-type GBS strains representing serotypes Ia, III and V . Targeted integrations in cylB, cylF and cylH retaining wild-type haemolytic activity were identified in all strains . In contrast, targeted integrations in cylE were invariably non-haemolytic and non-cytolytic, a finding confirmed by in frame allelic exchange of the cylE gene . The haemolytic/cytolytic activity of the cylE allelic exchange mutants could be restored by reintroduction of cylE on a plasmid vector . Inducible expression of cylE, cylF and cylEF demonstrated that it is CylE that confers haemolytic activity in E . coli . We conclude that cylE probably represents the structural gene for the GBS haemolysin/cytolysin, a novel bacterial toxin. J Cataract Refract Surg, 2000 Dec, 26(12), 1786 - 91 Intraocular bacterial contamination during sutureless, small incision, single-port phacoemulsification; John T et al.; PURPOSE: To evaluate the incidence of anterior chamber bacterial contamination during no-stitch, 1-handed, small incision phacoemulsification . SETTING: Little Company of Mary Hospital, Evergreen Park, Illinois, USA . METHODS: This study comprised 53 eyes of 46 patients . Topical gentamicin sulfate was administered 1 hour preoperatively . After povidone-iodine cleansing solution and povidone-iodine paint (5% and 10%) were applied, the eyes were draped in a sterile manner . Aqueous fluid was aspirated upon entering the anterior chamber and at the end of surgery; the specimens were cultured for up to 14 days . All eyes had no-stitch, 1-handed, small incision phacoemulsification with implantation of a foldable acrylic posterior chamber intraocular lens through a 3.5 mm scleral tunnel incision . RESULTS: Three specimens (5.7%) aspirated on entry into the anterior chamber were positive for microorganisms . Of the cultures obtained at the end of surgery, 4 (7.5%) were positive for microorganisms . All posterior lens capsules were intact . The following organisms were cultured at the end of phacoemulsification: alpha-streptococci, micrococci, saprophytic mold, alpha-viridans streptococci, coagulase-negative Staphylococcus species, and anaerobic positive cocci . No eye developed endophthalmitis . CONCLUSIONS: The incidence of anterior chamber bacterial contamination was low . Bacterial contamination of the anterior chamber occurred at the beginning and toward the end of phacoemulsification . Staphylococcus species was the most common organism in the beginning, while Streptococcus species was the most common at the end . Saprophytic mold was present only at the end . No eye developed endophthalmitis. J Bacteriol, 2001 Jan, 183(2), 621 - 7 Biochemical characterization of signal peptidase I from gram-positive Streptococcus pneumoniae; Peng SB et al.; Bacterial signal peptidase I is responsible for proteolytic processing of the precursors of secreted proteins . The enzymes from gram-negative and -positive bacteria are different in structure and specificity . In this study, we have cloned, expressed, and purified the signal peptidase I of gram-positive Streptococcus pneumoniae . The precursor of streptokinase, an extracellular protein produced in pathogenic streptococci, was identified as a substrate of S . pneumoniae signal peptidase I . Phospholipids were found to stimulate the enzymatic activity . Mutagenetic analysis demonstrated that residues serine 38 and lysine 76 of S . pneumoniae signal peptidase I are critical for enzyme activity and involved in the active site to form a serine-lysine catalytic dyad, which is similar to LexA-like proteases and Escherichia coli signal peptidase I . Similar to LexA-like proteases, S . pneumoniae signal peptidase I catalyzes an intermolecular self-cleavage in vitro, and an internal cleavage site has been identified between glycine 36 and histidine 37 . Sequence analysis revealed that the signal peptidase I and LexA-like proteases show sequence homology around the active sites and some common properties around the self-cleavage sites . All these data suggest that signal peptidase I and LexA-like proteases are closely related and belong to a novel class of serine proteases. J Med Microbiol, 2000 Dec, 49(12), 1069 - 74 PCR for detection and identification of Streptococcus sobrinus; Igarashi T et al.; Oligonucleotide primers were designed based upon a comparison of the dextranase gene (dex) sequences from Streptococcus sobrinus and S . mutans . The primers amplified a 1610-bp long DNA fragment on the dex gene by a PCR . The pair of primers was specific to S . sobrinus as the other members of the mutans streptococci - S . mutans, S . downei, S . cricetus, S . rattus, S . macacae and S . ferus - gave no PCR products . Other gram-positive oral bacteria (15 strains of 10 species of cocci and 18 strains of 12 species of rods) and gram-negative oral bacteria (3 strains of 3 species of cocci and 31 strains of 22 species of rods) also gave negative results in the PCR . The PCR procedure was able to detect as little as 100 fg of purified chromosomal DNA or as few as 9 cfu of S . sobrinus NIDR6715 . Seven clinical isolates of S . sobrinus were also positive in the dex PCR . This laboratory developed the S . mutans-specific PCR (dexA PCR) method with the primers specific for a portion of the dextranase gene of S . mutans Ingbritt . Primers for the dex and dexA PCR methods detected two species exclusively from the mutans streptococci . Furthermore, these two species were effectively differentiated by the species-specific amplicons with different lengths . The application of the PCR method to human dental plaque showed that the prevalence of S . sobrinus (83%) in oral cavities was higher than currently supposed (0-50%) . These results suggest that the described PCR method is suitable for the specific detection and identification of human cariogenic bacteria, S . sobrinus and S . mutans. J Chemother, 2000 Oct, 12(5), 379 - 84 Postantibiotic effects and postantibiotic sub-MIC effects of amoxicillin on Streptococcus gordonii and Streptococcus sanguis; Lee SY; Amoxicillin is one of the most frequently recommended antibiotics for prophylaxis of infective endocarditis in dental/oral procedures . In this study, the postantibiotic effect (PAE), postantibiotic sub-MIC (PASME) and sub-MIC effect (SME) of amoxicillin on oral streptococci, Streptococcus gordonii and Streptococcus sanguis, which are two of the major etiological agents in infective endocarditis, were investigated . The PAE was induced by 10 x MIC of amoxicillin for 2 h and the antibiotic was eliminated by washing . The PASMEs were studied by addition of 0.1, 0.2 and 0.3 x MICs during the postantibiotic phase of the bacteria, and the SMEs were studied by exposing bacteria to amoxicillin at the sub-MICs only . The PAE of amoxicillin was 2.0 h with S . gordonii DL1 and 0.7 h with S . sanguis MPC1 . The PASME and SME of amoxicillin were observed both for S . gordonii DL1 and for S . sanguis MPC1 . However, the durations of effects for S . sanguis MPC1 were shorter than those for S . gordonii DL1 . The PASME values for both strains increased as the concentration of amoxicillin increased . The PASME values for both strains were substantially longer than the SME values . The present study illustrates the existence of PAE, PASME and SME for amoxicillin against S . gordonii and S . sanguis, thereby extending the pharmacodynamic advantages of amoxicillin for these bacteria in the prophylaxis procedures of infective endocarditis. Indian J Pathol Microbiol, 1999 Oct, 42(4), 417 - 9 Bacteremia due to beta haemolytic streptococci; Jesudasan MV et al.; The Beta haemloytic streptococci (BHS) are well recognised human pathogens causing a variety of infections, including septicemia . It is important to ensure their isolation from clinical specimens by using optimum media . Moreover, since the different groups have different pathogenic potential, it is equally important to routinely serogroup them; this is emphasized here . Since, BHS are uniformly will greatly decrease morbidity and mortality due to BHS infection. Caries Res, 2001 Jan-Feb, 35(1), 75 - 80 Diverse activity spectra of bacteriocin-like inhibitory substances having activity against mutans streptococci; Balakrishnan M et al.; Mutans streptococci (MS) are known to be causative agents of dental caries . It has been suggested that these cariogenic bacteria could be eliminated from dental plaque by application of bacteriocins or bacteriocin-like inhibitory substances (BLIS) . In the present study 272 bacterial strains of the genera Streptococcus, Enterococcus and Staphylococcus were tested for their production of BLIS activity against MS by use of a deferred antagonism test on agar media supplemented with either whole blood or yeast extract . Although only 14.3% of the test strains displayed anti-MS activity, the inhibitory agents produced by these strains were characterised by considerable diversity in the range of their inhibitory action against both MS and other common oral streptococcal species . It is suggested that combinations of relatively specifically targeted anti-MS BLIS may have potential application to the prevention of dental caries. Mol Microbiol, 2000 Dec, 38(5), 1004 - 16 Life in protein-rich environments: the relA-independent response of Streptococcus pyogenes to amino acid starvation; Steiner K et al.; Considering that group A streptococci are multiple auxotrophs that may encounter shortage of amino acids during specific stages of the infectious process, we studied their adaptive response to amino acid deprivation . We found that, in addition to the (p)ppGpp-mediated stringent response characterized previously, Streptococcus pyogenes exhibits a relA-independent response comprising transcriptional modulation of a specific subset of genes involved in pathogenesis . Genes/operons transcriptionally upregulated during starvation of both wild type and relA mutants included the two-component signal transduction system covRS, the positive regulator (ropB) of the pyrogenic exotoxin B gene, speB, the oligopeptide (opp) and dipeptide (dpp) permease systems and the pepB gene putatively involved in the intracellular processing of oligopeptides . Upregulation of covRS was accompanied by downregulation of ska, one of the target genes of the negative CovR regulator, and the net effect of amino acid starvation also favoured repression of speB . A significant feature of upregulated opp expression was stimulated readthrough transcription of the operon-internal oppA terminator, leading to increased mRNA levels for synthesis of the translocator complex relative to the substrate-binding protein . Based on these and previous results, a stimulus-response network is proposed that counteracts the stringent response and may enable the pathogen to mount a dynamic response to the protein-rich environment provided by its human host. Antimicrob Agents Chemother, 2001 Jan, 45(1), 263 - 6 Disruption of an Enterococcus faecium species-specific gene, a homologue of acquired macrolide resistance genes of staphylococci, is associated with an increase in macrolide susceptibility; Singh KV et al.; The complete sequence (1,479 nucleotides) of msrC, part of which was recently reported by others using a different strain, was determined . This gene was found in 233 of 233 isolates of Enterococcus faecium but in none of 265 other enterococci . Disruption of msrC was associated with a two- to eightfold decrease in MICs of erythromycin azithromycin, tylosin, and quinupristin, suggesting that it may explain in part the apparent greater intrinsic resistance to macrolides of isolates of E . faecium relative to many streptococci . This endogenous, species-specific gene of E . faecium is 53% identical to msr(A), suggesting that it may be a remote progenitor of the acquired macrolide resistance gene found in some isolates of staphylococci. Infect Immun, 2001 Jan, 69(1), 551 - 5 Severity of group B streptococcal arthritis in selected strains of laboratory mice; Puliti M et al.; The susceptibilities of C3H/HeN, BALB/c, and C57BL/6N mouse strains to group B streptococci (GBS) infection were evaluated . C3H/HeN mice developed severe polyarthitis; mild lesions and no lesions were observed in BALB/c and C57BL/6N mice, respectively . A correlation between the severity of arthritis, the number of GBS in the joints, and local interleukin-6 and interleukin-1beta production was evident. Infect Immun, 2001 Jan, 69(1), 58 - 64 Characterization of a streptococcal endopeptidase with homology to human endothelin-converting enzyme; Oetjen J et al.; A gene encoding an endopeptidase from Streptococcus parasanguis FW213 has been cloned and shown to have high sequence homology to genes encoding mammalian metalloendopeptidases . The gene, designated S . parasanguis pepO, was cloned into the pET28a expression vector, resulting in a fusion of vector sequences encoding a hexahistidine tag at the carboxyl terminus . The recombinant PepO (rPepO) was expressed in Escherichia coli and purified using an Ni(2+) affinity column . Polyclonal antiserum to rPepO was raised in rabbits and used to localize FW213 PepO to the cytosol . Southern hybridization and immunoblot analysis revealed that other oral streptococci contain regions of DNA with homology to pepO and produce a protein with antigenic properties similar to that of FW213 PepO . Enzymatic activity assays indicated that only S . parasanguis species possess the ability to cleave metenkephalin, the natural substrate of the human neutral endopeptidase (NEP) . Inhibition assays revealed that S . parasanguis PepO is a member of the M13 category of metalloendopeptidases, which includes NEP and endothelin-converting enzyme 1 (ECE-1), an enzyme involved in the maintenance of vascular tone . Thiorphan and phosphoramidon, two specific inhibitors of this category of endopeptidases, were used to determine that S . parasanguis PepO is more similar to ECE-1 than to NEP. FEMS Immunol Med Microbiol, 2000 Dec, 29(4), 289 - 94 Streptococcus pneumoniae heat shock protein 70 does not induce human antibody responses during infection; Kolberg J et al.; Mouse monoclonal antibodies (mAbs) were developed against Streptococcus pneumoniae in search for potential common pneumococcal proteins as vaccine antigens . mAb 230,B-9 (IgG1) reacted by immunoblotting with a 70-kDa protein which was isolated by immunoaffinity chromatography and subsequent preparative electrophoresis . N-terminal amino acid sequencing showed homology to that of heat shock protein 70 (hsp70) . The hsp70 epitope reactive with mAb 230,B-9 was found in all the pneumococci examined as well as in other streptococci and enterococci . The epitope was not expressed in several other examined Gram-positive or -negative bacteria . Pneumococcal hsp70 has by other investigators been proposed to be a vaccine candidate . Binding experiments using flow cytometry showed that the epitope was not surface-exposed on live exponential phase grown S . pneumoniae . Human patient sera did not react with affinity-purified pneumococcal hsp70 . Therefore the pneumococcal hsp70 does not seem to be of special interest in a vaccine formulation . The human sera contained antibodies to high molecular proteins co-purified with hsp70 . Some of these proteins could be the pneumococcal surface protein A. Epidemiol Infect, 2000 Oct, 125(2), 299 - 301 Genetic relatedness of group A streptococci of the newly designated serotype M90 causing a food-borne outbreak and sporadic infections; Pournaras S et al.; Twenty-six isolates of the newly designated M90 serotype group A Streptococcus (GAS) from a large food-borne outbreak of pharyngitis in Greece and six M90 sporadic isolates from UK, were typed by pulsed-field gel electrophoresis (PFGE) . Twenty-four outbreak isolates were identical and two closely related . The Greek isolates were possibly related with one UK isolate, while other sporadic isolates exhibited distinct PFGE profiles from the former isolates. APMIS, 2000 Sep, 108(9), 573 - 80 Changed expression of leukocyte adhesion molecules and increased production of reactive oxygen species caused by Streptococcus pyogenes in human whole blood; Saetre T et al.; To elucidate the innate immune responses to group A streptococci (GAS) important in the pathophysiology of sepsis, flow cytometric techniques were applied to study the effects of live and heat-inactivated GAS, including their particulate and soluble components, on the expression of leukocyte adhesion molecules CD11b (Mac-1) and CD62L (L-selectin), and leukocyte production of reactive oxygen species (ROS) in human whole blood . GAS caused marked time- and concentration-dependent increases in CD11b and ROS, while CD62L was downregulated . Live and heat-inactivated GAS induced similar changes in leukocyte adhesion molecules, whereas ROS production induced by heat-inactivated GAS (and its particulate fraction) was 4 (2.5)-fold higher than with live GAS . Leukocyte nitric oxide production (24 h) was not enhanced . Although GAS proved a more potent inducer of ROS production, leukocyte responses to GAS were similar to those reported for lipolysaccharides, indicating that Gram-positive and Gram-negative bacteria activate common pathways in the inflammatory response . High ROS production may contribute to tissue damage caused by GAS. Arch Pediatr, 2000 Nov, 7(11), 1194 - 6 {Perianal streptococcal dermatitis}; Souillet AL et al.; BACKGROUND: Pediatric perianal streptococcal dermatitis (PSD) is a well-defined clinical entity . However, its highly uniform presentation remains surprisingly unrecognized by many practitioners 33 years after its first description . CASE REPORT: A seven-year-old girl had a three-week history of perianal and vulva redness with well-defined margins . Functional symptoms associated perirectal tenderness and pain during defecation, which was responsible for constipation . At onset she also presented with a sore throat, which resolved spontaneously, and she had been complaining for a few days about a perioral impetigo . She received mycostatin unsuccessfully for an alleged candidiasis . Positive cultures for group A beta-hemolytic streptococci from both perirectal and perioral swabs confirmed the diagnosis of PSD . Therapy with amoxicillin (50 mg/kg/d) was prescribed for ten days . Perianal lesions were cleared by day 2 . CONCLUSION: Since PSD can masquerade as candidiasis, psoriasis, seborrheic dermatitis, inflammatory bowel disease or even sexual abuse, it remains an underdiagnosed entity . This situation leads to delayed diagnosis and treatment which in turn might increase the frequency of secondary complications related to streptococcal infections (i.e., post-streptococcal acute nephritis and rheumatism, guttate psoriasis, etc.). J Public Health Dent, 2000 Summer, 60(3), 159 - 66 Rampant early childhood dental decay: an example from Italy; Petti S et al.; OBJECTIVES: This study sought to estimate the prevalence and related prediction factors for dental caries in 3- to 5-year-old children in Rome, Italy . METHODS: From a sample of 2,025 children, 1,494 (73.8%) were included in the analysis . Children with at least two primary maxillary incisors showing evidence of caries experience were considered affected by rampant early childhood dental decay (RECDD) . Behavioral and socioeconomic variables, mutans streptococci counts, diet, and nutritional status were investigated for their association with RECDD using regression analysis . RESULTS: The prevalence of any caries was 27.3 percent, and was 7.6 percent for RECDD . Among all children, mean dft and dt scores per person were 1.1 (SD = 2.4) and 0.9 (SD = 2.3), respectively; among those classified as having RECDD, scores were 6.9 (SD = 4.2) and 6.7 (SD = 4.3), respectively . Children with RECDD had 56 percent of all the decayed teeth in the sample . Low and medium social classes, use of a baby bottle filled with sweetened beverages, high salivary mutans streptococcal levels, and malnutrition were directly associated with RECDD; milk and yogurt consumption and low Plaque Index scores were inversely associated with the condition . CONCLUSIONS: The high prevalence of RECDD suggests that the implementation of preventive programs should be a priority for dental public health . Because of its high prevalence among children as young as 3 years of age, preventive measures targeted toward pregnant women and toddlers should be developed and tested, while kindergarten students could be used for monitoring RECDD prevalence and for detection of communities at risk. Minerva Pediatr, 2000 Jul-Aug, 52(7-8), 375 - 9 Childhood glomerulonephritis associated with varicella and streptococcal infection; Miceli Sopo S et al.; Varicella is a usually benign disease of childhood and its complications are uncommon in immunocompetent children . In recent years we have witnessed the increasing virulence of group A beta-haemolytic streptococci (GABHS) . In particular, in 1993, 50% of new cases of invasive GABHS disease were associated with varicella infection and all were suppurative complications . Because also a non suppurative complication of varicella as glomerulonephritis associated with GABHS infection, has been published in only one case, we feel that it could be of interest to describe this condition in two other cases we have observed. Crit Care Med, 2000 Nov, 28(11), 3684 - 91 Contact activation in shock caused by invasive group A Streptococcus pyogenes; Sriskandan S et al.; OBJECTIVES: The aim of this study was to characterize abnormalities of coagulation in mice with experimental, invasive group A, streptococcal shock, in an attempt to explain the prolongation of the activated partial thromboplastin time identified in patients with streptococcal toxic shock syndrome . DESIGN: A longitudinal descriptive animal model study of coagulation times and single coagulation factors in mice infected with Streptococcus pyogenes . This was followed by an experimental study to determine whether streptococci or streptococcal products could activate the human contact system in vitro . SETTING: University infectious diseases and hemostasis molecular biology laboratories . SUBJECTS: CD1 outbred mice . INTERVENTIONS: None . MEASUREMENTS AND MAIN RESULTS: Coagulation times, single factor assays, and bradykinin assays were conducted on murine plasma at different times after streptococcal infection and compared with uninfected mice . In experiments in which streptococcal products were co-incubated with human plasma, we compared coagulation times, single factor assays, and activities against a range of chromogenic substrates with control plasma . In a murine model of streptococcal necrotizing fasciitis, the activated partial thromboplastin times were significantly prolonged in infected mice compared with controls, whereas prothrombin times were normal, suggesting an isolated abnormality of the intrinsic pathway . Bleeding was not seen . Prolongation of activated partial thromboplastin time was associated with reduced factor XII and prekallikrein, whereas levels of factors VIII, IX, XI, and high molecular weight kininogen were elevated . In vitro studies suggested that streptococcal supernatants can activate prekallikrein, in addition to causing plasminogen activation through the action of streptokinase . CONCLUSIONS: Prolongation of activated partial thromboplastin time in streptococcal toxic shock syndrome is associated with activation of the contact system, possibly contributing to the profound shock associated with streptococcal toxic shock syndrome. Dtsch Med Wochenschr, 2000 Oct 20, 125(42), 1257 - 9 {Contagious impetigo--pathogen spectrum and therapeutic consequences}; Abeck D et al.; OBJECTIVE: The aim of this prospective study was to compare the clinical picture of contagious impetigo (C.I.) with the causative organism and to generate data of the susceptibility of bacteria as the basis for adequate therapy . PATIENTS AND METHODS: In 126 patients with C.I . (86 children, 66 of them younger than 10 years) bacterial swabs were taken and antibiotic sensitivity testing for isolated organisms was tested . RESULTS: In all cases in which contents of vesicles or pustules were analysed, Staphylococcus aureus was the only pathogen isolated . In non-bullous variants of C.I . Staphylococcus aureus was the most often isolated organism as well . Both staphylococci and streptococci were isolated in 12 cases, whereas in just 9 cases streptococci were the only pathogen detected . All Staphylococcus aureus isolates were sensitive to flucloxacillin and cefotaxime . Erythromycin-resistance amounted to more than 20 percent . The percentage of resistant staphylococci against the predominantly topically applied antibiotics fusidinic acid and mupirocin was 2 and 0 per cent, respectively . CONCLUSION: For all manifestations of C.I . Staphylococcus aureus is at present the leading organism which has to be taken into consideration for treatment . If oral antibiotic therapy is indicated, penicillinase-stable penicillins or cephalosporins, preferably of the cefalexin-type, are the drugs of choice . Macrolides are no longer recommended for initiating of C.I . treatment. Folia Microbiol (Praha), 1999, 44(6), 735 - 6 Protein G expressed by human group C and G streptococci: cloning of gene and binding properties; Voltchek N et al.; PCR generated fragments of the protein G gene from three GCS and GGS strains belonging to different G types had been cloned . The resulting PCR products were cloned into E . coli using expression vector pQE31 . The clones, producing IgG-binding peptides were selected . Recombinant plasmids carried different inserts and encoded proteins of different size and with different binding properties. Folia Microbiol (Praha), 1999, 44(6), 726 - 8 Cloning and expression of gene fragment IgA-binding protein of group B streptococci; Ustinovitch I et al.; Different fragments of the bac gene coding for the IgA-binding protein were cloned, sequenced and expressed in E . coli . Cloning was accomplished after amplification of different parts of the gene by PCR . The 1.5-kb fragment of the gene was cloned using plasmid pBluescript . This fragment coded for the 45-kDa protein with the stable expression of IgA binding . In order to verify the exact location of the IgA-binding domain two smaller plasmids were constructed . Both plasmids were prepared using pQE30 (31, 32) expression vectors from Qiagen . The plasmids carried 245 and 123 bp bac gene fragments encoding 14- and 7-kDa proteins . These proteins together with the 20-amino-acid oligopeptide ITNEDKDSMLKKIEDINRQA were tested for IgA binding . Only the 14-kDa protein was able to bind IgA . This protein was used for rabbit immunization and found to be immunogenic . The data obtained lead to the conclusion that there is a lower limit in the size of recombinant IgA-binding proteins that can be utilized for anti-GBS vaccination. Folia Microbiol (Praha), 1999, 44(6), 703 - 5 Characterization of clinical isolates of group C and G streptococci on the basis of protein G gene; Gupalova T et al.; Treatment of human group C and G streptococci with cyanogen bromide results in solubilization of surface protein G molecules . Strain-to-strain variation in the quantity, molar mass and functional activity of protein G extracted from representative group C and G isolates led to the identification of three structurally and functionally distinct forms of the protein . Using different molecular biological approaches it was possible to determine the group of streptococci (C or G), or the quantity of IgG and HSA domains. Biochem Biophys Res Commun, 2000 Nov 30, 278(3), 826 - 32 Analysis of expression of a cytosolic enzyme on the surface of Streptococcus pyogenes; D'Costa SS et al.; The normally cytosolic glycolytic enzyme, glyceraldehyde-3-phosphate dehydrogenase, (GAPDH) has been reported to be expressed on the surface of Streptococcus pyogenes, group A, where it can act as a plasmin binding protein (Plr), and potentially a signaling molecule . In studies of wild-type and isogenic mutants, an association between surface expression of antigenic GAPDH/Plr and M and M-related fibrinogen-binding proteins was identified . Inactivation of the mga gene, whose product controls expression of M and M-related proteins also influenced expression of surface GAPDH/Plr . Revertants or pseudorevertants of mga mutants led to concomitant re-expression of surface GAPDH/Plr and M and M-related proteins . Using surface enhanced laser desorption ionization (SELDI) mass spectroscopy, a physical association between GAPDH/Plr and streptococcal fibrinogen-binding proteins was demonstrated . These studies support the hypothesis that surface M and M-related proteins are involved in anchoring GAPDH/Plr on the surface of group A streptococci . Curr Infect Dis Rep, 1999 Aug, 1(3), 253 - 260 A Current Approach to Diabetic Foot Infections; Lipsky BA; Foot infections are a common, complex, and serious problem in diabetic patients . Infections usually begin in foot ulcers, which are associated with neuropathy, vasculopathy, and various metabolic disturbances . These infections are potentially limb and sometimes life threatening . Etiologic agents are usually aerobic gram-positive cocci, but chronic or serious infections often contain gram-negative rods and anaerobes . Chronic infections can lead to contiguous bone infection . Diagnosing osteomyelitis may require imaging studies (especially magnetic resonance imaging) and occasionally bone biopsy . In addition to proper cleansing, debridement, and local wound care, diabetic foot infections require carefully selected antibiotic therapy . Serious infections necessitate hospitalization for initial parenteral broad-spectrum antibiotic therapy, but appropriately selected patients with mild infections can be treated as outpatients with oral (or even topical) agents . Initial antibiotic selection is usually empiric; modifications may be needed based on the results of properly obtained cultures and the clinical response . Therapy should be active against staphylococci and streptococci, with broader-spectrum agents indicated if polymicrobial infection is likely . Levels of most antibiotics, except fluoroquinolones, are often subtherapeutic in infected foot tissues . The duration of therapy ranges from a week (for mild soft tissue infections) to over 6 weeks (for osteomyelitis) . No single antibiotic agent or combination has proven to be optimal . With appropriate local, surgical, and antimicrobial therapy, most diabetic foot infections can now be successfully treated. Curr Infect Dis Rep, 1999 Aug, 1(3), 230 - 237 Therapeutic Approaches to Streptococcal Toxic Shock Syndrome; Baracco GJ et al.; The streptococcal toxic shock syndrome (STSS) is a severe, life-threatening condition characterized by hypotension and multiorgan system dysfunction associated with infection by the group A Streptococcus (GAS) or rarely by streptococci of other Lancefield serogroups . It is associated with a soft tissue infection, such as necrotizing fasciitis, in about half of the cases; the remainder are secondary to a variety of other invasive and noninvasive GAS infections . Although the pathophysiology of STSS is not yet fully understood, there are compelling reasons to believe that the syndrome results at least in part from the action of the streptococcal pyrogenic exotoxins, which act as superantigens . Patients with STSS should be admitted to an intensive care unit for support of cardiovascular, respiratory, and renal function as required . In experimental models of overwhelming GAS infection, clindamycin has greater efficacy than penicillin, and therapy with this agent is recommended . Penicillin, to which GAS are uniformly susceptible, may be used in addition to clindamycin . Limited clinical experience, most of which is anecdotal, suggests marked improvement in some STSS patients after administration of intravenous immunoglobulin . Even in the absence of conclusive data, the potential benefits of intravenous immunoglobulin in this highly lethal disease make its use reasonable in life-threatening cases . Other experimental approaches are also discussed, such as the use of anti-tumor necrosis factor monoclonal antibodies and plasmapheresis. Caries Res, 2000 Nov-Dec, 34(6), 486 - 90 Strain-related acid production by oral streptococci; de Soet JJ et al.; Acid production, in particular at low pH, is thought to be an important ecological determinant in dental caries . The aim of the present study was to determine the acid producing capability at different pH levels of 47 streptococcal strains, representing 9 species, isolated from human dental plaque . The bacteria were grown until mid log-phase under anaerobic conditions and acid production was measured in a pH-stat system at pH 7.0, 6.0, 5.5 and 5.0 . At all pH values, the mean velocity of acid production (V(ap)) by Streptococcus mutans and S . sobrinus was significantly higher (p<0.01; ANOVA) than that of the other oral streptococci, including S . mitis, S . oralis, S . gordonii, S . sanguis, S . intermedius, S . anginosus, S . constellatus, and S . vestibularis . However, the V(ap) of some strains of S . mitis biovar 1 and S . oralis, particularly at pH values of 7.0 and 6.0, exceeded that of some strains of S . mutans . The V(ap) decreased with pH for all strains, but some strains of S . mitis biovar 1 and strains of the mutans streptococci maintained a relatively high rate of acid production . The results suggest that some strains of S . mitis biovar 1 and S . oralis may play an important role in caries development by modifying the environment in dental plaque to become favourable for the succession of aciduric species . The study furthermore emphasises the need for detailed species and biovar identification of oral streptococci and for recognition of the significant physiological differences that occur within single species. Caries Res, 2000 Nov-Dec, 34(6), 481 - 5 Similarity of bacteriocin activity profiles of mutans streptococci within the family when the children acquire the strains after the age of 5; van Loveren C et al.; It has been shown that there is a window of infectivity for mutans streptococci between the ages of 19 and 31 months, when many children acquire mutans streptococci transmitted from their mothers . Part of the children that escape this window acquire mutans streptococci at a later age . In this group, maternal transmission is expected to be less prevalent . The present study compared the bacteriocin activity profiles of mutans streptococci isolated from mothers, fathers and children when the children acquired the mutans streptococci between the ages of 5 and 11 . Twelve families were randomly selected from a group of 11-year-old children who were known to have acquired mutans streptococci during this age period . From the saliva of the mothers (n = 12), fathers (n = 8) and children (n = 12) approximately 30 mutans streptococci strains were isolated . All isolates were tested twice for bacteriocin activity against 21 indicator strains with a double-layer technique . Bacteriocin activity of strains was considered to be different when the number of strains against which bacteriocin was produced differed >1 or when the width of one or more inhibition zones differed > or =4 mm . In 7/12 mother-child pairs similar profiles were found . In the 8 father-child pairs similar profiles were only found on 2 occasions . In these 2 families, all 3 ( mother, father and child) harboured strains with a similar profile . In 4/8 father-mother pairs similar profiles were found . There was no correlation between the prevalence of mutans streptococci strains, the number of indicator strains against which the strains made bacteriocin, nor the mean size of the inhibition zones and the presence of similarity of bacteriocin activity profiles of mutans streptococci within the family members . The results show that even when a child acquires mutans streptococci after the age of 5, there may be similarity between mutans streptococci in mother, father and child, indicating that transmission between the family members occurs. Caries Res, 2000 Nov-Dec, 34(6), 474 - 80 Site-specific oral colonization of mutans streptococci detected by arbitrarily primed PCR fingerprinting; Gronroos L et al.; The clonal diversity and colonization pattern of mutans streptococci within an individual were studied by using a total of 50 tooth site samples obtained from seven 3- to 7-year-old children . Five children contributed saliva samples . From the 7 subjects, 90, 74, 81, 53, 83, 103, and 114 isolates (a total of 598) representing Streptococcus mutans and Streptococcus sobrinus were included for arbitrarily primed polymerase chain reaction (AP-PCR) fingerprinting . The children harbored one to four different AP-PCR types of mutans streptococci . In 3 of the 7 children, the distribution of AP-PCR types of S . mutans differed depending on tooth site (chi-square test for heterogeneity, p<0.001), suggesting that mutans streptococcal clones may selectively colonize specific hard-tissue sites. J Agric Food Chem, 2000 Nov, 48(11), 5666 - 71 Inhibitory effects of apple polyphenols and related compounds on cariogenic factors of mutans streptococci; Yanagida A et al.; The inhibitory effects of apple polyphenols (APP) on the synthesis of water-insoluble glucans by glucosyltransferases (GTF) of streptococci of the mutans group and on the sucrose-dependent adherence of the bacterial cells were examined in vitro . APP markedly inhibited the activity of GTF purified from the cariogenic bacterial cells . However, APP showed no significant effect on the growth of the cariogenic bacteria . The strongest GTF inhibitors in APP were apple condensed tannins (ACT), a mixture of procyanidins . The 50% inhibitory doses of ACT against the GTF of S . sobrinus and that of S . mutans were 1.5 microgram/mL and 5 microgram/mL, respectively . The ACT efficacy largely depended upon the degree of polymerization . Interestingly, while the other polyphenols known to inhibit GTF such as tannic acid markedly inhibited salivary alpha-amylase activity, APP and ACT only scarcely inhibited that enzyme activity . This means that APP and ACT might selectively inhibit the bacterial GTF activity under oral conditions. Ned Tijdschr Geneeskd, 2000 Nov 4, 144(45), 2148 - 52 {An outbreak of scarlet fever, impetigo and pharyngitis caused by the same Streptococcus pyogenes type T4M4 in a primary school}; Hoebe CJ et al.; EPIDEMIC: Following the notification of an unusual number of scarlet fever cases within the same primary school, the epidemiological and clinical features of the outbreak were investigated . Questionnaire information about the cases was collected from parents and general practitioners per telephone . Throat specimens were taken, before and after treatment, for culturing and specific typing of streptococci was performed to determine transmission . Within a period of one month, 21 schoolchildren in a class of 29 pupils, with a mean age of 5 years, presented with symptoms caused by streptococcal infection (attack rate: 72%) . Eight had scarlet fever, 5 suffered from impetigo and 8 had pharyngitis . A further 6 children, outside of this class, had complaints of scarlet fever, impetigo or pharyngitis . For 90% (26/29) of the schoolchildren a throat culture was established . Twelve positive cultures of the same strain of beta-haemolytic group A streptococcus, T4M4 exotoxin C gene positive, were found . The advice given was to treat all positive children for 3 days with azithromycin to prevent complications and further spreading of the disease . After two weeks only one child, that had not taken the antibiotics, still had a positive throat culture . No further cases or complications were reported . DISCUSSION: The pattern of the outbreak was typical of a person-to-person transmission . This was confirmed by typing of the isolates . The results of this study demonstrate the importance of mandatory notification of infectious clusters by institutions, such as schools, as introduced in the new Dutch Infectious Disease Act . On the one hand, the notification gives the municipal health authority the opportunity to analyse source and transmission dynamics and on the other to prevent disease and complications. Pediatr Dermatol, 2000 Sep-Oct, 17(5), 360 - 3 The effects of amoxicillin therapy on skin flora in infants; Brook I; In order to determine the effect of amoxicillin therapy on the perineal skin microbial flora in infants, we took quantitative bacterial and fungal cultures of perineal and sternal areas from 25 infants treated with amoxicillin (40 mg/kg/day) for 10 days . Specimens were obtained prior to therapy, within 3 days of conclusion of therapy, and 14-16 days later . Immediately following therapy, a decline in the number of bacterial isolates occurred on both the perineum (89 to 47) and sternum (84 to 39) . The greatest decline occurred in the number of anaerobic bacteria (mostly Peptostreptococcus spp . and Propionibacterium acnes) . Other organisms that were less often isolated were aerobic streptococci and Staphylococcus epidermidis . The number of Candida albicans isolates increased from 3 to 11 (p < 0.05) on the perineum, and 1 to 7 (p < 0.025) on the sternum . Four of the infants developed diaper dermatitis . The density of C . albicans increased more than 14-fold following amoxicillin therapy . Cultures done 14-16 days after cessation of therapy revealed an increase in the number of bacterial isolates on the perineum (47 to 72) and on the sternum (39 to 61) and a decline in recovery of C . albicans . This study demonstrates the effects of amoxicillin on the ecology of skin microbial flora in infants-a decrease in the number of bacterial isolates and an increase in recovery of C . albicans. Infect Immun, 2000 Dec, 68(12), 7132 - 6 Reactivity of rheumatic fever and scarlet fever patients' sera with group A streptococcal M protein, cardiac myosin, and cardiac tropomyosin: a retrospective study; Jones KF et al.; Archived sera (collected in 1946) from acute rheumatic fever (ARF) and untreated scarlet fever and/or pharyngitis patients were reacted with streptococcal M protein, cardiac myosin, and cardiac tropomyosin . Except for very low levels to tropomyosin, antibodies to other antigens were not elevated in the sera of ARF patients relative to those of non-ARF patients, even though there was roughly equivalent exposure to group A streptococci . This suggests that antibodies to these molecules may not play a central role in the induction of ARF. Infect Immun, 2000 Dec, 68(12), 6587 - 94 Protective and nonprotective epitopes from amino termini of M proteins from Australian aboriginal isolates and reference strains of group A streptococci; Brandt ER et al.; The M protein is the primary vaccine candidate to prevent group A streptococcal (GAS) infection and the subsequent development of rheumatic fever (RF) . However, the large number of serotypes have made it difficult to design a vaccine against all strains . We have taken an approach of identifying amino-terminal M protein epitopes from GAS isolates that are highly prevalent in GAS-endemic populations within the Northern Territory (NT) of Australia . Australian Aboriginals in the NT experience the highest incidence of RF worldwide . To develop a vaccine for this population, 39 peptides were synthesized, representing the amino-terminal region of the M protein from endemic GAS . Mice immunized with these peptides covalently linked to tetanus toxoid and emulsified in complete Freund's adjuvant raised high-titer antibodies . Over half of these sera reduced bacterial colony counts by >80% against the homologous isolate of GAS . Seven of the peptide antisera also cross-reacted with at least three other heterologous peptides by enzyme-linked immunosorbent assay . Antiserum to one peptide, BSA10(1-28), could recognize six other peptides, and five of these peptides could inhibit opsonization mediated by BSA10(1-28) antiserum . Cross-opsonization studies showed that six of these sera could opsonize at least one heterologous isolate of GAS . These data reveal vaccine candidates specific to a GAS-endemic area and show the potential of some to cross-opsonize multiple isolates of GAS . This information will be critical when considering which epitopes may be useful in a multiepitope vaccine to prevent GAS infection. J Dent, 2000 Nov, 28(8), 571 - 6 Low-cariogenicity of trehalose as a substrate; Neta T et al.; OBJECTIVES: The effects of trehalose on cariogenesis by mutans streptococci were investigated . METHODS: Inhibited effect of trehalose on water-insoluble glucan (WIG) synthesis from sucrose by glucosyltransferase (GTase) of mutans streptococci was assayed . The acid fermentability of trehalose by mutans streptococci was determined by the measurements of pH, and amounts of lactic acid production . Plaque pH was determined by the measurements of collected plaque from volunteers after sugar mouth-rinse . Rat experimental caries was investigated by feeding a sucrose and/or trehalose diet . RESULTS: Trehalose was not utilized as a substrate for GTase . In addition, trehalose inhibited synthesis of WIG by GTase in the presence of sucrose . Trehalose showed weaker and slower acid fermentation than sucrose by mutans streptococci . The levels of lactic acid production from trehalose by Streptococcus mutans and Streptococcus sobrinus were 24.2 and 59.8% of those from sucrose, respectively . The minimum plaque pH after sucrose mouth-rinse was lower than those after trehalose mouth-rinse in all subjects . Plaque pH after trehalose mouth-rinse never reached critical pH . The substitution of trehalose for sucrose in the rat diet significantly reduced caries scores . Furthermore, rats fed diets containing sucrose and trehalose had significantly lower caries scores than those fed a sucrose diet . CONCLUSIONS: These results suggested that trehalose might be not only lowly cariogenic but also anti-cariogenic, and is promising as a sugar substitute. Chirurg, 2000 Oct, 71(10), 1277 - 80 {Fulminant necrotizing fasciitis secondary to Crohn's disease}; Neuber M et al.; Necrotizing fasciitis is a life-threatening infection, commonly caused by group A streptococci, which has to be treated by surgical exploration and debridement during the first 24 h . Clinical clues are severe pain, in some cases followed by the appearance of bullous formations, and the detection of gas in the soft tissues by computed tomography or MRI . In addition to that, the infection is characterized by rapid inflammatory progression, producing a highly life-threatening situation . Diagnosis is finally based on surgical exploration obtaining specimens for culture and histopathologic examination . Debridement and exploration, in some cases amputation of the extremity, are indicated as soon as possible . Antibiotic therapy increases efficacy too, but there is no substitute for surgical treatment . Inflammatory bowel disease (Crohn's disease in this case) followed by necrotizing fasciitis is rarely mentioned in the literature . Therapeutic management in a situation of immunosuppression is discussed by illustration of an actual case. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 2000 Nov, 90(5), 600 - 8 Bacteriologic features and antimicrobial susceptibility in isolates from orofacial odontogenic infections; Kuriyama T et al.; OBJECTIVE: The aim of this study was to obtain information for an effective antimicrobial therapy against orofacial odontogenic infections; such information was obtained from recent bacteriologic features and antimicrobial susceptibility data . STUDY DESIGN: The bacteriology and antimicrobial susceptibility of major pathogens in 163 patients with orofacial odontogenic infections to 7 antibiotics was examined . RESULTS: Mixed infection of strict anaerobes with facultative anaerobes (especially viridans streptococci) was observed most often in dentoalveolar infections, periodontitis, and pericoronitis . Penicillin (penicillin G) was effective against almost all pathogens, although it did not work well against beta-lactamase-positive Prevotella . Cefmetazole was effective against all test pathogens . Erythromycin was ineffective against viridans streptococci and most Fusobacterium . Clindamycin exerted a strong antimicrobial activity on anaerobes . Minocycline was effective against almost all the test pathogens . The antimicrobial activity of levofloxacin against viridans streptococci was not strong . CONCLUSIONS: An antibiotic that carries out antimicrobial activity against both viridans streptococci and oral anaerobes should be suitable for treatment of dentoalveolar infection, periodontitis, and pericoronitis . Penicillin remains effective as an antimicrobial against most major pathogens in orofacial odontogenic infections . Cefmetazole, clindamycin, and minocycline may be effective against most pathogens, including penicillin-unsusceptible bacteria. West Indian Med J, 2000 Sep, 49(3), 212 - 5 Brain abscess at the University Hospital of the West Indies; Donaldson G et al.; Surgical infections of the central nervous system are still attended by high rates of morbidity and mortality, although substantial progress has been made since the advent of computed tomography (CT) scanning technology . In this retrospective review of 25 surgically treated patients with either brain abscess or subdural empyema at the University Hospital of the West Indies, the majority of patients were male and between the ages of 10 and 30 years with a mean age of 16.9 years . Almost half the patients had a hemiparesis on presentation while 60% had fever . Subdural empyema was more common than a localized intracerebral abscess which was most frequently located in the frontal lobe . The most common predisposing factors were sinusitis and congenital heart disease . Streptococci spp and Staphylococci spp were the most frequently isolated organisms . All patients underwent CT scanning and surgical intervention . The mortality rate was 20%, and 21% of the survivors had late seizures . There must be a high index of clinical suspicion and early referral to specialist centres where neuroradiological investigation and prompt neurosurgical intervention can be carried out to minimize morbidity and mortality. Enferm Infecc Microbiol Clin, 2000 Jun-Jul, 18(6), 271 - 3 {Carriers of beta hemolytic streptococci from groups A, B, and C among schoolchildren in Las Palmas}; Gonzalez-Lama Z et al.; BACKGROUND: Betahemolytic streptococci, particularly group A, are the most frequently isolated pathogen in the cases of acute pharyngotonsilitis in school-aged children . A study was carry out in school children of Las Palmas de Gran Canaria with the aim of knowing of the state of pharyngeral carriers of betahemolytic streptococci in Lancefield groups A, B and C . METHODS: A total of 1,002 healthy school children (520 boys and 482 girls) with ages ranging from 4 to 15 of aged were included in the study in which a pharyngeal exudate was obtained to detect the presence of betahemolytic streptococci . RESULTS: 69.5% of the healthy school children were not pharyngeal carriers of betahemolytic streptococci . The prevalence of streptococci group A in all the age groups studied was of 6% . The prevalence of beta streptococci groups B and C were of 11 and 13.5%, respectively . CONCLUSIONS: The results of this study are in agreement with the literature reviewed in which the rate of pharyngeal carriers of beta-hemolytic streptococci in school children of Las Palmas de Gran Canaria are more similar that studies reported from tropical and subtropical zones showed a high prevalence of groups B and C and a lower prevalence of a group A than others communities of our country and zones with temperature climate where showed a high prevalence of group A and lower prevalence of groups B and C. Schweiz Med Wochenschr, 2000 Oct 14, 130(41), 1471 - 8 {Epidemiology of septicemias in a university hospital over 5 yeaars}; Laffer RR et al.; Bloodstream infections (are associated with high mortality . The incidence of bloodstream infections is increasing worldwide, with a shift towards multiresistant pathogens such as methicillin-resistant Staphylococcus aureus, enterococci and Candida spp . This study analysed retrospectively 1814 episodes of bacteraemia from 1993 to 1997 at a single tertiary care centre . True bloodstream infections was defined as clinical sepsis and positive blood culture without evidence for contamination of skin bacteria . Of the 1814 episodes, 380 (20.9%) were contaminated, resulting in 1434 true episodes of bloodstream infection . 42% were nosocomial bloodstream infections and one fourth were primary bloodstream infections . The incidence of bloodstream infections increased from 13.0/10,000 patient-days (1993) to 15.8/10,000 patient-days (1997) . Mortality increased from 15.4% (1993) to 21% (1997) (p = 0.059) . The five most frequently isolated microorganisms were Escherichia coli, Staphylococcus aureus, Streptococcus pneumoniae, coagulase-negative staphylococci and streptococci . The distribution of bacteria did not change over time from 1993 to 1998 . Multiresistant bacteria such as methicillin-resistant Staphylococcus aureus, enterococci, Pseudomonas spp . and yeasts were isolated in less than 5% of episodes . In addition, there is a trend towards decreasing resistance, in contrast to most other institutions in Southern Europe and the US . Further analyses and studies are necessary to answer questions raised by this retrospective study. Schweiz Med Wochenschr, 2000 Oct 14, 130(41), 1437 - 46 {Diagnosis and antibiotic therapy of infections in outpatients}; Sturchler MS et al.; BACKGROUND: The study aim was to analyse the diagnostic and therapeutic approach to selected infectious diseases, in particular with regard to the use of antibiotics, in the light of current guidelines and the problem of developing resistance . METHODS: A questionnaire was sent to all physicians with a general or internal medicine practice in the Cantons Basel-Stadt and Basel-Landschaft, Switzerland . RESULTS: Of 440 physicians, 286 (65%) took part in the study . The most frequent diagnoses of infection were cystitis (16.6%), flu-like syndrome (16.4%), acute bronchitis (12.3%), and tonsillopharyngitis (10.1%) . The most frequent indications for antimicrobial therapy were cystitis (19.9%), acute sinusitis (14.1%), acute bronchitis (11.5%), and tonsillopharyngitis (9.2%) . Macrolides (24.0%), aminopenicillins (22.6%), and fluoroquinolones (16.8%) were the most frequently prescribed antibiotics . CONCLUSIONS: The majority of physicians diagnosed and treated according to rational principles . However, a few exceptions were found, e.g . omission of x-ray in the diagnosis of pneumonia (24%), the use of antibiotics in the treatment of viral diseases and antibiotic therapy for tonsillopharyngitis despite a negative rapid antigen detection test against group A streptococci (75%). Clin Infect Dis, 2000 Nov, 31(5), 1126 - 30 Epub 2000 Nov 06. Serious complications of bacteremia caused by Viridans streptococci in neutropenic patients with cancer; Marron A et al.; We prospectively studied 485 episodes of bacteremia in neutropenic patients with cancer . Viridans streptococci caused a total of 88 episodes (18%) . Ten (11%) of these 88 cases were associated with serious complications: acute respiratory distress syndrome (ARDS) plus septic shock (5 cases), ARDS (3), and septic shock (2) . Streptococcus mitis was the species most frequently isolated (7 of 10 episodes) . Four viridans streptococci showed a diminished susceptibility to penicillin (MICs ranged from 0.25 to 4 microg/mL), and 5 strains were resistant to ceftazidime (MICs ranged from 2 to >32 microg/mL) . Patients with viridans streptococcal bacteremia (VSB) who developed serious complications were compared with patients with VSB without complications . Severe oral mucositis (70% vs . 32.5%, respectively; P=.036), high-dose chemotherapy with cyclophosphamide (60% vs . 25%, respectively; P=.043), and allogeneic bone marrow transplantation (40% vs . 10%, respectively; P=.040) were the only variables found to be significantly associated with the development of complications . Neither a specific species of viridans streptococci nor resistance to penicillin was associated with the occurrence of complications . The mortality rate was higher in case patients than in control patients (80% vs . 17.5%, respectively; P<.001) . Serious complications associated with VSB occur mainly in patients receiving high-dose chemotherapy with cyclophosphamide before allogeneic bone marrow transplantation who develop severe oral mucositis; these complications are associated with a high mortality rate. Infection, 2000 Sep, 28(5), 314 - 7 Automated ribotyping and pulsed-field gel electrophoresis reveal a cluster of group A streptococci in intravenous drug abusers; Brunner S et al.; BACKGROUND: In 1998, an unexpected increase of group A streptococci (GAS) in blood cultures was observed at our institution . MATERIALS AND METHODS: To determine whether they were from unrelated sporadic cases or attributable to a common source, all isolates were analyzed by pulsed-field gel electrophoresis (PFGE) and by automated ribotyping . RESULTS: Two clusters were found . All isolates, except one, of cluster 2 had been isolated from intravenous drug abusers . CONCLUSION: All patients were hospitalized either in different hospitals or at different times in the same hospitals indicating that the putative common source is to be found in the drug community rather than in a particular hospital. Mol Microbiol, 2000 Oct, 38(2), 242 - 53 Role for a secreted cysteine proteinase in the establishment of host tissue tropism by group A streptococci; Svensson MD et al.; Primary infection of the human host by group A streptococci (GAS) most often involves either the epidermis of the skin or the oropharyngeal mucosa . A humanized in vivo model for impetigo was used to investigate the basis for host tissue tropism among GAS . Disruption of the speB gene (encoding for a secreted cysteine proteinase) led to a loss of virulence for two impetigo-derived strains (M-types 33 and 53), as evidenced by a diminution in tissue damage and a lack of reproductive growth . The level of cysteine proteinase activity in overnight cultures was associated with the extent of gross pathological changes induced by strains displaying varied degrees of virulence in the impetigo model . Moreover, high levels of secreted cysteine proteinase activity correlated with a genetic marker for preferred tissue site of infection at the skin (emm pattern D) . The addition of exogenous SpeB to a speB mutant (emm pattern D) or to an avirulent throat-like strain (emm pattern A) led to increased bacterial reproduction at the skin . The data provide both experimental and epidemiological evidence for a critical role of a secreted bacterial protease in promoting host tissue-specific infection. J Infect Dis, 2000 Dec, 182(6), 1712 - 21 Epub 2000 Nov 08. Antibodies to streptococcal surface enolase react with human alpha-enolase: implications in poststreptococcal sequelae; Fontan PA et al.; The pathogenic mechanisms for developing acute rheumatic fever after group A streptococcal pharyngitis are still poorly understood . The glycolytic enzyme enolase is one of the major proteins on the surface of group A streptococci . Herein, significant cross-reactivity was shown between streptococcal enolase and human enolase . Fluorocytometric analysis revealed that antistreptococcal enolase antibodies react with the enolase expressed on the surface of hematopoietic cells . Furthermore, the enolase on the leukocyte surface was found to be up-regulated by inflammatory stimuli . Evaluation of antibody titers indicated that serum samples from patients with acute rheumatic fever have higher levels of antibodies that react with the human and bacterial enolases than do serum samples from patients with streptococcal pharyngitis or healthy control subjects . These results show that streptococcal enolase is a novel cross-reactive antigen that may play an important role in the initiation of the autoimmune diseases related to streptococcal infection. Can J Microbiol, 2000 Oct, 46(10), 946 - 51 Identification of streptococci isolated from various sources by determination of cfb gene and other CAMP-factor genes; Hassan AA et al.; In the present study, the CAMP-factor (cfb) gene of streptococci of serological group B (Streptococcus agalactiae) and the CAMP-factor (cfu) gene of S . uberis could be amplified by polymerase chain reaction . A cfb specific amplicon could be observed for all 128 phenotypically CAMP-positive S . agalactiae, for the phenotypically CAMP-negative S . agalactiae strain 74-360, and for 2 S . difficile reference strains . A cfu specific amplicon could be observed for all 7 phenotypically CAMP-positive S . uberis . Four S . agalactiae strains isolated from 4 cows with mastitis appeared to be phenotypically CAMP-negative and negative in the cfb gene PCR . The CAMP-positive and CAMP-negative isolates, including both S . difficile, could be identified as S . agalactiae by amplification of a S . agalactiae specific part of the V2 region of the 16S rRNA and a species-specific part of the 16S-23S rRNA intergenic spacer region . Amplification of an internal fragment of the cfb gene with a reduced annealing temperature yielded positive reactions not only for CAMP-positive S . agalactiae, but also for phenotypically CAMP-positive S . pyogenes (n = 4), S . canis (n = 28), and S . uberis (n = 7), indicating a close relation of the CAMP genes of these 4 species . The relation could be further demonstrated by sequencing the internal fragment of the CAMP-factor (cfg) gene of S . canis and comparing the sequence with those of S . agalactiae, S . pyogenes, and S . uberis. Lakartidningen, 2000 Oct 4, 97(40), 4437 - 42, 4445-6, 4448 {Guidelines for diagnosis and treatment of sore throat}; Flottorp S et al.; BACKGROUND: Available guidelines for the diagnosis and treatment of sore throat give conflicting recommendations . Our aim was to develop evidence-based guidelines . MATERIAL AND METHODS: We searched The Cochrane Library, Medline and other sources for systematic reviews and other evidence that met explicit inclusion criteria for all of the relevant options and outcomes we identified . The validity of included studies was assessed . Draft recommendations based on assessment of this evidence were widely circulated and discussed in focus groups with patients and physician assistants . RESULTS: Throat infections are self-limiting and complications rare . Penicillin shortens the duration of symptoms in tonsillitis caused by beta-haemolytic streptococci and reduces the risk of complications . Penicillin has adverse effects and increases the risk of reinfections . Patients with sore throat should usually be treated without antibiotics . Visiting a physician is normally unnecessary . Antibiotics should be considered in serious cases or if the patient prefers this, but should only be prescribed for throat infections caused by beta-haemolytic streptococci . The diagnosis should be based on clinical criteria and a rapid antigen test in cases of doubt . INTERPRETATION: Benefits of antibiotics must be weighed against harms . Patients should be given good information and involved in decision/making if they want antibiotics. J Immunol, 2000 Nov 15, 165(10), 5760 - 6 Bacterial killing is enhanced by expression of lysozyme in the lungs of transgenic mice; Akinbi HT et al.; To assess the role of lysozyme in pulmonary host defense in vivo, transgenic mice expressing rat lysozyme cDNA in distal respiratory epithelial cells were generated . Two transgenic mouse lines were established in which the level of lysozyme protein in bronchoalveolar (BAL) lavage fluid was increased 2- or 4-fold relative to that in WT mice . Lung structure and cellular composition of BAL were not altered by the expression of lysozyme . Lysozyme activity in BAL was significantly increased (6.6- and 17-fold) in 5-wk-old animals from each transgenic line . To determine whether killing of bacteria was enhanced by expression of rat lysozyme, 5-wk-old transgenic mice and WT littermates were infected with 10(6) CFU of group B streptococci or 10(7) CFU of a mucoid strain of Pseudomonas aeruginosa by intratracheal injection . Killing of group B streptococci was significantly enhanced (2- and 3-fold) in the mouse transgenic lines at 6 h postinfection and was accompanied by a decrease in systemic dissemination of pathogen . Killing of Pseudomonas aeruginosa was also enhanced in the transgenic lines (5- and 30-fold) . Twenty-four hours after administration of Pseudomonas aeruginosa, all transgenic mice survived, whereas 20% of the WT mice died . Increased production of lysozyme in respiratory epithelial cells of transgenic mice enhanced bacterial killing in the lung in vivo, and was associated with decreased systemic dissemination of pathogen and increased survival following infection. Ann Trop Paediatr, 2000 Sep, 20(3), 199 - 202 A comparison of the efficacy of cefuroxime axetil and intramuscular benzathine penicillin for treating streptococcal tonsillopharyngitis; Uysal S et al.; Throat cultures were performed on 297 children suspected of tonsillopharyngitis on clinical findings . Group A beta-haemolytic streptococci (GABHS) were isolated from 86 patients (41 males/45 females) aged 6-15 (mean (SD) 7.8 (0.04)) years . They were randomly allocated to receive oral cefuroxime axetil for 10 days (group 1) or one dose of benzathine penicillin by intramuscular injection (group 2) and responses were evaluated 2 weeks later . Clinical cure was observed in 95% of group 1 and 96% of group 2 and bacteriological cure in 86 and 84% of groups 1 and 2, respectively . Our results show that intramuscular benzathine penicillin remains an effective treatment for GABHS and that oral cefuroxime axetil is also effective. J Antimicrob Chemother, 2000 Nov, 46(5), 789 - 92 Erythromycin resistance genes in group A streptococci of different geographical origins . The Macrolide Resistance Study Group; Kataja J et al.; A total of 238 erythromycin-resistant Streptococcus pyogenes isolates were collected in 1986-1997 from eight different countries in Europe and North and South America . The antibiotic susceptibility patterns of all isolates and the resistance genes of 92 isolates of known clonal origin were studied . The mefA gene was detected in all 54 isolates with the M-phenotype and was found in every country . The ermTR and the ermB genes were detected in 27 and 11, respectively, of the 38 isolates with the macrolide-lincosamide-streptogramin B resistance phenotypes . In addition to the mefA gene, the recently sequenced ermTR gene was also widely distributed among isolates of different clonal origin. Knee Surg Sports Traumatol Arthrosc, 2000, 8(5), 270 - 4 Arthroscopic management of septic arthritis: stages of infection and results; Stutz G et al.; Seventy-six patients with septic arthritis (78 affected joints) were treated with a combination of arthroscopic irrigation, debridement, and antibiotic therapy according to the tested bacterial sensitivity . There were 62 knee, 10 shoulder, 5 ankle joints, and 1 hip joint . No antibiotics were added to the irrigating solution . The arthroscopic and radiological stage of infection, treatment, and outcome in these patients was analyzed . The patients were classified into three groups according to initial stage of joint infection (stage I: 21 patients, 22 joints; stage II: 43 patients, 44 joints; stage III: 12 patients, 12 joints) . Causes of infection were: hematogenous dissemination in 54%, postoperative wound infection in 28% (17% after open, 11% after arthroscopic procedures) . Other causes were: 10% intra-articular steroid injections, 3% diagnostic punctures, and 3% open traumatic injury of the joint . In 78% of the infected joints the causative organism could be identified: Staphylococcus aureus was the most common organism found (42%), followed by streptococci (15%), pneumococci (6%), Escherichia coli (4%), Staphylococcus epidermidis (3%), Borrelia burgdorferi (3%), and others in 5% . In the stage I group only one patient needed repeated arthroscopic irrigation, in the stage II group 52%, and in the stage III group 75% . Open revision for eradication of the infection was necessary in one joint with stage II and in two joints with stage III infection (3%) . Two joints of the stage III group needed additional surgery after successful treatment of the infection . The combination of arthroscopic irrigation and systemic antibiotic therapy was able to cure 91% of the affected joints . Open revision was necessary in 4% of joints . The number of arthroscopic procedures and the efficacy of treatment depended on the initial stage of the infection . It is concluded that an arthroscopic staging of the initial joint infection has prognostic and therapeutic consequences. J Altern Complement Med, 2000 Oct, 6(5), 383 - 9 Detection of antimicrobials in bee products with activity against viridans streptococci; Tichy J et al.; OBJECTIVES: Bee products have been studied extensively for their healing properties and have become part of cosmetic preparations and folk medicine . The major objective of this study was to examine the presence of antimicrobials in various bee products . DESIGN: Propolis, honeycomb lids, pollen, honeycombs, and honey were screened for antimicrobial compounds . Viridans streptococci were used as indicator strains . Ethanol extracts were applied onto paper disks, dried, and put on the surface of nutrient agar plates with the overlay containing viridans streptococci . The plates were then incubated and evaluated the next day for the presence of inhibition zones . The size of the inhibition zone represented a quantitative measure of antimicrobial activity in a sample . Thin-layer chromatography was used for separation of compounds in the samples and biodetection-an overlay with indicator strain-identified the antimicrobial compounds by formation of inhibition zones . RESULTS: Ethanol extracts of propolis and honeycomb lids, as well as honey containing honeycomb lids contained a mixture of antimicrobial compounds in various amounts . Thin-layer chromatography experiments with two different solvent systems differing in polarity suggested that major antimicrobials present in the samples prepared from honeycomb lids, honeycombs, pollen, and propolis have similar properties . These active compounds were not extremely hydrophobic . CONCLUSIONS: Extracts from the tested samples of bee products exhibited antimicrobial properties at various levels depending on the sample and bacterial species used for testing . Using chromatographic techniques, we demonstrated similar properties of the active compounds in various active samples . In conclusion, our results suggest that honey containing honeycomb lids may be a beneficial food supplement because of the presence of antibacterial compounds. Ophthalmology, 2000 Nov, 107(11), 2111 - 4 Pathologic findings in late endophthalmitis after glaucoma filtering surgery; Beck AD et al.; OBJECTIVE: To report the clinicopathologic features of four eyes enucleated for late-onset bleb-related endophthalmitis . STUDY DESIGN: Retrospective case series . MATERIALS: Four enucleated eyes . METHODS: The clinical and histopathologic features of four patients who underwent enucleation for late-onset endophthalmitis after glaucoma filtering surgery were reviewed . RESULTS: The eyes were enucleated for endophthalmitis one to five years after trabeculectomy . Two of the four eyes had trabeculectomy with adjunctive mitomycin-C . All four eyes had streptococci cultured from the aqueous and/or vitreous . Common pathologic features included inflammation involving the anterior segment, lens and choroid . One eye exhibited focal granulomatous uveitis . CONCLUSIONS: Late-onset endophthalmitis after glaucoma filtering surgery is often due to streptococcal species and rapidly progresses over a few days . Phacoanaphylaxis with associated granulomatous uveitis may contribute to the poor prognosis in this setting. Int J Antimicrob Agents, 2000 Oct, 16(2), 97 - 101 New pathogens in neutropenic patients with cancer: an update for the new millennium; Zinner SH; As patients with malignant diseases are treated with increasingly potent agents it is likely that they will be subject to infection with an ever broadening array of microorganisms . As a result of the prompt institution of empirical antibiotics at the onset of fever in neutropenic patients, mortality has been reduced but new problems have emerged . First, there has been a shift in the type of infecting organisms responsible for bacteraemia in these patients from predominantly Gram-negative organisms to Gram-positive cocci . Secondly, perhaps as a consequence of the effectiveness of antibiotics, there is increasing concern about infections with antibiotic-resistant organisms . As an example, viridans streptococci are becoming increasingly resistant to penicillin . Thirdly, organisms previously thought to be non pathogens or 'commensals' are now being reported as agents of serious invasive infections in neutropenic patients with cancer . This review will highlight these changes and discuss 'new' pathogens in these patients. Rinsho Byori, 2000 Jul, 48(7), 580 - 7 {Mechanism to cause streptococcal toxic-shock syndrome}; Miyoshi-Akiyama T et al.; Group A streptococci(GAS) are responsible for a number of infectious diseases in humans . The development of a variety of antibiotic drugs decreased the number of bacterial infections dramatically . Streptococcal toxic shock-like syndrome(TSLS), which is now also called streptococcal toxic shock syndrome(STSS) has, however, become an important disease because it causes severe life-threatening clinical symptoms . Several reports have described STSS during pregnancy . Although a number of GAS virulence factors have been examined, the critical causative agents for STSS has not yet been identified . The clinical symptoms and pathological examinations of STSS suggest that STSS is caused by multiple factors . We need to study the pathogenic mechanism of STSS from both the bacterial and host side . Our study indicated that the lethal activity and anti-phagocytic activity examined in mice and SLO may be a major pathogenic factor in STSS. J Dairy Sci, 2000 Oct, 83(10), 2350 - 60 Heritability of clinical mastitis incidence and relationships with sire transmitting abilities for somatic cell score, udder type traits, productive life, and protein yield; Nash DL et al.; The objective of this study was to determine the relationships among daughter clinical mastitis during first and second lactations and sire transmitting abilities for somatic cell score, udder type traits, productive life, and protein yield . Data on clinical mastitis during first lactation were available for 1795 daughters (in six Pennsylvania herds, one Minnesota herd, and one Nebraska herd) of 283 Holstein sires . Data on clinical mastitis during second lactation were available for 1055 of these daughters . A total of 479 cows had 864 clinical episodes during first lactation, and 230 cows had 384 clinical episodes during second lactation . Clinical mastitis incidence and the total number of clinical episodes during each lactation were regressed on herd-season of calving (a classification variable), age at first calving, lactation length, and sire transmitting abilities taken one at a time . Linear effects, nonlinear effects, and odds ratios were estimated for sire transmitting abilities . Separate analyses were conducted on dependent variables that considered clinical mastitis from: all organisms, coagulase-negative staphylococci, coliform species, streptococci other than Streptococcus agalactiae, and the most common environmental organisms (coliform species and streptococci other than Streptococcus agalactiae) . Heritability of clinical mastitis ranged from 0.01 to 0.42 . Daughters of sires that transmit the lowest somatic cell score had the lowest incidence of clinical mastitis and the fewest clinical episodes during first and second lactations . Daughters of sires that transmit longer productive life, shallower udders, deeper udder cleft, and strongly attached fore udders had either fewer clinical episodes or lower clinical mastitis incidence during first and second lactations . The incidence of clinical mastitis and the number of clinical episodes per lactation may be reduced by selection for lower somatic cell score, longer productive life, shallower udders, deeper udder cleft, or strongly attached fore udders. Pedia