Diagn Microbiol Infect Dis, 2000 Mar, 36(3), 159 - 62 Comparison of gen-probe AccuProbe group B streptococcus culture identification test with conventional culture for the detection of group B streptococci in broth cultures of vaginal-anorectal specimens from pregnant women; Williams-Bouyer N et al.; The performance of the AccuProbe Group B Streptococcus Culture Identification Test (Gen-Probe Incorporated, San Diego, CA, USA) for the detection of group B streptococci (GBS) directly from LIM broth cultures of vaginal-anorectal swab specimens from pregnant women (two swabs per patient in most cases) was evaluated by comparing results to those of conventional GBS culture . Of 411 specimens analyzed, 82 were positive and 312 were negative for GBS by both methods . After initial testing, the percent agreement was 95.9% . The initial sensitivity, specificity, and positive and negative predictive values for the AccuProbe test were 90.1%, 97.5%, 91.1%, and 97.2%, respectively . Results were discrepant for 17 specimens: eight were GBS positive by probe and negative by culture; nine were negative by probe and positive by culture . To resolve discrepancies, culture plates were re-examined for GBS colonies, AccuProbe testing was repeated on the initial LIM broth cultures, and the second swab (if received) was inoculated to LIM broth for AccuProbe testing after overnight incubation . After discrepant resolution testing, the percent agreement between the two test methods was 97.8% . The final sensitivity, specificity, and positive and negative predictive values for the AccuProbe test were 95.6%, 98.4%, 94.6%, and 98.7%, respectively . These data suggest that the AccuProbe test is a reliable method for detecting GBS in vaginal-anorectal specimens, providing results more rapidly than conventional culture . However, strict adherence to the manufacturer's test protocol is necessary to limit technical errors. Acta Otolaryngol, 1999, 119(8), 944 - 8 Tolerance and efficacy of interfering alpha-streptococci in recurrence of streptococcal pharyngotonsillitis: a placebo-controlled study; Falck G et al.; A total of 342 patients with clinical signs of tonsillitis and suspected group A beta-haemolytic streptococci (GAS) aetiology, verified with rapid test and GAS culture, were enrolled in a randomized, placebo-controlled, double-blind, multicentre study . They received antibiotic treatment for 10 days, followed by 10 days of alpha-streptococcal or placebo spray treatment in the ratio of 2 : 1 . Pharyngeal status, throat culture and adverse events were investigated up to 75 days after treatment . The frequency of bacteriologically verified clinical recurrence was 13% in the alpha-streptococcal group and 15% in the placebo group at the follow-up on day 22 . The corresponding figures at the last valid visit after 45-75 days were 19% and 30%, respectively, a statistically significant difference (p = 0.037) . Furthermore, at the last valid visit 5% of subjects in the alpha-streptococcal and 12% in the placebo group were healthy carriers, bacteriological treatment failures, of GAS (p = 0.029) . Treatment with alpha-streptococci and placebo spray were equally well tolerated . Thus, re-colonization with alpha-streptococci seem to hinder late recurrences of GAS pharyngotonsillitis. J Dent Res, 2000 Feb, 79(2), 778 - 84 Relationship among mutans streptococci, "low-pH" bacteria, and lodophilic polysaccharide-producing bacteria in dental plaque and early enamel caries in humans; van Ruyven FO et al.; Multiple interactions occur among major determinants of dental caries . We have studied the bacterial flora and pH-lowering capacity of the same dental plaques in relation to caries . The findings on the plaque flora are reported here . The buccal surfaces of upper teeth in each subject were selected for study . A low-caries group had no "white spot" caries (ws) in the selected dentition area; a higher-caries group averaged 4.1 ws in this area . The latter group was divided into subjects with 2, 3, or 4 ws and subjects with 5, 6, or 7 ws . Enumerated organisms in plaque samples (sound and ws sites) from all subjects were: (1) mutans streptococci (MS) on mitis-salivarius-bacitracin and mitis-salivarius agar; (2) non-mutans streptococci (non-MS) on mitis-salivarius agar; (3) organisms that were categorized according to their minimum pH in sugar broth, i.e., the predominant undifferentiated total flora on blood agar or the predominant non-MS flora on mitis-salivarius agar; and (4) iodophilic polysaccharide-storing organisms on trypticase-yeast extract-salts agar . Plaques covering ws lesions contained generally only low proportions (< 0.1%) of MS . The plaque proportions of all the above 4 bacterial groups were increased in the higher-caries group but were similar for s and ws sites in this group . Over half of the total plaque flora in subjects with 5, 6, or 7 ws consisted of "low-pH"-type organisms (minimum pH < 4.4) . Many of these were neither MS nor "low-pH" non-MS . The numerical emergence of MS in plaque appeared to be preceded often by other types of "low-pH" bacteria, including the non-MS . Caries development in the absence or presence of MS as well as different bacterial successions in plaque can be explained readily by the dynamic and positive relationship among the factors carbohydrate consumption, plaque flora composition, plaque acidogenic potential, and caries activity. Biol Pharm Bull, 2000 Mar, 23(3), 339 - 43 Effects of caffeine and theophylline on the development of dental caries in rats; Ruenis AP et al.; The purpose of this study was to evaluate the influence of caffeine and theophylline on the development of dental caries in rats . Six Wistar dams (spf), mutans streptococci free, were obtained, each with six male pups . The dams were infected by Streptococcus sobrinus 6715 and divided into three groups which received during the lactating period: (1) diet 2000; (2) diet 2000 plus caffeine (2 mg/100 g) and (3) diet 2000 plus theophylline (0.57 mg/100 g) . After weaning, the pups were infected by S . sobrinus, placed in a Konig-Hofer programmed feeder machine, and received 17 meals daily at hourly intervals, for five weeks . During this time the pups were fed with the same diet that their dams were . The percentage of S . sobrinus relative to total flora was significantly higher in the theophylline group . The results for slight (Ds) and moderate (Dm) dentine lesions, for smooth-surface and sulcal scores were statistically higher for the theophylline group than the other groups . Salivary assays did not demonstrate significant inorganic alterations in salivary composition . Caffeine and theophylline groups showed the highest ulcer score . It is concluded that caffeine does not affect the cariogenic potential of the diet, however theophylline can increase the development of dental caries, and this effect may be related to organic alterations of salivary composition. J Calif Dent Assoc, 1999 Nov, 27(11), 843 - 51 Newer approaches to preventing dental caries in children; Udin RD; Although the incidence of dental caries has shown a general decline during the past few decades, it still remains a significant health problem in children . The role of mutans streptococci in the caries process is discussed, including its transmission from mother to child during a discrete "window of infectivity." Anticipatory guidance--an approach used to better intercept the caries process to prevent it from progressing--is discussed . This program is introduced during infancy and is adapted to the child's particular needs as he or she matures . Anticipatory guidance allows for the implementation of some newer preventive strategies . Following the determination of mutans streptococci levels in at-risk infants and their mothers, a prevention program can be provided to both . Through proper education, various forms of topical fluoride supplementation, and antimicrobial therapy, it is hoped that newer preventive strategies can more effectively reduce the threat of caries at a much younger age than previously possible. Obstet Gynecol, 2000 Apr, 95(4), 525 - 34 Influence of human immunodeficiency virus infection on pelvic inflammatory disease; Irwin KL et al.; OBJECTIVE: To examine the influence of human immunodeficiency virus (HIV) infection on clinical and microbiologic characteristics of pelvic inflammatory disease (PID) . METHODS: Forty-four HIV-infected women and 163 HIV noninfected women diagnosed with PID by standard case definition were evaluated by using clinical severity scores, transabdominal sonograms, and endometrial biopsies . After testing for bacterial infections, patients were prescribed antibiotics as recommended by the Centers for Disease Control and Prevention (CDC) . RESULTS: Symptoms of PID and analgesic use before enrollment did not differ by HIV serostatus . More HIV-infected women had received antibiotics before enrollment (40.9% versus 27.2%, P =.08), a factor associated with milder signs regardless of serostatus . More HIV-infected women had sonographically diagnosed adnexal masses at enrollment (45.8% versus 27.1%, P =.08), a difference that yielded higher median severity scores (17.5 of 42 points versus 15 of 42 points, P =.07) . However, those differences were not significant at the P <.05 level . Mycoplasma (50% versus 22%, P <.05) and streptococcus species (34% versus 17%, P <.05) were isolated more commonly from biopsies of HIV-infected women . Within 30 days after enrollment, HIV-infected women generally responded as well to therapy as HIV-noninfected women did, regardless of initial CD4 T-lymphocyte percentage . CONCLUSION: Among women with acute PID, HIV infection was associated with more sonographically diagnosed adnexal masses . Clinical response to CDC-recommended antibiotics did not differ appreciably by serostatus . Mycoplasmas and streptococci were isolated more commonly from HIV-infected women, but those organisms also might be associated with PID in immunocompetent women. Infect Immun, 2000 Apr, 68(4), 2053 - 60 Nonopsonic binding of type III Group B Streptococci to human neutrophils induces interleukin-8 release mediated by the p38 mitogen-activated protein kinase pathway; Albanyan EA et al.; Nonopsonic interaction of host immune cells with pathogens is an important first line of defense . We hypothesized that nonopsonic recognition between type III group B streptococcus and human neutrophils would occur and that the interaction would be sufficient to trigger neutrophil activation . By using a serum-free system, it was found that heat-killed type III group B streptococci bound to neutrophils in a rapid, stable, and inoculum-dependent manner that did not result in ingestion . Transposon-derived type III strain COH1-13, which lacks capsular polysaccharide, and strain COH1-11 with capsular polysaccharide lacking terminal sialic acid demonstrated increased neutrophil binding, suggesting that capsular polysaccharide masks an underlying binding site . Experiments using monoclonal antibodies to complement receptor 1 and to the I domain or lectin site of complement receptor 3 did not inhibit binding, indicating that the complement receptors used for ingestion of opsonized group B streptococci were not required for nonopsonic binding . Nonopsonic binding resulted in rapid activation of cellular p38 and p44/42 mitogen-activated protein kinases . This interaction was not an effective trigger for superoxide production but did promote release of the proinflammatory cytokine interleukin-8 . The release of interleukin-8 was markedly suppressed by the p38 mitogen-activated protein kinase inhibitor SB203580 but was only minimally suppressed by the mitogen-activated protein/extracellular signal-regulated kinase inhibitor PD98059 . Thus, nonopsonic binding of type III group B streptococci to neutrophils is sufficient to initiate intracellular signaling pathways and could serve as an arm of innate immunity of particular importance to the immature host. Infect Immun, 2000 Apr, 68(4), 1864 - 70 Identification of a fibronectin binding protein from Streptococcus mutans; Chia JS et al.; The interaction of viridans streptococci with components of the extracellular matrix (ECM) plays an important role in the pathogenesis of infective endocarditis . We have identified a surface protein of Streptococcus mutans which binds the ECM constituent fibronectin (Fn) . Initially, we found that S . mutans could adsorb soluble Fn in plasma, but with lower efficiency than Streptococcus pyogenes . In addition, S . mutans could bind immobilized Fn in a dose-dependent manner when tested using an enzyme-linked immunosorbent assay . Crude extracts of cell wall-associated proteins or extracellular proteins from S . mutans MT8148 specifically bound Fn through a protein with the molecular mass of ca . 130 kDa, as detected by far-Western immunoblotting . The candidate Fn binding protein (FBP-130) was purified to near homogeneity by using Fn coupled Sepharose 4B affinity column chromatography . A rabbit polyclonal antibody against FBP-130 reacted specifically with a protein of molecular mass of ca . 130 kDa in both cell wall and extracellular fractions, and the abundance of FBP was higher in the former than in the latter fractions . The purified FBP bound specifically to immobilized Fn, whereas the binding of soluble Fn to coated FBP could only be detected in the presence of high concentrations of Fn . The purified FBP, as well as anti-FBP immunoglobulin G, inhibited the adherence of S . mutans to immobilized Fn and endothelial cells (ECV304) in a dose-dependent manner . These results demonstrated that FBP-130 mediated the adherence of S . mutans specifically to Fn and endothelial cells in vitro . The characteristics of S . mutans and FBP-130 in binding Fn confirmed that viridans streptococci adopt different strategies in their interaction with ECM. Antimicrob Agents Chemother, 2000 Apr, 44(4), 1078 - 80 Susceptibilities of oral and nasal isolates of Streptococcus mitis and Streptococcus oralis to macrolides and PCR detection of resistance genes; Ono T et al.; The susceptibility of viridans group streptococci to macrolides was determined . Thirteen isolates (17%) were resistant to erythromycin . Five strains carried an erm gene that was highly homologous to that in Tn917 . Four strains had mefE genes that coded erythromycin efflux ability. Antimicrob Agents Chemother, 2000 Apr, 44(4), 840 - 7 Horizontal transfer of parC and gyrA in fluoroquinolone-resistant clinical isolates of Streptococcus pneumoniae; Ferrandiz MJ et al.; We have analyzed genetically three clinical isolates (3180, 3870, and 1244) of Streptococcus pneumoniae with high-level ciprofloxacin resistance . Isolates 3180 and 3870 were atypical because of their insolubility in deoxycholate . However, they hybridized specifically with pneumococcal autolysin and pneumolysin gene probes and have typical pneumococcal atpC and atpA gene sequences . Analysis of the complete sequences of the parC and gyrA genes revealed total variations of 8 and 8.7% (isolate 3180) and 7.4 and 3.6% (isolate 3870), respectively, compared to the wild-type strain R6 sequence . The variations observed between the sequences of R6 and isolate 1244 were less than 0.9% . The structure of the gyrA and parC genes from isolates 3180 and 3870 was organized in sequence blocks that show different levels of divergence, suggesting a pattern of recombination . These results are evidence for recombination at the fluoroquinolone target genes in clinical isolates of S . pneumoniae . The genetically related viridans group streptococci could act as a reservoir for fluoroquinolone resistance genes. Epidemiol Infect, 2000 Feb, 124(1), 47 - 51 Isolation rates of Streptococcus pyogenes in patients with acute pharyngotonsillitis and among healthy school children in Iran; Jasir A et al.; We examined three populations from the Tehran region and the North part of Iran (Gilan), in all more than 5000 individuals, for carriage of Streptococcus pyogenes (group A streptococci; GAS) . Children or adults with acute pharyngotonsillitis and healthy school children harboured GAS in 34-1, 20.0 and 21.0%, respectively . Typing of 421 randomly selected isolates showed a predominance of M-types M4, M5, M11, M12, as well as the provisional type 4245; however, many of the isolates were T and M non-typable . Forty-three percent of all strains were opacity factor (OF) negative . The type distribution differed markedly from that reported in 1973-4, when M types 1 and 12 were predominant. Enferm Infecc Microbiol Clin, 2000 Jan, 18(1), 16 - 8 {Fulminant streptococcus infection of soft tissue}; Corredoira JC et al.; BACKGROUND: In recent years there has been an apparent increase in severe infections produced by group A beta-hemolytic Streptococci in developed countries . Necrotizing fascitis and myositis are two rare but fearsome complications caused by this microorganism . METHODS: Two cases of fulminant soft tissue infection recently observed in the authors' center are presented and the clinical presentation and differential diagnosis commented upon . RESULTS: The first case was a necrotizing fascitis at a surgical wound which appeared following a gynecological surgery . The second case reports gluteal myositis following intramuscular injection . In both cases the evolution was disastrous . CONCLUSIONS: Streptococcus pyogenes may produce fulminant infections in patients without underlying disease either spontaneously or following minimum traumas . The most frequent involvement is of the soft tissues . This virulence at a local tissue and systemic level has been associated with the production of exotoxin. Adv Exp Med Biol, 1999, 467, 533 - 9 Cytokine mediated regulation of interferon-gamma-induced IDO activation; MacKenzie CR et al.; Stimulation of human monocyte-derived-macrophages (MDM) with interferon gamma induces the L-tryptophan degrading enzyme indoleamine 2,3-dioxygenase (IDO) . It has been well documented that the growth of some intra-cellular parasites such as Chlamydia and Toxoplasma in human fibroblasts and glioblastoma cells is inhibited by IDO mediated L-tryptophan depletion . We have recently shown that IDO induction in cord blood MDM is also responsible for the growth inhibition of extra-cellular group B streptococci and thus for the first time shown an anti-bacterial effect of IDO activation . In view of this immunological function we sought to investigate the regulation, and in particular the downregulation of IDO by the immune system . We describe here the effect of cytokines on IDO activation and in particular the inhibitory function of IL-10, TGF beta and IL-4. Adv Exp Med Biol, 1999, 467, 517 - 24 IFN-gamma activated indoleamine 2,3-dioxygenase activity in human cells is an antiparasitic and an antibacterial effector mechanism; Daubener W et al.; In nearly all human cells IFN-gamma stimulation leads to an activation of indoleamine 2,3-dioxygenase (IDO) activity, which is responsible for anti-toxoplasma and anti-chlamydia effects . We have recently shown that IDO activation is also a defense mechanism against extracellular beta-hemolytic streptococci groups A, B, C and G in human glioblastoma cells, fibroblasts and macrophages . Similar effects were also seen with enterococci and in approximately 65% of staphylococci tested, including multiresistant strains of both species . In addition, we have found that IDO activity is differentially regulated in different cells . For example we have found that TNF-alpha enhances IFN-gamma induced IDO activity and antimicrobial effect in human glioblastoma cells whereas both IFN-gamma mediated effects were blocked by TNF-alpha as well as by IL-1 in a human uroepithelial cell line . We were able to show that the IL-1 and TNF-alpha mediated inhibition of IFN-gamma-induced IDO activity in uroepithelial cells is due to stimulation of inducible nitric oxide synthase . In human astrocytoma cells, IL-1 and TNF-alpha did not inhibit IDO activity and in concordance with this finding these cells did not show a detectable nitric oxide production. Int J Antimicrob Agents, 2000 Mar, 14(2), 129 - 35 Viridans-group streptococcal infections in immunocompromised hosts; Shenep JL; Viridans streptococci, a diverse group of streptococcal species, are important causes of sepsis and pneumonia in the neutropenic host and sepsis and meningitis in the neonate . The oral mucosa is the most common portal of entry . Among the factors that predispose to development of viridans streptococcal sepsis are: profound neutropenia; mucositis, especially oral mucositis; cytarabine (Ara-C) therapy, which seems to have an effect beyond its association with mucositis; young age; and trimethoprim-sulphamethoxazole or quinolone administration . Fever is usually more than 39 degrees C and prolonged for several days even though blood cultures are typically negative after 24 h of therapy . The majority of patients recover uneventfully if appropriate therapy is initiated early . However, fulminant septic shock may occasional occur at onset . Delayed shock 2 or 3 days after presentation may also occur despite administration of microbiologically effective antibiotics . In severe cases, adult respiratory distress syndrome may be manifested two or three days after the initial bacteremia . There is considerable variability among institutions, but the median death rate associated with viridans streptococcal sepsis is about 10% . Local susceptibility patterns should be used to guide initial therapy for suspected viridans streptococcal infections . Some isolates of viridans streptococci are resistant to penicillins and cephalosporins, in which case vancomycin is preferred . Recurrence during subsequent neutropenic episodes is not unusual. Int J Antimicrob Agents, 2000 Mar, 14(2), 113 - 6 Cellulitis syndromes: an update; Baddour LM; Cellulitis is a commonly seen clinical syndrome that is most often associated with beta-haemolytic streptococci and Staphylococcus aureus . Several medical conditions and a variety of procedures can predispose to the development of cellulitis by a common mechanism: venous and lymphatic compromise . The precise pathophysiologic and immunologic details involved in the predisposition to cellulitis remain poorly understood . Therapy is directed at resolution of acute infection and prevention of recurrent episodes of cellulitis. J Ethnopharmacol, 2000 Apr, 70(1), 73 - 9 Selective activity of Streblus asper on Mutans streptococci; Taweechaisupapong S et al.; The purpose of this in vivo one group time series design and single blind study was to determine the antimicrobial effectiveness of a mouthrinse containing Streblus asper leaf extract on Streptococcus mutans and total salivary bacteria following single 60 s rinse . Changing in salivary pH and buffer capacity during the experimental period were also measured . Thirty human subjects participated in this study . At each experimental session, a pretest saliva sample was taken . After giving the pretest samples, the subjects rinsed with S . asper leaf extract or distilled water control for 60 s, then the post-test saliva samples were collected at 0, 0.5, 1, 3, 5 and 6 h . The samples were used to determine the numbers of S . mutans and total salivary bacteria . The results indicated that S . asper leaf extract significantly reduced S . mutans counts compared with distilled water . However, the mean difference from baseline of total salivary bacterial counts was not significantly different between rinsing with S . asper leaf extract and distilled water . Moreover, S . asper leaf extract showed no effects in modifying the salivary pH and buffer capacity . It is concluded that of mouthrinse containing S . asper leaf extract can reduce S . mutans without changing an oral ecology. J Chemother, 1999 Dec, 11(6), 478 - 85 High-dose intravenous fluoroquinolones in the treatment of severe infections; Modai J; A bacterial infection should be considered "serious" in case of underlying disease, nosocomial origin, antibiotic resistant pathogen, and/or poor delivery of antibiotics at the site of infection . Treatment of most serious infections requires parenteral administration of antimicrobial agents . Intravenous fluoroquinolones are a class of antimicrobial agents from which physicians must choose when treating nosocomial infections . Fluoroquinolones are bactericidal antimicrobial agents that act by inhibiting DNA gyrase . They are active in vitro against most gram-negative bacteria and methicillin-susceptible staphylococci . Activity against anaerobic bacteria and streptococci is poor . The rapid development of bacterial resistance in centers with high quinolone usage is of great concern . Resistance develops most commonly in Pseudomonas aeruginosa and staphylococci . Most clinical trials with ciprofloxacin, ofloxacin, pefloxacin, the fluroquinolones currently available in France for parenteral use, are almost 10 years old . There are few studies with higher dosage and most of them have been carried out with ciprofloxacin . The findings of these studies indicate that higher dosage regimens of i.v . ciprofloxacin are much more effective against severe nososcomial infections than is the dosage of 200 mg twice daily . The higher dosage regimens resulted in greater rates of clinical cure and improvement in both monomicrobial and polymicrobial infections . Although the overall frequency of side effects to fluoroquinolones is low, seizures and allergic reactions have been attributed to their use. Ann Dermatol Venereol, 2000 Jan, 127(1), 33 - 9 {Comparative diffusion of fusidic acid, oxacillin, and pristinamycin in dermal interstitial fluid after repeated oral administration}; Vaillant L et al.; OBJECTIVE: The aim of this study was to use the suction bullae technique to compare skin diffusion of 3 antibiotics commonly used for skin infections (fusidic acid, oxacillin, pristinamycin) and to estimate their potential activity at the site of skin infections . SUBJECTS AND METHODS: This comparative open study was conducted in 12 healthy volunteers using a repeated latin square experimental scheme . Antibiotic concentrations in serum and suction bullae fluid were measured by high performance liquid chromatography after 5.5 days of repeated oral administration of fusidic acid (1 g/d), oxacillin (2 g/d), and pristinamycin (2 g/d) . RESULTS: Mean antibiotic concentrations in serum and interstitial fluid (suction bullae fluid) were highest for fusidic acid with a Cmax at 91.3 +/- 23.0 mg/l and 45.5 +/- 18.0 mg/l respectively (interstitial fluid/serum ratio=49 +/- 10 p . 100) . For oxacillin, Cmax was 8.3 +/- 3.6 mg/l and 0.98 +/- 0.49 mg/l (ratio 13 +/- 5 p . 100) . Pristinamycin concentrations were low with a Cmax at 0.51 +/- 0.40 and 0.26 +/- 0.15 mg/l (ratio 73 +/- 57 p . 100) . Comparing the area under the interstitial fluid and the serum concentration-time curves showed that the best diffusion was obtained with pristinamycin (114 +/- 61 p . 100), followed by fusidic acid (57 +/- 13 p . 100) and oxacillin (48 +/- 25 p . 100) . DISCUSSION: These data were used to calculate indicators of potential efficacy in the interstitial dermal fluid: inhibitor quotient (Cmax/MIC) and AUIC (ASC/MIC), indicator of the time antibiotic concentrations are maintained above the minimal inhibitor concentration (MIC) . This showed that fusidic acid was potentially more active against all staphylococci . For streptococci, the observed interstitial concentrations of pristinamycin and of fusidic acid should theoretically inhibit streptococci A growth, but oxacillin was the most adapted antibiotic. Burns, 2000 Mar, 26(2), 131 - 8 A historical review of the use of silver in the treatment of burns . II . Renewed interest for silver; Klasen HJ; In 1965, Moyer revived interest in silver nitrate solution . He concluded on the basis on in vitro and in vivo studies that a 0.5% solution represented the lowest concentration at which antibacterial action (against Staphylococcus aureus, haemolytic streptococci and generally against Pseudomonas aeruginosa and E . coli) was obtained . Mafenide acetate was introduced a short time after the reintroduction of silver nitrate, followed a few years later by silver sulphadiazine . Thus, in a short period of time three medicaments appeared on the market which represented a radical change in the topical treatment of burns . The action of silver sulphadiazine has been intensively studied . Since silver sulphadiazine does not offer sufficient protection to prevent or retard the growth of gram-negative bacteria in patients with burns covering more than 50% of body surface, Monafo introduced the combined preparation silver sulphadiazine and cerium nitrate . Although various attempts have been made to develop more effective silver compounds, so far silver sulphadiazine still remains the most widely used substance of this type. Rev Esp Cardiol, 2000 Mar, 53(3), 344 - 52 {The general characteristics and short- and long-term results of infective endocarditis in non-drug addicts}; Castillo Dominguez JC et al.; INTRODUCTION AND OBJECTIVES: Infective endocarditis is a disease with a high morbimortality during the active phase and a considerable risk of complications during follow-up . The aim of our study is to describe the clinical and prognostic features of infective endocarditis in non-drug addict patients in short and long terms . PATIENTS AND METHODS: A prospective study of 138 cases of infective endocarditis in non-drug addict patients through the parenteral pathway treated in our institution from 1987 to 1997 . RESULTS: The mean age was 44 +/- 20 years . Ninety-five patients (69%) had native valve infective endocarditis and forty-three (31%) had prosthetic valve endocarditis . Streptococci were the causal microorganism in 34% and staphylococci in 33% . 83% of patients developed some type of complications during hospital stay . 51% of patients were operated on during the active phase (22% were urgent) . The in-hospital mortality rate was 21% . 10 patients (9%) needed late cardiac surgery and seven patients (5%) died during follow-up . Global survival at 10 years was 71% . There were no statistical differences in survival in as much as the type of treatment received during the hospital stay in the active phase (medical alone or combined medical-surgical) . CONCLUSIONS: A high early surgery rate in the active phase related to good long-term results and does not increase early in-hospital mortality . Medical treatment also offers good long-term results in cases of infectious endocarditis with absence of bad prognostic factors and good clinical outcome. Obstet Gynecol, 2000 Mar, 95(3), 377 - 82 Effects of hospital policies based on 1996 group B streptococcal disease consensus guidelines . The Active Bacterial Core Surveillance Team; Factor SH et al.; OBJECTIVE: To determine whether the 1996 consensus guidelines for prevention of early-onset group B streptococcal disease developed by the Centers for Disease Control and Prevention, ACOG, and the American Academy of Pediatrics are affecting obstetric practice and disease occurrence . METHODS: Personnel in hospitals with obstetric services in seven surveillance areas completed surveys about their programs, patient populations, and group B streptococcal disease prevention policies . Survey results were linked to group B streptococcal disease cases identified by active surveillance in 1996 and 1997 . An early onset case was defined as a case in which group B streptococci were isolated from a sterile site in the 1st 6 days of life . The number of cases in 1996 and 1997 were compared using a paired t test . Linear regression was used to assess hospital characteristics associated with group B streptococcal disease cases . RESULTS: Of 177 hospitals, 165 (93%) responded, and 96 (58%) of those had group B streptococcal disease prevention policies . Hospitals that established or revised their policies in 1996 had a lower mean number of cases in 1997 than in 1996 (0.58 versus 1.29, P = .006) . Linear regression analysis, controlling for number of births, indicated that a hospital's having more black mothers and location in particular states were associated with more cases of disease . Citing the 1996 ACOG reference as the source for hospital group B streptococcal disease prevention policy was associated with fewer cases of group B streptococcal disease (P = .038) . CONCLUSION: The publication and adoption of the guidelines were associated with decreasing occurrence of group B streptococcal disease. J Med Microbiol, 2000 Mar, 49(3), 235 - 44 Isolation and characterisation of sialidase from a strain of Streptococcus oralis; Byers HL et al.; Streptococcus oralis, the most virulent of the viridans streptococci, produces a sialidase and this exo-glycosidase has been implicated in the disease process of a number of pathogens . The sialidase of S . oralis strain AR3 was purified in order to understand the characteristics of this putative virulence determinant . The enzyme isolated as a high mol . wt aggregate (c . 325 kDa) was purified 4520-fold from late exponential phase cultures by a combination of ultrafiltration, ammonium sulphate precipitation, ion-exchange and gel filtration chromatography . The sialidase component had a mol.wt of 144 kDa as determined by SDS-PAGE analysis . The purified sialidase released N-acetylneuraminic acid from a range of sialoglycoconjugates including human alpha1-acid glycoprotein, bovine submaxillary mucin, colominic acid and sialyl-alpha2,3- and sialyl-alpha2,6-lactose . Also, N-glycolylneuraminic acid was cleaved from bovine submaxillary mucin . The sialidase had a Km of 11.8 microM for alpha1-acid glycoprotein, was active over a broad pH range with a pH optimum of 6.0 and cleaved alpha2,3-, alpha2,6- and alpha2-8-sialyl glycosidic linkages with a marked preference for alpha2,3-linkages . The enzyme was competitively inhibited by the sialic acid derivative, 2,3-dehydro-N-acetylneuraminic acid, with a K(IC) of 1.2 microM . The characteristics of the purified sialidase would support a nutritional role for this enzyme that may be significant in the proliferation of this organism in the oral cavity and at extra-oral sites in association with life-threatening infections. Proc Natl Acad Sci U S A, 2000 Mar 14, 97(6), 2858 - 63 A nonpeptide integrin antagonist can inhibit epithelial cell ingestion of Streptococcus pyogenes by blocking formation of integrin alpha 5beta 1-fibronectin-M1 protein complexes; Cue D et al.; Streptococcus pyogenes can be efficiently internalized by a variety of human epithelial cells . beta-lactam antibiotics, commonly used to treat S . pyogenes infections, do not readily permeate mammalian cells . There is growing evidence that the ability of streptococci to enter host cells contributes to the frequent failure of antibiotics to eradicate the organism from infected individuals . Recent studies have suggested that host cell entry requires the formation of a complex of a bacterial fibronectin (Fn) binding protein (e.g., M1 protein or protein F1/SfbI), human Fn, and the epithelial cell Fn receptor, integrin alpha5beta1 . We report here that a low molecular weight, nonpeptide antagonist of integrin alpha5beta1, SJ755, can inhibit internalization of streptococci by primary human tonsillar epithelial cells and immortalized human epithelial (A549) cells, thus increasing the extent of bacterial killing by antibiotics . SJ755 blocked Fn binding by human tonsillar epithelial and A549 cells, suggesting that integrin alpha5beta1 is the major Fn receptor expressed by both cell types . SJ755 did not affect Fn binding by purified M1 protein or M1(+) bacteria . Purified M1 protein failed to associate with integrin alpha5beta1 unless the integrin had been prebound by Fn . Also, SJ755 blocked formation of alpha5beta1-Fn-M1 complexes in vitro . These results support the previous proposal that Fn functions as a molecular bridge between M1 protein and integrin alpha5beta1 . Furthermore, these results suggest that integrin antagonists may enhance the efficacy of antibiotics in treatment of S . pyogenes infections. Clin Chem, 2000 Mar, 46(3), 324 - 31 Development of conventional and real-time PCR assays for the rapid detection of group B streptococci; Ke D et al.; BACKGROUND: Group B streptococci (GBS), or Streptococcus agalactiae, are the leading bacterial cause of meningitis and bacterial sepsis in newborns . Currently available rapid methods to detect GBS from clinical specimens are unsuitable for replacement of culture methods, mainly because of their lack of sensitivity . METHODS: We have developed a PCR-based assay for the rapid detection of GBS . The cfb gene encoding the Christie-Atkins-Munch-Petersen (CAMP) factor was selected as the genetic target for the assay . The PCR primers were initially tested by a conventional PCR method followed by gel electrophoresis . The assay was then adapted for use with the LightCycler(TM) . For this purpose, two fluorogenic adjacent hybridization probes complementary to the GBS-specific amplicon were designed and tested . In addition, a rapid sample-processing protocol was evaluated by colony-forming unit counting and PCR . A total of 15 vaginal samples were tested by both standard culture method and the two PCR assays . RESULTS: The conventional PCR assay was specific because it amplified only GBS DNA among 125 bacterial and fungal species tested, and was able to detect all 162 GBS isolates from various geographical areas . This PCR assay allowed detection of as few as one genome copy of GBS . The real-time PCR assay was comparable to conventional PCR assay in terms of sensitivity and specificity, but it was more rapid, requiring only approximately 30 min for amplification and computer-based data analysis . The presence of vaginal specimens had no detrimental effect on the sensitivity of the PCR with the sample preparation protocol used . All four GBS-positive samples identified by the standard culture method were detected by the two PCR assays . CONCLUSION: These assays provide promising tools for the rapid detection and identification of GBS. J Clin Microbiol, 2000 Mar, 38(3), 1250 - 4 Epidemiological analysis of non-M-typeable group A Streptococcus isolates from a Thai population in northern Thailand; Pruksakorn S et al.; Infection with group A streptococci (GAS) can lead to the development of severe postinfectious sequelae such as rheumatic fever (RF) . In Thailand, RF and rheumatic heart disease (RHD) remain important health problems . More than 80% of GAS circulating in this population are non-M antigen typeable by conventional M serotyping methods . In this study, we determine the M protein sequence types of GAS isolates found in northern Thailand . The emm genes from 53 GAS isolates, collected between 1985 and 1995 from individuals with pharyngitis, impetigo, acute RF (ARF), RHD, or meningitis as well as from individuals without infections, were amplified by PCR and sequenced . Thirteen new sequence types that did not show homology to previously published sequences were characterized . Six of these sequence types could be isolated from both skin and throat sites of impetigo and pharyngitis/ARF patients, respectively . In many cases we could not specifically differentiate skin strains or throat strains that could be associated with ARF or acute glomerulonephritis . Antigenic variations in the emm gene of the isolates investigated, compared to published M protein sequences, were predominantly due to point mutations, small deletions, and insertions in the hypervariable region . One group of isolates with homology to M44 exhibited corrected frameshift mutations . A new M type isolated from an RHD patient exhibited nucleotide sequence corresponding to the N terminus of M58 and the C terminus of M25, suggesting that recombination between the two types may have occurred . This study provided epidemiological data relating to GAS endemic to northern Thailand which could be useful for identification of vaccine candidates in a specific region of endemicity. Kansenshogaku Zasshi, 2000 Jan, 74(1), 51 - 6 {A clinical investigation of infective endocarditis at a community hospital in Japan}; Hisamatsu Y et al.; There have been few reports on the clinical features of infective endocarditis (IE) in Japan . We clinically investigates 45 episodes (36 cases) of definite IE that were experienced from January 1985 to March 1997 at a community hospital, Okinawa Chubu Hospital, Okinawa, Japan . Regarding age, prior dental procedure, causative organisms and sites of infection, analyses and comparison were performed on a total of 94 episodes, by adding another 49 episodes of IE that were experienced between 1977 and 1984 at our hospital . The mean age was 47 years and majority of patients in the recent 12 years were older than 50 years of age . Mortality of all 94 episodes was 20%, while that of recent 45 cases was 13% . Eight % of all episodes had history of recent dental treatment but significance of the finding remains unclear . Alpha streptococci were most common (33%) and Staphylococcus aureus was the second most common organism (17%) . Eleven % of all episodes were culture-negative and there was a statistically significant difference in the histories of prior antibiotic therapy between culture-negative and culture-positive episodes . Regarding sites of infection, 27% of all episodes involved mitral valves, while 24% involved aortic valves . Prosthetic valves were involved in 12% . Ninety-eight % of the recent episodes had fever, 98% had cardiac murmurs and 27% had characteristic mucocutaneous lesions . Heart failure was the most common complication (27%) and half of the cases with prosthetic valve infection had heart failure . Cerebral embolism was most frequently seen among the major arterial embolic complications . Our results were similar to those which were previously reported from other countries . We should have a high index of suspicion for endocarditis whenever we see patients who present various clinical manifestations and fever of which origin remains unclear . Willingness to obtain blood culture before starting antibiotics is most important. J Oral Sci, 1999 Sep, 41(3), 117 - 22 Co-aggregation as a virulent factor of Streptococcus sanguis isolated from infective endocarditis; Ochiai K et al.; The pathogenicity of strains of the Streptococcus sanguis group, isolated from infective endcarditis, was studied by measuring the development of subcutaneous abscesses in mice after infection with S . sanguis and Actinomyces viscosus either singly or as co-aggregated pairs . The pathogenicity of the co-aggregates was also examined in various viable combinations of the two bacterial species . More abscesses were formed by A . viscosus than the S . sanguis group including clinical isolates . Abscess formation by co-aggregates of combinations of each isolate and A . viscosus produced a higher percentage of abscess formation than those caused by infection with a pure suspension of A . viscosus or tested streptococci . Co-aggregated cells were more resistant to phagocytosis and killing by neutrophils in vivo . These results indicated that S . sanguis group streptococci isolated from infective endocarditis are able to co-aggregate and resist phagocytosis . The ability of co-aggregation of S . sanguis may serve as a survival mechanism in a host defense system and may be linked with virulence of this bacteria. Int J Dermatol, 2000 Feb, 39(2), 126 - 33 Lichenoid and granulomatous dermatitis; Magro CM et al.; BACKGROUND: The prototypic lichenoid eruptions, lichen planus (LP), lichenoid drug eruptions, secondary syphilis, and collagen vascular disease, are defined histologically by a band-like lymphocytic infiltrate in close apposition to the epidermis . We describe a novel form of lichenoid dermatitis with a granulomatous component . DESIGN: Skin biopsies from 40 patients demonstrating a band-like lymphocytic infiltrate with concomitant granulomatous inflammation were encountered over 4 years . Clinicians were contacted to elucidate underlying triggers and medical illnesses . RESULTS: A lichenoid dermatitis, a linear eruption, vasculitis, annular erythema, and erythroderma were among the clinical presentations . A drug-based etiology was implicated in 14 cases: the drugs included antibiotics, lipid-lowering agents, anti-inflammatory drugs, antihistamines, hydroxychloroquine sulfate, and angiotensin-converting enzyme inhibitors . Over one-third of patients with drug-related eruptions had other medical illnesses associated with cutaneous granulomatous inflammation, namely rheumatoid arthritis (RA), Crohn's disease, hepatitis C, diabetes mellitus, and thyroiditis . A microbial trigger was implicated in 12 patients in the context of infective id reactions to herpes zoster, Epstein-Barr virus (EBV), or streptococci, or active infections by Mycobacterium tuberculosis, M . leprae, fungi, and spirochetes . The remainder had hepatobiliary disease and RA without obvious exogenous triggers, cutaneous T-cell lymphoma (CTCL), and idiopathic lichenoid eruptions (i.e . LP, lichen nitidus, and lichen striatus) . One patient with LP had underlying multicentric reticulohistiocytosis . The histiocytic infiltrate assumed one or more of five light microscopic patterns: (i) superficially disposed loose histiocytic aggregates; (ii) cohesive granulomata within zones of band-like lymphocytic infiltration with or without deeper dermal extension; (iii) a diffuse interstitial pattern; (iv) scattered singly disposed giant cells; and (v) granulomatous vasculitis . Additional features included lymphocytic eccrine hidradenitis in those patients with drug reactions, hepatobiliary disease, and antecedent viral illnesses, tissue eosinophilia and erythrocyte extravasation in drug hypersensitivity, granulomatous vasculitis in patients with microbial triggers, drug hypersensitivity or RA, and lymphoid atypia in lesions of CTCL or drug hypersensitivity . CONCLUSIONS: The cutaneous lichenoid and granulomatous reaction may reflect hepatobiliary disease, endocrinopathy, RA, Crohn's disease, infection, or a drug reaction . One-fifth of cases represent idiopathic lichenoid disorders . Lymphoproliferative disease or pseudolymphomatous drug reactions must be considered in those cases showing lymphoid atypia. J Dent Res, 2000 Jan, 79(1), 90 - 6 Effects of organic acid anions on growth, glycolysis, and intracellular pH of oral streptococci; Dashper SG et al.; Oral streptococci produce large quantities of organic acids as the end-products of carbohydrate fermentation . In an approach to determine if oral streptococci exhibit differential sensitivities to organic acid anions, we determined the effects of formate, lactate, and acetate on intracellular pH maintenance, glycolysis, and growth of Streptococcus mutans and Streptococcus sanguis . Growth was determined as maximum culture optical density in the presence of the organic acid anions at pH 7.1, 6.7, 6.3, and 6.1, and the effects of the anions on glycolytic activity and intracellular pH were determined at pH 7.0 and 5.0 . At pH 7.1, the organic acid anions had little effect on growth of either species . At the lower pH values, all of the anions reduced the maximum culture optical density of both species in a pH- and concentration-dependent manner, with S . sanguis being more sensitive to growth inhibition than S . mutans . The organic acid anions had little or no effect on glycolytic activity of either species at pH 7.0 . However, all of the organic acid anions tested reduced glycolytic activity at pH 5.0 in a concentration-dependent manner, with S . sanguis being more sensitive than S . mutans . The inhibition of glycolysis could be related to the pKa of the organic acid, with formate and lactate being more inhibitory than acetate . The organic acid anions decreased the intracellular pH of S . mutans and S . sanguis, glycolyzing at an extracellular pH of 5.0, such that the reduction in glycolytic activity caused by the organic acid anions could be directly attributed to the fall in intracellular pH . In conclusion, the production of lactic acid in plaque would not only lower pH, thereby having a disadvantageous effect on less aciduric oral streptococci, such as S . sanguis, but would also increase their sensitivity to the effects of low pH, helping S . mutans to become more dominant. FEMS Microbiol Lett, 2000 Mar 1, 184(1), 109 - 12 The extracellular hyaluronidase gene (hylA) of Streptococcus pyogenes; Hynes WL et al.; Group A streptococci produce an extracellular hyaluronidase (hyaluronate lyase) which may be associated with the spread of the organism during infection . The gene for this hyaluronidase (hylA) encodes an 868 amino acid protein with a molecular size of 99636 Da . Cleavage of the proposed signal peptide results in an extracellular protein of 95941 Da . Comparison with other bacterial hyaluronidases indicates strong similarities to the genes from Streptococcus pneumoniae, Streptococcus agalactiae and Staphylococcus aureus . A region internal to the hylA gene was amplified from all 175 strains of Streptococcus pyogenes tested suggesting a widespread distribution of the gene. Infect Immun, 2000 Mar, 68(3), 1061 - 8 A shift from oral to blood pH is a stimulus for adaptive gene expression of Streptococcus gordonii CH1 and induces protection against oxidative stress and enhanced bacterial growth by expression of msrA; Vriesema AJ et al.; Viridans group streptococci (VS) from the oral cavity entering the bloodstream may initiate infective endocarditis (IE) . We aimed to identify genes expressed in response to a pH increase from slightly acidic (pH 6.2) to neutral (pH 7.3) as encountered by VS entering the bloodstream from the oral cavity . Using a recently developed promoter-screening vector, we isolated five promoter fragments from the genomic DNA of Streptococcus gordonii CH1 responding to this stimulus . No common regulatory sequences were identified in these promoter fragments that could account for the coordinate expression of the corresponding genes . One of the isolated fragments contained the promoter region and 5' end of a gene highly homologous to the methionine sulfoxide reductase gene (msrA) of various bacterial and eukaryotic species . This gene has been found to be activated in S . gordonii strain V288 in a rabbit model of IE (A . O . Kilic, M . C . Herzberg, M . W . Meyer, X . Zhao, and L . Tao, Plasmid 42:67-72, 1999) . We isolated and characterized the msrA gene of S . gordonii CH1 and constructed a chromosomal insertion mutant . This mutant was more sensitive to hydrogen peroxide, suggesting a role for the streptococcal MsrA in protecting against oxidative stress . Moreover, MsrA appeared to be important for the growth of S . gordonii CH1 under aerobic and anaerobic conditions . Both these properties of MsrA may contribute to the ability of S . gordonii to cause IE. J Fam Pract, 2000 Jan, 49(1), 34 - 8 Use of a high-sensitivity rapid strep test without culture confirmation of negative results: 2 years' experience; Webb KH et al.; BACKGROUND: Optimal diagnostic management of patients with pharyngitis is controversial . In our study, we compared streptococcal complication rates at a large suburban medical center during 2 time periods: when pharyngitis patients were managed almost exclusively with throat culture and when they were managed primarily with a high-sensitivity antigen test without culture confirmation of negative results . METHODS: Using a combination of Current Procedural Terminology and International Classification of Diseases, Ninth Revision codes, we studied all patients seen for either pharyngitis or known streptococcal complications during a 4-year period . We then reviewed all available charts of patients with known streptococcal complications for coding accuracy . We compared streptococcal complication rates during each -time period . RESULTS: A total of 30,036 patients were seen for pharyngitis during the 4 years . A streptococcal diagnostic test was used in 66% of patient encounters . During the first 2 years (period 1), 99.9% of the tests ordered were blood agar plate throat cultures . During the second 2 years (period 2), 76.6% of tests ordered were high-sensitivity antigen tests without culture confirmation of negative results . Suppurative complications occurred in 37 patients in period 1 and 36 patients in period 2 . There were no cases of acute rheumatic fever in either period . There was one case of poststreptococcal glomerulonephritis in period 2 . CONCLUSIONS: Use of a high-sensitivity antigen test without culture confirmation of all negative results has not been associated with an increase in suppurative and nonsuppurative complications of group A beta-hemolytic streptococci. Acta Otolaryngol, 1999, 119(7), 832 - 6 Bacterial interference in the nasopharynx and nasal cavity of sinusitis prone and non-sinusitis prone children; Brook I et al.; The aim of this study was to compare the frequency of recovery of potential pathogens and aerobic and anaerobic interfering bacteria in the nasopharynx and nasal cavity of sinusitis prone (SP) children, with their recovery in non-sinusitis prone (N-SP) children . Nasopharyngeal and nasal cultures were taken from 20 SP and 20 N-SP children . Potential pathogens and aerobic and anaerobic bacteria with interfering capabilities against these micro-organisms were identified . Twenty-one potential pathogens (1.05 patient) were isolated from nasopharyngeal cultures from 14 of the 20 SP children, and 10 (0.5 patient) were recovered from 6 of the 20 NSP (p < 0.05) . Bacterial interference between two aerobic (alpha and non-haemolytic streptococci) and two anaerobic species (Prevotella and Peptostreptococcus species) and four potential pathogens was observed . Bacterial interference was noted in 64 instances against 4 potential pathogens by 24 normal flora isolates that were recovered from 7 of the SP group and in 144 instances by 47 isolates from 18 of the NSP group (p < 0.05) . Nineteen potential pathogens (0.95/patient) were isolated from nasal cultures of 13 of the 20 SP children and 8 (0.4/patient) were recovered from 5 of the 20 NSP (p < 0.05) . Bacterial interference by similar micro-organisms was noted in 21 instances by 9 normal flora isolates that were recovered from 5 of the SP group, and in 63 instances by 26 isolates from 15 of the NSP group (p < 0.05) . Our findings illustrate for the first time that the nasopharyngeal and nasal flora of NSP children contains more aerobic and anaerobic micro-organisms with interfering capability and less potential pathogens than that of SP children. J Perinatol, 1999 Jan, 19(1), 19 - 25 Readmission for group B streptococci or Escherichia coli infection among full-term, singleton, vaginally delivered neonates after early discharge from Florida hospitals for births from 1992 through 1994; Graven MA et al.; BACKGROUND: In Florida during the period 1992 through 1994, there was a major drop in the length of stay for full-term, singleton, vaginally delivered newborn babies in the hospital . A major concern on the part of clinicians has been the potential of an increased risk of sepsis (manifesting itself after discharge) associated with earlier newborn discharge from the hospital . We used the Florida hospital discharge dataset to study the frequency of readmission with sepsis after early newborn discharge to home . METHODS: Using the Florida Agency for Health-Care Administration Acute Care Hospital Discharge Dataset, we used a multivariate, probabilistic matching algorithm to merge newborn discharge records for births from 1992 through 1994 with readmission discharge records (including hospital-to-hospital transfers and multiple readmissions) during the first 28 days of life . We used the resulting merged dataset to study bacterial infection diagnoses on newborn and readmission records and to examine relationships between readmission diagnoses and timing of newborn discharge among the 364,528 full-term, singleton, vaginally delivered babies (FTSVDBs) without congenital anomalies from 1992 through 1994 in Florida acute-care hospitals . RESULTS: Overall, 86.3% of all FTSVDBs born in Florida acute-care hospitals were discharged between day of life (DOL) 0 (born and discharged the same day) and DOL 2 (discharged two calendar days after birth) . The group B streptococci (GBS) infection code was found on the newborn discharge records of 9.2 per 10,000 FTSVDBs over the 3-year period, 5.9% of which involved hospital-to-hospital transfer of the baby . Escherichia coli infection codes were found on the records of 3.4 per 10,000 FTSVDBs over the 3-year period, 2.3% of which involved hospital-to-hospital transfer of the baby . Of those FTSVDBs discharged to home without infection codes during DOL 1 to 2, 0.8 per 10,000 were readmitted within 7 days (inclusive) with GBS infection, and 2.0 per 10,000 with E . coli infection . When the data for readmitted babies were pooled for 1992 through 1994, the odds ratio for probability of readmission comparing discharges on DOL 1 to DOL 2 for GBS was 2.27 (95% confidence interval, 1.83 to 2.70), and for E . coli 2.16 (95% confidence interval, 1.46 to 2.85) . Over this 3-year period, for babies discharged on DOL 1, there was a 115% increase in the rate of readmission for GBS from 1992 through 1994 (p < 0.01) and a 36.5% increase in the rate of readmission for E . coli (p < 0.05) . However, among FTSVDBs discharged on DOL 2, the rate of readmission for both GBS and E . coli did not change during the period 1992 through 1994 . There were no deaths among FTSVDBs as either newborns, transfers, or readmissions within 7 days of discharge, with either GBS or E . coli infection codes on their discharge record . CONCLUSION: From 1992 through 1994, the increased number of babies discharged early in Florida was temporally associated with an increased rate of readmission during the week after discharge for both GBS and E . coli infection among babies discharged on the calendar day after birth . With an increase in both the number of babies exposed to the risks of early discharge, and an increased rate of these serious infections during the week after discharge from the hospital, the number of these babies grew to exceed, by several fold, the number of babies with inborn errors of metabolism picked up by state screening programs. FEMS Immunol Med Microbiol, 2000 Mar, 27(3), 257 - 61 Endocardiac infectivity and binding to extracellular matrix proteins of oral Abiotrophia species; Okada Y et al.; Microorganisms of the genus Abiotrophia, formerly known as nutritionally variant streptococci, are members of the oral flora and often isolated from patients with endocarditis, but pathogenicity of oral Abiotrophia species has not been examined yet . In this study, 17 strains isolated from healthy human oral cavities and 7 reference strains (all derived from patients with endocarditis) of Abiotrophia spp . were tested for their abilities to cause infections in damaged heart tissues in catheterized rats and to adhere to extracellular matrix proteins in vitro . The reference strains of A . defectiva and A . adiacens showed high infectivities in the rats . Four oral isolates of these two species showed similarly high infectivities and three had moderate infectivities . Most of 10 oral strains of A . para-adiacens and A . elegans were found to be generally less infective . The highly infective A . adiacens strains showed markedly high fibronectin-binding capacity, suggesting a possible relationship between the fibronectin-binding capacity and damaged heart tissue infectivity of the Abiotrophia species . A . defectiva strains which were also highly infective had moderate levels of binding to fibronectin and other extracellular matrix proteins . Most of A . para-adiacens and A . elegans strains showed low or negligible binding capacities to any extracellular matrix proteins tested. Hunan Yi Ke Da Xue Xue Bao, 1998, 23(2), 197 - 8, 208 {Antiviral and antibacterial actions of bingduqing granules in vitro}; Chen Y et al.; The antiviral and antibacterial actions in vitro of bingduqing granules which consists of nine kinds of Chinese traditional medicinal herbs were observed . The results showed that the inhibitive concentrations of bingduqing granules for Adv-7, RSV, HSV-1, and influenza virus A3, were >-6.9, 8.3, 13.8 and 83 mg x ml-1, respectively; while the minimum inhibitive concentrations for Staphylococcus aureus, Staphylococcus epidermidis, Type A and B Streptococci, and pseudomonas aeruginosa were 0.03125, 0.03125, 0.125, 0.125, and 0.25 g x ml-1, respectively . This study provide a pharmacodynamics basis for clinical application of Bingduqing Granules in the treatment of respiratory tract infection. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 2000 Feb, 89(2), 186 - 92 Past administration of beta-lactam antibiotics and increase in the emergence of beta-lactamase-producing bacteria in patients with orofacial odontogenic infections; Kuriyama T et al.; OBJECTIVE: The purpose of this study was to determine the current status of beta-lactamase-producing bacteria in orofacial odontogenic infections . STUDY DESIGN: Microbiologic data regarding purulent exudate from 111 cases with orofacial odontogenic infections were analyzed in relation to the past administration of beta-lactams . RESULTS: beta-lactamase-producing bacteria were isolated more frequently from the beta-lactam-administered group (38.5%) than from the beta-lactam-nonadministered group (10.9%; P <.005), and they were isolated more frequently as the duration of administration increased . The predominant bacteria isolated included Prevotella (the most frequent isolate), viridans streptococci, Peptostreptococcus, and Fusobacterium, and 7.1% of total isolates produced beta-lactamase . Penicillin and cefazolin worked well with beta-lactamase-nonproducing Prevotella but were remarkably affected by beta-lactamase-producing Prevotella . Cefmetazole, sulbactam/cefoperazone, and imipenem worked well against both types of Prevotella . CONCLUSIONS: beta-lactams are still suitable for the first antimicrobial therapy in the treatment of these infections . However, because past beta-lactam administration increases the emergence of beta-lactamase-producing bacteria, beta-lactamase-stable antibiotics should be prescribed to patients with unresolved infections who have received beta-lactams. Mol Microbiol, 2000 Feb, 35(3), 589 - 600 A folding variant of alpha-lactalbumin with bactericidal activity against Streptococcus pneumoniae; Hakansson A et al.; This study describes an alpha-lactalbumin folding variant from human milk with bactericidal activity against antibiotic-resistant and -susceptible strains of Streptococcus pneumoniae . The active complex precipitated with the casein fraction at pH 4.6 and was purified from casein by a combination of anion exchange and gel chromatography . Unlike other casein components, the active complex was retained on the ion-exchange matrix and eluted only with high salt . The eluted fraction showed N-terminal and mass spectrometric identity with human milk alpha-lactalbumin, but native alpha-lactalbumin had no bactericidal effect . Spectroscopic analysis demonstrated that the active form of the molecule was in a different folding state, with secondary structure identical to alpha-lactalbumin from human milk whey, but fluctuating tertiary structure . Native alpha-lactalbumin could be converted to the active bactericidal form by ion-exchange chromatography in the presence of a cofactor from human milk casein, characterized as a C18:1 fatty acid . Analysis of the antibacterial spectrum showed selectivity for streptococci; Gram-negative and other Gram-positive bacteria were resistant . The folding variant of alpha-lactalbumin is a new example of naturally occurring molecules with antimicrobial activity. Clin Infect Dis, 2000 Feb, 30(2), 336 - 41 Bicuspid aortic valve--A silent danger: analysis of 50 cases of infective endocarditis; Lamas CC et al.; We analyzed 50 cases of bicuspid aortic valve endocarditis in patients who presented to St . Thomas' Hospital from 1970 through 1998 . These represented 12.3% of the 408 cases of native valve endocarditis (NVE) . All patients were male, and their mean age was 39 years . Forty-five of the 50 cases were pathologically proven; 47 were clinically definite according to the Duke criteria and 49 according to our modifications of the Duke criteria . Viridans streptococci and staphylococci accounted for 72% of cases . The prevalences of clinical features were similar to those seen in NVE: fever (temperature >/=38 degrees C, 74%) and malaise (70%), although dyspnea was more frequent (36%) . There was a high incidence of serious complications (72% heart failure; 30% periannular abscesses) . Surgery was required during the initial admission in 82% of cases . Overall mortality was 14%, and surgical mortality was 9% . Few patients knew they had a "heart condition," and a bicuspid aortic valve was detected in only 35% of echocardiograms performed before surgery. J Med Microbiol, 2000 Feb, 49(2), 193 - 8 Distribution and expression of bca, the gene encoding the c alpha protein, by Streptococcus agalactiae; Maeland JA et al.; A total of 52 clinical isolates of group B streptococci (GBS) was tested for expression of the c protein c(alpha) by a fluorescent antibody test (FAT) and by PCR amplification of a 202-bp stretch within the repeat unit of the bca gene encoding the c(alpha) protein . The strains were categorised as follows: c(alpha) FAT positive and PCR positive with amplification products of multiple sizes (category A, n = 12); FAT negative and with PCR products of multiple sizes (category B, n = 11); FAT negative and with a single PCR product of c . 200 bp (category C, n = 5); negative in both tests (category D, n = 24) . A single amplification product of minimum size and additional products of larger sizes corresponded to one and more bca repeats, respectively . Five of the 11 category B strains showed expression of low Mr c(alpha) in whole cell-based Western blotting . The results showed that a proportion of the GBS isolates harboured bca gene elements that either were not expressed or they expressed c(alpha) molecular variants which could not be detected by the whole cell-based FAT . This genotype/phenotype discrepancy should be considered in relation to GBS typing, including the selection of antibody reagents and the technical approach to c(alpha) protein detection. Am Fam Physician, 2000 Jan 15, 61(2), 391 - 3, 397 Perianal streptococcal dermatitis; Brilliant LC; Perianal streptococcal dermatitis is a bright red, sharply demarcated rash that is caused by group A beta-hemolytic streptococci . Symptoms include perianal rash, itching and rectal pain; blood-streaked stools may also be seen in one third of patients . It primarily occurs in children between six months and 10 years of age and is often misdiagnosed and treated inappropriately . A rapid streptococcal test of suspicious areas can confirm the diagnosis . Routine skin culture is an alternative diagnostic aid . Treatment with amoxicillin or penicillin is effective . Follow-up is necessary, because recurrences are common. J Infect Dis, 2000 Feb, 181(2), 639 - 45 A pivotal role for interferon-gamma in protection against group A streptococcal skin infection; Raeder RH et al.; Administration of exogenous recombinant interleukin-12 (rIL-12) either prophylactically or therapeutically provides significant protection against lethal group A streptococcal skin infection in a mouse model . Treatment of mice with rIL-12 before infection with group A streptococci induced expression of interferon-gamma (IFN-gamma) at the infection site . In vivo neutralization of IFN-gamma increased susceptibility to lethal infection and completely abrogated the protective effects of rIL-12 . IFN-gamma knockout mice were also more susceptible to lethal infection . Although IL-12 treatment provided protection, higher doses induced significantly elevated levels of IFN-gamma transcription that were associated with increased susceptibility to lethal infection . These results support the hypothesis that IFN-gamma at the infection site is critical for protection but suggest that increased systemic levels are detrimental to survival after infection with group A streptococci. J Infect Dis, 2000 Feb, 181(2), 631 - 8 Invasive group A streptococcal disease in the Netherlands: evidence for a protective role of anti-exotoxin A antibodies; Mascini EM et al.; As part of a nationwide surveillance in The Netherlands during 1994-1997, 53 patients with invasive group A streptococcal (GAS) infections were evaluated for medical history, symptoms, and outcome . Patients' isolates were tested for the production of pyrogenic exotoxins A (SPE-A) and B (SPE-B) . Acute-phase sera from all patients and convalescent sera from 12 patients were investigated for the presence of antibodies against SPE-A and SPE-B . Twenty-three patients developed toxic shock-like syndrome and 16 died . Absence of antibodies against SPE-A and/or SPE-B was a risk factor for developing invasive streptococcal disease . Toxic shock and mortality were associated with a lack of anti-SPE-A antibodies (P<.025) . Anti-SPE-A antibodies were found in convalescent sera from all patients infected by speA-positive isolates . Virtually all invasive speA-positive streptococci expressed SPE-A protein in vitro . Thus antibodies against SPE-A appeared vital for mediating the outcome of invasive GAS disease in this population. Community Dent Health, 1999 Dec, 16(4), 220 - 6 An outline of graphical Markov models in dentistry; Helfenstein U et al.; BACKGROUND: In the usual multiple regression model there is one response variable and one block of several explanatory variables . In contrast, in reality there may be a block of several possibly interacting response variables one would like to explain . In addition, the explanatory variables may split into a sequence of several blocks, each block containing several interacting variables . The variables in the second block are explained by those in the first block; the variables in the third block by those in the first and the second block etc . OBJECTIVE AND METHODS: During recent years methods have been developed allowing analysis of problems where the data set has the above complex structure . The models involved are called graphical models or graphical Markov models . The main result of an analysis is a picture, a conditional independence graph with precise statistical meaning, consisting of circles representing variables and lines or arrows representing significant conditional associations . The absence of a line between two circles signifies that the corresponding two variables are independent conditional on the presence of other variables in the model . EXAMPLE: An example from epidemiology is presented in order to demonstrate application and use of the models . The data set in the example has a complex structure consisting of successive blocks: the variable in the first block is year of investigation; the variables in the second block are age and gender; the variables in the third block are indices of calculus, gingivitis and mutans streptococci and the final response variables in the fourth block are different indices of caries . Since the statistical methods may not be easily accessible to dentists, this article presents them in an introductory form . CONCLUSION: Graphical models may be of great value to dentists in allowing analysis and visualisation of complex structured multivariate data sets consisting of a sequence of blocks of interacting variables and, in particular, several possibly interacting responses in the final block. J Antimicrob Chemother, 2000 Feb, 45(2), 225 - 30 Activity of linezolid against multi-resistant gram-positive bacteria from diverse hospitals in the United Kingdom; Johnson AP et al.; The in vitro activity of linezolid, an oxazolidinone, was assessed against 374 gram-positive cocci, with an emphasis on testing multi-resistant, epidemiologically unrelated isolates . MICs of linezolid for staphylococci, pneumococci and streptococci had a narrow range, from 0.5 to 2 mg/L, whereas MICs for enterococci were uniformly 4 mg/L . For all the species tested, the MICs of linezolid were unrelated to those of other antimicrobials . Linezolid appears to be a potentially useful drug for infections caused by gram-positive cocci. J Antimicrob Chemother, 2000 Feb, 45(2), 167 - 73 Macrolide resistance and erythromycin resistance determinants among Belgian Streptococcus pyogenes and Streptococcus pneumoniae isolates; Descheemaeker P et al.; Resistance of streptococci to macrolide antibiotics is caused by target-site modification or drug efflux . The phenotypic expression of target-site modification can be inducible or constitutive . The prevalence of the three phenotypes among Belgian erythromycin-resistant Group A streptococci (GAS) and Streptococcus pneumoniae isolates was surveyed, their MICs for seven antibiotics were determined and the clonality of the isolates was explored . Of the 2014 GAS isolates tested 131(6.5%) were erythromycin resistant (MIC > 1 mg/L): 110 (84.0%) showed the M-resistance phenotype whereas the remaining 21 strains (16.0%) were constitutively resistant . No inducibly resistant strains were detected . Of 100 S . pneumoniae isolates, 33 were erythromycin resistant (MIC > 1 mg/L) . In contrast to the GAS isolates, only 9.1% of the 33 erythromycin-resistant S . pneumoniae isolates showed the M-resistance phenotype . The presence of mefA/E and ermB genes in the M-resistant and constitutively and inducibly resistant strains, respectively, was confirmed by PCR analysis . Genomic analysis based on pulsed-field gel electrophoresis (PFGE) using the restriction enzyme SfiI, revealed 54 different PFGE patterns among the 131 erythromycin-resistant GAS isolates, of which an M6 clone represented 16.0% of the strains; all other clones, exhibiting different M-types, represented <7% of the strains . The S . pneumoniae isolates also appeared to be polyclonally based, as determined by arbitrarily primed PCR . The macrolides miocamycin and rovamycin, the lincosamide clindamycin and the ketolide HMR 3647 showed excellent activity against the M-resistant GAS and S . pneumoniae strains. APMIS, 1999 Dec, 107(12), 1051 - 9 Is streptolysin S of group A streptococci a virulence factor? Ginsburg I. The possible role played by streptolysin S (SLS) of group A streptococci in the pathophysiology of streptococcal infections and in post-streptococcal sequelae is discussed . The following properties of SLS justify its definition as a distinct virulence factor: 1) its presence on the streptococcus surface in a cell-bound form, 2) its continuous and prolonged synthesis by resting streptococci, 3) its non-immunogenicity, 4) its extractability by serum proteins (albumin, alpha lipoprotein), 5) its ability to become transferred directly to target cells while being protected from inhibitory agents in the milieu of inflammation, 6) its ability to bore holes in the membrane phospholipids in a large variety of mammalian cells, 7) its ability to synergize with oxidants, proteolytic enzymes, and with additional host-derived proinflammatory agonists, and 8) its absence in streptococcal mutants associated with a lower pathogenicity for animals . Because tissue damage in streptococcal and post-streptococcal sequelae might be the end result of a distinct synergism between streptococcal and host-derived proinflammatory agonists it is proposed that only cocktails of anti-inflammatory agents including distinct inhibitors of SLS (phospholipids), gamma globulin, inhibitors of reactive oxygen species, proteinases, cationic proteins cytokines etc., will be effective in inhibiting the multiple synergistic interactions which lead to fasciitis, myositis and the flesh-eating syndromes, and often develop into sepsis, septic shock and multiple organ failure . The creation of mutants deficient in SLS and in proteases will help shed light on the specific role played by SLS in the virulence of group A hemolytic streptococci. Mol Gen Genet, 2000 Jan, 262(6), 965 - 76 Genetic organisation of the M protein region in human isolates of group C and G streptococci: two types of multigene regulator-like (mgrC) regions; Geyer A et al.; In addition to beta-haemolytic streptococci belonging to Lancefield group A (Streptococcus pyogenes, GAS), human isolates of group C (GCS) and group G (GGS) streptococci (S . dysgalactiae subsp . equisimilis) have been implicated as causative agents in outbreaks of purulent pharyngitis, of wound infections and recently also of streptococcal toxic shock-like syndrome . Very little is known about the organisation of the genomic region in which the emm gene of GCS and GGS is located . We have investigated the genome sequences flanking the emm gene in GCS by sequencing neighbouring fragments obtained by inverse PCR . Our sequence data for GCS strains 25287 and H46A revealed two types of arrangement in the emm region, which differ significantly from the known types of mga regulon in GAS . We named this segment of the genome mgrC (for multigene regulon-like segment in group C streptococci) . In strains belonging to the first mgrC type (prototype strain 25287) the emm gene is flanked up-stream by mgc, a gene that is 61% identical to the mga gene of GAS . A phylogenetic analysis of the deduced protein sequences showed that Mgc is related to Mga proteins of various types of GAS but forms a distinct cluster . Downstream of emm, the mgrC sequence region is bordered by rel . This gene encodes a protein that functions in the synthesis and degradation of guanosine 3',5' bipyrophosphate (ppGpp) during the stringent regulatory response to amino acid deprivation . In the second mgrC type (prototype strain H46A), the genes mgc and emm are arranged as in type 1 . But an additional ORF (orf) is inserted in opposite orientation between emm and rel . This orf shows sequence homology to cpdB, which is present in various microorganisms and encodes 2',3' cyclo-nucleotide 2'-phosphodiesterase . PCR analysis showed that these two mgrC arrangements also exist in GGS . Our sequence and PCR data further showed that both types of mgrC region in GCS and GGS are linked via rel to the streptokinase region characterised recently in strain H46A . A gene encoding C5a peptidase, which is present at the 3' end of the mga regulon in GAS, was not found in the mgrC region identified in the GCS and GGS strains investigated here. J Dermatol, 1999 Dec, 26(12), 803 - 7 Characteristics of Streptococcus species isolated from infectious skin diseases; Higaki S et al.; During the period from January of 1995 to June of 1998, 27 beta-hemolytic streptococci were isolated from 25 cases of infectious skin diseases including secondary infections, impetigo, phlegmone, and paronychia . The rate of beta-hemolytic streptococci among all kinds of the isolates was found to be similar during those 4 years, ranging from 3.5% to 5.6% . Staphylococcus aureus were found to coexist with beta-hemolytic streptococci in 20 (80%) out of 25 cases . beta-hemolytic streptococci were also often associated with coagulase-negative staphylococci, gram-positive rods, or other species . Twelve cases (48%) carried beta-hemolytic streptococci predominantly . Most beta-hemolytic streptococci showed high susceptibilities to all antimicrobials tested; however S . agalactiae showed no susceptibility to gentamicin . The evaluation of characteristics of Streptococcus species is very important for selecting the right antimicrobial agents and the proper term of chemotherapy. Microbiology, 2000 Jan, 146 ( Pt 1), 41 - 8 Adhesion of Candida albicans to oral streptococci is promoted by selective adsorption of salivary proteins to the streptococcal cell surface; O'Sullivan JM et al.; Adhesion of Candida albicans to saliva-coated surfaces is an important early step in the colonization of the oral cavity . C . albicans cells also adhere to several species of oral streptococci including Streptococcus gordonii, Streptococcus oralis and Streptococcus sanguinis in what are believed to be multi-modal interactions . It is now demonstrated that incubation of streptococcal cells of these species with human parotid saliva further promotes the adhesion of C . albicans cells by up to 2-3-fold . Various species of streptococci were shown to adsorb different protein components of parotid saliva to their cell surfaces . The basic proline-rich proteins (bPRPs), to which C . albicans cells bind on nitrocellulose blot overlay, were strongly adsorbed to the surface of S . gordonii cells but not to S . oralis cells . Parotid saliva that was pre-adsorbed with S . gordonii cells and then applied to hydroxylapatite beads was <50% effective at supporting adhesion of C . albicans compared with control (non-adsorbed) saliva, demonstrating that bPRPs are major pellicle receptors . C . albicans cells did not adsorb bPRPs from fluid-phase parotid saliva . Following size-exclusion chromatography of parotid saliva samples, pooled fractions enriched in bPRPs promoted maximal adhesion of C . albicans to S . gordonii cells . The results demonstrate that C . albicans cells recognize only surface-bound forms of bPRPs and suggest that these proteins adsorbed to enamel or to streptococcal surfaces promote C . albicans adhesion and oral colonization. J Immunol, 2000 Feb 15, 164(4), 2064 - 9 Human toll-like receptor 2 mediates monocyte activation by Listeria monocytogenes, but not by group B streptococci or lipopolysaccharide; Flo TH et al.; Human Toll like receptor (TLR) 2 has been implicated as a signaling receptor for LPS from Gram-negative bacteria and cell wall components from Gram-positive organisms . In this study, we investigated whether TLR2 can signal cell activation by the heat-killed group B streptococci type III (GBS) and Listeria monocytogenes (HKLM) . HKLM, but not GBS, showed a time- and dose-dependent activation of Chinese hamster ovary cells transfected with human TLR2, as measured by translocation of NF-kappaB and induction of IL-6 production . A mAb recognizing a TLR2-associated epitope (TL2.1) was generated that inhibited IL-6 production from Chinese hamster ovary-TLR2 cells stimulated with HKLM or LPS . The TL2.1 mAb reduced HKLM-induced TNF production from human monocytes by 60%, whereas a CD14 mAb (3C10) reduced the TNF production by 30% . However, coadministrating TL2.1 and 3C10 inhibited the TNF response by 80% . In contrast to this, anti-CD14 blocked LPS-induced TNF production from monocytes, whereas anti-TLR2 showed no inhibition . Neither TL2.1 nor 3C10 affected GBS-induced TNF production . These results show that TLR2 can function as a signaling receptor for HKLM, possibly together with CD14, but that TLR2 is unlikely to be involved in cell activation by GBS . Furthermore, although LPS can activate transfected cell lines through TLR2, this receptor does not seem to be the main transducer of LPS activation of human monocytes . Thus, our data demonstrate the ability of TLR2 to distinguish between different pathogens. J Clin Microbiol, 2000 Feb, 38(2), 830 - 8 Fluorescent In situ hybridization allows rapid identification of microorganisms in blood cultures; Kempf VA et al.; Using fluorescent in situ hybridization (FISH) with rRNA-targeted fluorescently labelled oligonucleotide probes, pathogens were rapidly detected and identified in positive blood culture bottles without cultivation and biotyping . In this study, 115 blood cultures with a positive growth index as determined by a continuous-reading automated blood culture system were examined by both conventional laboratory methods and FISH . For this purpose, oligonucleotide probes that allowed identification of approximately 95% of those pathogens typically associated with bacteremia were produced . The sensitivity and specificity of these probes were 100% . From all 115 blood cultures, microorganisms were grown after 1 day and identification to the family, genus, or species level was achieved after 1 to 3 days while 111 samples (96.5%) were similarly identified by FISH within 2.5 h . Staphylococci were identified in 62 of 62 samples, streptococci and enterococci were identified in 19 of 20 samples, gram-negative rods were identified in 28 of 30 samples, and fungi were identified in two of two samples . Thus, FISH is an appropriate method for identification of pathogens grown in blood cultures from septicemic patients. J Clin Microbiol, 2000 Feb, 38(2), 781 - 8 Rapid diagnosis of bacteremia by universal amplification of 23S ribosomal DNA followed by hybridization to an oligonucleotide array; Anthony RM et al.; The rapid identification of bacteria in blood cultures and other clinical specimens is important for patient management and antimicrobial therapy . We describe a rapid (<4 h) detection and identification system that uses universal PCR primers to amplify a variable region of bacterial 23S ribosomal DNA, followed by reverse hybridization of the products to a panel of oligonucleotides . This procedure was successful in discriminating a range of bacteria in pure cultures . When this procedure was applied directly to 158 unselected positive blood culture broths on the day when growth was detected, 125 (79.7%) were correctly identified, including 4 with mixed cultures . Nine (7.2%) yielded bacteria for which no oligonucleotide targets were present in the oligonucleotide panel, and 16 culture-positive broths (10.3%) produced no PCR product . In seven of the remaining eight broths, streptococci were identified but not subsequently grown, and one isolate of Staphylococcus aureus was misidentified as a coagulase-negative staphylococcus . The accuracy, range, and discriminatory power of the assay can be continually extended by adding further oligonucleotides to the panel without significantly increasing complexity or cost. J Clin Microbiol, 2000 Feb, 38(2), 643 - 50 A new alkaline pH-adjusted medium enhances detection of beta-hemolytic streptococci by minimizing bacterial interference due to Streptococcus salivarius; Dierksen KP et al.; A new selective medium (CNA-P) that reduces or eliminates the inhibitory activity of bacteriocin-producing Streptococcus salivarius against beta-hemolytic streptococci has been developed and compared with sheep blood agar (SBA) for the sensitive detection of small numbers of beta-hemolytic streptococci in clinical specimens . CNA-P has as its basis a commercial medium (Difco Columbia CNA agar) supplemented with 5% (vol/vol) sheep blood, and the CNA is further modified by addition of 100 mM PIPES buffer {piperazine-N,N'-bis(2-ethanesulfonic acid)} (pH 7.5) to maintain cultures at an alkaline pH during incubation . CNA-P was shown to inhibit the production and/or release of four different types of S . salivarius bacteriocins or bacteriocin-like inhibitory molecules . The efficacies of CNA-P and SBA for detection of beta-hemolytic streptococci in 1,352 pharyngeal samples from 376 children were compared . The beta-hemolytic streptococcal isolates recovered from the samples included 314 group A (S . pyogenes), 61 group G, 33 group B, and 5 group C streptococci . Of 314 samples that yielded S . pyogenes, 300 were positive on CNA-P (96%) and 264 (86%) were positive on SBA . A significantly greater number of S . pyogenes isolates from these samples were recovered only on CNA-P (50 of 314) compared with the number of isolates recovered only on SBA (14 of 314) . In addition, the degree of positivity, a measure of the total numbers of S . pyogenes isolates on the plate, was significantly higher on CNA-P than on SBA (2.40 versus 2.07; P < 0.001) . Interestingly, CNA-P was also found to enhance the hemolytic activity of streptolysin O, allowing detection of streptolysin S-deficient S . pyogenes strains which might otherwise go undetected on SBA and other isolation media. J Leukoc Biol, 2000 Jan, 67(1), 81 - 9 TNF-alpha release by monocytic THP-1 cells through cross-linking of the extended V-region of the oral streptococcal protein I/II; Chatenay-Rivauday C et al.; We tested the hypothesis of a conserved activation mode of monocytic THP-1 cells by proteins I/II expressed by several species of oral streptococci through the specific role of the extended V-region . We studied the binding and modulating activities of six proteins I/II purified from strains representing four different species of oral streptococci, and of expression products of polymerase chain reaction-amplified sequences encoding corresponding extended V-regions . We found that the different proteins I/II bound to THP-1 cells in a sugar-dependent mode involving the extended V-region . Furthermore, all the proteins I/II stimulated THP-1 cells to produce tumor necrosis factor alpha, indicating that these properties are not strain- or species-specific . Despite the weak stimulation of THP-1 cells by the extended V-region alone, we obtained evidence that cross-linking of this region can be one of the mechanisms involved in monocytic cell activation by proteins I/II. Biochem J, 2000 Feb 1, 345 Pt 3, 557 - 64 The recombinant N-terminal region of human salivary mucin MG2 (MUC7) contains a binding domain for oral Streptococci and exhibits candidacidal activity; Liu B et al.; MG2 (the MUC7 gene product) is a low-molecular-mass mucin found in human submandibular/sublingual secretions . This mucin is believed to agglutinate a variety of microbes and thus is considered an important component of the non-immune host defence system in the oral cavity . We have shown that MUC7 can bind to cariogenic strains of Streptococcus mutans and that this binding requires a structural determinant in the N-terminal region . In the present study an expression construct, pNMuc7, encoding the N-terminal 144 amino acids of MUC7 was generated, and the recombinant protein rNMUC7 was expressed in Escherichia coli . Purified rNMUC7 was characterized and the binding of this protein to oral bacteria was investigated in an established assay . The results showed that the recombinant protein bound to S . mutans ATCC 25175 and ATCC 33402, and that alkylation of the two cysteine residues (Cys(45) and Cys(50)) resulted in the complete loss of bacterial binding . This suggests that binding of MUC7 to S . mutans occurs between the N-terminal region of the mucin molecule and the bacterial surface, and that this interaction is dependent on a cysteine-containing domain within this region of MUC7 . In addition, the killing activity of rNMUC7 was compared with that of the candidacidal salivary protein histatin 5 in an established Candida albicans (ATCC 44505) blastoconidia killing assay . It was found that the LD(50) values of rNMUC7 and histatin 5 were comparable, and that the recombinant protein displayed significant killing activity at the physiological concentration range of MUC7 in whole saliva . This study is the first to show that the N-terminal region of MUC7 contains a structural determinant for bacterial binding and that this region exhibits candidacidal activity. J Eur Acad Dermatol Venereol, 1999 Nov, 13(3), 183 - 92 Comparative chemical evaluation of two commercially available derivatives of hyaluronic acid (hylaform from rooster combs and restylane from streptococcus) used for soft tissue augmentation; Manna F et al.; Hyaluronic acid (HA) derivatives have been developed to try to enhance rheological properties of this molecule to make it suitable for various medical applications . The main dermatological application of HA derivatives is the augmentation of soft tissues, via injection into the dermis . HA derivatives are indicated for the correction of cutaneous contour deficiencies of the skin, particularly in cases of ageing or degenerative lesions or to increase lips . Two HA derivatives have been evaluated: Hylaform Viscoelastic Gel (Hylan B), derived from rooster combs and subjected to cross-linking, and Restylane, produced through bacterial fermentation (streptococci) and stabilized, as declared by the producer . In both cases the purpose is to improve HA theological characteristics and slow down its degradation once it is in contact with biological structures . Distribution of particle dimensions, pH, protein concentration and rheological properties have been investigated in order to evaluate their reliability as fillers for soft tissue augmentation . The results of the analyses showed that there are differences between Restylane and Hylaform . Especially as far as rheological characteristics are concerned, the results outline different structures of the products: Hylaform behaves as a strong hydrogel, Restylane as a weak hydrogel; rheologically Hylaform is clearly superior to Restylane . Hylaform contains a definitely minor quantity (about a quarter) of cross-linked hyaluronic acid than Restylane . Furthermore, although not declared by the manufacturer, Restylane contains protein, resulting from bacterial fermentation or added to enable cross-linking reaction; the quantity of proteins contained by Restylane can be as much as four times the quantity contained by Hylaform, for the same volume (1 ml) . It is evident that Hylaform offers higher safety margin than Restylane . Furthermore, wide literature and 20 years of clinical experience on hyaluronan derived from rooster combs confirm the reliability of this derivative while we did not find evidence regarding about the safety of HA obtained from streptococcus. Infect Immun, 2000 Feb, 68(2), 744 - 51 Absence of SpeB production in virulent large capsular forms of group A streptococcal strain 64; Raeder R et al.; Passage in human blood of group A streptococcal isolate 64p was previously shown to result in the enhanced expression of M and M-related proteins . Similarly, when this isolate was injected into mice via an air sac model for skin infection, organisms recovered from the spleens showed both increased expression of M and M-related proteins and increased skin-invasive potential . We show that these phenotypic changes were not solely the result of increased transcription of the mRNAs encoding the M and M-related gene products . Rather, the altered expression was associated with posttranslational modifications of the M and M-related proteins that occur in this strain, based on the presence or absence of another virulence protein, the streptococcal cysteine protease SpeB . The phenotypic variability also correlates with colony size variation . Large colonies selected by both regimens expressed more hyaluronic acid, which may explain differences in colony morphology . All large-colony variants were SpeB negative and expressed three distinct immunoglobulin G (IgG)-binding proteins in the M and M-related protein family . Small-colony variants were SpeB positive and bound little IgG through their M and M-related proteins because these proteins, although made, were degraded or altered in profile by the SpeB protease . We conclude that passage in either human blood or a mouse selects for a stable, phase-varied strain of group A streptococci which is altered in many virulence properties. Infect Immun, 2000 Feb, 68(2), 725 - 31 Streptococcus sobrinus antigens that react to salivary antibodies induced by tonsillar application of formalin-killed S . sobrinus in rabbits; Fukuizumi T et al.; We previously found that tonsillar application of antigen induces a strong antibody response to Streptococcus sobrinus in saliva and blood plasma . Rabbits immunized against S . sobrinus by tonsillar application were highly resistant to experimental dental caries triggered by oral inoculation of living S . sobrinus organisms with sucrose . In the present study, we examined the reaction of S . sobrinus antigens to the antibodies induced by the tonsillar application of S . sobrinus AHT-k in rabbits and compared them to those antibodies induced by intramuscular injection . In an enzyme-linked immunosorbent assay using ultrasonic fragments from mutans group streptococci, the saliva and blood plasma selectively reacted to S . sobrinus AHT-k (serotype g) and serologically related streptococci (serotypes a, d, and h) in the sixth week after tonsillar application, whereas the blood plasma in the sixth week after intramuscular injection reacted to the unrelated streptococci (serotypes b, c, e, and f) in addition to the aforementioned streptococci . The antibody reactivity induced after tonsillar application was not lost after treatment of the antigen with heat or proteinase digestion, whereas these treatments resulted in a 70% decrease of the antibody reactivity induced by intramuscular injection . The inhibition by haptenic sugars and the decrease in immunoreactivity by heat treatment and proteinase digestion suggested that 80% of the antibodies induced by tonsillar application reacted to saccharides . These saccharide antigens appeared to be involved in a specific reaction with S . sobrinus-specific streptococci and a selective reaction with serologically related streptococci . These antigens are probably involved in anticaries reactions in experimental dental caries. Infect Immun, 2000 Feb, 68(2), 637 - 43 Streptococcus suis serotype 2 interactions with human brain microvascular endothelial cells; Charland N et al.; Streptococcus suis serotype 2 is a worldwide causative agent of many forms of swine infection and is also recognized as a zoonotic agent causing human disease, including meningitis . The pathogenesis of S . suis infections is poorly understood . Bacteria circulate in the bloodstream in the nonimmune host until they come in contact with brain microvascular endothelial cells (BMEC) forming the blood-brain barrier . The bacterial polysaccharide capsule confers antiphagocytic properties . It is known that group B streptococci (GBS) invade and damage BMEC, which may be a primary step in the pathogenesis of neonatal meningitis . Interactions between S . suis and human endothelial cells were studied to determine if they differ from those between GBS and endothelial cells . Invasion assays performed with BMEC and human umbilical vein endothelial cells demonstrated that unlike GBS, S . suis serotype 2 could not invade either type of cell . Adherence assays showed that S . suis adhered only to BMEC, whereas GBS adhered to both types of cell . These interactions were not affected by the presence of a capsule, since acapsular mutants from both bacterial species adhered similarly compared to the wild-type strains . Lactate dehydrogenase release measurements indicated that some S . suis strains were highly cytotoxic for BMEC, even more than GBS, whereas others were not toxic at all . Cell damage was related to suilysin (S . suis hemolysin) production, since only suilysin-producing strains were cytotoxic and cytotoxicity could be inhibited by cholesterol and antisuilysin antibodies . It is possible that hemolysin-positive S . suis strains use adherence and suilysin-induced BMEC injury, as opposed to direct cellular invasion, to proceed from the circulation to the central nervous system. Minerva Stomatol, 1999 Sep, 48(9), 361 - 6 Variables affecting salivary Streptococcus mutans counts in a cohort of 12-year-old subjects; Petti S et al.; BACKGROUND: Several factors such as toothbrushing, diet, acidogenic potential of the mutans streptococci strain and site of the carious lesion can modify the salivary Streptococcus mutans (Sm) counts . In the present investigation the effect of some behavioural, clinical and microbiological variables on Sm salivary counts was evaluated in a cohort of 12-year-olds . METHODS: Forty subjects were examined by two calibrated examiners (GC, AL) . The number of surfaces either decayed occlusal, decayed smooth or filled and the number of bleeding sextants, (clinical index for oral hygiene) were reported . Saliva was collected using a tongue depressor and was plated onto mitis salivarius agar with bacitracin and 20% sucrose . The presumptive Sm colonies were counted and the concentrations were logarithmically transformed . One Sm strain per subject was identified and the cariogenic potential evaluated as the minimum pH value recorded, during 5 hrs of incubation in 5% sucrose solution . The children's parents or guardians completed a questionnaire concerning the frequency of toothbrushing, the consumption of sweet foods and soft drinks and at what age the children started brushing their teeth . The effect of the explanatory variables on Sm count logarithms was evaluated by stepwise multiple regression . RESULTS: The regressors with significant additional explanatory power were cariogenic potential (b = -1.335, p = 0.00001, R2 increment = 0.312), decayed smooth surfaces (b = -0.456, p = 0.009, R2 increment = 0.114) and bleeding sextants (b = -0.113, p = 0.004, R2 increment = 0.062), whereas the power of filled surfaces was marginally significant (p = 0.08) . CONCLUSIONS: On the basis of these results, it is suggested that acidogenicity is not only a cariogenic factor, but also a factor promoting colonization of oral sites by Sm, especially in subjects with a high frequency of sugar consumption. Presse Med, 1999 Dec 18-25, 28(40), 2265 - 76 {Diffusion in bone tissue of antibiotics}; Boselli E et al.; DIFFICULT ASSESSMENT: Bone and joint infections are difficult to treat . Therapeutic success depends greatly on the diffusion of antibiotics into bone tissue . Few studies have been devoted to this subject and the variable nature of those reported hinders interpretation . Bone biopsies are generally obtained during orthopedic procedures . Antibiotic administration routes vary although intravenous infusion predominates . Agar gel diffusion is generally used for antibiotic assays but methodology varies depending of the study . The most recent reports use high-performance liquid chromatography . DIFFUSION STUDIES: The different studies examining antibiotic diffusion in bone tissue describe three classes: good diffusion (greater than 30%), moderate diffusion (between 15% and 30%), and low diffusion (less than 15%) . Antibiotics in the good diffusion class include fluoroquinolones, teicoplanin, macrolides, rifampicin and trimethoprime . Antibiotics with moderate bone diffusion are ureidopenicillins, second and third generation cephalosporins, aminoglycosides, clindamycin, fosfomycin and vancomycin . Those with low bone diffusion are aminopenicillins, penicillin M and first generation cephalosporins . No data is available on the bone diffusion of pristinamycin . DATA INTERPRETATION: The clinical impact of these classifications must be interpreted with precaution when considering bone and joint infections as they were established on the basis of pharmacokinetic studies and not clinical trials . They would however appear to be useful in guiding antibiotic prophylaxis for orthopedic surgery in protocols with administration conditions and concentration goals similar to the experimental conditions . PRACTICAL ATTITUDES: These laboratory results could be used in clinical practice by comparing the MIC50 of the germs regularly encountered in bone infections (staphylococci, streptococci including enterococci, Gram negative bacilli including P . aeruginosa and H . influenzae) with concentrations obtained in the different studies, i.e . by calculating the inhibitor coefficient (IQ) of each antibiotic for each susceptible germ . This gives a classification by efficacy (excellent IQ > 10, good 1 < IQ < 10, poor IQ < 1) useful for guiding antibiotic choice in the difficult situation of bone and joint infection. BMJ, 2000 Jan 15, 320(7228), 150 - 4 Penicillin for acute sore throat: randomised double blind trial of seven days versus three days treatment or placebo in adults; Zwart S et al.; OBJECTIVE: To assess whether treatment with penicillin for three days and the traditional treatment for seven days were equally as effective at accelerating resolution of symptoms in patients with sore throat compared with placebo . DESIGN: Randomised double blind placebo controlled trial . SETTING: 43 family practices in the Netherlands . PARTICIPANTS: 561 patients, aged 15-60 years, with sore throat for less than seven days and at least three of the four Centor criteria-that is, history of fever, absence of cough, swollen tender anterior cervical lymph nodes, and tonsillar exudate . 142 patients were excluded for medical reasons and 73 needed penicillin . Interventions: Patients were randomly assigned to penicillin V for seven days, penicillin V for three days followed by placebo for four days, or placebo for seven days . MAIN OUTCOME MEASURES: Resolution of symptoms in the first week, eradication of bacteria after two weeks, and recurrences of sore throat after two, four, and six months . RESULTS: Symptoms resolved 1.9 and 1.7 days earlier in patients taking penicillin for seven days than in those taking penicillin for three days or placebo respectively . Symptoms resolved 2.5 days earlier in patients with group A streptococci and 1.3 days earlier in patients with high colony counts of non-group A streptococci . 23 (13%) of the placebo group had to be given antibiotics later in the week because of clinical deterioration; three developed a peritonsillar abscess . The eradication rate for group A streptococci was 72% in the seven day penicillin group, 41% in the three day penicillin group, and 7% in the placebo group . Sore throat recurred more often in the three day penicillin group than in the seven day penicillin or placebo groups . CONCLUSION: Penicillin treatment for seven days was superior to treatment for three days or placebo in resolving symptoms of sore throat in patients with group A streptococcal pharyngitis and, possibly, in those with non-group A streptococcal pharyngitis. J Chemother, 1999 Oct, 11(5), 379 - 84 Incidence of severe streptococcal-related diseases in Italian children in an era of high group A streptococcal resistance to macrolides . Italian Group A Streptococcal Resistance to Macrolides Study Group; Principi N et al.; Macrolides are still widely prescribed for adult and pediatric respiratory infections in Italy despite the fact that it is known that the resistance of group A streptococci has dramatically increased since 1994 . The aim of this study was to evaluate the incidence of severe streptococcal-related diseases from 1990 to 1996 on the basis of data derived from computer-generated lists of children hospitalized in 35 Pediatric Departments . The clinical record of each case was reviewed in order to gather data concerning clinical diagnoses, laboratory investigations and antibiotic therapies in the preceding four weeks . Six hundred and twenty of the total of 321,612 hospitalized children had severe streptococcal diseases; the overall annual rate remained stable at 2.13/1000 admissions in 1990 to 1.7/1000 admissions in 1996 . Severe diseases were preceded by a microbiologically confirmed acute streptococcal infection treated with antibiotics in only 392 of the 620 children (63.2%) . Between 1993 and 1996 (with the exception of 1995), macrolides were more frequently prescribed than beta-lactam antibiotics for acute streptococcal infections that subsequently developed into severe disease . There was no difference in the rate of severe streptococcal complications between the patients adequately treated with antibiotics and those who were inadequately or not treated . Possible explanations for the relatively stable rate of severe streptococcal complications in Italian children could be (1) a relative absence of invasive, rheumatogenic or nephritogenic strains and/or (2) a difference between in vitro and in vivo resistance of group A streptococci to macrolides . Further studies are needed to investigate the biological characteristics of resistant group A streptococcal strains and their relationships to short- and long-term clinical outcomes. Pediatr Clin North Am, 1999 Dec, 46(6), 1125 - 43 Bacterial resistance and antibiotic use in the emergency department; Bennett J et al.; Antibiotic resistance among bacteria that are commonly encountered in the pediatric emergency department is a fact of nature . New antibiotics will provide some help, but probably only temporarily . Vaccine strategies seem to provide the best answer to resistance, and many physicians eagerly await the conjugated pneumococcal vaccines, which we can only hope to be as successful as the H . influenzae type b vaccines . Vaccines against other resistant organisms are likely further off . At this point, a major goal must be to limit the prevalence of antibiotic resis