Streptococcal

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.

Pediatr Dent, 2000 Sep-Oct, 22(5), 377 - 80
Influence of colonization with mutans streptococci on caries risk in Japanese preschool children: 24 month survival analysis; Ansai T et al.; PURPOSE: This study evaluates how various microbial- and salivary-related risk factors influenced the hazard for caries development in preschool children . METHODS: The study population consisted of 131 subjects (age: 0.5 to 6.0 yrs) . Oral examination, including two bacterial tests and buffering capacity test, was conducted at six month intervals over 24 months . A survival analysis was used to describe caries hazard over a 24-month follow-up period . A Cox proportional hazards regression analysis was performed to test the influence of salivary mutans streptococci (MS), aciduric bacteria, buffering capacity and age on caries development . RESULTS: Of the total subjects, 60 children (46%) were found to be caries-free at baseline . Caries hazard correlated significantly with salivary MS levels at baseline (relative risk, 1.7; P = 0.003), but not with aciduric bacteria and buffering capacity . This analysis showed that all of children with high colonization of MS at baseline had dental caries 15 months later . CONCLUSION: The results suggest that salivary MS level at baseline influenced caries hazard in preschool children.

J Dent Res, 1988 Jan, 67(1), 51 - 5
Gallotannins inhibit growth, water-insoluble glucan synthesis, and aggregation of mutans streptococci; Wu-Yuan CD et al.; During screening for anti-plaque agents of plant origin, ethanolic extracts from Melaphis chinensis (Bell), the Chinese Nutgall, exhibited strong inhibition of glucosyltransferase (GTF), in vitro adherence and glucan-induced agglutination of Streptococcus mutans 3209 and S . sobrinus B13 . More than 91% inhibition of water-insoluble glucan synthesis from sucrose by GTF was noted at a concentration as low as 7.8 micrograms/mL . Bactericidal effects on other mutans streptococci, S . salivarius, and Actinomyces viscosus were also evident . Through chemical fractionation and analyses, along with bioassays, the active components were identified as gallotannins.

J Dent Res, 1988 Jan, 67(1), 9 - 14
A preliminary report of long-term elimination of detectable mutans streptococci in man; Sandham HJ et al.; Application of an antimicrobial varnish to the teeth of 33 adult volunteers resulted in the elimination of detectable mutans streptococci from the saliva of 21 of them for a mean period of 34.6 weeks (range, 4 to 89 weeks) without additional treatment . The mean number of applications of varnish required for elimination was 3.14 (range, 1 to 5) . Extensive examination of 10 subjects made free of mutans streptococci on the basis of saliva examination revealed no detectable mutans streptococci in their dental plaque . In 14 of the subjects in whom mutans streptococci were eliminated, they subsequently re-appeared after a mean period of 22.7 weeks (range, 4 to 71 weeks) . Four out of the five recurrences that were treated were eliminated with only one additional varnish application . The treatment failed to provide long-term elimination of detectable mutans streptococci in 12 of the 33 treated subjects . No serious adverse reactions were observed in any of the treated subjects . The results indicate that it is possible to eliminate mutans streptococci from man in a safe and effective manner.

Infect Immun, 2000 Nov, 68(11), 6384 - 90
Role of streptolysin O in a mouse model of invasive group A streptococcal disease; Limbago B et al.; Many of the virulence factors that have been characterized for group A streptococci (GAS) are not expressed in all clinical isolates . One putative virulence factor that is present among most is streptolysin O (Slo), a protein with well-characterized cytolytic activity for many eukaryotic cells types . In other bacterial pathogens, proteins homologous to Slo have been shown to be essential for virulence, but the role of Slo in GAS had not been previously examined . To investigate the role of Slo in GAS virulence, we examined both revertible and stable slo mutants in a mouse model of invasive disease . When the revertible slo mutant was used to infect mice, the reversion frequency of bacteria isolated from the wounds and spleens of infected animals was more than 100 times that of the inoculum, indicating that there was selective pressure in the animal for Slo(+) GAS . Experiments with the stable slo mutant demonstrated that Slo was not necessary for the formation of necrotic lesions, nor was it necessary for escape from the lesion to cause disseminated infection . Bacteria were present in the spleens of 50% of the mice that survived infection with the stable slo mutant, indicating that dissemination of Slo(-) GAS does not always cause disease . Finally, mice infected with the stable slo mutant exhibited a significant decrease in mortality rates compared to mice infected with wild-type GAS (P < 0.05), indicating that Slo plays an important role in GAS virulence.

Infect Immun, 2000 Nov, 68(11), 6362 - 9
Inverse relation between disease severity and expression of the streptococcal cysteine protease, SpeB, among clonal M1T1 isolates recovered from invasive group A streptococcal infection cases; Kansal RG et al.; The streptococcal cysteine protease (SpeB) is one of the major virulence factors produced by group A streptococci (GAS) . In this study we investigated if differences exist in SpeB production by clonally related M1T1 clinical isolates derived from patients with invasive infections . Twenty-nine of these isolates were from nonsevere cases and 48 were from severe cases, including streptococcal toxic shock syndrome (STSS) and necrotizing fasciitis (NF) cases . The expression and amount of the 28-kDa SpeB protein produced were determined by quantitative Western blotting, and protease activity was measured by a fluorescent enzymatic assay . A high degree of variation in SpeB expression was seen among the isolates, and this variation seemed to correlate with the severity and/or clinical manifestation of the invasive infection . The mean amount of 28-kDa SpeB protein and cysteine protease activity produced by isolates from nonsevere cases was significantly higher than that from STSS cases (P = 0.001) . This difference was partly due to the fact that 41% of STSS isolates produced little or no SpeB compared to only 14% of isolates recovered in nonsevere cases . Moreover, the cysteine protease activity among those isolates that expressed SpeB was significantly lower for STSS isolates than for isolates from nonsevere cases (P = 0.001) . Increased SpeB production was also inversely correlated with intact M protein expression, and inhibition of cysteine protease activity blocked the cleavage of the surface M protein . Together, the data support the existence of both an "on-off" and a posttranslational regulatory mechanism(s) controlling SpeB production, and they suggest that isolates with the speB gene in the "off" state are more likely to spare the surface M protein and to be isolated from cases of severe rather than nonsevere invasive infection . These findings may have important implications for the role of SpeB in host-pathogen interactions via regulation of the expression of GAS virulence genes and the severity of invasive disease.

Infect Immun, 2000 Nov, 68(11), 6346 - 54
Identification of polymorphonuclear leukocyte and HL-60 cell receptors for adhesins of Streptococcus gordonii and Actinomyces naeslundii; Ruhl S et al.; Interactions of oral streptococci and actinomyces with polymorphonuclear leukocytes (PMNs), mediated by sialic acid- and Gal/GalNAc-reactive adhesins, respectively, result in activation of the PMNs and thereby may contribute to the initiation of oral inflammation . Sialidase treatment of PMNs or HL-60 cells abolished adhesion of Streptococcus gordonii but was required for adhesion of Actinomyces naeslundii . The same effects of sialidase were noted for adhesion of these bacteria to a major 150-kDa surface glycoprotein of either PMNs or undifferentiated HL-60 cells and to a 130-kDa surface glycoprotein of differentiated HL-60 cells . These glycoproteins were both identified as leukosialin (CD43) by immunoprecipitation with a specific monoclonal antibody (MAb) . Adhesion of streptococci and actinomyces to a 200-kDa minor PMN surface glycoprotein was also detected by bacterial overlay of untreated and sialidase-treated nitrocellulose transfers, respectively . This glycoprotein was identified as leukocyte common antigen (CD45) by immunoprecipitation with a specific MAb . CD43 and CD45 both possess extracellular mucinlike domains in addition to intracellular domains that are implicated in signal transduction . Consequently, the interactions of streptococci and actinomyces with the mucinlike domains of these mammalian cell surface glycoproteins result not only in adhesion but, in addition, may represent the initial step in PMN activation by these bacteria.

Am J Obstet Gynecol, 2000 Oct, 183(4), 859 - 62
Group B streptococci causing neonatal bloodstream infection: antimicrobial susceptibility and serotyping results from SENTRY centers in the Western Hemisphere; Andrews JI et al.; OBJECTIVE: Group B streptococcal infection is a common cause of neonatal sepsis . Surveillance of antimicrobial susceptibility and serotype frequencies of invasive group B streptococci is important to ensure the effectiveness of therapeutic regimens and to guide vaccine development . STUDY DESIGN: Prospective surveillance of neonatal bloodstream infection was performed at all Western Hemisphere sites participating in the SENTRY Program . From January 1997 through December 1999, a total of 122 isolates of bloodstream infections with group B streptococci were collected and sent to the University of Iowa for antimicrobial susceptibility testing and serotyping . RESULTS: No isolates were resistant to penicillin . More than 25% of isolates from US hospitals and 14% of isolates from Canadian hospitals were erythromycin resistant . Seven percent of isolates from the United States and Canada were resistant to clindamycin . No clindamycin or erythromycin resistance was found among isolates from Latin America . Clindamycin and erythromycin resistance was most frequent among serotype V strains . CONCLUSIONS: No emerging resistance to penicillin was noted among bloodstream infection isolates of group B streptococci from a broad geographic area; erythromycin and clindamycin resistance was found in the United States and Canada and appeared most frequently among serotype V strains.

Am J Obstet Gynecol, 2000 Oct, 183(4), 810 - 4
Neonatal sepsis and death after multiple courses of antenatal betamethasone therapy; Vermillion ST et al.; OBJECTIVE: This study was undertaken to compare the effects of single versus multiple courses of betamethasone therapy on the frequencies of neonatal outcomes and perinatal infectious morbidity among singleton pregnancies complicated by preterm delivery . STUDY DESIGN: We performed a nonconcurrent prospective analysis of singleton pregnancies delivered between 24 and 34 weeks' gestation after antenatal betamethasone exposure . Patients were categorized into two groups according to betamethasone exposure: (1) two 12-mg doses in a 24-hour interval on admission (single-course group) and (2) repeated dosing after the initial single course (multiple-course group) . All patients received prophylactic antibiotics for group B streptococci . Any patients with ruptured membranes for >24 hours before delivery were excluded . Data were analyzed with the Student t test, the chi(2) test, and the Fisher exact test . Multiple logistic regression analyses were performed to examine the effect of each steroid dosing regimen on early-onset neonatal sepsis and neonatal death . P <.05 was considered significant for all 2-tailed tests . RESULTS: A total of 453 patients were included, with 267 in the single-course group and 186 in the multiple-course group . The two groups were similar with respect to maternal demographic characteristics, gestational age at delivery, mode of delivery, birth weight, and maternal group B streptococcal colonization . Multiple courses were significantly associated with early-onset neonatal sepsis (odds ratio, 5.00; 95% confidence interval, 1.3-23 . 2), chorioamnionitis (odds ratio, 9.96; 95% confidence interval, 2 . 1-64.6), endometritis (odds ratio, 3.61; 95% confidence interval, 1 . 7-8.1), and neonatal death (odds ratio, 2.92; 95% confidence interval, 1.3-6.9) . The frequencies of the other neonatal outcomes analyzed, including respiratory distress syndrome and grade III or IV intraventricular hemorrhage, were similar between the 2 groups . Multiple logistic regression analyses confirmed that multiple courses of antenatal betamethasone were independently associated with early-onset neonatal sepsis (odds ratio, 1.25; 95% confidence interval, 1.1-1.9) and neonatal death (odds ratio, 1.70; 95% confidence interval, 1.1-1.9) . CONCLUSIONS: Multiple courses of antenatal betamethasone are associated with increased risks of perinatal infectious morbidity and neonatal death.

Lancet, 2000 Sep 30, 356(9236), 1167 - 9
Pharyngeal carriage of group C and group G streptococci and acute rheumatic fever in an Aboriginal population; Haidan A et al.; Acute rheumatic fever (ARF) and rheumatic heart disease (RHD) represent an autoimmune response to group A streptococcal pharyngitis . In the Aboriginal population of the Northern Territory of Australia, some of the highest rates of ARF in the world have been reported, although throat carriage rates of group A streptococcus in this population are extremely low and symptomatic group A streptococcal pharyngitis is uncommon; by contrast, carriage rates of group C and G streptococci are high . Therefore, we questioned the involvement of these groups in ARF and showed that they have the potential to elicit an autoimmune response that may trigger ARF.

J Biol Chem, 2001 Jan 5, 276(1), 139 - 46
Functional analysis in type Ia group B Streptococcus of a cluster of genes involved in extracellular polysaccharide production by diverse species of streptococci; Cieslewicz MJ et al.; Several species of streptococci produce extracellular polysaccharides in the form of secreted exopolysaccharides or cell-associated capsules . Although the biological properties and repeating unit structures of these polysaccharides are diverse, sequence analysis of the genes required for their production has revealed a surprising degree of conservation among five genes found in the capsule gene cluster of each of several polysaccharide-producing streptococci . To determine the function of these conserved genes, we characterized a series of isogenic mutants derived from a wild-type strain of type Ia group B Streptococcus by selectively inactivating each gene . Inactivation of cpsIaE resulted in an acapsular phenotype, consistent with previous work that identified the cpsIaE product as the glycosyltransferase that initiates synthesis of the polysaccharide repeating unit . Mutants in cpsIaA, cpsIaB, cpsIaC, or cpsIaD produced type Ia capsular polysaccharide, but in reduced amounts compared with the wild type . Analysis of the mutant polysaccharides and of capsule gene transcription in the mutant strains provided evidence that cpsIaA encodes a transcriptional activator that regulates expression of the capsule gene operon . Mutants in cpsIaC or cpsIaD produced polysaccharide of reduced molecular size but with an identical repeating unit structure as the wild-type strain . We conclude that CpsA to -D are not required for polysaccharide repeating unit biosynthesis but rather that they direct the coordinated polymerization and export of high molecular weight polysaccharide.

Bangladesh Med Res Counc Bull, 1999 Aug, 25(2), 42 - 5
Humoral immune response in a sample of Bangladeshi children with rheumatic fever; Zaman MM et al.; Several researchers have investigated cellular response, and antibody response to different antigens of group A beta-haemolytic streptococci, cardiac tissues and B cell alloantigen in rheumatic fever (RF) . However, immunoglobulins (Ig) which may indicate general immune status did not receive attention . This study was done in the outpatient clinic of the National Center for Control of Rheumatic Fever and Heart Diseases, Dhaka, to compare Ig levels in subjects with and without RF who have had recent group A beta-haemolytic streptococcal infections . We have recruited 44 RF cases aged 5 to 20 years, and 44 subjects without RF were randomly matched for age and sex as controls . Convalescent blood samples were used to measure antistreptolysin O and IgG, IgM, and IgA levels . The cases, as compared with the controls, had significantly higher levels of antistreptolysin O (mean 399 versus 321 IU/ml), IgG (mean 2386 versus 1885 mg/dl), IgM (mean 286 versus 222 mg/dl) and IgA (mean 258 versus 184 mg/dl) . It is not clearly known why the immune response is higher in the RF cases . We have to elucidate factors responsible for higher immune response in children with RF.

FEMS Microbiol Lett, 2000 Oct 15, 191(2), 235 - 41
The NAD-glycohydrolase (nga) gene of Streptococcus pyogenes; Ajdic D et al.; The gene for NAD-glycohydrolase (nga) of group A streptococci (Streptococcus pyogenes) was identified and shown to be located immediately adjacent to the gene for streptolysin O (slo) . The nga gene contains 1341 base pairs and encodes a protein of 447 amino acids, including an N-terminal signal peptide . Results from analysis with the polymerase chain reaction indicated that the nga gene is present in all of the strains tested . Functional extracellular NAD-glycohydrolase, also known as NADase, was detected among a wide variety of clinical isolates and known laboratory strains and shown to be present in 72% of 100 strains examined . In contrast, 92% of strains isolated from patients with invasive streptococcal infections were positive for NADase production.

Caries Res, 2000 Sep-Oct, 34(5), 432 - 9
A randomised controlled trial of the caries-preventive efficacy of a chlorhexidine-containing varnish in high-caries-risk adolescents; Forgie AH et al.; A professionally applied two-stage chlorhexidine varnish, Chlorzoin((R)), was developed to achieve sustained release and minimise the problems of staining and bad taste associated with chlorhexidine mouthrinses . The primary aim of this randomised controlled clinical trial was to assess the efficacy of Chlorzoin in reducing the caries increment in high-caries-risk adolescents . Secondary aims included investigating the effect of compliance upon caries increment, the effect of Chlorzoin upon salivary mutans streptococci levels and assessing the benefit of individual dental health advice by dental auxiliaries in a community setting . 1,240 children, initially aged 11-13 years, assessed to be at high caries risk were recruited into the trial . The trial design involved four arms: an observational group, a control group, an active (Chlorzoin) varnish group and a placebo varnish group . All subjects were examined annually by a calibrated examiner who was blind to the group allocation . Three-year caries increments were calculated using clinical, clinical and fibre-optic transillumination, and clinical and bitewing data sets . The results indicated that the use of Chlorzoin had an initial effect on mutans streptococci levels but that no long-term reduction in caries increment or mutans streptococci infection could be detected . One reason for this lack of efficacy may have been the regimen of reduced frequency of varnish applications after the initial period . Children who followed the protocol and, therefore, were seen regularly by dental auxiliaries had a lower caries increment than those who did not . This finding was independent of varnish allocation . In summary, under this regimen, Chlorzoin has been found to be effective in decreasing salivary mutans streptococci but ineffective as a caries-preventive agent in high-risk Scottish children when applied pragmatically in a community setting.

J Biol Chem, 2000 Dec 22, 275(51), 39860 - 6
Salivary agglutinin, which binds Streptococcus mutans and Helicobacter pylori, is the lung scavenger receptor cysteine-rich protein gp-340; Prakobphol A et al.; Salivary agglutinin is a high molecular mass component of human saliva that binds Streptococcus mutans, an oral bacterium implicated in dental caries . To study its protein sequence, we isolated the agglutinin from human parotid saliva . After trypsin digestion, a portion was analyzed by matrix-assisted laser/desorption ionization time-of-flight mass spectrometry (MALDI-TOF MS), which gave the molecular mass of 14 unique peptides . The remainder of the digest was subjected to high performance liquid chromatography, and the separated peptides were analyzed by MALDI-TOF/post-source decay; the spectra gave the sequences of five peptides . The molecular mass and peptide sequence information showed that salivary agglutinin peptides were identical to sequences in lung (lavage) gp-340, a member of the scavenger receptor cysteine-rich protein family . Immunoblotting with antibodies that specifically recognized either lung gp-340 or the agglutinin confirmed that the salivary agglutinin was gp-340 . Immunoblotting with an antibody specific to the sialyl Le(x) carbohydrate epitope detected expression on the salivary but not the lung glycoprotein, possible evidence of different glycoforms . The salivary agglutinin also interacted with Helicobacter pylori, implicated in gastritis and peptic ulcer disease, Streptococcus agalactiae, implicated in neonatal meningitis, and several oral commensal streptococci . These results identify the salivary agglutinin as gp-340 and suggest it binds bacteria that are important determinants of either the oral ecology or systemic diseases.

Pflugers Arch, 2000, 440(5 Suppl), R91 - 3
A mouse model of chronic bacterial lesions (a cotton trap) for studying oral bacteria-lymphocyte interactions; Hudler P et al.; We established a mouse model of chronic bacterial infection (cotton trap) to get a deeper insight into interactions between immune cells and bacterial strains, that are most commonly isolated from periapical processes . We have used flow cytometry to identify the presence of intracellular cytokines of activated T cells collected from cotton traps, previously infected with different strains of bacteria and implanted subcutaneously into the back of the mice . We provide an evidence that anaerobic bacteria (Bacteroides sp.) and nocardiae are more effective in inducing cytotoxic immunity and Th1 response compared to oral streptococci . Differences in immune response against anaerobic bacteria when compared to streptococci are probably dependent on some non-specific immune cell stimulation (e.g . by bacterial cell wall components), nevertheless the role of specific antigen-dependent immune mechanism can not be excluded.

Pflugers Arch, 2000, 440(5 Suppl), R86 - 8
Immune response in chronic periapical parodonititis; Ihan Hren N et al.; The purpose of our study was to investigate the immune response in chronical periapical parodontitis (CPP) by using multidisciplinary approach . 30 CPP samples were obtained after surgical removal--apicoectomy . Each CPP sample was examined by histological, bacteriological and flow cytometrical (FC) analysis of lymphocytes infiltrating CPP samples . Ten percent of bacteriological samples were sterile, others had significant aerobic and anaerobic growth . We used pathohistologic and microbiologic findings and compared them to the results of immunological analysis . By FC we found a significant increase in proportions of T lymphocytes expressing interleukin-2 receptors and ICAM-1 compared to peripheral blood lymphocytes . Proportions of T helper cells that produce interferon-gama (IFN-gamma) was higher in CPP samples predominantly colonized by anaerobic bacteria . There were no differences in IL-4 expression by T cells in both groups (anaerobic and streptococcal) . Among anaerobic CPP samples differences in proportion of T cells that express IL-2 receptors expression was also found between samples colonised by P . acnes and Bacteroides sp . Oral streptococci cause relatively limited tissue destruction and induce Th2 type of immune response accompanied by non-cytotoxic inflammatory reaction . On the contrary, anaerobic bacteria induce Th1 type of immune response that cause more severe inflammatory reaction (type 4) of hypersensitivity that damage the tissue by the action of cytotoxic T cell activation.

Pflugers Arch, 2000, 440(5 Suppl), R67 - 9
Immune response in lymphocyte cultures stimulated by oral bacteria preparations; Vardjan N et al.; Lymphocyte cultures were used as an in vitro experimental model to get a deeper insight into immune response to oral bacteria in periapical granulomas . Lymphocytes isolated from leucocyte concentrate were in lymphocyte cultures stimulated by antigen preparations of oral bacteria . Lymphocyte subsets that have developed in lymphocyte cultures after a week of stimulation were analysed by flow cytometry . A significant increase in expression of INF-gamma molecules in CD3+ cells stimulated by antigen preparations of oral streptococci was found, compared with negative control . On the other hand we observed a significant increase in expression of IL-4 in CD3+ cells stimulated by antigens of anaerobic bacteria, compared with negative control . Our results show that antigens of oral streptococci in in vitro lymphocyte cultures induce the differentiation of T helper cells into Th2 cells and that antigen preparations of anaerobic bacteria induce the differentiation of T helper cells into Th1 cells . Furthermore, an increased expression of HLA-DR molecules on CD8+ T cells stimulated by antigens of oral streptococci was found, compared with negative control.

Obstet Gynecol, 2000 Oct, 96(4), 498 - 503
Group B streptococcal colonization and serotype-specific immunity in pregnant women at delivery; Campbell JR et al.; OBJECTIVE: To describe the relationship between serum concentration of group B streptococcal capsular polysaccharide-specific immunoglobulin (Ig) G, colonization status, race or ethnicity, and age in pregnant women . METHODS: Pregnant women (n = 3307) were enrolled from geographically and ethnically diverse populations . At the time of admission for delivery, swabs of the lower vagina and rectum were obtained for isolation of group B streptococci . In a subset of women whose sera were available, capsular polysaccharide-specific IgG concentrations were quantified by serotype-specific (Ia, Ib, II, III, and V) enzyme-linked immunosorbent assay and compared by group B streptococcal colonization status . RESULTS: Group B streptococcal colonization was detected in 856 women (26%), and the rate was significantly higher among black women (37%) than in other racial or ethnic groups (odds ratio 1.7, 95% confidence interval 1.4, 2.1) . Colonization status did not differ by study site or age . Colonization with serotypes Ia, II, III, or V was associated with significantly higher serum concentrations of IgG specific for the capsular polysaccharide of the colonizing serotype compared with noncolonization . However, 48% of colonized women had low capsular polysaccharide-specific IgG levels (less than 0.5 microg/mL) in their delivery sera . Colonized teenagers had the lowest median concentration . CONCLUSION: Colonization with group B streptococcus can elicit a systemic immune response, with a cumulative increase in the prevalence of capsular polysaccharide-specific IgG with increasing age . Conversely, low antibody levels in colonized teenagers might account in part for the reported increased risk of group B streptococcal disease in neonates born to these patients.

An Esp Pediatr, 2000 Mar, 52(3), 212 - 9
{Rational use of antibiotics in pediatrics: impact of a rapid test for detection of beta-haemolytic group A streptococci in acute pharyngotonsillitis}; Contessotto Spadetto C et al.; OBJECTIVES: To assess the reliability and validity of a rapid test for the identification of Streptococcus pyogenes in the pharyngeal exudate of children presenting with pharyngotonsillitis . To evaluate the impact of its use in outpatient clinics on antibiotic use, on the incidence of second medical visits and complications, and on the degree of parental satisfaction . PATIENTS AND METHODS: After a clinical diagnosis of acute pharyngitis was established and written informed consent obtained from the parents, dual throat swabs were collected from 430 children who attended the emergency department of our hospital or the pediatric offices of three health centers in our area . The first specimen was examined by the rapid test, QuickVue Flex Strep A, and the second one was sent to the laboratory for conventional culture . As a rule, antibiotics were indicated only when the rapid test was positive . Special emphasis was placed on explaining to parents that treatment was not necessary when the test was negative . Telephone follow-up was provided to the family during the next four weeks, after which a satisfaction survey was carried out . RESULTS: The sensitivity of the investigated rapid test was 91.2% (negative predictive value: 96.5%) and specificity was 96.2% (positive predictive value: 90.4%) . Antibiotics were given to 41.9% of the patients, approximately half the expected rate in the absence of the rapid test . There was no significant difference in the number of second visits or hospitalizations between the groups of treated and non-treated subjects . Clinical evolution was good in all cases . The degree of parental satisfaction was very high, independent of the treatment given to the patients . CONCLUSIONS: The rapid test for the detection of group A streptococci is a reliable tool for the selection of patients able to benefit from antibiotic treatment . It is easy to handle and apply and its use allows a significant reduction in the administration of antibiotics in pharyngotonsillitis . Most users accept and are satisfied with this novel diagnostic and therapeutic procedure.

Mol Genet Metab, 2000 Sep-Oct, 71(1-2), 451 - 4
Bacterial genetics and human immunity to group B streptococci; Adderson EE et al.; Serotype III group B Streptococcus agalactiae (GBS) are the most common cause of neonatal sepsis and meningitis . We have classified type III GBS by restriction digest patterns of chromosomal DNA and demonstrated that a subgroup of genetically related strains (RDP type III-3) causes the majority of type III GBS neonatal infection . Genetic differences between type III GBS strains contribute significantly to differences in virulence and host immune responses . While 100% of less virulent RDP type III-1 and III-2 organisms express C5a-ase, an inhibitor of neutrophil chemotaxis, only 63% of virulent RDP type III-3 isolates have functional C5a-ase . Functional differences in type III GBS C5a-ase are attributable to a shared genetic polymorphism, supporting our genetic classification . The mean capsular sialic acid content of virulent RDP type III-3 strains is significantly higher than that of less virulent strains, suggesting that capsular sialylation is also genetically regulated . C5a-ase is not critical for all RDP type III-3 strains to be invasive because the higher capsular sialic acid content of III-3 strains limits complement activation . The identification of these and additional genetic differences between GBS strains has important implications for our understanding of the pathogenesis of these important human infections .

Mund Kiefer Gesichtschir, 2000 Jul, 4(4), 234 - 9
{Pathogen and resistance spectrum in intraoral infections of the jaw-facial area with special reference to anaerobic bacteria}; Eick S et al.; The aim of the study was to obtain more knowledge about the aerobic and anaerobic species causing maxillofacial infections and their resistance patterns today . Samples of pus or infectious tissue obtained from 110 patients of maxillofacial surgery were investigated microbiologically by means of aerobic and anaerobic cultivation . After incubation, the cultivated species were isolated and identified . The resistance patterns of all bacteria to penicillin, doxycyclin, and clindamycin were determined . Additionally, the resistance of aerobic species to cefuroxim was documented, and the MICs of cefoxitin and metronidazole to the anaerobic species were assessed . The most frequent disease was periodontitis apicalis (70 patients) . Aerobic species alone were found in 23% of the samples, 14% of the infections harbored only anaerobes, but 63% were mixed infections caused by aerobic and anaerobic bacteria . In case of detection of aerobic species, streptococci were always identified . Five patients were infected by Staphylococcus aureus and gram-negative aerobic rods were found in eight patients . Most of the anaerobic species were black pigmented prevotella species (62), nonpigmented prevotellae (56), and fusobacteria (37) . Metronidazole and clindamycin were highly efficient to gram-negative anaerobic rods . Most of the oral species were resistant to penicillin and doxycyclin . The indication for applying antibiotics should always be noticed and these drugs should only be used after determination of the pathogenic microorganisms and their susceptibility to the antimicrobials.

Infect Immun, 2000 Oct, 68(10), 5794 - 802
Lectin site interaction with capsular polysaccharide mediates nonimmune phagocytosis of type III group B streptococci; Albanyan EA et al.; Group B Streptococcus (GBS) causes substantial morbidity but most individuals exposed to the organism remain healthy . These experiments tested the hypothesis that engagement of the complement receptor 3 (CR3) lectin site would effectively trigger neutrophil-mediated phagocytosis of complement-opsonized type III GBS by nonimmune human sera . Using an opsonophagocytosis assay, saccharides identified as interacting with the CR3 lectin site effectively inhibited neutrophil-mediated killing of type III, strain COH1 . Fructose, which does not interact with the lectin site, promoted significantly less inhibition of opsonophagocytosis . Saccharide-mediated inhibition was reversed in a dose-related fashion by addition of type III, GBS capsular polysaccharide-specific immunoglobulin G . When capsule-deficient or asialo mutant type III strains were employed, the lectin site was not required . Structurally defined GBS serotypes with a side chain at least two sugars in length engaged the lectin site, and N-acetyl D-glucosamine was not a required component monosaccharide . Intact type III capsular polysaccharide interacted significantly more efficiently with the lectin site than did oligosaccharides representing approximately 5 or 20 repeating units, respectively . Taken together, these experiments indicate that interaction of type III GBS capsular polysaccharide with the lectin site of CR3 effects phagocytosis of these organisms by nonimmune serum . Use of this mechanism of innate immunity provides a potential explanation for the infrequency with which susceptible individuals exposed to type III GBS develop invasive infection.

Infect Immun, 2000 Oct, 68(10), 5749 - 55
Systemic and mucosal immune responses in mice after mucosal immunization with group B streptococcus type III capsular polysaccharide-cholera toxin B subunit conjugate vaccine; Shen X et al.; Group B streptococci (GBS) colonize the female genital and rectal tracts and can cause invasive infection in susceptible newborns . An optimally effective GBS vaccine should induce mucosal and systemic immunity . In this study, we investigate the local and systemic immune responses to GBS type III capsular polysaccharide (CPS) after mucosal vaccination of mice via intranasal, peroral, rectal, and vaginal routes, with GBS type III CPS conjugated with recombinant cholera toxin B subunit (GBS III CPS-rCTB) . Cholera toxin (CT) was added as an adjuvant . Immunoglobulin G (IgG) and IgA antibodies to the CPS were tested in serum, lungs, and intestinal, rectal, and vaginal extracts by enzyme-linked immunosorbent assay . The conjugated CPS administered by intranasal, peroral, rectal, and vaginal routes was much more effective at inducing both mucosal and systemic antibody responses to GBS III CPS than was unconjugated CPS . The CPS-specific immune responses in various organs were dependent on the route of immunization . Generally, the highest levels of IgA and IgG were generated in the regions or sites of the conjugate exposure . Thus, intranasal vaccination elicited the highest anti-CPS IgA and IgG antibody levels in the lungs, whereas peroral administration in the intestinal site and vaginal vaccination elicited the highest antibody levels in the vagina . Rectal vaccination was superior to the other routes in inducing high antibody levels in the rectum . The four routes of mucosal vaccination also induced distant antibody responses to CPS . Rectal vaccination induced high specific IgA levels in the vagina and intestine, and oral administration induced high specific IgA levels in the lungs and rectum . All four routes of vaccination with the conjugate elicited similarly high levels of anti-CPS IgG in serum . Intranasal vaccination with different doses of the conjugate (10, 30, and 80 microg of CPS) did not have a significant influence on the anti-CPS specific antibody responses . Intranasal immunization induced better antibody responses when one dose of the conjugate was divided and given on three consecutive days compared to administration of the full dose on one occasion . In conclusion, rectal and vaginal vaccination may be the best way of stimulating anti-CPS immune responses in the rectal and vaginal tracts, while high levels of anti-CPS antibodies in the lungs can be achieved after intranasal administration . The vaccination regimen thus might influence the mucosal immune response to CPS . This conjugate may serve as an effective mucosal vaccine for preventing mucosal colonization and invasive infection caused by GBS.

Infect Immun, 2000 Oct, 68(10), 5610 - 8
Identification of group B streptococcal Sip protein, which elicits cross-protective immunity; Brodeur BR et al.; A protein of group B streptococci (GBS), named Sip for surface immunogenic protein, which is distinct from previously described surface proteins, was identified after immunological screening of a genomic library . Immunoblots using a Sip-specific monoclonal antibody indicated that a protein band with an approximate molecular mass of 53 kDa which did not vary in size was present in every GBS strain tested . Representatives of all nine GBS serotypes were included in the panel of strains . Cloning and sequencing of the sip gene revealed an open reading frame of 1,305 nucleotides coding for a polypeptide of 434 amino acid residues, with a calculated pI of 6 . 84 and molecular mass of 45.5 kDa . Comparison of the nucleotide sequences from six different strains confirmed with 98% identity that the sip gene is highly conserved among GBS isolates . N-terminal amino acid sequencing also indicated the presence of a 25-amino-acid signal peptide which is cleaved in the mature protein . More importantly, immunization with the recombinant Sip protein efficiently protected CD-1 mice against deadly challenges with six GBS strains of serotypes Ia/c, Ib, II/R, III, V, and VI . The data presented in this study suggest that this highly conserved protein induces cross-protective immunity against GBS infections and emphasize its potential as a universal vaccine candidate.

Chirurg, 2000 Jul, 71(7), 844 - 7
{Streptococcal toxic shock-like syndrome with necrotizing myositis}; Rhomberg M et al.; Streptococcal toxic shocklike syndrome is caused by group A streptococci and characterized by multiorgan failure and soft-tissue necrosis, often in young patients with a bland history and at most a minor trauma . Diagnosis is reached through the clinical presentation, imaging methods and positive bacterial verification . The course is fulminant and in the case of muscle involvement, mortality reaches 80-100% . Therapy consists of immediate fasciotomy and often of debridement of affected soft tissues with high-dose antibiotics in intensive care . Sometimes an unconfirmed diagnosis must be sufficient to operate . We report the case of a 29-year-old man without an exceptional history who was forced to undergo thigh amputation, multiple soft-tissue debridements, and after a total of 240 erythrocyte concentrates, finally hip joint enucleation.

J Bacteriol, 2000 Oct, 182(19), 5290 - 9
Aerotolerance and peroxide resistance in peroxidase and PerR mutants of Streptococcus pyogenes; King KY et al.; Survival in aerobic conditions is critical to the pathogenicity of many bacteria . To investigate the means of aerotolerance and resistance to oxidative stress in the catalase-negative organism Streptococcus pyogenes, we used a genomics-based approach to identify and inactivate homologues of two peroxidase genes, encoding alkyl hydroperoxidase (ahpC) and glutathione peroxidase (gpoA) . Single and double mutants survived as well as the wild type under aerobic conditions . However, they were more susceptible than the wild type to growth suppression by paraquat and cumene hydroperoxide . In addition, we show that S . pyogenes demonstrates an inducible peroxide resistance response when treated with sublethal doses of peroxide . This resistance response was intact in ahpC and gpoA mutants but not in mutants lacking PerR, a repressor of several genes including ahpC and catalase (katA) in Bacillus subtilis . Because our data indicate that these peroxidase genes are not essential for aerotolerance or induced resistance to peroxide stress in S . pyogenes, genes for a novel mechanism of managing peroxide stress may be regulated by PerR in streptococci.

Baillieres Best Pract Res Clin Rheumatol, 2000 Sep, 14(3), 559 - 78
Rheumatic disorders associated with streptococcal infections; Li EK; The proteins in the cell wall of Streptococcus have many functions, with some proteins being regarded as a marker of their rheumatological potential . High levels of antibodies directed against some proteins are seen in patients with acute rheumatic fever . The theory of molecular mimicry forms the basis of the relationship between the bacteria and the disease acute rheumatic fever . A distinct entity which does not fulfil Jones' criteria, and which is known as post-streptococcal reactive arthritis following infection with beta-haemolytic streptococci, is being encountered more frequently . A pyogenic form of arthritis due to Streptococcus is one of the most common and serious joint infections and requires prompt recognition and treatment.

J Infect Dis, 2000 Oct, 182(4), 1109 - 16 Epub 2000 Sep 08.
Contrasting molecular epidemiology of group A streptococci causing tropical and nontropical infections of the skin and throat; Bessen DE et al.; Disease caused by group A streptococci (GAS) in tropical regions often takes the form of impetigo, whereas pharyngitis tends to predominate in temperate zones . GAS derived from asymptomatic throat infections and pyoderma lesions of rural Aboriginal Australians were evaluated for phylogenetic distant emm genes, which represent ecological markers for tissue site preference . On the basis of the percentage of total isolates from a given tissue, emm pattern A-C organisms exhibited a stronger predilection for the throat, whereas pattern D organisms preferred the skin . Only 16% of isolates collected by active surveillance displayed pattern A-C, which reflects the low incidence of oropharyngeal infection . Importantly, most (70%) pattern A-C organisms were isolated from skin sores, despite their innate tendency to infect the throat . Combined with findings from nontropical populations, analysis of the data supports the hypothesis that GAS tissue preferences are genetically predetermined and that host risk factors for infection strongly influence the differential reproduction of individual clones.

Optometry, 2000 Apr, 71(4), 233 - 8
Post-streptococcal uveitis; Besada E et al.; BACKGROUND: We report additional evidence supporting the association between the occurrence of bilateral nongranulomatous uveitis and previous infection by group A streptococci--i.e., post-streptococcal syndrome . METHODS: As shown through a series of case reports, physical examination and laboratory blood analysis--including antistreptolysin O (ASO) antibody titer--were ordered due to a recent history of sore throat and presence of nongranulomatous bilateral anterior uveitis . RESULTS: Serological laboratory testing revealed elevated ASO antibody titer . The etiology of the uveitis was attributed to streptococcal infection . Bilateral uveitis responded to topical corticosteroids . Systemic antibiotic treatment was used to treat possible post-streptococcal syndrome sequelae with resolution of symptoms . CONCLUSION: Uveitis should be considered a possible manifestation of post-streptococcal syndrome . ASO antibody quantification should be included in the serologic testing performed in evaluating the cause of seemingly idiopathic bilateral nongranulomatous anterior uveitis associated with signs and symptoms that suggest previous streptococcal infection.

Clin Diagn Lab Immunol, 2000 Sep, 7(5), 817 - 22
Influence of modified natural or synthetic surfactant preparations on growth of bacteria causing infections in the neonatal period; Rauprich P et al.; Connatal bacterial pneumonia is common in neonates . Animal studies and initial clinical reports indicate that surfactant dysfunction is involved in the pathophysiology of severe neonatal pneumonia . Since respiratory distress syndrome and connatal pneumonia may be difficult to differentiate in the first hours of life, neonates with respiratory failure due to bacterial infections might receive surfactant . Under such conditions surfactant components might be catabolized by bacteria and promote bacterial growth . We therefore investigated the influence of three modified natural (Curosurf, Alveofact, and Survanta) and two synthetic (Exosurf and Pumactant) surfactant preparations on the growth of bacteria frequently cultured from blood or tracheal aspirate fluid in the first days of life . Group B streptococci (GBS), Staphyloccocus aureus, and Escherichia coli were incubated in a nutrient-free medium (normal saline) for 5 h at 37 degrees C, together with different surfactants at concentrations of 0, 1, 10, and 20 mg/ml . With the exception of E . coli, incubation in saline alone led to a variable decrease in CFU . In the presence of Alveofact, Exosurf, and Pumactant the decline in bacterial numbers was less marked than in saline alone . Curosurf was bactericidal in a dose-dependent fashion for GBS and had a strong negative impact on the growth of a GBS subtype that lacked the polysaccharide capsule . In contrast, Survanta (10 and 20 mg/ml) significantly promoted the growth of E . coli, indicating that surfactant components may actually serve as nutrients . We conclude that bacterial growth in different surfactant preparations is influenced by microbial species and the composition and dose of the surfactant . Further studies are necessary to elucidate the mechanisms behind our findings and to evaluate the effects of surfactant on bacterial growth in vivo.

Biol Neonate, 2000, 78(2), 121 - 8
Effects of anti-CD18 monoclonal antibody, R15.7, on the cardiopulmonary manifestations of group B streptococcal sepsis in piglets; Bandel JW et al.; We hypothesized that anti-CD18 monoclonal antibody, R15.7, a murine IgG(1) antibody which blocks leukocyte-endothelial cell adherence, might ameliorate the cardiopulmonary manifestations of sepsis secondary to group B streptococci (GBS) . Twenty-six anesthetized, mechanically ventilated newborn piglets received a continuous infusion of GBS (7.5 x 10(9) cfu/kg/min) and were randomly assigned to a treatment group receiving R15.7 (1 mg/kg i.v.) 15 min prior to GBS infusion or to a control group . Cardiopulmonary measurements, arterial blood gases and peripheral blood leukocytes were obtained over 120 min of R15.7 infusion . GBS infusion caused significant increases in pulmonary artery and systemic arterial blood (Psa) pressures, pulmonary vascular (PVR) and systemic vascular (SVR) resistances, and PVR/SVR ratio with decreases in cardiac output and stroke volume . R15.7-treated piglets maintained significantly higher Psa (p < 0.003), dynamic lung compliance (p < 0.04), PaO2 and pH (p < 0.05), and lower total lung resistance (p < 0.01) and PaCO2 (p < 0.04) . A longer median survival time was observed in the treatment group (p < 0.01) . These data suggest that administration of a CD18-blocking agent prolongs survival in a young animal model of GBS sepsis, possibly secondary to improved tissue perfusion, lung mechanics and acid-base status .

J Clin Microbiol, 2000 Sep, 38(9), 3420 - 8
Genotyping of the capsule gene cluster (cps) in nontypeable group B streptococci reveals two major cps allelic variants of serotypes III and VII; Sellin M et al.; Forty group B Streptococcus (GBS) isolates obtained from Europe and the United States previously reported to be nontypeable (NT) by capsule serotype determination were subjected to buoyant density gradient centrifugation . From nearly half of the isolates capsule-expressing variants could be selected . For characterization of the remaining NT-GBS isolates, the capsule operon (cps) was amplified by the long-fragment PCR technique and compared by restriction fragment length polymorphism (RFLP) analysis . The patterns from serotype reference isolates (n = 32) were first determined and used as a comparison matrix for the NT-GBS isolates . Using two restriction enzymes, SduI and AvaII, cluster analysis revealed a high degree of similarity within serotypes but less than 88% similarity between serotypes . However, serotypes III and VII were each split in two distant RFLP clusters, which were designated III(1) and III(2) and VII(1) and VII(2), respectively . Among the isolates that remained NT after repeated Percoll gradient selections, two insertional mutants were revealed . Both were found in blood isolates and harbored insertion sequence (IS) elements within cpsD: one harbored IS1548, and the other harbored IS861 . All other NT-GBS isolates could, by cluster analysis, be referred to different serotypes by comparison to the RFLP reference matrix . In pulsed-field gel electrophoresis of SmaI-restricted chromosomal DNA, patterns from allelic type 1 and 2 isolates were essentially distributed in separate clusters in serotypes III and VII . A covariation with insertion sequence IS1548 in the hylB gene was suggested for serotype III, since allelic type III(1) harboring IS1548 in hylB, clustered separately . The variation in serotype VII was not dependent on the presence of IS1548, which was not detected at any position in the type VII chromosome.

Intern Med, 2000 Sep, 39(9), 687 - 94
Acute glomerulonephritis; Yoshizawa N; Acute glomerulonephritis (AGN) is a representative disease of acute nephritic syndrome characterized by the sudden appearance of edema, hematuria, proteinuria, and hypertension . The prototype of AGN is acute poststreptococcal glomerulonephritis (APSGN) . "Nephritogenic streptococci" are defined as organisms that are cultured from a patient who develops AGN . Although only a limited number of M-types of streptococci have been recognized as "nephritogenic streptococci", all M-types of streptococci may have nephritogenic potential because the genes for major putative nephritogenic antigens such as SPEB and NAPIr are found to be present in all group A streptococci thus far examined . Pathogenic mechanisms for APSGN involving both humoral and cell-mediated immunity have been recently proposed . The role of humoral immunity is presumed to be mediated by the in situ formation of nephritogenic streptococcal antigen-antibody complexes and circulating immune complexes . While in the cellular immune component a role for delayed-type hypersensitivity has been suggested to contribute to the pathogenesis of APSGN.

Pediatr Dent, 2000 Jul-Aug, 22(4), 299 - 301
Mutans streptococci prevalence in Puerto Rican babies with cariogenic feeding behaviors; Lopez L et al.; PURPOSE: Previous studies have demonstrated that babies are at higher risk for mutans streptococci (ms) colonization if their mothers have dense salivary ms reservoirs relative to babies who have mothers with negligible salivary reservoirs . This communication provides data that identifies another potential risk factor (use of a nursing bottle at bedtime and/or naptime that contains a substrate other than water) for baby infection by ms . METHODS: The study population consisted of 60 babies (28 males/32 females; mean age 15 mos; age range 12-18 mos) who were all healthy, caries free, and slept with a nursing bottle that contained a substrate other than water (NB+) . Pooled maxillary incisor plaque and saliva samples were obtained and immediately placed in Reduced Transparent Fluid (RTF); they were serially diluted and plated onto Mitis Salivarius Agar plus Bacitracin (MSB) and blood agar plates within 4 hours of collection; the plates were incubated in an anaerobic environment for 48 h at 37 C and then placed for 24 h under aerobiosis prior to examination; representative ms colonies were isolated and subjected to mannitol and sorbitol fermentation tests for taxonomic verification . Plates with colony counts between 20 and 300 were utilized to determine the % of ms in each sample . RESULTS: Fifty one of the 60(85%) babies harbored ms in at least 1 of the 2 samples . The 95% confidence interval for the proportion of subjects with detectable levels of ms was 73%-93% . Fisher's exact test showed that babies 16-18 mos age were more likely to have detectable levels of ms than babies 12-15 mos age (p = 0.01) . Levels of ms in plaque and saliva were as follows: < 0.1% (plaque 27/51, mean age 15 mos, sd 1.77; saliva 28/51, mean age 15 mos, sd 1.76); 0.1%-1.0% (plaque 4/51, mean age 14 mos, sd 1.5; saliva 6/51, mean age 15 mos, sd 1.46); > 1.0% (plaque 14/51, mean age 16 mos, sd 2.1; saliva 11/51, mean age 16 mos, sd 1.91) . The density of infection did not vary by age for plaque (P = 0.32) or saliva (P = 0.64) . CONCLUSION: These findings support the concept that NB+ is a strong indicator for ms infection in Puerto Rican babies; that prevalence of infection increases with age; and that density of infection does not vary with age in this population.

Microb Pathog, 2000 Sep, 29(3), 145 - 53
Molecular characterization and allelic distribution of the phage-mediated hyaluronidase genes hylP and hylP2 among group A streptococci from western Norway; Mylvaganam H et al.; Forty-two isolates of group A streptococcus from patients with invasive and non-invasive diseases in western Norway, belonging to the emm sequence types emml, emm3, emm6, emm22, emm28, emm75 and emm78 were screened by PCR for the phage-mediated hyaluronidase genes hylP and hylP2 . The amplified genes were characterized by nucleotide sequencing and/or by PCR-RFLP, with the objective of looking for possible associations between alleles of these two genes and invasiveness . The hylP was amplified from all isolates and two main alleles were found hylP-emm3 in all emm3 isolates and hylP-emm6A in all emm6 isolates, the latter possibly generated by an intergenic recombination between hylP and hylP2 . The isolates of the other sequence types had either of these two alleles, or both . Only 27 isolates gave amplicons of the appropriate size with the primers targeting hylP2 . Sequencing of these amplicons showed two main types: one was similar to the published hylP2 and the other (hylP-emm6B) was probably a variant of hylP . PCR-RFLP revealed the presence of both hylP-emm6B and hylP2 in at least six of the emm6 isolates . The alleles of both hylP and hylP2 seemed to have emm sequence type preferences . No association between invasiveness and specific phage-mediated hyaluronidase genes/alleles or the production of extracellular hyaluronidase was observed .

J Med Microbiol, 2000 Sep, 49(9), 811 - 6
Haemolysin-deficient variants of Streptococcus pyogenes and S . dysgalactiae subsp . equisimilis may be overlooked as aetiological agents of pharyngitis; Dierksen KP et al.; Variants of large colony beta-haemolytic Lancefield group A, C and G streptococci that are non-haemolytic or alpha-haemolytic on sheep blood agar have been detected in clinical specimens due to their enhanced haemolytic activity when grown on a new selective and differential blood agar medium containing colistin, nalidixic acid and pH 7.5-adjusted PIPES buffer (CNA-P) . The large colony Lancefield group C and G isolates were identified as Streptococcus dysgalactiae subsp . equisimilis by API 20 Strep classification and 16S rDNA profiling . The haemolytic activity of these variants on various blood agar media, including CNA-P, was closely similar to that of known streptolysin S-defective mutants of S . pyogenes and was blocked by addition of cholesterol, a specific inhibitor of the streptolysin O family of haemolysins . As haemolysin variants could be detected in large numbers in cultures from patients with clinical symptoms of pharyngitis it is suggested that they may function as primary pathogens in such infections . The high frequency with which haemolysin variants were isolated from clinical specimens during a 3-month trial (3%, 13% and 10%, respectively, of group A, C and G streptococcal isolates) indicated that a substantial proportion of streptococcal infections may go undetected if only conventional sheep blood agar media are used in clinical laboratories for the detection of beta-haemolytic streptococci . As haemolysin variants have been implicated in the development of serious streptococcal sequelae, further investigation of the full extent of their contribution to streptococcal disease is indicated.

Res Microbiol, 2000 Jul-Aug, 151(6), 471 - 3
Mechanisms and spread of fluoroquinolone resistance in Streptococcus pneumoniae; Varon E et al.; The development of fluoroquinolones (FQs) with enhanced activity against Streptococcus pneumoniae is a potential advance in the treatment of pneumococcal infections, particularly those due to beta-lactam-resistant pneumococci . However, FQ-resistant clinical isolates selected by the older FQs have already been reported, with mutation(s) in both FQ targets conferring cross-resistance to newer FQs . It is likely that recombinational events between topoisomerase genes from related species of streptococci contribute to the spread of FQ resistance in S . pneumoniae . A scenario resembling that of the worldwide spread of resistance to beta lactams should be anticipated.

Scand J Infect Dis, 2000, 32(4), 421 - 2
Acute phlegmonous jejunitis and viridans streptococcal peritonitis associated with bronchial carcinoma; Svane S; A 61-y-old man developed acute non-specific phlegmonous jejunitis associated with relatively mild diffuse peritonitis . Bacteriological cultures of the abundant peritoneal fluid resulted in only growth of viridans streptococci (Streptococcus mitis and S . salivarius) . Antibiotic treatment had a favourable effect, but a hitherto unknown bronchial cancer led to his death 5 months later . It is assumed that this peculiar case was the result of the immunosuppressive effect related to the malignant neoplasm (opportunistic infection).

Scand J Infect Dis, 2000, 32(4), 377 - 84
Beta-haemolytic streptococci isolated from acute sore-throat patients: cause or coincidence? A case-control study in general practice; Zwart S et al.; As beta-haemolytic streptococci can be cultured in people with and in those without a sore throat, a case-control study was set up in 43 family practices in The Netherlands . The association was tested between the number of colony counts, specific T/M types and exotoxin genes and an acute sore throat . Duplicate throat swabs were taken from 663 sore-throat patients, selected by clinical criteria, and from 694 healthy controls . They were cultured for beta-haemolytic streptococci by combining several updated laboratory methods . Approximately 40% of the controls and 80% of the patients had beta-haemolytic streptococci-positive cultures . When focusing on cultures with high colony counts, not only group A (46%), but also non-group A streptococci (20%), predominated significantly in adult patients compared with controls . No T/M or exotoxin gene type was significantly more prevalent in patients than in controls . Thus, semiquantitative analysis, but not T/M and exotoxin gene typing, showed an association between beta-haemolytic streptococci and active disease . Groups A, C and G streptococci were found to be potentially pathogenic in adult sore-throat patients, and should be included in the discussion on the use of rapid antigen detection tests and penicillin treatment in primary care.

Scand J Infect Dis, 2000, 32(4), 343 - 56
Infective endocarditis: a diagnostic and therapeutic challenge for the new millennium; Alestig K et al.; This review on infective endocarditis (IE) is based on clinical studies carried out in Goteborg since 1984, data obtained from a Swedish national registry of IE since 1995 and existing literature . IE is still a great challenge in medicine, although improved bacteriological and echocardiographical techniques have facilitated diagnosis . In Sweden the incidence of IE is about 6 per 100,000 inhabitants a year . During recent decades IE has changed character . Patients are older, fever is often the only major symptom and a new murmur is less frequent . Streptococci, including viridans species and staphylococci, are still the most common bacteria found . Antibiotic treatment for 4-6 weeks may reduce mortality of IE to 30-50% . For further reduction, heart surgery is necessary in 20-25% of patients in order to remove infected tissues and restore valve function . Rapid diagnosis, careful antibiotic treatment and optimal surgery may reduce mortality associated with treatment to 10% . Antibiotic treatment is still mainly empiric . Penicillin and aminoglycoside for 2 weeks only seem to be effective in uncomplicated IE caused by alpha-streptococci . Otherwise, 4 weeks of treatment is needed, but aminoglycoside treatment may be reduced to 1 week in general and 2 weeks for enterococcal infections.

Antimicrob Agents Chemother, 2000 Sep, 44(9), 2554 - 6
Trovafloxacin treatment of viridans group Streptococcus experimental endocarditis; Piper KE et al.; The activity of trovafloxacin was compared with those of vancomycin and penicillin in a model of Streptococcus sanguis species group (trovafloxacin MIC, 0.125 microg/ml) and Streptococcus mitis species group (trovafloxacin MIC, 0.125 microg/ml) experimental endocarditis . Rabbits with catheter-induced aortic valve vegetations were given no treatment, trovafloxacin at 15 mg/kg of body weight three times a day (t.i.d.), vancomycin at 15 mg/kg twice a day, or penicillin at 1 . 2 x 10(6) IU t.i.d . After 3 days of treatment, the animals were sacrificed; cardiac valve vegetations were aseptically removed and cultured quantitatively . Penicillin was as active as vancomycin as measured by in vivo clearance of bacteria . Trovafloxacin was less active (P < 0.05) than vancomycin or penicillin against S . sanguis species group infection but had similar efficacy against S . mitis species group infection . Quinolones, despite MICs in the susceptible range, may not be active for serious infections caused by some viridans group streptococci.

J Infect Dis, 2000 Sep, 182(3), 974 - 7 Epub 2000 Aug 17.
Effects of group B streptococci on cord and adult mononuclear cell interleukin-12 and interferon-gamma mRNA accumulation and protein secretion; Joyner JL et al.; Group B streptococci (GBS) are a major cause of early-onset infection in neonates . Neonates, who have defects in neutrophil function that likely contribute to susceptibility to GBS infection, are deficient in the production of the phagocyte activator interferon (IFN)-gamma . GBS-stimulated mRNA accumulation and protein secretion of IFN-gamma and interleukin (IL)-12, a major enhancer of IFN-gamma production, by mixed mononuclear cells (MMCs) from umbilical cord and adult peripheral blood was examined . GBS-exposed cord blood MMCs secreted lower concentrations of both IL-12 and IFN-gamma proteins than did MMCs from adults . IL-12 and IFN-gamma mRNA accumulation was examined by use of comparative reverse transcriptase-polymerase chain reaction . Cord blood MMCs accumulated less mRNA for both IL-12 and IFN-gamma than did adult blood MMC . The deficiency in cord blood cell production of IL-12 may have a role in inadequate IFN-gamma production, which contributes to the unique susceptibility of neonates to GBS infections.

J Chemother, 2000 Aug, 12(4), 326 - 31
Comparison of efficacy and safety of teicoplanin and vancomycin in children with antineoplastic therapy-associated febrile neutropenia and gram-positive bacteremia; Sidi V et al.; To compare their efficacy and safety, teicoplanin and vancomycin were randomly administered to 32 children for 52 gram-positive bacteremias during malignancy-associated neutropenia (<1000/microl) . Patients mainly suffered from hematological malignancies . Twenty-five episodes were treated with teicoplanin (10 mg x kg(-1) x d(-1)) and 21 with vancomycin (40 mg x kg(-1) x d(-1)) plus ceftazidime and netilmicin . Six episodes were treated with teicoplanin because of previous "red man" reaction to vancomycin . Staphylococci (12% Staphylococcus aureus) were isolated from 50 episodes and viridans streptococci from 2 . Defervescence on 3rd-4th day occurred in 29/31 (93.5%) teicoplanin-treated and 18/21 (85.7%) vancomycin-treated episodes . All 12 teicoplanin-treated and 13/13 vancomycin-treated episodes with repeat blood cultures on 3rd-4th day showed microbiological response . Two teicoplanin-treated and 3 vancomycin-treated patients required antifungals . Mild renal insufficiency appeared in 5 vancomycin-treated patients that was corrected without drug discontinuation . While both glycopeptides exhibit equal clinical and microbiological efficacy, teicoplanin is less likely to induce allergic reactions or nephrotoxicity in children.

Infect Immun, 2000 Sep, 68(9), 5018 - 25
Genetic polymorphisms of group B streptococcus scpB alter functional activity of a cell-associated peptidase that inactivates C5a; Bohnsack JF et al.; Many group B Streptococcus agalactiae strains and other pathogenic streptococci express a cell-associated peptidase that inactivates C5a (C5a-ase), the major neutrophil chemoattractant produced by activation of the complement cascade . Type III group B streptococci (GBS) can be classified genotypically into three restriction digest pattern types . Functional C5a-ase activity of GBS correlates with this genetic typing; therefore, we sought to identify a genetic basis for this phenomenon . Southern hybridization confirms that all type III GBS contain scpB, the gene encoding GBS C5a-ase . GBS strains with high C5a-ase functional activity and those with no or very low activity both express immunoreactive C5a-ase . The scpB sequence of strain I30, which has high C5a-ase activity, is 98.2% homologous to the previously reported serotype II GBS scpB sequence . The scpB sequences of strains I25 and GW, which have low or no C5a-ase activity, are identical . The predicted I25 and GW C5a-ase proteins share a four-amino-acid deletion affecting the protease histidine active-site consensus motif . Recombinant I30 C5a-ase has good functional activity, whereas recombinant I25 C5a-ase has low activity . These data demonstrate that functional C5a-ase differences between type III GBS strains are attributable to a genetic polymorphism of scpB . The ubiquitous expression of C5a-ase, irrespective of functional activity, suggests that C5a-ase may have a second, as yet unidentified, function.

Infect Immun, 2000 Sep, 68(9), 5011 - 7
Toxoids of streptococcal pyrogenic exotoxin A are protective in rabbit models of streptococcal toxic shock syndrome; Roggiani M et al.; Streptococcal pyrogenic exotoxins (SPEs) are superantigens that have been implicated in causing streptococcal toxic shock syndrome (STSS) . Most notably, SPE serotype A is made by nearly all M-protein serotype 1 and 3 streptococci, the M types most associated with the illness (these strains contain one or more other SPEs, and those proteins are likely also to contribute to disease) . We have prepared double-, triple-, and hexa-amino-acid mutants of SPE A by PCR and other mutagenesis procedures . The sites chosen for mutation were solvent-exposed residues thought to be important for T-cell receptor (TCR) or major histocompatibility complex (MHC) class II interaction . These mutants were nonsuperantigenic for human peripheral blood mononuclear cells and rabbit and mouse splenocytes and were nonlethal in two rabbit models of STSS . In addition, these mutants stimulated protective antibody responses . Interestingly, mutants that altered toxin binding to MHC class II were more immunogenic than mutants altering TCR binding . Collectively, these studies indicate that multiple-site mutants of SPE A are toxoids that may have use in protecting against the toxin's effects in STSS.

Int Dent J, 2000 Feb, 50(1), 57 - 9
Fibronectin levels in stimulated whole-saliva and their relationship with cariogenic oral bacteria; Llena-Puy MC et al.; AIM: Fibronectin is a multifunctional glycoprotein that plays a fundamental role in mechanism of cellular union and in bacterial adhesion in the oral cavity . The aim of this study was to test the clinical relationship between fibronectin concentration in stimulated whole-saliva and the number of Mutans streptococci bacteria . PARTICIPANTS: The sample consisted of 167 children aged 12 years . METHODS: Saliva samples were collected from the subjects . Bacterial quantification was carried out using a semiquantitative method (Dentocult SM, Vivadent) . Fibronectin was measured by the ELISA method with modifications . RESULTS: An inverse clinical relation was found between the levels of soluble fibronectin and the number of SM colony forming units . CONCLUSIONS: Bacterial counts sufficiently high to destroy the protein films increase bacterial binding to dental surfaces, thereby contributing to the regulation of bacterial plaque composition and its pathogenic potential . This capacity of glycoproteins to reduce the adhesion of microorganisms to the oral tissues and favour macrophage action supports the hypothesis that such proteins contribute to the first line of immune defence together with secretory antibodies.

Proc Natl Acad Sci U S A, 2000 Aug 15, 97(17), 9630 - 5
Mosaicism in the alpha-like protein genes of group B streptococci; Lachenauer CS et al.; Members of a family of repeat-containing surface proteins of group B streptococci (GBS) defined by the alpha C and Rib proteins exhibit size variability and cross-reactivity and have been studied as potential vaccine components . We report evidence of horizontal DNA transfer with subsequent recombination as a mechanism generating diversity within this antigen family . Alp2 and Alp3 are additional members of the alpha C protein family identified in strains of the emerging GBS serotypes V and VIII . Each contains an overall genetic organization highly similar to that of the alpha C and Rib proteins, including a tandem repeat region and conserved N- and C-terminal regions . Among different strains, protein size varies according to the number of tandem repeats within the corresponding gene . Unlike the alpha C and Rib proteins, however, the newly described alpha-like proteins contain other regions, including one similar to the IgA-binding region of the GBS beta C protein, a nontandem repeat region, and an isolated repeat highly homologous to the alpha C repeat . Sequence analysis of the regions flanking the alpha C protein gene on a 13.7-kb insert reveals several ORFs that are likely to be involved in basic metabolic pathways . Analysis of corresponding flanking regions in other GBS strains, including the parent strains of the newly described alpha-like proteins, shows striking conservation among all strains studied . These findings indicate that the alpha-like proteins are encoded by mosaic variants at a single genomic locus and suggest that recombination after horizontal DNA transfer is a means of generating diversity within this protein family.

Am J Obstet Gynecol, 2000 Aug, 183(2), 372 - 6
Late third-trimester treatment of rectovaginal group B streptococci with benzathine penicillin G; Bland ML et al.; OBJECTIVE: We sought to determine the efficacy of late third-trimester benzathine penicillin G administration in eradicating maternal group B streptococcal colonization at delivery . STUDY DESIGN: We performed a prospective trial of late third-trimester treatment with benzathine penicillin G versus observation in 78 obstetric patients colonized with group B streptococci . Patients were screened by use of rectovaginal swabs cultured in selective media between 34 and 37 completed weeks' gestation . Patients with positive cultures were offered antepartum treatment with 4.8 million units of intramuscular benzathine penicillin G or observation . Participants in both groups were recultured at their delivery admission before receiving standard intrapartum therapy . The primary outcome was the frequency of persistent maternal group B streptococcal colonization at the delivery admission . Other outcome variables included semiquantitative growth characteristics of all group B streptococcal cultures, the frequency of neonatal sepsis, and adverse maternal effects . Data were analyzed by the Student t test for continuous variables and the chi(2) or Fisher exact test for categoric variables, with significance established at P <.05 . RESULTS: Both groups were similar with respect to selected demographics, gestational age at delivery, and frequency of heavy group B streptococcal growth in initial screening cultures . The mean interval from treatment until delivery was 19.4 +/- 7.5 days (mean +/- SD) . There were no cases of neonatal sepsis in either group or any adverse maternal effects attributed to the treatment . Group B streptococcal culture characteristics at delivery admission were as follows . Positive results for group B streptococci were found in 7 (25%) treated patients and 41 (82%) patients under observation (relative risk, 0.30; 95% confidence interval, 0.16-0.59; P <.0001) . Positive results for heavy growth of group B streptococci were found in 0 (0%) treated patients and 31 (62%) patients under observation (relative risk, 0.01; 95% confidence interval, 0.00-0.12; P <.0001) . CONCLUSIONS: Treating group B streptococci carriers with benzathine penicillin G in the late third trimester eradicates or significantly reduces maternal group B streptococcal colonization at delivery . This may provide an adjuvant therapy to those mothers at risk for receiving inadequate intrapartum antibiotic prophylaxis against group B streptococci.

Blood Coagul Fibrinolysis, 2000 Jul, 11(5), 433 - 8
Systemic activation of coagulation and fibrynolysis in a porcine model of serogroup A streptococcal shock; Saetre T et al.; In a porcine model of Gram-positive sepsis, 28 juvenile pigs were studied to evaluate the effect of a continuous infusion of live serogroup A streptococci (GAS) on the activation of coagulation and fibrinolysis . Plasma levels of thrombin-antithrombin (TAT) complexes, tissue plasminogen activator (t-PA) and plasminogen activator inhibitor-1 (PAI-1) activities were measured using commercially available kits . The continuous infusion of GAS {(3-5) x 10(8) colony-forming units/kg per h} caused early signs of severe septicaemia in the pigs, with pulmonary hypertension, systemic hypotension, reduced cardiac output and liver hypoperfusion, ultimately leading to shock with a high mortality . There was a sequential and ordered activation of the coagulation, fibrinolytic and antifibrinolytic systems . GAS infusion induced a gradual, maximally 2.5-fold increase in plasma TAT levels . Plasma t-PA activity levels peaked at 2 h (nine-fold increase), whereas the peak of PAI-1 activity was delayed (eight-fold increase at 4 h) . These findings are similar to changes observed during endotoxin infusion . This procoagulant state favours disseminated intravascular coagulation and microthrombus formation, ultimately threatening tissue viability.

Turk J Pediatr, 2000 Apr-Jun, 42(2), 96 - 100
Alternative diagnostic method for streptococcal pharyngitis: Breese scoring system; Ulukol B et al.; This study was performed to determine the effectiveness of the Breese scoring system for the diagnosis of streptococcal pharyngitis with respect to different age groups . Two hundred and two children aged three years and younger (Group 1), and 514 children over three years old (Group 2) with complaints of acute pharyngitis were evaluated by Breese scoring and throat-swab cultures . In Group 1, no significant difference was detected in Breese scoring between subjects who had positive and negative culture for group A beta-hemolytic streptococci (GABHS) . However, in Group 2 the mean value of the Breese scores was found to be higher in subjects who had positive GABHS . The diagnostic value of Breese scoring was examined for each group . Its sensitivity, and positive and negative predictive values were higher in Group 2 than in Group 1 . In conclusion, Breese scoring was determined to be helpful in the diagnosis of streptococcal pharyngitis in children over three years of age.

J Oral Rehabil, 2000 Aug, 27(8), 708 - 13
Presence of microorganisms on the fitting denture complete surface: study 'in vivo'; Monsenego P; It was the intention to study if glazing the fitting surface of maxillary dentures with a light-curing acrylic resin would diminish the bacterial counts . The study included the application of a photopolymerizing glaze to one half of the fitting denture surface; after 15 days microbial plaque was collected from a 1 cm2 area of the glazed and the untreated resin, respectively . At the same time bacteria were collected from a 1 cm2 area of the corresponding sites on the palatal mucosa . The application of the glaze had modified the number of bacteria cultured from the glazed surface versus the untreated surface . Denture surface: total aerobic bacteria, 1:4; aerobic streptococci, 1:4; aerobic staphylococci, 1:5; anaerobic bacteria, 1:3.5; mucosal surface aerobic bacteria, 1:4; streptococcal, 1:4 . The differences were statistically significant at P<0.002 . However, from a quantitative and qualitative point of view these differences were minor compared with the actual concentrations of the microorganisms of 104-106/cm2 observed on the fitting denture surface and the palatal mucosa.

FEMS Microbiol Lett, 2000 Aug 15, 189(2), 293 - 7
Replication origin of Streptococcus pyogenes, organization and cloning in heterologous systems; Suvorov AN et al.; The origin of DNA replication (oriC) of Streptococcus pyogenes, group A streptococci (GAS), has been cloned in Escherichia coli and reintroduced by transformation into other GAS strains . Transformation frequencies into GAS strains with oriC-carrying plasmids occurred with unusually high frequencies . However, the oriC-containing plasmids in the new recipients were found to be unstable and had a tendency to integrate into the chromosome, even when a recA GAS strain was used as a recipient . The GAS oriC was able to direct the replication of autonomous plasmids in group B streptococcal recipients . The chromosomal organization of the oriC region of GAS relative to other bacterial species appears to be similar to oriC of Bacillus subtilis and other Gram-positive microorganisms.

Am J Surg, 2000 May, 179(5), 361 - 6
The microbiology of necrotizing soft tissue infections; Elliott D et al.; OBJECTIVE: A large number of necrotizing soft tissue infections (NSTI) treated at a single institution over an 8-year period were analyzed with respect to microbial pathogens recovered, treatment administered, and outcome . Based on this analysis, optimal empiric antibiotic coverage is proposed . METHODS: A retrospective chart review of all patients with documented NSTI was conducted . Microbiologic variables were tested for impact on outcome using Fisher's exact test and multivariate analysis by logistic regression . RESULTS: Review of the charts of 198 patients with documented NSTI revealed 182 patients with sufficient microbiologic information for analysis . These 182 patients grew an average of 4.4 microbes from original wound cultures, although a single pathogen was responsible in 28 patients . Eighty-five patients had combined aerobic and anaerobic growth, the most common organisms being, in order, Bacteroides species, aerobic streptococci, staphylococci, enterococci, Escherichia coli, and other gram-negative rods . Clostridial growth was common but did not affect mortality unless associated with pure clostridial myonecrosis . Mortality was affected by the presence of bacteremia, delayed or inadequate surgery, and degree of organ system dysfunction on admission . CONCLUSIONS: NSTI are frequently polymicrobial and initial antibiotic coverage with a broad-spectrum regimen is warranted . The initial regimen should include agents effective against aerobic gram-positive cocci, gram-negative rods, and a variety of anaerobes . The most common organisms not covered by initial therapy were enterococci . All wounds should be cultured at initial debridement, as changes in antibiotic coverage are frequent once isolates are recovered.

Syst Appl Microbiol, 2000 Jun, 23(2), 245 - 50
Taxonomic study of "tufted mitior" strains of streptococci (Streptococcus sanguinis biotype 11); recognition of a new genospecies; Kawamura Y et al.; The taxonomic position of tufted strains of streptococci, phenotypically resembling Streptococcus mitis and previously referred to as 'tufted mitior' was investigated . By 16S rRNA sequence analysis, it was clear that the "tufted mitior" strains belonged to the mitis group of species within the genus Streptococcus . It was confirmed that these strains were taxonomically independent at the species level, sharing less than 43%, DNA-DNA similarity with all established species of the mitis group . However biochemical test data obtained, using three commercial identification kits (Rapid ID32 Strep, STREPTOGRAM, and Biolog GP-plate) together with in-house biochemical tests employing 4-MUF-linked fluorogenic substrates did not reveal sufficient differential tests with which to identify the "tufted mitior" strains unequivocally . From these data, we conclude that these "tufted mitior" strains represent a new taxon within the mitis group of the genus Streptococcus, and propose that they should be considered as a genospecies until differential phenotypic characteristics are found for their identification.

Salud Publica Mex, 2000 May-Jun, 42(3), 226 - 9
{Antimicrobial resistance characteristics of clinical isolates of Streptococcus pyogenes}; Rodriguez RS et al.; OBJECTIVE: To determine the antibiotic susceptibility of recent isolates of Streptococcus pyogenes and to evaluate the prevalence of macrolide-resistant phenotypes . MATERIAL AND METHODS: In 1999, we conducted a cross-sectional study at Mexico Children's Hospital "Federico Gomez", to analyze one hundred strains of S . pyogenes isolated from 1992 to 1998, in children with uncomplicated pharyngotonsillitis . Strains were frozen at the bacteriology lab until they were analyzed . Strains were tested for susceptibility against some beta-lactams, macrolides and clindamycin . Double-disk testing was carried out to evaluate erythromycin-resistant phenotypes . Data are presented using central tendency measures . RESULTS: All tested strains were not resistant to beta-lactams and clindamycin; 16% of the strains were resistant to macrolides and all of them belonged to phenotype M . CONCLUSIONS: Susceptibility testing is recommended to identify possible changes in antibiotic resistance to streptococci.

J Vector Ecol, 2000 Jun, 25(1), 114 - 7
Musca domestica as a mechanical carrier of bacteria in Chiang Mai, north Thailand; Sukontason K et al.; The common house fly, Musca domestica L., was assessed for its potential as a mechanical carrier of bacteria in urban areas of Chiang Mai province, north Thailand . Sixty-one specimens (61.0%) were found to carry bacteria, with each harboring 1-5 bacteria . No significant difference between the sex of flies for carrying bacteria was found . A total of 21 bacteria was isolated, of which the most common was coagulase negative staphylococci (n = 38), followed by Viridans streptococci (n = 9) . The highest bacterial load for all bacteria isolated was 10(3)-10(4) (67%), followed by > 10(4) (26%) colonies per fly . It is recommended that fly control management measures, including sanitation improvement, should be implemented.

Berl Munch Tierarztl Wochenschr, 2000 Jun, 113(6), 234 - 45
{Sensitivity of bovine and equine streptococci to beta-lactam antibiotics (benzylpenicillin, ampicillin, oxacillin, cefotaxime) in the agar diffusion and E-test}; Trolldenier H et al.; 368 streptococcal strains from udder secretions of cattle (Sc . agalactiae, Sc . dysgalactiae, Sc . uberis) and 191 streptococcal isolates from horse specimens (Sc . equi ssp . zooepidemicus, Sc . equi ssp . equi) originating from different agricultural regions in Germany (Lower Saxony, in particular the region of Weser-Ems, Bavaria, Altmark) were investigated for their sensitivity to 4 beta-lactam antibiotics (benzylpenicillin, ampicillin, oxacillin, cefotaxime) . Two different test methods were applied: the agar diffusion test for determination of the diameter of the zone of inhibition and the E-test for determination of the minimal inhibitory concentration (MIC) . According to the evaluation code of DIN 58,940, 98% to 100% of the isolates from the cow udder as well as of the Streptococcus strains from horses were sensitive to the four antibiotics tested . Only Sc . uberis was less sensitive to benzylpenicillin (79.7%) and Oxacillin (83.2%) . The strains from different agricultural regions did not differ from each other concerning their sensitivity to beta-lactams . The results of the two methods of sensitivity testing were in satisfactory agreement: Compared to the MIC reference values, misclassifications occurred in the agar diffusion test only at an error rate of between 1.62% (for ampicillin) and 5.21% (for benzylpenicillin).

Med Microbiol Immunol (Berl), 2000 Jun, 188(4), 203 - 7
There is no disease-specific role for streptococci-responsive synovial T lymphocytes in the pathogenesis of psoriatic arthritis; Thomssen H et al.; The initiation or exacerbation of psoriasis vulgaris is associated with infections by group A streptococci . T lymphocytes specific for streptococcal antigens or expressing a restricted, for streptococcal superantigens typical T cell receptor Vbeta chain repertoire have been described in psoriatic skin lesions . The aim of our study was, therefore, to clarify whether streptococci-reactive T lymphocytes played a role in the pathogenesis of psoriatic arthritis (PsA), and by which antigens they might be stimulated . Synovial membrane mononuclear cells from patients with PsA and other arthropathies, separated by collagenase digestion, were expanded in interleukin-2-supplemented medium and subsequently cloned in a representative cloning procedure . The T cell lines and about 30% of the T cell clones proliferated in response to preparations of group A streptococci but not to other bacteria as tested by {3H}thymidine incorporation assays . Interestingly, they did not proliferate in response to exotoxin-negative streptococci, but did so in response to the streptococcal pyrogenic exotoxins A and C, which are known to be superantigens . Accordingly, no HLA-DR restriction was seen for the proliferative response . The remaining 70% of the established T cell clones did not react to an antigen of group A streptococci . Our results show that in patients with PsA, osteoarthritis or rheumatoid arthritis a significant number of synovial T lymphocytes were responsive to streptococcal superantigens, but not to conventional streptococcal antigens . A disease-specific role of streptococci-reactive T lymphocytes in the pathogenesis of PsA is, therefore, unlikely.

Rev Esp Quimioter, 2000 Jun, 13(2), 171 - 5
{Study of macrolide-resistant genes in group C and G streptococci}; Seral C et al.; In the present study we investigated the macrolide-lincosamide-streptogramin B (MLSB) resistance in 47 clinical isolates of group C beta-hemolytic streptococci and 17 group G streptococci . Resistance to erythromycin was found in 31.6%; and 47%, respectively . On the basis of the erythromycin-clindamycin double-disk test, all strains were assigned to the MLSB phenotype . None of the strains were of the M phenotype . The distribution of the erythromycin-resistant genes were studied by dot blot hybridization and PCR . Resistance to erythromycin was due to the presence of mefA, ermB and ermTR genes . The ermTR gene was predominant among the group C and G streptococci (90% of the strains) . Different mechanisms of erythromycin resistance predominate in group C and G streptococci than in Streptococcus pyogenes where there is an association between erythromycin resistance and active-efflux mechanism . Two of the strains harbored more than one erythromycin-resistant gene.

Arch Otolaryngol Head Neck Surg, 2000 Aug, 126(8), 1011 - 3
In vitro bacterial interference in the nasopharynx of otitis media-prone and non-otitis media-prone children; Brook I et al.; OBJECTIVE: To compare the frequency of recovery of potential pathogens and aerobic- and anaerobic-interfering bacteria in the nasopharynx of otitis media-prone (OMP) with that in non-OMP (N-OMP) children . PATIENTS AND METHODS: Nasopharyngeal cultures were obtained from 20 OMP and 20 N-OMP children . Potential pathogens and aerobic and anaerobic bacteria with interfering capabilities against these organisms were identified . RESULTS: Eighteen potential pathogens were isolated from 12 of the 20 OMP children, and 9 were recovered from 5 of the 20 N-OMP children (P<.05) . Fifty-eight aerobic and anaerobic isolates with interfering capability against 4 potential pathogens were recovered from 5 of the OMP group, and 139 from 17 of the N-OMP group (P<.05) . These interfering organisms included alphahemolytic streptococci, nonhemolytic streptococci, Prevotella species, and Peptostreptococcus species . CONCLUSION: The nasopharyngeal flora of N-OMP children contains more aerobic and anaerobic organisms with interfering capability and less potential pathogens than that of OMP children.

Pediatr Pulmonol, 2000 Aug, 30(2), 106 - 13
Interaction between lung surfactant and nitric oxide production by alveolar macrophages stimulated by group B streptococci; Bouhafs RK et al.; The major etiologic agent in neonatal pneumonia and meningitis is group B streptococci (GBS) . Nitric oxide (NO) production by alveolar macrophages (AM) in response to Gram-positive bacteria such as GBS and the effect of surfactant on this production have received little attention . We studied production of NO by GBS-stimulated AM using the Griess reaction, the effect of lung surfactant on this NO production, and the possible lipid peroxidation (LPO) of surfactant caused by NO . The LPO test was used to measure surfactant peroxidation . Heat-killed and live GBS were found to stimulate NO production by rat alveolar macrophages, and the presence of interferon gamma (IFN-gamma) increased this stimulation in a synergistic manner . Curosurf(R), the natural surfactant used in our study, significantly reduced NO production in various sets of experiments . Lipid peroxidation of surfactant was noted when NO was produced by stimulated AM, a phenomenon that could be suppressed by NG-monomethyl L-arginine (L-NMMA), the inhibitor of NO synthase . In the lung of GBS-infected neonates, nitric oxide produced by AM might contribute to the destruction of surfactant caused by inflammatory cells . Pediatr Pulmonol . 2000; 30:106- 113 .

Pediatrics, 2000 Aug, 106(2 Pt 1), 276 - 81
Perineal group A streptococcal disease in a pediatric practice; Mogielnicki NP et al.; OBJECTIVE: This study was designed to document the frequency and define the clinical, epidemiologic, and microbiologic characteristics of perineal disease caused by group A beta-hemolytic streptococci (GAS) in a pediatric practice in which increased numbers of cases had been observed . METHODS: Clinical, epidemiologic, and microbiologic data were collected on all culture-confirmed cases of perineal GAS disease during the calendar year 1997 . GAS isolates from clinical cases and a comparison group of children with GAS pharyngitis were analyzed by T typing, emm gene analysis, and pulsed-field gel electrophoresis (PFGE) . RESULTS: Twenty-three cases of GAS perineal disease were diagnosed during 4530 office visits in 1997 . Thirteen cases had perianal disease, 8 had vulvovaginal infection, and 2 were infected at both sites . No cases of penile disease were identified . Infections peaked in late winter and early spring and affected children with an average age of 5 years with a range of perineal, gastrointestinal, and genitourinary symptoms . Analysis of T and emm types showed the majority (82%) of perineal isolates to be T 28 emm 28, showing 2 closely related PFGE patterns . In contrast, the pharyngeal isolates were distributed among 6 different T and emm types . CONCLUSION: Perineal infection caused by GAS may be a relatively common diagnosis in a pediatric or family practice setting . There may be specific GAS types that have a tropism for perineal tissues but the mechanism of infection is yet to be established.

Pediatrics . 2000 Aug;106(2):E18.
Bacterial colonization of toys in neonatal intensive care cots; Davies MW et al.; OBJECTIVES: To investigate the bacteria and fungi contaminating toys in neonatal intensive care unit (NICU) cots, the colonization rates, and factors that influence them . METHODS: A cross-sectional, longitudinal bacteriologic survey of all toys in the cots of infants in an NICU . All the toys in an infant's cot were cultured weekly for 4 weeks . Data were collected on the infant's postnatal age, the type of cot, whether humidity was added, characteristics of the toy, and any infant infections . RESULTS: Over the 4-week period, there were 86 cultures from 34 toys of 19 infants . Bacteria were grown from 84/86 (98%): 84 of the cultures grew coagulase-negative Staphylococcus, 50 Micrococcus sp, 21 Bacillus sp, 13 methicillin-resistant Staphylococcus aureus, 12 diphtheroids, 4 group B streptococcus, 3 S aureus, 3 nonhemolytic streptococci, 3 group D streptococci, 4 alpha-hemolytic streptococci, and 2 coliforms . None grew fungi . The colonization rate did not differ with cot type, presence of humidity, size of the toy, toy fiber length, or the fluffiness score . Eight (42%) of the infants had positive blood culture results and 5/8 of the isolates (63%) were of the same type as that colonizing their corresponding toy . IMPLICATIONS: With time, all the toys in NICU cots became colonized with bacteria . Many were potentially pathogenic . Toys may be reservoirs for potential infantile nosocomial sepsis . infant, newborn, toys, infection, neonatal intensive care.

N Z Dent J, 2000 Jun, 96(424), 44 - 9
Dental caries and the microbial ecology of dental plaque: a review of recent advances; Simmonds RS et al.; Our understanding of the microbial ecology of dental plaque has rapidly grown with recent developments in the techniques of molecular biology . In particular, knowledge of the mechanisms underlying the acquisition, establishment, pathogenicity, and evolution of the group of organisms responsible for dental caries--the mutans streptococci--has expanded to the point that we can now contemplate new opportunities for caries prevention . These advances reinforce developing concepts of dental plaque as an interdependent, interacting community of specialised organisms with an ability to rapidly adapt conferred by gene structures that facilitate the expeditious modular rearrangement of protein components.

Kansenshogaku Zasshi, 2000 Jun, 74(6), 511 - 7
{Prevalence of hemolytic streptococcal infection in Kitakyushu: incidence and characteristics of isolates (1994-1997)}; Kano S et al.; In the study of prevalence of hemolytic streptococci in Kitakyushu-city from 1994 to 1997, both seasonal variation of the number of group A hemolytic streptococci isolates and their age distribution fitted in well with the cases of streptococcal infection which is monitored in the Japanese infectious disease surveillance system . Dominant serotypes of group A hemolytic streptococci in Kitakyushu-city were T-12 and T-3 from 1994 to 1995, T-28 and T-12 in 1996, T-2 and T-4 in 1997 . Compared with prevalent serotypes of group A hemolytic streptococci in the City and those in Japan, the geographically close relation was observed . The epidemic serotypes in the City tended to fall behind those in Honshu, the main land of Japan . Most of the isolates were resistant to kanamycin (KM) . Few isolates were resistant to other drugs except tetracycline (TC), to which 14% of the isolates were resistant . Strains of multiple-drug resistant were less than 5% . Gene of speB was detected in all group A strains by PCR method, and a close relationship was observed between T-type and SPE gene type.

J Am Dent Assoc, 2000 Jul, 131(7), 909 - 16
Maintaining mutans streptococci suppression with xylitol chewing gum; Hildebrandt GH et al.; BACKGROUND: One strategy for treating dental caries is to suppress oral mutans streptococci, or MS, with chlorhexidine, or CHX, mouthrinse . Oral MS levels, however, tend to quickly return to baseline values without further intervention . In this clinical study, the authors evaluated the effect of xylitol chewing gum on MS regrowth . METHODS: The authors selected 151 subjects with elevated oral MS levels (> or = 105 colony-forming units per milliliter, or CFU/mL, of paraffin-stimulated saliva) . Subjects rinsed with 0.12 percent CHX gluconate mouthrinse twice daily for 14 days . The authors then randomly assigned the subjects to one of three groups . Those in the test group (n = 51) chewed a commercial xylitol gum three times daily for a minimum of five minutes each time for three months . The placebo group subjects (n = 50) used a commercial sorbitol gum, and the control group subjects (n = 50) did not chew gum . The authors estimated MS load on the dentition using paraffin-stimulated saliva samples . The authors serially diluted the samples, plated them on selective media and incubated them anaerobically; they then enumerated the colonies under a stereomicroscope . RESULTS: MS levels were not significantly different between the three groups at baseline (mean log CFU/mL +/- standard deviation: 5.4 +/- 0.7, 5.4 +/- 0.8, 5.2 +/- 0.7, respectively) nor after CHX therapy (2.7 +/- 0.8, 3.1 +/- 1.1, 3.0 +/- 1.1, respectively) . After three months of gum chewing, the test group subjects had significantly lower salivary MS levels (3.6 +/- 1.2) than did the placebo (4.7 +/- 1.2) or control (4.4 +/- 1.3) group subjects . CONCLUSIONS: Xylitol chewing gum appears to have the ability to prolong the effect of CHX therapy on oral MS . CLINICAL IMPLICATIONS: Maintaining long-term caries-pathogen suppression is feasible with currently available commercial products and can be expected to result in significant caries inhibition.

Adolesc Med, 2000 Jun, 11(2), 327 - 58
Infectious exanthems and unusual infections; Vincent JM et al.; Invasive disease due to group A beta-hemolytic streptococci (GABHS) can be divided into 3 categories of disease: streptococcal toxic shock syndrome (strepTSS), necrotizing fasciitis, and other invasive GABHS disease . Patients with strepTSS may have multiorgan failure within hours of presentation . Clindamycin and penicillin G should be used in combination for treatment of invasive GABHS disease . The mortality rate for menstrual staphylococcal toxic shock syndrome has decreased with early recognition and treatment, and removal of hyperabsorbent tampons from the market . Kawasaki syndrome (KS) is the most common cause of acquired heart disease in children in the U . S., and atypical forms have a higher mortality rate than typical KS . Hantavirus pulmonary syndrome is a zoonosis with an 80% mortality rate if the diagnosis is not made on first presentation and patients return to the hospital in shock . Children and adolescents with Lyme disease have an excellent prognosis and respond well to antimicrobial therapy . Cat scratch disease (CSD) is caused by Bartonella henselae and is transmitted by flea-infested kittens . CSD lymphadenopathy typically resolves spontaneously in 2n3 months; however, there is a 50% likelihood of resolution in 1 month if patients receive a 5-day treatment course with azithromycin.

Curr Microbiol, 2000 Sep, 41(3), 192 - 6
Effect of a new variety of Apis mellifera propolis on mutans Streptococci; Koo H et al.; The effects of a new variety of propolis, from Northeastern Brazil (BA), on growth of mutans streptococci, cell adherence, and water-insoluble glucan (WIG) synthesis were evaluated . Propolis from Southeastern (MG) and Southern (RS) Brazil were also tested as an extension of our previous work . Ethanolic extracts of propolis (EEP) were prepared and analyzed by reversed-phase HPLC . For the antibacterial activity assays, minimum inhibitory concentrations (MIC) and minimum bactericidal concentrations (MBC) of EEPs against Streptococcus mutans, S . sobrinus, and S . cricetus were determined . Cell adherence of S . mutans and S . sobrinus to a glass surface was measured spectrophotometrically at 550 nm . WIG synthesized from sucrose by glucosyltransferase (Gtf) was extracted and quantified by the phenol-sulfuric method . The HPLC profile of the new variety of propolis was entirely different from Southeastern and Southern propolis . Neither flavonoid aglycones nor p-coumaric acid were detected in EEP BA . All EEPs demonstrated biological activities against mutans streptococci; EEP BA showed the highest potency in all in vitro parameters evaluated in this study . The ranges of MIC values were 50 (EEP BA)-400 microg/ml (MG), for S . mutans; and 25 (BA)-400 microg/ml (MG), for S . sobrinus and S . cricetus . The bactericidal concentration of EEPs was four to eight times the MIC values . The adherence of S . mutans and S . sobrinus cells and WIG synthesis were markedly inhibited by EEPs, demonstrating significant inhibition at all concentrations compared with the control (80% ethanol) (p<0.05) . EEP BA showed 80% inhibition of cell adherence and WIG synthesis at concentrations as low as 12.5 and 7.8 microg/ml, respectively . The results show that the new variety of propolis was exceptionally effective in all in vitro parameters tested against mutans streptococci; biological effects of propolis are likely not to be due solely to flavonoids and (hydroxy)cinnamic acid derivatives.

Clin Infect Dis, 2000 Jul, 31(1), 76 - 9 Epub 2000 Jul 24.
Antibiotic susceptibility profiles for group B streptococci isolated from neonates, 1995-1998; Lin FY et al.; Antibiotic susceptibility profiles were analyzed for 119 invasive and 227 colonizing strains of group B streptococci isolated from neonates at 6 US academic centers . All strains were susceptible to penicillin, vancomycin, chloramphenicol, and cefotaxime . The rate of resistance to erythromycin was 20.2% and to clindamycin was 6.9% . Resistance to erythromycin increased in 1997 . Type V strains were more resistant to erythromycin than were type Ia (P=.003) and type Ib (P=.004) strains and were more resistant to clindamycin than were type Ia (P<.001), type Ib (P=.01), and type III (P=.001) strains . Resistance rates varied with geographic region: in California, there were high rates of resistance to erythromycin and clindamycin (32% and 12%, respectively), and low rates in Florida (8.5% and 2.1%, respectively) . Penicillin continues to be the drug of choice for treatment of group B streptococcus infection . For women who are penicillin intolerant, however, the selection of an alternative antibiotic should be guided by contemporary resistance patterns observed in that region.

J Bacteriol, 2000 Aug, 182(16), 4466 - 77
The serotype of type Ia and III group B streptococci is determined by the polymerase gene within the polycistronic capsule operon; Chaffin DO et al.; Streptococcus agalactiae is a primary cause of neonatal morbidity and mortality . Essential to the virulence of this pathogen is the production of a type-specific capsular polysaccharide (CPS) that enables the bacteria to evade host immune defenses . The identification, cloning, sequencing, and functional characterization of seven genes involved in type III capsule production have been previously reported . Here, we describe the cloning and sequencing of nine additional adjacent genes, cps(III)FGHIJKL, neu(III)B, and neu(III)C . Sequence comparisons suggested that these genes are involved in sialic acid synthesis, pentasaccharide repeating unit formation, and oligosaccharide transport and polymerization . The type III CPS (cpsIII) locus was comprised of 16 genes within 15.5 kb of contiguous chromosomal DNA . Primer extension analysis and investigation of mRNA from mutants with polar insertions in their cpsIII loci supported the hypothesis that the operon is transcribed as a single polycistronic message . The translated cpsIII sequences were compared to those of the S . agalactiae cpsIa locus, and the primary difference between the operons was found to reside in cps(III)H, the putative CPS polymerase gene . Expression of cps(III)H in a type Ia strain resulted in suppression of CPS Ia synthesis and in production of a CPS which reacted with type III-specific polyclonal antibody . Likewise, expression of the putative type Ia polymerase gene in a type III strain reduced synthesis of type III CPS with production of a type Ia immunoreactive capsule . Based on the similar structures of the oligosaccharide repeating units of the type Ia and III capsules, our observations demonstrated that cps(Ia)H and cps(III)H encoded the type Ia and III CPS polymerases, respectively . Additionally, these findings suggested that a single gene can confer serotype specificity in organisms that produce complex polysaccharides.

MMW Fortschr Med, 1999 Nov 4, 141(44), 28 - 31
{Sore throat in general practice . Minimizing diagnosis--preventing superfluous use of antibiotics}; Barwitz HJ; Sore throat usually is caused by viral pharyngitis, in about 15 to 30% by group A beta-haemolytic streptococci . Based on current concepts a guideline for the management in general practice is developed . If the typical symptoms of streptococcal pharyngo-tonsillitis are present--serious sore throat, fever more than 38.5 degrees C, purulent tonsillar exsudate, painful cervical lymphadenopathy, lack of cough or rhinorrhea--without any other diagnostic procedure penicillin is given for ten days . Only in cases of doubt throat swabs are taken for rapid diagnostic test and culture . The implementation of the guideline permits differentiation between viral pharyngitis and streptococcal tonsillitis by simple questions and physical examination and prevention of unnecessary diagnostics and antibiotic overuse.

Acta Paediatr Taiwan, 1999 Jul-Aug, 40(4), 258 - 61
Croup syndrome in children: five-year experience; Chiu TF et al.; To investigate the etiology and clinical features of croup syndrome, clinical records of hospitalized children with a diagnosis of croup syndrome were reviewed from April 1990 to January 1996 . There was a total of 132 children, aged between three months and seven years with a mean age of 21.3 +/- 16.8 months . A diagnosis of laryngotracheobronchitis was made in 123 (93.2 percent) children . Twenty-three pathogens were identified in twenty-two of them, including seven parainfluenza viruses, five respiratory syncytial viruses, four influenza A viruses, four Mycoplasma pneumoniae, and three adenoviruses . Bacterial tracheitis was confirmed by bronchoscopic examination in seven cases (5.3 percent) . Cultures of the respiratory secretions yielded viridans streptococci in six and Staphylococcus aureus in one child . Two children (1.5 percent) had spasmodic croup . No case with epiglottitis was noted in the present study . A fever lasting for more than three days was noted in five (71 percent) children with bacterial tracheitis and thirty-five (28 percent) children with laryngotracheobronchitis (p = 0.048) . Among children with laryngotracheobronchitis, an associated diagnosis of pneumonia, acute otitis media, or paranasal sinusitis was more frequently observed in those with fever > 3 days (40 percent) than those with a shorter duration of fever (17 percent, p = 0.013) . In conclusion, a child with a longer duration of fever and more severe manifestations of airway obstruction probably has a bacterial cause of croup syndrome or a bacterial complication . Bacterial tracheitis is more common than epiglottitis in Taiwan.

Acta Otolaryngol Suppl, 2000, 543, 186 - 9
Necrotizing fascitis of the head and neck--report of three cases and review of the literature; Djupesland PG; Necrotizing fasciitis (NF) of the head and neck is a rare but potentially life-threatening soft tissue infection primarily affecting the superficial fascial planes . It is caused by group A streptococci or by a synergistic combination of aerobe and anaerobe micro-organisms . If proper treatment is delayed, the infection may cause extensive necrosis of overlying skin, extend to deeper planes and produce severe systemic toxicity . Recent reviews suggest that cervical and facial NF should be considered separate clinical entities with different clinical features and prognosis . In both, early diagnosis with prompt, aggressive surgical and medical treatment is essential to a successful outcome . Three cases of NF of the neck secondary to peritonsillar/parapharyngeal infections are presented and the main characteristics of 117 well-characterized cases of cervical and facial NF are reviewed.

Adv Microb Physiol, 2000, 42, 239 - 74
Adaptation of oral streptococci to low pH; Quivey RG Jr et al.; The strategies employed by oral streptococci to resist the inimical influences of acidification reflect the diverse and dynamic niches of the human mouth . All of the oral streptococci are capable of rapid degradation of sugar to acidic end-products . As a result, the pH value of their immediate environment can plummet to levels where glycolysis and growth cease . At this point, the approaches for survival in acid separate the organisms . Streptococcus mutans, for example, relies on its F-ATPase, to protect itself from acidification by pumping protons out of the cells . S . salivarius responds by degrading urea to ammonia and S . sanguis produces ammonia by arginolysis . The mechanisms by which these organisms regulate their particular escape route are now being explored experimentally . The picture that emerges is that the acid-adaptive regulatory mechanisms of the oral streptococci differ markedly from those employed by Gram-negative bacteria . What remains to be elucidated are the breadth of the acid-response systems in these organisms and how they permit the microbes to sustain themselves in the face of low pH and the bacterial competition present in their respective niches . In this article, we summarize reports concerning the means by which oral streptococci either utilize acidification to subdue their competitors or protect themselves until pH values return to a more favorable level.

Tidsskr Nor Laegeforen, 2000 Jun 10, 120(15), 1754 - 60
{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.

Thromb Res, 2000 Jul 1, 99(1), 93 - 8
Asp41-His48 region of streptokinase is important in binding to a substrate plasminogen; Kim DM et al.; Streptokinase is a plasminogen activator protein produced by several strains of beta-hemolytic streptococci . Random mutagenesis of streptokinase was carried out for the determination of critical amino acid residues in plasminogen activation . We selected and sequenced 14 streptokinase mutants with no plasminogen activation activity on skim milk-plasminogen overlay plate . Specific activities of the selected streptokinase mutants were determined with chromogenic assay . Eight mutants (V19F, V35E, E85D, L292R, D325P, D341E, I345N, and M369L) resulted in greatly decreased amidolytic activities . However, unexpectedly, six mutants (D41C, S44K, S44P, R45P, H48T, and D220G) showed substantial amidolytic activities comparable to that of wild type . Moreover, five-point mutations were concentrated on the Asp41-His48 region . These data indicate that the Asp41-His48 region in a streptokinase-plasminogen binary complex plays an important role in binding to a substrate plasminogen.

Clin Microbiol Rev, 2000 Jul, 13(3), 470 - 511
Pathogenesis of group A streptococcal infections; Cunningham MW; Group A streptococci are model extracellular gram-positive pathogens responsible for pharyngitis, impetigo, rheumatic fever, and acute glomerulonephritis . A resurgence of invasive streptococcal diseases and rheumatic fever has appeared in outbreaks over the past 10 years, with a predominant M1 serotype as well as others identified with the outbreaks . emm (M protein) gene sequencing has changed serotyping, and new virulence genes and new virulence regulatory networks have been defined . The emm gene superfamily has expanded to include antiphagocytic molecules and immunoglobulin-binding proteins with common structural features . At least nine superantigens have been characterized, all of which may contribute to toxic streptococcal syndrome . An emerging theme is the dichotomy between skin and throat strains in their epidemiology and genetic makeup . Eleven adhesins have been reported, and surface plasmin-binding proteins have been defined . The strong resistance of the group A streptococcus to phagocytosis is related to factor H and fibrinogen binding by M protein and to disarming complement component C5a by the C5a peptidase . Molecular mimicry appears to play a role in autoimmune mechanisms involved in rheumatic fever, while nephritis strain-associated proteins may lead to immune-mediated acute glomerulonephritis . Vaccine strategies have focused on recombinant M protein and C5a peptidase vaccines, and mucosal vaccine delivery systems are under investigation.

Community Dent Oral Epidemiol, 2000 Aug, 28(4), 295 - 306
Dental caries and its relationship to bacterial infection, hypoplasia, diet, and oral hygiene in 6- to 36-month-old children; Milgrom P et al.; Caufield et al . (1) have suggested that the acquisition of mutans streptococci in young children most likely takes place during a "window of infectivity" from 19 to 31 months of age . OBJECTIVES AND METHODS: This study determined the prevalence of dental caries and bacterial infection in a randomly selected sample of 199 children 6 to 36 months old from the island of Saipan in the Common-wealth of the Northern Mariana Islands, USA . The relationships between caries and Streptococcus mutans infection, hypoplasia, diet and oral hygiene behavior were investigated . RESULTS AND CONCLUSIONS: The overall estimated prevalence of caries was high: 46.8% of the children had white spot lesions and 39.1% had enamel cavitation . Colonization was seen in very young children; S . mutans was detected in 25% of the predentate children . The results of multi-variable modeling support the hypothesis that bacterial infection, diet, and hypoplasia are important in the etiology of dental caries in this population . Adjusted for age and ethnicity, children with a high level of S . mutans detected were 5 times more likely to have dental caries than children with a lower level of S . mutans detected . Hypoplasia and a high cariogenicity score (diet) were also significant independent predictors . The odds of having any white spot lesions or enamel cavitation were 9.6 times greater for children with any hypoplasia, and 7.8 times greater for children with high cariogenicity scores relative to those with lower scores after adjusting for level of S . mutans, age and ethnicity . Sleeping with a bottle, maternal sharing of utensils, and high snacking frequency were not significant predictors of caries in this population.

Community Dent Oral Epidemiol, 2000 Aug, 28(4), 267 - 73
Surveillance of primary dentition caries in Germiston, South Africa, 1981-97; Cleaton-Jones P et al.; OBJECTIVE: This 17-year-long study examined trends of dental caries rates in the primary dentition of 6843 preschool children in a South African city . METHODS: Calibrated dentists did repeated cross-sectional epidemiological surveys of dental caries in 2- to 5-year-old nursery school children using WHO diagnostic criteria between 1981 and 1997 . RESULTS: Both the percentage of children with dmft>0 and mean dmft increased between 1981 and 1989 and have slowly declined ever since in the absence of organised prevention to produce a secular trend of decreasing caries rates . The dt/dmft percentage ranged between 60% and 100% except in 1991 when it dropped to 40% and the ft/dmft percentage component rose proportionally, probably due to an economic effect . CONCLUSIONS: The percentage of children with dmft>0 and mean dmft decreased over the study period at all ages, the reason for which is unknown but is speculated to be due to a change in mutans streptococci strains.

N Engl J Med, 2000 Jul 20, 343(3), 175 - 9
Rapid detection of group B streptococci in pregnant women at delivery; Bergeron MG et al.; BACKGROUND: Group B streptococcal infections are an important cause of neonatal morbidity and mortality . A rapid method for the detection of this organism in pregnant women at the time of delivery is needed to allow early treatment of neonates . METHODS: We studied the efficacy of two polymerase-chain-reaction (PCR) assays for routine screening of pregnant women for group B streptococci at the time of delivery . We obtained anal, vaginal, and combined vaginal and anal specimens from 112 pregnant women; in 57 women, specimens were obtained before and after the rupture of the amniotic membranes . The specimens were tested for group B streptococci by culture in a standard selective broth medium, with a conventional PCR assay, and with a new fluorogenic PCR assay . RESULTS: Among the 112 women, the results of the culture of the combined vaginal and anal specimens were positive for group B streptococci in 33 women (29.5 percent) . The two PCR assays detected group B streptococcal colonization in specimens from 32 of these 33 women: the one negative PCR result was in a sample obtained after the rupture of membranes . As compared with the culture results, the sensitivity of both PCR assays was 97.0 percent and the negative predictive value was 98.8 percent . Both the specificity and the positive predictive value of the two PCR assays were 100 percent . The length of time required to obtain results was 30 to 45 minutes for the new PCR assay, 100 minutes for the conventional PCR assay, and at least 36 hours for culture . CONCLUSIONS: Colonization with group B streptococci can be identified rapidly and reliably by a PCR assay in pregnant women in labor both before and after the rupture of membranes.

Antimicrob Agents Chemother, 2000 Aug, 44(8), 2197 - 200
Fluoroquinolone resistance associated with target mutations and active efflux in oropharyngeal colonizing isolates of viridans group streptococci; Guerin F et al.; Oropharyngeal samples from 60 hospitalized patients (30 fluoroquinolone {FQ}-treated and 30 non-FQ-treated patients) and 30 untreated nonhospitalized healthy control subjects yielded 20 isolates of viridans group streptococci with reduced susceptibility to FQ, mostly from the hospitalized patients . An efflux phenotype was commonly encountered, expressed either alone or with topoisomerase mutations . Interspecies transfer of the efflux phenotype was demonstrated via transformation of Streptococcus pneumoniae R6 with DNA from S . mitis and S . oralis.

Antimicrob Agents Chemother, 2000 Aug, 44(8), 2130 - 2
Antimicrobial susceptibilities and clinical sources of Facklamia species; LaClaire L et al.; Facklamia spp . are gram-positive cocci, arranged in short chains or diplos, and resemble viridans streptococci on 5% sheep blood agar . Eighteen strains representing four species of Facklamia were isolated from blood cultures, an abscess, bone, cerebrospinal fluid, gall bladder, vaginal swab, and one unknown source . Cultures were tested against 15 antimicrobial agents by using the broth microdilution MIC method . Reduced susceptibilities to the beta lactams, erythromycin, clindamycin, trimethoprim-sulfamethoxazole, and tetracycline were found . These results indicate that the susceptibilities of the Facklamia species are varied and that some strains have resistance patterns which may present difficulty in managing systemic infections in patients.

Clin Exp Rheumatol, 2000 May-Jun, 18(3), 394 - 6
Reiter's syndrome caused by Streptococcus viridans in a patient with HLA-B27 antigen; Huang DF et al.; A 26-year-old male patient with mitral valve prolapse and HLA-B27 antigen received endodontic treatment for dental caries . Two weeks later fever, dysuria, diarrhea, sterile inflammatory arthritis of lower limbs, enthesitis, dactylitis, conjunctivitis, and uveitis consecutively developed . Blood culture performed at the time of active arthritis yielded Streptococcus viridans . He did not have any history of psoriasis, acute infectious diarrhea, chronic inflammatory bowel diseases, or sexually transmitted diseases . Laboratory studies also excluded the possibility of infections by human immunodeficiency virus, hepatitis B or C virus, chlamydia, and streptococci from the upper airway . This report indicates that Streptococcus viridans can be the triggering microorganisms of Reiter's syndrome in some circumstances.

Rev Esp Quimioter, 1999 Dec, 12(4), 346 - 51
{Phenotypes of macrolide, lincosamide, and streptogramin resistant Streptococcus viridans isolated from blood}; Rodriguez-Avial C et al.; Macrolide resistance has been widely studied in Streptococcus pyogenes and Streptococcus pneumoniae although not in viridans group streptococci (VGS) . We studied 30 blood culture isolates of viridans group streptococci (25 resistant to erythromycin: 10 S . mitis, 8 S . milleri, 6 S . sanguis and 1 S . salivarius; and 5 susceptible: 2 S . mitis, 2 S . milleri and 1 S . sanguis) . We carried out a double-disk test and determined MICs . The susceptibility testing was carried out by agar dilution for 14-, 15- and 16-member lactone ring macrolides, as well as for clindamycin and quinupristin-dalfopristin . Fifty-six percent of the erithromycin-resistant strains (6 S . mitis, 6 S . milleri and 2 S . sanguis) showed an MLS(B) phenotype, with a high level of intrinsic resistance to all the macrolides studied and clindomycin; 28% were of the M phenotype (4 S . sanguis, 2 S . mitis and 1 S . salivarius) . We found a third resistance phenotype, which was present in 4 strains with MICs of 2-8 microg/ml, with resistance to macrolides and different degrees of resistance to clindamycin . All isolates were fully susceptible to quinupristin-dalfopristin . The MLS(B) and M phenotypes initially described in S . pyogenes and S . pneumoniae are also observed in VGS.

J Bacteriol, 2000 Aug, 182(15), 4319 - 27
Identification, evolution, and essentiality of the mevalonate pathway for isopentenyl diphosphate biosynthesis in gram-positive cocci; Wilding EI et al.; The mevalonate pathway and the glyceraldehyde 3-phosphate (GAP)-pyruvate pathway are alternative routes for the biosynthesis of the central isoprenoid precursor, isopentenyl diphosphate . Genomic analysis revealed that the staphylococci, streptococci, and enterococci possess genes predicted to encode all of the enzymes of the mevalonate pathway and not the GAP-pyruvate pathway, unlike Bacillus subtilis and most gram-negative bacteria studied, which possess only components of the latter pathway . Phylogenetic and comparative genome analyses suggest that the genes for mevalonate biosynthesis in gram-positive cocci, which are highly divergent from those of mammals, were horizontally transferred from a primitive eukaryotic cell . Enterococci uniquely encode a bifunctional protein predicted to possess both 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase and acetyl-CoA acetyltransferase activities . Genetic disruption experiments have shown that five genes encoding proteins involved in this pathway (HMG-CoA synthase, HMG-CoA reductase, mevalonate kinase, phosphomevalonate kinase, and mevalonate diphosphate decarboxylase) are essential for the in vitro growth of Streptococcus pneumoniae under standard conditions . Allelic replacement of the HMG-CoA synthase gene rendered the organism auxotrophic for mevalonate and severely attenuated in a murine respiratory tract infection model . The mevalonate pathway thus represents a potential antibacterial target in the low-G+C gram-positive cocci.

Clin Ther, 1999 Nov, 21(11), 1873 - 81
Comparison of cefdinir and penicillin for the treatment of streptococcal pharyngitis . Cefdinir Pharyngitis Study Group; Nemeth MA et al.; Cefdinir, an oral cephalosporin active against Streptococcus pyogenes (group A beta-hemolytic streptococci {GABHS}), is also resistant to degradation by most oropharyngeal beta-lactamases . This multicenter, randomized, controlled, double-masked study assessed the tolerability and efficacy of 2 dosing regimens of cefdinir in the treatment of pharyngitis due to GABHS . Adults and adolescents with pharyngitis due to GABHS received cefdinir 600 mg QD, cefdinir 300 mg BID, or penicillin V 250 mg QID each for 10 days . A throat culture and clinical assessment were obtained 4 to 9 days after completion of therapy . Of 919 patients enrolled, 644 (70.1%) were microbiologically assessable . The eradication rates 4 to 9 days after completion of therapy were 91.4% in the cefdinir QD group, 91.7% in the cefdinir BID group, and 83.4% in the penicillin group (P = 0.02 for cefdinir QD vs penicillin, P = 0.01 for cefdinir BID vs penicillin, P = 0.95 for cefdinir QD vs cefdinir BID) . Clinical cure rates were also superior with cefdinir QD (94.8%, P = 0.02) and cefdinir BID (96.3%, P < 0.01) compared with penicillin (88.9%) . Diarrhea was more common in the cefdinir groups (P < 0.001) . Seventeen cefdinir patients and 4 penicillin patients discontinued therapy because of adverse reaction (P = 0.13) . Ten days of treatment for streptococcal pharyngitis with cefdinir QD or BID is superior to treatment with penicillin V for the eradication of GABHS from the pharynx, although it is associated with a higher rate of adverse reactions.

J Dent Res, 2000 Jun, 79(6), 1371 - 7
Water-insoluble glucan synthesis by mutans streptococcal strains correlates with caries incidence in 12- to 30-month-old children; Mattos-Graner RO et al.; Early mutans streptococci (MS) infection has been associated with higher caries activity in childhood . Since colonization with MS does not always lead to caries activity, additional factors may be involved in MS cariogenicity . For example, MS may differ in virulence traits such as the potential to synthesize glucan polymers from sucrose . In the present study, we tested the hypothesis that caries activity can be associated with variations in virulence factor expression of MS-infecting strains . At baseline, levels of MS obtained by the tongue-blade sampling method, and the presence of visible plaque on upper incisors, were measured in 101 12- to 30-month-old children . Dental caries lesions were diagnosed at baseline and after one year . Caries incidence data were then used to select ten caries-free and nine caries-active children from whom a total of 20 MS fresh isolates was studied . Water-insoluble glucan (WIG) synthesis, final pH, and sucrose-dependent adherence on glass surfaces were measured in these MS isolates . Concentrated culture supernatants were separated in duplicate SDS-PAGE gels, which were then either stained for protein or incubated with 5% sucrose . The intensities of the WIG bands developed in the 5% sucrose PAGE gels and the corresponding protein-stained GTF bands were measured by scanning densitometry . High MS levels (> or = 100 CFU) were associated with high caries incidence (p < 0.01) . The presence of visible plaque did not correlate with caries incidence . The intensities of WIG bands were positively correlated with caries incidence (p < 0.05) and with the ability of MS to adhere to glass surfaces (p < 0.05) . Analysis of our data suggests that the ability to synthesize WIG is an important virulence factor in initial caries development by increasing MS adherence and accumulation in the plaque of young children.

Parasite, 2000 Jun, 7(2), 91 - 4
Role of streptococcal infection in the acute pathology of lymphatic filariasis; Esterre P et al.; Growing evidence suggest that secondary bacterial, mainly streptococcal, infections contribute significantly to recurrent episodes of acute adenolymphangitis (ADL) of filarial origin . We examined the role of group A streptococci in the progression of lymphedema in Polynesian patients with filariasis-related ADL (22 cases) or chronic pathology (10 cases), or with erysipela (10 patients) and, as controls, in 20 healthy adults . Antistreptolysin O (ASLO) and anti-streptodornase B (ASDB) titers were systematically determined in parallel to parasitological and biochemical tests . ASLO and ASDB assays were positive in 100% of erysipela, 75% of filarial ADL as compared to 50% of chronic pathology and 39% of healthy controls . Interestingly, by opposition to ASLO titers which were not significantly different between the four groups, ASDB titers were higher in ADL (p = 0.019) and erysipela (p = 0.002) than in controls . These results support the hypothesis that recurrent streptococcal infections may have an important role in the pathogenesis of ADL in lymphatic filariasis.

J Infect Dis, 2000 Jul, 182(1), 142 - 9 Epub 2000 Jun 30.
Cross-protection between group A and group B streptococci due to cross-reacting surface proteins; Stalhammar-Carlemalm M et al.; The R28 protein of group A streptococcus (GAS) and the Rib protein of group B streptococcus (GBS) are surface molecules that elicit protective immunity to experimental infection . These proteins are members of the same family and cross-react immunologically . In spite of extensive amino acid residue identity, the cross-reactivity between R28 and Rib was found to be limited, as shown by analysis with highly purified proteins and specific antisera . Nevertheless, immunization of mice with purified R28 conferred protection against lethal infection with Rib-expressing GBS strains, and immunization with Rib conferred protection against R28-expressing GAS . Thus, R28 and Rib elicited cross-protective immunity . Characterization of many clinical GAS and GBS isolates expressing R28 or Rib, respectively, indicated that most of them expressed proteins similar to those of the reference strains . Analysis of these data suggests that cross-protection may influence the outcome of natural infections with R28-expressing GAS and Rib-expressing GBS.

J Infect Dis, 2000 Jul, 182(1), 133 - 41 Epub 2000 Jun 29.
Acute serogroup A streptococcal shock: A porcine model; Saetre T et al.; To elucidate the pathophysiology of acute shock caused by serogroup A streptococci (GAS), GAS were given intravenously to 25 pigs . Short-time infusions of GAS (n=11) caused variable and unpredictable responses . A continuous infusion of 5x108 cfu/kg/h (n=8) caused pulmonary hypertension, arterial hypotension, and reduced cardiac output and liver perfusion, progressing to circulatory shock within 2-4 h . Halving the infusion rate (n=6) induced a more gradual development of shock and doubled the mean survival time from 2.1 to 4.0 h . Mean tumor necrosis factor-alpha levels (+/-SE) increased from 25+/-1 to 40+/-3 pg/mL . Only slight signs of organ dysfunction were observed, which indicates that this is primarily a model of acute septic shock . Light microscopy revealed moderate inflammatory reactions in lung, liver, and gut biopsy samples, although high numbers of viable, M-typeable GAS were recovered from tissues . The present model may be useful to study mechanisms involved in acute septic shock as well as therapeutic interventions.

Rev Med Chil, 2000 Jan, 128(1), 27 - 34
{Detection of pyrogenic exotoxin SpeA, SpeB and SpeC genes in Chilean streptococci isolates and their association with clinical manifestations}; Ulloa MT et al.; BACKGROUND: The virulence of Streptococcus pyogenes is determined by a variety of structural molecules, toxins and complex enzymes . Pyrogenic exotoxins cause fever, erythematous reactions, cytotoxic and immunological effects . AIM: To assess the frequency of speA, SpeB and SpeC genes in Chilean Streptococcus pyogenes strains and their association with the invasiveness of infections . MATERIAL AND METHODS: The genes for pyrogenic exotoxins SpeA, SpeB and SpeC were determined by polymerase chain reactions in 114 strains of group A Streptococcus pyogenes isolated from Chilean patients with invasive or non invasive infections . RESULTS: The gene for SpeA was present in 30.7% of isolates, the gene for SpeB was present in 69.3% and the gen for SpeC in 44.7% of isolates . The gene for SpeA was present in 20 of 33 invasive infections and in 15 of 81 non invasive infections (p < 0.0001) . On the contrary, the gene for SpeC was present in 11 of 33 invasive infections and in 41 of 81 non invasive infections (p < 0.05) . The frequency of speB was similar in invasive and non invasive infections . CONCLUSIONS: There is a clear relationship between the presence of SpeA genes and the severity of infections caused by Streptococcus pyogenes.

Rev Esp Quimioter, 1999 Sep, 12(3), 215 - 9
{Sensitivity of groups A, B and C beta hemolytic streptococci to antibiotics}; Gonzalez-Lama Z et al.; We studied the susceptibility of 330 strains of beta hemolytic streptococci (60 group A, 125 group B, 145 group C) isolated from healthy school children in Las Palmas de Gran Canaria to 17 antibiotics . Only 2% of group A streptococci showed resistance to erythromycin, and 18% to 31% of the beta hemolytic streptococci strains were resistant to trimethoprim-sulfamethoxazole . All of these strains showed susceptibility to betalactam antibiotics, chloramphenicol, clindamycin and vancomycin . Most of them were resistant to tetracycline and aminoglycoside antibiotics.

Rev Esp Quimioter, 1999 Sep, 12(3), 211 - 4
{Comparison between penicillin and amoxicillin-clavulanic acid for the treatment of recurrent tonsillopharyngitis in childhood}; Asensi F et al.; Fifty-one children aged 2-14 years with recurrent tonsillopharyngitis, presenting dysphagia, fever and lymphadenitis, with more than two similar episodes in the last three years and showing a beta-hemolytic group A streptococci in the pharyngeal smear, were studied . They underwent random treatment for ten days with phenoxymethylpenicillin (40-60 mg/kg/day) (n = 28) or amoxicillin-clavulanic acid (20-40 mg/kg/day) (n = 23) taken orally three times a day . Clinical and bacteriological tests were carried out at 10 days and 2, 6 and 12 months post-treatment . The clinical and bacteriological results showed the superiority of the amoxicillin-clavulanic acid treatment both in the short term (disappearance of symptoms) and in the long term (decrease in recurrence) . These results support the idea that betalactamases produced by the pharyngeal flora play an important role in the failures of penicillin.

J Clin Microbiol, 2000 Jul, 38(7), 2475 - 9
Prevalence of polyclonal mefA-containing isolates among erythromycin-resistant group A streptococci in Southern Taiwan; Yan JJ et al.; A total of 204 nonrepetitive isolates of group A streptococci (GAS), including 107 randomly collected between 1992 and 1995 and 66 and 31 consecutively collected in 1997 and 1998, respectively, from a university hospital in southern Taiwan were examined to determine the prevalence and mechanisms of erythromycin resistance among these isolates . Resistance to erythromycin was detected in 129 isolates (63.2%) by the agar dilution test . Of these, 42 isolates (32.6%) were assigned to the constitutive macrolide, lincosamide, and streptogramin B resistance (cMLS) phenotype, and all carried the ermB gene; 4 (3.1%) were assigned to the inducible MLS resistance (iMLS) phenotype, and all harbored the ermTR gene; and 83 (64.3%) were erythromycin resistant but susceptible to clindamycin (M phenotype), and all possessed the mefA gene . Distributed by years, the rates of erythromycin resistance and different phenotypes were 61.7% (53.0% cMLS, 6.1% iMLS, and 40.9% M phenotype) between 1992 and 1995, 62.1% (12.2% cMLS and 87.8% M phenotype) in 1997, and 71 . 0% (9.1% cMLS and 90.9% M phenotype) in 1998 . Pulsed-field gel electrophoresis showed that all but 2 cMLS isolates were clonal in origin, and 17 clones were detected among the M-phenotype isolates . These results indicate that the high incidence and increasing rate of erythromycin-resistant GAS in southern Taiwan are due to the prevalence of multiple M-phenotype clones and that clindamycin may be the drug of choice for the treatment of infections with GAS in penicillin-hypersensitive patients in this area.

Zh Mikrobiol Epidemiol Immunobiol, 2000 Jan-Feb, (1), 81 - 4
{Opportunistic microorganisms in respiratory tract diseases in patients of the Moscow Province region}; Mironov AIu et al.; The respiratory tract microflora in patients with inflammatory processes of the upper and lower respiratory tracts in the Moscow Province region has been studied . Changes in the microflora were found to occur in patients with pyoinflammatory diseases (PID) of the upper and lower respiratory tracts have been found to occur . Gram-positive cocci, mainly staphylococci and streptococci, were shown to play the leading etiological role in the development of PID . As revealed in this study, the microorganisms detected in the inflammations of the upper and lower respiratory tracts are coagulase-negative staphylococci, mainly S . epidermidis, as well as enterococci and streptococci belonging to the group viridans.

Ann Thorac Surg, 2000 May, 69(5), 1448 - 54
Surgery for active culture-positive endocarditis: determinants of early and late outcome; Alexiou C et al.; BACKGROUND: The purpose of this study was to describe a single unit experience in the surgical treatment of active culture-positive endocarditis and identify determinants of early and late outcome . PATIENTS AND METHODS: One hundred eighteen consecutive patients with positive blood culture up to 3 weeks before operation (or positive valve culture) and macroscopic evidence of lesions typical for endocarditis, undergoing operation between January 1973 and December 1996 in Southampton, were evaluated . The aortic valve was infected in 53 (48.9%), the mitral in 46 (39%), both aortic and mitral in 12 (10.1%), the tricuspid in 4 (3.9%), and the pulmonary valve in 3 (2.5%) . Native valve endocarditis was present in 83 (70.3%) and prosthetic valve endocarditis in 35 (29.7%) . Streptococci and staphylococci were the most common pathogens . Mean follow-up was 5.6 years (range, 0 to 25 years) . RESULTS: Operative mortality was 7.6% (9 patients) . Endocarditis recurred in 8 (6.7%) . A reoperation was required in 12 (10.2%) . There was 24 late deaths, 17 of them cardiac . Actuarial freedom from recurrent endocarditis, reoperation, late cardiac death, and long-term survival at 10 years were 85.9%, 87.2%, 85.2%, and 73.1%, respectively . On multiple regression analysis the following were independent adverse predictors: pulmonary edema (p = 0.007) and impaired left ventricular function (p = 0.02) for operative mortality; prosthetic valve endocarditis (p = 0.01) for recurrent infection; myocardial invasion by the infection (p = 0.01) and reoperation (p = 0.04) for late cardiac death; and coagulase-negative staphylococcus (p = 0.02), annular abscess (p = 0.02), and longer intensive care unit stay (p = 0.02) for long-term survival . CONCLUSIONS: Operation for active culture-positive endocarditis carries an acceptable mortality . Freedom from recurrent infection, reoperation, and long-term survival are satisfactory . In our data, patients' hemodynamic status at operation was the major determinant of operative mortality . Prosthetic valve endocarditis, coagulase-negative staphylococcus, and annular or myocardial infectious invasion were the critical adverse determinants of late outcome.

Rev Esp Quimioter, 1999, 12(4), 346 - 351
{Different phenotypes of erythromycin-resistant blood isolates in viridans group streptococci}; Rodriguez-Avial C et al.; Macrolide resistance has been widely studied in Streptococcus pyogenes and Streptococcus pneumoniae although not in viridans group streptococci (VGS) . We studied 30 blood culture isolates of viridans group streptococci (25 resistant to erythromycin: 10 S . mitis, 8 S . milleri, 6 S . sanguis and 1 S . salivarius; and 5 susceptible: 2 S . mitis, 2 S . milleri and 1 S . sanguis) . We carried out a double-disk test and determined MICs . The susceptibility testing was carried out by agar dilution for 14-, 15- and 16-member lactone ring macrolides, as well as for clindamycin and quinupristin-dalfopristin . Fifty-six percent of the erithromycin-resistant strains (6 S . mitis, 6 S . milleri and 2 S . sanguis) showed an MLS(B) phenotype, with a high level of intrinsic resistance to all the macrolides studied and clindomycin; 28% were of the M phenotype (4 S . sanguis, 2 S . mitis and 1 S . salivarius) . We found a third resistance phenotype, which was present in 4 strains with MICs of 2-8 microg/ml, with resistance to macrolides and different degrees of resistance to clindamycin . All isolates were fully susceptible to quinupristin-dalfopristin . The MLS(B) and M phenotypes initially described in S . pyogenes and S . pneumoniae are also observed in VGS.

Hautarzt, 2000 May, 51(5), 319 - 26
{Prospective detection of important bacterial pathogens in pyoderma and their in vitro antibiotic susceptibility}; Ochsendorf FR et al.; BACKGROUND AND OBJECTIVE: For rational therapeutic recommendations the spectrum and resistance of bacteria in skin diseases were investigated . PATIENTS/METHODS: Within 4 months 911 swabs of dematoses possibly caused by bacteria were taken prospectively (481 outpatients, 430 inpatients) and the material cultured on standard media . The positive cultures including resistance screening of 210 swabs of 168 outpatients and of 175 swabs of 85 inpatients could be evaluated, the remaining cultures were sterile . RESULTS: Staphylococcus aureus was the most frequent pathogen (outpatient 67%, inpatient 61% of all positive cultures), followed by streptococci (groups A and B; 25%) . In patients Pseudomonas aeruginosa was the most common pathogen in leg ulcers and between the toes (45% and 70% respectively) . 13% of the Staphylococcus aureus isolates were resistant to tetracyclines and erythromycin; one strain proved to be methicillin resistant . CONCLUSIONS: Cephalosporins (I . generation), penicillins with beta-lactamase-inhibitors, and to a lesser extent isoxazoyl-penicillin and clindamycin can be recommended for the treatment of skin infections . Oral quinolones are suited for infections with gram-negative bacteria (such as bewteen the toes) . The indications for systemic antibiotic therapy of leg ulcers should be restricted.

Am J Obstet Gynecol, 2000 Jun, 182(6), 1335 - 43
Performance of a group B streptococcal prophylaxis protocol combining high-risk treatment and low-risk screening; Reisner DP et al.; OBJECTIVE: This study was undertaken to evaluate a group B streptococcal protocol in a large community hospital that combined treatment of high-risk patients with rapid screening of low-risk patients . STUDY DESIGN: In a prospective cohort study from 1994 through 1996 laboring patients in a level III community hospital were considered to be at high risk for neonatal group B streptococcal transmission if they were at <37 weeks' gestation, if they had rupture of membranes >12 hours, if they were known carriers of group B streptococci, if they had a temperature > or =100 degrees F, if the gestation was complicated by fetal growth restriction or was a multiple gestation, or if they had a previous neonate infected with group B streptococci . High-risk patients were treated intravenously with antibiotics during labor . Low-risk patients were screened for group B streptococcal antigen by means of a rapid optical immunoassay . Patients with positive screening results were treated . Neonatal morbidity and mortality were evaluated . RESULTS: Two of 9932 infants delivered had group B streptococcal sepsis diagnosed . In the 2 previous years without a protocol 9 cases of neonatal group B streptococcal sepsis had been diagnosed in 8188 deliveries (P =.0287 by Fisher exact test) . The 2 cases of group B streptococcal sepsis during the protocol were as follows: 1 infant born to a high-risk mother with delay in treatment and 1 infant born to a low-risk mother with negative results of both culture and rapid screen during labor . During the previous period 7 infected infants had been born to high-risk mothers and 2 had been born to low-risk mothers . The maternal group B streptococcal carriage rate during the study was 18% . Group B streptococcal rapid optical immunoassay sensitivity was 81% . Elapsed time from screening to treatment was < or =2(1/2) hours for 93% of patients . No maternal anaphylaxis, no increase in bacterial neonatal sepsis caused by organisms other than group B streptococci, and no protocol-related group B streptococcal antibiotic resistance were noted . CONCLUSION: Successful implementation and maintenance of a protocol combining treatment of high-risk patients with rapid screening of low-risk patients during labor reduced neonatal group B streptococcal sepsis.

Eur J Epidemiol, 2000 Mar, 16(3), 257 - 63
Comparison of serotyping, ribotyping and pulsed-field gel electrophoresis for distinguishing group A Streptococcus strains isolated in Albania; Shundi L et al.; Conventional serotyping for T antigens, rRNA gene restriction fragment length polymorphism analysis (ribotyping) and pulsed-field gel electrophoresis were compared for distinguishing among group A streptococci isolated in Albania between 1980-1982 and in 1995 . A total of twelve serotypes were identified among seventy GAS strains . Ribotyping revealed eight and eleven distinct patterns after digestion with HindIII and PvuII, respectively . Twenty-three strains of serotype T12 were subdivided in 10 ribotypes and 11 strains of T2 serotype were differentiated in 5 ribotypes . By comparison, PFGE generated 37 patterns after SmaI digestion . The index of discrimination, using the Hunter-Gaston formula, was applied to assess the value of these methods for interpretation of the epidemiological data . For serotyping the value of index was 0.85 . The ribotyping system revealed an ID of 0.83 when the combination HindIII and PvuII was used . This index reached 0.97 for PFGE . The methods used were useful to subtype the isolates of GAS.

Arch Oral Biol, 2000 Sep, 45(9), 805 - 8
Cariostatic activity of cacao mass extract; Ooshima T et al.; Chocolate is suspected to contain some caries-inhibitory substances . The cariostatic activity of cacao mass extract (CM), the main component of chocolate, was examined in vitro and in experimental animals . CM showed no detectable effects on the cellular growth and acid production of mutans streptococci . On the other hand, the cell-surface hydrophobicity of mutans streptococci was significantly reduced by the presence of CM . Furthermore, insoluble glucan synthesis by the glucosyltransferases from either Streptococcus mutans MT8148R or Strep . sobrinus 6715 was inhibited by CM, but not significantly . Hence, the sucrose-dependent cell adherence of mutans streptococci was also depressed by CM . Finally, CM in both a 40% sucrose diet and drinking water resulted in reductions of caries development and plaque accumulation in rats infected with Strep . sobrinus 6715, but not significantly . These results indicate that cacao mass extract possesses some anticariogenic potential, but its anticaries activity is not strong enough to suppress significantly the cariogenic activity of sucrose.

Arch Oral Biol, 2000 Aug, 45(8), 667 - 74
Effects of Streptococcus crista and human saliva on the viability of Fusobacterium nucleatum ATCC 10953; Rudney JD et al.; Associations with facultative species might help planktonic oral anaerobes survive when they traverse saliva . This study investigated whether co-aggregation with Streptococcus crista ATCC 51110 enhanced the viability of Fusobacterium nucleatum ATCC 10953 . Two tubes each of co-aggregates and Fus . nucleatum ATCC 10953 alone were prepared . One of each set was resuspended in buffer, and the other in clarified saliva from each of 20 donors . After 1 h, cells were stained for viability . The median percentage of viable Fus . nucleatum ATCC 10953 in buffer with Strep . crista (86%) was significantly higher (p=0.04) than in buffer alone (77%) . A similar trend was observed for saliva with Strep . crista (81%) and saliva alone (74%), although that difference was not significant (p=0.41) . The median percentage of Fus . nucleatum co-aggregated in buffer (44%) was significantly reduced after incubation in saliva (16%) (p<0.0002) . No such change was seen when saliva was replaced with purified salivary proline-rich glycoprotein, which can bind both species . For co-aggregate suspensions, there was no difference in the viability of fusobacteria that were or were not in direct contact with Strep . crista . In both cases, viability was significantly reduced in saliva relative to buffer . Strep . crista may enhance the viability of planktonic Fus . nucleatum ATCC 10953, but it is not yet clear whether that requires co-aggregation . Transmission of fusobacteria through saliva could depend on the interplay between protective factors, such as the presence of streptococci, and antimicrobial factors, which kill cells or disassociate co-aggregates.

Arch Oral Biol, 2000 Aug, 45(8), 639 - 45
Caries inhibitory activity of cacao bean husk extract in in-vitro and animal experiments; Ooshima T et al.; Cacao bean husk extract (CBH) was examined for inhibitory effects on the caries-inducing properties of mutans streptococci in vitro and on caries development in specific pathogen-free Sprague-Dawley rats infected with mutans streptococci . CBH reduced the growth rate of almost all oral streptococci examined, which resulted in the reduction of acid production . Furthermore, insoluble glucan synthesis by the glucosyltransferases from Streptococcus mutans MT8148R and Streptococcus sobrinus 6715 was significantly inhibited by CBH . Hence, the sucrose-dependent cell adherence of mutans streptococci was also depressed by CBH . The administration of CBH in drinking water resulted in significant reductions of caries development and dental plaque accumulation in rats infected with either Strep . sobrinus 6715 or Strep . mutans MT8148R, and the minimum cariostatic concentration was 1.0 mg/ml . These results indicate that CBH possesses powerful anticariogenic potential.

Eur J Pediatr, 2000 Jun, 159(6), 450 - 2
Severe neonatal group A streptococcal disease; Verboon-Maciolek MA et al.; Since the mid-1980s, an increase in incidence of invasive disease caused by group A streptococci has been noted amongst adults and children; however, neonatal disease is still rare . Between 1979 and 1998, seven neonates with severe group A streptococcal disease were admitted to our neonatal intensive care unit . The clinical presentation, treatment and outcome are described . In three cases of early-onset disease vertical transmission was documented . CONCLUSION: Because the incidence of group A streptococcal disease in the general population seems to have increased over the last two decades, we should be aware of the possibility and particularly the severity of group A streptococcal disease in the neonatal period.

Braz Dent J, 1999, 10(2), 99 - 104
First permanent molar: first indicator of dental caries activity in initial mixed dentition; Noronha JC et al.; The objective of the present study was to investigate among children in the initial mixed dentition phase the presence of clinical signs that might eventually function as more sensitive indicators of the development of caries disease, denoted here as caries activity . On this basis, we investigated the relationship between salivary levels of mutans streptococci (MS) and decayed, missing and filled permanent and deciduous tooth surfaces (DMFS and dmfs) using microbiological, clinical and radiographic examinations in 81 schoolchildren aged 7-8 years . Whereas dmfs did not present a positive correlation, DMFS was significantly correlated with salivary MS levels . The first permanent molars of the schoolchildren studied comprised 87.3% of the affected surfaces recorded in the DMFS, suggesting that the development of new lesions was preferentially located on the surfaces of the first permanent molars . These results permit us to conclude that the first permanent molars function as first indicators of dental caries activity in the schoolchildren examined.

Braz Dent J, 1999, 10(1), 15 - 21
Evaluation of the antimicrobial activity of three irrigating solutions in teeth with pulpal necrosis; Ferreira CM et al.; The antimicrobial activity of 0.4% papaine gel (FCF-USP), an antibacterial product derived from 3.3% castor oil (IQSC-USP), and 0.5% sodium hypochlorite (FORP-USP) was evaluated in teeth with radiographically visible pulpal necrosis and periapical lesion in vivo . After cavity access, under aseptic conditions, a first harvesting was performed . The 3 irrigating solutions were used for biomechanical preparation . After 72 hours, a second harvesting was performed, also under aseptic conditions . The number of colony forming units (cfu) was counted with a stereomicroscope under reflected light . Castor oil and 0.5% sodium hypochlorite presented similar antimicrobial activities for the reduction of the anaerobe number, S . mutans and streptococci; however, the papaine gel showed lower activity . We conclude that both castor oil and sodium hypochlorite are effective as antimicrobial agents and can be used in the treatment of root canals with pulpal necrosis.

Braz Dent J, 1999, 10(1), 11 - 4
Scanning electron microscopy of the rat tongue mucosa with special attention to the bacteria on epithelial cell membranes; Motoyama AA et al.; The authors examined the filiform and fungiform papillae surfaces of rat tongue by scanning electron microscopy showing the numerous groupings of bacteria on the epithelial cell membranes . The fungiform papillae were round in shape and present few bacteria . The epithelial cell of filiform papillae revealed numerous streptococci . The grouping of the bacteria are attached on the epithelial cell membrane, demonstrating three-dimensional SEM images.

Med Res Rev, 2000 Jul, 20(4), 231 - 93
The 2-pyridone antibacterial agents: bacterial topoisomerase inhibitors; Li Q et al.; Many attempts have been made to prepare analogs of 4-quinolone antibacterial agents bearing novel ring systems, which might retain the favorable properties of these widely used antibacterial agents and at the same time increase activity against multidrug-resistant bacteria, streptococci, and anaerobic microorganisms . One such attempt involved bioisosteric exchange of the 1-N atom and 4a-C atom of naphthyridones, quinolones, and benzoxazines to produce a family of highly active pyridopyrimidines, quinolizines, and ofloxacin bioisosteres . These new antibacterial agents have been named collectively as the 2-pyridones . Many hundreds of 2-pyridones have been synthesized and evaluated in vitro and in vivo, and selected members are advancing toward human clinical trials . Preparation of these bioisosteres required the development of enabling chemistry, as previous methods were unsuccessful in producing the needed core structures . This review compares the structure-activity relationships of these agents with known trends among 4-quinolones, from which it is seen that there are many parallels, but also some significant departures as well . Generally, 2-pyridones are more highly active in vitro and in vivo and more water soluble than comparable 4-quinolones . These properties are posited to arise from electronic and conformational alternations in these new substances . Selected members show excellent pharmacodynamic properties, justifying the view that this is a very promising new class of totally synthetic antibacterial agents.

Ugeskr Laeger, 2000 May 15, 162(20), 2891 - 2
{Life-threatening puerperal sepsis caused by group A streptococci}; Helmig RB et al.; A case of postpartum streptococcal toxic shock syndrome due to group A streptococci is described . The patient suffered multiorgan failure, was critically ill and stayed in the intensive care unit for 18 days before recovering . The patient received massive antibiotic treatment as well as intravenous immunoglobulin therapy . The case is described to draw attention to the reoccurrence of serious group A streptococcal infections.

Antimicrob Agents Chemother, 2000 Jul, 44(7), 1838 - 41
Comparative in vitro activities of linezolid, quinupristin-dalfopristin, moxifloxacin, and trovafloxacin against erythromycin-susceptible and -resistant streptococci; Betriu C et al.; The in vitro activities of the new agents linezolid, quinupristin-dalfopristin, moxifloxacin, and trovafloxacin were determined and compared with those of penicillin, clindamycin, and four macrolides against 53 erythromycin-resistant Streptococcus pneumoniae, 117 S . pyogenes (64 erythromycin-susceptible and 53 -resistant), and 101 S . agalactiae (53 erythromycin-susceptible and 48 -resistant) isolates . Differentiation of macrolide resistance phenotypes was performed by the double-disk method . The genetic basis for macrolide resistance in 52 strains was also determined . The M phenotype was found in 84.9, 6.3, and 1.9% of S . pyogenes, S . agalactiae, and S . pneumoniae isolates, respectively . These strains were susceptible to miocamycin and clindamycin . Strains with the inducible phenotype accounted for 27.1% of S . agalactiae isolates and 9.4% each of S . pyogenes and S . pneumoniae isolates . All erythromycin-resistant isolates were also resistant to the 14- and 15-membered macrolides tested . Strains with all three phenotypes were susceptible to </=2 microgram of linezolid per ml . Quinupristin-dalfopristin exhibited good in vitro activity against all strains, irrespective of their resistance to erythromycin (MICs at which 90% of the isolates tested were inhibited {MIC(90)s}, 0.2 to 1 microgram/ml) . Against the erythromycin-resistant S . pyogenes and S . agalactiae strains, moxifloxacin and trovafloxacin were the most active agents (MIC(90)s, 0.1 microgram/ml) . The new antimicrobials evaluated may be alternative agents to treat infections caused by macrolide-resistant as well as macrolide-susceptible streptococci.

Infect Immun, 2000 Jul, 68(7), 4018 - 23
Natural history of Streptococcus sanguinis in the oral cavity of infants: evidence for a discrete window of infectivity; Caufield PW et al.; The heterogeneous group of oral bacteria within the sanguinis (sanguis) streptococci comprise members of the indigenous biota of the human oral cavity . While the association of Streptococcus sanguinis with bacterial endocarditis is well described in the literature, S . sanguinis is thought to play a benign, if not a beneficial, role in the oral cavity . Little is known, however, about the natural history of S . sanguinis and its specific relationship with other oral bacteria . As part of a longitudinal study concerning the transmission and acquisition of oral bacteria within mother-infant pairs, we examined the initial acquisition of S . sanguinis and described its colonization relative to tooth emergence and its proportions in plaque and saliva as a function of other biological events, including subsequent colonization with mutans streptococci . A second cohort of infants was recruited to define the taxonomic affiliation of S . sanguinis . We found that the colonization of the S . sanguinis occurs during a discrete "window of infectivity" at a median age of 9 months in the infants . Its colonization is tooth dependent and correlated to the time of tooth emergence; its proportions in saliva increase as new teeth emerge . In addition, early colonization of S . sanguinis and its elevated levels in the oral cavity were correlated to a significant delay in the colonization of mutans streptococci . Underpinning this apparent antagonism between S . sanguinis and mutans streptococci is the observation that after mutans streptococci colonize the infant, the levels of S . sanguinis decrease . Children who do not harbor detectable levels of mutans streptococci have significantly higher levels of S . sanguinis in their saliva than do children colonized with mutans streptococci . Collectively, these findings suggest that the colonization of S . sanguinis may influence the subsequent colonization of mutans streptococci, and this in turn may suggest several ecological approaches toward controlling dental caries.

J Mol Biol, 2000 Jun 16, 299(4), 885 - 95
Mechanism of hyaluronan binding and degradation: structure of Streptococcus pneumoniae hyaluronate lyase in complex with hyaluronic acid disaccharide at 1.7 A resolution; Ponnuraj K et al.; Hyaluronic acid (HA) is an important constituent of the extracellular matrix; its bacterial degradation has been postulated to contribute to the spread of certain streptococci through tissue . Pneumococci and other streptococci produce hyaluronate lyase, an enzyme which depolymerizes HA, thus hyaluronate lyase might contribute directly to bacterial invasion . Although two different mechanisms for lyase action have been proposed, there was no crystallographic evidence to support those mechanisms . Here, we report the high-resolution crystal structure of Streptococcus pneumoniae hyaluronate lyase in the presence of HA disaccharide product, which ultimately provides the first crystallographic evidence for the binding of HA to hyaluronate lyase . This structural complex revealed a key interaction between the Streptococcus peneumoniae hyaluronate lyase protein and the product, and supports our previously proposed novel catalytic mechanism for HA degradation based on the native Streptococcus peneumoniae hyaluronate lyase structure . The information provided by this complex structure will likely be useful in the development of antimicrobial pharmaceutical agents .

J Oral Maxillofac Surg, 2000 Jun, 58(6), 611 - 6
Investigation of infectious organisms causing pericoronitis of the mandibular third molar; Peltroche-Llacsahuanga H et al.; PURPOSE: The purpose of the study was to identify the most frequently encountered pyogenic organisms involved in pericoronitis to permit more targeted antibiotic therapy . PATIENTS AND METHODS: Pericoronal pockets of mandibular third molars from 37 patients showing symptoms of acute, severe pericoronitis were sampled and subjected to microbiologic analysis, including primary evaluation by phase-contrast microscopy . To avoid overgrowth with faster-growing, less fastidious organisms, specimens were cultured on a wide variety of selective media (supporting growth of fastidious bacteria, protozoa, and fungi) . RESULTS: Microscopic examination indicated spirochetes in 55% and fusiform bacteria in 84% of the samples . A total of 441 microorganisms were isolated and identified from the 37 cultured samples . Besides obligate anaerobic bacteria, including various Actinomyces and Prevotella species, a predominantly facultative anaerobic microflora was cultivated, that is, Streptococcus milleri group (78% of samples), Stomatococcus mucilaginosus (71%), and Rothia dentocariosa (57%) . CONCLUSION: It was concluded that the Streptococci milleri group bacteria, well-known for their ability to cause suppurative infections, are most likely involved in the pathogenesis of acute severe pericoronitis of the lower third molar.

J Med Microbiol, 2000 Jun, 49(6), 499 - 502
Relationship between asymptomatic carriage of Streptococcus pyogenes and the ability of the strains to adhere to and be internalised by cultured epithelial cells; Sela S et al.; This study was undertaken to determine whether the ability of group A streptococci to persist in the throat following antibiotic therapy corresponded with their capacity to adhere to and be internalised by epithelial cells . The study employed a HEp-2 cell model to examine the adherence and internalisation capacities of 42 strains (13 from asymptomatic patients with bacteriological eradication failure and 29 from patients with bacterial eradication) . The adherence and internalisation efficiencies of strains from symptomless carriers were significantly higher . The average adherence efficiency of the carriers' strains was 53 (SEM 6)% versus 35 (SEM 5)% in control strains . The average internalisation efficiency of the carriers' strains was 13.4 (SEM 4)% compared with 4.4 (SE 1.6)% in the control group . The results are in agreement with the hypothesis that, in a significant number of cases, streptococcal internalisation might contribute to eradication failure and persistent throat carriage.

Prim, Care Update Ob Gyns . 2000 May 1, 7(3), 85 - 90
Toxic shock syndrome; Reiss MA; Toxic shock syndrome (TSS) is an acute febrile illness accompanied by watery diarrhea, sunburn rash, vomiting, hypotension, and multiple organ involvement . When it was initially recognized 20 years ago, TSS was primarily associated with menstruation . Since then, the frequency of menstrual TSS has decreased dramatically . Staphylococcus aureus is the cause of menstrual TSS and is also responsible for about half of all cases of nonmenstrual TSS . Since the late 1980s, Streptococcus pyogenes has been shown to cause a nonmenstrual TSS-like illness, with a higher mortality rate . The mechanism of TSS is attributable to bacterial endotoxins that impede the body's immune system and cause the release of cytokines, which are responsible for the clinical manifestations of the disease . Early recognition and treatment of TSS are important factors in improving patient survival . Patients should be treated with parenteral antibiotics that are highly effective against staphylococci and streptococci . They should also receive fluid resuscitation and vasopressors . Some patients require intubation, dialysis, or immunoglobulin therapy.

J Antimicrob Chemother, 2000 Jun, 45(6), 771 - 5
Comparison of gyrA and parC mutations and resistance levels among fluoroquinolone-resistant isolates and laboratory-derived mutants of oral streptococci; Kaneko A et al.; Laboratory-derived fluoroquinolone-resistant mutants were obtained by serial passage of Streptococcus sanguis and Streptococcus anginosus isolates on agar containing increasing concentrations of old and new fluoroquinolones, ofloxacin and DU-6859a, respectively . Sequencing of an S . sanguis isolate exposed to DU-6859a showed that resistance was associated with two mutations in the quinolone resistance determining region (QRDR) of the gyrA gene (Ser83-->Phe; Glu87-->Lys), and with a mutation in the parC gene (Ser79-->Ile) . However, different mutations in the gyrA gene (Ser83-->Tyr) and parC gene (Ser79-->Phe) were found in a S . sanguis isolate exposed to ofloxacin . A fluoroquinolone-resistant isolate, QR-95101, from a dental infection, had a single mutation in the gyrA gene (Ser83-->Phe) and in the parC gene (Ser79-->Phe) . Two fluoroquinolone-resistant mutants, QS-701OFm and QS-701DUm, were obtained from S . anginosus QS-701, by exposure to ofloxacin and DU-6859a, respectively . These mutants showed a common substitution at codon 83 (Ser-->Phe) in the gyrA gene but had different substitutions at codon 87 (QS-701OFm, Glu-->Gln; QS-701DUm, Glu-->Lys) . They also had different substitutions at codons 79 and 135 in the parC gene (QS-701OFm, Ser79-->Leu but no change at Glu135; QS-701DUm, Ser79-->Ile and Glu135-->Gln) . The resistance levels of the DU-6859a-selected resistant S . sanguis mutant QS-951DUm to DU-6859a, ofloxacin, ciprofloxacin and norfloxacin were higher than those of the ofloxacin-selected resistant mutant QS-951OFm . However, ampicillin susceptibilities of these mutants were not different from the parental strains . In S . anginosus, the DU-6859a-selected fluoroquinolone-resistant mutant QS-701DUm was resistant to all the fluoroquinolones tested, while the ofloxacin-selected mutant QS-701OFm was resistant to three fluoroquinolones, but not DU-6859a . The results indicate that different fluoroquinolones select distinct mutations in the QRDR of the gyrA and parC genes in oral streptococci . The gyrA or parC mutation in oral streptococci may determine the levels of fluoroquinolone resistance.

Microbiology, 2000 May, 146 ( Pt 5), 1195 - 209
emm and sof gene sequence variation in relation to serological typing of opacity-factor-positive group A streptococci; Beall B et al.; Approximately 40-60% of group A streptococcal (GAS) isolates are capable of opacifying sera, due to the expression of the sof (serum opacity factor) gene . The emm (M protein gene) and sof 5' sequences were obtained from a diverse set of GAS reference strains and clinical isolates, and correlated with M serotyping and anti-opacity-factor testing results . Attempts to amplify sof from strains with M serotypes or emm types historically associated with the opacity-factor-negative phenotype were negative, except for emm12 strains, which were found to contain a highly conserved sof sequence . There was a strong correlation of certain M serotypes with specific emm sequences regardless of strain background, and likewise a strong association of specific anti-opacity-factor (AOF) types to sof gene sequence types . In several examples, M type identity, or partial identity shared between strains with differing emm types, was correlated with short, highly conserved 5' emm sequences likely to encode M-type-specific epitopes . Additionally, each of three pairs of historically distinct M type reference strains found to share the same 5' emm sequence, were also found to share M serotype specificity . Based upon sof sequence comparisons between strains of the same and of differing AOF types, an approximately 450 residue domain was determined likely to contain key epitopes required for AOF type specificity . Analysis of two Sof sequences that were not highly homologous, yet shared a common AOF type, further implicated a 107 aa portion of this 450-residue domain in putatively containing AOF-specific epitopes . Taken together, the serological data suggest that AOF-specific epitopes for all Sof proteins may reside within a region corresponding to this 107-residue sequence . The presence of specific, hypervariable emm/sof pairs within multiple isolates appears likely to be a reliable indicator of their overall genetic relatedness, and to be very useful for accurate subtyping of GAS isolates by an approach that has relevance to decades of past M-type-based epidemiological data.

Nephrol Dial Transplant, 2000 Jun, 15(6), 772 - 7
Streptococcal M protein enhances TGF-beta production and increases surface IgA-positive B cells in vitro in IgA nephropathy; Nishikawa Y et al.; BACKGROUND: High serum levels and enhanced in vitro production of IgA are observed in more than half of patients with IgA nephropathy (IgAN); and transforming forming growth factor-beta (TGF-beta) is certain IgA class switching factor . On the other hand, macroscopic haematuria appears frequently with upper respiratory infection as tonsillitis in IgAN . METHODS: We compared the lymphocytic response to in-vitro stimulation by group A streptococcal M proteins of apparent virulence factor between IgAN, non-proliferative glomerulonephritis (NPGN), and normal subjects . M proteins were extracted from group A streptococcal strain type 5 and type 12 determined serologically . RESULTS: M protein-induced proliferation of lymphocytes from IgAN was higher than in NPGN but not in healthy control subjects . Flow cytometric analysis indicated that stimulation by M protein extracts derived from type 5 streptococci (M5) increased surface IgA-positive B cells in IgAN, but did not activate the production of soluble IgA . We also showed that M5 induced significant increases in TGF-beta, in culture supernatants of lymphocytes from patients with IgAN . CONCLUSION: Our results suggest that Streptococcal infection may play an important role in the pathogenesis of IgAN by stimulating IgA production through TGF-beta synthesis.

Scand J Infect Dis, 2000, 32(2), 215 - 7
Group B streptococcus meningitis in an HIV-positive adult: case report and review; Guerin JM et al.; We report a new case of meningitis due to group B streptococci (S . agalactiae) in an HIV-positive patient . Only three other cases have been reported so far, and common features are discussed.

Scand J Infect Dis, 2000, 32(2), 214 - 5
Streptococcus mitis septicaemia and hepatitis; Galanakis E et al.; The case of an otherwise well 9-y-old boy with fever, papular rash, jaundice and impaired liver function is presented . Streptococcus mitis sensitive to penicillin grew in blood culture . The boy had an excellent outcome . The clinical spectrum of viridans streptococci may be wider than currently anticipated, and Streptococcus mitis may cause septicaemia and hepatitis in immunocompetent individuals.

Int J Syst Evol Microbiol, 2000 Jan, 50 Pt 1, 55 - 61
A new species of oral Streptococcus isolated from Sprague-Dawley rats, Streptococcus orisratti sp . nov; Zhu H et al.; Taxonomic studies were performed on an unusual oral Streptococcus strain isolated from Sprague-Dawley rats . The isolates were alpha-haemolytic, bile-tolerant, aesculin-hydrolytic and unable to grow in 6.5% NaCl . They fermented lactose, sucrose and trehalose . They were distinguished from other recognized species of oral and viridans streptococci by several biochemical characteristics and by Lancefield's group antigen, as well as by unique DNA-DNA hybridization characteristics . 16S rDNA sequence studies confirmed the genealogical distinctiveness of the species . The results of the study demonstrated that the isolates represented a new species of the oral and viridans streptococci . The name Streptococcus orisratti sp . nov . is proposed for the new species . The type strain is A63T (= ATCC 700640T).

Eur J Obstet Gynecol Reprod Biol, 2000 Jun, 90(2), 153 - 8
Semmelweis: the combat against puerperal fever; Adriaanse AH et al.; Groups A and B streptococci are of great significance in the history of obstetrics . Group A streptococci were a great threat to the puerperium, especially in the 19th century, when homebirth was replaced by institutional birth in lying-in hospitals . The history of the rise and fall of puerperal fever is indeed a tragedy . Some people, like Semmelweis, who brought new and important evidence based findings were not believed by their fellow obstetricians, an attitude that spoiled thousands of innocent lives . Even today group A streptococci, though seldom, may be the cause of puerperal sepsis . Group B streptococci are widespread and may cause sepsis and important lifelong morbidity or mortality of the newborn . Obstetricians today try to establish cost-effective prophylactic measures during labor to prevent these neonatal infections.

Ann Trop Paediatr, 2000 Mar, 20(1), 16 - 21
Group A streptococcal throat colonization is a dynamic phenomenon; Dawson KP et al.; In order to gain knowledge about the nature of group A streptococcal throat colonization of asymptomatic children, we studied a cohort of healthy children selected at random . Those with throat cultures positive for group A Streptococci (GAS) were followed for 5 weeks . Repeat throat swabs were obtained at weekly intervals for antigen detection and culture . GAS obtained were serotyped for T antigen . Twenty-two children were identified as having GAS and 50% had a positive antigen test and culture at least five times in 6 weeks . There was no consistent pattern in the typeable organisms . Most individuals had more than one T-type alternating with non-T-typeable organisms . We conclude that colonization may be a dynamic process involving numerous organism serotypes, which wax and wane.

J Antimicrob Chemother, 2000 Apr, 45 Suppl 1, 51 - 3
In vitro activity of gemifloxacin compared with other antimicrobial agents against recent clinical isolates of streptococci; Ieven M et al.; This study investigated the in vitro activity of gemifloxacin (SB-265805) against 50 recent clinical isolates of Streptococcus pyogenes, Streptococcus agalactiae and viridans streptococci using the microdilution method . This activity was compared with that of the quinolone agents ofloxacin, ciprofloxacin, levofloxacin, trovafloxacin and grepafloxacin, and with that of penicillin, ampicillin, clarithromycin and azithromycin . Gemifloxacin was significantly more potent than the other quinolones tested . Its potency was equal to that of penicillin for S . agalactiae, and superior to that of penicillin for viridans streptococci . The MIC(50) of gemifloxacin for S . pyogenes (0.015 mg/L) was equal to that of penicillin, with an MIC(90) of 0.03 mg/L . Gemifloxacin was also active against isolates of S . agalactiae (MIC = 0.03-0.06 mg/L) and S . pyogenes (MIC = 0.03- 0.06 mg/L) with reduced susceptibility to ofloxacin (MIC = 4-8 mg/L) and grepafloxacin (MIC = 4 mg/L) . These preliminary observations indicate that gemifloxacin is a promising antimicrobial agent for clinical use.

J Antimicrob Chemother, 2000 Apr, 45 Suppl 1, 1 - 12
Comparative in vitro activity of gemifloxacin; King A et al.; Gemifloxacin is a new quinolone and, like moxifloxacin, trovafloxacin, grepafloxacin and clinafloxacin, is more potent in vitro than ciprofloxacin or ofloxacin against Gram-positive aerobes . Gemifloxacin was the most potent of the quinolones tested against streptococci and most ciprofloxacin-resistant pneumococci were susceptible to gemifloxacin . Gemifloxacin, like moxifloxacin, trovafloxacin, grepafloxacin and clinafloxacin, was more potent than ciprofloxacin or ofloxacin against all staphylococci and many ciprofloxacin-resistant isolates were susceptible to these quinolones . Against Gram-negative aerobes gemifloxacin was as potent as or slightly less potent than ciprofloxacin, and isolates resistant to ciprofloxacin were also resistant to gemifloxacin and to moxifloxacin, trovafloxacin and grepafloxacin . Gemifloxacin was also the most potent quinolone against Gram-positive anaerobes and fusobacteria but trovafloxacin was the most potent agent tested against other Gram-negative anaerobes.

J Vet Diagn Invest, 2000 May, 12(3), 224 - 32
Detection of Streptococcus suis by in situ hybridization, indirect immunofluorescence, and peroxidase-antiperoxidase assays in formalin-fixed, paraffin-embedded tissue sections from pigs; Boye M et al.; Streptococcus suis is an important pathogen in pigs and is considered a zoonotic agent . To aid diagnosis of infection caused by S . suis, a species-specific probe targeting 16S ribosomal RNA was designed and used for fluorescent in situ hybridization . Two additional immunohistochemical detection methods, an indirect immunofluorescence assay and a peroxidase-antiperoxidase method, using polyclonal antibodies also were developed . The specificity of the oligonucleotide probe was examined by whole-cell and dot-blot hybridization against reference strains of the 35 serotypes of S . suis and other closely related streptococci and other bacteria commonly isolated from pigs . The probe was specific for S . suis serotypes 1-31 . The specificity of the polyclonal antibodies, which has previously been evaluated for use in diagnostic bacteriology for typing of serotype 2, was further evaluated in experimentally infected murine tissue with pure culture of different serotypes of S . suis, related streptococci, and other bacteria commonly found in pigs . The polyclonal antibodies against S . suis serotype 2 cross-reacted with serotypes 1 and 1/2 in these assays . The in situ hybridization and the immunohistochemical methods were used for detection of S . suis in formalin-fixed, paraffin-embedded tissue sections of brain, endocardium, and lung from pigs infected with S . suis . The methods developed were able to detect single cells of S . suis in situ in the respective samples, whereas no signal was observed from control tissue sections that contained organisms other than S . suis . These techniques are suitable for determining the in vivo localization of S . suis for research and diagnostic purposes.

Otolaryngol Pol, 2000, 54(1), 51 - 6
{Monitoring of the inflammation in children before and after tonsillectomy}; Steiner I et al.; A group of 54 children aged from three to 13 years was qualified to tonsillectomy for laryngological indications . In sera of all children following measurements were performed: the concentrations of C-reactive protein (CRP), alpha1-acid glycoprotein (AGP) and alpha1-antichymotrypsin (ACT) were measured using rocket immunoelectrophoresis according to Laurell, also concentrations of three main immunoglobulin classes (IgA, IgG, IgM) and antistreptolysin titer . The microheterogeneity of both AGP and ACT was investigated, using crossed affinity immunoelectrophoresis according to Bog-Hansen with Concanavalin A (Con A) as a ligand . Results were expressed as reactivity coefficients (RC), being the proportion of all Con A-reacting variants to the non-reacting variant . It is worth mentioning that there was no difference in all investigated parameters as well between groups obtained by categorizing children according to the presence or absence of elevated antistreptolysin titer . It may mean that at least in some cases the chronic inflammation was caused by streptococci non-producing streptolysin O . The results obtained suggest that the absence of the arthritic pain does not exclude the need of antibiotic therapy in children after tonsillectomy . Generally it is postulated that estimation of acute phase proteins concentrations and glycosylation profiles, which were previously shown to be useful in clinical assessment of various diseases may serve as additional marker in laryngology in cases where indications to tonsillectomy are still controversial.

J Immunol, 2000 Jun 1, 164(11), 5871 - 6
Beta 2 integrins are involved in cytokine responses to whole Gram-positive bacteria; Cuzzola M et al.; Proinflammatory cytokines have an important pathophysiologic role in septic shock . CD14 is involved in cytokine responses to a number of purified bacterial products, including LPS . However, little is known of monocyte receptors involved in cytokine responses to whole bacteria . To identify these receptors, human monocytes were pretreated with different mAbs and TNF-alpha was measured in culture supernatants after stimulation with whole heat-killed bacteria . Human serum and anti-CD14 Abs significantly increased and decreased, respectively, TNF-alpha responses to the Gram-negative Escherichia coli . However, neither treatment influenced responses to any of the Gram-positive bacteria tested, including group A and B streptococci, Listeria monocytogenes, and Staphylococcus aureus . Complement receptor type III (CR3 or CD18/CD11b) Abs prevented TNF-alpha release induced by heat-killed group A or B streptococci . In contrast, the same Abs had no effects when monocytes were stimulated with L . monocytogenes or S . aureus . Using either of the latter bacteria, significant inhibition of TNF-alpha release was produced by Abs to CD11c, one of the subunits of CR4 . To confirm these blocking Ab data, IL-6 release was measured in CR3-, CR4-, or CD14-transfected Chinese hamster ovary cells after bacterial stimulation . Accordingly, streptococci triggered moderate IL-6 production (p < 0.05) in CR3 but not CD14 or CR4 transfectants . In contrast, L . monocytogenes and S . aureus induced IL-6 release in CR4 but not CR3 or CD14 transfectants . Collectively our data indicate that beta 2 integrins, such as CR3 and CR4, may be involved in cytokine responses to Gram-positive bacteria . Moreover, CD14 may play a more important role in responses to whole Gram-negative bacteria relative to Gram-positive ones.

Biochem J, 2000 Jun 1, 348 Pt 2, 465 - 71
Action pattern and substrate specificity of the hyaluronan lyase from group B streptococci; Baker JR et al.; The hyaluronan lyase of group B streptococci rapidly cleaves hyaluronan by an elimination mechanism to yield the unsaturated disaccharide 2-acetamido-2-deoxy-3-O-(beta-D-gluco-4-enepyranosyluronic acid)-D-glucose . Additionally, it has been shown that the enzyme has limited specificity for achondroitin sulphate and cleaves the chain at unsulphated sites {Baker,Yu, Morrison, Averett and Pritchard (1997) Biochem . J . 327,65-71} . In the present extension of that study it was found that 6-sulphated regions of chondroitin sulphate are also susceptible to cleavage by this hyaluronan lyase . Of the four 6- and/or 4-sulphated tetrasaccharides which can be isolated from testicular hyaluronidase digests of chondroitin sulphate, only those two tetrasaccharides with a6-sulphated disaccharide at the reducing end were cleaved . From thisand other data, a model is proposed for the cleavage specificity of hyaluronan lyase on a chondroitin sulphate . Evidence is presented in support of an action pattern for hyaluronan lyase which involves aninitial random endolytic cleavage followed by rapid exolytic and processive release of unsaturated disaccharide . Since the on lyoligosaccharides which tend to accumulate in near-complete digests of hyaluronan are unsaturated, it is argued that the processive cleavage occurs from the non-reducing to the reducing end of a hyaluronan chain.This detailed knowledge of substrate specificity contributes to our understanding of the enzyme's role in Group B streptococcal pathogenesis . In addition, the hyaluronan lyase may find application in sequence studies of chondroitin sulphates.

Methods, 2000 Jun, 21(2), 185 - 97
The potential role for nephritis-associated plasmin receptor in acute poststreptococcal glomerulonephritis; Yamakami K et al.; Immunoglobulin G from a patient convalescing from acute poststreptococcal glomerulonephritis (APSGN) bound specific antigenic sites in early APSGN glomeruli . A streptococcal cytoplasmic antigen (preabsorbing antigen, PA-Ag), could selectively preabsorb fluorescein isothiocyanate (FITC)-labeled IgG and prevented glomerular staining . The antigen was purified and identified as an M(r) approximately 43,000 protein with a pI of 4.7 that strongly activated complement C3 (N . Yoshizawa, S . Oshima, I . Sagel, J . Shimizu, and G . Treser, 1992, J . Immunol . 148, 3110-3116) . In the present study, a nephritogenic antigen was purified by affinity chromatography using APSGN IgG-immobilized Sepharose followed by chromatography on an anion-exchange resin . Purification was monitored by ELISA and Western blotting using the binding characteristics of the specific antibodies present in APSGN serum . The molecular weight of the purified antigen, named nephritis-associated plasmin receptor (NAPlr), was an M(r) approximately 43,000 protein and the internal amino acid sequence was found to be homologous to those of the plasmin receptor (Plr) of group A streptococci strain 64/14 and glyceraldehyde-3-phosphate dehydrogenase (GAPDH) from Bacillus subtilis . The purified NAPlr exhibited GAPDH activity and plasmin(ogen) binding activity . Using FITC-labeled rabbit anti-NAPlr, the antigen was found to be present in the glomeruli of 22 of 22 patients in the early stage of APSGN . Bacterial Plr was also demonstrated in human APSGN glomeruli for the first time using monoclonal antibody to the recombinant Plr protein . Antibody to NAPlr was found in the sera of 46 of 50 (92%) patients within 3 months of onset . These results led us to speculate that NAPlr bound to the glomeruli may contribute to the pathogenesis of APSGN via plasmin and complement activation .

Methods, 2000 Jun, 21(2), 165 - 77
Interaction of group A streptococci with human plasmin(ogen) under physiological conditions; D'Costa SS et al.; A series of methods for analyzing the interaction of group A streptococci with the human plasminogen system are described . Examples of group A streptococcal isolates capable of assembling surface plasminogen activator activity when grown in human plasma are presented and the key requirements for this process are evaluated . The stabilities of cell-associated plasmin and plasminogen activator complexes are compared and a model for the interaction of group A streptococci with the plasminogen system in an infected host is presented .

Methods, 2000 Jun, 21(2), 111 - 24
Expression and regulation of the streptokinase gene; Malke H et al.; Recent research in various areas has appreciably expanded our knowledge of streptokinase, a plasminogen activator produced by all human group A (GAS), group C (GCS), and group G (GGS) streptococci . Several molecular genetic approaches are described here to study the expression of the streptokinase gene, skn . Southern hybridization analysis demonstrated homology of synteny of ska, skc, and skg in the genomes of the above serogroups . S1 nuclease mapping, the use of transcriptional fusions to beta-galactosidase and luciferase reporter genes, in conjunction with site-directed mutagenesis, led to the localization of the core promoter region of skc and the identification of a cis-active upstream region required for full promoter activity . Circular permutation analysis of the promoter upstream region identified an intrinsic DNA bending locus as the pivotal DNA element stimulating the activity of the core promoter . The detection of skn allele-specific expression phenotypes, which proved not to be due to different skn mRNA half-lives, prompted allele swap experiments, showing that promoter activity is dictated by the host genetic background, rather than the sequence of the regulatory region . These findings suggest the involvement in skn expression of an as yet unidentified transcriptional activator that contacts the bent DNA region . Transcription termination of skc is directed by a bidirectional terminator whose structural requirements for termination efficiency were determined with base substitution mutants fused to a chloramphenicol acetyl transferase reporter . Finally, mutagenic plasmids are described for insertion-duplication and allele replacement mutagenesis of the skn locus .

Methods, 2000 Jun, 21(2), 143 - 50
Analysis of plasminogen-binding M proteins of Streptococcus pyogenes; Ringdahl U et al.; Group A streptococci are common human pathogens that cause a variety of infections . They express M proteins which are important cell wall-bound type-specific virulence factors . We have found that a set of strains, associated primarily with skin infections, express M proteins that bind plasminogen and plasmin with high affinity . The binding is mediated by a 13-amino-acid internal repeated sequence located in the N-terminal surface-exposed portion of these M proteins . This sequence binds to kringle 2 in plasminogen, a domain that is not involved in the interaction with streptokinase, a potent group A streptococcal activator of plasminogen . It could be demonstrated that plasminogen, absorbed from plasma by growing group A streptococci expressing the plasminogen-binding M proteins, could be activated by exogenous and endogenous streptokinase, thereby providing the bacteria with a surface-associated enzyme that could act on the tissue barriers in the infected host .

Epidemiol Infect, 2000 Apr, 124(2), 239 - 44
Cumulative incidence of rheumatic fever in an endemic region: a guide to the susceptibility of the population?
Carapetis JR, Currie BJ, Mathews JD.
Aboriginal Australians in northern Australia are subject to endemic infection with group A streptococci, with correspondingly high rates of acute rheumatic fever and rheumatic heart disease . For 12 communities with good ascertainment, the estimated lifetime cumulative incidence of acute rheumatic fever was approximately 5.7%, whereas over the whole population, with less adequate ascertainment, the cumulative incidence was only 2.7% . The corresponding prevalences of established rheumatic heart disease were substantially less than the cumulative incidences of acute rheumatic fever, at least in part because of poor ascertainment . The cumulative incidence of acute rheumatic fever estimates the proportion of susceptible individuals in endemically exposed populations . Our figures of 2.7-5.7% susceptible are consistent with others in the literature . Such comparisons suggest that the major part of the variation in rheumatic fever incidence between populations is due to differences in streptococcal exposure and treatment, rather than to any difference in (genetic) susceptibility.

J Leukoc Biol, 2000 May, 67(5), 615 - 21
Induction of cyclooxygenase-2 by human monocytes exposed to group B streptococci; Maloney CG et al.; Group B streptococcal (GBS) infections are associated with high morbidity and mortality . The molecular pathways mediating the pathophysiological events in GBS infection are not fully delineated . Cyclooxygenases (COX) are the enzymes that convert arachidonate to active eicosanoids . To identify the effects of GBS on eicosanoid metabolism and regulatory mechanisms, we exposed human monocytes to GBS and found that they secreted prostaglandin E2, prostacyclin, and thromboxane A2 . Exposure to GBS caused monocytes to express COX-2 mRNA and protein in both a time- and concentration-dependent manner that correlated with eicosanoid production . COX-1 protein was unchanged . Addition of the anti-inflammatory cytokines interleukin (IL)-4 or IL-10 markedly attenuated GBS-induced COX-2 protein accumulation after GBS exposure, as did inhibition of p38 MAPK . Our experiments are the first to show that exposure of monocytes to a gram-positive bacterium (GBS) results in induction of functional COX-2, suggesting that eicosanoids may play important roles in the pathogenesis of GBS infections.

Br J Dermatol, 2000 May, 142(5), 943 - 6
Microbiology of infected poison ivy dermatitis; Brook I et al.; We report the aerobic and anaerobic microbiology of secondarily infected poison ivy dermatitis . The study involved retrospective review of clinical and microbiology laboratory records of patients with secondarily infected poison ivy lesions . Bacterial growth was noted in 33 specimens . Aerobic or facultative anaerobic bacteria only were present in 18 (55%) patients, anaerobic bacteria only in seven (21%), and mixed anaerobic-aerobic bacteria in eight (24%) . Forty-five isolates were recovered (1.4 per specimen): 27 aerobic or facultative anaerobic bacteria, and 18 strict anaerobes . The predominant aerobic and facultative anaerobic bacteria were Staphylococcus aureus (13 isolates) and group A beta-haemolytic streptococci (six) . The predominant anaerobes were Peptostreptococcus spp . (seven isolates), pigmented Prevotella and Porphyromonas spp . (four) and Fusobacterium spp . (two) . Single bacterial isolates were recovered in 18 (55%) patients, eight of which were S . aureus . Nineteen of the organisms isolated from 16 (48%) patients produced the enzyme beta-lactamase . Organisms that resided in the mucous membranes close to the lesions predominated in those infections . Enteric gram-negative rods and Bacteroides fragilis group predominated in leg and buttock lesions . Group A beta-haemolytic streptococci, pigmented Prevotella and Porphyromonas and Fusobacterium spp . were most frequently recovered from lesions of the finger, face and neck . The polymicrobial aetiology of secondarily infected poison ivy lesions, and the association of bacterial flora with the anatomical site of the lesions, are demonstrated.

J Bacteriol, 2000 Jun, 182(11), 3254 - 8
Characterization of the streptococcal C5a peptidase using a C5a-green fluorescent protein fusion protein substrate; Stafslien DK et al.; A glutathione-S-transferase (GST)-C5a-green fluorescent protein (GFP) fusion protein was designed for use as a substrate for the streptococcal C5a peptidase (SCPA) . The substrate was immobilized on a glutathione-Sepharose affinity matrix and used to measure wild-type SCPA activity in the range of 0.8 to 800 nM . The results of the assay demonstrated that SCPA is highly heat stable and has optimal activity on the synthetic substrate at or above pH 8.0 . SCPA activity was unaffected by 0.1 to 10 mM Ca(2+), Mg(2+), and Mn(2+) but was inhibited by the same concentrations of Zn(2+) . The assay shows high sensitivity to ionic strength; NaCl inhibits SCPA cleavage of GST-C5a-GFP in a dose-dependent manner . Based on previously published computer homology modeling, four substitutions were introduced into the putative active site of SCPA: Asp(130)-Ala, His(193)-Ala, Asn(295)-Ala, and Ser(512)-Ala . All four mutant proteins had over 1,000-fold less proteolytic activity on C5a in vitro, as determined both by the GFP assay described here and by a polymorphonuclear cell adherence assay . In addition, recombinant SCPA1 and SCPA49, from two distinct lineages of Streptococcus pyogenes (group A streptococci), and recombinant SCPB, from Streptococcus agalactiae (group B streptococci), were compared in the GFP assay . The three enzymes had similar activities, all cleaving approximately 6 mol of C5a mmol of SCP(-1) liter(-1) min(-1).

Zh Mikrobiol Epidemiol Immunobiol, 2000 Mar-Apr, (2), 74 - 9
{The classification of streptococci and human streptococcal diseases}; Riapis LA et al.; The modern nomenclature, phenotypic, medical, ecological and phylogenetic classification of streptococci and different classification of streptococcal human diseases are presented . All phylogenetic groups of streptococci have been shown to contain species causing diseases in man . The most medically significant groups are the phylogenetic groups Pyogenes and Mitis . Directions of the improvement of the classification of streptococci and streptococcal human diseases on the basis of modern concepts on the taxonomy of streptococci, the biological properties and ecology of the infective agents, as well as the genesis and clinical picture of diseases induced by them, have been determined.

J Microbiol Immunol Infect, 2000 Mar, 33(1), 49 - 52
The assessment of anaerobic blood culture in children; Lee CS et al.; Over the past 20 years, there has been a decline in the percentage of positive blood cultures yielding anaerobic organisms . Due to the limited blood volume drawn from pediatric patients, we have assessed the value of routine anaerobic blood cultures in children . From January 1994 to December 1998, 9886 paired aerobic and anaerobic blood cultures were analyzed in the pediatric microbiology laboratory at the Taipei Veterans General Hospital . Six hundred and eighteen (6.25%) isolates were considered to be clinically important microorganisms . Staphylococci, streptococci, aerobic gram-negative bacilli, and yeasts showed more significant growth within the aerobic culture than that within the anaerobic culture . Significantly more aerobic gram-positive cocci, aerobic gram-negative bacilli, and yeasts were detected at least 1 day earlier by using the aerobic culture . Three patients with documented anaerobic bacteremia had obvious symptoms related to anaerobic infections . Our study concludes that routine use of anaerobic blood culture in pediatric patients is not necessary . Anaerobic blood cultures should be reserved for patients with diseases like intra-abdominal or oral infections, neutropenic patients on steroid therapy, pressure sores, cellulitis, and human bite wounds.

J Med Microbiol, 2000 May, 49(5), 467 - 71
Molecular characterisation of group A streptococci from invasive and non-invasive disease episodes in Belgium during 1993-1994; Descheemaeker P et al.; Five hundred clinical group A streptococcal (GAS) isolates were collected in Belgium during the period 1 Nov . 1993 to 31 Oct . 1994 . Clinical and laboratory data were recorded and isolates were characterised . The presence of the genes encoding streptococcal pyrogenic exotoxin types A (speA), B (speB), C (speC), F (speF) and streptococcal superantigen (ssa) were determined by PCR to target specific sequences . These isolates were also emm-typed and analysed by pulsed-field gel electrophoresis (PFGE) of genomic macrorestriction fragments with the enzyme SmaI . In total, 136 unrelated GAS PFGE types were identified and genetic diversity was clearly demonstrated . Two GAS PFGE types predominated; a first PFGE type comprised 66 (13.2%) emm1 isolates characterised by speA-, speB+, speC-, speF+ and ssa-; the second PFGE type comprised 44 (8.8%) emm12 isolates characterised by speA-, speB+, speC+ (or speC-), speF+ and ssa- . Indistinguishable PFGE types were observed among both invasive and non-invasive isolates . Ten different PFGE types were found among 11 streptococcal toxic shock syndrome (STSS) isolates, and five of these lacked speA . Twenty-five (34.7%) of 72 invasive isolates gave negative results for speA, speC and ssa . This retrospective study confirmed the observation that the dissemination of one specific clone cannot be associated with invasive GAS disease and posed a question regarding the role of SPE A as a major virulence factor . Other streptococcal virulence factors in conjunction with host factors may determine the outcome of invasive GAS infection.

Dakar Med, 1999, 44(1), 76 - 83
{Micromethod for the identification of streptococcal, enterococcal and staphylococcal species}; Gassama A et al.; The aim of this study was to set accurate and reliable methods in the identification of streptococcal, enterococcal and staphylococcal species . Micro CSB Strep and Staph system consists each of a strip with cupules containing dehydrated substrates for biochemical identification of bacterial species . Baye's theorem was used to validate tests . Reactions from micromethods were clear and easily read . Identification of 229 strains of streptococci and enterococci was correct for most species with 98.7% species with 99.3% sensitivity . 41 strains of staphylococci were also correctly identified with 85.2% of specificity and 97.68% of sensitivity.

Nervenarzt, 2000 Apr, 71(4), 316 - 8
{Isolated reversible unilateral paresis of hypoglossal nerve in tonsillitis--case report}; Kovalev D et al.; We report on a 30-year-old patient with isolated, left-sided hypoglossal nerve palsy after uncomplicated, presumably streptococci-induced tonsillitis . Needle electromyography (EMG) of the tongue showed denervation changes in the muscles supplied by the left hypoglossal nerve . Cranial CT and MRI, CSF examination, Doppler sonography, visual evoked potential (VEP), and auditory evoked potential (AEP) showed no abnormalities and, in particular, no signs of the carotid artery dissection or brainstem lesion . The symptoms and signs resolved within a few weeks after penicillin V treatment . We suppose that the hypoglossal affection of the uncomplicated tonsillitis in this case was due to an aberrant position of the nerve.

J Clin Microbiol, 2000 May, 38(5), 1713 - 6
Evaluation of the PASCO strep plus broth microdilution antimicrobial susceptibility panels for testing Streptococcus pneumoniae and other Streptococcal species; Mohammed MJ et al.; Antimicrobial resistance continues to increase worldwide among isolates of Streptococcus pneumoniae and other species of streptococci . Increasing rates of penicillin resistance, particularly in viridans group streptococci, and resistance to multiple classes of antimicrobial agents, including beta-lactams, macrolides, and fluoroquinolones, in pneumococci have increased the importance of having accurate antimicrobial susceptibility testing results for guiding therapy . One commercial method of assessing resistance in streptococci is the PASCO Strep Plus panel . This broth microdilution-based method has recently been expanded to include a variety of newer antimicrobial agents . Therefore, we compared the results of the new PASCO Strep Plus panels for 26 antimicrobial agents against the results generated using the National Committee for Clinical Laboratory Standards (NCCLS) broth microdilution reference method for 75 pneumococci and 68 other streptococcal isolates . Only 4 (0.2%) very major errors (all with pneumococci and each with a different antimicrobial agent) were observed . There were 5 (0.3%) major errors observed with pneumococci (each with a different antimicrobial agent), but only 1 major error with nonpneumococcal streptococci . All of the very major and major errors resolved on retesting . Of the 65 (3.9%) and 17 (1.6%) minor errors observed with pneumococci and other streptococci, respectively, all were within 1 dilution of the broth microdilution reference MIC result . Thus, the PASCO Strep Plus panel has comparable accuracy to the NCCLS broth microdilution reference method.

J Laryngol Otol, 2000 Jan, 114(1), 47 - 9
Labyrinthine involvement and multiple perforations of the tympanic membrane in acute otitis media due to group A streptococci; Kanazawa T et al.; We present here three cases of acute otitis media caused by a virulent group A streptococcal infection that rapidly led to deterioration in hearing . Two of the three cases presented with severe sensorineural and mixed hearing loss with multiple tympanic membrane perforations, and the third presented with severe bilateral sensorineural hearing loss following acute otitis media involving group A streptococci . All patients were treated with systemic (piperacillin) and topical antibiotics (ofloxacin ear drops): one patient also received a systemic steroid (betamethasone) . Deafness persisted in one patient but in the other two, hearing gradually recovered . Severe cytotoxicity was considered to have occurred in all patients, resulting in multiple perforations of the tympanic membrane and necrosis in the middle ear.

Indian J Exp Biol, 1999 Oct, 37(10), 971 - 5
Effects of intranasal challenge with group A beta haemolytic streptococcus M type 49 in Swiss albino mice; Stephen J et al.; Mice are susceptible to natural infections with streptococci and therefore can serve as suitable animal models to study experimental streptococcal infections . In an earlier study, we had shown the development of pharyngeal colonization, antibody response and histopathological changes in the heart following intranasal (IN) challenge with a rheumatogenic serotype of group A beta haemolytic streptococcus, the M type 18 . To determine if nonpharyngitis associated serotypes can also elicit similar responses, 30 Swiss albino mice were challenged intranasally with 2 x 10(7) colony forming units of a skin associated serotype of group A beta haemolytic streptococcus, the M type 49 . Pharyngeal colonization varied from 64% (n = 30) in the first week to 69% (n = 16) during the fourth week after IN challenge . Eleven (36.7%) of the 30 animals studied showed antibody response to DNase B (ADNB) with peak titers varying from 150 to 1200 units . Wide variations were seen in ADNB titers in individual mice . Histopathological evidence for cardiac lesions were seen in three animals . The changes were mild and varied from mild to chronic endocardial inflammation to calcification . The study shows that Swiss albino mice are also susceptible to IN challenge with skin associated strains of GABHS and therefore can serve as useful models to study the effects of experimental infection with diverse serotypes of GABHS.

J Orofac Orthop, 2000, 61(2), 138 - 48
The influence of a 0.2% chlorhexidine mouthrinse on plaque regrowth in orthodontic patients . A randomized prospective study . Part II: Bacteriological parameters; Gehlen I et al.; In a prospective plaque regrowth study focusing on oral hygiene during fixed appliance therapy 12 adolescent patients (mean age 14.1 +/- 1.5 years) were evaluated twice over 2-day test periods . In the randomized, double-blind study the influences of a 0.2% chlorhexidine mouthrinse (Corsodyl, CHX) and a commercially available dentifrice supplementing fluoride (Odol-med-3) were compared intra- and interindividually in a crossover design with regard to the bacteriological parameters . The bacteriological parameters of vital fluorescence, bacteriological counts (BC), colony forming units (CFU), plating efficiency (PE) and mutans streptococci (MS) were related to the clinically assessed indices of plaque and gingivitis . All parameters analyzed demonstrated significant differences between the control and the test (chlorhexidine) group . Where-as the values of BC, CFU, and PE progressively increased in the control group from T0 to T2, these parameters distinctly decreased in the chlorhexidine group . All values of vital flora (VF) scored around 75% in the control group compared to values of 30% in the test group . BC, CFU und PE correlated significantly . The score of mutans streptococci persisted or increased in the controls whereas mutans streptococci approached 0 in the chlorhexidine group . Until the 5th day of washout a clear-cut carry over of the chlorhexidine rinse on mutans streptococci as well as on the gingival index was evident . Since dead microorganisms remain on the tooth surface and in order to maintain oral health, chlorhexidine application might advisedly be supplemented by mechanical plaque control.

Biochim Biophys Acta, 2000 May 1, 1474(3), 346 - 52
Modulation of glucan-binding protein activity in streptococci by fluoride; Luengpailin S et al.; Glucan-binding lectin (GBL) activity of Streptococcus sobrinus was significantly reduced by fluoride in the growth medium . Approximately 1.5 mM fluoride was required for a 50% reduction in GBL activity . In addition to the GBL, several other glucan-binding proteins were reduced when the bacteria were grown in subinhibitory fluoride . Fluoride had no effect on glucosyltransferases (GTFs), enzymes capable of converting sucrose into alpha-1,6-glucans . All the proteins were detected by use of enhanced chemiluminescence (ECL of fluorescein-labeled dextran) and Western blotting of renatured SDS-PAGE gels . The effects of fluoride on the bacteria were abrogated when the manganous ion was included in the growth medium . It thus appears that one mechanism of action of fluoridated water is its effects on glucan-binding proteins . The fluoride may be reducing metabolism of the mangano aquo ion, essential for expression of the glucan-binding proteins.

J Assoc Physicians India, 1999 Jul, 47(7), 673 - 5
Preceding infection as a risk factor of stroke in the young; Nagaraja D et al.; INTRODUCTION: The cause of stroke in the young remains unknown in 20-50% of the patients . Infections preceding stroke have been recently recognised to be an independent risk factor of stroke . MATERIAL AND METHODS: Sixty consecutive patients aged 40 years or less presenting with ischaemic completed stroke are taken up for the study . Patients with neurological deficit of less than 24 hours, evidence of haemorrhage on CT scan, infection occurring after the onset of stroke were excluded . Controls consisted of age and sex matched persons residing in the same area . Both the groups were enquired about preceding fever and infections and were examined for evidence of infections . Serum was examined for antibodies against measles, herpes simplex, and Japanese B encephalitis viruses . Cultures were put up from appropriate samples and CSF examined in patients only . RESULTS: Evidence of infection was noted in 26 (43.3%) of patients and 6 controls (p < 0.001) . History of fever was elicited in 23 patients and 3 controls while 15 patients were febrile on examination at admission . Signs of local infection was observed in 14 patients and one control . The commonest site of infection was respiratory tract . Cultures were positive in 11 patients, commonest being beta haemolytic streptococci in six from throat . Conventional risk factors were identical in both groups of patients with and without evidence of preceding infection . Smoking and alcoholism were significantly higher in patients with preceding infection . CONCLUSION: Preceding infection is an important risk factor of stroke in the young . Smoking and alcoholism are more frequent in patients with preceding infection . Whether they predispose the individual for infection or infection increases the stroke risk in them needs to be examined.

Jpn J Infect Dis, 2000 Feb, 53(1), 1 - 5
Current understanding of the cause of dental caries; Hanada N; Dental caries-associated oral streptococci are called the mutans streptococci, with Streptococcus mutans and Streptococcus sobrinus being the most prevalent caries-associated organisms in humans . Strains of the mutans streptococci are highly conserved within not only mothers and their children but also racial groups, suggesting vertical transmission of this organism within human populations . It has been found that the mother-child infection route of the mutans streptococci can be prevented by simply reducing the amount of the mutans streptococci contained in the mothers' saliva . Moreover, a chlorhexidine varnish reduces the salivary mutans streptococci by an average of 3 logs (99.9%), and moved them below detectable levels . We should attempt to eliminate the infection with the mutans streptococci among Japanese people by attempting to break the infectious chain from mothers to children.

Joint Bone Spine, 2000 Jan, 67(1), 11 - 21
Pyogenic arthritis in adults; Dubost JJ et al.; Septic arthritis has shown no change in incidence, and despite advances in antimicrobial therapy is often responsible for residual functional impairment and for a high mortality rate among debilitated patients . Risk factors include older age, diabetes mellitus, rheumatoid arthritis, immunodeficiency, and a preexisting joint disease (e.g., rheumatoid arthritis) to which the symptoms of septic arthritis are sometimes ascribed . Staphylococcus aureus contributes over two-thirds of identified organisms; a range of streptococci and gram-negative bacilli are next in frequency . The most common site is the knee, followed by the hip and shoulder . Over 10% of patients have polyarticular involvement reflecting bacteremia and diminished resistance to infection; (over 50% of polyarticular forms occur in rheumatoid arthritis patients) . Prosthetic joint infection is becoming increasingly common; chronic forms due to intraoperative contamination and resulting in septic loosening should be distinguished from acute hematogenous infection in which emergency treatment can allow to salvage the prosthesis . Demonstration of the organism in the joint is the key to the diagnosis . Joint aspiration should be performed on an emergency basis, if needed after identification of radiographic landmarks or under ultrasonographic guidance . Seeding the fluid on blood culture flasks immediately after aspiration increases the yield . Antibiotics should be started as soon as the microbiological specimens have been collected . When aspiration is difficult (hip) or inadequate, arthroscopic drainage usually makes arthrotomy unnecessary . Early antiinflammatory therapy (nonsteroidal antiinflammatory drugs, systemic or local glucocorticoids, anticytokines, and antiinflammatory cytokines) are being considered as tools for limiting joint damage; their efficacy and safety will first have to be established in animal studies.

Caries Res, 2000 Mar-Apr, 34(2), 133 - 9
Genotypes of mutans streptococci tend to persist in their host for several years; Emanuelsson IR et al.; The aim of this study was to evaluate the consistency of the prevalence of mutans streptococci in a group of Swedish families . Eleven families, which had previously been examined for genotypes of mutans streptococci, were re-examined after 2-5 years . The families consisted of mother, father and a child (mean age 7.2 years at the follow-up examination) . One father did not participate . Pooled plaque samples were obtained from buccal and occlusal surfaces . Isolates of mutans streptococci were genotyped using chromosomal DNA digested with restriction endonuclease HaeIII, separated by gel electrophoresis and visualised through UV illumination after ethidium bromide staining . Comparing the DNA fingerprints of mutans streptococci found at baseline and follow-up, 9 children harboured one or two genotypes which were similar on the two sampling occasions . Two of these children had also gained a genotype . The remaining 2 children had lost a genotype each and 1 of them had gained two new genotypes . All 21 adults showed one or two genotypes identical to those found at baseline . Nine of these 21 adults had also lost one genotype . Four of these 9 and additionally 4 of the remaining adults showed one or two new genotypes . Six mother-child pairs shared a genotype at baseline and this pattern remained for five pairs at the end of the study . The results suggest that genotypes of mutans streptococci have a fairly high degree of consistency in children between 3 and 8 years of age as well as in adults, indicating persistence of the strains . However, the results also indicate that some subjects may gain and/or lose genotypes.

Caries Res, 2000 Mar-Apr, 34(2), 123 - 32
The fidelity of mutans streptococci transmission and caries status correlate with breast-feeding experience among Chinese families; Li Y et al.; Our previous study reported that the fidelity of mutans streptococci (MS) transmission from mother to infant was gender- and race-specific within a Birmingham, Ala., population . We hypothesized that fidelity might be a function of postnatal nurturing practices . The purpose of the present study was to investigate those factors that could be correlated with MS transmission among Chinese children whose nurturing histories were known . Forty-eight families with 2- to 3-year-old children were selected from two kindergartens of Beijing, China . A questionnaire concerning the childhood nursing practice was obtained from the parents . Dental caries status was examined, and bacterial samples were collected for all participants twice at 6-month intervals . An average of six isolates of MS was picked at random from selective medium from each individual at each visit . Chromosomal DNA fingerprints were performed for all MS isolates to determine the genomic similarity within each family and among individuals . The results showed that 66% of the children at 2-3 years of age harbored MS, and 46% were caries-active . Of those children, 70% were breast-fed . Among the children whose chromosomal DNA fingerprint genotypes of MS matched that of their mothers, 88% were breast-fed compared with only 12% who were not breast-fed (p = 0.03) . We also found that children who were breast-fed for more than 9 months were likely to harbor strains of MS common to their mothers (p = 0.04) and experience more dental caries (dmft = 4.4) at 3 years of age compared with children who were breast-fed less than 9 months (dmft = 1.4, p = 0.04) . The data suggest that breast-feeding, especially prolonged breast-feeding, may correlate with the fidelity of transmission and that prolonged breast-feeding may contribute to a higher caries rate.

Infect Immun, 2000 May, 68(5), 2698 - 703
Coimmunization with complementary glucosyltransferase peptides results in enhanced immunogenicity and protection against dental caries; Taubman MA et al.; Peptide constructs from the catalytic (CAT) and glucan-binding (GLU) regions of the mutans streptococcal glucosyltransferase enzymes (GTF) can provide immunity to dental caries infection . A strategy of coimmunization was tested to determine whether protection could be enhanced . Rats were immunized with one of the previously described peptide constructs from the CAT or GLU region of the GTF of mutans streptococci or coimmunized with a combination of these constructs (CAT-GLU) . Coimmunized animals demonstrated significantly higher serum immunoglobulin G (IgG) and salivary IgA antibody levels to CAT or GTF than rats immunized with either construct alone . To assess the functional significance of coimmunization with these constructs, animals were immunized as above or with Streptococcus sobrinus GTF and then infected with S . sobrinus to explore the effects of immunization on immunological, microbiological, and disease (dental caries) parameters . Serum antibody from the communized group inhibited S . sobrinus GTF-mediated insoluble glucan synthesis in vitro above that of the individual-construct-immunized groups . Immunization with CAT or GLU constructs resulted in significantly reduced dental caries after infection with S . sobrinus compared with sham-immunized animals . Coimmunization produced greater reductions in caries than after immunization with either CAT or GLU . Also, significant elevations in lymphocyte proliferative responses to CAT, GLU, and GTF were observed after coimmunization with CAT-GLU compared with the responses after immunization with the individual constructs . The results suggested that increased numbers of memory T cells, which could proliferate to CAT, were generated by coimmunization . The experiments support the functional significance of these GTF domains in dental caries pathogenesis and present coimmunization as a simple alternative to intact GTF to enhance protective immunity against cariogenic microorganisms.

Infect Immun, 2000 May, 68(5), 2475 - 83
Purification, characterization, and molecular analysis of the gene encoding glucosyltransferase from Streptococcus oralis; Fujiwara T et al.; Streptococcus oralis is a member of the oral streptococcal family and an early-colonizing microorganism in the oral cavity of humans . S . oralis is known to produce glucosyltransferase (GTase), which synthesizes glucans from sucrose . The enzyme was purified chromatographically from a culture supernatant of S . oralis ATCC 10557 . The purified enzyme, GTase-R, had a molecular mass of 173 kDa and a pI of 6.3 . This enzyme mainly synthesized water-soluble glucans with no primer dependency . The addition of GTase markedly enhanced the sucrose-dependent resting cell adhesion of Streptococcus mutans at a level similar to that found in growing cells of S . mutans . The antibody against GTase-R inhibited the glucan-synthesizing activities of Streptococcus gordonii and Streptococcus sanguis, as well as S . oralis . The N-terminal amino acid sequence of GTase-R exhibited no similarities to known GTase sequences of oral streptococci . Using degenerate PCR primers, an 8.1-kb DNA fragment, carrying the gene (gtfR) coding for GTase-R and its regulator gene (rgg), was cloned and sequenced . Comparison of the deduced amino acid sequence revealed that the rgg genes of S . oralis and S . gordonii exhibited a close similarity . The gtfR gene was found to possess a species-specific nucleotide sequence corresponding to the N-terminal 130 amino acid residues . Insertion of erm or aphA into the rgg or gtfR gene resulted in decreased GTase activity by the organism and changed the colony morphology of these transformants . These results indicate that S . oralis GTase may play an important role in the subsequent colonizing of mutans streptoccoci.

Infect Immun, 2000 May, 68(5), 2441 - 8
Characterization of an isogenic mutant of Streptococcus pyogenes Manfredo lacking the ability to make streptococcal acid glycoprotein; Degnan BA et al.; An isogenic mutant of Streptococcus pyogenes Manfredo that lacks the ability to make streptococcal acid glycoprotein (SAGP) has been constructed by inserting a deletion in the sagp gene using the method of allelic exchange . An assay of cell extracts (CE) prepared from the wild-type and mutant Manfredo strains for the enzyme arginine deiminase (AD) showed that significant activity was present in wild-type CE but none could be detected in mutant CE . These findings confirm our earlier conclusion that SAGP has AD activity (B . A . Degnan, J . M . Palmer, T . Robson, C . E . D . Jones, M . Fischer, M . Glanville, G . D . Mellor, A . G . Diamond, M . A . Kehoe, and J . A . Goodacre, Infect . Immun . 66:3050-3058, 1998) . Wild-type CE but not mutant CE potently inhibited human peripheral blood mononuclear cell proliferation in response to phytohemagglutinin, and this inhibition was overcome by the addition of L-arginine to proliferation assay mixtures . Invasion assays showed that the isogenic mutant organisms lacking SAGP, and thus AD activity, were between three and five times less able to enter epithelial cells (Hep-2C and A549) than were the wild-type streptococci . Both wild-type and mutant S . pyogenes bacteria were extremely sensitive to low pH . However, L-arginine (1 mM or above) significantly increased the viability of the wild type but not the isogenic mutant organisms under acidic conditions . The difference in acid susceptibility between wild-type and mutant bacteria may explain the reduced capacity of the isogenic mutant bacteria to invade and survive intracellularly.

Heart, 2000 May, 83(5), 525 - 30
Long term outcome of infective endocarditis in patients who were not drug addicts: a 10 year study; Castillo JC et al.; OBJECTIVE: To determine the clinical features and long term prognosis of infective endocarditis in patients who were not drug addicts . DESIGN: Prospective case series . SETTING: A university hospital that is both a referral and a primary care centre . PATIENTS: 138 consecutive cases of infective endocarditis diagnosed and treated from January 1987 to March 1997 . RESULTS: Mean patient age was 44 (20) years old . 95 patients (69%) had native valve endocarditis and 43 (31%) had prosthetic valve endocarditis . Staphylococci were the causal microorganisms in 34% of cases and streptococci in 33% . Severe complications occurred in 83% of patients and 51% of patients underwent surgery during the active phase (22% was emergency surgery) . Inpatient mortality was 21% . During a follow up of 56 (44) months, 10 patients (9%) needed late cardiac surgery and seven (5% of the whole series) died . Overall 10 year survival was 71% . There were no significant differences in survival depending on the type of treatment received during the hospital stay (medical or combined medical-surgical) . CONCLUSIONS: A high early surgery rate is related to good long term results and does not increase in-hospital mortality . Medical treatment, however, also offers favourable long term results in cases of responsive infective endocarditis where poor prognostic factors are absent.

Ann Med, 2000 Mar, 32(2), 107 - 12
Development of oral bacterial flora in young children; Kononen E; The intimate relationship with bacteria is a fundamental factor in the health status of an individual . After birth infants are exposed to continuous person-to-person and environmental contacts with microbes, and the development of the indigenous microflora begins on the surfaces of the human body . In a developing ecosystem microbial colonization may easily occur because of the still inadequate host response . Adhesion is the initial event in the colonization of bacteria . In the mouth, only mucosal surfaces are available during the first months of life . After teeth emerge, the number of attachment sites and potential niches increases significantly . Bacteria adhere not only to oral surfaces but also to each other, forming multigeneric communities where specific partner relationships influence their composition and stability . Viridans streptococci and a strictly anaerobic species, Fusobacterium nucleatum, are of interest in this context . The oral colonization pattern differs between individuals already in infancy; variable bacterial load in saliva of attendants and other close contacts and the frequency of this bacterial exposure may partly account for individual differences . In addition, the exposure of an infant to antibiotics affects the quality of colonizing bacteria . This article presents an overview of the age-related acquisition of oral bacteria and the role of the indigenous oral microflora in health and disease.

Scand J Gastroenterol, 2000 Mar, 35(3), 287 - 92
Crohn disease arthropathy: antigens in synovial fluid share epitopes with strains of two species of viridans streptococci; Baker SJ et al.; BACKGROUND: There is evidence to suggest that Crohn disease is caused by an immunologic response to an unknown intestinal luminal antigen, probably of bacterial origin . The reported demonstration of yersinia antigen in the synovial fluid of patients with yersinosis therefore prompted a search for bacterial antigens in the synovial fluid of patients with Crohn arthropathy . METHODS: Antisera were raised in rabbits to synovial fluids obtained from seven patients with Crohn arthropathy and from seven 'control' subjects with other forms of arthropathy . These antisera were used to probe sonicates of the bacteria cultured from the gastric juice of patients with gastric Crohn disease . RESULTS: The antisera made from the Crohn synovial fluids, but none of those made from the controls, reacted uniquely with antigens in sonicates of strains of two species of viridans streptococci (Streptococcus parasanguis and an atypical S . oralis) isolated from four of the five patients with gastric Crohn disease . CONCLUSIONS: These findings suggest that the arthropathy of Crohn disease and, possibly, the intestinal disease itself may involve an immunologically mediated inflammatory response to these antigens.

J Dent Res, 2000 Mar, 79(3), 882 - 7
Influence of maternal xylitol consumption on acquisition of mutans streptococci by infants; Soderling E et al.; Xylitol is effective as a non-cariogenic sugar substitute . Habitual xylitol consumption appears to select for mutans streptococci (MS) with impaired adhesion properties, i.e., they shed easily to saliva from plaque . One hundred sixty-nine mother-child pairs participated in a two-year study exploring whether the mothers' xylitol consumption could be used to prevent mother-child transmission of mutans streptococci . All mothers showed high salivary levels of mutans streptococci during pregnancy . The mothers in the xylitol group (n = 106) were requested to chew xylitol-sweetened gum (65% w/w) at least 2 or 3 times a day, starting three months after delivery . In the two control groups, the mothers received either chlorhexidine (n = 30) or fluoride (n = 33) varnish treatments at 6, 12, and 18 months after delivery . The children did not chew gum or receive varnish treatments . MS were assessed from the mothers' saliva at half-year intervals and from the children's plaque at the one- and two-year examinations . The MS were cultured on Mitis salivarius agars containing bacitracin . The salivary MS levels of the mothers remained high and not significantly different among the three study groups throughout the study . At two years of age, 9.7% of the children in the xylitol, 28.6% in the chlorhexidine, and 48.5% in the fluoride varnish group showed a detectable level of MS . In conclusion, therefore, habitual xylitol consumption by mothers was associated with a statistically significant reduction of the probability of mother-child transmission of MS assessed at two years of age . The effect was superior to that obtained with either chlorhexidine or fluoride varnish treatments performed as single applications at six-month intervals.

Chemotherapy, 2000 May-Jun, 46(3), 160 - 5
Lack of in vitro and in vivo selection of bacterial resistance by roxithromycin; Drago L et al.; The in vitro and in vivo selective pressure exerted by roxithromycin on Lancefield group A beta-haemolytic streptococci (GABHS) was investigated . In vitro antimicrobial activity on fifty GABHS strains was determined by the microdilution method and by boundary concentration (BC) determination . Insorgence of resistance was evaluated by redetermining MIC and BC after exposure to 16 x MIC roxithromycin concentration . In vivo insorgence of resistance was evaluated by MIC and BC determinations on the GABHS strain recovered from infected mice peritoneum, after treatment with 20 mg/kg roxithromycin . The roxithromycin serum kinetics was established in healthy and infected mice . Neither significant changes in GABHS MIC or BC after in vitro or in vivo exposure to roxithromycin nor a difference in roxithromycin serum levels between healthy and infected mice were detected, suggesting that the roxithromycin selection of resistance in GABHS is low .

Microb Pathog, 2000 Apr, 28(4), 221 - 6
Inactivation of the cysteine protease SpeB affects hyaluronic acid capsule expression in group A streptococci; Woischnik M et al.; The human pathogen Streptococcus pyogenes expresses several virulence factors that are required for the pathogens survival within the host and the concomitant development of disease . To examine the influence of one virulence factor, the extracellular cysteine protease SpeB, on the expression of other virulence factors, the speB structural gene of a serotype M3 and M49 strain was inactivated . Morphologic examination, quantification of extracellular hyaluronic acid capsule, and Northern blot analysis of the isogenic speB -mutants revealed a strain-dependent decrease of hyaluronic acid capsule production and an increase in superoxide dismutase transcription . The transcription of streptolysin O (slo), di- and oligo-peptide permease (dpp, opp), hyaluronidase (hyl), streptokinase (ska) and streptococcal pyrogenic exotoxin A (speA) was unaffected .

Ann Med Interne (Paris), 2000 Feb, 151(1), 3 - 9
{Erysipelas . A retrospective series of 92 patients in a department of internal medicine}; Jego P et al.; Erysipleas, also known as Saint Anthony's fire, is an acute infection of the skin caused, in most of cases, by group A streptococci . In the past, the most common site of involvement was the face and, in the pre-antibiotic era, mortality was high . In this retrospective study, we highlight the clinical and bacteriological features and report follow-up in 92 patients hospitalized in an internal medicine unit between 1st March 1992 and 31st December 1996 for 94 episodes of erysipelas . The involvement of the lower limbs predominated as involvement of the face is becoming very rare . Streptococci from others groups and Staphylococcus aureus have been implicated on occasions . Recovery is usual even if this infection may greatly weaken these often fragilized patients . In this paper, antibiotic treatment as well as the place of anticoagulants and Doppler ultrasound are discussed . Hospitalization is often necessary but it must not be systematic.

Eur J Immunol, 2000 Apr, 30(4), 1243 - 53
Assessment of the interaction of human complement regulatory proteins with group A Streptococcus . Identification of a high-affinity group A Streptococcus binding site in FHL-1; Perez-Caballero D et al.; Group A Streptococcus (GAS), the most frequent bacterial cause of suppurative infections in humans, expresses on the cell surface M proteins with capacity to bind factor H, FHL-1 and C4b binding protein (C4BP) . This has been interpreted as a mechanism developed by this pathogen to decrease phagocytosis by macrophages and polymorphonuclear cells . We report the analysis of the capacity to bind factor H, FHL-1 and C4BP of 69 clinical isolates from 19 different serotypes . We show that strains binding complement regulators (30/69) belong to specific M serotypes . Of these, M18 strains are relatively frequent and interact with all three complement regulators simultaneously . However, the most virulent M1 and M3 strains did not bind complement regulators in our assays . The relevance of the interaction between complement regulators and S . pyogenes was analyzed using different approaches with the conclusion that under physiological conditions only FHL-1 and C4BP bind to streptococci . We show that FHL-1 presents a higher binding affinity for S . pyogenes than factor H because it carries a hydrophobic, high-affinity, GAS binding site in addition to the heparin binding site in SCR7 . Using synthetic peptides we provide evidence that the high-affinity GAS binding site in FHL-1 involves the hydrophobic tail (Ser-Phe-Thr-Leu) that distinguishes FHL-1 from factor H.

Eur J Immunol, 2000 Apr, 30(4), 993 - 1001
Preferential stimulation of human lymphocytes by oligodeoxynucleotides that copy DNA CpG motifs present in virulent genes of group A streptococci; Chatellier S et al.; Immunostimulatory oligodeoxynucleotides (ODN) containing CpG dinucleotides have been shown to stimulate murine and human lymphocytes . We investigated the presence of stimulatory DNA motifs in specific group A streptococcal (GAS) genes to elucidate the potential role of DNA in the immunopathogenesis of GAS infections . Despite low GC content in GAS DNA, the emm1 gene encoding the streptococcal M1 protein contained a relatively high frequency of TTCG(T/C), TCGTCG and (G/A)TCGT motifs that preferentially stimulated human lymphocytes . Interestingly, these motifs were also found in genes encoding M-like proteins of group C and G streptococci . ODN copying the emm1 gene sequences harboring these motifs induced the proliferation of human B cells and up-regulated the expression of CD25 on their surface . T cells were not required for the response to the ODN, indicating a direct effect of these motifs on B lymphocytes . Inter-individual variations in responsiveness to ODN were observed, suggesting that host factors potentiate these responses . The finding that GAS DNA contains stimulatory motifs that induce activation of human B cells in a T cell-independent manner suggests that this may be an important mechanism by which the bacteria can target the innate arm of the immune system in the early stages of invasive infections.

J Antimicrob Chemother, 2000 Feb, 45 Suppl, 23 - 30
Comparison of short-course (5 day) cefuroxime axetil with a standard 10 day oral penicillin V regimen in the treatment of tonsillopharyngitis; Adam D et al.; Oral penicillin V given three times daily in doses of 50,000-100,000 IU daily has been the standard treatment for tonsillopharyngitis for the last few decades . These regimens, initially recommended by the American Heart Association, were extrapolated from i.v . dosing with long-acting forms of penicillin which had been shown to prevent post-streptococcal sequelae . More recently, several antibiotics, including cefuroxime axetil, have been shown to be at least as effective as penicillin G in eradicating group A beta-haemolytic streptococci (GABHS) but their influence on post-streptococcal sequelae has never been assessed in a large-scale trial . The German Society for Pediatric Infectious Diseases (DGPI) undertook a large study of culture-proven tonsillopharyngitis involving several agents and included a 1 year follow-up to establish the effect on sequelae . In one arm of this study, cefuroxime 250 mg bid was compared with 50,000 IU penicillin V given in three divided doses . Cefuroxime axetil was more effective than oral penicillin V in eradicating GABHS at the assessment 2-4 days post-treatment (441/490 (90%) patients versus 1196/1422 (84%) patients; P = 0.001) . Clinically, the two agents were equivalent in efficacy, and carriage rates were similar (11.1% and 13.8%, respectively) in patients receiving cefuroxime axetil and penicillin V, 7-8 weeks post-treatment . One case of glomerular nephritis occurred in a patient given penicillin V . There were no post-streptococcal sequelae confirmed for patients treated with cefuroxime axetil . The findings confirm the previously reported efficacy of short-course (4-5 day) treatments with cefuroxime axetil and indicate that short-course treatment is comparable to the standard oral penicillin V regimen in preventing post-streptococcal sequelae.

J Antimicrob Chemother, 2000 Feb, 45 Suppl, 13 - 21
Rheumatic fever--is it still a problem?
Olivier C.
The incidence of rheumatic fever has declined in industrialized countries since the 1950s and now has an annual incidence of around 0.5 cases per 100,000 children of school age . In developing countries it remains an endemic disease with annual incidences ranging from 100 to 200 per 100,000 school-aged children and is a major cause of cardiovascular mortality . Interest in the pathogenesis of rheumatic fever was rekindled by outbreaks in the USA (1985-1987) and the rare cases still seen in industrialized countries . The current concept is that the disease results from the host's poorly adapted autoimmune response to group A beta-haemolytic streptococci . The risk of developing rheumatic fever following untreated tonsillopharyngitis is 1% in the civilian population . Knowledge of virulence factors has been greatly enriched by progress in molecular biology . One of the key elements is protein M, a surface protein on the bacterial wall which carries specific epitopes . Several serotypes which lead to rheumatic fever have been recognized among more than 80 identified serotypes . However, the reason why specific strains within a given serotype have increased rheumatogenic virulence remains unknown . The causal strain adheres to the oral and pharyngeal cells and then releases its degradation products . These products present antigenic determinants which cross-react with certain human tissues, particularly in cardiac valve tissue and myocardium . Diagnosis is now difficult owing to the low incidence . Late diagnosis can have serious consequences and acute rheumatic fever is a therapeutic emergency requiring immediate antibiotic and anti-inflammatory treatment . In most of Europe there is tacit agreement that all cases of pharyngitis and tonsillitis should be treated with antibiotics without identification of the causal agent despite the fact that only about 20% of the cases are caused by group A beta-haemolytic streptococci, and could lead to rheumatic fever.

J Antimicrob Chemother, 2000 Feb, 45 Suppl, 3 - 12
Group A streptococci in the 1990s; Efstratiou A; The last decade has witnessed a remarkable change in the epidemiology of group A streptococcal infections . There has been a marked increase globally in the reporting of invasive infections caused by Streptococcus pyogenes, Lancefield group A streptococci . Many of these cases were deep-seated infections associated with shock and multi-organ failure and are defined as streptococcal toxic shock syndrome . In addition, reports of streptococcal sequelae, in particular, acute rheumatic fever, have re-emerged and remain a serious health threat in developed countries . It appears that these infections are related to the type distributions of the organism among the general population, with the re-emergence of more 'virulent' strains, such as the M1 serotype which in earlier decades was primarily seen in cases of either superficial disease or scarlet fever . Population-based surveillance studies have clearly indicated the importance and relevance of type identification for epidemiological purposes . There have also been suggestions that certain extracellular products and toxins play a major role in the so-called 'increased virulence' of the organism; these include cell surface molecules such as the M protein, opacity factor, the hyaluronic acid capsule, C5a peptidase and streptococcal inhibitor of complement (SIC), in addition to secreted proteins, pyrogenic exotoxins, cysteine proteinase, streptolysins O and S, hyaluronidase, streptokinase and other enzymes . All these factors, and events during the last decade, strongly emphasize the need for a better understanding of the epidemiology, pathogenesis, treatment and prevention of group A streptococcal infections.

Pediatr Res, 2000 Apr, 47(4 Pt 1), 516 - 23
Hemodynamic homeostasis during acute hypoxia in septic and nonseptic piglets: differential role of prostaglandins and nitric oxide; Rudinsky B et al.; We studied the hemodynamic responses of 29 anesthetized and mechanically ventilated piglets to acute hypoxia {reduction of Pao2 from 130 to 38 mm Hg induced by inhalation of 7% fraction of inspired oxygen (Fio2) for 7.5 min} before and during group B beta-hemolytic streptococci (GBS) sepsis . During hypoxia, nonseptic piglets maintained stable systemic blood pressure {105+/-9 (SD) to 97+/-14 mm Hg} and cardiac output (CO) (667+/-72 to 685+/-113 mL/min) . However, during GBS/hypoxia, systemic blood pressure fell from 94+/-17 to 49+/-25 mm Hg, CO fell from 397+/-146 to 223+/-142 mL/min (both p < 0.001 versus pre-GBS), and cardiac arrest often ensued . We tested three hypotheses that might underlie GBS-induced intolerance to systemic hypoxia: 1) GBS-induced reduction of systemic CO/systemic oxygen delivery (QO2) below a critical QO2 beyond which the superimposition of hypoxia becomes intolerable; this mechanism is unlikely as nonseptic piglets with comparable reductions in CO/QO2 (induced by inflation of a left atrial balloon) tolerated hypoxia well; 2) GBS-induced inhibition of nitric oxide (NO) synthesis that is vital to tolerance of hypoxia; this mechanism is unlikely as infusion of the NO substrate L-arginine did not restore tolerance to hypoxia during GBS infusion (as it did after inhibition of NO synthesis during infusion of N-nitro-L-arginine in nonseptic piglets); and 3) GBS-induced production of pathologic prostaglandins that impaired the piglet's capacity to tolerate hypoxia; this mechanism finds support in the observation that inhibition of prostaglandins with the cyclooxygenase inhibitor indomethacin completely restored the ability of septic piglets to tolerate hypoxia . Further evaluation of GBS-induced intolerance to systemic hypoxia may provide insight into the incompletely understood mechanisms by which sepsis induces circulatory collapse in experimental animals and in humans.

Am Fam Physician, 2000 Mar 15, 61(6), 1725 - 32, 1739
Management of bacterial endocarditis; Giessel BE et al.; Most cases of bacterial endocarditis involve infection with viridans streptococci, enterococci, coagulase-positive staphylococci or coagulase-negative staphylococci . The choice of antibiotic therapy for bacterial endocarditis is determined by the identity and antibiotic susceptibility of the infecting organism, the type of cardiac valve involved (native or prosthetic) and characteristics of the patient, such as drug allergies . Antibiotic therapies discussed in this report are based on recommendations of the American Heart Association . Treatment with aqueous penicillin or ceftriaxone is effective for most infections caused by streptococci . A combination of penicillin or ampicillin with gentamicin is appropriate for endocarditis caused by enterococci that are not highly resistant to penicillin . Vancomycin should be substituted for penicillin when high-level resistance is present . Resistance of enterococci to multiple antibiotics including vancomycin is becoming an increasing problem . Native valve infection by methicillin-susceptible staphylococci is treated with nafcillin, oxacillin or cefazolin . The addition of gentamicin for the first three to five days may accelerate clearing of bacteremia . Infection of a prosthetic valve by a staphylococcal organism should be treated with three antibiotics: oral rifampin and gentamicin and either nafcillin, oxacillin, cefazolin or vancomycin, depending on susceptibility to methicillin . Vancomycin is substituted for penicillin in patients with a history of immediate-type hypersensitivity to penicillin.

J Clin Periodontol, 2000 Mar, 27(3), 157 - 61
Effect of an essential oil-containing antiseptic mouthrinse on plaque and salivary Streptococcus mutans levels; Fine DH et al.; BACKGROUND: Clinical studies in which antimicrobial mouthrinses were shown to have significant antiplaque activity most frequently have used gingivitis as the clinically relevant endpoint . However, there is evidence to suggest that mouthrinses containing active agents effective against Streptococcus mutans, such as chlorhexidine, may also have a role in inhibiting dental caries . This clinical study was conducted to determine the effect of 2x-daily rinsing with an essential oil-containing antiseptic mouthrinse (Listerine Antiseptic) on levels of recoverable S . mutans and total streptococci in supragingival interproximal plaque and in saliva . Additionally, a follow-up in vitro study is reported which determined whether a differential susceptibility to the antiseptic mouthrinse exists among different strains of streptococci . METHOD: Following baseline saliva and plaque sampling for quantification of recoverable S . mutans and total streptococci, 29 qualifying subjects were randomly assigned either the essential oil mouthrinse or a sterile water control . They rinsed with 20 ml for 30s 2 x daily for 11 days and once on the 12th day, in addition to their usual oral hygiene procedures . On day 12, saliva and plaque samples were again collected and microbiological quantification performed . The procedures were repeated with the alternate rinse after a 1-week washout period . RESULTS: The essential oil mouthrinse produced respective reductions of 69.9% and 75.4% in total recoverable streptococci and in S . mutans in plaque, and corresponding reductions of 50.8% and 39.2% in saliva . The in vitro study revealed that streptococci from the mutans group were more susceptible to the bactericidal activity of the essential oil mouthrinse than streptococci from the mitis group . CONCLUSIONS: As antimicrobial mouthrinses are most frequently recommended to patients whose mechanical oral hygiene procedures are not adequate for the control of supragingival plaque and gingivitis, this study provides an additional rationale for the inclusion of the essential-oil mouthrinse as an adjunct to daily oral hygiene procedures.

Hautarzt, 2000 Feb, 51(2), 86 - 9
{Perianal streptococcal dermatitis}; Heidelberger A et al.; Two boys aged 6 and 9 years presented with persistent sharply circumscribed perianal erythema . One boy had no other skin findings; the other had additional lesions on the genitalia and extremities . The diagnosis of perianal streptococcal dermatitis was made after streptococci were cultured from skin swabs . This primarily childhood disease should be distinguished from candidiasis and perianal atopic dermatitis . As in our cases, topical therapy is usually ineffective and oral penicillin remains the treatment of choice.

Biochim Biophys Acta, 2000 Apr 6, 1474(2), 212 - 8
Glycine prevents the phenotypic expression of streptococcal glucan-binding lectin; Luengpailin J et al.; Glycine has been used extensively in bacterial cell surface research . Some researchers employ glycine in growth media so as to increase the transformability of streptococci during electroporation . Others have found that glycine, similar to wall antibiotics, 'weakens' peptidoglycan . It is now shown that when glycine is incorporated into the growth medium, Streptococcus sobrinus exhibits a diminished ability to aggregate with high molecular weight alpha-1,6-glucan . Growth of the bacteria in either a rich or a chemically defined medium results in a cell population with full lectin (glucan-binding) fidelity . Incorporation of glycine, but not serine or other amino acids, at concentrations of 100-200 mM gives rise to bacteria with lowered lectin activities . Bacteriolytic enzymes were able to lyse bacteria from glycine-grown cultures more readily than from cultures without the glycine supplement . The bacteria produce glucan-binding proteins, including glucosyltransferases, but they do not readily aggregate with added dextran . Furthermore, SDS-PAGE gels of supernatants of growth media (+/-glycine) are similar, suggesting the bacteria do not produce a unique set of proteins . Western blotting with a fluorescein isothiocyanate-labeled dextran probe reveals normal amounts of glucan-binding proteins in glycine-grown streptococci . Glycine may be acting as a type of antibiotic, reducing wall integrity upon which glucan promoted cellular aggregation depends.

Nat Med, 2000 Apr, 6(4), 455 - 9
New multi-determinant strategy for a group A streptococcal vaccine designed for the Australian Aboriginal population; Brandt ER et al.; Infection with group A streptococci can result in acute and post-infectious pathology, including rheumatic fever and rheumatic heart disease . These diseases are associated with poverty and are increasing in incidence, particularly in developing countries and amongst indigenous populations, such as Australia's Aboriginal population, who suffer the highest incidence worldwide . Immunity to group A streptococci is mediated by antibodies against the M protein, a coiled-coil alpha helical surface protein of the bacterium . Vaccine development faces two substantial obstacles . Although opsonic antibodies directed against the N terminus of the protein are mostly responsible for serotypic immunity, more than 100 serotypes exist . Furthermore, whereas the pathogenesis of rheumatic fever is not well understood, increasing evidence indicates an autoimmune process . To develop a suitable vaccine candidate, we first identified a minimum, helical, non-host-cross-reactive peptide from the conserved C-terminal half of the protein and displayed this within a non-M-protein peptide sequence designed to maintain helical folding and antigenicity, J14 (refs . 8,9) . As this region of the M protein is identical in only 70% of group A streptococci isolates, the optimal candidate might consist of the conserved determinant with common N-terminal sequences found in communities with endemic group A streptococci . We linked seven serotypic peptides with J14 using a new chemistry technique that enables the immunogen to display all the individual peptides pendant from an alkane backbone . This construct demonstrated excellent immunogenicity and protection in mice.

Yonsei Med J, 2000 Feb, 41(1), 56 - 60
Bacteriologic characteristics and serotypings of Streptococcus pyogenes isolated from throats of school children; Kim SJ; To determine the carrier rate of beta-hemolytic streptococci (BHS), throat cultures were taken from healthy elementary school children in four separate areas of Korea from 1992 to 1995, including Inje, Nonsan, Seoul and Chinju . The strains of Streptococcus pyogenes had been serotyped with anti-T, -OF and -M sera . The isolation rates of BHS and S . pyogenes ranged from 14.1-32.4% and 10.9-18.5% respectively . More than half of the carriers showed heavy growth of BHS . M78 (48.6%) and M28 (22.2%) were most common in Inje, M12 (23.6%) and M5 (20.3%) in Nonsan, M12 (48.8%) and M5 (14.6%) in Seoul, and M12 (26.3%) and M22 (14.5%) in Chinju, respectively . About 15% of school children were positive for S . pyogenes in throat cultures, and the distribution of serotypes varied according to geographical regions.

J R Soc Med, 1998 Dec, 91(12), 634 - 7
Management and morbidity of cellulitis of the leg; Cox NH et al.; Ascending cellulitis of the leg is a common emergency . An audit was conducted in two district general hospitals to determine how it is managed and the long-term morbidity, and to formulate a treatment strategy . Case notes were reviewed for 92 patients admitted to hospital under adult specialties . Mean duration of inpatient therapy was 10 days . A likely portal of entry was identified in 51/92 cases, of which the commonest were minor injuries and tinea pedis . Pathogens were rarely identified, group G streptococci being the single most frequent organism . Benzylpenicillin was administered in only 43 cases . Long-term morbidity, identified in 8 of 70 patients with over six months' follow-up, included persistent oedema (6) and leg ulceration (2); an additional 19 patients had either suffered previous episodes or experienced a further episode subsequently . Ascending cellulitis of the leg has substantial short-term and long-term morbidity . Important but often neglected therapeutic suggestions are the inclusion of benzylpenicillin in all cases without a contraindication, assessment and treatment of tinea pedis, use of support hosiery, and serological testing for streptococci to confirm the diagnosis in retrospect . The high frequency of recurrent episodes suggests that longer courses of penicillin, or penicillin prophylaxis, might be useful.

Pathol Res Pract, 2000, 196(3), 175 - 83
Histopathological study of experimental poststreptococcal pneumonia in mice . Group A, type 50, streptococcal infection of murine nares controls with Staphylococcus aureus and E . coli; Haferkamp O et al.; Microscopic methods (light and electron microscopy, histochemistry, immunohistochemistry) have been used to assess previously unknown pulmonary inflammatory responses of specific pathogen-free (SPF) mice secondary to infection via the nares by group A, type 50, streptococci suspended in saline ("strep group mice") . As controls for the strep group mice, the animals were either injected with saline alone via nares (no lesions were seen), or with Staphylococcus aureus in saline ("staph group mice") or with E . coli ("E . coli group mice") . The three different bacterial species caused clearly different histological changes in the lung . In the strep group mice, the microscopic findings were consistent with the diagnosis of lymphocytic interstitial pneumonia of bronchiolovascular bundles, secondary to exaggerated pulmonary recirculation of lymphocytes, concomitant with vasoconstrictive angiopathy of encased pulmonary artery branches and nodular inflammatory cell aggregates in lung parenchyma . These aggregates either consisted predominantly of lymphocytes, or of mixed cells (neutrophils, lymphocytes, macrophages) or of activated macrophages only . In 18 of 22 inflamed lungs of strep group mice, no bacteria could be cultured from lung tissue . In staph group mice the microscopic findings are consistent with the diagnosis of lymphocytic interstitial pneumonia of bronchiolovascular bundles, secondary to exaggerated pulmonary recirculation of lymphocytes only . In 12 of 17 inflamed lungs of staph group mice, no bacteria could be cultured from lung tissue . In E . coli group mice the microscopic findings were consistent with the diagnosis of distal terminal bronchiolitis and early pleural-based pneumonitis, in which lymphocytes and neutrophils mingled with macrophages . In 10 of 11 inflamed lungs of E . coli group mice, no bacteria could be cultured from lung tissue . The morphologic approaches described here may have potential for unravelling the complex inflammatory processes underlying different forms of interstitial and parenchymal pneumonia.

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